Mix4 Flashcards
What are some of the cardiac manifestations of sarcoidosis?
Cardiac noncaseating granulomas can exist in about 25% of Pt with sarcoidosis. Infiltration of noncaseating granulomas»_space; surrounding inflammation and can cause cardiac conduction defects (complete AV block), restrictive cardiomyopathy (early manifestation), dilated cardiomyopathy (late manifestation), valvular dysfunction, and HF.
Why are pregnant women sometimes hypothyroid?
Rise in estrogen levels cause decrease clearance of thyroxine binding globulin (TBG)»_space; elevated TBG»_space; greater availability of binding sites for free thyroid»_space; decreased free thyroxine and increased TSH.
What effect does phenobarbital, rifampin, phenytoin, and carbamazepine have on metabolism of thyroid hormone?
T4 and T3 are metabolized by deiodination, glucuronidation, and sulfation in the liver. These drugs increase the metabolism of T3 and T4.
The autoantibodies anti-Jo1 and anti-M2 are associated with this disease:
Dermatomyositis.
Anti-Jo1 (antisyntheatse Ab)
anti-M2 (anti-helicase)
Tarsal tunnel syndrome is due to compression of the ___ nerve:
Tibial nerve. Tarsal tunnel syndrome is due to compression of the tibial nerve as it passes through the ankle. Usually caused by fracture of the ankle bones. Pt typically feel burning, numbness, and aching of distal plantar (not dorsal) surface of foot/toes radiating up to the calf.
Why are Pt with ankylosing spondylitis more prone to spinal fractures?
These Pt typically have sacroiliitis and osteopenia/osteoporosis with longstanding AS due to increased osteoclast activity in the setting of chronic inflammation (mediated by IL6 and TNFa). Increased spinal rigidity in these Pt also increases risk of vertebral fractures.
What is the most likely diagnosis in a Pt presenting with recent weight loss, diarrhea, anemia, DM II, and erythematous plaques with large painful blisters with central clearing?
This is Necrolytic Migratory Erythema due to Glucagonoma.
** Normocytic/normochromic anemia is due to glucagon direct effect on erythropoiesis.
How does gram stain results differ for chlamydia vs gonococcal infection?
Chlamydia is an intracellular pathogen and can’t be visualized on gram stain. Dx is made by Nucleic Acid amplification of a first catch urine sample without pre-cleaning genital area.
*Rx = azithromycin or doxycycline.
Gonococcal infection however shows up as G(-) cocci.
What skin condition do you need to watch out for with chronic HepC infection?
You need to watch out for porphyria cutanea tarda. Presents with fragile photosensitive skin that develops vesicles and bullae with trauma or sun exposure typically on dorsum of hands.
** Dx of PCT is supported by increased plasma and urine porphyrins. Rx = serial phlebotomy or hydroxychloroquine with mgmt. of underlying disease (HCV).
If a Pt from Wisconsin presents with multiple well circumscribed verrucous crusted lesions and fever/night sweat/cough with recent weight loss then what is the most likely Dx?
Blastomycosis. Pulm Sx and CXR findings of blasto may resemble TB and histoplasmosis but skin findings and lytic bone lesions are unique to blasto. Broad based budding yeast found on sputum cx confirms Dx. Treat with itraconazol or amphotericin b.
Displaced apical impulse, holosystolic murmur, and third heart sound are characteristic of what valvular abnormality?
Severe mitral regurg.
** The third heart sound is from LV volume overload and doesn’t necessarily represent HF. Chronic severe MR can cause LA dilation which can lead to A-fib (felt as palpitations).
Why does peripheral edema often occur with calcium channel blocker therapy?
CCB (i.e. amlodipine) causes preferential dilation of precapillary vessels (arteriolar dilation)»_space; increase capillary hydrostatic pressure and fluid extravasation into interstitium.
** DHP CCB (amlodipine, nifedipine) are potent arterial dilators and cause more peripheral edema than non DHP CCB (diltiazem, verapamil)
Why is angioedema a common side effect of ACEi?
Angioedema of the face, mouth, lips, tongue, glottis, and larynx are common manifestations of ACEi. Angioedema occurs due to pro-inflammatory action of bradykinin which promotes edema, inflammation, and sensation of pain. ACE normally breaks down bradykinin, so ACEi»_space; ^ bradykinin.
What is the preferred test for HIV in an asymptomatic patient?
Preferred HIV screening test is HIV p24 Ag and HIV antibodies. Pt with a positive test should have confirmatory test with HIV-1/2 Ab differentiation immunoassay. Plasma HIV RNA testing is recommended in Pt with neg (-) serologic tests and high clinical suspicion of acute HIV.
Why do you typically have lumbar pain with testicular cancer?
Testicular cancer predominantly spreads through regional lymphatics and goes to the retroperitoneal lymph nodes which then compress adjacent structures (nerve roots, psoas muscle).
- Should perform scrotal U/S and biopsy (AFP, B-hCG) to confirm diagnosis.
