Medicine 4 Flashcards
Causes of macrocytic anemia?
Megaloblastic:
B12 and folate deficiency
Non-megaloblastic: Alcoholism, hypothyroid, liver disease, some drugs
20s female presents with 10 days of aching in her hands (MCP, PIP, wrist) and knees. She has some mild patchy redness on her skin with mild diarrhea. No fever or lymphadenopathy. Joints are tender. What are the likely elevated antibodies?
Anti-parvovirus B19 IgM antibodies. Parvo presents as an RH-like disease with a rash (slapped cheek or erythema infectiosum). Typical polyarticular, symmetric arthritis develops with the rash and other viral Sx (diarrhea).
What parasite results in hydatid cysts in the liver (or lung) and how is it spread?
Echinococcus granulosus spread via dog feces. It is a tapeworm endemic to rural developing countries. The presentation is often with one large cyst in the liver on US and smaller “daughter cysts”, which are septations of the original large cyst. IgG serology is best testing. Albendazole is Rx in smaller cysts. Surgery if big.
Contaminated pork consumption can lead to infxn with?
Taenia solium. This is Tx via human to human contact (feces). This disease is called cysticercosis and usually affects the brain (Sz) or cerebral ventricular system (intracranial HTN). Liver cysts uncommon.
What is the most common cause of constrictive pericarditis in developing countries?
Tuberculosis in Africa, India, and China. In first-world countries, viruses, cardiac surgery, and chest radiation are more common causes.
Lack of what vitamin leads to sideroblastic anemia due to impaired protoporphyrin synthesis?
Pyridoxine (B6). Often, two groups of microcytic RBCs can be demonstrated on microscopy (hypochromic and normochromic RBC populations). Increased serum iron concentration and decreased total iron binding capacity helps to differentiate it from iron-deficiency anemia.
Autoantibodies to voltage-gated calcium channels in presynaptic nerves at NMJ. Dx?
Lambert-Eaton. Associated with small cell lung cancers. The loss of Ca++ influx leads to loss of presynaptic release of ACh and proximal muscle weakness with depressed DTRs.
In a person receiving solid organ transplantation, what opportunistic infxn is likely to cause systemic illness involving multiple organ systems (pneumonitis, hepatitis, gastroenteritis)?
CMV. In the absence of prophylaxis, this should be looked for if they have pneumonitis, GI symptoms, and LFTs are elevated. It can cause breathing issues, but if lung issues are present in the absence of liver/GI symptoms then more likely to be PCP.
Pt has recurrent syncopal episodes. What are some ways by which these episodes can be averted?
Physical counterpressure maneuvers. These maneuvers involve tensing muscles (legs, hands, arms, etc.) to maintain venous return and CO, sometimes aborting syncopal episodes.
What methods reduce confounding bias effects in studies?
Early in design stage of study: matching, restriction, randomization
Analysis stage: stratified analysis, statistical remodeling
A female has dysphagia, regurgitation, and pain that radiates to her back from the chest. She notices these episodes occur when she is upset or emotional. Dx?
Esophageal spasm. Monometry establishes a Dx, but episodes like this that occur with emotional distress are typical of esophageal spasm.
55yo female presents with pain, itching, and red streaks on her arm. Similar symptoms had resolved weeks ago on her chest. She is a smoker of 30 years and drinks some alcohol. She has mild epigastric tenderness. Tender, erythematous, palpable cord-like veins on the left arm and upper chest are present. Dx?
Trousseau’s syndrome. It is a hypercoagulability disorder associated with an occult visceral malignancy (pancreas usually, stomach, lung or prostate also) where recurrent migratory superficial thrombophlebitis occur at unusual sites.
A young female from China presents with dyspnea, nocturnal cough, and hemoptysis. Dx?
Rheumatic mitral stenosis. Increased left atrial pressures lead to pulmonary congestion. Dyspnea, orthopnea, paroxysmal nocturnal dyspnea, and hemoptysis can result. A fib can also occur leading to stroke.
40s male presents with changes in personality. Coworkers note that he also seems to have a tic of some sort. He is withdrawn and depressed. MRI of the head shows enlarged lateral ventricles. Dx?
Huntington’s chorea. Atrophy of the caudate nucleus is characteristic and can lead to lateral ventricle enlargement.
The presence of a systolic-diastolic abdominal bruit has high specificity for?
Renovascular HTN. It has low indication for AAA.
Female has sensory change across the dorsal foot and lateral shin. She has impaired ankle dorsiflexion and great toe extension with preserved plantar flexion and reflexes. Dx?
Common fibular neuropathy. Usually the result of leg immobilization, leg crossing, or protracted squatting. Unilateral foot drop with impaired ankle dorsiflexion (walking on heels) and preserved plantar flexion (walking on toes) are typical.
Drug of choice for treating chemotherapy-induced nausea and vomiting?
5HT3 serotonin receptor antagonists.
Best test for suspected ankylosing spondylitis?
X-ray of the SI joints can show sacroiliitis
What is the gold standard for acute angle-closure glaucoma?
Gonioscopy (slit lamp view of the angle) is the gold standard. Ocular tonometry is helpful if gonioscopy is unavailable.
When do symptoms for IgA nephropathy occur vs postinfectious glomerulonephritis?
IgA neph: Usually occurs within 5 days of URI (synpharyngitic). Recurrent gross hematuria results.
Postinfectious glomeruloneph: Usually 10-21 days after URI (post-pharyngitic). Gross hematuria. Low C3 complement.
A woman with DMII and osteomyelitis due to a foot wound would likely have infxn with what kind of bacteria?
Polymicrobial (+, -, and anaerobes). Osteomyelitis is often due to contiguous spread.
What is the duration of effect of “bath salts”?
Duration of effects can be days or weeks even, vs other drugs that last hours. Typical symptoms include agitation, combativeness, psychosis, delerium, myoclonus, and Sz.
40s male develops CP and diaphoresis in a meeting. He loses consciousness and is given CPR by coworkers. He regains consciousness in 60 seconds. He has DMII, HTN, and high lipids. ECG shows STEMI in V1-V3. What’s the most likely mechanism for his syncope/arrest?
Reentrant ventricular arrhythmia (like V.fib) are the most common cause of sudden cardiac arrest in the immediate post-infarction period in acute MI. R. sided MI can cause AV conduction blocks, especially those with inferior MI, but it is transient and resolves after reperfusion therapy (thrombolytics).
What medication is approved for use in ALS patients?
Riluzole, a glutamate inhibitor, may prolong survival and the time to tracheostomy.
Pt. presents with vague abdominal pain, bluish discoloration to her right great tue and all the toes in her left foot. She has a lacy appearing rash on her legs also. Her Cr is 2.3mg/dL (1.1 on admission). ECG shows NSR with Q waves in anterior leads. Dx?
Atheroembolism (cholesterol embolism). This is a complication of cardiac catheterization and some other vascular procedures. Blue toe syndrome and livedo reticularis (lacy/reticular rash) are typical symptoms. Intestinal, cerebral, kidney ischemia are common. Hollenhorst plaques (cholesterol in retina) are present on fundoscopy.
Pulmonary emboli most likely originate from?
Proximal thigh (iliac, femoral, popliteal veins). These veins are the source of >90% of acute PEs. DVT in the distal leg or calf are less likely to embolize and more likely to resolve spontaneously.
Electrical alternans is fairly specific for what cardiac emergency?
Pericardial effusion leading to cardiac tamponade. This presents as varying QRS complex amplitudes.
A 52yo man presents to the office with polyuria and polydipsia. He has some weight loss despite no appetite changes. His dad has HTN and DMII. Nonfasting glucose is 280. What is likely to be elevated in this Pt?
Insulin levels. Insulin resistance in type 2 diabetes can lead to normal or high insulin levels. Remember that DKA occurs in DM1, while HHNK occurs in DM2.
