Low Subjects Amboss Flashcards
(41 cards)
cystinuria
FLANK PAIN W/ COSTOVERTERBRAL TENDERNESS. RECURRENT IN ADOLESCENT W/ - XRAY.
Hexagonal crystals on urinalysis indicate cystine stones, which typically develop in individuals with cystinuria and persistently acidic urine. Cystinuria is caused by an autosomal recessive defect in the cystine-reabsorbing proximal convoluted tubule transporter in the kidneys. Cystine stones are weakly radiopaque (i.e., visible on CT scan but not necessarily on x-ray). A positive urine cyanide nitroprusside test confirms the diagnosis. Prevention includes adequate hydration, a low-sodium diet, urine alkalinization, and, in refractory cases, tiopronin and chelating agents (e.g., penicillamine).
CA stones
urine ph varies
incidence 75%
RO - dumbells or bipyrimadal envelopes
Hypercalciuria
Hyperoxaluria
Hypocitraturia
Can result from increased intake of
Ethylene glycol (antifreeze)
Vitamin C
Associated with inflammatory bowel disease, i.e., ulcerative colitis and Crohn disease due to malabsorption
UA stones
urine pH is low and volume is low, incidence ~ 10% . RL rounded rhomboids/rosettes. Gout, hyperuricemia, hyperuricosuria. high cell turnover like leukemia/chemo
struvite
high urine ph, incidence 5-10%, rectangluar coffin lids RO . UTI with urease-producing bacteria (e.g., Proteus mirabilis, S. saprophyticus, Klebsiella)
calcium phos stones
high urine ph , wedge shaped prism, RO, Hyperparathyroid. t1RTA
cystine
low urine ph , hexagon RO stones, cystinuria (hereditary)
xanthine stones
independent of urine PH, amorphous, RL, xanthinuria (hereditary)
SIADH sclc
hyponatremia- admin 3% saline w/ possible loop diuretic such as furosemide (if urine osm is 2x that of serum). then can give demeclocycline/vasopressin antag. after tx then do fluid restriction.
AKI labs
An increase in serum creatinine to ≥ 1.5 times the baseline level within a week indicates acute kidney injury (AKI). A BUN:creatinine ratio of < 15 and the finding of epithelial casts (due to sloughed renal tubular epithelium) suggest intrinsic AKI due to acute tubular necrosis (ATN).
contrast nephropathy
ATN. Patient-related risk factors for contrast-induced nephropathy include advanced age, diabetes mellitus, underlying chronic kidney disease (CKD) such as diabetic nephropathy, and concomitant use of certain nephrotoxic drugs (e.g., NSAIDs). The course of contrast-induced nephropathy is typically mild (unless CKD is already present), with creatinine levels peaking after 3–5 days and returning to baseline within one week.
GI bleeding w/ CKD - uremia secondary to uremic platelet dysfnx
bnormal platelet adhesion and platelet aggregation in individuals with uremia are multifactorial and most likely occur because of the presence of platelet function inhibitors, uremic toxins, and glycoprotein IIb/IIIa dysfunction. Abnormalities in von Willebrand factor and thrombocytopenia may also play a role in increased bleeding tendency in patients with CKD. Laboratory findings that suggest dysfunctional platelet aggregation may include increased bleeding time and normocytic anemia. PT and aPTT are usually normal unless there is concomitant coagulopathy. Treatment includes renal replacement therapy by hemodialysis, peritoneal dialysis, or kidney transplantation.
overflow incontinence
- imparied detruser contractibility or BOO. neuro disorders BPH.
A history of intermittent dribbling of urine not associated with increased intraabdominal pressure (e.g., laughing, sneezing, coughing, exercising) or an urge to urinate . Underactivity of the detrusor muscle is one of the causes of overflow incontinence. Patients with an acute spinal cord injury (SCI) can have spinal shock, which is a combination of decreased sensation, flaccid paralysis, and autonomic dysfunction below the level of an SCI. Autonomic dysfunction results in parasympathetic inactivation and a consequent atonic bladder. CAN ALSO HAVE BLADDER OUTFLOW OBSTRUCTION
urge incontinence
autonomous contraction of detrusor. inflammatory (UTI), neurogenic, idiopathic
stress incontinence
high intraabd. psi w/ bladder outlet incompetence. coughing sneezing, etc. urethral hypermobility, intrinsic sphincter deficiency
oliguria, hypertension, a BUN:creatinine ratio < 15, and features of fluid overload (peripheral edema, dyspnea and crackles indicating pulmonary edema). These findings suggest intrinsic acute kidney injury (AKI), most likely due to post-streptococcal glomerulonephritis (PSGN) secondary to streptococcal pharyngitis that occurred 3 weeks ago (indicated by the positive antistreptolysin O antibody titers).
Mild but significant leukocyturia and severe hematuria with RBC casts are seen in PSGN, which results in nephritic syndrome; the RBC casts indicate glomerular damage and the sterile pyuria (leukocyturia) reflects renal inflammation. The proteinuria in nephritic syndrome is typically mild (i.e., 1+ or 2+ on a urine protein dipstick test), but in severe nephritic syndrome nephrotic-range proteinuria (i.e., ≥ 3+ on urine protein dipstick) might be seen. PSGN is most common in children 3–12 years old and in elderly patients.
ADPKD
cerebral saccular aneurysm, hepatic cysts, mitral v. prolapse, hernias
premature ejaculation
use SSRI. paroxetine can delay ejaculation up to 9 min . it pt also has ED, pd5i are used first line . but dont give with tamulosin b/c of ortho hypotension
chlorthalidone
thiazine can cause ED. Thiazide diuretics
A group of diuretic agents that act as Na⁺-Cl⁻ cotransporter inhibitors in the early distal renal tubule. Used mainly to treat hypertension. Examples include hydrochlorothiazide and chlorthalidone. Adverse effects include metabolic alkalosis, electrolyte abnormalities (hypokalemia, hyponatremia, hypomagnesemia, hypercalcemia), metabolic effects (hyperglycemia, hyperuricemia), and sulfonamide hypersensitivity.
active error
An active error (sharp end flaw) is one that is performed by the operator, immediately apparent, and typically noticed first by the individual who committed it. A surgeon who transects the common bile duct instead of the cystic duct has made an active error.
Next of Kin
Spouses are most often listed first, followed by adult children, parents, adult siblings, and close friends.
brain death
The absence of the pupillary reflex, vestibuloocular reflex, corneal reflex, gag reflex, and cough reflex indicate brainstem areflexia, which is one of the criteria for brain death. The presence of cardiac activity and spontaneous or reflex motor responses as a result of bioelectrical activity restricted to the spinal cord, peripheral nerves, and muscles (e.g., deep tendon reflexes, Babinski sign, fasciculations, myoclonus) should not be interpreted as evidence against brain death.
Donabedian model
A method of evaluating healthcare quality. Comprises the domains of structural measures, process measures, outcome measures, and balancing measures. Structural measures evaluate the material, organizational, and professional resources (e.g., equipment, facilities, staff) available at a health care facility. Examples include the evaluation of the number of beds, volume of surgeries performed, usage of medication order entry systems, and provision of digital copies of health records to patients. A facility’s structural characteristics affect other domains of healthcare quality, which can be assessed via process measures, outcome measures, balancing measures, and composite measures. Composite measures aggregate several types of quality measures into a single score and allow a comprehensive view of the overall performance of a health care system.
