right kidney
left kidney
gastric, GB, pancreas
Liver
Esophageal
100

What is the most common cause of hyperkalemia in a relatively healthy patient?

Poor phlebotomy causes a pseudohyperkalemia

100

What is a contraindication to performing an ABG?

Negative Allen's test = poor collateral blood flow 

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100

What is charcot's triad and Reynold's pentad?

Symptoms of cholangitis 

  • Charcot’s= RUQ tenderness + fever + jaundice 

  • Reynold’s= Charcot’s + AMS + hypotension 

100

You are evaluating a patient with Hepatitis B. What other type of Hepatitis can only occur alongside this infection?

Hep D is a co-infection that only occurs with hep B

100

What medications can cause pill induced esophagitis?

NSAIDs and bisphosphonates 

Avoid by drinking plenty of water, not taking meds while prone, and avoid laying flat 30 min after taking.

200

A 13-year-old boy presents with fever and blood in his urine. Examination shows an asymptomatic mass in the left lower quadrant. Urinalysis shows hematuria and small leukocytes. Which of the following is the most likely diagnosis?

nephroblastoma= Wilms tumor 

  • Child < 15 yo with palpable abdominal mass and hematuria 

  • Mass does not cross the midline 

  • Often asymptomatic

200

a 32-year-old female presents with fever, chills, nausea, and flank pain for 24 hours. She developed dysuria and urinary frequency 3 days prior and states that both have worsened. On physical exam, you note suprapubic abdominal pain and CVA tenderness. The urinalysis reveals white blood cell casts. What is the diagnosis and management?

Pyelonephritis

  • Empiric treatment is with fluoroquinolones but need to culture urine to confirm susceptibilities 

  • Pyelo vs acute cystitis: systemic symptoms including fever, chills. CVA tenderness 

200

What can cause a false negative urea breath test for h. Pylori?

  • PPI or H2 blocker use

    • Stop PPI 2 weeks prior and H2 blocker at least 24 hours prior 

  • Antibiotic use or bismuth (pepto) use 

200

What are the LFT ratios for alcoholic and non-alcoholic FLD? AKA AST and ALT

Alcoholic = 2:1 AST: ALT 

NAFLD= 2:1 ALT:AST 

200

A patient presents with reflux. When further questioned, he reports the regurgitation of small amounts of food back into his mouth. You notice he has a very foul-smelling breath. What do you suspect?

Zenker's diverticulum 

Zenker Diverticulum is an outpouching of the hypopharynx which causes foul smelling breath and regurgitation of solid foods.

Barium swallow can visualize the outpouching 

Treatment is based on symptoms: observation vs diverticulotomy 

300

A GFR of 49 indicates what stage of CKD and about what percentage of kidney function?

Stage 3A= 59-45 GFR and about 45-59% of kidney function 

300

What size kidney stone requires more than supportive treatment? What is a commonly used treatment?

Over 5 mm usually. Tamsulosin to relax ureter and help pass, shockwave, lithotripsy 

300

How can you differentiate the location of an ulcer based on timing symptoms?

  • Gastric ulcer pain worsens with eating 

  • Duodenal ulcer usually improves after eating and pain is 2-3 hours after 

300

Which Hepatitis infections have an available vaccine?

Hepatitis A and B (D) 

  • HBV at birth, 2 months, 6 months

  • HAV two doses starting at 12 months

300

What is the gold standard diagnostic test in most esophageal motility disorders?

Esophageal manometry 

Assesses motor contractions and pressure 

400

A 67 yo patient with HTN is started on lisinopril. He returns 1 month later with no improvement to his HTN, increased serum creatinine, and a decreased GFR. What is most likely going on and what is the best next step?

  • Renal artery stenosis- bilateral. Mostly from atherosclerosis. 

  • Renal ultrasound. Angiography is gold standard but invasive

  • ACEi and ARBs cause further decrease in renal perfusion and can cause an AKI in patients with stenosis 

400

What medication used for BPH actually alters the size of the prostate?

Finasteride, 5-alpha reductase inhibitor. Decreases synthesis of dihydrotestosterone and can decrease size of prostate by 50% in 6 months.

No immediate relief of LUTS so tamsulosin often used in conjunction

400

A 32-year old woman presents with a 4-day history of sudden right upper quadrant abdominal pain that is referred to the right shoulder tip. Pain was initially colicky, and then became constant. Positive history of fever, nausea and vomiting. On examination, she’s acutely ill looking, anicteric, febrile, positive murphy’s sign, right upper quadrant abdominal tenderness with muscle guarding and rebound tenderness present. CBC done showed WBC: 13 x 109/L; Serum amylase: 170U/L. What is the gold standard test to diagnose?

HIDA scan is gold standard to diagnose cholecystitis 

It can visualize the flow of bile through biliary system 

However, ultrasound is more commonly used

400

What are some complications of cirrhosis?

VARICES!

  • Varices

  • Anemia 

  • Renal failure 

  • Infection 

  • Coagulation disorders

  • Encephalopathy 

  • Sepsis

  • Also: portal HTN, ascites and other volume disorders










400

What are some red flags in patients with dysphagia that would cause a more urgent work up?

  • Progressive dysphagia, first solids then liquids

  • Weight loss

  • Age over 65 years old 

  • Smoker 

  • Odynophagia 

  • Any patient with symptoms of GERD accompanied by dysphagia, recurrent vomiting, weight loss, hematemesis, anemia, melena, or age > 50 should undergo endoscopy as these are considered high risk for the presence of an upper gastrointestinal malignancy

500

What are some indications for hemodialysis with end stage renal disease?

  • GFR<10 

  • Uremic symptoms- acidosis, fluid, hypertension, anemia, encephalopathy 

  • Fluid overload. No response to diuretics 

  • Refractory hyperkalemia 

  • Pericarditis

  • malnutrition/ failure to thrive 

500

For each UA finding give the type of AKI: 

Muddy brown cast= 

WBC casts= 

RBC casts=

  • Muddy brown casts= Acute tubular necrosis 

  • WBC casts and eosinophils= interstitial nephritis 

  • RBC casts= glomerulonephritis

500

A 36 year old man presents with sudden onset severe epigastric pain following an alcohol binge. Pain radiates to his back. Pain is alleviated when he sits and leans forward. There is also nausea and vomiting. Physical examination revealed upper abdominal tenderness, bluish discoloration around the umbilicus, bowel sounds are absent. What imaging is best? What lab is the most sensitive and specific? How will you manage?

  • Acute pancreatitis likely from alcohol abuse

  • CT abdomen is imaging of choice 

  • Lipase is more sensitive and specific than amylase

    • CBC, bilirubin, LFTs also useful 

  • Management includes IV fluids, pain control, bowel rest

500

A 31-year-old nurse presents to the emergency department after being stuck with a blood-filled hollow bore needle during a resuscitation. She discovers the patient has hepatitis B. That same day, she had her blood drawn. 

What serologic markers indicate prior hepatitis B immunization?

What would it appear like if she was acutely infected?

Prior hepatitis immunization: positive surface antibody (anti-HBs)

Acute infection: positive surface antigen (HBsAg), positive core antibody (anti-HBc - IgM), negative surface antibody (HBsAb)

  • Helpful hints:

    • if positive surface antigen (HBsAg) they either have acute or chronic hepatitis 

    • if they have positive surface antibody (HBsAb) they are immune (past infection or vaccine)

    • it's chronic if the positive core antibody shifts from IgM to IgG

500

A 46-year old man presented at the ED with hematemesis following excessive retching and vomiting after having alcohol binge. He’s hemodynamically stable and there is no fever. 

What is the diagnostic and treatment of the suspected diagnosis?

Mallory Weiss Tear from excessive vomiting- usually from a binge drinking episode 

EGD is diagnostic and can treat a tear if visualized. 

Most tears are self limiting and resolve spontaneously. 

If unstable pt or bleeding is uncontrolled then EGD with clipping, sclero, cautery, etc. 

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