IM Flashcards
(217 cards)
1
Q
Creat of normal kidney, CRF, and ESRD
A
- 8
- 0
- 0 (need dialysis)
2
Q
Urinalysis of prerenal AKI
A
Una<10
FEna<1% or FEurea <35%
BUN:Cr >20
3
Q
Signs of AKI
A
Elevated creat or decreased urine output
4
Q
Causes of prerenal AKI
A
Anything in front of the heart: CHF, MI, diarrhea, dehydration, aggressive diuresis, cirrhosis, gastritis, FMD/RAS
5
Q
Causes post-renal AKI
A
Anything behind the kidney: cancer/stones in the ureter, bladder, urethra
BPH, foley, neurogenic bladder
6
Q
Dx post-renal AKI
A
CT: stones, US: hydronephrosis
7
Q
Most common causes of post-renal AKI
A
BPH, neurogenic bladder, kinked catheter
8
Q
Most common place of bladder obstruction
A
Ureter
9
Q
Muddy casts indicate
A
ATN
10
Q
WBC casts or eosinophils indicate
A
AIN
11
Q
RBC casts indicate
A
GN
12
Q
Next step if RCB casts are seen in UA
A
R/O nephrotic syndrome:
- proteinuria >3.5g/day
- increased cholesterol
- edema
13
Q
Phases of ATN
A
Prodrome: elevated creat, normal urine output
Oliguric: elevated creat, urine output drops
Polyuric: increased urine output
14
Q
Avoid contrast ATN in existing renal damage
A
Tons of IVF, n-acetyl-cysteine, stop ACEI/ARBs
15
Q
Indications for dialysis
A
Acidosis Electrolytes Ingestion (SLIME) Overload Uremia
16
Q
Definition of CKD
A
> 3 decreased GFR (creat ~2)
17
Q
GFR in renal failure/ESRD
A
<15
18
Q
DM drug contraindicated in CKD?
A
Meformin
19
Q
Secondary complications of CKD
A
Anemia (decreased EPO)
HyperPTH (increased phosphate and decreased Ca)
Volume overload
Acidosis
20
Q
How to correct moderate vs severe hyper and hypo natreamia?
A
Moderate (both): IV NS
Severe hyper: IV D5W/ hypo: IV hypertonic (3%)
21
Q
Max Na correction per hour and day?
A
0.25 mmol/hr
4-6/day
22
Q
Equation to measure serum osmoles
A
Serum osmoses = (2*Na) + (glucose/18) + (bun/2.8)
23
Q
Causes of hypertonic hyponatremia
A
Elevated glucose, BUN or sugar alcohols
24
Q
How to correct Na for elevated glucose
A
For every 100mg glucose above 100, add 1.6 to Na
25
Causes of euvolemic hyponatremia
RTA
Addisons
Thyroid
SIADH
26
Treatment for hypercalcemia
IVF (can add furoside after fluids)
| Calcitonin if severe, bisphosphonates for chronic
27
Sx of hypercalcemia
Boans, stones, groans, moans
28
When would you see elevated PTH-rp
Squamous cell of lung
29
Sx of hypocalcemia
Perioral tingling, Trousseau and Chvostek
30
Treatment for hypocalcemia
IV Ca if severe
31
Next step of Asx hypocalcemia
Check albumin
32
Order of EKG changes with elevated K?
Peaked T wave, prolonged PR, wide QRS, sine wave
33
Normal K
3. 5-5.5
| 4. 0-5.5 in hospital/cardiac patients
34
Sx of hyperkalemia
Areflexia, flaccid paralysis, paresthesias (decreased motor and sensation) and EKG changes
35
Treat hyperkalemia
1. IV Ca gluconate
2. Insulin/glucose or bicarb
3. Kayexalate (aka sodium polystyrene sulfonate)
36
Radiolucent kidney stones
Uric acid and cysteine
37
Radioopaque kidney stones
Calcium and struvite
38
Diagnostic test for kidney stones
U/A first then non-con CT
39
Treatment of kidney stones
<5mm: IVF and pain
<7mm: CCB (amlodipine) or terazosin
<1.5cm: lithotripsy or ureteroscopy
>1.5cm: exlap or perc anterograde nephrolithotomy
40
Classic triad of RCC
flank pain, hematuria, flank mas
41
Factors that increase risk of RCC
Smoking, ESRD, VHL
42
How does RCC spread?
Hematogenously
43
Common complications of RCC
Renal vein thrombosis, anemia/polycythemia
44
Normal serum pH?
7.4
45
Normal ABG CO2?
40
46
Causes of respiratory acidosis
Hypoventilation: Opiates, COPD/asthma/OSA, decreased muscle strength (GB)
47
Next step after determining metabolic acidosis?
Anion gap
48
Normal value and equation for serum anion gap?
12
Na-Cl-Bicarb
>12 = anion gap acidosis
49
Causes of +anion gap acidosis?
```
Methanol
Uremia
DKA
Propylene glycol
Iron and INH
Lactic acidosis
Ethylene glycol
Salicylates
```
50
Next step of -anion gap acidosis?
Urine anion gap; Na+K-Cl
51
What causes +urine anion gap acidosis?
RTA
52
What causes -urine anion gap acidosis?
Diarrhea
53
Causes of respiratory alkalosis?
Hyperventiliation: Pain, anxiety, hypoxemia
54
Next step after determining metabolic alkalosis and its normal value?
Urine Cl; 10
55
Metabolic alkalosis with urine Cl <10
Volume responsive aka contraction alkalosis
| Diuretics, dehydration, emesis, NG
56
Metabolic alkalosis with urine Cl >10
Not volume responsive; look for HTN
+ Hyperaldosterone (renal arter stenosis or Conn's)
- Genetic (Barter, Gitelman)
57
What is the Diamond Classification and what are the components?
IDs risk of CAD based on sx
Substernal chest pain, worse with exertion, better with NTG
Typical is 3/3, atypical is 2/3
58
When should nitrates be avoided in treatment of angina?
Right sided infarct (II, III, aVF)
59
Why do we give B-blockers for angina?
Reduce myocardial work, prevent ventricular arrhythmias
60
When do you do a CABG?
Left main stem or 3 vessel disease
61
Causes of systolic heart failure?
"cant push blood forward"
| Leaky valves, dilated cardiomyopathy, dead muscle, "floppy" muscle (EtOH, HTN, drugs)
62
Causes of diastolic heart failure?
"cant relax/fill"
| Hypertrophy or infiltration (tamponade, effusion)
63
Most common cause of heart failure?
Hypertension: increases systemic vascular resistance, hypertrophies and then fails
64
Classic triad of CHF
Exertional dyspnea, orthopnea, paroxysmal nocturnal dyspnea
65
Sx of left sided heart failure
Orthopnea, crackles, rales, exertional dyspnea, S3 (overly compliant), PND
66
Sx of right sided heart failure
Hepatosplenomegaly, JVD, peripheral edema, exertional dyspnea, increased JVP
67
What is BNP used for?
To determine if the patient is volume overloaded or not
68
How do you diagnose CHF?
BNP
2D echo: systolic failure (EF<55%) or diastolic (nml EF)
Nucelar study
69
Treating CHF class I-III
Reduce preload and afterload
Reduce preload: reduce fluid by restricting salt (<2g/day) and PO fluids (<2L); add furosemide/nitrates at class II
Reduce afterload: ACE-I or ARBs; add spironolactone or hydralazine at class III
Beta-blocker
70
Treating CHF class IV
Same drugs as I-III
| Add ionotropes: dobutamine and prepare for transplant
71
When is an AICD considered in CHF?
EF <35%
72
When do you need to work up a murmur?
Diastolic, symptomatic or > grade 3
73
Murmur of mitral stenosis?
Diastolic opening snap followed by decrescendo murmur
74
What indicates the severity of mitral stenosis?
Earlier snap = worse stenosis
75
How do you treat mitral stenosis?
Preload reduction
| Balloon valvotomy/replacement
76
Sequelae of mitral stenosis
CHF sx, Afib (atrial stretch)
77
What causes mitral stenosis?
Rheumatic fever
78
What causes aortic stenosis?
Calcification
79
Murmur of aortic stenosis
Crescendo-decrescendo at the aorta
80
Sx of aortic stenosis
Angina, especially with exertion
| Syncope
81
Sequela of aortic stenosis
CHF (bad prognosis, 1-3 years)
82
Treatment of aortic stenosis
```
Decrease preload
Replace valve (also will require CABG dt loss of ostia)
```
83
Murmur of mitral regurg
Holosystolic radiating to axilla
| High-pitched, blowing
84
Sequelae of mitral regurg
Afib (atrial stretch), Pulmonary congestions/CHF, cardiogenic shock (decreased forward flow)
85
Causes of acute mitral regurg
Ruptured papillary muscle or chordae, endocarditis, trauma
86
Causes of chronic mitral regurg
2/2 ischemia or MVP
87
Sx of mitral regurg
Exertional dyspnea, fatigue, CHF
88
Murmur of aortic insufficiency
Decrescendo murmur heard best aortic valve
89
Cause of aortic insufficiency
Floppy valve 2/2 ischemia or infection
90
Presentation of aortic insufficiency
Dilated heart failure (chronic) cardiogenic shock (acute)
91
Murmur of MVP
Mid-systolic click followed by a late systolic rumble
92
Cause of MVP
Usually congenital
| Also seen in pregnant women
93
Treat MVP
Expand intravascular volume
94
Murmurs that improve with leg raise (and worsen with valsalva)
HCOM and MVP
| *all the rest are the opposite
95
Result of leg raise vs valsalva
Leg raise: increases venous return
| Valsalva: decreases venous return
96
Types of cardiomyopathy
Dilated, Hypertrophic, Restrictive
97
Mechanism in dilated cardiomyopathy
Decreased contractility -> systolic heart failure
98
Cause of dilated cardiomyopathy
Ischemia, valve disease, infections, metabolic, EtOH, etc
99
Cause hypertrophic cardiomyopathy
AD mutation in sarcomeres
| Asymmetric hypertrophy of septal wall
100
What causes improvement in murmur/sx of HCM?
Increased preload (increased volume moves the hypertrophied tissue out of the way)
101
Population of hypertrophic cardiomyopathy
Sudden death of young athelete
102
Treatment of HCM?
Hydration and B-blockers (or CCB) (increase in ventricular filling)
103
Mechanism of restrictive cardiomyopathy
Heart cant relax -> diastolic failure
104
Causes of restrictive cardiomyopathy
Sarcoid, amyloid, hemochromatosis, Cancer, fibrosis
105
Treatment of restrictive cardiomyopathy
Diuresis and HR control
| Eventual transplant
106
Cause of concentric cardiomyopathy and sequelae
HTN
| Diastolic CHF
107
Sx of pericarditis
Pleuritic and positional CP (better with leaning forward)
| Friction rub
108
EKG of pericarditis
Diffuse ST elevation and PR segment depression (pathognomonic)
109
Treatment of pericarditis
NSAIDS and colchicine
110
Sx of chronic pericardial effusion
Looks like CHF: exertional dyspnea, orthopnea, PND
111
Sx of acute pericardial effusion/tamponade
Becks triad: JVD, hypotension, distant heart sounds
| Pulsus paradoxus
112
Treatment of tamponade
Pericardiocentesis
113
Pericardial knock indicates what?
Constrictive pericarditis (fibrosis)
114
Neuro cause of syncope
Vertebrobasilar insufficiency
115
What is second line to statins?
Fibrates
116
What makes an arrhythmia unstable?
CP, SOB, AMS, systolic bp <90
117
First line treatment for unstable arrhythmias
electricity
118
Fast + unstable rhythm vs slow + unstable rhythm treatment
Shock
| Pace
119
Treatment for fast + narrow + stable arrhythmia
Adenosine
120
Treatment for fast + wide + stable arrhythmia
Amiodarone
121
Treatment for acute afib
Rate control first (BB or CCB)
122
When do you shock in cardiac arrest?
Only vtach or vfib
123
Age related sick syndrome
Dry eyes and mouth
Higher risk in women, w/ DM or thyroid disorders
Exocrine atrophy
124
Labs in Pagets
Ca, Serum phosphorus normal
| Alkaline phosphatase and urine hydroxyproline high
125
Treatment for Pagets
Bisphosphonates
126
Factors associated with increased prevalance
PPV (up) and NPV (down) in a higher prevalence population
127
Pain with walking that is relieved by bending forward
Osteoarthritis/spinal stenosis
128
Main difference between SJS and TEN
<10% BSA: SJS (also has basal cell degeneration on bx)
| >30% BSA: TEN (full thickness epidermal necrosis)
129
Most common type of kidney stone
calcium oxalate
130
Cause of pronator drift
UMN/pyramidal or corticospinal tract dysfunction
131
Sx of basal ganglia dysfunction
Extrapyramidal sx: resting tremor, rigidity, bradykinesia, choreiform movements
132
Sx of cerebellar dysfunction
Ataxia, intention tremor, impaired rapid alternating movements
133
Sx of Huntington's
Chorea, delayed saccades, depression, decreased executive function, motor impersistance
134
Sx of SAH (besides HA)
Meningeal irritation (n/v, photophobia)
135
Pure motor hemiparesis
Lacunar infarct in the internal capsule
| Will see microatheroma and lipohyalinosis of small vessels
136
Elevated homocysteine levels is related to
Decreases folate, B6 and B12
137
EKG of pericarditis
Diffuse ST elevations with depression in aVR
138
Common abnormalities associated with MG?
Thymic: thymoma or thymic hyperplasia
139
Cause of achalasia and sx?
Degeneration of neurons in the myenteric plexus
| Gradual dysphagia to solids and liquids
140
Mechanism of PAH in SS?
Hyperplasia of the intimal smooth muscle layer
141
Cross sectional study set up
Compare two groups; see if they have risk factors and then see if they have the dz
142
Histone ab
Drug induced lupus
143
ds-DNA ab
Lupus + renal
144
Smooth muscle ab
autoimmune hep
145
mitochondrial ab
PBC
146
Centromere ab
CREST
147
RO/LA ab
Sjorgrens
148
CCP or RF ab
Rheumatoid arthritis
149
Jo ab
Polymositis
150
Topoisomerase ab
Systemic scleroderma
151
Classic RA presentation
Symmetric arthritis of 3+ joints that spares the DIPs
152
CREST
Collagen replaces smooth muscle; skin tightness in hands/face
Spares heart and kidneys; effects skin and GI
anti-centromere
153
Systemic sclerosis
Diffuse disease with cardiac and renal involvement
| Anti-scl (topoisomerase 1)
154
Treatment for scleroderma
Treat sx: CCB, penicillamine, steroids, ACE-I
155
Difficulty rising from chair but intact grip strength
Polymyositis/dermatomyositis/inclusion body myositis
156
Gottron's papules
Scaly area over major joints -> myositis
| Will be seen with photosensitivity, heliotrope rash and proximal muscles weakness
157
Presentation of ankylosing spondylitis
Back pain, morning stiffness, improved with exercise/use; can have achilles tendon inflammation
Associated with IBD but independent of course
158
Presentation of reactive arthritis
Asymmetric b/l arthritis of low back and hands
159
Presentation of psoriatic
Symmetric PIP and DIP, pitting of nails
160
Enteropathic arthritis
Symmetric, b/l, non-deforming, peripheral and migratory
| Hx of diarrhea
161
Increase risk for which bugs with immunosuppression following transplant?
CMV and Pneumocystis
162
Dx for proximal muscle weakness
myositis vs Eaton Lambert
163
What is the ice pack test for?
MG
164
XR findings of OA
Joint space narrowing, osteophytes and subchondrol sclerosis/cysts
165
Cancers associated with Lynch syndrome
Colorectal, endometrial, ovarian
166
Feltys syndrome
RA + neutropenia + splenomegaly
167
Part of the spine affected in RA?
Cervical only
168
Complications of PBC
Nutrient deficiencies, hepatocellular carcinoma, metabolic bone disease
169
CT of diffuse axonal injury
Minute punctate hemorrhages with blurring go gray-white interface
Often seen in sudden deceleration
170
Hemoptysis + hematuria
Goodpasture
171
Asthma + hematuria
Churg Strauss
172
Hemineglect indicates a lesion where?
Non-dominant (usually right) parietal lobe
173
Presentation of dacrocystitis
Infection of lacrimal sac
| Sudden onset pain and redness over medial canthal region; can have purulent discharge
174
Presentation of episcleritis
Inflammation of the episcleral tissue between the conjunctiva and sclera
175
Hordeolum
Abscess over upper or lower eyelid
176
First line for symptomatic PVCs
BB or CCB (increase dose if already on)
177
Pemphigus vulgaris
Autoimmune against desmoglein; ab on epithelial cells throughout lesion
Between epithelial cells; blister is thin (+ Nikolsky)
Life threatening, involves mucosa, 30-50s
178
Bullous pemphigoid
Autoimmune against hemidesmosomes (basement membrane); intact epithelium detached from BM; ab at dermal-epidermal junction
Rigid blister; not life threatening/no mucosal involvement/70-80s
179
Dermatitis herpetiformis
IgA against translutaminase
Ab-antigen complex deposition
Multiple, small, vesicular eruptions; pruritic
Seen on butt, legs, extensor surfaces
180
Porphyria Cutanea Tarda
Bullae on sun-exposed areas
| Dx with coral red urine under Wood's lamp
181
Seborrheic dermatitis
Fungal infection in areas of hair
182
Pityriasis Rosea
Herald patch: flat, oval, salmon-colored scaling lesion -> multiple similar appearing lesions with trailing scale
Spares palms and soles if self-limiting
Can be initial presentation of syphillis; will have hands and feet
183
Lichen planus
Intensely pruritic pink or purple flat topped papule with a reticulated network of white lines
Can be caused by lichenoid drug eruption
184
Atopic dermatitis
- Dry, red, itchy rash
| - Associated with 3As: asthma, allergies, atopy
185
What type of HS is contact dermatitis?
IV
186
Statsis dermatitis
Chronic LE edema
Edema, erythema, brown discoloration with scaling
Might look like cellulitis but will be b/l
187
Urticaria
Type I HS
Crosslinking of IgE on mast cells -> histamine
-Annular, blanching red papule
188
Drug reaction
Pink, morbilliform rash 7-14 days after exposure
| Widespread, symmetric, pruritic
189
Erythema-Multiforme
Cutaenous drug reaction
Target shaped lesion on palms and soles
Self-limited
190
Differentiate SSSS and TEN
SSSS doesnt have mucosal involvement
191
Nevi
Bening hyperplasia of melanocytes
| Wise excesional bx
192
Seborrheic keratosis
Large, brown, greasy, crusted mole; stuck on
193
Actinic keratosis
Premalignant -> SCC
Erythematous with sandpaper-like yellow to brown scale
Cryosurgery; 5-FU for diffuse lesions
194
SCC
Invasive malignancy of keratinocytes that can met
| Fleshy, erythematous, crusted or ulcerated
195
Keratoacanthoma
Looks like SCCC but will regress spontaneously
196
Erysipelas
S. pyognes
| Dark red, well demarcated, indurated lesions that outline the lymphatics "climb up the extremity"
197
Medial knee pain/pain at top of tibia
pes anserinus
| Treatment: strengthen quads
198
Anterior knee pain
patellofemoral syndrome
199
Muscle weakness following an asthma exacerbation
Possible hypokalemia; SE of B2 agonist
200
Thrombotic thrombocytopenia purpura
Thrombocytopenia, microangiopathic hemolytic anemia, renal insufficiency, neuro changes, fever
Treat with plasma exchange
201
Most common cause of constrictive pericarditis in developing countries
TB
202
Required to dx malignant HTN
papilledema/retinal hemorrhages
203
Mixed connective tissue disease
Scleroderma, RA, myositis, SLE mix
| Anti-U1
204
Widened pulse pressure
aortic regurg
205
Sx of acute angle-closure glaucoma
Severe eye pain, halos, injection, poorly responsive to light, tearing, headache
Treat: acetazolamide, BB, steroid
206
Gonococcal vs non-gonococcal septic arthritis
Gonococcal tends to be multi joint
207
Metabolic alkalosis + low urine Cl
Vomiting or previous diuretic use
208
Serum changes in diarrhea vs vomiting
Vomiting leads to alkalosis; diarrhea leads to acidosis
209
Nerve that gives corneal sensation
Trigeminal
210
Best measurement of response to treatment in DKA?
Serum anion gap (monitor resolution of ketonemia)
211
Hyponatremia, hypotension and hyperkalemia
Adrenal insufficiency
212
Treatment for prostatitis
Acute: TMP/SMX or quinolone
Chronic: quinolone
213
Rhabdo
RBC in UA -> ATN/Rhabdo
214
Most common cause of nosocomial blood stream infections
Central venous catheter (regardless of what the culture shows)
215
Treat acute pericarditis
NSAIDs and colchicine
216
Type I cryoglobulinemia
Assoc w/lymphoproliferative or hematologic diseases
| Asymptomatic, hyerviscosity, livedo reticularis
217
Type II/III cyroglobulinemia
Assoc w/ HCV, HIV, SLE
Arthralgias, glomerulonephritis, HTN, palpable purpura
Low C4
