AAC 2 Flashcards
Tx of acute gout attack
o NSAIDs (indomethacin)
o Glucocorticoids
o Colchicine – stabilizes tubulin to impair leukocyte chemotaxis
Tx of chronic gout
o Probenecid – inhibits reabsorption of uric acid in PCT
o Allopurinol – inhibits xanthine oxidase, thus inhibiting uric acid synthesis
o Febuxostat – also xanthine oxidase inhibitor
What will you see in x-ray of osteoarthritis
Joint space narrowing, osteophytes, and polishing of the bone
What will you see on x-ray os pseudo gout
Chondrocalcinosis - Calcification of joint cartilage
What will you see on x-ray of RA
Periarticular osteopenia with erosion of the joint margin
Describe skin/MSK findings in Marfan syndrome
Tall, long limbs, arachnodactyly, hyperflexible joints (not skin)
Describe cardio findings of Marfan
Aortic dilation, aortic regurg (diastolic murmur), acute aortic dissection
Describe pulm findings of Marfan
Spontaneous pneumothorax from apical blebs
Describe common findings in Ehlers danlos
♣ Elastic skin
♣ Hypermobility of joints
♣ Increased bleeding tendency
♣ May also be associated with joint dislocation, berry and aortic aneurysm, organ rupture
Describe De Quervain tenosynovitis
- Caused by inflammation of the abductor pollicis longus and extensor pollicis brevis as they pass through a fibrous sheath at the radial styloid process
- Tenderness can be elicited with direct palpation of the radial side of the wrist at the base of the hand
- The Finkelstein test, which is conducted by passively stretching the affected tendons by grasping the flexed thumb into the palm with the fingers, elicits pain
- Often affects new mothers who hold their infants with the thumb outstretched (abducted/extended)
Describe MEN 1
- Pituitary tumors (prolactin or GH)
- Pancreatic endocrine tumors (Zollinger-Ellison, insulinoma, glucagonoma)
- Parathyroid adenoma
Describe MEN 2A
- Medullary thyroid carcinoma (secrete calcitonin - hypocalcemia)
- Pheochromocytoma
- Parathyroid hyperplasia
Describe MEN 2B
- Medullary thyroid carcinoma
- Pheochromocytoma
- Mucosal neuromas
Tx of seborrheic dermatitis
Topical antifungals or anti-inflammatory (topical steroids)
When do you use octreotide in cirrhosis
During active variceal bleeding
What are the most common bugs in secondary bacterial pneumonia
Staph aureus, Strep pneumo
- Strep is most common (age >65)
- Secondary bacterial pneumonia is less likely in younger people and more likely to be staph in the young
Describe pathogenesis of bronchiectasis
- Chronic infection of the bronchi causes permanent dilation of airways
- Cronchial wall damage and airway dilation due to recurrent cycle of infection, inflammation, and tissue damage
Presentation of bronchiectasis
- Cough, dyspnea, foul-smelling sputum
- Rhinosinusitis, hemoptysis
- Crackles, wheezing
- Clinical presentation is similar to that of chronic bronchitis, however sputum production is more prominent in bronchiectasis and exacerbation are typically bacterial and require antibiotics
Most common cause of bacterial meningitis
Strep pneumo
What might be produced by squamous cell lung cancer
May produce PTH = hypercalcemia
REMEMBER: sCa++mous
What might be produced by small cell lung cancer
- ADH = SIADH
- ACTH = Cushings
- Antibodies against pre-synaptic Ca2+ channels = Lambert Eaton
Presentation of mycobacterium avium complex (MAC)
- Nonspecific sx (fever, cough, abd pain, diarrhea, night sweats, weight loss)
- splenomegaly
- elevated alk phos
Tx of MAC
Azithromycin
What are the cut-offs for positive tuberculin PPD skin test
♣ >/5 mm
• HIV+ patients
• Recent contacts of known TB cases
• Nodular or fibrotic changes on CXR consistent with previously healed TB
• Organ transplant recipients or other immunosuppressed
♣ >/= 10 mm
• Recent immigrants (<5 years) from TB-endemic areas
• Injection drug users
• Residents and emplyees of high-risk settings (e.g. prisons, nursing homes, hospitals, homeless shelters)
• Mycobacteriology lab personnel
• Higher risk for TB reactivation (e.g. DM, leukemia, ESRD, chronic malabsorption syndromes)
• Children age <4, or those exposed to adults in high-risk categories
♣ >/= 15 mm
• All of the above plus healthy individuals
When with Hep B core antibody be positive
• IgM = acute/recurrent infection
• IgG = prior exposure or chronic infection
o Will NOT be positive if immunized
o Think of HBcAB as a marker of positive history of disease
• Positive in window period (when antibodies are binding antigens and neither antigens or antibodies are detectable)
what is the triad seen in Felty syndrome
- RA
- Neutropenia
- Splenomegaly
What age group and how often should mammograms happen?
- Women age 50-75
- Every 2 years
Describe pathophysiology of CO poisoning
♣ The affinity of CO for binding hgb is >200x that of O2
♣ Once bound to Hb, CO forms carboxyhemoglobin, which impairs O2 delivery to tissue
Tx of CO poisoning
♣ High flow 100% oxygen
♣ Intubation/hypercarbic oxygen therapy
What is haptoglobin and what do decreased levels indicate
- Haptoglobin is the protein used to carry free Hgb to the spleen
- Haptoglobin will be low in intravascular hemolysis because it will all be bound up to Hgb
What acid-base disorder would you expect in Primary adrenal insufficiency
Metabolic acidosis
Diagnostic imaging for kidney stones
US or NON-contrast CT
What 4 groups of patients would benefit from statin therapy
- Pts with clinical ASCVD (ACS, h/o MI, stable or unstable angina, stroke, TIA, or PAD)
- Pts with LDL >190
- Pts with DM, age 40-75 with LDL of 70-189
- Pts w/o DM, age 40-75, with ASCVD >/= 7.5%
Whats the difference between Cushing Syndrome and Cushing Disease
- Cushing syndrome = cortisol
- Cushing disease = ACTH-secreting pituitary adnoma
What is the cause of pancytopenia in lupus
Auto-immune destruction (e.g. peripheral destruction)
Next step in management of pt with suspected giant cell arteritis and vision loss
High-dose IV corticosteriods (even before biopsy to make official diagnosis - blindness can be permanent!)
Presentation of glucagonoma
- Mild hyperglycemia
- Necrolytic migratory erythema
- Diarrhea
- Weight loss
Best method for diagnosis of aortic dissection
♣ Transesophageal echo (TEE) – preferred method in patients with renal insufficiency of hemodynamic instability
♣ CT angiography with contrast – preferred in hemodynamically stable patients; requires contrast so avoid in renal insufficiency
♣ MR angiography – time consuming; avoid in patients with kidney disease
What are Wells criteria
♣ Wells Scoring Criteria:
• Clinical symptoms of DVT (leg swelling, pain with palpation) = 3
• Other diagnosis less likely than PE = 3
• Heart rate > 100 = 1.5
• Immobilization (>/= 3 days) or surgery in the previous 4 weeks = 1.5
• Previous DVT/PE = 1.5
• Hemoptysis = 1
• Malignancy = 1
Scoring
• Wells <2 = low probability = Get D-dimer
• Wells >4-6 = high probability = CTA angio
Tx of hypertrophic cardiomyopathy
• Beta blockers
o Negative inotropes prolong diastole and decrease myocardial contractility, which in turn decreases LVOT obstruction and improves symptoms of angina
• Non-dihydropyridine CCBs (e.g. Verapamil)
o Used when symptoms persist despite beta blocker therapy
Symptoms of lupus
R - rash A - arthritis S - serositis (e.g. pleuritic, pericarditis) H - hematologic disorders (anemia, leukopenia, lymphopenia, thrombocytopenia) O - oral ulcers R - renal disease P - photosensitivity A - antinuclear antibody I - immunologic disorder N - neurologic disorders
Meds used to treat BPH
- Alpha-1 antagonists
- 5a-reductase inhibitors
- Antimuscarinics (to treat symptoms)
How do alpha-1 antagonists work to treat BPH
♣ Relax smooth muscle in bladder neck, prostate capsule and prostatic urethra
How do 5a-reductase inhibitors work to treat BPH
♣ Inhibit conversion of testosterone to dihysrotestosterone
♣ Reduce prostate gland size
When do you see bite cells?
o Due to Glucose-6-phosphate dehydrogenase (G6PD) Deficiency
♣ No NADPH created in order to reduce glutathione, which is needed to protect RBCs from oxidative damage
o Heinz bodies are precipitated hemoglobin within the RBC
o Bite cells are due to the phagocytic removal of bite cells
What is the difference between Steven Johnson Syndrome and Toxic Epidermal Necrolysis
SJS involves <10% of skin
TEN involves >30% of skin
