Day 5- nephrology, infx disease Flashcards
1
Q
nephrotic syndrome + retinopathy = think?
A
DM nephropathy
2
Q
Familial HypOcalcuric HypERcalemia –> Ca levels in Serum and Urine?
A
- High Ca in Serum
- Low Urine Ca
3
Q
Blood Ca high next steps?
A
1) See if related to albumin
2) See if PTH causing
3) Check Urine Ca level
4
Q
Hyperparathyroidism –> Ca levels in Serum and Urine?
A
Both high
5
Q
Sestamibi scan looks for?
A
Parathyroid adenomas
6
Q
HypERcalcemia causes what EKG findings?
A
Short QT syndrome
7
Q
HypOcalcemia causes what EKG findings?
A
Long QT syndrome
8
Q
dysmorphic RBC = think where is the problem?
A
glomerulus –> glomerular nephritis
9
Q
RBC casts = think where is the problem?
A
glomerulus –> glomerular nephritis
10
Q
Gold standard/best to localize and determine which type of glomerular nephritis ?
A
Renal biopsy
11
Q
Anorexia has what type of metabolic derangement?
A
Hypochloremic Metabolic Alkalosis
12
Q
WBC casts = think?
A
Pyelonephritis
13
Q
sore throat –> >1wk later kidney disease = think?
A
Poststrep Glomerulonephritis
14
Q
sore throat –>
A
IgA nephritis
15
Q
How to differentiate b/t Poststrep Glomerulonephirtis and IgA nephritis
A
Timeline!
>1wk from sore throat to kidney disease = PSG
16
Q
Interstitial nephritis look for what buzzword?
A
Eosinophil
17
Q
muddy brown casts = think?
A
Acute tubular necrosis
18
Q
muddy brown casts + eosinophils - think?
A
Interstitial nephritis
19
Q
anion gap
A
normal!
20
Q
anion gap > 15 = think?
A
MUDPILES
21
Q
What are 2 main causes of focal segmental glomerulosclerosis?
A
- HIV
- IV drug use
22
Q
Membranoproliferative glomerulonephritis is associated w/ what disease?
A
Hep C
23
Q
leg trauma (or trauma not to kidney/abdomen) + hematuria = think?
A
Rhabdomyolysis
24
Q
Rhabdomyolysis - helpful labs?
A
- Urinanalysis
- Serum Creatinine Kinase
25
tense extremity = think?
compartment syndrome
26
Na high, K low = think?
HypERaldosteronism
27
Aldosterone causes what metabolic derangement?
Alkalosis
28
Spirinolactone and Acetazolamide cause what metabolic derangement?
Acidosis
29
Furosemide and Thiazides cause what metabolic derangement?
Alkalosis
30
To determine primary or secondary hypERaldosteronism, look at what?
Renin
- Low - primary hypERaldosteronism
- High - renovascular disease
31
diffuse mesangial proliferation = think?
IgA nephropathy
32
What vitamins/electrolytes do you give pts w/ renal failure?
Calcium supplementation
| Vit D supp
33
Treat SIADH (mmm
mild - water restriction
moderate - loop diuretic and nL saline
severe - hypertonic saline
34
Minimal change disease adult treat?
Oral Steroids
35
Middle ear stuff
- strep pneumo
| - H influenza
36
Outside ear stuff think?
pseudemonas
37
salivary gland infection = think?
Mumps virus
38
recent (w/in 6 mo) hemorrhagic stroke can't give?
anticoagulants
39
if grandparent has had chicken pox has contact w/ grandkid w/ chickenpox, and they breakout with Zoster is it related?
NO!
- Zoster is a reactivation of their own chickenpox virus, not a new infx! (caused by stress on body)
40
pinpoint lesions in nails = think?
these are splinter hemorrhages
| THINK: ENDOCARDITIS
41
esophagitis caused by (3) ?
- Herpes (acyclovir)
- CMV (gancylovir)
- Candida (fluconazole)
42
Esophagitis w/ BIG ULCER = think?
CMV
43
pneumonia + alcohol abuse what microbes thinking?
- strep pneumo (for everyone, regardless of AA)
- klebsiella (esp in AA)
- anaerobes (esp in AA - bc of aspiration, should be serious w/ some bad smelling and should be in RLL)
44
Aspiration pneumonia/abscess treat w/?
Clindamycin
45
Bad smelling breath w/ RLL abscess and productive cough, think?
Aspiration pneumonia likely due to anaerobes (treat w/ clindamycin)
46
Pneumonia treatment if sending pt home?
cephalosporin + macrolide
Fluoroquinilone alone
47
Walking pneumonia w/o scary stuff, treat w/?
Azithromycin
48
cavitary lesion diff dx (5)?
- TB
- Lung abscess
- Aspergillis
- Cancer
- Septic Emboli
49
Treatment for active TB (4)?
- Rifampin
- Isoniazid
- Pyrazinamide
- Ethambutol
"RIPE"
50
Most common cause of seizures in pts from mexico?
Neurocysticercosis
51
Neurocysticercosis is?
Infectious parasitic disease caused by eggs of Taenia solium (pork tapeworm) found in contaminated pork. Neurocysticercosis occurs when cysts formed by the infection grow within the brain causing neurologic syndromes such as epileptic seizures.
52
Partial seizure --> generalized seizure indicates?
Structural lesion, NOT drug/toxin induced
53
positive PPD but neg chest xray --> indicates? treat?
- Latent TB
| - Treat w/ Isoniazid for 9 mo (1st line), rifampin 4mo (2nd line)
54
What can you give w/ isoniazid to avoid vit def?
Pyridoxine to avoid B6 def (which isoniazid can cause)
55
Post exposure prophylaxis for HIV?
PEP - truvada + ____
56
syphilis spread of rash pattern?
starts on trunk --> spreads to hands and feet
57
rickettsia spread of rash pattern?
Hands and feet --> spread to trunk
58
How to differentiate b/t syphilis rasha dn rickettsia rash?
Pattern of spread
- Syphilis: trunk --> hands/feet
- Rickettsia: hands/feet --> trunk
59
Treat of adult bacterial meningitis?
strep pneumo --> vanc
Neisseria --> ceftriaxone
Listeria --> ampicillin
60
Adults bacterial meningitis most common?
1) Strep pneumo (vancomycin)
2) Neisseria meningitis (ceftriaxone)
3) Listeria (elderly pt - ampicillin)
61
Old pt w/ bacterial meningitis treat w/ what while waiting on cultures?
vanc, ceftriaxone, and ampicillin
| strep pneumo, neisseria, and listeria, respectively
62
Baby w/ bacterial meningitis treat w/ what while waiting on cultures?
cephalosporin, aminoglycoside, and ampicillin
| GBS, E.coli, & Listeria, respectively
63
Treat baby bacterial meningitis?
GBS --> cephalosporin
E.coli --> aminoglycoside (ie gentamicin)
Listeria --> Ampicillin
64
Needle stick, most likely virus to contract?
Hep B
65
What are percentages of contracting HBV, HCV, or HIV from needle stick?
Hep B --> 30%
Hep C --> 3%
HIV --> 0.3%
66
second line for gonorrhea?
azithromycin (ie if pt allergic to beta-lactams)
67
Nephrotic syndrome + flank pain = think?
renal vein thrombosis
68
Kidney issues + high edema + flank pain = think?
renal vein thrombosis
69
CD4 count 50 --> worry about? Treat w/?
PCP and Toxo
| treat w/ TMP-SMX
70
CD4 count worry about? Treat w/?
MAC
| treat w/ azithromycin
71
Main 4 groups to vaccinate for meningitis?
- military groups
- adolescents prior to going to college
- complement deficiency
- asplenia
72
meningitis + papilledema, what do you not do?
Lumbar puncture!
73
Meningitis symp, next step?
fundoscopy to check for pailledema
74
Meningitis symps workup?
1) fundoscopy
2) LP (unless papilledema then go to 3) [WBC! then gram stain and/or cx]
3) CT
75
Zidovudine-related toxicity causes?
- -> muscle problems, proximal (thighs & shoulders)
| - Not neuronal (so no incontinence, etc)
76
HIV pt w/ UMN issues + Normal MRI of head - think?
Vacuolar HIV myelopathy
77
Mono what greatest risk/what could kill?
splenic rupture
78
Eating shellfish + diarrhea --> think?
vibrio cholerae
79
shucking oysters + cuts self --> think?
vibrio vulnificans
80
When do you give steroids for PCP pneumonia in addition to TMP-SMX?
PaO2
81
cruise ship + cough = think?
Legionella
82
treat legionella?
macrolide (ie erythromycin)
83
conference + pneumonia --> think?
Legionella
84
Treat Neurocysticercosis?
-bendazole
85
rabbits, what microbe?
tularemia
86
gram pos + filamentous = think?
nocardia
87
gram neg + filamentous = think
actinomyces
88
Nocardia vs actinomyces treatment?
"SNAP"
sulfa - nocardia
penicillin - actinomyces
89
Reasons for endocarditis prophylaxis?
- Surgery that may predispose to endocarditis (ie big abdominal or heart surg, dental procedures)
AND
- Risk factor for endocarditis (ie valve/structural problem w/in heart, hx of endocarditis)
90
Endocarditis abx prophylaxis?
Oral amoxicillin
91
jaw spasms/problems think?
Tetanus
92
Edema + big kidneys + neg HIV test= think?
Amyloid nephropathy
93
Main 2 reasons for big kidneys?
- AIDS nephropathy (post HIV test)
| - Amyloid nephropathy (neg HIV test)
94
End stage lyme disease (severe, in CSF) --> treat?
IV penicillin G
95
Treat rhizopus?
- surgical debridment
| - amphotericin B
96
branching septate hyphae in lungs = thinks?
Aspergillis
97
Treatment of choice for aspergillosis?
Voriconazole
98
line infx while waiting for cx treat w/?
vanc
99
lyme disease which tick?
Ixodes
100
treatment of bacterial meningitis >50yo and don't know what microbes, how treat?
Vanc (Strep pneumo)
Ceftriaxone (Neisseria)
Listeria (Ampicillin)
101
treatment of bacterial meningitis
Vanc (Strep pneumo)
| Ceftriaxone (Neisseria)
102
Lancet-shaped gram-positive diplococci + meningitis, empiric treat?
Vanc + ceftriaxone (to cover for resistent stuff until sensitivities come back)
103
Lyme disease ECG finding?
atrioventricular block
104
CD4
cryptococcus
105
Adolescent + seizure + temporal lobe hemorrhage = think? treat?
HSV encephelopathy
| IV acyclovir
106
chronic sinusitis +severe headache + papilledema/protrusion of eyes + seizures + cranial nerve issues (R eye pointed down, non-constriction of eye, etc) --> think?
cavernous sinus thrombosis
107
continuous machinery murmur
PDA
108
holosystolic murmur w/ radiation to axilla
MR
109
MR vs TR louder on inspiration or expiration?
TR - louder on INspiration
MR - louder on EXpiration
"TRI MRE" - try Mr.E spelled wrong
110
most specific test for Mono?
Measure IgM to EBV viral capsule antigen
111
Mexico + liver abscess = think?
Entomeoba
| treat w/ metronidazole
