VZV - tip of the nose involvement increases involvement of the cornea; nasociliary branch of V1 crosses over with the innervation of cornea. Vesicles of the nose are called Hutchison sign.

Ristocetin assay showing minimal agglutination indicates difficulty in platelet aggregation, platelet count is normal that may indicate VWD

Normal urine Na is about 30. HF will bring it below 20

Phase 1 - side effects, healthy pt's. Phase 2 - Drug works for conidtion Phase 3 - New drug vs. standard of care Phase 4 - Drug is approved. wider population of use.

Lead Tox: Cerebral edema, seizures. 09 oral chelation w/ succimer or parenteral chelation w/ dimercaprol/edta

PCA-Internal Carotid Aneurysm - CN III and loss of parasympathetic pupil activity.

• Levator palpbrae superioris, sup. rectus, med. rectus, inf. rectus, inf. oblique. are all affected - can only ABDUCT

Focal Nodular Hyperplasia - Bengign liver mass w/ no malignant potential; common enough, usually incidental finding on imaging. Intervention not required unless it grows large enough to cause pain.

• Mallory-Weiss Syndrome
  • small volume hematemesis after significant vomitting,usually normal vitals, mucosal a damage only; no trx
• Boerhaave Syndrome
  • Painful hematemesis of esophogeal perforation (pneumomedastinum/subQ emphysema), Surgical management
• Variceal Hemorrhage -Liver dz, portal HTN, varices on EGD; banding, octreotide, balloon tamponade
• Peptic Ulcer Disease
  • OTC asprin, NSAID use leading to ulcers; EGD

Dressler's/ Post cardiac injury synd: Autoimmune infalmation 2-6 weeks post MI that can cause pleuritis, pneumonitis, pleuritic chest pain, paracardial friction rub. NSAIDs to treat.

Bartonella Henselae - Azithromyin or Doxycycline

Parinaud oculoglandular synd. Enlarged submandiublar/preauricular lymph nodes

MC benign tumor of the liver: Cavernous hemangioma

Suspect occult scaphoid fx: Thumb spica splint, serial xray Q2weeks

Tuberous sclerosis

• Genetic, affecting skin,cns, orgams. Male=female.
• Shagreen patch: connective tissue nevus or collagenoma that appears as a white to yellow plaque w/ pebbled surface on lumbo-sacral surface.
• Ash-leaf sign, hypopigmented macule that lights up on wood's lamp
• Periungual fibromas
• Adenoma sebaceum (facial firboadenomas)
• Seizures if CNS is affected = Retinal hamartomas, angiomyolipomas, cardiac rhabdomyoma, pulmonary cysts

Pseudogout: Monoarticular arthritis + chondrocalcinosis Septic Arthritis will show elevated WBC in serum + synovial fluid + inflammatory makers

Hep B Serology Recovery from Infection: Anti-HBs + anti HBc IgG Active infection: HBsAg, HBeAg, anti-HBc (IgM) Vaccine: Anti-HBs Window: antiHBc (IgM) w/ or w/o antiHBe HBeAg is a maker of viral replications.

Myxedema Coma: Give Hydrocortisone w/ Levothyroxine, if concominant adrenal insufficency has not already been ruled out - otherwise adrenal crisis may result.

Hypothermia: 35-32 C, passive rewarming, then minimally invasive by truncal active, blankets, IV fluids 32-28: See J-waves on EKG; active rewarming as long as still brady and not arrest. extracorporeal rewarming to 30C if arrest

<28 C: Coma, apnea, fixed pupils, oliguria, ventricular arrhythmia

Birth = condylar compression = XII compression = poor suck

ACEi: decreased mortality, MANDATORY in systolic l. valve dysfunction. improved survival/symptoms, hspitalizations. titrate 3-4 weeks, monitor K+

B-Blockers; improve prognosis, low/slow. Transietn tiredness. Caution in bronchospastic pts, asthma.

Dig: advanced chf, a-fib. improves exercise capacity, reduces hospitalization. Titrate to tolerance

Furosemide: reduces edema, hosp. improves exercise, for systolic dysf. High dose for systolic dysf. is associated w/ increased mortality, sudden death, pump failure.

Hydralazine: arteriolar dilator; in hemodynamic failure increases cardiac output, stroke vol, decreases vascular resistance w/o affecting pulmonary. Can benefit mitral/aortic regurg, VSD w/ reduced systemic output; but long term is unknown. Chronic HF + low cardiac output, sustained/benififcal hemodynamic effect.

CCB: no role in systolic dysf, adverse outcomes. no role in HF.

Spironolactone: lowers mortality/hosp. in systolic dysunction w/ dyspnea @ rest in the last 6 mo. Gyncomastia uncommon. HF + Dyspnea @ rest, + Cr<2.5 = spironolactone

Osgood-Schlatter disease: Overuse osteochondritis, knee swelling/tenderness Legg-Calve-Perthes: Avascular necrosis, males 4-10, delayed bone age, slow onset knee/thigh pain. Splint/decrease wt. bearing

Succinylcholine toxicity:

• Malignant hyperthermia, rhabdo, HTN, constipation, bradycardia/arrest.
• Releases K+ from mm, do not give it with HyperK+
• Do not give in kidney failure, renal excretion + hyperK of renal failure

Owl Eye inclusion bodies - CMV.

Dermatomyositis - Eczema + mm. weakness

• purple heliotropic rash of periorbital skin
• Scaling of pip/dip joints (Gottron papules)
• Soft tissue calcifications (x-ray)
• "Shawl Sign" rash

Pheochromocytoma: Rule of tens 10% are extra-adrenal, 10% are familial, 10% in kids, 10% bilateral.

Suspect TB w/ bloody sputum, travel to endemic regions or close confinement, CHX and sputum stain first; Rifampin, Indomethacine, pyrazinamide, ethambutol: RIPE

Microminerals

Chromium Def.

• Type II DM, people who don't eat and are ill, burn vitim,s short bowel synd, parenteral nutrition, malnutrition.
• Glucose intolerance is primary symptom, look for pt. who is requiring ridiculous amounts of insulin.

Copper Def.

• Menkes dz - deficient absorbtion in prox. si and stomach via menkes P-Type ATPase; can result in shortened lifespan
• Can also come from malabsorbtion, copper poor formula, excessive zinc
• Fragile hiar, depigmented skin, ataxia, neuropathy, cog. defects, edema, osteoporosis.
• MIcrocytic anemia + neutropenia.

Zinc

• Acrodermatits enterpathica; AR, impaired zinc absobrtion
• Parenteral nutriton, chronic diarrhea, IBS
• diarrhea, hair loss, and an erythematous, mixed vesiculobullous, pustular rash around both the patient's mouth and anus.
• sexual maturation, impotence, hypogonadism, oligospermia, dysgeusia (impaired taste), alopecia, immune dysfunction, night blindness, decreased wound healing, characteristic rash (perioral/perianal erythematous vesiculobullous/pustular eruption).

Iodine

• Noniodized salt
• Goiter, hypothyroid, slowed mental development (cretinism), neonatal infant mortality.
• Cretinism: Mom was low iodine or hypothyroid; hypotonia, umbilical hernia, puffy face, flattened nasal bridge, macroglossia, gait disturbance, lethargy

Selenium:

• Resident of china, Meat, seafood, kidney, liver.
• Muscle dysfunction, cardiomyopathy, mood dz, impaired immunity, macrocytosis, white nail beds. .

Prognosis is worse with age, and MUCH worse with active accelerated phase/blast ciris.

Genetic testing: Karyotping, PCR, RT-PCR PHILADELPHIA CHROMOSOME IS NOT EXCLUSIVE TO CML: ALL, AML can have 5:22 but it's rare. If you see 5:322 CML unless clinical picture or labs don't match.

Monocytosis with a low Neut:Mono ration may indicate p190 BCR-ABL1 over classic p210

Marrow biopsy: Granulocyte hyperplasia in paratrabecular cuff, neutrophils in intertrabecular areas. Erythroid islands are reduced in number/size. Dwarf megakaryocytes. Sea-blue histocytes + Pseudoguacher cells (high turnover markers) Iron laden macrophages are low/absent

Absolute basophilia seen in ALL CML, Eosinophilia 90% of cases

1/2 are asymptiomatic. The rest will complain of Faituge, Platelet dysfucntion, wt. loss sweating, abdominal fullness, malaise in descending order. Exam will show splenomegaly. Labs will likely show anemia, WBC >100,000 (myleocytes/seg dominant), Plts >600 to700 Leukocyte alkaline phosphotase will be LOW Extramedullary involvement usually = blast crisis.

More likely an incidental finding

Older adult Males w/ exposure to ionizing radiation.

Labs show normal % but really high # Neutrophils, Basophils, Eosinophils.