Mix12 Flashcards
What’s the first line treatment for seborrheic dermatitis?
SD presents as pruiritic, erythematous plaques with fine, loose, yellow looking greasy scales. Primarily affects areas with a lot of sebaceous glands but sebum production is normal. High association with malassezia infection so topical antifungals (ketoconazole and selenium sulfide) are effective in treating conditions.
What antibodies would be elevated in rheumatoid arthritis?
CCP - cyclic citrullinated peptide (diagnostic test)
Also has high IgM titer. High CRP and ESR.
X ray demonstrates soft tissue swelling and joint space narrowing with bony erosions.
What joints are typically involved in an early presentation of Rheumatoid Arthritis?
MCP and PIP but not DIP. Also metatarsophalangeal (MTP) of the toes, and wrist joints are affected in early stages of RA. Disease can eventually trigger larger joints like knee, elbow, ankles, and shoulders later on.
** Sx include pain and joint swelling in the morning that improve throughout the day.
What’s the first diagnostic step in confirming a diagnosis of Cushing Disease?
Need to confirm hypercortisolism with a late night salivary cortisol assay, 24 hr free cortisol measurement, and overnight low dose dexamethasone suppression test.
- Don’t do early morning cortisol levels because they will be reduced in patients with primary adrenal insufficiency.
** If hypercortisolism is confirmed, then you can do a serum ACTH to differentiate between ACTH dependent vs independent causes.
- If cortisol production is decreased with dexa suppression test then the cause is central (pituitary) vs ectopic (tumor).
What’s the timeline for ABO incompatibility after a blood transfusion?
Within 1 hr of transfusion, presents as fever, flank pain, hemoglobinuria, renal failure and disseminated intravascular coagulation.
Pos(+) direct coombs, and pink plasma are found.
If a patient presents with angioedema, hypotension, and difficulty breathing within minutes of receiving a blood transfusion, what’s the most likely cause?
Anaphylaxis due to host IgA deficiency (blood products contain IgA so the host anti-IgA IgG Ab cause the reaction). Should happen within minutes of transfusion. Give Epi and circulatory/respiratory support.
What’s the timeline for developing febrile nonhemolytic transfusion reactions after blood transfusion?
Normally 1-6 hrs after transfusion. Due to release of cytokines in stored blood. Causes transient fevers, chills, malaise.
What’s the pentad for TTP?
Thrombocytopenia, Microangiopathic hemolytic anemia, renal insufficiency, neurolgic changes, and fever.
What’s the pathophys of TTP (thrombotic thrombocytopenic purpura)?
TTP is a disorder of microvasculature due to small vessel thrombus formation»_space; schistocytes and platelet sequestration»_space; end organ damage (CNS, and renal).
TTP is due to an acquired autoantibody to ADAMTS13 (plasma protease that cleaves vWF), so as ADAMTS13 levels drop you have vWF multimers accumulating on the vessel wall, trapping platelets at areas of high shearing force.
** TTP happens in young adults while HUS happens in kids.
** TTP needs to be treated with emergent plasma exchange. Glucocorticoids are also generally added.
What is pentamidine used for?
Pentamidine is used for the prevention and treatment of pneumocystis pneumonia in Pt with advanced HIV who can’t tolerate TMP-SMX .
Fluconazole is the first line treatment for esophageal candidiasis, what can you use if the pt is resistant to this medication?
Voriconazole, echinocandin (caspofungin), or amphotericin may be used.
What type of metabolic derangement is seen in TB?
Normal AG metabolic acidosis.
Common extrapulmonary sites of TB are liver, spleen, kidney, bone, and adrenal gland. TB is a common cause of primary adrenal insufficiency.
Primary adrenal insufficiency (Addison’s disease) - decreased cortisol, adrenal sex hormone, and aldosterone secretion. Aldosterone acts at distal tubule to increase Na+ reabsorption and promote H and K secretion. If aldosterone is deficient you have inappropriate loss of Na+ while retaining K+ and H+ leading to a normal AG and hyperkalemic/hyponatremic metabolic acidosis.
** Metabolic alkalosis is seen in cases of hyperaldosteronism.
If a middle aged woman presents with pain, itching, and red streaks on her arms after experiencing a similar symptom 3 months ago that resolved on its own, what is the best next step in management.
CT abdomen. This is Trousseau’s syndrome - hypercoagulability disorder of recurrent and migratory superficial thrombophlebitis at unusual sites (arm,chest). Usually early sign of occult visceral malignancy (pancreatic [mcc], stomach, lung, or prostate carcinoma).
What is a potential complication of sildenafil with alpha blockers and nitrates?
Significant Hypotension.
Sildenafil = PDE-5 inhibitor causes vasodilation.
Can cause serious hypotension in Pt taking alpha blockers (doxazosin) and nitrates. Should take lowest dose possible and 4 hrs apart from other meds
Why is abnormal hemostasis a common complication in Pt with renal failure? What are the effects of PT, aPTT, and bleeding time? What is the cure?
Uremic coagulopathy (guanidosuccinic acid). Major defect is in the interaction between platelet-vessel interaction and platelet-platelet interaction.
PT, aPTT, and thrombin times are normal but bleeding times are prolonged. Platelet COUNT is normal, but platelets are defective.
Correct with DDAVP, cryoprecipitate, and conjugated estrogens.
Can present as GI bleeding, hemopericardium, subdural hematoma, and bleeding from surgical/invasive sites
Common location of histoplasma vs blastomyces:
Both in central and Midwest states
Common location of coccidoides
endemic of southwest desert.
Causes community acquired pneumonia: (fever, chest pain, cough, lobar pneumonia). Accompanied by arthralgias, erythema nodosum, and erythema multiforme. Sx last weeks to months.
At risk Pt (immunocomp) need fluconazole or ketoconazole.
If a young mom presents with symmetric polyarticular arthritis of a brief self limited course, then what is the likely Dx?
Viral arthritis due to parvo B19 infection (can also be seen in HIV, mumps, rubella, and other viruses.
What’s the difference between Type 1 and 2 heparin induced thrombocytopenia?
Type 1 = nonimmune direct effect of heparin on platelet activation. Presents in first 2 days of heparin exposure.
Type 2 = immune mediated disorder due to antibodies to platelet factor 4 complexed with heparin. Takes several days (5-10 days)
The antiemetics metoclopramide, prochlorperazine, and promethazine are dopamine antagonists, which along with antipsychotics, can cause ____ Sx such as dystonia, akathisia, and parkinsonism.
Extrapyramidal sx.
Can be an emergency if you have laryngeal spasm»_space; life threatening airway obstruction. Rx for dystonic reaction involves discontinuation of medications, and admin of anticholinergic meds (benztropine) or diphenhydramine.
