The type of access associated with lowest risk for pts undergoing HD is ____
What is the treatment for essential tremor of the voice or head?
What hyperkeratotic rash of the palms and soles is indistinguishable from pustular psoriasis and may be associated with reactive arthritis?
What is the number 1 cause of death in CKD? 2nd MC?
Cardiovascular dz; infection
If a CKD patient with worsening GFR trend gets endocarditis and requires tx for 6 weeks with IV Abx what is the best access to obtain?
An IJ (?maybe even a port) or tunneled line in the IJ because you need to preserve the peripheral veins for future AV fistula tx since AV fistula is the safest form of access for pt with CKD
What is the other term for aristocholic acid nephropathy?
Balkan Endemic Nephropathy, associated with an increased risk of transitional cell CA
What UC medication can lead to acute interstitial nephritis months/years or years after initial exposure?
MRI is good for diagnosing what diseases of the chest?
pleural, hilar, and mediastinal disease (and the whole field of cardiac MRI) but not good for bronchiectasis (HRCT is best there) or parenchymal dz
What is indicated in medically refractory debilitating essential tremor?
If refractory and debilitating, can do a Deep Brain Stimulator specifically to the ventral intermediate nucleus of the thalamus
What kind of damage occurs in Balkan Endemic Nephropathy? What is the mechanism? What complications may arise?
It is a tubulointerstitial nephritis; the mechanism is due to exposure to aristocholic acid and it can lead to increased risk of transitional cell CA
What is the appropriate mgmt for patients who cannot safely undergo anticoagulation therapy for VTE i.e. those w/ bleeding?
IVC filter (assuming lower body VTE)
When should you suspect that someone has bronchiectasis?
If they have a chronic cough with purulent sputum and recurrent pneumonias
What are the most common findings on UA for interstitial nephritis?
Sterile Pyuria and leukocyte casts
Sterile pyuria and leukocyte casts are the most common finding for _____
What is a Primary Duct Stone?
Primary duct stones develop in the biliary ducts of people with strictures such as in PSC or an infection (i.e. they are bile stones that did not form in the gallbladder)
What are the 3 MC causes of acute cholangitis? What is the treatment?
E. coli, K. pneumoniae, and P. aeruginosa; prompt IV Abx (Cefepime, zosyn, meropenem) w/ urgent endoscopic decompression; if unable to do then need percutaneous cholangiography with perc chole tube
What are the symptoms of reactive arthritis? What testing needs to be done?
Oligoarticular arthritis with upper and lower extremity dactylitis, and possibly keratoderma blenorrhagicum; test all for Chlamydia trachomatis using DNA amplification test
Adjunctive dexamethasone improves outcomes in pt with meningitis due to _____. What is the dose?
S. pneumoniae; 0.15 mg/kg q6h x4d (so if 100 kg then 15 mg q6h x4d); START 15 MINUTES BEFORE ANTIBIOTICS
What is ranolazine and in whom is it used?
Inhibitor of late inward sodium channel reserved for symptomatic patients with stable angina who are symptmatic on BB+Nitrates+CCB or intolerant
What is the first line therapy for Essential Tremor? What if medically refractory? What if involved with face or head?
Propanolol or Primidone; Deep Brain Stimulator to Ventral Intermediate Nucleus of thalamus; Botox injections
What infectious agent is often associated with Anal SCC?
What is the NINDS trial?
This is the trial that showed that r-TPA within 3 hours of stroke led to better neurologic outcomes in the next 3 months vs. those who did not receive r-TPA; of note, this trial included pt with A-fib and ALL ischemic stroke types and showed no significant difference between all stroke types (exept the huge ones where you cant use it anyway)
In whom are calcium channel blockers contraindicated?
Pt w/ LV dysfunction or symptomatic AV block
What is the treatment for Vibrio vulnificus infection?
Doxycycline + Ceftazidine and surgical debridement (Vibrio is a gram negative bacillus)
Mitomycin C and 5-FU with pelvic radiation is the standard of care for _____
Stage I, II, and III anal CA; if these fail then you do surgical resection (but will lose sphincter mechanism)
What kind of findings on pulmonary function tests might you see for bronchiectasis?
Mild air flow obstruction which can overlap with diseases such as COPD so if you suspect, need to order a HRCT
What are two ways to contract Vibrio vulnificus?
Eating raw oysters or by swimming in contaminated water (sea water or brackish water); immunocompromised hosts are at greatest risk
Explain the difference in the amount of proteinuria seen when something causes interstitial nephritis vs. glomerulonephritis
If it is mainly affecting the interstitium it can lead to some proteinuria but if it is an inflammation and damage of the glomerulus then you would expect heavy proteinuria because the glomerulus reabsorbs the protein
What is a Fanconi syndrome in the kidneys (can have multiple etiologies but just define the syndrome)
occurs w/ damage to the PCT and leads to incomplete absorption and therefore kidney wasting of glucose, phosphate, uric acid, bicarb, and amino acids
What is unique about mesalamine-induced acute intersitial nephritis?
It is a well-recognized phenomenon that can be months or years after the exposure and associated with subnephrotic range proteinuria
Antibiotic tx for meningitis varies with organism and clinical response. How long for N. meningitidis and H. flu? S. pneumo? Staph, GNR and Listeria?
N. meningitidis and H. flu (7 days); S. pneumo (14 days); Staph, GNR, or Listeria (21 days)
In whom is topamax contraindicated?
hx of nephrolithiasis or glaucoma
What is the gold standard to diagnose bronchiectasis?
High Resolution CT scan
What is the most common adverse effect of ganciclovir?
Thrombocytopenia; it can cause lots of cytopenias including neutropenia but thrombocytopenia is MC
Advanced tubulointersitial disease often has poor renal handling of what?
Glucose, amino acids, uric acid, and phosphate (Termed Fanconi syndrome)
What are the characteristics of kidney disease associated with systemic lupus erythematosus?
It is highly variable but most often will have significant hematuria, proteinuria, and cellular casts
Pseudothrombocytopenia will resolve if blood is drawn in what tube?
Heparinized tube or citrated tube; as clumping occurs due to EDTA agglutinins
Which patients are at the highest risk for Vibrio vulnificus?
Immunocompromised pt such as those with liver dz (some raw bars will say that if you have liver dz don't eat here)
How does Rapidly Progressive Glomerulonephritis (RPGN) often present?
Often associated with hematuria, erythrocyte casts, and variable amounts of proteinuria often associated with HTN
What is a biliary stone called that forms in the biliary ducts but not in the gallbaldder (i.e. proximal to a stricture in PSC)?
Primary Duct Stone
What are some neurologic sequelae of meningitis?
Seizures, Hearing loss, Cranial Nerve deficits, and paralysis
What is Enhanced Physiologic Tremor and how is it different from Essential tremor?
it looks similar but is enhanced by triggers such as caffiene, thyroid dz, toxins, and anxiety
What are the two approved agents first-line for Essential Tremor?
Propanolol and Primidone (often assoc. w/ action tremor, FMHx of tremor, and ethanol responsiveness)
What is the point of thrombolysis in ischemic stroke?
Restore blood flow to the ischemic penumbra where cerebral tissue has sustained injury but not yet infarcted
What are the first, second, and third line MEDICAL options for stable angina?
First line is Beta Blockers and Nitrates; CCBs are second line if continued sx or intolerant to BB and nitrate (or if Prinzmetals); lastly is Ranolazine if symptomatic on BB, nitrate, and CCB; last step = cath
What is erythrasma?
A scaly reddish rash that forms in intertriginous regions and caused by Corynebacterium minitussimum (coral red on Wood Lamp)
What is the usual histology of anal CA? When is surgery indicated?
Squamous Cell and typically HPV assoc; usually 5-FU and Mitomycin C + pelvic RT is indicated for Stages I-III but if these fail then surgical resection but will lose continence