Patient is on an a drug that is being looked into for CV disease. Doctor decides to switch him to a new drug, before study has come out. What is this called?
Non-malifiscence (To do no harm)
What is an algorithm for Renal Tubular acidosis
Step 1: Determine if the patient has a high chloride level and then a low bicarbonate level (hyperchloremic acidosis), normal GFR and normal anion gap and no diahrea Step 2: look at the potassium lvl. if high its RTA 4 and ph 5.5 or less. If low not type 4 Step 3: Look at urine ph. IF lower than 5.5 it RTA type 2. If above then probably not Step 4: Look at bicarbonate level. If its normal its RTA type 1. If low but at 12-20 then its RTA type 2
What is RTA Type 1?
Results from the kidney to not be able to secrete H+ in the distal collecting tubule. Characterized with hyperchloremic acidosis, with a normal anion gap, HYPOCALEMIA AND CALCIUM STONES
Patient having a SEIZURE, more forgetful, with cognitive decline and CAUDATE and PUTAMEN degradtion after spending years in UK. What is the disease and cause?
Creutzfeld Jakob's A prion disease due misfolded proteins.
How is Creutzfeld Jakob's spread?
Prions are misfolded proteins passed through eating of cows brain. These cause a spongiform encelopathy that effects the CAUDATE and PUTAMEN which will shows lesions are MRI. ALSO SEEN WITH SEIZURES, dementia and ataxia
Flank pain with tenderness to percussion at the costovertebral angle is seen with what disease and cause?
Pyleonephritis and cause is a UTI from sexual intercourse that has spread to the kidneys
Signs and symptoms of YELLOW FEVER?
HIGH FEVER, COFFEE ground emesis, and Jaundice, due to a travel to africa and by the Aedes mosquito. It is from the Flavivirus, which is an enveloped, icosohedral, RNA virus, that is linear and single stranded. Prevent with a live attenuated vaccine
Signs of Coal workers' lung
progressive dysnpea and cough without infection. Due to working in the mines. Seen with an upper lung infiltrate on X-ray. Commonly seen with Rheumatoid arthiritis!!!!!
Bronchogenic Carcinoma
Most common cancer due to Asbestos (GOLDEN BROWN DUMBELL SHAPED RODS on microscope). From the bronchogenic epithelium. Shows up as pleural based plaques
Mesothelioma
Most common cancer of the pleura-- not seen with smoking and associated with asbetsos
Silicosis
Seen in people who sandblast, stone cut and mining. TESTED THING IS THAT HAVE EGG SHELL Calification in HILAR NODES, possible lung cancer and TB
Inheritance pattern for vWD
Autosomal Dominant!!!!! KEY!!!!
vWD signs and symptoms
is seen with factor 8 in the epithelial cells. Commonly have long PTT and bleeding time but normal PT. present with excessive bleeding and bruising at any time bc they can't form a clot
33 y/o F who presents with scanning speech, tremors, nystagmus, loss of vision, hemiparesis and incontience has what condition and what cell is affected?
MS (multiple sclerosis)--- anytime you seen a middle age female with neural changes think this (autoimmune disorder) Cell affected is the oligodendrocyte bc this a white matter tract
Patient appears have hallucinations and automonic instability (not responding to stimulation. What is the cause and what transporter is affected?
This is caused by STIMULANTS (amphetamines and cocaine) NMDA receptors like (pcp) and CANNABOIDS (mary jane). Affects the monamine oxidase transporters
Opiate toxicity is seen with?
euphoria, sedation and respiratory depression
GABA toxicity
Causes sedation and cognitive suppression (alcohol, benzos, and barbs)
Bowing of the femurs in a child
Rickets, Vitamin D deficiency--- due to kidney damage (converts it to its active form)
Patient has family history of aneurysms, hemorrhage, and enlargement of kidney? What is the disease and test of choice
ADPKD (known cause of berry aneursym) Test of choice is renal ultrasound Seen with large cysts all over kidney causing enlargement and flank pain with possible hematuria
Patient persents with anemia after having an infection. he is placed on a TMP-SMX. What is the cause of the anemia?
G6PD deficiency. (oxidative stress--- seen with heinz bodies) Known causes are sulfa drugs, fava beans
Most common cause of edema in a pregnant women?
due to increase of hydrostatic pressure Caused by uterus increasing pressure on IVC--- increasing hydrostatic pressure and causing edema
Turner syndrome
High arched palate, broad based chest, neck webbing. 45 XO
Drug used for reversal Amoxifestine Dexrafazone Filagrastim Levocorin Mesna
Amox- used for the prevention of renal toxicity with PLATIN DRUGS Dexrafazone- Prevention of DOXORUBICIN AND DANORUBICIN TOXICITY-- (HEART0 Filagrastim--- INCREASE of Granulocytes Levocorin- USED FOR FOLATE REPLACEMENT against METHOTREXATE, and (dihydrofolate reductase inhibitors) MESNA--- for hemorraghic cystitis with CYCLOPHOSAMIDE
LICHEN PLANUS:
Purple with white lesions (LACY RASH). (5 Ps-- purple, papular, pustular, polygonular plaques) AFFECTS: WRIST, ANKLES, CHEEK MUCOSA, and GENITALS
NAS SIGNS AND SYMPTOMS (opiate dependence in infants)
PATHOMNEUMONIC: HIGH PITCHED CRY AND YAWNING also seen w/ irritability, poor feeding, vomiting and increased tone in first days of life Give morphine
High school to college age student with pneumonia
Mycoplasma pneumonia Gram negative bacilli w/out cell walls
Red lesions in the genital region that are painful? Treatment?
Herpes simplex (dna virus) Treatment is valcyclovir and acyclovir with inhibit just dna polymerase
What class of Drug are these? Cytolopram Amitryptaline Mirtazipine Phelezine Venalfaxine
1) SSRI 2) TCA 3) Serotonin and alpha 2 receptors 4) MAOI 5) SNRI
Chapmans pt for the 1) EYE 2) EAR 3) Tonsils 4) Upper lungs 5) esophagus, trachea, and such
1) surgical neck of the humerus 2) clavicle 3) 1st intercostal space 4) 3rd intercostal space 5) 2nd intercostal space
What is the disease seen with a white flaky scaly lesion on the scalp?
Seborrhic dermatitis Also known as cradle cap infants. Seen on the yellow flaky portions in babies
seborrhic Kertosis
Is seen with a stuck on lesion in adults! Typically old people over 50 and the plaque wont go away
What is the lipid lowering drug that causes flushing when given? What is the antidote and how does it work
Niacin Antidote is an aspirin- which stops prostaglandin synthesis
Patient reports with megablastic anemia? MCV above 100, what are the causes
1) Folate 2) Cobalamin Nonmegablastic is chronicly seen with liver disease, alcohol, hypothyroidism
Pt. Complains of clicking and popping on their index finger when they flex and extend. What is the diagnosis and cause
Trigger Finger---- due to inflammation of the flexor tendon sheath
Stomach cancer
Most commonly seen is gastric adenocarcinoma--- seen due to high amount of salt and then signet ring cells on microscope
What is the inheritance pattern in CF
AR
A pt comes in with a hot nodule on the radionucleotide iodine exam in the thyroid area. What is the diagnosis
Most likely is cancer, typically seen with increased uptake is a follicular adenoma (hot nodule) Papillary adenoma is a cold nodule
What is the stages of sleep and waves seen with it
B- beta (awake) A- alpha (getting ready to go to sleep T- (stage 1)- theta S- stage 2)--- spindle cells an D- Stage 3- delta waves (seen with nightmares and sleep terrors B- REM sleep
Patient is traveling into South Africa and develops a macolupapular rash on the extremities and has eosinophils in urine. This is seen on a slide. What is the cuase and main concern?
Cause is by SCHISTOMONISIS--- a blood fluke seen in freshwater in subsaharan africa and southeast asia. Seen the thick terminal spine in image
CONCERN is the development of BLADDER CANCER
What are good stabilizing drug to give to someone who is on antidepressants for Major Depressive Disorder?
Lithium can be used to help stabilize a patient with major depressive disorder
JAPANESE immigrant who has eosinophils in blood work and complaining of long term abdominal pain and coughing up blood
Paragonimus Westermani
A liver fluke from undercooked crawfish and shellfish. Eggs eaten and cause abdominal pain/diahrea. Then heads to lungs causing cough, fever, and chest pain. And then it colonizes lung causing chronic bronchectasis and coughing up blood.
Pranquizetal is treatment!
Female who comes back from a long flight is with change in R) side aortic pressure
DVT due to OCPs
Known as the Itch that rashes?
Effects what part of the infant and older child?
What defect is it associated with?
Atopic Dermatitis
Infants: Effects the extensor surfaces arms and legs with red, rough patches. Children: It affects the flexor surfaces of the child
Defect is associated with fliggrin and decresed cermanides leads to the defective epidermal seen on microscopy
What kind of arrthymia is seen?
What part of the heart is effected in this
3rd Degree bundle branch block
AV NODE
Cause- due to the P waves not being in sink with SVC--- leading to bradycardia, dizziness, dysnpea and syncope
painful parotitis and testis?
Other diseases seen with it?
MUMPs
Aseptic menigitis, pancreatitis, and joints and eyes
paramyxovirus--- a rna - virus, linear, single stranded and enveloped
Key presentation of whipple's disease?
malabsorption, arthralgias, cardiac symptoms (endocarditis), and neurologic (demetia)
KEY FINDING HISTO--- PAS + macrophages in lamina propria!