Random Diseases I've never heard of

Question 1

Aspirin sensitive asthma

Answer 1

Asthma with nasal polyps

Avoid aspirin or NSAIDs because they can cause systemic reaction

Question 2

Histiocytosis X

Answer 2

Chronic interstitial pneumonia caused by abnormal proliferation of histiocytes

90% are cigarette smokers

Symptoms: dyspnea and nonproductive cough
Can also have spontaneous pneumothorax, lytic bone lesions, and diabetes insipidus

CXR: honeycomb appearance, Ct scan shows cystic lesions

Treatment: corticosteroids and lung transplantation

Question 3

Pulmonary alveolar protenosis

Answer 3

Accumulation of surfactant lke protein and phospholipids in alveoli

Symptoms: dry cough, dyspnea, hypoxia, and rales

CXR: ground glass appearance with bilateral alveolar infiltrates that resemble a bat shape

Diagnosis: lung biopsy required for definitive diagnosis

Treatment: lung lavage or Granulocyte-colony-stimulating factor
Do not give steroids due to increased risk of infection

Question 4

Cryptogenic organizing pneumonitis

Answer 4

Inflammatory lung disease with similar features to pneumonia

Features: cough, dyspnea, flu-like symptoms

CXR: bilateral patchy infiltrates

Treatment: spontaneous recovery or corticosteroids

Question 5

Radiation pneumonitis

Answer 5

Interstitial pulmonary inflammation

Acute: 1-6 months after irradiation
Chronic: 1-2 years after

Features: low-grade fever, cough, chest fullness, dyspnea, pleuritic chest pain, hemoptysis, ARDS

CXR: normal

CT scan: best study-diffuse infiltrates, ground glass density, consolidation, pleural/pericardial effusions

Treatment: corticosteroids

Question 6

Complications of Ventilators

Answer 6

Anxiety, agitation and discomfort-use benzos for sedation
opiods for analgesia

Tracheal secretions: suction on the reg

Nosocomial pneumonia: if >3 days

Barotrauma-high airway pressures

O2 toxicity: if FiO2 greater than .6 for 2-3 days

Hypotension: increased intrathoracic pressure decreases venous return

Tracheomalacia: softening of tracheal cartilage if greater than 2 weeks

Stress ulcers and cholestasis

Question 7

Gardner’s syndrome

Answer 7

Colon Polyps plus osteomas, dental abnormalities, benign soft tissues tumors, desmoid tumors, sebaceous cysts

Risk of Colorectal cancer is 100% by 40

Question 8

Turcot’s syndrome

Answer 8

AR

Polyps plus cerebellar medulloblastoma or gliobalstoma multiforme

Question 9

Angiodysplasia of the colon

Answer 9

Tortuous, dilated veins in submucosa of he colon-usually proximal wall
Common cause of lower GI bleeding

Diagnosed by colonscopy

90% bleeding stops spontaneously

Treated with: colonscopic coagulation
persists-right hemicolectomy

Question 10

Ogilvies Syndrome

Answer 10

Signs, symptoms and radiological evidence of large bowel obstruction are present but there is no mechanical obstruction

Causes: recent surgery or trauma, serious medical illnesses and medications (narcotics, psychotropic drugs, anticholinergics)

Treatment: stop offending agent
IV fluids, electrolyte repletion 
Decompression with enemas or nasogastric suction
Colonoscopic decompression 
Surgical decompression is last resort

Question 11

hepatorenal syndrome

Answer 11

indicates end stage liver disease
Progressive renal failure in advanced liver disease, secondary to renal hypoperfusion from vasoconstriction of renal vessels

Precipitated by infection or diuretics

Clinical: azotemia, oliguria, hyponatremia,, hypotension, low urine sodium (

Question 12

Spontaneous bacterial periotnitis

Answer 12

Infected ascitic fluid-occurs in 20% of patients hospitalized for ascites
High mortality rate (associated with ESLD)

Etiologic agents: E. Coli (most common), Klebsiella, Strep. pneumo

Clinical: abdominal pain, fever, vomiting, rebound tenderness, SBP may lead to sepsis

Diagnosis: established by paracentesis
WBbs >500 PMN>250
Culture fluid

Treatment: broad sprectrum antibiotics
Repeat paracentesis in 2-3 days to decrease ascitic fluid PMN to less than 250

Question 13

Hepatic Hydrothorax

Answer 13

Tansudative pleural effusion more common on right side

Treatment: liver transplantation
Therapeutic thorancentesis
salt restriction and diuretics

Refractory: transjugular intrhepatic portosystemic shunt

Question 14

Hemobilia

Answer 14

Blood draining into duodenum via common bile duct

Causes: trauma, papillary thyroid carcinoma, surgery, tumors, infection

Clinical: GI bleeding, jaundice, and RUQ pain

Diagnosis: arteriogram
Upper GI endoscopy shows blood coming out of the ampulla of Vater

Treatment: resuscitation
Severe bleeding: surgery-ligation of hepatic arteries or embolization of vessel

Question 15

Aortoenteric fistula

Answer 15

Rare but lethal cause of GI bleed

history of aortic graft surgery who has a small GI bleed involving the duodenum before massive fatal hemorhage hours to weeks later

Endoscopy or surgery during small window to prevent death

Question 16

Schatzki’s ring (distal esphogeal webs)

Answer 16

Cricumferetnial ring in lower esophagus acompanied by a sliding hiatal hernia

usually asymptomatic but can have dysphagia

Symptomatic but no reflux=esophageal dilatation
Reflux=antireflux surgery

Due to ingestion of alkali, acids, bleach or detergents (alkali most dangerous due to full thickness necrosis)

Complications: strictures leading to esophageal cancer

Treatment: esophagectomy if full thickness necrosis has occurred
Patient should avoid vomiting, gastric lavage, and all oral intake
Give patient steroids and antibiotics as well
Perform bougienage for stricture

Question 17

Myxedema coma

Answer 17

Depressed state of consciousness, profound hypothermia, and respiratory depression

Develops after years of severe untreated hypothyroidism

Trauma, infection, cold exposure and narcotics may precipitate coma

high mortality event with treatment

Supportive therapy to maintain BP and respiration
IV thyroxine and hydrocortisone while maintaining hemodynamic state