None for asymptomatic patients Endoscopic cautery for patients with anemia or gross/occult bleeding

Internal Med 6 Flashcards by Giselle McIntyre

What type of infection causes skin ulcerations that travel up the lymphatic chain

Sporotrichosis from Sporothrix schenckii
Fungus
From decaying plant matter/soil (rose bush)

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Describe timeline of common complications associated with MI

Reinfarction (hours - 2 days)
Ventricular septal rupture (hours - 1 week)
Free wall rupture (hours - 2 weeks)
Postinfarction angina (hours - 1 month)
Papillary muscle rupture (2 days - 1 week)
Pericarditis (1 day - 3 months)
LV aneurysm (5 days = 3 months)

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What will you see on EKG in a ventricular aneurysm

Persistent ST-elevation after a recent MI and deep Q waves in the same leads

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Describe thyroid adenoma

• Almost always a “cold” nodule

Does not overproduce thyroid hormone

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Describe Papillary thyroid carcinoma

•	Most common type of thyroid cancer
•	Histology:
o	Orphan Annie eye nuclei
o	Nuclear grooves 
o	Psammoma bodies

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Describe Follicular thyroid carcinoma

• Second most common type of thyroid cancer
• Histologically the same as follicular adenoma but invade the tumor capsule
o This finding is made on exam of a surgically excised nodule
o Cannot differentiate based on histology)
• Histology:
o Uniform follicles

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Describe Medullary thyroid carcinoma

From parafollicular “C cells”

* Will have increased calcitonin (hypocalcemia)

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How long after liver transplant will you likely see bacterial vs. viral infection

Bacterial < 1 month

Viral 1-6 months

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What are the 2 renal diseases associated with SLE

Diffuse proliferative glomerulonephritis or membranous glomerulonephritis

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Diagnose: Unexplained, painless, episodic GI bleeding (hematochezia) and anemia

Angiodysplasia

♣ Tortuous dilation of vessels within the bowel, leading to hematochezia

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Tx of angiodysplasia

None for asymptomatic patients

* Endoscopic cautery for patients with anemia or gross/occult bleeding

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What are the tumors of MEN 1

♣ Pituitary tumors (prolactin or GH)
♣ Pancreatic endocrine tumors (Zollinger-Ellison syndrome, insulinomas, VIPomas, glucagonomas)
♣ Parathyroid adenomas

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What are the tumors of MEN2A

♣ Medullary thyroid carcinoma (neoplasm of parafollicular C cells which secrete calcitonin)
♣ Pheochromocytoma
♣ Parathyroid hyperplasia

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What are the tumors of MEN2B

♣ Medullary thyroid carcinoma
♣ Pheochromocytoma
♣ Mucosal neuromas (oral/intestinal ganglioneuromatosis) / Marfanoid habitus

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Where is calcitonin produced and what is its function

Produced by Parafollicular cells of thyroid

- “Tones” down calcium - inhibits osteoclasts, leading to decreased bone resorption

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What can calcitonin be used to treat

Osteoporosis
Hypercalcemia of malignancy
Paget disease

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What is the effect of parathyroid hormone

Increases bone resorption (increasing Ca2+)
Increases calcium reabsorption at the kidney
Decreases phosphate reabsorption

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Tx of hypercalcemia of malignancy

Bisphosphonates + Calcitonin

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Describe ankylosing spondylitis

o Involves sacroiliac joint and spine
o Fusion of vertebrae (ankyloses) bamboo spine
♣ Reduced spine mobility
♣ Improves with exercise
o Uveitis
o Aortitis (weakened walls may lead to dilation and aortic regurgitation)
o Think: Pandas:
♣ They eat bamboo bamboo spine
♣ Raccoon eyes uveitis
♣ Clumsy climbing up trees causes branches to bend aortitis

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How do you decide if you should anticoagulate a patient with A-fib

CHADSVASc score

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What are the components of CHADSVASc

C = CHF
H = HTN
A = age >75
D = DM
S = Stroke/TIA/Thromboembolism
V = Vascular disease (MI, PAD)
A = Age 65-74
S = Sex (female)

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What CHADSVASc score do you need before anitcoagulation is indicated

Score = 1 (Rivaroxaban or ASA)

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What lab values will you see in sarcoidosis

Elevated Ca2+ and ACE

Tx of sarcoidosis

Steroids

Diagnose: Hypopigmented lesion with no sensation as well as nodular, painful nearby nerves

Leprosy

Tx of Mycobacterium leprae

- Tuberculoid form = Dapsone + Rifampin | - Lepromatous form = Dapsone + Rifampin + Clofazimine

Describe lab findings seen in intravascular hemolyisis

• Hemoglobinemia, hemoglobinuria, hemosiderinuria (due to iron taken up by renal tubular cells, which later shed), decreased serum haptoglobin, corrected reticulocyte count > 3%

Why is there elevated haptoglobin in intravascular hemolysis

o Haptogloblin is the protein that will carry Hb to spleen o In intravascular hemolysis, the amount of free Hgb exceeds the binding capacity of haptoglobin, thereby decreasing the level of haptoglobin

Which classes of antiarrythmics control rhythm vs. rate

Rhythm control = Class I and III Rate control = Class II and IV

MOA of each class of anti-arrythmic

- Class I = Na channel blocker - Class II = beta blocker - Class III = K+ channel blocker - Class IV = CCB

What are the Class IA antiarrhythmicc

Procainamide, Quinidine, and Disopyramide

Uses of Class IA

supraventricular and ventricular arrhythmias, WPW

What are the Class IB

Lidocaine, Phenytoin, Mexiletine

Uses of Class IB

Ventricular arrhythmias (especially in ischemic tissue)

Names of Class IC

Flecanide, Propafenone

Uses of Class IC

Supraventricular arrhythmias, A-fib

Uses of beta blockers in arrhythmias

Causes prolongation of AV conduction - Supraventricular arhythmias (e.g. A-fib with RVR) - Rate control in A-fib / A-flutter

Names of Class III antiarrhythmics

- Amiodarone (properties of Class I, II, III, and IV) - Sotalol (Class III and II) - Dofetilide and Ibutilide ("til I die")

Uses of Class IV antiarrythmics

Non-dihydropyridine CCB - Supraventricular arrythmias (e.g. A-fib with RVR) - Rate control in A-fib

Describe MOA of Digoxin in arrhythmias

* Exerts direct parasympathomimetic effects via direct stimulation of the vagus nerve, leading to AV inhibition * Similar effect of beta-blockers (Class II) and Ca2+ blockers (Class IV)

Uses of Digoxin in arrhythmias

Atrial arrthythimias (e.g. A-fib)

Describe use of Magnesium in arrhythmias

Treatment of torsades de pointes

Describe MOA of Adenosine in arrhythmias

• Activates inhibitor A1 receptors on the myocardium and at the SA and AV nodes • Activation of A1 receptors increases potassium outward conduction and suppresses calcium inward current o This causes membrane potential to remain negative for a longer period and calcium-dependent action potentials (at nodes) are suppressed o This decreases AV conduction, leading to prolonged AV refractory period

Uses of adenosine in arrhythmias

* First line agent for acute treatment of supraventricular arrhythmias * Coronary dilation (mediated by A2 receptors)

Describe how each will appear on EKG: - Ischemia - Injury - Infarct

- Ischemia = ST depression or T wave inversion - Injury = ST elevation - Infarct = pathologic Q waves

What are the lateral leads

I, aVL, V5-V6

What are the inferior leads

II, III, aVF

What are the anterior leads

V1-V4

What vessel provides the lateral leads

LCX (or LAD)

What vessel provides the inferior leads

RCA

What vessel provides the anterior leads

LAD

Serious 6 of chest pain

- ACS - PE - PTX - Dissection - Tamponade - Esophageal rupture

Medical tx for acute MI

MONA BASH C Morphine, O2, Nitro, ASA, BB, ACEi, Statin, Heparin, Clopidogrel Things to ALWAYS give: ASA and high dose Statin

Most common EKG findings in PE

1) tachycardia 2) R axis deviation 3) S1Q3T3 (rare)

When do you use tPA in PE

Refractory hypotension (pt with massive PE given O2 and Heparin and fluids and still remains hypotensive)

Tx of PE

1. LMWH 2. DOAC (higher risk of cranial bleed) 3. Warfarin (higher risk of GI bleed)