Adam Shared "Boards" - 47 Picmonics

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Streptomycin
Aminoglycoside drug class
Interferes with 30S component of ribosome
Mycobacterium tuberculosis (2nd line)
IV only
Resistance in mycobacterium is via ribosomal alterations (as well as other aminoglycoside mechanisms of resistance)
Side Effects
Tinnitus
Vertigo
Ataxia
Nephrotoxicity especially with aminoglycosides
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Dapsone
MOA: Similar to sulfonamides, but structurally distinct agent (Inhibit dihydropteroate synthase)
Indications
Leprosy (lepromatous and tuberculoid)
Pneumocystis jirovecii prophylaxis
Dermatitis herpetiformis (celiac disease)
Side effects
Hemolysis if G6PD deficient
Fever, rash and methemogloinemia
Pigment changes
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Daptomycin
MOA: Lipopeptide that disrupts cell membrane of gram ⊕ cocci; Bactericidal
Indications
S aureus skin infections (especially MRSA), bacteremia, endocarditis, VRE
Not used for pneumonia (avidly binds to and is inactivated by surfactant)
Depolarizes cellular membrane by creating transmembrane channels
Side effects
Myopathy
Rhabdomyolysis
CPK elevation
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Simeprevir
HCV protease inhibitor, preventing viral replication
Chronic HCV in combination with ledipasvir (NS5A inhibitor)
Do not use as monotherapy
Side Effects
Photosensitivity reactions
Rash
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Menkes disease
X-linked recessive
Connective tissue disease
Impaired copper absorption and transport due to defective Menkes protein (ATP7A)
Decreased activity of lysyl oxidase (copper is a necessary cofactor); leads to defective collagen cross linking
Presentation
Brittle, "Kinky" hair
Growth retardation
Hypotonia
May have silver hair
Sideroblastic anemia
Skin depigmentation
Neurologic dysfunction (eg, ataxia, peripheral neuropathy)
Osteoporosis
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Scombroid
Source
Spoiled dark-meat fish such as tuna, mahimahi, mackerel, and bonito
Mechanism
Bacterial histidine decarboxylase converts histidine to histamine
Frequently misdiagnosed as fish allergy
Symptoms
Mimics anaphylaxis
Acute burning sensation of mouth
Facial flushing
Erythema
Urticaria
Pruritis
May progress to bronchospasm, angioedema, hypotension
Peppery taste
Treatment
Antihistamines. Albuterol and epinephrine if needed
Symptoms: throbbing headache, palpitations, abdominal cramps , diarrhea
These typically begin 10-30 minutes after ingesting the fish, and are self-limited
Patients sometimes describe a bitter taste, but this is not always present
Physical findings may include skin erythema, wheezing, tachycardia and hypotension
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Hypophosphatemic Rickets
Vitamin D–resistant rickets
Phosphate wasting at proximal tubule
Rickets-like presentation
Can be secondary to Proximal renal tubular acidosis (type 2) which can be caused by Fanconi syndrome
Can be primary (X linked dominant)
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Systemic 1° Carnitine Deficiency
Inherited defect in transport of LCFAs into the mitochondria leads to toxic accumulation
Weakness
Hypotonia
Hypoketotic
Hypoglycemia
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Medium chain acyl-CoA dehydrogenase deficiency
Autosomal recessive disorder of fatty acid oxidation
Decreased ability to break down fatty acids into acetyl-CoA
Leads to accumulation of 8- to 10-carbon fatty acyl carnitines in the blood and hypoketotic hypoglycemia
May present in infancy or early childhood
Vomiting
Lethargy
Seizures
Coma
Liver dysfunction
Minor illness can lead to sudden death
Treat by avoiding fasting
Patient is asymptomatic until fasting occurs
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IIa—Familial hypercholesterolemia
Autosomal dominant
Absent or defective LDL receptors
Increased LDL, cholesterol
Heterozygotes (1:500) have cholesterol ≈ 300mg/dL; homozygotes (very rare) have cholesterol ≈ 700+ mg/dL
Accelerated atherosclerosis (may have MI before age 20)
Tendon (Achilles) xanthomas
Corneal arcus
Defective ApoB-100
Xanthelasmas
Although other body parts have LDL recptors, 70% of LDL is cleared by the liver
IIb - Familial hypercholesterolemia
In addition to cholesterol and LDL increase, there is a VLDL increase
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IV—Hypertriglyceridemia
Autosomal dominant
Hepatic overproduction of VLDL
Increased VLDL, TG
Hypertriglyceridemia (> 1000 mg/dL) can cause acute pancreatitis because the binding capacity of albumin becomes overwhelmed
Coronary disease
ApoA-V
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Ranolazine
Inhibits the late phase of sodium current thereby reducing diastolic wall tension and oxygen consumption
Indication: Angina refractory to other medical therapies
SE: Constipation, dizziness, headache, nausea, QT prolongation.
Does not affect heart rate or contractility
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Laron syndrome (dwarfism)
Defective growth hormone receptors
Decreased linear growth
Increased GH, decreased IGF-1
Clinical Features
Short height
Small head circumference
Characteristic facies with saddle nose and prominent forehead
Delayed skeletal maturation
Small genitalia
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Glucagonoma
Tumor of pancreatic α cells
Overproduction of glucagon
Dermatitis (necrolytic migratory erythema), typically affects the groin mostly (but also face/extremities)
Elevated, painful, pruritic, coalesces to form large lesion with central clearing and bronze colored induration
Blistering and scaling
Diabetes (hyperglycemia)
Easily controlled with oral agents & diet, Usually does not require insulin
DVT
Declining weight
Depression
Anemia
Glossitis, cheilitis, blepharitis
MEN 1 Association
Gastrointestinal symptoms: Diarrhea, anorexia, abdominal pain, or occasional constipation
Neuropsychiatric (eg, ataxia, dementia, proximal muscle weakness)
Treatment
Octreotide
Surgery
Diagnosis
Hyperglycemia with elevated glucagon >500 pg/ml
Abdominal imaging (computed tomography or magnetic resonance imaging) to localize tumor &/or metastases
Normocytic, normochromic anemia due to likely anemia of chronic disease or glucagon directly affecting erythropoiesis
GLUCAGON LEVELS reach >500pg/mL NOT GLUCOSE the diabetes is mild usually
Most glucagonomas are malignant and have metasta sis, mainly in the liver, at the time of diagnosis
Some of its clinical manifestations are due to the secretion of other peptides, such as VIP, calcitonin, and GLP1
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Somatostatinoma
Tumor of pancreatic δ cells
Overproduction of somatostatin
Decreased secretion of secretin, cholecystokinin, glucagon, insulin, gastrin
Symptoms
Diabetes/glucose intolerance
Steatorrhea
Gallstones because somatostatin decreases CCK secretion (decreased gallbladder contraction)
Can be hyperglycemia or hypoglycemic
Achlorhydria (due to inhibition of gastrin)
Inhibiting GI motility
Treatment
Surgical resection
Somatostatin analogs (eg, octreotide) for symptom control
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Salivary gland tumors
All Three
Most commonly in the parotid gland
Facial pain or paralysis suggests malignant involvement of CN VII
The facial nerve runs through the parotid gland
Pleomorphic adenoma
Benign mixed tumor which rarely transforms to a carcinoma (facial nerve invasion/pain)
Composed of chondromyxoid stroma and epithelium and recurs if incompletely excised or ruptured intraoperatively
Mobile, painless, circumscribed
Most common salivary gland tumor
Mucoepidermoid carcinoma
Most common malignant tumor
Mucinous and squamous components
Often involves the facial nerve
Warthin tumor
Alternative name: papillary cystadenoma lymphomatosum
Benign cystic tumor with germinal centers
Lymph node like stroma
Typically found in smokers. Bilateral in 10%; malignant in 10%.
Second most common
Almost always arises inthe parotid
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Esophageal Carcinoma
Both
Presents with progressive dysphagia (first solids, then liquids)
Weight loss
Pain; hematemesis
Poor prognosis; presents late
Lymph node spread: Upper 1/3 (cervical), Middle 1/3 (mediastinal and tracheobronchial), Lower 1/3 (celiac and gastric)
Can cause pseudoachalasia
Endoscopic evaluation can differentia te between achalasia and pseudoachalasia
Tumor metastasis (eg, mediastinal nodes) or local involvement may give a radiologic appearance similar to that seen with widened mediastinum
Definitive diagnosis of esophageal cancer requires esophageal endoscopy with biopsy
Young, low-risk patients with undetermined esophageal symptoms may start with barium esophagram
Surgery for definitive cure is advised for patients with limited-stage disease
Adenocarcinoma
Lower 1/3
Risk factors: Chronic GERD, Barrett esophagus, obesity, smoking, achalasia
More common in America
Arises from glandular tissue
Ulcerative/exophytic
Distal esophagus (from barretts)
Squamous Cell Carcinoma
Upper 2/3
Risk factors: Alcohol, hot liquids, caustic strictures, smoking, achalasia, esophageal web (Plummer-vinson), Injury (lye ingestion)
N-nitroso containing foods, betel nuts
More common worldwide
May have hoarse voice (Recurrent laryngeal) and cough (tracheal involvement)
Can cause GI bleed and iron deficiency anemia
Histology: Eosinophilic cytoplasm, keratin pearls, intercellular bridging
Plaque like thickening, may become ulcerated
Usually occurs in men over 50
Retrosternal discomfort/burning
U. In the USA its mostly due to alcohol and smoking
Caustic injestion is another cause
Arises anywhere in the esophagus
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Fludrocortisone
Synthetic analog of aldosterone with little glucocorticoid effects
Mineralocorticoid replacement in 1° adrenal insufficiency
Side Effects
Similar to glucocorticoids
Edema
Exacerbation of heart failure
Hyperpigmentation
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Cinacalcet
Sensitizes Ca2+-sensing receptor (CaSR) in parathyroid gland to circulating Ca2+ Žcausing a decrease in PTH
Indication: 1° or 2° (secondary in dialysis patients) hyperparathyroidism
Side Effects
Hypocalcemia
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Secondary and tertiary hyperparathyroidism
Secondary
2° hyperplasia due to decreased Ca2+ absorption and/or increased PO4 3−
Chronic renal disease (causes hypovitaminosis D Ždecreased Ca2+ absorption)
Hypocalcemia, hyperphosphatemia
Increased ALP and PTH
Renal osteodystrophy
Tertiary
Refractory (autonomous) hyperparathyroidism
Result of chronic renal disease
Highly increased PTH, increased calcium
Requires surgery
Bone pain and an elevated bone-specific alkaline phosphatase (due to high bone turnover)
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