IM Clerkship Flashcards
DDX for WBC casts?
Pyelonephritis Acute intersitial nephritis
DDx for muddy brown casts?
Acute tubular necrosis Can be caused by ischemic AKI or nephrotoxic AKI (antibiotics, radiocontrast agents, NSAIDs, poisons, myoglobinuria, hemoglobinuria, chemotherapy, AL in MM)
Metabolic derangements in AKI
Hyperkalemia Anion gap metabolic acidosis Hypocalcemia Hyponatremia Hyperphosphatemia Hyperuricemia
Metabolic derangements in CKD
Hyperkalemia Hypermagnesemia Hyperphosphatemia Metabolic acidosis Hypocalcemia
Side effects of ACEI
ACEI dilate afferent arteriole Hyperkalemia
Absolute indications for dialysis
Acidosis Electrolyte abnormalities Intoxications Overload, hypervolemic Uremia based on clinical presentation (e.g. AMS, pericarditis)
Minimal change disease
Most common in children May present as nephrotic syndrome A/w lymphomas Microscopy: no changes on light microscopy, foot process fusion Tx: 4-8 weeks of steroids
Focal segmental glomerulosclerosis (FSGS)
More common in Blacks Microscopy: focal segmental sclerosis, foot process fusion A/w HIV, heroin use, sickle cell disease Does not respond well to steroids
Membranous glomerulonephritis
Microscopy: thick glomerular basement membrane A/w: Hep B, Hep C, SLE Does not respond well to steroids
Post-infectious glomerulonephritis
Nephritis 10-21 days following URI Low C3 complement Elevated anti-streptolysin O and/or anti-DNAse B
IgA nephropathy
Nephritis 5 days following URI Normal complements
Prostate cancer
Risk factors include age, African American race, high-fat diet, FHx, exposure to herbicides and pesticides Mostly adenocarcinoma, starts at periphery Mostly asymptomatic but can cause obstruction in late phase Likes to metastasize to bone (pelvis, vertebral bodies, long bones in the legs) Indications for transrectal ultrasound: PSA > 4.1, abnormal DRE Tx: radiation + androgen deprivation OR prostatectomy OR orchiectomy, antiandrogens, leuprolide, GnRH antagonists
Treatment of CAD
Risk factor modification (HTN, DM, HLD control, etc.) Aspirin (reduces risk of MI) Nitrates Beta-blockers (reduces frequency of coronary events) + coronary angiography to assess for PCI (if moderate) + consider CABG (if severe)
Treatment of hypertrophic cardiomyopathy
Beta-blockers
Treatment of CHF
ACEI + loop or thiazide diuretic Beta-blockers Spironolactone/Eplerenone
Treatment post-stent placement
Dual platelet therapy (aspirin + clopidogrel) 1 month for BMS 12 months for DES
Treatment for aortic dissection
IV beta-blocker to SBP 100-120 If SBP still > 120, add sodium nitroprusside
Treatment for cocaine-induced chest pain
IV benzodiazepines Aspirin, nitroglycerin, CCB Beta-blockers contraindicated
Arrhythmia most specific for digitalis toxicity
Atrial tachycardia with AV block
Finds for aortic stenosis
Fatigue, lightheadeness with exertion, presyncope Midsystolic murmur over RUSB Diminished and delayed carotid pulse Soft and single S2
Tx for sinus bradycardia
IV atropine
Light’s criteria?
Pleural effusion is exudative if: PF/serum protein > 0.5 PF/serum LDH > 0.6 PF LDH > 2/3 upper limit of normal (about 200)
