Topics of choice Flashcards
Multiple Sclerosis
Etio: AI, type 4 hypersensitivity. Environmental (viral infections EBV, HHV-6) and genetics (HLA DR2). Low vitamin D. Female. Molecular mimicry. Demyelination + secondary axonal damage. Types: relapsing remitting, primary progressive, secondary progressive, progressive relapsing.
Symp: optic neuritis (blurred vision, double vision, eye pain), fatigue (physical or mental), pain (headache, back pain, tonic spasms or burning pain in extremities), movement issues (spasticity, ataxia, balance problems, dizziness). Numbness, depression, concentration problems. Can have + Babinski.
Diag: MRI of brain and spinal cord (w and w/o contrast), periventricular white matter, brain stem, spinal cord, cerebellum. T2 show as bright spots. Contrast enhances the active lesions. McDonalds criteria. VEP - reduced AP and low conduction velocity. CSF - oligoclonal banding, IgG index increase, pleocytosis.
Tx: acute - high dose corticosteroids, plasma apharesis (remove Abs). Supportive therapy - baclofen, TCA, antidepressive. Prevention - INF- beta, Glitiramire actate (decoy and inhibit cytokine release), ocrelizumab (inhibit B-cells and plasma cells), natalizumab (inhibiting B and T lymphocytes).
Endometriosis (endometrial tissue outside of the uterus cavity)
Etio: Retrograde menstruation, vascular and lymphatic dissemination, coelomic metaplasia of multipotent cells. Risk - low birth weight, early menarche, genetics, short menstrual cycle, obesity, late menopause. Protective - multiple pregnancies, prolonged lactation, fruit and vegetables.
Symp: chronic fatigue, infertility, chronic pelvic pain, dysmenorrhea, dyspareunia, dysuria, dyschezia. (4 D’s). Chocolate cyst, superficial peritoneal lesion (gun shot lesion), deep infiltrative endometriosis (>5 mm under the peritoneal surface.
Diag: CBC, BMP, abdominal and transvaginal US, CT/MRI, laparoscopy (gold standard)
Tx: Symptomatic (NSAIDs), hormone treatment (mimic pregnancy/menopause) - GnRH agonist, progestagens, Mirena, OCP. Surgical tx, eliminate all visible peritoneal tissue. Laparoscopic, open surgery or hysterectomy.
Placenta Previa
Etio: placenta is located near or over cervical os. Complete, partial, marginal and low-lying. Risk- multiparity, mulitple gestations, previous C-section / D&C, increased maternal age.
Symp: fresh painless blood out of vagina at 2-3rd trimester.
Diag: transvaginal US.
Tx: asymptomatic - expectant management. For low-lying - 11-20mm can do vaginal. Emergency C-section if unstable fetus or maternal hemorrhage.
Placenta Abruptio
Etio: partial or complete premature separation of the placenta from the uterus. Can be occult or apparent hemorrhage. Risk - trauma, smoking, HTN, PROM, HELLP syndrome.
Symp: painful, 3rd trimester bleeding. Acute. Deck-hard uterus. Can develop to DIC or fetal distress.
Diag: labs, US, fetal heart trace
Tx: expectant management. If dead, vaginal delivery. Fetus or mother unstable - emergency C-section.
Placenta Accreta/Increta/Percreta
Etio: A: trophoblasts invade into myometrium. Absence of Nitabuch’s layer on US. I: trophoblasts invade through myometrium. P: trophoblasts invade completely through myometrium and serosa. Can attach to nearby organs like the bladder and rectum. Risk - hx of C-section, radiation, uterine surgery and endometritis.
Symp: profuse life-threatening postpartum bleeding
Diag: US, MRI
Tx: Hysterectomy. For accreta, possible to do manual revision and observation. If continuous pospartum bleeding - hysterectomy. 3-5L blood loss during delivery.
Celiac
Etio: maladaptive immune response to gluten. AI. HLA DQ2.
Symp: loss of brush border - malabsorption, diarrhea (steatorrhea), pain, nausea, vomiting, lack of appetite. failure to thrive, growth failure, extraintestinal manifestations.
Diag: tissue transglutaminase, deamidated gliadin peptide, endomysin, IgA. Biopsy.
Tx: life long gluten free diet, Fe and vitamin suppliments.
Schizophrenia
Etio: not fully understood. Risk - family hx, drugs, stress, trauma, infections, AI. Subtypes: catatonic, paranoid, disorganized.
Symp: delusions, hallucinations (auditory), disorganized behavior & speech, % symptoms (alogia, ambivalence, asociality, anhedonia, avolition). 6 months.
Diag: DSM-V criteria. Brief psychotic disorder -1 month, schizophreniform disorder - 1-6 months.
Tx: 1st or 2nd generation antipsychotics. 1st (D2 antagonist, mainly help + symptoms). 2nd (serotonin as well as D4, both + and %). Clozapine for treatment-resistant. Mood stabilizers such as lithium, valproate, carbamazepine. cognitive behavioral therapy.
Esophageal cancer
Etio: Barretts esophagus, acid reflux, smoking (adenocarcinoma), alcohol, hot drinks, poor diet (SCC).
Symp: hoarse voice, dysphagia, enlarged LN, hemoptysis, dry cough, weight loss.
Diag: barium swallow, endoscopy with biopsy. CT for mets. TNM based on depth of penetration, amount of LN and distant spread.
Tx: Ivor-Lewis (2 chest, abdomen), transhiatal (abdomen, cervical), Mckeown (3 incision). Use stomach, colon or jejunum. Cisplatin + 5-FU.
CRC
Etio: adenocarcinoma, mostly sporadic. Lynch and familial adenomatous polyposis.
Symp: hematochezia, melena, ileus, change in bowel habits, fistula, hemorrhage, perforation, tenesmus, weight loss.
Diag: screening fecal occult blood test, colonoscopy (every 5 years, from 50 yr in low risk, much earlier in high risk). Increased CEA or CA 19-9. Rectal digital examination. Duke’s criteria, A - before muscular layer, B - through muscular layer, C - LN, D - met.
Tx: Surgery. Colectomies. Adjuvant CT (5-FU, FOLFOX, FOLFIRI) - especially from C. Liver met is common, liver tissue remaining should be more than 30%.
