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Medicine shelf > Conrad Fischer 3 > Flashcards

Conrad Fischer 3 Flashcards

1
Q

What is the first step in management in an IV drug user with suspected acute endocarditis?

A

Blood cultures and IV antibiotics. Antibiotics BEFORE waiting for results of culture or getting echo

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2
Q

Which antibiotics should be used in suspected acute endocarditis?

A

Empiric therapy should be vancomycin and gentamicin due to synergistic effect

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3
Q

What is “red man syndrome?”

A

Possible histamine mediated response to rapid infusion of vancomycin

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4
Q

What is the best next step if a patient on vancomycin develops “red man syndrome?”

A

Decrease rate of infusion. Total dose need not be decreased. Antihistamines and corticosteroids are not necessary.

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5
Q

Which type of anemia can be present in infectious endocarditis?

A

Anemia of chronic disease

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6
Q

What happens to complement levels in endocarditis?

A

Low complement levels are associated with endocarditis. There are circulating immune complexes and activation of the immune system

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7
Q

What is the next step when a patient’s blood culture is positive for Streptococcus bovis?

A

Colonoscopy. Strep bovis is HIGHLY associated with colonic pathology (cancer, polyps, and diverticulosis)

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8
Q

What should be added to therapy of endocarditis in individuals with prosthetic valves?

A

Rifampin. Helps with tissue penetration

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9
Q

What is the best next study in suspected endocarditis if a transthoracic echo is negative?

A

Transesophageal echo

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10
Q

Under what conditions would a transesophageal echo be indicated first (instead of transthoracic)?

A

In patients with prosthetic valves

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11
Q

What organism is associated with endocarditis in homeless, flea bitten, patients?

A

Bartonella

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12
Q

Which organism is associated with drinking unpasteurized milk?

A

Brucella

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13
Q

What type of prophylaxis is necessary prior to colonoscopy?

A

None

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14
Q

What are the indications for endocarditis prophylaxis?

A

Patients with prosthetic valves, uncorrected cyanotic heart disease, previous endocarditis, or heart transplantation who are going to undergo dental procedures with bleeding or oral surgery

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15
Q

What type of endocarditis prophylaxis is necessary in a patient with aortic stenosis undergoing dental work?

A

None. ONLY if they have one of the criteria (prosthetic valves, uncorrected cyanotic heart disease, previous endocarditis, or heart transplant)

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16
Q

What antibiotic(s) should be used when prophylaxis for endocarditis is indicated?

A

Oral amoxicillin. If allergic, use clindamycin

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17
Q

What is the typical presentation of giardiasis?

A

Flatus/bloating in patient with history of camping/hiking

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18
Q

Which skin lesions are associated with IBD?

A

Erythema nodosum and pyoderma gangrenosum

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19
Q

What skin condition is associated with celiac disease?

A

10% of patients will have dermatitis herpetiformis

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20
Q

What is erythema nodosum?

A

Idiopathic inflammation of the subcutaneous tissue resulting in tender, reddish brown lesions of the legs

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21
Q

What is erysipelas?

A

Acute streptococcal infection of the deep epidermis with lymphatic . Usually Group A Strep

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22
Q

Which skin lesion in IBD corresponds to the level of disease activity?

A

Erythema nodosum. Pyoderma gangrenosum does NOT correspond to disease activity

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23
Q

What is pterygium?

A

Outgrowing from the conjunctiva due to irritation. Can be replaced with amniotic transplant

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24
Q

Which ophthalmological findings are seen in IBD?

A

Iritis and uveitis. Debris from inflammation of the iris floats up and gets stuck on the back of the cornea

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25
Q

How is iritis/uvetis in IBD detected?

A

Slit lamp exam

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26
Q

What is the clinical presentation of uveitis/iritis?

A

Redness and photophobia

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27
Q

How is uveitis/iritis treated?

A

Steroids

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28
Q

What pathology of the biliary system is associated with IBD?

A

Sclerosing cholangitis and cholangiocarcinoma

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29
Q

Why does IBD cause sclerosing cholangitis?

A

Inflammatory mediators from the colon bathing the liver through the portal circulation

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30
Q

What is the treatment for sclerosing cholangitis?

A

Ursodeoxycholic acid and cholestyramine

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31
Q

Which kind of kidney stones are associated with IBD?

A

Oxalate stones (increased absorption in GI in IBD)

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32
Q

What is the cure for sclerosing cholangitis?

A

Only cure is liver transplantation. Treating the IBD or colectomy doesnt cure the cholangitis.

33
Q

What is the most accurate test for sclerosing cholangitis?

A

ERCP - will show beading and narrowing of the biliary system

34
Q

What is the best test for primary biliary cirrhosis?

A

Anti-mitochondrial antibody

35
Q

What antibodies are present in autoimmune hepatitis?

A

Anti-smooth muscle antibody and liver-kidney microsomal antibody

36
Q

Is UC ANCA positive or negative? Crohns?

A

UC is ANCA positve; Crohn’s is ANCA negative

37
Q

Is UC anti-saccharomyces cervevisiae positive or negative? Crohns?

A

UC is anti-saccharomyces cerevisiae negative. Crohn’s is positive

38
Q

Which type of IBD tends to spare the rectum?

A

Crohn’s spares the rectum. UC always involves the rectum

39
Q

Which type of IBD is transmural?

A

Crohn’s is transmural, UC is not

40
Q

What is the drug of choice for maintenance in IBD?

A

Mesalamine (5-ASA derivative)

41
Q

Which type of IBD can result in rectovesicular or rectocutaneous fistulas?

A

Crohn’s due to transmural granulomas

42
Q

What should be done prior to treatment with infliximab for fistulas in Crohn’s?

A

PPD placement. Infliximab dissolves granulomas. Granulomas are trapping the TB and infliximab can reactivate the TB.

43
Q

What is the mechanism of infliximab?

A

anti-TNF. TNF is necessary for granuloma formation so infliximab “unlocks” granulomas

44
Q

What is budesonide?

A

Oral corticosteroid used for IBD treatment. Low systemic effects because high first pass effect so therapy is targeted to GI

45
Q

What is the best treatment for IBD that is poorly controlled with mesalamine?

A

Azathioprine

46
Q

What are the drugs of choice for diverticulitis?

A

Ciprofloxacin and metronidazole

47
Q

What is the typical presentation of hemochromatosis?

A

Patient with fatigue, joint pain, and erectile dysfunction along with skin darkening.

48
Q

What is the best initial diagnostic method for Wilson’s disease?

A

Slit lamp exam for Kayser-Fleischer rings

49
Q

What is the difference in presentation between Wilson’s disease and hemochromatosis?

A

Both have fatigue and liver disease but Wilson’s has neuropsychiatric disturbances (tremor, psychosis, paranoia) whereas hemochromatosis doesn’t

50
Q

Where in the GI is iron primarily absorbed?

A

Duodenum

51
Q

What is the genetic transmission of hemochromatosis?

A

AR

52
Q

What is the difference in neutrophil count between gout and septic arthritis?

A

Septic arthritis will have joint aspiration with >50,000 neutrophils. Gout will stay ~20,000

53
Q

What is the pathology in the joints of hemochromatosis?

A

Deposition of calcium pyrophosphate (pseudogout).

54
Q

Which endocrine disease is strongly associated with hemochromatosis?

A

Diabetes mellitus (iron deposition in pancreas). If a patient has “bronze diabetes” think hemochromatosis

55
Q

What will be seen on echocardiogram in hemochromatosis?

A

Restrictive cardiomyopathy

56
Q

What is the most likely cause of death in hemochromatosis?

A

Cirrhosis

57
Q

What type of stain is used in hemochromatosis biopsies?

A

Prussian Blue

58
Q

When is a Sudan Black stain used?

A

Stain for fat in stools to detect malabsorption

59
Q

What is the best initial test for hemochromatosis?

A

Iron studies. The most accurate test, however, is a liver biopsy

60
Q

What is the most accurate test for hemochromatosis?

A

Liver biopsy (or HFE gene test and MRI)

61
Q

Infection by which organism is most likely in hemochromatosis patients?

A

Vibrio vulnificus

62
Q

What is the treatment of choice for hemochromatosis?

A

Phlebotomy

63
Q

What medicine is used for patients with Wilson’s disease?

A

Penicillamine (removes copper)

64
Q

What is the typical presentation of SLE?

A

Rash, fever, and fatigue with joint pain w/ swelling

65
Q

What is the best initial diagnostic test for SLE?

A

ANA? (95-99% sensitivity, poor specificity)

66
Q

What is the most specific test for SLE?

A

Anti-dsDNA

67
Q

What is CREST?

A

Calcinosis, Raynauds, esophageal dysmotility, sclerodactyly, telangiectasia

68
Q

What is anti-centromere antibody associated with?

A

CREST syndrome

69
Q

What is anti-histone antibody associated with?

A

Drug induced lupus

70
Q

What organs does drug induced lupus spare?

A

Brain and kidneys

71
Q

What condition is associated with anti-Ro and anti-La?

A

Sjogren’s syndrome

72
Q

What are the skin manifestations of SLE?

A

Malar rash, discoid lupus, photosensitivity, and oral ulcers

73
Q

What is the treatment for Raynaud’s?

A

Calcium channel blockers

74
Q

What can be seen on X-ray of joints in SLE?

A

Nothing, normal X-rays (vs RA which has abnormal X-rays)

75
Q

Which form of joint disease has osteophytes?

A

OA

76
Q

Which disease presents with X-rays showing elevation of the periosteum?

A

Osteomyelitis

77
Q

What is likely seen on a CBC of a patient with SLE?

A

Coomb’s positive hemolytic anemia or pancytopenia

78
Q

What are Howell Jolly bodies?

A

Nuclear remnants in RBCs seen in pt’s who have splenectomies. Small basophilic dot in RBCs

79
Q

Which RBC abnormality can be seen in SLE?

A

Spherocytosis (antibody attack tears off a piece of RBC membrane and makes it smaller, rounder, and tighter)

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