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CLINICAL MEDICINE I MIDTERM TREATMENTS EXAM 2025|REAL QS WITH CORRECT AS|A+ GRADED
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Horseshoe Kidney -Asymptomatic: No treatment needed -Children should avoid contact sports -Obstruction: Surgery Hydronephrosis -Treat underlying cause -Acute Blockage: Catheter Polycystic Kidney Disease -Strict BP control with ACEi/ARB -Restrict sodium, increase fluid intake -Tolvaptan (must monitor LFTs) -ERSD requires dialysis or transplant
Renal Cell Carcinoma -Localized: Surgery is definitive -Metastatic: Immunotherapy and molecular targeted therapy -Resistant to chemo and radiation!! Wilm's Tumor
Chronic Kidney Disease -Control BP <130/ -Control proteinuria with ACEi/ARB -SGLT2 Inhibitors for DMII -GFR <15: Dialysis Rhabdomyolysis -IVF first line! -Correct electrolyte abnormalities -Treat underlying cause Hypovolemia -Administer Na and water -Mild: Oral rehydration -Moderate/Severe 1st: Correct hypovolemia with isotonic IVF (NSS, LR) -Correct water deficit with hypotonic solution (5% dextrose, 0.45% NaCl) Hypervolemia
-Water and sodium restriction -Diuretics Renal Artery Stenosis -ACEi/ARBs in unilateral disease -ARBs/CCB/Thiazide Diuretics in bilateral disease -Revascularization via stunting -Thromboembolic Disoder: A/C with Coumadin (Heparin Bridge) Renal Artery Thrombosis Acute -Anticoagulation (Heparin) -Thrombolysis -Percutaneous revascularization Renal Artery Thrombosis Chronic -ACEi/ARBs -Lipid lowering therapy -Revascularization
-Children: Empiric trial of Prednisone, biopsy if proteinuria despite 6- weeks of steroids -Proteinuria: ACEi/ARB Focal Segmental Glomerulonephritis -Regardless of proteinuria, initial treatment is BP control via ACEi/ARBs -Aggressive Treatment: Prednisone, Cyclophosphamide Membranous Glomerulonephritis -Initial treatment is BP control via ACEi/ARB -Refractory: Steroids, immunosuppressives -Ponticelli Regimen: Alternate steroids and immunosuppressives Hemolytic Uremic Syndrome -Stx-HUS: Supportive, BP control with ACEi/ARBs, NO ABX -Non-Stx-HUS: Plasma exchange (contraindicated in strep pneumoniae) Pauci-Immune Diseases
-Immunosuppression: PO Prednisone + Rituximab -Mild: Methotrexate + Prednisone -Severe: IV cyclophosphamide, pulsed IV steroids IgA Nephropathy -Treat HTN and keep between 125/75-130- -ACEi for proteinuria or declining renal function -Tonsillectomy, steroid therapy, or fish oil Henoch-Schonlein Purpura -Supportive -Abdominal Pain/Decreased PO intake/Impaired ADLs: Prednisone Post-Infectious Glomerulonephritis -Loop diuretics to increase urinary output to control edema and BP Membranoproliferative Glomerulonephritis -Treat HTN via ACEi
-Ketoacidosis: IVF (if DKA insulin) -Lactic Acidosis: Supportive -Uremia: Identify cause and treat Non-Anion Gap Metabolic Acidosis -With the exception of RTA and primary hyperparathyroidism treatment is supportive Renal Tubular Acidosis -Type 1: Sodium Bicarbonate -Type 2: Sodium Bicarbonate, Thiazide Diuretics -Type 4: Fludrocortisone Hypertensive Nephrosclerosis -BP control <140/ -ACEi/ARB if no edema -If Edematous: Diuretics
Diabetic Nephropathy -Non-dialysis dependent kidney disease: protein intake 0.8 kg of body weight/day (can be higher if on dialysis) -Increase urinary albumin secretion -GFR 45-60: Monitor every 6 months -GFR 30-44: Monitor every 3 months -GFR <30: Refer for renal replacement Hyponatremia -Severe: 3% saline infusion of 100-150 mL over 10-20 minutes and recheck every 1-2 hours Hypernatremia -Increase free water -Calculate free water deficit Hypokalemia -Potassium Chloride -If Acidotic: Potassium Bicarbonate/Phosphate
-First Line: MONA -Anti-platelets: Aspirin, Clopidogrell -Heparin -Emergent Invasive Tx: Angiography with ballon, PCI, Stent replacemtent STEMI -First Line: MONA -Anti-platelets: Aspirin, Clopidogrell -Heparin -If symptoms less than 12 hours: PCI door to balloon in 90 minutes, fibrinolysis door to needle in 30 minutes -Symptoms +12 hours: Aspirin + Heparin Aortic Stenosis -Surgery: If EF <50%, open valve replacement preferred -Diuretics to manage the CHF
Aortic Insufficiency -Acute: IV Nitroprusside/Dobutamine -Dissection: IV Beta Blockers/Surgery -Infective Endocarditis: Valve replacement surgery EVEN during active infection -Intra-Aortic Balloon Pump is CONTRAINDICATED -Chronic: Surgical intervention is definitive treatment Mitral Stenosis -Diuretics to decrease pulmonary congestion -Mitral Valve Replacement! Mitral Valve Prolapse -Medications do not decrease progression -Surgery Mitral Regurgitation
Acute Pericarditis -NSAIDs -Colchicine Recurrent Pericarditis -Colchicine for 6-12 months with gradual taper + NSAIDs -Arcalyst -Pericardiectomy if multiple treatments fail Constrictive Pericarditis -Pericardiectomy is definitive treatment (not in severe/early cases too risky) -Medical Management: Diuretics, Colchicine, Steroids Pericardial Effusion -If chronic or large drain via pericardiocentesis or pericardial window Cardiac Tamponade
-Avoid diuretics -Acute cases can be drained with needle or balloon catheter Endocarditis -IV antibiotics for 2-6 weeks -Acute: Broad spectrum -Subacute: Wait for sensitivities -Prosthetic valves may need rifampin Premature Atrial Contraction -Asymptomatic: Reassurance, avoid triggers -Symptomatic: Metoprolol (BB) or Diltiazem (CCB) Premature Junctional Contraction -Symptomatic: BB or CCB -Difficult to ablate or suppress with anti-arrhythmics
Atrial Tachycardia -Single event with reversible cause does not require treatment -Digoxin Toxicity: Digibind -Unstable: Cardioversion, IV verapamil (CCB), IV BB -Stable: IV CCB/BB Multifocal Atrial Tachycardia -Treat underlying condition -COPD/Bronchospasm: CCB -No cardioversion or digoxin Atrial Fibrillation -Electrocardioversion preferred over chemical -No Structural Heart Disease: PO Flecainide (Cardioversion), Sotalol (Maintaining NSR) -Moderate Structural Heart Disease: PO Tikosyn/Sotalol (Cardioversion), Sotalol (NSR) -Severe Structural Heart Disease: Amiodorone (Cardioversion/Maintaining NSR) -Ablation is last resort
-If CHA2DS2-VASc Score is +2: Anticoagulation via Warfarin Atrial Flutter -Cardioversion -Amiodorone -Ablation Right Bundle Branch Block -No treatment needed -Patients with RBBB +65 should be screened for cardiac disease Left Bundle Branch Block -Asymptomatic: No treatment -New LBBB + Syncope: Treat as MI -LBBB + Syncope: Work up for VT or structural heart disease (EF <35% qualify for biventricular AICD) First Degree AV Block
