Micro quiz 4th yr
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This document provides summaries of various medical conditions and lesions. It begins by describing hereditary hemorrhagic telangiectasia, also known as Osler-Weber-Rendu disease, which is characterized by abnormal blood vessel formation and criteria including recurrent epistaxis, telangiectasias, visceral arteriovenous malformations, and a family history of the condition. Next, it summarizes infective endocarditis and its presentation, criteria for diagnosis, high-risk pathogens, and treatment recommendations. Finally, it concludes by outlining treatments for various intestinal parasites including Isospora belli, hookworm, Ascaris lumbricoides, Capillaria spp., Cyclospora
Micro quiz 4th yr
- 1. Nano Quiz(t) For medical student Sathienwit Rowsathien, MD, Flg. Off. Internal Medicine Resident Chiang Mai University
- 2. Describe these lesion and Diagnosis… Cutaneous telangiectasia AVM of the left hemisphere (Brain) AVM of the left lung (Pulmonary) Mucosal telangiectasia
- 3. Hereditary hemorrhagic telangiectasia • Eponym: Osler–Weber–Rendu disease • Autosomal dominant ENG, ACVRL1 and MADH4 mutations • Abnormal blood vessel formation in the • Skin, Mucous membranes and end organs such as Lungs, Liver and Brain. • Curaçao criteria (3/4) • Spontaneous recurrent epistaxis • Multiple telangiectasias in typical locations • Proven visceral AVM (lung, liver, brain, spine) • First-degree family member with HHT • Only symptomatic treatment William Osler, Frederick Parkes Weber and Henri Jules Louis Marie Rendu
- 4. Describe these lesion and Diagnosis… Splinter hemorrhage Roth’s spot Osler node Janeway lesion
- 5. Infective endocarditis • Modified Duke’s criteria (2 majors, 1+2 or 5 minors) • Major • Sustained Bacteremia (viridans streptococci,Staphylococcus aureus, Streptococcus bovis, HACEK group or only +ve Coxiella) • Evidence of Endocardial involvement (TTE see Vegetation, New valvular regurgitation) • Minor • Predisposing heart condition, Fever >= 38.0 C, Vascular phenomena, Immunologic phenomena, Positive blood culture not meeting major • Acute (high Virulence S.Aureus), subacute (less S.Viridans) • EKG: new conduction abnormalities • NVE: Acute Vanco, subacute Cef-3 • PVE: Early < 60days Vanco+Cefepime+Genta, subacute Vanco+Genta • Endocarditis prophylaxis (PV, previous NVE, transplant, CHD) before Dental&Respiratory procedure • Amoxycillin 2 g, Cef-3 1 gm IM or Clinda 600 mg 30 min before.
- 6. Describe these lesion and Diagnosis… Necrobiosis Lipoidica Diabeticorum Acanthosis Nigricans Kimmelstiel Wilson FSGH Foot (Pressure area) Ulceration
- 7. Diabetes Mellitus • FBS >=126,HbA1C > 6.5 or Random >= 200 mg/dl *2 occasions • 1 if severe + symptomatic (DKA, HHS) • Type 1, 2, MODY, 2nd causes (Gestational, drugs (PI, Psychi), cushing) • Polyuria, Polydipsia and polyphagia. • Aware Complication Retinopathy, Nephropathy, Neuropathy, Artherosclerosis, Infections • Must control comorbid disease (HT keep <140/90, LDL <100) • Must screening yearly for • Dilated Retinal exam yearly by ophthalmologist • Microalbuminuria (spot) goal <30 • Diabetic neuropathy (Monofilament)
- 8. Describe these lesion and Diagnosis… Xanthelasma Corneal Arcus Eruptive Xanthoma Tendon Xanthoma
- 9. Dyslipidemia • Tendon Xanthoma LDL specific (may >300mg/dl) • Eruptive Xanthoma (pimple) TG specific (may >1,000 mg/dl) • Xanthelasma any type of dyslipidemia, Corneal arcus non specific in older adults. Risks Male> 45, Female>55,smoking, HTN, FHX +ve, HDL<40 (if >60 -1risk)
- 10. Describe these and Diagnosis… S1Q3T3, Sinus tachycardia, RBBB, TWI in V1-V4(5), P pulmonale
- 11. Describe these lesions and Diagnosis… Hampton’s Hump Westermark sign
- 12. Pulmonary Embolism • Dyspnea and pleuritic chest pain, tachypnea • Hypoxemia with increase A-a gradient • Simplified Well score • EKG: most common Sinus tachycardia • Gold: CTA if high risk, d-dimer if low risk (< 500ng/ml excluded PE) • Work up for Thrombophilia OCP, HRT and Malignancy • Enoxaparin 1mg/kg SC BID 5 days long term warfarin INR 2-3
- 13. Describe these lesions and Diagnosis… Discoid rash (Erythematous papule/plaque with keratosis and plugging) Malar rash
- 14. Systemic Lupus Erythematosus • Serositis, Oral Ulcer, • Arthritis (non-erosive), • Photosensitivity rash, • Blood (leukopenia <4,000, lymphopenia <1,500 or thrombocytopenia <100,000), • Renal (RBC cast or Protein uria >0.5 gm/day), • ANA, Immunologic (dsDNA, smith, Anti Phospholipid), • Neuro (seizure or psychosis), • Malar, Discoid • 4/11
- 15. Revise (2012) SLICC for Research
- 16. Systemic Lupus Erythematosus • Control symptom • Prednisolone low dose (10-15mg) • HCQ • NSAIDS • Lupus Flare/ severe flare • Steroid high dose (1mkd) • Mycophenolate LN • IVCY LN, CNS • AZA, MTX, CsA, Rituximab, Belimumab limit used
- 17. Describe these lesions and Diagnosis… Webbed neck 45X
- 18. Turner syndrome • Ullrich–Turner syndrome "Gonadal dysgenesis“ • Absence of an entire sex chromosome, the Barr body, sporadic • Low set ears, Low hairline, Amenorrhea, Webbed neck, • AS(Bicuspid),Coarctation of aorta, • Horse shoe kidney, • Lymphedema, Short stature • Treatment • GH • Estrogen replacement therapy
- 19. Describe these and Diagnosis… ST segment elevation V1-V3
- 20. Brugada Syndrome • Nocturnal Death Syndrome • 3 type of EKG • I. Coved ST segment elevation >2mm in >1 of V1-V3 followed by a negative T wave. • II. >2mm of saddleback shaped ST elevation. • III. I or II morphology but <2mm ST elevation • Treatment: ICD
- 21. Describe these lesions and Diagnosis… Pneumatocele at RLL
- 22. Staphylococcal Pneumonia • May be post viral or HAP/ HCAP • Consider MRSA Vancomycin • Prediction of severity • SMARTCOP • SBP < 90 (2), multilobar, albumin <3.5g/dl, RR >= 30, Tachycardia >125, Confusion, O2sat <90% (2), Arterial pH <7.35(2) • CURB 65 • Confusion, BUN >19 mg/dl, RR > 30, BP< 90/60, Age >=65 • >=3 point need ICU
- 23. Describe these lesions and Diagnosis… Kayser–Fleischer ring
- 24. Wilson’s disease • Mutation in ATP7B copper overload • Neurologic Wilson’s Parkisonism (hepatolenticular), KF rings • Diagnosis by • Increase 24 hours urine Cu, decrease of serum Ceruloplasmin • Treatment • Copper chelation with Penicillamine + B6, Zinc
- 25. Describe these lesions and Diagnosis… Plasmacytoma Rouleaux Formation Plasma cell Bony erosion “Punch out”
- 26. Multiple Myeloma • Clinical CRAB • Hypercalcemia • Renal involvement (Ig light chain, RF or infiltrative) • Anemia • Bone pain • Symptomatic MM criteria (3/3) • M protein in serum/ urin • Bone marrow clonal plasmacytosis >10% or plasmacytoma • ROTI lytic bones, Ca >11.5g/dl, Cr >2mg/dl, Hb <10 • Treatment by induction chemo + supportive treatment
- 27. Describe these lesions and Diagnosis… Golden S sign
- 28. Lung cancer • Golden S sign = reverse S sign of Golden • RUL atelectasis • May be from central mass obstructing the upper lobe bronchus • Suspicion of a primary bronchogenic carcinoma • Central lesion Squamous, Small cell • Peripheral Adenocarcinoma(KRAS), Large cell • Adenocarcinoma most common in non-smoker! • Endobronchial growth symptom cough, hemoptysis and dyspnea • Paraneoplastic ACTH, ADH release, Eaton Lambert SCLC, PTH-rP Squamous, Clubbing finger non-small cell, Hypertrophic osteoarthropathy Adenocarcinoma
- 30. Spot parasite Diagnosis Isospora belli oocyst Hookworm ova Ascaris fertilized ova Capillaria Cyclospora Cryptosporidium
- 31. Intestinal parasitic treatment • Isospora Self limited, AIDS TMP-SMX • Hookworm Ivermectin 200ug/kg/day for 3 day, Albendazole (400) 3 days • Ascaris Albendazole (400) single dose • Capillaria Albendazole (400) 10 days • Cyclospora TMP-SMX DS bid 3 days, AIDS 10 days • Cryptosporidium Self limited, only supportive, AIDS Atovaquone, Paromomycin???
- 32. Good Luck For tournament and Exam