1 Flashcards
how to tx uncomplicated cystitis
TMP-SMX- 3ds nitrofurantoin- 5ds fosfomycin- 1x FQs if cannot take above (sulfa allergy) or high resistance *can tx without urine culture
what makes cystitis complicated
DM, CKD, immunocompromised, pregnant, urinary tract obstruction, hospital-acquired, infection with procedure, indwelling FB (cath)
how to tx complicated cystitis
get a urine culture
abx: FQs i.e. levofloxacin, cipro
may require ceftriaxone if more severe
if UA shows large blood but there is lack of RBCs on ur microscopy, think?
myoglobinuria from rhabdomyolysis
or hemoglobinuria
when to consider SIADH
hypotonic hyponatremia but euvolemia (water is reabsorbed)
low serum osm less than 275 (“dilute” blood)
high urine osm more than 100 (concentrating urine)
high urine sodium concentration more than 40 (losing salt)
membranoproliferative glomerulonephritis
dense intramembranous deposits that stain for C3 (type 2)
caused by IgG Abs (C3 nephritic factor) against C3 convertase of alternative complement pathway->persistent pathway activation and kidney damage
asterixis is seen in
hepatic encephalopathy, uremic encephalopathy, CO2 retention
indications for urgent dialysis
AEIOU
Acidosis, metabolic: refractory pH less than 7.1
E-lyte abnormalities: symp. hyperK (EKG change, V arrhyth) or severe refractory hyperK >6.5
Ingestion: tox. etOHs, salicylate, lithium, valproic acid, carbamazepine
Overload
Uremia: symptomatic: enceph, pericarditis, bleeding
meds that can induce crystal-induced AKI (renal tubular obstruction)
acyclovir, sulfa, MTX, ethylene glycol, protease inhibitors
*give fluid with drug
AIN usually occurs after ? days of drug exposure
7-10
muddy brown granular casts RBC casts WBC casts fatty casts broad, waxy casts
muddy brown granular casts -ATN RBC casts -glomerulonephritis WBC casts -interstitial nephritis, pyelo fatty casts -nephrotic syndrome broad, waxy casts -chronic renal failure
pathogenesis of uremic coagulopathy in chronic renal failure
what can be used to tx?
platelet dysfunction: plt-plt and pot-vessel wall interactions
i.e. aPTT, PT, and TT are normal, BT is prolonged
DDAVP (desmopressin): increases release of factor VIII: vW factor multimers from endothelium
also: cryoprecipitate, conj. estrogens
if albumin is decreased, how to correct calcium
normal albumin: 4, normal calcium: 10
therefore, if albumin is 3 (dec. by 1) calcium may measure at 9.2, but correct it by 0.8(each 1 pt reduction in albumin)
i.e. this would be 10
how to tx hypercalcemia
fluids, bisphosphonates, diuretics (inhibit calcium reabsorption)
maybe calcitonin if severe
when to get 1,25-vitamin D vs 25-vitamin D
get 1,25-vit D in granulomatous disease (i.e. sarcoidosis) and 25-vit D in vitamin D deficiency
symptoms of amyloidosis
proteinuria, nephrotic syndrome
restrictive cardiomyopathy, LVH (w/o hx of HTN)
anemia, GI bleed, early satiety
subQ nodules, enlarged tongue
mottled, cold LE, think?
acute limb ischemia from arterial occlusion
typically from cardiac emboli, thrombosis, or trauma
“livedo reticularis”
how to tx stable vs unstable Vtach
stable: IV amiodarone
unstable: synch. cardioversion
unstable Vtach
hypotension, signs of shock, AMS, resp. distress, persistent tachycardia, acute HF, pulmonary edema
how to ddx Vtach and SVT with aberrancy
both wide-complex tachycardias
presence of AV dissociation and fusion/capture beats supports Vtach
hypokalemia can potentiate to toxicity of what med
digoxin
SEs of amiodarone
hypo/hyperthyroidism, hepatotoxicity, bradycardia/heart block, prolonged QT, torsades de pointes, interstitial pneumonitis, peripheral neuropathy, visual disturbances, hepatitis/transaminitis, blue-gray skin
*monitor LFTs and TFTs
murmur of HOCM increases with?
LESS blood in heart (decreased preload)
i.e. valsalva, standing, nitro admin
murmur of HCM decreases with?
MORE blood in heart (increased after load and/or increased preload)
i.e. hand grip, squatting, passive leg raise
