Medicine UWorld Flashcards
Paget Disease of the bone
Most patients are asymptomatic.
Bone pain and deformity - headache and hearing loss, spinal stenosis, radiculopathy, bowing, fractures, arthritis.
Giant cell tumor, osteosarcoma.
Results as an osteoclast dysfunction and increased bone turnover.
Labs - Elevated alkaline phosphatase and bone turnover markers (PINP, urine hydroxyproline).
Calcium and phosphorus are normal.
Treat with bisphosphonates.
What are the typical imaging findings of Paget Disease of the Bone?
XR: Cortical thickening with osteolytic or mixed lytic/sclerotic lesions
Bone scan: increase uptake
Bacillary Angiomatosis
Immunocompromised patients - HIV with CD4 <100
Bartonella henselae/quintana (Gram negative) from cat exposure or homelessness (lice)
Vascular cutaneous lesions, systemic symptoms, organ involvement
Diagnose with lesional biopsy and microscopy/histopathology
Treat with doxycycline or erythromycin plus antiretroviral therapy
What are the common drugs associated with pancreatitis?
Anti-epileptics - Valproic acid Diuretics - furosemide, thiazides IBD - sulfasalazine, 5-ASA Asothioprine HIV - didanosine, pentamidine Antibiotics - metronidazole, tetracycline
What is the MOA of Methotrexate? What are its side effects? How can side effects be prevented?
Inhibits Dihydrofolate Reductase - DMARD
SE: macrocytic anemia, pancytopenia, nausea, stomatitis, rash, hepatotoxicity, interstitial lung disease, alopecia, fever
Prevent SE with folic acid supplementation
Chronic Pancreatitis
Alcohol, cystic fibrosis, ductal obstruction (stones, malignancy), autoimmune
Chronic epigastric pain, malabsorption, steatorrhea, weight loss, diabetes mellitus
Amylase and lipase may not be helpful, CT scan for diagnosis (pancreatic calcifications)
Treat with pain management, alcohol and smoking cessation, frequent and small meals, pancreatic enzyme supplements
What is the presentation of botulism toxicity? What is the treatment? What is the pathogenesis?
Acute onset within 36 hours of ingestion.
Bilateral cranial neuropathies: blurred vision, diplopia, facial weakness, dysarthria, dysphagia.
Symmetric descending muscle weakness.
Diaphragmatic muscle weakness with respiratory failure.
Treatment requires equine serum heptavalent botulinum antitoxin.
Preformed toxin that inhibits presynaptic acetylcholine release at the neuromuscular junction.
Polymyalgia Rheumatica
Age >50
Bilateral pain and morning stiffness (proximal)
Constitutional symptoms
Decreased active ROM in the shoulders, neck, hips
ESR >40
Elevated CRP
Normocytic Anemia
Treat with oral glucocorticoids
Associated with temporal arteritis
What is the treatment for sporotrichosis?
Dimorphic fungus
3-6 months of itraconazole
What electrolyte abnormalities are seen in Addison’s disease?
Hyponatremia
Hyperkalemia
+/- hyperchloremic acidosis
What is the management of ARDS?
Mechanical ventilation with low TV, high PEEP, and permissive hypercapnia.
Renal vein thrombosis is a complication of what?
Nephrotic syndrome - most commonly membranous glomerulopathy
Corrected serum calcium
Carried by albumin in the blood
decreased 0.8 for every 1 decrease in albumin
= (measured total calcium) + 0.8 (4.0 - serum albumin)
Pathophysiology of Bullous Pemphigoid
IgG autoantibodies against the hemidesmosome and basement membrane
Linear IgG and C3 deposits at the dermal-epidermal junction on DIF
What is the first line treatment of Bullous Pemphigoid?
High-potency topical steroids like clobetasol
What part of the esophagus does adenocarcinoma usually affect?
Distal, near the G-E junction, secondary to Barrett esophagus and chronic GERD
What part of the esophagus is affected by squamous cell carcinoma? What are the risk factors?
Anywhere in the esophagus
Heavy alcohol and smoking
Effects of glucocorticoids on the HPA axis?
Suppress secretion of corticotropin-releasing hormone from the hypothalamus and ACTH from the pituitary.
Sudden discontinuation of glucocorticoids can lead to central adrenal insufficiency.
Oligoclonal bands in a CSF sample:
Multiple Sclerosis
14-3-3 protein on CSF sample:
Creutzfeldt Jakob Disease
CSF findings in Guillan-Barre:
Albuminocytologic Dissociation (elevated CSF protein with a normal cell count)
Monoclonal M-Spike
Waldenstrom Macroglobulinemia
Confirmation with bone marrow biopsy showing >10% clonal B cells
What are the symptoms of Waldenstrom Macroglobulinemia?
Hyperviscosity syndrome (diplopia, headache, dilated/segmented fundoscopic findings)
Neuropathy (electric sensations)
Evidence of infiltrative disease (hepatosplenomegaly, anemia, thrombocytopenia)
What are P2y12 receptor blockers?
Anti-platelets - Clopidogrel, Prasugrel, Ticagrelor
Dual antiplatelet therapy is recommended for 12 months after drug-eluding stent placement.
What is endophthalmitis?
Bacterial or fungal infection of the eye, particularly the vitreous part.
Present with pain and decreased visual acuity.
Exam: swollen eyelids and conjunctiva, hypopyon (collection of pus in the anterior chamber)
Tabes Dorsalis
Damage of the dorsal sensory roots and secondary degeneration of the dorsal columns.
Presents with sensory ataxia, lancinating pains, neurogenic urinary incontinence, Argyll Robertson pupils (normal constriction with accommodation but not with light)
What are common extrapulmonary sites for TB?
liver, spleen, kidney, bone, adrenal gland
Common infectious cause of primary adrenal insufficiency in endemic areas?
TB
Other granulomatous diseases as well
What are the electrolyte abnormalities in chronic adrenal insufficiency?
Hyponatremia
Hyperkalemia
Hypercalcemia
Normal anion gap hyperkalemic, hyponatremic, metabolic acidosis
Cough, fever, dyspnea, pulmonary infiltrates while on amiodarone:
Amiodarone toxicity
Causes chronic interstitial pneumonitis
Epidural hematoma
Meningeal artery
Biconvex hemorrhage, does not cross suture lines
Subarachnoid Hemorrhage
Ruptured saccular aneurysm
Subdural Hematoma
Rupture of bridging veins
Concave hemorrhage, crosses suture lines
Lacunar Stroke
Microatheroma formation and lipohyalinosis in the lenticulostriate vessels of the internal capsule
Bath Salt Intoxication
Agitation, combativenss, psychosis, delirium, myoclonus, seizures
Prolonged duration of intoxication - lasts days after ingestion
Not on routine tox testing
Phencyclidine (PCP) Intoxication
Psychomotor agitation, combativeness, diminished pain perception, hallucinations, hypertension, tachyardia, multidirectional nystagmus
Shorter duration than bath salts
Included in standard tox screens
Marjolin Ulcer
SCC that develops at the site of a wound or burn, increased risk of metastasis
Expansile and eccentric lytic area (soap bubble) at the bone epiphysis in a young patient:
Giant Cell Tumor of the Bone
Osteitis Fibrosa Cystica
Commonly due to hyperparathyroidism from parathyroid carcinoma
Bone is replaced by fibrous tissue (brown tumors) and there is bone pain
Subperiosteal bone resorption on the radial aspects of the middle phalanges, clavicular tapering, salt and pepper skull, bone cysts, and brown tumors of the long bones
Osteoid Osteoma
Sclerotic, cortical lesion on imaging with a central nidus of lucency
Pain that is worse at night and unrelated to activity, relieved by NSAIDs
Most common cause of secondary bacterial pneumonia (post-influenza) in young adults:
Staph aureus - likely community associated MRSA
Severe, necrotizing pneumonia that is rapidly progressive and may be fatal
What are the side effects of radioactive iodine ablation for hyperthyroidism?
Permanent hypothyroidism
Worsening occular problems - titers of TRAB (thyrotropin receptor antibodies) increase after RI ablation leading to worsening of ophthalmopathy
Radiation side effects
What is the cause of Grave’s Ophthalmopathy?
Effects of activated T cells and thryotropin receptor antibodies (TRAB) on TSH receptors on retro-orbital fibroblasts and adipocytes
How do you decrease worsening of Grave’s Ophthalmopathy with RI ablation?
Administer glucocorticoids
Thyroidectomy if moderate to severe Grave’s
Crypt abscesses on colonoscopy:
ulcerative colitis
Intestinal villous atrophy on colonscopy:
Celiac disease
Perianal fistula:
Crohn’s disease
