1st Flashcards
What are causes to have high alkaline phosphatase with all other normal labs
This value will be high in hepatobiliary tissue (cholestatic liver disease) and in bone.
What is most likely diagnosis for elderly pt who is asymptomatic with an elevated alkaline phosphatase
Paget disease of the bone.
Clinical features of pagets disease
- bone pain (due to mircro fractures)
- Increased hat size
- hearing loss ( impingement of cranial nerves)
- lion-like faces (involvement of craniofacial bones)
Complications of Paget disease
- High output heart failure ( AV shunts in bone)
- Osteosarcoma
What is best diagnosis for pt with proximal muscle weakness starting in lower extremity first and anxiety, tremor (similar to essential), fatigue, weightloss
Hyperthyroidism
What are the common traits of Cryptosporidium infection and and what area is it most likely to be found in
- high volume,
- watery,
- nonbloody stools
- occur for 2 weeks or greater
- it is a protozoan that occurs in other countries such as eastern europe where their water is not extremely clean
What will be the levels of ACTH, Cortisol, and Aldosterone in a pt who has been on glucocorticoids for a long period of time.
- Low cortisol
- Low ACTH
- Normal Aldosterone
What is most likely cause of a patient who comes in with blunt force trauma to the chest and in less than 24 hrs has tachypnea, tachycardia, hypoxia with rales and decrease breath sounds?
Most likely suffered from a Pulmonary Contusion which causes an intraalveolar hemorrhage and edema. With CT you will see patchy nonlobular opacifications ( not restricted to the anatomical landmarks)
What tx for graves disease could cause worsening of opthalmopathy
Radioactive Iodine
Side effects of PTU for Graves disease
hepatic failure
- ANCA associated vasculitis
- Agranulocytosis
Fine needle aspiration is not reliable for which thyroid cancer type
Follicular
What are risk factors for thyroid cancer
Head and neck radiation
Gardner syndrome and cowden syndrome (papillary)
MEN type 2
How does follicular thyroid cancer spread
Hematogenous route
How do you tell follicular carcinoma from a benign adenoma
Expansion through tumor capsule or vascular invasion
What are the urine and serum lab values for pt with diabetes insipidus
urine- Low specific gravity and low osmolality
plasma osmolality- high osmolality ( 280-310)
What is tx of pt with central diabetes insipidus and pts with nephrogenic
- Central- Give desmopressin
- Nephrogenic- salt restriction and thiazide diuretics ( which deplete the body of sodium so that more is reabsorbed in the proximal tubules)
What is the diagnosis when patient has widened mediastinal silhouette, inc aortic nob, tracheal deviation. with vague chest discomfort in pt with HTN, Hypercholesterolemia, smoking
Descending aortic aneurysms
What is the diagnosis for patient with frequent itching after bathing, heacaches and dizziness
Polycythemia vera
What will you see with erythropoietin in pt with polycythemia vera
low serum erythropoietin
What is the mutation in polycythemia vera
JAK2 mutation
What are treatments for polycythemia vera and why would you use them
phlebotomy
Hydroxyurea (if increased risk of thrombus)
What is diagnosis for pt that is older than 60, dysphagia, coughing, regurgitation, halitosis and neck mass which increased after liq.
Zenker Diverticulum
What are causes of Zenker Diverticulum
Sphincter dysfunction and esophageal dysmotility
What is study used to diagnose Zenker Diverticulum
Barium esophagram
What are the ocular and neurology symptoms of pts with graves disease
- protosis, inpaired extraocular motion, diplopia, irritation (gritty), photophobia,
- tremors, hyperreflexia, proximal muscle weakness.
What is cause of exophthalmos in graves disease
T cell activation and stimulation of orbital fibroblasts and adipocytes results in orbital tissue expansion and lymphocytic infiltration.
What is pseudogout? And when will you see it?
calcium pyrophosphate dihydrate crystals.
- Can see it in patients with hypercalcemia sometimes due to hyperparathyroidism
What is pseudogout also associated with?
- hypothyroidism
- Hemochromatosis
What are the characteristics of synovial fluid analysis of pt with pseudogout
- rhomboid shaped positively birefringent crystals
What is screening test for Lupus
ANA
What is screening test for Rheumatoid Arthritis
Rheumatoid factor and Anti-CCP
What does positive double stranded DNA mean?
Sensitive for Lupus
What does positive Histone mean?
Drug induced Lupus
What does positive Anti-Centromere mean?
Scleroderma, CREST
What does positive Topoisomerase mean?
Scleroderma, Systemic
What does positive smooth muscle antibodies mean?
Autoimmune hepititis
What does positive Roa and La mean?
Sjogrins
What does positive Jo mean?
Polymyositis- dermatomyositis
What does positive Mitochondrial antibody mean?
Primary- biliary sclerosis
What will you see in septic joint tap?
- cloudy
- greater than 50,000 WBC
- Possible positive gram stain
- No Crystals
What is normal patient and common complaints of pt with Rheumatoid arthritis?
- Women greater than 45 yrs
- Morning stiffness longer than an hour
- Symmetric joints of hands, wrist, feet. Spairs DIP
- Nodules: if you biopsy them they will be colesterol
What do you do for Diagnosis of Pt with Rheumatoid Arthritis?
- First look at serologic markers: Anti-CCP> RF
- then get xray= look for erosions ( pariarticular osteopenia)
What is primary tx for Rheumatoid Arthritis
- NSAIDS ( Ibprofin or Meloxicam)
-Plus- - DMARDS ( Methyltrexate) : if this does not work then try to add more DMARDS then going to biologics such as
( Leflunomide, Hydroxycloroquine, Sulfasalazine) - If severe symptoms after DMARDS are biologics ( TNF-alpha, Infliximab, Rituximab)
What is protocol for Tx of RA
all patients on NSAIDs and DMARDS
If this doesnt work then add DMARDS then
You can go on to Biologics
What do you need to do before placing a patient on Biologics for severe RA?
test for TB and Fungus
What is Feltty’s syndrome
RA + Neutropenia + Splenomegally
What is the treatment of patients with Actinomyces infection
Penicillin 2-6 months
What is best test for diagnosis of Bronchiectasis?
High resolution CT scan
What are characteristics of patient with Bronchiectasis
- Chronic cough
- Mucopurulent sputum
- Common respiratory infections.
What is rapid tx of patient with hyperkalemia
Calcium gluconate
What is first step for patient with fever and acute monarticular arthritis that has had worsening symptoms over last three days?
- Synovial fluid analysis
WHat is the normal time frame for symptoms of patient with gout
12-24 hours (abrupt onset)
What is diagnosis of pt with 2 weeks of weakness, SOB, fingertip pain and urine has been cloudy.
Infective endocarditis
What is tx for patient with paget disease?
Bisphosphonates
Would the lab results be high or low for patient with pagets disease?
- Ca
- Phosphorus
- Alkaline Phosphatase
- Urine Hydroxyproline
- Normal
- Normal
- High
- High
What is diagnosis of patient with bone pain, deformity and mixed lytic/sclerotic lesions.
- Patients may have headaches, cranial nerve dysfunction and hearing loss, fracture of bones
- Pagets disease of bone.
What is diagnosis for pt with fever, cough, weight loss and cavitary lesion in lung, who now has hypotension, hyperkalemia, and hypoglycemia?
Pt has TB that has spread to the adrenal glands and has caused addison’s disease. Pt will have hyperkalemia and high hydrogen ions causing metabolic acidosis. They will also have hypoglycemia.
What are symptoms of patient with optic neuritis?
- Common in women 20-45, rapid impairment in vision, changes in color perception and pain with eye movement
What is a common symptom of a patient with type 2 DM with a physiologic stressor
Nonketotic hyperosmolar syndrome.
Patients with cirrhosis should undergo what screening test?
Endoscopy to exclude varices, and indicate the risk of variceal hemorrhage.
What are treatments for patients with esophageal varices?
endoscopic variceal ligation or non-selective betablockers such as propranolol or nadolol
What are possible diagnosis and what is next best step for patient who has trouble swollowing solids and liquids and dilated esophagus with smooth tapering of distal esophagus on barium studies?
- Primary achalasia
- Pseudoachalasia (due to esoph cancer)
- To differentiate between two should do an endoscopic evaluation.
What is diagnosis of patient with chronic gastoesophageal reflux with new dysphagia of solids but not liquids and symmetric lower esophageal narrowing
- Esophageal stricture
you can also see improvement of acid reflux with this because as they grow they block reflux
What are presenting symptoms of patient with gonococcal septic arthritis?
- asymmetric polyarthralgias ( associated with tenosynovitis and skin rash) OR
- Isolated purulent mono- or polyarthritis