- Clinical Findings & Diagnostic Criteria
- Etiology
- Pathology
- Epidemiology
- Management & Treatment
- Prevention
- Complications
- Prognosis
- Research Frontier
- Clinical Case Studies
- Study Questions
Symptoms
Signs
A whitening of the top layer of the tongue or the presence of white spots or patches on the tongue can also be seen withinfection, irritation, or chronic inflammation of the surface of the tongue. Certain oral infections, notably Candida yeastinfections (known as oral thrush), are characterized by a whitetongue.Jan 31, 2017
Most people with pyelonephritis do not have complications if appropriately treated with bacteria-fighting medications called antibiotics.
In rare cases, pyelonephritis may cause permanent kidney scars, which can lead to chronic kidney disease, high blood pressure, and kidney failure. These problems usually occur in people with a structural problem in the urinary tract, kidney disease from other causes, or repeated episodes of pyelonephritis.
Infection in the kidneys may spread to the bloodstream—a serious condition called sepsis—though this is also uncommon.
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Mr. Riviera is a 42-year-old man with anuric end-stage renal disease due to diabetes mellitus. Due to recent car trouble, he missed his most recent dialysis appointment and presents to the emergency department with shortness of breath. His heart rate is 105 bpm, and blood pressure is 185/100 mmHg. He has fine rales in the bilateral lower lung fields, and his jugular venous pulse is elevated. ECG shows sinus tachycardia without ST deviation. Initial troponin I assay returns at 0.14 ng/dL (normal is <0.06 ng/dL). What are the next most appropriate therapeutic and diagnostic steps?
The correct answer is E. You answered E.
The answer is E. (Chap. 294) It is important to remember that although cardiac troponin biomarkers (troponin I or T) are quite sensitive for myocardial infarction due to coronary occlusion, they lack somewhat in specificity. In patients without a clear clinical history of myocardial ischemia, minor cardiac troponin elevations have been reported and can be caused by congestive heart failure, myocarditis, or pulmonary embolism; in addition, using high-sensitivity assays, they may occur in ostensibly normal subjects. Thus, in patients with an unclear history, small elevations of cardiac troponin, especially if they are persistent, may not be diagnostic of an ACS. In this patient, the troponin elevation is likely due to his hypertensive urgency brought on by missed hemodialysis and volume overload. Treating the proximal cause will help him. It would be prudent to continue to trend cardiac biomarkers and ECGs over time as well.
A 75-year-old triathlete complains of gradually worsening vision over the past year. It seems to be involving near and far vision. The patient has never required corrective lenses and has no significant medical history other than diet-controlled hypertension. He takes no regular medications. Physical examination is normal except for bilateral visual acuity of 20/100. There are no focal visual field defects and no redness of the eyes or eyelids. Which of the following is the most likely diagnosis?
The correct answer is A. You answered A.
Age-related macular degeneration is a major cause of painless, gradual bilateral central visual loss. It occurs as nonexudative (dry) or exudative (wet) forms. Recent genetic data have shown an association with the alternative complement pathway gene for complement factor H. The mechanism link for that association is unknown. The nonexudative form is associated with retinal drusen that leads to retinal atrophy. Treatment with vitamin C, vitamin E, beta-carotene, and zinc may retard the visual loss. Exudative macular degeneration, which is less common, is caused by neovascular proliferation and leakage of choroidal blood vessels. Acute visual loss may occur because of bleeding. Exudative macular degeneration may be treated with intraocular injection of a vascular endothelial growth factor antagonist (bevacizumab or ranibizumab). Blepharitis is inflammation of the eyelids usually related to acne rosacea, seborrheic dermatitis, or staphylococcal infection. Diabetic retinopathy, now a leading cause of blindness in the United States, causes gradual bilateral visual loss in patients with long-standing diabetes. Retinal detachment is usually unilateral and causes visual loss and an afferent pupillary defect.
Mr. Jenson is a 40-year-old man with a congenital bicuspid aortic valve who you have been seeing for more than a decade. You obtain an echocardiogram every other year to follow the progression of his disease knowing that bicuspid valves often develop stenosis or regurgitation requiring replacement in middle age. Given his specific congenital abnormality, what other anatomic structure is important to follow on his biannual echocardiograms?
The correct answer is A. You answered A.
The answer is A. (Chap. 282) Bicuspid aortic valve is among the most common of congenital heart cardiac abnormalities. Valvular function is often normal in early life and thus may escape detection. Due to abnormal flow dynamics through the bicuspid aortic valve, the valve leaflets can become rigid and fibrosed, leading to either stenosis or regurgitation. However, pathology in patients with bicuspid aortic valve is not limited to the valve alone. The ascending aorta is often dilated, misnamed “poststenotic” dilatation; this is due to histologic abnormalities of the aortic media and may result in aortic dissection. It is important to screen specifically for aortopathy because dissection is a common cause of sudden death in these patients.