Notes

RTA

Renal Tubular Acidosis Type 1 (Distal) Distal tubule can not generated Bicarb under aldosterone influence ⇒ ↓ H secretion Etiology Amphotericin SLE Sjogren Presentation Normal AG metabolic acidosis ↓K Diagnosis Best initial → UA → pH >5.5 Most accurate → Ammonium Cl (acid) infusion → Urine remains alkaline ↓K Complications Alkaline...

Endocrine Diagnostic Tests

Condition Problem Test Acromegaly ↑ GH Serum IGF-1 Glucose suppression test Prolactinoma ↑ Prolactin Serum prolactin DI ↓ ADH Water deprivation DDAVP stimulation SIADH ↑ ADH Urine Osm/Na Cushing Syndrome ↑ Cortisol 24h Urine cortisol 1 mg Dexa ACTH 8 mg Dexa Addison ↓ Cortisol 8AM Cortisol Cosyntropin Conn’s...

Metabolic Syndrome

WEIGHHT (3 out of 5) Waist ↑ → >40 inch Impaired Glucose → >100 Hypertension → >130/85 HDL ↓ → <40 TG ↑ → >150

Antibodies

Antibody Disease ANA SLE Anti Smith (Sm) SLE Anti dsDNA SLE + Renal involvement Anti Histone Drug-induced SLE Lupus Anticoagulant Antiphospholipid Syndrome + ↑aPTT Anti Cardiolipin Antiphospholipid Syndrome + Spontaneous abortion Anti SS-A (Ro) Sjogren’s Neonatal SLE Anti SS-B (La) Sjogren’s Anti CCP RA RF RA Anti Scl-70 (Topoisomerase...

Complex Regional Pain Syndrome

Etiology After trauma 3 Phases Acute/Traumatic phase Dystrophic phase Atrophic phase Presentation Diffuse pain Out of proportion to injury Non-anatomic distribution Can occur anytime after injury Loss of function → of affected limb Sympathetic dysfunction Skin changes Soft tissue changes Blood flow changes Change in Skin temperature Hair growth...

Bone Cancer

Ewing Sarcoma Classic presentation 10-20y Multilayered onion-skinning on X-ray of Femur diaphysis 11, 22 translocation Mid shaft Systemic symptoms → Fever, Anorexia, Fatigue Onion skin on X-ray Eat Wings and Onion Rings Osteosarcoma Rb gene (Retinoblastoma) Metaphysis Distal femur Proximal tibia Proximal humerus Metastasis to lungs ↑ Alk. P...

Opportunistic Infections

Thrush (Oropharyngeal Candidiasis) Etiology Xerostomia → Dry mouth Antibiotic use Denture ↓Immune Presentation Soft white plaque CAN be rubbed off Erythematous base Mucosal burning Candidial Esophagitis → Odynophagia Oral Hairy Leukoplakia EBV Lateral border of tongue Can NOT be rubbed off Diagnosis Clinical KOH/Gram stain → Budding yeast or...

Systemic Fungal Infections

Coccidioidomycosis Etiology Coccidioides imitis Southwest US Presentation Pneumonia Fever Anorexia Headache Chest pain Cough Dyspnea Arthralgia Night sweats Flulike illness Extrapulmonary CNS → Meningitis Bone → Osteomyelitis Skin Erythema nodosum Erythema multiform Diagnosis Best initial → Serology → If negative repeat testing Most accurate → PCR Bronchoalveolar lavage Culture...

Erythema Nodosum

Panniculitis → Inflammation of subcutaneous adipose tissue → Delayed hypersensitivity Etiology Infection Strep Coccidioides Yersinia TB Drug Sulfa drugs Antibiotic OCP Inflammatory IBD Crohn Ulcerative Colitis Sarcoidosis Behcet syndrome (Erythema nodosum-like lesions) Presentation Anterior shin nodules Painful Erythematous Spread → Turn brown/gray Fever Joint pain False ⨁ VDRL Diagnosis...

Obstructive/Restrictive Lung Diseases

Obstructive Asthma Bronchiectasis COPD Chronic bronchitis Emphysema Restrictive Alveolar Edema Hemorrhage Pus Interstitial Idiopathic interstitial pneumonia Inflammatory Sarcoidosis Cryptogenic organizing pneumonia Cryptogenic means idiopathic Bronchiolitis obliterans organizing pneumonia (BOOP) Inflammation of bronchioles Seen in the context of Rheumatoid arthritis Dermatomyositis Amiodarone Idiopathic pulmonary fibrosis Neuromuscular Myasthenia Phrenic nerve palsy...

Defense Mechanisms

Porphyrias

Etiology Heme production abnormality ⇒ Porphyrin accumulation Porphyria Cutanea Tarda HCV Hemochromatosis Acute Intermittent Porphyria Erythropoietic Porphyria Lead Poisoning → Porphyria-like disorder Presentation General Photodermatitis Erythema Blisters Neuropsychiatric Psychosis Polyneuropathy Areflexia Visceral Abdominal pain Seizure Hemolytic anemia Pink/brown urine → Telltale sign Tachycardia Disease specific Porphyria Cutanea Tarda Most common...