Kidney-ing around
AKI in the setting of recent abdominal surgery, hemorrhage, or acute pancreatitis. Intravesicular pressure >20 mm Hg.
What is abdominal compartment syndrome?
A 66-year-old man is hospitalized because of azotemia and hypercalcemia. Laboratory studies show a normal serum PTH level and an elevated 1,25-dihydroxyvitamin D3 level. A chest radiograph shows an interstitial infiltrate and an enlarged left paratracheal lymph node.
What is sarcoidosis?
Severe or recalcitrant seborrheic dermatitis or abrupt onset of severe psoriasis
What is early manifestation of HIV infection?
A 54-year-old woman has a 4-month history of diarrhea and weight loss. Laboratory studies show hypocalcemia, microcytic anemia, and an increased PT.
What is celiac disease?
An 18-year-old woman fainted while standing in line to purchase concert tickets. She felt “woozy” and became pale and sweaty before fainting. Friends observed jerking motions of her face and fingers.
What is vasovagal syncope?
A 70 year old woman took 20 aspirin approximately 3 hours ago because she thought it would help her headache. She is currently breathing 30 times a minute. ABG: pH 7.45, pCO2 25, HCO3 24. What medication do you give her?
What is IV sodium bicarb?
A 35-year-old woman with asthma has daily coughing and shortness of breath. She uses triamcinolone, 4 puffs twice daily, and albuterol, 2 puffs twice daily as needed. Her sleep is disturbed nightly by coughing. The chest examination shows soft bilateral expiratory wheezing. PEF is 60% of predicted.
What is severe persistent asthma?
A 25-year-old man has epistaxis managed by nasal packing. The next day, he is confused, his temperature is 39.0 °C (102.2 °F), and BP is 90/82 mm Hg. Erythema of his face, shoulders, and palms is present. The nasal packing is still in place. Serum creatinine and aminotransferase levels are elevated.
What is Staphylococcal TSS?
Coexistent pulmonary diseases and/or recurrent Giardia infection. Consider evaluation for cystic fibrosis.
What is CVID (common variable immunodeficiency) and selective IgA deficiency?
Chronic cough with normal chest x-ray findings, normal spirometry, and negative methacholine challenge test; failed empiric PPI therapy. Diagnosed with putum induction or bronchial wash for eosinophils or exhaled nitric oxide testing. Treated with inhaled glucocorticoids.
What is nonasthmatic eosinophilic bronchitis?
Doc! CT is back on our patient in ER 15 and she has a AAA (abdominal aortic dissection). BP is still 220s systolic. What IV med do you want to give?
What is esmolol?
Often secondary to an inciting event (e.g., childhood pneumonia, TB); may be associated with foreign body, CF, immotile ciliary syndrome, nontuberculous mycobacteria, and allergic bronchopulmonary aspergillosis
Large-volume sputum production with purulent exacerbations, and hemoptysis. Chest radiograph showing “tram lines”
Diagnosed with HRCT, which will show airway diameter greater than that of its accompanying vessel and lack of distal airway tapering and bronchial wall thickening
What is bronchiectesis?
A 45-year-old man with HIV and a CD4 cell count of 100/μL has had 3 weeks of dry cough and progressive dyspnea on exertion, now present at rest. On examination, his temperature is 38.3 °C (100.9 °F) and Po2 is 67 mm Hg breathing ambient air. His chest x-ray shows diffuse bilateral infiltrates. Management for this disease should include this.
What is IV trimethoprim-sulfamethoxazole and glucocorticoids?
This disease is characterized by chronic watery diarrhea, sometimes accompanied by mild abdominal pain and weight loss, most commonly in women aged 45 to 60 years. It is associated with tobacco smoking, medications (NSAIDs, SSRIs, and PPIs), and other autoimmune conditions, particularly celiac disease. Colonoscopy with biopsies is required for diagnosis.
Symptoms are managed with antidiarrheal agents such as loperamide. Budesonide has the best documented efficacy for moderate to severe symptoms.
What is microscopic colitis?
Oral-ocular-genital syndrome (angular stomatitis, glossitis, pruritic scrotal dermatitis with balanitis)
What is Zinc deficiency?
A 45 year old female with PMH of Bipolar disorder, stable on Lithium for the past 10 years comes in for evaluation of significant polyuria and polydipsia. Water deprevation test is attempted and urine osm is low at 150. Desmopressin is also attempted and urine osm remains unchanged. This medication is the next best step.
What is Amiloride?
A 62-year-old woman is evaluated in the emergency department for fatigue, headaches, confusion, and weakness that have progressed over the past 6 weeks. She has an 11.3 kg (25 lb) unintentional weight loss over the past month. She has an 85-pack-year history of smoking and quit smoking 3 months ago. Laboratory evaluation reveals a serum sodium level of 123 mEq/L (123 mmol/L). CT scan of the chest shows a 4-cm mediastinal mass compressing the left upper lobe bronchus with associated bulky mediastinal lymphadenopathy.
What is small cell lung cancer?
Mosquitoes serve as the primary vector, and most human infections occur during the summer and early fall. This disease may present with meningitis, encephalitis, or myelitis. Older adults and immunocompromised patients are at highest risk. Severe disease may manifest as acute asymmetric flaccid paralysis.
Diagnosis is established by detecting IgM antibody to this virus in the serum and CSF
What is West Nile Neuroinvasive disease?
Nocturnal diarrhea and diabetes mellitus or systemic sclerosis. Diagnosed with hydrogen breath test adn treatment includes empiric antibiotic trial
What is small bacterial overgrowth?
A 20-year-old male comes to the office for sports physical. This patient has played varsity basketball since high school and he has no previous history of chest pain, shortness of breath, palpitations or fainting spells. Apical precordial impulse is hyperdynamic. There is normal S1/S2 and an S4 is heard. He has a 2/6 systolic murmur at the left sternal border that increases with Valsalva maneuver. TTE reveals interventricular septal thickness of 1.8 cm (normal is less than 1.1) and posterior left ventricular wall thickness of 0.9 cm (normal is less than 1.1). LVEF 75%. What is the appropriate recommendation?
What is avoid high intensity physicial activity?
A 50-year-old male with past medical history of hypertension, hyperlipidemia, diabetes mellitus, cirrhosis secondary to nonalcoholic steatohepatitis is evaluated for worsening ascites. Paracentesis was performed in clinic and SBP has been excluded. Home medications include metformin, lisinopril and atorvastatin. Serum creatinine 1.1 and random urine protein-creatinine ratio is 16. Patient is being initiated on a low-salt diet. What is the next best step?
What is to discontinue Lisinopril?
A 29-year-old woman was hospitalized 24 hours ago with hypoxemic respiratory failure due to influenza pneumonia. She was intubated and placed on mechanical ventilation. On physical examination, temperature is 38.1 °C (100.6 °F), blood pressure is 109/59 mm Hg, pulse rate is 90/min, and respiration rate is 24/min. The arterial PO2 is 60 mm Hg on FIO2 of 0.65, and positive end-expiratory pressure is 10 cm H2O. Tidal volume is 6 mL/kg ideal body weight, and plateau pressure is 27 cm H2O. What is the next best step?
What is prone positioning? (Proseva trial)
A 56-year-old man is evaluated in the emergency department for a 3-day history of fever, dyspnea, and anterior chest pain. Five other men were seen in the emergency department today with similar symptoms. All attended a baseball game 4 days ago and sat in the same stadium section. CXR shows bilateral lower lobe infiltrates and mediastinal widening.
What is Bacillus anthracis (Anthrax)?
Postprandial abdominal pain, fear of eating, and weight loss; often, signs and symptoms of atherosclerosis in other vascular beds. Surgical bypass or angioplasty with stenting is the treatment.
What is chronic mesenteric ischemia?
A 32-year-old man is hospitalized for a 2-week history of gradually worsening headache and fever. He was diagnosed with HIV infection 1 month ago, but he has yet to initiate antiretroviral therapy. Medical history is otherwise noncontributory, and he takes no medications. Laboratory studies show a positive serum cryptococcal antigen test result of 1:256, HIV viral load of 95,640 copies/mL, and CD4 cell count of 42/µL. A noncontrast CT scan of the head is negative. Intravenous liposomal amphotericin-B and oral flucytosine are initiated. What is the next best step?
What is Lumbar Puncture?