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
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.