deck 36 Flashcards
warfarin-induced skin necrosis due to underlying…
protein C deficiency
hemolytic disorder associated with hyper coagulable state
PNH
use of synthetic cannabinoids (dronabinol)
advanced HIV cachexia
caveat about empirically treating macrocytic anemia with folate
- both folate and cobalamin are cofactors in conversion of homocysteine to methionine so folate can improve cobalamin deficiency
- but folate can precipitate or worsen neurologic deficits of b12 deficiency
painless thyroiditis (silent thyroiditis)
- acute thyrotoxicosis with mild thyroid enlargement + suppressed tSH
- decreased radio iodine uptake
most common SE’s of epo
- worsening of HTN + HA + flu-like symptoms
Why HIT is a major concern
HIT is highly thrombogenic and patients must be coagulated ur to risk of arterial and venous clots (HIT antibodies activate platelets, resulting in platelet aggregation and release of procoagulant factors)
Trousseau’s syndrome
hyper coagulability disorder presenting with recurrent and migratory superficial thrombophlebitis at unusual sites (eg, arm, chest area)
- usually associated with occult visceral malignancy such as pancreatic (most common), stomach, lung, or prostate
classic complication of HIT in patients receiving subcu heparin
- skin necrosis at abdominal injection site
cause of NAFLD
peripheral insulin resistance leading to increased peripheral lipolysis, triglyceride synthesis, and hepatic uptake of fatty acids
presentation of chronic CO poisoning
HA + dizziness + nausea + polycythemia
important cause of reversible changes in memory and mentation
hypothyroidism
less common but impt features of hypothyroidism
hoarseness, memory changes
acute cholangitis
infection of the bile duct
acute cholangitis presentation
fever + jaundice + RUQ pain + confusion/hypotension sometimes seen
when to start statin for primary prevention
1) age 40-75 + 10-yr risk of atherosclerotic CV disease greater than 7.5
2) diabetic
3) LDL greater than 190
4) clinically significant atherosclerotic disease (ACS,MI/stable or unstable angina/coronary or other arterial revascularization/stroke/TIA/PAD)
management of bite from normal dog with regard to rabies
observe dog for 10 days, no prophylaxis
SBP presentation
- can be very subtle so consider in any cirrhotic w/ fever or AMS (fever or changes in mental status are the most common)
- abdominal pain often not prominent
most common cause of lower GI bleeding
- diverticulosis (can be large volume)
- not always febrile
lab profile of alcoholic hepatitis
- AST:ALT of 2:1
- *elevated ferritin (acute phase reactant)
isolated systolic HTN definition
systolic greater than 140 and diastolic less than 90
RCA occlusion leds
V4-V6R
LAD occlusion leds
some or all of leads V1-V6
RCA or LCX
ST elevation in leads II, II, aVF
presentation of bone pain secondary to metastasis
constant pain + awakens patient at night
morton neuroma presentation
- pain between third and fourth toes on plantar surface
- clicking sensation (under sign) that occurs when palpating space and squeezing metatarsal joints
initial evaluation of thyroid nodule
TSH level + US
initial therapy for low back pain
- NSAIDs or acetaminophen + maintain moderate activity
- PT only if persistent (6-12 weeks)
other name for charcot joint
neurogenic arthropathy
charcot joint can also happen with
B12 deficiency
presentation of hypercalcemia of malignancy
high calcium + very symptomatic patient
epidural spinal cord compression setting
- ## pt w/ history of malignancy with back pain + motor and sensory abnormalities
first step of epidural spinal cord compression
IV glucocorticoids
skeletal survey means
x-rays of major bones
more common HCC or mets with solitary liver nodule?
mets
folate and b12 involved in metabolism of what
homocysteine to methionine, thus homocysteine will be elevated
secretory diarrhea
large volume stool + occurs during fasting or sleep (this is because luminal ion channels are disrupted in the GI tract, resulting in a state of active secretion)
how to distinguish osmotic from secretory diarrhea
- Stool osmotic gap (difference between plasma osmolality and stool osmolality)’
- with osmotic diarrhea, nonabsorbed and unmeasured osmotically active agents are present in the GI tract. These elevate the osmotic gap.
- secretory diarrhea is due to increased secretion of ions, therefore difference is reduced.
common causes of secretory diarrhea
bacterial infections (cholera) + rotavirus + CF + post surgical changes (unabsorbed bile acids reach the colon and result in direct stimulation of luminal ion channels)
other trigger of situational syncope
urinating (triggers cardioinhibitory response)
situational syncope
- form of reflex or neurally mediated syncope
- cause an alteration in the autonomic response and can precipitate a predominant cardioinhibitory, vasodepressor, or mixed response
colonoscopy recommendation for ulcerative colitis
start 8 yrs after initial diagnosis and repeat every 1-2 years
condition in which patients are prone to diuretic-induced hypokalemia
primary hyperaldosteronism
important other cause of cardiomyopathy
tachycardia-mediated
ECG for ventricular aneurysm
persistent ST elevation + deep Q waves
gastronome (zollinger-ellison syndrome) presentation
multiple stomach ulcers + thickened gastric folds on endoscopy
acute erosive gastropathy
hemorrhagic lesions develop in gastric mucosa after exposure to various agents (eg, alcohol, aspirin, cocaine) (aspirin decreases protective prostaglandin production, cocaine results in vasoconstriction)
effect of aspirin and alcohol on stomach
cause direct mucosal injury
acute erosive gastropathy presentation
hematemesis + abdominal pain
acute erosive gastropathy vs. mallory-weiss tear
- mallory-weiss tear usually proceeded by multiple episodes of nausea/vomiting
- acute erosive gastropathy presents with hematemesis with first episode of vomiting
