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Spring Round II Exams > clin med last two lectures > Flashcards

clin med last two lectures Flashcards

1
Q

Endocrine pancreas (DIABETES)

A

Islet of langerhan

insulin and glucagon

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2
Q

Exocrine pancreas

A

Acinar cells- amylase, lipase, protease

Pancreatic juice- electrolytes, bicarb, enzymes, neutralize acid

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3
Q

Acute pancreatitis

A

Alc induced >Males

Gallstone induced >Females

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4
Q

Pathophys of Pancreatitis

A

High TRYPSIN levels, pancreas destroys itself

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5
Q

Subtypes of pancreatitis

A

Necrosis or nah

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6
Q

Two most common causes of Pancreatitis

A

Gallstones

Alcohol (chronic use)

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7
Q

Abdominal pain with pancreatitis

A

Acute, post meal
Epigastric –> radiating into back

Constant, steady, boring

Better w leaning forward

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8
Q

PE of Pancreatitis

A

Tachy, hypo, fever
Sometimes jaundice, pallor, sweating

Epigastric pain
Guarding
Dec bowel sounds

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9
Q

Scleral icterus, be thinking of

A

Choledocholithiasis or Edema of pancreatic head

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10
Q

Parotid swelling can be sign of

A

Mumps

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11
Q

Severe necrotizing pancreatitis

A

Cullen sign- bruising around belly button

Grey turner- bruising to flanks

Panniculitis- red tiny nodules

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12
Q

Labs of Pancreatitis

A

Elevated:
Bilirubin, Triglycerides, Pancreatic enzymes, LIPASE (more spec to pancreas)

CRP >150= severe pancreatitis

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13
Q

Genetic testing panc

A

Strong fam hx of pancreatitis

<35 YO onset

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14
Q

If Clinical presentation and Labs are suggestive of Pancreatitis, do we want a CT?

A

NOT RECOMMENDED

most cases are uncomplicated
IV contrast may worsen panc

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15
Q

Suspect pancreatitis, what imaging do I order?

A

US –> EUS –> MRCP

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16
Q

Do not do ERCP unless

A

EUS or MRCP are abnormal

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17
Q

Diagnostic criteria for Pancreatitis,

Requires TWO of the following

A

Clinical (acute, persistent, severe, boring, epigastric pain radiating to back)

Elevated Lipase or Amylase

Imaging

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18
Q

Get a CT if >72 hours of onset sx AND

A

Persistent or recurrent abd pain
Inc in panc enzymes after initial decrease
New or worse organ dysfx
Sepsis (fever and increased WBC)

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19
Q

Tx for Pancreatitis

A 
Admit
SUPPORTIVE
Meds (pain, abx, n/v)
Aggressive hydration
Monitor for worsening
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20
Q

Complications of pancreatitis

A

Local (fluid, cyst, necrosis)

Systemic inflammatory response syndrome (SIRS)

Organ failure

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21
Q

Pancreatic pseudocyst

A

Localized collection of fluid (enzymes, blood, and pancreatic tissue)

Palpable mass mid epigastric

may spont resolve or get bigger

Complicated if: rupture, hemorrhage, infection

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22
Q

Tx of Pancreatic pesudocyst

A

Surgery vs drainage if symptomatic or infected

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23
Q

Most cases of Pancreatitis are

A

Mild acute

Better in 3-5 days

  • no organ failure
  • no local or systemic complications
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24
Q

SIRS

A

Present on admission

Persists >48 hours

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25
Q

Death related to pancretitis

A

First 2 weeks: SIRS/organ failure

After 2 weeks: Sepsis

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26
Q

Some causes of pancreatitis you can treat to prevent another case

A

Remove gallstone

Stop drinking

Lower triglycerides w diet / meds

Discontinue offending med

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27
Q

Chronic pancreatitis

A

Progressive inflammatory changes

Long term structural damage of pancreas

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28
Q

Is Mortality lower with chronic or acute pancreatitis?

A

Chronic

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29
Q

Sx of Chronic pancreatitis

A

STEATORRHEA
DM
weight loss

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30
Q

Brittle DM

A

alpha and beta cells of pancreas affected d/t chronic pancreatitis

hard to control

typically insulin DEPENDENT

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31
Q

Classic TRIAD of Chronic Pancreatitis

A

DM
Steatorrhea
Calcifications

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32
Q

Most labs with CHRONIC Pancreatitis are more mild, maybe even normal… so we test

A

Fecal fat

72 hr: Gold standard

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33
Q

Test of choice for Steatorrhea

A

Fecal Elastase

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34
Q

Calcifications on X Ray

Calcifications, ductal dilation, and pseudocyst on CT

A

Chronic Pancreatitis

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35
Q

ERCP (diagnostic and therapeutic) of Chronic Pancreatitis shows what?

A

“chain of lakes” gold standard

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36
Q

Tx of Chronic Pancreatitis

A 
Behavior
Pain relief
Lithotripsy
Endoscopic dilation or stenting
Decompression/drainage
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37
Q

Acute, severe, epigastric pain radiating to back

better w leaning forward

A

Pancreatitis

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38
Q

Diagnosis of Pancreatitis (at least 2)

A

Clinical
Labs (lipase/amylase)
Imaging

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39
Q

Triad: DM, steatorrhea, calcifications

“chain of lakes” on ERCP

A

Chronic Pancreatitis

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40
Q

“chain of lakes”

A

alternating stenosis and dilation of pancreatic duct on ERCP

41
Q

Pancreatic CA

Males>females

A

Etiology:

Abn glucose metabolism
Insulin resistance
Obese
Chronic pancreatitis

42
Q

Is Pancreatic CA usually exocrine or endocrine?

A

Exocrine

43
Q

Most common type of Pancreatic CA

A

Ductal adenocarcinoma

Head of pancreas

44
Q

Only cure for pancreatic CA

A

Resection

BUT unfortunately most already have locally advanced or METs when it is found

45
Q

Presentation of Pancreatic CA

A

Epigastric pain
Jaundice
Weight loss

maybe also: dark urine, steatorrhea

46
Q

PE shows this:

Hepatomegaly
Abd pain
RUQ/epigastric mass
"Courvoiser sign" 
Ascites
Jaundice/icterus

be thinking

A

Pancreatic CA

47
Q

Courvoisier sign

A

Nontender palpable gallbladder

48
Q

Initial imaging if pt has JAUNDICE

A

Abdominal US

49
Q

Initial imaging if pt has Epigastric pain and weight loss (but no jaundice)

A

Triple phase thin slice enhanced helical CT of Abd

50
Q

Resection of Pancreatic CA

A

Whipple procedure

51
Q

Prognosis for Pancreatic CA

A

Very poor

5 yr survival <5%

52
Q

Prognosis with Un-resectable pancreatic CA

A

8-12 mo with local invasion

3-6 mo if METs

53
Q

Lymphogranuloma Venereum (LGV)

A

all among MSM w HIV infection

54
Q

HIV populations most affected

A

Men
20-29
Hispanic and African American

55
Q

CD4 count is what

A

T helper cells that enhance the immune response and tell B cells to MAKE ANTIBODIES

56
Q

HIV stages

A

Primary infection “Acute HIV” (sx)
Clinical latency
Symptomatic HIV
AIDS

57
Q

Acute HIV/ primary infection

A

2-6 wks after exposure
Mono like/ Flu like
Lasts about 2 wks, resolves spontaneously

Viral load EXTREMELY high

58
Q

During acute HIV, the routine HIV Ab test will be

A

negative! antibodies are not made yet

59
Q

Common manifestations of Acute HIV

A
  • Rash
  • Mouth ulcers

+ others

60
Q

Labs with Acute HIV

A

Elevated LFT

LOW blood counts (white, red, platelet)

61
Q

Clinical latency to HIV

A

Immune system starts to resolve to infection

Patient seroconverts within 3 MONTHS of infection- now they are producing antibodies

62
Q

Clinical latency

last avg 10 years

A

HIV remains active in lymphnodes

Pt has no sx (or lymphadenopathy)

63
Q

Symptomatic infection HIV

A

Lymph nodes “burnt out”
Virus may mutate
Body fails to keep up replacement of CD4 count

HIV RNA viral load increase

64
Q

HIV (and AIDS) sx

A

Oral hairy leukoplakia
Kaposi Sarcoma
Thrush

Others: fever, night sweat, arthralgia, weight loss, prolonged diarrhea

65
Q

AIDS is defined as CD4 <200 OR

A

HIV + 1 of the 27”AIDs defining conditions”

PCP
Toxoplasmosis
CMV
Thrush of esoph/tracheus/bronchi
Kaposi sarcoma
etc
66
Q

PCP
Pneumocystis Jirocevi PNA

when CD4 <200

A

BACTRIM

67
Q

Toxoplasmosis

when CD4 <100

A

SULFA and PYRIM

68
Q

ToxoPlaSmosis

tx starts with P and S
Pyrimethamine
Sulfa

A

Sx: HA, focal neuro def, AMS
Dx: lesions on Brain CT or MRI

1st line tx: Sulfa and Pyrimethamine

69
Q

MAC

when CD4 <50

A

Bacteria in soil and dust
Sx: Night sweat, weight loss, abd pain, diarrhea, ANEMIA

Dx: AFB
Tx: Macrolide + Ethambutol

70
Q

CMV (herpes gets in eye)

when CD4 <50

A

Most common RETINAL infection in AIDS pts

Dx: white fluffy exudates on fundoscopic exam
Tx: IV Gangcyclovir

71
Q

AIDs related Kaposi sarcoma

A

Most frequent in homosexual male

72
Q

Classic Kaposi’s

A

Elderly eastern european and Mediterannean males

73
Q

Screen everyone for HIV at least one

A 
Everyone 13-64YO
Anyone being tx for TB
Each STD presentation
Annual for risk pts
Pregnant women
74
Q

DIAGNOSTIC testing for

A

Opportunistic infection
TB
Sx consistent with HIV (weight loss, night sweat, diarrhea >1wk, PNA)
Sx consistent w Acute HIV

75
Q

Test of choice for HIV

A

Combo HIV antibody AND Antigen test

76
Q

HIV Antibody test

A

only will show positive AFTER pt Seroconverts

4-12 wks after infection

77
Q

PEP post exposure proph for HIV

A

Must start w/in 72 hours

3 drug regimen for 28 days

78
Q

PrEP for people at risk

partner to HIV positive, ror MSM

A

Daily med

main option is Truvada

79
Q

Normal CD4 count

A

600-1200 cells per cubic/mm

80
Q

All HIV+ pts should be screened for TB AND

A

given TB prophylaxis if latent TB is present

81
Q

If HIV+ pt CD4 falls below 250

A

give Diflucan prophylactically for Cocci

82
Q

If HIV+ pt CD4 falls below 200

A

give Bactrim prophylactically for PCP

83
Q

If HIV+ pt CD4 falls below 100

A

give Bactrim prophylactically for Toxoplasosiss

84
Q

Syphillis

A

Trepenoma Pallidum

Direct contact w infected lesion

85
Q

Clinical presentation of Primary syphillis

A

Painless chancre lasting 4-6 wks (then resolves)

86
Q

Secondary syphillis has many manifestations

+ systemic like malaise and lymphadonopathy

A

Rash (common) on PALMS AND SOLES
Warts- Condyloma lata- highly infectious
Mucous patches- highly infectious

87
Q

How long does Secondary Syphillis last?

A

2-6 wks then enter Latent period

88
Q

Latent syphillis

A

No sx
Syphillis is NO LONGER transmitable
may persist for YEARZz

89
Q

Tertiary (late) syphillis

A

Most do not get to this point

only 15% of those untreated

10-30 yrs after infected

90
Q

Tertiary syphillis

A

can damage heart, blood vessles, brain, and nervous sx

91
Q

Clinical sx of Tertiary syphillis

A

NEURO and EYE

Paralysis, coordination troubles, dementia, vision change, blindness

92
Q

Dx of Syphillis

A

Start w RPR or VDRL (non specific)

Confirm w Treponemal antibody test: FTA-ABS

93
Q

If you suspect Neuro or Ocular involvement from Syphillis, what do you need to do?

A

Lumbar Puncture

perform VDRL on spinal fluid to confirm

94
Q

Syphillis tx

A

BENZATHINE Pen G ( a shot)

95
Q

Retest syphillis after tx at

A

6, 12, 24 mo

Check RPR titer

96
Q

Congenital syphillis

A

stillbirth
neonatal death
infant disorder- deaf, neuro imp, bone disoder

97
Q

If pregant pt is PCN allergic, consider

A

desensitization with oral PCN

Monitor serology closely to confirm successful tx

98
Q

LGV
Lympho Venereum

Treat with DOXY

A

Caused by CHLAMYDIA

Rare, but present in MSM

Unilateral inguinal BUBO (swollen lymphnode)
Anal d/c and rectal bleeding

Tx: DOXY

99
Q

Chancroid

H. ducreyi

A

Painfu, tender ulcer
FOUL SMELLING d/c

Tx: Azithro, Ceftriaxone, or Cipro

Spring Round II Exams (10 decks)

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