Medical Conditions and Treatments Quiz

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Petechiae

• Defined as tiny, red, non-blanching spots, commonly found in dependent areas
• Causes: thrombocytopenia, capillaritis, infections (e.g., dengue, Rocky Mountain spotted fever)

Adrenal Insufficiency

• Primary (Addison's disease): caused by adrenal gland damage
• Secondary: caused by pituitary dysfunction
• Monitor for adrenal crisis: hypotension, hyponatremia, hyperkalemia
• Treatment: glucocorticoid replacement (e.g., hydrocortisone), mineralocorticoid replacement (e.g., fludrocortisone) for primary adrenal insufficiency

Hirschsprung's Disease

• Congenital disorder with absent ganglion cells in distal colon, causing functional obstruction and constipation in infants and children
• Epidemiology: 1 in 5,000 live births, male predominance (4:1), associations with other congenital anomalies
• Clinical presentation: delayed meconium passage, progressive constipation, abdominal distension, enterocolitis (life-threatening)
• Diagnosis: rectal biopsy, anorectal manometry
• Treatment: rectal irrigations, stool softeners, definitive surgery

Metastatic Cancer Node

• Types: gastrointestinal, lung, breast, prostate cancers
• Virchow's node (left supraclavicular) is a common site of metastasis

Viral Conjunctivitis

• Presents with fever, coryza (runny nose), and conjunctivitis
• Pathognomonic Koplik spots (small white spots on the buccal mucosa)

Subacute Sclerosing Panencephalitis (SSPE)

• Definition: progressive, fatal brain disorder caused by persistent measles virus infection
• Pathogenesis: virus persists in the brain, leading to chronic inflammation and progressive damage to the central nervous system
• Symptoms: behavioral changes, memory loss, myoclonic jerks
• Diagnosis: based on clinical history, characteristic EEG findings, elevated measles antibody titers in CSF, and typical MRI brain findings
• Prognosis: usually fatal within 1-3 years after symptoms begin

Post-streptococcal Glomerulonephritis (PSGN)

• Common cause of acute glomerulonephritis in children
• Occurs 1-3 weeks after a streptococcal infection
• Clinical features: hematuria, edema, hypertension, and decreased urine output
• Diagnosis: confirmed by elevated ASO titers and low C3 complement levels
• Treatment: supportive, and the condition usually resolves spontaneously within weeks to months

Dumping Syndrome

• Common complication after gastric surgery
• Early dumping syndrome: occurs within 30 minutes of eating, caused by rapid gastric emptying
• Symptoms: abdominal fullness, nausea, flushing, palpitations, and lightheadedness
• Treatment: dietary modifications, and in severe cases, octreotide analogs

Hyperprolactinemia

• Causes: pituitary adenoma, dopamine antagonists, and chest trauma
• Symptoms: amenorrhea, galactorrhea, and infertility
• Treatment: dopamine agonists (e.g., bromocriptine, cabergoline), and pituitary MRI to rule out a prolactinoma

Malignant Otitis Externa

• Invasive infection of the external auditory canal, typically caused by Pseudomonas aeruginosa
• Risks: diabetes, antibiotic use
• Symptoms: severe ear pain, purulent discharge, and cranial nerve palsies
• Treatment: IV antibiotics, surgical debridement, and strict glucose control for diabetics

Type 2 Diabetes

• Characterized by insulin resistance and progressive beta-cell dysfunction
• Complications: cardiovascular disease, neuropathy, nephropathy, and retinopathy

Vitamin A Toxicity

• Caused by excessive intake of vitamin A supplements or megavitamins
• Symptoms: headache, blurred vision, dryness, nausea, and skin changes (peeling, pruritus)
• Diagnosis: based on clinical presentation and elevated serum vitamin A levels
• Treatment: discontinuation of vitamin A supplements and supportive care

Addison's Disease

• Primary adrenal insufficiency caused by destruction of the adrenal cortex
• Symptoms: fatigue, weight loss, hyperpigmentation, and electrolyte imbalances
• Treatment: lifelong replacement of glucocorticoids (e.g., hydrocortisone) and mineralocorticoids (e.g., fludrocortisone)

Gout

• Form of inflammatory arthritis caused by the deposition of monosodium urate crystals in the joints
• Management: NSAIDs, colchicine, or corticosteroids, and urate-lowering therapy (e.g., allopurinol, febuxostat)

Thalassemia

• Inherited blood disorder characterized by reduced hemoglobin production
• Thalassemia major: presents in early childhood with severe anemia, failure to thrive, and hepatosplenomegaly
• Treatment: regular blood transfusions, iron chelation therapy, and bone marrow transplant

Hyperthyroidism

• Condition characterized by excessive production of thyroid hormones
• Causes: Graves' disease, toxic multinodular goiter, thyroiditis, and exogenous thyroid hormone intake
• Symptoms: tachycardia, weight loss, heat intolerance, anxiety, and tremors
• Diagnosis: based on TSH, free T4, and free T3 levels
• Treatment: antithyroid drugs, radioactive iodine ablation, and thyroidectomy

Bacterial Sinusitis

• Infection of the paranasal sinuses, often following a viral upper respiratory infection
• Symptoms: facial pain, purulent nasal discharge, fever, and dental pain
• Diagnosis: based on clinical presentation and duration of symptoms (>10 days)
• Treatment: antibiotics, nasal corticosteroids, and decongestants

Cushing's Syndrome

• Condition characterized by excess glucocorticoid levels
• Causes: endogenous (pituitary adenoma, adrenal tumors, ectopic ACTH secretion) or exogenous (steroid abuse)
• Symptoms: central obesity, moon facies, buffalo hump, and proximal muscle weakness
• Diagnosis: based on 24-hour urinary free cortisol, late-night salivary cortisol, and low-dose dexamethasone suppression test
• Treatment: depends on the underlying cause and may include surgery, radiation, or medication

Vitamin D Deficiency

• Condition characterized by low levels of serum 25-hydroxyvitamin D
• Risk factors: limited sun exposure, dark skin pigmentation, malabsorption disorders, and obesity
• Symptoms: bone pain, weakness, and increased risk of fractures
• Diagnosis: based on serum 25-hydroxyvitamin D levels
• Treatment: oral vitamin D supplementation (cholecalciferol or ergocalciferol)

Asthma Exacerbation

• Acute worsening of asthma symptoms, often triggered by viral infections, allergens, or irritants
• Severity assessed based on peak expiratory flow rate, oxygen saturation, and degree of respiratory distress
• Treatment: depends on the severity of the exacerbation and may include SABA, prednisone, and oxygen therapy- Cardiovascular*
• Tx: CCB + BB + nitrates for symptomatic relief
• Consider additional therapies: CRT, heart transplantation, or mechanical circulatory support for end-stage disease
• Cardiac surgery consult, CT, and intubation for a suspected AAA
• Heparin therapy, dopamine, and Swan-Ganz catheter are not initial management for AAA
• Pulmonary*
• Chylothorax is associated with spontaneous pneumothorax, not bronchus, diaphragm, or esophagus rupture
• Milky pleural effusion after a motor vehicle collision indicates chylothorax
• Arrhythmia*
• SVT in PEDS: Vagal maneuvers are first-line treatment, followed by adenosine or sync cardioversion if needed
• Neurology*
• TIA in the vertebrobasilar arterial system: vertigo, ischemia, and aphasia are symptoms
• Amaurosis fugax is a symptom of retinal or ophthalmic artery ischemia, not vertebrobasilar ischemia
• Congenital Heart Defects*
• VSD is the most common congenital heart defect and can cause a holosystolic murmur in neonates
• PDA typically presents with a continuous or machinery-like murmur
• Hepatitis C*
• Risk factors: IV drug use, high-risk sexual behavior, blood transfusion before 1992
• First-line treatment: Direct-acting antivirals (DAAs) like sofosbuvir and ledipasvir
• Hypercalcemia*
• Common in postmenopausal women and patients with renal disease
• Presents with bones, stones, abdominal groans, and psychic moans
• First-line treatment: Surgical removal of parathyroid adenoma if present
• Retina*
• Central Retinal Vascular Occlusion: sudden, painless loss of vision, often unilateral
• Funduscopic exam shows retinal edema and cherry-red spot
• Myasthenia Gravis*
• Chronic autoimmune disorder affecting the neuromuscular junction
• Antibodies against AChR or muscle-specific kinase impair contraction
• Presents with proximal muscle weakness, worsens with repetition, and improves with rest
• Diagnosed with EMG, decremental response to repetitive nerve stimulation, and serum Anti-AChR or MuSK
• Lambert-Eaton Myasthenic Syndrome (LEMS)*
• Autoimmune disorder affecting the presynaptic neuromuscular junction
• Antibodies against voltage-gated calcium channels impair ACh release
• Presents with proximal muscle weakness, improving with repetition
• Diagnosed with EMG showing incremental response to repetitive stimulation
• Treated with 3,4-diaminopyridine, immunosuppressants, and cancer screening
• Guillain-Barré Syndrome*
• Acute inflammatory demyelinating syndrome
• Autoimmune attack on peripheral nerve myelin sheaths
• Presents with ascending muscle weakness and paresthesias
• Diagnosed with clinical presentation, exam, and CSF analysis
• Treated with supportive care, IVIG or plasmapheresis in acute phase
• Gout*
• Meds that worsen gout: thiazide diuretics, beta blockers, ACE inhibitors, loop diuretics
• Renal Cell Carcinoma*
• Risk factors: smoking, hypertension, end-stage kidney disease, family history
• Symptoms: flank pain, hematuria, palpable abdominal mass
• Diagnosed with CT or MRI, and tissue analysis after nephrectomy
• Adjuvant pembrolizumab for intermediate-high risk after nephrectomy
• Nephritic and Nephrotic Syndromes*
• Nephritic syndrome: glomerular inflammation, hematuria, proteinuria, hypertension, and edema
• Nephrotic syndrome: heavy proteinuria, hypoalbuminemia, hyperlipidemia, and edema
• Causes of nephritic syndrome: post-streptococcal glomerulonephritis, IgA nephropathy, lupus nephritis
• Causes of nephrotic syndrome: minimal change disease, focal segmental glomerulosclerosis, membranous nephropathyHere are the study notes for the text:

Childhood Viral Exanthems

• Rubeola (Measles): • Prodrome of 3Cs (cough, coryza, conjunctivitis) • Koplik spots (small white spots on buccal mucosa) appear 2 days before rash onset • Maculopapular rash begins on the face and spreads downward, becoming confluent • Rash appears around day 4 of illness • Contagious from 4 days before to 4 days after rash onset
• Roseola (Exanthem subitum): • Primarily affects infants and young children (6-30 months old) • High fever (>39.5°C or 103°F) for 3-5 days, followed by rapid defervescence • Pink maculopapular rash appears as fever subsides, starting on the trunk and spreading to the extremities • Rash typically lasts 1-2 days • Caused by human herpesvirus 6 (HHV6)
• Erythema infectiosum (Fifth disease): • Caused by parvovirus B19 • "Slapped cheek" appearance: bright red, well-demarcated rash on cheeks • Lacy, reticular rash on trunk and extremities follows the facial rash • Rash may wax and wane for several weeks, exacerbated by heat, stress, or exercise • Prodromal symptoms (low-grade fever, malaise) may occur 7-10 days before rash onset
• Rubella (German measles): • Mild, post-auricular cervical lymphadenopathy • Maculopapular rash begins on the face and spreads downward, lasting 3-5 days • Rash is less confluent and fades more quickly than measles rash

Other Medical Conditions

• Nephrotic syndrome: • Proteinuria, hypoalbuminemia, hyperlipidemia, and edema • No hypertension or hematuria
• Sarcoidosis: • Hilar adenopathy, uveitis, elevated ACE levels
• Rheumatoid arthritis: • Symmetric small joint arthritis, elevated ESR, 20% RF negative
• Female Infertility: • Consider hysterosalpingogram to evaluate tubal scarring/adhesions if hx of PID or appendicitis

Pharmacology

• Mycoplasma pneumonia during pregnancy: • Erythromycin is the drug of choice
• Thrombocytopenia: • Platelet count below 100,000/μL • Causes: pregnancy, hepatitis B & C, HIV, chronic liver disease, medications, malignancies • Spontaneous bleeding: usually occurs when platelets are below 10,000/μL • Surgical bleeding: typically happens when platelets are below 50,000/μL • Treatment: address the underlying cause and maintain platelets above 20,000/μL

Genetics

• Down Syndrome: • Trisomy 21 confirmed by karyotyping • Physical: up-slanting eyes, flat facial profile, single palmar crease, hypotonia, congenital heart defects • Cognitive: intellectual disability, developmental delay, characteristic facial features
• Turner Syndrome: • 45,X karyotype or mosaic pattern confirmed by karyotyping • Physical: short stature, webbed neck, wide-spaced nipples, cubital valgus, ovarian dysgenesis leading to amenorrhea and infertility • Other: lymphedema, cardiac abnormalities, renal anomalies

Hematology

• Essential Thrombocytosis: • Elevated platelet count • JAK2 mutation • Increased risk of thrombosis • Hemorrhagic complications
• Myelofibrosis: • Bone marrow fibrosis • JAK2 mutation • Splenomegaly • Anemia • Teardrop cells
• Polycythemia Vera: • Elevated red blood cell mass • JAK2 mutation • Splenomegaly • Thrombosis • Pruritus after showering
• Acute Myeloid Leukemia (AML): • Auer rods • p53 mutation • Cytogenetic abnormalities • Bone marrow failure • Acute onset • Fever, bone pain, and bleeding • Splenomegaly
• Chronic Lymphocytic Leukemia (CLL): • Smudge cells • CD5+, CD23+ • Lymphocytosis • Hypogammaglobulinemia • Painless lymphadenopathy

Infectious Diseases

• Blastomycosis: • Often presents with flu-like symptoms • Typically found in the Midwest and South • Disseminated disease may involve the skin, bones, and CNS • Exact diagnostic criteria: identification of Blastomyces dermatitidis in culture or tissue biopsy • Pathognomonic: broad-based budding yeast forms on histopathology • Red flags: disseminated disease, CNS involvement • Treatment cornerstone: antifungal therapy with itraconazole or amphotericin B

Immune System

• Type III allergic reaction: • Immune complex-mediated • Timing of reaction: 3-10 hours • Common symptom: arthralgia • Cause: medications (e.g., PCN)
• Type II allergic reaction: • Antibody-mediated • Timing of reaction: 6-24 hours • Common symptom: low platelets • Cause: transfusions, Rh incompatibility