Step3 35 Flashcards
Extraintestinal manifestations of celiac disease
Skin: dermatitis herpetiform
Oral: enamel hypotropia, atrophic glossitis
M/E: rickets/osteomalacia due to Vit D deficiency
Neuro: peripheral neuropathy, depression, dementia: B12 def.
Hem: iron deficiency anemia
Risk factors for celiac disease
First-degree relative
Down sd.
Other autoimmune diseases
Features of Central hypothyroidism
Hypothyroid symptoms with low free T4 and low or inappropriately normal TSH
Other pituitary hormones are low (LH, FSH,)
Mass effect
Diagnosis and treatment of central hypothyroidism
DIAGNOSIS
Low free T4
Low or inappropriately normal TSH
MRI of pituitary
TREATMENT
Levothyroxine until free T4 is normal. TSH is not used for treatment adjustment
Perform an ACTH stimulation test before treatment. Thyroid hormone can precipitate an adrenal crisis by increasing cortisol metabolism
Risk factors for a rapid decline in CKD
Most significant:
Hypertension
Hyperglycemia
Proteinuria
Others: Hyperuricemia Metabolic acidosis Anemia Hyperphosphatemia Hyperlipidemia
Expected response in Creatinine after ACEI initiation
Creatinine and K can raise
An increase in <30% is ok and treatment can stay as is
More severe increases warrant treatment discontinuation
Renal tubular acidosis type 1
Pathogenesis
Clinical presentation
Laboratory findings
Treatment
(Compare to type 2)
Pathogenesis:
Impaired excretion of Hydrogen (vs. impaired absorption of HCO3)
Clinical presentation:
Nephrolithiasis, nephrocalcinosis, bone demineralization
Laboratory findings: Non-anion gap metabolic acidosis Urine pH >5.5 Hypokalemia (K wasting), hypochloremia Hypercalciuria
Treatment:
Bicarbonate
+/- Potassium supplementation
pH depending on the kind of stone and shape of the stone
Calcium: square
Calcium phosphate: pH is High
Calcium oxalate: pH is low
Struvite: paralelepidedo
pH is High
Uric acid: diamond
pH is Low
Cysteine: hexagon
pH is Low
Complications of Juvenile osteoarthritis
Joint destruction, deformities
Osteoporosis
+/- Uveitis
Painful vs. Painless genital lesions
Painful:
Herpes
Chancroid (H. ducreyi)
Painless:
Syphilis (Treponema pallidum)
Granuloma inguinale (Klepsiella granulomatis)
Lymphogranuloma venereum (Chlamydia trachomatis)
Clinical presentation of the Painful genital lesions and treatment
Chancroid: Large, deep, and well-demarcated ulcer Gray-yellow exudate Severe lymphadenopathy that may suppurate Azithromycin or ceftriaxone
Herpes: Small vesicles Systemic symptoms Painful lymphadenopathies Acyclovir/valacyclovir
Clinical presentation of the Painless genital lesions
Syphilis:
Usually single ulcer, indurated border
Red, raised, non-purulent
Penicillin G
Lymphogranuloma venereum: (Chlamydia trachomatis)
Small ulcer, usually missed
Painful and fluctuant adenitis (bubones)
Azithromycin or ceftriaxone
Granuloma inguinale: (Klebsiella granulomatis)
Small, single, or multiple
Granulomatous ulcers
Doxy or azythro
Behcet syndrome
It’s a vasculitis that causes multiple and recurrent ulcers in the genitals, mouth, and other tisues similar to aphthous soar.
It may be in Dxx of genital ulcers
When do you vaccinate preterm babies
According to their chronological age, no need to correct
Treatment for SSRI-induced sexual dysfunction
Bupropion
General approach to erectile dysfunction
- Treat reversible cause
- Lyfe-style modifications
If erection… psychological
Cardiovascular
Endocrine: TSH,
Hypogonadism: slow onset, other signs
Neuropathic: diabetes, other neurological disorder
Medications: bp, depression, antiandrogenic
Case-control vs. a cohort study
Case-control:
Selects the outcome (eg. patients with cancer) and compares the risk of exposure in people with cancer vs. people without it
Cohort:
Classifies people as exposed vs. unexposed and then looks for the outcome
When do you start screening for ADPCKD?
After 18 years old
Renal cyst: Simple vs. Malignant
Simple: Smooth, thin wall Uniloculated No septation Homogenous filling Usually asymptomatic Absence of contrast enhancement on CT or MRI No follow up needed
ADPCKD diagnosis
Ultrasound after 18
15-40: >3 cyst uni or bilat
40-50: >2 cysts on each
>60: >4 cysts on each
If no family history:
>10 at any age
Internal vs. external validity. How to increase or decrease it?
Internal validity: describes causality (a change in the independent variable causes a change in the dependent variable)
More tightly controlled = more validity
Threat to validity: confounding, measurement, maturation, regression, etc
External validity: is generalizability.
The tighter the study, the less generalizability
Threat to validity: artificial environment. measurement effects, the sample is not representative
Explanatory trials vs. Pragmatic trials
Explanatory:
Usually, phases II and III of clinical trials
Small samples, tightly controlled,
Pragmatic: for external validity
Phase IV
Large samples, less controlled, more diverse enviroment
Treatment for Anorexia vs. Bulimia
Both:
CBT
Nutritional support
Anorexia: Olanzapine if above fails
Bulimia: SSRI in combination with above
Approach to menopause with vasomotor symptoms
- Mild or Moderate to severe?
Mild: behavioral therapy
Mod/Sev: step 2 - Strogen contraindication?
Yes: SSRI
No: step 3 - Does the patient have an intact uterus?
No: Strogen only
Yes; Strogen + progesterone
What do you do next in a patient with molluscum contagiosum
Child: just treat (curetting, freezing, cantharidin)
Genital lesions: other STD screening
Severe infection: HIV screening
Pyogenic granuloma
Small benign capillary hemangiomas (red papuples)
Gingival bleeding in pregnancy
Normal
Due to gums hypertrophy and inflamation
Endocarditis mnemonic
FROM JANE
Fever
Roth spots
Oslher node
Mumur
Janeway lesion
Anemia
Nail
Embolic phenomena
Empiric treatment for infective endocarditis
Vanco genta
