VIII Flashcards
development of palpable mass in epigastrium after acute pancreatitis in recent past
pancreatic pseudocyst
clinical signs of hereditary hemochromatosis
hyperpigmentation
arthralgia, arthropathy
elevated hepatic enzymes with hepatomegaly, cirrhosis
increased risk hepatocellular CA
DM, secondary hypogonadism and hypothyroidism
restrictive or dilated cardiomyopathy
what infections are those with hereditary hemochromatosis more likely to contract
Listeria
Vibrio vulnificus and Yersinia enterocolitica
what mutations occur in hereditary hemochromatosis
C282Y, H63D
what can occur if correct hyponatremia too fast
osmotic demyleination
what can occur if correct hypernatremia too fast
cerebral edema
bradycardia, AV block, hypotension and diffuse wheezing
beta blocker OD
what to do with beta blocker OD patient
O2 and IV atropine and then glucagon because it increased cAMP
signs of wilsons
tremor, rigidity, depression paranoia and catatonia
will have mallory bodies in liver Bx
Dx of wilsons
measure ceruloplasmin— low
Tx for empyema
surgery
viral myocarditis most likely due to
coxsackie B virus
herpes zoster opthalmicus
dendriform corneal ulcers and vesicular rash in trigeminal distribution
what will Ca and phosphate levels be in chronic kidney disease
high phosphorus from retention
low Ca from dec intestinal absorption from dec active Vit D
increased PTH because of low Ca
all in all causes secondary hyperparathyroidism
sudden onset photopsia and floaters
retinal detachment
anemia of chronic disease MCV, iron, TIBC ferritin and transferrin levels
MCV normal/ low iron low TIBC low ferritin normal/ high transferrin normal/low
anemia from iron deficiecny
MCV, iron, TIBC, ferritin, transferrin levels
MCV low iron low tibc high ferritin low transferrin low
which drugs can cause esophagitis
tetracycline
aspirin and NSAIDs
Alendronate
KCl, quinidine and iron
most important risk factor for squamous cell CA
sunlight
production of angiotensin II causes what
vasoconstriction of afferent and efferent arterioles increasing renal vascular R and net decrease in blood flow
vasoconstricts efferent more so maintain GFR
stimulates resorption in proximal tubules and increases secretion aldosterone from adrenals– decreased sodium delivery to distal tubule increasing Extracell volume
CHF what happens to RAAS
increases Renin to increase angiotensin II to maintain kidney function and increase CO
Hawthorne effect
tendency of the study population to affect the outcome since they are aware that they are being studied
sample distortion bias
estimate of exposure and outcome association is biased because the study sample is not representattive of the target population
confounding bias
one or more variables associated independently with both exposure and outcome
manifestations paroxysmal nocturnal hemoglobinuria
hemolysis- fatigue
cytopenias
venous thrombosis
what cutaneous lesions are found with Primary Biliary Cirrhosis
xanthelasma
Tx for paroxysmal nocturnal hemoglobinuria
iron and folate supplementation
eculizumab
labs for intravascular hemolysis
anemia with low haptoglobin and an elevated bilirubin and LDH
when do those not working in high risk environment and no risk factors have to be treated for + ppd
> 15mm
what patients need to be treated for tb when ppd >5mm
HIV
recent contacts with known tb cases
nodular or fibrotic changes on CX
organ transplants
when to use oseltamivir fo rinfluenza
age >65 pregnant COPD, CV, renal or hepatic chronic illness immunosuppression morbid obesity native americans nursing home or chronic care facility
skin lesion in leprosy
insensate hypopigmented plaque
progressive peripheral nerve damage causing muscle atrophy
confirm Dx leprosy
acid fast bacilli on skin biopsy
ethnicity to think leprosy
asian
Tx for visual Sx of giant cell arteritis
high dose corticosteroids and oral therapy with slow taper over the course of months
Tx CMV retinitis
ganiclovir or foscarnet
Dx amebic liver abscess
stool examination for trophozoites, serology and liver imaging
Tx amebic liver abscess
metronidazole
what can cause malignant biliary obstruction
cholangiocarcinoma
pancreatic or hepatocellular carcinoma
metastatic CA
middle ear disease
get tinnitus but not vertigo
Tx for agitation in elderly
low dose haloperidol
atypicals: quetiapine or risperidone
what cause bacillary angiomatosis
bartonella, gram neg bacillus
Tx bacillary angiomatosis
erythromycin
definition of pulsus paradoxus
exaggerated fall in systemic BP >10mmHg
pulsus paradoxus is found in what conditions
cardiac tamponade but also can happen in severe asthma or COPD
Tx toxic megacolon
IV fluids, broad spectrum antibiotics and bowel rest
if IBD induced megacolon then use IV corticosteroids
cerebellar dysfunction signs in alcoholic
gait instability, truncal ataxia, dysdiadachokinesia, hypotonia and intention tremor
most common cause of bicuspid aortic valve in developed countries? non developed?
developed- bicuspid aortic valve
non developed- rheumatic heart disease
Becks triad
cardiac tamponade
- hypotension
- distended neck vv
- muffled heart sounds
what happens to preload, SV and CO in cardiac tamponade
all decrease
why does inspiration worsen cardiac tamponade
because that increases venous return but the heart cannot accommodate to the increase fluid because restricted
fixed upper airway obstruction
laryngeal edema
will flatten inspiratory and expiratory flow curves
causes of erythema nodosum
strep infection most common
sarcoidosis, TB, histo, IBD
value for pulmonary hypertension
> 25
management pulmonary HTN
loops and ACEI
Type 2 HIT
autoimmune from autoAb against heparin platelet factor 4 complexes
how to Dx type 2 HIT
serotonin release assay
Tx for type 2 HIT
stop heparin and start alternative anticoagulants like direct thrombin inhibitors
what cutaneous lesions are found with Primary Biliary Cirrhosis
xanthelasma
common extracolonic manifestations of IBD
erythema nodosum, pyoderma gangrenosum, eouscleritis, arhtritis, cholangitis
which marker is + in Ulc Colitis
p ANCA
HLA B27
ankylosing spondylitis
also assoc with UC
low pcwp and high mixed venous O2 saturation
septic shock
what decreases intensity of mitral prolapse
squatting from standing because increases preload
behcets
recurrent oral ulcers plus 2+:
- recurrent genital ulcers
- anterior uceitis
- erythema nodosum
ethnicities of behcets
turkish, asian, middle eastern
most common occular manifestation of giant cell arteritis
anterior ischemic optic neuropathy
Tx for visual Sx of giant cell arteritis
high dose corticosteroids and oral therapy with slow taper over the course of months
Tx for Dx of familial colonic polyposis (auto dom)
procto-colectomy
what causes conjugated hyperbilirubinemia
hepatocellular injury, decreased bilirubin excretion in bile canaliculi, intrahepatic cholestasis or extrahepatic cholestasis from biliary obstruction
elevated alkaline phosphatase out of proportion to the transaminases suggests what
intrahepatic cholestasis or biliary obstruction
what can cause malignant biliary obstruction
cholangiocarcinoma
pancreatic or hepatocellular carcinoma
metastatic CA
what can cause false positive VDRL
Antiphospholipid Ab syndrome
Tx antiphospholipid Ab syndrome pregnant lady
low molecular weight heparin
S4 heart sounf at end of diastole is associated with what
L ventricular hypertrophy from prolonged HTN
definitive Tx for acute popliteal artery occlusion
surgical embolectomy
Dx imaging for zenkers diverticulum
contrast esophagram
signs of zenkers diverticulum
elderly dysphagia regurg foul smelling breath aspiration occasionally palpable mass
travelers diarrhea with persistent non bloody watery diarrhea >2 weeks
cryptosporidium
cerebellar dysfunction signs in alcoholic
gait instability, truncal ataxia, dysdiadachokinesia, hypotonia and intention tremor
young female with history of trigeminal neuralgia
MS
