Internal Medicine Flashcards
What drug should be initiated in all patients post-MI to limit ventricular remodeling?
ACE inhibitors
Treatment of pyelonephritis
Fluoroquinolones (Levofloxacin)
What type of stroke is not usually visualized acutely on a CT scan?
Lacunar stroke – due to small infarct size
S3 indicates?
Heart failure
Lab findings in diabetes insipidus
Euvolemic hypernatremia
Very dilute urine: the body doesn’t make ADH or doesn’t respond to ADH
Most common cause of severe hypercalcemia
Malignancy is the most common cause of PTH-independent hypercalcemia and typically presents as very high (>14) and symptomatic (polyuria, constipation, nausea) calcium levels
Humoral hypercalcemia of malignancy is due to secretion of PTH-related peptide by malignant cells
Nephrotic syndrome associated with SLE
Membranous nephropathy
Ludwig Angina
o Rapidly progressive bilateral cellulitis of the submandibular and sublingual spaces
o Classically arises from an infected second or third mandibular molar
o Present with fever, dysphagia, odynophagia,, and drooling
o Most common cause of death = asphyxiation
o Tx: antibiotics anf removal of the infected tooth
What is the ECG finding in pericarditis? What is the treatment?
ECG: diffuse ST elevations and PR depression
Tx: NSAIDs, colchicine
What causes hepatorenal syndrome? What is the treatment?
Progressive renal failure in advanced liver disease, 2/2 renal hypoperfusion resulting from vasoconstriction of renal vessels
Liver transplantation is the only cure
Diagnosis of Whipple disease
biopsy of small intestine: visualization of villous atrophy and foamy macrophages in the intestinal lamina propria that are PAS positive and contain gram positive bacilli
Possible sequelae of nephrotic syndrome
Hyperlipidemia – leading to inc risk of atherosclerosis
Inc risk of infections – due to loss of immunoglobulins in urine
Hypercoagulability due to loss of antithrombin III in urine
What drug should be avoided in a patient with cocaine use that caused an MI and tachycardia?
DO NOT GIVE BETA BLOCKERS – this can cause unopposed alpha activity, which can worsen vasospasm and increase ischemia
What is dermatomyositis associated with?
Malignancy: ovarian, lung, breast, colorectal and non Hodgkin Lymphoma
*Dermatomyositis associated with malignancy often remits once the tumor is removed
Anatomy of upper vs lower GI bleed?
Upper GI bleed: above the ligament of treitz
Lower GI bleed: below the ligament of treitz
A 27 yo F presents with visual disturbances and painful eye movements. She also says that when she flexes her neck, she develops a shock-like sensation down her back. What do you suspect and how will you diagnose this?
Multiple sclerosis
MRI is diagnostic (periventricular plaques)
CSF findings: oligoclonal IgG
What does the Abdominal succession splash maneuver test for?
Gastric outlet obstruction
place the stethoscope on the upper abdomen and rock the patient back and forth at the hips – Retained gastric material >3 hrs after a meal will generate a splash sound, indicating the presence of a hollow viscus filled with fluid and gas
Heparin induced thrombocytopenia
- presentation
- treatment
IgG is formed against the heparin-platelet factor 4 complex and results in platelet activation and aggregation → clotting
• Platelets <100k or less than 50% from baseline
Leads to DVT and PE (hypercoaguable state)
o Stop heparin and treat with Agatroban or Bivalrudin (direct thrombin inhibitors)
o Do not treat patients with Warfarin, because the transient inhibition of protein C can worsen the clotting
Sequelae of EBV
Splenic rupture (avoid sports for >3 weeks)
Autoimmune hemolytic anemia (cold aggultinin- IgM)
Sideroblastic anemia
Causes and treatment
defect in heme synthesis due to defect in ALA synthase
Typically manifests as microcytic hypochromic anemia simulating iron-deficiency anemia
• Usually can see two groups of RBCs – hypochromic and normochromic
Can be caused by genetic defect (X linked), alcohol abuse, lead, vitamin B6 deficiency, copper deficiency, isoniazid
Treatment: vitamin B6 (cofactor for ALA synthase)
Treatment of prolactinomas
Dopamine agonists (Bromocriptine and Cabergoline) inhibit prolactin secretion
Consider surgical intervention if symptoms progress despite appropriate medical therapy
Most head and neck CA are what type of cancers?
Squamous cell carcinomas
What must be given to patients taking Isoniazid?
Vitamin B6 (pyridoxine)
To avoid side effect of peripheral neuropathy
Electrical vs pharmacological cardioversion
What do you need to be sure of before doing cardioversion in a stable patient?
Electrical is preferred
If electrical fails, do pharmacologic with ibutilide, procainamide, flecainide, sotalol, or amiodarone
If patient has been in Afib for >48 hours, then need to perform TEE to check for thrombus in the left atrium. Or you can anticoagulate for 3 weeks prior. need to anticoagulate for 4 weeks after cardioversion
Asian female with microcytic anemia
Likely due to alpha thalassemia
Treatment of trigeminal neuralgia?
Carbamazepine
Takayasu arteritis
Granulomatous inflammation of arteries seen mainly at aortic branch points
Seen in young, Asian females
S/S: constitutional (fever, weight loss), aterio-occlusive (claudication, ulcers) in upper extremities, arthralgias, myalgias
Exam: BP discrepancies, pulse deficits, arterial bruits
Tx: systemic corticosteroids
Stroke in periphery vs stroke in deep structures
- Stroke in periphery = embolus
* Stroke in deep structures = HTN
What can you give to increase appetite and weight gain in patients with cancer-related anorexia/cachexia syndrome?
Progesterone analogs (megestrol acetate)
synthetic cannabinoids are useful in advanced HIV cachexia
Sinusitis can lead to developmen of a brain abscess. This is usually due to what type of bacteria?
Viridans streptococci (strep intermedius, S mitis, S oralis, S mutans) and other anaerobic bacteria (Prevotella, Peptostreptococcus, Bacteroides)
Where does A Fib originate from? What about A flutter?
A Fib = The pulmonary veins
A flutter = reentrant circuit around the tricuspid annulus
What is the most common cause of death in multiple myeloma pateints?
Infections– due to decreased production of normal immunoglobulins
Achalasia versus Systemic Sclerosis
Both cause dysphagia and dyspepsia
Achalasia causes increased LES pressure and incomplete LES relaxation
Systemic sclerosis causes decreased LES pressrue
Characteristic feature of Huntington’s
Atrophy of the caudate nucleus
Treatment of pituitary adenomas
transsphenoidal surgery is indicated in most patients, except in patients with prolactinomas, for which medical management should be tried first
What causes hyperkalemia in DKA?
Extracellular shift (H+ shifts into cells, and K+ shifts out of cells)
Also the lack of insulin causes decreased action of Na/K ATPase
What is enthesitis?
Inflammation and pain at sites where tendons attach to bone
Classic site is at the insertion of the Achilles tendon at the heel
Can occur as an isolated disorder or in spondylarthropathies (especially Ankylosing spondylitis)
What causes proptosis in Graves’ ophthalmopathy?
Fibroblasts behind the orbit express the TSH receptor –> cytokines released by activated T cells increase fibroblast proliferation and secretion of glycosaminoglycan, resulting in mucinous edema and tissue expansion
Lacunar stroke
due to HTN – involve the small penetrating vessels that supply the deep brain structures and subcortical white matter
Causes pure motor dysfunction or pure sensory dysfunction
Vessels develop arteriolar sclerosis and may become occluded → development of small cavitary lesions due to liquefaction (tissue loss surrounded by gliosis)
What are precipitating causes of Acute Respiratory Distress Syndrome? How does a CXR look?
Trauma, sepsis, shock, gastric aspiration, acute pancreatitis, amniotic fluid embolism
CXR shows bilateral “white out”
Common electrolyte abnormality seen in chronic kidney disease
Hyperphosphatemia
Hypocalcemia
(Secondary hyperparathyroidism)
Cyanide poisoning treatment
- Amyl nitrite- oxidizes ferrous iron (Fe2+) to ferric iron (Fe3+) generating methemoglobin – methemoglobin cannot carry O2 and it has a high affinity for cyanide – it binds and sequesters cyanide in the blood, freeing it from cytochrome oxidase and limiting its toxic effects
- Hydroxycobalamin- generates nontoxic metabolites that are easily excreted in the urine
- Thiosulfate- serves as a sulfar donor to promote hepatic conversion of cyanide to thiocyanate – which is excreted in urine
What is a complication of high use of B2 agonists?
Hypokalemia
drive K+ into cells by increasing activity of Na/K ATPase
The presence of epigastric discomfort on exertion that is not relieved by antacids is concerning for what?
cardiac pathology
Features of IgA deficiency
Recurrent pneumonia, atopy (asthma, eczema), and an anaphylactic reaction during blood transfusion
Nephrotic syndrome associated with HIV?
FSGS (Focal segmental glomerulonephritis)
Child from Africa with an expanding jaw mass
Burkitt Lymphoma (Non hodgkin lymphoma)
- associated with EBV
- path will have “starry sky” appearance
target INR
Between 2-3
EKG findings in pericarditis
Diffuse ST elevations and PR depressions
Treatment of opioid withdrawal
Methadone (long half life)
Where does heme –> bilirubin take place?
In the spleen
Heme -> biliverdin -> bilirubin
Intensive glycemic control in T2DM decreases what complications?
Microvascular complications (nephropathy, retinopathy)
No change in macrovascular complications (MI, stroke, PAD)
Waldenstrom macroglobinemia vs Multiple myeloma
Both have Rouleaux formation on blood smear and bone marrow biopsy shows >10% clonal plasma cells
WM: (IgM)
- Hyperviscosity syndrome
- Neuropathy
- Bleeding
- Hepatosplenomegaly
- Lymphadenopathy
MM (IgG, IgA, light chains) Osteolytic lesions - Anemia - Hypercalcemia - Renal insufficiency
Brain mets
lung>breast>melanoma
Light criteria
Transudative vs exudative pleural effusions
Exudate
Protein (pleural/serum) >0.5
LDH (pleural/serum) >0.6
Haptoglobin in hemolytic anemia
Decreased haptoglobin in hemolytic anemia
As the RBC is lysed and hemoglobin is released into the blood, it is scavenged by haptoglobin. The haptoglobin+hemoglobin is engulfed by macrophages`
Treatment of BPH
alpha blockers (tamsulosin and terazosin) to relax smooth muscle
5a reductase inhibitors (finasteride) to reduct prostate size
CSF in Guillain Barre
CSF is significant for albuminocytologic dissociation (increased protein with normal cell count)
Anion gap equation
Causes of inc anion gap
AG = Na – (Cl + HCO3)
Normal range = 8-12
MUDPAILES o Methanol o Uremia o DKA o Propylene glycol o Alcoholic ketoacidosis o Isoniazid o Lactic Acidosis o Ethylene Glycol o Salicylates
Most common causes of cough
“GAA”
GERD
Asthma
Allergies (post nasal drip)
What would you expect to see in a patient with atheroembolism (cholesterol embolism)?
What medication should be initiated in these patients?
Atheroembolism is a complication of cardiac catheterization and other vascular procedures
Features: cutaneous findings (blue toe syndrome, livedo reticularis), cerebral or intestinal ischemia, AKI, and Hollenhorst plaques on retina
Tx: supportive and statin therapy
Ice pack test for myasthenia gravis
an ice pack is applied over the eyelids for several minutes, leading to an improvement in the ptosis
• The cold temperature improves muscle strength by inhibits the breakdown of Ach at the NM junction
In what kinds of patients would you expect to see acalculous cholecysitis? What is the treatment?
In patients with a severe illness: trauma, burns, postop
tx with emergent cholecystectomy
Relationship of magnesium and potassium
Hypomagnesemia causes refractory hypokalemia because Mg is an important cofactor for K+ uptake and maintenance of intracellular potassium levels
• Need to correct both Mg and K levels when a patient is hypokalemic
Treatment of essential tremor
B blocker or primidone (anticonvulsant)
What valvular defect can occur in aortic dissection?
Aortic regurg
Metabolic syndrome
HTN, impaired fasting glucose, and dyslipidemia –> Due to insulin resistance
Diagnose when 3/5 of the following criteria are met:
- Abdominal obesity (M: >40 in, F: >35 in)
- Fasting glucose >100-110
- BP > 130/80
- Triglycerides >150
- HDL Cholesterol (M:
Most common cause of alkaline phosphatase in an asymptomatic elderly patient? Treatment?
Paget disease
Tx with bisphosphonates
Beck’s triad
Indicative of cardiac tamponade
- muffled heart sounds
- JVD
- hypotension
Patient presents with fever, malaise, and cough with foul smelling sputum.
What do you suspect? What are risk factors? What is the best treatment?
Aspiration pneumonia (anaerobic infection)
RF= poor dentition, upper airway instrumentation (NG tubes), dysphagia, and impaired consciousness
Tx: Clindamycin
What are some causes of dilated cardiomyopathy? What would an echocardiogram show?
Idiopathic (>50% of cases) Viral: coxsackievirus B Alcohol abuse Doxorubicin Pregnancy thiamine or selenium deficiency
Echocardiogram shows dilated ventricles with diffuse hypokinesia resulting in low ejection fraction (systolic dysfunction)
Who is at risk for warfarin induced skin necrosis?
Protein C/S deficiency
With the initiation of warfarin therapy, there is a rapid drop in F7 and protein C , which causes a transient hypercoagulable state –> causes thrombotic occlusion of microvasculature and skin necrosis
Red urine with no RBCs detected on dipstick
Rhabdomyolysis (myoglobin)
HSV encephalitis
Hemorrhagic necrosis of the temporal lobe
Diagnose via PCR analysis of HSV DNA in the CSF
Most common cause of lower GI bleeding in adults?
Diverticulosis– can produce painless, large volume bleeding
Nephrotic syndrome associated with NSAIDs
Minimal change disease
Patient with Crohn disease presents with alopecia, loss of taste and appetite, and bullous lesions around orifices. What is the likely cause?
Zinc deficiency
How does hypokalemia cause hepatic encephalopathy?
Increased renal production of ammonia
Treatment of torsades de pointes
Magnesium sulfate
Treatment of cluster headache? What can be used for prophylaxis?
Tx: 100% O2
Prophylaxis: Verapamil
Lab values in primary adrenal insufficiency
hyperkalemia, hyponatremia, hyperchloremia, and non-anion gap metabolic acidosis
Rickets/osteomalacia
Vitamin D deficiency (Vit D normally increases absorption of calcium and phosphate in the intestines and enhances bone mineralization)
Defective mineralization of osteoid due to lack of phosphate
What is the cause and what is the treatment of neuroleptic malignant syndrome
Cause: drug reaction to dopamine antagonist medications
Treatments: D/c the psych med that caused this adverse reaction supportive care Dantrolene Bromocriptine Amantidine
What happens if you replenish a folate and b12 deficient patient with folate but dont also give them B12?
Correction of megaloblastic anemia but rapid progression of neurological symptoms
What is more important in management of AFib? Rate control or rhythm control?
Rate control! With B blockers or calcium channel blockers
What are some common clinical features in adrenal insufficiency?
Fatigue, weakness, anorexia/weight loss, GI symptoms
Postural hypotension
Hyperpigmentation or vitiligo (in primary adrenal insufficiency)
Hyponatremia, hyperkalemia
Hypoglycemia
Rapidly progressive dementia with myoclonus
Creutzfeldt Jakob: prior disease
What treatment should be started in a woman with polycystic ovarian syndrome in order to induce ovaluation
Clomiphene citrate
SERM that antagonizes estrogen in the hypothalamus and allows LH and FSH to increase –> leading to ovulation
What deficiency is associated with carcinoid syndrome?
Niacin – due to inc production of serotonin
Tx of hypercalcemia
Normal saline hydration plus calcitonin
Long term tx = bisphosphonates
Prinzmetal Angina Presentation: Diagnosis: Treatment: Risk factors:
Presentation: transient coronary vasospasm causing chest pain classically at night
Diagnosis: hallmark is transient ST segment elevation on EKG during chest pain
Treatment: Diltiazem and nitrates
Risk factors: smoking, HLD
When do you see pneumocystis pneumonia? What lab value is always elevated during infection?
Treatment:
HIV patients with CD4 less than 200
LDH is characteristically elevated
Tx: Tx with Bactrim (TMP-SMX)
• Add corticosteroids if the A-a gradient is > 35 or if the patient has a low O2 sat
What type of bilirubin is seen in urine?
Conjugated (direct) - it is loosely bound to albumin and therefore water soluble
*Unconjugated bilirubin is tightly bound to albumin and is toxic
Management of Afib in a hemodynamically unstable vs stable patient
Unstable: immediate electrical cardioversion
Stable: rate control with B blockers, then consider cardioversion
Nephrotic syndrome associated with heroin use
FSGS
EBV DNA in the CSF is specific for what?
Primary CNS lymphoma
Where does choriocarcinoma metastasize to?
The lungs
How to differentiate between CML and leukemoid reaction
CML has a very low leukocyte alkaline phosphatase (LAP) score because the neutrophils in CML are chemically and functionally abnormal
Compared to benign neutrophilia (Leukemoid reaction) in which LAP is high
How does the pneumococcal polysaccharide vaccine work?
Induces a T cell independent B cell response (polysaccharides alone cannot be presented to T cells)
Felty syndrome
Advanced RA with splenomegaly and neutropenia
Severe, seropositive RA with inc risk for extra-articular manifestations (vasculitis, skin ulcers)
What thyroid cancer produces calcitonin?
Medullary carcinoma – arises from parafollicular c-cells
Jarisch-Herxheimer reaction
may develop in the tx of syphilis
When syphilis is treated with PCN, the spirochetes die rapidly, thereby leading to the release of antigen-antibody complexes in the blood, and consequent immunologic reaction, which seems like an acute flare-up of syphilis
Why do you see hyperpigmentation in primary adrenal insufficiency?
because excess ACTH (due to lack of negative feedback from cortisol) stimulates melanocytes
ACTH and MSH share common origins
What acid-base disorder would you expect in a person with primary adrenal insufficiency?
Normal anion gap metabolic acidosis
Dec. in aldosterone means that the patient will have hyponatremia and hyperkalemia. H+ moves out of cells and K+ moves into cells to correct disturbance, and causes metabolic acidosis
What does hyponatremia in a CHF patient indicate?
Poor prognosis
Management of a patient with wolff parkinson white who presents in afib and is hemodynamically stable.
Procainamide (DO NOT GIVE B BLOCKER OR CA CHANNEL BLOCKER)
A young woman presents to your office with a heeadache for the past two weeks. On exam, she is obese and you note papilledema on fundoscopic exam. MRI of the head is unremarkable. What do you suspect and what is the tx? What is this associated with? What is a complication of this problem?
Pseudotumor cerebri (idiopathic intracranial HTN) Suspect this in a young obese female with a headache that is suggestive of a brain tumor yet has normal imaging and elevated CSF pressure
Associated with vitamin A excess, OCP use, obesity
Treat with weight reduction & Acetazolamide
Complication: blindness
Familial hypocalciuric Hypercalcemia
o Caused by a mutation in the calcium sensing receptor
o Features: asymptomatic hypercalcemia, elevated or inappropriately normal parathyroid hormone levels, and low urinary calcium excretion
Acid Base findings with salicylate overdose
Salicylate overdose will have respiratory alkalosis and metabolic acidosis
Pt will present with respiratory alkalosis (tachypnea causes loss of CO2) which then develops into anion gap metabolic acidosis (accumulation of organic acids in the blood such as ketoacids, lactate, and pyruvate)
Which valvular disorder is associated with A fib? Why?
Mitral stenosis –> causes L atrial dilation
Treatment of hyperkalemia
o If severe and with EKG changes, give IV calcium (stabilizes the cardiac cell membrane and decreases excitability)
o Glucose and insulin – increases activity of Na/K ATPase and shifts K+ into the intracellular compartment
o Kayexalate: GI potassium exchange resin (Na/K exchange in the gut) absorbs K+ in the colon and allows K+ to be cleared in stool
How does cirrhosis cause hypothyroidism
o The liver is responsible for making serum binding proteins for T3 and T4 (Thyroxine binding globulin, thranthyretin, albumin and lipoproteins)
o Cirrhosis leads to dec synthesis of these proteins and lowers the total T3 and T4
Lambert Eaton syndrome is associated with what? What causes it?
Small cell carcinoma (paraneoplastic syndrome)
Antibodies directed at the presynaptic Calcium channels causes symmetric proximal muscle weakness
What may still be intact with brain death?
The spinal cord – DTRs may be intact
Treatment of diabetic peripheral neuropathy
NSAIDs
Gabapentin
TCAs
Why does cyanide poisoning cause lactic acidosis?
Cyanide inhibits cytochrome oxidase a3 in the electron transport chain – blocks ceullar respiration and increases anaerobic metabolism, which causes a build up of lactic acid
Nephrotic syndrome associated with obesity
FSGS
What is the major risk factor for papillary thyroid carcinoma?
History of radiation to the head/neck
Alternating amplitude of QRS complexes on EKG
Electrical alterans (cardiac tamponade)
Obstructive lung disease PFT findings
- Very dec FEV1 (amount of air expired in one sec)
- Dec FVC (total amount forcibly expired)
- **Dec FEV1/FVC ratio
- Inc TLC (see hyper inflated lungs in CXR)
- Dec diffusing capacity for CO (DLCO)
What can pica syndrome be associated with?
Iron deficiency anemia
What is a contraindication to use of succinylcholine for rapid intubation? What should you use instead?
Hyperkalemia – succinylcholine can cause significant potassium release and life-threatening arrhythmias
o Includes patients with recent crush or burn injuries, demyelinating syndromes like Guillain Barre and patients with tumor lysis syndrome
o Instead, use non depolarizing agents such as vecuronium or rocuronium
Lid lag
Hyperthyroidism
What is the most feared side effect of propylthiouracil and methimazole (tx of hyperthyroidism)? What should you look out for in your patient?
Agranulocytosis
If a patient complains of sore throat and fever, STOP THE DRUG immediately and determine WBC count
What is pulsus paradoxus and when is it seen?
Exaggerated drop in systolic blood pressure during inspiration
Seen in cardiac tamponade, asthma, COPD, pericarditis, and croup
CXR shows bilateral hilar fullness/lymphadenopathy
Sarcoidosis
Causes of aseptic necrosis of the femoral head
(ASEPTIC): Alcoholism, Sickle cell disease, Exogenous/endogenous corticosteroid use, Pancreatitis, Trauma, Idiopathic, Caisson (“the bends” due to deep sea diving)
What arrhythmia is associated with hyperthyroidism
A fib
Ramsay hunt syndrome
A form of herpes zoster that causes Bell’s palsy (paresis of CN 7).
Typically see vesicles in the outer ear
What is cor pulmonale? What are the signs/symptoms?
Right sided heart failure due to PAH
JVD and edema
Calcium and albumin
Patients with hypoalbuminemia can have decreased total serum calcium – however, ionized calcium (physiologically active form) is hormonally regulated and remains stable
Corrected calcium = (measured total calcium) + 0.8 (4 - serum albumin)
What is the classic triad of Wernicke encephalopathy? What is the treatment?
- Encephalopathy (AMS)
- Ocular dysfunction
- Gait ataxia
Give thiamine along with or before glucose
Closed angle glaucoma
Features
Diagnosis
Triggers
medical emergency!! When the peripheral iris pushes up against the trabecular network and prevents aqueous humor from draining
Features: sudden-onset eye pain, headache, nausea, diminished vision, and halos around lights. Nonreactive and mid-dilated pupil
Gonioscopy is the gold standard for diagnosis
Ocular tonometry can be helpful if urgent ophthalmological consultation is unavailable
Can occur spontaneously or be triggered by certain medications (decongestants, antiemetics, anticholinergic drugs)
Why could you seen hypocalcemia after a patient is given a blood transfusion?
Citrate is a calcium chelator
Where is a varicocele more common (L or R)? Why?
On the left – the left testicular vein drains into the left renal vein which then drains into the IVC, while the right testicular vein drains directly into the IVC
What is the most common complication of ADPKD
Intracerebral berry aneurysm rupture
What is the initial treatment for RA? If they dont respond, what should be added?
- initial tx with Methotrexate
2. if unresponsive , add a TNF alpha inhibitor such as etanercept or infliximab
Nephrotic syndrome associated with Hep B and C
Membranoproliferative
What type of arthritis does hemochromatosis cause?
Pseudogout (CPPD): will see chondrocalcinosis on XR
HIV is related to which nephropathy
Focal segmental glomerulonephritis (FSGS) aka HIV-related nephropathy
Treatment of hepatic encephalopathy
- Treat the precipitating cause (alkalosis, hypokalemia, sedatives, GI bleeding, infections, hypovolemia)
- Lower serum ammonia levels
a. Lactulose: converts ammonia to ammonium in the gut (traps ammonia in the stool)
b. Rifaximin: antibiotic that kills ammonia-producing gut bacteria
If a person has medullary carcinoma what should you screen them for?
Pheochromocytoma (medullary carcinoma is associated with MEN2A/B)
Most common type of renal stone
Calcium oxalate
What labs would you expect in someone with multiple myeloma/
Hypercalcemia
Anemia
Renal insufficiency
Nephrotic syndrome associated with malignancy (adenocarcinoma)
Membranous nephropathy
Low back pain that classically improves with activity
Ankylosing spondylitis
What is the most common cause of kidney stones in people with Crohn disease?
increased oxalate absorption due to fat malabsorption
Under normal circumstances, calcium binds oxalate in the gut and prevents its absorption. In patients with fat malabsorption, calcium is preferentially bound by fat and this leaves oxalate unbound and free to be absorbed
UA and labs in ethylene glycol poisoning
New onset elevation in creatinine and metabolic acidosis with elevated anion gap and UA with oxalate crystals is characteristic of ethylene glycol (antifreeze) poisoning
Pressures in the heart equalized…what should you suspect?
Cardiac tamponade
How do vagal maneuvers work? What drug has a similar mechanism of action?
Valsalva, carotid sinus massage, and immersion in cold water
Increase vagal tone and decreases conduction through the AV node – slows the HR
Adenosine is a short acting AV node blocker
3 main features of Aspirin Exacerbated Respiratory Disease
- Asthma
- Nasal polyps
- Bronchospasm following ingestion of ASA or other NSAIDs
Strongest predictors of AAA expansion are:
large aneurysm diameter, rapid rate of expansion, and current cigarette smoking
Hemochromatosis
iron overload due to increased intestinal absorption, leading to iron deposition in the liver, pancreas, skin, heart, and joints (pseudogout)
AR condition
Classic triad: cirrhosis, diabetes mellitus, and skin pigmentation (“bronze diabetes”)
Can cause reversible dilated or restrictive cardiomyopathy (reversible), arthropathy, and hepatocellular carcinoma
What is senile purpura?
ecchymoses in elderly patients in areas exposed to repeated minor trauma (extensor surfaces of the hands and forearms)
Due to age related loss of elastic fibers in perivascular connective tissue
Pressures in the heart seen with cardiac tamponade
Pressures in the RV, LV, RA, LA, pulmonary artery, and pericardium equalize during diastole
Churg Strauss
o Necrotizing granulomatous inflammation with eosinophils, involving the heart and lungs
o Often associated with asthma and peripheral eosinophilia
o Antibodies against neutrophil myeloperoxidase (p-ANCA)
o Asymmetric multifocal neuropathy due to vasculitis of the epineural vessels)
Hypertrophic cardiomyopathy murmurs
A systolic murmur that increases with Valsalva (decreased preload) and decreases with squatting (increased preload)
Aortic regurg
o High pitched diastolic decrescendo murmur that is associated with visible and palpable cardiac pulsations
o Rapid and forceful distention of arterial pulse with quick collapse due to transfer of momentum from the increased LV stroke volume to the head and neck
o Involuntary head bobbing: a sign of widened pulse pressure
Which lung cancer can cause hyponatremia?
Small cell carcinoma – SIADH
