Renal

Question 1

What level urine sodium is associated with ATN?

Answer 1

More than 20

Question 2

What is the calculation for FENa

Answer 2

(UNa/PNa divided by UCr/PCr) X 100

Cutoff 1%. Only useful in setting of oliguria

Question 3

Does NAC help with contrast nephropathy?

Answer 3

No. Debate whether contrast nephropathy even exists

Question 4

What is the other way to determine if there’s a concomitant AB disorder other than delta gap?

Answer 4

Take AG and add to bicarb= this is the bicarb before the metabolic acidosis

Question 5

How do you calculate free water deficit?

Answer 5

%body water x kg x (current Na-ideal Na/ideal Na)

%body water is 60% in men 50% in women

Question 6

What are common causes of euglycemic DKA?

Answer 6

SGLUT2i, ETOH, cirrhosis, pregnancy, anorexia/fasting state

Question 7

In thyroid storm, how long do you wait after giving PTU/MMI before giving iodine?

Answer 7

1 hr

Question 8

How is pituitary apoplexy treated?

Answer 8

SDS, watch for DI, NSGY consult for potential decompression
Thyroid replacement eventually

Question 9

Are there any differences in outcomes for trickle feed vs full feeds?

Answer 9

No except trickle feeds have less GI intolerance episodes

No worse or better outcomes

Mya have benefit to underfeeding patients with baseline low prealbumin

Question 10

What do studies say about enteral vs parenteral nutrition?

Answer 10

Only difference is more infections with parenteral

Question 11

What does activated charcoal NOT absorb?

Answer 11

iron, lithium, alcohols, hydrocarbons, acids, alkalis

Question 12

Which toxic alcohols have an increased osmol gap and how do you differentiate between them?

Answer 12

Ethylene gycol: oxalate crystals
Methanol: optic neuropathy, intracranial bleed/infarct

Tx ethanol or fomepizole. HD if level above 25, osmolar gap above 25

Question 13

What are the features of cyanide poisoning?

Answer 13

Setting: metal extraction, electroplating, smoke exposure, mitroprusside
Lactic acidosis, seizures, coma, shock
Give sodium nitrite (can cause methemoglobinemia) then sodium thiosulfate to excrete
VitB12 (hydroxocobalamin)

Question 14

What common drugs cause bradycardia?

Answer 14

Barbituates, clonidine, cholinergic drugs (pyridostigmine), GHB, organophosphates

Question 15

What treatments are used for refractory BBer/CCBer overdose?

Answer 15

High dose insulin, pressors, pacing, lipid emulsion, ECMO

Question 16

How are sulfonylurea overdose treated?

Answer 16

Octreotide, supportive care

Question 17

What are the characteristics for cholinergic sydrome?

Answer 17

Hypersecretory, brady, weakness.
Give atropine
Give pralidoxime for weakness
Avoid succinylcholine

Question 18

What are the features of proprofol infusion syndrome?

Answer 18

Refractory bradycardia in the presence of metabolic acidosis/rhabdo/HLD/hepatomegaly. usually >4mg/kg/hr for more than 48hrs

Question 19

What are symptoms of hypocalcemia

Answer 19

Parasthesias, arrhythmias, bronchospasm

Question 20

How does tylenol cause metabolic acidosis?

Answer 20

Accumulation of 5-oxoproline

More prone in sepsis, chronic ETOH, chronic liver disease, malnutrition, old age, pregnancy due to glutathione depletion

Question 21

How can one distinguish type B lactic acidosis?

Answer 21

lactate:pyruvate ratios are normal as anaerobic metabolism isn’t driving it

Question 22

Which med should be used in thyroid storm in first trimester of pregnancy?

Answer 22

PTU

Question 23

When do you give steroids for hypercalcemia?

Answer 23

Mild-moderate due to vitamin D as steroids lower 1,25 vit D

Question 24

What are the symptoms of lithium toxicity?

Answer 24

Levels more than 5, AMS, bradycardia, AKI, shock

HD removes it