Flashcards in Kaplan 2 Deck (48):
splenic vein thrombosis
Splenic vein thrombosis is a rare complication of pancreatitis. Because the splenic vein runs on the posterior surface of the pancreas, adjacent inflammation can induce thrombosis. The clue is the presence of isolated gastric varices without any concomitant esophageal varices.
Treatment is splenectomy.
treatment to slow the progression of primary biliary cirrhosis (PBC) and improves clinical, biochemical, and histologic symptoms of PBC.
Ursodeoxycholic acid (UDCA)
Primary biliary cirrhosis
primary biliary cirrhosis (PBC): middle-aged woman, itching, and hepatomegaly. Arthralgias, fatigue, and Sjögren-like symptoms are commonly associated with the disease, as are hyperpigmented macules and patches on the skin.
an aggressive malignancy of the biliary system that may present initially with jaundice due to biliary obstruction
Risk factors include PSC and EPC – any sort of cholangitis that damages the biliary ducts, leading to chronic inflammation, which predisposes to malignancy
Cirrhosis>>>HCC; chronic pancreatitis>>>pancreatic cancer
Migratory thrombophlebitis, or painful thrombosis of superficial veins, may be seen in association with
Pulsus paradoxus in the setting of an asthma attack
indicates severe disease.
This is an indication for intubation and mechanical ventilation.
Important associations to remember that distinguish between the types of RTA are:
Type 1: associated with nephrocalcinosis and nephrolithiasis
Type 2: associated with lytic bone lesions, myeloma
Type 4 associated with diabetes mellitus, hypoaldosteronism, ACE inhibitors
If adenosine fails to terminate the SVT after 3 attempts, the next step should be
to decrease the rate of AV nodal transmission with IV beta-blockers, calcium-channel blockers, or digoxin.
a cystic duct impacted gallstone externally obstructing the common hepatic duct, which leads to biliary obstruction
Biliary obstruction/stasis leads to cholangitis, which is a medical emergency requiring ERCP-mediated drainage
Dawn vs Somoghi phenomenon
Dawn phenomenon: due to nocturnal release of GH and cortisol; increase the evening dose of insulin.
Somogyi phenomenon: rebound morning hyperglycemia due to nocturnal hypoglycemia; decrease the evening dose of insulin.
symptoms include drowsiness, lethargy, fatigue, headache, dizziness, and visual aberration, which is often an early indication and of which yellow-green distortion is the most common.
GI complaints include anorexia, nausea, vomiting, abdominal pain, and diarrhea. Cardiac symptoms include palpitations, shortness of breath, syncope, bradycardia, and hypotension. The physical findings include an irregular pulse, respirations that may be increased, and hypotension that may occur as a result of CHF or dehydration. This patient is taking diuretics, which can lead to depletion of potassium stores, something that occurs frequently in patients who have heart failure. An electrolyte panel thus should be ordered to assess this patient’s potassium status, because hypokalemia increases digoxin cardiac sensitivity.
right-sided infective endocarditis.
The most common presentation is tricuspid insufficiency with faint murmur that increases with inspiration and is heard in the lower sternal border.
IV drug users- major risk
TTP and HUS
TTP has predominantly neurologic symptoms with a lesser degree of renal failure.
HUS has predominantly renal failure with few to no neurologic symptoms.
can be from a pituitary adenoma (Cushing’s disease) or due to ectopic production.
Primary production is suppressible with high-dose dexamethasone.
Secondary production can be from a variety of sources, with a paraneoplastic syndrome from small cell lung cancer being the most common.
most effective drug for reducing mortality in MI?
Absolute contraindications to the use of thrombolytics include:
Prior intracranial hemorrhage (ICH
Known structural cerebral vascular lesion
Known malignant intracranial neoplasm
Ischemic stroke within 3 months
Suspected aortic dissection
Active bleeding or bleeding diathesis (excluding menses
Significant closed-head trauma or facial trauma within 3 months
herbal supplement that increases INR (warfarin)
Pure red cell aplasia
rare condition of profound anemia
There is a well-documented association of pure red cell aplasia and thymoma, thus a chest CT should be performed in all patients with presumed idiopathic disease.
often idiopathic, but it can also occur in association with systemic lupus erythematosus, leukemia, lymphoma, thymoma, and infections with parvovirus B19.
near drowning treatment
CPAP is the most effective treatment in near drowning episodes to improve both hypoxia and acidosis.
skin thickening and hardening and multiple organ damage caused by excess collagen.
Multiple systems are involved in diffuse scleroderma, including renal (hypertension), GI (dysmotility, pseudo-obstruction, GERD), pulmonary (fibrosis and hypertension), and cardiac (fibrosis, heart failure).
Lung disease caused by pulmonary fibrosis and pulmonary hypertension is the most common cause of mortality in patients who have systemic sclerosis.
ulcerative colitis skin condition
IBD is associated with erythema nodusum and pyoderma gangrenosum
EN presents as tender nodules on the lower extremities
Treating the underlying condition (IBD) can help resolve the nodules
another word for vasovagal
Neuropathic arthropathy (Charcot joint) is due to peripheral neuropathy.
Diabetes and syphilis are the classic underlying diseases.
Symptoms: leg swelling, warmth, redness, and joint effusion.
Hypermobility is a key underlying pathology.
Paroxysmal nocturnal hemoglobulinuria i
CD55/59 deficiency making RBCs sensitive to complement-mediated lysis.
Patients are prone to thromboses, which may manifest as painful skin lesions.
Red-brown urine in the morning is the classic complaint.
look for fat soluble vitamin issue
Reactive arthritis is an inflammatory arthritis caused by infection with Chlamydia, Yersinia, Salmonella, Shigella, and Campylobacter species.
It is characterized by arthritis, urethritis, and uveitis.
Treatment is with NSAIDs first and then sulfasalazine if NSAIDs are not effective. Also, treat the underlying infection (doxy for chlamydia).
ECG in pulmonary embolism:
sinus tachycardia, nonspecific ST-T wave changes.
S1-Q3-T3 pattern, though classic, is uncommonly seen.
If large PE, will cause right heart strain (RBBB, right axis deviation).
can occur in an intravenous drug abuser with recurrent soft-tissue infections. The clinical presentation includes nephrotic syndrome, enlarged kidneys, organomegaly (heart, liver), and chronic renal failure.
most common cause of hypercalcemia
lyme disease cardiac manifestation
primary vs secondary polycythemia
High EPO in SECONDARY
low in primary
CAP outpatient treatment
what to do in hypertensive emergency
The first step in management of any hypertensive emergency is the immediate control of blood pressure. Blood pressure should be reduced by 25% from presentation over the first 2 hours.
Drugs of choice for hypertensive emergencies include IV nitroprusside followed by nitroglycerin, labetalol, esmolol, nicardipine, and others.
In a hypertensive emergency after blood pressure has been stabilized, the patient should receive a non-contrast head CT scan to evaluate for hemorrhagic stroke.
SIADH classically occurs in patients with head trauma and as a paraneoplastic syndrome associated with small cell lung cancer.
Management include fluid restriction, salt tablets, and loop diuretics.
ADH antagonists such as demeclocycline and lithium can be used.
sinus bradycardia after MI RX
Sinus bradycardia occurs in 15-25% of patients after acute myocardial infarction, particularly those affecting the inferior wall, because the right coronary artery supplies the SA node in approximately 60% of people.
The treatment of choice for symptomatic bradycardia is IV atropine.
If atropine therapy does not resolve the bradycardia, pacing may be necessary.
counteract hypotension caused by dobutamine
colonic polyps, colon cancer before age 50, osteomas, epidermal inclusion cysts, congenital hypertrophy of the retinal pigment epithelium
PSC goes with
p-ANCA and UC
acalculous acute cholecystitis
presents similarly to calculous cholecystis, but is seen in hospitalized patients with long-term critical illness, diabetes mellitus, and total parenteral nutrition.
This diagnosis is likely in one with new-onset right upper quadrant pain, elevated white blood cell count and elevated LFTs (especially alkaline phosphatase).
Intravenous broad-spectrum antibiotics and eventual cholecystectomy are the treatments of choice.
an acute, self-limiting form of sarcoidosis characterized by severe symmetric arthritis in addition to the classic signs and symptoms of sarcoidosis.
It is self-limited, resolving within a few months
NSAIDs and the kidney
acute interstitial nephritis
rare codominant familial disease characterized by alpha-lipoprotein deficiency leading to low levels of high-density lipoprotein (HDL).
Clinical manifestations of Tangier disease include polyneuropathy, lymphadenopathy, hepatosplenomegaly, and orange-yellow tonsillar hyperplasia.
gallbladder cancer associated organism
alternate constipation and diarrhea
better at night
dx of exclusion
antibodies with PBC