Term
| Who is at risk for cerebral edema during an acute hyponatremic episode? |
|
Definition
| premenopausal women have a 25x higher risk than men |
|
|
Term
| What is considered a low plasma osmolality? |
|
Definition
|
|
Term
| How do you treat someone who is hyponatremic? |
|
Definition
| if they are hypovolemic, replete volume with NS; if they are euvolemic or hypervolemic, restrict salt and water |
|
|
Term
| How quickly can you correct someone's low sodium? |
|
Definition
| symptomatic pts need 2/hr for the first few hours until symptoms resolve; in general no more than 10-12 for the first day then up to 18 over the first two days |
|
|
Term
| What is the peak age for nephrolithiasis? |
|
Definition
|
|
Term
| What are the most common elements found in stones? |
|
Definition
| ammonia, calcium (75%), magnesium, phosphorus |
|
|
Term
| What is the significance of calcium kidney stones? |
|
Definition
| could be calcium oxalate or less commonly calcium phosphate; seen in high oxalate diets, hyperparathyroidism, and sarcoidosis |
|
|
Term
| What kind of kidney stone is produced by proteus? |
|
Definition
| struvite/magnesium ammonium pohsphate |
|
|
Term
|
Definition
|
|
Term
| Significance of urice acid kidney stone= |
|
Definition
| pts with gout or those undergoing chemo |
|
|
Term
| What HIV medicine can cause kidney stones? |
|
Definition
|
|
Term
| Which type of kidney stone will be missed by AXR? |
|
Definition
|
|
Term
| RIsk factors for nephrolithiasis= |
|
Definition
| family history, age 20-40, diet (high protein, low fluids), medications, immobility, ileostomy, liver disease, renal disease (medullary sponge kidney, RTA, polycystic kidney disease) |
|
|
Term
| What is the next step in evaluating a person with hyponatremia? |
|
Definition
| looking at the serum osmolality |
|
|
Term
| hyponatremia + normal serum osmolality= |
|
Definition
| isotonic hyponatremia= pseudohyponatremia= hyperproteinemia, hyperlipidemia |
|
|
Term
| hyponatremia + hyposmolality= |
|
Definition
| hypotonic hyponatremia= need to evaluate volume status to narrow differential |
|
|
Term
| hyponatremia + hyperosmolality= |
|
Definition
| hypertonic hyponatremia= hyperglycemia, mannitol, sorbitol, glycerol, maltose, radiocontrast agents |
|
|
Term
| hypotonic hyponatremia + hypovolemic= |
|
Definition
| need to look at Urine Na+; if more than 20 mEq/L there is renal loss, if less than 10 there is extrarenal loss |
|
|
Term
| hypotonic hyponatremia + hypovolemia + UNa <10= |
|
Definition
| extrarenal salt loss such as dehydration, diarrhea, vomiting |
|
|
Term
| hypotonic hyponatremia + hypovolemia + UNa > 20 mEq/L= |
|
Definition
| renal salt loss due to things like diuretics, ACEIs, nephropathies, mineralocorticoid deficiency, cerebral salt wasting syndrome |
|
|
Term
| hypotonic hyponatremia + euvolemia= |
|
Definition
| SIADH, postop hyponatremia, hypothyroidism, psychogenic polydipsia, beer potomania, idiosyncratic drug reaction (thiazide, ACEIs), endurance exercise |
|
|
Term
| Hypotonic hyponatremia + hypervolemic= |
|
Definition
| CHR, liver diseaes, nephrotic syndrome, advanced renal failure |
|
|
Term
| What are some general treatment guidlines for kidney stones? |
|
Definition
| hydration so that UOP is >2.5 L/day; IV analgesia (ketorolac), |
|
|
Term
| What percent of kidney stones pass on their own? |
|
Definition
| 80% of small stones (<4mm) |
|
|
Term
| When do you need to do something about a kidney stone because you are afraid it won't pass? what can you do? |
|
Definition
| >5mm; shock wave lithotripsy, retrograde ureteroscopy, percutaneous nephrolithotomy |
|
|
Term
| What is the recurrence rate o fkidney stones? |
|
Definition
|
|
Term
| What are some preventative measures for kidney stones? |
|
Definition
| increase fluid intake; dietary restriction (low protein, nitrogen, sodium, oxalate), adequate calcium intake, and administration of thiazides (decrease urinary calcium); for uric acid stones, urine should be alkalinized with potassium citrate and allopurinol should be considered |
|
|
Term
|
Definition
| acute abdomen; pancreatitis, bowel ischemia |
|
|
Term
| hyperactive bowel sounds= |
|
Definition
|
|
Term
| Name some test of liver function= |
|
Definition
|
|
Term
| Describe cirrhosis of the liver= |
|
Definition
| diffuse fibrosis and regenerative nodules |
|
|
Term
|
Definition
| in US= alcohol abuse; in world= viral hepatitis |
|
|
Term
| Name some hereditary metabolic diseases that can cause cirrhosis= |
|
Definition
| wilson's, hemachromatosis, alpha 1 antitrypsin deficiency |
|
|
Term
| Name some drugs and toxins that can cause cirrhosis. |
|
Definition
| acetaminophen, INH, methyldopa, methrotrexate, carbon tetrachloride |
|
|
Term
| What are the characteristics of hepatorenal syndrome? |
|
Definition
| oliguria, low fractional exretion of sodium, and failure of the azotemia to respond to fluid bolus |
|
|
Term
| T/F Peptic ulcer is a can be caused by portal hypertension. |
|
Definition
|
|
Term
| When someone is in liver failure what abnormalities will you expect on routine labs? |
|
Definition
| increased ammonia, decreased BUN (b/c of fall in protein production), hyponatremia, anemia, thrombocytopenia, increased transaminase and alkaline phosphatase |
|
|
Term
| What test do you get to diagnose wilson's disease? |
|
Definition
| ceruloplasmin (decreased in wilson's) |
|
|
Term
| What will iron studies show in a person with hemochromatosis? |
|
Definition
| high high ferritin; and TIBC |
|
|
Term
|
Definition
| serum ascites albumin gradient; SAAG > 1.1= portal hypertension= cirrhosis, CHF, Budd Chiari; <1.1 pancreatitis, bile duct leak, peritoneal TB or metastases |
|
|
Term
| What is the medical treatment for acites? |
|
Definition
| sodium restriction, potasium sparing diuretics combined with a loop diuretic; and large volume paracentesis |
|
|
Term
| What is the surgery for ascites? major downside to it? |
|
Definition
| transjugular intrahepatic portosystemic shunt that connects the portal vein to the IVC; can precipitate encephalopathy |
|
|
Term
| How do you treat esophageal varices? |
|
Definition
| nonselective beta blockers; IV vasopressin with nitroglycerin, IV somatostatin, endoscopic sclerotherapy or band ligation and balloon tamponade |
|
|
Term
| What is the criterion for applying for liver transplant? |
|
Definition
| "decompensation" or child pugh class B |
|
|
Term
| How is cirrhosis severity judged? |
|
Definition
|
|
Term
| What are the factors of the child pugh criteria? |
|
Definition
| serum bilirubin, serum albumin, ascites, neurologic changes, prothrombin time, INR |
|
|
Term
| How do you score bilirubin based on the child pugh criteria? |
|
Definition
| 1 pt= <2.0; 2 pts= 2.0-3.0; 3 pts= >3.0 |
|
|
Term
| How do you score serum albumin level according to the child pugh criteria for the classification of cirrhosis? |
|
Definition
| 1 pt= >3.5; 2 pts 3.0-3.5; 3 pts= <3.0 |
|
|
Term
| HOw do you score ascites according to child pugh criteria? |
|
Definition
| 1 pt= none; 2pts= easily controlled; 3 pts= poorly controlled |
|
|
Term
| How do you score neurologic changes based on the child pugh criteria= |
|
Definition
| 1pt= none; 2 pts= minimal; 3 pts= advanced coma |
|
|
Term
| How do you score prothrombin time based on child pugh critera? |
|
Definition
| 1pt= 0-4, 2 pts= 4-6; 3 pts= >6 |
|
|
Term
| How do you score INR based on the child pugh criteria? |
|
Definition
| 1 pt= <1.7, 2 pts= 1.7-2.3, 3 pts = >2.3 |
|
|
Term
| What child pugh scores go with which class? |
|
Definition
| class A=5-6; B=7-9; C=10 or greater |
|
|
Term
| How can you manage hepatic encaphalopathy? |
|
Definition
| protein restriction, lactulose (to promote ammonia excretion with three bowel movements a day), neomycin (to inhibit ammonia producing bacteria in teh colon) |
|
|
Term
| What are the main risk factors for viral hepatitis? |
|
Definition
| IVDU, unprotected sexual intercourse, and overseas travel (A and E) |
|
|
Term
| What percent of alcoholics develop hepatitis? |
|
Definition
|
|
Term
| What transaminase finding indicates alcoholic hepatitis? |
|
Definition
|
|
Term
| How can you diagnose chronic hepatitis with a lab value? |
|
Definition
| transaminases elevated for more than 6 months |
|
|
Term
| What percent of patients with HCV have comorbid depression? |
|
Definition
| 30%; must think about this before starting interferon treatment |
|
|
Term
| Steroids can be used in what setting of liver failure? |
|
Definition
| severe alcoholic hepatitis |
|
|
Term
| How can you treat chronic viral hepatitis? |
|
Definition
| alpha 2b interferon (or pegylated interferon and lamivudine); alpha interferon and ribavirin for chronic HCV |
|
|
Term
| How do you monitor HCV response to treatment? |
|
Definition
|
|
Term
| What typ eof virus is HAV? |
|
Definition
|
|
Term
| What type of virus is HBV? |
|
Definition
|
|
Term
| What type of virus is HCV? |
|
Definition
|
|
Term
| What type of virus is HDV? |
|
Definition
| defective RNA virus; delta virus |
|
|
Term
| What type of virusi s HEV? |
|
Definition
|
|
Term
|
Definition
| fecal oral (e.g. shellfish) |
|
|
Term
| What percent of pts with HBV go on to develop chronic hepatitis, cirrhosis or HCC? |
|
Definition
| 10% get chronic hepatitis, 30% get cirrhosis and 3-5% get hepatocellular carcinoma |
|
|
Term
| What percent of pats with HCV get chronic hepatitis, cirrhosis, or HCC? |
|
Definition
| 80% get chronic hepatitis, 30% get cirrhosis, hepatocellular carcinoma |
|
|
Term
| Waht is the mortality rate of HEV in pregnant women? |
|
Definition
| 20%; no risk of chronic hepatitis or malignancy |
|
|
Term
| What is teh "window" period in HBV? |
|
Definition
| period when HBsAG disappears but before anti-HBs appears |
|
|
Term
| How much stool do you have to have for it to be considered diarrhea? |
|
Definition
|
|
Term
| What is the difference between acute and chronic diarrhea? |
|
Definition
| acute is less than 3 weeks; chronic more than 3 weeks |
|
|
Term
| Name the different types of diarrhea? |
|
Definition
| secretory diarrhea, osmotic diarrhea, malabsorptive diarrhea |
|
|
Term
| What is secretory diarrhea? |
|
Definition
| occurs when secretagogues such as endogenous endocrine products (VIPomas, serotonin), endotoxins/infection (cholera), and GI luminal substances (bile acids, fatty acids, laxatives) stimulate increased levels of fluid transport across the epithelial cells into the intestinal lumen |
|
|
Term
| What causes osmotic diarrhea? |
|
Definition
| ingestion of excess osmoles (mannitol or sorbitol ingestion), to the ingestion of substrate that is subsequently converted to excess osmoles, or to the presence of a genetic enzyme deficiency for a particular diet (lactase deficiency) |
|
|
Term
| What is a malabsorptive diarrhea? |
|
Definition
| due to the inability to digest or absorb a particular nutrient which can in turn be attributable to bacterial overgrowth, pancreatic enzyme deficiency, or altered motility/anatomy |
|
|
Term
| When does acute diarrhea warrant laboratory studies? |
|
Definition
| if the pt has a high fever, bloody diarrhea, or a diarrhea lasting >4-5 days |
|
|
Term
| What is a Wright's stain used for? |
|
Definition
|
|
Term
| How can you determine whether a diarrhea is an osmotic diarrhea? |
|
Definition
| stool osmotic gap >50 mOsm/kg |
|
|
Term
| What are the clinical characteristics of a secretory vs an osmotic diarrhea? |
|
Definition
| secretory diarrhea may be watery and will not improve with fasting; osmotic diarrhea may be greasy or bulky and will improve with fasting |
|
|
Term
| Name some antidiarrheal agents and contraindications to their use. |
|
Definition
| loperamide and bismuth salicylate; contraindicated in patients with bloody diarrhea, high fever, or systemic toxicity |
|
|
Term
| Recent ingestion of shellfish + diarrhea= |
|
Definition
|
|
Term
| recent ingestion of undercooked poultry + diarrhea= |
|
Definition
| campylobacter and salmonella |
|
|
Term
| What agents can be used to treat a chronic diarrhea? |
|
Definition
| loperamide, opioids, clonidine, octreotide, cholestyramine, and enzyme supplements |
|
|
Term
| What do you call vomiting that occurs suddenly, without nausea? |
|
Definition
|
|
Term
| What do you call gastritis in a burn patient? |
|
Definition
| probably due to curling's ulcers |
|
|
Term
| What can cause acute "stress" gastritis (superficial lesions that evolve rapidly)? |
|
Definition
| NSAIDs, alcohol, stress from severe illness |
|
|
Term
| What are the two types of chronic "nonerosive" gastritis? |
|
Definition
| type A gastritis= fundal gastritis secondary to autoantibodies to parietal cells; type B gastritis antral gastritis cuased by NSAIDs, H pylori, CMV, and HSV |
|
|
Term
| What is the most common type of gastritis? |
|
Definition
|
|
Term
| Diarrhea with normal osmotic gap but increased stool weight= |
|
Definition
| secretory or laxative abuse |
|
|
Term
| Once you determine that a stool has an increased osmotic gap, what is the next step? |
|
Definition
| to determine whether there is increased fecal fat or normal fecal fat |
|
|
Term
| What types of things can reduce LES tone and increase reflux symptoms? |
|
Definition
| alcohol, fatty foods, caffiene, nicotine, chocolate |
|
|
Term
| What are some risk factors for GERD? |
|
Definition
| obesity, pregnancy, scleroderma |
|
|
Term
| Sour taste in the mouth associated with GERD: |
|
Definition
|
|
Term
| "corkscrew" on upper GI radiographic series? |
|
Definition
|
|
Term
| When do you get endoscopy in pts with GERD? |
|
Definition
| longstanding symptoms, or to identify and grade esophagitis or Barrett's esophagus |
|
|
Term
| What kind of lifestyle modification can help treat GERD? |
|
Definition
| weight loss, head of bed elevation, avoidance of late meals |
|
|
Term
| Which is more common: peptic or duodenal ulcers? |
|
Definition
| duodenal ulcers are 5x more common |
|
|
Term
| What is the lifetime incidence of PUD? |
|
Definition
|
|
Term
| What is the pathophys of duodenal ulcers? |
|
Definition
| excess gastric acid production |
|
|
Term
| What is the pathophys of gastric ulcers? |
|
Definition
| impaired mucosal defenses without acid hypersecretion |
|
|
Term
| What are the three major causes of PUD? |
|
Definition
| NSAID use, chronic H pylori infection, acid hypersecretory states such as zollinger ellison syndrome |
|
|
Term
| What percent of ulcers are due to H pylori? |
|
Definition
| >90% of duodenal ulcers; 60-70% of gastric ulcers |
|
|
Term
| What test can you use for zollinger ellison syndrome? |
|
Definition
| serum gastrin levels are usually >500 pg/mL; they also have a paradoxical rise in serum gastrin with secretin stimulation |
|
|
Term
| T/F PUD symptoms are relieved by food. |
|
Definition
| depends on the type of ulcer; duodenal ulcers are relieved by food; peptic ulcers are worsened by food and can lead to weight loss |
|
|
Term
| What is a "succession splash"? |
|
Definition
| sign of PUD; the sound of air and fluid in a distended stomach; can also be heard as a result of gastric outlet obstruction roughly three hours after eating |
|
|
Term
| What is the most common source of hemorrhage in PUD? |
|
Definition
| erosion into the gastroduodenal artery |
|
|
Term
| What percent of gastric ulcers are found to harbor adenocarcinoma on biopsy? |
|
Definition
|
|
Term
| Which peptic ulcers usually are the ones to perforate/ |
|
Definition
|
|
Term
| What is first line quadruple therapy for H pylori? |
|
Definition
| PPI + bismuth salicylate + amoxicillin + metronidazole X 1 day |
|
|
Term
| What is triple therapy for H pylori? |
|
Definition
1) tetracycline (or amoxicillin) + bismuth salicylate + metronidazole X 14 days
2) PPI + amoxicillin (or metronidazole) + clarithromycin X 7-14 days
3) ranitidine or PPI + amoxicillin + metronidazole X 12 days |
|
|
Term
| What is double therapy for H pylori? |
|
Definition
| ranitidine + clarithromycin X 14 days |
|
|
Term
| What kinds of studies can you get to evaluate a patient with irritable bowel syndrome? |
|
Definition
| CBC, electrolytes, TSH, ESR, stool cultures, abdominal films, contrast CT and barium contrast studies |
|
|
Term
| What lifestyle changes can be implemented in patients with IBS? |
|
Definition
| increase fiber intake and decrease consumption of gas producing foods |
|
|
Term
| What kind of medicines can be used for IBS? |
|
Definition
| loperamide, antispasmodics, anticholinergics (dicyclomine and hyoscyamine) and antidepressants; cholestyramine (for diarrhea type IBS), alosetron |
|
|
Term
|
Definition
| a 5HT3 antagonist for women with severe chronic or diarrhea predominant IBS; the availability of alosetron is limited owing to reports of ischemic colitis |
|
|
Term
| What is the Rome II criteria for the diagnosis of IBS? |
|
Definition
| at least 12 weeks (continuous or recurrent; need not be consecutive) in the preceding 12 months of abdominal discomfort/pain with two of the following: relief with defecation, change in frequency of stool, chagne in form or appearance of stool |
|
|
Term
| What medications can cause a folate deficiency? |
|
Definition
| methotrexate, TMP-SMX, sulfa drugs |
|
|
Term
| What is the first value you should get to determine the etiology of an anemia? |
|
Definition
| retic count; if retic count is more than 2.5 then the bone marrow is in good shape |
|
|
Term
| What are some facial feature changes associated with hypothyroidism? |
|
Definition
| loss of lateral eyebrows, periorbital edema |
|
|
Term
| What is teh TIBC and percent saturation in iron deficiency anemia? |
|
Definition
| TIBC is high; percent sat is low |
|
|
Term
| What is the TIBC and percent saturation in ACD? |
|
Definition
| TIBC is low; percent saturation is low |
|
|
Term
| What is the TIBC and % saturation in sideroblastic anemia? |
|
Definition
| decreased TIBC, increased percent saturation |
|
|
Term
| What is the hemoglobin electorphoresis pattern of beta-thalassemia? |
|
Definition
| decreased A1, increased A2, increased F |
|
|
Term
| What HLAs are associated with type 1 DM? |
|
Definition
|
|
Term
| What causes acute episodes of blurry vision in type 2 DM? |
|
Definition
| change in the hydration status of the lens |
|
|
Term
| What is the diagnostic criteria for DM? |
|
Definition
| two of the following values met on two occasions: a 2 hr glucose tolerance test >200; fasting 8 hr glucose >126; classic symptoms and random glucose >200 |
|
|
Term
| What lab value could you get to differentiate between type 1 and type 2 DM? |
|
Definition
|
|
Term
|
Definition
| fast acting insulin; peaks at 1 hour, gone in 3-4 hrs |
|
|
Term
|
Definition
| relatively fast; peaks at 4 hours gone by 10 hour |
|
|
Term
|
Definition
| slow acting, peaks at 10 hrs, gone by 20 hours |
|
|
Term
|
Definition
| slow acting insulin; peaks at 10 hours; gone by 20 hours |
|
|
Term
|
Definition
| slow acting insulin; peaks at 12 hours, gone by 24 hrs |
|
|
Term
| What is the MOA of metformin? |
|
Definition
| increases peripheral uptake of glucose and inhibits hepatic gluconeogenesis |
|
|
Term
| What is the most serious side effect of metformin? |
|
Definition
|
|
Term
| What is the MOA of sulfonylureas? |
|
Definition
| increased pancreatic secretion of insulin |
|
|
Term
|
Definition
| glyburide, glipizide, tolbutamide |
|
|
Term
| What are the side effects of sulfonylureas? |
|
Definition
| weight gain and hypoglycemia |
|
|
Term
| What is the MOA of glitazones? |
|
Definition
| increased insulin sensitivity in the muscle and liver |
|
|
Term
| What should you monitor if your patient is on glitazones? |
|
Definition
| increased insulin sensitivity in the muscle and liver; because troglitazone has been associated with hepatotoxicity, monitoring of LFTs is necessary |
|
|
Term
| What is the MOA of acarbose? |
|
Definition
| decreased intestinal absorption of carbohydrates by inhibiting the breakdown of oligosaccharides |
|
|
Term
| What is the major side effect of acarbose? |
|
Definition
| postprandial GI discomfort |
|
|
Term
| What are the yearly tests you should get in pts with DM? |
|
Definition
| spot microalbumin to creatinine ratio to monitor kidney function, lipids, dilated retinal exam, kidney exam |
|
|
Term
| What is teh goal spot microalbumin to creatinine ratio to monitor kidney function? |
|
Definition
|
|
Term
| What is the goal BP for diabetics? |
|
Definition
|
|
Term
| What are the lipid goals for pts with DM? |
|
Definition
| LDL <100, TG <150, HDL >40 |
|
|
Term
| When should you start giving diabetics prophylactic daily aspirin? |
|
Definition
| when they are over 40 yoa and have other cardiac risk factors |
|
|
Term
| What is the Somogyi effect? |
|
Definition
| nocturnal hypoglycemia leads to increased morning glucose as a result of the release of counterregulatory hormones. treat patients by decreasing rather than increasing nighttime insulin |
|
|
Term
| What is the dawn phenomenon? |
|
Definition
| early morning hyperglycemia caused by decreased effectiveness of insulin at that time |
|
|
Term
| What can precipitate DKA? |
|
Definition
| infections, MI, alcohol, corticosteroids, thiazide diuretics, pancreatitis, cholecystitis, insulin deficiency |
|
|
Term
| What is the typical glucose of someone who presents in a diabetic coma? |
|
Definition
|
|
Term
| Retinopathy occurs with diabetes has been present for at least ___ years. |
|
Definition
|
|
Term
| What percent of diabetic patients eventually get evidence of retinopathy? |
|
Definition
| 98% of type 1; 80% of type 2 |
|
|
Term
| What are some preventive measures for diabetic retinopathy? |
|
Definition
| laser pohtocoagulation and tight control of blood glucose and BP |
|
|
Term
| What is the most common cause of adult kidney failure necessitating dialysis in the developed world? |
|
Definition
|
|
Term
| What is the most common cause of death in diabetic patients? |
|
Definition
|
|
Term
| In what percentage of FUO is no cause identified? |
|
Definition
|
|
Term
| What is teh definition of FUO? |
|
Definition
| fever of at least 101 (38.3) x 3 weeks with at least one oweek of workup in teh hospital for which no cause can be found |
|
|
Term
|
Definition
| >60% are caused by infections or cancer |
|
|
Term
| What are the most common systemic infections causing FUO? |
|
Definition
|
|
Term
| What are the most common cancers to cause FUO? |
|
Definition
| leukemia and lymphoma are the most comon cancers that casue FUO; hepatic and renal cell carcinomas are the most common solid tumors |
|
|
Term
| What are some common autoimmune causes of FUO? |
|
Definition
| responsible for 15% of cases; includes still's disease, temporal arteritis, RA, SLE, and polyarteritis nodosa |
|
|
Term
|
Definition
| start broad-spectrum antibiotics empirically in severely ill patients, but discontinue if the fever does not abate; avoid empiric steroids except for vasculitis |
|
|
Term
| What percent of HIV patients have the flulike symptoms during seroconversion? |
|
Definition
|
|
Term
| What is the definition of AIDS? |
|
Definition
| CD4<200 or the presence of an AIDS defining illness: CMV, MAC, PML, HSV esophagitis or recurrent oral/genital lesions, candidal esophagitis, AIDS wasting syndrome, invasive fungal infection, toxoplasmosis, PCP, Kaposi's sarcoma, lymphoma (CNS), TB and pneumococcal pneumonia |
|
|
Term
| What kind of lab values might you get to evaluate a pts HIV status? |
|
Definition
| you need a positive ELISA and western blood to diagnose HIV; further testing involves HIV viral load and CD4 count |
|
|
Term
| What kind of screening labs might you get if you just diagnosed a pt with HIV? |
|
Definition
| PPD, VDRL, antibodies against CMV, toxoplasmosis, HBV, HAV, HCV, CBC, CMP, pap smear and pregnangy test |
|
|
Term
| When do you begin HAART therapy? |
|
Definition
| if the CD4 count is <500 or if the patient has an AIDS defining illness; teh optimal timing of treatment initiation is still controversial |
|
|
Term
| What is the typical HAART treatment regimen? |
|
Definition
| protease inhibitor, and two nucleoside analogs |
|
|
Term
| Which is worse: 20% adherence to HAART therapy or 90% adherence to HAART therapy? |
|
Definition
| 90% is more likely to induce resistance than 20% |
|
|
Term
| What prophylaxis do you start in AIDs pts with CD4 < 200? |
|
Definition
|
|
Term
| What prophylaxis do you start when CD4 count becomes <100? |
|
Definition
|
|
Term
| What prophylaxis do you startwhen CD4 count is 75? |
|
Definition
|
|
Term
| What prophylaxis do you start when CD4 count is <50? |
|
Definition
| candida albicans, cryptococcus neoformans |
|
|
Term
| What is the HIV screening test? |
|
Definition
|
|
Term
| What is the most common extrapulmonary site of TB infection? |
|
Definition
| the kidney, but TB can affect nearly every organ system |
|
|
Term
| What infectious agent is by itself responsible for more infectious disease deaths than any other single agent? |
|
Definition
|
|
Term
| What are the risk factors for getting TB? |
|
Definition
| immunosuppression, alcoholism, preexisting lung disease i.e. silicosis, diabetes, CKD/dialysis, old age, homelessness, malnourishment/low body weight, and crowded living conditions wtih poor ventilation |
|
|
Term
|
Definition
| cervical LAD assoc with TB |
|
|
Term
| Imigrants from which countries are at risk for TB? |
|
Definition
| africa, latin america, asia and caribbean countries |
|
|
Term
| What CXR findings are associated with active pulmonary TB? |
|
Definition
| enlarged, clacified mediastinal lymph nodes and calcified pulmonary granulomas (Ghon complex) in the apical and posterior areas of the upper lobes of the lungs; apical pleural scarring; cavitary lesions |
|
|
Term
| ___ is commonly given with INH to prevent the common side effect of ___. |
|
Definition
| vitamin B6 (pyridoxine); peripheral neuritis |
|
|
Term
| How do you treat someone who is PPD+ but has no symptoms of active pulmonary TB on CXR? |
|
Definition
| INH therapy for nine months if they are less than 35 yoa (regardless of HIV status); many physicians forgo INH prophylaxis in patients >35 because of the risk of INH induced liver toxicity that increases with age |
|
|
Term
| What is teh TB multidrug treatment regimen. |
|
Definition
induction phase: INH + pyrazinamide + rifampin + ethambutol X 8 weeks
standard full course: INH + rifampin X nine months |
|
|
Term
| How much more common are UTIs in women than men? |
|
Definition
|
|
Term
| PPD test >5mm is positive if the pt is... |
|
Definition
| HIV or other risk factors, close TB contacts, CXR evidence of TB |
|
|
Term
| PPD test >10mm is positive if the pt is... |
|
Definition
| homeless/indigent, immigrants from developing nations, IVDU, those with chronic illness, residents of health and correctional institutions |
|
|
Term
| IF you have no risk factors what is a positive PPD? |
|
Definition
|
|
Term
| What are some common UTI organisms? |
|
Definition
| ecoli (50-80%), staph saprophyticus (10-30%), klebsiella pneumoniae (8-10%), proteus mrabilis, enterobacter, serratia, pseudomonas |
|
|
Term
| Treatment for acute uncomvlicated UTI= |
|
Definition
| flouroquinolone or TMP-SMX DS X 3 days, cephalexin X 5 days or nitrofurantoin X 7 days; always treat men for seven days |
|
|
Term
| How do you treat recurrent UTI related to coitus? |
|
Definition
| TMP-SMX DS X 1 dose post coital |
|
|
Term
| How do you treat recurrent UTI unrelated to coitus? |
|
Definition
| TMP-SMX, cephalexin, or nitrofurantoin (X 3-7 days); may be continued for six months for prophylaxis |
|
|
Term
| How do you treat acute uncomplicated pyelonephritis as an outpatient? |
|
Definition
| flouroquinolone or amoxicillin/clavulanate X 4 days |
|
|
Term
| How do you treat acute, uncomplicated pyelonephritis (inpatient)/ |
|
Definition
| IV flouroquinolone or ampicillin/sulbactam until afebrile X 24-48 hrs then PO ciprofloxacin X 14 days |
|
|
Term
| How do you treat complicated UTI? |
|
Definition
| high dose flouroquinolone (ciprofloxacin 1000 mg QD, levofloxacin 300 mg QD, or ofloxacin 300 mg BID); treat until asymptomatic and then continue for 2 to 14 days |
|
|
Term
| What is the gold standard for diagnosis of URI? |
|
Definition
| culture with >100,000 CFUs per mililiter of clean catch urine |
|
|
Term
| What is the most specific test on UA for UTI? |
|
Definition
|
|
Term
| Increased pH on UA indicates infection with... |
|
Definition
|
|
Term
| when you have a clinical picture and UA consistent with UTI, when should you get a urine culture? |
|
Definition
| recurrent UTIs, pyelonephritis, complicated UTIs, and those in men, pregnant women, and immunocompromised paitents |
|
|
Term
| When do you treat asymptomatic bactiuria? |
|
Definition
| treat in patient siwth chronic pyelonephritis; do not treat asymptomatic bactiuria in patients with indwelling catheters |
|
|
Term
|
Definition
| systemic inflammatory response syndrome; presents with fever/hypothermia, tachypnea, tachycardia, and leukocytosis/leukopenia |
|
|
Term
|
Definition
| defined as suspected or proven infection plus sirs |
|
|
Term
|
Definition
| sepsis with organ dysfunction (hypotension, hypoexemia, oliguria, metabolic acidosis, thrombocytopenia, or mental status changes) |
|
|
Term
|
Definition
| severe sepsis with hypotension despite adequate fluid resuscitation |
|
|
Term
| What laboratory/vital sign values should you expect with SIRS? |
|
Definition
| temp >38 or <36; HR >90; RR >20 or PaCO2 <32; WBCs >12,000 or <4,000 or presence of >10% bands |
|
|
Term
| What is the therapy for SIRS/sepsis? |
|
Definition
| aggressive fluid resuscitation, lung-protective ventilation, broad spectrum antibiotics, possibly steroids, tight glucose control, and possibly activated protein C |
|
|
Term
| T/F Chronic complicated UTIs show decreased responsiveness to antibiotics and may result from structural abnormalities/changes or functional disorders, pregnancy, DM, AIDS, indwelling catheters, or renal obstruction. |
|
Definition
|
|
Term
| What percent of SLE pts are women of chilbearing age? |
|
Definition
|
|
Term
| What is the female to male ratio of lupus? |
|
Definition
|
|
Term
| What race is at increased risk of lupus? |
|
Definition
|
|
Term
| What HLA are associated with Lupus? |
|
Definition
|
|
Term
| What antibody can increase the risk of still birth and abortion in pregnancy? |
|
Definition
| antiphospholipid antibody (including lupus anticoagulant and anticardiolipin antibody) |
|
|
Term
| What is lupus with characteristic skin manifestations without systemic involvement? |
|
Definition
|
|
Term
| What are some mucocutaneous symptoms of SLE? |
|
Definition
| photosensitivity, malar erythema, alopaecia, discoid lesions, livedoreticularis, mouth ulcers, cutaneous infarcts, raynaud's phenomenon, leg ulcers, Sjogren's syndrome |
|
|
Term
| What are some lung manifestations of lupus? |
|
Definition
| pleuritis, pneumonitis, hemorrhage, fibrosis, pulmonary hypertension |
|
|
Term
| What are some lymphatic manifestations of lupus? |
|
Definition
|
|
Term
| What are some cardiac manifestations of lupus? |
|
Definition
| pericarditis, myocarditis, endocarditis with sterile valve vegetations (Libman-Sacks endocarditis) |
|
|
Term
| What are some neurologic manifestations of lupus? |
|
Definition
| depression, seizures, psychosis, organic brain syndrome, movement disorders, neuropathy, myelopathy |
|
|
Term
| What are some GI manifestations of lupus? |
|
Definition
| pancreatitis, bowel vasculitis |
|
|
Term
| What are some hematologic manifestations of lupus? |
|
Definition
| hemolytic anemia, leukopenia, thrombocytopenia, arterial and venous thrombosis |
|
|
Term
| What are the criteria for lupus? |
|
Definition
| at least four of the following: serositis (pleuritis, pericarditis, myocarditis), oral aphthous ulcers, arhtritis, photosensitivity, blood abnormalities (hemolytic anemia, thrombocytopenia, leukopenia, lymphopenia), renal disease, ANA+, immunologic abnormalities (anti dsDNA, anti-Sm, antiphospholipid), neurologic abnormalities (lupus cerebritis, seizures, or psychosis), malar rash, discoid rash |
|
|
Term
| What diseases besides SLE are ANA+? |
|
Definition
| Sjogren's syndrome, scleroderma, RA, polymyositis, and dermatomyositis |
|
|
Term
| What is a good way to treat lupus in the stages of initial flares and remissions? |
|
Definition
| NSAIDS to treat serositis and arthritis; can use steroids for flares |
|
|
Term
| What drugs decrease the incidence of flares and need for steroids in pts with lupus? |
|
Definition
| DMARDs; hydroxychloroquine (plaquenil), methotrexate, cyclophosphamide, and azathioprine; used for progressive or refractory cases |
|
|
Term
| What drug is esp effective at treating lupus symptoms such as arthritis, skin disease and fatigue? |
|
Definition
|
|
Term
| What drugs are effective for lupus nephritis? |
|
Definition
| cyclophosphamide (cytoxane) and mycophenolate (CellCept) with steroids |
|
|
Term
| What should you do for pregnant women with prior fetal lossand the presence of antiphospholipid antibodies? |
|
Definition
| they should receive low dose heparin |
|
|
Term
| T/F Drug induced lupus is permanent. |
|
Definition
| false; d/cs when the drug is d/c'd |
|
|
Term
| Mortality in Lupus patients is most often due to... |
|
Definition
| end organ damage (esp renal failure) and opportunistic infections secondary to immunosuppression |
|
|
Term
|
Definition
| RA (80%), SLE (15-35%), Sjogren's syndrome (75-95%), MCTD (50-60%), FR may also be detected in the setting of viral infection, syphilis, TB, sarcoidosis and malignancy |
|
|
Term
| What is the significance of anti-cyclic citrullinated peptide-2? |
|
Definition
| RA (often precedes diagnosis by several years) |
|
|
Term
| What is the significance of ANA? |
|
Definition
| drug induced lupus (100%), SLE (99%), scleroderma (97%), Sjogren's syndrome (96%), MCTD (93%), polymyositis/dermatomyositis (78%), RA (40%), ANA may also be detected in 5% of healthy adults |
|
|
Term
| What is the significance of Anti-dsDNA? |
|
Definition
| very specific for SLE (60%), and titers parallel disease activity (esp renal disease) |
|
|
Term
| What is the significance of antihistone antibody? |
|
Definition
| drug induced lupus (90%), SLE (50%) |
|
|
Term
| What is the significance of anti-Sm? |
|
Definition
| very specific for SLE (20-30%) |
|
|
Term
| What is the significance of anti-ro (anti-SS-A)? |
|
Definition
| Sjogren's syndrome (75%), SLE (40%; increased risk of neonatal SLE) |
|
|
Term
| What is the significance of anti-LA (anti-SS-B)? |
|
Definition
| Sjogren's syndrome (40%), SLE (10-15%; increased risk of neonatal SLE) |
|
|
Term
| What is the significance of antiphospholipid (anticardiolipin or anti-beta2 glycoprotein 1 and antiprothrombin)? |
|
Definition
| primary antiphospholipid syndrome or secondary disease |
|
|
Term
| What is the significance of anticentromeric antibodies? |
|
Definition
|
|
Term
| What is teh significance of anti-topo-1? |
|
Definition
|
|
Term
| What's another name for anti-topo-1? |
|
Definition
|
|
Term
| What's the significance of anti-Jo1? |
|
Definition
| polymyositis/dermatomyositis (30%) |
|
|
Term
| What is teh significance of anti-thyroid peroxidase? |
|
Definition
|
|
Term
| What is the significance of anti-smooth muscle antibody? |
|
Definition
|
|
Term
| Wha tis the significance of antimitochondrial antibody? |
|
Definition
| primary biliary cirrhosis |
|
|
Term
| What is the significance of c-ANCA/antiproteinase? |
|
Definition
| Wegener's granulomatosis (90%) |
|
|
Term
| What is the significance of p-ANCA/anti-MPO? |
|
Definition
| Wegener's granulomatosis (10%); also detected in crescenteric GN, microscopic polyangiitis, and Churg-Strauss syndrome |
|
|
Term
| What is the significance of anti-GBM? |
|
Definition
|
|
Term
| What is teh significance of antitransglutaminase? |
|
Definition
|
|
Term
| What is the significance of decreased complement C3/C4? |
|
Definition
| SLE, cyroglobulinemia, also in GN |
|
|
Term
| What is the significance of HLA-B27? |
|
Definition
| ankylosing spondylitis (50-95%), reactive arthritis (Reiter's sydrome) (50-80%), psoriatic arthritis (50-80%), IBD-associated arthritis (50-80%) |
|
|
Term
| What are the recommendations forcolon cancer screening? |
|
Definition
flex sig every 3-5 yrs >50 yoa (ACS)
FOBT yearly >50 yoa (USPSTF)
DRE yearly >40 yoa (ACS)
colonoscopy every 10 yrs >50 yoa (ACG) |
|
|
Term
| What are the recommendations for prostate exam? |
|
Definition
| yearly in patients >50 yoa (ACS) |
|
|
Term
| What are teh recommendations for breast self exam? |
|
Definition
| monthly after age 20 if desired by the patient (no consensus) (ACS) |
|
|
Term
| What are the recommendations for clinical breast exam? |
|
Definition
| every three years for patients 20-40 yoa; yearly for patients >40 yoa (USPSTF) |
|
|
Term
| What are the recommendations for mammography? |
|
Definition
| every 12 to 33 months for patients >40 yoa (NIH) |
|
|
Term
| What are the recommendations for pap smears? |
|
Definition
| yearly for sexually active patients or those 18-65 yoa; every three years after three normal smears (USPSTF) |
|
|
Term
| What are the recommendations for pelvic exam? |
|
Definition
| every 1-3 yrs in patients 20-40 yoa; yearly in patients >40 yoa (USPSTF) |
|
|
Term
| What ar ethe recommendations for endometrial tissue biopsy? |
|
Definition
|
|
Term
| What are the recommendations for cholesterol screening? |
|
Definition
| every five years in patients voer 35 (USPSTF) |
|
|
