Internal medicine Flashcards
(199 cards)
1
Q
Antinuclear antibodies
A
SLE
2
Q
Antimitochondrial
A
Primary Biliary Cirrhosis
3
Q
Anti SSA anti SSB (Anti-Ro, Anti-La)
A
Sjogren Syndrome
4
Q
c-ANCA
A
Wegener granulamotosis with polyangiitis
5
Q
pANCA
A
Churg Strauss, microscopic polyangiitis, pAnca is positive in Ulcerative Colitis
6
Q
antimicrosomal Ab
A
Hashimoto
7
Q
anti-centromere
A
limited scleroderma CREST
8
Q
anti cardiolipin, lupus anticoagulant
A
SLE, antiphospholipid syndrome
9
Q
Rheumatoid factor
A
Rheumatoid arthritis
(IgM ab against Fc IgG)
10
Q
Adult onset Still disease
A
a systemic inflammatory disorder characterized by quotidian (daily) fever, evanescent (salmon bumpy) rash, arthritis, and multisystem involvement. Dx of exclusion (infection, lymphoma, leukemia). Labs abnormalities in patients with AOSD include leukocytosis, anemia, thrombocytosis, elevated erythrocyte sedimentation rate, elevated serum ferritin level (≥1000 ng/mL [1000 µg/L]), and abnormal liver chemistry tests; antinuclear antibody titer and rheumatoid factor typically are negative.
11
Q
A fib treatment
A
3 basic principles: rate control, restoration/maintenance of sinus rhythm, and stroke prevention. Hemodynamically unstable–>cardioversion, otherwise
- Rate control: oral non-dihydropyridine calcium channel blocker (dialtiazem) or β-blocker (metoprolol) as first step in therapy with ventricular rate goal of 1 year) recurrence rate of symptomatic atrial fibrillation is 20% to 50%.
- Ablation: around the ostia of the pulmonary veins -CHADS2 risk score to predict stroke in patients with nonvalvular atrial fibrillation. Use Warfarin target [INR] of 2.0-3.0 or Rivaroxaban and Apixaban (factor Xa inhibitor), Dabigatran (a direct thrombin inhibitor)
12
Q
Toxic megacolon
A
is the most severe complication associated with ulcerative colitis. Pt usually have at least 1 week of bloody diarrhea that is unresponsive to medical therapy. Xray: transverse colon most affected, w/ dilatation exceeding 6 cm. About 50% of patients with toxic megacolon may improve with medical therapy (bowel rest, intravenous glucocorticoids, antibiotics, and fluids); however, progressive abdominal distention and tenderness with hemodynamic instability are indications for immediate surgery.
13
Q
Diagnostic eval of CKD
A
14
Q
Nephritic syndrome is characterized by
A
hematuria, variable proteinuria, and hypertension
postinfectious glomerulonephritis, IgA nephropathy, Wegener, microscopic and membranoproliferative glomerulonephritis (this last can also be nephrotic).
SLE commonly affects the kidneys and may cause nephritic or nephrotic syndrome. A kidney biopsy often is needed to make a specific diagnosis and to guide therapy.
15
Q
Nephrotic syndrome is characterized by
A
high-grade proteinuria ( >3.5 g/24 h), hypoalbuminemia, and edema. Common causes include minimal change disease, focal glomerulosclerosis, membranous nephropathy, and amyloidosis. SLE commonly affects the kidneys and may cause nephritic or nephrotic syndrome. A kidney biopsy often is needed to make a specific diagnosis and to guide therapy.
16
Q
T score of osteoporosis and osteopenia & dif of osteomalacia
A
Dual-energy x-ray absorptiometry (DEXA) scanning determines T score.
Osteoporosis: dx by T score <-2.5 or any presence of fragility fracture (ractures with normal life activity:). Typical sites of fractures: vertebra, neck of the femur, Colles fracture of the wrist).
Osteopenia: T score -1.0 to -2.5,
Osteomalacia: “softening of the bones” Generalized disorder of bone resulting in decreased mineralization of newly formed osteoid at sites of bone turnover. Asx or diffuse bone and joint pain, muscle weakness, and difficulty walking. MOST COMMONLY due to low levels of vitamin D or low Ca, but also hypophosphatemia and, increased serum parathyroid hormone and alkaline phosphatase levels.
17
Q
Paget disease (bone)
A
Increase rate of bone turnover leading to mosaic lamellar bone patttern on xray. Usually asx, but aching bone or joint pain , HA, bony deformities, fractures, nerve entrapment (loss of hearing in 30-40% of cases involving skull)
Dx: ELEVATED alkaline phosphatase but nrml Ca and PO4.
Tx: Asx in most pt and no cure therefore no tx. Bisphosphonates, calcitonin can be used to slow bone resorption, NSAID for pain.
18
Q
Celiac disease screening/dx
A
- tissue transglutaminase (tTG) IgA antibody assay, if positive-> small bowel biopsy,
- Histologic findings: increased intraepithelial lymphocytes and mucosal atrophy with loss of villi.
- sx: diarrhea, bloating, and weight loss.
- Associated disease: Iron deficiency anemia, autoimmune diseases: Hashimoto thyroiditis & type 1 diabetes mellitus.
- tx: gluten free diet
19
Q
Absolute risk
A
the risk of a specific disease based on its actual occurrence, or its event rate (ER), in a group of patients being studied, and is expressed as:
AR = Patients with event or disease in group/Total patients in group
20
Q
How many patients need to be treated (number needed to treat [NNT]) with drug A compared with drug B to prevent one extra case of DVT?
Drug A 25 (DVT)/2500 (total pt)
Drug B 50(DVT)/2500 (total pt)
A
NNT=100
Drug A: Absolute risk AR= 25/2500=1%
Drug B: AR=50/2500=2%
Absolute benefit index (ABI) or Absolute risk reduction (ARR)= 2%-1%=1%
NNT= 1/ABI = 1/0.01 = 100
21
Q
COPD dx Spirometry
A
FEV1/FVC < 70%
Level 1 (mild) COPD = FEV1 of 80% or greater of predicted.
Level 2 (moderate) = FEV1 of 50% -79% of predicted.
Level 3 (severe) = FEV1 of 30% - 49% of predicted. Level 4 (very severe)= FEV1 < 30% of predicted.
22
Q
Viral vs bacterial meningitis
A
CSF findings that predict bacterial etiology with ≥99% certainty include:
Protein concentration >220 mg/dL (2200 mg/L)
Glucose concentration <34 mg/dL (1.9 mmol/L)
CSF-blood glucose ratio <0.23
Leukocyte count >2000/µL (2 x 10^9/L)
Neutrophil count >1180/µL (1.18 x 10^9/L)
In patients with suspected viral meningitis, CSF polymerase chain reaction (PCR) testing should be considered for non-poliovirus enteroviruses (echoviruses and coxsackieviruses) and HSV, as well as enzyme-linked immunosorbent assay (ELISA) testing for arboviruses (West Nile virus, St. Louis encephalitis virus, California encephalitis virus, and eastern equine encephalitis virus).
23
Q
HSV encephalitis
A
Herpes simplex virus is one of the most common causes of identified sporadic encephalitis worldwide, accounting for 5% to 10% of cases.
Sx: fever, hemicranial headache, language and behavioral abnormalities, memory impairment, cranial nerve deficits, and seizures.
dx: PCR assay
Imaging: CT or MRI: Bilateral temporal lobe involvement is nearly always pathognomonic for herpes simplex encephalitis but is a late development.
24
Q
FeUrea <35% is suggestive of
A
Pre renal, (euvolemic pt have Feurea > or = to 35%)
FeNa <1% also pre-renal but cant use it if pt take s diuretics
25
+ Rheumatoid factor
+ Anti–cyclic citrullinated peptide (anti-CCP) antibodies
Rheumatoid arthritis
tx: NSAIDS, steroids, methotrexate,
Sulfasalazine (an aspirin-like agent often used in combination with methotrexate or another nonbiologic DMARD when there is an inadequate response to therapy), Infliximab (TNF factor α inhibitor that is often used when patients do not respond to methotrexate or if they have advanced disease and a poor prognosis, such as early erosive disease)
26
Graves Disease tx
**Methimazole** (preferred over propylthiouracil) and atenolol for tachycardic. (Atenolol preferred bc β-1 selectivity and long half-life allowing once a day dosing)
Sx of Grave: tachycardia; elevated systolic blood pressure with a widened pulse pressure; palpable goiter, which is classically smooth; thyrotoxic stare due to lid retraction; proptosis; and, infrequently, an infiltrative dermopathy
27
Primary Parathyroidism
Effects of excess parathyroid hormone include increased 1,25-dihydroxy vitamin D levels, increased osteoclast-mediated bone resorption, enhanced distal tubular reabsorption of calcium, decreased proximal tubular reabsorption of phosphorus, hypercalcemia, hypophosphatemia, and increased urine phosphate and calcium levels.
28
Stepwise approach of asthma treatment
29
Biguanides
Metformin: mechanism unknown, Increases insulin sensitivity.
First line in T2DM
SE: lactic acidosis. CI in RENAL FAILURE
30
Sulfonylureas
Glyburide, Glipizide
mecha: close K+ channel in beta c membrane, so cell depolarizes by triggering of insulin release via
increase in Ca2+ influx. Stimulates release of endogenous insulin
SE: **Hypoglycemia, g**lipizide has fewer hypoglycemically active metabolites and has a shorter half-life than glyburide, it also frequently causes hypoglycemia, particularly in older patients
31
Glitazones: Rosiglitazone, Pioglitazone
Increase insulin sensi in peripheral tissue. Binds to PPAR-σ nuclear transcription regulator
SE: weight gain, edema, hepatotoxicity, HF
32
alpha-glucosidase inhibitors: Acarbose, miglitol
Inhibit brush border alpha glucosidase. Delays glucose absorption
Se: GI disturbances
33
Acral lentiginous melanoma
as a longitudinal dark pigmented streak on a fingernail or toenail, dark pigmentation of a proximal nail fold, and dark pigmented patches on the palms or soles. This variant of melanoma is the most common type among Asian and dark-skinned people. Acral lentiginous melanomas account for only 5% of melanoma cases.
34
Lentigo maligna melanoma presents i
nitially as a freckle-like, tan-brown patch. When confined to the epidermis, the lesion is called lentigo maligna type. The lesion may be present for many years before it expands and becomes more variegated in color. When it invades the dermis, it becomes melanoma. It most often arises in sun-damaged areas (face, upper trunk) in older people. Lentigo maligna melanoma accounts for approximately 10% of melanoma cases.
35
Nodular melanoma
presents as a dark blue or black “berry-like” lesion that expands **vertically** (penetrating skin-most agressive melanoma). It most commonly arises from normal skin and is most often found in people age 60 years or older. Nodular melanoma accounts for approximately 15% of melanoma cases.
36
Superficial spreading melanoma
presents as a variably pigmented plaque with an irregular border and expanding diameter ranging from a few millimeters to several centimeters. It can occur at any age and anywhere on the body, although it is most commonly seen on the back in men and on the legs in women. Most superficial spreading melanomas appear to arise de novo. Superficial spreading melanoma accounts for approximately 70% of melanoma cases.
37
Tumor lysis syndrome
Life-threatening complication in patients with malignancies associated with rapid cell turnover (leukemia, Burkitt lymphoma) or with bulky disease and high leukocyte counts associated with rapid and significant sensitivity to chemotherapeutic agents (large cell lymphoma, chronic lymphocytic leukemia).
Signs/Sx: hyperkalemia, hyperuricemia, hyperphosphatemia, hypocalcemia, acute kidney injury, and DIC
tx: Aggressive hydration with diuresis + allopurinol and rasburicase or hemodialysis
38
TTP thrombotic thrombocytopenic purpura
(consumptive thrombocytopenia and microangiopathic hemolysis from platelet thrombi that form throughout the microvasculature)
Pathologic process w/ abnormal activation of platelets and endothelial cells, deposition of fibrin in the microvasculature, and peripheral destruction of erythrocytes and platelets.
TTP should be suspected in patients who have:
(1) microangiopathic hemolytic anemia, characterized by **schistocytes** on the peripheral blood smear, **decreased haptoglobin** and **increased serum lactate dehydrogenase** (LDH)
and
(2) thrombocytopenia
Possible Sx: fever; Hematuria, Elevated serum creatinine levels, and proteinuria; and fluctuating neurologic manifestations, such as headache, confusion, sleepiness, coma, seizures, and stroke, but the absence of these symptoms does not exclude the diagnosis.
tx: Plasma exchange should be instituted emergently at diagnosis because 10% of patients die of this disease despite therapy, glucocorticoids
Most patients with **TTP have an autoantibody that inhibits a metalloproteinase (ADAMTS13)** that normally cleaves unusually large von Willebrand factor multimers into smaller fragments
39
erythema multiforme (EM)
an acute, often recurrent mucocutaneous eruption that usually follows an acute infection, most frequently recurrent herpes simplex virus (HSV) infection. Drugs (ABx), cancer, autoimmune disease can also cause it.
pt 20-40yo
rash: erythematous plaques with concentric rings of color, on the extensor surfaces of the extremities, particularly the hands and feet. Mucosal lesions are present in up to 70% of patients and involve the cutaneous and mucosal lips, gingival sulcus, and the sides of the tongue. Mucosal lesions consist of painful erosions or, less commonly, intact bullae.
Lesions usually last 1 to 2 weeks before healing; however, hyperpigmentation may persist.
tx: Symptomatic: steroids, antiviral
40
Acute lymphocytic leukemia
Most common childhood malignancy
Most responsive to chemotherapy
Sx: Anemia, thrombocytopenia, hepatosplenomegaly, swollen and bleeding gums
t(12, 21) better prognosis
Poor prgnosis: \<1yo or \>10yo, WBC\>50,000, CNS involvement
41
Acute myelogenous leukemia
AML type M3: Acute Promyelocytic Leukemia (APL) has Auer rods, t(15,17) treated with ATRA (All thrans retinoic acid therapy= Vitamin A. DIC common in this type.
42
CLL
**Smudge cell** on peripheral smear
Well differentiated B lymphocytes mostly
Older adults \>60yo
Flow cytometry: CD5+, CD20+ and CD21+
tx mostly palliative but chemotherapy
43
CML
t(9,22) philadelphia chrm, BCR-ABL translocation
3 phases:
chronic: w/o tx last 3.5-5y, tx ith imatinib (selective inhibitor of bcr abl tyrosine kinase product of 9,22 translocation)
Accelerated: Transition towards blast crisis w/ increase in peripheral and bone marrow blood counts
Blast crisis: Resembles acute leukemia, survival 3-6mths, tx same as for acute leukemia dasatinib + transplantation
Leukocyte alakaline phosphatase low, LDH/uric acid/B12 elevated
44
Non hodgkins lymphoma
Most are B cell origin
5 times more common than hogdkin's
pt \>50 yo
dx: LN biopsy
45
Hodgkin's
30 and 60 yo
Prsentation is above the diaphragm
systemic B sx
dx: fine needle aspiration: **Reed Sternberg cells**
tx: chemo, radiation, prognosis is good
46
Sick sinus syndrome
Tachycardia-bradycardia sydrome
Intermittent supraventricular tachy and bradyarrhythmias
May develop syncope, palpitations, dyspnea, chest pain, TIA, stroke
Get PACEMAKER
((sinus bradycardia correlated with dizziness
Caused by collection of pathologic findings that result in bradycardia: sinus arrest, sinus exit block, and sinus bradycardia))
47
Adrenal insufficiency
Primary: Autoimmue=Addison's disease, infection (TB leading cause of AI worldwide, Neisseria meningitis-: Waterhouse, Friderichsen syndrome), congenital enzyme deficiency.
Secondary/Tertiary: decreased ACTH by pituitaryMOST OFTEN DUE TO CESSATION OF LONG TERM STEROIDS (even 1 week of steroids is long enough to cause this)
Clinical manisfestation:
No adolsterone, no cortisol, no andorgen-\> hyponatremia and Hypovolemia, HyperKalemia, acidosis. ADH elevated bc of hypovolemia so Urine Osm greater than Serum Osm (concentrated urine), Skin and mucosa hyperpigmentation in Primary
Females: loss of axilla and pubic hair, loss of libido
48
Adrenal crisis
Tx: 4S
Salt: 0.9% NS
Steroids: IV hydrocortisone 100mg q8h
Support (correct hypoglycemia with 50% dextrose)
Search of underlying cause
49
Addison's disease
Primary AI due to adrenal atrophy or destruction by disease (TB, autoimmune, metastasis).
Deficiency in aldosterone and cortisone causing HYPOtension (hyponatremic volume contraction), HYPERkalemia, acidosis, and skin and mucosal HYPERpigmentation (due to MSH, a by-product of increased ACTH production from proopiomelanocortin (POMC). C
Distinguish from 2° adrenal insufficiency (decreased pituitary ACTH production), which has no skin/mucosal hyperpigmentation and no hyperkalemia.
50
RAAS
51
Management of acute, uncomplicated cystitis (ABX)
Trimethoprim-sulfamethoxazole or nitrofurantoin
52
The 1 for 10 Rule for Acute Respiratory Acidosis
The [HCO3] will increase by 1 mmol/l for every 10 mmHg elevation in pCO2 above 40 mmHg.
53
Winter's formula
pCO2 = 1.5 x [HCO3] + 8 (+/- 2) **for metabolic acidosis compensation**
Respi compensation is usually 1.2 mmHg fall in pCO2 for every 1mEq/L fall in [HCO3]
_Quick but less accurate formula:_
pH: 7.XX then pCO2 should be XX
(Ex: pH 7.30 than expect pCO2 to be 30)
54
The 4 for 10 Rule for Chronic Respiratory Acidosi
The [HCO3] will increase by 4 mmol/l for every 10 mmHg elevation in pCO2 above 40mmHg.
55
Polyarteritis nodosa
Medium-sized vessels vasculitis involving CNS and GI. Immune complex mediated. PMN invasion of all layers and fibrinoid necrosis + resulting intimal proligeration=reduced luminal area-\>ischemia, infarction, aneurysms.
Pt: Associated with Hepatitis B seropositivity, HIV, drug reactions
Sx: Constitutional + Adominal pain (bowel angina)
Dx: Biopsy, mesenteric anguigraphy, ESR elevated, **p-ANCA**
Treat with corticosteroids, cyclophosphamide. Poor prognosis.
56
Gout tx acute vs chornic
Chronic: allopurinol, (febuxostat)
Acute: NSAIDS, Colchicine, steroids
Be careful! At first, allopurinol transiently increases the risk for acute gout attacks for 3 to 6 months; SO also use colchicine.
57
Restrictive lung disease pattern on Spirometry
Reduced FEV1 (less than 80%)
Normal FEV1/FVC ratio, (greater than 70%)
Reduced total lung capacity and DLCO (Diffusing Capacity of the Lung for Carbon Monoxide).
58
Enteropathic arthritis
Arthritis associated with IBD: Chron's and ulcerative colitis
59
Churg-Strauss syndrome
Medium vessel vasculitis involving **many systems: Respi, Cardiac, GI, Skin, Renal, Neuro**
Clinical features: fever, fatigue, weight loss, PROMINENT respi findings (ASTHMA (usuall antecedent, DYSPNEA).
Dx: Eosinophilia, **+ p-ANCA**
Prognosis: 5 y survival at 25% (death due to cardio or pulm complications), W/ tx: steroids, 5 y survival to 50%.
60
Wegener's Granulomatosis (Granulomatosis with polyangiitis)
Medium vessel vasculitis
Involves predominantly **kidneys and upper & lower respiratory tract**
MOST pt have sinus disease +pulm disease + Glomerulonephritis
Dx: CXR: nodules, infiltrates. Elevated ESR, anemia, **+ C-anca** in 90% of pt
Prognosis: poor, pt die w/in 1 y of diagnosis
Tx: cyclophosphamide and corticosteroids can induce remissino but relapse possible
61
Temporal arteritis
"Giant cell arteritis"
pt\>50yo Women\>men
Temporal arteries mostly but also aorta or carotids therefore increase risk of aortic aneurysm and dissection
Sx: **HA**-severe, **visual impairment** (involemt of ophthalmic artery), optic neuritis-\> blindness (amaurosis fugax), **Jaw pain** with chewing, tenderness over temporal artery (no pulse), **malaise,** fatigue, weight loss, low-grade fever
**40% of pt have also polymylagia rheumatica**
Dx: ESR elevated, Biopsy of temporal artery
Tx: Prednisone IMMEDIATELY ( do not wait for biopsy results) bc of blindness risk, if visual lost do IV steroids may be reversible.
62
Takayasu's arteritis
Large vessel vasculitis of aortic arch and its major branches
Young Asian women (suspect if decreased/absent peripheral pulses, discrepancies of BP (arm/leg), arterial bruits)
Dx: Arteriogram
Tx: steroids may help, treat HTN, surgery to recannulate stenosed vessles, bypass grafting sometimes required
63
Behcet's syndrome
Autoimmune, multisystem vascultis disease
Recurrent oral and genital ulcerations, arthritis, eye sx, CNS sx
Dx: biopsy
Tx: steroids
64
Buerger's disease
young men who smoke cigarettes
Acute inflammation of small and medium vessel affecting arm and legs-\> gangrene
Sx: Ischemic claudication, cold, cyanotic painfule extremeties
SMOKING CESSATION needed
65
ABX for Pseudomonas
**beta-lactam and aminoglycoside** mostly for patients with neutropenia, bacteremia, sepsis, severe upper respiratory infections (URIs), or abscess formation
Ex: Piperacillin-tazobactam (Zosyn) + Gentamicin/neomycin/amakicin/tobramycin/streptomycin
Just zosyn, Just aminoglycosides
Ceftazidime (3rd generation cephalosporin)
Cefepime (4th generation cephalosporin)
Fluroquinilone: Ciprofloxacin, levofloxacin
Carbenapems: Imipenem, Meropenem
No proven benefits of combo\>mono therapy unless Abx resistance but some still prefer combo as initial until sensitivities come back
66
Status epilepticus tx
IV benzo (lorazepam) + loading dose of fosphenytoin
If seizures continue intubate and load with phenobarbital
67
Serum osmolality formula =
2[Na+] + [BUN]/2.8 + [glucose]/18
68
Metabolic syndrome diagnosis
3/5 of
* Increased waist circumference,
* Elevated systolic ≥130 mm Hg or diastolic blood pressure ≥85 mm Hg,
* Decreased HDL cholesterol level \<40 mg/dL men and \<50 mg/dL women,
* Elevated triglyceride level≥150 mg/dL,
* Elevated fasting plasma glucose level ≥110 mg/dL .
69
Cauda Equina syndrome
Bowel, bladder dysfxn, impotence and saddle area anesthesia
SURGICAL EMERGENCY
70
Anti-Jo 1
Polymyositis/dermatomyositis
71
Antihistone
drug induced SLE
72
Anti-smooth muscle
Autoimmune hepatitis, SLE
73
Antitopoisomerase I (Anti-Scl-70)
Scleroderma
74
Anti ds DNA
SLE
75
SLE
DOPAMINE RASH: must have at least 4
Discoid rash
Oral ulcers
Photosensitivity
Arthritis
Malar rash
Immunologic criteria: anti-ds DNA, anti sm-Ab
Neurologic sx: seizures, psychosis
Elevated ESR
Renal disease
**ANA +**
Serositis: pleural or pericardial effusion
Hematologic abnormalities: leukopenia, lymphopenia, thrombocytopenia
tx: NSAIDs, steroids, hydroxychloroquine !eye-retina!, cyclophosphamide
76
Hypertension
Hypernatremia
Hypokalemia
Metabolic alkalosis,
and low plasma renin or high plasma renin
Primary Hyperaldosteronism: low plasma renin.
Causes: Adrenal hyperplasia or an aldosterone-secreting adrenal adenoma (Conn syndrome).
Normal Na+ due to aldosterone escape = no edema due to aldosterone escape mechanism.
Tx: Surgery to remove the tumor and/or spironolactone, a K+ -sparing diuretic that acts as an aldosterone antagonist.
Secondary Hyperaldosteronism: high plasma renin
Renal perception of low intravascular volume results in an overactive renin-angiotensin system. Due to renal artery stenosis, CHF, cirrhosis, or nephrotic syndrom
Tx: Spironolactone
77
Stroke management
tPA if 1h of entering emergency room and with/in 3h of sx onset
- Thrombolysis is contraindicated in patients with intracerebral hemorrhage, a systolic BP \>185 mm Hg or diastolic BP \>110 mm Hg, or mean arterial pressure \>130 mm Hg
- If pass 3h mark, start antiplatelet therapy: aspirin within 48 hours of stroke and TIA to reduce subsequent stroke risk.
- Do NOT treat HTN unless BP exceeds 220/120 mm Hg, UNLESS pt has acute coronary syndrome, heart failure, aortic dissection, hypertensive encephalopathy, or acute kidney injury.
- Hypoglycemia associate with poor outcome. Give insulin if glucose levels \>140 mg/dL
78
Variant angina tx
cocaine induced chest pain
Variant: CCB
COcaine: CCB and benzo ok
DO NOT USE beta blockers!!
79
Fibromyalgia tx
SNRI duloxetine
80
Bisphosphonates
bind to the bone matrix and decrease osteoclast activity, thereby slowing bone resorption while new bone formation and mineralization continue
PO: Alendronate
IV: Zoledronic acid (if any esophageal disorders as esophagitis is a SE of po biphosphonates).
81
COPD tx
Bronchodilators:
1st line tx: short acting beta2-agonist (albuterol), short acting anticholinergics (ipratroprium), or combo
Long acting neta agonist (Salmetorol) or anticholinergics (tiotropium)
(Theophylline is the least preferred long-acting bronchodilator option because its effects are modest and toxicity is a concern)
If pt had repeated exacerbations add a steroid
O2 if pt had chronic hypoxemia
82
anisopoikilocytosis
rbc of different size and shape (variant red blood cell distribution width (RDW) measurement)
(Think nutrient deficiency: iron, folate, or vitamin B12)
83
Normal Sodium
Normal Potassium
Normal Chloride
Normal Calcium
Sodium: 136-145 mEq/L
Potassium: 3.5-5
Chloride: ~100
Calcium: ~10
84
delayed hemolytic transfusion
5 to 10 days after erythrocyte transfusion, alloantibodies agaisnt erythrocytes
anemia, jaundice, and fever and a worsening pain crisis in patients with sickle cell anemia.
85
DIC
Prolonged PT & aPTT
**Increase D-dimer titer, (ascites increased this either way just FYI)**
Decreased serum fibrinogen level & platelet count,
Presence of microangiopathic hemolytic anemia.
Most common causes: infection (GN mostly), cancer, obstretrics complications
86
Light's criteria
Exudate if:
Total protein **/** serum total protein ratio \>0.5
Pleural fluid LDH \>2/3 of the upper limit of normal (or pleural fluid / serum lactate dehydrogenase ratio \>0.6).
87
Tricuspid regurgitation
systolic murmur **at the lower left sternal border** that may increase in intensity with inspiration.
88
Multiple sclerosis dx test
Clinical young adult with relapsing and remitting neuro signs and sx that are difficult to explain due ton involvment of different areas of CNS matter.
MRI- test of choice, demyelinating lesions
Lumbar puncture! NEXT test of choice : oligoclonoal bands of IgG (in 90% of MS pt)
89
Radioactive iodine uptake in Grave's disease
Diffuse iodine uptake
Grave's: autoimmune HYPER thyroidism, autoAb stimulate the increase of T3 and T4 production by stimulating the TSH receptor
tx:Propanolol, methimazole
90
Thyroid cancer Papillary
Popular: most common
Papable LN
"pupil" nuclei: "Orphan Annie" nuclei
Psommomma bodies
91
MEN 1
Diamond
Parathyroid tumors
Pituitary tumors (prolactin or GH)
Pancreatic endocrine tumors (Zollinger- Ellison syndrome, insulinomas, VIPomas, glucagonomas (rare))
Commonly presents with kidney stones and stomach ulcers
Auto Dominant
* primary hyperparathyroidism (\>90%)
* Enteropancreatic tumors (60-70%)
* Pituitary tumors (10-20%)
92
MEN2A
Square
**Medullary thyroid carcinoma (secretes calcitonin) (\>90%)**
Pheochromocytoma (40-50%)
Parathyroid hyperplasia (10-20%)
RET gene mutation, auto dominant
93
MEN2B
Triangle:
Medullary thyroid carcinoma (secretes calcitonin)
Pheochromocytoma
**Oral/intestinal ganglioneuromatosis (mucosal neuromas)**.
Associated with **marfanoid habitus**
RET gene mutation, auto dominant
94
Hypercalcemia
"Stones, Bones, Moans, Groans and psychiatric overtones"
tx: IV fluids and loop diuretics
95
familial hypocalciuric hypercalcemia
Inherited disorder due to mutation in calcium sensing receptor present on parathyroid and kidney, presents with elevated calcium levels BUT unlike primary hyperparathyroidism, pt are asx and have LOW urinary calcium levels.
96
C. diff treatment and if relapse treatment
Tx: metrodinazole, add oral vancomycin if relapse (not IV)
97
porphyria cutanea tarda
Most common porphyria. Skin manifestations are varied and include blisters, erosions, hyperpigmentation, and hypertrichosis.
**very strong association with chronic hepatitis C infection**
a deficiency in uroporphyrinogen decarboxylase, an enzyme in the heme biosynthesis pathway.
Sunlight activates the large amounts of uroporphyrinogen that are deposited in the skin, leading to photosensitization and tissue damage
98
Lichen planus
polygonal, pruritic, papular, planar, purple, and with plaques (the six Ps).
association with hepatitis C,
99
CURB-65
Confusion,
Uremia: BUN \>19.6 mg/dL,
Respiration rate ≥30/min,
Systolic Blood pressure \<90 mm Hg or diastolic \<60 mm Hg, and
age ≥65 years
100
bilateral hilar adenopathy
Sarcoidosis
101
Target cells
Thalessemia, liver disease
Asplenia, HbC disease
102
Primary Hyperaldosteronism
Hypertension, mild hypernatremia, suppressed renin activity, metabolic alkalosis,
HypoKalemia not always present (but will be if pt on diuretics. CLinical significant hypernatremia and edema not present due to aldosterone escape mechanism.
Cause: Bilateral nodular hyperplasia, hyperfunctioning adrenal adenoma
Leads to: Aldosterone elevated, therefore K+ excreted, H+ excreted, Na+ reabsorbed-\>Hypokalemia, Metaboli alkalosis, Hypertension -\> decrease renin and aldosterone levels
BUT: Increased renal Blood flow, increased GFR, increased atrial natriuretic peptide avoids edema and hypernatremia by leading to Na+ excretion (ALdosterone escape).
103
chlorthalidone
diuretic that works like thiazide but doesnt have the same molecular structure
104
Renal Tubular Acidosis type 1, 2, 4
**Type 1:**
* Cant secrete H+ in distal tubule -\> non anion gap metabolic acidosis
* Urine pH\>5.5 increased
* Hypokalemia
* **Calcium Phosphate Kidney Stones**
* Causes of type 1: amphotericin B toxicity, multiple myeloma...
**Type 2:**
* Defect at proximal tubule in **HCO3- reabsorption leading to increased excretion** -\> non anion gap met acidosis
* Hypokalemia
* Causes: Fanconi syndrome, chemical toxic (lead, aminoglycosides) and carbornic anhydrase inhibitors
**Type 4:**
* Hyperkalemia -\> decreased buffering capacity and decreased H+ secretion, ph urine\<5.5
* Hypoaldosteronism, aldosterone resistance, or K sparing diuretics
105
Treatment for idiopathic intracranial hypertension or pseudotumor cerebri
**Acetazolamide:** inhibits the choroid plexus carbonic anhydrase: to decrease CSF production
Clinical findings: Increased CSF opening pressure but CSF is normal
106
ECG findings for hyperkalemia
Reduced P waves, Increased 'peaked' T waves, widden QRS complex, ECG can evolve in sinuisodal shape.
Tx: Give **Calcium chloride or gluconate** to protect and revert Potassium effects
107
Tzanck cells (multinucleated cells)
Found in:
* Herpes simplex
* Varicella, herpes zoster
* Pemphigus Vulgaris
* CMV
108
Hepatitis B tx
Interferon: younger patient with compensated liver disease, short term tx
Lamivudine: (Increased resistance)
Entecavir: Decompensated cirrhosis, less resistance
**Tenofovir: Most potent with limited drug resistance, preferred**
109
Dementia , gait apraxia, urinary incontinence
Normal Pressure Hydrocephalus NPH
110
Cat scratch disease
*Bartonella henselae*
Localized cutaneous reaciton: Vesicular, erythematous, pustular or nodula
+ draining LN: localized, regional, tender, may be supporative
**Tx: 5 days of _azithromycin_**
111
Aortic dissection type B tx
B betablockers and only then (after bet blockers) vasodilators, otherwise you have tachycardia that creates more stress
112
Acute cocaine toxicity
O2 and IV benzos
Benzo reduce sympathetis outflow, improve BP and HR (if pt is having MI related to cocaine tox)
DO NOT use Beta-blockers as it will leave alpha adrenergic stimulaiton unopposed and lead to more coronary artery vasoconstriction.
Cocaine potentiates sympathomimetic actions by causing inhibition of NE reuptake -\> alpha and beta adrenergic receptors stimulation and therefore coronary vosconstriciton, increase myocardial demand and increased HR.
113
Bugs causing atypical pneumonia
Mycoplasma pneumonia, Chlamydia pneumonia, Legionella
114
Mycobacterium avium complex treatment
**Clartithromycin,**
2nd line: Ethambutol +/- rifabutin
Prophylaxis is **arythromycin**
Sx: Non spe systemic sx, splenomegaly in pt with CD4\<50
115
Toxoplasmosis treatment
Pyrimethamine + Sulfadiazine and leucovorin
116
Partial/weak acid-fast, filamentous, branching
Nocardia, GP anaerobe, causes pulm infection in immunocompromised and cutaneous infection afer trauma in immunocompetent
tx: Bactrim
(Actinomyces, P anaerobe, does not stain on acid-fast but is also branching, **oral/facial abcesses drains through sinus tracks, forms yellow sulfur granules**)
117
Post-viral pneumonia
S pneumo, Staph a., H. influ
118
common causes of esophagitis in HIV
* HSV: Herpetic vesicle, round/ovoid ulcers, concurrent peri-oral/oral HSV
* Candida: white plaques, oral thrust
* Idiopathic/Aphthous: aphthous ulcers in mouth
* CMV: **deep linear ulcer**s, distal esophagus
119
Bloody diarrhea
**Campylobacter**
E.histolytica (amebic dysentery, liver abscess)
Enterohemorrhagic E.Coli (O157:H7, can cause HUS, Shiga-like toxins
Enteroinvasive E.Coli (invasdes colonic mucosa)
+/- Salmonella (lactose (-), flagellar motility, poultry& eggs)
Shigella (lactulose (-), Shiga toxin, bacillary desentery)
Y. enterocolitica (day care outbreaks, pseudoappendicitis)
120
Watery diarrhea
C.diff
C.perfringes
Entero**toxigenic** E.COli **(travelers diarrhea**s, heat labile and heat stable toxins)
Protozoa: Giardia
Chlorea
Viruses: rotavirus, norovirus
121
Treatment for HIstoplasmosis
**Itra**conazole and if severe amphotericin B
122
CMV treatment
Ganciclovir
123
Restless leg syndrome treatment
_1st line:_ Dopamine agonist: pramipexole
_2nd line:_ Apha 2 calcium channel ligand: gabapentin
124
Porphyria cutunea tarda
Strong correlation **with Hepatitis C**
Fragile, photosensitive skin-\> vesicle and erosion on dorsum of hands
Hep C also strongly associated with essential mixed cryoglobulinemia
125
Whipple's disease
Caused by Tropheryma whippelii
White men 40-60 yo
Weight loss, diarrhea, malabsorption with distension, flatulence, steatorrhea, myocardial or valvular involvement -\> congestive HF or valvular regurgitation, also low grade fever, lymphadenopathy, pigmentation
Later: CNS involvement including dementia
**Biopsy finding: PAS-positive materal in the lamina propria of the small intesting + FOAMY MACROPHAGES**
**Tx: Penicillin, Ampicillin, Tetracycline for 1-2 years or doxycyline + hydroxychloroquine for 12-18mths**
126
Conn's syndrome
Primary Hyperaldosteronism:
Too much aldosterone (therefore low renin) -\> to HTN
Causes: enlargement of adrenal glands, adrenal adenoma making aldosterone
Tx: aldosterone antagonist: Spironolactone
127
young pt with progressive low back pain w/ morning stiffness lasting \>30min w/ improvement w/ physical therapy. Reduced forward flexion, tenderness at sacro-iliac joint
Ankylosing spondilitis
Chronic inflammation disease of spine and sacroiliac joint (get XR of sacro-iliac joints, bamboo spine on back XR), uveitis, Aortic regurgitation.
HLA-B27 (test not spe for diagnosis)
Young male pt (\>female). 20-30yo
Anterior uveitis (most commone side effect)
128
Glomerulonephritis associated with HIV
Nephritic or Nephrotic?
Focal segmental GN
More common in blacks\>whites
Nephrotic
129
CMV retinitis
White-yellow patches of retinal opacification and retinal hemorrhages. Tx: ganciclovir or foscarnet. AIDS pt with CD4 ct less than 50cells/uL
130
Charcot joint
Neurogenic arthropathy
Decreases prioprioception, pain & temperature perception can be caused 2/2 to DM, peripheral nerve damage, syrngomyelia, spinal nerve injury, B12 deficiency
Pt traumatize joint bc cant feel pain anymore
Xray: degenerative joint, loss of cartilage, osteophyte development, loose bodies
131
Bisphosphonates rare but tested SE
Jaw necrosis
132
Polymyalgia Rheumatica
Age\>50, Bilateral pain and morning sitffness\> 1mth
2 of the following involved:
Neck or torso, Shoudlers or proximal arms,proximal thigh or hip, Constitutional sx
PE: decreased active ROM in shoulders, neck and hips. NO MUSCLE WEAKNESS.
Labs: ESR\>40 or \>100, elevated CRP, normocytic anemia, (20% of time normal)
Tx: Glucocorticoids
133
cor pulmonale
Right sided heart failure 2/2 to pulmonary HTN (COPD, sleep apnea, interstitial lung disease)
134
Posterior limb of internal capsule stroke (lacunar infarct)
Unilateral motor impairment
No sensory or cortical deficits
No visual field abnormalities
135
Anterior cerebral artery occlusion
Contralateral paresis (weakness therfore motor affected) and sensory loss in leg. Cognitive and personality changes.
Abulia (lack of will or initiative)
136
Middle cerebral artery occlusion
Contralateral somatosensory and motor deficit (face, arm , leg)
Conjugate eye deviation toward side of infarct
Homonymous hemianopia
Aphasia
Hemineglect
137
Vertebrobasilar system lesion (supplying the brain stem)
Alternate syndromes with contralateral hemiplegia and ipsilateral cranial nerve involvement
Possible ataxia
138
Central vision loss
Macular degeneration:
Progressive and bilateral central vision loss in 50 yo and + due to degeneraiton and atrophy of outer retinar, retinal pigment epithelium...
Tx: None, Vit and antioxidant
139
Lack of Pharyngitis and cervical lymphadenopathy, mono like sx, atipycal lymphocytes, negative monospot
CMV!!
Atypical lymphocytes: large basophilic cells with vacuolated appearance.
140
Cutaneous larva migrans
Helminth worm, caused by Ancylostoma braziliense (dog, cat hookworm). Infection occurs after skin contact with dog or cat feces containing the larvae. Prevalent in the topical and subtropical regoins (including southeast US). People at risk: sandboxes, sandy beaches.
Multipe pruritic, erythematous papules at site of larva entry--\> pruritic elevates serpiginous reddish brown skin lesions,
Tx: PO:Albendazole, ivermectin
TOPICAL or PO: thiabendazole
Benadryl for the itch
141
Alcoholic hepatitis labs:
AST/ALT\> or= 2
AST and ALT\<300U/L
increased GGT and ferritin
142
Haptoglobin
Protein that binds free hemoglobin. Made by liver. Will be decreased in hemolysis bc free hemoglobin overload binds all the free haptoglobulin
143
gliobastoma multiforme
Common, hilghly malignant primary brain tumor with mean survival of 1 year. In cerebral hemisphere. "Butterfly glioma". stain astrocytes for GFAP. "psudopalisading" pleomorphic tumor cells: border central areas of necrosis and hemorrhage.
144
Hypokalemia, normotensive, alkalosis
Surreptitious vomiting
Diuretic abuse
Bartter's syndrome (urine chloride=HIgh)
Gitelman's syndrome (Urine chloride= HIgh)
145
Contralateral hemianesthesia with transient hemiparesis, athetosis, ballistic mvt. Dyesthesia of the area affected by the sensory loss is characteristic of thalamic pain phenomenon
Dejerine Roussy Syndrome aka thalamic stroke
Hemi sensory loss with severe dyesthesia of affected area
146
Mulitple system atrophy (Shy-Drager syndrome)
1. Parkisonism
2. Autonomic dysfxn (postural hypotension, abnorml sweating, disturbance of bowel or bladder ctrl, abnrml salivation/lacrimation, impotence, gastroparesis)
3. Widespread neurological signs (cerebellar, pyramidal, lower motor neuron)
147
Cross sectional study
Estimate prevalence: do people have the disease at this point in time.
Disadvantage: cant determine cause of disease, cant determine incidence or risks
148
Prevalence vs incidence
Prevalence= #of cases in pop / total pop
Incidence: # new cases in pop over given time/total pop at risk during time\*
\*(new cases-total pop)
Prevalence= Incidence\* average duration of disease
If mortality decreases, prevalence increases
Prevalence is more general than incidence
149
Sensitivity vs Sensitivity
_Sensitivity:_ **Probability that pt with the disease will have a positive test.** (remember table).A sensitive test **rarely misses people with the disease** and is really good at **RULING OUT (SNOUT)**
High sensi desired early in a diagnostic workup or screening test to reduce broad differential.
_Specificity:_ The probability that pt wihtout the disease will have a negative test. A specific test will rarely determine that someone has the disease when infact they dont and is really good at **RULING IN (SPIN)**
High spe useful in confirming likely diagnosis
Think Lyme: elisa (sensi) if - (dont have it) if + --\> western blot (spe) if - (dont have it) if + (have it)
150
Cohort study
Group of people withOUT the disease but possibly with risks being followed over time for disease development. Classified as exposed and unexposed to risk factor.
Determines Incidence.
151
Case control studies
The researched determines whether the participants have the disease or not and looks back retrospectively to whether they were exposed or unexposed.
HAVE DISEASE LOOK BACK FOR EXPOSURE/RISKS
(Backwards of cohort study: HAVE RISKS-\> DO they get disease?)
152
p-value\<0.05
Statiscally signigicant
153
Modified Wells criteria
+3 pt: DVT, no other better dx than PE
+1.5pt: Previous PE or DVT, HR\>100, recent surgery and immobilization
+1pt: hemoptysis, cancer
Total \>4=PE likely
154
Rectangular, envelope shaped urine crystals
Calcium oxalate crystals seen with ethylene glycol poisoning
155
Fulminant hepatic failure
Hepatic encephalopathy that develops within 8 weeks of acute liver failure. MC in heavier users of acetminophen, alcohol, methamphetamines or co-infected with hep B and D.
Mortality rate \>80% high priority for liver transplant risk
156
Febrile nonhemolytic transfusion reaction
MC reaction
Fever and chills
1-6h post transfusion
Due to cytokines accumulation during blood storage
157
Acute hemolytic transfusion reaction
Fever, flankpain, hemoglobinuria, renal failure, DIC
Within 1 hour!!!!!
+ direct coombs test
Due to ABO incompatibility!!!!!!!!!!!!
158
Anaphylctic transfusion reaction
Rapid onset of shock, angioedema/urticaria and respi distress
Few sec to min of transfution
DUE to recipient anti-IgA antibodies
159
Transfusion related acute lung injury transfusion reaction
Respi distress and pulm edema (ARDS)
within 6h of transfusion
caused by donor anti leukocyte antibodies.
160
Type 2 heparin induced thombocytopenia
Due to heparin exposure \>5 days and
* Plt count reduction \>50% from baseline
* Arterial and venous thrombosis
* Necrotic skin lesions at heparin injectino
* Acute systemic (anaphylactic) reactions to injection
Due: to Antibodies against heparin plt factor 4 complexes
Test: Serotonin release assay (gold standard)
Tx: STOP heparin, start direct thrombin inhibitor (argatroban) or fondaparinux
161
Kidney stones less than ...mm pass on their own
less than 5mm
162
Steppage gait with foot drop due to ....
L5 radiculopathy or common peroneal nerve neuropathy
163
Broad flat and inversion T waves, U waves, ST depression and
Hypokalemia
(peaked T waves in HYPERkalemia and small nondiscernible P wave)
164
Holosystolic murmur that increases with inspiration
Tricuspid regurgitation
best heard at left lower sternal border
165
Lung Cancer Screening
Age 55-80, have a \> or = 30 pack-year smoking hx currently smoking or quit within the past 15 years
166
Hematologic complication of Mononucleosis
Thrombocytopenia and Autoimmune hemolytic anemia
2-3 weeks post sx
due to crossreactivity of EBV induced Ab against rbc and plt (IgM cold Ab--\> complement mediated destruction of rbc)
167
Risk factors for esphageal adenocarcinoma
**Barett's esophagus,** obesity, high dietary calorie and fat intake, smoking, meds that provoke **GERD**
168
Risk factors for esophageal squamous cell carcinoma
**SMOKING**, alcohol, dietary deficency of beta carotene, vit B1, zinc, selenium, envmt viral infection, toxin producing fungi, hot food and beverages, **pickled veggies and food rich in N nitroso compounds**
169
Wernicke encephalopathy
Thiamine deficiency: ataxia, ophtalmoplegia, nystagmus and confusion
If untreated can progress to Korsakoff syndrome: memory loss with confabulation (cant remember therefore make things up
170
Huntington
**Autosomal dominant,** age 35-50, choreiform mvmt
## Footnote
**Atrophy of caudate nuclei**
171
Sturge Weber syndrome
Somatic disorder. Dvlmpt anomaly of neural creast cells
Affects small blood vessels
Port wine stain of the face (birthmark)
Ipsilateral leptomeningeal angioma-\> seizures /epilepsy
Intellect disability
Early onset glaucoma
Tram-track Calcium deposits
172
Fetal alcohol syndrome 3 physical features:
Small palpebral fissures, smooth philtrum, thin vermillon border (upper lip is thin)
173
Anterior spinal cord syndrome
Anterior spinal artery supply anterior 2/3rd of spinal card: **motor tract and sensory tract for pain/temperature**
Thoracic aortic surgery complication by impeding flow into radicular arteries--\> anterior spinal infarction
Abrupt onset of **bilateral flaccid paralysis** (due to spinal shock), **loss of pain/temp sensation below site of infarction**
**VIBRATION AND PROPRIOCEPTION are preserved.** (dorsal column not affected).
174
Craniopharyngiomas
Derived from epithelial cells remnants of Rathke's pouch
May be confused with pituitary adenoma
**Calcified lesion above sella with bitemporal hemianopsia with increase intracranial pressu**re
Benign childhood tumor
175
Histaplasmosis tx
Itraconazole
176
Lesch-Nyhan Syndrome
Genetic deficiency of enzyme **hypoxanthine-guanine** phosphoribosyl **transferase**. Overproduction of **uric acid**, behavioral problems (self injury), neuro disability. Dx in childhood
177
MMSE less than.... suggest dementia
Less than 24/30
178
Hypertrophic cardiomyopathy murmur
Harsh crescendo-decrescendo systolic murmur heard best at the apex and lower sternal border
## Footnote
**Vasalva and abrupt standing decreases preload (decreased LV) and increases the mumur**
179
Decrescendo diastolic early murmur
AR (bicuspid aortic valve)
Best heard at **Left sternal border 3rd and 4th intercostal spaces**
Sometimes only heard if pt is sitting up, leaning forward and holding breath in full expiration.
180
Cholinesterase inhibitors
Galantamine, rivastigmine, Donepezil,
181
Serotonin syndrome
Fever, myoclonus, mental status change, cardiovas collapse
182
Extrapyramidal sx
Hours: Acute dystonia tx: anticholinergics (benztropine, diphenhydramine)
Days: Dyskinesia (pseudoparkisonism) tx: anticholinergic, dopamine agonist
Weeks: Akathisia (sujective/objective restlessness that is perceived as distressing) tx: betablockers, benzos, anticholinergics
Months: tardative dyskinesia (oral-facial mvmt, stereotypic) 30% irreversible tx: change neuroleptic, anticholinergics (may worsen first before getting better)
183
Venous thrombosis + hx of miscarriages
Antiphospholipid syndrome
Antibodies such as lupus anticoagulant (LA), anticardiolipin antibody, or beta 2 glycoprotein 1 antibody.
REMEMBER **IN VITRO it prolongs PTT test bc it binds the phospholipids present in most assays. ARTIFACT**
184
Eggshell cyst on CT abdomen on liver
Hydatid cyst, echinococcus granulosus
Tx: resection with albendazole tx
Common in sheep breeders
185
Diabetes + Skin rash and findings:
Erythematous papules/plaques on face, perineum, extermities with lesions that enlarge and coalesce -\> central clearing and blistering, crusting and scaling border
Glucagonoma:
Necrolytic migratory erythema (findings noted before)
Diabetes mellitus (easily controlled with meds and diet)
GI sx: Diarrhea, anorexia, abdominal pain, +/- constipation
Other findings: weight loss, neuropsych (ataxia, dementia, proximal muscle weakness), venous thrombosis
Dx: Hyperglycemia **with elevated glucagon\> 500**; Normocytic, normochromic anemia; Abdominal imaging (CT or MRI)
186
cosyntropin=
ACTH
187
1. Decreased T3, Nrml T4 and TSH
2. Increased TSH, Nrml T4 and T3
1. Euthyroid sick syndrome
2. Subclinical hypothyroidism
188
Hyperthyroidism + decrease radioactive iodine uptake
Thyroiditis
1. Subacute granulomatous thyroiditis (De Quervain's)
2. Levothyroxine overdose
3. iodine-induce thyrotoxicosis
4. Subacute painless thyoiditis
5. Struma ovarii
189
Pronator drift
UMN lesion!
190
erythema nodosum
Subcutaneous, painful, pre-tibial nodules
Associated with Tuberculosis, sarcoidosis, histaplasmosis, recent strep and IBD (occurs at same time as IBD flair-up so watch for GI sx)
191
Digitalis toxicity leads to ....arrhthymia
Atrial tachycardia with AV block
(Atrial tachy has a slower rate than atrial flutter 250-350 bpm)
Digitalis toxicity increases ectopy and vagal tone
192
Central cord syndrome (neuro injury)
Occurs with hyperextension (car accident) in elderly patients with pre-existing degenerative changed (arthritis) in ther cervical spine. Selective dmage to central portion of anterior spinal cord: **central portions of corticospinal tracts and decussating fibers of the lateral spinothalamic tract**
193
Testicular atrophy, decreased sexual drive, arthropathy, diabetes and hepatomegaly
Hereditary hemochromatosis
Auto recessive disorder of HFE gene causing increased intestinal iron absorption.
Skin: Hyperpig
MSK: Arthalgia, arthropathy, chondrocalcinosis
GI: Increased hepatic enzymes w/ hepatomegaly, can lead to cirrhosis, can lead to increased risk of hepatocellular carcinoma
Endocrine: DM, secondary hypogonadism and hypothyroidism
Cardiac: Restrictive or dilated cardiomyopathy and conductive abnormalities
Infection: at increased risk of LIsteria, V.Vulnificus, Yersinia Enterocolitica
194
Primary hyper parathyroidism + Pheochromocytoma
MEN (multiple endocrine neoplasia) type 2A:
- Medullary thyroid cancer ( almost all)
- Pheochromocytoma (50% pt)
- PHPT (20% pt)
195
Ulcer with purulent base and voiletaceous borders associated with 50% of patient with systemic disease (such as inflammatory bowel diseases)
Pyoderma Gangrenosum
196
Nrml PR interval
Nrml QRS
Nrml QT
PR= 120-200msec
QRS\<120
QT\<440
197
Conditions with pulsus paradoxus
Pulsus paradoxus: when systolic pressure falls by \> 10mmhg during inspiration
Conditions: severe asthma, COPD, cardiac tamponade
198
The probability of being disease free if the test result is negative
Negative predictive value (varies with pretest probability of a disease)
199
OBGYN: hydatiform mole
One form of gestational trophoblastic neoplasia-\> products of contraception become a tumor. Clues:
- Preeclampsia bf 3rd trimester
- hCG levels off
- expulsion of grapes like structure
- snowstorm on US
Complete mole: karyotype 46 XX (all chrm from father and no fetal tissue). Incomplete mole: karyote 69 XXY with fetal tissue.
