Uworld4 Flashcards
what is a common heart problem after viral myocarditis
dilated cardiomyopathy
- dilated ventricles and diffuse hypokinesia
what causes eccentric hypertrophy
chronic volume overload
what causes concentric hypertrophy
chronic pressure overload
What is the most common malignancy diagnosed in patients exposed to asbestos
bronchogenic carcnioma
what are the most common causes of secondary digital clubbing
Lung malignancies
cystic fibrosis
right-to-left cardiac shunts
clinical features of mixed cryoglobulinemia
fatigue palpable purpura arthralgias renal disease peripheral neuropathies
Lab values for mixed cryoglobulinemia
hypocomplementemia
positive rheumatoid factor
elevated transaminases
kidney injury
What is required to diagnose Community-acquired pneumonia
presence of a lobar, interstitial, or cavitary infiltrate on chest x-ray.
when is sputum and blood cultures not required for CAP
outpatient setting, empiric oral abs are almost always curative
does hypoventilation cause alveolar-arterial oxygen gradient
no
what causes alveolar-arterial oxygen gradient
right-to-left intrapulumonary shunting
V/Q mismatch
interstitial lung disease
What scenario is decreased cardiac contractility observed in
systolic heart failure
what is the initial step for toxic megacolon?
abdominal x-ray
Surgery is only for pts not responding to medical therapy
What are other causes of cirrhosis other than alcohol
- viral hepatitis
- nonalcoholic fatty liver disease
- hemochromatosis
what causes pancreatitis complicated by hypotension
intravascular volume loss secondary to local and systemic vascular endothelial injury –> vasodilation, increased vascular permeability,
BUN levels greater than what typically causes uremic pericarditis
60
What medications can be used for patients who exercise daily with exercise asthma
inhaled corticosteroids or antileukotriene agents
Patients with severe bladder outlet obstruction due to BPH can develop what? next step?
acute kidney injury
renal U/S to assess hydronephrosis
Stain with Congo red and demonstrates an apple-green birefringence under polarized light of kidney.
amyloidosis
What is the most common cause of AL amyloidosis
multiple myeloma
What is the most common cause of AA amyloidosis
rheumatoid arthritis
Crescent formation on light microscopy
rapidly progressive glomerulonephritis
Hyalinosis that affects both afferent and efferent arterioles
hypertension
normal light microscopy
minimal change disease
how does pH change with aspirin poisoning
respiratory alkalosis
anion gap metabolic acidosis
normal pH, low bicarb, low PaCO2
What is the next step if someone has painless hematuria as an adult (age>35)
CT urogram and cystoscopy
What is the most common cause of abnormal hemostasis in patients with chronic renal failure? lab values? treatment?
platelet dysfunction
normal PT, PTT, and platelet count
bleeding time prolonged
Desmopressin
Most common cause of death in dialysis patients
cardiovascular
what leads to cyanide toxicity?
sodium nitroprusside prolonged infusion, especially if patient has chronic kidney disease
how do you treat lithium-induced nephrogenic DI
salt restriction and discontinuation of lithium
Initial choice of treatment for blacks with hypertension
Thiazide or CCB, alone or in combination
Initial treatment of choice for ethnicities with chronic kidney disease for hypertension
ACEI or ARB
What is the earliest renal abnormality seen in diabetic nephropathy
- glomerular hyperfiltration
- thickening of glomerular basement membrane
- Mesangial expansion
- Nodular sclerosis
what is the preferred method for urine microablumin
Spot urine collection and timed urine collection
What is the most common cause of nephrotic syndrome in adults, particularly African Americnas
Focal segmental glomerulosclerosis
Which kidney thing associated with HIV and heroin use
Focal segmental glomerulosclerosis
Which kidney thing is associated with Hep B and C
Membranoproliferative glomerulonephritis
what are 3 causes of astreixis
- hepatic encephalopathy
- uremic encephalopathy
- hypercapnia
What are urgent indications for dialysis
AEIOU
- Acidosis (pH <7.1)
- Electrolyte abnormality (K>6.5)
- Ingestion
- Overload, volume
- Uremia
treatment for uremic encephalopathy
dialysis
What is a risk factor for Hepatorenal syndrome
advanced cirrhosis with portal hypertension and edema
what is one indication for hepatorenal syndrome
no improvement in renal function with fluids
decrease in GFR
Why does hepatorenal syndrome occur?
- splanchnic arterial dilation
- decreased vascular resistance
- local renal vasoconstriction
Name 6 medications that cause hyperkalemia
- Beta blocker
- ACE i
- ARB
- Spinolactone
- digoxin
- NSAIDs
Treatment for acute hyponatremia encephalopathy?
3% saline
What makes IgA nephropathy different from postinfectious glomerulonephritis
IgA nephropahty: within 5 days of URI. young adult men.
normal serum complements
Interstitial cystitis
Bladder pain that is worsened by filling and relieved by voiding. Dyspareunia, urinary frequency and urgency can also be present.
What is intersittial cystitis associated with?
psychiatric disorders and fibromyalgia
Side effect of Rifampin
red urine
What acid base values give you the best picture
pH and CO2
When do you use steroids to treat hypercalcemia
excessive vitamine D uptake
Sarcoidosis
lymphomas
what abs causes hyperkalemia
Trimethoprim
EKG changes for hyperkalemia
- peaked t waves
- PR prolongation
- QRS widening
Most common renal vascular lesions seen in hypertension are
arteriosclerotic lesions of afferent and efferent renal arterioles and glomerular capillary tufts
acidosis does what to potassium
hyperkalemia
What is the difference between vomiting and Diuretic abuse/Bartter’s syndrome
Vomiting: low urine chloride concentration
Diuretic abuse/Bartter’s syndrome: positive urine chloride is high
Risk factor for correcting low sodium to normal
central nervous system osmotic demylination syndrome
Risk factor for correcting high sodium to normal
cerebral edema
what will show up in urine for diuretic abuse
urinary sodium and potassium will be elevated
What causes membranoproliferative glomerulonephritis
persistent activation of the alternative complement pathway
What acid base disturbance occurs after tonic-clonic seizure? treatment?
metabolic acidosis
resolves without treatment within 90 minutes following resolution of seizure activity
What is normal anion gap
6-12
MUDPILES
methanol uremia DKA Paraldehyde Isoniazid/INH Lactic Acidosis Ethylene glycol Salicylates
Appropriate compensation for metabolic acidosis?
PaCO2 = 1.5 (serum HCO3-) +8 +/- 2
What’s a good way to distinguish between saline responsive metabolic alkaosis and saline resistant
saline resistant: a disease like hyperaldosteronism, cushing,
saline responsive: diuretic/laxative abuse. vomiting
Patients with nephrotic syndrome have increased risk of what
- atherosclerosis (due to hyperlipidiemia)
2. arteriovenous thrombosis
Unfavorable metabolic side effects of thiazide
hyperglycemia
increased LDL cholestrol and plasma triglyceride
increased hyeruricemia
Electrolyte abnormalities of thiazide
hypo- Na, K, Mg
Hyper - Ca
Treatment for patients with hypertension and renal artery stenosis?
ACE or ARB
- surgery is reserved for resistant hypertension or recurrent pulmonary edema
What is radiolucent? type of stone?
Uric acid stones (acid stones)
may be seen on U/S or CT scan
treatment for uric acid stones
oral potassium citrate to alkalinze the urine
Absorption of what is increased in Crohn?
oxalate
Do you need a detailed metabolic evaluation for a first tine renal stone
no
what size stone passes spontaneously with conservative management
less than 5 mm
Drug used for kidney stone
alpha-1 receptor blocker
Tamsulosin
Unilateral varicoceles that fail to empty when a patient is recumbent raise suspicion for?
underylying mass pathology (renal cell carcinoma)
Who usually gets type 4 renal tubular acidosis
poorly controlled diabetics
Type 4 renal tubular acidosis
hyperkalemic renal tubular acidosis
non-anion gap metabolic acidosis
persistent hyperkalemia
mild-to-moderate renal insufficiency
Electrolyte distrubance with laxative abuse
hypokalemia
non-anion gap metabolic acidosis
U/A for rhabdomyalsis
large amount of blood but no RBC on urine microscopy
severe hyponatremia for SIADH treatment
3% saline
Urgency incontinence? txt
sudden overwhelming or frequent need to void
anti-muscarinic (oxybutynin)
Overflow incontinence? txt?
constant involuntary dribbling cholinergic agonists (Bethanechol)
What does positive urine leukocyte indicate?
pyruia
what does positive urine nitrate indicate?
presence of bacteria
Treatment for uncomplicated cystitis
Nitrofurantoin
Trimethoprim-sulfamethoxazole
Fofomycin
Treatment for complicated cystitis
Fluoroquinolones
What lab values should you get before starting them on lithium
baseline metabolic calcium pregnancy test thyroid function test U/A
What are long term side effects of lithium
nephrogenic diabetes inspidus
chronic kidney disease
Hyperparathyroidism with hypercalcemia
thyroid dysfunction
What is MRI of HIV patient
Diffuse increase in intensity in white matter
Advance sleep phase syndrome
inability to stay awake in the evening (usually after 7pm)
When is melatonin the first line treatment for insomnia
delayed sleep-wake phase disorder ( wake and sleep times different than conventional times)
MOA for metoclopramide
dopamine antagonist
MOA hyroxyzine
antihistamine
MOA ondansetron
Serotonin antagonist
severe MDMA intoxication
hyperthermia
Trastuzumab treats what
HER-2 positive breast carcinoma
Side effect of Trastuzamab
cardiotoxicity
side effect of Bleomycin
pulmonary fibrosis
treatment for urge incontinence
oxybutynin
