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RTA I |
RTA II |
RTA IV |
| Site of defect |
Distal |
Proximal |
Distal |
| Primary defect |
Inability to acidify |
Bicarbonate wasting |
Hypoaldosteronism or ineffective aldosterone |
| Urinary pH |
high |
low ( maybe high with bicarb supplementation) |
low |
| Serum bicarb |
very low |
moderately low |
slightly low |
| Potassium |
low |
low to normal |
high |
| Examples |
primary or idiopathic amphotericin Sjogren |
multiple myeloma heavy metals acetazolamide |
Diabetes Mellitus adrenal insufficiency spironolactone |
 |
This table is a generalization and some exceptions
exist, e.g., some RTA I may manifest with hyperkalemia
|
 |
A 17 year old female presents with 3 month history of mild fatigue. Work-up
reveals a hemoglobin of 10 and a hematocrit of 30 with a MCV of 78. Further
laboratory data reveals a low Fe level, low Ferritin and a high TIBC. What would
be the best way to treat this patient? |
(A) Transfusion of 2 u PRBC
(B) Ferrous
sulfate 300mg po tid
(C) Folate 1mg po qd
(D) Do not treat at this time.
 |
You
were called from a juvenile psychiatric ward to evaluate a new admit with
elevated liver enzymes. What is the most likely differential diagnosis? |
(A)
Hemochromatosis
(B) Cystic fibrosis
(C) Wilson’s disease
(D) Hepatic
encephalopathy
(E) Chronic hepatitis C
 |
57 year old male is to undergo (R)
femoral-popliteal bypass surgery in two weeks. The surgeon asks you to perform a
pre-operative evaluation due to multiple cardiac risk factors. The patient
denies ant history of MI, CHF, chest pain, syncope, or palpitations. Ambulation
limited by claudication to walking around the house. PMHx: DM II,
Hypercholesterolemia, chronic low back pain. SHx: Auto mechanic, 2 pack-per-day
smoker for 30 years, social alcohol, no drugs. Exam: BP 146/92, P 80, RR 14, T
37.2oC, Neck without JVD, Lungs clear with prolonged expiratory phase, Heart is
regular with no murmurs, Abdomen is benign, Extremities with (R) femoral bruit,
weak distal pulses, no edema. Rest ECG is normal. Bedside PFT with FEV1 of 1.2,
FVC of 2.6. What is the next step in pre-operative assessment? |
(A) Proceed with
surgery with no further evaluation or intervention.
(B) Refer for treadmill
stress test to further risk stratify cardiac risk.
(C) Obtain transthoracic
echocardiogram to look for wall motion abnormalities.
(D) Refer for persantine
thallium to further risk stratify cardiac risk.
(E) Start Atenolol 50 - 100 mg
qd to minimize peri-operative cardiac risk
 |
A 15 year old female is worried
because she has not yet started menstruating. Physical exam shows appropriate
breast and pubic/axillary hair development, pelvic exam reveals normal external
genitalia with normal appearing uterus. What is the next initial step in
work-up? |
(A) Obtain U/S of pelvis to confirm normal uterus and ovaries
(B)
Obtain TSH and prolactin levels
(C) Obtain a serum beta HCG
(D) Obtain Karyotype
(E) Reassure patient, do nothing
 |
You are called by the nurse to evaluate a
patient who had been admitted for cholecystectomy. When you arrive you notice
that the cardiac monitor shows a narrow-complex tachycardia with a rate of 150
bpm. The BP is 135/70 and the patient denies shortness of breath or chest pain.
He states he has never been diagnosed with any cardiac problems before. You
initially attempt carotid massage with no change in either cardiac rate of
rhythm. You ask the nurse to give the patient 6mg of adenosine fast iv push.
Shortly thereafter the patient’s cardiac rate transiently slows down and you
are able to distinguish a rhythm consistent with atrial flutter before the rate
rises to 150 beats per minute again. What would be your next step in management? |
(A) Immediate synchronized cardioversion
(B) Diltiazem 20mg intravenous push x 1
(C) Anti-coagulation with coumadin for 3 wks
followed by cardioversion
(D)
Adenosine 12mg intravenous push x 1
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