By M. Agenak. Smith Chapel Bible College. 2017.
The joint inﬂammation is triggered by bacterial infection at a distant site proven super cialis 80 mg, usually in the gastrointestinal or genitourinary tract cheap super cialis 80 mg with visa. Not everyone who develops these bacterial infections will develop reactive arthritis. Some people are genetically susceptible and the inheri- tance of the HLA-B27 gene increases the risk of 126 thefacts AS-17(125-142) 5/29/02 5:55 PM Page 127 Spondyloarthropathies Table 5 The European Spondyloarthropathy Study Group (ESSG) criteria for classifying disease as a spondyloarthropathy Spondyloarthropathy is deﬁned as the presence of inﬂammatory spinal pain or synovitis and one or more of the following: • family history: presence, in ﬁrst- or second-degree relatives, of: ankylosing spondylitis, psoriasis, acute iritis, reactive arthritis, or inﬂammatory bowel disease. The disease tends to be more severe and more likely to become chronic in people with a triggering infection that is symptomatic and proven by bacterial culture, espe- cially if they are born with the HLA-B27 gene, than if the triggering infection produces no symp- toms and is suggested only by a positive antibody test. Depending on the bacterial trigger, reactive arthritis can be more common in men than in women. Table 6 lists some of the important bac- terial triggers. Genitourinary tract infection with Chlamydia is the more commonly recognized initia- tor in the US, but enteric infections with Shigella, Salmonella, Yersinia, or Campylobacter are more com- mon triggers in developing countries. Sometimes there is no recognized antecedent infection, or the triggering infection may be asymptomatic. The term reactive arthritis is often used when the identity of the triggering organism is known, and it encom- passes the more restrictive and less commonly used term Reiter’s syndrome. Table 6 Bacteria triggering reactive arthritis Chlamydia trachomatis Shigella ﬂexneri Salmonella (many species) Yersinia enterocolitica and Y. The prevalence of reactive arthritis in a population varies with that of HLA-B27 and the triggering bac- terial infections. Chlamydia-induced reactive arthri- tis is most commonly seen in young promiscuous men. However, it is under-diagnosed in women because their chlamydial infection is often subclini- cal or asymptomatic, and also because doctors rarely do pelvic examinations to look for the presence of cervicitis (inﬂammation of the cervix, the part of the uterus that protrudes into the vagina). The post-enteritic form of the disease affects children and adults, both male and female, including elderly people. The incidence of Chlamydia-induced reactive arthritis has declined since 1985 in Europe and the US, but the post-enteritic form of the disease may be increasing. After some epidemics of bacterial gastroenteritis or food poisoning (e.
After 18 hours trusted super cialis 80 mg, she becomes symptomatic buy super cialis 80 mg low price, and her blood is drawn. The serum glucose concentration is 48 mg/dl, the serum insulin level is high, and test results are negative for insulin antibodies. The C-peptide level is low, and tests for sulfonylurea and meglitinides are negative. Which of the following is the most likely diagnosis for this patient? Noninsulinoma pancreatogenous hypoglycemia syndrome (NIPHS) D. Insulin autoimmune hypoglycemia Key Concept/Objective: To be able to recognize the patient with factitial hypoglycemia Factitial hypoglycemia is more common in women and occurs most often in the third or fourth decade of life. Many of these patients work in health-related occupations. Factitial hypoglycemia results from the use of insulin or drugs that stimulate insulin secretion, such as sulfonylureas or meglitinides. The possibility of factitial hypoglycemia should be con- sidered in every patient undergoing evaluation for a hypoglycemic disorder, especially when the hypoglycemia has a chaotic occurrence—that is, when it has no relation to meals 3 ENDOCRINOLOGY 15 or fasting. The diagnosis of factitial hypoglycemia can usually be established by measur- ing serum insulin, sulfonylurea, and C-peptide levels when the patient is hypoglycemic. In a patient whose hypoglycemia results from covert use of a hypoglycemic agent, the agent will be present in the blood. In insulin-mediated factitial hypoglycemia, the serum insulin level is high and the C-peptide level is suppressed, usually close to the lower limit of detec- tion, as seen in this patient. A 38-year-old man is brought to the emergency department after a generalized seizure. The complete blood count and results of a blood chemistry 7 panel are normal, with the exception of a low glucose level. A head CT is negative, and a lumbar puncture reveals no evidence of infection. After the patient is stabilized and able to give a history, he tells you that he has been experiencing episodes of dizziness, confusion, headache, blurred vision, and weakness for the past month. The episodes always occur about 2 hours after he eats.
Which of the following antimicrobial regimens would be recommended in the treatment of this patient? Key Concept/Objective: To understand the need of treating patients with gonococcal urethritis for both Neisseia gonorrhea and Chlamydia trachomatis Patients with evidence of gonococcal infection on urethral Gram stain should be treat- ed for gonorrhea generic super cialis 80 mg on line. Recommended regimens include single doses of the following agents: (1) cefixime purchase 80 mg super cialis with visa, 400 mg p. Consequently, quinolones are no longer recommended for the empirical treatment of gonorrhea in persons in these areas or in their contacts. Because of the high chlamydial coinfection rate, all patients with gonorrhea should also be treated for Chlamydia, unless that diagnosis has been microbiologically excluded. Treatment for presumptive chlamydial infection in men with nongonococcal urethritis is with azithromycin in a single 1 g oral dose or doxycycline, 100 mg orally twice a day for 7 days. A 28-year-old woman presents to clinic for the evaluation of vaginal discharge and pruritus. Which of the following is NOT a component of the Amsel criteria for the diagnosis of bacterial vagi- nosis (BV)? Presence of a homogeneous, thin vaginal discharge B. Presence of amine odor when vaginal fluid is mixed with 10% potassium hydroxide (KOH) Key Concept/Objective: To recognize the Amsel criteria for the diagnosis of BV BV is the most common cause of vaginal discharge in women of reproductive age. Prevalence studies have found BV in 10% to 40% of women tested, with higher rates of infection in women tested in STD clinics and in African Americans. Douching and use of intrauterine devices (IUDs) have also been associated with BV. Physical examination 76 BOARD REVIEW of women with BV typically reveals a homogeneous, white, uniformly adherent vagi- nal discharge. The Amsel criteria for the diagnosis of BV include the following: (1) pres- ence of a homogeneous, thin vaginal discharge; (2) vaginal pH greater than 4. The presence of three of the four criteria establishes the diagnosis. A 24-year-old woman presents to the emergency department for evaluation of fever and dull lower- abdominal pain. The patient is sexually active; she reports the onset of her symptoms corresponded with the start of menses 10 days ago.