PPP ROSH- Renal/Derm Flashcards
Lithium use can cause ? type of kidney issue
When is Tx by dialysis indicated
What other intervention is used to increase lithium elimination
Nephrogenic Diabetes Insipidus
Seizure AMS Dysrhythmia
Aggressive fluids
How is HyperCa Tx
Causes of high anion gap metabolic acidosis
Aggressive hydration, IV Bisphosphonate (Zoledronic Acid- inhibits Ca release from bones)
Na - (BiCarb + Cl): 10 +/-2: A CAT MUDPILE: ASA CO/Cyanide Acetaminophen Theophylline Methanol/Metformin Uremia DKA/Alcohol KA Propylene glycol Isoniazid/Ibuprofen Lactiv acidosis Ethylene glycol
What 3 meds can lead to lactic acidosis
Hyper/HypoK EKG findings
How are PTs Tx
Propylene glycol Metformin Salicylates
+: Bradycardia, Wide QRS, Absent P-wave, Peaked T-wave- first seen
-: Flat/inverted T-wave, U-wave- MC,
Ca chloride/gluconate
Albuterol- shifts K intracellularly
Furosemide- inc K elimination
? ABX can cause HyperK
Nephrotic induced protein loss can cause Pts to adopt ? blood d/o
What are the features of a naphrotic syndrome
TMP-SMX
Hypercoagulable- DVTs
Na dec Albumin dec Proteinuria >3.5g/day Hyperlipid Renal vein thrombosis Orbital edema Infections Coagulability d/t antithrombin 3 lost in urine
What UA finding will be seen in Pts w/ hyperlipidemia induced by nephrotic syndromes
? med class needs to be d/c in Pts w/ pre-renal AKI
Normal pH, PaCO2 and BiCarb
Oval fat bodies- lipid deposit in sloughed renal tubular cells
ACEI- blunting afferent arteriole will worsen GFR
7.35-.45, 35-45, 22-26
ROME: compare pH and PCO2
MC type of renal Ca in adults
Only method of Tx is ?
? triad can Pts present w/
Renal cell carcinoma- originates in renal cortex w/ smoking doubling risk of development
Surgical resection
Flank pain, Hematuria, Palpable mass
Why do varicoceles occur more often on the left side
MCC of HypoCa
Expected PCO2 formula
Spermatic vein to L renal vein, R connects w/ IVC
Advanced CKDz; stabilized w/ Ca gluconate
pCO2= 1.5(BiCarb) + 8 +/2
Measured Co2 >Winters formula= respiratory acid
Measured Co2
DiGeorge Syndrome mnemonic
Stages of CKDz
CATCH-22: Cardiac abnormalities Abnormal facies Thymic absence/T-cell abnormality Cleft palate HypoCa Chrom22
1: ≥90
2: 60-89
3: 30-59
4: 15-29
5: <15
How long does kidney dz need to be present to be labeled as chronic
Best method to Dx renal artery stenosis
Refractory HypoK needs to be Tx w/ ?
> 3mon
Gadloinium enhanced MRAngiography
Mg
MCC of nephrotic syndrome in adults
What med is used to Tx anemia of chronic dz
MC complication of CKDz
Focal segment glomerulosclerosis
Darbepoetin
HTN
What lab finding suggest interstitial nephritis
How is this Tx
Red Blood Cell casts suggest ? Dx
Eosinophiluria d/t allergic reaction to meds
D/c offending med
Acute glomerulonephritis- hematuria, proteinuria, casts, HTN, vol overload
MC solid renal tumor of childhood
MC electrolyte imbalance seen after laparoscopic surgery
How does post-strep glomerulonephritis present
Nephroblastoma- Wilms tumor
Metabolic alkalosis d/t volume contraction and gastric fluid loss
1-2wks post-strep infection w/ hematuria, HTN and periorbital edema
Degrees of skin burn
1st, Superficial- dry, red, blanches w/ pressure
2nd, Superficial partial- blisters w/ blanching
2nd, Deep partial- blisters w/ sluggish blanching
3rd, Full- waxy, dry and no blanching
How does Post-Strep Glomerulonephritis present
How are Pts Tx
How is Pityriasis Rosea Tx
Hematuria Periorbital edema HTN** d/t GAS infection
Furosemide for fluid overload
Triamcinolone acetonide, consider antihistamine (-ine)
Initial HyperCa d/t malignancy Tx
Prolonged Tx
How is HyperK Tx
NS fluids w/ loop diuretic (ide)
Bisphosphonates
Ca gluconate, Albuterol, Reg insulin, Glucose, Furosemide
Indications for emergency dialysis
What is the risk for rapidly correcting Na deficiency
How does pH alter K flow
AEIOU:
Acidosis E+ disturbance Intoxication Overloaded volume, Uremia
Central pontine myelinolysis
Acid- K moves out of cells
MCC of acute kidney injury in kids
What is the triad for this condition
How are Pts managed
HUS d/t E coli O157:H7
Schistocytes Thrombocytopenia Renal insufficiency
Monitor BUN/Cr, give Eculizumab if severe CNS involvement occurs
HypoMg PE finding
How is HyperMg Tx
MCC of Secondary HyperCa
Hyper reflexia
Dialysis, CaCl/gluconate
CKDz decreasing Vit D levels
How is acute hypoparathyroidism Tx
? causes kidney staghorn calculi
DI will cause ? osmolality shifts
Ca gluconate
Proteus mirabilis bacteria
Urine: low Na, Serum: inc Na
? lung condition leads to chronic respiratory acidosis
HyperK effect on heart muscle
Proteinuria and nephrotic syndrome can lead to ? type of casts
Pulm fibrosis
Inactivated Na channels= dec membrane excitability
Fatty
Where will fluid collection d/t nephrotic syndrome accumulate in non-ambulatory Pts
Microscopic oval fat bodies and maltese cross is associated w/ ? Dx
What will Pts present w/ as c/c
Sacrum
Nephrotic syndrome
Foamy/Suds urine
? lab result is highly sensitive to nephrotic syndrome
How is this Tx
Why can Pts develop DVTs
Lipiduria
ACEI, Fluid/Na restriction
Loss of Protein C,S and Antithrombin 3
? anti-hypertensive meds are c/i during HyperK
How does Fibromuscular Dysplasia present
Define Status Epilepticus
ACEI/ARBs
Woman <35y/o w/ HTN and abdominal bruit
Continues seizure >10min or ≥2 seizures w/out full recovery
How is status epilepticus Tx
? antiepileptic can cause HyoNa at therapeutic doses
How are genital warts Tx during pregnancy
L/D-zepam/Midazolam
Phenytoin
Phenobarbital/Propofol
Oxcarbazepine
Trichloroacetic acid at 32wks
Condyloma acuminata is d/t ? infection
What causes Pitryriasis Rosia
How is Histamine Fish Toxicity Tx
HPV 6, 11
HHV 6, 7
Diphenhydramine (antihistamine)
? is an absorbable material
ABCDEs of melanoma
This mnemonic is not applicable to ? melanoma lesion
Vicryl
Asymmetry Border irregular Color Diameter <6mm, 1/4”, Evolution
Subungual
Non-DM acanthosis nigricans is d/t ?
? causes Measles
How does this present/progress
Gastric Ca
Rubeola
High fever then rash:
3 C’s: Cough Coryza Conjunctivitis
Morbiliform rash
MCC of mortality from measles
What is the most life threatening complication
MC microbe from dog bites
Pneumonia
Subacute sclerosing panencephalitis
Pasteurella
? dog bite microbe can cause bacteremia/fatal sepsis
When are dog bites closed w/ primary intention
Define Pemphigus Vulgaris
Capnocytophaga canimorsus
Face
Bullous lesions from autoimmune (myasthenia, thymoma) origin w/ +Nikolsky sign
What needs to be differed in Pts w/ Pemphibus Vulgaris
MCC of skin abscess
How is this differed from cellulitis on PE and how are abscesses Tx
BP- >60y/o w. autoimmune induced sub-epidermal pruritic papules/tense blisters w/out Nikolsky
PV: 40-60y/o w/ flaccid blisters and mucossal involvement, +Nikolsky
Staph A- culture and Tx: Clinda/Tetracycline/TMP
Fluctulance- Clinda, TMP, Tetracycline
? causes HFM Dz
? is the classic derm finding during tertiary syphilis
Mnemonic and Tx for Kawasakis
Coxsackie A virus
Gummas
CRASH and Burn: Conjunctivitis, non-purulent Rash Adenopathy Strawberry tongue Hand/foot swelling w/ peeling Burning fever x 5 days Tx: IVIG and high dose ASA
Allergy to Amoxicillin will likely cross react w/ ? other ABX class
How are Black Widow bites Tx
How does Perioral Dermatitis present and how is it Tx
1st gen cephalosporin- Fa/Pha
Opioids, Benzos, Antivenom
Perioral papule/pustules w/ sparing of vermillion border; Metronidazole gel
How is Perioral dermatitis Tx when periorbital dermatitis is also present
Define Erythema Toxicum Neonatorum presentation
What wold be seen in wright stain was performed
Tetracycline- doxy
2nd day of life w/ firm pale papule w/ surrounding erythematous flare
Eosinophils
Define Kerion
How is this Tx
MC benign tumor in older Pts
Delayed T capitis induced hypersensitivity reaction casuing boggy plaque w/ heaped up nodules
PO griseofulvin, Steroids
SKs d/t keratotic plugging; Dx w/ shave biopsy
? type of SK presentation indicates malignancy
SJS vs TEN body involvement
Skin infections d/t MRSA are Tx w/ ?
Lesser Trelat- multiple, eruptive SKs
SJS: <10%, TEN >30%
Doxy
How does Atopic Dermatitis present by age
How is Onychomycosis Tx
Exclamation point hairs mean ? Dx
Infant: cheek/trunk
Peds: flexor surface
Adult: hands
Terbinafine > Itraconazole w/ LFT monitoring
Alopecia areata- Tx w/ Triamcinolone
Hair feeling like wire brush is associated w/ ? Dx
Fixed drug eruption presentation
What can be done for Tx other than d/c offender
Trichotillomania
NSAID induced erythematous, edematous plaque appearing in the same location each time med is used leaving hyperpigmented macule
Diphenhydramine
What other PE finding will be positive w/ Pemphigus Vulgaris along w/ Nikolski
How is Candidis Diaper Dermatitis Tx
Define Vitiligo and Tx
Asboe Hansen- lateral pressure spreads fluid into unaffected skin
Nystatin cream
Depigmentation of skin d/t destruction of melanocytes; Topical Tacrolimus, Narrow UVB therapy
How are scabies Tx
What is the most important prognostic factor for melanoma
HS affects ? structure and AKA ?
5% permethrin, PO Ivermectin for residential outbreaks
Depth of lesion
Apocrine sweat glands; Acne inversa
What causes Lichen Simplex Chronicus
Rule of 9s
This rule only applies to ? burns
Neurodermatitis d/t chronic itch/scratch
Head 9
Arms 9
Torso: 18 front/back
Leg: 18
2nd and 3rd degree
? can cause a normal anion gap metabolic acidosis
Most serious complication that can arise from PCKDz
What are women at increased risk fot
Diarrhea
Cerebral aneurysms
Ectopics
MC type of kidney cancer
? lab test is serially measured and tracked in Pts w/ post-streptococcal glomerulonephritis
MC type of cast
Renal cell carcinoma arising from epithelial cells of proximal tubules of renal cortex
Antistreptolysin O Abs
Hyaline d/t Tamm Horsfall protein from dehydration/exercise
WBC cast mean ?
? E+ abnormality can cause hiccups
What is the only approved Tx for hiccups
Pyelonephritis, Nephrotic syndrome, Post-strep nephritits
HypNa/Ca
Chlorpromazine
What other defects can be seen w/ Wilms Tumors
Muddy brown casts are associated w/ ? Dx
? ABX class can commonly cause these casts
Horse shoe kidney
Hypospadia
Cryptochordism
Acute tubular necrosis
Aminoglycosides
Salicylate toxicity can cause ? acid-base disturbance
What is used to trap the ASA and enhance elimination
First line therapy for Peds w/ idiopathic nephrotic syndrome
Metabolic acidosis w/ respiratory alkalosis
Na bircarb
GCCS
Define Dermatophyte presentation
What can this presentation mimic
What causes Staph Scaled Skin Syndrome
Ring worm: demarcated, scaling plaque w/ central clearing
Granuloma Annulare- no scaling
Ritter Dz: exotosins cleaving desmoglein 1
Winter Green Oil poisoning
What ABG results will be seen
How is rosacea Tx
Salicylate toxicity: tinnitus, vertigo, vomit, diaphoresis, delerium
Resp alkalosis
Metronidazole
? conditions are associated w/ Koebner Phenomenon
Which one of these conditions is associated w/ Hep C infections
Define Mask of Pregnancy
Psoriasis, Vitiligo, Lichen planus
Lichen Planus- Tx w/ topical betamethasone
Melasma- Tx w/ tretinoin (c/i in pregnancy= sunscreen)
What are the 5 P’s of Lichen Planus
What meds can cause this
How are these Pts Tx
Pruritic Purple Planar Polygon Papular w/ Wickham striae (white streaks)
Furosemide Antimalarials Thiazides BBs
CCS- topical fluocinonide
First line Tx therapy for Tinea Corpis
What other condition presents similarly and how are they differed
First line therapy for facial eczema in Peds
Topical clotrimazole
Granuloma annulare- no scaling
Emolients then Dapson/Hydrocortisone
How does Erythema Multiforme present
How is this Tx
How are hives PE explained in words
Palm/Sole target lesions surrounded by pale halo d/t HSV infection
Steroids- if mucosal involvement + Antivirals
Raised, circumscribed erythematous plaques w/ central pallor of various sizes
How are hives Tx
“Waxy, stuck on” appearance
What other skin condition did you confuse this with
Anithistamines, GCCS if angioedema is present
SKs- keratin filled pseudocysts; Initial Tx: cryo
AKs- flesh colored/yellow lesions w/ ill defined borders on sun exposed areas; Risk for SCC, Tx: 5-FU, Imiquimod, Diclofenac
MC subtype of melanoma
How is Toxicodendron cases Tx
What type of reaction is this
Superficial Spreading
Ivy dermatitis w/ Pred x 21d
Type 4- Lymphocyte mediated (same as scabies)
Etiology/Tx for Tinea pedis
Pressure ulcer staging
Trichophyton dermatophyte w/ topical clotrimazole or allylamines: Terbinafine/Naftifine
1: non-blanching erythema w/ intact skin
2: red wound bed (partial)
3: adipose visible (full skin loss)
4: bone/tendon/muscle visible (full tissue loss)
Max dose of lidocaine w/out Epi
Max dose of liodcaine w/ Epi
Etiology/presentation of Scarlet Fever
5mg/kg
7mg/kg
GABHStrep; sandpaper, erythematous rash sparing palms/soles, circumoral pallow, strawberry tongue, Pasia lines in axilla
? causes 5th Dz
Define Ecthyma
How is this Tx
Erythema Infectiosum d/t Parvo B19- Slapped cheek
Deeper, ulcerative form of impetigo
PO Cephalexin
Alternative first line to PO Terbinafin for Onychomycosis Tx
Define Intertrigo
What causes this and how is it Tx
Itraonazole
Superficial inflammation of dermis where there is friction, moisture and lack of ventilation
Corynebacterium minutissimum- coral red w/ woods lamp; Tx: Erythromycin
What are the 3 predisposing RFs for Intertrigo
How is a Kerion viewed w/ woods lamp to ID etiology
What is first and second line Tx
HIV Obese DM
Fluorescent green= Microsporum
1st: Griseofulvin- antifungal
2nd: Terbinafine Flu/Itr-conazole
OTC med to reduce duration of PO HSV outbreaks
How is Lyme Dz Tx
? Tinea infection in Peds is Tx w/ systemic antifungals
Docosanol
Doxy, Amox- pregnancy, Neuro/Cardio Sxs- Ceftriaxone
Capitis w/ Griseofulvin
MC bacterial infection associated w/ Erythema Multiforme
? phenomenon is seen on PE during RMSF
? other med can be used for Tx other than Doxy
Mycoplasma
Rumpel Leed- petechiae bleeding after BP cuff
Chloramphenicol
Why is HSV Dx w/ Viral cultures
Kaposi Sarcoma is associated w/ ? infection
Alternative to Isotretinoin for Tx severe/resistant acne vulgaris
Tzanck smear can’t differ HSV from Varicella Zoster
HHV-8
Pred
? microbe species causes tinea versicolor
Define Hutchinson Sign
How does Cutaneous Candidiasis appear on microscopy
Malasezzia
Herpes zoster blistering on tip of nose
Pseudohyphae
MOA of Isotretinoin
What occurs if Sickle Pts are infected by Parvovirus B19
What occurs if pregnant Pt is infected
Dec skin oil, Gland size and production
Aplastic anemia
Hydrops fetalis
How is post-herpetic neuralgia after shingles Tx
First line Tx for psoriasis
What causes Molluscum Contagiosum
Gabapentin, TCAs
Topical CCS
DNA poxvirus
Only Hepatitis infection w/ DNA
How is this Tx
Best way for SLE Pts to avoid flare ups
Hep B
Tretinoin, LN2, Cantharidin
Sun protection
What Pts should get the Shingles Vaccine?
How is simple cellulitis Tx
How is PCN allergic Pts Tx
> 50y/o regardless of chicken pox history
Cephalexin Amox/Diclox-acillin
Azith/roClinda/Erythro-mycin
Family name of brown recluse
Family name of black widow
How is sexually transmitted Molluscum Contagiosum Tx
Loxosceles reclusa
Cryo, Curettage, Cantharidin/Podophyllotoxin
Define Pilonidal abscess
How are these Tx
Define Dyshidrotic Eczema and it’s AKA
Embedded hair creates cavity and tract that becomes infected
InD
Dyshidrosis/Pompholyx- intense pruritis w/ deep seated “tapioca pudding” vessicles d/t excessive sweat/heat
How is Dyshidrotic Eczema Tx
Cutaneous abscesses are best evaluated w/ ? and Tx w/ ?
What causes the purple papules seen w/ LP
High potency topical steroids
Culture for sensitivity- Clinda, TMP-SMX, Tetracycline
CD8 T-cells directed against basal keratinocytes in Pts w/ Hep C
MC s/e of isotretinoin
How is head lice Tx in Peds
MCC of subungual onychomycosis
Dry lips/eyes
1% Permethrin, repeat in 10days
Trichophyton rubrum (fingers- C albicans)
Define Bullous Pemphigoid
Where do these develop which is how these are ID’d on PE
This has ? MC stat
Chronic autoimmune blistering dz w/ itching in Pts >60
Epidermal basement membrane- no Nikolskky sign
MC blistering dz of elderly
Define Hidranitis Suppurativa
What makes this condition worse and increase the recurrence
What would be seen on microscopy results of LP
Recurrent painful, erythematous nodules MC in axilla/groin d/t follicle occlusion and inflamed apocrine glands
Smoking
Homogenized dermis w/ flat dermoepidermal junction
What two HPV strain are associated w/ cervical cancer
How is Condyloma Acuminata Tx during pregnancy
Onychomycosis does not require Tx unless ? is present
HPV 16, 18
Podophyllin/toxin, Imiquimod
ImmSupp- risk for cellulitis
Slightly raise pearly lesion w/ telangiectasias is clue for ? MC skin Ca in USA
What skin lightening meds can be used for melasma
Define Rubella
BCC
Hydroquinone, Azelaic acid, Retinoids
German Measles- maculopapular rash, adenopathy (post-occipital/auricular) and fever
What are the risks if pregnant Pt contacts Rubella
Gram pos cocci in chains
How is Tinea Capitis Tx
Cataract, Heart defect, Hearing loss
Streptococcus
PO Griseofulvin > Terbinafine
How does T Capitis present
How are family members in contact w/ Pt Tx
Primary Tx for Acne Vulgaris
Patchy hair loss w/ scale and occipital adenopathy
Selenium sulfide shampoo
Topical retinoids
Where are the 3 common sites for melanoma to mets to
Brain Liver Bone
