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IPAP > IMC/FM/EMED Rheum/Endo/Renal > Flashcards

IMC/FM/EMED Rheum/Endo/Renal Flashcards

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1
Q

Define RA

How does this present on exam

What two syndromes can be seen w/ this Dz

A

Chronic autoimmune inflammatory dz w/ persistent symmetric polyarthritis

AM stiffness improving throughout the day affecting DIP and PIP

Felty’s: RA+splenomegaly and repeat infection
Caplan: pneumoconiosis and RA

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2
Q

What lab result is most specific for Dx RA

How is RA Tx

What drug can be used for Tx of RA and Ankylosing but w/ ? s/e

A

Anti-CCP

Methotrexate
Hydroxychloroquine
Sulfasalazine

Leflunomide; diarrhea

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3
Q

What will be seen in lab results of OA

What issue develops from OA in the knee

What are the 3 meds that can cause lupus

A

Normal ESR/CRP

Bakers Cyst

Procainamide
Isoniazid
Quinidine

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4
Q

SLE is a systemic autoimmune d/o characterized by ? triad

? is the best, initial test for Dx SLE

What f/u test is used for confirmation that is 100% specific

A

Butterfly rash, spares nasolabial folds
Joint pain
Fever

ANA

dsDNA
AntiSM

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5
Q

? lab result in an SLE work up indicates Pt is at higher risk for thrombosis

What result is associated w/ false positives

Pregnant females with the above result are at risk for miscarriages if they also have ?

A

Antiphospholipid Ab syndrome

Anticardiolipin Ab

B2 glycoprotien 1 Ab

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6
Q

What two biomarkers in an SLE work up indicate a higher risk for neonatal lupus erythematosus

? result has a high sensitivity for drug induced lups

A

Anti-Ro and Anti-La

Antihistone Ab

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7
Q

SLE is Dx by four or more of ? mnemonic

A 
RASHNIA-4
Rneal d/o
Arthralgia
Serositis
Heme d/o
Neuro d/o
Imm derangemetns
ANA

4 types of rash:
Malar
discoid
Photosensitivity
Mucosal involvement
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8
Q

How is SLE Tx

Define CREST Syndrome

What condition is this syndrome associated w/?

A 
Hydroxychloroquine
Acetaminophen
NSAIDs
Sun protection
Methotrex/Cychophos

Calcinosis
Raynauds
Esophageal dysfunction
Sclerodactyly
Telangiectasis

Scleroderms

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9
Q

How is Scleroderma Dx

How is it Tx

What medication is reserved for resistant cases

A

Anti-centromere: limited CREST, better prognosis
Anti-SCL 70: diffuse dz w/ multiple organ involvement

Methotrexate
Mycophenolate

Cychlophosphamide

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10
Q

How is Raynauds in Scleroderma Tx

How is P-HTN Tx in scleroderma

How is the renal invovlement Tx in scleroderma

A

CCBs and prostacyclin

Ambrisenten
Tadalafil

ACEI: Captopril drug of choice during renal crisis

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11
Q

Ankylosing Spondylitis is also associated w/ ? Dxs

? is the gold standard method to eval and support a Dx

How is this condition Tx

A

Psoriasis
Anterior uveitis
IBDz
Regurg, aortic

X-ray

PT, NSAIDs
Refractory:
a-TNFs: Etanercept, Infliximab
Joint Sxs: Sulfasalzine, Methotrexate

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12
Q

? is the classic triad of Reiters Syndrome

What type of infections is this MC seen w/

How is it Dx

A

Conjunctivitis
Urethritis
Oligoarthritis

G/C
Campylobacter
Salmonella
Yersinia
Shigella

HLA-B27
Synovial fluid: aseptic w/ negative bacterial cultures

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13
Q

How is Reiter’s Tx

Define Gout

What causes these attacks/flares

A

NSAIDs
ABX
Methotrexate
Etanercept/Infliximab

Uric acid accumulation in joints/tissue

Purine rich food

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14
Q

What meds can cause/worsen gout attacks

What is the name of the attach in the great toe

Define Pseudogout

A 
Thzd/Loops
ACEI
Pyrazinamide
ASA
ARBS men >30 and postmenopause women

Podagra

Ca pyrophosphate crystals accumulate in tissues

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15
Q

What joints does Pseudogout affect most often

What will be seen on x-rays of pseudogout

What uric acid levels helps confirm a Dx of tou

A

Knees, Wrist

Chondrocalcinosis- linear radiodensities

> 7.5

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16
Q

What does gout look like under microscope

What does psuedogout look like under microscope

A

Neg birefringent needle crystals

Pos biregringent rhomboids

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17
Q

What is done for acute management of gout

What drug is used for 2nd line Tx

What med is used for no response to any of the above

What drug needs to be avoided

A

NSAIDs-
Naprosyn, Indomethacin

Colchicine

Prednisone, possible first line in elderly Pts

ASA- inc uric acid levels

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18
Q

When is chronic gout management considered

What is used for management

A

2 or more acute gout flares/year

Allopurinol- dec production
Probenecid (Uricosuric drug)- inc urine excretion
NSAID/Colchicine x 3mon

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19
Q

How is pseudogout Tx

What is used for prophylaxis

Define Polymyositis

A

First line: CCS
NSAIDs

Colchicine

Chronic, idiopathic inflammatory dz of muscle causing symmetric, proximal weakness/pain

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20
Q

What would be seen on PE in Pts w/ Polymyositis

What parts of the body are MC affected

How is Polymyositis different from Dermatomyositis and Polymyalgia Rheumatica

A

Early fatigue
Inability to rise from seated

Shoulders, Hips

Derm: skin changes
PR: lack of joint pain
Polymyositis will have inc muscle enzymes

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21
Q

Define Dermatomyositis

What differentiators may be seen on exam

A

Autoimmune myopathy w/ symmetric proximal weakness AND cutaneous findings

Gottrons: raised purple, scaling plaques on bone prominences

Shawl/V-sign: pink rash on neck/trunk

Heliotrope rash: purple/red rash around eyes/on lids

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22
Q

What would be seen on muscle biopsy results in Dermatomyositis Pts

What serology result is specific for Dermatomyositis

What marker is specific for interstitial lung fibrosis

A

Endomysial inflammation

Anti-Mi-2 Ab

Anti-Jo 1 Ab

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23
Q

How is Polymyositis/Dermatomyositis Tx

Fibromyalgia is associated w/ ? three issues

How is it Tx

A

Suppress w/ CCS
Long term Polymyositis management w/ Methotrexate

RA
Apnea
Hypothyroid

TCAs
Swimming
Pregablain

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24
Q

What part of the body is attacked during Sjogrens

How is it Dx

What test can be done in office for Dx

A

Exocrine glands

ANA
Anti-SS A (anti-RO) and,
Anti SS B (anti-La)

Schirmers tear test: pos if <5mm lacrimation in 5min

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25
How is Sjogrens Tx What is the Rule of 50 for GCA What branches of the carotid artery are affected by GCA
Tears Pilocarpine- cholinergic for xerostomia Cevimeline Age >50 ESR >50 Steroids >50 Posterior Ciliary Occipital Ophthalmic Temporal
26
# Define Polymylagia Rheumatica This condition is heavily associated w/ ? other d/o What do Pts present w/ as c/c
Inflammatory condition causing synovitis, bursitis and tenosynovitis GCA Morning stiffness and joint swelling w/ normal strength
27
How is Polymyalgia Rehumatica managed Define Polyarteritis Nodosa Small percentage of Pts will have ? underlying d/o
CCS Methotrexate Vasculitis of med/small arteries Hep B/C
28
Two abnormal c/c making Polyarteritis Nodosa a possible dx How is a Dx confirmed How is this condition Tx and what is used for refractory cases
New foot/wrist drop Rapid developing HTN Biopsy- necrotizing arteries Ateriography- aneurysms in small/med arteries CCS Refractory= Cyclophos +Hep B: plasmapheresis
29
? is the MCC of hypothyroidism What will be seen on lab results How is this form of thyroid d/o Dx
Hashimotos High TSH, low FT4 Anti-TOP Abs
30
? type of anemia is commonly seen in hypothyroidism What other lab result is usually high too How is this Tx
Normo/Normo Serum cholesterol Thyroxine/Synthroid
31
? is the MCC of hyperthyroidism What will lab results show How is this Tx
Graves dz Low TSH, high T3 and FT4 (graves- only T3 is elevated) Methimazole- mild cases PTU- including pregnancy
32
# Define Thyroid Storm How is hyperthyroidism Dx How are cardiac Sxs of hyperthyroidism Tx
Hyperthyroidism from uncontrolled/un-Dx hyperthyroidism Anti-thyrotropin Abs (TSHR-Ab)= Graves Atenolol
33
How is Graves Dz Tx What are 5 etiologies of thyroiditis
Methimazole PTU ``` Hashimotos Post-Partum Subacute (Quervains) Drug induced Infection w/ bacteria ```
34
? is the MCC of thyroid pain What is the etiology of this MC What path does this follow and w/ ? lab result
Subacute thyroiditis (Quervains) Post infectious/viral Hyper to hypo-thyroid; Inc ESR
35
Two common meds that cause thyroiditis Infectious thyroiditis are usually d/t ? microbes Painful thyroiditis usually means ?
Lithium Amiodarone Staph/Strep Trauma Radiation Infection Painful subacute
36
How is Subacute/Postpartum thyroiditis Tx ? is the MC RF for thyroid Ca ? is the MC type
BBs, ASA Radiation Papillary
37
? is the MC benign thyroid nodule Thyroid nodules must be bigger than ? size to be palpable What are the RFs for thyroid Ca
Thyroid adenoma >1cm diameter FamHx Age >65/<20 Radiation
38
How are thyroid Ca Dx What imaging results are suspicious for Ca How to tell if thyroid nodules are malignant or not
US >1cm- biopsy ``` Calcifications Hypoechogenicity Solid Irregular margins Chaotic vasculature More tall than wide ``` Thyroid uptake: Ca- cold, no uptake; next step= FNA Benign- hot, will uptake
39
How is thryoid Ca Tx What Tx step is different for ? type of Ca What does hyperparathyroidism cause
Thyroidectomy w/ chemo External beam radiation- anaplastic Ca Inc PTH= Inc Ca; Ca >12= Sxs
40
What causes Primary and Secondary Hyperparathyroidism What saying goes w/ the presentation of hyperparathyroidism What would be seen in UA results
P: PTH secreting parathyroid adenoma S: CKDz Bone pain Stone, kidney Groan, ab cramps Psychic depression, irritability, psychosis Hyperphosphate HyperCa
41
How is hyperparathyroidism Tx How can the hyperCa be Tx What is used for Tx if osteroporosis is present
Ectomy Furosemide Calcitonin Bisphosphonates
42
What are the two MCC of hypoparathyroidism What two PE findings suggest this Dx What is seen on EKG
Surgical damage Autoimmune destruction Trousseaus: carpal Inc DTRs Chvosteks: facial Prolonged QTc
43
How is hypoparathyroidism Tx immediately What is done if tetany is present What is done for long term management
Vit D, Ca Secure airway IV Ca gluconate Recombinant PTH
44
? bone Ca is most associated w/ Paget's Dz Define Paget's Dz ? infection can cause this dz
Osterosarcoma (Paget's Sarcoma) Bone remodeling d/o leading to less compact/weaker bones Measles
45
What parts of the body are MC involved w/ Paget's Dz What PE finding can be seen in these areas What non Ortho issue can PTs have
Skull Lumbar Pelvis Femur Excessively warm d/t inc vasculature Deafness
46
How is Paget's Dz Dx How is this condition Tx Define DMT1
Inc ALP levels CXR- lytic lesions, thickened cortices Bisphosphonates Calcitonin Autoimmune Abs against B-cells
47
# Define Dawn Phenomenon Define Somogyi effect How is each one corrected
Normal glucose until early AM increase d/t insuline sensitivity/nightly surge of regulatory hormones Nocturnal hypoglycemia followed by hyperglycemia rebound d/t GH surge D: inc bedtime insulin S: dec bedtime insulin dose
48
? type of fluid should be used in the Tx of DKA What lab results Dx DMT1 How are all DMT1 Tx
NS Fasting >125 A1c 6.5%/> Random >200 w/ Sxs Insulin w/ Basal/pre-meal A1c rechecks q3mon
49
When does ASA become part of DMT1 Tx What vaccinations are needed
Men >50y/o or Women >60y/o w/ one CVD RF: Hyper-tension/lipid or albuminuria Tdap Annual flu PCV-13 Pneumococcal
50
Onset, Peak and Duration of insulin
Novolog/Apidra/Humalog: 10-15m 60-90m 4-5hrs Regular: 30-60m 2-4hr 5-8hrs NPH 1-3h 5-8hrs 12-18hrs Levemir 90min no peak 12-24hrs Lantus 90min no peak 24hrs
51
# Define Gynecomastia Define Pseudogynecomastia What is the MCC in infants/boys
Enlarged breast tissue Appearance of enlarged breast in obese Pts Physiologic gynecomastia
52
What is the MCC of gynecomastia in men What labs are ordered when onset is painful/sudden w/out drugs or pathological cause How is Osteoporosis Dx
Persistent pubertal Idiopathic Drugs: spironolactone, anabolics, antiandrogens ``` TSH FSH T Estradiol hCG ``` DEXA scan Confirmed fragility Fx
53
What do T-scores mean Directions for use of medications during Tx What adverse outcome can occur
Porosis: -2.5/< Penia: -1 - -2.4 Take on empty stomach w/ 8oz of water, remain upright x 30min Jaw osteonecrosis
54
How is osteoporosis Tx What med is used in Pts w/ very high risks for Fxs What other time is the above med used
Alendronate Risedronate Teriparatide- recombinant PTH (T-score -3.5 or less Pts continue to Fx while on bisphosphonates
55
# Define Primary Adrenal Insufficiency What causes secondary adrenal insufficiency What infection can cause Primary Insufficiency
Dz in adrenal gland causing dec cortisol secretions Exogenous steroid- MC Pituitary adenoma TB
56
What meds can cause Primary Adrenal Insufficiency How is Adrenal Insufficiency Dx What results mean Dx
Phenytoin Rifampin Ketoconazole Barbituates 8AM serum cortisol and ACTH High ACTH, low cortisol= primary Low ACTH, low cortisol- secondary
57
How is a Dx of Adrenal Insufficiency confirmed and differentiated between Primary/Secondary How is Primary/Secondary Tx
Cosynotropin Stim test- Primary: high ACTH, low cortisol Secondary: little/no increase of cortisol after ATCH is given Addison: Hydrocortisone Fludrocortisone Secondary: pituitary adenoma resection
58
# Define Pheos What other Dxs are these associated w/? What are the 5 Ps of Pheo Sxs
Catecholamine secreting adrenal tumor releasing Epi/NorEpi NF-1 MEN 2A/@b Von Hippel Dz ``` Pressure, HTN Pain, HA Perspiration Palpitations Pallor ```
59
How are Pheos Dx How are these Tx What has to be done prior to Tx
24hr catecholamine UA for metanephrine/canillylmandelic acid Adrenalectomy A-blockade: phenoxybenzamine or, Phentolamine
60
# Define Cushings Syndrome Define Cushings Dz What will be seen in lab results of Syndrome
Inc cortisol Sxs Inc cortisol d/t excess ACTH, usually pitutary adenoma Inc cortisol/BP Dec K
61
Why do Cushing's Dz Pts gain weight How is Cushings Syndrome Dx
Cortisol stimulates fat/carb metabolism Insulin released Increased appetitie Dexamethasone suppression test and, 24hr urine cortisol- gold standard
62
When working up Cushings Syndrome, what is the next step after a positive low dose dexamethasone test What are results interpretted
High dose dexamethasone suppression test Dec ACTH: adrenal tumor Inc/Norm ACTH: ectopic ACTH producing tumor
63
Cushings Syndrome is Tx by removing ectopic/adrenal tumor, what is done for PTs ineligible for surgery What is the difference between gigantism and acromegaly How is Acromegaly Dx
Ketoconazole Giant: GH secretion in childhood prior to epiphyses closing Acro: GF secretion starts in adulthood Serum IG-F1
64
How is Acromegaly Tx if surgical resection is not possible Define Diabetes Insipidus What are the two types
Octerotide/Lanreotide to suppress GH secretion Deficiency/resistance to vasopressin Central: MC; no ADH production Nephrogenic: insensitivity to ADH
65
What drugs can cause Nephrogenic Diabetes Insipidus What electrolyte abnormalities can cause DI
Lithium Amphoterrible HyperCa HypoK
66
How is Diabetes Insipidus Dx w/ lab results What is the simplest and most reliable test to Dx How is a Dx differentiated from Central and Nephrogenic
High serum osmolality Low urine osmolality Water deprivation test: DI continues to produce diluted urine Desmopressin stimulation test: Central: dec urine output (no ADH production) Nephro: continues urine production (ADH resistance)
67
How is Central Diabetes Insipidus Tx How is Nephrogenic Diabetes Insipidus Tx
Desmopressin/DDAVP- monitor E+ Na/Protein restrictions Chronic: Hydrochlorothiazide, Amiloride Acute in FamMed/ER: Indomethacine
68
What are the four types of stones seen in Nephrolithiasis Which ones are radiolucent and radiopaque
Ca Oxalate- MC; grapefruit inc production Struvite: chronit UTI d/t Klebsiella, Proteus Uric acid- acidic urine Cystine- genetic difficiency; Paque: oxalate, struvite Lucent: cystine, uric acid
69
How is Nephro/Urolithiasis Dx How are these conditions Tx What are the indications to admit
CT w/out contrast Morphine/Ketoralac Hydration ABX if +UTI Flomax- A-blocker; stones 5-10mm Pain uncontrolled w/ PO meds Anuria Renal Colic and UTI/Fever
70
When are elective lithotripsys considered for Nephro/Urolithiasis Tx ? is the MC method of lithotripsy What is the next step if lithotripsy fails to Tx
5-10mm >10mm- stent of nephrostomy if renal function jeopardized Extracorporeal- best for stones <5mm, <2cm Percutaneous nephrolithotomy- >2cm
71
# Define Cystitis What two findings help solidify this Dx What is the first and second MC microbe to cause this type of infection
Bladder infection w/ dysuria and w/out d/c Afebrile No flank pain 1st: E Coli 2nd: Enterococcus/Saprophyticus
72
What is the MCC of recurrent cystitis in men How is Cystitis Dx How are they Tx What is used for pain relief
Chronic bacterial prostatitis Culture- gold standard Dipstick: nitrite, leukocyte esterase TMP-SMX Nitrofurantoin Fluoroquinolone Fosfomycin Phenazopyridine
73
ASx bacteriuria in geriatrics requires no Tx unless ? How are UTIs Tx in pregnancy How are postcoital UTIs Tx
DM Sructural abnormals Nitrofurantoin Cephalexin TMP-SMX Cephalexin
74
How are UTIs in Peds Tx How does Pyelonephritis present What microbe is the MCC
Low risk renal involvement: Keflex High risk for renal involvement: Cefuroxime Fever CVA tenderness N/V E Coli
75
What UA result is pathognomonic for pyelonephritis What other Dx is this pathognemonic for How is this Tx
WBC casts Interstitial nephritis Cipro/Levo/Cephalexin
76
What is used for Tx pyelonephritis in admitted Pts How are these infections Tx in pregnant Pts What is the most important RF for ED
Ceftriaxone Admit, IV Ceftriaxone Artherosclerosis of cavernous arteries d/ smoking/DM
77
Priapism is associated w/ ? 3 etiologies How is ED Tx What is the MOA
Trazodone Coaine Sickle cell dz Phosphodiesterase inhibitors Inc cGMP to increase NO release
78
What ED Txs need to be taken w/ or w/out food Which one has the longest effect of 24-36hrs How are med induced priapisms Tx
Sildenafil- w/ Vardenafil- w/out Tadalafil Stairs Sudafed
79
What are the 5 types of incontinence
Mixed- MC Urge- detrusor over activity Dx: urodynamic study Functional- physical/mentally disabled Overflow- impaired detrusor contractility Stress- weak pelvic floor; post-pregnancy
80
? is the only mandatory lab needed for Peds w/ enuresis Define Nocturnal Enuresis
UA Involuntary sleeping urination after 5y/o
81
How is incontinence Tx depending on etiology
Mixed- lifestyle mod and floor exercises Urge- training, Oxybutynin, Imipramine- TCA Functional- schedule Overflow- self-cath, Bethanechol, -zosin) Stress- kegels, vaginal estrogen, pessary, mid-urethral sling surgery
82
Epididymitis is characterized by ? triad How is the microbe etiology differed by age What PE finding is classic for this Dx
Dysuria Unilateral pain, posterior testis Swelling <35: G/C >35: EColi Prehns- relief w/ elevation
83
How is Epididymitis Tx How is this Tx in Pts that practice insertive anal sex Define Orchitis
``` <35y/o: Ceftriaxone and Doxy >35y/o: Levoflox or, TMP-SMX ``` Ceftriaxone and Levofloxacine Ascending bacterial infection from urinary tract to testes
84
How is Orchitis Dx How is this Tx
UA w/ culture: Pyuria, Bacteriuria <35y/o: Ceftriax and Doxy or Azithromycin >35 w/ no STI DDx: Levofloxacin (x21 days if w/ prostatitis)
85
How does acute bacterial prostatitis present on DRE What is the MC form of prostatitis How does the MC present on DRE
Boggy, warm and tender Chronic Enlarged, non-tender
86
How are acute/chronic prostatitis Dx What microbe will usually be isolated from prostate fluids How is prostatitis Tx
Acute: UA w/ WBC, +cultures Chronic- negative cultures ``` <35y/o: Ceftriax and Doxy >35y/o/ chronic: Fluroquinolones or Bactrim IV Levo/Cipro ```
87
Pts w/ BPH need to avoid ? three classes of drugs How does BPH present on DRE What PSA result is beneficial for Dx
Anticholinergic Sympathomimetics Opioids Enlarged, firm/rubbery Normal: <4 BPH/Ca/Prostatitis: >4
88
How is BPH Tx How is this Tx if Pt is refractory to meds How does prostate Ca present on DRE
Tamsulosin 5-a reductase- dec size: Finasteride/Dutasteride TURP; transurethral resection of prostate Hard, nodular and asymmetric
89
What are the two RFs for prostate Ca What is the Dx work up When is screening done
Age FamHx PSA >4: US w/ needle biopsy PSA >10: bone scan >50y/o 40y/o if first degree FamHx/AfAm
90
How is Prostate Ca Tx How is this Tx if mets is present How is this Tx if no mets are present What is used for monitoring
Prostatectomy Ieuprolide Castration PSA <0.1
91
? is the MC type of bladder Ca What is the 'classic' presentation How is this definitively Dx
Transitional cell Ca Painless hematuria in smoker Cystoscopy w/ biopsy
92
How is bladder Ca Tx What is the classic triad for renal cell carcinoma What is the MC type of renal cell carcinoma and w/ ? RF
Endoscopic resection w/ cystoscopy q3mon Flank pain Hematuria Mass Clear cell; smoking
93
What are the first tests for Dx renal cell carcinoma How is this Tx How does testicular cancer present
Abdominal CT/US Radical Nephrectomy Firm, painless mass in 15-40y/o
94
? is the MC type of testicular Ca What are the two types of this MC What is the RF for this type of Ca
Germ cell tumor Seminoma Non-seminomatous Cryptorchidism
95
How is testicular Ca Dx What are the 3 most likely locations for mets What tumor markers are used What non-tumor marker is also used
US Belly Brain Lung AFP- NSGCT only HCH- both seminoma and NSGCT LDH- Higher seminoma burden NSGCT recurrence
96
How is testicular Ca Tx ? is the most convenient marker for assessing acute RF What are the 3 mechanisms of acute RF
Orchiectomy Seminoma- radiosensitive NSGCT- radioresistant Creatinine Pre: perfusion Renal: glomerular, tubular, interstitial Post: obstructive
97
What do UA results look like in pre-renal acute RF What do UA results look like in renal acute RF
Spec Grav: >1.030 BUN/Cr >20 Osmolality >500 FENA <1 Spec Grav <1.010 BUN/CR <10 Osmolality <300 FENA >1
98
During renal failure work ups, what doe the following mean RBC casts WBC casts Muddy casts Hyaline casts Waxy casts Inc osmolality FENA >2%
RBC: glomerulonephritis WBC: pyelonephritis Muddy: tubular necrosis Hyaline: normal Waxy: chronic renal dz O-FENA: tubular necrosis
99
What are the 3 MC causes of acute renal failure in order
Tubular necrosis Interstitial nephriti Glomerulonephritis
100
What causes acute tubular necrosis What is the MCC What does the FENA look like
Kidney ischemia Toxins Pre-renal fialure >2%
101
What causes Interstitial Nephritis What will be seen on UA results How is it Tx
Immune mediated response WBC casts, Hematuria Eosinophils D/c offender CCS Dialysis
102
What are the 3 etiologies of Glomerulonephritis What will be seen on UA results What criteria is needed for Dx of CKDz
IGA nephropathy (bergers dz) Post-infectious Membranoproliferative Hematuria RBC casts ``` eGFR <60mL x 3mon or, Albuminuria >30mg/day Proteinuria/Cr >0.2 Hematuria Structural abnormals ```
103
? is the MCC of CKDz How is CKDz staged What stag is considered "symptomatic stage"
DM 1: normal GFR w/ persistent albuminuria/structural dz 2: GFR 60-89 3: GFR 30-59 4: GFR 15-29 5: GFR <15 Stage 4
104
Pts w/ CKDz need to avoid ? compound ? UA result is a specific finding to CKDz ? marker is used for kidney damage w/ ? appearing early in dz
Mg Broad waxy casts Proteinuria; Microalbuminuria
105
How is CKDz Tx What is the JNC-8 BP goal What is the A1c goal range What vaccine do Pts need
ACEI/ARB <140/90 11-12g Pneumococcal
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# Define Glomerulonephritis There are two types and are based on ?
Inflammed glomeruli causing protein/RBC leakage into urine d/t immune response 24hr protein: Nephritis 1-3.5g/day Nephrotic >3.5g/day
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What is the classic presentation of Nephritic Syndrome ? infection can cause this syndrome How is this post-infectious etiology Dx
HTN Edema RBC casts Proteinuria <3.5g/day Group A strep ASO titer w/ low complement
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? is the MCC of anute glomerulonephritis worldwide How do Pts present How is this Dx
IgA Nephropathy- Berger Dz Gross hematuria Flank pain URI IgA deposits in mesangium
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# Define Alports Syndrome What non-renal exam needs to be done How is this syndrome Dx
Isolated, persistent hematuria in Peds w/ RF and hearing loss Ophth exam: anterior lenticonus Complement
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What causes Membranoproliferative Glomerulonephritis How is this form Dx What lab result is Dx of Rapidly Progressing Glomerulonephritis
SLE Viral hepatitis C Low C4, C4 Crescent formation of biopsy d/t fibrin/plasma proteins
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Rapidly Progressing Glomerulonephritis is AKA ? ? type of Abs are found How is it Tx
Goodpastures Anti-GBM Steroids Plasmapheresis Cyclophosphamide
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What type of Abs are seen in Rapidly Progressing Glomerulonephritis induced vasculitis This is AKA ? Glomerulonephritis as a group usually has ? decreased lab result and needs / for Dx
ANCA Abs Wegners Dec C3, Renal biopsy- gold standard
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How is Glomerulonephritis Tx This Tx is changed to ? in post-strep nephritis How is the IgA nephropathy Tx
Enalapril/Losartan Nifedipine CCS
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What makes the cysts in PCKDz ? other life threatening c/c can these Pts present w/ What cardiac abnormalities can these Pts have
Epithelial cells from renal tubules Worst HA d/t brain aneurysms MVP, LVH
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How is PCKDz Dx What genetic studies are needed How are these Pts managed until transplant is possible
US PKD-1 and 2 ACE/ARB
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? is the MC E+ d/o What causes this MC to occur What are the 4 types
HypoNa Hypotonic fluids HypoVol, HypoNa- volume contracted HyperVol, HypoNa- volume expanded SIADH- volume expands w/out edema HypoNa w/ euvolemia
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How is HypoNa Tx How fast is Tx limited to If severely hypoNa, don't Tx faster than ?
0.9% NS Loop diuretics No fast 0.5mEq/L/hr 3% NS; Don't exceed 10mEq over 24hrs to avoid demyelination syndrome
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What lab result suggest HyperNa How is this Tx What happens if Tx is too fast
BUN/CR >20:1 D5W Cerebral edema Pontine herniation
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HyperK can be seen in ? stage CKDz How is this Tx When is HypoK seen
Stage 5 Peaked T-wave Prolonged QRS Sodium bicarb Insulin Glucose Diuretic OD Cushing syndrome
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What does HypoK look like on EKG What is avoided while replacing K MCC of hypo/hyperCa
Flat/Invert T wave U-waves Destrose- stimulates insulin and will cause K shift into cells Hypo: Hypoparathyroidism Hyper: hyperparathyroidism
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How does HypoCa look on EKG How is it Tx How is HyperCa Tx
Prolonged QT Ca gluconate Ca chloride NS and furosemide
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How does HypoMg present How is this Tx How is HyperMg Tx
Weak Hyper-reflex Widened EKG Acute: IV Mg Chronic: PO Mg Isotonic saline Loop diuretics
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What is the average value rule for Acid-Base d/os What is the 3 step approach to assessing acid/base d/ox DDx for metabolic acidosis
24/7 40/40 Bicarb: 24 pH 7.40 Co2- 40 pH PCO2 Bicarb ``` Anion gap: Na - (Cl+BiCarb)= 10-16 >16: MUDPILES Methanol Uremia DKA Paraldehyde Infection Lactic acidosis Ethylene glycol Salicylates ```
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metabolic Acidosis w/ low anion gap suggests ? Posterior pituitary AKA ? Anterior pituitary AKA ? Hormones stored by posterior pituitary
Diarrhea Pancreatic/biliary drainage Renal tubular acidosis Neurohypophysis Adenohypophysis ADH Oxytocin
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What receptors does ADH stimulate What stimulates ADH release
V1- vessels, smooth muscle V2- collecting duct causing water retention via aquaporin 2 channels Osmoreceptors in hypothalamus- Inc serum osmolality Baroreceptors in arteries/atria- dec in pressure/volume
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4 etiologies of Central DI 3 etiologies of Nephrogenic DI How does DI present to clinic
Surgery, brain Infection: Syphilis Encephalitis TB Trauma/inflammation/tumor Sheehan syndrome- pituitary infarct Meds HypoK, HyperCa Renal Dz >2L urine/day w/ low SpecGrav <1.006
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How is Central DI isolated on tests How is Nephrogenic DI Dx
``` (No ADH production)- Measure 12hr urine output Desmopressin acetate given Measure 12hr urine output + Central DI= dec thirst/output, inc urine osmolality ``` Serum vasopressin measured during fluid restriction, += elevated
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What hormones are produced in anterior pituitary The hormones located here are responsible for ? 3 functions First line therapy for anterior pituitary adenomas is ? w/ ? exception
FSH LH ACTH GH PRL Endorphins TSH Melanocyte stimulating hormone Metabolism Sexual development Growth Surgery; Prolactinomas- medical therapy
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? drugs suppress prolactin secretion ? drugs suppress GH secretion Stopped
Dopamine agonists Somatostatin analogues Slide 30, Deck 2

IPAP (212 decks)

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