nbme's Flashcards
Necrotizing pulmonary vasculitis
Goodpastures syndrome:
vasculitis involving basement membrane of lung and kidneys
hematuria and hemopytisis
collagen 4 BM
Granulomatosis with Polyangiitis
Wegeners granulomatosis
vasculitis: Upper Resp (sinus), lungs, kidney
Takayasu arteritis
different pulses on arms
granulomatous inflammation and fibrosis in large arteries
Shortness of breath, fatigue, tachycardia, tachypnea, jugular venous distention, bilateral basilar crackles, an S3gallop, ejection murmur, and lower extremity edema raise + LVEF 70% + hemoglobin is LOW + dark blood in stools
high- output heart failure
pt has severe anemia –> heart must over compensate by pumping harder and more so that blood (carrying O2) can go to the body
impaired relaxation and chamber hypertrophy on echo
pulmonary vascular congetion d/t chronic, poorly controlled HTN, or aortic stenosis
Left ventricular diastolic dysfunction
reduced ejection fraction
echo: enalrged dilated chamber with poor contractillity
2/2 alcohol abuse, beriberi, trypanosoma, chemotherapy, peripartum cardiomyoopathy
left ventricular Systolic dysfunction
Causes bloody diarrhea + either appendicitis-like (i.e., RLQ) pain or arthritis.
Yersinia enterocolitica
Bloody diarrhea 1-3 days after infection from consuming poultry, or following exposure to eggs or reptiles
salmonella typhi
Bloody diarrhea 1-3 days after consumption of beef.
Shigella
causes bloody diarrhea 1-3 days after consumption of beef.
shiga-like toxin
EHEC
can cause hemolytic uremic syndrome (HUS; triad of renal dysfunction, schistocytosis, and thrombocytopenia).
WATERY Diarrhea travelers diarrhea
ETEC
C-diff diagnosis:
stool AB toxin test
a GI malabsorptive syndrome where the patient can also get arthritis and renal and cardiac disease.
PAS-positive macrophages in the lamina propria.
T. whipplei
tx: ceftriaxone and daily TM/SMX for one year
- Bloody diarrhea in person who went to Mexico.
- Can cause “flask-shaped ulcers” in the small bowel and liver abscess.
- Demonstrates “erythrophagocytosis,” where RBCs can be seen within it on LM.
Entamoeba histolytica
tx: metronidazole
Watery diarrhea in person who went to Mexico. - Appears as acid-fast cysts (same stain as TB).
Cryptosporidium parvum
self limiting in normal pt
chronic diarrhea in hiv tx: nitazoxanide
- Steatorrhea in person who went to Mexico. (scuba diving or water ocean)
- Steatorrhea = bloating + extremely foul-smelling stool that floats.
Giardia
falagellated protozoan
tx: metronidazole
- Tortuous, superficial vessels in the colonic wall that cause painless bleeding per rectum in elderly.
- Classically associated with aortic stenosis
angiodysplasia
- Can cause colovesical fistula (on new 2CK NBME), where a passageway between the colon and bladder forms, leading to UTI and mixed flora in the urine.
- straining throughout life leads to herniation of mucosa + submucosa through the muscularis propria of the colonic wall.
- Usually asymptomatic, but can bleed. ______ is most common cause of painless bleeding per rectum in elderly, followed by colorectal cancer, followed by angiodysplasia.
diverticulosis
- LLQ pain + fever in patient over 60.
diverticulitis
dx: CT abdomen with contrast
tx: antibiotics
then colonoscopy should be scheduled later to rule out malignancy (never scope acutely)
- Patient over 75 + 2-3 days of constipation + abdo pain.
- Rotation around its mesentery causes “dilation of sigmoid colon”
sigmoid volvulus
abdominal xray: coffe bean sign
- Tx on NBME is “sigmoidoscopy-guided insertion of rectal tube.”
DKA
2 processes:
Dysregulated fatty acid degradation and ketone synthesis occurs because of the relative state of starvation created through absent insulin signaling.
b-hydroxybutyric acid, acetoacetic acid, and acetone
DKA
2 processes:
Dysregulated fatty acid degradation and ketone synthesis occurs because of the relative state of starvation created through absent insulin signaling.
b-hydroxybutyric acid, acetoacetic acid, and acetone
second to fourth decades of life as multiple, recurrent sinus or pulmonary infections, including pneumonia, bronchitis, and sinusitis.
uses ICS – has mild oral thrush
CVID – do a serum immunoglobulin measurement
vs
HIV – not risk factors and oral thrush d/t ICS
acute onset of dizziness vertigo, ataxia, n/v, hearing loss
(usually but not always after a viral infection)
labrynthitis
acromegaly
functional pituitary adenoma
growth hormone – upregulatesIGF-1
Diagnosis is made by clinical presentation, measured hormonal levels, and cross-sectional imaging to detect the culprit adenoma.
Surgical resection is the preferred treatment. If surgery cannot be performed, somatostatin analogues (e.g., octreotide) and antagonists of the GH receptor (e.g., pegvisomant) can be used.
sob/WHEEZING for 2 days
just came back from long trip
peripheral edema, JVD, S3 gallop, and crackles on lung examination
pulmonary edema:
tx: diuresis to reduce the patient’s hypervolemic state and lower cardiac filling pressure, pulmonary venous, and pulmonary capillary pressure. **Nitroglycerin, a venodilator, can also be utilized to shift fluid into capacitance vessels and lower preload. **Positive pressure ventilation can also reduce alveolar and interstitial edema and drive fluid back into circulation.
vs pulmonary embolism would have way more acute symptoms of pleurtic chest pain and hemopytisis with hypotension
2 days of fever chills left flank pain, hypotension, tachycardia, WBC on urine
pyleonephritis
must cover gram neg rods (ecoli)
IV ceftriaxone
nephrotic syndrome
3 types
complications: (2)
workup:
tx:
minimal change disease, membranous nephropathy, FSGS
loss of normal size and charge filtration of glomerular capillary (dminised intravascular oncotic pressure) (Pie C)
Complications include hypercoagulability caused by urinary loss of antithrombin-3 and infection caused by
urinary loss of gamma globulins. Workup includes renal biopsy and treating underlying causes such as HIV, hepatitis, and systemic lupus erythematosus. Treatment involves the use of glucocorticoids and immunomodulators, though treatment-refractory disease is common. Patients may ultimately require renal replacement therapy or transplantation.
innfection or inflammation traveling within the lymphatic system and presents with streaking, sometimes traveling away from areas of cellulitis or abscess.
Lymphangitis
spororthrixx
obstruction or excision of lymphatic channels, such as in cases of lymphoma or after lymph node dissection. It is typically localized to a single upper, single lower, or bilateral lower extremities,
lymphedema
