Renal
prenatal US shows oligohydramnios, neonate has pulmonary hypoplasia, flattened nose & limb deformities. prognosis is poor :(
What is Potter sequence?
EKG strip: regular, narrow complex
Pulse: 210 bpm
What is Supraventricular tachycardia (SVT)?
Tx: Vagal maneuvers and Adenosine
Adenosine results in short active blockade of AV Node conduction -> terminating the rhythm or slowing it down enough to see underlying arrhythmia
2nd line: b blockers
3rd line: amiodarone
Diagnostic test for bronchiectasis?
What is a High-Resolution CT scan?
Pt on lifelong gluten free diet, avoiding wheat, barley and rye.
Diagnostic: + anti-tTG IgA
Screened for deficiencies in Fe, B12, Folate, Vit D and Ca
What is Celiac Disease?
Strict vegan + neurologic symptoms → ?? deficiency.
What is B12 deficiency?
Only in animal products — supplement or give IM.
B12 is not given IV.
Match symptoms to Acid-Base disorder.
A-B Dxs: Metabolic acidosis/alkalosis, Respiratory acidosis/alkalosis
1. hyperventilating/ severe anxiety/ hypoxic
2. vomiting/ diuretic use/ excess mineralocorticoid
3. diarrhea/ renal failure/ metformin SE/ moonshine
4. COPD/ benzo OD
What is...
1. Respiratory alkalosis
2. Metabolic alkalosis
3. Metabolic acidosis
4. Respiratory alkalosis
🧠 ROME = Respiratory Opposite, Metabolic Equal
🔁 What it means:
🫁 Respiratory disorders → OPPOSITE directions
Example:
🧪 Metabolic disorders → EQUAL directions
Example:
HR 100, RR 20, BP 80/40, in distress
Lacerations/ecchymosis all over body due to MVC
JVD, Distant heart sounds
NBS to confirm DX
What is Echocardiography?
Cardiac Tamponade
Needs pericardiocentesis
Asthma exacerbation pt, starts to no longer wheeze as much nor using expiratory muscles... NBS?
What is INTUBATE!!!!!
Silent chest 2/2 exhaustion
ABG will show increasing CO2
Early (30 min) after meal, pt experiences nausea, cramping and diarrhea (2/2 fluid shift from hyperosmolar chyme)... later (1-3 hr) patient is hypoglycemic (2/2 excess insulin).
What is Dumping Syndrome?
Usually after bariatric surgeries.
Rx- small meals, decrease simple carbs, lie down after eating.
B12 VS. FOLATE DEFICIENCIES (BOTH ? ANEMIA)
Compare and contrast using the following:
MCV, hyperseg PMNs, homocysteine, neuro symptoms, methylmalonic acid
B12 VS. FOLATE (BOTH MEGALOBLASTIC)
Both: ↑ MCV, hyperseg PMNs, ↑ homocysteine
B12 only: neuro symptoms
B12 only: ↑ methylmalonic acid
Primary vs Secondary vs Tertiary Hyperparathyroidism
Give Vit D, Ca, PO4, PTH and AlkPhos levels
What is...
1* (Adenoma)
Key mechanism: PTH is inappropriately high → pulls calcium from bone + increases renal reabsorption + activates vitamin D
2* (CKD/Vit D Deficiency)
Key mechanism: Low calcium → compensatory PTH rise
3* (Sequela of Chronic CKD - Autonomous PTH Gland)
Key mechanism: Parathyroid glands “reset” → no longer respond to calcium → act like primary
nbs for this dx is labetolol/esmolol + nitroprusside
What is Pseudomonas?
oral: ciprofloxacin/levofloxacin
IV: pip-tazo, cefepime, ceftazidimine, meropenem/imipenem
CF, Celiac, Chrons and Bariatric Surgery Pts are very at risk for Fat Malabsorption.
Name the possible deficiencies and the effect.
Hint: vitamins (4), lipids (2), electrolytes (2) and bile (derivative).
What is...
K- bleeding, inc PT/INR, neonatal hemorrhages
A- night blindness, xeropthalmia, bitot spots
D- children: rickets, adult: osteomalacia
E- hemolytic anemia, spinocerebellar dysregulation, decreased DTRs, posterior column signs
Essential FA (linoleic, linolenic)- dematitis, alopecia, poor growth
Cholesterol- decreased steroid production
Ca- binds to FFA -> soap formation-> dec Ca absorption -> hypocalcemia... increased oxalate binds to calcium in kidneys = kidney stones
Mg
Bile Salts *esp. if ileum is involved- worsens fat absorption deficit
Hemolytic anemia; spinocerebellar degeneration; ↓ DTRs; posterior column signs
Deficiency of Vitamin ??
What is E (Tocopherol)?
Key Role: Antioxidant; protects RBCs & neurons
HY Pearl: Premature infants on TPN; CF. Mimics B12 deficit but no ↑ MMA.
3 Drugs causing SIADH (Syndrome of Inappropriate ADH Secretion)
What is SSRIs, Carbamazepine, Cyclophosphamide?
distinguishing physical exam finding between LHF v RHF
what is clear lung sounds?
+1$: exam finding
+2$: spread can lead to what life threatening condition?
+3$: management
+4$: uvula deviation: Y/N?
What is a retropharyngeal abscess?
+1$: posterior pharyngeal wall bulge
+2$: mediastinitis
+3$: IV Ampicillin-Sulbactam OR IV Clindamycin
+4$: NO! Uvula deviation AWAY From affected side is seen in Peritonsillar abscess aka Quinsy
52yo man w excessive sleepiness for the past 48hours, hx of alcoholism, fever, severe jaundice, lethargic, distended with fluid wave. cant assess tenderness due to somnolence. WBCs mildly elevated, BUN/Cr elevated, LFTs elevated.
NBS?
What is paracentesis?
Spontaneous bacterial peritonitis
Dx made if paracentesis has wbc >1000 leukocytes or >250 neutrophils
tx: gram - rod coverage w/ a 3rd gen cephalosporin
ASCITES + FEVER + ABD PAIN -> R/O SBP!
Refeeding Syndrome — Pathophysiology & High-Risk Groups
Describe what happens in each step:
Prolonged Starvation (Intracellular depletion of ?,?,?,? yet serum levels WNL)→ Refeeding (Carbs trigger ?) → ? Surge (?, ?, ? driven into cells. ? consumed rapidly. Serum levels crash.)→ DANGER (Name 5 Complications)
What is...
Prolonged Starvation (Intracellular depletion of PO4,K,Mg,Thiamine (Vit B1) yet serum levels WNL)→ Refeeding (Carbs trigger insulin surge) → ? Surge (PO4, K, Mg driven into cells. Thiamine consumed rapidly. Serum levels crash.)→ DANGER (Rhabdo, Cardiac Arrythmia, Respiratory Failure, Seizure/AMS, Heart Failure (BeriBeri)
★ #1 Electrolyte to Monitor: Hypophosphatemia. Refeeding syndrome's hallmark!
Also watch K and Mg.
Prevent by: starting feeds slowly, repleting electrolytes before feeding, giving thiamine before any glucose.
High-risk pts: anorexia nervosa, alcoholism, cancer cachexia, NPO >5 days, post-bariatric, IBD, uncontrolled DM.
cc: hematuria, flank pain
labs: hypercalcemia, HTN, erythrocytosis, hepatic dysfunction
What is Renal Cell Carcinoma?
Classic triad: hematuria, flank pain, palpable abdominal mass (Rare)
Incidental finding on imaging at times!
Paraneoplastic syndromes: erythrocytosis, hypercalcemia, HTN, Stauffer syndrome (non-metastatic hepatic dysfunction)
NBS: DX/Stage using CT or MRI W/wo Con & Chest Imaging to evaluate for Mets
Biopsy usually not req if imaging is typical scenario
TX: Localized= partial/radical nephrectomy. Mets= targeted therapy or immunotx.
In select patients with small tumors, you can do surveillance.
PT 1 Young baseball pitcher presents with sudden arm swelling and heaviness.
DX?
NBS?
TX?
What is Subclavian Vein Thrombosis AKA Effort Thrombosis (Paget-Schroetter Syndrome)?
NBS: Compression Doppler US
TX? Anticoagulation x3mo (outpt: DOAC- Apixaban, inpt: Heparin or enoxaparin)
1 Alcoholic + IV glucose → ?. Always give ? first.
2 Crohn's + terminal ileum resection → ? malabsorption. Needs IM ? indefinitely.
3 Sarcoidosis + hypercalcemia + low PTH → macrophage 1-α-hydroxylase → ?.
4 Post-bariatric + confusion/ataxia/ophthalmoplegia → ? deficiency. Vomiting depletes ? rapidly.
5 Anorexic started on TPN → check ? aggressively.
? = #1 refeeding killer.
6 INH therapy → ? deficiency → peripheral neuropathy. Give ? prophylactically with INH.
7 Strict vegan + neurologic symptoms → ? deficiency. Only in animal products — supplement or give IM.
8 Premature infant on TPN + hemolytic anemia + ↓ DTRs → ?deficiency.
9 TPN patient + elevated LFTs + steatosis → ?.
10 CF + fat malabsorption + bleeding → ? deficiency. Supplement ? in all CF patients
What is ...
1 Alcoholic + IV glucose → Wernicke encephalopathy. Always give thiamine first.
2 Crohn's + terminal ileum resection → B12 malabsorption. Needs IM B12 indefinitely.
3 Sarcoidosis + hypercalcemia + low PTH → macrophage 1-α-hydroxylase → granulomatous hypercalcemia.
4 Post-bariatric + confusion/ataxia/ophthalmoplegia → thiamine (B1) deficiency. Vomiting depletes B1 rapidly.
5 Anorexic started on TPN → check phosphate aggressively. Hypophosphatemia = #1 refeeding killer.
6 INH therapy → B6 (pyridoxine) deficiency → peripheral neuropathy. Give B6 prophylactically with INH. Microcytic anemia with ringed sideroblasts; peripheral neuropathy; cheilosis.
7 Strict vegan + neurologic symptoms → B12 deficiency. Only in animal products — supplement or give IM.
8 Premature infant on TPN + hemolytic anemia + ↓ DTRs → Vitamin E (Tocopherol) deficiency. Mimics B12 deficit but no ↑ MMA. Antioxidant; protects RBCs & neurons Hemolytic anemia; spinocerebellar degeneration; ↓ DTRs; posterior column signs
9 TPN patient + elevated LFTs + steatosis → TPN-associated liver disease. Transition to enteral if possible.
10 CF + fat malabsorption + bleeding → Vitamin K deficiency. Supplement ADEK in all CF patients