IM 2 Flashcards
Early findings of Alzheimer disease?
Anterograde memory loss (ie, immediate recall affected, distant memories preserved)
Visuospatial deficits (eg, lost in own neighborhood)
Language difficulties (eg, difficulty finding words)
Cognitive impairment with progressive decline
Late findings in Alzheimer disease?
Neuropsychiatric (eg, hallucinations, wandering)
Dyspraxia (eg, difficulty performing learned motor tasks)
Lack of insight regarding deficits
Non-cognitive neurologic deficits (eg, pyramidal and extrapyramidal motor, myoclonus, seizures)
Urinary incontinence
Death usually occurs within ___ years of a diagnosis of AD regardless of treatment offered.
10
Dx Lewy body dementia?
Presence of dementia
Presence of 2+ of the following: parkinsonism, fluctuating cognition, visual hallucinations, rapid eye movement sleep behavior disorder
Presentation of frontotemporal dementia?
Early and prominent behavioral/personality change
Late prominent memory deficits
Manifests around age 60, much earlier than AD
Features of normal pressure hydrocephalus?
Abnormal gait (most prominent feature, appears early, broad-based and shuffling), cognitive impairment, urinary incontinence
In vascular dementia, deficits in ___ function are much more severe than memory deficits early in the course of the disease.
Executive
Rome diagnostic criteria - IBS
Recurrent abdominal pain/discomfort 3+ days/month for the past 3 months AND 2+ of the following:
- Symptom improvement with bowel movement
- Change in frequency of stool
- Change in form of stool
Warning signs/symptoms suggesting etiologies other than IBS?
Rectal bleeding
Nocturnal (awakens from or prevents sleep) or worsening abdominal pain
Weight loss
Abnormal lab findings (eg, anemia, electrolyte disorders, elevated inflammatory markers)
What is the most common GI diagnosis in North America? Prevalence?
IBS; 10-15%
Common presentation of IBS?
Young women with chronic, crampy abdominal pain with alternating episodes of constipation and diarrhea; passage of stool relieves the pain; may present with non-specific symptoms (reflux, dysphagia, early satiety, chest pain)
Criteria for diagnosing IBS without excluding other causes?
- ROME III criteria
- No alarm features
- No family Hx IBD or colorectal cancer
Colonoscopic findings on IBS patients?
Normal colonic mucosa
Crypt abscesses are characteristic for what disease? How does it present?
Ulcerative colitis; fever, colicky abdominal pain, chronic diarrhea with bloody stool, weight loss
Presentation of duodenal ulcer?
Epigastric pain, GI bleeding, anemia
Intestinal villous atrophy is the hallmark of what? How does it present?
Celiac disease (AI disease resulting in gluten intolerance); GI distress (diarrhea, abdominal distention, etc.), malabsorption, nutritional deficiencies
Perianal fistulas suggest possible ___ - presentation?
Crohn’s disease; abdominal pain, weight loss, extra-intestinal manifestations (eg, arthritis, skin disorders, nephrolithiasis)
Once ESRD develops, there are only two treatment options available - what are they? The choice depends on the patient and co-morbid conditions; if both options are available which is preferred and why?
Dialysis
Renal transplant
Renal transplant is preferred, as it is associated with better survival and quality of life
Discuss advantages of renal transplantation over dialysis.
- Better survival and quality of life
- Anemia, bone disease, and hypertension persist in spite of dialysis; better controlled with transplantation
- Transplant patients have a return of normal endocrine, sexual, and reproductive functions, and enhanced energy levels (return to full-time employment, more strenuous activity possible)
- In diabetics, autonomic neuropathy persists or worsens after dialysis (vs. stabilizes or improves with transplant)
Expected survival rate after kidney transplantation is ___% at 1 year and ___% at 5 years.
95; 88
Major disadvantages of renal transplantation?
Difficulty finding a donor
Surgical risk
Cost
Side effects of immunosuppression
Types of dialysis?
Hemodialysis (home or in-center) Peritoneal dialysis (chronic ambulatory or cyclic peritoneal dialysis)
In the US, 85% have in-center hemodialysis, 15% have peritoneal, 1% have home.
5-year survival rate in non-diabetic patients who are on dialysis? Diabetes?
30-40%; 20%
List 5 primary causes of nephrotic syndrome.
- Focal segmental glomerulosclerosis (FSGS)
- Membranous nephropathy
- Membranoproliferative glomerulonephritis
- Minimal change disease
- IgA nephropathy
Define nephrotic syndrome.
Heavy proteinuria (>3.5 g/24 hr)
Hypoalbuminemia (periorbital edema, peripheral edema, ascites)
Edema
Other findings include hyperlipidemia, lipiduria
Secondary causes of nephrotic syndrome?
DM, amyloidosis, etc.
Most common cause of nephrotic syndrome in adults?
FSGS
Clinical associations of FSGS?
African American and Hispanic ethnicity
Obesity
HIV and heroin use
IgA nephropathy can present with nephrotic syndrome (<10%), but more commonly presents with what?
Hematuria following a URI (40-50% of patients)
Second leading cause of nephrotic syndrome overall?
Membranous nephropathy
Clinical associations of membranous nephropathy?
Adenocarcinoma (eg, breast, lung)
NSAIDs
Hepatitis B
SLE
Which nephrotic syndrome is more common in children? In adults, what is it associated with?
Minimal change disease; NSAIDs and lymphoma (usually Hodgkin)
Amyloidosis is usually associated with ___ or ___.
Multiple myeloma; chronic inflammatory disease (RA, bronchiectasis, etc.)
Clinical associations of membranoproliferative glomerulonpheritis?
Hepatitis B and C
Lipodystrophy
Presentation concerning for native valve bacterial endocarditis with acute cardioembolic stroke?
Fever, aortic valve vegetation, cerebral infarct; high risk for complications including TIA or stroke due to septic emboli
Where does cardioembolic stroke due to bacterial endocarditis typically occur?
MCA
Treatment of infective endocarditis?
IV antibiotics (significantlyr educe the risk of septic cardioembolism) Aortic valve surgery IF there is significant valvular dysfunction resulting in heart failure, if infection is persistent or difficult to treat medically, or if septic embolization is recurrent
Early (within 48 hours) use of ___ in acute ischemic stroke due to atherosclerotic thrombosis or embolism is associated with a lower risk of recurrent stroke and decreased mortality.
Aspirin