Mix12 Flashcards
Initial Rx for dermatitis herpetiformis?
Remove gluten from diet. Temporize with dapsone.
Primary treatment for borderline personality disorder?
Dialectical behavior therapy. SSRI are typically not effective (unless there is comorbid major depressive disorder or anxiety disorder)
Older man presents with lower back pain, constipation, renal insufficiency and hypercalcemia. What is the cause and what diagnostic step do you do?
Multiple myeloma (plasma cell dyscrasia)»_space; IgG overproduction.
CRAB. Calcinosis, Renal Failure, Anemia, Bone pain.
Dx = Spep/Upep (M spike), skeletal survey, confirmed w/BM biopsy
Rx = Melphalan (antineoplastic) + steroids
Rx for Langerhans cell histiocytosis?
Chemo (prednisone + vinblastine). Desmopressin for associated central DI.
What’s the main pathology behind Langerhans cell histiocytosis?
Histiocytes (Macs within tissue) proliferate and infiltrate one or more organ systems: bone (punched out lytic lesions in skull, femur, vertebrae, etc), skin (eczematous rash), lymph nodes, lungs, liver, spleen, CNS (central DI with polyuria and hypernatremia).
Infant initially appears normal at birth but gradually develops apathy, weakness, difficulty feeding, hypotonia, large tongue, abdominal bloating, and sluggish movements. What’s the most likely cause?
Congenital hypothyroidism
How can you tell the difference between laryngomalacia vs vascular ring in a child with stridor?
Laryngomalacia = inspiratory stridor only. Stridor worse when supine and improves when prone.
Vascular ring = Biphasic (inspiratory and expiratory) stridor that improves with neck extension. Vascular rings are due to abnormal development of aortic arch
Aside from serum B12 [ ] , what other test should be ordered in the case of suspected
Should also order serum MMA levels because they are more sensitive in detecting Vit B12 deficiency than serum B12 levels alone.
Timepoint differentiating postpartum blues vs postpartum depression
Post partum blues shows up 2-3 days after birth and lasts < 2 weeks.
Postpartum depression shows up within 4-6 weeks after delivery (can be up to a year) and last >2 wks.
Aplastic anemia vs aplastic crisis in SCD:
Aplastic crisis = acute drop in Hb with low retic count (no splenomegaly) most often due to parvo B19 infection»_space; Sudden stop in erythropoiesis
Aplastic anemia = full pancytopenia due to BM failure. Can be congenital (Fanconi anemia) or acquired (drug induced/autoimmune)
Pt with Parkinsonism displays impotence, orthostatic hypotension, gastroparesis, and abnormal sweating:
Shy Drager syndrome. Parkinsonisim with autonomic dysregulation. May have bulbar dysfunction and laryngeal stridor»_space; death.
AntiParkinson’s drugs are ineffective. Rx = intravascular volume expansion with fludrocortisone, salt supplementation, and alpha-adrenergic agonists.
Antiplatelet factor 4 antibody is assoc with what Dz?
HIT
Rx for acute asthma exacerbation:
Albuterol (SABA) + Ipratropium (Antimuscarinic) + IV Methylprednisolone (glucocorticoid) + Steroid taper
Antinuclear Ab and anti-dsDNA Ab are pathognomonic for what disease?
SLE
Anti CCP Ab is assoc with what disease?
RA
What are 4 major long term side effects of Li3+ use?
Nephrogenic DI, CKD, Thyroid dysfunction, and Hyperparathyroidism
Compare presentation of Mallory Weiss vs Boerhaave syndrome:
Mallory Weiss = incomplete mucosal tear at GE junction. Due to protracted vomiting. Self limited hematemesis and pneumomediastinum.
Boerhaave = esophageal perforation. Spontaneous rupture of esophagus with prolonged straining/vomiting. Suprasternal crepitus and retrosternal pain due to pneumomediastinum and contamination of mediastinum with gastric contents. Presents with fever and leukocytosis.
What’s the big concern about TCA overdose?
QRS prolongation. Causes cardiotoxicity due to blockade of cardiac fast Na+ channels»_space; QRS prolongation»_space; ^ risk for ventricular arrhythmia.
Can also cause AMS, seizures, tachycardia, HoTN, and anticholinergic effects (dilated pupils, flushed skin, hyperthermia)
Metolazone is a thiazide diuretic sometimes used in Pt with decompensated CHF. It can cause electrolyte abnormalities such as (3):
HypoK, Hypo Mg, hypochloremic alkalosis
What arteries are predominantly affected in fibromuscular dysplasia?
Renal and ICA
Projection vs displacement:
Displacement = transference of upsetting emotion to safer alternative
Projection = attribute one’s own feelings to someone else
Why are PTT and PT not representative of the clinical picture in Antiphospholipid syndrome?
LA (lupus anticoagulant) is found in ~30% of cases with APS. Prolonged PT and PTT is artifact in lab because it binds all phospholipids in the assay. In real life if it causes venous thromboembolism. Prolonged PTT is an indirect indicator for the presence of LA. Specific confirmatory tests include diluted Russell viper venom test and the kaolin clotting time.
Major side effect of cyclophosphamide?
Bladder cancer. Can also cause acute hemorrhagic cystitis, sterility and myelosuppression. These effects are due to acrolein (metabolite of cyclophos). Rx = Mesna and ^ fluid intake.
