Medicine- Uworld Flashcards
ATN vs AIN basics
ATN: hypotension, AGs –> BROWN muddy casts
AIN: drugs, abx (PCNs, cef, TMX) –> white blood cells, esopinophils, maculorpapular rash
dense intramembranous deposits that stain + for C3 on renal bx
membranoproliferative glom –> persistent activation of alternative complement pathway
most common kidney stone
calcium oxalate
when is increased fluid intake approp in nephrolithiasis?
when stones are <5mm
- inc urinary flow
- dec urinary solute concentration to prevent further stone formation
plan for hyperkalemia
Shift K out of serum into cells –> insulin/ glucose, inhaled beta ag, NaHCO3
Stabilize cardiac membrane –> calcium carbonate
Removal from body –> diuresis, HD, cation exchange resins
Renal vein thrombosis
complication of nephrotic syndrome (loss of AT III)
most commonly seen in mebranous glomerular nephropathy
RVT p/w: acute hematuria, abdominal pain, fever
aspirin toxicity sx triad
fever, tachypnea, tinnitus
***mixed metabolic acidosis with resp alkalosis, expect to see a relatively nl pH
learn contraction alkalosis
loss of fluid, ie from vomiting, triggers RAAS, which kicks in aldosterone –> inc Na reabsorption at the expense of K/H.
Chronic NSAID use can induce _________ anemia
Fe deficiecny
MEN1
1) Hyperparathyroid/ adenoma –> hypercalcemia
2) pancreatic islet cell neoplasia –> gastrinoma, VIPoma, insulinoma, glucagonoma
3) pituitary adenoma
MEN 2A vs 3B
RET protooncogene
both have: medullary thyroid carcinoma + pheo
2A= parathyroid hyperplasia
2B= mucosal and gastrointestinal neuromas
gastrinoma (ZES) diagnosis
fasting serum gastrin (off PPI one week)
<110 pg/ml= nl
>1000pg/ml= diagnostic
110-1000 –> secretin stimulation test. Secretin should inhibit normally functioning G cells
crunching sound on auscultation following esophageal rupture
hamman’s sign
sponteneous rupture of esophagus from vomiting
borehaav syndrome
offenders in pill induced esophagitis
KCl –> osmotic effect
NSAIDs
Bisphosphonates
Tetracyclines
primary proph for esophageal varices in cirrhosis?
nonselective beta blocker
precipitating factors of hepatic encephalopathy
- low Na, K
- hypovolemia –> diarrhea, too much diuresis
- nitrogen load –> ex GI bleed
- drugs
- TIPS
- infections
how does hypokalemia induce hepatic enceph?
dec K –> inc intracellular H+ to maintain neutrality –> so tublar cells inc NH3 production via glutamine progression
most common bugs isolated in ascites? treatment?
GNR –> e coli, klebsiella
staph
tx with 3rd gen ceph
symmetric circumfrential narrowing on barium swallow
esophageal stricture
- -> progressive dysphagia to solids without weight loss
- bx to ro adenocarcinoma
can be cause by sclerosis, irritants, reflux –> inflammation, or irritatnts
longitudinal tears in mucosal lining near GE junction. Contrasted to esophageal perf that presents with vomiting….
mallory weiss
supportive care generally
borheave
VHL associated cancers
renal cell
pheo
hemangioblastomas
two associations with PBC besides positive AMA antibody, hm, generalized pruritis are….
osetoporosis/ osteomalacia
hyperlipidemia –> xanthelasomas
what is the charcot triad assoc with acute cholangitis?
reynolds pentad?
fever, jaundice, RUQ
+
hypotension, AMS
rotors syndrome shows bilirubin on urinalysis because it has a build up of _________ which is _________
CONJUGATED bili which is WATER SOLUBLE
d-xylose test
NOT broken down by pancreatic enzymes = normal absorpotion in pancreatic insuf
ABSORBED by intestinal brush –> abnormal test in celiac disease
how do vagal manuevers help in AVNRT
they trigger parasympathetic tone which slows conduction at AV node an increase in AV node refractory period to restore rythm
cold water (dive reflex), valsalva, carotid massage
with super high BP you generally want to decrease slowly except for in……..
dissection! Decrease rapidly within 20 minutes. IV labetalol
first line for torsades
IV mag
first line for symptomatic brady or heart block
atropine
causes of pericarditis
Infx= most common iatrogenic connective tissue= RA, SLE Uremic = BUN>60 usu cardiac= dressler malignant= hodgkin, lung, breast, RADIATION
first line aortic dissection for BP
IV beta blocker, ie labetolol, to decrease BP as well as Hr and contractility
**hydral can cause reflex tachy
Hyponatermia in CHF?
independent predictor of poor prog
mech: low CO –> inc renin, ADH, norepi –> all lead to increased water retention –> hyponatremia
reversible causes of complete heart block
myocardial ischemia
inc vagal tone –> pain, sleep
metabolic –> hyperK
AV nodal blocking agents –> bb, ccb
cause of aortic dissection before 40? after 60?
<40= marfans
> 60= HTN
becks triad
hypotension
distended neck veins
muffled heart sounds
medications to withhold before exercise stress test
beta blockers
CCB
nitrates
***anything that is antianginal
norepinephrine induced vasospasm
norepi has alpha 1 agonist properties –> vasoconstriction –> can see dusky cool fingers and toes in someone on pressors
how do you respond to PEA
pressors and CPR
how do you treat SIADH?
fluid restrict
what is gold standard for cor pulmonale diagnosis? And what is the def?
right heart cath showing RVH and PH
most common Superior sulcus tumor (pancoast tumor)
squamos cell and small cell of lung
-can cause parasthesias of 4th, 5ht, medial arm, forearm
secondary spontaneous pneumothorax in someone with COPD
bleb rupture –> bleb is cause by chornic destruction of alveolar sacs –> creates “bleb” –> can rupture and allow air to flow into intrapleural space
digital clubbing with sudden onset joint arthropathy in wrists in smoker
COPD –> hypertrophic osteoarthropathy
signs of impending respiratory failure
decreased breath sounds
absent wheeze
change/dec mental status
hypoxia and cyanosis
clinical findings in wegeners?
upper resp, lower resp, heme, renal, skin
UR: chronic sinusitis, saddle nose deformitry –> tracheal ulceration
LR: cavitation, nodules
heme: anemia of chronic dz
renal: RPGN
skin: livedo reticularis, nonhealing ulcers
lights criteria
fluid prot/serum prot >0.5
fluid LDH/serum LDH >0.6
fluid LDH >2/3 ULN
indications that a pleural effusion is “complicated”
low pH, low glucose (<60), high protein (>50kWBC)
most common cap bugs
strep
legionella
mycoplasma
h flu?
what are CURB65 crit and what does it mean?
confusion
BUN > 20
>65 yo
*should be admitted to hospital for managment of PNA
type of shock seen in massive PE?
obstructive! increased right heart and pulm pressures with decrease wedge pressures
3 things that PROLONG survival in COPD?
- supp O2
- quit smoking
- lung reduction surgery
type of lung process that has INC breath sounds and tactile fremitus
consolidation
t/f: afib is associated with PE?
true
irregular RR intervals with no p waves on EKG
vent settings for ARDS
low TV
high PEEP, FiO2
epigastric pain that radiates to interscapular region, relieved by CCB or sublingual nitroglycerin
diffuse esophageal spasm
dx with manometry –> intermittment peristalsis with simultaneous contractions –>”corkscrew”
stool pH in lactose intolerance
ACIDIC –> test with hydrogen breath test
inc stool osmotic gap
positive stool reduction test
