Internal Medicine Flashcards
What are the stigmata of Infective endocarditis found on exam?
Roth spots (red spots in retina) (immune complex microvasculitis)
Janeway lesions (septic emboli)
Osler nodes (immune complex microvasculitis)
Splinter Hemorrhages (immume or emboli not sure)
Splenomegaly
Petechiae (also conjunctival petchiae) (immume or emboli not sure)
Clubbing
Murmurs
Fever
What are some complications of pancreatitis?
Early
- Infection
- Kidney failure
- Shock
- Hypocalcemia
- Resp sx - can have pleural effusions, ARDS,
- Acute necrotizing pancreatitis
Late Complications
- Pseudocyts
- Hemorragic pancreatitis
- Diabetes
What signs (on exam) are associated with severe necrotizing pancreatitis?
- Cullen sign (bluish discoloration around the umbilicus resulting from hemoperitoneum)
- Grey-Turner sign (reddish-brown discoloration along the flanks resulting from retroperitoneal blood dissecting along tissue planes); more commonly, patients may have a ruddy erythema in the flanks secondary to extravasated pancreatic exudate
- Erythematous skin nodules, usually no larger than 1 cm and typically located on extensor skin surfaces; polyarthritis
What are causes of pancreatitis?
Idiopathic: Hypertensive sphincter or microlithiasis
Gallstones (45%)
Ethanol (35%)
Tumours: Pancreas. Ampulla. Choledochocele
Scorpion stings
Microbiological
- Bacteria: Mycoplasma. Campylobacter. TB. M. avium intracellular. Legionella. Leptospirosis
- Viral: Mumps. Rubella. Varicella. Viral hepatitis. CMV. EBV. HIV. Coxsackie virus. Echovirus. Adenovirus
- Parasites: Ascariasis. Clonorchiasis. Echinococcosis
Autoimmune: SLE. Polyarteritis nodosa. Crohn’s
Surgery or trauma
- Manipulated sphincter of Oddi (ERCP). Post cardiac surgery. Blunt trauma to abdomen. Penetrating peptic ulcer
Hyperlipidemia
- (TG >11.3 mmol/L; >1000mg/dL). Hypercalcemia. Hypothermia
Emboli or ischemia
Drugs or toxins
- Azathioprine. Mercaptopurine. Furosemide. Estrogen. Methyldopa. H2blockers. Valproic acid. Antibiotics. Acetaminophen. Salicylates. Methanol. Organophosphates. Steroids
What is the diagnostic criteria for lupus?
A diagnostic criteria for SLE is to fulfill at least four of the following eleven letters that make up the mnemonic “SOAP BRAIN MD”:
Serositis
Oral ulcers
Arthritis
Photosensitivity
Blood disorders
Renal disease
Anti-nuclear antibody positive (ANA)
Immunologic abnormalities (Anti-sm, Anti-ds DNA)
Neurologic disease
Malar rash - face
Discoid rash
What is you approach/ ddx for Hyponatremia?
- Determine if Hyperosmolar, Iso-osmolar, Hypo-osmolar
Hyperosmolar
- extra osmoles in ECF draws water out of cells.
- Glucose, Mannitor
- Every 10 mmol/l incr in glucose 3 mmol/L decrease Na
Iso-osmolar (factitious)
- Normal ECF osmolality but increased plasma solids (lipids or protein)
- Hyperlipidemia (familial, nephrotic syn, pancreatitis)
- Hyperproteinemia (MM)
Hypo-osmolar (most common)
2. Determine if Hypovolemic, Euvolemic or Hypervolemic
Hypovolemic
- Diuretics
- Salt wasting nephropathy
- Diarrhea
- Excessive sweating
- 3rd spacing (peritonitis, burns, pancreatitis)
Rx: replenish Na and water. NS, rarely hypertonic
Euvolemic - SIADH - Adrenal insufficiency - Hypothyroidism - Psychogenic polydipsia Rs: Water restriction, treat underlying cause
Hypervolemic - CHF - ARF, CRF - Cirrhosis and ascities - Pregnancy Rx: Tx goal Na loss with relatively more H20 loss. Salt and water restriction +/- diuretic
What is the requirement for nephrotic syndrome?
Hypo albuminemia
Dyslipidemia
> 3 g proteinuria
Edema
What are a few complications of nephrotic syndrome?
Edema - secondary to low albumin
Hypercoaguable state- arterial and venous thrombus
Dyslipidemia
Incr infections -? Hypogammaglobinemia, bacterial peritonitis (ascities common), esp encapsulated organisms
What are the Vitamin K sensitive clotting factors?
2,7,9,10
What are the symptoms of Hypercalcemia?
Stones (renal or biliary)
Bones (bone pain)
Groans (abdominal pain, nausea and vomiting)
Thrones (polyuria) and polydipsia are more specific and occur early.
Psychiatric overtones (Depression 30–40%, anxiety, cognitive dysfunction, insomnia, coma)
Other symptoms can include fatigue, anorexia, and pancreatitis
What are the first steps in treatment of hypercalcemia?
- Fluid resuscitation- rehydration and volume expansion
- Diuretics can be used too - care on pt 1
- IV bisphosphonates are used for malignant hypercalcemia (inhibit osteoclast activity)
- Calcitonin injections are also considered in the life threatening circumstances.
- Dialysis also effective.
List 10 causes of hypercalcemia?
- Malignancy (Breast, lung, ENT, MM, leukemia)
- Mets to bone
- Hyperparathyroidism
- Multiple endocrine neoplasms (MEN_
- Hyperthryroidism
- Adrenal insuff
- Granulomatous disease (sarcoid, TB, histo, coccidio)
- Drugs: (Vit D + A), thiazides, milk alkali
- Dehydration
- Prolonged immobilization
- Iatrogenic
- Rhabdomyolysis
- Familial
- Lab error
