Mix13 Flashcards
If a young man presents with persistent dry cough, sore throat, HA, and fatigue with recent development of rash on arms and legs, and a CXR demonstrating interstitial markings and R sided pleural effusion, what it is the most likely cause and how do you treat it?
Consider Mycoplasma pneumonia. Sx are indolent and include HA, fever, malaise, and incessant dry cough. Nonpurulent pharyngitis, macular skin rash, and subclinical hemolytic anemia (due to cold IgM agglutinins) may occur.
CXR shows interstitial infiltrates and possible pleural effusion. Empiric Rx is with azithromycin.
Of the following antidiabetic drugs (sulfonylureas, bigaunides, thiazolidinediones, GLP1 agonists, insulin, dpp4 inhibitors) which is best to induce weight loss and have lower hypoglycemic risk?
GLP1 agonists (liraglutide, exenatide) induce weight loss and have lower hypoglycemic risk.
BUT these are assoc with acute pancreatitis.
What diabetes drug is indicated if Pt is unable to take metformin or sulfonylureas?
Pioglitazone (Thiazolidinedione) - can be used if Pt can’t take metformin or sulfonylureas. Side effects include weight gain, edema, CHF, bone fracture and bladder cancer.
Can be used in renal insufficiency
What physical exam findings on auscultation help you differentiate between consolidation (lobar pneumonia) and pleural effusion?
Consolidation = dull to percussion, increased tactile fremitus, increased breath sounds (crackles and egophony present), and mediastinal shift is absent
** Sound conducts more rapidly through consolidated lung.
Pleural effusion = dull to percussion, decreased tactile fremitus, decreased/absent breath sounds, mediastinal shift away from effusion (if large)
** Pleural fluid in thoracic cavity acts to insulate sound and vibration originating from the lung. As with consolidation, dullness to percussion is present due to increased tissue/fluid density compared to normal air filled lung tissue.
What’s the management for TTP?
Plasma exchange, glucocorticoids, and rituximab.
** TTP is due to deficiency of plasma protease ADAMTS13 (due to autoab). In the absence of the protease, long chains of vWF accumulate on endothelial wall»_space; trapping of platelets»_space; generation of thrombi in areas of high shearing force»_space; microangiopathic hemolytic anemia.
How is diagnosis of vertebrobasilar insufficiency made?
MR Angio or Doppler U/S. Treatment involves lifestyle management and stent placement.
Most of the time Pt with subclavian steal are asymptomatic. But when it happens you have atherosclerosis of subclavian vein proximal to origin of vertebral artery and you have increased use of the arm you can divert blood from subclavian vein»_space; vertebrobasilar ischemia (dizziness, ataxia, disequilibrium) to supply blood to the arm.
Note: Difference in BP measurements are pathognomonic for subclavian steal/subclavian artery occlusion. Will also have systolic bruit in supraclavicular fossa on affected side.
What’s the treatment for primary Reynaud’s?
Dihydropyridine CCB (amlodipine)
** For Secondary Reynaud’s - CCB and aspirin for patients at risk of digital ulceration.
You see well demarcated depigmented macules in vitiligo. What is the cause of the depigmentation?
Destruction of melanocytes (typically due to autoimmune etiology).
May treat with topical or systemic glucocorticoids as first line intervention.
Subacute lateral elbow pain worse with flexion/supination and radiation to forearm would be:
lateral epicondylitis
What’s the first line treatment for bullous pemphigoid?
High potency topical glucocorticoid (clobetasol).
** Bullous pemphigoid is caused by IgG autoAb against hemidesmosomes and basement membranes. Ab binding activates complement and inflammatory mediators»_space; blister formation. Dx is made by skin biopsy and light microscopy shows subepidermal cleavage. Direct immunofluorescence microscopy shows linear IgG and C3 deposits on basement membrane.
What’s the most likely outcome for Hep A infection?
Most patients recover in 3-6 weeks with supportive therapy.
Hep A generally presents with fever, N/V, tender hepatomegaly, abdominal pain, jaundice/pruritis, and significant elevations in transaminases, bilirubin, and Alk Phos.
** There are few long term risks for Hep A, but there is an increased risk of hepatocellular CA and cirrhosis with HepB and C.
How does the presentation differ between ligamentous sprain vs vertebral compression fracture?
Vertebral compression fracture = Acute back pain, point tenderness, reproducible pain on palpation of vertebrae. Not relieved with rest.
Ligamentous sprain = relieved by rest, worse with activity. Pain is typically paraspinal and doesn’t have tenderness to palpation of vertebra.
What’s the treatment of choice for mycoplasma pneumonia?
Macrolides (Clarithromycin is treatment of choice)
Community acquired pneumonia typically presents with dyspnea, pleuritic chest pain, fever, and productive cough. What would you typically find on CXR?
Consolidative alveolar filling process
If a young man presents with recent hearing loss, ocular abnormalities, hematuria, and progressive renal insufficiency, then what is the most likely diagnosis?
Alport syndrome (X linked defect in collagen IV of basement membrane). Kidney biopsy generally shows thinning of the GBM.
