Step studying 8 Flashcards
What specific test is used for C. Diff
C. Diff nucleic amplification assay (NAAT)
not toxin
Presentation of VIPoma
WDHA (watery diarrhea, hypokalemia, achlorhydria)
o Watery diarrhea
o Hypo- or achlorhydia due to decreased gastric acid secretion
o Associated flushing, lethargy, nausea, vomiting, muscle weakness/cramps
Presentation of carcinoid tumor
BFDR • Bronchospasm • Flushing • Diarrhea • Right-sided heart disease/murmur
How do you reverse Warfarin
- Immediate = fresh frozen plasma (contains clotting factors)
- Delayed = Vitamin K
What presents as PAINLESS bleeding in pregnancy
Placenta previa or vasa previa
Next step in pt with likely PE
Assess for contraindications to anti-coagulation - if not contraindications + high likelihood, give anti-coag BEFORE diagnostic test
Best test for diagnosis of abdominal aortic aneurysm
Abdominal US
Management of epiglottitis
Intubation + abx
Describe laryngomalacia and its managemetn
- Due to collapse of supraglottic structures during inspiration
- Inspiratory stridor most prominent in infants
- Stridor worse when supine, improves when prone
- Management = reassurance in most cases; supraglottoplasty in severe cases
Describe Ehlers Danlos
o Faulty collagen synthesis due to:
♣ Type V collagen defect seen in classic type
♣ Type III collagen defect seen in vascular subtype
o Presentation:
♣ Elastic skin
♣ Hypermobility of joints
♣ Increased bleeding tendency
♣ May also be associated with joint dislocation, berry and aortic aneurysm, organ rupture
Describe Marfan syndrome
o Autosomal dominant mutation in fibrillin gene (FBN1) which codes for a protein responsible for the production and maintenance of elastin fibers
o Presentation:
♣ Arachnodactyly
♣ Lens dislocation (upward) – vs. homocystinuria which is down and in
♣ Aortic dilation, regurgitation (diastolic murmur), or acute aortic dissection
♣ Hyperflexible joints
♣ Spontaneous pneumothorax from apical blebs
♣ Mitral valve prolapse
What disorder is associated with wrist pain in mother’s carrying newborn babies
De Quervain tenosynovitis
• Caused by inflammation of the abductor pollicis longus and extensor pollicis brevis as they pass through a fibrous sheath at the radial styloid process
• Tenderness can be elicited with direct palpation of the radial side of the wrist at the base of the hand
• The Finkelstein test, which is conducted by passively stretching the affected tendons by grasping the flexed thumb into the palm with the fingers, elicits pain
Describe how D-xylose is used to assess for types of malabsorption
o D-xylose is a monosaccharide that is absorbed in the small intestine without needing to be degraded by pancreatic or brush border enzymes
o Patients with small intestinal mucosal disease will have impaired absorption of D-xylose, and thus decreased urinary excretion of D-xylose
o Patients with malabsorption due to enzyme deficiencies (e.g. pancreatitis), will have normal absorption of D-xylose
What is topical sprue and how do you treat it?
♣ Infectious cause – vs Celiac sprue which is autoimmune
♣ Looks like celiac but:
• Affects the entire small bowel
• Does not get better with avoidance of gluten
• Usually presents in a Caribbean farmer
• Responds to antibiotics – e.g. Rifaximin
Presentation of Whipple disease
- Malabsorptive diarrhea (steatorrhea, flatulence, distension) - Arthralgias - Lymphadenopathy - Neurologic symptoms
How do you diagnose Whipple disease
Histology will show PAS+ foamy macrophages
Tx of Whipple disease
• Abx = TMP-SMP or Doxycycline
Tx of mild diverticulitis
- Liquid diet
- Oral abx
Tx of severe diverticulitis w/o perf
- NPO
- IV abx
Tx of diverticulitis w/ abscess
- NPO
- IV abx
- Drainage
Tx of perforated diverticulitis
- Exploratory laparotomy
- IV abx
Tx of refractory diverticulitis
- Exploratory laparotomy
- IV abs
- Consider hemicolectomy
What is the defect in Lynch syndrome
o Aka Hereditary Nonpolyposis Colorectal Cancer (HNPCC)
o Autosomal dominant
o Defect in DNA mismatch repair (MMR) – e.g. MSH2, MLH1
o Cancer that does NOT arise from polyps
What cancers are associated with Lynch syndrome
♣ THINK: Mr. Lynch is the CEO of a company
• C = colorectal
• E = endometrial
• O = ovarian
What is Turcot Syndrome
o FAP + malignant CNS tumor (medulloblastoma)
♣ THINK: TURcot = TURban
What is Gardner syndrome
♣ THINK: Gardener from the Kaposi sketchy
• Digging through haustra-shaped planters = FAP
• Digs up a bone = osteoma
• Old lady smiles with extra teeth = supernumerary teeth
Describe Peutz Jeghers syndrome
o Hamartomas (excess accumulation of normal tissue) throughout the GI tract
o Hyperpigmentation of mouth, lips, hands, and genitalia
o Associated with increased risk of breast and GI cancers
Clinical features of Wilson disease
Due to inadequate copper excretion into the bile
Liver disease, Kayser-Fleischer rings, renal disease (Fanconi syndrome), neurologic manifestations (behavioral changes, dementia, chorea, parkinsonian sx)
Cause of primary hemochromatosis
o Recessive mutation in HFE gene = abnormal iron sensing = increased intestinal absorption
Presentation of primary hemochromatosis
o Cirrhosis
o Diabetes mellitus
o Skin pigmentation
Tx of hemochromatosis
- Phlebotomy (blood-letting)
* Chelation with Deferoxamine
Tx of Wilson disease
Penicillamine
Liver transplant
Where is the problem and what population is affected in Primary biliary cholangitis
o Autoimmune destruction of intra-hepatic bile ducts
♣ Occurs in women (think that the B in PBC stands for Bitches) who are subtle (intra-hepatic)
Where is the problem and what populatino is affected in primary sclerosis cholangitis
o Is a disease of the EXTRA-hepatic bile ducts
♣ Occurs in men so think that men are not subtle = extra-hepatic
• Vs women (PBC) who are subtle (intra-hepatic)
Which is associated with UC/Crohns, PBC or PSC?
PSC
Remember that men are NOT subtle, so will all these extra stuff
What is the cause of increased estrogen in liver failure and how does it present
The liver is responsible for metabilism of estrogen : decreased liver function = increased estrogen
Presents with:
- Gynecomastia
- Palmar erythema
- Spider angioma
Tx of bleeding esophageal varices
- BB (Propranolol, Nadolol) to reduce portal pressure
- Octreotide to reduce portal pressure
- Ceftriaxone
- Banding
- TIPS procedure
What is the serum-albumin ascites gradient (SAAG) and what values mean what
SAAG = (serum albumin) – (ascites albumin)
SAAG > 1.1
o This occurs when there is not a lot of stuff in the ascites, meaning it was caused by hydrostatic pressure pushing fluid out
o Causes: portal HTN, R-sided heart failure
SAAG < 1.1
o This occurs when there is a lot of stuff in the ascites meaning it was caused by oncotic pressure pulling fluid into the belly
o Causes: cancer, nephrotic syndrome, tuberculosis, pancreatitis, biliary disease, connective tissue disease
What organisms are found in SBP
Strep and/or GNR
o If culture comes back with a bunch of different organism, then this was most likely caused by a bowel perforation = need surgery
What do you look for to diagnose SBP
Tap showing neutrophils >250
Tx of SBP
- IV CTX
* Fluoroquinolones for SBP prophylaxis
How do you diagnose hepatocellular carcinoma
o NOT WITH BIOPSY!
o Screen with RUQ US looking for mass + elevated AFP
o Confirmatory test = triple phase CT
♣ Cancer is supplied by arteries, so during arterial phase of the CT, the cancer will light up
♣ Liver is supplied by the portal vein so it will not light up in the arterial phase of the CT but will light up in the venous phase, whereas cancer will not light up in venous phase
Treatment of bipolar depression
♣ Second generation antipsychotics (Quetiapine) and Lamotrigine
♣ Lithium, valproate, and combo Olanzapine + Fluoxetine have also demonstrated efficacy
♣ Antidepressant monotherapy should be xavoid due to risk of precipitating mania
Describe the presentation and common complication of scaphoid fracture
Presentation = tenderness at the snuff box
Complication = osteonecrosis due to pathway of blood supply near scaphoid bone
Describe breast milk jaundice
- Problem with quality of feeding
- Thought to be due to human milk causing increase of intestinal absorption of bilirubin
- Concentrations up to 30 mg/dL during 2nd to 3rd week of life can be seen
- If breast feeding continued, the levels gradually decrease
- Tx = Formula substitution for breast milk for 12-24 hours results in rapid bilirubin level decrease
- Breast-feeding can be resumed without return of hyperbilirubinemia
Describe breastfeeding failure jaundice
- Problem with quantity of feeding
- Decreased intake causes decreased stooling and therefore decreased bilirubin elimination and increased intrahepatic circulation
- Will have exaggerated unconjugated hyperbilirubinemia (Indirect > direct)
- Pt will have signs of dehydration / feeding difficulty
- Tx = feed baby more
Most common cause of meningitis in children (age 1 month to 10 years)
- Strep pneumo (~70%)
2. Neisseria meningitis (~15%)
Describe presentation of cauda equina syndrome
• Cauda equina syndrome (spinal cord ends at L1-L2 and nerve roots below this level form cauda equine)
o Likely due to disc herniation or rupture, spinal stenosis, tumors, infection, hemorrhage, or iatrogenic injury
o Causes LMN signs as the nerve roots are part of the peripheral nervous system
o Usually bilateral, severe radicular pain
o Saddle hypo/anesthesia
o Asymmetric motor weakness
o Hyporeflexia/areflexia
o Late-onset bowel and bladder dysfunction
Describe conus medullaris syndrome
• Conus medullaris syndrome (conus medullaris is the spinal cord termination)
o Causes both UMN and LMN symptoms
o Sudden onset severe back pain
o Perianal hypo/anesthesia
o Symmetric motor weakness
o Hyperrreflexia
o Early-onset bowel or bladder dysfunction
How is lithium excreted
Renally
What drugs can be used to treat Tourette’s
- Antipsychotics
- Alpha-2-agonists (Clonidine)
How can antipsychotics produce infertility
Dopamine blockade = increased prolactin = galactorrhea, menstrual abnormalities, infertility
Describe pathogenesis of mesenteric ischemia
Due to vasculopathy - occlusion of vessels
Pain out of proportion or pain after eating
Describe pathogenesis of ischemic colitis
Occurs in watershed areas after an episode of hypotension
Tx of mesenteric ischemia
Resect and revascularize
Tx of ischemic colitis
Supportive: Bowel rest, IVF, abx
Only resect if necrosis develops
How can you remember which childhood diseases will have elevated unconjugated vs conjugated bilirubin (Gilbert, Crigler, Dubin, Rotor)
U Go Crazy, C Dr. Rogers
Unconjugated = Gilbert and Crigler Conjugated = Dubin and Rotor
