emma holliday high yield lecture Flashcards
(115 cards)
1
Q
what is electrolyte abnormalities in pt with numbness, Chvostek or Troussaeu sign, prolonged QT interval
A
hypocalemia
2
Q
what is electrolyte abnormalities in pt with bones, stones, groans, psycho, Shortened QT interval
A
hypercalemia
3
Q
what is electrolyte abnormalities in pt with paralysis, ileus, ST depression, U waves
A
hypokalemia
4
Q
what is electrolyte abnormalities in pt with peaked T waves, prolonged PR and QRS, sine waves
A
hyperkalemia
5
Q
what is treatment of patient with hyperkalemia
A
- calcium-gluconate (to stabalize cardiac cell membrane)
- insulin +glucose
- albuterol and sodium bicarb
6
Q
What is diagnosis of pt with muddy brown casts in pt taking ampho, AG, Cisplatin or prolonged ischemia
A
Acute Tubular necrosis
7
Q
what is treatment of patients with acute tubular necrosis
A
fluids and stop medication
8
Q
What is diagnosis of pt with protein, blood, eosinophils, plus fever and rash who took bactrim 1-2 weeks ago
A
Acute Interstitial nephritis
9
Q
What is diagnosis of pt who is army recruit or crush victim with CPK of 50K plus + blood on dipstick but no RBC
A
Rhabdomyolysis
10
Q
What is best FIRST test of pt with rhabdomyolysis?
A
Check K lever or ECG
11
Q
What is tx of patient with Rhabdo
A
tx with bicarb to alkalinize the urine and prevent precipitation
12
Q
What is diagnosis of pt with enveloped shaped cyrstals on UA
A
Ethylene glycol intoxication.
13
Q
What is tx of pt with ethylene glycol intox
A
Fomepizol
14
Q
What is diagnosis of pt with Bump in creatinine 48 hours s/p cardiac cath or CT scan
A
contrast nephropathy
15
Q
What is diagnosis of pt with blood in urine 1-2 days after runny nose, sore throat and cough
A
IgA nephropathy
16
Q
What is diagnosis of pt with 1-2 weeks after sore throat or skin infection
A
Post strep GN
17
Q
What is best first step of pt with post strep GN
A
ASO titer
18
Q
What is diasnosis for pt with Hematuria and Hemoptysis in young male
A
Goodpasture’s syndrome
19
Q
What is diagnosis of pt with Hematuria and deafness
A
Alport syndrome
20
Q
What is diagnosis of young pt with viral URI w/ renal failure, abd pain, arthralgia and purpura
A
Henoch- Schonlein Purpura (IgA)
21
Q
What is tx of pt with Henoch-Schonlein Purpura
A
- Steroids for supportive tx
22
Q
What is diagnosis of pt with c-ANCA, kidney, lung and sinus involvement
A
Wagener’s Granuolmatosis.
23
Q
What is tx for pt with Wagner’s
A
steroid and cyclophosphamide
24
Q
What is diagnosis of pt with p-ANCA, renal failure, astham and eosinophilia
A
Churg strauss
25
Best tx for Churg Strauss
Cyclophosphamide
26
p-ANCA, no lung involvement, Hep B association (can effect all other organs)
Polyarteritis Nodosa
27
What is best test for Kidney stones
CT
28
Most common type of Kidney stone?
Calcium oxylate
29
What type of kidney stone is seen in a kid with family history of stones?
Cysteine (cant resorb certain AA)
30
What is most likely type of stone seen in pt with indwelling foley and alkaline pee
Struvite
31
What are common bacteria that cause Struvite stones?
Proteus, staph, pseudomonas, klebsiella
32
What is the most common cause of death in dialysis patients?
Cardiovascular disease ( 20% acute MI, 60% sudden cardiac deaths)
33
What is tx for uric acid stones.
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34
What is diagnosis in pt with palpable purpura, proteinuria, and hematuria, arthralgia, hepatosplenomegaly and hypocompliment in pt with Hep C?
Mixed cryoglobinemia
35
What are common symptoms of patient with salicylate intoxication?
- tinnitus
- fever
- tachypnea
- nausia
36
What type of drugs are triamterene and amiloride?
potassium-sparing diuretics.
37
What is drug you would use to decrease calcium stones?
Thiazide diuretics
38
what is cause of increase creatine in patients on IV acyclovir and what is tx?
acyclovir in high levels exceeds solubility and crystallizes and causes renal tube damage.
- have to tx with adequate hydration.
39
what is diagnosis for nephrotic patient that suddently develops flank pain
suspect renal vein thrombosis due to loss of ATIII and protein C and S
40
What is first test for pt who you believe has renal vein thrombosis
CT or US stat
41
What is diagnosis for pt with splenomegally, family history of this, bilirubin gallstones and Increased MCHC
- Hereditary spherocytosis (AD loss of Spectrin)
42
What is tx of pt with hereditary spherocytosis
- splenectomy
43
What is diagnosis for pt with dark urine i the morning and budd-chiari syndrome?
Paroxysmal nocturnal hemoglobinuria. (lysis of complement)
44
if you have normocytic anemia and you believe hemolysis is occuring what is the next test you would do?
smear
45
What is test you would do to diagnose pt with paroxygsmal nocturnal hemoglobinuria?
flow cytometry (CD55 - cells)
46
sudden onset of anemia after use of drugs like dapsone, tmp, nitrofurotoin, primiquine, fava beans
G6PD def
47
What will you see on smear of pt with G6PD def?
Heinz bodies
| bite cells
48
What is best test for G6PD deficiency?
G6PD levels
| cant be checked during an attack has to be 6-8 weeks after
49
What is most likely diagnosis for young female patient with autoimmune disease in family, recurrent epistaxis, heavy menses and petechiae. In labs only abnormality is low platelets.
- ITP.
50
What is first line and second line tx for pt with ITP
- steroids
- spenectomy
- IVIG if < 10,000
51
What is diagnosis for patient with recurrent epistaxis, heavy menses, petechiae, normal platelets, but increased bleeding time and PTT
VWD.
52
What is most likely diagnosis for patient who enjoys eating a lot of meat and just recently finished an antibiotic coarse who has hemarthroses, and oozing from venipuncture sites.
Vit K def
53
What is treatment for patient with acute vit K def
FFP and Vit K shot
54
What is diagnosis for patient who is extremely sick and then starts to bleed and on labs decreased platelets, increased PT/PTT, dec fibrinogen and increased D dimer
DIC
55
What is diagnosis of pt with fever anemia thrombocytopenia and labs show normal PT/PTT, fibrinogen and d dimer and smear shows schictoyctes
TTP
56
What is treatment for TTP
exchange transfusion
57
what is diagnosis of patient 7 days post-op develops and arterial blood clot. Platelets are found to be 50% less tan pre-op?
HIT
58
What is most likely diagnosis of pt with knee pain, DIP involvement no
swelling or warmth, worse @ the
end of the day, crepetence.
Osteoarthritis
59
what is most likely diagnosis of pt w DIP involvment, rash w silvery scale on elbows and knees, pitting nails and swollen fingers
Psoriatic arthritis
60
PIP and wrists bilaterally, worse in the AM, low grade fever.
RA
61
Pt comes in w acute swollen painful joint. what is first test?
tap it
62
What is most likely diagnosis for patient with tapped joint that comes back with > 50,000 WBC
septic arthritis
63
What is likely diagnosis of patient "who travels a lot" and has tenossynovitis and arm pustules.
Gonococcal septic arthritis.
| culture may be negative.
64
What is most likely diagnosis for septic arthritis in older individual with no sexual history
staph aureus
65
what is tx for septic arthritis caused by staph aureus
- nafcillin
| - or vanco
66
What are two antibodies test for RA?
- RF
| - Anti-CCP
67
What is antibodies for CREST syndrome?
- Anti-centromere
68
What is antibodie for systemic sclerosis?
- Anti-Scl-70, Anti-topoisomerase
69
What is tx of prolactinoma?
- Bromocriptine or cabergoline.
70
What is most likely diagnosis in pt that has polyuria, polydipsia, hypernatremia, hyperosm, dilute urine
Diabetes insipidus
71
What is test you would do for patient you are testing for diabetes insipidus
water deprivation test
72
What will you see in patient who you has central diabetes insipidus when you do a water deprivation test? what would be the second test you would preform?
- urine osmo still down, you would then give desmopressin and would see that the urine osm would increase
73
what will you see in patient who has nephrogenic diabetes insipidus when you do a water deprivation test? what would be the second test you would preform?
- urine osmo still down, then give desmopressin and would still be down.
74
What is the tx for patient with nephrogenic diabetes insipidus
- hydroclorothyazide
| - amiloride
75
What type of cancer does hashimoto's predispose you to?
Thyroid lymphoma
76
what is most likely diagnosis for patient with weakness, hypotension, weight loss, hyperpigmentation and labs show inc K, dec Na and pH
suspect adrenal insufficiency
77
What is best screening test for adrenal insuficiency
Cosyntropin stimulation test.
78
What is most common cause of adrenal insuficinecy?
Autoimmune disease (addison's)
79
What is test to look for pheochromocytoma?
urine and plasma free metanephrines
80
What is most likely diagnosis for patient with high blood pressure and low K and plasma renin levels
primary aldosteronism
81
what is test to look for primary aldosteronism
plasma aldosterone-to-renin ratio
82
What is most likely cause of post MI patient who has a persistant ST elevation 1 month later and a systolic MR murmur
Ventricular wall aneurysm
83
What is most likely cause of post MI patient who has a new systolic murmur 5-7 days later
mitral reguritation due to papillary muscle rupture
84
What is most likely cause of post MI patient who has a cannon A-waves on physical exam?
-Third degree heart block
85
What is most likely cause of post MI patient who has pleuritic CP, low grade fever 5-10 weeks later
Dressler syndrome (most likely autoimmune pericarditis)
86
How do you treat dressler syndrome?
NSAIDS
87
Young patient comes in with chest pain it is worse on inspiration, better with leaning forward, friction rub and diffuse ST elevation
- Pericarditis
88
What is most likely diagnosis of patient with chest pain occurs at rest, more often at night, few cardiac risk factors and has migrains with transient ST elevation during episodes
Prinzmetal angina
89
What is diagnostic step for pt with prinzmetal angina
Ergonovine stim test
90
What is tx for prinzmetal angina
CCB or nitrates
91
What is first line treatment of SVT
- Carotid massage
92
If you suspect patient has PE what is first step?
give heparin!
93
What is likely diagnosis in young patient who had flu like symptoms three weeks ago and now has SOB on exertion or needs three pillows at night
Viral myocarditis
94
What is most likely diagnosis of patient who has kidney stones, constipation, malaise and a central lung mass?
squamous cell carcinoma that is producing a paraneoplastic syndrome that is making PTH like peptide
95
What do you think about when AST> ALT and high GGT?
Alcoholic Hepatitis
96
What do you think about when ALT> AST and in the 1000s
Viral Hepatitis
97
What do you think about when AST and ALT in the 1000s after surgery or hemorrhage
ischemic hepatitis
98
What do you think about when you have an elevated Direct Bilirubin
- Obstruction (stone or cancer)
- Dubin Johnsons
- Rotor
99
What do you think about when Indirect bilirubin is elevated
- Hemolysis
- Gilbert (stress)
- Crigler-Najjar syndrome
100
What do you think about when you see elevated alk phos and GGT
Bile duct obstruction
101
What do you think about when see high Alk phos but normal GGT and Ca
Pagets disease
102
What is most common bugs to cause Meningitis?
Strep Pneum
H. flu
N. Meningitidi
103
What is treatment for most common bugs for meningitis
Ceftriaxone and Vanco
104
What do you want to add for tx of meningitis in old and young patients?
Ampicillin to cover lysteria
105
What is order for tx if you think patients has Meningitis?
- start empiric tx
- get CT look in eyes for intercranial pressure
- LP
106
Best first step for pt you think has pneumonia?
CXR
107
What do you give for roommate of kid who has n.meningitis?
Rifampin
108
What is most likely cause of pneumonia of pt who just skinned a rabbit and lives in Ark.
- What do you do to tx it?
Franciella Tularensis
- streptamycin or gentimycin
109
What is most likely cause and how will you tx patient who just had the flu and now you think they have pneumonia?
- MRSA
| - Vanco
110
If screening (XCR and sputum) for TB is postive in normal person what do you do?
- tx w 4 drug RIPE regimen for 6 months.
111
What are side effects of Rifampin?
- turns tears and urine orange
| - Inducer of CytoP450
112
What are side effects of INH?
| What else do you have to do?
- Peripheral neuropathy and sideroblastic anemia
| - give B6
113
What are side effects of Ethambutol
Optic neuritis
| color vision abnormalities
114
When do you start HAART therapy?
CD4 <350 or viral load >55,000
115
What HIV drug causes GI side effects, Leukopenia and macrocytic anemia?
Zidovudine
