16 Flashcards
Presentation - prolonged duration of sore throat with high fever, rigors, dysphagia, and neck pain and swelling along the SCM muscle
Lemierre syndrome
What is Lemierre syndrome and what causes it?
Severe life-threatening infection that affects young immunocompetent patients, usually caused by GN anaerobic bacillus Fusobacterium necrophorum
Pathogenesis of Lemierre syndrome?
Begins with an oropharyngeal infection (tonsillitis) or as a complication from dental work or mastoiditis -> bacterium invades lateral pharyngeal space through the lymphatic system and affects the neurovascular structures -> internal jugular vein thrombosis and infection -> may send septic thromboemboli to other organs, particularly the lungs
GP bacillus that commonly causes food poisoning and gas gangrene
C. perfringens
Patients with PCOS are at increased risk of developing ___ and should be screened with ___.
DM2; oral glucose tolerance test
When is BRCA mutation testing indicated?
Family history of ovarian cancer at any age
Personal/family history of breast cancer ate age 50 or less in a first-degree relative
Presentation - unilateral abdominal mass, +/- abdominal pain/HTN/hematuria, age 2-5
Wilms tumor (nephroblastoma)
Wilms tumor may be associated with what syndromes?
WAGR (Wilms tumor, Aniridia, GU abnormalities, mental Retardation)
Beckwith-Widemann
Denys-Drash
First step in work-up for abdominal mass/suspected Wilms tumor?
Abdominal U/S -> contrast-enhanced CT or MRI to evaluate extent of Mass + CT chest (pulm mets)
Distinguish neuroblastoma from Wilms tumor based on age.
NB - <2 y/o
Wilms - 2-5 y/o
DDx - hirsutism in women
PCOS Idiopathic Non-classic 21-hydroxylase deficiency Androgen-secreting ovarian tumors/ovarian hyperthecosis Cushing syndrome
What factors suggest a diagnosis of PCOS with a CC of hirsutism?
Oligomenorrhea, obesity, associated with DM, HLD, HTN
What factors suggest idiopathic hirsutism with a CC of hirsutism?
Normal menses
Normal serum androgens
What factors suggest a diagnosis of non-classic 21-hydroxylase deficiency with a CC of hirsutism?
Similar to PCOS
Elevated serum 17-hydroxyprogesterone
What factors suggest a diagnosis of androgen-secreting ovarian tumors with a CC of hirsutism?
More common in post-menopausal women
Rapidly progress + virilization
Very high serum androgens
Elevated testosterone + normal DHEAs -> ?
vs.
Elevated DHEAS + normal testosterone?
Elevated T/normal DHEAS -> ovarian source (eg, SL cell tumor)
Elevated DHEAS/normal T -> adrenal tumor
MR classically results in a ___ murmur heard best at the apex with radiation to the ___.
Holosystolic; axilla
Common signs of MR?
Exertional dyspnea and fatigue, signs of heart failure, AFib
___ infection in pregnancy can cause non-immune fetal hydrops (excessive fluid accumulation in the interstitium). List 3 other non-immune causes.
Parvovirus B19
Fetal aneuploidy, CV abnormalities, thalassemia
MOA leading to hydrops?
High-output heart failure from either immune or non-immune etiologies
Most common immune etiology of hydrops?
Rh(D) alloimmunization
List 4 common medications that may potentiate the anticoagulant effects of warfarin (CYP inhibitors), leading to variable dose response, and/or increase the risk of bleeding.
Acetaminophen
NSAIDs
Amiodarone
ABX
List 7 medications that may decrease the effect of warfarin as CYP450 inducers.
- Carbamazepine
- Phenytoin
- Ginsent
- St. John’s wort
- OCs
- Phenobarbital
- Rifampin
List the factor 10 a inhibitors.
Direct: rivaroxaban and apixaban
Indirect: fondaparinux
List the direct thrombin inhibitors.
Argatroban
Bivalrudin
Dabigatran
Presentation - diffuse breast erythema, warmth, pain, edema, peau d’orange appearance
Inflammatory breast carcinoma
Presentation - unilateral bloody nipple discharge, no other symptoms or skin changes
Intraductal papilloma
Patients with new-onset AFib should have what lab test completed to look for an underlying cause?
TSH/Free T4 levels - occult hyperthyroidism
High-frequency hearing loss is associated with aging and certain ___ syndromes.
Congenital long QT
Suspect what 4 conditions when a patient presents with hypokalemia, alkalosis, and normotension? Distinguish them.
- Surreptitious vomiting - low urine Cl
- Diuretic abuse
- Bartter syndrome
- Gitelman’s syndrome
All others have high urine Cl
Septic arthritis is usually caused by ___. Therefore, empiric treatment with ___ is generally adequate. However, a minority of patients have continued symptoms despite a few days of this treatment, which usually indicates infection with ___. These patients require the addition of ___.
GP aerobic bacteria (especially S. aureus)
Vancomycin
GN bacterium
Ceftriaxone (good choice, as it has GP, GN, and some anaerobic coverage)
Why is doxycycline not often used to broaden antimicrobial coverage for severe infections when other ABX choices are available?
It is bacteriostatic (rather than cidal)
A ___ presents within the first few months of life as isolated hyperpigmented patches with an increased density of hair follicles.
Congenital melanocytic nevus
Describe the appearance of cafe-au-lait spots and 2 associated syndromes.
FLAT hyperpigmented patches
McCune-Albright
NF
DDx - bloody diarrhea?
- E. coli O157:H7
- Shigella
- Campylobacter
Key features of bloody diarrhea due to E. coli O157:H7 + treatment?
Associated with undercooked beef; can be complicated by HUS
Supportive care only
Key features of bloody diarrhea due to Shigella?
Associated with contaminated food or water; often implicated in outbreaks (eg, daycare)
Less commonly complicated by HUS
Supportive care + ABX (azithro, ceftriaxone, ciprofloxacin are options)
Key features of bloody diarrhea due to Campylobacter?
Associated with raw or undercooked meat
Can be complicated by GBS
Supportive only
Why is E. Coli O157:H7 infection treated with supportive care only?
The risk of HUS increases in patients who receive ABX or antimotility agents
Rx severe or high-risk cases of Salmonella gastroenteritis in children?
TMP-SMX
What are the main substrates of 4 gluconeogenesis?
Alanine
Glutamine
Lactate
Glycerol 3-phosphate
Alanine is converted to ___ during gluconeogenesis.
Pyruvate
Glutamine and other glucogenic amino acids enter gluconeogenesis at which step?
Citric acid cycle
The liver maintains glucose levels in the blood via glycogenolysis and gluconeogenesis. During fasting states, glycogen reserves drop dramatically in the first 12 hours, by which time gluconeogenesis represents the sole source of glucose production. The main substrates for gluconeogenesis are gluconeogenic amino acids (from ___), lactate (from ___), and G3P (from ___). Alanine is the major gluconeogenic amino acid in the liver and is converted into pyruvate by alanine aminotransferase.
Breakdown of muscle protein; anaerobic glycolysis; triacylglycerol in adipose
Presentation - microcephaly, wide anterior fontanelle, cleft lip and palate, distal phalange hypoplasia, cardiac defects
Fetal hydantoin syndrome (exposure to antiepiletpics like phenytoin and carabmazepine)
Features of chronic hyperthyroid myopathy?
Painless proximal muscle weakness in the setting of clinical features of hyperthyroidism, muscle atrophy
Matching is frequently used in case-control studies because it is an efficient method to control ___. What should the matching variables be?
Confounding; the potential confounders
Empiric therapy for UTI?
Third-generation cephalosporin (cefixime, ceftriaxone)
Rx otitis externa?
Topical antipseudomonal treatment (ciprofloxacin, other FQ) +/- topical glucocorticoid
What is the most common cause of death in patients with ESRD?
CV disease
Traditional risk factors - HTN, DM, dyslipidemia, LVH, advanced age, low physical activity
ESRD-specific risk factors: anemia of CKD, vascular calcifications (increased Ph, Ca2+)
Oxidative stress related to uremia and dialysis
For patients who present soon after a single, potentially toxic ingestion (>7.5 g) of acetaminophen, what is the first step in management? If they are asymptomatic?
Gastric decontamination with activated charcoal (if within 4 hours of ingestion) and measurement of acetaminophen levels, use nomogram to guide N-acetylcysteine
Doesn’t matter - patients can be asymptomatic during the first 24 hours