Questions--March 2017 Flashcards
Disseminated gonococcal infection: Clinical presentation
Purulent monoarthritis and/or triad of (1) dermatitis, (2) assymetric migratory polyarthralgias, and (3) tenosynovitis
Disseminated gonococcal infection: diagnostic testing
Blood and pustule cultures may be negative.
NAAT of urethra, cervix, pharynx, or rectum usually will come back positive.
Two types of contact dermatitis
allergic vs irritant
Allergic contact dermatitis: pathophys, triggers, appearance
pathophys: type IV hypersensitivity
triggers: poison oak, poison ivy, nickel, rubber, meds
appearance: primarily on exposed skin and well demarcated, with erythema, papules/vesicles, and chronic lichenification
Irritant contact dermatitis: pathophys, triggers, appearance
pathophys: physical or chemical
triggers: soaps, detergents, chemicals
appearance: commonly on hands, with erythema and fissures
VIPoma: clinical presentation
watery diarrhea, hypo or achlorhydia due decreased gastric acid secretion, associated flushing, NN/V, muscle weakness, cranps
VIPoma: lab findings
hypokalemia, hyperclacemia, hyperglycemia, stool studies showing secretory diarrhea and increased sodium and osmolol gap less than 50
VIPoma: diagnostic criteria
watery diarrhea with VIP level greater than 75; abdominal CT or MRI to localize tumor in the pancreas (usually the pancreatc tail)
Acute interstitial nephritis: Clinical features and number of days until symptom onset
maculopapular rash, fever, new drug exposure (penicillins, TMP SMX, cephalosporins, NSAIDS), +/- arthralgias
NOTE: 5days to several weeks after use of offending agent
Acute interstitial nephritis: lab findings
AKI
Pyuria, hematuria, WBC casts
Eosinophilia, urinary eosinophils
Renal biopsy: inflammatory inflitrate, edema
stevens-johnson syndrome: triggers
Drugs: allopurinol, antibiotics, anticonvulsants, NSAIDs, sulfasalazine
Other: Mycoplasma pneumo, vaccination, graft-vs-host disease
steven-johnson syndrome: clinical features
4-28 days after exposure to trigger
Acute influenza-like prodrome
Rapid-onset erythematous macules, vesicles, bullae
Necrosis and sloughing of epidermis
Mucosal involvement (this is distinction with toxic epidermal necrolysis, which does not have mucosal involvement and involves >30% body surface area as opposed to <10%)
Systemic signs: AMS, fever, HDinstability
true positive vs flase positive rate
true positive (sensitivity) false positive (1-specificity) the higher the false positive rate the lower the specificity
Trichinellosis infection: clinical presentation
Intestinal stage (within one week of ingestion): asymptomatic or GI upset including abdominal pain, N/V/D
Muscle stage (up to 4 weeks after ingestion): myositis, fever, subungal splinter hemorrhages, periorbital edema, eosinophilia (usually >20%) with possible elevated CK and WBC
NOTE: severe disease can involve the heart, lungs, and CNS
Bacteria in viridans group streptococci
strept mutans/mitis/oralis/sanguinis
Major modified Duke criteria for infective endocarditis
Blood culture positive for typical organism (s. viridans, staph aureus, entercoccus), Echo showing valvular vegetation
NOTE: definite IE = 2 major OR1 major + 3 minor criteria
Minor modified Duke criteria for infective endocarditits
Predisposing cardiac lesion, IVDU, febrile, immunologic phenomena (glomerulonephritis), positive blood cx not meeting above criteria
6 clinical features of inectious mononucleosis
fever tonsillitis/pharyngitis +/- exudates Posterior or diffuse cervical lymphadenopathy Significant fatigue \+/- hepatosplenomegaly \+/- rash after amoxicillin
Equation for appropriate respiratory compensation for a metabolic acidosis
PaCo2 = 1.5 x bicarb + 8 +/- 2
Digoxin toxicity
N/V, decreased appetite, confusion, weakness, scotoma/blurry vision with changes in color/blindness
NOTE: Inciting events include anything that leads to volume depletion (viral illness or excessive diuretic use)
5 clinical features of primary hyperparathyroidism
nephrolithiasis, osteoporosis, nausea, constipation, and neuropsychiatric sxs (stones, bones, abdominal moans,and psychic groans)
Conditions associated with secondary amyloidosis
inflammatory arthritis (RA) Chronic infections (Tb) IBD Malignancy Vasculitis
Clinical presentation and treatment of secondary amyloidosis
Clinical presentation: multi-organ dysfunction–asymptomatic proteinuria or nephrotic syndrome, cardiomyopathy with heart failure, hepatomegaly, mized sensory and motor peripheral neuropathy and/or autonomic neuropathy, visible organ enlargement (macroglossia), bleeding diathesis, waxy thickening/easy bruisability of skin
Treatment and ppx: colchine
Infective endocarditis: vascular phenomena
systemic emboli, mycotic aneurysm, janeway lesions (macular, erythematous, nontender lesions on the palms and soles)
Infective endocarditis: immunologic phenomena
Osler nodes (painful, violacious nodules seen on the fingers and toes) Roth spots (edematous and hemorrhagic lesions of the retina)
hepatitis A virus vaccine: indications
chronic liver disease (including HBV and HCV)
Risk factors for HIV (men who have sex with men, IVDU) or HIV itself
Chronic pancreatitis: clinical presentation
chronic epigastic pain with intermittent pain free periods, malabsorption (steatorrhea, weight loss), DM, partial relief when leaning forward
Chronic pancreatitis: appropriate labs and imaging
CT scan or MRCP (can show calcifications, dilated ducts, and an enlarged pancreas)
NOTE: Amylase/lipase in CPcan be nl or nondiagnostic, while they will be elevated 3xnl in AP
Adult Still Disease
An uncommon inflammatory d/o characterized by recurrent high fevers, arthritis/arthralgias, and a salmon-colored macular/maculopapular rash. ESR may be markedly elevated
NOTE: distinguished from infective endocarditis by absence of active urine sediment, painful fingertips, and pulmonary symptoms
MEN1
Primary hyperparathyroidism (hypercalcemia)
Pituitary tumors (prolactin, visual defects)
Pancreatic tumors (especially gastrinomas)
MEN2A
Medullary thyroid cancer (calcitonin)
pheo
parathyoid hyperplasia
MEN2B
Medullary thyroid cancer (calcitonin)
Pheo
Mucosal neuromas/marfanoid habitus
Porphyris cutanea Tarda: clinical features and associations
Clinical: blisters, bullae, scarring on sun-exposed skin
Scarring and calcification can look similar to scleroderma
Progressive buildup of porphorin lends itself to more severe presentations over time
Association: HCV, HIV, ecessive alcohol consumption, smoking, estrogen use
Scleroderma renal crisis
Occurs in 20% of those with systemic scleroderma (for most within first 5 years)
Presents with acute renal failure (w/ out previous kidney disease) and malignant HTN (HA, blurry vision, and nausea). UA may show mild proteinuria. PBScan show microangiopathic hemolytic anemia with schistocytes and thrombocytopenia
3 prokinetic agents used in diabetic gastroparesis
metoclopramide, erythromycin, and cisapride
Treatment of primary biliary cholangitis
ursodeoxycholic acid
relative risk vs exposure odds ratio
Relative risk: risk of one group having a certain outcome vs another group (cohort study where people tracked over time )
Exposure odds ratio: used in case-control (retrospective) studies where expousre of people already known to have the disease is compared to the exposure of those without the disease
ABG findings: COPD vs decompensated CHF
COPD: respiratory acidosis and hypoxia
CHF: respiratory alkalosis and hypocapnia as well as hypoxia
3 criteria in COPD exacerbation
Increased dyspnea
Increased cough (more frequent or severe)
Change in sputum production (color or volume)
Use antibiotics if fits 2 or more criteria, especially with increased sputum purulence
antibiotic tx of moderate-severe COPD exacerbation
macrolides (azithro)
fluoroquinolones (levofloxacin, moxifloxacin)
penicillin/beta-lactamase inhibitors (amoxicillin-clavulante)
Etiologies of interstitial lung disease
chronic inhalation of organic/inorganic dust (asbestos berylium, silicon dioxide)
Drug toxicity (amiodarone, bleomycin, nitrofurantoin)
radiation
systermic connective tissue disease (RA, scleroderma)
Adverse effects of ACE inhibbitors
Acquired angiodema
cough
hyperkalemia
acute renal failure in pts with bilateral renal artery stenosis
pulmonary capillary wedge pressure =
left atrial pressure and left-sided heart function
Pseudogout
An acute inflammatory arthritis caused by calcium pyrophosphate crystals
Occurs in the setting of recent surgery or medical illness
Diagnosed with synovial fluid showing rhomboid-shaped positively birefringent crystals and radiographic evidence of chondrocalcinosis ( caalcified articular cartilage)
Theophylline toxicity: 2 main manifestations
central nervous system stimulation (HA, insomnia, seuzures) and cardiac toxicity (arrythmia) in the setting of medication changes
Bronchiectasis
A disease of bronchial wall damage and airway dilation due to a recurrent cycle of infection, inflammation, and tissue damage in combinatio with impaired bacterial clearance (d/t impaired immmune defenses, structural airway defect, etc)
Modified Wells criteria for pretest probability of PE
+3 points–clinical signs of DVT, alternate diagnosis less likely
+1.5 points–previous PE or DVT, hr greater than 100, recent surgery or immobilization
+1 point–hemoptysis, cancer
Greater than 4 points = PElikely
DKA: Lab findings
metabolic acidosis (shownn by low bicarb) with an elevated anion gap Hyperkalemia (d/t extracellular shift and loss of insulin dependent cellular uptake. however, osmotic diuresis is actually promoting total body depletion of potassium)
Anion gap calculation
sodium - (chloride + bicarb)
nl is 10-14
Treatment of DKA: 3 must-haves +/- 2
IVfluids + potassium (when K<5.2 as nearly all pts K depleted even when hyperkalemic)
Insulin
Bicarb for pH < 6.9
Phosphate if cardiac dsyfunction
PIKIB