Medicine 3 Flashcards
1
Q
Hyperglycemia and or high serum protein causes ___natremia
A
Hypo
2
Q
Hydrochlorothiazide can cause ___ natremia
A
Hypo
3
Q
Ssris can cause ___ natremia
A
Hypo
4
Q
Lithium makes your sodium go
A
Up
5
Q
Siadh corresponds with a really ___ bun and ___ uric acid
A
Low and low
6
Q
Ecstasy can cause ___ natremia and ___ teeth
A
Hypo; clenching
7
Q
What do you give if sodium is urgently low
A
3% saline
8
Q
Younger people who are really sick and hyponatremic give
A
3% saline
9
Q
Three common features of ecstasy
A
Euphoria, bruxism and tachycardia
10
Q
What fluid do you give in hypernatremia
A
D5w
11
Q
Most common cause of hypernatremia
A
Inability to get to water
12
Q
When people are hypomagnesemic they are usually also hypo___ and you can’t fix that til you fix their magnesium
A
Kalemic
13
Q
Alcohol causes ___magnesemia and because of that ___ potassium
A
Hypo, low
14
Q
If you have massively high wbc count why do you get hyperkalemia
A
Because the lysis of all those cells leads to release of a bunch of calcium
15
Q
Causes of hyperkalemia
A
Too much intake(iatrogenic), too little excretion (renal failure or drugs blocking renal excretion), or shift (acidosis or muscle injury-rhabdo)
16
Q
If you have acute hyperkalemia what do you give acutely
A
Calcium gluconate first, then insulin and glucose and bicarb
17
Q
Kayexalate is used to treat
A
High levels of potassium in the body
18
Q
Pt can’t see and they have a gap and serum acidosis. cause?
A
Methanol poisoning
19
Q
Metformin and renal insufficiency can cause
A
Lactic acidosis
20
Q
Six causes of decreased anion gap
A
Low albumin (decreased unmeasured anions), myeloma (increased unmeasured anions), hypermag, hypercalcemia, lithium, bromide
21
Q
If you have diarrhea you get ___kalemic
A
Hypo
22
Q
Difference between total protein and albumin is the
A
Protein gap
23
Q
If the protein gap is above four, look for
A
Immunoglobulins
24
Q
Differential of low albumin
A
- Cirrhosis (can’t build proteins)
- Nephrosis (spilling proteins)
- Gastrosis (losing proteins or malnutrition)
25
Quick test for hiv
Elisa
26
Differential dx for elevated protein gap
Sepsis, hiv, hep c, multiple myeloma, autoimmune
27
If ast and alt are in the thousands, think what four things causing hepatocellular injury
Tylenol tox,
acute hep a or b,
budd Chiari (clot in portal system
Autoimmune hepatitis
28
Isolated elevated alk phos indicates
Bone formation
29
Elevated alk phos and bone ggt indicates
Biliary tree involvement
30
Really high bun to creatinine ratio indicates what kind of injury
Prerenal
31
50 yo pt with hx of cad comes in with diffuse muscle aches for the past month. What is it most likely
Statin induced myalgias
32
Rank these statins in terms of worst myalgia side effects: pravastatin, atorvastatin, rosuvastatin, simvastatin
Simvastatin> atorvastatin > pravastatin and rosuvastatin
Worst to best (sim is worst)
33
50 pt with hx of cad and one month diffuse muscle aches. Another cause other than statin induced myalgias
Bad hypothyroid
34
78 year old man with fatigue with low hematocrit, low plts and high wbcs. What is it? What test to run?
Cll
| Blood smear to see smudge cells (rarely) and lots of lymphocytes
35
Why do you sometimes give metoclopramide with migraines
Because they can cause gastroparesis
36
4 prophylactic txs for migraines
Beta blockers, topiramate, riboflavin, butterbur
37
Tx of bppv
Epli maneuver
38
Physical exam to evaluate for ascites
Le edema, shifting dullness, fluid wave
39
Chylothorax differential
Thoracic back trauma (test with lymphangiogram), nontraumatic malignancy, infection
40
Triglyceride level to be considered chylothorax
Above 110
41
Mgmt of chylothorax
Chest tube, low fat diet, lymphangiogram, thoracic embolization
42
Imaging to dx kidney stones
Ct scan of abdomen without contrast
43
Kidney stones measuring less than ___ mm in diameter generally pass spontaneously
5mm
44
Acyclovir can cause ___ if adequate hydration is not also provided
Crystalline nephropathy
45
Most common kidney stones
Calcium oxalate
46
Calcium phosphate kidney stones are common in what two conditions?
Primary hyperparathyroidism and rta
47
Initial treatment of hypercalcemia
Saline hydration
48
Rank the first three places jaundice shows up
Sublingual then eyes then skin
49
Low fibrinogen is a sign of
Dic
50
Metabolic syndrome includes what three disorders?
Dyslipidemia, htn, abdominal obesity
51
Thiazide diuretics cause ___glycemia
Hyper
52
If hyponatremic, hypovolemic, and symptomatic, what fluid do you give?
0.9% saline until euvolemic
53
If hyponatremic, hypovolemic, and asymptomatic, what fluid do you give?
5% dextrose
54
Four causes of high bun:cr ratio
- Vol depletion
- gi bleed (likely upper gi),
- high dose ccsteroids due to muscle breakdown,
- prerenal State due to poor co or acei/nsaid
55
You get a call about a 90 year old with confusion. What do you think of and what do you do?
Delirium; physical exam and cam
56
Side effect of ssris esp paroxtine in elderly
Increased risk of falls
57
What is cam?
Confusion assessment method for delirium
58
Workup for postrenal problems
Bladder scan and post void residual
59
Urine dipstick checks
Protein, ketones, leukocyte esterase, nitrate, blood (heme but not rbcs)
60
Which is responsive to volume, atn or prerenal?
Prerenal
61
Urine sodium in prerenal? Atn?
Prerenal <10, atn>20
62
FeNa in prerenal? Atn?
Prerenal <1%, atn>2%
63
Midodrine and octreotide are used in the treatment of
Hepatorenal syndrome
64
Azotemia definition
High levels of urea/crt/waste products in the blood
65
Protein level in nephrotic syndrome
Above 3.5
66
Best assessment of proteinuria
Urine spot test for protein:cr ratio
67
Three causes of non anion gap acidosis
1) gi-diarrhea
2) carbonic anhydrase inhibitors (acetazolamide)
3) rta
68
What rta is seen in diabetics and causes hyperkalemia? Why?
Type IV rta
Seen in diabetic pts because they are extremely sensitive to potassium effects of aces and arbs
69
Low magnesium is caused by what three things
Heavy alcohol intake, diuretics, cis platinum
70
If mag is low, what else is almost always low and can’t be replaced until mag is?
Potassium
71
Differential for euvolemic hyponatremia
1) endocrine: hypothyroid and adrenal insufficiency
2) drugs esp ssris (paroxetine) and hydrochlorothiazide
3) siadh
72
Tx of asymptomatic or mildly symptomatic euvolemic hyponatremia
Water restrict
73
Mgmt of edematous hyponatremia
Diuretics
74
Mgmt of hypovolemic hyponatremia
Normal saline infusion
75
Paroxetine side effects
Falls in elderly and hyponatremia
76
Causes of anion gap acidosis
```
Methanol
Uremia
Lactic acidosis
Ethylene glycol
Paraldehyde
Aspirin (salicylate)
Ketoacidosis (diabetic, alcoholic, starvation)
```
77
Oxalate crystals in urine, renal insufficiency, urine may fluoresce with Woods lamp. What is it?
Ethylene glycol poisoning
78
Treatment of ethylene glycol poisoning
Fomepizole
79
Tinnitus, fever, tachypnea and nausea may be a sign of what intoxication?
Aspirin
80
Cherry red flushing, headache/ams/seizures, abdo pain n/v, arrythmia, tachypnea. What kind of toxicity?
Cyanide toxicity
81
Causes of cyanide toxicity
Wool and silk, mining, sodium nitroprusside
82
Mixed cryoglobulinemia presents with
Palpable purpura, proteinuria, hematuria and nonspecific systemic sx. Also circulating cryoglobulins.
83
Most patients with mixed cryoglobulinemia present with underlying
Underlying hep c
84
Causes of new onset dic
1) infection
| 2) chemo/leukemia
85
General maintenance fluid dose
Between 75 and 150cc/hr
86
Tenesmus definition
The feeling of needing to poop even if there’s nothing in there
87
Cause of extremely elevated alt and ast
Hepatocellular injury
88
Cause of high alk phos and d bill; may see increase in alt and ast but primarily alk phos and d Bili
Obstruction (usually hurts unless it’s cancer)
89
Is gallbladder cancer painful? What will you see?
See thin walled gallbladder and no pain
90
Causes of infiltration in the liver. What lab will you see?
Sarcoid, amyloid, hemochromatosis , cancer, fibrosis
See an elevation of alk phos
91
Leading cause of euvolemic hypernatremia
Diabetes insipidus
92
Normal specific gravity of urine
1-1.03
93
Three causes of ascites in cirrhosis
1) increase in hydrostatic pressure due to portal htn
2) activation of raas due to fluid pooling and not perfusing the kidneys
3) loss of albumin leading to loss of oncotic pressure
94
Initial therapy for pts with htn and renal artery stenosis
ace or arb
95
Renal artery stenting or revascularization is for which renal artery stenosis patients
Those with resistant htn or recurrent flash pulm edema and Or refractory hf due to severe htn
96
Aki tends to cause metabolic ___ and ___kalemia
Acidosis; hyperkalemia
97
Renal vein thrombosis is most commonly associated with which nephrotic disease
Membranous glomerulopathy
98
Why do you have an increased risk for atherosclerotic disease in nephrotic syndrome
Low plasma oncotic pressure due to hypoalbuminemia increases hepatic lipoprotein synthesis
99
Pts with nephrotic syndrome are ___coagulable
Hyper
100
What diuretic helps prevent formation of calcium kidney stones?
Thiazides
101
What kind of cancer is a common cause of siadh
Small cell lung cancer
102
Hyponatremia, serum osmolality<275mosm/kg, urine osmolality>100mosm/kg h20 in a euvolemic pt. What is it?
Siadh
103
Why does a low sodium diet help prevent calcium renal stones?
Low sodium intake promotes sodium and calcium reabsorption
104
Will urine sodium be low or high in self induced vomiting?
Low as kidneys try to conserve water
105
Oxalate absorption is ___creased in Crohn’s disease
Increased, leading to oxalate Stone formation
106
What are the four features of nephrotic syndrome
Proteinuria, hypoalbuminemia, edema, hyperlipidemia
107
Treatment of uric acid kidney stones
Hydration
Alkalinization of the urine (eg potassium citrate)
Low purine diet
108
What kind of kidney stones are radiolucent
Uric acid stones
109
Beta hydroxybutyrate lab tests for
Ketones
110
What are the things you think of in cirrhosis ? (Purple cats)
Les CHATS Violes
```
Cancer
Hepatic enceph
Ascites
Thrombocytopenia
Sbp
Varices
```
111
Isolated elevated bilirubin could be due to what three things
Virus
Hemolysis
Gallbladder
112
Most common causes of diarrhea, viruses or bacteria?
Viruses
113
What viruses are the most common causes of diarrhea
Rotavirus, norovirus, adenovirus
114
What is the most common bacterial cause of diarrhea
Campylobacter
115
If pt is unstable with diarrhea what do you give
Cipro
116
Three antibiotics that are high risk for pt developing c diff
Clinda, 3rd gen cephalosporin, fluoroquinolones
117
Tx of mild to moderate c diff
Flagyl 10-14 days
118
Tx for severe c diff
Po vanco 10-14 days
119
Tx of first relapse of c diff
Follow normal guidelines
120
Tx of 2nd recurrence of c diff
Po vanc 6wk course tapered
121
Don’t give loperamide in diarrhea pts when there are what symptoms/concerns
Fever, blood, mucus in stool
| Concern for c diff
122
What two meds do you recommend for rate control?
Metoprolol, anticoag (10a inhibitor)
123
What three things do you give for dka?
Insulin
Fluids
Potassium
124
Why do you give potassium in dka?
Because you give insulin which drives potassium into cells and lowers potassium
125
Why might someone with dka have blurred vision
Osmotic effect—> lens swells. Will get better.
126
Two side effects of metformin
Kidney damage and diarrhea
127
Multiple and refractory peptic ulcers, ulcers distal to the duodenum, chronic fatty diarrhea due to pancreatic enzyme inactivation. What am i?
Zollinger Ellison syndrome
128
What is the diagnosis of ze syndrome?
Markedly elevated serum gastrin level (>1000 pg/mL) in the presence of acidic gastric pH (<4)
Generally there are ulcers
129
How do you first view a gastric adenocarcinoma
Ct scan
130
What’s dupuytren contracture?
Thickening and shortening of the palmar fascia in cirrhosis
131
What are the risk factors for toxic megacolon?
Ibd, c diff
132
Sx of toxic megacolon
Systemic toxicity (fever, tachycardia, hypotension)
Bloody diarrhea
Distention/peritonitis
133
Imaging to dx toxic megacolon
Abdominal X-ray
134
Complication of pt with hepatic encephalopathy on diuretics
Can develop low intravascular volume despite total volume overload, leading to metabolic alkalosis with associated hypokalemia
135
To avoid complications with diverticulosis what should you do?
High fiber diet
136
Hypogonadism, impaired wound healing, impaired taste, alopecia, rash of erythematous pustules around mouth and on extremities indicates what mineral deficienvt?
Zinc
137
What neoplasms are associated with lynch syndrome?
Crc, endometrial, ovarian
138
Is bilirubin usually seen on UA?
No
139
Why do you have dark pee with hepatic dysfunction, biliary obstruction ?
Plasma buildup of conjugated bilirubin which overflows and leaks into the Urine
140
What causes zenker diverticulum?
Upper esophageal sphincter dysfunction and esophageal dysmotility
141
Two month hx of Wt loss and jaundice raises concern for
Pancreatic cancer
142
Porcelain gallbladder is associated with ___ and increased risk for ____
Chronic cholecystitis and gallbladder adenocarcinoma
143
Lactose intolerance presents at what age range? It is a deficiency of what?
20-40, brush border enzyme deficiency
144
Dx of esophageal cancer
Egd
145
Can pancreatic insufficiency cause steatorrhea
Yes
146
Cause of mesenteric ischemia (crampy post prandial epigastric pain and food aversion)
Atherosclerosis
147
Dx of mesenteric ischemia
Ct angiography
148
Causes of isolated thrombocytopenia
Drug induced due to abx, quinine, hit
Alcohol
Itp
Infection
149
Mucosal bleeding (rectal and nose) and Petechiae point to
Thrombocytopenia
150
What infections could cause thrombocytopenia
Viral, cmv, hiv, parvo, hcv, ebv)
151
Tx for itp
Steroids first line; step up is ivig then rituximab
152
Platelets below ___ is risky for intercranial bleed
10
153
Three most common causes of decompensated cirrhosis
Sbp, gi bleed, pv clot
154
Three risk factors for c diff
Recent abx, hospitalization, ppi
155
Losartan ___ uric acid levels
Decreases
156
At what hemoglobin level should stable pts receive a packed red blood cell transfusion
Under 7g/dL
157
Dx of lactose intolerance
Hydrogen breath test
158
What do you see on serology in latent chronic hep b?
Core igg and surface antigen
159
Wt loss, fatigue, multiple liver lesions indicate what?
Metastatic disease to the liver
160
What is the most common source of metastasis to the liver. Diagnosis?
Crc. Diagnosis-colonoscopy
161
AFP is associated with what kind of cancer?
Hcc
162
What is the Cullen sign?
Periumbilical bluish coloration indicating hemoperitoneum severe pancreatitis
163
What is the gray Turner sign
Reddish brown coloration around flanks indicating retroperitoneal bleed
164
Why do you get large volumes of fluid migrating from vascular system to surrounding peritoneum in severe pancreatitis?
Severe pancreatitis causes local release of pancreatic enzymes that increase vascular permeability around the pancreas. Leads to large volumes in the retroperitonium.
165
What is courvoisiers sign
Nontender but palpable gallbladder at the right costal margin in a jaundiced pt in pancreatic cancer
166
Prednisone can cause a ___ wbcount
High
167
Hyperglycemia can cause __natremia
Hypo
168
What is hepatic hydrothorax
Transudative pleural effusion in cirrhosis due to small defects in the diaphragm, more common in the right side
169
Tx of hepatic hydrothorax
Salt restriction and diuretic administration
170
Where do gallstones usually lodge
Cystic duct
171
Which is associated with noncaseating granulomas, crohns Or ulcerative colitis
Crohns
172
Corkscrew esophagus is associated with
Diffuse esophageal spasm
173
What is the abdominal succussion splash
Put a stethoscope on the upper abdomen and rock pt back and forth at hips. Splash=sign of gastric outlet obstruction
174
Common bile duct obstruction normally causes
Obstructive jaundice, aka severe jaundice and very high alk phos levels
175
D xylose test is ___ in pancreatitis
Normal
176
D xylose test is ___ in celiac disease
Low
177
Hepatic adenomas show up in
Women on low term ocps
178
Worsening epigastric pain and wt loss in the setting of idiopathic chronic pancreatitis suggests
Pancreatic cancer
179
Worsening epigastric pain and wt loss and jaundice in the setting of idiopathic chronic pancreatitis suggests___. How to diagnose?
Pancreatic cancer in the head of the pancreas, rule out with abdominal ultrasound
180
Worsening epigastric pain and wt loss and no jaundice the setting of idiopathic chronic pancreatitis suggests
Cancer in body or tail of pancreas . Should have abdo ct scan
181
How often do you screen pp in uc with colonoscopy
Every 1-2 years
182
Esr and wbc count are __ in crohns dz
Elevated
183
Abdominal pain, microcytic anemia, positive fecal occult blood and hepatomegaly with a hard edge on liver palpation is likely a
GI malignancy
184
Acute urinary incontinence in a pt with dementia is likely due to
A uti
185
Diclofenac is a
Nsaid
186
Colchicine treats
Gout flares
187
Febuxostat is used to treat
Gout
