Which important complication of end-stage liver disease is characterized by a significant decrease in glomerular filtration in the absence of another clear cause of renal dysfunction, minimal hematuria (< 50 erythrocytes/hpf) and lack of improvement with volume resuscitation?
Hepatorenal syndrome (HRS)
List 3 ways to treat hepatorenal syndrome?
- Address precipitating factors i.e., hypovolemia, anemia, infection
- Splanchnic vasoconstrictors i.e., midodrine, octreotide, NE + albumin
- Liver transplantation
What are 3 indications for giving HAV vaccine to patient with HIV?
- Chronic liver disease
- Men who have sex with men
- IV drug users
Renal injury typically causes hypocalcemia; the presence of hypercalcemia suggests what?
Multiple myeloma cast nephropathy
Which drugs have ben shown to increase appetite and weight gain in pt's with cancer-related anorexia/cachexia syndrome?
- Progesterone analogues i.e., megestrol acetate and medroxyprogesterone acetate
Transmural intestinal inflammation is seen in what?
What is the preferred initial DMARD in pt's with moderately to severely active RA?
What are 3 potential complications of primary biliary cholangitis?
- Metabolic bone disease i.e., osteoporosis or osteomalacia
- Hepatocellular carcinoma
What is the most likely cause of occult GI hemorrhage days after being admittd to the ICU for septic shock?
TTP must be treated emergently with what?
Plasma exchange (most important) + glucocorticoids
What are 3 effective first-line tx's for uncomplicated cystitis in non-pregnant women?
- Oral TMP-SMX
Pt's with clinical signs of HTN but normal BP readings should be tested for what?
Masked HTN w/ ambulatory BP monitoring
Cupping of the optic disc with loss of peripheral vision is characteristic of what?
Open angle glaucoma
What is the preliminary investigation of choice in the managment of pleural effusion; exception?
- Diagnostic thoracentesis
- EXCEPT in pt's w/ classic signs and sx's of CHF, where a trial of diuretic is warranted
Which 2 markers are the most appropriate diagnostic tests for acute hepatitis B infection?
What should be recommended as part of the initial tx regimen in all pt's with intermittent claudication?
- Low-dose aspirin + statin therapy
- Exercise therapy
Hyperkalemia with EKG changes needs immediate tx with what?
- IV Calcium
- Although this does not affect the serum K+ concentration, Ca2+ does ↓ cardiac membrane excitability and provide short-term cardioprotection from the membrane depolarizing effects
Pt's with Turners Syndrome often present with rib notching and on cardiac auscultation have a short 2/6 midsystolic murmur heard at the left paravertebral interscapular area which is consistent with what?
Coarctation of the aorta
What are the 2 classic autoantibodies most often assoc. w/ Dermatomyositis?
anti-Jo-1 (antisynthetase antibody) and anti-Mi-2 (against helicase)
How is Dermatomyositis managed clinically and what type of regular screening is essential for these pt's?
- High-dose glucocorticoids PLUS glucocorticoid-sparing agent
- Regular, age-appropriate cancer screening
Why is there an increased risk of non-Hodgkin lymphoma in pt's with chronic autoimmune diseases (i.e., SLE, Sjogren's)?
- Persistent B-cell stimulation
- Immune dysregulation
- Exposure to immunosuppressive agents
What is the mainstay pharmacotherapy for Bell's palsy?
Oral glucocorticoids (i.e., prednisone)
In a pt with chronic liver disease, such as with chronic HCV infection, what are the strategies recommended to prevent further liver damage?
- Alcohol avoidance
- Hepatitis A and B vaccination
Which 2 infectious agents are responsible for severe, acute retinal necrosis with pain, keratitis, uveitis, and funduscopic findings of peripheral pale lesions and central necrosis in HIV patients?
Both HSV and VZV
Which cause of retinitis is painless and has findings of hemorrhages and fluffy or granular lesions around the retinal vessels?
What laboratory value is often elevated in pt's with upper GI bleeding; why?
- BUN/creatinine ratio
- Increased urea production from intestinal breakdown of hemoglobin
- Increased urea reabsorption in the prox. tubule due to assoc. hypovolemia
What are some underlying conditions which can increase thyroid binding globulin (TBG)?
- Estrogens i.e., pregnancy and OCPs + estrogenic drugs i.e., tamoxifen
- Acute hepatitis
Which features of peritonsillar abscesses can be helpful in distinguishing from epiglottitis?
Deviation of the uvula and unilateral LAD
Which DMARD sometimes used for RA is associated with retinopathy as an AE?
Which 2 pro-motility drugs can be used to tx diabetic gastroporesis?
Metoclopramide and Erythromycin (for short intervals <4 weeks)