Questions and Answers
TB is a common cause of exudative pleural effusions. It is characterized by pleural fluid with which 3 characteristics?
Very elevated protein (>4 g/dL), Lymphocytic leukocytosis, Low glucose levels
What is the most common cause of aortic stenosis in elderly patients?
Name 2 mast cell stabilizing agents indicated for the treatment of allergic conjunctivitis.
Olopatadine, Azelastine
What are the 3 most common causes of secondary digital clubbing?
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High titers of anti-TPO antibodies are associated with an increased risk of which complications in women with Hashimoto thyroiditis?
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Which of the following medications can be used for malaria chemoprophylaxis?
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What is the treatment for uremic encephalopathy?
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What is used to confirm the diagnosis of Primary Biliary Cholangitis (PBC)?
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What complication should be suspected in patients presenting with right-sided heart failure after pacemaker or defibrillator placement?
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____ can occur as a catastrophic complication of a AAA and should be suspected in patients with hypotension, tachycardia, distended neck veins, and pulsus paradoxus.
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Name the 2 most common peripheral artery aneurysms associated with AAA.
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Post-cardiac surgery pleural effusions that are small to moderate in size and not enlarging can be managed with ____.
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What is likely the diagnosis for a patient with nausea, dysphagia, chest pain, and a retrocardiac air-fluid level on imaging?
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What is the next step in managing complicated diverticulitis?
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What should be noted on imaging for focal nodular hyperplasia?
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Name 4 causes of anorectal fistula.
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What are the next steps for a patient diagnosed with postcholecystectomy syndrome?
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What should patients on warfarin who require urgent surgery with a high risk of bleeding receive?
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What is the treatment for emphysematous cholecystitis?
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What is a common cause of sialadenosis?
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Study Notes
Exudative Pleural Effusions in TB
- Characterized by very elevated protein levels (> 4 g/dL)
- Lymphocytic leukocytosis is common
- Low glucose levels present (often < 60 mg/dL)
Aortic Stenosis Causes
- Elderly: Degenerative calcification of aortic valve leaflets
- Younger individuals: Bicuspid aortic valve
- Nondeveloped countries: Rheumatic valve disease
Mast Cell Stabilizers
- Two agents indicated for allergic conjunctivitis:
- Olopatadine
- Azelastine
Secondary Digital Clubbing Causes
- Most common causes include:
- Lung malignancies
- Cystic fibrosis
- Right-to-left cardiac shunts
Hashimoto Thyroiditis and Anti-TPO Antibodies
- Over 90% of patients have antithyroid peroxidase (anti-TPO) antibodies
- High anti-TPO titers increase risk of progression to overt hypothyroidism
- Associated with increased risk of miscarriage in both euthyroid and hypothyroid women
Malaria Chemoprophylaxis
- High rates of chloroquine resistance in endemic countries
- Recommended chemoprophylaxis should start 2 weeks before travel, continue during, and for 4 weeks after
- Potential medications:
- Mefloquine
- Doxycycline
- Atovaquone-proguanil
Asterixis Causes and Treatments
- Can occur due to hepatic encephalopathy (HE), uremic encephalopathy, or hypercapnia
- Treatment for HE: Lactulose
- Treatment for uremic encephalopathy: Urgent hemodialysis
Primary Biliary Cholangitis (PBC)
- Chronic liver disease due to autoimmune destruction of small bile ducts
- Common in middle-aged women, symptoms include fatigue and pruritus
- Diagnosis confirmed by serum anti-mitochondrial antibody titers
Transvenous Lead Placement Complications
- Can lead to severe tricuspid regurgitation due to valve leaflet damage
- Symptoms to suspect: Right-sided heart failure after pacemaker or cardioverter-defibrillator placement
Cardiac Tamponade and AAA
- Can occur as a catastrophic complication of abdominal aortic aneurysm (AAA)
- Signs: Hypotension, tachycardia, distended neck veins, pulsus paradoxus, sudden onset tearing chest pain radiating to the back
Peripheral Artery Aneurysms
- Two most common peripheral artery aneurysms associated with AAA:
- Popliteal artery
- Femoral artery
Post-Cardiac Surgery Pleural Effusions
- Manage with observation if:
- Small to moderate size
- Early onset (post-operative day 1 or 2)
- No respiratory symptoms present
Paraesophageal Hiatal Hernia
- Symptoms include nausea, dysphagia, chest pain, and retrocardiac air-fluid levels on imaging
- Condition characterized by the gastric fundus migrating into the thoracic cavity
Complicated Diverticulitis Management
- Refers to diverticulitis with abscess, perforation, obstruction, or fistula
- Next step: Percutaneous abscess drainage under CT guidance
- Surgical drainage if percutaneous method fails
Focal Nodular Hyperplasia Imaging
- Associated with anomalous arteries
- Imaging findings: Arterial flow and central, stellate scar
Causes of Anorectal Fistula
- Secondary to several conditions, including:
- Rupture of perianal abscess
- Crohn's disease
- Malignancy/radiation proctitis
- Infection (lymphogranuloma venereum)
Postcholecystectomy Syndrome
- Next steps in management include:
- Abdominal ultrasound
- Endoscopic retrograde cholangiopancreatography (ERCP)
Urgent Surgery for Warfarin Patients
- Patients requiring urgent surgery and are on warfarin should receive:
- Prothrombin complex concentrate (PCC) and IV vitamin K
- Alternative if PCC is unavailable: Fresh frozen plasma (FFP)
Emphysematous Cholecystitis Treatment
- Management requires emergent cholecystectomy
- Broad-spectrum antibiotics with Clostridium coverage (e.g., piperacillin-tazobactam)
Sialadenosis
- Benign, non-inflammatory enlargement of salivary glands
- Commonly associated with chronic alcohol use
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Description
This quiz covers important medical concepts related to exudative pleural effusions and aortic stenosis. Test your knowledge on the characteristics of pleural fluid in TB and the causes of aortic stenosis across different demographics. Perfect for medical students preparing for their Step 2 examinations.
