TEST 9-10 Flashcards
Ddx of GRANULOMATOUS ULCERS:
Generally would see SYSTEMIC SIGNS (fever, night sweats)
TERTIARY SYPHILIS
TB
DISSEMINATED FUNGAL DISEASE
Crusted ulcer in LOWER LIP
BIOPSY: INVASIVE CORDS OF SQUAMOUS CELLS + KERATIN PERALS
SQUAMOUS CELL CARCINOMA = most common carcinoma of lip (particularly in LOWER lip)
Crusted ulcer in UPPER LIP
BIOPSY: Invasive clusters of spindle cels surrounded by PALISADED BASAL CELLS
BASAL CELL CARCINOMA
Recurrent, self-limiting ulcerations of oral cavity
BIOPSY: SHALLOW FIBRIN-COATED ulcerations + underlying MONONUCLEAR INFILTRATE
ORAL APHTHOUS ULCER
What is first-line Tx of DIFFUSE ESOPHAGEAL SPASM-related chest pain?
ENDOSCOPY: Usually normal
ESOPHAGRAM: Corkscrew
MANOMETRY: Intermittent peristalsis + multiple simultaneous contractions
CCB - Diltiazem
Relieves pain and reduces dysphagia
Food impaction + Dysphagia + Heartburn NOT relieved by standard medications
ENDOSCOPY: Esophageal rings/stricture
EOSINOPHILIC ESOPHAGITIS
What medications POTENTIATE effect of WARFARIN?
1) ACETAMINOPHEN
2) DECONGESTANT (PHENYLEPHRINE - ay elevate BP
What is the main usage of TRANEXAMIC ACID (anti-fibrinolytic agent)
1) Heavy menstrual bleeding
2) Prevention of bleeding during certain surgeries
Which state HYPER or HYPOTHYROIDISM causes SYSTEMIC HTN? How is contractility, HR, and SVR affected in each?
BOTH HYPER AND HYPO = HTN
1) HYPER - Increase contractility/HR (Increase SNS) + DECREASED SVR
2) HYPO - Decreased contractility/HT + INCREASED SVR
Agent used to treat URINARY RETENTION or ATONIC BLADDER:
CHOLINERGIC AGENT (BETHANECHOL)
Agent used to treat URGE URINARY INCONTINENCE (detrusor instability):
ANTI-CHOLINERGIC: OXYBUTYNIN
1st line agent for BPH? 2nd Line?
- TAMSULOSIN - alpha1 blocker
2. FINASTERIDE - 5alpha-reductase inhibitor (blocks conversion of testosterone -> Dihydrotestosterone)
What is an anti-depressant medication used to treat CHILDHOOD ENURESIS (hint: anti-muscarinic effect)
IMIPRAMINE - TCA
YOUNG OBESE FEMALE pt with headache (almost suggestive of brain tumor) BUT NORMAL neuroimaging/MRI + elevated CSF pressure (PAPILLEDEMA)
What is the recommended Tx?
Without Tx, what is the most significant complication? What Tx can prevent these complications?
BENIGN INTRACRANIAL HTN (PSEUDOTUMOR CEREBRI) - Defective CSF resorption from arachnoid villi
Recommended Tx - weight loss + ACETAZOLAMIDE (if weight loss fails)
BLINDNESS = most significant complication
Tx - SHUNTING, OPTIC NERVE SHEATH FENESTRATION
Erythema of central face + Facial flushing + Telangiectasias of skin + Burning discomfort precipitated by heat, ALCOHOL, emotion, rapid temperature changes
ROSACEA
Therapy for ACUTE DECOMPENSATED HEART FAILURE in pts who are NORMOTENSIVE/HYPERTENSIVE:
- Aggressive diuretics (loop diuretics - furosemide)
- Supplemental O2
- +/- vasodilators (NITROGLYCERIN, NITROPRUSSIDE)
What is the general cutoff value of Glc for HYPERGLYCEMIC NON-KETOTIC STATE for sx - altered mental status + focal neuro deficits?
Glc>600
More often >1000
Ddx of DIFFERENTIAL BP in UPPER EXTREMITIES:
1) AORTA DISSECTION (Right SBP > Left SBP) - dissection impairs flow to the left carotid/left arm
2) AORTA COARCTATION
3) SUPRAVALVULAR AS - Congenital LV outflow tract obstruction due to diffuse narrowing of ascending aorta
UNEQUAL CAROTID PULSES + DIFFERENTIAL BLOOD PRESSURES in UE + Palpable thrill in suprasternal notch + Mid-systolic murmur at right ICS
SUPRAVALVULAR AORTIC STENOSIS
Drugs that cause FACIAL FLUSHING
VANC Vancomycin - mediated by HISTAMINES Adenosine Niacin - mediated by PGs (controlled by NSAIDs) CCB
What is the MOST effective non-pharmacologic measure of controlling HTN in individuals with BMI >25?
What are other helpful methods?
10% WEIGHT LOSS
Also helpful: DASH diet (high in fruits/vegetables, low in saturated fat/total fat) + Exercise + dietary sodium restriction + decreased alcohol intake
Which medication should be DISCONTINUED in a diabetic pt who is acutely ill with AKI, liver failure, or sepsis?
METFORMIN** - These conditions INCREASE risk of lactic acidosis with HYPOTENSION-related pre-renal azotemia in these acute settings
What are the 3 LIGHTS CRITERIA for PLEURAL EFFUSION?
1) FLUID LDH>2/3 of upper limit (90)
2) FLUID LDH/SERUM LDH >0.6
3) FLUID TOTAL PROTEIN/SERUM TOTAL PROTEIN >0.5
Any one of these 3 = EXUDATIVE
