Medicine

Question 1

pleural fluid analysis shows amylase that is VERY high (>2500), it is exudative fluid with a low pH. What syndrome is this consistent with

Answer 1

This is consistent with Boerhaave syndrome (esophageal transmural tear caused by forceful retching)

-see esophageal air/fluid leakage into nearby areas such as pleura (subq emphysema)

Question 2

name some drugs that can cause interstitial nephritis

Answer 2

cephalosporins

PCNs

sulfonamides

sulfonamide containing diruetics

NSAIDS

rifamipin

phenytoin

allopurinol

Question 3

treatment for mild hypernatremia vs severe hypernatremia

Answer 3

mild: 5% dextrose in 0.45% NaCl (1/2 normal saline)
severe: 0.9% NS…when this is slightly corrected, they can be switched to 0.45% NS (1/2 normal saline)

Question 4

Nephrotic syndrome associated with NSAIDS and lymphoma

Answer 4

Minimal Change Disease

-will usually resolve with treatment of the Hodgkins Lymphoma

** Remember that membranous nephropathy is the MOST common nephropathy associated with malignancy but is more associated with solid cancers (lung, colon, prostate, breast) **

Question 5

anti-mitochondrial antibody

Answer 5

primary biliary cholangitis: an autoimmune distruction of the intrahepatic bile ducts with resulting cholestasis.

Presents most commonly in middle-aged women and is insidious in onset

-also see elevated alk phos

Question 6

best test to dx pancreatic carcinoma

Answer 6

abd CT

-presents with dull abdominal pain that radiates to the back, wt loss, jaundice

PE is unremarkable except for jaundice with abd mass only present in 20% of cases

Question 7

name of drug used to treat kidney stones and mechanism

Answer 7

Tamsulosin = FLOMAX (alpha 1 antagonist) acts on distal ureter to lower muscle tone and reduce reflex ureteral spasm secondary to stone impaction

Question 8

SIADH treatment

Answer 8

fluid restriction +/- salt tabs

-hypertonic (3%) saline

DO NOT GIVE DESMOPRESSIN, used to treat DI, would WORSEN the SIADH

Question 9

Most common cause of death in dialysis pts

Answer 9

cardiovascular disease

Question 10

secretory diarrhea

Answer 10

large stoool volumes >1L/day

diarrhea that occurs even during fasting or sleeping

Question 11

helpful way to determine secretory vs osmotic diarrhea

Answer 11

Stool Osmotitc gap (SOG)

SOG= plasma osmolarity -2 (stool sodium + stool potassium)

Osmotic SOG >125 mOsm/kg

Secretory <50 mOsm/kg

Question 12

major cause of morbidity and mortality in cirrhosis pts

Answer 12

esopgageal varicies (can occur in 30-60% of pts with cirrhosis)

**As a result, all pts with cirrhosis should undergo a screening endoscopy to exclude varicies, determine risk of variceal hemorrhage

Question 13

primary prophylaxis that should be given once pt already has esophageal varicies?

Answer 13

Nonselective Beta blockers such as propanolol or nadolol. Also should do esophageal variceal ligation

Question 14

Nephrotic syndrome in AA and hispanic ethnicity , obesity, and HIV and heroin use

Answer 14

FSGS

Question 15

D-xylose test used for

Answer 15

small intestine mucosal disease such as Crohns (NOT pancreatitis)

Question 16

cyanide nitroprusside test + with h/o kidney stones that are hexagonal

Answer 16

cystinuria (defective COLA amino acid reabsorption)

Question 17

RA predispose to which type of nephrotic syndrome

Answer 17

Amyloidosis (also can be caused by multiple myeloma, the most common cause)

Question 18

most common cause of abnormal hemostasis in pts with chronic renal failure

Answer 18

platelet dysfunction (DDAVP is the tx of choice)

Pts present with abnormal bruising and bleeding