QG SB1 (F) Flashcards
W1 QG blocks (1,2,4,6) Deck is full
What type of hypersensitivity rxn is contact dermatitis?
Type 4
How does klienfelters present (s/s + labs)?
- lack of 2* sex characteristics
- bilat gynecomastia
- small, firm testes
- nL smell
- labs: T = low. FSH = incr. LH = incr.
Lab values in Kallman’s?
T = low. FSH = low. LH = low.
Klienfelters karyotype
XXY
What distinguishing feature of kallman’s synd can skip generations due to incomplete penetrance?
anosmia
What causes cysticercosis?
T. soleum (pork ingestion)
Neurocysticercosis presentation?
- siezures (MC)
- HA
- AMS
Tx HSV esophagitis vs CMV esophagitis
HSV (shallow ulcers) = acyclovir
CMV (deep ulcers) = gancyclovir (longer name txs bigger ulcers)
Which has a more favorable side effect profile ketoconazole or fluconazole?
fluconazole
Which can be applied topically ketoconazole or fluconazole?
ketoconazole
Cause of pseudotumor cerebri in young pts
tetracyclines
OCPs
obesity
What meds will cause rash in pt w/ h/o recent mono infection?
penicillins (esp. amoxicillin and ampicillin)
E+ R+ breast cancer tx=?
tamoxifen (SERM -E breast, +E uterus)
Her2/nue+ breast cancer tx=?
traztuzimab
What do you never to tx PEA?
cardiovert
Homocysteine & MMA levels in vitB12 vs folate deficiencies?
Homocysteine MMA
vitb12 : incr incr 9 so b12=both.
folate : incr nL
Presentation of Carcinoid
BFDR Bronchospasm (wheezing) Flushing Diarrhea Right heart valve lesions
**NO s/s until liver mets
How does niacin (vitB3) deficiency present?
pellagra = 4Ds
Dermatitis, Diarrhea, Dementia, Death
HCV tx = ?
1st = prevent further damage!! (No EtOH, HAV and HBV vaccinations) 2nd = Tx HCV = sofosbuvir-velpatasvir
Colonoscopy findings c diff vs laxative abuse?
c diff –Bx–> pseudomemranous colitis (red, thick fragile walls)
laxative abuse –Bx–> melanosis coli (dk brown wall w/ pale lymph patches)
What liver condition do you tx w/ prednisolone?
severe alcoholic hepatitis
What is lamivudine?
RT inhib used for HIV + HBV co-infec
MALT lymphoma MC pathogenesis
H. pylori infec
RF gastric adenocarcinoma
- tobacco use
- incr Na diet
- N-nitrosamine compounds (smoked meats, aged cheeses)
- pernicious anemia
Pernicious anemia associations
gastric adenocarcinoma
gastric carcinoid tumors
Best test dx acute HBV infec?
HBsAg + IgM anti-HBc
^infected ^earliest antibody formed
What two scenarios incr alk phos?
- biliary tree obstruction
2. condition w/ incr bone turn (eg paget’s dz)
Features of colon polyps w/ incr. malig potential?
HIGH potential - large, high dysplasia, villous, sessile
LOW potential - small, low dysplasia, tubular, pedunculated
Who gets lung cancer screening (LDCT)?
age 55-80
30+ pack year smoker
current smoker or quit within last 15 yr
What meds cause pill induced esophagitis?
NSAIDS BATH +KCl
Celiac pts w/ what comorbid condtion will test neg for anti-TTG?
IgA deficiency
When to suspect SBP?
cirrhosis + ascites
Low fever, abdominal discomfort, or AMS
SBO presents w/
diffuse abd pain
n/v
incr bowel sounds
dialated loops sm bowel & nL lg bowel
D xylose test result interpretation
positive = D xylose excreted in u. = pancreatic enzyme issue (you can absorb, so brush border is intact) negative = not excreted = celiac's dz (damaged brush border fails to absorb)
Burning pain = ____ pain
nerve
Gamma-glutamyltransferase (GGT) = ____ marker
liver damage
What is the purpose of ferratin?
Fe storage
What is ferratin?
an acute phase reactant that is incr w/ liver damage
Unilat pleural effusion = ____ until proven otherwise
CANCER
What benign liver mass presents as young F on prolonged OCP?
hepatic adenoma
How does the MC benign liver mass, _____, present?
hepatic hemangioma
nL = asymp
Lg mass = RUQ pain
**Rupture is rare, so not likely to see solid mass surrounded by free fluid.
Acalculous cholecystitis is associated w/ what conditions?
Trauma Surgery Burns Sepsis Prolonged parenteral nutrition
SIBO presentation
Bloating, flatulence, watery diarrhea
+/- malabsorption s/s
What conditions predispose to SIBO?
Conditions that alter gut motility, anatomy or GI sectretions
How does dumping synd. present?
Incr s/s after high carb meals
Flushing, tachy, n/v/d, low BG
What other than AI and infec causes massive LFT spikes?
liver damage 2/2 ischemic compromise
Why does TPN incr risk of gallstones?
causes gall bladder stasis
Which is more likely to lead to toxic megacolon obstructive colon ca or IBD?
IBD
Tx toxic megacolon
IV steroids
NG decompression
ABX
IVF
SAAG > 1.1 g/dL indicates what?
portal HTN etiology of ascites (cardiac, cirrhosis)
SAAG < 1.1 g/dL indicates what?
non-portal HTN etiology of ascites (malignancy, TB, pancreatitis, nephrotic synd)
What is the timeline for breast milk vs breast feeding jaundice?
Breast milk = starts day 3-5 and peaks @ 2 wks old
Breast feeding = starts 1st week of life
What are the causes of breast milk vs breastfeeding jaundice?
Breast milk = enzymatic problem with breast milk
Breastfeeding = baby not getting enough milk
3 causes of bright red blood per rectum and how much blood should you expect to see?
- hemorrhoids (streaks on TP)
- AVM (sm vol frank blood)
- diverticulosis (Lg vol frank blood)
Drugs that induce hepatitis?
TB drugs (Rifampin, Isoniazid, Pyrazynamide)
Tetracyclines
Acetaminophen OD
OCP affects on liver
- incr LFTs w/o necrosis
2. hepatic adenoma
AFP is incr in what two cancer types?
- Liver
2. Yolk Sac
How does multiple myeloma present on xray?
Bone LYTIC lesions. NO BLASTIC LESIONS.
Cholangiocarcinoma tumor markers and labs?
CEA = incr
Ca19-9 = incr
alk phos = incr
AFP = nL
What is P/E sign for temporal wasting suspicious for?
Immunosupression
AIDS
Cancer
Elderly
Foreign people, immigrants, and pts w/ h/o recent travel abroad are suspicious for ___
Infectious process
Which arthritis causes anemia of chronic dz?
RA
Can an intubated pt receive an EGD?
yes (you dummy!)
NS in management in pt w/ acute liver failure 2/2 drug OD?
liver transplant (esp if LFTs trending up)
How does gastric outlet syndrome present?
- early satiety
- nasuea
- nonbillous vomiting
- weightloss
What are the s/s vit A def?
Eyes: -decr adaptation to darkness -photophobia -xerosis conjunctiva -xerosis cornea Skin: -keratomalacia -folicular hyperkeratosis and bitot spots (shoulders, butt, extensor surfaces) -dry scaley skin
what causes biliary colic?
intermittent incr pressure when gallstone obstructs cystic duct –> colicky pain
How does stress fracture of the foot present?
+ point tendernesss
+/- edema
- redness/bruising
**HAIRLINE fracture on xray
when does the w/u of an ankle injury include xray?
- pt unable to weightbear
- tenderness over boney landmarks
what types of pts present w/ stress fractures?
- sudden incr in exercise
- long distance runners
- low BMI
- *look out for F w/ the athlete’s traid (oligomeorrhea, osteoporosis, decr caloric intake)
what is podagra?
gout of the big toe. often begins at night
How to tx stress fracture?
- REST and NSAIDs
- Sx if s/s not resolving
What are the osteoporosis screening guidelines?
1x DEXA scan F age>=65
DEXA scan F age<65 if high risk
why might celiac pts fracture easily?
celiacs = malabsorptive dz. malabsorption –>vit ADEK def. vit D def –> osteoporosis –> fragility fractures
What are the 5 causes of high output heart failure? (Bonus: why?)
- severe anemia (low O2 carrying capacity –> heart pumps faster to deliver O2)
- hyperthyroidism (incr metabolism –> incr O2 demand –> heart works harder)
- AV fistula (diverted blood –> heart works harder to feed body)
- Beriberi (incr metabolism –> incr O2 demand –> heart works harder)
- Paget’s disease (abn bone –> abn vasc grows –> heart works harder to compensate)
How does paget’s dz of the bone present?
- skeletal deformities (thick skull, bowed legs)
- bone pain
- fractures (make lots of poor quality bone)
what does pt feel w/ meniscal tear?
popping sensation
what does dr feel on P/E of pt w/ meniscal tear?
locking sensation w/ IR
MC mechanism of injury meniscal tear = ?
sudden twisting on a planted foot
What conditions are associated w/ gout?
- idiopathic gout
- tumor lysis syndrome
- lesch-nyhan (hypoxanthine oxidase def)
- myeloproliferative
How does polycythemia vera present?
- headache (high blood viscosity)
- itchy after hot bath
- hepatosplenomegaly
If gout presents w/ self-mutilation, what is the dz?
Lesch-nyhan
What causes gout in Lesch-nyhan?
hypoxanthine-guanine phosphoribosyl transferase def
How does AVN present on xray?
Early = no changes Late = boney remodeling
Anti-U1 RNA (ribonucleoprotein) is associated w/ what condition?
MCTD
MCTD includes features of what 3 conditions?
- SLE
- Systemic sclerosis
- Polymyositis
What should you have decr index of suspicion for in dermatomyositis pts?
malignancy
What are the s/s of hypercalcemia?
BONES (bone pain) STONES (kidney stones) GROANS (fatigue) MOANS (constip) PSYCH OVERTONES
What is the typical presentation of polymyalgia rheumatica?
- F age>50
- > =1 mos STIFF/painful neck, shoulders, pelvic girdle
- ESR > 40
