PPP ROSH- Renal/Derm Flashcards by brandon lovin

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

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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

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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

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? 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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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)

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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

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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

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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

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HypoMg PE finding

How is HyperMg Tx

MCC of Secondary HyperCa

Hyper reflexia

Dialysis, CaCl/gluconate

CKDz decreasing Vit D levels

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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

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? 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

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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

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? 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

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? 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

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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

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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