Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Level 2 Boards > Gastrointestinal/ Renal/ Genitourinary > Flashcards

Gastrointestinal/ Renal/ Genitourinary Flashcards

(333 cards)

Start Studying
1
Q

Tx Oral thrush

A

Fluconazole PO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Mouth
Large linear superifical ulcerations

Intranuclear and intracytoplasmic inclusions on biopsy

TX

A

Cytomegalovirus

Tx: Ganciclovir IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Esophagitis caused by medications

A

Tetracyclines
Bisphosphonates
NSAIDs
Potassium chloride

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Cork screw shaped esophagus

Dx

Tx

A

Diffuse (distal) Esophageal spasm

Esophageal manometry (most accurate) 
- High amplitude simultaneous contractions in greater than 20% of swallows

Triggered by hot or cold liquids

Relieved by nitroglycerin

Tx: CCB
Tricyclic antidepressants
Nitrates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Tx Achalasia

A

Short term:

  • Nitrates
  • CCB
  • Botox

Long term:
- Penumatic balloon dilation or surgery (heller) myotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Tx Zenker diverticulum

A

Myotomy of the cricopharyngeus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Narrowing of esophagus with an irregular border protruding into the lumen

A

Esophageal cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Tx GERD

A

Lifestyle modifications
- avoid alcohol, chocolate and coffee

Mild: Antiacids

Chronic/ frequent:

  • H2 receptor antagonists (cimetidine, ranitidine
  • PPI (omeprazole, lansoprazole)

Severe/ erosive:

  • PPI (first)
  • If refractory: Nissen surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Tx Hiatal hernia

A

If paraesophageal hernia surgery gastropexy to prevent gastric volvulus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Types of Chronic gastritis

A

Type A (10%)

  • Fundus
  • Autoantibodies to parietal cells
  • causes pernicious anemia
  • increased risk of gastric adenocarcinoma and carcinoid tumors

Type B (90%)

  • Antrum
  • NSAIDS/ H.pylori
  • Increased risk peptic ulcer disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Low hemoglobin
High MCV

Macrocytic Megaloblastic anemia

A

Pernicious anemia

Disease where large, immature nucleated cells (megaloblasts) circulate in the blood and do not function as blood cells

Disease caused by impaired uptake of Vit B12 due to lack of intrinsic factor in gastric mucosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

H pylori test

A

First: stool antigen

Serology: cant determine if active disease

Urea breath test: PPI cause false negative results

Ab stay + even when the infection is cleared

Use urea breath test or repeat stool antigen as a test of cure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

H pylori tx

A

Triple therapy

Amoxicillin
Clarithromycin
Omeprazole

Pencillin allergy= metronidazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Krukenberg tumor

A

Gastric adenocarcinoma that metastasizes to ovary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Virchow node

A

enlarged left supraclavicular LN

Gastric cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Sister Mary Joseph node

A

Palpable lymph node near the umbilicus

Gastric cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

1) Posterior ulcer erodes into

2) Ulcer on lesser curvature of stomach

A

1) Gastroduodenal artery

2) Left gastric artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What to give patients with peptic ulcer disease who require NSAIDS for arthritis

A

Misoprostol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Bloody diarrhea (4)

A

Campylobacter
Salmonella
Shigella
Ecoli (EHEC)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Watery diarrhea (6)

A 
Vibrio cholerae
Rotavirus
Ecoli (ETEC)
Cryptosporidium
Giardia
Norovirus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Tx Campylobacter

A

Supportive tx

Fluoroquinolones (ciprofloxacin) or

Azithromycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Tx Clostridium difficile

A

PO metronidazole (mild)

PO vancomycin (moderate to severe)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Diarrhea
Egg shell calcifications

  • T
A

Echinococcus granulosus

Contact w/ dogs, host for tape work

Causes simple liver cysts

  • Albendazole
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Arthritis
Lymphadenopathy
Cardiac issues

PAS positive granules on lamina propria on biopsy

A

Whipple disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Diarrhea Confusion Rash
Pellagra Deficiency of Vit B3 (niacin)
26
Foul smelling, bulky stools Flatus Bloating - Examples (4)
Malabsorption/ maldigestion Celiac disease Whipple Tropical sprue Crohns
27
Carcinoid tumor found where
Ileum or appendix
28
``` Flushing Diarrhea Abdominal cramps Wheezing Right sided cardiac valvular lesions ``` Measure what Tx Can develop Due to MOA
Carcinoid syndrome Measure 5-HIAA Tx: Octreotide Surgical resection Develop niacin deficiency because tryptophan is metabolized into serotonin
29
Gallstone ileus
Fistula between gallbladder and GI tract —> stone enters GI lumen —> obstructs at ileocecal valve Air in biliary tree (pneumobilia) Form of small bowel obstruction Resulting from the passage of a large stone >2.5 cm into the bowel through cholecystoduodenal fistula
30
Severe abdominal pain out of proportion to exam Dx
Mesenteric ischemia Dx: Mesenteric/ CT angiography
31
Ischemia of bowels after cardiac catheterization due to
Cholesterol embolism
32
Diverticulitis tx
``` NPO NG tube Broad spectrum Ab - Metronidazole - Fluroquinolone or third generation cephalosporin ``` Diver's Mask Covers Face
33
Streptococcus bovis
Cancer in butt
34
Ischemic colitis dx
Insufficent blood supply Watershed area Crampy abdominal pain followed by bloody diarrhea CT scan w/ contrast - thickened bowel wall, atherosclerosis
35
Crohns disease - Location - Features (4) - Tx (2)
``` Any portion GI tract Skip lesions Fistulas Watery diarrhea Creeping fat ``` Tx: 5-ASA agents - Sulfasalazine - Mesalamine Corticosteriods - Increased risk colon cancer
36
UC - Location - Features (2) - Tx (2)
Rectum Bloody diarrhea Toxic megacolon Tx: 5-ASA agents - Sulfasalazine - Mesalamine TNF-alpha inhibitors - infliximab - adalimumab - golimbumab Corticosteriods - Increased risk colon cancer
37
Hesselbach triangle
Area bound by ``` Inguinal ligament (inferior) Inferior epigastric artery (lateral) Rectus abdominis (medial) ```
38
Hernia lateral to inferior epigastric vessel
Indirect hernia Results from congenital patent processus vaginalis
39
Herniation medial to epigastric vessels
Direct hernia Mechanical breakdown in transversalis fascia from age
40
Hernia Mnemonic
Directly to the middle (medial) Indirect (LIE) lateral to inferior epigatsric vessel
41
Black gallstones
Hemolysis | Sickle cell
42
Brown gallstones
Infection
43
Cholecystitis Choledocholithiasis Cholangitis
Cholecystitis - inflammation of GB due to stone in cystic duct - RUQ pain, fever, murphy sign Choledocholithiasis - stone in common bile duct - Jaundice, RUQ pain, afebrile - Dilated CBD - MRCP or ERCP - Elevated Alk Phos and direct bilirubin Cholangitis - infection of CBD due to stone - RUQ pain, fever, jaundice, reynolds pentad (shock + mental status changes) - Elevated Alk Phos and direct bilirubin
44
RUQ pain following opiate administration
Sphincter of Oddi dysfunction
45
HBsAg HBsAb HBcAg HBcAb HBeAg
HBsAg - Presence of virus HBsAb - antibody to HBsAg (immunity) HBcAg HBcAb - Antibody to HBcAg - prior or current infection (no vaccine) HBeAg - Transmissibility
46
+ ANA + Anti-smooth Ab Elevated IgG P-ANCA
Autoimmune hepatitis
47
HBV tx
Tenofovir | Entecavir
48
Complication of cirrhosis and ascites - Lab - Tx - Prophylaxis
Spontaneous bacterial peritonitis > 250 PMNs/mL in ascitic fluid Tx: third generation cpehalosporin IV albumin prophylaxis w/ fluoroquinolne to prevent reoccurance
49
Ascites and Serum ascites albumin gradient (SAAG)
SAAG= serum albumin - ascites albumin SAAG > 1.1 - Related to portal HTN Presinusoidal: splenic or portal vein thrombosis, schistosomiasis Sinusoidal: Cirrhosis Postsinusoidal: Right heart failure, constrictive pericarditis, Budd-Chiari syndrome SAAG< 1.1 - Not related to portal HTN Nephrotic syndrome TB Malignancy w/ peritoneal carcinomatosis (ovarian cancer) [Sarcoidosis, SLE]
50
Associated with UC
Primary sclerosing cholangitis P-ANCA "Onion skin" bile duct Increase IgM
51
Primary sclerosing cholangitis associated with Risk for
UC Increased risk for cholangiocarcionoma
52
``` Progressive jaundice Pruritus Fatigue Increase Alk phos Increase bilirubin ``` P-ANCA Hx UC - Name - MOA - Seen on imaging (2) - Increase - Tx - Affects who
Primary sclerosing cholangitis Idiopathic disorder characterized by progressive inflammation and fibrosis accompanied by strictures of extrahepatic and intrahepatic bile ducts MRCP/ERCP shows multiple bile duct strictures and dilations (beading) "Onion skin" bile duct Increase IgM Tx ERCP w/ dilation Young men
53
Progressive jaundice Pruritus Fat soluble vitamin deficiencies (A, D, E, K) Increase Alk Phos Increased Bilirubin + Anti-mitochondrial Ab Increased cholesterol - Name - MOA - Affects who - Tx (3)
Primary Biliary cholangitis Autoimmune disorder characterized by destruction of intrahepatic bile ducts (lobular ducts) [Not common bile duct] Middle aged women Tx: Ursodeoxycholic acid (slow progression) Cholesyramine (pruritus) Liver transplant
54
Elevated alpha feto protein
Hepatocellular carcinoma Yolk Sac tumor
55
Liver mass Oral contraceptives
Hepatic adenomas Benign
56
``` Abdominal pain DM Hypogonadism Cirrhosis Bronze skin Hepatomegaly ``` - Name - Labs (3) - Tx (2) - Susceptible (3)
Hemochromatosis Elevated iron Elevated ferritin Decreased transferrin Tx: phelbotomy Deforxamine, deferiprone or deferasiroxcan can help maintain Increased suseptibility to - Vibrio vulnificus - Listeria monocytogenes - Yersinia enterocolitica Hemochromatosis Very Yellow Legs
57
Cirrhosis Tremor Psychosis/ Anxiety Jaundice Hepatomegaly Choreiform movements Rigidity - Name - Inheritance - Test (2) - Lab - Tx - Avoid
Wilson disease AR Slit lamp exam Decreased ceruloplasmin Most accurate test: 24 hour urinary copper excretion after given penicillamine Tx: Penicillamine or trientine Avoid: Shellfish, liver, legumes and zinc
58
Elevated serum insulin | C peptide elevated
Insulinoma
59
Watery diarrhea Dehydration Muscle weakness Flushing Low stomach acid
VIPoma
60
CA 19-9
Pancreatic cancer
61
Hx Cirrhosis Fever Mental status changes
Spontaneous bacterial peritonitis
62
7 day old taking oral formula ``` Low temp Lethargic Cyanotic Abdominal distension Absent bowel sounds ``` Red blood in stool NG tube= bilious fluid - Name - Risks (2)
Necrotizing enterocolitis Risks: very low birth weight, enteral feeding
63
AST and ALT >25 x upper limit
Toxin induced (acetaminophen) Ischemic Viral hepatitis
64
Recurrent rectal pain 5 minutes Unrelated to defecation No blood - Name - MOA - Tx
Proctalgai fugax Spastic contraction of the anal sphincter Pudendal nerve compression Nitroglycerin cream
65
Gas in gallbladder wall - Name - Risk factors (3) - Caused by (2) - Tx (2)
Emphysematous cholecystitis Risk factor DM, vascular compromise, immunosuppression Clostridium Ecoli Klebsiella Emergery surgery Piperacillin taxobactam
66
Meckel diverticulum test
Technetium-99m pertechnetate scan Detects ectopic gastric tissue
67
UC tx
< 4 watery BM Initial management is with 5-aminosalicylic acid (5-ASA) - mesalamine - sulfasalzine - balsalazide Mesalamine enemas >6 watery BM - Severe: TNF-alpha inhibitors (infliximab, adalimumab, golimbumab)
68
Food stuck in throat Vomiting water Frequent heart burn - PPI dont help
Eosinophilic esophagitis Leads to stricture formation
69
Ascites protein characteristics
Total Protein <2.5 - Cirrhosis - Nephrotic Total protein > 2.5 - CHF - Constrictive pericarditis - TB - Budd-Chiari SAAB <1.1 - tb, pancreatic ascites - Sarcoidosis, SLE, cancer - nephrotic syndrome ``` SAAG >= 1.1 - portal htn cardiac ascites Cirrhosis Budd chiari ```
70
Distended abdomen with shifting dullness Due to what? Paracentesis: albumin 2.5 Blood: Albumin 3.8 MOA
SAAG= serum- ascites albumin 3.8-2.5= 1.3 Indicated portal hypertension - cardiac ascites - cirrhosis - Budd-chiari Which indicates an increased hydrostatic pressure within hepatic capillary beds
71
Ascites with increased capillary permeability
Malignant ascites SAAG < 1.1 Non-portal HTN
72
Infant Painless bloody stools 1 month old Reflux/ spit up Eczema
Food protein induced allergic proctocolitis Remove all dairy and soy
73
Abdominal bloating Steatorhhea Macrocytic anemia Hx Gastric bypass - What is it - Caused by - Results in - Dx - Tx
Small intestinal bacteral overgrowth (SIBO) Gastric bypass results in a blind loop of intestine that allows for excessive bacterial growth Nutritional deficiencies Dx: Carbohydrate breath test measures the hydrogen by intestinal flora ``` Correction of abnormality Empiric ab (rifaximin) ```
74
RUQ pain Gaseous distension of small and large bowels without air fluid levels Gallbladder is distended with no gallstones Small amount of pericholecystic fluid
Acalculous cholecystitis Due to gallbladder stasis, hypoperfusion or infection (CMV) Antibiotics and percutaneous cholecystostomy
75
Luminal irregularities with mild focal dilations within both intrahepatic and extrahepatic biliary ducts High elevated Alk phos Increased bilirubin Elevated Gamma glutamyl transpeptidase
Primary sclerosing cholangitis 90% also have inflammatory bowel disease w/ UC more common than crohns Get colonoscopy to rule out IBD
76
Causes of subphrenic abscess
Perforated ulcer Appendicitis Abdominal surgery
77
What should be check on ascites
Fluid color Total protein count SAAG Cell count and differential to rule out spontaneous bacterial peritonitis
78
Young man Vomiting Now retrosternal pain Fever Crepitus
Esophageal perforation Crepitus & Fever are key [ Aortic dissection doesnt have these]
79
Ectopic pregnancy on doppler
Increased doppler flow (Ring of fire) around ectopic pregnancy
80
Develops GI hemorrhage days after being admitted to ICU
Stress induced ulcer Risk factors shock and sepsis
81
Occult bleeding
Only found on labs (not visible)
82
Itching Fatigue Hepatomegaly No scleral icterus or jaundice Elevated cholesterol Elevated bilirubin Elevated Alk phos Normal common bile duct
Primary biliary cholangitis Check anti-mitochondrial ab
83
32 y.o Intense, midline chest pain and diaphoresis Recurrent vomiting Alcohol Cocaine Fever BP 100/60 Dilated pupils Diminished breath sounds on left Widened mediastinum Moderate pleural effusion on left Pleural fluid= yellow exudate with high amylase
Esophageal perforation
84
Refeeding syndrome
Hypophosphatemia Hypokalemia Weakness Arrhythmias
85
Risk factors for C. diff
Recent antibiotics PPI Advanced age Hospitilization
86
Pancreatic leak
Develop metabolic acidosis - low pH - low bicarb - normal anion gap
87
Suprapubic tenderness Painful urination Tx
Acute cystitis | Tx: Nitrofurantoin (5days TMP-SMX 3 days) Fosfomycin (single dose)
88
Hypernatremia due to
Free water loss rather than sodium gain
89
Tx hypernatremia
isotonic 0.9% NaCl if hypovolemic with unstable vital signs If normal volume status and asymptomatic - D5W, 0.45% NaCl
90
Hypernatremia causes
The 6 D's ``` Diuresis Dehydration Diabetes insipidus Docs (iatrogenic)D Diarrhea Disease (kidney, sickle cell) ```
91
How to tell cause of hypernatremia
If Low urine osmolality (< 300) - Then central or neprhogenic DI - Check water restriction, if osm rise then central If High urine osmolality > 600
92
Hyponatremia caused by
Increase in ADH
93
When to use hypertonic saline
Only if patient is having seizures caused by hyponatremia When serum Na is < 120
94
Hyponatremia Hypotonic serum osmolality < 280 Assess EC fluid
``` Low EC fluid Hypovolemic hypotonic - GI losses (diarrhea) - burns - Diuretics - urinary obsturction - RTA ``` Normal Isovolemic hypotonic - > 100 urine osm= SIADH, hypothyroidism - <100 osm primary polydipsia Elevated Hypervolemic hypotonic - FENa < 1% Cirrhosis, CHF, Nephrotic - FENa > 2% AKI, Chronic renal failure
95
Treatment of hyperkalemia
C BIG K Calcium chloride or gluconate (IV) Bicarbonate, B2 agonists Insulin + Glucose Kayexalate (sodium polystyrene sulfonate) Only tx if > 7 ECG changes
96
Hyperkalemia on ECG
Peaked T waves PR prolongation Widened QRS
97
Peaked T waves PR prolongation Widened QRS
Hyperkalemia
98
26 y.o to ER with hx of depression comes in with altered mental status, tinnitus, nausea and vomiting ABG shows pH of 7.4, PaCO2 of 22, HCO3 of 13 Diagnosis? Acid/base? - Compensation formula
Aspirin overdose pH is normal Mixed metabolic acidosis and respiratory alkalosis Bicarb is low indicating metabolic acidosis Winters formula that predicts PaCo2 under normal compensation should be 29 (PaCO2- 1.5 (HCO3)+8) Her PaCO2 islower than this at 22 so concurrent respiratory alkalosis
99
Tx Rhabdomyolysis
Saline hydration Mannitol Bicarbonate ECG to rule out life-threatening hyperkalemia
100
Hypokalemia on ECG
T wave flattening U waves ST segment depression
101
T wave flattening U waves ST segment depression
Hypokalemia on ECG
102
Chronic kidney disease
> 3 months of GFR > 60 mL/min
103
pH < 7.35 | PCo2 > 44
Respiratory acidosis ``` Airway obstruction Acute lung disease Chronic lung disease Opioids Weakening of respiratory muscles ```
104
pH < 7.35 | HCO3 < 20
Metabolic acidosis ``` High anion gap= MUDPILES Methanol Uremia Diabetic ketoacidosis Propylene glycol Iron tablets or INH Lactic acidosis Ethylene glycol Salicylates (late) ``` Normal anion gap - Addisons - Renal tubular acidosis - Diarrhea - Acetazolamide - Spironolactone - Saline infusion
105
Anion gap
Na- (Cl+ HCO3) 8-12 normal
106
pH > 7.45 | PCO2 < 36
Respiratory alkalosis ``` Anxiety Hypoxemia Salicylates (early) Tumor Pulmonary embolism ```
107
pH > 7.45 | HCO3 > 28
Metabolic alkalosis Loop diuretics Vomiting (low cl) Antacid use Hyperaldosteronism
108
Normal anion gap metabolic acidosis Hyperchloremic Urine pH > 5.5 Hypokalemia
Type I RTA Defect in H secretion Complication is nephrolithiasis Sjogren
109
Normal anion gap metabolic acidosis Hyperchloremic Urine pH <5.5 Hypokalemia
Type II RTA HCO3 reabsorption defect MM Amyloidosis Fanconi Cisplatin Complication - RIckets - Osteomalacia
110
Normal anion gap metabolic acidosis Hyperchloremic Variable Urine pH Hyperkalemia
Type IV RTA Aldosterone deficiency
111
Prerenal - feature seen
BUN/ Cr > 20:1 Hyaline casts
112
Intrinsic renal - feature (2)
BUN/Cr < 15:1 RBC casts RBC dysmorphic
113
Post infectious glomerulonephritis vs IgA nephropathy
Postinfectious glomerulonephritis - 2-6 weeks after infection - low C3 IgA nephropathy - presetn concurrent with an infection - normal C3
114
Nephritic syndrome findings
PHAROH ``` Proteinuria Hematuria Azotemia (high nitrogen content) RBC casts Oliguria (small amount urine) Hypertension ```
115
Diuretic that causes ototoxicity
Loops
116
Diuretic that causes pancreatitis
Thiazides
117
Nephritic/ nephrotic syndrome with low C3
Postinfectious glomerulonephritis Membranoproliferative glomerulonephritis Lupus nephritis
118
Tea colored urine Edema HTN Recent infection
Post infectious glomerulonephritis Low serum C3
119
Episodic blood in urine Respiratory infections GI infections HTN Proteinuria
IgA nephropathy (Berger disease) Normal C3 IgA deposit [Henoch Schonlein purpura renal manifestation is pathologically the same]
120
Joint pain Blotchy purple skin lesions on trunk and extremities Abdominal pain
Henoch Schonlein purpura | [ Immunoglobulin A vasculitis]
121
Sinus infections Cavitary lung lesion Hemoptysis HTN Hematuria C-ANCA - Name - Biopsy - Tx
Granulomatosis with polyangiitis Segmental necrotizing glomerulonephritis with crescents Tx: Corticosteriods
122
p-ANCA AKI HTN Hematuria Skin lesions Lung
Microscopic polyangiitis
123
p-ANCA Asthma sinsuitis skin nodules/ purpura AKI HTN Hematuria
Eosinophilic granulomatosis with polyangiitis (Churg strauss syndrome) eosinophils Increased IgE
124
Hemoptysis AKI HTN Hematuria 20 y.o Iron deficency Anemia - Name - Biopsy - Finding - Tx
Good pasture Linear anti-GBM deposits Anti-basement membrane Plasma exchange therapy
125
Microscopic hematuria Proteinuria Sensorineural deafness - Seen on biopsy
Alport syndrome GBM splitting
126
Nephritic disease (8)
Postinfxn glomerulonephritis IgA nephropathy Henoch Schonlein Granulomatosis w/ polyangiitis Microscopic polyangiitis Eosinophilic granulomatosis with polyangiitis (Churg- Strauss) Goodpasture Alport syndrome
127
Nephrotic syndrome (7)
Minimal change Focal segmental glomerulosclerosis Membranous nephropathy Diabetic nephropathy Lupus nephritis Renal amyloidosis Membranoproliferative nephropathy
128
HTN Edema Hyperproteinuria Patchy areas on biopsy
Focal segmental glomerulosclerosis
129
Deposits of IgG and C3 on basement membrane Edema Hyperproteinuria
Membranous nephropathy
130
Associted with HBV, HCV
Membranoproliferative nephropathy
131
Tram track double layered basement membrane Low serum C3
Membranoproliferative nephropathy
132
``` Palpable purpura Arthralgias Proteinuria Hematuria Edema Low C3 Positive HCV ```
Mixed cryoglobulinemia
133
Staghorn calculi
Urease producing bacteria Proteus Klebsiella
134
Tx to help pass stone (4)
Hydration Analgesia Alpha 1 receptor blockers (Tamsulosin) CCB (nifedipine)
135
End stage renal disease can painful calcified lesions on extremities due to
Hyperphosphatemia Hypercalcemia High PTH
136
Renal and carotid arteries affected
Fibromuscular dysplasia
137
Painless hematuria No bacteria/ nitrates WBC casts Trace proteinuria
Suggests non-glomerular disorder Tubulointerstitial nephritis
138
Weakness Hyperkalemia Rapid Bicarb < 18 (metabolic acidosis) Edema
AKI BUN/CR 15:1= intrinsic Renal tubular injury
139
Glomerulonephrtiis
Hematuria | RED blood casts
140
Seen with diabetic nephropathy
Takes years Mild proteinuria Shrunken atrophic kidneys Hypocalcemia
141
Drug induced interstitial nephritis
Rash Fever WBC cases
142
Prerenal acute kidney injury
Intravascular volume depletion
143
Prerenal acute kidney injury Dry mucus mebranes
Increased central venous pressure Volume overload due to heart failure
144
Obstructive uropathy
Postrenal AKI
145
1 day hx fever and joint pain Being treated with cephalexin for skin infxn Urine turned darker Rash ``` 8 RBC 12 WBC White cell casts Eosinophiluria Proteinuria ``` BUN 40 Cr 2.2
Discontinue cephalexin Drug induced interstitial nephrtiis Caused by pencillins, cephalosporins, and sulfonamides Fever Rash Arthralgias
146
Nephrotic syndrome at risk for developing
Accelerated atherosclerosis
147
Headache Confusion Hyperreflexia Arrhythmias SOB Vomiting Flushing
Cyanide toxicity
148
Elevated blood tacrolimus
Acute calcineurin inhibitor renal toxicity Tacrolimus Cyclosporine AE: vasoconstrictive properties
149
Edema Proteinuria Hx. RA Enlarged kidneys Adult
Amyloidosis Glomerular deposits seen after special straining Congo red
150
Small atrophic kidneys Bland (no wbc, rbc) Mild proteinuria S4 Strong apical impulse
Hypertensive nephrosclerosis
151
Nephrotic syndrome that then presents with abdominal pain, fever, and hematuria
Renal vein thrombosis Commonly seen with membranous glomerulopathy
152
Pancreatitis affect on kidneys
Hypovolemia due to vomiting Kidneys increase renin Vasoconstriction Sodium and water reabsorption
153
High pH Low PaCo2 High respiratory rate Normal oxygen saturation
Respiratory alkalosis Inadequate pain control
154
Previous UTI Flank pain WL Fever Leukocytosis Anemia Elevated Glucose
Renal abscess
155
Tx uric acid stones
Alkalinization of urine (potassium citrate)
156
Tx Renal artery stenosis
ACE inhibitor/ ARB
157
Hx Sjogrens pH 7.32 PaO2 100 PaCO2 30
Metabolic acidosis Nonanion gap RTA type 1 due to sjogrens
158
Hematura Varicocele that fails to empty on lateral recumbant Elevated Hemoglobin and platelets
Renal cell carcinoma Get abdominal CT Ectopic production of erythropoetin
159
Hypercalcemia with normal PTH
Familial hypocalciuric hypercalcemia Bengin
160
Interstitial cystitis
Chronic painful blader condition that is associated with psychiatric disorders and other pain syndromes (fibromyalgia) Bladder pain exacerbated by exercise, sexual intercourse, and alcohol consumption Tx Avoiding triggers Amitriptyline
161
If want to add Phosphodiesterase inhibitor make sure not on
Nitrates Leads to significant decrease in BP can lead to myocardial ischemia
162
Tx BPH
Alpha blockers - Tamsulosin - Terazosin Next best 5alpha reductase inhibitors - Finasteride
163
19 y.o with kidney stones Father also with kidney stones What is most likely
Cystinuria Decreased cystine reabsorption caused by defect in proximal tubular amino acid transport Hexagonal cystals on UA
164
Spread of Renal cell carcinoma
Tumors can spread along the renal vein to the IVC and metastasize to lung and bone
165
Middle aged smoker with left sided varicocele Seen with
Renal cell carcinoma Anemia Polycythemia
166
Testicular cancer of man in his 40s
Seminoma
167
Germ cell tumors
Seminoma Yolk sac - increased AFP Choriocarcinoma - increased b-hCG Teratoma - increased AFP and b-hCG
168
Non Germ cell tumors
Leydig cell - Increased testosterone and estrogen - decrease LH and FSH Sertoli cell Testicular lymphoma
169
Elevated b-hCG in men
Choriocarcinoma
170
Tx Pyelonephritis that is multidrug resistant Develops acute renal failure due to what drug No WBC Elevated FEna
Amikacin Aminoglycoside No WBC or eosinophils so not interstitial nephritis Probably a gram negative (so no vancomycin)
171
Vomiting ``` pH PaCo2 HCo3 K Cl ```
Increased pH Increased PaCO2 Increased HCO3 Decreased K Decreased Cl
172
Dilute urine with overnight fasting
Lithium induced nephrogenic diabetes insipidus Renal collecting ducts - ADH resistance Dilute urine (urine osm < 300)
173
Hemangioblastoma Cystics in cerebrum Multiple cysts in kidneys - Name - Risk for
Von Hippel Lindau disease Risk RCC
174
Autosomal dominant polycystic kidney disease
CNS and renal disease Aneurysms
175
Recurrent bilateral flank pain Hematuria HTN Labs (2)
Polycystic kidney disease AD Increased renin release Increased vasopressin levels
176
Rhabdomyolysis
Causes myoglobinuria Looks like hematuria Blood on urinarlysis NO RBC cells
177
Nephrolithiasis with Crohns
Fat malabsorption —> hyperoxaluria Oxalate from diet Increased oxalate absorption in gut
178
Hematuria Decreased urine output Hep C Cirrhosis Doesn't improve with fluids
Hepatorenal syndrome Splanchnic arterial dilation Triggered by SBP, excessive diuretics, sepsis, vomiting, GI bleed No RBC, protein or granular casts Tx Splanchnic vasoconstrictors (midodrine, octreotide, NE)
179
Metabolic acidosis with high anion gap Envelope-shape crystals
Ethylene glycol poisoning
180
Aspirin (salicylate) toxicity ABG
Mixed anion gap metabolic acidosis and respiratory alkalosis with no osmolal gap
181
Nephrotic proteinuria Hematuria C3 deposits
Membranoproliferative glomerulonephritis Caused by IgG antibodies against C3 convertase in alternative complement pathway
182
Circulating immune complexes Renal disease
Glomerulopathies SLE Post-streptococcal glomerulonephritis
183
Non-immunologic kidney damage
Diabetic nephropathy | HTN nephropathy
184
Acute urinary retention Taking diphenhydramine
First generation H1 antihistamine can have anticholinergic effects Detrusor hypocontractility
185
Worsening SOB Breathless at night Facial edema BP 200/120 Bibasilar crackles JVD 1+ Protein Hematuria
Acute nephritic syndrome with fluid overload Primary glomerular damage - Post strep glomer - IgA nephropathy - Lupus nephritis - Membranoprolifer - Rapidly progressive glomerulo
186
Portal HTN
no JVD Cirrhosis Ascites Edema in lower extremities
187
SE Thiazides
Hyperglycemia Increased uric acid Increased LDL cholesterol
188
Pre renal azotemia
high levels of nitrogen contain compounds BUN Cr Abdominal pain Thirst BUN/CR greater than 20:1 due to increased urea absorption Volume depletion
189
Low Bicarb Normal anion gap Hyperkalemia High chloride BUN/CR: 20:1
Metabolic acidosis ``` Diarrhea Fistulas Carbonica anhydrase inhibitors Renal tubular acidosis Ureteral diversion Iatrogenic ```
190
Primary hyperaldosteronism
Increased H and K excretion Hypokalemia Metaboic alkalosis Aldosterone Saves Sodium and Pushes Potassium out
191
Renal artery stenosis labs
Secondary hyperaldosteronism Hypokalemia Metabolic alkalosis HTN
192
How to rapidly reduce hyperkalemia
Insulin and glucose B2 adrenergic agonist Sodium bicarbonate
193
How to remove potassium slowly
Diuretics Cation exchange resins Hemodialysis
194
Hiking Hematuria Flank pain Resolved ``` Anemia pH 5.8 3+ blood RBC WBC 6% reticulocytes ```
Papillary necrosis Sickle cell trait No casts= extraglomerular cause Dehydrated
195
Pregnancy asymptomatic bacteriuria left untreated becomes
Acute pyelonephritis Tx: Cephalexin Amox-clavulatante Nitrofurantoin Fosfomycin
196
Elevated creatinine (double since admission) BUN:Cr > 20 Elevated anion gap metabolic acidosis
Prerenal azotemia/ AKI Acute kidney injury from diuretic therapy
197
Proteinuria Edema Hypoalbuminemia Joint pains Hand deformities
Rheumatoid arthritis complicated by AA amyloidosis
198
AKI BUN CR 20:1 Nothing on urinalysis JVD Edema
Volume overload due to acute heart failure exacerbation AKI due to cardiorenal syndrome LV failure with reduced cardiac output —> decreased renal perfusion —> activation of RAAS *Elevated central venous pressure is major driver of AKI in cardiorenal syndrome
199
Glomerular hyperfiltration
Occurs in early stages of diabetic nephropathy and is recognized by temporary increase in GFR Increase in GFR Decrease in Cr
200
Low blood oncotic pressure
Occurs in neprotic syndrome Total body volume overload with intravascular volume depletion
201
Reduced left ventricular preload
Increased in heart failure
202
``` Muscle weakness Dark urine Decreased urine output Elevated Cr Hematuria Low WBC, RBC ``` Gout Takes Aspirin, ticagrelor, simvastatin, metoprolol, lisinopril and colchicine - Name - Cause - Check for what
Rhabdomyolysis Statins and colchicine are direct myotoxins Check for creatine phosphokinase
203
Pain in legs, weakness and swelling Binge drinking Cocaine use HTN
Drug induced rhabdomyolysis —> AKI
204
Trauma Clean urine sample RBC in urine Get what
CT scan of abdomen and pelvis Kidney injury Urethral would have gross hematuria
205
Tx Metabolic alkalosis
Normal saline
206
COPD Antibiotics Corticosteriods Albuterol Ipratropium Develops hypokalemia why
Increased beta adrenergic activity Potassium shift into intracellular space
207
Decreased insulin on K
Hyperkalemia Insulin promotes K shift into IC space
208
Trauma Widening pubic symphysis Intraperitoneal free fluid What next step
Retrograde cystography
209
Diarrhea ABG
Excess HCO3 loss non-anion gap metabolic acidosis
210
Right flank pain Decreased urination Hx Total left nephrectomy ``` Low potassium High Cr Protein trace WBC RBC No casts ```
Unilateral obstructive uropathy
211
Rejection of kidney at 6 months
Acute rejection | first 6 months
212
Acute toxicity to taacrolimus
Vasoconstriction of afferent and efferent renal arterioles Prerenal acute kidney injury HTN BUN:Cr > 20:1
213
Evaluation hyponatremia Serum osm 252 Urine osm 78
1. Serum osm > 290 yes: advanced renal failure, marked hyperglycemia 2. Urine osm < 100 yes: Primary polydipsia, malnutrition (beer drinker) 3. Urine sodium < 25 yes: volume depletion, CHF, cirrhosis no: SIADH, adrenal insufficiency, hypothyroidism
214
UTI infant
Cefixime Ecoli
215
Diabetic ketoacidosis ABG
Hyperventilation Decreased pH Decreased PaCo2 Decreaed Bicarb Metabolic acidosis Compensatory respiratory alkalosis
216
Urine pH
6.5-7.5
217
Increase pH with stone
Struvite Urease producing
218
Urge incontinece tx
Bladder training If fails Antimuscarinic drugs - Oxybutynin
219
Stress incontience with unipolar depression
Duloxetine
220
Tx urinary retention due to neurogenic bladder
Bethanechol (cholinergic agonist) Intermittent urethral catheterization
221
Medications to discontinue if develop prerenal azotemia
Nephrotoxins (NSAIDS) Metformin (can cause lactic acidosis in AKI)
222
Medications that cause hyperkalemia
nonselective beta adrenergic blockers Potassium sparing diuretics - triamterene - amiloride ACE inhibitors ARBs NSAIDS TMP-SMX
223
Isolated proteinuria Rapidly progressive renal failure CD4 220 ``` A. BK virus B. Crystal induced tubular dysfunciton C. Drug induced interstital nephritis D. HIV associated nephropathy E. Primary membranous nephropathy ```
HIV associated nephropathy Heavy proteinuria Rapidly progressive renal failure
224
Proteinuria WBC Fatty casts Edema -Risk for
Nephrotic syndrome Risk for hypercoagulability Thromboembolic complications
225
Repeat episodes of SOB, dyspnea, diaphoresis ABG
Panic attack Hyperventilation Respiratory alkalosis Elevated pH Low pCO2 Decreased serum ionized calcium (competes w/ hydrogen ions to bind albumin) Elevated blood pH —> dissociation of hydrogen ions from albumin results in increased calcium binding and decreased serum ionized calcium
226
25 bladder issues High post void
Urethral stricture
227
BPH tx
1st: Alpha 1 blocker Terazosin Tamsulosin 5 alpha reductase inhibitors (finasteride) can be added if persistent symptoms
228
Salicylate toxicity of ABG
Respiratory alkalosis Anion gap metabolic acidosis Results in near normal pH Low PaCo2 Low HCO3
229
Testis has how long to descend before needing surgery
6 months
230
Risk if varicocele left
Infertility and testicular atrophy due to increased scrotal temperatures
231
Lower abdominal pain 2 days fever, chills dysuria and pelvic pain Cant pass urine Suprapubic fullness Tender prostate Catheter drains 800 mL urine Positive Leukocyte esterase and nitrites Tx
Acute bacterial prostatitis (ABP) Tx: Levofloxacin or TMP-SMX
232
Pelvic pain (pain in perineum and testes) radiates to back > 3 months Frequency Urgency Pain with ejaculation - Name - MOA - Tx
Chronic prostatitis/ chronic pelvic pain syndrome Noninfectious chronic prostate inflammation Tx Tamsulosin
233
How to prevent calcium oxalate stones
Limit sodium intake
234
Upper GI Bleed see what change in labs
Elevated BUN/Cr ratio Increased urea production from intestinal breakdown fo hemoglobin and increased urea reabsorption in proximal tubule
235
Pancreatic atrophy and calcifications
Chronic pancreatitis Lipase supplementation for pain
236
Epigastric pain WL Iron deficiency Anemia Hepatomegaly China
Gastric cancer
237
Consistent elevated liver enzymes Large gamma gap (total protein - albumin= >4)
Autoimmune hepatitis
238
Crampy abdominal pain occasional Relieved by defecation
Irritable bowel syndrome Normal mucosa
239
Recurrent diarrhea Nocturnal diarrhea Cholecystectomy hx
Bile acid diarrhea Tx: Bile acid binding resins - Cholestyramine - Colestipol
240
Asymptomatic man Hepatosplenomegaly Elevated LFTs Hypercalcemia Mediastinal fulliness Bilateral reticulonodular opacities of upper lungs
Sarcoidosis Systemic granulomatous inflammation
241
Dilated loops of large bowel with air in colon and rectum
Paralytic ileus
242
Alcoholic liver disease Ascites Fever Abdominal tenderness Confusion Decreased bowel sounds Dilated loops of large bowel with air in colon and rectum Diagnosis
Spontaneous bacterial peritonitis —> Paralytic ileus if severe Ecoli Klebsiella Tx: 3rd gen cephalosporin (cefotaxime) Fluoroquinolones for SBP prophylaxis
243
Hyperechoic- appearing liver Elevated ALT, AST Elevated Alk Phos
Non fatty alcoholic liver disease
244
Small bowel obstruction in teenager from Asia
Ascariasis Round worm
245
Post seizure see what in labs
Anion gap metabolic acidosis Postictal lactic acidosis
246
CF Infant with bright green vomiting Dilated loops of bowel with no rectal air
Meconium ileus Get contrast enema
247
Esophageal spasm what test to get
Esophageal motility studies
248
UC at risk for
Colorectal carcinoma
249
Crypt abscess
UC
250
Epigastric pain Relieved by leaning forward
Chronic pancratitis
251
Suspected cirrhosis what exam
Upper GI endoscopy to look for varices
252
Tx Varices
Nonselective beta blockers Nadolol
253
What causes spider angioma What is also caused by this
Hyperestrinism due to impair hepatic metabolism of circulating estrogens Palmar erythema
254
D-xylose given, urinary and vneous D-xylose levels low
Celiac disease
255
Elevated AFP Elevated alk phos Back pain
Hepatocellular carcinoma
256
Bloody ascites
Hepatocellular carcinoma
257
Rhabdomyolysis at risk for
AKI
258
Chronic renal failure and bleeding due to
Uremic coagulopathy Platelet dysfunction
259
Malignancy in young man
Testicular Lymphoma Leukemia
260
Angular cheilitis Glossitis Rash Anemia Deficiency of what vitamin
Vit B2 (riboflavin)
261
Dermatitis Diarrhea Dementia
B3 niacin deficiency
262
Chilosis Glossitis Confusion
B6 pyridoxine
263
Uncontrolled DM Opiate use Abdominal pain Loose stools for months Postive glucose breath test - Name - Due to - Causes - Test for diagnosis (2) - Tx
Small intestinal bacterial overgrowth Happens with altered small bowel motility (uncontrolled DM) Vit B12 deficiency common Jejunal aspiration gold standard for diagnosis Carbohydrate breathe test Tx Rifaximin, neomycin
264
IBD vs IBS
IBD - anemia - Erythrocyte sedimentation level
265
Chronic pancreatitiis —> diarrhea due to
Decrease fecal elastase Exocrine insufficiency
266
Increase fecal calprotectin
Inflammatory bowel disease
267
Watery diarrhea after starting chemo tx
Tx loperamide | diphenoxylateatropine
268
Abdominal pain Microcytic anemia Positive fecal occult blood Hepatomegaly Small left side pleural effusion Elevated Alk phos
Colon cancer metastatic to liver
269
Common bile duct obstruction vs cystic duct
Common bile duct = jaundice
270
Erythema nodosum Looser stools
Inflammatory bowel disease
271
Test to get for zenker diverticulum
Contrast esophagography
272
70 y.o watery diarrhea Became lethargic Abdominal pain Abdominal distension Leukocytosis fever Distened colon
Clostridioides difficle infection Toxic megacolon
273
Vague abdominal pain, nausea, anorexia and constipation Now severe in lower abdomen Vomiting Pain initially improved then intensified through whole abdomen Bowel sounds diminished Seen with abdominal imaging
Diverticulitis Free air in the peritoneal cavity
274
Foul smelling urine Bubbles in urine Multiple bacteria in sample
Colovesical fistula *Stool in urine Abdominal CT with oral or rectal contrast (not IV)
275
What makes crohns disease worse
smoking
276
Enlarged firm neck mass Ulcerated tonsillar lesion Two enlarged firm fixed nontender lymph nodes What organism
Squamous cell carcinoma HPV
277
Painful itching red streaks on arm Previously on chest
Migratory superficial thrombophlebitis Trousseau syndrome Hypercoagulable disorder Associated with cancer of the pancreas Get CT scan abdomen
278
Crohns disease On Total parenternal nutrition Development of gallstones why
Gallstone stasis Normal stimulus for CCK release and gallbladder contraction is absent
279
Pelvic radiation Fecal incontience due to
Decreased rectal compliance
280
Camping | Diarrhea
Giardia
281
Traveler's diarrhea
Enterotoxigenic Ecoli
282
Fried rice
Bacillus cereus
283
Inflammatory bowel disease with increased risk of cancer
UC
284
30 y.o man with UC presents with fatigue, jaundice and pruritus
Primary sclerosing cholangitis
285
Medical tx for hepatic encephalopathy
Decrease protein intake Lactulose Rifaximin
286
4 y.o presents with oliguria, petechiae, and jaundice following an illness with bloody diarrhea. Most likely cause?
HUS caused by Ecoli
287
Drug induced hepatitis
TB medications - Isoniazid - Rifampin - Pyrazinamide Acetaminophen Tetracycline
288
40 y.o obese woman with elevated alkaline phosphatase Elevated bilirubin Pruritus Dark urine Clay colored stools
Biliary tract obstruction
289
Diarrhea Dehydration Muscle weakness Flusing
VIPoma Replace fluids and electrolytes May need to surgically resect or use ocetreotide
290
Hypotonic Hypervolemic Hyponatremia
``` Cirrhosis HF Nephrotic syndrome AKI CKD ```
291
Peaked T waves | Widened QRS
Hyperkalemia
292
T wave flattening and U waves
Hypokalemia
293
Salicylate ingestions causes
Anion gap acidosis and primary respiratory alkalosis caused by central respiratory stimulation
294
RTA associated with abnormal H + secretion and nephrolithiasis
RTA type I distal
295
RTA associated with abnormal HCO3 reabsorption and rickets
Type II (proximal) RTA
296
RTA associated with low aldosterone state
Type IV (distal) RTA
297
Drowsiness Asterixis (tremor of hands and wrist) Nausea Pericardial friction rub
Uremic syndrome seen in patients with renal failure
298
Glomerulonephritis with hemoptysis
Granuomatosis with polyangiitis (wegener) and Goodpasture syndrome
299
Nephrotic syndrome (5)
``` Proteinuria > 3.5 g Hypoalbuminemia Edema Hyperlipidemia Thrombosis ```
300
Waxy casts in urine sediment | Maltese cross
Nephrotic syndrome
301
Most common nephrotic syndrome in adults
Focal segmental glomerulosclerosis
302
US with bilateral enlarged kidneys with cysts Associated brain anomaly
ADPKD Cerebral aneurysm
303
Hematuria Flank pain Palpable flank mass
RCC
304
Most common type of testicular cancer
Seminoma Germ cell tumor
305
Testicular cancer associated with increase in beta-hCG
Choriocarcinoma
306
ABG of pregnancy
Respiratory alkalosis
307
Tx Giardia
Metronidazole
308
Perianal disease Fissures Skin tags Fistula
Crohns disease
309
MALT of stomach caused by
H. pylori
310
Hx of Shot in abdomen Diarrhea even with fasting. Low osmotic gap
Secretory diarrhea Due to unabsorbed bile acids
311
High stool osmotic gap Diarrhea Diarrhea after digestion WHat test?
Osmotic diarrhea Hydrogen breath test
312
Patient with cirrhosis dont give what medication
ACE inhibitor Blunt RAAS system important for compensatory response
313
Vomiting Serum - Bicarb - Chloride Urine - Sodium - Chloride
Hypokalemic, hypochloremic metabolic alkalosis
314
Tx Primary biliary cholangitis At risk for
+ Anti mitochondria Ursodeoxycholic acid Liver transplant later on Risk - Malabsorption, fat soluble vitamin defiiencies - Osteoporosis - HCC
315
Diarrhea 10-12 x day Diarrhea in middle of night Dark brown discoloration of colon
Laxative abuse
316
Hx UC Anemia Elevated total bilirubin Elevated Alk phos What test to get Increase Appearance on imaging Lab
Magnetic resonance cholangiopancreatography Primary sclerosing cholangitis Increase IgM Onion skin bile duct + P-ANCA
317
Diarrhea Abdominal pain WL Bulky foul smelling stools Arthralgia Lymphadenopathy Skin hyperpigmentation Villous atrophy PAS + material in lamina propria
Whipple disease Bacteria Tropheryma whippelii
318
Drug induced lupus
Rash is not common
319
Pellagra
Dermatitis Diarrhea Dementia Niacin deficiency
320
Constant sensation of dripping in back of throat Nasal congestion Food tasting bland Hx Severe wheezing after naproxen
Aspirin exacerbated respiratory disease Triad of: Asthma Bronchospasm from aspirin Nasal polyposis
321
Icterus High direct bilirubin Positive urine bilirubin
Dubin Johnson syndrome Defect in hepatocyte bilirubin excretion
322
P- ANCA
Microscopic polyangiitis Eosinophilic granulomatosis with polyangiitis Ulcerative colitis Primary sclerosing cholangitis
323
Elevated Alkaline phosphatase means
Liver disease
324
Why are patient that had Roux-en Y gastric bypass more like to develop gall stones
Rapid weight loss Which promotes gallstone formation increased bile concentrations of mucin and calcium Prophylactic ursodeoxycholic acid administed 6 month postoperative to reduce gallstone development
325
Achy pain in lower back, hips and knees Elevated Creatinine Low Calcium High Phosphorous ``` A. Autoimmune parathyroid destruction B. Granulomatous infiltration of parathyroid C. Parathyroid gland atrophy D. Parathyroid gland hyperplasia E. Single parathyroid adenoma ```
D. Parathyroid glandular hyperplasia Hypocalcemia and hyperphosphatemia in setting of chronic kidney disease= secondary hyperparathyroidism In CKD decreased production of 1,25 dihydroxyvitamin D —> decreased absorption of calcium GFR decreases Kidneys can not adequately excrete phosphate —> hyperphosphatemia Hypocalcemia and hyperphosphatemia —> release of PTH to maintain levels results in parathyroid hyperplasia
326
Causes of hepatic encephalopathy
``` Drugs (sedatives, narcotics) Hypovolemia (diarrhea) Electrolyte changes (hypokalemia) Increased nitrogen load (GI bleeding) Infection (pneumonia UTI SBP) ```
327
Develops watery diarrhea Has low sodium why? ``` A. High plasma osm B. Inappropriate ADH secretion C. Intravascular volume depletion D. Left ventricular dysfunction E. Renal tubular necrosis ```
C. Intravascular volume depletion Hypovolemic due to diarrhea —> antidiuretic hormone (ADH) secretion —> RAAS Extrarenal fluid losses are associated with decreased urine output and urine sodium < 20
328
Corkscrew small bowel
Midgut volvulus
329
Glomerulopathy with Ear involvement
Granulomatosis with polyangiitis
330
23 y.o with severe epigastric pain, nausea, vomiting after a party Similar episode 1 year ago Yellowish streaks on palms Blood sample= milky and opalescent Medication to prevent ``` A. Lovastatin B. Fenofibrate C. Cholestyramine D. Ezetimibe E. Psyllium ```
B. Fenofibrate Severe hypertriglyceridemia Secondary to familial dysbetalipoproteinemia [Cholestyramine is a bile acid resin that helps reduce LDL levels] [Ezetimibe prevents absorption of dietary cholesterol from gut, reduced LDL]
331
Arthritis Lymphadenopathy Cardiac issues Neurologic symptoms - Name - Stain - Biopsy - Late stage - Who
Whipple disease +PAS (Periodic acid- Schiff) stain - Stains glycogen Foamy macrophages Mesenteric nodes Diarrhea later on Older men
332
Rifaximin
Decreases ammoniagenic bacteria Hepatic encephalopathy Small intestinal bacterial overgrowth (SIBO)
333
Autoimmune hepatitis Features (6)
Constantly elevated LFT ANA Anti-Smooth P-ANCA Large gamma gap Total protein- Albumin = >4 Increased IgG

Level 2 Boards (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions