Riddler Q9
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A 24-year-old former injection drug user presented with elevated blood and urine tests. Tests were positive for HIV but negative for hepatitis. Kidney ultrasound showed normal sized kidneys. A renal biopsy was performed. The most likely pattern of glomerular injury given these findings is collapsing focal and segmental glomerulonephritis, which is seen in HIV nephropathy.
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1. Secondary hypertension accounts for 5-20% of hypertension cases and has an identifiable underlying cause. Common causes include renal parenchymal disease, renovascular hypertension, primary aldosteronism, Cushing's syndrome, pheochromocytoma, and coarctation of the aorta.
2. Renal disease is the most common cause of secondary hypertension. Renovascular hypertension, usually caused by atherosclerosis or fibromuscular dysplasia, can lead to renal artery stenosis and impaired renal function.
3. Other hormonal causes include primary aldosteronism, characterized by excessive aldosterone secretion leading to hypokalemia, and Cushing's syndrome, where excess cort
AKIforResidentsInternalMedicine2022.pptx
The document discusses acute kidney injury (AKI), defining it as an abrupt reduction in kidney function over a period of less than 3 months and outlining approaches to diagnosis and treatment. Common diagnostic markers for AKI include laboratory tests and urinalysis to identify abnormalities. Management of AKI depends on the underlying cause and severity, and may include intravenous fluids, diuretics, or renal replacement therapies like dialysis.
Minimal change nephrotic syndrome
This document provides an overview of minimal change nephrotic syndrome (MCD), including its pathogenesis, epidemiology, clinical manifestations, pathology, variants, differential diagnosis, natural history, and treatment. MCD is the most common cause of nephrotic syndrome in children and accounts for 10-15% of cases in adults. It is defined by normal glomeruli on light microscopy but fusion of epithelial foot processes on electron microscopy. Treatment involves corticosteroids, which achieve remission in over 80% of adults. For frequent relapsing or steroid dependent patients, cyclophosphamide, calcineurin inhibitors, or mycophenolate mofetil may be used.
Nephrotic syndrome
A 3-year-old boy presented with puffy eyes and edema. Examination found pitting edema, elevated heart rate, and proteinuria. Tests showed normal kidney and liver function. He was diagnosed with nephrotic syndrome based on his symptoms and urine protein level. Nephrotic syndrome is characterized by protein in the urine and symptoms of edema, low albumin, and high cholesterol or lipids. The majority of cases in children are idiopathic and due to minimal change disease. Treatment involves supportive care, steroids, and other medications depending on response and side effects.
Top 100 secrets of medicine
The document provides 94 medical secrets or key points from an unknown medical book. Some of the main topics covered include: treatment of severe sepsis, diagnosis of pulmonary embolism, appropriate diagnostic tests for suspected PE, common causes of bacterial meningitis, immunizations recommended for newly diagnosed HIV patients, criteria for diagnosing metabolic syndrome, presentations of hypogonadism, goals for treating blood pressure and cholesterol in patients with diabetes or vascular disease, and treatments for acute myocardial infarction and systolic heart failure.
23 Ppt Itp
This document summarizes idiopathic thrombocytopenic purpura (ITP), a condition characterized by low platelet count due to increased platelet destruction. ITP can be acute or chronic, with acute cases typically resolving within 6 months. While the cause is unknown, it may involve autoantibodies targeting platelets. Treatment depends on severity and includes corticosteroids, IVIG, anti-D immunoglobulin, and splenectomy for chronic cases. The goal is to raise platelet counts to reduce bleeding risk.
Renovascular disorder final shivaom
This document provides an overview of renovascular disorders. It begins by introducing how the kidneys rely on blood pressure and are vulnerable to vascular diseases. It then classifies renovascular disorders by anatomic location and describes several specific disorders in more detail, including thrombotic microangiopathies (like HUS and TTP), renal artery stenosis, ischemic renal disease, and others. It provides information on pathogenesis, clinical presentation, treatment, and prognosis for each.
Clinical cases march 24,13
This document contains several clinical case summaries presented as questions with multiple choice answers. The cases cover topics including a patient presenting with hives, a post-surgery complication, a patient with joint swelling and chronic gout, and a pregnant patient with SLE and high blood pressure. For each case, the correct answer is provided to identify the underlying mechanism, appropriate treatment, most likely diagnosis, or best next test.
Clinical cases march 24,13
The document contains several clinical cases presented as short paragraphs with multiple choice questions. It discusses cases involving a man with hives, a woman who underwent fundoplication surgery, a man with gout and kidney disease, a man with hemoptysis and kidney problems, a man with ulcerative colitis, a woman with asthma, a woman with sudden vision loss, a man with HIV and brain lesions, a man with sepsis and kidney injury, and a pregnant woman with lupus and hypertension. Each case is followed by a question testing the reader's knowledge of diagnosis or treatment.
Nephrotic syndrome.pptx
Nephrotic syndrome is a kidney condition characterized by heavy proteinuria, hypoalbuminemia, edema, and hyperlipidemia. It can be caused by primary kidney diseases like minimal change disease or secondary causes such as diabetic nephropathy. Patients present with edema, thromboembolic risks, infections, malnutrition, and bone fractures due to proteinuria. Diagnosis involves urine protein estimation through 24-hour urine collection or spot urine protein:creatinine ratio. Treatment focuses on managing the underlying cause, complications, and reducing proteinuria with ACE inhibitors.
Case based discussion on Listeria monocytogenes
A 68-year-old man presented to the emergency room with fever, chills, and cough for 2 weeks. He has a history of diabetes, hypertension, chronic kidney disease, and coronary artery disease for which he had coronary bypass grafting one month ago. Initial tests showed leukocytosis and elevated inflammatory markers. Blood cultures grew Listeria monocytogenes. He was treated with ampicillin and symptoms improved, but he was readmitted 3 days later with similar symptoms and found to be COVID-19 positive. The diagnosis is Listeria bacteremia likely from contaminated food. Timely antibiotic treatment is important for good outcomes in immunocompromised patients at risk for Listeria infections.
強皮症腎クリーゼ
Scleroderma Renal Crisis (SRC) is a malignant hypertension and acute renal failure that can occur in scleroderma patients. It typically affects 5% of scleroderma patients, mainly those with the diffuse type. Pathology shows thickened endothelial cells in blood vessels resembling onion skin. SRC is triggered by factors that further reduce renal blood flow in patients who already have renal hypoperfusion. Early diagnosis and treatment with ACE inhibitors has greatly improved prognosis for SRC. Risk factors include diffuse skin involvement, rapid skin progression, disease duration less than 4 years, recent cardiac events, steroid use over 15mg/day.
Chronic Lymphocytic Leukemia
Chronic lymphocytic leukemia (CLL) is the most common type of leukemia in adults. It has an average incidence of 2.7 per 100,000 people in the US and is more common in older men. CLL accounts for about 0.8% of all cancers and 30% of leukemias. The neoplastic cells are typically B-cell lymphocytes. Farming exposure and hepatitis C may play a role in etiology. CLL has various genetic abnormalities that affect prognosis. Clinical features include lymphadenopathy, fatigue, infections. Diagnosis requires a sustained lymphocytosis above 5000/uL. Treatment is indicated for symptomatic disease, doubling time under 6 months, or disease complications. Prognostic factors
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Sudden Cardiac Death
Sudden cardiac death is defined as a natural death from cardiac causes within one hour of the onset of symptoms. It occurs in about 300,000 cases per year in the United States. Common causes include long QT syndrome, Brugada syndrome, hypertrophic cardiomyopathy, arrhythmogenic right ventricular dysplasia, commotio cordis, and coronary artery anomalies. Diagnosis involves electrocardiograms, cardiac imaging, and application of diagnostic criteria. Treatment depends on the underlying cause but may include medications, implantable cardioverter-defibrillators, ablation procedures, and lifestyle modifications.
Internal Medicine Board Review
This document contains 15 clinical vignettes asking about appropriate diagnosis and management. The correct answers are provided after each question. Key themes include appropriate treatment for conditions like Lyme disease, fungal infections, meningitis, sexually transmitted infections, neutropenic infections, and rabies exposure.
Cardiology Board Review 2008
1. The document discusses treatment guidelines for a 55-year-old male presenting with chest pain, including administering aspirin, heparin, beta blockers, and transferring the patient for primary angioplasty within 90 minutes.
2. It provides an overview of guidelines for various treatments of acute coronary syndromes, including thrombolytics, primary PCI, facilitated PCI, and rescue PCI.
3. The document reviews evidence and recommendations for therapies like beta blockers, analgesics, and anticoagulants in treating acute coronary syndromes.
Liver Failure Case
This document presents a case study of a 63-year-old male who developed fatal cholestatic liver failure. He had undergone surgery for bladder cancer and cholecystectomy. His liver function tests continued rising after surgery. Extensive testing found no clear cause of cholestasis. Liver biopsies showed features of obstruction or drug effect. He was exposed to imipramine and amoxicillin-clavulanic acid, both known to cause cholestasis. Literature review found rare cases of progressive cholestasis and liver failure from these drugs. The patient's declining condition was treated supportively but he ultimately died of sepsis.
Riddler Q6
A 20-year-old female in her first trimester of pregnancy is referred for progressive dyspnea. An echocardiogram shows severe pulmonary hypertension with right ventricular systolic pressure of 90 mmHg and systemic pressure of 110 mmHg. There is no evidence of pulmonary embolism or intracardiac shunt. Termination of pregnancy carries the lowest risk of maternal mortality given her new diagnosis of primary pulmonary hypertension, which carries a 30-50% risk. She should be counseled on termination and started on prostacyclin or bosentan therapy if she refuses. Anticoagulation should also be considered.
Riddler Q5
Magnesium depletion causes hypocalcemia through two main mechanisms: 1) Resistance to parathyroid hormone when magnesium levels fall below 0.8 meq/L, and 2) Decreased secretion of parathyroid hormone in patients with more severe hypomagnesemia. Severe hypermagnesemia above 6 mg/dL can also cause hypocalcemia by suppressing parathyroid hormone secretion.
Riddler Q4
The document discusses three separate topics. It mentions pericarditis presenting with diffuse ST elevations and PR depression on an ECG. It provides a historical fact that the first "White House" was a rented mansion in New York City that was later demolished for the Brooklyn Bridge. It also describes a case of a homeless man found down with hypocalcemia and hypomagnesemia who had a very high blood alcohol level and low magnesium level.
Riddler Q3
The document discusses several medical cases and conditions:
1) Hypercalcemia is a systemic disease caused by increased calcitriol that can lead to kidney stones and failure.
2) Bilateral anterior uveitis is an eye inflammation that is usually treated with topical or injected steroids.
3) Erythema nodosum skin lesions and fever from sarcoidosis usually resolve within 6 weeks without treatment.
4) Persistent cough can be treated with inhaled steroids and bronchodilators.
Riddler Q1
A 33-year-old male presents for a scheduled appointment about GERD and asks about colon cancer screening. He has no risk factors like smoking or drinking, but his father died of colon cancer at age 54 after being diagnosed two years prior. Based on these factors and guidelines from cancer organizations, the doctor should recommend beginning colon cancer screening for the patient now at age 40.
Abd Pain ER Case Presentation
An 85-year-old man presented with 5 days of abdominal pain and worsening mental status. On exam, he had a suprapubic mass. Labs showed elevated creatinine. A renal ultrasound found right hydronephrosis. Inserting a Foley catheter drained 2500cc of urine and resolved the mass. He was diagnosed with urinary retention from an enlarged prostate and treated with catheterization, hydration, and medications for his prostate and urinary symptoms.
Myocarditis
This document summarizes the case of a 20-year-old male presenting with new onset dilated cardiomyopathy. Endomyocardial biopsy revealed lymphocytic infiltrates consistent with viral myocarditis. He was initially stabilized with supportive therapies including an LVAD and ECMO. While his EF improved, he suffered multiple complications during his hospital stay including cardiac tamponade, hemorrhagic stroke, and infections, leaving him with residual deficits.
Acute Pancreatitis Management Conference
This document summarizes key points about the management of acute pancreatitis. It discusses the epidemiology, etiology, clinical presentation, diagnostic evaluation, determination of severity, treatment approaches, and complications of acute pancreatitis. Management depends on determining if the pancreatitis is mild, moderate, or severe based on the presence of organ failure or local complications on imaging. Nutritional support, antibiotics, and drainage of fluid collections are addressed.
Vasculitis Overview
This document provides an overview of vasculitis, including:
1) Vasculitis is inflammation and necrosis of blood vessels that can lead to occlusion, ischemia, and multi-system organ dysfunction.
2) It is classified based on the size of affected vessels as well as the organ systems involved.
3) Diagnosis involves determining which organ systems are affected, excluding other potential causes, and obtaining biopsies of involved tissues when possible. Laboratory tests including ANCA can also provide clues to diagnosis.
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