GU Whiz
100
65 y/o M comes to your office because he had an episode of hematuria. He had NSTEMI 3 months ago and is on aspirin/plavix. UA confirms RBCs w/o proteinuria. Labs are all looking good!
What is the next step in evaluating his hematuria?
CT urography followed by cystoscopy.
[] DAPT increases bleeding risk but its presence still warrants a search for a cause.
[] Malignancy should be evaluated
200
76 y/o brought to the ER for lethargy. He has fatigue, constipation, poor appetite, weight loss and long history of smoking. His Calcium is 16 and his creatinine is 1.6. You start IVF and calcitonin. What medication can you add for a longer lasting reduction in calcium?
IV Zoledronic acid or denosumab.
In severe hypercalcemia always start with IVF and calcitonin (decrease bone resorption) in addition add biphosphonates (further decrease bone resorption), it takes 2-4 days to work but provide a sustained calcium lowering effect.
choose denosumab if severe kidney function!
300
65 y/o F with PMH COPD and HF comes with volume overload, you start her on IV diuresis w/improvement of symptoms. On the day of dc you checked a BMP and her HCO3 is 40, so you now order an ABG that showed
pH 7.48
HCO3 45
CO2 65.
How do you interpret her acid base status???
Mixed disorder, she has metabolic alkalosis and respiratory acidosis.
First check pH, alkalotic, most abnormal lab is her bicarb, so she has metabolic alkalosis from diuresis now check if compensated. EASIEST > if the ph is similar to the CO2 is compensated (48) more exactly for every 10 rise in hco3 increase 7 in co2.
this patient should be approx 48 co2 but is 65! she aditionally has respiratry acidosis from her COPD.
400
25 y/o F IVDU here for tricuspid valve endocaritis growing enterococcus faecalis, on IV cetriaxone and ampicilin. On week 2 she develops fever, BC are negative. Labs showed wbc 9, Na 136, K 4.4, Creatinine 2.4 (0.8 baseline). UA leukocyte esterase positive, wbc 20-30, RBC 20-30, WBC casts. trace protein. What is the most likely cause of her new acute kidney injury?
AIN!
Triad fevers/rash/eosinohilia but these are nor specific or sensitive. Their absence does not exclude diagnosis.
best next step?
500
What is the most likely causative organism?
PROTEUS MIRABILIS!!
Urease producing organism that alkalinizes urine, driving struvite stone formation.