common diseases Flashcards
Review key knowledge base in general internal medicine.
How many ounces of hard liquor, wine, and beer does it take to contain 18 ml of alcohol?
One shot of 80 proof liquor is 1.5 ounces, 44 ml, , 40% alcohol by volume, contains18 ml of alcohol.
One glass of wine, 5 ounces, 140 ML is 12% alcohol, or 18 ml.
One beer, 12 ounces 355 ML is 5% alcohol and contains 18 ml of alcohol.
What is the relationship between blood alcohol level and symptoms, and what are the legal limits?
Euphoria occurs from 0.03 to 0.06 %(by volume) blood level, slurred speech at 0.1 to 0.19, and stupor thereafter. Death may occur at levels greater than 0.5. Legal limit for driving is 0.08 or greater in the United States for car drivers over 21, 0.04 or commercial drivers and 0.01 for common carriers such as bus drivers.
For men weighing 140 pounds a blood level of 0.03 occurs after one drink and 0.8 after three. Females approach 0.8 after two drinks. Blood levels decrease by 0.01 every 40 minutes.
When considering ITP, what red flags suggest alternate diagnoses?
Red flags that suggest ITP may not explain thrombocytopenia include:
fever – SLE, sepsis, DIC, drug-induced
hepatosplenomegaly- steatohepatitis, tumor,
neurologic findings-GTP-HUS, B12 deficiency
lymphadenopathy-infection-hiv, lymphoma
thrombosis-heparin, antiphospholipid syndrome, paroxysmal nocturnal hemoglobinuria.
What are the risk factors for preeclampsia?
Preeclampsia is defined as new onset of hypertension in either proteinuria or an organ dysfunction after 20 weeks of gestation. This occurs in about 4% with increased incidence in first pregnancies and greater than 34 weeks. Complications include renal failure, placental abruption, hepatic failure, pulmonary edema, DIC, and progression to eclampsia (grand mal seizure). Risk factors-pre-gestational diabetes 3.5, hypertension 3.2, antiphospholipid antibodies 9.7, BMI over 26 2.5, chronic kidney disease. Twin pregnancies three, age over 40 2. The proximal stimulation may be placental under perfusion.
What causes episodic capillary leak syndrome?
Episodic capillary leak syndrome may be due to increased interleukin-2 receptors on circulating mononuclear cells due to kinin generation associated with monoclonal gammopathy. Adult respiratory distress syndrome with high levels of IL-2 and TNF might also be pathogenic. Diabetic vascular changes might also contribute.
Clinical edema also depends largely upon sodium retention.
What enzyme deficiency contributes to TTP?
Thrombotic thrombocytopenic purpura (TTP) is a form of micro-angiopathic anemia with renal and CNS involvement (confusion, headache) with ADAMTS13 deficiency (von Willebrand factor cleaving protease).
What is the HELLP syndrome?
HELLP syndrome (hemolysis from micro angiopathic changes, elevated liver enzymes, and low platelet count) is a complication of pregnancy associated with the development of eclampsia. Total bilirubin over 1.2 mg/dL and ASG greater than 70 units. Delivery and/or dexamethasone is effective. Acute fatty liver of pregnancy needs to be considered.
What are some available factor X inhibitors?
Rivaroxaban (Xarelto) is a factor Xa inhibitor given once a day. Other direct Xa inhibitors include xabans (Apixaban, Betrixaban, Darexaban, Edoxaban, and Otamixaban).
Other Xa inhibitors include various heparins (Bemiparin, Enoxaparin), glycosaminoglycans (Nadroparin), and antithrombin binders(Danaparoid Dermatan sulfate).
What level of thrombocytopenia requires treatment in ITP?
Less than 30,000 platelet his usual indication to start glucocorticoid treatment with the equivalent of 1 mg per kilogram of methylprednisolone.
What is the usual order of progression to treat unresponsive thrombocytopenia from ITP?
If initial steroid treatment fails then try 5 mg per kilogram and/or IVIG. If that fails then either rituximab or splenectomy. On such regimens death due to treatment complications is about one third the total death rate.
What are some neurological complications of VZV (varicella zoster virus)?
Herpes zoster due to varicella zoster virus (VZV), may produce CNS complications such as delayed contralateral hemiparesis due to the involvement of the first branch of the fifth cranial nerve and subsequent vasculitis of the middle cerebral artery, encephalitis (one in 10,000 cases), transverse myelitis, varicella with cerebellar ataxia (one in 4,000 cases), aseptic meningitis, Bell’s palsy, Ramsay Hunt syndrome, and acute retinal necrosis in AIDS patients.
Peripheral nerve complications include Guillain-Barre syndrome, polyradiculitis, motor neuropathies, and zoster sine herpete.
What are some causes of optic neuropathy?
Optic neuropathy includes all pathological processes of the optic nerve including optic neuritis from demyelination as in multiple sclerosis. Other inflammatory processes include infections causing encephalitis or meningitis (West Nile virus, Scratch disease, toxoplasmosis, syphilis, VZV), noninfectious (SLE, Sjogren syndrome, granulomatosis with polyangiitis, sarcoidosis, Behcet’s disease, inflammatory bowel disease), paraneoplastic disease), compressive neuropathies (neoplasia, lymphoma), drugs (ethambutol, infliximab, sildenafil, bevacizumab), and rarely thyroid ophthalmopathy, arterial aneurysms, abscess, nutritional deficiencies, radiation, trauma, and hereditary forms-Leber’s hereditary optic neuropathy.
What is age-related macular degeneration (AMD)?
Macular degeneration usually refers to age-related retinal disease either dry (non exudative-drusen accumulation) or wet (with neovascularization and retinal detachment). The incidence is 50% if one relative as the disease and 12% if not.
Mutations in complement system components-factor H (CFH), factor B, C3, mitochondrial genes (MT-ND2), tissue inhibitor of metalloproteinase (TIMP3), cholesterol metabolising genes, ABC-binding cassette A1.. Inability to control complement activation is a proximal cause of macular degeneration.
Dry age-related macular degeneration (AMD) responds poorly, but vitamins and antioxidants may help.
In wet AMD antiangiogenics against vascular endothelial growth factor might help. Bevacizumab Fab fragment-ranibizumab is approved for use
What monoclonal antibodies are used to treat age-related macular degeneration?
Bevacizumab is a monoclonal antibody against vascular endothelial growth factor (VEGF). Ranibizumab is the Fab fragment, which perhaps results in less gastrointestinal complaints, when use intraocularly to treat macular degeneration.
