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85 Cards in this Set

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what is the best test for nutritional status?
prealbumin
what is the difference in marasmus and kwashiorkor?
marasmus is low Kcal intake and growth failure but kwashiorkor is normal Kcal intake but decreased protien. These pts will have fatty livers, edema and diarrhea whereas in marasmus they are emanciated
malnourished young child has alternating streaks of light and dark color in hair (flag sign) and rash that looks like "flaky paint". dx?
kwashiorkor
anorexia.
1. how much below normal is weight?
2. what hormone imbalances are there and what are the complications of those imbalances?
3. what is treatment?
1. >15% below normal weight
2. no gnrh so no FSH/LH which causes amenorrhea and osteoporosis.
Also have increased cortisol, increased ghrelin and growth hormone but decreased leptin
3. SSRI and psychotherapy
bulemia.
what is the electrolyte abnormality?
1. hypokalemia metabolic alkalosis
What are the fat soluble vitamins?
ADEK
pt presents with night blindness (nyctalopia) and bitots spot of cornea. what is problem and what ist he cause?
Vit A deficiency, from malabsorption or starvation.
pt presents with elevated calcium, papilledema, yellow skin, fulminant liver failure. what is likely cause
high vit a
classic test question...."man eats polar bear liver and then turns yellow." what is cause?
vit a toxicity.
vit d.
1. what are causes for deficiency?
2. how does it present in kids? in adults?
3. what is classic physical exam findng on ribs?
4. what electrolyte abnormality is present?
5. what is seen on xray?
6. what is most accure measure of body pool of vit d?
1. malabsorption, renal failure
2. rickets in kids, osteomalcia in adults
3. rachitic rosary
4. hypocalcemia with tetany
5. loosers lines on x ray aka milkmans fractures
6. Vit D2 is best test
1. what are vit k dependent factors?
2. what does epoxide reductase do?
3. what is the first factor to decrease with coumadin?
1. 2, 7, 9, 10 and C&S
2. keeps vit K1 in active form and active vit K
3. factor 7 and then protein C
what are causes of Vit K def in adults?
malabsorption, cirrhosis, ileal dz, and antibiotics, coumadin
pt presents with hemarthroses, poor wound healing, gingival hyperplasia and fatigue, malaise and bleeding from gums. what is dx?
Vit C deficiency causing scurvy
what is the role of vit c in the body?
enhances folate adn iron absorption
what are symptoms of low thiamine?
what are causes of low thiamine?
what is important in treatment of low thiamine?
sx are CAN-->confusion/confabulation, ataxia, nystagmus
--alcohol leading to deficiency can cause beriberi with wernickes and korsakoffs
--give glucose first then thiamine
what vitamin is important in the TCA cycle for making ATP with pyruvate and acetyl CoA?
thiamine (B1)
pt has cheilosis and magenta tongue?
low riboflavin (b2)
what is the cause of low B12?
what are the symptoms?
what lab finding will be on boards?
1. from pernicious anemia or gastric absorption problem.
2. peripheral neuropathy
3. hypersegmented polys
pt presetns wtih diarrhea, dermatitis, and dementia and a rash around her neck (cassals necklace). what is dx and cause?
pellegra from niacin deficiency
what is the role of B6 (pyroxidine) in the body?
heme synthesis and neurotransmitters
pt being treated with Isoniazid presents with anemia and peripheral neuropathy. what is the cause?
low B6

*hoskison says b6 treatment doesnt prevent the liver dz of INH
what is the number one cause of deficiency of trace elements?
doctor error in TPN ordering
pt presents with acrodermatitis, enteropathica, poor wound healing. what is cause?
zinc def
1. how does low mag effect PTH and ca?
2. what are the causes of low mag?
3. what are the symptoms?
1. causes low PTH and low ca
2. etoh , cisplatin, PPIs, diarrhea,
3. tetany, seizures, mm weakness
pt with CRF presents with mm flaccidity. what is most likely cause?
hypermag
what is a common finding in copper def?
aneurysms
chromium deficiency causes what?
glucose intolerance
selenium def caues what?
cardiomyopathy
what kind of cancer do nitrosamines cause?
gastric
pt with osteoporosis should have how much ca and vit d?
1200-1500mg ca and 400-800 IU vit d
what are K and Na requirements per day?
Kcal requirement?
80meq Na
44 meq K

20-25Kcal/kg
what is the function of B cells?
bacterial pathogens especially encapsulated and antibody production
what is the fxn of t cells?
type 4 hypersensitivity, regulates b cells, intracellular pathogens like TB and fungi
what is natural killer cell fxn?
killing virally infected and tumor cells
what lab should you order to check b cell fxn?
total immunoglobulin level
what test should you order to check t cell fxn?
monoclonal markers (T3, T4, etc), skin testing
peripheral T cells with antigen recognition site are called what?
CD3
what is the role of CD4 helper T cells.
help in tupe 4 rxns and make IL-2 to activate macrophages to activate CD8 cells
what is the role of CD8 T cells?
cytotoxic, killing pathogens
are the following B cell, T cell or mixed disorders?
1. bruton's
2. selective IgA
3. Digeorge
4. X linked lymphoproliferative
5. wishkott aldrich
6. CVID (common variable immune def)
7. SCID
8 ataxia telangiectasia
1. B cell
2. b cell
3. t cell
4. b cell
5. mixed
6. b cell
7. mixed
8. mixed
pt presents with recurrent infections like pneumonia, giardia, and lymphomas and is dx with burtons agammaglobulinemia.
1. how is it acquired
2. what is the path/
1. x-linked recessive
2. failure of pre-b cells to b cells
1. what is the cause of CVID. These pts also have recurrent infections with giardia, but will have granulomas not lymphomas like in burtons.
2. when do symptoms usually surface?
3. should they get live vaccines
1.failure of B cells to plasma cells
2. 2-3 decade
3. no live vaccines
what is the mot common hereditary immune def?
what other def is associated?
selective IgA def
associated with IgG2 and 4
pt has recurrent sinopulmonary infections and GI infections. and anaphylaxis to blood transfusions. what is cause?
IgA def
in diGeorge what is the cause and sx?
no parathyroids or thymus so recurrent infections and low calcium causing tetany
deficiency of adenosine deaminase is what disorder?
SCID
pt has thrombocytopenia, eczema, recurrent infections, and lymphomas and high IgE level. what is dx?
how is it acquired?
wiskott aldrich
x linked recessive
2 year old pt has cerebellar ataxia and high AFP. dx?
ataxia telangiectasia
autosomal recessive
what is the best test of th complement system?
CH50
in post strep and lupus nephritis C3 is high or low?
low
1. what are symptoms of C1 esterase inhibitor deficiency?
2. how is it acquired
3. how to screen for it?
4. what is treatment?
1. angioedema
2. hereditary autosomal dominant or acquired with ACE-Is.
3. screen is decreased C4
4. androgen is tx and FFP has C1 esterase inhibitor in it
what infection is seen with C5-8 def?
GC infections
HLA-B27 gene seen in what?
ankylosing spondylitis
HLA-DR3/4 gene seen in what?
type 1 DM
what type hypersensitivity rxn is this?
1. goodpastures?
2. allergy to dust mite feces (#1 cause) or cats
3. graves, myasthenia gravis?
4. serum sickness, farmers lung
5. anaphylaxis to bee stings
6. ABO incombatibilty
7. contact dermatitis to nickel or poison ivy
8. PPD testing
9. lupus
10. elevated IgE
11. ITP, autoimmune hemolysis
* I only did the bolded ones and some other random ones but not all inclusive. pg32 on hoskisons

1. 2
2. 1
3. 2
4. 3
5. 1
6. 2
7. 4
8. 4- delayed type
9. 3
10. 1
11. 2
on boards how to dx type 1 hypersensitivity?
scratch test- causes histamine release with a wheal and flare rxn
DONT pick RAST testing
high levels of what is a marker for anapylaxis?
tryptase
what is tx of type 2 hypersensitivity rxns?
plasmapheresis or steroids
what are causes of hemorrhagic arthritis?
scurvy and hemophilia
synovial fluid with >100k cells and mostly WBCs is what?
septic arthritis
synovial fluid with monosodium urate crystals that are needle shaped and negatively birefringent.
gout
synovial fluid that is calcium pyrophosphate crystals and rhomoid shape and +birefringent is what?
pseudogout
what is the mcc of septic arthritis?
N. gonorrhea then staph aureus
what is a common cause of osteo and septic joint in sickle cell?
salmonella
what bug are you worried about in cat bites and what is tx?
pasteurella tx with augmentin
if septic arthritis from sporotrichosis what is tx?
KI
pt gets bit by iguana and gets septic arthritis. what is the bug?
salmonella
if pt has low synovial glucose what is the likely dx
septic or RA
kid has joint pain, fever, rash, lymphadenopathy, hepatosplenomegaly.
what is dx?
tx?
lab findings?
juvenile RA
tx with ASA
RF or ANA negative
what is the mechanism for gout?
decreased excretion of uric acid
what are causes of secondary hyperuricemia?
diuretics
DM
excess cell states like cancer or hemolysis
increased gap metabolic acidosis
acute gouty flares involving the big toe are called what?
podagra
what is tx for an acute gout attack? and for chronic tx?
what is the tx goal?
indomethacin or colchicine

allopurinol not in acute attack
uric acid level less than 6 is goal
what are other terms for pseudogout?
CPPD calcium pyrophosphate dihydrate crystal deposition
chondrocalcinosis
1. What joints are involved in pseudogout?
2. what is tx of psuedogout?
3. what other disorders/diseases is psuedogout associated with ?
1. knee, MCPs
2. tylenol and NSAIDS
3. hyperparathyroid, hypothyroid, OA, RA, hypophosphatemia, hypomagnesemia, hemachromatosis
what is distinct about arthritis with hemochromatosis?
it involved 2nd and 3erd MCPs with classic "parrot beak" osteophytes
what are examples of seronegative arthritidies?
anklyosing spndylitis, reiters, psoriatic, enteropathic
young male pt has sacrolitis, restrictive lung dz, and aortic valve problems?
1.what is dx?
2.what lab finding?
3. what is tx?
1. ankylosing spondylitits
2. HLA-B27
3. indomethacin, maybe TNF alpha or methotrexate
pt presents with urethritis, conjunctivitis, mucocutaneous involvement and arthrits.
1. what is dx?
2. what are possible causes
3. what is tx?
4. what are the two classic skin manifestations in reiters?
1. reiters
2. chlamydia, shig/salmonella/campylobacter
3. NSAIDS
4. balanitis circinata and keratoderma blennorrhagicum
pt has sausage digits and arthritis mutilans and is dx with psoriatic arthritis.
what is tx?
NSAIDs, MTX, TNF drugs
pt with IBD complains of joint pain what is dx and tx?
enterohepatic arthritis and tx with sulfasalazine
septic arthritis
1. how is it acquired?
2. what joint is usually invovled
3. what is #1 overall cause
4. what complement deficiencies are associated with it?
1. hemotogenous
2. knee
3. gonococcus
4. C5,6,7,8 deficiency
ANA patterns
1. if pt has rim pattern ANA what is the dx you should think of ?
2. homogeneous pattern?
3. speckled pattern?
1. SLE with renal involvement, anti-ds DNA
2. nothing, continue work up
3. could mean several things
if specked ANA pattern think of the following associated antibodies. what dz goes with each ab?
1. anti-Sm (smith)
2. anti-RNP
3. anti Scl-70
4. anti JO-1
5. anti-Ro(SS-A)/La (SS-B)
6. nucleolar
7. anti-histone
1. SLE
2. mixd connective tissue disease
3. scleroderma
4. dermato/polymyositis
5. sjogrens
6. progressive systemic sclerosis
7. drug induced
match the follow antibodies with the disease associated?
1. anti-acetylcholine receptor ab
2. anti-centromere
3. c-ANCA and anti-porteinase-3
4. anti-gliadin/endomysial/gluten
5. tissue-transglutamase (tTG)
6. anti-GMB
7. anti-neutrophil
8. anti-insulin and GAD
1. mysthenia gravis
2. CREST
3. wegners
4. celiac
5. celiac
6. goodpastures
7. felty's
8. Type 1 DM