Uworld Mix 9/26 Flashcards
31 woman has some kind of nephrotic syndrome. has ascities, edema, proetinuria. RUS is unremarkable. Patient improves after diruetics and salt/protein restriction. Now, the patient has right sided abdominal pain, fever, and gross hematuria. What is the Dx on biopsy? and why?
Membranous Glomerulopathy: The later symptoms reflect a thrombus forming from the loss of antithombin III, and this is seen MOSTLY with membranous gn. this is the only reason why.
53 m has nonspecific chest pain in the left 5ICS. Hx includes smoker, PCKD, HTN. Has a solitary round lesion in the Left upper lung field, sharp round and 1cm. 3 years ago, CXR was normal. next step?
CT scan of the chest.
What is work up for a Solitary Pulmonary Nodule
1) Comparative CXR
2) If New - Chest CT
3) Benign Features - serial CT
suspicious - biopsy or PET
very suspicious of malignancy - surgical excision.
Rupture of the Free Wall vs Interventricular septum rupture?
Interventricular septum - within 3-5 days, noew holosystolic mumru, biventricular fail, shock. See more O2 in Ra to RV
Free Wall rupture - 5days to 2 weeks - Distant heart sounds, pericardial effusion - tamponade.
Patient (34F has chest pain for several months and is in CURRENT chest pain. the pain has lasted several hours each episode. ECG shows NSR, What do you do next?
No further workup. Patient is low risk due to gender and age, and has no risk factors that is mentioned.
Sequence of events for CHest pain eval
If intermediate risk
is able to exercise –> if a normal ECG - to exercise ECG. if abnormal, do the exercise imaging.
If not able to exercise - to pharmacological stress test.
20 year old male is recovering from HSV meningitis with acyclover. Now the patient has nausea and abdominal discomfort. labs noted from 2.8 cr, and 38 BUN. What is the cause of the AKI? why?
Renal TUbular obstruction. - this is due to the acyclovir
How would acyclovir cause Renal Tubular OBstruction?
Acyclover is rapidly excreted into the urine, but this has low solubiilty. thus, precipitates into the tubules. This is Crystal induced AKI
What drugs cause Crystal induced AKI
- acyclovir, methotrexate, ethylene glycol, protease inhibitors, uric acid
What are the QUICKEST way to decrease potassium in hyperkalemia
Insulin with glucose, B2 adrenergic agonisti, sodium bicarbonate. but the Insulin with glucose is the quickest - within minutes.
What are slower acting ways to decrease K
Diuretics, Hemodialysis, and Kayexlate - 1-2 hours to take effect.
When is Carotid Endarectomy done?
when theres SYMPTOMATIC high grade stneosis - 70-99% blockage.
What is the management if the carotids are less than 80%, but no symptoms
Managed mediaclly with asa and statins.
How does nitrates reduce chest pain during angina or MI.
venodilation - causes a decrease in preload and end diastolic volume - thuse reducing wall stress and decreased myocardial oxygen demand.
aside from leads, and congestion -what symptoms are distinct to Right Heart Failure
JVD, Kussmauls, clear breath sounds,
