IM Clerkship

Question 1

DDX for WBC casts?

Answer 1

Pyelonephritis Acute intersitial nephritis

Question 2

DDx for muddy brown casts?

Answer 2

Acute tubular necrosis Can be caused by ischemic AKI or nephrotoxic AKI (antibiotics, radiocontrast agents, NSAIDs, poisons, myoglobinuria, hemoglobinuria, chemotherapy, AL in MM)

Question 3

Metabolic derangements in AKI

Answer 3

Hyperkalemia Anion gap metabolic acidosis Hypocalcemia Hyponatremia Hyperphosphatemia Hyperuricemia

Question 4

Metabolic derangements in CKD

Answer 4

Hyperkalemia Hypermagnesemia Hyperphosphatemia Metabolic acidosis Hypocalcemia

Question 5

Side effects of ACEI

Answer 5

ACEI dilate afferent arteriole Hyperkalemia

Question 6

Absolute indications for dialysis

Answer 6

Acidosis Electrolyte abnormalities Intoxications Overload, hypervolemic Uremia based on clinical presentation (e.g. AMS, pericarditis)

Question 7

Minimal change disease

Answer 7

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

Question 8

Focal segmental glomerulosclerosis (FSGS)

Answer 8

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

Question 9

Membranous glomerulonephritis

Answer 9

Microscopy: thick glomerular basement membrane A/w: Hep B, Hep C, SLE Does not respond well to steroids

Question 10

Post-infectious glomerulonephritis

Answer 10

Nephritis 10-21 days following URI Low C3 complement Elevated anti-streptolysin O and/or anti-DNAse B

Question 11

IgA nephropathy

Answer 11

Nephritis 5 days following URI Normal complements

Question 12

Prostate cancer

Answer 12

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

Question 13

Treatment of CAD

Answer 13

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)

Question 14

Treatment of hypertrophic cardiomyopathy

Answer 14

Beta-blockers

Question 15

Treatment of CHF

Answer 15

ACEI + loop or thiazide diuretic Beta-blockers Spironolactone/Eplerenone

Question 16

Treatment post-stent placement

Answer 16

Dual platelet therapy (aspirin + clopidogrel) 1 month for BMS 12 months for DES

Question 17

Treatment for aortic dissection

Answer 17

IV beta-blocker to SBP 100-120 If SBP still > 120, add sodium nitroprusside

Question 18

Treatment for cocaine-induced chest pain

Answer 18

IV benzodiazepines Aspirin, nitroglycerin, CCB Beta-blockers contraindicated

Question 19

Arrhythmia most specific for digitalis toxicity

Answer 19

Atrial tachycardia with AV block

Question 20

Finds for aortic stenosis

Answer 20

Fatigue, lightheadeness with exertion, presyncope Midsystolic murmur over RUSB Diminished and delayed carotid pulse Soft and single S2

Question 21

Tx for sinus bradycardia

Answer 21

IV atropine

Question 22

Light’s criteria?

Answer 22

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)