Miscellaneous Flashcards
chronic hep C infection
elevated LFTs, hepatomegaly, increased liver echogenicity, pos HCV virus antibodies, and elevated HCV RNA
chronic HCV is frequently asx
HCV management strategies are to prevent further liver damage
- alcohol avoidance, give HAV and HBV vaccines (-instead of starting an anti-viral agent)
also evaluate these pts to determine presence of cirrhosis, etc.
- if pts have cirrhosis (shrunken liver, TCP, coagulopathy, ascites) - start diuretic
acute viral hepatitis
LFTs x25 ULN anorexia, N&V
B = sex
in order of appearance
1) HBsAg
2) IgM anti-HBc - same time as when clinical sxs develop and transaminitis occurs
3) window period = IgM anti-HBc, HBV DNA (lag time between disappearance of HBsAg and appearance of anti-HBs)
4) after window period, recovery phase - anti-HBs, IgG anti-HBc, anti-HBe (only time when you’ll see this), HBV DNA
- so for acute hepB infection - check for HBsAg and IgM anti-HBc
- note - HBeAg is a good level of infectivity
- get hep B virus DNA in patients with chronic hep B - to determine candidacy for anti-virals
pos HbsAg - sign of immunization
chronic carrier - pos HBsAG and IgG anti-HBc (for >6 mo)
resolved HBV infection - anti-HBs, anti-HBc
d-xylose test
monosaccharide - absorbed withOUT degradation by pancreatic or brush border enzymes
- absorbed in proximal small bowel
pts with proximal SI disease (celiacs) cant absorb d-xylose
false-positive D-xylose test (decreased urinary excretion, normal absorption) can be seen in pts with delayed gastric emptying or impaired GFR
- or with SIBO - because of bacterial fermentation of ingested D-xylose before it can be absorbed (rifaximin to kill bacteria)
pellagra
3Ds: dermatitis (on sun exposed areas), diarrhea (+loss of appetite), dementia (+mood changes)
- note - chronic scaly rash (not hypersensitivity reaction)
niacin is synthesized from trytophan - seen in populations that subsist primarily on corn products
- can also be seen in malnourished, carcinoid syndrome, or Hartnup disease (disorder of trytophan absorption)
acoustic neuroma
sensory hearing loss in one ear only, get MRI
oropharyngeal infections
tonsilitis- …tender ant cervical nodes, palatal petechiae
epiglottitis
herpangina
- coxsackie A - fever, sore throat, odynophagia
mono - fever, pharyngitis, and post C-LAD
peritonsillar abscess - fever, sore throat, trismus, hot potato voice, uvular deviation region between the tonsil and the pharyngeal muscle gets infected
- most common in older adolescents and young adults - drug and etoh increases risk
- tx - needle aspiration or I&D, abx to cover group a strep and respiratory anaerobes
note - adenoids are typically enlarged in early childhood, will regress with age
torus palatinus
benign bony growth - thought to be due to genetic and environmental factors
- more common in younger pts, women, and Asian
surgery indicated for sx pts
rhinoplasty
complications are common
- 1/4 may need revision - dissatisfaction, nasal obstruction, epistaxis
- septal hematoma (or abscess) –> septal perf - whistling noise
liver flukes
travel abroad
dx - ova and parasite stool tests
invade biliary tree
ganglion cyst
most common in individual 15-40 - arise due to repetitive stress and inflammation
ophtho
- ambylopia
- glaucoma
- cellulitis
- retina
amblyopia - vision impairment due to interference with processing of images by brain during first 6-7yrs
- ex - strabismus
- note true strabismus is present at birth and requires corrective surgery, strabismus that arises after birth can be fixed with corrective glasses
glaucoma
- acute angle closure = emergency - painful eye, headache
- mid-dilated, nonreactive pupil, halos around lights, eye is hard as a rock, cornea is greenish hue
- often Asian female who has been watching tv for a long time (pupil dilated for a long time) -
- tx - acetazolamide, etc.
orbital cellulitis = emergency - cellulitis + pupil is dilated and fixed and limited ROM, means there is pus in orbit
- CT scan and drainage
retinal detachment - floaters in eye and flashes of light
- other clues - snowstorm, dark cloud at top of visual field
- tx with emergency laser spot welding to protect remaining retina
embolic occlusion of retinal artery - sudden loss of vision (damage becomes irr in 30 min)
- recommendation - breath into paper bag and have someone press hard on eye and release (repeatedly)
- idea is to vasodilate and shake clot into more distal location
black widow spider bite
give calcium gluconate
heart murmurs
ASD - low pressure, fixed S2, hx of frequent colds
VSD (classically in membranous septum) - failure to thrive baby, loud pansystolic murmur
PDA - machine like murmur
Tet of Fallot
transposition of great vessels - need ASD or some other connection –> surgery
AS - surgical valvular stenosis, replace if gradient is more than 50 mm Hg (or other complications)
acute aortic insufficiency - endocarditis –> emergency valve replacement and abx
mitral stenosis - acute rheumatic fever
mitral regurg - holosystolic heart murmur, radiates to back and axilla
celiac disease
steatorrhea, ADEK and Fe deficiency
associated with dermatitis herpetiformis - autoimmune, on extremities
IgA, anti-TTG, and IgA anti-endomysial antibodies - however many pts with celiac disease have selective IgA deficiency!
villus atrophy on bx
B12 vs folate deficiency
body has large stores of B12, minimal stores of folate - b12 storage = 3-5 yrs
both B12 and folate are involved in DNA synthesis
- deficiency will affect cells with rapid turnover
- will see macrocytic anemia, low/nl retics, pancytopenia, hyperhomocysteinemia
- also elevated MMA levels in B12 deficiency
- causes of both - malnutrition
- causes of B12 deficiency - intestinal bacterial overgrowth (competes for the B12), pernicious anemia
myelodysplasia will also have macrocytic anemia with pancytopenia - but neutrophils will by hypogranulated and hyposegmented
