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
