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Glomerular hematuria a/f URI. Dx?

1. IgA nephropathy (<5 days), nL serum complement
2. post-strep GN (10-21 days), decr. serum complement

Most common extrarenal manifestation of PKD is?

hepatic cyst

Development of renal abnormalities in DM?

1. glomerular hyperfiltration
2. thickening of GBM
3. mesangial thickening
4. nodular sclerosis

Side effect of prazosin?


Tx for Goodpastures?

emergency plasmapheresis

Increased DTRs, muscle cramps, (rarely) convulsions in post-op pt who rec'd multiple transfusions...?

hypo-Ca 2/2 citrate binding

Severe hypo-Mg can mimic hypo-Ca, but how?

decreases PTH secretion & peripheral responsiveness to PTH

Intra-abdominal pathology causing shoulder pain = ?

subdiaphragmatic peritonitis

In blunt trauma to the bladder, where will the rupture occur?

bladder dome, at developmental hiatus, where urachus originated. (can cause chemical peritonitis)

BPH begins in which prostate zone?


Tx for uric acid stones?

alkalinization of urine with KCl

Elderly pt wih
- bone pain
- renal failure
- hyper-Ca.
Diagnosis, doctor?

multiple myeloma until proven otherwise

Hyper-K in a patient receiving chemo. Dx?

tumor lysis syndrome

Young black male with painless hematuria. Cause? etiology?

sickle cell trait.
papillary ischemia. Papillary necrosis can occur, with massive hematuria. (Usually mild, resolves spontaneously.)

Drug-induced interstitial nephritis Sx.

arthralgias, rash, renal failure, eosinophiluria

Causes of drug-induced interstitial nephritis.

- penicillins, cephalosporins
- sulfonamides
- rifampin
- phenytoin
- allopurinol

If suspect BPH, w/u should include?

DRE, UA, serum Cr.
If any abnl, needs further w/u.

Most common type of kidney damage associated with HIV


Most common type of drug-induced CRF is ?

analgesic nephropathy

Analgesic nephropathy. Path?

papillary necrosis & chronic tubulointerstitial nephritis

apple-green birefringence

amyloidosis (RA predisposes to this)

Acute Tx of symptomatic hyper-Ca

(if not caused by malignancy)
1 - IV fluids (incr. renal excretion of Ca by decr. Ca reabsorption in proximal tubule)
2 - loop (block Ca reabsorption in loop)
3 - identify cause and treat!

Acid-base d/o post-ictally.

lactic acidosis. resolves in 60-90 mins w/o Tx

In non-gap metabolic acidosis, how to narrow down DDx?

urine anion gap; to differentiate between intestinal and renal HCO3 losses.

Acid-base d/o in septic shock

lactic acidosis

Nephrotic patient with sudden onset:
- abdominal pain
- fever
- hematuria

renal vein thrombosis

Renal vein thrombosis is most commonly a complication of...?

membranous glomerulonephritis

Hypercoagulability in nephrotic syndrome is a result of...?

- urinary losses of antithrombin III
- altered levels of proteins C & S
- increased platelet aggregation
- hyperfibrinogenemia 2/2 increased hepatic synthesis
- impaired fibrinolysis

Screening test for cystinuria?

urinary cyanide nitroprusside. (also, hexagonal crystals)

Bowel ischemia can lead to what acid-base d/o?

lactic acidosis

Best treatment for hepatorenal syndrome?

liver transplant

How to treat recurrent hypercalcuric renal stones?

increase fluid intake
sodium restriction

Characteristics of simple renal cysts (i.e. no further w/u)

- thin walls
- no solid components
- no contrast enhancement

Diabetic pt with non-gap metabolic acidosis, persistent hyper-K, and renal insufficiency. Diagnosis, doctor?

type IV RTA!
- caused by aldosterone deficiency or renal tubular insensitivity to aldosterone
- worsened by ACE-I's, ARB's

Acyclovir adverse effect.

crystalline nephropathy (prevent with adequate hydration)
- usually transient
- Tx with hydration as well as adjusting dose (slow rate of IV infusion)

What type of nephropathy is assoc with carcinomas?


What type of nephropathy is assoc with Hodgkin's lymphoma?

minimal change dx

Cause of abnormal hemostasis in CRF? Tx?

platelet dysfxn.
Tx: DDAVP (increases release of factor VIII:vWF multimers from endothelial storage sites)
--transfused platelets would quickly become inactive

Nephrotic-range proteinuria
+ hematuria
+ "dense deposits" in GBM
= ?

membranoproliferative GN, type 2.
Dense deposits stain for C3 (not IgGs!)

Cause of Membranoproliferative glomerulonephritis type 2?

IgG against C3 convertase, leading to persistent activation of the alternative complement pathway ==> kidney damage

Renal colic with negative KUB. Causes?

1. radiolucent stone
2. Ca stone 1-3 cm diameter
3. non-stone obstruction (i.e. bloot clot, tumor)

Winter's formula.

what pCO2 should be to compensate for metabolic acidosis.
paCO2 = 1.5 ( HCO3-) + 8

FSGS associations/risk factors?

heroin use



nL QRS ?

< 120 msec

Claudication with normal ABIs?

[popliteal] arterial entrapment syndrome
- ABI's are falsely negative at rest; exercise ABI's abnl.
- on exam: nL pulses that decrease with plantar/dorsiflexion

for MI, how soon to balloon?

90 min.

___ increases rate of growth of AAA by 25%.


Drugs that improve mortality in CHF?


Etiology of isolated systolic HTN in elderly?

decreased vessel elasticity

___ is earliest manifestation of PKD


Leriche syndrome?

aortoiliac occlusive dx
- buttock claudication
- male impotence
- buttock atrophy


are always benign

Sx of digitalis toxicity.

diarrhea, nausea, fatigue.
atrial tachycardia with AV block

Causes of digitalis toxicity?

Digitalis is renally cleared.
toxicity incited by viral illness vs. excess diuretics

Latex allergy common in what congenital disease?

spina bifida

___ causes reversible cardiomyopathy.


Etiology of non-pitting edema

- lymphatic obstruction
- increased interstitial pressure (myxedema)

Etiology of pitting edema

- increased intravascular hydrostatic pressure
- decreased plasma oncotic pressure
- increased capillary permeability

How does nitroglycerine treat angina?

decreases preload

Complications of anterior, posterior MI?

anterolateral ==> free wall rupture
posteroseptal ==> papillary muscle dysfunction

High output heart failure occurs when...

increased ventricular function can't meet body's metabolic demands.

Causes of high output heart failure?

- anemia
- hyper-T
- beriberi (thiamine def)
- Paget's
- A/V fistulas

What is neurocardiogenic syncope? how to Dx?

vasovagal syncope
tilt-table test

Kussmaul's sign?

increased JVD with inspiration

Causes of pulsus paradoxus

- tamponade
- tension pneumo
- severe asthma

SLE & chronic steroids are both risk factors for...?

accelerated coronary atherosclerosis

Electrolyte abnormalities in primary hyper-aldo

Conn's syndrome
- hyper-Na
- hypo-K
- metabolic alkalosis

Use defibrillation to treat which arrythmias?

vtach, vfib (never afib)

Tx of PEA

1. CPR
2. IV epinephrine or vasopressin

Myocardial contusion. EKG findings? Complications?

(can cause cardiogenic shock)
new LBBB or dysrythmia
- myocardial rupture
- septal rupture
- valvular insufficiency

Cause of statin-induced myopathy?

decreased Coenzyme Q10 (HMG-CoA reductase also makes CoQ10)

Prolonged QRS ==> ?
Prolonged QT ==> ?


Can PVC's cause syncope?


When does fixed splitting of S2 happen?

- ASD (may also have RBBB)
- sometimes VSD

Abnormal breathing pattern seen in CHF.


Evolution of EKG in STEMI

T ==> ST ==> Q ==> T ==> ST ==> T
(peaked T ==> ST elevation ==> Q waves ==> T inversion ==> ST normalizes ==> T normalizes)

___ maintains PDA patency.
___ closes PDA.

prostaglandin E1

Physical exam findings in constrictive pericarditis

- sharp "x" and "y" descents
- pericardial knock (early heart sound a/f S2)

Dipyridamole properties.

- inhibits platelet aggregation
- coronary vasodilator

Tx for first degree heart block.

no treatment indicated

Which CCBs affect the heart?

- verapamil
- diltiazem

What happens if you give DHP-CCB's in STEMI?

they can worsen cardiac ischemia. cause peripheral vasodilation ==> reflex tachycardia.
- amlodipine
- nifedipine

What is DC cardioversion?

delivery of shock in synchrony with QRS complex--timed NOT to hit T wave (which could cause v.fib)

Cardioversion is used to treat which arrythmias?

- a-flutter
- a-fib
- v-tach with pulse

Tx for vtach WITHOUT hemodynamic compromise.

amiodarine or lidocaine

What is defibrillation?

delivery of shock NOT in synchrony with QRS

Defibrillation used to treat?

- v-fib
- pulseles v-tach

When treating "acute" afib, present for > 48 hrs (or an unknown time), what precautions should you take?

anticoagulate for 3 weeks before cardioversion and 4 weeks after. (or get echo to demonstrate no clot)

Tx for chronic afib

rate or rhythm control

EKG changes in hypo-Ca, hyper-Ca.

hypo-Ca ==> QT prolongation
hyper-Ca ==> short QT

Electrolyte changes in tumor lysis syndrome


In HHNKS, why are there no ketones?

there is enough insulin to suppress lipolysis, but not enough to lower plasma glucose.

Why treat elderly pts with methimazole/PTU before radioactive hormone?

need to deplete thyroid hormone stores, otherwise hormone released from dying cells ==> thyrotoxicosis

In secondary hyper-PTH in CRF, Ca ___, PO4 ___, PTH ___.

Ca is nL to low
PO4 high
PTH high

Osteomalacia: Ca ___, PO4 ___, PTH ___.

Ca nL to low
PO4 low
PTH high

Tx for diabetic gastroparesis

1. Dopamine antagonists b/f meals (metoclopramide, domperidone)
2. Bethanechol (pro-cholinergic)
3. erythromycin

Causes of primary adrenal insufficiency

- TB
- fungal infection
- CMV infection

Fever + sore throat in a patient taking PTU/methimazole = ? Tx?

agranulocytosis. Stop drug and check WBC.

Substrates for gluconeogenesis


In DKA, best indicators of metabolic recovery?

- arterial pH
- anion gap

Pellagra = deficiency of ?


Pseudotumor cerebri 2/2 toxicity of ___

vitamin A

Hypokalemic periodic paralysis

- episodic paralysis 2/2 abrupt decrease in serum K
- cause: familiar or due to thyrotoxicosis
- attacks precipitated by meals, stress
- Pathophys: K influx into cell due to release of epinephrine & insulin

Initial screening test or primary adrenal insufficiency?

cosyntropin stim test

Increased extracellular pH alters electrolyte levels how?

increases affinity of albumin for Ca, effectively decreasing ionied (active) calcium

Somogyi effect?

when nocturnal hypoglycemia leads to morning hyperglycemia due to release of epi, NE, glucagon

Hyper-Ca can result from prolonged immobilization. Tx?

Bisphosphonates decrease hyper-Ca and prevent osteopenia

DHEA made in ___? DHEAS in ___?

DHEA: adrenals, gonads, brain
DHEAS: adrenals

Hormones produced by Leydig cell tumors?

estrogen. (Leydig cells have aromatase)

Hormones produced by choriocarcinomas?


Hormones produced by seminomas?

serum tumor markers typically nL. But in those with syncytiotrophoblastic giant cells, beta-hCG may be increased.

Hormones produced by endodermal sinus tumor?

alpha-fetoprotein (yolk sac tumor)

APECED stands for?

autoimmune polyglandular endocrinopathy, candidiasis, & ectodermal dysplasia
- a cause of primary hypo-PTH

When does tertiary hyper-PTH happen?

when secondary hyper-PTH leads to autonomous PTH secretion ==> hyper-Ca. (e.g. pt with CRF & 2o hyper-PTH receives kidney transplant, but still has hyper-Ca after)

Correcting calcium in hypoalbuminemia

= 0.8 (4 - albumin) + serum Ca

Bartter Syndrome

defect in TAL

Gitelman syndrome

defect in DCT

Electrolyte changes in Bartter and Gitelman?

hypochloremic metabolic alkalosis
nL to low BP
elevated urinary chloride (similar to diuretic abuse)
(in chronic vomiting, urinary Cl is low)

Milk alkali syndrome?

Burnett's syndrome
- excessive ingestion of Ca leads to hyper-Ca, metastatic calcification, and renal failure

Vertical gaze paralysis
+ pupillary disturbances
+ eyelid retraction

pinealoma (Parinaud's syndrome)
- blocks hypothalamic inhibition pathway (leading to endocrine Sx)
- affects rostral midbrain at level of superior colliculus and CN III

In 21-hydroxylase deficiency (CAH), how is DHEA affected?

DHEA levels are normal

Central precocious puberty. Dx, Tx

increased LH, increased FSH
Tx: GnRH analog

Sx of pure riboflavin (B2) deficiency

- sore throat
- hyperemic & edematous oropharynx
- cheilitis, stomatitis, glossitis
- normocytic, normochromic anemia
- seborrheic dermatitis
- photophobia

Causes of pellagra?

(niacin, B3 def)
- alcoholism
- long term isoniazid use
- carcinoid syndrome
- Hartnup's dx

Hartnup's dx

- impaired absorption of neutral AA's, including TRP
==> can normally be converted to niacin

Sx of dry beriberi

symmetrical peripheral neuropathy with sensory & motor impairment of distal extremities

How to calculate tidal volume in assisted ventilation

~6 mL / kg ideal body wt

What happens to DLCO in emphysema?

decreased DLCO

What happens to DLCO in chronic bronchitis?

normal DLCO

on CXR, "triangular opacity in R hemithorax" = ?

R lower lobe atelectasis

postoperatively, hypoxemia + respiratory alkalosis = ?

postop atelectasis

most common precipitant of COPD exacerbation?

upper airway infection

Smoking cessation > ___ weeks preop decreases risk of postop pulmonary complications.

>8 weeks. Smoking cessation closer to surgery increases risk of postop pulm complications!

Most common cause of atypical PNA


Skin manifestation in mycoplasma PNA

erythema multiforme

Can see mild LFT elevation in PNA 2/2 ___.

Legionella. Also GI, neuro Sx. Think cruise ships & hotels!

Legionella PNA. Dx? Tx?

Dx - urinary antigen
Tx - quinolone or macrolide

PE findings in pleural effusion

decreased tactile fremitus, decreased breath sounds

PE findings in consolidation

increased fremitus, bronchial breath sounds (i.e. full expiratory phase)

Kidney dx + upper + lower respiratory disease, suspect...?


Dx Wegeners?

c-ANCA and biopsy

c-ANCA is an antibody against what?


Wegener's is defined clinically by what three criteria?

1. systemic vasculitis
2. upper & lower airway granulomatous inflammation
3. glomerulonephritis

Wegener's. Age of onset?

~ 40 y/o. M=F

Wegener's. Upper respiratory Sx / complications?

- epistaxis
- purulent rhinorrhea
- otitis
- sinusitis
- saddle nose deformity (destruction of nasal cartilage)

Wegener's. Cutaneous involvement?

- painful subQ nodules
- palpable purpura
- pyoderma gangrenosum

Adverse effects of amiodarone.

- pulmonary fibrosis
- corneal deposits

For a solitary, coin-shaped pulmonary nodule surrounded by nL parenchyma, what does calcification signify?

calcification favors benign.
"Popcorn" = hamartoma
"Bull's eye" = granuloma

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