This is a common cause of false positive VDRL in women or pregnancy age
Antiphospholipid antibody syndrome
-so positive VDRL needs to be confirmed with FTA-ABS
Describe the pathophysiology and Bleeding lab findings in Antiphospholipid antibody syndrome causing spontaneous abortions
- Can promote arterial and venous thrombosis and resultant tendancy toward spontaneous abortions
- Thrombocytopenia and prolonged PTT are also common findings
Positive VDRL, Negative FTA-ABS, thrombocyopenia, and prolonged PTT in pregnant women . . what should be started
Low molecular weight heparin and aspirin
Cyclosporine and tacrolimus have the same mechanism of action which is what?
-Calcineurin inhibitors
Toxicity of Cyclosporine
- Nephrotoxicity
- Hyperkalemia
- HTN
- GUM HYPERTROPHY
- HIRSUTISM
- tremor
Toxicity of Tacrolimus
- Same as Cyclosporine WITHOUT gum hypertrophy and hirutism
- nephrotoxicity
- Hyperkalemia
- HTN
This is a purine analog that is enzymatically converted to 6-mercaptopurine. it acts primarily by inhibiting purine synthesis
Azathioprine
Major toxicities of Azathioprine
- Dose related diarrhea
- Leukopenia
- Hepatotoxicity
This is a reversible inhibitor of Inosine monophosphate dehydrogenase (IMPDH) which is the rate limiting enzyme in de novo purine synthesis
Mycophenolate
What is the major toxicity of mycophenolate
Bone MARROW suppression
-Think Marrow Mycophenolate
Risk factors for HIV-associated neurocognitive disorders
- Long-standing HIV disease
- Age 50 or older
- CD4 count < 200
HIV-associated neurocognitive disorder is characterized by a chronic decline in multiple cognitive domains (eg, memory, attention, calculation, executive function). Mood and behavior disturbances are common. The diagnosis is based primarily on clinical features and neuropsychological testing, but MRI may also be helpfus and shows what?
diffuse increase in the intensity in the white matter
Progressive Multifocal leukoencephalopathy is caused by reactivation of the JC virus and has an increased incidence in patients with chronic HIV disease. symptoms include AMS, motor deficits, ataxia, and vision abnormalties. MRI shows what?
Focal, asymmetric (rather than diffuse) lesions
“bath salts” are synthetic cathinones, which consist of a large family of amphetamine analogues. As such, they may increase the release, or inhibit the reuptake, or norepinephrine, dopamine, and serotonin. Symptoms of intoxication include what?
- Severe agitation
- Combativeness
- psychosis
- Delirium
- myoclonus
- rarely, seizures
- Increased sympathetic outflow may lead to significantly increased BP and HR
What is the most distinguishing features of synthetic cathinone intoxication (bath salts)
- Prolonged duration of effect
- Delirium and psychosis due to bath salts may last up to a week whereas the effects of intoxication with other amphetamines or hallucinogens are usually of much shorter duration
Do normal drug screens test for bath salts?
no
Do normal drug screens test for PCP
yes
distinguishing characteristic of PCP intoxication
multidirectional nystagmus
symptoms of Opioid withdrawal
- dilated pupils
- piloerection
- dysphoria
- myalgia
- abdominal pain
CVID is one of the most common primary immunodeficiences in adults. Most cases of CVID are due to SPORADIC mutation, and family history of the disease is typically absent the majority of patients are diagnosed in adulthood ( age 20-45) due to a combination of variable presentation and diagnostic delay. How is diagnosis made
Quantitative measurement of immunoglobulin levels (significantly reduced serum IgG with low levels of IgA and/or IgM) as well as by markedly reduced or absent immune response to vaccination
Trastuzumab is a monoblonal antibody often used in combination with adjuvant chemo in patients with HER2-positive breast cancer. What is a known adverse effect of this medication?
- Cardiotoxicity that usually manifests as an asymptomatic decline in left ventricular ejection fraction; however, overt heart failure can occur
- The risk and extent of cardiotoxicity are amplified when trastuzumab is used in combination with chemotherapy agents that are also cardiotoxic (eg, doxorubicin)
Prior to initiating Trastuzumab, patients should undergo what testing?
-Baseline assessment of cardiac function by echocardiography
Inability to lift the skin on the dorsum of the second toe (positive stemmer sign) is highly specific for what?
lymphedema . . disruption of the lymphatic system
Acute dystonia, which is a type of extrapyramidal symptoms can occur with antiemetics that are dopamine antagonists such as what?
- Metoclopramide
- Prochlorperazine
- Promethazine
