Feb 20th Flashcards
What do muddy brown casts suggest on urinalysis?
Renal tubular necrosis
What is the mnemonic for drugs that cause acute interstitial nephritis? AKA tubularinterstitial nephritis
remember the P’s
- Pee (thiazides and sulfonamides)
- Pain Free (NSAIDs) (allopurinol) (Cimitidine)
- think H2 blocker to help with stomach ulcer pain - Penicillins, cephalosporins and cipro
- PPI
- rifaPin
A 42-year-old man taking ampicillin for acute cystitis presents with sudden onset of fever, oliguria, and a generalized skin rash. Lab findings include eosinophilia and a moderate proteinuria. Dx?
Acute interstitial nephritis
Classic triad of acute interstitial nephritis?
Low grade fever
Rash
Arthralgias
- usually with renal/urinary problems
What is a common fungal cause of diaper rash?
Candida
- shows true hyphae
- budding yeast
- Pseudohyphae
What is characteristically found on severe combined immunodeficiency on physical exam?
Decreased thymic shadow
- where the T and B cells go to college. If it is not getting used for pos and neg selection then it starts to atrophy
What are some other history’s common to severe combined immunodef?
Diarrhea
Thrush
Recurrent infections of all pathogens
Failure to thrive
What is the common mutation in severe combined immunodef?
Adenosine deaminase deficiency (AR)
What is the result and problem with adenosine deaminase deficiency?
Build up of dATP
- causes shut down of other purine and pyrimidine pathways. Thus we stop making cells that overturn rapidly
- like gut epithelial cells–> diarrhea
- T and B lymphocytes–> recurrent infections
What is the treatment for SCID?
Bone marrow transplant
What are the urinalysis findings in pre-renal azotemia?
> 500 mOsm
20 Serum Bun/Cr ratio
<20 urine Na
<1% FENa
What are the urinalysis findings in post renal azotemia?
< 350 mOsm > 40 Urine Na >1% mild > 2% severe varies for serum Bun/Cr ratio
What is Octreotide and its MOA?
Long acting somatostatin analog
- inhibits secretion of various splanchnic vasodilatory hormones
What does octreotide prevent release of?
Serotonin
- important for treating carcinoid syndrome
What is the classic triad of Carcinoid syndrome?
Bronchospasms
Diarrhea
Tricuspid degradation
- of note serotonin is metabolized in lungs and thus you rarely see left sided heart pathology
What is the classic triad for rickettsial illness?
Fever
Rash
Headache
What is the Weil-felix reaction and what is it used to test?
Ricketsiall disease
- Agglutination test that detects antiricketsial antibodies
What is Kehr sign and what does it indicate?
Referred pain to the left shoulder
- classic example of splenic rupture and infarct
What do pts with splenic rupture or infarct present with?
N
V
Left shoulder pain
LUQ pain
What is the treatment for lead poisoning?
Dimercaperol
ca-EDMA
Succimer in children
- Sometimes Penicillamine
What is N acetylcysteine used for?
Tylenol OD
- Pushing you to make more glutathione to reduce the NAPQI
What is the mnemonic for sx’s involved with lead poisoning?
LEAD
Lead lines–> Bruton lines and Metaphysis dense lines
Encephalopahty and Erythrocyte basophilic stippling
Abdominal colic and sideroblastic Anemia
Drops (wrist and foot) and Dimercaperol and ca-EDMA for treatment
Which enzymes does lead affect?
Inhibits:
Ferochelatase
S-ALA dehydratase
What are the lab levels for osteoporosis?
Completely normal
- only thing that is abnormal is a bone density test
What is Samter’s triad?
Asthma
Aspirin sensitivity
Nasal polyp
What are some agents that can bring along an asthma attack?
Aspirin
Yellow food dye
B-antagonists
Sulfating agents
What is thought to be the cause of an ACE cough?
ACE inhibitors inhibit the degradation of bradykinin which can accumulate in the lungs and cause bronchoconstriction and vasodilation which leads to a cough
What is the mechanism of action of theophylline?
Inhibits phosphodiesterase which is an enzyme that breaks down cAMP
- Increase cAMP leads to bronchodilation
How does an increase in cAMP lead to bronchodilation?
It activated protein kinase A which serves to inhibit the contract of smooth muscle by inhibiting myosin light chain kinase
Which disease present with ANCA, either P and C?
Small vessel vasculitis:
Wegeners
Churg-Struass
Microscopic Polyangiitis
What are other names for Wegener’s and Churg-Strauss?
W- Granulomatosis with polyangiitis
C- Eosinophilic granulomatosis with polyangiitis
What is a common serology found in Polyarteritis nodosa PAN?
30% of pts have Hep B positive serology
Pt presents with Melena, weight loss and abdominal pain. She has a fever and is 34 years old. Her BP is 170/75. She has negative ANCA but a positive hep b serology? Dx?
Polyarteritis nodosa
What are some diseases that can cause mononucleosis like syndromes?
CMV
HIV
Acute toxoplasmosis
Can patients with mono have hepatomegaly?
Yes but it is far less common than splenomegaly
- Thus it should present as just splenomegaly or hepatosplenomegaly
Pt has weight loss, smokes, has RA and has epigastric pain after eating. Likely dx?
Gastric ulcer
- Greater pain after eating
Pt presents with weight gain, smokes, has RA and has epigastric pain several hours after eating. Likely dx?
Duodenal ulcer
- pain Decreases with eating
What is another name for Meyer’s loop?
Geniculocalcarine tract
- Located in the temporal lobe
Lesion to the right Meyer’s loop results in what?
Left upper quadrantic anopia
What is the MOA of Etoposide?
Inhibits Topo II
What is the clinical use for Etoposide?
Solid tumors of the lung and testicle
- also lymphomas and leukemias
What are the adverse affects of Etoposide?
Alopecia and myelosuppression
- rapidly dividing cells
What are Kulchitsky cells?
Neuroendocrine or enterochormaffin cells
- they make serotonin and can be responsible for carcinoid syndrome
What doe Kulchitsky cells look like and what cancer are they commonly found?
Small cell carcinoma
- Small dark blue cells with scant cytoplasm
Where does the radial nerve run and with what artery?
Radial groove of the humerus
- Radial colateral artery
What should one suspect with a mid humerus break?
Radial nerve and Radial colateral artery invovlement
What nerve is damaged in wrist drop and what does this supply cutaneously?
radial nerve
- supplies the posterior arm/forearm and digits 1,2,3 dorsum of hand
What is the MOA of cyclophosphamide?
Calcineurin inhibitor and thus inhibits the release of IL-2
- Immunosuppresant
What is one bad AE of cyclophosphamide?
Nephrotoxic
What are some adverse affects of odancetron?
HA
Constipation
Prolonged QT
Bleeding swollen gums on a homeless patient with multiple lesions and several bruises? DX?
Scurvy
- Vit C def
What is the rash called in Rheumatic fever/
Erythema marginatum
What heart defect occurs in Rheumatic fever/
Mitral stenosis
how does a mitral stenosis murmur sound and where?
Apex of heart with an opening snap and a decresendo low pitched in late diastole
Where is actinomyces found?
Normal flora of oral, Gi and reproductive tract
Is there fructose in breast milk? Formula
No and yes respectively
- more like the that formula has table sugar which is sucrose which is glucose and fructose
What is defective in hereditary fructose intolerance and what is its inheritance?
Aldolase B
- AR
Why and when does hereditary fructose intolerance present with hypoglycemia?
After induction of fructose into a babies diet
- Fructokinase phosphorylates fructose to keep it in the cell
- using phosphate
- If aldolase B is mutated Fructose 1 phosphate gets stuck in the hepatocytes which leads to decrease in phosphate
- No phosphate means no gluconeogenesis of glycogen and thus leads to hypoglycemia
What other symptoms other than hypoglycemia can hereditary fructose intolerance babies present with?
Vomiting
Lethargy
Jaundice
Cirrhosis
What are hemoglobin Bart cells?
Gamma Hb tetramer due to complete dysfunction of alpha Hb
What is hydrops fatalis?
Defect in alpha globin (all four alleles are defective
- incompatible with life
