Divine Intervention

Thyroid biopsy is full of lymphoid follicles?

This is the number 1 cause of __

Can cause?

-Hashimoto’s

-hypothyroidism

-thyroid lymphoma

Exogenous thyroid hormone delivery in patients with factitious hyperthyroidism will have (high/low) thyroglobulin

-low(it’s the c-peptide of thyroid)

Newborn has umbilical hernia and macroglossia?

Main cause of this?

-congenital hypothyroidism

-thyroid dysgenesis

MEN types

What are the 2 high-intensity statins?

These reduce LDL by how much?

-atorvostatin and rosuvastatin

-more than 50%

Statin indications

What 3 pathologies result from vitamin B6 deficiency?

-seizures, sideroblastic anemia, and abnormal LFTs

What meds put a patient at-risk for a folate deficiency?

-valproate

Patient has Wilson’s disease and is treated with trientine, what mineral may they become deficient in? Why?

-zinc; it chelates both copper and zinc

What vitamin deficiency causes acanthocytosis and ataxia?

-vitamin E deficiency

Criteria for using SSRIs

What must be asked before medicating depression?

-if there’s any episodes of mania

Treatment for anxiety or panic attacks?

-one time benzo

PTSD treatment?

-prazosin or CBT

What drug can be used for bulimia?

-fluoxetine

Liver injury that has hepatocellular pattern vs choleric pattern?

-AST/ALT levels are elevated in hepatocellular pattern; alk phos/GGT levels are elevated in choleric pattern

Why are steroids give to alcoholic liver damage?

-to preserve liver function

Criteria for liver transplant?

-MELD score over 18, and Marjorie score over 32

Hep B serology

If a patient is at-risk of contracting Hep B, and is unvaccinated?

If vaccinated?

-give vaccine and IVIG

-nothing!

Special Hep B treatments

What 2 diseases are associated with Hep B, where a history of Hep B decides your diagnosis?

-PAN(look for abdominal pain, asymmetric neuro deficits, and ANCA-negative) and membranous nephropathy(nephrotic syndrome)

Porphyria Cutanea Tarda is linked to Hep __

-C

Older man with pigmented skin, ED, and arthritis?

-hemochromatosis

Very obese with elevated LFTs?

-NAFLD

PBC vs PSC

All cirrhosis patients need to be screened how?

-US every 6 months for HCC

Cirrhosis with high creatinine? These labs present the same as what type of AKI?

Cirrhosis with SOB and high A-a gradient?

Cirrhosis with SOB and high RV pressure?

-hepatorenal syndrome; pre-renal azotemia

-hepatopulmonary syndrome

-portal-pulmonary HTN

Treatment for all major GI bleeds?

What meds are options to give, too?

Scanning steps for finding the bleeding?

-2 large bore IVs, then fluids(plus blood if Hb is less than 7)

-octreotide and PPIs

-EGD, then colonoscopy, then tagged RBC scan

SBP treatment?

-albumin and cef

SAAG looks for __

-portal HTN

Varices

Treatment for ascites?

-furosemide

Patient in first trimester pregnancy has severe vomiting?

Outpatient treatment?

Inpatient?

-hyperemesis gravidarum

-vitamin B6 and doxyline

-hydration, thiamine, and anti-emetic

2nd/3rd trimester pregnancy and pruritis?

-intrahepatic cholestasis

HELLP syndrome?

If there was coma or encephalopathy?

-hemolysis(indirect hyperbilirubinemia), elevated liver enzymes, and low platelets

-this is actually not HELLP, but acute fatty liver of pregnancy

Treatment of acalculous cholestitis?

-cholecystostomy

Criteria for acute pancreatitis?

-RANSOM criteria

Mirizzi syndrome

Pneumobilia with dilated bowel loops, hyperactive bowel sounds, and intermittent vomiting?

-gallstone ileus

Patient has A fib, with acute severe abdominal pain?

-acute mesenteric ischemia

Patient has aortic stenosis, microcytic anemia, and bloody stool?

-Heyde syndrome