Myelofibrosis - chronic myeloproliferative neoplasm that replaces bone marrow with fibrous tissue --> hematopoietic failure; s/s: fatigue, weakness, abdominal pain/discomfort, splenomegaly, wt.loss, night sweats, fever, bone pain, hepatomegaly, pallor, bruising, portal HTN

Exotropia = eye outward deviation relative to other when focusing on object; Cover test - 1 eye moves to re-establish fixation when other eye covered = true strabismus (tropia) rather than tendency (phoria, only apparent during cover test, not in NL binocular vision)

Chadwick's sign - bluish or purplish discoloration of vagina, labia and/or cervix in pregnancy via increased blood flow. May start at 6 - 8th wk of pregnancy (an early indicator of pregnancy)

Membranous nephropathy - MCC adult primary nephrotic syndrome, particularly with conditions like diabetes --> immune complex deposition along glomerular basement membrane --> proteinuria, hypoalbuminemia, hyperlipidemia

Patient: Irregular menstruation, hirsutism, recent wt. gain, type 2 DM, ↑serum testosterone, U/S enlarged ovaries w/ multiple peripheral cysts = PCOS; Rx for those desiring to conceive & ovulation induction = Letrozole, ↑ ovulation & live birth rates compared to clomiphene

Antiglobulin testing (aka Coombs test) - lab to detect presence of antibodies against circulating red blood cells, which induce autoimmune hemolytic anemia

Diff Dx 'bright red blood streaked stool': Hemorrhoids (internal & ext), Anal Fissures, Diverticulosis/itis, Colorectal Polyps or Cancer, Inflammatory Bowel Dz, Ulcerative Colitis, Crohn’s Dz, Proctitis, Angiodysplasia, Infectious or Ischemic Colitis, Meds (anticoagulants etc)

'MUDDLES' = cholinergic syndrome --> major muscarinic effects of acetylcholine excess, commonly seen in organophosphate poisoning (inhibition of acetylcholinesterase):

Miosis
Urination
Diarrhea
Diaphoresis
Lacrimation
Emesis
Salivation

Cognitive Pharm in Elderly - Meds can have adverse cognitive effects in elderly: Anticholinergics, Benzodiazepine, Non-Benzodiazepine Hypnotics, Opioids, Antipsychotics, Anticonvulsants, Antidepressants, Antihistamines, Muscle Relaxants,Barbituates, Dig, Clonidine

T1 diabetes - genetic/environmental triggered autoimmune destruction of pancreas B-cells (insulin production); s/s: polyuria, polydipsia, fatigue, A1C > 6.5% or FPG > 126 mg/dL or 2-hr glucose >200mg/dL during OGTT or random glucose >200mg/dL w/ s/s

'All For One And One For All' (AFOAOFA) = intrinsic muscles of the hand, palmar, from lateral to medial:
A: abductor pollicis brevis
F: flexor pollicis brevis
O: opponens pollicis
A: adductor pollicis
O: opponens digiti minimi
F: flexor digiti minimi
A: abductor digiti minimi

Shigellosis - gram-neg Enterobacteriaceae; s/s 2-3 day hx of fever, abdominal cramps, copious bloody diarrhea after eating (fecal/oral transmission) culprit food source; Rx: Administer oral re-hydration solution and observe, Antibiotics considered in severe cases

Sjögren’s syndrome - Autoimmune attack on exocrine glands; Antibodies: Anti-Ro/SSA, anti-La/SSB antibodies; s/s: dry eyes, dry mouth, salivary gland swelling, fatigue, weakness, arthralgia/arthritis, muscle pain, dry skin, mucous membrane dryness, dry cough, peripheral neuropathy

Stiff-person syndrome - Hx of other autoimmune conditions (ex. T1DM) type 1 diabetes mellitus; s/s: stiffness, pain, muscle spasms starting paraspinal and abdominal progressing to proximal legs, ↑DTRs; Triggers: physical touch, cold temp, emotional upset, startle response

Exposure to pigeon 'droppings' may lead to several diseases - Histoplasmosis (spores of fungus), Cryptococcosis fungus, Psittacosis (parrot fever, bacterium Chlamydia psittaci), Salmonellosis, Ectoparasites (fleas, ticks, mites)

Pheochromocytoma associated w/ MEN 2 - rare, genetic, endocrine gland tumors in thyroid gland, parathyroid glands & adrenal glands; Cause: RET mutation; 3 subtypes (MEN2A, MEN2B, FMTC); MEN2: medullary thyroid cancer, pheochromocytoma, parathyroid gland cancer

Pheochromocytoma - Adrenal catecholamine-secreting tumor; s/s: HA,  sweating,  palpitations, tremors, vision chgs; PE: HTN, orthostasis; Dx: ↑24h urinary catecholamines & metanephrines, or ↑plasma metanephrines, CT or MRI; Rx: alpha-blocker prior to beta-blockade --> resection

HMG-CoA reductase = enzyme in rate limiting step of mevalonate pathway (metabolic pathway for synthesis of cholesterol, coenzyme Q10, isoprenoids & others); Cholesterol: vital component of cell membranes, cell signaling, synthesis of steroid hormones and bile acids