micro quiz 4th yr
TRANSCRIPT
![Page 1: Micro quiz 4th yr](https://reader034.vdocuments.mx/reader034/viewer/2022042602/55a618511a28abdd728b4638/html5/thumbnails/1.jpg)
Nano Quiz(t)For medical student
Sathienwit Rowsathien, MD, Flg. Off.Internal Medicine Resident
Chiang Mai University
![Page 2: Micro quiz 4th yr](https://reader034.vdocuments.mx/reader034/viewer/2022042602/55a618511a28abdd728b4638/html5/thumbnails/2.jpg)
Describe these lesion and Diagnosis…
Cutaneous telangiectasia
AVM of the left hemisphere (Brain)
AVM of the left lung (Pulmonary)
Mucosal telangiectasia
![Page 3: Micro quiz 4th yr](https://reader034.vdocuments.mx/reader034/viewer/2022042602/55a618511a28abdd728b4638/html5/thumbnails/3.jpg)
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
![Page 4: Micro quiz 4th yr](https://reader034.vdocuments.mx/reader034/viewer/2022042602/55a618511a28abdd728b4638/html5/thumbnails/4.jpg)
Describe these lesion and Diagnosis…
Splinter hemorrhage
Roth’s spot
Osler node
Janeway lesion
![Page 5: Micro quiz 4th yr](https://reader034.vdocuments.mx/reader034/viewer/2022042602/55a618511a28abdd728b4638/html5/thumbnails/5.jpg)
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.
![Page 6: Micro quiz 4th yr](https://reader034.vdocuments.mx/reader034/viewer/2022042602/55a618511a28abdd728b4638/html5/thumbnails/6.jpg)
Describe these lesion and Diagnosis…
NecrobiosisLipoidicaDiabeticorum
AcanthosisNigricans
KimmelstielWilson FSGH
Foot (Pressure area)Ulceration
![Page 7: Micro quiz 4th yr](https://reader034.vdocuments.mx/reader034/viewer/2022042602/55a618511a28abdd728b4638/html5/thumbnails/7.jpg)
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)
![Page 8: Micro quiz 4th yr](https://reader034.vdocuments.mx/reader034/viewer/2022042602/55a618511a28abdd728b4638/html5/thumbnails/8.jpg)
Describe these lesion and Diagnosis…
Xanthelasma Corneal Arcus
Eruptive Xanthoma
Tendon Xanthoma
![Page 9: Micro quiz 4th yr](https://reader034.vdocuments.mx/reader034/viewer/2022042602/55a618511a28abdd728b4638/html5/thumbnails/9.jpg)
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.
RisksMale> 45, Female>55,smoking, HTN, FHX +ve, HDL<40 (if >60 -1risk)
![Page 10: Micro quiz 4th yr](https://reader034.vdocuments.mx/reader034/viewer/2022042602/55a618511a28abdd728b4638/html5/thumbnails/10.jpg)
Describe these and Diagnosis…
S1Q3T3, Sinus tachycardia, RBBB, TWI in V1-V4(5), P pulmonale
![Page 11: Micro quiz 4th yr](https://reader034.vdocuments.mx/reader034/viewer/2022042602/55a618511a28abdd728b4638/html5/thumbnails/11.jpg)
Describe these lesions and Diagnosis…
Hampton’s Hump Westermark sign
![Page 12: Micro quiz 4th yr](https://reader034.vdocuments.mx/reader034/viewer/2022042602/55a618511a28abdd728b4638/html5/thumbnails/12.jpg)
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
![Page 13: Micro quiz 4th yr](https://reader034.vdocuments.mx/reader034/viewer/2022042602/55a618511a28abdd728b4638/html5/thumbnails/13.jpg)
Describe these lesions and Diagnosis…
Discoid rash (Erythematous papule/plaque with keratosis and plugging)
Malar rash
![Page 14: Micro quiz 4th yr](https://reader034.vdocuments.mx/reader034/viewer/2022042602/55a618511a28abdd728b4638/html5/thumbnails/14.jpg)
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
![Page 15: Micro quiz 4th yr](https://reader034.vdocuments.mx/reader034/viewer/2022042602/55a618511a28abdd728b4638/html5/thumbnails/15.jpg)
Revise (2012) SLICC for Research
![Page 16: Micro quiz 4th yr](https://reader034.vdocuments.mx/reader034/viewer/2022042602/55a618511a28abdd728b4638/html5/thumbnails/16.jpg)
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
![Page 17: Micro quiz 4th yr](https://reader034.vdocuments.mx/reader034/viewer/2022042602/55a618511a28abdd728b4638/html5/thumbnails/17.jpg)
Describe these lesions and Diagnosis…
Webbed neck 45X
![Page 18: Micro quiz 4th yr](https://reader034.vdocuments.mx/reader034/viewer/2022042602/55a618511a28abdd728b4638/html5/thumbnails/18.jpg)
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
![Page 19: Micro quiz 4th yr](https://reader034.vdocuments.mx/reader034/viewer/2022042602/55a618511a28abdd728b4638/html5/thumbnails/19.jpg)
Describe these and Diagnosis…
ST segment elevation V1-V3
![Page 20: Micro quiz 4th yr](https://reader034.vdocuments.mx/reader034/viewer/2022042602/55a618511a28abdd728b4638/html5/thumbnails/20.jpg)
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
![Page 21: Micro quiz 4th yr](https://reader034.vdocuments.mx/reader034/viewer/2022042602/55a618511a28abdd728b4638/html5/thumbnails/21.jpg)
Describe these lesions and Diagnosis…
Pneumatocele at RLL
![Page 22: Micro quiz 4th yr](https://reader034.vdocuments.mx/reader034/viewer/2022042602/55a618511a28abdd728b4638/html5/thumbnails/22.jpg)
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
![Page 23: Micro quiz 4th yr](https://reader034.vdocuments.mx/reader034/viewer/2022042602/55a618511a28abdd728b4638/html5/thumbnails/23.jpg)
Describe these lesions and Diagnosis…
Kayser–Fleischer ring
![Page 24: Micro quiz 4th yr](https://reader034.vdocuments.mx/reader034/viewer/2022042602/55a618511a28abdd728b4638/html5/thumbnails/24.jpg)
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
![Page 25: Micro quiz 4th yr](https://reader034.vdocuments.mx/reader034/viewer/2022042602/55a618511a28abdd728b4638/html5/thumbnails/25.jpg)
Describe these lesions and Diagnosis…
Plasmacytoma
RouleauxFormation
Plasma cell
Bony erosion “Punch out”
![Page 26: Micro quiz 4th yr](https://reader034.vdocuments.mx/reader034/viewer/2022042602/55a618511a28abdd728b4638/html5/thumbnails/26.jpg)
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
![Page 27: Micro quiz 4th yr](https://reader034.vdocuments.mx/reader034/viewer/2022042602/55a618511a28abdd728b4638/html5/thumbnails/27.jpg)
Describe these lesions and Diagnosis…
Golden S sign
![Page 28: Micro quiz 4th yr](https://reader034.vdocuments.mx/reader034/viewer/2022042602/55a618511a28abdd728b4638/html5/thumbnails/28.jpg)
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
![Page 29: Micro quiz 4th yr](https://reader034.vdocuments.mx/reader034/viewer/2022042602/55a618511a28abdd728b4638/html5/thumbnails/29.jpg)
![Page 30: Micro quiz 4th yr](https://reader034.vdocuments.mx/reader034/viewer/2022042602/55a618511a28abdd728b4638/html5/thumbnails/30.jpg)
Spot parasite Diagnosis
Isospora belli oocyst Hookworm ova Ascaris fertilized ova Capillaria
Cyclospora Cryptosporidium
![Page 31: Micro quiz 4th yr](https://reader034.vdocuments.mx/reader034/viewer/2022042602/55a618511a28abdd728b4638/html5/thumbnails/31.jpg)
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
• CapillariaAlbendazole (400) 10 days
• Cyclospora TMP-SMX DS bid 3 days, AIDS 10 days
• Cryptosporidium Self limited, only supportive, AIDS Atovaquone, Paromomycin???
![Page 32: Micro quiz 4th yr](https://reader034.vdocuments.mx/reader034/viewer/2022042602/55a618511a28abdd728b4638/html5/thumbnails/32.jpg)
Good LuckFor tournament and Exam