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MTB 5 Flashcards

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1
Q

Normal gap Metabolic Acidosis with positive UAG

A

RTA

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2
Q

Normal gap Metabolic Acidosis with negative UAG

A

Diarrhea

- kidney’s ability to excrete acid intact

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3
Q

Causes of Metabolic Acidosis - Normal AG

A

RTA

Diarrhea

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4
Q

Causes of Metabolic Acidosis - Increased AG

A 
MUDPILES
Methanol toxicity
Uremia
DKA
Phenytoin, Paraldehyde
INH
Ethylene glycol 
Salicylates
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5
Q

ABG in Metabolic Acidosis

A

All low

Low pH, pCO2, HCO3

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6
Q

Causes of Metabolic Alkalosis

A 
GI loss - vomiting, NG tube
Increased aldosterone
Diuretics
Milk-alkali syndrome - hi volume liquid antacids
Hypokalema
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7
Q

ABG in Metabolic Alkalosis

A

All high
High pH > 7.40
High HCO3
High pCO2

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8
Q

What are the 2 phases of Vomiting?

A
  1. Generation phase - loss of gastric fluids (HCl, etc) causes retention of H2O and HCO3. Loss of gastric acid - no stimulus for pancreas to secrete HCO3, so HCO3 is retained in blood = Metabolic Alkalosis
  2. Maintainance phase - volume loss causes ECV to go down, decreased renal perfusion so kidneys activate RAAS. Aldosterone retains H2O, loss of H+ and K+ to get Hypokalemia and contraction alkalosis
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9
Q

TX for Vomiting

A

IVF
NS
This will tx contraction alkalosis

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10
Q

Equation for minute ventilation

A

Minute ventilation = RR x TV

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11
Q

Respiratory Alkalosis
pCO2?
Minute ventilation?

A

Low pCO2

Minute Vent =Increased

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12
Q

Causes of Respiratory Alkalosis

A 
Anemia
Anxiety 
Pain
Fever
Interstitial Lung Dz
Pulmonary Emboli
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13
Q

Respiratory Acidosis
pCO2?
Minute ventilation?

A

High pCO2

Minute vent = Decreased

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14
Q

Causes of Respiratory Acidosis

A 
COPD/Emphysema
Drowning
Opiate OD
Alpha 1 antitrypsin deficiency
Kyphoscoliosis
Sleep apnea/morbid obesity
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15
Q

MCC nephrolithiasis

A

Calcium Oxalate in alkaline urine

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16
Q

MS risk factor for nephrolithiasis

A

Overexcretion of calcium in urine

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17
Q

Most accurate test for nephrolithiasis

A

CT scan
- does not need contrast
IVP needs contrast, takes hours

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18
Q

Pt w excruciating pain in left flank radiating to groin presents to ED. Next step?

A

Ketorolac - NSAID provides pain relief like opiates

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19
Q

Which GI disorder do we see kidney stones?

A

Crohn dz b/c of increased oxalate absorption

Also, fat malabsorption increases stone formation

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20
Q

When is IVP the right answer in nephrolithiasis

A

Never

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21
Q

Best initial TX for renal colic

A
  1. Analgesics
  2. Hydration
  3. Imaging to confirm stone location
  4. CT/Sonography to detect obstruction, ie hydronephrosis
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22
Q

How to assess etiology of kidney stone?

Study These Flashcards
A

Stone analysis
Serum calcium, uric acid, PTH, Mg, PO4
24 hr urine for volume, calcium, oxalate, citrate, cystine, pH, uric acid, PO4, Mg

23
Q

How do we visualize uric acid stones

Study These Flashcards
A

CT

Not on X-ray

24
Q

TX for cysteine stones

Study These Flashcards
A

Surgical removal

Alkalinize the urine

25
What does in-dwelling catheter increase the risk of
``` Urease producing bacteria - Proteus - Pseudomonas - Klebsiella - Morganella - Staph - Ureaplasma Alkalinize urine, increase pH ```
26
When is lithotripsy TX for stones
Between 0.5 - 3 cm
27
Which size stones spontaenously pass
Less than 5 mm
28
Which size stones do we surgically TX
Larger than 2 cm
29
Long term management of calcium stones
HCTZ removes calcium from urine - increased distal tubular reabsorption of calcium
30
What binds to calcium in the bowel
Oxalate
31
Metabolic Acidosis and kidney stone relationship
Met Acidosis removes calcium from bones and increase stone formation - Also decreases citrate levels (which binds calcium)
32
Stress Incontinence Presentation
Older woman w painless urinary leakage w coughing, laughing, lifting objects
33
Test for Stress Incontinence
Have pt stand and cough - observe for leakage
34
TX for Stress Incontinence
1. Kegals 2. Local estrogen cream 3. Surgical tightening of urethra
35
Urge Incontinence Presentation
Sudden pain in bladder, followed by overwhelming urge to urinate
36
Test for Urge Incontinence
Pressure measurements in half-full bladder | Manometry
37
TX for Urge Incontinence
1. Bladder training exercises 2. Local anticholinergics - Oxybutynin - Tolterodine - Solifenacin - Dariferancin 3. Surgical tightening of urethra
38
Causes of HTN
``` RA stenosis Glomerulonephritis Coarctation of Aorta Acromegaly Pheo Hyperaldosteronism Cushing syndrome/Hypercortisolism/GC use CAH ```
39
Renal Artery Stenosis Presentation
Bruit is auscultated in flank - abdominal bruit Continuous throughout systole and diastole Failure to control BP despite multiple meds
40
Coarctation of Aorta Presentation
UE >> LE BP
41
HTN pts tested for
EKG UA Glucose for diabetes Cholesterol
42
Best initial TX for HTN
Weight loss Sodium restriction DASH diet Exercise
43
How long do we try lifestyle modifications before medications started
3-6 months
44
Does tobacco smoking stop HTN
NO. | Prevents CVD
45
Best initial drug for HTN
Thiazides
46
When do we start 2 medications for HTN
BP > 160/100
47
If BP not controlled with thiazide, next step
``` Add: ACE ARB Beta blocker CCB ```
48
Antihypertensive for Osteoporosis
Thiazides
49
What is hypertensive crisis
HTN + end-organ damage - High BP - Confusion - Blurry vision - Dyspnea - Chest pain
50
AE's of thiazides
``` Hyperglycemia Increase LDL Increase TG Hyponatremia Hypokalemia Hypercalcemia ```
51
Best initial TX for hypertensive crisis
Labetolol | Nitroprusside
52
Presentation of Renal Cell Carcinoma
Triad: Flank pain + Hematuria + Palpable Abd mass Varicocele - fails to empty when pt is recumbant = tumor obstruction of gonadal vein Polycythemia - Ectopic EPO
53
Management for Renal Cell Carcinoma
CT Abdomen

Nephro (6 decks)

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