Internal Flashcards
Tea + toast diet = what vit deficiency?
Folate
(macrocytic anemia)
Also folate is broken down by heat, so heated foods don’t have it either.
potential complication of brochiectasis
hemoptysis
what does bronchiectasis look like on ct scan?
dilated bronchi with thickened walls
what kind of mutations have the most severe disease? (missense, etc)?
nonsense (stop)
and frameshift.
NF2
cafe au lait acoustic neuromas (schwanomas)/deafness subcutan neurofibromas (nodules) fam hx auto-dom mutation in TSG on chr 22
drug of choice for diabetic neuropathy
TCAs (amitriptyline)
gabipentin instead if the TCAs worsen urinary sx or if they cause orthostatic hypotension
Waldenstrom’s macroglobulinemia
hyperviscous blood d/t excess IgM production (see IgM spike on electrophoresis)
Primary Hyperaldosteronism (Conn’s)
HTN mild hyper Na+ hypo K+ metabolic alkalosis (so high bicarb) low renin high aldosterone
Rx for uric acid stones
alkalinize urine to >6.5 with oral potassium bicarb or potassium citrate
Drug of choice for stable angina w HTN
beta blocker
Px’ing sx of PKD
HTN, hematuria
What is chemosis?
swelling/edema of the conjunctiva
What is asterixis?
tremor of hand when wrist is extended
hepatic encephalopathy or wilson’s
periorbital edema + myositis + eosinophilia
Trichinellosis (roundworm).
can also have splinter hemorrhages and conjunctival/retinal hemorrhages
Non-pitting edema is due to…
either lymphedema (lymphatic obstruction) or increased interstitial accumulation of and other proteins, with low-normal lymphatic flow (the myxedema seen in hypothyroidism)
What is myxedema?
Cutaneous and dermal edema d/t increased CT deposition, seen in hypothyroidism and also graves
Drug of choice for torsade de pointes
Mg sulfate
(including when TdP is caused by digoxin toxicity)
It decreases Ca2+ influx.
Cancer in pancreatic head vs pancreatic body
Head- steatorrhea, obstructive jaundice, weight loss
Body/Tail- abd pain rads to back + wt loss
Phys Ex findings in pancreatic ca
palpable, non-tender, enlarged GB
virchow’s node- L supraclavicular lymphadenopathy
trousseau’s sign- migratory thrombophelbitis
In what cells is medullary thyroid cancer (MTC)? and what is the serum marker for MTC
MTC is in the parafollicular C cells of the thyroid.
Marker is calcitonin. Carcinoembryponic Ag can also be used as a marker.
MEN 2A
Pheo
Parathyroid hyperplasia
MTC
Pt w DM and HTN- what is drug of choice?
ACE inhib
Finding of osteoblastic metastases in a man means the ca came from where?
Prostate
central pontine myelinosis- what is the px?
quadriplegia and pseudobulbar palsy
what causes central pontine myelinosis?
correcting sodium too quickly
this can also cause cerebral edema
Px of sarcoidosis
young afr amer
bilateral hilar adenopathy
pulm infiltrates
skin, eye lesions
Sarcoidosis is a/w palsy of which nerve?
CN VII facial- bell’s palsy
How to treat the HTN in pheo?
alpha blocker (-zosin)
Pts w mult myeloma are at risk for what vascular problem?
hypercoag and DVT
What is the initial treatment for DVT?
IV heparin
fever, abd pain, and ascitic fluid polymorphonuclear cell count >250
spontaneous bacterial peritonitis
What is most common organism causing SBP (peritonitis)?
e. coli
also klebsiella pneumonia
Rx for SBP
3rd gen ceph (ceftoxamine)
and repeat percentesis in 48 hrs to confirm it’s working
osler-weber-rendau syndrome
hereditary hemorrhagic telangectasia.
vascular lesions- telangectasias, aneurysms, AV malformations- found thru-out body
esp lungs, brain, GI tract
Erlichiosis
from ixodes tick fever, chills headache myalgia, malaise naus/vom mental stat chg leukopenia, thrombocytopenia, mild transam elevation. rx doxy
what is CHOP chemo?
cyclophosphamide
doxyrubicin
oncovin (vincristine)
prednisone
get it for hodgkin’s lymphoma
how to dx mallory-weiss tear
hematemesis after excessive vomiting
do an endoscopy to dx
primary hyperaldosteronism- electrolytes?
hypokalemia!!
metabolic alkalosis (bicarb hi)
HTN
aldo incrs’s Na+ reabs (so hypernatremia) and incrs’s secretion of K+ and H+.
treatment for primary hyperaldosteronism
spironolactone (bc it’s K+ sparing, and also increases secretion of K+, so want to reverse that). spiro antagonizes aldo receptor in distal conv tubule
Large lymphoblasts w prominent nuclei and light blue cytoplasm
ALL
acute lymphoid leukemia
What drug type can cause bilateral cataracts after prolonged use?
high-dose steroids
anti-mitochonidrial Ab
primary billiary cirrhosis (will also have elevated alk phos)
how to tell alcoholic hepatitis apart from viral hep or cholestasis
look at the AST to ALT ratio- it is 2:1 in alch, esp if AST is <400
rx for alch hep
corticosteroids and treat delerium tremens
phys exam for differentiating RUQ pain
murphy’s sign- pos (painful) in cholecystitis. neg if stones, pyeloneph, or ascending cholangitis
Budd-Chiari
Caused by hepatic vein thrombosis
usu secondary to hyper-coag states: cancer, prego, OCP use, hematologic dz
Rx thrombolysis, then anti-coag
Rx for benzo OD
flumazenil
PSC primary sclerosing cholangitis
inflam and fibrosis of extrahepatic and intrahepatic biliary tree.
pts w UC have increased risk
leads to cirrhosis and hepatic failure
need a transplant
Most common benign tumor of lung
Hamartoma
hamartomas are common cause of solitary lung nodule (nodule = <3cm)
Causes of Conn’s syndrome
Conn’s = primary hyperaldo
Caused by adrenal adenoma or adrenocortical hyperplasia
Where to insert needle for pericardiocentesis
B/t xyphoid process and left costal margin, aim for left shoulder
Acute tumor lysis syndrome
Rapid destruction of WBCs by chemo --> rls of intercellular stuff into blood. Get hyperuricemia (incrsd BUN), which preciptates in renal tubules and causes renal failure, anuria also causes high K+ levels, which can cause arrhythmia
How to prevent acute tumor lysis syndrome?
Allopurinol (to prevent uric acid), lots of fluids, close electrolyte monitoring
Pts who are most at risk for tumor lysis syndrome
ALL pts w high WBC counts at dx
Burkit’s lymphoma pts
most sensitive dx’tic test for pheo
plasma free metanephrines
urine metanephrines 2nd best
10% rule for pheo
10% extra-adrenal 10% familial 10% in kids 10% malignant 10% bilateral
Osteitis fibrosia cystica
Von Recklinghausen syndrome. HyperPTH –> hi bone turnover, fragile bones. See bone resorption in distal phalanges and subperiosteal regions
Lab results in hyperPTH
PTH hi Ca2+ hi Phosphate low Alk phos hi (bc increased bone turnover) PTH stims osteoclast activitiy
Most common cause of bacterial meningitis in adults (<60)
Pnemococcus and Meningiocccus
Rx for bacterial meningitis in adults s the drugs cover)
Vanco & ceftriaxone
Ceft covers S. pneumo, GBS, H. influenza, N. meningitidis
Vanco added for resistant strands of S. pneumo (gram pos orgs)
Rx for bacterial meningitis in elderly and infants
Ceftriaxone & Vanco (like for adults)
plus ampicillin- this covers for listeria
Plummer Vinson syndrome
Dysphagia, esophageal webs, anemia (IDA)
non-small cell lung cancer
stg 0 - carcinoma in situ stg 1 - limited local; no nodal/mets stg 2 - limited local w local nodes stg 3 - limited local w contralat nodes stg 4 - distant mets.
for stg 1, surg resection is enough.
stg 2- surg + rads
prophylaxis for esphgl varices
non-selective B-blockers
they reduce portal and collateral blood flow, reducing rate of bleeding varices
hypokalemia on EKG
U waves and prolonged QT interval
Pt w DKA- what happens to potassium?
normal/elevated on initial px d/t K+ mvmt out of cells from secondary acidosis
But, as soon as you give insulin, will drop (a LOT)- can cause hypokalemia.
How does cardiac tamponade usu px?
Cardiogenic shock: beck’s triad of distant heart sounds, elevated JVP, hypotension
restrictive cardiomyopathy
decreased ventricular compliance –> impaired ventricular filling
px’s w heart failure (right > left), incrsd JVP, hepatic congestion, ascites, periph edema
Constrictive pericarditis vs Restrictive cardiomyopathy- differences in CT and echo
Px similarly, but:
Restrictive cardiomyopathy = increased wall thickness on echo, normal pericardium on CT
Constrictive pericarditis = normal wall thickness on echo, thickened and tethered pericardium on CT.
EKG for both shows low voltage.
Carcinoid syndrome - triad of sx
flushing
diarrhea
hypotension
Carcinoid syndrome- what will be elevated in blood? in urine?
Increased plasma serotonin
Increased 5-HIAA in urine (byproduct of serotonin metabolism)
How do carcinoid tumors affect the heart?
Affect R heart d/t fibrinous deposits on R-sided valves, can cause R heart failure
Rx for ITP
kids- nothing
adults- immunosuppressants or dialysis, or splenectomy
APKD w pyleonephritis- Rx?
amplicillin and gentamicin
How to treat minimal chg dz (nephrotic)?
Steroids- prednisone
Rx for central DI (and another dz it’s also used for)
Desmopressin (DDVAP)
Also used to treat vWF deficiency, so it raises serum vWF
Abrupt withdrawal of corticosteroids causes what?
(Secondary) adrenal insufficiency
AI sx = fatigue, naus/vom (but not hyperpigment bc ACTH is low)
In secondary adrenal insufficiency, what does stim w cosyntropin cause?
cosyntropin = ACTH
stim w ACTH causes increased cortisol levels (as ACTH normally would). the problem in secondary! AI is that the HPA is suppressed, so there’s no ACTH. adrenal fn is fine if ACTH is around.
Metyropone stimulation in secondary adrenal insufficency
Stim with metyropone does NOT cause an increase in ACTH. metyropone inhibits cortisol production at the adrenals. so no cortisol should mean that ACTH would increase, but in secondary! AI, the HPA fails to respond and make ACTH.
T/F malignant thyroid nodules are usually painless
True.
Tender nodule is usu benign- eg subacute viral thyroiditis or hemorrhage into a benign cyst
Sign that a malignant thyroid tumor has spread
Hoarseness
Massive PE Rx
First: hemodynamically stable. give NE to constrict arteries and increase CO. then work on thrombolysis (i don’t quite believe you should give NE- ok for massive PE w hypotension
Hypotension in ill pt that doesn’t correct w fluids and pressors
Acute adrenal crisis. Inadequate production of cortisol = hypotension, shock, reduced SVR
Thrombotic thrombocytic purpura- classic pentad
Thrombocytopenia Microangiopathic hemolytic anemia (see schistocytes aka helmet cells) less so: mental status chgs fever renal failure
