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flucas
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What commonly exacerbates psoriasis?
- Strep infection
- skin injury (e.g. (sun)burn, drug rxn)
- HIV
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What are common presentations of lichen planus?
- 5 P's:
- pruritic
- purple
- polygonal
- planar
- papules
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What condition is associated with heavy alcohol consumption, hepatitis C, and iron overload?
porphyria cutanea tarda
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What are clinical features of porphyria cutanea tarda?
- facial hirsutism
- milia
- erosions
- scars
- tense bullae (especially on hands)
- heavy alcohol consumption
- hepatitis C
- iron overload
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What is the primary presentation of pemphigus vulgaris?
- mouth ulcers/lesions
- high fatality rate if not treated
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If a patient presents with chronic mouth ulcers/lesions, what test would diagnose pemphigus vulgaris?
immunofluorescent studies of perilesional skin
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What conditions are associated with ertyhema nodosum?
- inflammatory bowel disease (esp. Crohn's)
- sarcoid
- strep infection
- drugs (esp OCP)
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What are some adverse clinical conditions associated with OCP use?
- cholestasis
- erythema nodosum
- (+ smoking or factor V mutation) DVT, VTE
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If a patient develops DVT/VTE soon after starting OCP, what condition should be investigated?
factor V leiden mutation (i.e. APC resistance)
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What conditions are associated with this skin lesion?
- skin lesions = erythema multiforme
- associated with:
- HSV
- drugs (esp. PCN, sulfa, phenytoin)
- Mycoplasma
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What conditions are associated with this skin finding?
- skin finding = acanthosis nigricans
- associated with:
- insulin resistance
- occasionally malignancy (60% gastric)
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What LFT changes do you expect with alcoholic hepatitis?
- AST levels <300
- trivial ALT elevation
- AST/ALT ratio >3
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What are some common features to hemochromatosis and alcohol liver disease?
- hepatomegaly
- glucose intolerance
- testicular atrophy
- cardiomyopathy
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What are clinical features of nonalcoholic steatohepatitis?
- hepatomegaly
- elevated transaminases (usually AST>>ALT)
- esp. middle-aged women with obesity, diabetes, and HTN
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What are common causes of acute liver failure?
- #1: drugs (esp. acetaminophen)
- viral hepatitis
- ischemia
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Who is usually affected by autoimmune hepatitis? What tests will confirm diagnosis?
- usually women
- antinuclear antibodies
- anti-smooth muscle antibodies
- hyperglobulinemia
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What are key clinical features of Wilson's disease?
- rare autosomal recessive
- hepatitis (fulminant, chronic)
- neurologic symptoms
- hemolytic anemia
- Kayser-Fleischer rings around iris
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What drugs are associated with cholestasis?
- OCP
- chlorpromazine
- chlopropamide
- erythromycin
- amoxicillin/clavulanate
- gold
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What condition is associated with ulcerative colitis, whether or not they underwent colectomy?
primary sclerosing cholangitis
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What is the initial therapy for acute variceal bleeding?
- sclerotherapy: successful 75-90%, serious complications
- variceal band ligation: as effective as sclerotherapy with fewer complications
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If a patient has EGD confirmed varicosities, what medication should they be put on?
Beta blockers
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What is the initial therapy for most spontaneous bacterial peritonitis?
- 5d course of 3rd generation cephalosporin
- (usually caused by gram neg. rod bacteria)
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What GI regions are commonly affected by Crohn's disease?
- terminal ileum
- cecal region
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What are common extraintestinal manifestations of Crohn's disease?
- uveitis
- spondyloarthropathy
- erythema nodosum
- pyoderma gangrenosum
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A patient presents with malabsorptive diarrhea. What conditions would make you suspect small bowel bacterial overgrowth?
- scleroderma
- diabetes
- high dose PPI's
- postoperative (Billroth 2)
- radiation enteropathy
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A patient presents with malabsorptive diarrhea. What conditions would make you suspect Whipple's disease (i.e. Tropheryma whipplei infection)?
- arthritis
- fever
- lymphadenopathy
- clubbing CNS involvement
- uveitis
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What clinical conditions are associated with celiac sprue?
- dermatitis herpetiformis
- small bowel lymphoma
- selective IgA deficiency
- (isolated ALT elevation)
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What blood tests are used to confirm celiac sprue?
- IgA endomysial antibody
- IgA tissue trans glutamine antibody
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A middle aged woman presents with chronic watery diarrhea. She denies recent weight loss or abdominal pain. What condition do you suspect? How would you treat her?
- microscopic (collaginous) colitis
- tx: bismuth
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A patient presents with malabsorptive diarrhea. What findings would make you suspect pancreatic insufficiency?
- greater amount of stool fat
- normal small bowel absorption tests (D-xylose, Hydrogen breath tests)
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What are the most common causes of acute pancreatitis?
- 60% of causes =
- alcohol consumption
- gallstones
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What 2 types of infectious colitis are known to mimic ulcerative colitis?
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What is the occurrence rate of pseudocysts with acute pancreatitis? When would you surgically drain them and why?
- occurrence rate = 20% of severe pancreatitis
- drain cysts >6cm
- risk of perforation, infection, hemorrhage
- also drain if pseudocysts do no resolve
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What is the preferred imaging test to diagnose chronic pancreatitis?
- X-ray:
- diffuse calcifications
- most sensitive test = ERCP
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How do patients with ALS initially present?
- asymmetric weakness
- bulbar or limb presentation
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What heart finding is associated with a patient who presents with stroke with a hx of DVT?
patent foramen ovale
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H. pylori is associated more with duodenal or gastric ulcers?
- duodenal ulcers (80-95%)
- gastric ulcers (60-90%)
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Should clopidogrel be used with aspirin for stroke prevention?
- no: aspirin + clopidogrel does not decrease stroke risk
- (it does increase bleeding risk)
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Which patients should receive carotid endarterectomy?
- symptomatic patients with >70% stenosis
- asymptomatic patients with >80% stenosis
- should be done ASAP post-TIA
- + low surgical risk and good 5yr survival
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Do statins reduce stroke risk?
yes: reduce stroke risk by 20-30%
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What are common causes of hypokalemia?
diuretics
- alcoholism
- hyperaldosteronism
- renal artery stenosis
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What condition would you suspect in a patient with hypertension and orthostatic hypotension?
pheochromocytoma
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What symptoms are associated with pheochromocytoma?
- think H's:
- hypertension
- hypotension (orthostatic)
- hyperhydrosis
- hyperglycemia
- headache
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What condition would you suspect in a patient with hypertension and hypokalemia?
hyperaldosteronism
(renal artery stenosis, alcoholism)
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Why are nephrotic patients at increased risk for infections? What other conditions are they at risk for?
- urinary loss of IgG and complement
- also at risk for thrombosis: urinary loss of anti-thrombin III, increase in coagulation factors
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What are prominent clinical features of renal vein thrombosis?
- flank pain
- hematuria
- enlarged kidney (ultrasound)
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What conditions are associated with adult onset minimal change disease?
- atopy/allergy
- NSAID use
- Hodgkin's disease
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What condition is associated with young male smokers with a history of hydrocarbon exposure?
Goodpasture's disease
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What is the most common cause of nephritis worldwide? How does this condition present?
- IgA nephropathy:
- micro/macroscopic hematuria
- usually presents <48hrs post-URI
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What imaging tests should be avoided in patients with chronic renal insufficiency? Why?
- gadolinium-contrast imaging (some MRI's):
- risk of nephrogenic fibrosing dermopathy
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What are clinical findings with atheroembolic renal disease?
- livedo reticularis
 - purple toes
- progressive renal dysfunction
- eosinophilia: peripheral >> urinary
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What procedures carry a risk of developing atheroembolic renal disease?
- angiography
- aortic surgery
- initiation of anticoagulation
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What condition would you investigate in a patient who presents with acute renal failure and thrombocytopenia?
- microscopic angiopathy:
- hemolysis
- schistocytes
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Which patients with thrombotic microangiopathy do you definitely plasmaphorese?
- TTP
- antiphospholipid antibody syndrome
- complement disorders
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What commonly causes acute interstitial nephritis?
- drugs:
- beta lactams (esp. PCN)
- NSAIDs
- dilantin
- allopurinol
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A patient presents with ARF. What findings would make you suspect ethylene glycol toxication?
- oxalate crystals in urine
- anion gap acidosis
- osmolar gap
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What are the clinical features of SLE?
- "SOAP BRAIN MD":
- Serositis (lung or heart)
- Oral ulcers
- Arthritis
- Photosensitivity
- Blood (Coombs+ hemolytic anemia, leukopenia)
- Renal (casts or proteinuria)
- ANA
- Immune abnml. (FP, VDRL, anti-DNA, anti-sm)
- Neurologic abnml. (seizures, psychosis)
- Malar rash
- Discoid rash
(+/- alopecia, Raynaud's)
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What drugs are associated with lupus-like syndromes?
- Hydralazine
- INH
- Procainamide
- Phenytoin
- Penacilamine
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