Renal Flashcards

1
Q

Saline resistant vs. responsive met alkalosis

(urinary chloride values)

A

> 20 vs. <20

metabolic alkalosis responsive is GI stuff
resistant—primary hyperaldo, cushing or severe hypokalemia

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2
Q

uroperitoneum with normal voiding

A

unilateral ureteral laceration

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3
Q

excessive diuresis (potassium)

A

potassium wasting so low potassium

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4
Q

weakness electrolyte

A

potassium

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5
Q

post obstructive diuresis

A

increased urine outflow leads to RAAS kicking in and low potassium

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6
Q

Children <2 years with UTI workup

A
  • 1-2 weeks of cephalosporin
  • Do renal/bladder ultrasound if have FEVER
    *Do voiding cystogram after ultrasound if 1) see
    scarring 2) organism is not e.coli 3) with a
    child with > than 2 UTIs
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7
Q

urethral hypermobility

A

stress incontinence

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8
Q

causes of MCD

A

most often idiopathic

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9
Q

Tx MCD

A

steroids

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10
Q

Transient proteinuria

A

Triggers: stress, fever, infection
Dx: urine protein/creatinine ratio and make sure returns to normal

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11
Q

most common nephritis in adults

A

IgA (usually within 5 days of URI)

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12
Q

crohns and kidney stones

A

Calcium binds to ox in gut so ox not absorbed. However, in crons when fat mal then calcium binds to fat in GI tract. then lots of oxaloacetate floating around then get kidney stones

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13
Q

10 mm stone

A
  • if <10 mm then do medical management but if uncontrolled and no passage in 4-6 weeks then do lithotripsy.
  • if >10 then do lithotripsy
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14
Q

30-40, flank pain, hematuria, palpable abdominal masses, CKD

A

ADPKD

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15
Q

MD SOAP BRAIN

A

SLE. Blood all low, renal is nephrotic or nephritic

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16
Q

resistant HTN what to do next?

A

Imaging of renal

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17
Q

drug that increases lactic acidosis

A

metformin so dont give to someone with CKD

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18
Q

when hypokalemia what happens to chloride?

A

also goes down

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19
Q

hexagonal nephrolethiasis

A

Cystinuria. Defect in renal transport of amino acids COLA cystine, ornithine lysine and arginine

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20
Q

Urinary disorder only affecting boys

A

PUV that can lead to bladder urinary obstruction bladder distension and hydronephrosis and lung hypoplasia becuase of decrease urine

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21
Q

cerebral aneurysm relationship as well as CKD, liver cysts

A

ADPKD

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22
Q

papillary necrosis features and sx

A

NSAID “Nonsteroidals, Sickle cell, Analgesics, Infection Diabetes” and get hematuria

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23
Q

hypokalemia, hypomagnesemia, hypophosphatemia

A

alcoholism

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24
Q

relationship between mag and potassium and calcium

A

magnesium blocks potassium secretion so have so high mag high potassium. Low mag low potassium

also low cal because mag stimulates parathyroid.

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25
Q

VHL mnemonic

A

CPR=Cerebellar and retinal hemangioblastomas

Pheo

Renal cell carcinoma

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26
Q

urinary sodium when prerenal

A

Decreased because RAAS kicking in

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27
Q

salicylate intoxication

A

AGMA and respiratory alkalosis so mixed and nml pH

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28
Q

laxitives vs. diuretics

A

GI vs. urinary

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29
Q

anticholinergics: dry or wet?

A

dry so no urine

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30
Q

test for renal calculi is

A

abdominal U/S or non-contrast spiral CT.

Use U/S if pregnant

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31
Q

renal artery stenosis first and second line

A

1) ACE and ARBS inhibit efferent vasocostriction 2) if resistant then do stenting

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32
Q

alkalosis and ionized calcium

A

H+and calcium compete with each other to bind to albumin. H usually wins but when alkalosis H dissociates and so calcium can bind so you have LOWER ionized calcium

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33
Q

sodium and calcium

A

same direction

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34
Q

renal cysts (benign vs. malignant)

A

benign actually no follow up is needed

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35
Q

diabetes high levels of what in urine?

A

albumin which is why we check albumin to creatinine ratio

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36
Q

acute renal allograph T cell

A

1) hyperacute-hours to days-thrombosis
2) acute weeks-months T cell mediated interstitial lymphocytic infiltrate
3) chronic-months to years then get fibrosis

then get graft vs. host where you get a rash

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37
Q

calcinurin toxicity what it does to kidneys

A

vasoconstricts both the afferent and efferent arterioles and so get High BUN to creatinine ratio because creates a prerenal state

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38
Q

AIN causes

A
Pee-Diuretics 
Pain free-NSAIDS
Penacillin and cephalosporins, trimethoprin, rifampin
rifamPin=red, orange bodily fluids 
PPIs

aminoglycaside, acyclovir, amphotercin too

Fever maculopap rash and renal failure, white blood cell casts

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39
Q

Transient metabolic acidosis

A

Seizures and don’t need to treat

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40
Q

crystal induced AKI mneumonic

A
Protease inhibitors
Uric acid (tumor lysis syndrome)
Methotrexate
Acyclovir 
Ethylene glycol 
Sulfonamides

renal tubular obstruction

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41
Q

thiazide SE

A

hyperglycemia, increased LDL, triglycerides, hyperuricemia so can get gout
hypercalcemia when tx

but then get hyponatremia, hypokalemia, hypomagnesemia

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42
Q

tx hyperkalemia

A

give calcium gluconate to stabilize the heart

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43
Q

stages of change

A

precontemplation, contemplation, prep, action, maintenance, identification where behavior is automatic

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44
Q

post partum thyroiditis vs. painless thyroiditis

A

HYPOTHYROID…
similar to hashimoto in that it moves from hypo to hyper and have TPO antibodies.

Post partum is within a year of pregnancy but painless is after a year of childbirth.

tx with propranolol

Low RAIU uptake because thyroid is destroyed and only preformed thyroid is released.

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45
Q

urine or plasma metanephrines

A

pheo

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46
Q

pheo tx

A

preop give alpha blockade to vasoconstrict prior to beta blockade and then surgery.

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47
Q

thyroid storm causes

A

thyroid or non-thyroid surgery, trauma, infection

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48
Q

epiphyseal widening

A

Rickets. Low vitamin D leads to low calcium leads to high PTH, low serum phosphate and high AlkP

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49
Q

MEN 1
MEN 2
MEN 3

A

1-Pituitary, Parathyroid like Primary Hyperparathyroidism, Pancreatic (like ZE syndrome) (3Ps, 0) so can have hypercalcemia and recurrent peptic ulcers because of ZE
2A- Parathyroid, Pheo, Medullary thyroid (2Ps and 1 M)
2B–Mucosal, Marfinoid habitus, medullary thyroid carcinoma, pheo (2Ms, 1Ps)

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50
Q

hypercalcemia, renal insufficiency (AKI), metabolic alkalosis

A

milk alkali. see symptomatic calcium much more here than w thiazides

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51
Q

hypercalcemia

A

bones, stones, groans, psychiatric overtones, moans

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52
Q

graves disease

A

passage of TSH Ab so give methimazole and beta blockers

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53
Q

metabolic syndrome

A
3-5. cause is insulin resistance
waist circumfence
fasting glucose
HTN
triglycerides
HDL
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54
Q

metaclopramide

A

can help with gastroperesis but lots of extrapyramidal SE

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55
Q

HHS treatment

A

type 2 diabetes, older age, very high glucose. Basically give aggressive hydration and normal saline and IV insulin.
Potassium replacement if potassium is less than 5.3. Hydration is key…

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56
Q

malignancy and hypercal

A

PTHrP:
squamous cell
renal and bladder
breast and ovarian

Bone:
Breast and bone

1,25 dihydorxi can be lymphoma

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57
Q

PB KTL

A

Prostate-blastic
breast-both
Kidney, Thyroid, Lungs-lytic

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58
Q

primary hyperaldo (acid distubrance)

PAC/PRA ratio is >20:1

A

metabolic alkalosis. No hypernatremia because of aldo escape where when enough perfusion kidneys start excreting sodium

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59
Q

myalgia, proximal muscle weakness, hich CK

A

hypothyroid myopathy

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60
Q

glucorticoids vs. mineralcorticoids

A

hydrocortisone, prednisone vs. fludricortisone

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61
Q

post prandial hyperglycemia tx

A

basal and then post prandial insulin

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62
Q

epleronone

A

aldosterone antagonists

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63
Q

hyperkalemia

A

PAI

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64
Q

surrepticious intake of thyroid hormone

A

get low TSH and elevated thyroid hormone

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65
Q

exudative vs. transudative pleural effusions

A

pleural protein/serum protein >0.5,
Pleural LDH/serum LDH > 0.6.
in transudative

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66
Q

Fe2 to Fe3

A

methemoglobenemia

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67
Q

Fe3 has stronger connection to what substance

A

cyaninde which is why you induce methoglobinemia to tx Cyanide poisoning using nitirites to treat cyanide posioning

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68
Q

tx methemoglobinemia

A

methylene blue and vitamin C

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69
Q

painless coiled scrotal mass that does not transilluminate and decompresses when supine

A

idiopathic vericocele

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70
Q

renal vein compressed between…

A

SMA and IVC

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71
Q

if varicocele is on the right rather than left

A

Scrotal mass compression of IVC due to say wilms tumor

also doesn’t decompress when supine and called a secondary vericocele because likely due to cancer

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72
Q

thiazide diuretics SE

A

gout

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73
Q

acute prostatitis treatment

A

Bactrium or Floriquinolone (6 weeks) bug is e. coli also get cultures

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74
Q

most common nephrotic symptom in teens and adults

A

membranous

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75
Q

If think that hyperthyroid and increased RAIU

A

graves, TNG or adenoma

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76
Q

if hyperthyroid and decreased uptake

A

thyroiditis, iodine exposure, exogenous thyroid hormone

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77
Q

acromegaly heart findings

A

concentric ventricular hypertrophy

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78
Q

how to treat hyperkalemia

A

. Think Potassium PIG Insulin and Glucose drives potassium inside the cell

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79
Q

chronic use of glucorcoidicoids get

A

secondary AI

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80
Q

primary AI

A

high ACTH and low cortisol and aldosterone

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81
Q

Diabetes, depression, Weight loss

A

new onset pancreatic cancer

82
Q

urethral meatas extending to the corna

A

hypospades

83
Q

Bloody Diarrhea

A
Yersinia
Campylobacter
Hemorrhagic e.coli
Enameba histolytica (parasite)
Shigella 
Salmonella
84
Q

diarrhea and vomitting in kids not immunized less than 2

A

rotavirus

85
Q

giardia and entameba histolytica vs. ETEC

A

ETC comes on more suddenly where as Giardia and histolytica comes on more slowly Because fungi

86
Q

lymphatic network dysgenesis

A

turner syndrome

87
Q

severe hypospades

A

karyotype analysis

88
Q

primary amenorrhea dx

A

do TSH–>ultrasound

89
Q

MRCP

A

biliary and pancreatic stones or structural abnormalities or pancreatitis

90
Q

proximal muscle weakness and increased abdominal girth

A

muscle wasting due to cushing, cortisol myopathy because catabolic effects of steroids

91
Q

cosyntropin

A

synthetic ACTH

92
Q

thyroid hormone increases during what state

A

preg

93
Q

ALT >150 and pancreatitis what do you do

A

do cholecystectomy

94
Q

prostatitis what will you UA be

A

normal

95
Q

tx calcium ox stones

A

thiazides

96
Q

Thyroid nodule workup

A
  • check TSH. If normal do U/S

- if >1 cm with weird features do FNA or > 2 cm with no weird features do FNA

97
Q

adrenal crisis in people with cushing

A

hypotension, so give hydrocortisone or any steroid

98
Q

DKA and potassium

A

Basically diuresis so net loss of potassium but appears normal because goes to extracellular compartments

99
Q

best tx for PTSD

A

CBT

100
Q

pheo electrolyte

A

get hyperglycemia, hypernatremia and potassium is normal

101
Q

primary hyperaldo tx

A

elepronine or spironalactone

102
Q

control diabetes with what med

A

basal bolus (a shot of insulin)

103
Q

Vitamin D deficiency (calcium and phosphorous)

A

Both low

104
Q

pap thyroid tx

A

surgery

105
Q

malaria vs. juvenile arthritis

A

can both have spiking fevers but only the latter also has a rash

106
Q

type I vs. IV RTA

A

Type I can’t excrete H+
II cant reabsorb bicarb so have high urinary pH
IV-impaired aldo
vs. NAGMA, hyperkalemia

107
Q

what can cause adrenal crisis

A

surgery, injury, infection

108
Q

most common cause of PAI

A

autoimmune adrenalitis

109
Q

central vs. primary adrenal insufficiency

A

only in primary do u see hyperpigmentation. Central always think brain

110
Q

fatigue

A

hypoglycemia

111
Q

what to do about kidney stones

A

increase fluid
decrease salt
normal dietary calcium intake

112
Q

no relief of testicle when elevates

A

testicular torsion

113
Q

what does kidney do when respiratory alkalosis and what happens to the urine pH

A

excretes bicarb elevating the urine pH

114
Q

what biliary thing is increased during pregnancy

A

gallstones

115
Q

euthyroid sick syndrome

A

can’t convert to T4–>T3

116
Q

Carotid endarterectomy when to do

A

All patients with carotid artery stenosis should receive medical therapy with anti-platelets agents and statins

Carotid endarterectomy in patients with high grade 80-99

Asx with lower grade 80

117
Q

bph treatment

A

frst line alpha blockers(terazosin), second line 5 alpha reductase (finasteride)

118
Q

strict glycemic control (6-6.5) reduces risk of___

A

mortality

119
Q

glycemic control below 7

A

decreases the risk of complications like retionopathy

120
Q

patients with macroprolactinoma (> 1cm or symptomatic prolactinoma), what do you do?

A

treat with dopaminergic agonists (cabergoline, bromocriptine) which can lower the prolactin levels

121
Q

panc pseudocyst, what do you do?

A

drain

122
Q

MM can lead to what kind of AKI

A

ATN

123
Q

testosterone and DHEAS

A

if only testosterone is elevated then think coming from ovaries and if both testosterone and DHEAS then can more of an adrenal source

124
Q

carcinoid tumor and vitamin deficiency

A

tryptophan–>serotonin. therefore not enough tryptophan for niacin B3

125
Q

urine osmolality in SIADH vs. neph

A

> 100 vs. <100

126
Q

VIPoma

A

decreased chloride and potassium

127
Q

refeeding syndrome increase in what?

A

Insulin leading to cellular uptake of potassium, phos and mag leading to deficienies.

128
Q

Renal vein thrombosis complication of what and what do you see

A

membranous nephropathy

129
Q

metabolic problems, what kind of stones

A

uric acid

130
Q

uric acid stones what do you treat w

A

potassium citrate

131
Q

hyponatremia give

A

NS

132
Q

central AI dont develop

A

skin hyperpigmentation and hyperkalemia

133
Q

third most common cause of pancreatitis

A

meds like diuretics

134
Q

greatest risk of prostate cancer

A

age

135
Q

primary vs. secondary epo

A

primary decreased epo like in case of PV
vs
secondary has high epo and is due to either tumor or hypoxia

136
Q

varices what do you give

A

beta blockers

137
Q

retain bicarb what happens to chloride

A

decreases it.

138
Q

prolactinoma when prolactin reaches

A

> 200

139
Q

PTU and MMI SE

A

agranulocytosis

140
Q

varicocele that doesn’t not go away in recumbant position

A

RCC

141
Q

RTA

A

failure to excrete H+ or absorb bicarb leading to NAGMA.

Give bicarb replacement. Get failure to thrive

142
Q

parafollicular thyroid cancer measure

A

calcitonin because they are calcitonin secreting

143
Q

uncomplicated cystitis what do next

A

can jump straight to treatment

144
Q

after stabilization of burns what is next step

A

urinary catheterization

145
Q

paroxetine (SSRI) can help w what male issue

A

premature ejaculation

146
Q

LM normal but effacement of foot processes on EM

A

MCD

147
Q

thickened bm with spikes

A

patho for membranous nephropathy

148
Q

mesangial hypercellularity

A

membranoproliferative

149
Q

opioids can cause

A

secondary hypogonadism such as low testosterone

150
Q

gallstone pancreatitis dx

A

U/S

151
Q

pyelo important sign

A

fever and can progress to TOA

152
Q

progesterone can help stimulate

A

appetite

153
Q

longitudinal splitting of membrane

A

alport

154
Q

meningococcemia problem

A

WF syndrome=adrenal hemorrhage

155
Q

sulfonylurea RF

A

weight gain

156
Q

DPP4 affect weight at all?

A

No

157
Q

tacrolimus and cyclosporin

A

nephrotoxic in that can make someone prerenal

158
Q

whipple disease

A

infection with grap pos bacillus tropheryma whipplei

chronic malabsorptive diarrhea, weight loss, migratory arthritis, lymphadenopathy

159
Q

salicylate=

A

aspirin

160
Q

succinylcholine electrolyte disturbance

A

because upregulates post synaptic acetylcholine can cause life threatening hyperkalemia

161
Q

neuromasucular blocking agent

A

vecuronium and rocuronium

162
Q

persistent activation of complement pathway

A

membranoproliferative

163
Q

acetazolamide

A

increasing HCO3- renal excretion so get NAGMA

164
Q

Shiga toxin E coli do you tx?

A

No, because abx can lead to HUS

165
Q

recurrent cystitis after sex

A

post-coital abx

166
Q

when give ace to someone with diabetes

A

only if HTN or albumin/creatine ratio is >30. Nml is <30

167
Q

+leukocyte esterase with no dysuria but frequency

A

still UTI

168
Q

portal hypertension leads to splanchnic vasodilation

A

to decrease SVR

169
Q

nml renal function, hypocal, hyperphosphate

A

hypoparathyroid

170
Q

low thyroglobulin if what state

A

taking exogenous

171
Q

chloride needed to excrete HCO3 so without Chloride you get

A

metabolic alkalosis

172
Q

diarrhea

A

NAGMA

173
Q

other mac/pap rash on hands and feet

A

staph

174
Q

urge incontinence

A

first line bladder training and second line is anti-muscarinic=oxybutin

175
Q

hypothyroidism leads to what elevation

A

prolactin that supresses FSH, LH and estrogen so annovulation

176
Q

fenofibrate

A

high triglycerides

177
Q

rhabdo get what kind of of casts on microscopy

A

pigmented casts

178
Q

paraneoplastic with small cell

A

also cushing

179
Q

calcified pancreas

A

pancreatitis

180
Q

secondary hyperparathyroidism

A

low calcium, high phosphate due to CKD

181
Q

cholinergic agonists

A

beth

182
Q

SBP

A

high temperature, abdominal pain/tenderness
AMS
hypotension, hypothermia

183
Q

HE causes

A

infection
electrolytes
bleeding

184
Q

adrenal med disease

A

pheo

185
Q

urine pH >8 think what bug

A

proteus miri

186
Q

increasing power size

A

decreases confid

187
Q

hydronephrosis radiating and non-radiating

A

non radating

188
Q

eosinophilia

A

HL

189
Q

water deprivation test

A

neph DI will remain dilute , vs. primary polydipsia will correct

190
Q

PE

A

dyspnea, tachycardia, tachypnea, edema can also see pleural effusion low grade fever and troponin levels

191
Q

struvite stones

A

recurrent UTIs with urease producing organism (proteus/klebsiella)

192
Q

uric acid stones

A

myeloproliferative

193
Q

conjugated bilirubin vs. uncon

A

con water soluble (dubin johnson) and is excreted in the urine (no urobin) vs. unconjugated is insoluble and forms excess metabolism to create urobolinogen

194
Q

trimethoprim SE

A

hyperkalemia due to blockade of sodium channels . and can artificiall increase creatinine
PRIM POTASSIUM

195
Q

flat facies, pulm hypoplasia, limb deformitis

A

potters sequence

196
Q

AST ALT for cirrhosis

A

<500

197
Q

triemterene SE

A

high potassium

198
Q

SIADH tx

A

water dep

199
Q

exocrine pancreas if damaged

A

because high bicarb from exocrine glands, if damaged, lead to acidosis

200
Q

thyroid in preg

A

estrogen increases total TBG and bhg increases T4 by stimulating TSH receptors

201
Q

d xylose test

A

if cant absorb the d xylose then urinary secretion will be low vs. enzyme def will be high

202
Q

prothrombin complex concentrate

A

give to reverse warfarin