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