OME/Books Flashcards
(115 cards)
1
Q
lab values AIN
A
WBC CASTS (not just pyelo) eosinophiluria
2
Q
what drugs cause AIN
A
tmp/sulfa
penicillin
cephalosporin
3
Q
two nephrotoxic agents that can cause ATN
A
IV contrast
myoglobin (rhabdo)
rx ATN with aggressive fluids
4
Q
hints of pre renal etiolgy (4)
A
- BUN:Cr >20
- FeNa <1%
-Urine Na - <10
FeUrea <35%
5
Q
steps to evaluate AKI
A
- urine lytes (r/o pre renal)
- U/S to r/o obstruction
- use H/P and U/A to evaluate intrinsic
- absolute last resort is kidney biopsy
6
Q
acute indications for hemodialysis
A
A E I O U
acidosis electrolytes (K, Ca) intoxication overload uremia
7
Q
how to manage PPROM >34 weeks
A
abx
corticosteroids
delivery
8
Q
causes of hypoventilation that can cause respiratory acidosis
A
opiate overdose (i.e. morhpine)
asthma/COPD severe
musculoskeletal weakness
OSA
9
Q
What to check of you determine you have metabolic alkalosis
A
urine chloride! and/or give fluids to assess volume responsiveness
urine chloride low <10 in contraction alkalosis (suggests pt is volume down, RAAS is working to reabsorb Na and Cl (which follows Na)) (diuresis, dehydration, emesis/NG suction)
this is called VOLUME RESPONSIVE
10
Q
what if you have met alk and Ucl is >10
A
this is not volume responsive alkalosis
check for HTN to r/o primary aldosteronism and Barter’s Gittlemans
11
Q
what cause of anion gap metabolic acidosis can present with urine crystals
A
ethylene glycol (antifreeze)
12
Q
anion gap formula
nml anion gap
A
Na - Cl - HCo3
nml < 12
anything greater than 12 = anion gap
13
Q
Next step to evaluate a non anion gap metabolic acidosis
A
calculate urine anion gap (Na + K) - Cl
positive - RTA
negative - diarrhea
14
Q
rx for drug induced parkinsonism
A
dopaminergic NMDA blocker, AMANTADINE
15
Q
woman in first trimester who’s been having lots of vomiting presents with confusion, ataxia, nystagmus, and lots of low electrolytes
A
thiamine deficiency
Wernicke’s encephalopathy 2/2 hyperemesis gravidarum
16
Q
if you’ve ruled out ACS and patient is very suggestive of aortic dissection, what to do next
A
check Cr to see if they can handle contrast angiography
if not to TEE…but CT with contrast is quicker if they can tolerate
17
Q
how to determine if respiratory acidosis/alkalosis is acute or chronic?
A
every DIME change (10) in CO2 = .08 change in pH (acute)= .04 change in pH chronic)
18
Q
ddx hypotonic euvolemic hyponatremia
A
"RATS" RTA (get urine lytes) addisons (get cortisol) thyroid (get TSH) SIADH
19
Q
rx SIADH
A
volume restriction
gentle diuresis
20
Q
surrogate for aldosterone
A
urine Na
21
Q
surrogate for ADH
A
urine osmolarity
22
Q
what causes cerebellar pontine demyelination
A
correcting Na (Hyponatremia) too quickly
only correct sodium no more than 0.25/hr, 4-6 points/day
23
Q
what 3 systems does PTH effect?
A
bone
kidney -> gut (indirectly when kidney turns on 1,25 vit D to stimulate Ca absorption from gut)
24
Q
how does PTH indirectly increase Ca absorption in gut
A
stimulates kidney to convert 25 to 1 25 vit D to stimulate increased Ca absorption in gut
25
how does PTH effect on bone and gut differ from kidney
PTH increases Ca and Phos in bone and gut, but increases Ca and DECREASES phos in kidney
26
How can granulomatous dx fuck up the Ca PTH system?
granulomas/TB/sarcoid secrete 1 25 vit D which will increase Ca and increase phos in gut
27
albumin correction for Ca
for every 1 decrease in albumin, add 0.8 to Ca
so in hypoalbuminemia, Ca may correct to normal range
28
inflate BP cuff and carpopedal spasm
trousseau's sign (hypocalcemia)
29
tap facial nerve, no dulling of reflex
chvostek's sign (hypocalcemia)
also tetancy, perioral tingling
30
how to correct hypocalcemia (symptomatic)
calcium IVVVVVVV!!!!
31
hypercalcemia symptoms
"stones, moans, groans, bones"
| kidney stones, AMS, abdominal pain, bone pain
32
rx hypercalcemia
IV FLUIDS IV FLUIDS IV FLUIDS IV FLUIDS IV FLUIDS, early bisphosphonate...then some meds (calcitnin longterm)
33
MCC cause asymptomatic hypercalcemia
hyperparathyroidism
34
three categoreis of hyperparathyroidism
primary - autonomous adenoma
secondary - early CKD,
tertiary - autonomous multiple adenomas
35
3 glucose tests that you can use to dx diabetes
1. 1 random blood glucose>200
2. two measurements fasting blood glucose>equal to 125 (<100 nml, 100-125 preDM)
3. 1 2hr OGTT>equal200
36
PREFERRED method for DM (90 day average of blood sugar)
HA1c
>6.5 = DM
<5.7 = nml
in between 5.7-6.5 = preDM
37
t1dm antibodies (2)
GAD
| IA2
38
rx preDM
lifestyle
| metformin!!!!!
39
order of rx for DM
lifestyle metformin (unless CKD/CHF/liver dz bc it can cause lactic acidosis), then 2nd agent, then insulin (add rx if re check A1c is not at goal)
40
when to immediately start insulin
A1c > 9
41
DM rx with side effect of diarrhea, lactic acidosis
biguanides! (metformin)
42
DM rx with side effect hypoglycemia
sulfonylurea (glyburide)
43
MOA sulfonylurea
increase insulin release from pancreatic BETA cells
44
MOA metformin
increase insensitivity
45
MOA TZD (glitazones)
activate PPAR (peroxisome proliferator activated receptrs) -> increase insulin sensitivity
46
DM rx with side effect CHF, water retention, edema
TZDs/glitazones
47
side effect GLP-1
weight loss
48
MOA GLP-1 (-utides)
incretin effect, increase insulin secretion via glucose, increase glucose sensitivity
49
MOA a-glucocidase inhibitor (acarbose)
block intestinal absorption of glucose
50
DM rx side effect rx foul smelling diarrhea/flatuelence
acarbose
51
DM rx side effect euglycemic DKA
SLGT-2 inhibitors (flozin)
52
MOA gliflozin (SLGT2)
inhibit Na Glucose transport protein
53
Goal A1c for DM
<7%
54
rx DM proteinuria
ACEI
55
how to screen DM nephropathy and treat it
monofilament screen
| rx gabapentin
56
adverse effect acyclovir
crystalline nephropathy
GIVE WITH LOTS OF FLUIDS
57
lab post strep glomeruloneph
low complement C3
RBC casts
proteinuria
58
left sided varicocele that fails to empty with recumbency
hematuria
smoking hx
watch out for RCC
| causing obstruction
59
intermittent headaches, nausea, dizziness...dx and hematologic side effect
carboxyhemoglobin
SECONDARY POLYCYTHEMIA
shifts o2 curve to the left, so kidney thinks they're hypoxic
60
rouleaux formation smear
multiple myeloma
61
diplopia, tinnitus, dilated/segmented fundoscopic findings, paresthesias, hepatosplenomegaly, anemia
M SPIKE
waldenstrom
(hyperviscosity syndrome, neuropathy, infiltrative diseas)
IGM, not IGg, IGa like multiple myeloma
62
leukomoid reaction vs CML
leukomoid-high LAP (leukocyte alk phos), metamyelocytes>myelocytes) more mature
CML - low LAP, myelocytes>metamyelocytes less mature
63
what drug can increase serum levels of digoxin?
amiodarone
64
DM patient checks glucose at lunch and is high...how to adjust insulin management?
adjust BREAKFAST dose
| (now is a product of insulin/food from previous meal)`
65
how does sepsis affect blood sugar
hypoglycemic
66
non DM, hypoglycemic low c-peptide
insulin injection exogenous
67
non dm hypoglycemic, elevated C peptide
elevated C peptide = endogenous production
screen for sulfonylurea use
68
non dm hypoglycemic, elevated C peptide, negative sulfonylurea use
screen for insulinoma!
69
3 things to watch when treating DKA
1. glucose - IV insulin (watch for hypokalemia)
2. gap - FLUIDS FLUIDS FLUIDS
3. K - replete when get low from insulin
monitor for gap and K with BNP
70
treating DKA, as glucose goes down, what fluids to start
d5w
71
T2DM, AMS, coma, no acidosis/ketones, glucose 800-1000
hyerglycimc hyperosmolar non ketotic coma
72
rx HHNKC
LOTS OF FLUIDS
| IV insulin
73
erythematous skin rash, raised sharply demarcated edges, rapid early onset, early fever
erysipelas 2/2 group a strep (lymphadenitis)
74
places where infective endo emboli can end up
skin (jane way lesions, painless)
nails (splinter hemhorrages)
septic emboli causing acute limb ischemia
75
rheumatologic manifestations of infective endo (3)
glomerulonephritis
roth spots
osler nodes
76
empiric rx for IE
vanc, gent + something
77
who needs abx prophylaxis for IE?
bad valve AND right procedure
bad valve - congenital heart, prtosthesis, hx of IE
right procedure - dental, lungs (bronch)
78
major Duke criteria
```
bactermia
endocardial involvement (on echo/new mitral regurg)
```
79
minor duke criteria
```
fever
predisposing condition
immune phenomena
positive blood cultures
positive echo
```
80
cushing syndrome vs cushing disease
cushing disease = ACTH secreting tumor (like small cell cancer)
cushing syndrome = anything leading to cortisol excess (elevated cortisol leading to supressed ACTH)
81
how to approach possible elevated cortisol
```
Low Then High
low dex
ACTH level
high dose dex
low dose dex
```
82
hypercortisol, low dose dex fails to suppress, normal ACTH
adrenal tumor
| dx CT/MRI then resect
83
hypercortisol, lose dose dex fails to suppress, low ACTH, high dose suppression does suppress
cushing disease (ACTH secreting tumor)
84
what to order along with low dose dex for initial work up
24 hour urine cortisol
| late night salivary cortisol
85
low cortisol due to ADRENAL problem
addison's disease
| low cortisol, low aldosterone
86
why are addison's patients hyperpigmented
no cortisol, so lots of ACTH made which is linked to melanin
87
orthostasis, hyperpigmentation, low Na, high K
addison's disease
88
first step in diagnosing addison's
early am cortisol
89
if you get low am cortisol then give acth stim test and get increase in cortisol?
problem with anterior pituitary
think pan hypopit
get an MRI
give cortisol
90
if you got a low am cortisol, then give acth stim test and NO increase in cortisol
problem with adrenal
CT MRI
give cortisol and FLUDROcortisol (to increase aldosterone)
91
hypertension, hypokalemia, refractory HTN despite many medications
Conn's syndrome
92
first step in evaluating for Conn's
aldosterone: renin ratio
93
aldo:renin ratio < 10, symptoms of refractory HTN, hypoK
renin is driving aldosterone since they're both increased
renovascular HTN, fibromuscular dysplasia, or atheroscleosis
94
aldo:renin ratio > 30, what to do next
salt suppression test
| salt load should decrease aldosterone normally, but it fails in Conn's
95
after salt suppression test fails to suppress, next step?
MRI for possible aldosterone secreting tumor WITH adrenal sampling before resection
96
patient with paroxysmal headaches and HTN and palpatiations
| what 2 things we can order?
24 hour urine metanephrine
or plasma free catecholamines in acute crisis
after this then get CT/MRI to find mass in abdomen and then adrenal vein sampling
97
how to rx pheochromocytoma preop
alpha blockade (to prevent HTN crisis)
then beta blockade to prevent unopposed alpha
then resect
98
how do you handle adrenal incidentaloma from other scan
r/o Conns, cushings, pheo with 24 hour urine
rx with either watch and wait (<4) or resect if functioning
99
besides autoimmune what other things can cause primary adrenal insufficiency
TB/infection
100
24 cortisol high, low dose fails to suppress, ACTH level high, what to do net
high dose suppression to find ACTH producing tumor (Cushing disease)
101
how to confirm laterality of adrenal tumor
MIBG Scan adrenals (adrenal vein sampling possible, but very invasive)
102
how does rhabdo cause acute renal failure
accumulation of myoglobin filtration causes ATN
103
what can cause HTN crisis in occult pheochromocytoma besides seeding the pheo tumor?
ANESTHETIC AGENTS
tumor palpation/positional changes
surgical procedures
104
how to treat hypernatremia 2/2 hypovolemia (mild and severe)
mild - .45% saline
| severe - IV NS to restore volume THEN .45% saline
105
nasal congestion, rhinorrhea, sneezing , drainage, no obvious trigger ERYTHEMATOUS nasal mucosa
dx and rx
non allergic rhinitis
| intransal histamine/glucocorticoids
106
nasal congestions, rhinorrhea, drainage, allergic trigger, PALE BLUISH mucosa
dx and rx
allergic rhinitis
intranasal glucocorticoids/antihistamines
107
patient with on antihistamine develops acute urinary retention
detrusor hypocontractility due to anticholinergic affects
108
when to prescribe fibrate (i.e. gemfibrozil) for hyper TGD
TGD>1000
if < than 1000
LIFE STYLE MOD
(weight loss, REDUCE ETOH, exercise) + statin
109
anticoagulation for DVT in patient with ESRD
UNFRACTIONATED heparin bridge to warfarin
LMWH (enoxaparin) or ravaroxabon c/i in ESRD
110
alcoholic with hypocalcemia
| underlying cause
hypomagnesemia (decreased release of PTH and PTH resistance)
111
hyperthyroidism, RAIU shows DECREASED uptake...what to order next
serum thyroglobulin
high - thyroiditis, iodide exposure
low - exogenous hormone
112
RA drug that cuases oral ulcers and hepatotoxicity
methotrexate
113
RA drug that cuases alopecia, bone marrow suppression (macrocytic anemia, leukpenia, thrombocytopenia)
MTX
give with folic acid
114
RA patient with splenomegaly and neutropenia
Felty syndrome
115
rx TTP
plasma xchange
