Test 38 - IM Flashcards
What is the significance of Leukocyte Alkaline Phophatase (LAP)? When is it high? when is it low?
Distinguishes a leukemoid reaction from leukemia. LAP score is usually decreased in CML and increased in leakemoid reaction.
What is milk-alkali syndrome? what is the classic triad seen in milk-alkali syndrome?
Milk alkali syndrome: caused by the ingestion of large amounts of calcium and absorbable alkali, with resulting hypercalcemia. With the development of nonabsorbable alkali and histamine-2 blockers for treatment of peptic ulcer disease, milk-alkali syndrome became a rare cause of hypercalcemia; however, with the increased use and promotion of calcium carbonate for dyspepsia and for calcium supplementation, a resurgence of milk-alkali syndrome has occurred.
Classic triad: symptomatic hypercalcemia, renal insufficiency, metabolic alkalosis
Patient px with: burning epigastric pain, constipation and excess urination and symptomatic hypercalcemia. Only partially relieved by OTC antacids and H2 blockers.
Fhx: multiple stomach ulcers and kidney stones
What does the patient have?
MEN1: Has to have 2 or more of the three Ps (parathyroid, pituitary and pancreatic (or upper GI tumor)
This patient has parathyroid tumor (hypercalcemia), gastrin producing stomach tumor
What fungus is endemic to the southwest including arizona and california?
Coccideomycosis - round fungus, square states
What cutaneous finings are associated with coccideomycosis?
Erythema nodosum and erythema multiforme
painful red nodules on the shins
What area is blastomycosis endemic to?
South central and north central US. infects immunocompromised hosts more commonly.
What would cause CHF in a young healthy woman with no risk factors for cardiac, autoimmune or thyroid problems.
Viral myocarditis from Coxsackie B virus
A patient with long standing HTN has a stroke. How do you determine the difference between a subarrachnoid bleed and intracerebral bleed?
Subarrachnoid: headache, N/V unconsious
Intracerebral: most likely to be in the deep brain, basal ganglia - will see neurological asymmetric changes
If basal ganglia: hemiplegia, hemisensory loss, gaze palsy,
When do you see elevated BNP?
Volume overload of the LV - CHF
What is MCV? When is it elevated?
MCV- mean corpuscular volume
Volume of the blood* proportion of the blood that is cellular
MCV does not increase in volume overload bc both extracellular and intracellular volume are increase proportionally, thus MCV is unchanged.
MCV instead is increased in B12 or folate deficiency.
When would it be appropriate to d/c metformin on a patient admitted to the hospital?
If the BUN/Cr ratio is over 20, suggesting a prerenal cause of azotemia, you would want to DC metformin bc metformin can cause lactic acidosis and could worsen the prerenal azotemia.
What is sympathetic opthalmia and why does it occur?
Problems in one eye, after a penetrating injury to the other eye. The theory if that the penetrating eye injury exposed the body’s immune system to antigens from the eye that it had previously been “protected from” (aka not previously exposed to). The body then forms antibodies against these antigens which results in eye problems inthe good eye. Usually anterior uveitis, or panuveitis.
What would cause needle shaped crystals in the urine of an HIV patient.
Indinavir - a protease inhibitor, causes crystal induced nephropathy due to precipitation of the drug in the urine. THis can cause urinary obstruction and hematuria.
What are the 5 common life threatening reactions associated with HIV therapy?
- Didanosine induced pancreatitis
- Abacavir related hypersensitivity syndrome
- NRTI induced lactic acidosis
- NNRTI induced Steven Johnson syndrome
- Nevirapine associated liver failure
