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internal medicine

Terms in this set (47)

drug induced liver lesion
mechnisms: direct toxic, dose dependent, long latent period, carbon tetrachloride, tetrocyclin, acetominophen, aminita phalloidus mushrooms
idiosyncratic: not dose dependent, variant latent period, halothone, retroviral therapy, isoniazide, chlopromazine
chronic hepatisis C extrahepatic manifestations:
cryoglobulenemia
B cell lymphoma
plasmacytosis
AUTOimmune disease: sjogren's syndrome
lichen planus
idiopathic thrombocytopenic purpura
porphoria cutanea tarda
chronic hepatitis B treatment
lamivudine or alpha interferon therapy for persistant ALT elevation or DNA level.
ALT 2 times higher than the upper limit as a therapeutic index
lamivudine is better with the way of administration (oral)
overall treatment is not promising in young children and immunoconpromised pts
opiod intoxication
most reliable and predictable: decreased respiratory rate
detoxication: naloxone
TCA overdose
CNS depression, seizure can occur
anticholinergic effects: hyperthermia, intestinal ilues, dialated pupils
hypotension --!! potential death reason
prolonged QRS --> ventricular arrhythmia

sodium carbonate -- increase blood pressure, shorten QRS interval and prevent arrhythmia.
Paget's disease
abnormal bone turn over and aberrant osteoid formation
pain, hearing loss, increase alkline phosphotase
neuroleptic malignant syndrome
dantrolene, bromocriptine, amantatine
ethylene glycol detoxication
fomepizole or ethanol to inhibit alcohol dehydrogenase and prevent further break down of ethylene or methonol into toxic metabolites.
ursodeoxycholic acid
alternative in treating gall stones in patients who can not tolerate surgery
primary biliary cirrhosis
PCP intoxication
agitation, violent behavior, hypertension, pupil dilation,
VERTICAL NYSTAGMUS
Dissociative feeling, hyperthermia, psychotic behavior
torsade de pointe
polymorphic ventricular tachycardia
Mg++
primary polydipsia
common in patients with schezophrenia
hyponatremia and extrememly diluted urine <1.003
addison disease
primary adrenal failure
fatigue, nausea, abdominal disturbance
hyponatremia, hyperkalemia
reactive arthritis
seronegative arthritis: asymmetric oligoarthritis, conjunctivitis, urithritis and mouth ulcers
fibromyalgia
young to middle aged woman
fatigue, multiple muscle pain (above and below waist)
cognitive impairement
GI disturbance
lab: normal
physical: tenderness
dianosis: widespread pain index and symptom severity score
polymyositis
elevated muscle enzymes
hyperglycemic hyperosmolar nonketotic coma
extremely high glucose level
non anion gap
high plasma osmolarity
age older than DKA patient group
neurological symptoms often seen
negative serum ketones
DKA diabetic ketoacidosis
ph<7.3
glucose > 250
serum bicarbonate < 15-20
detection of ketones in serum
hashimoto thyroititis antibodies
anti thyroid peroxidase ab
anti thyroglobulin
thyroid cancers
most common: papilary, somoma body, local and regional LN invasion, good prognosis even with mets
folicular: early hematogenic metastatsis
Hurthle cell carcinoma: one variant of forlicular cancer
thiamine difeciency
confusion, ataxia, ophthalmoplegia
ALS treatment
riluzole, glutamate inhibitor
histoplamosis in HIV patients
mild: itraconazole
severe: >103F, lab abnomalities: amphotericin B followed by itraconazole x 1 year
hereditary hemochromatosis, infection
listeria monocytogenes
yersinia enterocolitica
vibrio bulnificus
diarrhea and organisms
shigella: daycare
vibrio parahaemolyticus: sea food
yersinia enterocolitis: undercooked pork
O157: undercooked beef
campylobacter: undercooked infected poultry
life threatening reactions associated iwth HIV treatment
didanosine-induced pancreatitis
abacavir-related hypersensitivity syndrome
lactic acidosis secondary to the use of any of the NRTIs
Steven-Johnson syndrome secondary to the use of any of the NNTRIs
nevirapine-associated liver failure
Infectious monoculeosis (IM)
traid: fever, pharygitis, lyphoadenopathy
diagnosis: heterophile antibody test (monospot)
malignant otitis externa
diabetic patient
severe ear pain with discharge and granulation tissue in the ear canal
pseudomonas aeruginosa
dental related infective endocarditis
causative organism: viridans group streps:
streptococcus mitis, S sanguis, S mutans, S salivarius.
mediastinal tumors
anterior mediastinum: thymoma, retrosternal thyroid, teratoma, lymphoma
middle mediastinum: bronchogenic cyst, tracheal tumors, pericardial cysts, lymphoma, lymph node enlargement, artic anuerysms of the arch
posterior mediastinum: neurogenic tumors, meningocele, enteric cysts, lymphomas, diaphragmatic hernias, esophageal tumors and aortic aneurysms
design to control confounding
design stage:
matching
restriction
randomization
analysis:
stratified analysis
statistical modeling
MS
acute exacerbation treated with steroids.

decrease frequency of acute exacerbation:
plasmapheresis
interferon B
cyclophosphamide
IVIG
Glatiramer acetate
lynch syndrome
hereditary non polyposis colorectal cancer
at least 3 relatives with colorectal cancer, one of whom must be first degree relative of the other two
involvement of two or more generations
at least one case diagnosed before 50
familial adenomatous polyposis has been excluded

hereditary site specific colon cancer (I)
cancer family syndrome (II), associated with extracolonic tumors, endometrial carcinoma (43% female patients).
opriod intoxication treatment
naloxone: antagonist to increase respiration rate
precipitatants of hemolytic crisis in G6PD pts
sulfonamides, antimalarial drug and fva beans
chiari malformation
a downward displacement of the cerebellar tonsils through the foramen magnum (the opening at the base of the skull), sometimes causing non-communicating [1] hydrocephalus as a result of obstruction of cerebrospinal fluid (CSF) outflow
HBV pregnant women
neonatal administration of HBIG and vaccine immediately after delivery
HSV encephalitis
CSF examination:
high protein
hemorrhagic teporalitis
acute sinusitis organisms
strep pneumonia
HI
GGT
is specific for alcohol induced liver enzyme increase
wafarin side effect
spontaneous intramural small bowel hematoma
bowel obstruction + negative stool blood
LDL is calculated
indirectly using the formula C = H+ L + kT
where H is HDL cholesterol, L is LDL cholesterol, C is total cholesterol, T are triglycerides, and k is 0.20 if the quantities are measured in mg/dl and 0.45 if in mmol/l.
lung cancers
Small cell lung cancer (SCLC): Highly correlated with cigarette exposure. Has a central location. Has a neuroendocrine origin; associated with paraneoplastic syndromes.

Remember:
Squamous and Small cell cancers are "Sentral lesions".


Endocrine/metabolic
---------------------
Cushing Sd (ACTH) Small Cell
SIADH leading to Hyponatremia Small Cell
Hypercalcemia Squamous cell
Gynecomastia Large Cell
adrenal neurodystrophy
Adrenoleukodystrophy (ALD)
------------------------------

CNS Degeneration and Adrenal Cortical Insufficiency

X-Linked Recessive

*** Caused by ACCUMULATION OF VERY LONG CHAIN FATTY ACIDS IN NEURAL TISSUE AND ADRENALS due to mutations in the ABCD1 gene coding for the ALD protein.

Symptoms at 5-15 years of age:
* Decreased academic performance
* Behavioral Changes
* Gait abnormality
* Generalized seizures
* Spasticity, contractures, ataxia, swallowing disturbances
* Hypoadrenalism with skin Hyperpigmentation
Deterioration of * Hearing, * Vision and ** Sensation
* Death within 10 years
pda
33. F) Patent ductus arteriosus

PDA:
More common in girls (2:1), babies where maternal rubella infection was present, and premature infants. Typically asymptomatic; patients with large defects may present with FTT failure to thrive, recurrent lower respiratory tract infections, lower extremity clubbing, and CHF. Wide pulse pressure, bounding arterial pulses, and characteristic sound of "machinery" (to-and-fro murmur)

Indomethacin-induced closure helpful in premature infants. Term infants often require surgical closure.
pronator drift
upper motor neuron lesion
CML and leukemoid reaction
LAP is increased in leukemoid reaction
philadephia chromosome should be determined in suspected CML
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