UWORLD JOURNAL Flashcards
Patient develops dark colored urine, scleral icterus, and pale lips following treatment with Dapsone. Hg is 8.5. UA shows moderate amount of blood. What is the mechanism for urinary findings?
Oxidative injury.
He has G6PD deficiency.
Erythrocytes are unable to generate sufficient NADPH to counter oxidative injury –> hemolytic anemia.
UA showed false positive for blood due to heme in the urine excreted by kidneys.
What are the causes of hemolytic anemia in G6PD deficiency?
Medications
- Dapsone
- TMP-SMX
- Primaquine
- Chloroquine
- Nitrofurantoin
- Isoniazid
- NSAIDS
- Ciprofloxacin
- Chloramphenicol
Food
-Fava Beans
Infection
What is the inheritance pattern for G6PD Deficiency?
X linked recessive
What does a blood smear show in G6PD deficiency?
Heinz bodies and Bite cells
Signs of intravascular hemolysis
What are the signs of intravascular hemolysis?
Normocytic anemia Inc retic count Inc Unconj bili Inc LDH Dec Haptoglobin Hemoglobinuria
Antibody mediated hemolsis is seen with which disease process?
Warm or cold agglutinin disease.
Complement activation is associated with which disease that causes microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure?
Hemolytic uremic syndrome
UA shows hematuria and proteinuria.
Immune complex deposition causes ____ glomerulonephritis, leading to hematuria with dysmorphic RBCs on UA.
Membranous
Most cases caused by chronic infection (Hep B or C), rheumatic disease (SLE), or monoclonal gammopathy (multiple myeloma).
Interstitial leukocyte infiltration is seen in ____ in which the UA shows erythrocytes, leukocytes, and white cell casts. Pt typically has rash, fever, and peripheral eosinophilia
Acute interstitial nephritis.
What is the “ugly duckling” sign for melanoma and how sensitive is it?
It’s a lesion that appears substantially different from the others.
Up to 90%
What is the most important prognostic indicator in malignant melanoma?
Breslow depth
-Distance from the epidermal granular cell layer to the deepest visible melanoma cells
Should you biopsy skin lesions that itch or bleed?
yes, particularly with other concerning features
What type of biopsy should be done if melanoma is suspected?
Excisional with initial margins of 1-3mm
What medications have been shown to improve survival in LV systolic heart failure?
ACEi
ARBs
BetaBlockers
Mineralocorticoid receptor antagonists
- spironolactone
- eplerenone
In African American pts combination of hydralazine and nitrates
Pt with A fib/HF with diarrhea, nausea, dec appetite, confusion, and /or fatigue consider ____.
Digoxin toxicity
Can also have visual changes.
Viral illness or diuretic use can lead to volume depletion or renal injury that acutely elevates digoxin level.
Hypokalemia, often associated with loop diuretic use can inc pts susceptibility to toxic effects of digoxin.
What serious adverse effect can occur with long term Amiodarone use?
Interstitial Pulmonary Fibrosis
A baseline chest radiograph and PFT should be done prior to initiating Amiodarone
What are the common causes of hypogonadism in Men? Primary (4). Secondary (2). Combined (2).
Primary
- Congenital (Klinefelter syndrome, cryptorchidism)
- Drugs (alkylating agents, ketoconazole)
- Orchtis (mumps), trauma, torsion.
- Chronic Kidney Disease
Secondary
- Gonadotroph damage: Tumor, cranial trauma, infiltrative diseases like hemochromatosis, apoplexy.
- Gonadotropin suppression: Exogenous androgens, hyperprolactinemia, diabetes mellitus, morbid obesity
Combined
- Hypercortisolism
- Cirrhosis
What are the risk factors for squamous cell carcinoma of the skin?
UV, ionizing radiation
Immunosuppression
Chronic scars, wounds, burn injuries
What are the clinical features of squamous cell carcinoma of the skin?
Scaly plaques/nodules
+/- hyperkeratosis or ulceration
Neurologic signs with perineurial invasion
How do you diagnose squamous cell carcinoma of the skin?
Biopsy shows dysplastic/anaplastic keratinocytes
What is the treatment for SCC of the skin?
Small or low risk lesions: surgical excision or local destruction
High risk or cosmetically sensitive areas: Mohs micrographic surgery
What is it called when SCC of skin arises in a wound or burn?
Marjolin ulcer and it is associated with inc risk of metastasis.
What is the first line treatment for acne?
Topical retinoids
What is Beck’s Triad for cardiac tamponade?
- Hypotension
- Distended neck veins
- Muffled heart sounds
Pulsus Paradoxus is also a common finding (>10 mmHg drop in SBP during inspiration)
Cardiac tamponade restricts venous return to the heart –> what change in preload, stroke volume, CO?
Decreases all three
MEN Type 1 includes?
- Primary hyperparathyroidism (Parathyroid adenomas or hyperplasia)
- Pituitary tumors (prolactin, visual defects)
- Pancreatic tumors (esp gastrinomas)
MEN Type 2A includes?
- Medullary thyroid cancer (calcitonin)
- Pheochromocytoma
- Primary hyperparathyroidism
MEN Type 2B includes?
- Medullary thyroid cancer (calcitonin)
- Pheochromocytoma
- Mucosal neuromas/marfanoid habitus
Water hammer or bounding pulse is associated with which heart murmur?
Aortic regurgitate
What defect and murmur are associated with fixed splitting of S2?
ASD, mid systolic pulmonary flow murmur
Pulsus parvus and tradus are associated with which heart murmur?
Aortic stenosis
What is responsible for Chagas disease?
Protozoan Trypanosoma cruzi
Plantar warts are due to _____ and most commonly affect ___ or ___ individuals
HPV
Young adults
Immunocompromised
Initial evaluation for HTN includes:
UA
Chemistry panel
Lipid profile
baseline electrocardiogram
Erysipelas:
Organism?
Manifests?
Strep Pyogenes
- Superficial vermis and lymphatics
- Raised, sharply demarcated edges
- Rapid spread and onset
- fever early in the course
Cellulitis (non purulent)
Organism?
Manifests?
Strep pyogenes, MSSA
- Deep dermis & subcutaneous fat
- Flat edges with poor demarcation
- Indolent
- Localized
- fever later in course
Cellulitis (purulent)
Organism?
Manifests?
MSSA, MRSA
- purulent drainage
- Folliculitis: infected hair follicle
- farunculitis: folliculitis –>dermis –> abscess
- carbuncle: multiple furuncles
