Lectures Flashcards
Thyroiditis
Destruction of thyroid gland
Painless - autoimmune or post viral Postpartum - autoimmune Subacute - painful, post viral Suppurative Radiation
Medication induced thyrotoxicosis
Amiodarone - has iodine in it (increased production) also is directly toxic
Lithium - hypothyroidism is more common
Contrast - has iodine in it (increased production)
Exogenous thyroid hormone - psychiatrists do this
Atrial tachycardia treatment
Ablation
Metoprolol or flecainide second choice
Ventricular tachycardia etiology
Reentry
ARVC
Epsilon waves Inherited myocardial disease Fibrofatty replacement of the RV Autosomal dominant, more common in men, Mediterranean No sports - accelerates progression First degree relative screening
Giant cell myocarditis
Eosinophils
T cell dysregulation
Diagnose with biopsy
Immunosuppression, transplant
Ornithine transcarbamylase deficiency
Isolated hyperammonemia
Dialysis or ammonul
Arginine and citrulline supplementation - urea cycle intermediates
Diagnosis with urine orotic acid, genetics
Mitral stenosis severity
Rate matters
Gradient >10 is severe
HIT
Platelet factor 4 ~10 days after heparin Warfarin Argatroban Bivalrudin
Rheumatic afib
Very high thrombotic risk
Warfarin w INR goal 2.5-3.5
Gitelman syndrome
Urine high k high na high cl high mag low calcium
Scleroderma renal crisis
Htn, maha, nephritis
Ace inhibitor
LMN weakness differential
Anterior horn: WNV ALS Lead Polio
Spinal nerve
Peripheral neuropathy - GBS, amyloid, DM
Muscle weakness ddx
Electrolyte - Mg Phos K Ca
Medications - statins, steroids, linezolid, colchicine, hydroxychloroquine
Inflammatory - dermatomyositis, polymyositis, inclusion body
Endocrine - hypothyroid, Cushing
Toxins - alcohol
Dermatomyositis and polymyositis
Proximal weakness Ck Ana Jo-1 Mi-2 (dermatomyositis) Assoc with malignancy, scleroderma, mctd (dermatomyositis)
Steroids, azathioprine, mtx
Inclusion body myositis
Insidious onset
Prox and distal weakness
Asymmetric
Dysphagia - cricopharyngeal muscle
cN1A antibody
Mild CK elevation
Necrotizing myositis
Anti-SRP
Anti-hmgcr (statins)
Negative
Risk: statins, paraneoplastic, rheum
No infiltrate on biopsy
Spirometer study quality
6 seconds or plateau of exhalation
Spirometry obstruction
FEV1/FVC < 0.70
FVC > lln
Bronchodilator response increase by 12% and 200 cc
Spirometry restriction
Can’t diagnose by itself
FVC < LLN
Confirm with lung volumes
Obstructive Lung disease severity
%FEV
Mild >80
Mod 50
Severe 30
Intrathoracic vs extrathoracic central airway obstruction
Intrathoracic - flattening expiration
Extrathoracic - flattening inspiration
Lung volumes
Up obstruction
Down restriction
DLCO
Area available for gas exchange
Low - emphysema, ild, lobectomy, anemia, pulmonary hypertension, vasculitis
High - L-R shunt, high CO, polycythemia, DAH
Neurocystercercosis treatment
Albendazole
Anti phospholipid clues
Mild thrombocytopenia
Prolonged PTT
Livedo reticularis
Antiphospholipid antibody testing
Lupus anticoagulant (Russel viper venom) test falsely positive if anticoagulated
Other tests are beta 2 glycoprotein and cardiolipin
To diagnose you need antibodies and thrombosis or pregnancy event
Hypertensive emergency treatment options
Aortic dissection - esmolol
Pulmonary edema - nipride
NSTEMI - nitroglycerin
Sjogren’s patient with new parotid swelling
Lymphoma
Igg4
Fibroinflammatory All organs involved Lymph nodes, parotid Retroperitoneal fibrosis, aortitis Sausage pancreas Plasmocytic infiltration B cells, cd4 T cells, eos
Treat with steroids
Hypermagnesemia
Distributive shock
Don’t give mag citrate to old people or esrd
Ecthyma gangrenosum
Pseudomonas bacteremia
Rapidly progressive
Fever
Bullae
Hook osteophytes
Hemochromatosis
Primary spontaneous pneumothorax treatment
Observe if less than 2 cm
Needle if more than 2 cm
Diet for calcium oxalate stones
Increase dietary calcium
Low protein
Low sodium
High citrate
Lupus nephritis classifications
I - normal II - mesangiocapillary III - focal sclerosis IV - diffuse sclerosis V - membranous VI - burnt out
Immunosuppression for 3 and 4
Sodium and skin
Glycosaminoglycans buffer sodium
7 day circadian rhythm
Extensive burns end up with aldosterone mechanism alone - salt sensitive labile blood pressure
Methanol vs ethylene glycol
Methanol causes vision changes
Aspergillus in lung
Fungal ball w halo sign
Galactomannan and beta d glucan, not sensitive
Rheumatoid ILD
Men more likely
Smoking more likely
Monitor if asymptomatic
Steroids MMF cytoxan if symptomatic
RA vasculitis
25-30% of patients
Medium vessels
Cutaneous (scleritis, aortitis, GN)
Rituxan or cytoxan
RA lymphoma
DLBCL
Felty syndrome
NHL risk up RA plus neutropenia plus splenomegaly Low complements High immunoglobulins Methotrexate, rituximab If ANC <1000 can give GSF stimulation
Atabacept for inadequate response
Splenectomy if medical management fails
