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Level 2 Boards > Gastrointestinal/ Renal/ Genitourinary > Flashcards

Gastrointestinal/ Renal/ Genitourinary Flashcards

1
Q

Tx Oral thrush

A

Fluconazole PO

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2
Q

Mouth
Large linear superifical ulcerations

Intranuclear and intracytoplasmic inclusions on biopsy

TX

A

Cytomegalovirus

Tx: Ganciclovir IV

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3
Q

Esophagitis caused by medications

A

Tetracyclines
Bisphosphonates
NSAIDs
Potassium chloride

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4
Q

Cork screw shaped esophagus

Dx

Tx

A

Diffuse (distal) Esophageal spasm

Esophageal manometry (most accurate) 
- High amplitude simultaneous contractions in greater than 20% of swallows

Triggered by hot or cold liquids

Relieved by nitroglycerin

Tx: CCB
Tricyclic antidepressants
Nitrates

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5
Q

Tx Achalasia

A

Short term:

  • Nitrates
  • CCB
  • Botox

Long term:
- Penumatic balloon dilation or surgery (heller) myotomy

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6
Q

Tx Zenker diverticulum

A

Myotomy of the cricopharyngeus

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7
Q

Narrowing of esophagus with an irregular border protruding into the lumen

A

Esophageal cancer

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8
Q

Tx GERD

A

Lifestyle modifications
- avoid alcohol, chocolate and coffee

Mild: Antiacids

Chronic/ frequent:

  • H2 receptor antagonists (cimetidine, ranitidine
  • PPI (omeprazole, lansoprazole)

Severe/ erosive:

  • PPI (first)
  • If refractory: Nissen surgery
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9
Q

Tx Hiatal hernia

A

If paraesophageal hernia surgery gastropexy to prevent gastric volvulus

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10
Q

Types of Chronic gastritis

A

Type A (10%)

  • Fundus
  • Autoantibodies to parietal cells
  • causes pernicious anemia
  • increased risk of gastric adenocarcinoma and carcinoid tumors

Type B (90%)

  • Antrum
  • NSAIDS/ H.pylori
  • Increased risk peptic ulcer disease
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11
Q

Low hemoglobin
High MCV

Macrocytic Megaloblastic anemia

A

Pernicious anemia

Disease where large, immature nucleated cells (megaloblasts) circulate in the blood and do not function as blood cells

Disease caused by impaired uptake of Vit B12 due to lack of intrinsic factor in gastric mucosa

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12
Q

H pylori test

A

First: stool antigen

Serology: cant determine if active disease

Urea breath test: PPI cause false negative results

Ab stay + even when the infection is cleared

Use urea breath test or repeat stool antigen as a test of cure

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13
Q

H pylori tx

A

Triple therapy

Amoxicillin
Clarithromycin
Omeprazole

Pencillin allergy= metronidazole

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14
Q

Krukenberg tumor

A

Gastric adenocarcinoma that metastasizes to ovary

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15
Q

Virchow node

A

enlarged left supraclavicular LN

Gastric cancer

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16
Q

Sister Mary Joseph node

A

Palpable lymph node near the umbilicus

Gastric cancer

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17
Q

1) Posterior ulcer erodes into

2) Ulcer on lesser curvature of stomach

A

1) Gastroduodenal artery

2) Left gastric artery

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18
Q

What to give patients with peptic ulcer disease who require NSAIDS for arthritis

A

Misoprostol

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19
Q

Bloody diarrhea (4)

A

Campylobacter
Salmonella
Shigella
Ecoli (EHEC)

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20
Q

Watery diarrhea (6)

A 
Vibrio cholerae
Rotavirus
Ecoli (ETEC)
Cryptosporidium
Giardia
Norovirus
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21
Q

Tx Campylobacter

A

Supportive tx

Fluoroquinolones (ciprofloxacin) or

Azithromycin

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22
Q

Tx Clostridium difficile

A

PO metronidazole (mild)

PO vancomycin (moderate to severe)

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23
Q

Diarrhea
Egg shell calcifications

  • T
A

Echinococcus granulosus

Contact w/ dogs, host for tape work

Causes simple liver cysts

  • Albendazole
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24
Q

Arthritis
Lymphadenopathy
Cardiac issues

PAS positive granules on lamina propria on biopsy

A

Whipple disease

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25
Q

Diarrhea
Confusion
Rash

A

Pellagra

Deficiency of Vit B3 (niacin)

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26
Q

Foul smelling, bulky stools
Flatus
Bloating

  • Examples (4)
A

Malabsorption/ maldigestion

Celiac disease
Whipple
Tropical sprue
Crohns

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27
Q

Carcinoid tumor found where

A

Ileum or appendix

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28
Q 
Flushing 
Diarrhea
Abdominal cramps
Wheezing
Right sided cardiac valvular lesions

Measure what
Tx
Can develop
Due to MOA

A

Carcinoid syndrome

Measure 5-HIAA

Tx: Octreotide
Surgical resection

Develop niacin deficiency because tryptophan is metabolized into serotonin

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29
Q

Gallstone ileus

A

Fistula between gallbladder and GI tract —> stone enters GI lumen —> obstructs at ileocecal valve

Air in biliary tree (pneumobilia)

Form of small bowel obstruction

Resulting from the passage of a large stone >2.5 cm into the bowel through cholecystoduodenal fistula

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30
Q

Severe abdominal pain out of proportion to exam

Dx

A

Mesenteric ischemia

Dx: Mesenteric/ CT angiography

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31
Q

Ischemia of bowels after cardiac catheterization due to

A

Cholesterol embolism

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32
Q

Diverticulitis tx

A 
NPO
NG tube
Broad spectrum Ab
- Metronidazole
- Fluroquinolone or third generation cephalosporin

Diver’s
Mask
Covers
Face

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33
Q

Streptococcus bovis

A

Cancer in butt

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34
Q

Ischemic colitis dx

A

Insufficent blood supply

Watershed area

Crampy abdominal pain followed by bloody diarrhea

CT scan w/ contrast
- thickened bowel wall, atherosclerosis

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35
Q

Crohns disease

  • Location
  • Features (4)
  • Tx (2)
A 
Any portion GI tract
Skip lesions
Fistulas
Watery diarrhea
Creeping fat

Tx: 5-ASA agents

  • Sulfasalazine
  • Mesalamine

Corticosteriods
- Increased risk colon cancer

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36
Q

UC

  • Location
  • Features (2)
  • Tx (2)
A

Rectum
Bloody diarrhea
Toxic megacolon

Tx: 5-ASA agents

  • Sulfasalazine
  • Mesalamine

TNF-alpha inhibitors

  • infliximab
  • adalimumab
  • golimbumab

Corticosteriods
- Increased risk colon cancer

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37
Q

Hesselbach triangle

A

Area bound by

Inguinal ligament (inferior) 
Inferior epigastric artery (lateral) 
Rectus abdominis (medial)
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38
Q

Hernia lateral to inferior epigastric vessel

A

Indirect hernia

Results from congenital patent processus vaginalis

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39
Q

Herniation medial to epigastric vessels

A

Direct hernia

Mechanical breakdown in transversalis fascia from age

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40
Q

Hernia Mnemonic

A

Directly to the middle (medial)

Indirect (LIE) lateral to inferior epigatsric vessel

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41
Q

Black gallstones

A

Hemolysis

Sickle cell

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42
Q

Brown gallstones

A

Infection

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43
Q

Cholecystitis

Choledocholithiasis

Cholangitis

A

Cholecystitis

  • inflammation of GB due to stone in cystic duct
  • RUQ pain, fever, murphy sign

Choledocholithiasis

  • stone in common bile duct
  • Jaundice, RUQ pain, afebrile
  • Dilated CBD
  • MRCP or ERCP
  • Elevated Alk Phos and direct bilirubin

Cholangitis

  • infection of CBD due to stone
  • RUQ pain, fever, jaundice, reynolds pentad (shock + mental status changes)
  • Elevated Alk Phos and direct bilirubin
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44
Q

RUQ pain following opiate administration

A

Sphincter of Oddi dysfunction

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45
Q

HBsAg

HBsAb

HBcAg

HBcAb

HBeAg

A

HBsAg
- Presence of virus

HBsAb
- antibody to HBsAg (immunity)

HBcAg

HBcAb

  • Antibody to HBcAg
  • prior or current infection (no vaccine)

HBeAg
- Transmissibility

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46
Q

+ ANA
+ Anti-smooth Ab

Elevated IgG

P-ANCA

A

Autoimmune hepatitis

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47
Q

HBV tx

A

Tenofovir

Entecavir

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48
Q

Complication of cirrhosis and ascites

  • Lab
  • Tx
  • Prophylaxis
A

Spontaneous bacterial peritonitis

> 250 PMNs/mL in ascitic fluid

Tx: third generation cpehalosporin
IV albumin prophylaxis w/ fluoroquinolne to prevent reoccurance

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49
Q

Ascites and Serum ascites albumin gradient (SAAG)

A

SAAG= serum albumin - ascites albumin

SAAG > 1.1
- Related to portal HTN

Presinusoidal: splenic or portal vein thrombosis, schistosomiasis

Sinusoidal: Cirrhosis

Postsinusoidal: Right heart failure, constrictive pericarditis, Budd-Chiari syndrome

SAAG< 1.1
- Not related to portal HTN

Nephrotic syndrome
TB
Malignancy w/ peritoneal carcinomatosis (ovarian cancer)
[Sarcoidosis, SLE]

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50
Q

Associated with UC

A

Primary sclerosing cholangitis

P-ANCA
“Onion skin” bile duct
Increase IgM

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51
Q

Primary sclerosing cholangitis associated with

Risk for

A

UC

Increased risk for cholangiocarcionoma

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52
Q 
Progressive jaundice
Pruritus
Fatigue
Increase Alk phos
Increase bilirubin

P-ANCA

Hx UC

  • Name
  • MOA
  • Seen on imaging (2)
  • Increase
  • Tx
  • Affects who
A

Primary sclerosing cholangitis

Idiopathic disorder characterized by progressive inflammation and fibrosis accompanied by strictures of extrahepatic and intrahepatic bile ducts

MRCP/ERCP shows multiple bile duct strictures and dilations (beading)

“Onion skin” bile duct

Increase IgM

Tx ERCP w/ dilation

Young men

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53
Q

Progressive jaundice
Pruritus
Fat soluble vitamin deficiencies (A, D, E, K)

Increase Alk Phos
Increased Bilirubin
+ Anti-mitochondrial Ab
Increased cholesterol

  • Name
  • MOA
  • Affects who
  • Tx (3)
A

Primary Biliary cholangitis

Autoimmune disorder characterized by destruction of intrahepatic bile ducts (lobular ducts)

[Not common bile duct]

Middle aged women

Tx: Ursodeoxycholic acid
(slow progression)
Cholesyramine (pruritus)
Liver transplant

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54
Q

Elevated alpha feto protein

A

Hepatocellular carcinoma

Yolk Sac tumor

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55
Q

Liver mass

Oral contraceptives

A

Hepatic adenomas

Benign

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56
Q 
Abdominal pain
DM
Hypogonadism
Cirrhosis
Bronze skin
Hepatomegaly
  • Name
  • Labs (3)
  • Tx (2)
  • Susceptible (3)
A

Hemochromatosis

Elevated iron
Elevated ferritin

Decreased transferrin

Tx: phelbotomy
Deforxamine, deferiprone or deferasiroxcan can help maintain

Increased suseptibility to

  • Vibrio vulnificus
  • Listeria monocytogenes
  • Yersinia enterocolitica

Hemochromatosis
Very
Yellow
Legs

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57
Q

Cirrhosis
Tremor
Psychosis/ Anxiety

Jaundice
Hepatomegaly
Choreiform movements
Rigidity

  • Name
  • Inheritance
  • Test (2)
  • Lab
  • Tx
  • Avoid
A

Wilson disease

AR

Slit lamp exam

Decreased ceruloplasmin

Most accurate test: 24 hour urinary copper excretion after given penicillamine

Tx: Penicillamine or trientine

Avoid: Shellfish, liver, legumes and zinc

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58
Q

Elevated serum insulin

C peptide elevated

A

Insulinoma

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59
Q

Watery diarrhea
Dehydration
Muscle weakness
Flushing

Low stomach acid

A

VIPoma

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60
Q

CA 19-9

A

Pancreatic cancer

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61
Q

Hx Cirrhosis

Fever
Mental status changes

A

Spontaneous bacterial peritonitis

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62
Q

7 day old taking oral formula

Low temp
Lethargic
Cyanotic
Abdominal distension
Absent bowel sounds

Red blood in stool

NG tube= bilious fluid

  • Name
  • Risks (2)
A

Necrotizing enterocolitis

Risks: very low birth weight, enteral feeding

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63
Q

AST and ALT >25 x upper limit

A

Toxin induced (acetaminophen)

Ischemic

Viral hepatitis

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64
Q

Recurrent rectal pain

5 minutes

Unrelated to defecation

No blood

  • Name
  • MOA
  • Tx
A

Proctalgai fugax

Spastic contraction of the anal sphincter

Pudendal nerve compression

Nitroglycerin cream

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65
Q

Gas in gallbladder wall

  • Name
  • Risk factors (3)
  • Caused by (2)
  • Tx (2)
A

Emphysematous cholecystitis

Risk factor DM, vascular compromise, immunosuppression

Clostridium
Ecoli
Klebsiella

Emergery surgery
Piperacillin taxobactam

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66
Q

Meckel diverticulum test

A

Technetium-99m pertechnetate scan

Detects ectopic gastric tissue

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67
Q

UC tx

A

< 4 watery BM

Initial management is with 5-aminosalicylic acid (5-ASA)

  • mesalamine
  • sulfasalzine
  • balsalazide

Mesalamine enemas

> 6 watery BM
- Severe: TNF-alpha inhibitors (infliximab, adalimumab, golimbumab)

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68
Q

Food stuck in throat

Vomiting water

Frequent heart burn
- PPI dont help

A

Eosinophilic esophagitis

Leads to stricture formation

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69
Q

Ascites protein characteristics

A

Total Protein <2.5

  • Cirrhosis
  • Nephrotic

Total protein > 2.5

  • CHF
  • Constrictive pericarditis
  • TB
  • Budd-Chiari

SAAB <1.1

  • tb, pancreatic ascites
  • Sarcoidosis, SLE, cancer
  • nephrotic syndrome
SAAG >= 1.1
- portal htn
cardiac ascites
Cirrhosis
Budd chiari
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70
Q

Distended abdomen with shifting dullness

Due to what?

Paracentesis:
albumin 2.5

Blood:
Albumin 3.8

MOA

A

SAAG= serum- ascites albumin

3.8-2.5= 1.3

Indicated portal hypertension

  • cardiac ascites
  • cirrhosis
  • Budd-chiari

Which indicates an increased hydrostatic pressure within hepatic capillary beds

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71
Q

Ascites with increased capillary permeability

A

Malignant ascites

SAAG < 1.1

Non-portal HTN

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72
Q

Infant
Painless bloody stools

1 month old

Reflux/ spit up

Eczema

A

Food protein induced allergic proctocolitis

Remove all dairy and soy

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73
Q

Abdominal bloating

Steatorhhea

Macrocytic anemia

Hx Gastric bypass

  • What is it
  • Caused by
  • Results in
  • Dx
  • Tx
A

Small intestinal bacteral overgrowth (SIBO)

Gastric bypass results in a blind loop of intestine that allows for excessive bacterial growth

Nutritional deficiencies

Dx: Carbohydrate breath test measures the hydrogen by intestinal flora

Correction of abnormality
Empiric ab (rifaximin)
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74
Q

RUQ pain
Gaseous distension of small and large bowels without air fluid levels

Gallbladder is distended with no gallstones

Small amount of pericholecystic fluid

A

Acalculous cholecystitis

Due to gallbladder stasis, hypoperfusion or infection (CMV)

Antibiotics and percutaneous cholecystostomy

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75
Q

Luminal irregularities with mild focal dilations within both intrahepatic and extrahepatic biliary ducts

High elevated Alk phos
Increased bilirubin

Elevated Gamma glutamyl transpeptidase

A

Primary sclerosing cholangitis

90% also have inflammatory bowel disease w/ UC more common than crohns

Get colonoscopy to rule out IBD

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76
Q

Causes of subphrenic abscess

A

Perforated ulcer
Appendicitis
Abdominal surgery

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77
Q

What should be check on ascites

A

Fluid color
Total protein count
SAAG

Cell count and differential to rule out spontaneous bacterial peritonitis

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78
Q

Young man
Vomiting

Now retrosternal pain
Fever
Crepitus

A

Esophageal perforation

Crepitus & Fever are key
[ Aortic dissection doesnt have these]

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79
Q

Ectopic pregnancy on doppler

A

Increased doppler flow (Ring of fire) around ectopic pregnancy

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80
Q

Develops GI hemorrhage days after being admitted to ICU

A

Stress induced ulcer

Risk factors shock and sepsis

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81
Q

Occult bleeding

A

Only found on labs (not visible)

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82
Q

Itching
Fatigue

Hepatomegaly

No scleral icterus or jaundice

Elevated cholesterol
Elevated bilirubin
Elevated Alk phos

Normal common bile duct

A

Primary biliary cholangitis

Check anti-mitochondrial ab

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83
Q

32 y.o

Intense, midline chest pain and diaphoresis

Recurrent vomiting

Alcohol
Cocaine

Fever
BP 100/60

Dilated pupils

Diminished breath sounds on left

Widened mediastinum

Moderate pleural effusion on left

Pleural fluid= yellow exudate with high amylase

A

Esophageal perforation

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84
Q

Refeeding syndrome

A

Hypophosphatemia
Hypokalemia
Weakness
Arrhythmias

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85
Q

Risk factors for C. diff

A

Recent antibiotics

PPI

Advanced age

Hospitilization

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86
Q

Pancreatic leak

A

Develop metabolic acidosis

  • low pH
  • low bicarb
  • normal anion gap
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87
Q

Suprapubic tenderness

Painful urination

Tx

A

Acute cystitis

Tx: Nitrofurantoin (5days
TMP-SMX 3 days)
Fosfomycin (single dose)

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88
Q

Hypernatremia due to

A

Free water loss rather than sodium gain

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89
Q

Tx hypernatremia

A

isotonic 0.9% NaCl if hypovolemic with unstable vital signs

If normal volume status and asymptomatic
- D5W, 0.45% NaCl

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90
Q

Hypernatremia causes

A

The 6 D’s

Diuresis
Dehydration
Diabetes insipidus
Docs (iatrogenic)D
Diarrhea
Disease (kidney, sickle cell)
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91
Q

How to tell cause of hypernatremia

A

If Low urine osmolality (< 300)

  • Then central or neprhogenic DI
  • Check water restriction, if osm rise then central

If High urine osmolality > 600

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92
Q

Hyponatremia caused by

A

Increase in ADH

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93
Q

When to use hypertonic saline

A

Only if patient is having seizures caused by hyponatremia

When serum Na is < 120

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94
Q

Hyponatremia
Hypotonic serum osmolality < 280

Assess EC fluid

A 
Low EC fluid
Hypovolemic hypotonic
- GI losses (diarrhea)
- burns
- Diuretics
- urinary obsturction
- RTA

Normal
Isovolemic hypotonic
- > 100 urine osm= SIADH, hypothyroidism
- <100 osm primary polydipsia

Elevated
Hypervolemic hypotonic
- FENa < 1% Cirrhosis, CHF, Nephrotic
- FENa > 2% AKI, Chronic renal failure

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95
Q

Treatment of hyperkalemia

A

C BIG K

Calcium chloride or gluconate (IV)
Bicarbonate, B2 agonists
Insulin + Glucose
Kayexalate (sodium polystyrene sulfonate)

Only tx if > 7
ECG changes

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96
Q

Hyperkalemia on ECG

A

Peaked T waves
PR prolongation
Widened QRS

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97
Q

Peaked T waves
PR prolongation
Widened QRS

A

Hyperkalemia

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98
Q

26 y.o to ER with hx of depression comes in with altered mental status, tinnitus, nausea and vomiting

ABG shows pH of 7.4, PaCO2 of 22, HCO3 of 13

Diagnosis?
Acid/base?
- Compensation formula

A

Aspirin overdose

pH is normal

Mixed metabolic acidosis and respiratory alkalosis

Bicarb is low indicating metabolic acidosis

Winters formula that predicts PaCo2 under normal compensation should be 29 (PaCO2- 1.5 (HCO3)+8)

Her PaCO2 islower than this at 22 so concurrent respiratory alkalosis

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99
Q

Tx Rhabdomyolysis

A

Saline hydration
Mannitol
Bicarbonate
ECG to rule out life-threatening hyperkalemia

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100
Q

Hypokalemia on ECG

A

T wave flattening
U waves
ST segment depression

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101
Q

T wave flattening
U waves
ST segment depression

A

Hypokalemia on ECG

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102
Q

Chronic kidney disease

A

> 3 months of GFR > 60 mL/min

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103
Q

pH < 7.35

PCo2 > 44

A

Respiratory acidosis

Airway obstruction
Acute lung disease
Chronic lung disease
Opioids
Weakening of respiratory muscles
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104
Q

pH < 7.35

HCO3 < 20

A

Metabolic acidosis

High anion gap= MUDPILES
Methanol
Uremia
Diabetic ketoacidosis
Propylene glycol
Iron tablets or INH
Lactic acidosis
Ethylene glycol
Salicylates (late)

Normal anion gap

  • Addisons
  • Renal tubular acidosis
  • Diarrhea
  • Acetazolamide
  • Spironolactone
  • Saline infusion
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105
Q

Anion gap

A

Na- (Cl+ HCO3)

8-12 normal

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106
Q

pH > 7.45

PCO2 < 36

A

Respiratory alkalosis

Anxiety
Hypoxemia
Salicylates (early)
Tumor
Pulmonary embolism
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107
Q

pH > 7.45

HCO3 > 28

A

Metabolic alkalosis

Loop diuretics
Vomiting (low cl)
Antacid use
Hyperaldosteronism

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108
Q

Normal anion gap metabolic acidosis

Hyperchloremic

Urine pH > 5.5
Hypokalemia

A

Type I RTA

Defect in H secretion

Complication is nephrolithiasis
Sjogren

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109
Q

Normal anion gap metabolic acidosis

Hyperchloremic

Urine pH <5.5
Hypokalemia

A

Type II RTA

HCO3 reabsorption defect

MM
Amyloidosis
Fanconi
Cisplatin

Complication

  • RIckets
  • Osteomalacia
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110
Q

Normal anion gap metabolic acidosis

Hyperchloremic

Variable Urine pH

Hyperkalemia

A

Type IV RTA

Aldosterone deficiency

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111
Q

Prerenal

  • feature seen
A

BUN/ Cr > 20:1

Hyaline casts

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112
Q

Intrinsic renal

  • feature (2)
A

BUN/Cr < 15:1

RBC casts
RBC dysmorphic

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113
Q

Post infectious glomerulonephritis vs IgA nephropathy

A

Postinfectious glomerulonephritis

  • 2-6 weeks after infection
  • low C3

IgA nephropathy

  • presetn concurrent with an infection
  • normal C3
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114
Q

Nephritic syndrome findings

A

PHAROH

Proteinuria
Hematuria
Azotemia (high nitrogen content) 
RBC casts
Oliguria (small amount urine)
Hypertension
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115
Q

Diuretic that causes ototoxicity

A

Loops

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116
Q

Diuretic that causes pancreatitis

A

Thiazides

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117
Q

Nephritic/ nephrotic syndrome with low C3

A

Postinfectious glomerulonephritis

Membranoproliferative glomerulonephritis

Lupus nephritis

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118
Q

Tea colored urine

Edema

HTN

Recent infection

A

Post infectious glomerulonephritis

Low serum C3

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119
Q

Episodic blood in urine

Respiratory infections
GI infections

HTN
Proteinuria

A

IgA nephropathy (Berger disease)

Normal C3
IgA deposit

[Henoch Schonlein purpura renal manifestation is pathologically the same]

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120
Q

Joint pain
Blotchy purple skin lesions on trunk and extremities

Abdominal pain

A

Henoch Schonlein purpura

[ Immunoglobulin A vasculitis]

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121
Q

Sinus infections

Cavitary lung lesion
Hemoptysis

HTN
Hematuria

C-ANCA

  • Name
  • Biopsy
  • Tx
A

Granulomatosis with polyangiitis

Segmental necrotizing glomerulonephritis with crescents

Tx: Corticosteriods

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122
Q

p-ANCA

AKI
HTN
Hematuria

Skin lesions
Lung

A

Microscopic polyangiitis

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123
Q

p-ANCA

Asthma
sinsuitis
skin nodules/ purpura

AKI
HTN
Hematuria

A

Eosinophilic granulomatosis with polyangiitis (Churg strauss syndrome)

eosinophils
Increased IgE

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124
Q

Hemoptysis
AKI
HTN
Hematuria

20 y.o

Iron deficency Anemia

  • Name
  • Biopsy
  • Finding
  • Tx
A

Good pasture

Linear anti-GBM deposits

Anti-basement membrane

Plasma exchange therapy

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125
Q

Microscopic hematuria
Proteinuria
Sensorineural deafness

  • Seen on biopsy
A

Alport syndrome

GBM splitting

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126
Q

Nephritic disease (8)

A

Postinfxn glomerulonephritis

IgA nephropathy

Henoch Schonlein

Granulomatosis w/ polyangiitis

Microscopic polyangiitis

Eosinophilic granulomatosis with polyangiitis (Churg- Strauss)

Goodpasture

Alport syndrome

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127
Q

Nephrotic syndrome (7)

A

Minimal change

Focal segmental glomerulosclerosis

Membranous nephropathy

Diabetic nephropathy

Lupus nephritis

Renal amyloidosis

Membranoproliferative nephropathy

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128
Q

HTN
Edema
Hyperproteinuria

Patchy areas on biopsy

A

Focal segmental glomerulosclerosis

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129
Q

Deposits of IgG and C3 on basement membrane

Edema
Hyperproteinuria

A

Membranous nephropathy

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130
Q

Associted with HBV, HCV

A

Membranoproliferative nephropathy

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131
Q

Tram track double layered basement membrane

Low serum C3

A

Membranoproliferative nephropathy

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132
Q 
Palpable purpura
Arthralgias
Proteinuria
Hematuria
Edema
Low C3
Positive HCV
A

Mixed cryoglobulinemia

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133
Q

Staghorn calculi

A

Urease producing bacteria

Proteus
Klebsiella

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134
Q

Tx to help pass stone (4)

A

Hydration
Analgesia

Alpha 1 receptor blockers
(Tamsulosin)

CCB (nifedipine)

135
Q

End stage renal disease can painful calcified lesions on extremities due to

A

Hyperphosphatemia
Hypercalcemia

High PTH

136
Q

Renal and carotid arteries affected

A

Fibromuscular dysplasia

137
Q

Painless hematuria
No bacteria/ nitrates
WBC casts
Trace proteinuria

A

Suggests non-glomerular disorder

Tubulointerstitial nephritis

138
Q

Weakness
Hyperkalemia
Rapid Bicarb < 18 (metabolic acidosis)
Edema

A

AKI

BUN/CR 15:1= intrinsic

Renal tubular injury

139
Q

Glomerulonephrtiis

A

Hematuria

RED blood casts

140
Q

Seen with diabetic nephropathy

A

Takes years

Mild proteinuria

Shrunken atrophic kidneys

Hypocalcemia

141
Q

Drug induced interstitial nephritis

A

Rash
Fever
WBC cases

142
Q

Prerenal acute kidney injury

A

Intravascular volume depletion

143
Q

Prerenal acute kidney injury

Dry mucus mebranes

A

Increased central venous pressure

Volume overload due to heart failure

144
Q

Obstructive uropathy

A

Postrenal AKI

145
Q

1 day hx fever and joint pain

Being treated with cephalexin for skin infxn

Urine turned darker

Rash

8 RBC
12 WBC
White cell casts
Eosinophiluria
Proteinuria

BUN 40
Cr 2.2

A

Discontinue cephalexin

Drug induced interstitial nephrtiis

Caused by pencillins, cephalosporins, and sulfonamides

Fever
Rash
Arthralgias

146
Q

Nephrotic syndrome at risk for developing

A

Accelerated atherosclerosis

147
Q

Headache
Confusion
Hyperreflexia

Arrhythmias
SOB
Vomiting

Flushing

A

Cyanide toxicity

148
Q

Elevated blood tacrolimus

A

Acute calcineurin inhibitor renal toxicity

Tacrolimus
Cyclosporine

AE: vasoconstrictive properties

149
Q

Edema
Proteinuria

Hx. RA

Enlarged kidneys

Adult

A

Amyloidosis

Glomerular deposits seen after special straining

Congo red

150
Q

Small atrophic kidneys

Bland (no wbc, rbc)

Mild proteinuria

S4
Strong apical impulse

A

Hypertensive nephrosclerosis

151
Q

Nephrotic syndrome that then presents with abdominal pain, fever, and hematuria

A

Renal vein thrombosis

Commonly seen with membranous glomerulopathy

152
Q

Pancreatitis affect on kidneys

A

Hypovolemia due to vomiting

Kidneys increase renin

Vasoconstriction

Sodium and water reabsorption

153
Q

High pH
Low PaCo2

High respiratory rate

Normal oxygen saturation

A

Respiratory alkalosis

Inadequate pain control

154
Q

Previous UTI

Flank pain
WL
Fever

Leukocytosis

Anemia
Elevated Glucose

A

Renal abscess

155
Q

Tx uric acid stones

A

Alkalinization of urine (potassium citrate)

156
Q

Tx Renal artery stenosis

A

ACE inhibitor/ ARB

157
Q

Hx Sjogrens

pH 7.32
PaO2 100
PaCO2 30

A

Metabolic acidosis

Nonanion gap

RTA type 1 due to sjogrens

158
Q

Hematura
Varicocele that fails to empty on lateral recumbant

Elevated Hemoglobin and platelets

A

Renal cell carcinoma

Get abdominal CT

Ectopic production of erythropoetin

159
Q

Hypercalcemia with normal PTH

A

Familial hypocalciuric hypercalcemia

Bengin

160
Q

Interstitial cystitis

A

Chronic painful blader condition that is associated with psychiatric disorders and other pain syndromes (fibromyalgia)

Bladder pain exacerbated by exercise, sexual intercourse, and alcohol consumption

Tx Avoiding triggers
Amitriptyline

161
Q

If want to add Phosphodiesterase inhibitor make sure not on

A

Nitrates

Leads to significant decrease in BP can lead to myocardial ischemia

162
Q

Tx BPH

A

Alpha blockers

  • Tamsulosin
  • Terazosin

Next best
5alpha reductase inhibitors
- Finasteride

163
Q

19 y.o with kidney stones

Father also with kidney stones

What is most likely

A

Cystinuria

Decreased cystine reabsorption caused by defect in proximal tubular amino acid transport

Hexagonal cystals on UA

164
Q

Spread of Renal cell carcinoma

A

Tumors can spread along the renal vein to the IVC and metastasize to lung and bone

165
Q

Middle aged smoker with left sided varicocele

Seen with

A

Renal cell carcinoma

Anemia
Polycythemia

166
Q

Testicular cancer of man in his 40s

167
Q

Germ cell tumors

A

Seminoma

Yolk sac
- increased AFP

Choriocarcinoma
- increased b-hCG

Teratoma
- increased AFP and b-hCG

168
Q

Non Germ cell tumors

A

Leydig cell

  • Increased testosterone and estrogen
  • decrease LH and FSH

Sertoli cell

Testicular lymphoma

169
Q

Elevated b-hCG in men

A

Choriocarcinoma

170
Q

Tx Pyelonephritis that is multidrug resistant

Develops acute renal failure due to what drug

No WBC
Elevated FEna

A

Amikacin
Aminoglycoside

No WBC or eosinophils so not interstitial nephritis

Probably a gram negative (so no vancomycin)

171
Q

Vomiting

pH
PaCo2
HCo3
K
Cl
A

Increased pH
Increased PaCO2
Increased HCO3

Decreased K
Decreased Cl

172
Q

Dilute urine with overnight fasting

A

Lithium induced nephrogenic diabetes insipidus

Renal collecting ducts
- ADH resistance

Dilute urine (urine osm < 300)

173
Q

Hemangioblastoma

Cystics in cerebrum

Multiple cysts in kidneys

  • Name
  • Risk for
A

Von Hippel Lindau disease

Risk RCC

174
Q

Autosomal dominant polycystic kidney disease

A

CNS and renal disease

Aneurysms

175
Q

Recurrent bilateral flank pain
Hematuria

HTN

Labs (2)

A

Polycystic kidney disease

AD

Increased renin release

Increased vasopressin levels

176
Q

Rhabdomyolysis

A

Causes myoglobinuria

Looks like hematuria
Blood on urinarlysis

NO RBC cells

177
Q

Nephrolithiasis with Crohns

A

Fat malabsorption —> hyperoxaluria

Oxalate from diet

Increased oxalate absorption in gut

178
Q

Hematuria
Decreased urine output

Hep C
Cirrhosis

Doesn’t improve with fluids

A

Hepatorenal syndrome

Splanchnic arterial dilation

Triggered by SBP, excessive diuretics, sepsis, vomiting, GI bleed

No RBC, protein or granular casts

Tx Splanchnic vasoconstrictors (midodrine, octreotide, NE)

179
Q

Metabolic acidosis with high anion gap

Envelope-shape crystals

A

Ethylene glycol poisoning

180
Q

Aspirin (salicylate) toxicity ABG

A

Mixed anion gap metabolic acidosis and respiratory alkalosis with no osmolal gap

181
Q

Nephrotic proteinuria
Hematuria

C3 deposits

A

Membranoproliferative glomerulonephritis

Caused by IgG antibodies against C3 convertase in alternative complement pathway

182
Q

Circulating immune complexes

Renal disease

A

Glomerulopathies

SLE
Post-streptococcal glomerulonephritis

183
Q

Non-immunologic kidney damage

A

Diabetic nephropathy

HTN nephropathy

184
Q

Acute urinary retention

Taking diphenhydramine

A

First generation H1 antihistamine can have anticholinergic effects

Detrusor hypocontractility

185
Q

Worsening SOB
Breathless at night

Facial edema
BP 200/120

Bibasilar crackles
JVD

1+ Protein
Hematuria

A

Acute nephritic syndrome with fluid overload

Primary glomerular damage

  • Post strep glomer
  • IgA nephropathy
  • Lupus nephritis
  • Membranoprolifer
  • Rapidly progressive glomerulo
186
Q

Portal HTN

A

no JVD

Cirrhosis

Ascites
Edema in lower extremities

187
Q

SE Thiazides

A

Hyperglycemia

Increased uric acid

Increased LDL cholesterol

188
Q

Pre renal azotemia

A

high levels of nitrogen contain compounds

BUN
Cr

Abdominal pain
Thirst

BUN/CR greater than 20:1 due to increased urea absorption

Volume depletion

189
Q

Low Bicarb

Normal anion gap

Hyperkalemia
High chloride
BUN/CR: 20:1

A

Metabolic acidosis

Diarrhea
Fistulas
Carbonica anhydrase inhibitors
Renal tubular acidosis
Ureteral diversion
Iatrogenic
190
Q

Primary hyperaldosteronism

A

Increased H and K excretion

Hypokalemia
Metaboic alkalosis

Aldosterone Saves Sodium and Pushes Potassium out

191
Q

Renal artery stenosis labs

A

Secondary hyperaldosteronism

Hypokalemia
Metabolic alkalosis
HTN

192
Q

How to rapidly reduce hyperkalemia

A

Insulin and glucose

B2 adrenergic agonist

Sodium bicarbonate

193
Q

How to remove potassium slowly

A

Diuretics
Cation exchange resins
Hemodialysis

194
Q

Hiking
Hematuria
Flank pain
Resolved

Anemia
pH 5.8
3+ blood
RBC
WBC
6% reticulocytes
A

Papillary necrosis

Sickle cell trait

No casts= extraglomerular cause

Dehydrated

195
Q

Pregnancy asymptomatic bacteriuria left untreated becomes

A

Acute pyelonephritis

Tx: Cephalexin
Amox-clavulatante
Nitrofurantoin
Fosfomycin

196
Q

Elevated creatinine (double since admission)

BUN:Cr > 20

Elevated anion gap metabolic acidosis

A

Prerenal azotemia/ AKI

Acute kidney injury from diuretic therapy

197
Q

Proteinuria
Edema
Hypoalbuminemia

Joint pains
Hand deformities

A

Rheumatoid arthritis complicated by AA amyloidosis

198
Q

AKI
BUN CR 20:1
Nothing on urinalysis

JVD
Edema

A

Volume overload due to acute heart failure exacerbation

AKI due to cardiorenal syndrome

LV failure with reduced cardiac output —> decreased renal perfusion —> activation of RAAS

*Elevated central venous pressure is major driver of AKI in cardiorenal syndrome

199
Q

Glomerular hyperfiltration

A

Occurs in early stages of diabetic nephropathy and is recognized by temporary increase in GFR

Increase in GFR
Decrease in Cr

200
Q

Low blood oncotic pressure

A

Occurs in neprotic syndrome

Total body volume overload with intravascular volume depletion

201
Q

Reduced left ventricular preload

A

Increased in heart failure

202
Q 
Muscle weakness
Dark urine
Decreased urine output
Elevated Cr
Hematuria 
Low WBC, RBC

Gout
Takes Aspirin, ticagrelor, simvastatin, metoprolol, lisinopril and colchicine

  • Name
  • Cause
  • Check for what
A

Rhabdomyolysis

Statins and colchicine are direct myotoxins

Check for creatine phosphokinase

203
Q

Pain in legs, weakness and swelling

Binge drinking
Cocaine use

HTN

A

Drug induced rhabdomyolysis

—> AKI

204
Q

Trauma

Clean urine sample
RBC in urine

Get what

A

CT scan of abdomen and pelvis

Kidney injury

Urethral would have gross hematuria

205
Q

Tx Metabolic alkalosis

A

Normal saline

206
Q

COPD

Antibiotics
Corticosteriods
Albuterol
Ipratropium

Develops hypokalemia why

A

Increased beta adrenergic activity

Potassium shift into intracellular space

207
Q

Decreased insulin on K

A

Hyperkalemia

Insulin promotes K shift into IC space

208
Q

Trauma
Widening pubic symphysis

Intraperitoneal free fluid

What next step

A

Retrograde cystography

209
Q

Diarrhea ABG

A

Excess HCO3 loss

non-anion gap metabolic acidosis

210
Q

Right flank pain
Decreased urination

Hx Total left nephrectomy

Low potassium
High Cr
Protein trace
WBC
RBC
No casts
A

Unilateral obstructive uropathy

211
Q

Rejection of kidney at 6 months

A

Acute rejection

first 6 months

212
Q

Acute toxicity to taacrolimus

A

Vasoconstriction of afferent and efferent renal arterioles

Prerenal acute kidney injury

HTN

BUN:Cr > 20:1

213
Q

Evaluation hyponatremia

Serum osm 252
Urine osm 78

A
  1. Serum osm > 290
    yes: advanced renal failure, marked hyperglycemia
  2. Urine osm < 100
    yes: Primary polydipsia, malnutrition (beer drinker)
  3. Urine sodium < 25
    yes: volume depletion, CHF, cirrhosis
    no: SIADH, adrenal insufficiency, hypothyroidism
214
Q

UTI infant

A

Cefixime

Ecoli

215
Q

Diabetic ketoacidosis ABG

A

Hyperventilation

Decreased pH
Decreased PaCo2
Decreaed Bicarb

Metabolic acidosis
Compensatory respiratory alkalosis

216
Q

Urine pH

217
Q

Increase pH with stone

A

Struvite

Urease producing

218
Q

Urge incontinece tx

A

Bladder training

If fails
Antimuscarinic drugs
- Oxybutynin

219
Q

Stress incontience with unipolar depression

A

Duloxetine

220
Q

Tx urinary retention due to neurogenic bladder

A

Bethanechol (cholinergic agonist)

Intermittent urethral catheterization

221
Q

Medications to discontinue if develop prerenal azotemia

A

Nephrotoxins (NSAIDS)

Metformin (can cause lactic acidosis in AKI)

222
Q

Medications that cause hyperkalemia

A

nonselective beta adrenergic blockers

Potassium sparing diuretics

  • triamterene
  • amiloride

ACE inhibitors

ARBs

NSAIDS

TMP-SMX

223
Q

Isolated proteinuria

Rapidly progressive renal failure

CD4 220

A. BK virus
B. Crystal induced tubular dysfunciton
C. Drug induced interstital nephritis
D. HIV associated nephropathy
E. Primary membranous nephropathy
A

HIV associated nephropathy

Heavy proteinuria
Rapidly progressive renal failure

224
Q

Proteinuria
WBC

Fatty casts

Edema

-Risk for

A

Nephrotic syndrome

Risk for hypercoagulability

Thromboembolic complications

225
Q

Repeat episodes of SOB, dyspnea, diaphoresis

ABG

A

Panic attack

Hyperventilation
Respiratory alkalosis

Elevated pH
Low pCO2

Decreased serum ionized calcium (competes w/ hydrogen ions to bind albumin)

Elevated blood pH —> dissociation of hydrogen ions from albumin results in increased calcium binding and decreased serum ionized calcium

226
Q

25 bladder issues

High post void

A

Urethral stricture

227
Q

BPH tx

A

1st: Alpha 1 blocker
Terazosin
Tamsulosin

5 alpha reductase inhibitors (finasteride) can be added if persistent symptoms

228
Q

Salicylate toxicity of ABG

A

Respiratory alkalosis

Anion gap metabolic acidosis

Results in near normal pH

Low PaCo2
Low HCO3

229
Q

Testis has how long to descend before needing surgery

230
Q

Risk if varicocele left

A

Infertility and testicular atrophy due to increased scrotal temperatures

231
Q

Lower abdominal pain

2 days fever, chills dysuria and pelvic pain

Cant pass urine

Suprapubic fullness

Tender prostate

Catheter drains 800 mL urine

Positive Leukocyte esterase and nitrites

Tx

A

Acute bacterial prostatitis (ABP)

Tx: Levofloxacin or TMP-SMX

232
Q

Pelvic pain (pain in perineum and testes) radiates to back

> 3 months

Frequency
Urgency

Pain with ejaculation

  • Name
  • MOA
  • Tx
A

Chronic prostatitis/ chronic pelvic pain syndrome

Noninfectious chronic prostate inflammation

Tx Tamsulosin

233
Q

How to prevent calcium oxalate stones

A

Limit sodium intake

234
Q

Upper GI Bleed see what change in labs

A

Elevated BUN/Cr ratio

Increased urea production from intestinal breakdown fo hemoglobin and increased urea reabsorption in proximal tubule

235
Q

Pancreatic atrophy and calcifications

A

Chronic pancreatitis

Lipase supplementation for pain

236
Q

Epigastric pain
WL
Iron deficiency Anemia
Hepatomegaly

China

A

Gastric cancer

237
Q

Consistent elevated liver enzymes

Large gamma gap (total protein - albumin= >4)

A

Autoimmune hepatitis

238
Q

Crampy abdominal pain occasional

Relieved by defecation

A

Irritable bowel syndrome

Normal mucosa

239
Q

Recurrent diarrhea

Nocturnal diarrhea

Cholecystectomy hx

A

Bile acid diarrhea

Tx: Bile acid binding resins

  • Cholestyramine
  • Colestipol
240
Q

Asymptomatic man

Hepatosplenomegaly
Elevated LFTs
Hypercalcemia

Mediastinal fulliness

Bilateral reticulonodular opacities of upper lungs

A

Sarcoidosis

Systemic granulomatous inflammation

241
Q

Dilated loops of large bowel with air in colon and rectum

A

Paralytic ileus

242
Q

Alcoholic liver disease

Ascites
Fever
Abdominal tenderness

Confusion
Decreased bowel sounds

Dilated loops of large bowel with air in colon and rectum

Diagnosis

A

Spontaneous bacterial peritonitis

—> Paralytic ileus if severe

Ecoli
Klebsiella

Tx: 3rd gen cephalosporin (cefotaxime)

Fluoroquinolones for SBP prophylaxis

243
Q

Hyperechoic- appearing liver

Elevated ALT, AST

Elevated Alk Phos

A

Non fatty alcoholic liver disease

244
Q

Small bowel obstruction in teenager from Asia

A

Ascariasis

Round worm

245
Q

Post seizure see what in labs

A

Anion gap metabolic acidosis

Postictal lactic acidosis

246
Q

CF

Infant with bright green vomiting

Dilated loops of bowel with no rectal air

A

Meconium ileus

Get contrast enema

247
Q

Esophageal spasm what test to get

A

Esophageal motility studies

248
Q

UC at risk for

A

Colorectal carcinoma

249
Q

Crypt abscess

250
Q

Epigastric pain

Relieved by leaning forward

A

Chronic pancratitis

251
Q

Suspected cirrhosis what exam

A

Upper GI endoscopy to look for varices

252
Q

Tx Varices

A

Nonselective beta blockers

Nadolol

253
Q

What causes spider angioma

What is also caused by this

A

Hyperestrinism due to impair hepatic metabolism of circulating estrogens

Palmar erythema

254
Q

D-xylose given, urinary and vneous D-xylose levels low

A

Celiac disease

255
Q

Elevated AFP
Elevated alk phos

Back pain

A

Hepatocellular carcinoma

256
Q

Bloody ascites

A

Hepatocellular carcinoma

257
Q

Rhabdomyolysis at risk for

258
Q

Chronic renal failure and bleeding due to

A

Uremic coagulopathy

Platelet dysfunction

259
Q

Malignancy in young man

A

Testicular
Lymphoma
Leukemia

260
Q

Angular cheilitis
Glossitis

Rash
Anemia

Deficiency of what vitamin

A

Vit B2 (riboflavin)

261
Q

Dermatitis

Diarrhea

Dementia

A

B3 niacin deficiency

262
Q

Chilosis
Glossitis

Confusion

A

B6 pyridoxine

263
Q

Uncontrolled DM
Opiate use

Abdominal pain
Loose stools for months
Postive glucose breath test

  • Name
  • Due to
  • Causes
  • Test for diagnosis (2)
  • Tx
A

Small intestinal bacterial overgrowth

Happens with altered small bowel motility (uncontrolled DM)

Vit B12 deficiency common

Jejunal aspiration gold standard for diagnosis

Carbohydrate breathe test

Tx Rifaximin, neomycin

264
Q

IBD vs IBS

A

IBD

  • anemia
  • Erythrocyte sedimentation level
265
Q

Chronic pancreatitiis —> diarrhea due to

A

Decrease fecal elastase

Exocrine insufficiency

266
Q

Increase fecal calprotectin

A

Inflammatory bowel disease

267
Q

Watery diarrhea after starting chemo tx

A

Tx loperamide

diphenoxylateatropine

268
Q

Abdominal pain
Microcytic anemia
Positive fecal occult blood
Hepatomegaly

Small left side pleural effusion

Elevated Alk phos

A

Colon cancer metastatic to liver

269
Q

Common bile duct obstruction vs cystic duct

A

Common bile duct = jaundice

270
Q

Erythema nodosum

Looser stools

A

Inflammatory bowel disease

271
Q

Test to get for zenker diverticulum

A

Contrast esophagography

272
Q

70 y.o watery diarrhea

Became lethargic
Abdominal pain
Abdominal distension
Leukocytosis fever

Distened colon

A

Clostridioides difficle infection

Toxic megacolon

273
Q

Vague abdominal pain, nausea, anorexia and constipation

Now severe in lower abdomen
Vomiting

Pain initially improved then intensified through whole abdomen

Bowel sounds diminished

Seen with abdominal imaging

A

Diverticulitis

Free air in the peritoneal cavity

274
Q

Foul smelling urine
Bubbles in urine

Multiple bacteria in sample

A

Colovesical fistula

*Stool in urine

Abdominal CT with oral or rectal contrast (not IV)

275
Q

What makes crohns disease worse

276
Q

Enlarged firm neck mass

Ulcerated tonsillar lesion

Two enlarged firm fixed nontender lymph nodes

What organism

A

Squamous cell carcinoma

HPV

277
Q

Painful itching red streaks on arm

Previously on chest

A

Migratory superficial thrombophlebitis

Trousseau syndrome

Hypercoagulable disorder

Associated with cancer of the pancreas

Get CT scan abdomen

278
Q

Crohns disease
On Total parenternal nutrition

Development of gallstones why

A

Gallstone stasis

Normal stimulus for CCK release and gallbladder contraction is absent

279
Q

Pelvic radiation

Fecal incontience due to

A

Decreased rectal compliance

280
Q

Camping

Diarrhea

281
Q

Traveler’s diarrhea

A

Enterotoxigenic Ecoli

282
Q

Fried rice

A

Bacillus cereus

283
Q

Inflammatory bowel disease with increased risk of cancer

284
Q

30 y.o man with UC presents with fatigue, jaundice and pruritus

A

Primary sclerosing cholangitis

285
Q

Medical tx for hepatic encephalopathy

A

Decrease protein intake
Lactulose
Rifaximin

286
Q

4 y.o presents with oliguria, petechiae, and jaundice following an illness with bloody diarrhea.

Most likely cause?

A

HUS caused by Ecoli

287
Q

Drug induced hepatitis

A

TB medications

  • Isoniazid
  • Rifampin
  • Pyrazinamide

Acetaminophen

Tetracycline

288
Q

40 y.o obese woman with elevated alkaline phosphatase

Elevated bilirubin
Pruritus
Dark urine
Clay colored stools

A

Biliary tract obstruction

289
Q

Diarrhea
Dehydration
Muscle weakness
Flusing

A

VIPoma

Replace fluids and electrolytes

May need to surgically resect or use ocetreotide

290
Q

Hypotonic
Hypervolemic
Hyponatremia

A 
Cirrhosis
HF
Nephrotic syndrome
AKI
CKD
291
Q

Peaked T waves

Widened QRS

A

Hyperkalemia

292
Q

T wave flattening and U waves

A

Hypokalemia

293
Q

Salicylate ingestions causes

A

Anion gap acidosis and primary respiratory alkalosis caused by central respiratory stimulation

294
Q

RTA associated with abnormal H + secretion and nephrolithiasis

A

RTA type I distal

295
Q

RTA associated with abnormal HCO3 reabsorption and rickets

A

Type II (proximal) RTA

296
Q

RTA associated with low aldosterone state

A

Type IV (distal) RTA

297
Q

Drowsiness
Asterixis (tremor of hands and wrist)
Nausea
Pericardial friction rub

A

Uremic syndrome seen in patients with renal failure

298
Q

Glomerulonephritis with hemoptysis

A

Granuomatosis with polyangiitis (wegener) and Goodpasture syndrome

299
Q

Nephrotic syndrome (5)

A 
Proteinuria > 3.5 g
Hypoalbuminemia
Edema
Hyperlipidemia
Thrombosis
300
Q

Waxy casts in urine sediment

Maltese cross

A

Nephrotic syndrome

301
Q

Most common nephrotic syndrome in adults

A

Focal segmental glomerulosclerosis

302
Q

US with bilateral enlarged kidneys with cysts

Associated brain anomaly

A

ADPKD

Cerebral aneurysm

303
Q

Hematuria
Flank pain
Palpable flank mass

304
Q

Most common type of testicular cancer

A

Seminoma

Germ cell tumor

305
Q

Testicular cancer associated with increase in beta-hCG

A

Choriocarcinoma

306
Q

ABG of pregnancy

A

Respiratory alkalosis

307
Q

Tx Giardia

A

Metronidazole

308
Q

Perianal disease
Fissures
Skin tags

Fistula

A

Crohns disease

309
Q

MALT of stomach caused by

310
Q

Hx of Shot in abdomen

Diarrhea even with fasting.

Low osmotic gap

A

Secretory diarrhea

Due to unabsorbed bile acids

311
Q

High stool osmotic gap

Diarrhea

Diarrhea after digestion

WHat test?

A

Osmotic diarrhea

Hydrogen breath test

312
Q

Patient with cirrhosis dont give what medication

A

ACE inhibitor

Blunt RAAS system important for compensatory response

313
Q

Vomiting

Serum

  • Bicarb
  • Chloride

Urine

  • Sodium
  • Chloride
A

Hypokalemic, hypochloremic metabolic alkalosis

314
Q

Tx Primary biliary cholangitis

At risk for

A

+ Anti mitochondria

Ursodeoxycholic acid

Liver transplant later on

Risk

  • Malabsorption, fat soluble vitamin defiiencies
  • Osteoporosis
  • HCC
315
Q

Diarrhea 10-12 x day
Diarrhea in middle of night

Dark brown discoloration of colon

A

Laxative abuse

316
Q

Hx UC

Anemia
Elevated total bilirubin
Elevated Alk phos

What test to get

Increase
Appearance on imaging
Lab

A

Magnetic resonance cholangiopancreatography

Primary sclerosing cholangitis

Increase IgM
Onion skin bile duct
+ P-ANCA

317
Q

Diarrhea
Abdominal pain
WL

Bulky foul smelling stools

Arthralgia

Lymphadenopathy
Skin hyperpigmentation

Villous atrophy
PAS + material in lamina propria

A

Whipple disease

Bacteria Tropheryma whippelii

318
Q

Drug induced lupus

A

Rash is not common

319
Q

Pellagra

A

Dermatitis
Diarrhea
Dementia

Niacin deficiency

320
Q

Constant sensation of dripping in back of throat

Nasal congestion

Food tasting bland

Hx Severe wheezing after naproxen

A

Aspirin exacerbated respiratory disease

Triad of:
Asthma
Bronchospasm from aspirin
Nasal polyposis

321
Q

Icterus
High direct bilirubin

Positive urine bilirubin

A

Dubin Johnson syndrome

Defect in hepatocyte bilirubin excretion

322
Q

P- ANCA

A

Microscopic polyangiitis

Eosinophilic granulomatosis with polyangiitis

Ulcerative colitis

Primary sclerosing cholangitis

323
Q

Elevated Alkaline phosphatase means

A

Liver disease

324
Q

Why are patient that had Roux-en Y gastric bypass more like to develop gall stones

A

Rapid weight loss

Which promotes gallstone formation increased bile concentrations of mucin and calcium

Prophylactic ursodeoxycholic acid administed 6 month postoperative to reduce gallstone development

325
Q

Achy pain in lower back, hips and knees

Elevated Creatinine
Low Calcium
High Phosphorous

A. Autoimmune parathyroid destruction
B. Granulomatous infiltration of parathyroid
C. Parathyroid gland atrophy
D. Parathyroid gland hyperplasia
E. Single parathyroid adenoma
A

D. Parathyroid glandular hyperplasia

Hypocalcemia and hyperphosphatemia in setting of chronic kidney disease= secondary hyperparathyroidism

In CKD decreased production of 1,25 dihydroxyvitamin D —> decreased absorption of calcium

GFR decreases

Kidneys can not adequately excrete phosphate —> hyperphosphatemia

Hypocalcemia and hyperphosphatemia —> release of PTH to maintain levels results in parathyroid hyperplasia

326
Q

Causes of hepatic encephalopathy

A 
Drugs (sedatives, narcotics)
Hypovolemia (diarrhea)
Electrolyte changes (hypokalemia)
Increased nitrogen load (GI bleeding) 
Infection (pneumonia UTI SBP)
327
Q

Develops watery diarrhea

Has low sodium why?

A. High plasma osm
B. Inappropriate ADH secretion
C. Intravascular volume depletion
D. Left ventricular dysfunction
E. Renal tubular necrosis
A

C. Intravascular volume depletion

Hypovolemic due to diarrhea —> antidiuretic hormone (ADH) secretion —> RAAS

Extrarenal fluid losses are associated with decreased urine output and urine sodium < 20

328
Q

Corkscrew small bowel

A

Midgut volvulus

329
Q

Glomerulopathy with Ear involvement

A

Granulomatosis with polyangiitis

330
Q

23 y.o with severe epigastric pain, nausea, vomiting after a party

Similar episode 1 year ago

Yellowish streaks on palms

Blood sample= milky and opalescent

Medication to prevent

A. Lovastatin
B. Fenofibrate
C. Cholestyramine
D. Ezetimibe
E. Psyllium
A

B. Fenofibrate

Severe hypertriglyceridemia

Secondary to familial dysbetalipoproteinemia

[Cholestyramine is a bile acid resin that helps reduce LDL levels]

[Ezetimibe prevents absorption of dietary cholesterol from gut, reduced LDL]

331
Q

Arthritis
Lymphadenopathy
Cardiac issues
Neurologic symptoms

  • Name
  • Stain
  • Biopsy
  • Late stage
  • Who
A

Whipple disease

+PAS (Periodic acid- Schiff) stain
- Stains glycogen

Foamy macrophages
Mesenteric nodes

Diarrhea later on

Older men

332
Q

Rifaximin

A

Decreases ammoniagenic bacteria

Hepatic encephalopathy
Small intestinal bacterial overgrowth (SIBO)

333
Q

Autoimmune hepatitis

Features (6)

A

Constantly elevated LFT

ANA
Anti-Smooth
P-ANCA

Large gamma gap
Total protein- Albumin = >4

Increased IgG

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