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22 Cards in this Set
- Front
- Back
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What are the risk factors for non-alcoholic steatohepatitis? |
- Obesity - Diabetes Mellitus - Hyperlipidemia - Total Parenteral Nutrition - Medications (i.e. corticosteroids, amiodarone, diltiazem, tamoxifen, HAART) - Endocrinopathies (i.e. Cushing's Syndrome) |
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How is alpha-1 antitrypsin deficiency diagnosed? |
The diagnosis of A1AT deficiency is established by measurement of the serum A1AT level, followed by confirmatory genetic testing. |
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What is the treatment for alpha-1 antitrypsin deficiency? |
- Treatment options include augmentation therapy with purified human A1AT for those with severe deficiencies. - Individuals suffering from severe pulmonary impairment are candidates for lung transplants, while those in hepatic failure can be treated with liver transplantation. |
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What causes Hydatid disease? |
- Hydatid disease is due to infection with Echinococcus granulosus. - Humans contract the infection from the close and intimate contacts with dogs, which are the definitive host in the life cycle of E. granulosus. - It can cause unilocular cystic lesion in any organs including liver, lung, muscle, and bones. - Multiple lesions are associated with E. multilocularis infection. |
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How does a Hydatid cyst present? |
- In most patients, hydatid cysts are asymptomatic and generally diagnosed on screening for some other problem. - However, it may cause symptoms, usually due to compression on surrounding tissues. - Imaging techniques can be used for diagnosis along with the serological test. - "Eggshell" calcification of a hepatic cyst on CT scan is highly suggestive of hydatid cyst. - Aspiration of the cyst is generally not indicated due to the risk of anaphylactic shock secondary to spilling of cyst contents. - Treatment is generally surgical resection under the cover of Albendazole. |
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What is the most common malignancy of the liver? |
- Metastases are the most common malignant neoplasms of the adult liver and are twenty times more common than hepatocellular carcinoma. - The liver is the second most common site of metastatic spread (after the lymph nodes) because of its large size, dual blood supply, high perfusion rate, and the filtration function of Kupffer cells. - The most common primary tumors to metastasize to the liver include malignancies of the GI tract, lung, breast, and skin (melanoma). - The most common malignancy of the liver is metastasis from another primary source. |
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What are the 3 major pathological stages of alcoholic liver disease? |
The 3 major pathological stages of alcoholic liver disease are: 1. Fatty liver (steatosis) 2. Alcoholic Hepatitis 3. Alcoholic Fibrosis/cirrhosis - Fatty liver is the result of short term alcohol ingestion, whereas hepatitis and cirrhosis require long term, sustained alcohol use. - Alcohol hepatitis is characterized by Mallory bodies, infiltration by neutrophils, liver cell necrosis, and a perivenular distribution of inflammation. - Fatty liver (steatosis), alcohol hepatitis, and even early fibrosis can all be potentially reversible with the cessation of alcohol intake. - True cirrhosis (with regenerative nodules) is irreversible, regardless of alcohol abstinence. |
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What is the clinical presentation of Glucagonoma? |
Necrolytic Migratory Erythema - Erythematous papules/plaques on face, perineum, extremities - Lesions enlarge & coalesce over next 7-14 days with central clearing & blistering, crusting & scaling at borders Diabetes Mellitus - Mild hyperglycemia easily controlled with oral agents & diet - Usually does not require insulin Gastrointestinal symptoms - Diarrhea, anorexia, abdominal pain, or occasional constipation Other findings - Weight loss - Neuropsychiatric (e.g., ataxia, dementia, proximal muscle weakness) - Association with venous thrombosis |
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What are common causes of Macrocytic anemia? |
- Folate deficiency - Vitamin B12 deficiency - Myelodysplastic syndromes - Acute myeloid leukemias - Drug-induced (e.g., hydroxyurea, zidovudine, chemotherapy agents) - Liver disease - Alcohol abuse - Hypothyroidism |
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How does Sickle Cell Disease contribute to folate deficiency? What is the solution for this? |
- Sickle cell disease (SCD) is usually a chronic normocytic, hemolytic anemia with appropriate reticulocytosis response. - In SCD, folate deficiency can occur due to increased red blood cell turnover and increased consumption of folate in the bone marrow. - Daily folic acid supplementation is recommended in all SCD patients to correct the underlying folate deficiency. |
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Describe the clinical features of Monoclonal Gammopathy of Undetermined Significance. |
- Absence of anemia, hypercalcemia, lytic lesions & renal insufficiency - Serum monoclonal protein <3 g/dL - <10% plasma cells in the bone marrow |
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Describe the clinical features of Multiple Myeloma |
- Presence of anemia, hypercalcemia, lytic lesions & renal insufficiency - Serum monoclonal protein >3 g/dL - >10% plasma cells in the bone marrow - Elevated Beta-2 microglobulin |
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What diagnostic test is required in Monoclonal Gammopathy of Undetermined Significance? |
A metastatic skeletal bone survey (e.g., long bones, skull) is recommended in MGUS patients to exclude lytic lesions suggesting Multiple Myeloma. |
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What is a Baker's cyst? |
- Baker's cyst (popliteal synovial cyst) refers to the swelling on the medial side of the popliteal fossa due to an enlarged gastrocnemius-semimembranosus bursa. - Baker's cysts is often secondary to degenerative joint disease or injury. - Ultrasound usually shows the cystic, fluid-filled space. |
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What are the risk factors for popliteal (Baker's) cyst? |
- Trauma (e.g., meniscal tear) - Underlying knee joint disease (e.g. osteoarthritis, rheumatoid arthritis) |
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What is the clinical presentation of a Baker's cyst? |
- Can be asymptomatic - Posterior knee pain, swelling, or stiffness - Posterior knee swelling increased with patient standing and knee extended - Swelling usually decreases with knee flexion to 45 degrees (Foucher's sign) |
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What are the complications of Baker's cyst? |
- Cyst enlargement with dissection into calf (can present with erythema, distal edema, positive Homan's sign) - Cyst enlargement into popliteal space (can compress adjacent vein and cause leg/ankle swelling) - Cyst rupture with severe calf pain, warmth, tenderness, erythema (can also have ecchymoses from posterior calf to ankle) |
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What are common paraneoplastic syndromes associated with lung cancer? |
Endocrine - Syndrome of inappropriate antidiuretic hormone (associated with small cell lung cancer) - Hypercalcemia due to increased parathyroid hormone-related protein (PTH-rp) (associated with squamous cell lung cancer) - Cushing syndrome due to ectopic adrenocorticotropic hormone (ACTH) production (associated with small cell lung cancer) Hematologic - Hypercoagulability (e.g., Trousseau's syndrome, deep vein thrombosis) Neurologic - Lambert-Eaton myasthenic syndrome (associated with small cell lung cancer) - Ataxia, autonomic or sensory neuropathy Musculoskeletal - Hypertrophic osteoarthropathy (clubbing) - Dermatomyositis & polymyositis |
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What are some causes of Syndrome of Inappropriate Antidiuretic Hormone (SIADH)? |
Causes of SIADH include: - Central Nervous System Disorders (e.g., stroke, hemorrhage) - Malignancies (e.g. small cell lung cancer) - Drugs - Other pulmonary conditions (e.g., pneumonia) |
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What is the clinical presentation of SIADH? |
- Patients are Euvolemic, but elevated antidiuretic hormone levels lead to hyponatremia and inappropriately concentrated urine (urine osmolality >100 mOsm/kg H2O and greater than plasma osmolality). - Clinical symptoms are often initially vague, but untreated SIADH can lead to significant hyponatremia causing seizures or coma. |
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What are common paraneoplastic syndromes associated with small cell lung cancer? |
- Syndrome of Inappropriate Antidiuretic hormone (SIADH) - Ectopic adrenocorticotropic hormone (ACTH) production - Lambert-Eaton syndrome |
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Which cancer is associated with Pernicious Anemia? |
- Pernicious anemia leads to vitamin B12 deficiency in 2 ways: - First, anti-intrinsic factor antibodies decrease the amount of functional intrinsic factor available to facilitate B12 absorption. - Second, patients develop a chronic atrophic gastritis with decreased production of intrinsic factor by gastric parietal cells. - This atrophic gastritis increases the risk of intestinal-type gastric cancer and gastric carcinoid tumors by 2-3 times over the general population. - Thus, patients with pernicious anemia need to be monitored for the development of gastric cancer (periodic stool testing for the presence of blood). |
