Medicine Flashcards
Polymyalgia rheumatica
QID: 3317
Age >50, subacute to chronic (1+ month) pain in shoulder and hip girdles
- Elevated ESR (>40)
- Tx: Low dose prednisone
Fibromyalgia
QID: 3317
- Widespread pain
- POINT TENDERNESS
- Tx: Regular aerobic exercise + good sleep hygiene
Irritable bowel syndrome
QID: 4595
- ROME diagnostic criteria: recurrent abd pain/discomfort for 3+ days/month for past 3 months with at least 2 of: improvement with BM, change in frequency of stool, change in form of stool
- Normal colonic mucosa on colonscopy
Toxic adenoma(TA)/Toxic Multinodular goiter (MNG) QID: 4307
- Most common causes of hyperthyroidism after Graves
- Activating mutations at TSH receptor –> Follicular hyperplasia
- Initial tx: beta blocker + thionamide (MMI or PTU)
- Definitive tx: RAI or surgery
Thyroid hormone effects
QID: 4307
- leads to increased osteoclastic bone resorption
- Cardiovascular effects = tachycardia, increased SBPs, increased pulse pressure, tachyarrhythmias (AFib)
Atheroembolism
QID: 2310
Complication post cardiac cath or vascular procedure
Skin manifestations:
- blue toe syndrome (cyanosis with intact pulses)
- livedo reticularis (reticular, lacy skin discoloration/erythema that BLANCHES)
- Gangrene and ulcers
Polycythemia vera
QID: 2883
- HTN (incr. blood viscosity),
- ERYTHROMELALGIA (burning cyanosis in hands/feet),
- TRANSIENT VISUAL DISTURBANCES
PE: Facial plethora (ruddy cyanosis) + Cyanosis
Complications: Thrombosis + Myelofibrosis/Acute leukemia
Tx: Phlebotomy + Hydroxyurea
Tumor lysis syndrome
QID: 2641
Initiation of cytotoxic chemo
- Hyperuricemia, hyperphosphatemia, hyperkalemia, hypocalcemia
- Comp: AKI (due to uric acid and phos) + Arrhythmias
- IVF + Allopurinol/rasburicase
Dehydroepiandrosterone sulfate (DHEAS)
produced predominantly in the adrenals
Acute respiratory distress syndrome (ARDS)
QID: 3020
RF: infection, trauma, massive transfusion, acute pancreatitis
Pathophys: lung injury with leakage of proteins and inflammatory cytokines and neutrophils into alveoli
- Decreased lung compliance
- V/Q Mismatch
- Pulmonary HTN - Hypoxic vasoconstriction, parenchymal destruction, loss of surfactant with alveolar collapse
- Increased A-a gradient
Dx: B/l lung opacities (noncardiogenic pulm edema)
- Hypoxemia with PaO2/FiO2 < 300 mmHg
Tx: Mechanical ventilation (low TV, high PEEP, permissive hypercapnia
Ulcerative colitis
QID: 2581
- Pseudopolyps, mucosal and submucosal inflammation, crypt abscesses
- Comp: Toxic megacolon, PSC, colorectal CA, Erythema nodosum, PYODERMA gangrenosum, spondyloarthritis
Pneumococcal vaccination
QID: 3892
PPSV23 x ONCE = adults < 65, current smokers or chronic medical conditions (heart/lung dz, DM, chronic liver dz)
PCV 13 + PPSV23 (6-12 mo later) x ONCE = ALL adults > 65
SEQUENTIAL PCV13+PPSV23 = high risk patients (CSK leak, cochlear implants, sickle cell disease, asplenia, Immunocompromised (HIV/malignancy), CKD)
Tdap
QID: 3892
Patient gets Td booster q10 years with one time dose of Tdap in place of Td
Prerenal azotemia/AKI
QID: 4435
- Can be 2/2 to diuretic use
Features:
- Increased Cr,
- BUN:Cr > 20
- Elevated AGMA - 2/2 uremia
Glucocorticoids and BUN
QID: 4435
Steroids are catabolic –> Increased BUN, no effect on Cr
Early localized Lyme (days to 1 mo)
QID: 3243
- Erythema chronicum migrans (ECM), Fatigue + HA, myalgia + arthralgia
- ECM is pathognomonic for lyme; allows for clinical dx
- No serology (too insensitive)
- IgM in 1-2 weeks
- IgG in 2-6 weeks
Early disseminated Lyme (weeks to months)
QID: 3243
- Multiple ECM, Unilateral or B/L Bell’s palsy, meningitis, carditis (AV block), migratory arthralgias
- Test serology
Late Lyme (months to years) QID: 3243
- Arthritis, encephalitis, peripheral neuropathy
- Test serology
Peripheral artery disease (PAD)
QID: 8927
PAD with intermittent claudication is a strong predictor for future risk of cardiovascular M&M
Acute angle-closure glaucoma (AACG)
QID: 3429
- Sudden onset eye pain, headache, nausea
- Conjunctival erythema, corneal opacification, and non-reactive, mid-dilated pupil
Dx: Gonioscopy (gold standard) or ocular tonometry (to measure IOP)
Infectious mononucleosis
QID: 3007
- Tonsillitis/pharyngitis WITH exudates
- Posterior or diffuse cervical LAD
- Hepatosplenomegaly (no contact sports for 4+ weeks)
- RASH with amoxicillin
Factor V Leiden (FVL)
QID: 3999
- MOST COMMON inherited hypercoag disorder
- AD Point mutation in factor V gene –> unable to respond to inactivation by activated protein C –> continued thrombin formation and slow degrad. of factor 8
- PT/PTT can be normal
Hereditary telangiectasias (Osler-Weber-Rendu) QID: 4447
- Diffuse telangiectasias, recurrent epistaxis, widespread AVM formation (mucous membranes, skin, GI tract, and less in liver, brain, and LUNG)
- Lung AVMs –> R to L SHUNT + chronic hypoxemia and reactive polycythemia, hemoptysis
Polycythemia
QID: 4447
Causes:
- Myeloproliferative (PV)
- Hemoconcentration (loss of plasma volume)
- Reactive (hypercarbia, CO poisoning
Can cause:
- Pulmonary HTN (due to increased viscosity)
