UWORLD 3-4

diagnosis of acute pancreatitis?

2 of the following: characteristic epigastric pain serum amylase/lipase >3 times imaging

Acute necrotic collection (ANC)?

A collection containing variable amounts of both fluid and necrosis associated with necrotizing pancreatitis; the necrosis can involve the pancreatic parenchyma and/or the peripancreatic tissues

Walled-off necrosis (WON)?

A mature, "encapsulated" collection of pancreatic and/or "peripancreatic" necrosis that has developed a well defined inflammatory wall. WON usually occurs >4 weeks after onset of necrotizing pancreatitis.

Treatment of acute pancreatitis

Aggressive IV fluid Pain control NPO, nasopharyngeal feed if oral intolerance > 3-4 days

Pancreatic pseudocyst?

An "encapsulated" collection of fluid with a well defined inflammatory wall usually outside the pancreas with minimal or no necrosis. This entity usually occurs more than four weeks after onset of interstitial edematous pancreatitis to mature.

classification of leukocytoclastic vasculitis?

IgA vasculitis (Henoch-Schönlein purpura) Acute hemorrhagic edema of infancy Urticarial vasculitis Cryoglobulinemic vasculitis Erythema elevatum diutinum Granuloma faciale ANCA-associated vasculitis Arthropod bites Platelet dysfunction or deficiency Cholesterol emboli Septic emboli Livedoid vasculopathy

when to do ERCP in the course of acute pancreatitis?

In patients with "gallstone pancreatitis", urgent (<24 hours) ERCP and sphincterotomy for patients with cholangitis

which diuretics cause photo-sensitivity?

Thiazides

CT scan of necrotizing pancreatitis with peripancreatic necrosis?

pancreas enhances "homogeneously" (arrow) but there is evidence of peripancreatic necrosis (arrowhead).

In patients with infected necrosis who fail to respond to antibiotics or who are clinically unstable do what?

pancreatic debridement

dermatitis herpetiformis

seen in Celiac dx

perianal skin tag

seen in Crohn's dx

pyoderma gangrenosum

seen in Crohn's dx

lichen planus

seen in HCV

porphyria cutanea tarda

seen in HCV

Explosive onset of multiple itchy, seborrheic keratosis is associated with what conditions?

GI cancer

neuropathic pain in MS

Gabapentin Duloxetine

severe seborrhic dermatitis is associated with what conditions?

HIV parkinson

Pseudocyst vs WON?

"Reguar" wall border

CT scan of acute interstitial edematous pancreatitis

"heterogeneous" appearance of the pancreas (arrow) and peripancreatic fat stranding (arrowhead)

WON CT scan?

"irregular" wall border

Contrast-enhanced computed tomography criteria for APFC?

1. Occurs in the setting of interstitial edematous pancreatitis 2. Homogeneous collection with fluid density 3. Confined by normal peripancreatic fascial planes 4. NO definable wall encapsulating the collection 4. Adjacent to pancreas (NO intrapancreatic extension)

Contrast-enhanced computed tomography criteria for pseudocyst?

1. Well circumscribed, usually round or oval 2. Homogeneous fluid density 3. No non-liquid component 4. Well defined wall (ie, completely encapsulated) 4. Maturation usually requires ">4 weeks" after onset of acute pancreatitis; occurs after interstitial edematous pancreatitis

Acute pancreatitis can be divided into two broad categories?

1. edematous, interstitial 2. necrotizing

what are skin conditions associated with HIV?

1. sudden-onset severe psoriasis 2. recurrent herpes zoster 3. Disseminated molluscum contagiosum

acute peripancreatic fluid collection (APFC) vs. Pseudocyst?

APFC=> first 4 weeks pseudocyst=> "AFTER" 4 weeks

Tamponade signs?

Beck triad: hypotension, JVD, muffled heart sounds pulsus paradoxus (SBP ~>10 with inspiration)

leukocytoclastic vasculitis?

Cutaneous small-vessel vasculitis, also known as hypersensitivity vasculitis, cutaneous leukocytoclastic vasculitis, hypersensitivity angiitis, cutaneous leukocytoclastic angiitis, cutaneous necrotizing vasculitis and cutaneous necrotizing venulitis.

dupuytren contracture risk factors?

DM male, >50yo, family hx smoking alcohol

skin tags are associated with what conditions?

DM obesity metabolic sx insulin resistance pregnancy colonic polyps

Diagnosis of cardiac tamponade

ECG: low voltage, elec. alternans CXR: clear lung, enlarged cardiac silhouette Echo: RA and RV "collapse", plethora of IVC

Treatment of infected necrosis in acute pancreatitis?

Empiric antibiotics "NOT CT-guided fine needle aspiration"

DOC for narcolepsy?

Modafinil

Routine abdominal computed tomography (CT) scan is.......... recommended at initial presentation in patients with acute pancreatitis unless there is..............about the diagnosis

NOT Uncertainty

When to do CT scan in the course of acute pancreatitis?

Patients with severe acute pancreatitis, signs of sepsis, or clinical deterioration 72 hours after initial presentation, should undergo a "contrast-enhanced CT scan" to assess the presence of pancreatic or extrapancreatic necrosis and local complications.

APFC features?

Peripancreatic fluid associated with interstitial edematous pancreatitis with NO associated peripancreatic necrosis. This term applies only to areas of peripancreatic fluid seen within the first four weeks after onset of interstitial edematous pancreatitis and without the features of a pseudocyst.

DOC for cataplexy?

SNRI SSRi TCA

Both ANC and WON are initially sterile but may become infected. T/F?

T.

thyroid hormon resistance

^TSH ^T3, T4 diffuse goiter NL SHBG NL alpha-subunit

pregnancy and MS

acute exaecerbations are managed the same higher risk of asissted delivery and cesarean

how to treat Fatigue in MS?

amantadin stimulants

why stop estrogen receptor modulators before surgery?

assoaciated with DVT stop 4wks prior surgery

Treatment of sarcoidosis

asymptomatic=> no Rx symptomatic=>12-24months of steroid most cases resolve over time and DO NOT recur

cherry angioma

benign no Rx

what drugs in MS can decrease frequency of exacerbations?

beta-interferon glitamer

Ehrlichiosis vs chikungunya fever?

both have arthralgia, fever etc. but in Ehrlichiosis, there is significant lab abnormality (leukopenia, low plt, high LFT)

Acute pancreatitis Etiology

chronic alcohol use gallstone dx hyper TG, hypercalcemia valporate, diuretics infection (CMV, HIV, ascariasis) trauma, ischemia, post-ERCP

pathogenesis of atopic dermatitis?

mutations affecting filaggrin & other key components of epidermal permeability barrier

if pt develops DVT while on menopausal hormone therapy (MHT) do what?

discontinue MHT begin "SSRI/SnRI" FOR HOT FLASHES!!!!!

what about EF in chronic MR?

effective EF is lower than estimated echo findings due to MR. Hence in chronic MR, EF<60% is considered impaired LV systolic function

spider angioma

esterogen dependent seen in cirrhosis

strawberry hemangioma

grow rapidly regress spontaneously manage consertaviley "beta-blockers" for ulcerating lesions

Rx of dupuytren contracture

hand tools needle aponeurotomy intralesional steroid surgery

lab findings in atopic dermatitis

high IgE Eosinophilia ^leukocyte phosphodiesterase

Lab features of sarcoidosis

hypercalcemia, hypercalciuria ^serumACE levels

what are electrolyte causes of MAT?

hypokalemia hypomagnesemia

When to suspect infected necrosis in acute pancreatitis?

in patients with pancreatic or extrapancreatic necrosis who deteriorate (clinical instability or sepsis physiology, increasing WBCt, fevers) or fail to improve after 7 to 10 days of hospitalization.

leukocytoclastic vasculitis?

inflammation of small blood vessels (usually "post-capillary venules" in the dermis), characterized by palpable purpura. It is the most common vasculitis seen in clinical practice.

acanthosis nigricans is associated with what conditions?

insuln resistance GI cancer

intussusception

target sign

Urge urinary incontinency in MS

timed voiding fluid restriction anticholinergic (oxybutinin, tolterodine)