Flashcards in Kaplan 1 Deck (107):
Henoch Schoenlein purpura
hematuria (IgA nephropathy)
self-limited disease, no therapy
what kidney stones are common in immobilized people?
Magnesium - ammonium- phosphate (Struvite)- usually from Proteus
peritonitis in a patient on CAPD (continuous ambulatory peritoneal dialysis) is usually caused by
gram-positives such as Staph aureus/ Staph epidermidis
DX: ab pain/ tenderness, cloudy dialysate w/ more than 100 white blood cells in a sample.
treat w/ cephalosporins such as cephalothin, cefazolin AND a 3rd gen like ceftazidime.
treat neuro lyme disease with what?
(radicular pain, facial paralysis etc.)
most common cause of community acquired pneumonia
strep pneumo. Others: H flu, Moraxella
fever, rales/ friction rub, consolidation of affected lobe.
mycoplasma pneumonia looks like
bilateral patchy infiltrate
increasing weakness (proximal)
heliotrope rash, Gottron papules, rash in shawl-like distribution
elevated CPK and aldolase
do an EMG to rule out other causes of muscle weakness
pt has dyspnea lying down. What to do first?
help into sitting position, may go a long way to relieving dyspnea (reduces central venous pressure, decreases preload)
HIV goes with what kidney disease?
focal segmental glomerulosclerosis (FSGS)
amiodarone lung-- why type of pulmonary disease
best treatment of acute pulmonary edema from congestive heart failure
IV loop diuretic (like furosemide), nitrates, and morphine (anxiety, decrease sympathetic outflow, cause venodilation- decrease preload)
what to give to prevent IV contrast nephropathy?
severe dehydration, fluid of choice IV?
.9% saline; sodium confines it to the extracellular compartment
seen in diabetic women
air in the renal parenchyma (often from e coli, e.g.)
can be fatal-- do percutaneous nephrostomy ASAP!
most common cause of primary nephrotic syndrome in adults in the US
best early indicator for diabetic nephropathy
atrial septal defect, what do we see?
wide, fixed split S2
relatively young female
Tic douloreux, trigeminal neuralgia treatment of choice
treatment of choice for cluster headache
prophylaxis: calcium channel blocker like verapamil
1st time needs imaging
tuberous sclerosis rx for kids
ACTH (infantile spasms)
neurocutaneous symptom: ash leaf macules more visible under wood's lamp
RX for neurocystercicosis
albendazole and dexamethasone
Personality first in Pick
von hippel lindau
the combination of hemangioblastoma and an angiomatous lesion of the retina is diagnostic of von Hippel-Lindau syndrome.
Acute diffuse encephalomyelitis
a diffuse autoimmune demyelination process that typically follows a viral infection or antiviral vaccination.
It produces multiple inflammatory lesions in the brain and spinal cord, particularly in the white matter.
ADEM causes signs and symptoms of demyelination with encephalopathy, acute hemiparesis, cerebellar ataxia, cranial neuropathies, and spinal cord dysfunction.
RX for choreiform mvmts of huntingtons
Excess dopamine is responsible for the involuntary movements. Dopamine receptor blockers, such as haloperidol, olanzapine, risperidone, and aripiprazole are thus good choices to control these movements.
complex regional pain syndrome
characterized by severe hyperesthesia (pain with innocuous stimuli) unilaterally, usually in an arm, weeks to months following trauma.
Initial symptoms of complex regional pain syndrome include swelling, edema, and redness.
Later in the course, signs and symptoms include atrophy, cyanosis, or pallor and contracture.
A ring-enhancing lesion on MRI in a patient who is HIV positive would suggest CNS toxoplasmosis.
If a patient is treated for CNS toxoplasmosis and does not respond to treatment,
CNS lymphoma should be considered.
A brain biopsy may be required for diagnosis.
RX for myasthenic crisis
plasmapheresis or IVIG
RX for acute MS flare-up
5 classic syndromes include pure motor hemiparesis, pure sensory stroke, sensorimotor stroke, ataxic hemiparesis, and clumsy-hand dysarthria.
test to confirm CSF leak
beta-2 transferring of nasal fluid
small cell lung cancer business
small cell- sensitive to chemo
and goes with SIADH
adenosine deaminase is a marker for
CSF leak most common complication?
commonly strep pneumo
side effects of phenytoin
Gingival hypertrophy is the most common side effect and is nearly pathognomonic of chronic phenytoin use.
An acute third nerve palsy accompanied by pupillary abnormalities (drooping eyelid, dilated pupil, and inability to adduct, elevate, or depress the eye.)
is highly suggestive of an intracranial aneurysm.
A headache preceding the third nerve palsy suggests a sentinel hemorrhage.
Angiography followed by a neurosurgical consult is indicated.
presents with a triad of confusion, ataxia, and ophthalmoplegia.
Treatment is IV thiamine BEFORE glucose.
amyotrophic lateral sclerosis (ALS)
progressive motor neuron disease that presents with a combination of lower and upper motor neuron findings. Lower motor neuron signs include muscle weakness, fasciculations, and atrophy, whereas upper motor neuron signs include spasticity and increased deep tendon reflexes.
The median survival after diagnosis is 3 to 5 years, with death usually occurring from respiratory failure.
The majority of cases are sporadic and about 10% are familial.
myoclonic jerking movements and characteristic EEG changes.
diverticulitis. When to get a colonoscopy?
6 weeks later. too soon--> perforation, too late miss cancer
ulcerative colitis, when colonoscopy?
8 years from diagnosis and every year thereafter
reduces portal pressure (cirrhoses, GI bleed)
Hep c, when do we screen for hepatocellular carcinoma?
when they have fibrosis
start with hydroxychloroquine
flairs get steroids
cylophosphamide for nephritis
anti histone antibodies associated with
drug induced lupus (esp hydralazine)
common primary brain tumor in children.
Hydrocephalus results from compression of the fourth ventricle.
It is highly responsive to radiation and chemotherapy.
The cholesterol subset that correlates most strongly with coronary events is
LDL cholesterol levels
Tricyclic antidepressant toxicity
manifests as cardiac conduction abnormalities, obtundation, seizures, and anticholinergic toxicity.
Electrocardiogram is the most valuable tool for determining the extent of poisoning.
Treatment is primarily of IV fluid resuscitation for hypotension and sodium bicarbonate for QRS elongation or cardiac arrhythmias.
prostate cancer metastasizes where?
lymph --> bone
Patients who have hereditary spherocytosis who are relatively asymptomatic should be treated with
daily folic acid supplementation to sustain erythropoiesis caused by high red blood cell turnover.
RX for WEgeners
high-dose steroids and oral cyclophosphamide.
treatment of primary chronic adrenal insufficiency
corticosteroid (prednisone) and mineralocorticoid (fludrocortisone) replacement.
Diagnose mesenteric ischemia
with CT abdominal imaging.
you suspect c diff. How to test?
c diff toxin assay
Treatment of UC:
aminosalicylate enema, steroid foams, or support.
Auer rods go with
Hypothyroidism effects on cardiovascular
results in hypertension and hypercholesterolemia.
When treated, blood pressure, serum LDL, and serum triglycerides all decrease.
best test for finding pheochromocytoma
The most sensitive test for the diagnosis of pheochromocytoma is plasma free fractionated metanephrines.
Remember the key symptoms for the diagnosis of pheochromocytoma: paroxysmal hypertension, tachycardia, and diaphoresis.
Elderly women with new-onset ascites
should be investigated to rule out ovarian malignancy. (peritoneal carcinomatosis)
Constrictive pericarditis pressures
presents with equal diastolic pressures for all cardiac chambers
Pericardial calcifications are a key imaging finding
Symptoms show right-sided heart failure, including the Kussmaul sign
nonmechanical obstruction of the small bowel. It is secondary to extensive manipulation of the bowel and is contributed to by narcotic use and electrolyte imbalances.
Diagnosis is made on clinical grounds with the aid of x-ray and/or CT scan.
Management consists of nothing-by-mouth (NPO) and nasogastric tube placement.
metastatic pancreatic cancer, what do we do?
chemotherapy, not surgery
treatment of UC
the mainstay of outpatient management of mild ulcerative colitis is topical anti-inflammatory therapy with 5-ASA preparations such as mesalamine, olsalazine, and balsalazide.
decrease in hemoglobin during the course of erythropoietin therapy in a patient who has CRF signifies one of the following:
Presence of an underlying infection
Depleted iron stores
Management includes stopping the erythropoietin, treating the anemia with transfusion, and addressing the underlying cause.
most likely complication in pancreatitis?
Adult respiratory distress syndrome (ARDS) is a life-threatening complication of acute pancreatitis caused by release of phospholipase, which circulates through the bloodstream and damages the alveolar capillary membranes in the lungs.
loss of normal inhibitory neurons in the lower esophageal sphincter (LES).
postprandial abdominal discomfort and bloody diarrhea in elderly patients.
Acute angle-closure glaucoma
is a medical emergency in which the iris is pushed or pulled up against the trabecular meshwork at the angle of the anterior chamber of the eye, causing a block in the normal outflow of aqueous humor, thereby increasing the intraocular pressure.
Mixed connective tissue disease (MCTD) classically is associated with anti-U1-RNP antibodies
Initial presentation may be Raynaud phenomenon or dyspnea due to pleural effusion
This is a diagnosis of exclusion so make sure to evaluate for other autoantibodies
how does sarcoidosis increase calcium?
Granulomatous lesions produce hypercalcemia by increasing the production of vitamin D, which promotes calcium uptake from the duodenum.
mutations and their diseases
Melanoma is associated with CDKN2A mutation (tumor suppressor gene).
p53 mutation = Li-Fraumeni syndrome.
RET mutation = MEN 2A/2B.
TSC mutation = tuberous sclerosis.
PTCH mutation = Gorlin syndrome. (basal cell nevus)
Chest pain precipitated by hot or cold liquids without other obvious pathology
is most likely the result of diffuse esophageal spasm.
The best diagnostic test is esophageal manometry testing, which will reveal uncoordinated peristalsis in the esophagus.
Endoscopy is usually normal and does not aid in the diagnosis of peristaltic disorders.
chronic hepatitis of unknown etiology characterized by hypergammaglobulinemia and a positive ANA and ASMA.
Corticosteroids are the mainstay of anti-inflammatory/immunosuppressive therapy in autoimmune hepatitis.
A combination of diarrhea, arthralgias, endocarditis, and central nervous system dysfunction should prompt consideration of Whipple disease, which is treated with antibiotics.
PCR is diagnostic; PAS-positive macrophages in the lamina propria are associated
Sudden hemodynamic compromise (in ventilated patients, shortly after adding or increasing PEEP)
Distended neck veins
Jugular venous pulsations
Absent breath sounds on one side
suspect tension pneumothorax
The outpatient management of recurrent calcium oxalate stones includes:
Exclusion of hypercalcemia and hyperparathyroidism
24-hour urine testing for calcium, phosphate, oxalate, and uric acid
Hydrochlorothiazide to reduce tubular calcium concentration
impaired ventricular filling during diastole.
The most common cause of diastolic dysfunction is chronic hypertension leading to left ventricular hypertrophy.
amiodarone and warfarin
amiodarone inhibits warfarin metabolism, decrease the warfarin dose!
A patient presenting with a history of eye pain, blurry vision, and red eye with signs of increased intraocular pressure in the setting of juvenile rheumatoid arthritis points toward the diagnosis of
Patients presenting with glaucoma usually have extreme pain and blurred vision, see halos around lights, and have nausea and abdominal pain. On examination, there is chemosis, the cornea is described as steamy, and the pupil is moderately dilated and nonreactive. Intraocular pressure is significantly elevated. Secondary acute angle closure is seen with anterior uveitis (iridocyclitis), dislocation of the lens, or topiramate therapy. In this question the patient has ANA-positive JRA, which is associated with anterior uveitis and is the reason for her secondary acute angle-closure glaucoma.
Valvular lesions are most accurately assessed with
what metastasizes to the bone?
Carcinomas of the breast, prostate, and lung are the most common tumors that metastasize to bone.
Multiple endocrine neoplasia IIa (MEN IIa):
Pheochromocytoma, medullary thyroid carcinoma and hyperparathyroidism
Autosomal dominant, associated with mutations in the RET proto-oncogene
when to treat external hemorrhoids
Best time to treat thrombosed external hemorrhoids = first 3 days of symptoms.
After 3 days, pain from the procedure will last longer than the pain from the disease.
Rubber band ligation is only used in the treatment of internal hemorrhoids.
Chronic atrophic gastritis caused by pernicious anemia is associated with
markedly elevated serum gastrin levels, because normal acid inhibition of G cells is lost.
Suspect pernicious anemia in a patient who has vitamin B12 deficiency, atrophic gastritis, and peripheral neuropathy.
The acid-base disturbances
pulmonary embolism, acute asthma, and chest trauma acute respiratory alkalosis with hypoxemia (high pH, low pCO2, and low pO2).
Chronic obstructive lung disease and sedative overdose can cause respiratory acidosis with low pH, high pCO2, and low pO2.
Renal failure and sepsis cause metabolic acidosis,
aspirin overdose causes metabolic acidosis with respiratory alkalosis.
RX for hypertension and BPH together?
Plummer-Vinson syndrome i
dysphagia, upper esophageal webs, atrophic glossitis, and severe iron-deficiency anemia.
Other manifestations of severe iron-deficiency anemia include koilonychias, angular cheilitis, and pica.
Treatment of keloids
intralesional steroid injection.
Crohn's disease and bleeding
Vitamin K deficiency
DKA, what do we use to guide conversion from IV insulin to subcutaneous insulin.
Symptoms of opiate overdose are
severe respiratory depression, nausea, vomiting, miosis (constriction), and CNS depression.
Treatment is supportive, with naloxone to reverse symptoms.
Chronic laxative abuse can lead to melanosis coli, a benign diffuse or patchy pigmentation of the colonic mucosa that presents on pathology as lipofuscin-laden macrophages.
This condition is benign and does not require intervention.
sickle cell and gallstones
Sickle cell disease commonly causes cholelithiasis, specifically black pigment stones
Sickle cell disease causes splenic autoinfarction and H-shaped vertebrae
pancreatic abcess timing
10-14 days after pancreatitis
fever and leukocytosis
as opposed to pancreatic pseudocyst, 6 weeks later and w/o fever/ leukocytosis
common bile duct (CBD) strictures
80% of common bile duct (CBD) strictures occur after injury during a laparoscopic or open cholecystectomy.
Strictured ducts are more prone to obstruction and secondary infection (cholangitis).
Cholangitis, which can rapidly become life-threatening, presents with the Charcot triad.
dx of PE
sometimes V/Q scan (patients who cannot tolerate the load of intravenous contrast necessary for an angiogram due to allergy or impaired renal function.)
right ventricular infarct vs cardiac tamponade
The clinical signs of cardiac tamponade are exactly the same as a right ventricular infarct. However, there is one clinical sign that differentiates the two: the presence or absence of pulsus paradoxus.
high dose steroid risk
Steroid use is a risk factor for the development of a gastric ulcer, and all patients on steroids should be put on antihistamine blockers or proton-pump inhibitors as prophylaxis.
Suspicion for an ulcer in a patient with pneumoperitoneum indicates perforation and mandates urgent surgical exploration.
clamping the portal triad (hepatic artery, portal vein, and CBD). Temporarily, will stop the blood flow if the injury includes vessels in the hepatoduodenal ligament.
If blood flow continues even after the Pringle maneuver, the vessel that is most likely injured is a hepatic vein or the inferior vena cava behind the liver.
things that put AST/ ALT in the thousands
hepatitis (acute viral or autoimmune)
aflatoxin (death cap mushroom)
pancreatic pseudocyst rules
6 cm, 6 weeks. Either of these warrants intervention.
graft vs host disease is mediated by
what to do with skin cancers
Skin cancers should be biopsied prior to definitive management.
Biopsies should be full thickness and from the periphery of the lesion to assess the interface with normal skin.
Basal cell carcinoma requires minimal surgical margin, compared to melanoma which requires wider margin and lymph node dissection.
Progressive dysphagia from solids to liquids is
esophageal cancer until proven otherwise.
Smoking and drinking are strong risk factors for the development of squamous cell carcinoma of the esophagus.
Longstanding GERD and Barrett esophagus are associated with adenocarcinoma.
Increased intracranial pressure caused by intracerebral hemorrhage is evident from the presence of Cushing triad: bradycardia, hypertension, and irregular respiratory patterns.
It is diagnosed clinically, with CT scan or with direct measurement by intracranial pressure monitor insertion.
Management encompasses various strategies to decrease intracranial pressure, including raising the head of the bed, sedation, mechanical ventilation, hyperventilation, administration of mannitol, and surgical decompression with a Burr hole or craniotomy.
major risk of AAA repair
Ischemic colitis is a known complication of abdominal aortic aneurysm (AAA) repair secondary to occlusion of the inferior mesenteric artery.
Prompt recognition and diagnosis with colonoscopy allows for timely resection of the colon with a colostomy to prevent sepsis and death.