Internal Medicine NBME;Questions And
Answers
Causes of Hypervolemic hypoNa (3) - answer:-CHF
Nephrotic syndrome
Cirrhosis
Causes of euvolemic hypoNa (3) - answer:-SIADH ***
Hypothyroidism
Addison's
Causes of hypovolemic hypoNa (2) - answer:-Diuretics
Vomitting
How to treat: hypoNa + no sx at all? - answer:-Fluid restrict +/- diuretics
How to treat: hypoNa + mild sx no seizures)? - answer:-Normal saline
How to treat: hypoNa + seizures? - answer:-Hypertonic 3% saline
Why shouldnt you correct hypoNa more than 12 mEq per day? - answer:-Central
pontine myelinolysis
Causes of hyperNa - answer:-dehydration
extra renal loss (vom, diarrhea, sweating)
Renal loss - osmotic diuresis, DI
Renal loss of water causing hyperNa:
DI = ____ urine osm
Osmotic diuresis = ____ urine osm - answer:-DI = low urine osm
OD = high urine osm
numbness, chovstek or trousseau's sign, prolonged QT - answer:-hypoCa
bones, stones, groans, altered mental status/confusion, short QT - answer:-hyper Ca
paralysis, ileus, ST depression - answer:-hypoK
peaked T waves, prolonged PR, sine waves - answer:-hyperK
first thing you give someone with hyper K? - answer:-Ca gluconate, then insulin +
glucose/dextrose
Options to shift K into cells in hyperK treatment? - answer:-Insulin + glucose
,Internal Medicine NBME;Questions And
Answers
Albuterol (B2 agonist)
NaHCO3
If you have a metabolic alkalosis, what is the next test to check? - answer:-urine Cl
Low urine Cl in the setting of metabolic alkalosis? - answer:-dirrhea
vomitting
diuretics
High urine Cl in the setting of metabolic alkalosis? - answer:-Barter's
Gittleman's
Conn's (hypoaldosterone)
Causes of non-anion gap metabolic acidosis? - answer:-diarrhea
diuretics
RTAs (1, 2, 4)
Renal tubular acidosis causes what acid base abnormality? - answer:-NAGMA
Type 1 RTA MC cause? - answer:-Lithium
Pathophys of type 1 RTA? - answer:-Cant excrete H+
Features of Type 1 RTA - answer:-alkaline urine (pH >5.4)
Hypo K
How to treat type 1 RTA? - answer:-replace K
oral HCO3
Type 2 RTA MC cause? - answer:-MM
Pathophys of Type 2 RTA? - answer:-Cant reabsorb HCO3
Presentation of type 2 RTA? - answer:-Hypo K
NORMAL URINE pH!!! (<5.4)
How to treat type 2 RTA? - answer:-replace K
diuretic
, Internal Medicine NBME;Questions And
Answers
NO HCO3 for you!!! Cant reabsorb it anyways.
Type 4 RTA MC cause? - answer:-diabetes
presentation of type 4 RTA? - answer:-hyper K
high Na in urine even with salt restriction
pathophys of type 4 RTA? - answer:-hyper renin
hypo aldosterone
lots of K, loss of Na
Treatment of type 4 RTA? - answer:-mineralcorticoid replacement (fludrocortisone)
Causes of pre-renal AKI - answer:-Dehydration
CHF
Cirrhosis
renal artery stenosis
GN
Muddy brown casts in a patient with prolonged ischemia, on amphoB? - answer:-ATN
fluids, dialysis if need.
Protein, blood, and eosinophils in urine + fever + rash + hx of Tri-Sulf use - answer:-AIN
stop abx
Crush victim or intense athlete + elevated CK + blood on dip but no RBCs - answer:-
Rhabdomyolysis
First test to order if you suspect rhabdo? - answer:-K!!! + ECG.
rhabdo = cell lysis = release of K = they can die from arrhythmia
How to treat rhabdo? - answer:-HCO3
enveloped crystals on urinalysis + AGMA - answer:-Ethylene glycol toxicity
dialysis
Answers
Causes of Hypervolemic hypoNa (3) - answer:-CHF
Nephrotic syndrome
Cirrhosis
Causes of euvolemic hypoNa (3) - answer:-SIADH ***
Hypothyroidism
Addison's
Causes of hypovolemic hypoNa (2) - answer:-Diuretics
Vomitting
How to treat: hypoNa + no sx at all? - answer:-Fluid restrict +/- diuretics
How to treat: hypoNa + mild sx no seizures)? - answer:-Normal saline
How to treat: hypoNa + seizures? - answer:-Hypertonic 3% saline
Why shouldnt you correct hypoNa more than 12 mEq per day? - answer:-Central
pontine myelinolysis
Causes of hyperNa - answer:-dehydration
extra renal loss (vom, diarrhea, sweating)
Renal loss - osmotic diuresis, DI
Renal loss of water causing hyperNa:
DI = ____ urine osm
Osmotic diuresis = ____ urine osm - answer:-DI = low urine osm
OD = high urine osm
numbness, chovstek or trousseau's sign, prolonged QT - answer:-hypoCa
bones, stones, groans, altered mental status/confusion, short QT - answer:-hyper Ca
paralysis, ileus, ST depression - answer:-hypoK
peaked T waves, prolonged PR, sine waves - answer:-hyperK
first thing you give someone with hyper K? - answer:-Ca gluconate, then insulin +
glucose/dextrose
Options to shift K into cells in hyperK treatment? - answer:-Insulin + glucose
,Internal Medicine NBME;Questions And
Answers
Albuterol (B2 agonist)
NaHCO3
If you have a metabolic alkalosis, what is the next test to check? - answer:-urine Cl
Low urine Cl in the setting of metabolic alkalosis? - answer:-dirrhea
vomitting
diuretics
High urine Cl in the setting of metabolic alkalosis? - answer:-Barter's
Gittleman's
Conn's (hypoaldosterone)
Causes of non-anion gap metabolic acidosis? - answer:-diarrhea
diuretics
RTAs (1, 2, 4)
Renal tubular acidosis causes what acid base abnormality? - answer:-NAGMA
Type 1 RTA MC cause? - answer:-Lithium
Pathophys of type 1 RTA? - answer:-Cant excrete H+
Features of Type 1 RTA - answer:-alkaline urine (pH >5.4)
Hypo K
How to treat type 1 RTA? - answer:-replace K
oral HCO3
Type 2 RTA MC cause? - answer:-MM
Pathophys of Type 2 RTA? - answer:-Cant reabsorb HCO3
Presentation of type 2 RTA? - answer:-Hypo K
NORMAL URINE pH!!! (<5.4)
How to treat type 2 RTA? - answer:-replace K
diuretic
, Internal Medicine NBME;Questions And
Answers
NO HCO3 for you!!! Cant reabsorb it anyways.
Type 4 RTA MC cause? - answer:-diabetes
presentation of type 4 RTA? - answer:-hyper K
high Na in urine even with salt restriction
pathophys of type 4 RTA? - answer:-hyper renin
hypo aldosterone
lots of K, loss of Na
Treatment of type 4 RTA? - answer:-mineralcorticoid replacement (fludrocortisone)
Causes of pre-renal AKI - answer:-Dehydration
CHF
Cirrhosis
renal artery stenosis
GN
Muddy brown casts in a patient with prolonged ischemia, on amphoB? - answer:-ATN
fluids, dialysis if need.
Protein, blood, and eosinophils in urine + fever + rash + hx of Tri-Sulf use - answer:-AIN
stop abx
Crush victim or intense athlete + elevated CK + blood on dip but no RBCs - answer:-
Rhabdomyolysis
First test to order if you suspect rhabdo? - answer:-K!!! + ECG.
rhabdo = cell lysis = release of K = they can die from arrhythmia
How to treat rhabdo? - answer:-HCO3
enveloped crystals on urinalysis + AGMA - answer:-Ethylene glycol toxicity
dialysis
