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MS3 > Step studying 8 > Flashcards

Step studying 8 Flashcards

1
Q

What specific test is used for C. Diff

A

C. Diff nucleic amplification assay (NAAT)

not toxin

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2
Q

Presentation of VIPoma

A

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

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3
Q

Presentation of carcinoid tumor

A 
BFDR
•	Bronchospasm
•	Flushing
•	Diarrhea
•	Right-sided heart disease/murmur
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4
Q

How do you reverse Warfarin

A
  • Immediate = fresh frozen plasma (contains clotting factors)
  • Delayed = Vitamin K
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5
Q

What presents as PAINLESS bleeding in pregnancy

A

Placenta previa or vasa previa

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6
Q

Next step in pt with likely PE

A

Assess for contraindications to anti-coagulation - if not contraindications + high likelihood, give anti-coag BEFORE diagnostic test

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7
Q

Best test for diagnosis of abdominal aortic aneurysm

A

Abdominal US

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8
Q

Management of epiglottitis

A

Intubation + abx

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9
Q

Describe laryngomalacia and its managemetn

A
  • 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
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10
Q

Describe Ehlers Danlos

A

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

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11
Q

Describe Marfan syndrome

A

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

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12
Q

What disorder is associated with wrist pain in mother’s carrying newborn babies

A

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

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13
Q

Describe how D-xylose is used to assess for types of malabsorption

A

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

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14
Q

What is topical sprue and how do you treat it?

A

♣ 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

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15
Q

Presentation of Whipple disease

A 
- Malabsorptive diarrhea
(steatorrhea, flatulence, distension)
- Arthralgias
- Lymphadenopathy
- Neurologic symptoms
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16
Q

How do you diagnose Whipple disease

A

Histology will show PAS+ foamy macrophages

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17
Q

Tx of Whipple disease

A

• Abx = TMP-SMP or Doxycycline

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18
Q

Tx of mild diverticulitis

A
  • Liquid diet

- Oral abx

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19
Q

Tx of severe diverticulitis w/o perf

A
  • NPO

- IV abx

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20
Q

Tx of diverticulitis w/ abscess

A
  • NPO
  • IV abx
  • Drainage
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21
Q

Tx of perforated diverticulitis

A
  • Exploratory laparotomy

- IV abx

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22
Q

Tx of refractory diverticulitis

A
  • Exploratory laparotomy
  • IV abs
  • Consider hemicolectomy
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23
Q

What is the defect in Lynch syndrome

A

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

24
Q

What cancers are associated with Lynch syndrome

A

♣ THINK: Mr. Lynch is the CEO of a company
• C = colorectal
• E = endometrial
• O = ovarian

25
Q

What is Turcot Syndrome

A

o FAP + malignant CNS tumor (medulloblastoma)

♣ THINK: TURcot = TURban

26
Q

What is Gardner syndrome

A

♣ 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

27
Q

Describe Peutz Jeghers syndrome

A

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

28
Q

Clinical features of Wilson disease

A

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)

29
Q

Cause of primary hemochromatosis

A

o Recessive mutation in HFE gene = abnormal iron sensing = increased intestinal absorption

30
Q

Presentation of primary hemochromatosis

A

o Cirrhosis
o Diabetes mellitus
o Skin pigmentation

31
Q

Tx of hemochromatosis

A
  • Phlebotomy (blood-letting)

* Chelation with Deferoxamine

32
Q

Tx of Wilson disease

A

Penicillamine

Liver transplant

33
Q

Where is the problem and what population is affected in Primary biliary cholangitis

A

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)

34
Q

Where is the problem and what populatino is affected in primary sclerosis cholangitis

A

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)

35
Q

Which is associated with UC/Crohns, PBC or PSC?

A

PSC

Remember that men are NOT subtle, so will all these extra stuff

36
Q

What is the cause of increased estrogen in liver failure and how does it present

A

The liver is responsible for metabilism of estrogen : decreased liver function = increased estrogen

Presents with:

  • Gynecomastia
  • Palmar erythema
  • Spider angioma
37
Q

Tx of bleeding esophageal varices

A
  • BB (Propranolol, Nadolol) to reduce portal pressure
  • Octreotide to reduce portal pressure
  • Ceftriaxone
  • Banding
  • TIPS procedure
38
Q

What is the serum-albumin ascites gradient (SAAG) and what values mean what

A

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

39
Q

What organisms are found in SBP

A

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

40
Q

What do you look for to diagnose SBP

A

Tap showing neutrophils >250

41
Q

Tx of SBP

A
  • IV CTX

* Fluoroquinolones for SBP prophylaxis

42
Q

How do you diagnose hepatocellular carcinoma

A

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

43
Q

Treatment of bipolar depression

A

♣ 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

44
Q

Describe the presentation and common complication of scaphoid fracture

A

Presentation = tenderness at the snuff box

Complication = osteonecrosis due to pathway of blood supply near scaphoid bone

45
Q

Describe breast milk jaundice

A
  • 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
46
Q

Describe breastfeeding failure jaundice

A
  • 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
47
Q

Most common cause of meningitis in children (age 1 month to 10 years)

A
  1. Strep pneumo (~70%)

2. Neisseria meningitis (~15%)

48
Q

Describe presentation of cauda equina syndrome

A

• 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

49
Q

Describe conus medullaris syndrome

A

• 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

50
Q

How is lithium excreted

A

Renally

51
Q

What drugs can be used to treat Tourette’s

A
  • Antipsychotics

- Alpha-2-agonists (Clonidine)

52
Q

How can antipsychotics produce infertility

A

Dopamine blockade = increased prolactin = galactorrhea, menstrual abnormalities, infertility

53
Q

Describe pathogenesis of mesenteric ischemia

A

Due to vasculopathy - occlusion of vessels

Pain out of proportion or pain after eating

54
Q

Describe pathogenesis of ischemic colitis

A

Occurs in watershed areas after an episode of hypotension

55
Q

Tx of mesenteric ischemia

A

Resect and revascularize

56
Q

Tx of ischemic colitis

A

Supportive: Bowel rest, IVF, abx

Only resect if necrosis develops

57
Q

How can you remember which childhood diseases will have elevated unconjugated vs conjugated bilirubin (Gilbert, Crigler, Dubin, Rotor)

A

U Go Crazy, C Dr. Rogers

Unconjugated = Gilbert and Crigler
Conjugated = Dubin and Rotor

MS3 (88 decks)

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