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Spring Round II Exams > clin med last two lectures > Flashcards

clin med last two lectures Flashcards

1
Q

Endocrine pancreas (DIABETES)

A

Islet of langerhan

insulin and glucagon

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2
Q

Exocrine pancreas

A

Acinar cells- amylase, lipase, protease

Pancreatic juice- electrolytes, bicarb, enzymes, neutralize acid

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3
Q

Acute pancreatitis

A

Alc induced >Males

Gallstone induced >Females

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4
Q

Pathophys of Pancreatitis

A

High TRYPSIN levels, pancreas destroys itself

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5
Q

Subtypes of pancreatitis

A

Necrosis or nah

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6
Q

Two most common causes of Pancreatitis

A

Gallstones

Alcohol (chronic use)

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7
Q

Abdominal pain with pancreatitis

A

Acute, post meal
Epigastric –> radiating into back

Constant, steady, boring

Better w leaning forward

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8
Q

PE of Pancreatitis

A

Tachy, hypo, fever
Sometimes jaundice, pallor, sweating

Epigastric pain
Guarding
Dec bowel sounds

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9
Q

Scleral icterus, be thinking of

A

Choledocholithiasis or Edema of pancreatic head

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10
Q

Parotid swelling can be sign of

A

Mumps

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11
Q

Severe necrotizing pancreatitis

A

Cullen sign- bruising around belly button

Grey turner- bruising to flanks

Panniculitis- red tiny nodules

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12
Q

Labs of Pancreatitis

A

Elevated:
Bilirubin, Triglycerides, Pancreatic enzymes, LIPASE (more spec to pancreas)

CRP >150= severe pancreatitis

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13
Q

Genetic testing panc

A

Strong fam hx of pancreatitis

<35 YO onset

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14
Q

If Clinical presentation and Labs are suggestive of Pancreatitis, do we want a CT?

A

NOT RECOMMENDED

most cases are uncomplicated
IV contrast may worsen panc

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15
Q

Suspect pancreatitis, what imaging do I order?

A

US –> EUS –> MRCP

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16
Q

Do not do ERCP unless

A

EUS or MRCP are abnormal

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17
Q

Diagnostic criteria for Pancreatitis,

Requires TWO of the following

A

Clinical (acute, persistent, severe, boring, epigastric pain radiating to back)

Elevated Lipase or Amylase

Imaging

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18
Q

Get a CT if >72 hours of onset sx AND

A

Persistent or recurrent abd pain
Inc in panc enzymes after initial decrease
New or worse organ dysfx
Sepsis (fever and increased WBC)

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19
Q

Tx for Pancreatitis

A 
Admit
SUPPORTIVE
Meds (pain, abx, n/v)
Aggressive hydration
Monitor for worsening
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20
Q

Complications of pancreatitis

A

Local (fluid, cyst, necrosis)

Systemic inflammatory response syndrome (SIRS)

Organ failure

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21
Q

Pancreatic pseudocyst

A

Localized collection of fluid (enzymes, blood, and pancreatic tissue)

Palpable mass mid epigastric

may spont resolve or get bigger

Complicated if: rupture, hemorrhage, infection

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22
Q

Tx of Pancreatic pesudocyst

A

Surgery vs drainage if symptomatic or infected

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23
Q

Most cases of Pancreatitis are

A

Mild acute

Better in 3-5 days

  • no organ failure
  • no local or systemic complications
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24
Q

SIRS

A

Present on admission

Persists >48 hours

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25
Death related to pancretitis
First 2 weeks: SIRS/organ failure After 2 weeks: Sepsis
26
Some causes of pancreatitis you can treat to prevent another case
Remove gallstone Stop drinking Lower triglycerides w diet / meds Discontinue offending med
27
Chronic pancreatitis
Progressive inflammatory changes Long term structural damage of pancreas
28
Is Mortality lower with chronic or acute pancreatitis?
Chronic
29
Sx of Chronic pancreatitis
STEATORRHEA DM weight loss
30
Brittle DM
alpha and beta cells of pancreas affected d/t chronic pancreatitis hard to control typically insulin DEPENDENT
31
Classic TRIAD of Chronic Pancreatitis
DM Steatorrhea Calcifications
32
Most labs with CHRONIC Pancreatitis are more mild, maybe even normal... so we test
Fecal fat | 72 hr: Gold standard
33
Test of choice for Steatorrhea
Fecal Elastase
34
Calcifications on X Ray Calcifications, ductal dilation, and pseudocyst on CT
Chronic Pancreatitis
35
ERCP (diagnostic and therapeutic) of Chronic Pancreatitis shows what?
"chain of lakes" gold standard
36
Tx of Chronic Pancreatitis
``` Behavior Pain relief Lithotripsy Endoscopic dilation or stenting Decompression/drainage ```
37
Acute, severe, epigastric pain radiating to back better w leaning forward
Pancreatitis
38
Diagnosis of Pancreatitis (at least 2)
Clinical Labs (lipase/amylase) Imaging
39
Triad: DM, steatorrhea, calcifications | "chain of lakes" on ERCP
Chronic Pancreatitis
40
"chain of lakes"
alternating stenosis and dilation of pancreatic duct on ERCP
41
Pancreatic CA Males>females
Etiology: Abn glucose metabolism Insulin resistance Obese Chronic pancreatitis
42
Is Pancreatic CA usually exocrine or endocrine?
Exocrine
43
Most common type of Pancreatic CA
Ductal adenocarcinoma | Head of pancreas
44
Only cure for pancreatic CA
Resection BUT unfortunately most already have locally advanced or METs when it is found
45
Presentation of Pancreatic CA
Epigastric pain Jaundice Weight loss maybe also: dark urine, steatorrhea
46
PE shows this: ``` Hepatomegaly Abd pain RUQ/epigastric mass "Courvoiser sign" Ascites Jaundice/icterus ``` be thinking
Pancreatic CA
47
Courvoisier sign
Nontender palpable gallbladder
48
Initial imaging if pt has JAUNDICE
Abdominal US
49
Initial imaging if pt has Epigastric pain and weight loss (but no jaundice)
Triple phase thin slice enhanced helical CT of Abd
50
Resection of Pancreatic CA
Whipple procedure
51
Prognosis for Pancreatic CA
Very poor | 5 yr survival <5%
52
Prognosis with Un-resectable pancreatic CA
8-12 mo with local invasion 3-6 mo if METs
53
Lymphogranuloma Venereum (LGV)
all among MSM w HIV infection
54
HIV populations most affected
Men 20-29 Hispanic and African American
55
CD4 count is what
T helper cells that enhance the immune response and tell B cells to MAKE ANTIBODIES
56
HIV stages
Primary infection "Acute HIV" (sx) Clinical latency Symptomatic HIV AIDS
57
Acute HIV/ primary infection
2-6 wks after exposure Mono like/ Flu like Lasts about 2 wks, resolves spontaneously Viral load EXTREMELY high
58
During acute HIV, the routine HIV Ab test will be
negative! antibodies are not made yet
59
Common manifestations of Acute HIV
* Rash * Mouth ulcers + others
60
Labs with Acute HIV
Elevated LFT | LOW blood counts (white, red, platelet)
61
Clinical latency to HIV
Immune system starts to resolve to infection Patient seroconverts within 3 MONTHS of infection- now they are producing antibodies
62
Clinical latency | last avg 10 years
HIV remains active in lymphnodes Pt has no sx (or lymphadenopathy)
63
Symptomatic infection HIV
Lymph nodes "burnt out" Virus may mutate Body fails to keep up replacement of CD4 count HIV RNA viral load increase
64
HIV (and AIDS) sx
Oral hairy leukoplakia Kaposi Sarcoma Thrush Others: fever, night sweat, arthralgia, weight loss, prolonged diarrhea
65
AIDS is defined as CD4 <200 OR
HIV + 1 of the 27"AIDs defining conditions" ``` PCP Toxoplasmosis CMV Thrush of esoph/tracheus/bronchi Kaposi sarcoma etc ```
66
PCP Pneumocystis Jirocevi PNA when CD4 <200
BACTRIM
67
Toxoplasmosis when CD4 <100
SULFA and PYRIM
68
ToxoPlaSmosis tx starts with P and S Pyrimethamine Sulfa
Sx: HA, focal neuro def, AMS Dx: lesions on Brain CT or MRI 1st line tx: Sulfa and Pyrimethamine
69
MAC | when CD4 <50
Bacteria in soil and dust Sx: Night sweat, weight loss, abd pain, diarrhea, ANEMIA Dx: AFB Tx: Macrolide + Ethambutol
70
CMV (herpes gets in eye) when CD4 <50
Most common RETINAL infection in AIDS pts Dx: white fluffy exudates on fundoscopic exam Tx: IV Gangcyclovir
71
AIDs related Kaposi sarcoma
Most frequent in homosexual male
72
Classic Kaposi's
Elderly eastern european and Mediterannean males
73
Screen everyone for HIV at least one
``` Everyone 13-64YO Anyone being tx for TB Each STD presentation Annual for risk pts Pregnant women ```
74
DIAGNOSTIC testing for
Opportunistic infection TB Sx consistent with HIV (weight loss, night sweat, diarrhea >1wk, PNA) Sx consistent w Acute HIV
75
Test of choice for HIV
Combo HIV antibody AND Antigen test
76
HIV Antibody test
only will show positive AFTER pt Seroconverts | 4-12 wks after infection
77
PEP post exposure proph for HIV
Must start w/in 72 hours 3 drug regimen for 28 days
78
PrEP for people at risk | partner to HIV positive, ror MSM
Daily med | main option is Truvada
79
Normal CD4 count
600-1200 cells per cubic/mm
80
All HIV+ pts should be screened for TB AND
given TB prophylaxis if latent TB is present
81
If HIV+ pt CD4 falls below 250
give Diflucan prophylactically for Cocci
82
If HIV+ pt CD4 falls below 200
give Bactrim prophylactically for PCP
83
If HIV+ pt CD4 falls below 100
give Bactrim prophylactically for Toxoplasosiss
84
Syphillis
Trepenoma Pallidum Direct contact w infected lesion
85
Clinical presentation of Primary syphillis
Painless chancre lasting 4-6 wks (then resolves)
86
Secondary syphillis has many manifestations + systemic like malaise and lymphadonopathy
Rash (common) on PALMS AND SOLES Warts- Condyloma lata- highly infectious Mucous patches- highly infectious
87
How long does Secondary Syphillis last?
2-6 wks then enter Latent period
88
Latent syphillis
No sx Syphillis is NO LONGER transmitable may persist for YEARZz
89
Tertiary (late) syphillis
Most do not get to this point only 15% of those untreated 10-30 yrs after infected
90
Tertiary syphillis
can damage heart, blood vessles, brain, and nervous sx
91
Clinical sx of Tertiary syphillis
NEURO and EYE Paralysis, coordination troubles, dementia, vision change, blindness
92
Dx of Syphillis
Start w RPR or VDRL (non specific) Confirm w Treponemal antibody test: FTA-ABS
93
If you suspect Neuro or Ocular involvement from Syphillis, what do you need to do?
Lumbar Puncture perform VDRL on spinal fluid to confirm
94
Syphillis tx
BENZATHINE Pen G ( a shot)
95
Retest syphillis after tx at
6, 12, 24 mo | Check RPR titer
96
Congenital syphillis
stillbirth neonatal death infant disorder- deaf, neuro imp, bone disoder
97
If pregant pt is PCN allergic, consider
desensitization with oral PCN Monitor serology closely to confirm successful tx
98
LGV Lympho Venereum Treat with DOXY
Caused by CHLAMYDIA Rare, but present in MSM Unilateral inguinal BUBO (swollen lymphnode) Anal d/c and rectal bleeding Tx: DOXY
99
Chancroid H. ducreyi
Painfu, tender ulcer FOUL SMELLING d/c Tx: Azithro, Ceftriaxone, or Cipro

Spring Round II Exams (10 decks)

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