12 April wk6-B Flashcards
Patient has DM, cholelithiasis, and diarrhea/steatorrhea. What is this a classic triad for?
Somatostatinoma
What are the classic Sx of a somatostatinoma?
Triad: DM, diarrhea/steatorrhea, cholelithiasis Can also have weight loss and abdominal pain
How would esophageal cancer present?
Dysphagia to solids and/or liquids, regurgitation of undigested food, aspiration pneumonia Risk Factors: alcohol, tobacco, acid reflux
How would gallbladder cancer present?
Biliary colic, jaundice, calcifications within the gallbladder wall as seen on US
What is a characteristic sign of a glucagonoma besides hyperglycemia, weight loss?
A scaling rash called necrolytic migratory erythema
What is hemochromatosis?
AR disease that causes too much iron storage in cells leading to bronze DM
What are the effects of somatostatin?
Decreases release of: insulin, glucagon, gastric acid, GH, all pancreatic and small intestine fluids Decreases contraction of gallbladder Acid stimulates its secretion and Vagal stimulation decreases it
What are the two lab findings that are diagnostic of SLE?
Anti-Smith antibodies Anti ds-DNA antibodies
What disease groups should be considered when a patient presents with chronic fatigue, weight loss, unexplained fevers?
Autoimmune disease Malignancy Chronic infection from HIV or TB
What diseases present with a malar rash?
SLE Dermatomyositis Pellagra
What are the classic findings in SLE?
Malar rash, photosensitivity, discoid rash, oral ulcers, arthritis, renal disease, anti-Smith Ab, anti-dsDNA Ab, ANA can also be present but is not diagnostic or specific.
When would you see anti-centromere Ab’s?
Limited Cutaneous Systemic Sclerosis or CREST Syndrome Calcinosis Raynaud’s Esophageal Dysmotility Sclerodactyly Telangectasia Patient has hardened skin, reduced ROM of hands and face, subQ calcifications and difficulty swallowing
When would you see anti SS-a and SS-b Ab’s?
Sjogren’s Syndrome
When would you see elevated antistrepolysin AB? What are the other classic features of the disease?
Acute Rheumatic Fever Young patient with history of sore throat Migratory arthritis, pancarditis, chorea, erythema marginatum, subQ nodules, arthralgia, fever
How can NSAID use affect the kidneys?
By blocking COX enzymes they prevent the production of PGE2 which dilates the afferent arterioles to the kidney. Without it, the kidneys have reduced perfusion and can cause ischemic injury.
Patient is found to have eosinophils and RBC’s in the urine and has a fever, rash, and azotemia. What is the condition and what agents can cause it?
Eosinophils in the urine is a classic finding in Acute Interstitial Nephritis It is a type of allergic reaction to an agent This is classically caused by certain drugs that act as haptens and increase antigenicity: Penicillins, Sulfonamides, NSAID’s, diuretics, rifampin, isoniazid
What is a kidney complication of Acyclovir?
Can deposit crystals in the renal tubules
What are the most common pulmonary infections of HIV patients?
Pneumocystis Jiroveci TB Histoplasmosis capsulatum
Features of Pneumocystis jiroveci
Most common pulmonary infection of HIV patients with low CD4 T-cell counts and not on prophylactic therapy. It is a disc-shaped yeast transmitted by inhalation and presents as exertional dyspnea, non-productive cough and fever. Lung lavage shows the yeast on silver stain and HE shows honeycomb lung. Common in lungs of animals and doesn’t cause a problem unless immunecompromised Extracellular pathogen often seen in cysts containing several nuclei Most common cause of death in AIDS patients Considered normal flora because so common Also found in kids with mirasmus Treat and prophylax with TMP-SMX
Features of Histoplasma capsulatum
Dimorphic fungus that is a yeast in the body and a mold when cultured Soil fungus found in the Ohio and Mississippi river valleys Inhaled mold usually infects the lungs but can also disseminate Most commonly seen as yeast inside macrophages and PMNs CXR: granulomatous foci, miliary appearance Sx: Fever, pulmonary illness, weight loss, hepatomegaly Virulence factors: urease, ammonia, bicarbonate to blunt killing of phagolysosome T-Cell immunity essential–HIV patients susceptible
What is the classic sign on histology of a CMV infection?
Owl-Eye Cowdry A inclusions
What are the classic age groups for ALL, CLL, HCL, AML, CML?
ALL: most common leukemia of kids CLL: over 50 HCL: around 50, male predominates AML: most common leukemia of adults, around 65 CML: 30-60, male predominates
Describe the lineage of cells produced by hematopoiesis
What is terminal deoxynucleotidyl transferase (TdT)?
TdT is a marker for pre B and T cells
Used to identify ALL
What disease is known for having Auer Rods?
AML
Acute Myelogenous Leukemia
