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Final Flashcards

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1
Q

Jaundice with what kind of bilirubin is concerning in neonates?

A

Conjugated

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2
Q

Gilbert syndrome

A

Benign, asymptomatic jaundice, autosomal dominant

Indirect bili increased, usually too low to show jaundice

Intermittent and generally asymptomatic

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3
Q

Crigler najar syndrome type 1

A

Unconjugated increased, persistent, fatal kernicterus

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4
Q

Cigler najjar type 2

A

Unconjugated hyperbilirubinemia

Later onset, mild elevation

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5
Q

Reye’s syndrome

A

Encephalopathy, fatty liver, transaminitis

Avoid ASA!

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6
Q

Hemochromatosis

A

Autosomal recessive

Heme uptake increased in liver, pancreas, heart

Hyperpigmentation, fatigue, impotence, DM

Phlebotomy to treat

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7
Q

Wilson disease

A

Autosomal recessive

Disrupted copper transport, deposits in liver and brain, can look like Parkinson’s in a young patient

Kayser fleischer pathognomonic, elevated copper in urine

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8
Q

AAT deficiency

A

AAT made in hepatocytes, can lead to cholestasis. Antiprotesase that acts in the lungs

Can lead to early onset emphysema

Stop smoking!

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9
Q

Primary biliary cirrhosis

A

Chronic autoimmune destruction of bile ducts, usually women 40-60

Way increased alk phos, xanthomas, jaundice, portal HTN

AMA positive!

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10
Q

Liver abscess

A

Fever, chills, pain, cough

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11
Q

Cavernous hemangioma

A

Vascular lesion in liver, no risk of bleed

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12
Q

Focal nodular hyperplasia

A

Hypervascular mass with stellate appernce

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13
Q

Hepatocelluar adenoma

A

20-40 women on OCP

Small risk of malignant transformation

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14
Q

HHC is 80% in cases of…

A

Cirrhotic liver

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15
Q

HCC

A

Cachexia, weakness, weight loss, sudden increase in alk phos

Triple phase CT shows rapid contrast filling with washout !

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16
Q

Fulminant

A

Within 8 weeks of onset of acute liver dz

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17
Q

Subfulminant

A

8 weeks to 6 months from onset of acute liver disease

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18
Q

Acute liver failure manifestations

A

Hepatic encephalopathy

Impaired synthetic function

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19
Q

Acute liver failure caused by…

A

APAP in a lot of cases, like half

Also viral hepatitis

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20
Q

Hepatic encephalopathy

A

Ammonia commonly elevated, but not the only factor

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21
Q

Asterixis

A

Most specific exam finding for hepatic encephalopathy

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22
Q

Fetor hepaticus

A

Sweet, fecal odor of breath, ammonia and ketones

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23
Q

Depuytren’s contracture and gynecomastia found in…

A

Liver disease

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24
Q

Child Pugh score

A

ABC stages

Encephalopathy, ascites, bilirubin, albumin, PTT

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25
TIPS
Shunt placed between portal and hepatic veins to bypass the liver in portal HTN
26
Another scotch and tonic
AST at least 2x ALT in alcoholic liver disease
27
Alcoholic liver disease prognosis
Reverses with abstinence, this is the cornerstone of treatment
28
Non alcoholic fatty liver disease
Effects a lot of the population Metabolic syndrome increases the risk, correct the modifiable risk factors
29
Cholelithiasis presentation
Biliary colic Nausea belching, bloating Pain after eating, may radiate to the back
30
Acute cholecystitis presentation
Vomiting, peritoneal signs, jaundice
31
Ascending cholangitis
ERCP emergently!!! Can cause charcot's triad- RUQ pain, fever, jaundice then reynold's Pentad!- charcot's plus AMS, hypotension
32
Primary sclerosing cholangitis
Men 20-50, patients have IBD, fibrosis of biliary tract
33
Hep B labs
HBsAg- active infection HBsAb- immunity, vaccine or from infection HBcAb- following an active infection HBeAg- actively infectious HBeAb- infectivity reduced, acute phase over
34
Hep C
Illness often mild and asymptomatic, high rate of chronic hepatitis Associated with a lot of other systemic symptoms!
35
Autoimmune hepatitis
All ages, often younger females ANA or ASMA, other autoimmune diseases White blood cells attacking the liver
36
Budd chiari syndrome
Occlusion of hepatic vein, usually thrombotic, polycythemia vera in half of cases Causes pain, ascites and HM **doppler
37
Which pancreatic enzyme is more sensitive?
Lipase
38
Sentinel lop
Paralysis and accumulation of gas, acute pancreatitis
39
Colon cutoff sign
Gas filled section of colon abruptly ending at pancreas
40
Pancreatic cancer pearls
St mary Joseph's nodule- periumbilical nodule, mets Painless jaundice Courvoisier's sign- palpable gallbladder = neoplastic obstruction
41
Hemobilia
Blood in biliary fluid, sign of biliary cancer until proven otherwise
42
Boerhaave syndrome
Rupture of esophagus due to vomiting
43
Singultus
Hiccups
44
Intractable hiccups
Chronic renal failure
45
Organic cause of hiccups
Doesn't go away when you sleep, psychogenic cause does go away when you sleep
46
Normal transit time
35 hours, up to 72 hours
47
Normal transit constipation
Incomplete evacuation, psychosocial stress
48
Slow transit constipation
Infrequent stools, lack of urge, poor response to fiber and laxatives
49
Non inflammatory diarrhea
Water, non bloody Periumbilical cramping, bloating Maybe vomiting if food poisoning
50
Inflammatory diarrhea
Blood, pus, fever Urgency, tenesmus Must be distinguished from ulcerative colitis Tissue damage from invasive organism or toxin
51
Chronic diarrhea is ...
Greater than 4 weeks
52
Secretory diarrhea
Excessive stool water from extra electrolytes Decreased electrolyte absorption or simulated electrolyte secretion in the intestines
53
Osmotic diarrhea
Ingestion of poorly absorbed cations (mg) and anions (sulfate) or carb malabsorption Increased stool osmotic gap Weight loss, steatorrhea, fecal fat >10
54
Shigella
Very high attack rate Hemorrhage, bloody mucoid stools in small volume Can cause reiter's syndrome (uveitis, arthritis, urethritis) and HUS
55
Campylobacter can cause...
Guillan barre
56
Shigatoxin diarrhea
Can cause HUS, very deadly
57
Taenia solium
Can migrate to eyes and brain, cause neurocystercercosis Punched out lesions in the brain
58
Ascaris lumbricodes
Free swimming, liver heart and lungs Eosinophilia, urticaria, cough Can be vomited out
59
Candida esophagitis looks...
Shaggy
60
Herpetic esophagitis
Volcano like appearance, multinucleated giant cells
61
Which is worse, alkaline or acid?
Alkaline
62
Eosinophilic esophagitis
Could be inflammatory response to allergies Genetic Need endoscopy with bx to confirm Peripheral eosinophilia
63
Achalasia
Slowly progressive dysphagia Loss of peristalsis in deep esophagus and failure of LES to relax BIRD BEAK APPEARANCE on barium swallow
64
What is required for achalasia diagnosis?
Manometry
65
DES barium findings
Rosary need or corkscrew esophagus
66
Zenker's goes through what?
Killian's triangle
67
Schatzki ring
Circumferential mucosal structure at lower esophageal ring
68
Plummer Vinson syndrome
Triad of: Irone deficiency Dysphagia Cervical esophageal web
69
Etiology of esophageal cancer
Squamous cell most common worldwide Adenocarincoma most common in the US (distal 1/3)
70
Coffee ground emesis
Gastritis
71
H pylori
Spiral gram negative rod Inflammation and injury in intestine, fecal Ag immunoassay or urea breath test!
72
Pernicious anemia gastritis
Autoimmune destruction Decreased intrinsic factor secretion and B12 malabsorption, elevated gastrin production
73
Most common site of ulcer
Antrum Then lesser curvature
74
Ulcers feel better with...
Food and antacids, especially duodenal ulcers
75
Zollinger ellison syndrome
Gastrinoma Gastrin secreting neuroendorcine tumor, often in the gastrinoma triangle or the duodenum 2/3 are malignant
76
Zollinger ellison syndrome diagnosis
Secretin stimulation test- give secretin and it increases gastrin secretino in a gastrinoma
77
What is the dividing line of upper and lower GI?
Ligament of treitz, suspensions ligament of duodenum
78
Dieulafy's legion
Abnormally dilated submucosal artery that erodes overlying mucosa and bleeds Angiodysplasia
79
Melena
Blood in stool, dark and tarry from UGIB
80
Hematochezia
Usually lower GI bleed, more frank blood, but still can be from an UGIB
81
Norm for lower GI bleeds
Hematochezia Brown stools with blood mixed or streaked, bright red from colon, maroon from small bowel
82
Painless large volume bleed =
Diverticular dz
83
Gastroparesis diagnostics
Gastric scintigraphy, measures gastric retention after a meal KUB/CT may show dilation
84
Ogilvie syndrome
Massive cecal/ascending colon dilation, high risk of perforation Critically ill inpatients Similar to ileus but more sever
85
Intestinal atresia
Hx of polyhydramnios Bilious vomiting Double bubble sign, gas in stomach and proximal duodenum
86
Celiac
Diffuse damage to proximal small intestine from immunologic response to gluten Dermatitis herpetiformis (itchy papulovesicles)
87
Whipple disease
Fatal if untreated Hyperpigmentation, LAD, diarrhea, arthralgias, weight loss, fever
88
Diagnostic for lactase deficiency
Hydrogen breath test or 2 week lactose free diet
89
Coiled spring sign
Small bowel obstruction
90
X-ray distinguishing SBO from LBO
LBO, haustral markings don't cross the entire lumen
91
String of pearls
Bowel obstructions
92
Wandering spleen
Risk of torsion with movement
93
Most common surgical problem in pregnancy?
Appendicitis
94
Peritonitis/abscess
Peritonitis more free with aerobes Abscess more often with anaerobes
95
Incarceration vs strangulation
Incarceration means it cannot be manually reduced Strangulation means that there is ischemia and necrosis
96
Diastasis recti
Separation of rectus abdominis muscles with intact facia Bulges like a hernia, but there is no defect Seen in obesity and post pregnancy
97
Indirect hernia
Though inguinal ring Can feel it on the tip of finger
98
Direct hernia
Hesselbachs triangle, feel it on the side of your finger
99
Femoral hernia
More commonly female Often incarcerated/strangulated
100
Mesh too tight on hernia repair, risk damaging...
Ilioinguinal nerve
101
C diff microbiology
Gram positive anaerobe Spore forming Toxin producing Need to wash hands, not use alcohol
102
Diagnosis of c diff
EIA for toxin- need a high toxin burden PCR- very expensive Culture- takes time Flex sig/colonoscopy- pseudomembranous colitis
103
How long should symptoms be present before diagnosis of IBD?
3 months
104
Diagnostic criteria of IBS
Rome III
105
CD or UC has more family hx risk?
Crohn's
106
Aphthous ulcers more common in...
Crohn's disease
107
Most common skin disorder with IBD
Erythema nodosum - red subQ pretibial nodules
108
Which has transmural inflammation?
Crohn's dz
109
Which has more perianal dz?
Crohn's
110
Cobblestoning seen in...
Crohn's
111
Advanced adenoma
Take 5 years to develop Greater liklihood of malignant transformation, 10 years to develop malignancy
112
Polyps in the ..... colon associated with more advanced neoplasia
Proximal
113
If >10 polyps, consider...
Familial polyposis syndrome
114
3-10 adenomas, >1 cm with high grade dysplasia, rescope in ...
3 yeras
115
Lynch syndrome
Hereditary nonpolyposis colon cancer Autosomal dominant, can lead to endometrial CA, ovarian CA, and others Fewer polyps, but progress to cancer in 1-2 years!
116
Bethesda criteria
Should be considered for genetic testing for lynch syndrome
117
Colorectal cancer findings
Apple core lesion CEA (>5 is bad)
118
Screening for colorectal cancer
Start at age 50, 45 in black patients Colonoscopy every 10 years, all other every 5 yeras
119
Hemorrhoids are...
Normal anatomic structures! Become symptomatic when venous pressure rises and they become engorged
120
Thrombosed external hemorrhoids
Young healthy adults Coughing, heavy lifting or straining Painful, tense, bluish perianal nodule
121
Pilonidal cyst location
Skin/soft tissue infection near upper gluteal cleft
122
Most common anal cancer
Squamous cell carcinoma HPV
123
Most common solid tumor of young adult males
Testical cancer 90% are germ cell tumors
124
Bell clapper deformity
Intravaginal, testicular torsion
125
Torsion of testicular appendage
Blue dot sign Paratesticular nodule on superior testicle
126
Interstitial cystitis
Painful bladder sydrome, pain with bladder filling Relieved by urination
127
Unexplained hematuria in older patient (especially male smoker)=
Bladder CA until proven otherwise
128
DIAPPERS
``` Delirium Infection Atrophic urethritis/vaginitis Pharmaceuticals Psych factors Excess urine output Restricted mobility Stool impaction ``` *urinary incontinence
129
Prostate cancer PSA levels
>.75 annual increase, PSA velocity
130
Most common kidney stones
Calcium oxylate | Envelope
131
Struvite crystals
Infection Coffin lid Staghorn calculi Proteus, pseudomonas
132
If a patient has normal erections during sleep or in the early am...
Organic dz (like a vascular cause) is unlikely.
133
Ischmic priapism
Emergency, more common
134
Txt of ischemic priapism
Less than 4 hours, give phenylephrine Greater than 4 hours, give phenylephrine AND aspirate the blood
135
If increased FSH and LH, ...
Primary testicular failure
136
If decreased FSH and LH, then...
Secondary testicular failure Hypothalamic or pituitary issue
137
Lichen sclerosis
Inflammation Epithelial thinning Itching and pain Onion skin Cigarette paper skin May lose anatomical landmarks, severe stenosis of vaginal opening
138
Lichen simplex chronicus
Itch that rashes Scratching/rubbing from irritant dermatitis Hyperplastic/hyperpigmented areas
139
Lichen planus
Chronic burning/itching Insertional dyspareunia Profuse vaginal discharge Wickham striae, reddened ulcerated lesions, patchy distribution
140
Vulvar vestibulitis
Inflammation of vestibular glands New onset insertional dyspareunia and pain with tampon insertion Light touch with moistened cotton applicator recreates exact pain
141
Normal vaginal pH
4-.5
142
If elevated vaginal pH, suggests...
BV or trich
143
BV clinical presentation
Sometimes asymptomatic White, thin and homogenous discharge that has a fishy smell
144
Amsel's criteria
``` For BV, need 3/4: Homogenous white discharge Clue cells PH >4.5 Positive whiff test ```
145
Wet mount finding in candidiasis
Budding yeast and hyphae
146
Findings in trich
Strawberry cervix Wet prep shows motile trichomonads
147
Gonorrhea
Gram negative diplococci
148
Gonorrhea presentation
Symptomatic during menses Urinary pain, frequency, urgency Purulent discharge Could develop into PID
149
Gold standard for gonorrhea
Culture
150
Initial test for gonorrhea
NAAT First morning urine
151
Most common STI
Chlamydia
152
Post coital bleeding...
Chlamydia
153
Difference in men and women test for chlamydia
Women is vaginal swab Men is first catch urine
154
Lifespan of sperm
No more than 5 days
155
Lifespan of ovum after ovulation
24 hours
156
Fertile
5 days before ovulation to 24 hours after
157
Estrogen suppresses...
Lactation
158
Phyllodes tumor
Looks like fibroadenoma, but rapidly enlarges, can progress to CA
159
Triple negative breast cancer
Poor prognosis because it doesnt have any of the receptors that hormone therapies target to kill the cancer
160
Preservation of axillary lymphtics in breast cancer
Sentinel lymph node bx Radiotracer dye injected near tumor, tracks to nodes, excise those nodes it tracks to
161
Cervical cancer risks
HPV, specifically 16, 18 an 31 Smoking HIV
162
Postcoital spotting
Cervical cancer!
163
Pap test every...
3 years if 21-29 (and one option if >30) If >30, can do pap and HPV testing every 5 years
164
Aceto white
Abnormal areas
165
Schiller test
Normal epithelium absorbs the stain, nonstaining needs to be bx'd
166
Unopposed estrogen =
Endometrial growth, risk factor for endometrial cancer
167
Follicular phase is...
Estrogen dominant
168
Luteal phase is...
Progesterone dominant
169
Endometrial eval indicated for...
Any bleeding postmenopausal woman
170
Tumor marker for extra uterine spread
Ca 125
171
Hydatidiform mole
Proliferation of trophoblast Not a viable pregnancy, markedly elevated HcG, snowstorm or honeycomb uterus on US
172
Vague GI concerns in an older female, think...
Ovarian cancer
173
If mid luteal progesterone concentration is less than...then...
3, evaluate patient for causes of anovulation
174
MCC of secondary dysmenorrhea
Endometriosis
175
Chronic pelvic pain
6 months or more
176
Uterosacral nodularity
Classic for endometriosis, but often not present
177
Dx of endometriosis
Tissue biopsy, must have 2 or more: Endometrial epithelium Endometrial glands Endometrial stroke Hemosiderin laden macrophages
178
Elevated hormone in menopause
FSH
179
Oligomenorrhea
Reduction in the frequency of menses, cycle lengths of >40 days and <6 month
180
Hypomenorrhea
Reduction in the number of days or the amount of menstrual flow
181
Amenorrhea
Always check pregnancy@
182
String of pearls on ovary
PCOS
183
Reinke albuminoid crystals
Pathognomonic for hilar cell tumors
184
Cushing diagnosis
Overnight dexamethasone suppression test
185
Polymenorrhea
Frequent menstrual bleeding, less than 21 day cycles
186
Menorrhagia
Prolonged or excessive uterine bleeding occuring at regular intervals
187
Metrorrhagia
Irregular menstrual bleeding/bleeding between periods
188
Menometrorrhagia
Frequent menstual bleeding that is excessive and irregular in amount and duration
189
Stages of vaginal prolapse
Stage 2- between 1 cm above and 1 cm below the hymen Stage 3- greater than 1 cm past the hymen, but at least some of the vaginal mucosa is not everted Stage 4- complete eversion
190
Pregnancy is a high...
Progesterone state and estrogen state
191
Bohr effect
Compensated respiratory alkalosis during pregnancy, facilitates oxygen delivery to the fetus and co2 removal rom the fetus
192
HPL effect in pregnancy
Diabetic effect, makes a type 2 diabetes environment Insulin resistance, hyperplasia of the insulin secreting beta cells
193
Trimesters in pregnancy
First trimester is up to 14 weeks Second is 14-28 weeks Third is 28 weeks- delivery
194
Quickening occurs..
16-20 weeks GA
195
Naegele's rule
Add 9 months and 7 days from the first day of the last menstrual period
196
Fundal height measuring
20-36 weeks
197
Fetal heart tones
110-160
198
Screening for diabetes
24-48 weeks
199
Ritgen maneuver
Giving the baby's chin upward pressure
200
Inspect umbilical cord for...
2 umbilical arteries and 1 umbilical vein
201
Degree of lacerations in delivery
2nd- underlying subq tissue 3rd- rectal sphincter, but not mucosa 4th- extends into rectal mucosa
202
Late deceleration
Reflect hypoxemia of the fetus with CST or NST
203
STOP late decels
Sterile vaginal exam Turn patient on left side Oxygen Pitocin off
204
Biophysical profile scores
Normal = 8-10 Equivocal is 6 Abnormal is <4
205
<20 weeks growth
Hyperplastic, number of cells symmetric growth restriction
206
>20 weeks growth
Hypertrophic, size of cells is growing Asymmetric intrauterine growth restriction
207
Vasa previa
Unprotected fetal vessels lying over the cervix Can cause large bleeds, requires c section
208
Placenta accreta, increased and percreta
Accreta- attaches to myometrium Increta- invades the myometrium Percreta- penetrates through the myometrium
209
External version
Don't perform before 36 weeks GA Initially without anesthesia, can re attempt at 39 weeks with epidural
210
Fetal fibronectin asay
Vaginal swab of posterior fornix, if negative then there is a 99% chance for NO preterm delivery
211
McDonald versus shirodkar cerclage
McDonald- suture placed at cervical/vaginal junction Shirodkar- suture placed at internal os
212
Bishop score
If 6 or greater, induce because it should go well If they are induced, how likely will it be to a spontaneous vaginal birth
213
Stay in hospital after birth
2 days if vaginal | 3-4 days if C section
214
HELLP
Hemolysis Elevated liver enzymes Low platelets
215
Transvaginal US vs. transabdominal US levels
Vaginal- 1000-2000 | Abdominal- 5000-6000
216
Medicinal approach to abortion is appropriate...
<49 days gestation
217
Isoimmunization can occur when...
Rh negative mom has a fetus with a rh positive dad (rh positive baby)
218
Screening for rh
1st prenatal visit 28 weeks Delivery
219
Anti D immunoglobulin administered at ...
28 weeks Postpartum to a negative mom that delivers positive baby
220
MCC of post partum hemorrhage
Uterine atony
221
Anemia in pregnancy is when...
Hgb is less than 11, hct is less than 33%
222
Prevention and traetment of folic acid deficiency anemia
.4 mg of folic acid for prevention 1 mg daily of folic acid for treatment
223
Antiphospholipid syndrome
Recurrent pregnancy losses Treated with heparin and ASA
224
Group b strep screening
Between 35-37 weeks GA, if positive treat with antibiotics during labor
225
DM type 1B
Idiopathic, inflammation but not anti islet autoantibodies
226
Latent autoimmune diabetes of adulthood
Adult age of onset, don't need insulin for about 6 months
227
Maturity onset diabetes of the young
Rare, mild form of noninsulin dependent DM Impaired glucose-induced secretion of insulin
228
OGTT
Restrict carbs, 8 hours fast, no smoking or exercise the day of the test 0 and 120 minute blood draws
229
Serum fructosamine
Eval of glucose levels in the preceding 1-2 weeks Greatly affected by serum albumin, but helpful when there are hemoglobinopathies
230
DM test values for fasting plasma glucose, OGTT and HbA1c
Fasting- >126 2 hour OGTT- >200 HbA1c- >6.5
231
Nonproliferative diabetic retinopathy
Early stages Microaneurysms, dot hemorrhages, exudates and retinal edema
232
Proliferative diabetic retinopathy
Leading cause of blindness in the US New, fragile capillary growth, hemorrhages, increased risk of retinal detachment from fibrous tissue growth
233
Isolated peripheral neuropathy
Sudden onset with subsequent recovery, motor abnormalities predominate Vascular ischemia, traumatic damage Cranial and femoral nerves
234
Monitoring hba1c
Every 3 months if treatment changes or not at goal Every 6 months if stable and at goal
235
DKA triad
Hyperglycemia Ketonemia Anion gap metabolic acidosis
236
Cornerstone of DKA treatment
Fluid replacement! Need to restore normal perfusion Keep BS between 250-300 to prevent hypoglycemia/cerebral edema
237
Sodium bicarb replacement in DKA
If pH is less than 7
238
Whipple triad
Pancreatic beta cell tumor 1. Hx of hypoglycemic symptoms 2. Fasting BS less than 45 3. Glucose administration leads to recovery
239
Noninsulinoma pancreatogenous hypoglycemia syndrome (islet cell hyperplasia)
Hyperinsulin hypoglycemia after meals, but not with fasting!
240
Occult diabetes
Exaggerated insulin release after initial hyperglycemia from GTT Delay in early insulin release, potential diabetics!
241
Most common cause of worldwide hypothyroid
Iodine deficiency
242
Posterior pituitary secreted
Oxytocin and ADH
243
Gigantism vs acromegaly
In gigantism, epiphyseal plates are still open. Acromegaly they are already closed
244
Acromegaly labs
IGF-1, normal values of this rule out this diagnosis
245
Pituitary apoplexy
Sudden onset of HA, visual changes, AMS, hormonal abnormalities Hemorrhagic or ischemic
246
Cortex vs medulla
Cortex secretes steroids and estrogen/androgen Medulla secretes the catecholamines
247
Conn syndrome
Hyperaldosteronism from an adrenal adenoma
248
Adrenal insufficiency diagnosis
ACTH stimulation test Pretest serum cortisol, administer synthetic ACTH Cortisol should double within an hour, and if it doesn't the adrenals aren't functioning properly
249
Pheochromocytoma
Severe HA Tachy/palpitations Perspiration
250
Hypocalcemia effect on muscles
Causes hyperexcitability!
251
Hypercalcemia on muscles
Causes hypoexcitbaility, depresses neuronal activity
252
3 ways that PTH increases calcium
Bone resorption Renal reabsorption Increased intestinal absorption
253
Hypoparathyroidism presentation
Tetany, muscle cramps/spasms, tingling, lethargy or anxiety, cataracts, prolonged QT
254
Pseudohypoparathyroidism
Congenital resistance to PTH Hypercalcuria and hypocalcemia, PTH still acting normally at the level of the bone so short metacarpal bones, short stature, osteodystrophy
255
Secondary hyperparathyroidism
CKD/dialysis Phosphorus is not getting excreted, PTH thinks we are hypoglycemia
256
Hyperparathyroidism presentation
Bones, stones, abdominal groans, psychic moans with fatigue overtones Brown tumors, kidney stones
257
Post op secondary hyperparathyroidism
Hungry bones that soak up ca Persistently low ca triggers PTH release
258
Defective mineralization of bones...
Rickets in kids Osteomalacia in adults
259
Paget dz of bone/osteitis deformans
Excess bone mass with little integrity Tibial bowing, chalkstick fx, hearing loss
260
If thyroid nodule is greater than 2 cm...
Use TSH
261
Follicular thyroid CA
Elevated thyroglobulin More aggressive than papillary
262
Medullary thyroid cancer
Secrete calcitonin, CEA Flushing, diarrhea
263
Osmolality equation
2(sodium) plus glucose/18 plus BUN/2.8
264
Serum osmolality reference range
285-295
265
If spot urine is less than 10, suggests...
Extrarenal salt loss, kidneys are trying to hold onto sodium
266
DI
ADH deficiency or resistance If deficiency, its central DI If resistance, its nephrogenic DI
267
DI workup
Desmopressin challenge Central DI will have decreased thirst and urination if given desmopressin (tx of choice)
268
Hypokalemia effect on neuromuscular
Tougher to trigger action potential
269
Hyperkalemia effect on neuromuscular
Easier to trigger action potential, hyperexcitability
270
Mg and K
Mg inhibits K secretion, so if hypokalemia, HAVE to check Mg levels
271
Hypokalemia on EKG
U waves St depression Broadened and flattened T waves PVCs
272
Drugs causing hyperkalemia
K sparing diuretics ACEIs ARBs Trimethoprim Digitalis toxicity
273
Hyperkalemia EKG changes
Peaked T waves Wide QRS V Fib
274
KDIGO criteria for AKI
Increase in serum Cr >.3 in 48 hours Increase in serum Cr >1.5x baseline within prior 7 days Urine volume 6 hours Any of these!
275
Prerenal AKI
MCC Renal hypoperfusion BUN:Cr >20:1, low excretion of sodium in the urine
276
NSAIDs and ACE inhibitors effect on glomerulus
NSAIDs dilate the afferent arteriole ACEIs and Arbs constrict the efferent arteriole
277
Postrenal AKI
Obstructive Increased urine sodium Isosthenuria (urine and plasma osmolality become the same)
278
2 causes of acute tubular necrosis
Ischemia | Nephrotoxin
279
Interstitial nephritis
``` Drugs are the culprit! Fever Rash Eosinophilia RBCs in urine ```
280
Renal tubular acidosis
Defect in wither proximal tubular bicarb reabsorption or defect in distal tubule hydrogen ion secretion Normal anion gap, hyperchloremic metabolic acidosis
281
Nephritic
Hematuria Proteinuria <3 g HTN Edema
282
Postinfectious GN
Lumpy bumpy/starry sky pattern on immunofluorescence Sub epithelial humps 1-3 weeks post infection
283
IGA nephropathy
Gross hematuria, associated post infection 1-2 days
284
Pauci immune GN
Fever, malaise, weight loss prodrome ANCA subtyping
285
Anti GBM GN
Goodpasture syndrome with hemorrhage in the lungs
286
Membranoproliferative GN
Tram track appearance, nephritic or nephritic syndrome
287
Nephrotic
Hyperproteinuria Hypoalbuminemia Hypertriglyceridemia Edema
288
Minimal change dz
Kids | Fused foot processes
289
Membranous nephropathy
MCC of Primary nephrotic syndrome in adults DVT is a common initial sign Spike and dome pattern
290
HTN plus abdominal mass, think...
PKD
291
Complications of PKD
Cerebral aneurysm in the circle of Willis, other vascular issues
292
Swiss cheese kidney =
Medullary sponge kidney
293
Wilms tumor
Most common malignant renal tumor of childhood
294
MCA stroke findings
More face and arm deficits Aphasia Neglect of non dominant
295
ACA stroke findings
Leg more than face/arm deficits Abulia, paratonic rigidity, grasp reflex Incontinence
296
PCA findings
Visual abnormalities 3rd CN palsy Spontaneous pain
297
Vertebrobasilar stroke findings
``` Ataxia Dizziness NV CN palsies Coma ```
298
Vegetative state
Intact wakefulness, sleep wake cycles, but absent awareness
299
Minimally conscious state
Intact wakefulness, and awareness but poor response
300
Locked in syndrome
Intact awareness and wakefulness

Clin Med 2 (8 decks)

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