UWorld wrong questions part 2 (2nd 200 q's) Flashcards
how to tell apart methanol poisoning and ethylene glycol poisoning?
methanol = blurry vision, blindness. Ethylene gycol = kidney damage.
Pericarditis with atypical ECG findings, check what? Tx?
BUN/Cr, as this can be uremic pericarditis. Tx with dialysis (NOT NSAIDS)
thunderclap headache worse when lying flat, vision changes, mausea, noncontrast CT with slit=like lateral ventricles and no blood = ? Dx with?
idiopathic intracranial HTN, due to impaired CSF absorption/excess production. Dx: LP showing increased ICP.
a) HTN b) amyloid angiopathy c) AV malformation d) venous sinus thrombosis ) berry aneurysm leads to what kind of brain hemorrhage?
a) intracerebral b) intracerebral c) both intracerebral and subarachnoid d) intracerebral e) subarachnoid
1 and #2 nonpharm ways to decrease BP?
1) weight loss; 2) DASH diet
1st thing to do for a stroke when it has been >4 hrs?
ASA; ASA + clopidogrel/dipyrimadole if already on ASA
Person got stabbed, now has BP 170/68, brisk carotid upstroke, systolic murmur, tachy, this is what? Dx?
AV fistula.(high output cardiac failure). Dx: doppler U/S
Forgetful old patient with CT showing a) diffuse cortical atrophy greater in temporal/parietal lobes =? b) Areas of hypodensity involving diff brain regions =?
a) Alzheimer’s. b) Multi infarct dementia
eye problem where straight lines appear wavy =?
macular degeneration (do “grid test” to screen; see drusen deposits on optho exam)
PDE-inhibitors: contraindications? what you can use but need to space >4hrs apart?
contra: do not use with nitrates. 4 hrs apart with alpha blocks (-zosin) to prevent hypotension.
How to confirm diagnosis of pericardial effusion?
echo
patient has increased glucose – what treatment should you initiate?
besides metformin, all patients ages 40-75 should get statin!!
what heart defect is common with Edwards syndrome?
VSD
common complication of acute aortic dissection?
cardiac tamponade (so, pericardial fluid accumulation)
why is sodium low in CHF?
from increased renin, NE, and ADH; so, the lower Na is, the more severe the HF
difference between breathing of croup and bronchiolitis?
croup = inspiratory stridor, bronchiolitis = expiratory stridor
how to treat bronchiolitis?
O2 and iV; NOT steroids!! not ribavirin!!
how to treat croup?
O2, steroids, racemic epi
what meds to withhold prior to cardiac stress testing?(48 hrs)
beta blockers, CCBs, nitrates, dipyridamole
what heart meds are contraindicated in restrictive lung disease? obstructive lung disease?
restrictive: amiodarone (b/c pulm fibrosis). obstructive: beta blockers
how are cyanotic spells in Tetralogy of Falot decreased(thru what physiologic mechanism)?
tet spells (bringing legs up) increases systemic vascular resistance, so there is a bigger difference between ss and pulm vascular resistance and blood is shunted L–>R instead of R–>L
when do you not need to treat a fib w/ RVR with anything?
when it is “lone AF” – single time, score 0 (no risk – no CAD or heart issues)
inflammation of all vessels except lung in hep B/C patient, +ESR, increased WBCs?
polyarteritis nodosa
decreased pulses in UE of young woman, what is it? Dx with? tx with?
Takayasu arteritis. Dx with CT angio/MRA. Tx with steroids, immunosuppressants.
child with recent URI, spots on LEs, arthritis, increased BUN/Cr
Henoch Schleinen Purpura (IgA nephropathy)
red eyes, rash on trunk, increased lymphadennopathy, erythema of mucous membrains, fever, edematous hands in kid = ? Tx?
Kawasaki (mucocutaneous lymph node syndrome). Tx with IVIG, high dose aspirin, then low dose. do echo. NO steroids
pansystolic murmur at LLSB in neonate = ?
VSD
systolic murmur at LLSB with cyanosis = ?
truncus arteriosus
loud S2 and cyanosis =? Tx?
transposition of great vessels. Tx: keep PDA open with prostaglandin; balloon atrial septrostomy, Sx.
widely split S2, tricuspid regurgitation, dilated right atrium =? leads to what? dilated RA causes what? Tx?
Ebstein anomaly (tricuspid leaflets displaced into right ventricle so it becomes hypoplastic; SVT and WPW common with dilated RA. Tx: PGE, digoxin, diresis, propanolol for SVT
newborn with signs of LHF and ECG interpreted as L sided MI = ?
anomalous pulm venous return (pulm veins go to R instead of L)
tetralogy of Fallot treatment?
PGE2, O2, IVF, BB
most common microbe for pneumonia in a) COPD pt? b) rust colored sputum? c) after flu infection d)with vent?
a) H flu b) Strep pneumo c) Staph aureus d) Pseudomonas
who should get pneumococcal vaccine?
all smokers ages 19/54, all ppl ages 65+, immunocomp and chronic disease ppl
What is CENTOR criteria for pharyngitis?
Points to bacterial cause if numbers are high: Cough (absence of), Exudates, Nodes, Temp, OR age (young). 0-1 points = do nothing. 2-3 points = culture, 4-5 points = treat.
what are the 4 indicators for home O2?
pulse Ox
what to do about pulm nodule found on CXR after checking old one?
do CT; if benign looking (
idiopathic pulm fibrosis - Tx?
pirfenidone, nintedanib
increased risk of TB with which restrictive lung disease?
sarcoidosis
How to treat a)Goodpasture syndrome? b) Granulomatosis with Polyangitis (Wegeners)?
a) plasmapheresis, steroids. b) cyclophosphamide, steroids
How to treat pulmonary edema?
“NO LIP” = nitrates, O2, loop diuretics, inotropic drugs, positioning
treatment for croup?
humidified O2, dexamethasone/prednisolone, racemic epi
how to treat pulm component of CF?
beta agonist, DNase I(dornase alpha), hypertonic saline, physiotherapy, azithro to prevent Pseudomonas
What is the only bacterial diarrhea that you treat with drug (besides C difficile) and with what?
Shigella: FQ or TMP-SMX
what diarrhea mimics appendicitis (RLQ pain).
Yersinia
bloody diarrhea with liver abscess = ? Tx?
E. HISTOLYTICA. Tx: metro.
periorbital edema + diarrhea, fever, myalgias, CNS/cardiac probs = ? Tx?
Trichinella. Tx: -bendazole
How to treat Taenia solium?
praziquantel if in GI, steroids + albendazole if in CNS
PE with hemoptysis and pleuritic pain = ?
b/c of occlusion of a pulmonary artery by thrombus –> pulmonary infarction
what is usually high starting out on vent setting that should be lowered after initial intubation?
FiO2 – lower to under 60% to prevent O2 toxicity (but do not increase above this if you need to improve O2 – in those cases, increase PEEP)
what two conditions both have decreased O2 and decreased CO2, and resp alkalosis?
ARDS, CHF exacerbation (b/c of tachypnea)
how to tell diff between pneumonia and PE when both show exudative effusion?
pH is acidic in pneumonia (&TB & cancer etc) while pH is normal in PE
what numbers on the vent relate to CO2? which should you modify to change the CO2?
Tv and RR. Change RR
suspect pneumonia, what is the first step in management?
CXR (NOT sputum stain – this is s low and optional b/c you can just give empiric Abx)
definitive diagnosis of sarcoidosis with what?
mediastinoscopy/bronchoscopy for tissue Bx (NOT ACE/Ca levels)
diff between pneumonia and pleural effusion?
pneumonia will have increased fremitus(sound conducts well through solid), effusion will have decreased fremitus
low back pain esp at night in young adult that improves with exercise but not at rest = ? what eye and lung probs does it also have?
ankylosing spondylitis. with anterior uveitis, restrictive lung disease from chest wall motion restriction
what pneumonia presents with hyponatremia and gram strain with many neutrophils but no organisms? How to treat?
Legionella. Tx: fluoroquinolones or new macrolides.
what is upper airway cough syndrome and how is it treated?
post-nasal drip – treated with H1 antagonist like chlorpheniramine
calcified lesion above sella = ?
craniopharyngioma
how to treat hep encephalopathy?
lactulose or rifaximin (Abx)
asciites + fever and increased WBCs in it, what is this? How to treat?
Spontaneous bacterial peritonitis. Tx: cefotaxime or ceftriaxone, albumin
How to treat portal HTN?
salt restrict, spironolactone + furosemide, beta blockers for varices, vasopressin if varices are bleeding, TIPD procedure
hypocalcemia - what is next step, then 3rd step?
1) measure PTH 2) measure vit D
NPH - how to diagnose? Tx?
Dx: enlarged ventricles on MRI/CT + normal P on LP. Tx: sequential CSF removal with serial LPs, then VP shunt
why should you not give beta blockers right away in pheochromocytoma?
will cause rapid increase in BP (so, give alpha blocker 1st)
How to treat TCA O.D.?
NaHCO3 for the QRS widening/ventricular arrhythmias, benzo for sezure, IVF, O2, intub. charcoal if within 2 hrs of ingestion
after suspecting Guillian-Barre (CSF shows protein, no organisms), what is next step in management?
spirometry to measure FVC, b/c NM respiratory failure is biggest complication of the disease). If FVC is declining, intubate.
side effect risk of radioactive I2 ablation?
hypothyroidism, worsening of eye bulging (of Graves)
side effect of PTU & methimazole
agranulocytosis. PTU: hepatic failure.
treatment for Alzheimer’s
ChE inhibitors: donepezil, memantine (mod–>severe), galantamine, rivastigmine. NOT amantadine (this is for Parkinson’s!)
Marfanoid body habitus + stroke-like sx & fair eyes/hair, developmental delay = ? Tx?
Homocystinuria (stroke is due to hypercoagulability). Tx: B6, folate, B12 to lower homocysteine. Anticoag/antiplatelets.
what is livedo reticularis (lacy red areas that blanch) + blue toes, ulcers found in ?
cholesterol emboli (can be from recent cardiac cath or other procedure)
how to treat febrile seizure?
If 1st time and 5 min, abortive therapy i.e. benzos.
what is number 1 risk factor for pancreatic cancer?
smoking (NOT alcohol; that is for chronic pancreatitis)
liver problems(cirrhosis), hypotension, and increased Cr which doesn’t change with IVF admin, think ..=? Tx?
hepatorenal syndrome. Tx: liver transplant
after NG tube is put in to determine upper GI bleed, what is next step in management?
endoscopy
what to do for tension pneumothorax? for other __-thoraxes?
tension: needle thoracostomy. All others: chest tube
diagnostic test for pancreatic cancer?
abd CT (do after abd U/S for jaundice)
decreased lung compliance found in…
restrictive lung diseases
digital clubbing is a sign of what?
lung malignancy, CF, or R to L cardiac shunt
how to treat MALT lymphoma?
triple therapy for H. pylori (b/c this is cause!)
Cryptosporidium causes diarrhea in HIV patients under what CD4 count?
180
where is Zinc digested? sx of deficiency?
in the jejunum (so bowel resection will decrease this; it is not included in TPN formula). Alopecia, abnormal taste, rash, impaird wound healing.
main problem with selenium deficiency?
cardiomyopathy (Se is not in TPN)
patient with cirrhosis, saw liver on abd U/S – what are next steps in management?
if liver mass that looks like HCC, do CT. if no mass, then next is endoscopy to look for varices (if yes, beta blockers, EGD yearly); then abd U/S every 6 months
CO2 and O2 in people with OSA?
increased CO2, decreased O2, because of hypoventilation. resp acidosis, so kidneys compensate by retaining HCO3
MoA of exudative pleural effusion?
increased capillary permeability (because this is what allows proteins to get thru)
suspect PE - what to do next?
if unlikely (low Wells criteria), do D-dimer to exclude PE. If likely, go SRAIGHT to CT angio
diff btwn Sx of GERD and diffuse esophageal spasm? next steps in management?
GERD: burning discomfort. 1st step= empiric PPI trial.(NOT 24 hr pH) DES: pain precipitated by emotional stress radiating to the back. Manometry.
main s.e. of KCl?
drug-induced esophagitis
impaired O2 gas exchange, decreased lung compliance, and pumonary HTN lead to what?
ARDS
Face and arm swelling, dyspnea, engorged veins = ? Cause? Dx?
SVC syndrome. Caused by malignancy, so watch out for cancer signs. Dx: CXR.
elderly person with iron def anemia – first step? second step?
fecal occult blood. 2nd step(definitive diagnosis) = colonoscopy and endoscopy EVEN IF FOBT is (-)!
patient uses NSAIDS and aspirin, think what kind of anemia?
Iron-deficiency anemia (because it causes ulcers, which impairs absorption at duodenum)
Dx? treatment for achalasia?
Dx with manomtry, Barium, and r/o malignancy with EGD. Tx: SURGICAL: pneumatic dilation, myotomy, Botox,
how to treat Diffuse esophageal spasm?
MEDICAL: CCBs ie nifedepine, TCAs, nitrates
how to diagnose Zenker diverticulum?
Barium shows outpouching (DO NOT do EGD - can perforate.
patient with dysphagia – 1st step in management?
Barium swallow (THEN EGD and manometry if NM suspected)
How to diagnose PUD? Tx?
EGD; urea breath/serum Abs/stool Ag to see if H pylori; gastrin then secretin test if refractory to look for ZE. Tx: triple therapy if H pylori, sucralfate, bismuth, misprostol or COX-2 inhibitors if NSAID-caused ulcer
How to Dx and Tx Z-E syndrome?
Dx: fasting gastrin, secretin stimulation, and CT/MRI OR endoscopic U/S OR somatostatin-R scintigraphy to look for tumor. Tx: resection, PPI.
what does (abn) Sudan stain mean? (abn) D-xylose? What does it mean for lactose intolerance?
Sudan: problem absorbing fat. D-xylose: problem absorbing carbs. so lactose intolerance has normal Sudan, abnormal D-xylose
How to Dx, Tx Whipple Dz?
Dx: jejunal Bx: foamy macrophages on PAS, villous atrophy. Tx: IV ceftriaxone & TMP-SMX
what to do for acute diarrhea (
If no fever, blood, less than 5 days –> IVF. If fever, blood, more than 5 days do stool cultures, acid fast, fecal WBCs, ova/parasites
what to do for chronic diarrhea (>14)
fecal occullt blood, CBC, CMP, lactose restriction, D-xylose, Sudan, stool lytes, and eventually colonoscopy
how to calculate stool osmolar gap? what numbers mean what?
290 - 2(Na + K). if 125, osmotic (gets pulled with solute i.e. celiac, lactose)
IBS criteria
Sx for at least 3 days per month in the past 3 months
ASCA is positive with whar IBD? pANCA positive with what IBD?
ASCA: Crohns. pANCA: U.C.
Tx for SBO?
NPO, IVF, Foley, NG tube, repeat CTs. Sx (laparotomy) if no improvement in 12-24 h, complete SBO, or strangulation
Tx for LBO?
NPO, IVF, colonoscopy, surgery
appendicitis – when to do what?
if Sx 5 days Abx, IVF, bowel rest, then appendectomy 8 weeks later
Tx of sigmoid volvulus?
sigmoidoscopy/colonoscopy for decompression; resection if gangrenous. Add mesosigmoidopexy, resection with primary anastomosis, or Hartmann’s procedure to prevent recurrence.
How to Tx anal fissure?
topical nitroglycerin, diltiazem/nifedipine, bethanechol. Botox
Main treatment of carcinoid syndrome?
octreotide
f/u for patient who had colorectal cancer ?
CEA every 3 months for 3 years, CT chest/abd/pelvis every year (mets), colonoscopy at 1, 3, and every 5 years
1st step, then 2nd step in patient with hematemesis/melena?
1st: NG tube (likely upper). 2nd: EGD if stable, IVF/transfusions if not.
1st step, then 2nd step in patient with hematochezia?
1st: NG tube (rule out fast upper), colonoscopy if stable, IVF/transfusions if not
what is SAAG?
serum albumin - asciites albumin. if >1.1, portal HTN is cause. if
Tx for spontaneous bacterial peritonitis?
cefotaxime or ceftriaxone
what are reportable diseases?
STDS, hep, Lyme, food-borne illnesses, meningitis, rabies, TB
hypoglycemia, increased C-peptide, tumor in pancreas on CT = ? Tx?
insulinoma. Tx: resection, diazocide, octreotide
swollen, painful vessels popping up in random areas throughout the body = sign for what?
pancreatic adenocarcinoma (this is Trousseau syndrome, aka migratory thrombophlebitis)
best way to diagnose kidney stones?
noncontrast CT abd/pelvis (because plain film/KUB won’t show uric acid stones, which are radioluscent)
treatment for glucagonoma?
surgical resection, octreotide, IFN-alpha, embolization
patient with RUQ pain, jaundice, fever, AMS, and low BP – what is this? Tx?
Reynold’s pentad – primary sclerosing cholangitis. Tx: IVF, IV ABx, endoscopic biliary drainage, DELAYED cholecystectomy
diff btwn treatment for cholecytitis and cholangitis?
Cholecystitis: cholecystectomy. Cholangitis: drain bile ducts with ERCP, IVF & Abx, then delayedcholecystectomy.
what is Ab for primary biliary cirrhosis? primary sclerosing cholangitis?
PBC: AMA, ANA……PSC: p-ANCA
Tx for Crigler-Najjar syndrome type 1? type 2?
1: phototherapy, plasmapheresis, liver transplant. 2: phenobarbital.
patient with acute RUQ pan and hepatomegaly, and rapid development of jaundice and asciites, think… ? Initial Dx? Gold standard? Tx?
Budd Chiari syndrome. Initial: U/S(shows hepatic vein thrombosis). Gold: hepatic venography. Tx: thrombolytics, diuretics, anticoag, angioplasty, shunt.
treatment for Wilson disease?
trientine, penicillamine, Zn and B6 supplements. Eventual liver transplant.
autoimmune hepatitis – two Ab’s? Tx?
anti-SM, anti-Liver-Kidney-Microsomal. Tx: glucocorticoids +/- azathioprine
Other conditions/symptoms associated with HCC?
decreased glucose, increased EPO, watery diarrhea, increased Ca, skin lesions
increased hematocrit in what?
Potentially Really High Hematocrit: Pheochromo, RCC, HCC, Hemangioblastoma
Dx of pyloric stenosis with what 2 things?
Barium swallow: string sign. U/S: pyloric muscle thickness
How to Tx necrotizing enterocolitis?
TPN, IV Abx, NG suction, surgical resection of affected bowel (if necrosis)
Intussusception - Dx? Tx?
Dx: barium enema. Tx: Barium enema (reduces defect), Sx if refractory
what Abx is contraindicated in neonates with increased bili?
ceftriaxone
How to treat renal stone (Ca) less than 1 cm? When to do Sx?
strain urine with strainer, bring stones, tamsulosin, nifedepine, NSAIDS for pain. Do Sx if unable to pass after 4-6 wks, complete obstruction, persistent infection, or impairment of renal function
How to Tx stones in renal pelvis/upper ureter? In rest of ureter? How to Tx staghorn calculi?
Pelvis: Extracorporeal shock wave lithotripsy. Ureter: ureterorenoscopy with poss lithotripsy & possible stent placement. Staghorn calculi: percutaneous nephrostolithotomy.
incidence – formula? prevalence – formula?
Incidence = # of new case / total pop. ——- Prevalence = # new + old cases / total pop
relative risk =?
probabilitiy of getting a disease in group exposed / probability of getting that disease in unexposed. ——- HORIZONTAL —– A/(A+B) / C/(C+D). —— R>1 = positive relationship (thing causes the disease), R
relative risk relates to what kind of study? odds ratio relates to what study?
relative risk = cohort study.—— Odds ratio = case control (retrospective)
odds ratio = ?
VERTICAL — (A/C) / (B/D)
when does relative risk become similar to odds ratio?
with low prevalence
what is a type I error?
null hypothesis rejected even though it is true (study showing effect that isnt actually true)
what is a type II error?
null hypothesis not rejected but should be (showing no effect where there actually is one)
confidence interval = ?
mean +/- Z x Standard Error of Mean. If 99%, Z=2.6, If 95% Z=2. If 90% Z=1.6.
what is attributable risk?
rate of disease in exposed = rate of disease in unexposed. A/(A+B) - C/(C+D
what is sensitivity? specificity?
Sens: prob that screening test will be (+) in patients with disease (disease in denominator): A/(A+C) ————- Spec: prob that screening test will be (-) in patients without the disease (disease in denominator): D / (D+B)
What is PPV? NPV?
test result in denominator PPV = A/(A+B), probability that patient who tested (+) actually had the disease.———— NPV = D/(C+D), prob that (-) test shows ppl who don;t have disease
what is accuracy?
[true (+) + true (-)] / everything
what is positive likelihood ratio?
PLR = sensitivity / 1-spec OR sens / false (+) rate
what is the relationship between prevalence and predictive value?
high prevalence means high PPV, low NPV
persistent hematuria, three causes to think of?
APKD, neoplasm, glomerular disease
male child with daytime incontinence or UTI or oliguria, distended bladder = next step in management? Tx?
Dx: voiding cystourethrogram (VCUG) to look for posterior urethral valve. Tx: FOle or vesicostomy
If you need meds for child with daytime incontinence, what do you use?
DDAVP (desmopressin)
In gallbladder issues, when is HIDA scan used? ERCP? Abd CT? Perc transhep gallbladder drainage?
HIDA: when abd U/S is not clear. ERCP: with stones in ducts (choledoco); then do sphincterotomy. Per transhep: to decompress gallbladder if patient is unstable or has contraindication to surgery.
what drug causes CNS stimulation (headache, insomnia, seizures), GI (N/V), and arrythmias?
theophylline tox, esp when used with other drugs
someone sustains blunt abd trauma, what is next step after IVF? Next step after this?
assess for intraperitoneal free fluid with bedside U/S = FAST exam (Focused Assessment with Sonography for Trauma). Next step: DPL if study is limited; if either are (-) do abd CT, if either are (+) do exp lap
patient with asthma with very high WBCs and neutrophils – why?
from glucocorticoid induced neutrophilia
diff btwn bronchitis and bronchiectasis Sx? How to Dx bronchiectasis?
bronchitis: nonpurulent sputum.
bronchiectasis: purulent, copious sputum, hemoptysis, recurrent infections with Pseudomonas, linear atelectasis on CXR. Dx: high-res chest CT; THEN bronchoscopy/sputum analysis.
STEPWISE Tx FOR ASCIITES: (4)
- Na and H2O restriction / 2. spirinolactone // 3. loop diuretic (not more than 1L/day / 4. abd paracentesis
4 main things that cause normal anion gap metabolic acidosis?
diarrhea, renal tubular acidosis, TPN, and hypoaldosteronism
patient with hyponatremia – what is next step? 2nd step? 3rd step.
Check serum osm. If high, it is either hyperglycemia or mannitol. If normal, it is hyperlipidemia or mult myeloma. If low, NEXT STEP = check urine sodium, then volume status.
Treatment of central DI? nephrogenic DI?
central: Desmopressin. Nephrogenic: salt restrict, increase H2O, thiazides, indomethacin. If lithium-induced, Amiloride.
Treatment for hyperkalemia?
C BIG K Drop: Calcium gluconate –> B-agonist, insulin + glucose –> kayexalate, dialysis
low urine calcium, high serum Ca, but no stones/bones/moans = ?
familiar hypocalcuric hypercalcemia
QT prolongation in what electrolyte abnormality?
hypocalcemia
what drug treats glaucoma, idiopathic intracranial HTN, alt sickness(resp alkalosis), met alkalosis? s.e.?
acetazolamide. S.E.: metabolic acidosis, hypokalemia, nephrolithiasis, sulfa rxn
what treats AKI, acute angle glosure glaucoma, increased ICP? s.e.?
mannitol. S.E.: hypernatremia, hyperosmolarity, pulm edema
what treats hypercalcemia, periph AND pulm edema, asciites? Contraindications? s.e.?
Loops (tosemide, bumetanide,etc). Contra: stones/hypercalcURIA). s.e. hypocalcemia, increased uric acid, hyperkalemia, ototoxicity
what diuretic treats hypercalciuria, nephrogenic DI? s.e.?
thiazides (chlorthalidone, metolazone, HCTZ). s.e.: hypokalemia, hyponatremia, hyperuricemia, hypercalcemia
what drugs treat PCOS, acne, portal HTN, and good for post-MI?
ald antagonists (spironolactone: PCOS, acne; eplenerone: everything else).
what are amiloride, triamterene?
K+ sparing diuretics (not ald antagonists)
next step in evaluating hematuria in woman? next step? 3rd step? Management?
1) U/A with straight cath (r/o vaginal bleed) 2) CT abd/pelvis (no contrast) r/o renal stone. 3) CT abd/pelvis WITH contrast and post-CT plain film KUB to view radiopaque stones/neoplasm. ——— after all this, if neg, manage by treatming as UTI
If you suspect bladder cancer in patient, what is next step?
send urine for cytology and perform cystoscopy
CV issues with APCKD? Tx?
berry aneurysms –> SAH, AND MVP/ Tx: vasopressin-R antagonists (-vaptan), amiloride, drain large cysts.
RCC: #1 risk factor? CT shows? Lab shows? Dx?
smoking. CT: SOLID (not cystic) renal mass. Labs: increased EPO. Dx: is also the Tx – nephrectomy (DO NOT BIOPSY)
someone taking Abx/NSAIDS, gets rash, fever, increased Cr, eosinophilia, U/A showing granular casts and eosinophils = ? Tx?
acute interstitial nephritis/interstitial nephropathy. Tx: stop drug; steroids.
Someone with protein in U/A, what is next step?
24 hour urine
How to Tx post-inf glomerulonepritis? Bx shows what?
steroids, ACE-i, statins. Bx: subepithelial hymps (granular IgG), many neutrophils.
Tx of Goodpasture Syndrome?
plasmapheresis, steroids
increased Cr, splitting of basement membrane, high frequency hearing loss, cataracts?
Alport Syndrome
4 types of RPGN, What is common feature
common: a type of nephritic syndrome + crescents in glomerulus & lead rapidly to RF. Type I: anti-GBM Ab(Goodpasture). Type II: immune complexes (i.e. IgA neph, lupus). Type III: pauci immune, p-ANCA, type IV: idiopathic.
lupus nephritis – Tx?
Tx: steroids, ACE-i, statin
most common nephrotic syndrome? What do you see in glomeruli? what comorbid Dz?
FSGS. Glomeruli: scerosis & hyalinosis in
spike and dome appearance/thickening of BM = ? comorbid Dz? Tx?
membranous (“member” = thickened) nephropathy. Dz: hep B. Tx: steroids, ACE-i, statins
splitting of/”double” BM aka tram-track appareance with subendothelial humps= ? what comorbid Dz?
MPGN (“proliferating”, so double BM) Dz: Hep C>B (longer name than memb nephropathy so later in alphabet).
thickened BM + mesangial expansion, nodules = ?
diabetic nephropathy
what do hyaline casts mean? WBC casts? epithelial cast? granular/muddy brown casts?
hyaline: no disase (concentrated urine). WBC: tubular interstitial disease, pyelo. epithelial: glomerulonephritis. Gran/mud: acute tubular necrosis (ethylene glycol, drugs, etc)
if FENa 2%?
2% intra or post.
FENa formula?
[urine Na/serum Na] / [urine Cr/serum Cr]
Labs = increased K, decreased Na, increased PO4, decreased Ca, anemia, increased BUN/Cr, urine Osm close to serum Osm, what is this?
CKD
indicators for dialysis?
very high K+, met acidosis, uremia, Cr >12, BUN >100, fluid overload, severe O.D.
what else is urease (+) aside from Proteus?
Klebsiella (so, can cause struvite stones)
most common bacteria from indwelling cath?
Pseudomonas
gold standard diagnosis for UTI? for pyelonephritis also do what?
UTI: Urine culture. Pyelo, add blood culture.
empiric Tx for pneumonia in 2 month old? 2 year old?
2 month: macrolide + cefotaxime. 2 year: amp/amoxicillin
what 4 drugs can you use to Tx UTI in pregnant woman?
amoxicillin, ampillicin, cephalosporin, nitrofurantoin
Tx for urge incontinence? Stress incontinence? Overflow?
Urge: anticholinergics (oxybutynin, tolterodine), imipramine.
- —– Stress: Kegels, weight loss, imipramine, mid urethral sling surgery.
- —–Overflow: decompression of bladder with cath, long term self cath.
how to Dx overflow incontinence?
U/S or cath post-void shows full bladder
what is transitional cell bladder cancer usually from? squamous? adeno? Tx?
transitional: tobacco. Squamous: schistosoma. Adeno: urachal remnants. Tx: transurethral cystoscopic resection of tumor, THEN radical cystectomy + urinary diversion if progresses.
next step in management of urethritis or prostatitis in man
gram stain (if (-) diplo, then Gonorrhea. if nothing, then do DNA amplification to look for Chlamydia)
Dx of prostate cancer – 1st, 2nd, 3rd step? Tx?
1st: DRE (but may be normal); 2nd: PSA, alk phos. 3rd: transrectal U/S with Bx.——-Tx: radical prostatectomy if life expectancy high enough; may need antiandrogen/continuous GnRH analog(- effect) for chemical castration of advanced/met disease.
two disease to think of with painful testicle?
testicular torsion (no cremasteric reflex, compromised blood flow on U/S, raised testicle, support doesn’t help pain) OR epididymitis (infection/STD signs, support helps pain, normal blood flow and reflexes)
right sided varicocele: sign of what disease? Varicocele Dx?
RCC (because reg varicoceles are L»R). Dx: color doppler U/S showing retrograde flow to scrotum
Dx of testicular Ca (2 steps)? Tx(2 steps)?
Dx: scrotal U/S, CT abd/pelvis for mets. ——Tx: radical orchiectomy, followed by chemo for seminoma (b-hcg) / retroperitoneal lymph node dissection for nonseminoma
primary testicular failure in male infertility is indicated by what lab finding? Tx?
FSH. —Tx: surg, hormones but NOT exogenous testosterone.
increased prolactin in man. Next step in management?
MRI of head
Tx for epididymitis if 35?
35: FQ or TMP-SMX
workup for ED - 4 labs
total T, prolactin, TSH, PSA
