High -Yield Internal Medicine Board Exam Pearls by Knowmedge - HTML preview

Containing Preparations

 These include over-the-counter agents such as Maalox and Mylanta

 Use of these agents can lead to hypermagnesemia, acute aluminum toxicity, worsening

renal function, bone disease, and neurotoxicity

 The preferred quantitative test is spot urine protein to creatinine ratio (accurate & more

convenient than 24-hr urine collection)

 A urine protein to creatinine ratio ≥ 1 has a higher risk of progression of CKD

Pearl # 9: Most Patients With Hypertension Should NOT Be Screened for Secondary

Hypertension, But be Aware of Certain Clinical Clues

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 In general 95% of patients have primary or essential hypertension, and only 5% have

a secondary cause

 Clues include: Severe or difficult to control HTN, HTN that suddenly develops, or HTN

that is associated with other clinical findings are some clues

 Hypokalemia: Consider primary hyperaldosteronism

 Headaches, palpitations, and sweats: Consider Pheochromocytoma

 Moon facies and/or striae: Consider Cushing Syndrome

 History of snoring in obese patient: Consider Obstructive Sleep Apnea

 Bruit on one side of the abdomen: Consider Renal Artery Stenosis

 Over-the-counter medications (NSAIDs, Birth Control Pills, or Decongestants)

 Non-compliance with Diet (High Sodium Intake)

Pearl # 10: Recurrent Nephrolithiasis, Needs a Metabolic Evaluation to Identify and