Test 32 Flashcards
Renal artery stenosis
Renovascular HTN should be suspected in patients with resistant HTN and signs of diffuse atherosclerosis. Such patients should be evaluated with noninvasive testing and renal duplex Doppler ultrasonography or CT or MR angiography. Due to risk of contrast-induced nephropathy and nephrogenic systemic fibrosis when performing CT and gadolinium MR angiography, respectively, these should be avoided in patients with renal insufficiency.
Iron deficiency anemia
Children with untreated iron deficiency anemia are at risk for psychomotor delay and long-term cognitive impairment. Therefore, universal screening should occur around age 1, and empiric iron supplementation is first-line treatment.
Celiac disease
Patients with untreated celiac Dx are at risk of developing enteropathy-associated T cell lymphoma (EATL). Manifestations typically include abdominal pain, B symptoms, and gastrointestinal bleeding. Bowel obstruction or perforation may also occur. Patients with celiac disease who adhere to a strict gluten-free diet have minimal risk of EATL.
Tuberculosis
Prior BCG vaccination should rarely cause more than 15 mm induration with tuberculin skin testing. The effect of BCG vaccination on induration decreases significantly 15 years after the vaccine is received. Rifamycin-based treatment regimens for 3-4 months are recommended for patients with latent tuberculosis.
Dyspepsia
Dyspepsia is characterized by epigastric pain that is often associated with postprandial fullness and/or nausea. Patients greater than or equal to age 60 with new dyspepsia should undergo upper endoscopy to rule out malignancy. Endoscopy is also recommended for patients age less than 60 with significant weight loss, overt gastrointestinal bleeding, or >1 alarm feature (persistent vomiting, progressive dysphasia or odynophagia, palpable mass or lymphadenopathy, unexplained iron deficiency anemia, family history of gastrointestinal malignancy).
Foodborne illness
The symptoms of scombroid poisoning include flushing, a throbbing headache, palpitations, abdominal cramps, diarrhea, and oral burning. These typically begin 10-30 minutes after ingesting the fish, and are self-limited.
Macular degeneration
Cataracts and associated macular degeneration are extremely common in the elderly population and often result in visual impairment. Elderly patients should be thoroughly evaluated for the severity of macular degeneration, as they may not benefit from cataract surgery.
