Integrative Cases III Flashcards
What are some other medical conditions that individuals experiencing hypoactive delirium (decreased alertness) are at higher risk for?
- Peptic ulcer disease
- Pulmonary emboli
- Aspiration pneumonia
___ is useful in differentiating delirium and dementia on exam without knowing the full history.
Inattention is useful in differentiating delirium and dementia on exam without knowing the full history.
Patients with dementia do not become inattentive until the dementia is severe, while patients with delirium will often become acutely inattentive.
c-ANCA vs p-ANCA
c-ANCA is often against PR3
p-ANCA is often against MPO
Both may present with small vessel vasculitis resulting in glomerulitis.
ANCA-associated gomerulonephritis will be ___ on immunofluorescence
ANCA-associated gomerulonephritis will be pauci-immune on immunofluorescence
UTI in the presence of highly alkaline pH (~8 or above) suggests ___ infection.
UTI in the presence of highly alkaline pH (~8) suggests Proteus mirabilis infection.
These produce bases which elevate urine pH.
Most cases of uncomplicated cystitis in young women are treated with ___.
Most cases of uncomplicated cystitis in young women are treated with empiric nitrofurantoin.
Can a woman’s UTI be transmitted sexually to a male partner?
No.
Are kidney stones always painful?
Actually not always. Most often, yes, but not necessarily. It should always be on the differential for painless, protein-poor hematuria.
Fat embolism syndrome
- Occurs following trauma to large bones or orthopedic procedures
- Onset of 24-72 hours, usually self-limited and resolves quickly, but may last for months or be refractory
- Involves vacsulature of the extremities, lungs, and brain, often presenting as the trinity of dyspnea, cyanosis, and mental status change
- Some evidence that microemboli may cause delirium post-operatively in orthopedic patients
Patient presents with evidence of subacute renal failure. Extremities show petechiae. They are febrile. What is the most likely diagnosis?
TTP or HUS
Don’t forget that these exist and cause acute renal failure!
Hyperemia of small bowel on CT
Suggests local engorgement of blood vessels reuslting from inflammation
Proctitis
Inflammation of the rectum
May be seen in both Crohn’s and UC
Bile acid diarrhea
Bile acid diarrhea can occur when there has been disruption of the reabsorption of bile acids– in this case, partial removal of the ileum
Bile salts can induce secretion and mucus production and increase colonic motility, resulting in diarrhea (not just steatorrhea!)
Treatment is bile acid sequestration w/ oral sequestrants
Immodium
Aka Loperamide
mu opioid agonist, slows intestinal motility
Why doesn’t UC tend to present with malnutrition?
The colon isn’t involved in nutrient absorption! (at least not much)
How to target specific areas of UC involvement
Complications of having a J pouch
Increased frequency of bowel movements, “pouchitis,” fistulizing, infertility, and development of Crohn’s.
Tenesmus
A continual or recurrent inclination to evacuate the bowels, caused by disorder of the rectum or other illness.
Someone presents with apparent IBD and has mouth ulcerations. What is the diagnosis?
Not enough information!
Yes, Crohn’s can present with mouth ulcers primary to the Crohn’s pathology. BUT, UC can also present with secondary mouth ulcers due to physiologic stress. You would need a biopsy to differentiate these.
FMT for refractory C. diff
90% effective for refractory cases!
____ is the human microbiome segment that tends to include most of the pathogenic species.
Proteobacteria is the human microbiome segment that tends to include most of the pathogenic species.
Expected respiratory compensation for metabolic acidosis and alkalosis
Acidosis: pCO2 expected = 1.5 x [HCO32-] + 8 +/- 2
Alkalosis: pCO2 expected = 0.7 x [HCO32-] + 21 +/- 1.5
Tm in type II RTA
FGF-19
Occulomotor movements
37-year-old M presents with renal failure. No FHx of renal disease or history of prior renal disease. Patient reports regular injection of heroin. Kidnies are visualized by ultrasound and appear moderately enlarged, but have no cysts. A renal biopsy is taken and shown below, stained with Congo red. What is the likely diagnosis?
AA Amyloidosis
Arterioles show involvement by a material which is strongly congophilic on Congo red staining. Congo red is a dye used to stain amyloid. Amyloid will also appear as pale eosinophilic and amorphous on H and E, and will be apple‑green birefringent on polarized light microscopy. Glomerular amyloid appears as amorphous material in the mesangium and capillary loops.
In cases of AA amyloidosis associated with injection-drug use, heroin is the most commonly implicated drug. A specific type of heroin, “black tar,” may be more likely to cause AA amyloidosis than other types. Renal involvement is universal in patients with AA amyloidosis.
Fungi with septate vs aseptate fungi in clinical medicine
What is going on in this H and E?
The arrows point to fragmented red blood cells within the glomerulus. This is characteristic of microangiopathic hemolytic anemia, and may be seen in any of the three: DIC, TTP, or HUS.
Forms of tularemia
Tularemia lifecycle
Rickettsialpox vs Rocky Mountain Spotted Fever
Rickettsialpox lesions
Rocky Mountain Spotted Fever lesions
Xanthelasma
Sharply-demarcated periocular deposites of cholesterol underneath the skin. Seen in advanced hyperlipidemia.
Cardinal signs of various types of shock
Diagnostic criteria for diabetes
AA vs AL amyloid
Complications of various diarrheas
Salt-losing nephropathies
MPA vs GPA vs eGPA
AGN vs RPGN
Acute Glomerulonephritis: Syndrome of AKI and sudden onset edema and/or worsening hypertension. Urinalysis includes active sediment, significant proteinuria, hematuria, and possibly red cell casts.
Rapidly Progressing Glomerulonephritis: Syndrome of proteinuria and hematuria, sometimes with red cell casts, that progresses to renal failure in days to weeks. Pathologic hallmark is celluloproliferative crescenting.
Delta ratio
Urinary anion gap
