Neurology Flashcards
1
Q
Glomerulonephritis:
1-post streptococcal glomeruolonephritis:
History
A
.URTI in the last 1-2 weeks
2
Q
Glomerulonephritis
Organism……..
A
group A- beat hemolytic streptococci
3
Q
Glomerulonephritis
Cp:
A
Oliguria
Edema
4
Q
Glomerulonephritis
HTN
A
Tea-colored urine
5
Q
Glomerulonephritis
Labs:
A
Hematuria and mild protenuria
6
Q
Glomerulonephritis
Inv of choice
A
…renal biopsy
7
Q
Glomerulonephritis TTT:
FIRST STEP
A
..admission
8
Q
Glomerulonephritis Diet
A
increased carbohydrate and decrease protein
9
Q
Anti-hypertensive drugs and fluid restriction for Glomerulonephritis is..
A
..most imp step
10
Q
Glomerulonephritis Fate
A
over 95 % complete recovery
11
Q
IgA nephropathy (Berger)
Most common type of )___________
Most common cause of _________ in kids
A
Most common type of glomerulonephritis
Most common cause of renal failure in kids
12
Q
Berger’s History
A
.URTI in the last 1-2 days
13
Q
Berger’s Cp
A
HTN
14
Q
Labs (Berger’s)
A
.hematuria ( GROSS) and proteinuria…..best is biopsy
15
Q
TTT (Beger’s)
A
.cortisone and control blood pressure
16
Q
Renal affection 1-2 days of URTI =
Renal affection after 1-2 weeks =
Most common cause of renal failure in pediatrics =
A
Renal affection 1-2 days after URTI………IGA nephritis
Renal affection after 1-2 weeks……….post strep. Glomerulonephritis
Most common cause of renal failure in pediatrics…..IGA
nephritis
17
Q
Thin basement membrane nephropathy: (benign hematuria) :
Is the most common cause of?
A
Most common cause of persistent glomerular bleeding in children and adults
18
Q
Thin basement membrane nephropathy
Signs and symptoms:
A
Hematuria
Blood pressure, kidney function…… normal.
Mild proteinuria
19
Q
Thin basement membrane nephropathy
Treatment
A
only reassurance.
20
Q
Thin basement membrane nephropathy
Prognosis:
A
excellent prognosis.
21
Q
Alport syndrome:
A
X-linked
Triad ( hematuria, ocular abnormalities and deafness)
22
Q
hemolytic uremic syndrome :
Cause
A
:( E-coli O157-H7)
23
Q
hemolytic uremic syndrome :
Source
A
..undercooked meat, unpasteurized milk
24
Q
hemolytic uremic syndrome :
History
A
.bloody diarrhea
25
hemolytic uremic syndrome :
| Age
Kids
26
Cp:
5- 7 days of infection…….intravascular hemolysis
| Sudden pallor and irritability
27
hemolytic uremic syndrome :
| Kidney affection
.oliguria and renal in sufficiency
28
THROMBOTIC THROMBOCYTOPENIC PURPURA:
More in kids or adults?
Affected?
more in the adult
The same scenario but the CNS is the most commonly
Affected……neurological symptoms and fever
29
THROMBOTIC THROMBOCYTOPENIC PURPURA
| Labs:
Low platelets
Schistocytes
Anemia
30
THROMBOTIC THROMBOCYTOPENIC PURPURA
| TTT
plasmapharesis …….ttt of choice
| Never to give platelets
31
Henoch schonlein purpura pathology:
IGA NEPHRITIS
32
THROMBOTIC THROMBOCYTOPENIC PURPURA
| CP:
1-Hematuria
2-abdominal pain
3-joint pain esp. knee
4-rash ( maculopapular) affecting buttock and knee (vasulitis
33
THROMBOTIC THROMBOCYTOPENIC PURPURA
| History
URTI
34
THROMBOTIC THROMBOCYTOPENIC PURPURA
| Complication
Intussusceptions vvvvvv imp
35
THROMBOTIC THROMBOCYTOPENIC PURPURA
| Fate
..usually resolve spontaneously
36
THROMBOTIC THROMBOCYTOPENIC PURPURA
| TTT
USUALLY NONE
37
THROMBOTIC THROMBOCYTOPENIC PURPURA
| Resistant cases…
.cortisone is the drug of choice
38
Proteinuria:
Orthostatic:
Age
usually kids and adolescent
39
Proteinuria
| First step
.repeat the test
40
```
Proteinuria
If still (+)
```
24 h urine collection
41
Proteinuria
| TTT
....reassure
42
Proteinuria Transient:
| Causes:
.fever, exercise, dehydration, cold exposure, seizure
43
Proteinuria Transient
| Fate
resolve spontaneously…..reassure
44
What if this proteinuria is recurrent…..biopsy …vvvv imp???
Proteinuria and hematuria in kids with URTI
45
Proteinuria and hematuria in kids with URTI
| First step
repeat the test after recovery from the URTI
46
Nephrotic syndrome marked?
marked edema esp. periorbital
47
Nephrotic syndrome Cp:
Most common type
48
Nephrotic syndrome Labs:
Proteinuria ++++
Hypoalbuminemia
Hyperlipidemia
49
Nephrotic syndrome Renal functions
usually normal
50
Nephrotic syndrome Complications:
1-Infections
51
Nephrotic syndrome Organism
streptococcus pnemoniae
52
Nephrotic syndrome Most common area affected
..spontaneous bacterial peritonitis
53
Nephrotic syndrome 2-thrombophilia…
…esp renal vein thrombosis
54
Nephrotic syndrome
TTT:
Mild cases
.home management and bed rest
55
Nephrotic syndrome
| Severe cases
hospital admission
56
Nephrotic syndrome
| Diet
increase protein
57
Nephrotic syndrome
| Drug of the choice
steroid
58
Nephrotic syndrome
| If resistant
.immunosuppressive
59
Vesicoureteral reflux is?
Abnormal backflow of urine from bladder to kidney
60
Vesicoureteral reflux
| Cp:
recurrent UTI infections
61
Vesicoureteral reflux
| Complications:
Recurrent pyelonephritis…..scarring…..renal failure
62
Vesicoureteral reflux
| Inv:
VCUG……….of choice
63
Vesicoureteral reflux
| Inv for the scars
..DMSA scan
64
Vesicoureteral reflux
| Grades
..1-5 according to severity
65
Vesicoureteral reflux
| Fate
majority resolve by age 6-7 ys
| Grade 5 rarely resolves
66
Vesicoureteral reflux
| TTT:
Prophylactic antibiotics (trimethoprim sulpha)……continuously
67
obstructive uropathy:
1-posterior urethral valve:
Complications:
Renal failure
| Hydronephrosis
68
```
obstructive uropathy (PUV)
Diagnosis:
```
.VCUG
69
```
obstructive uropathy (PUV)
TTT:
```
Decompress the bladder with catheter
| Transurethral ablation
70
2-ureteropelvic junction obstruction is the most common cause of :
Most common cause of obstructive uropathy
71
```
obstructive uropathy (UJO)
Cp:
```
Hydronephrosis…..renal mass and pain
| Recurrent UTI
72
obstructive uropathy (UJO)
Inv:
Prenatally
US
73
```
obstructive uropathy (UJO)
INV After birth
```
VCUG
74
```
obstructive uropathy (UJO)
TTT
```
endoscopic ttt
75
Hepatorenal syndrome:
Severe liver cell failure
New onset renal failure with no explanation
No improvement in renal functions with fluids or diuretics
76
Hepatorenal syndrome
| Labs
.increased creatinine and BUN
77
Hepatorenal syndrome
| TTT:
OCTREOTIDE
78
Athero-emboli after catheter:
..vvvvvvvvvimp
79
Athero-emboli
| Cause
cholesterol emboli
80
Athero-emboli
| Cp:
History of catheterization
| Blue/purple skin lesion in finger and toes
81
livedo reticularis is?
…Network like rash
82
livedo reticularis
| Labs:
Eosinophilia
83
livedo reticularis
| TTT
NONE
84
Contrast induced nephropathy:
History of radiological procedures
Labs
increased creatinin
85
Contrast induced nephropathy
| Prevention
…hydration vvvvvvvvvvvviml
86
ANALGESCIC INDUCED NEPHROPATHY:
Long intake of analgesic e:g: analgesics
87
ANALGESCIC INDUCED NEPHROPATHY
| Labs
increased creatinine
88
ANALGESCIC INDUCED NEPHROPATHY
| TTT
stop the drug
89
GOOD PASTURE SYNDROME:
vvvvvvvvvvvvvvv imp
90
GOOD PASTURE SYNDROME
Affection of 2 organs:
Lung
.hemoptysis and dyspnea
91
GOOD PASTURE SYNDROME
Affection of 2 organs:
Kidney
.hematuria
92
GOOD PASTURE SYNDROME
| x-ray
.bilateral lung involvement
93
GOOD PASTURE SYNDROME
| Screening……
.anti basement membrane antibody
94
GOOD PASTURE SYNDROME
| Most accurate
.renal biopsy…..linear deposit
95
GOOD PASTURE SYNDROME
| TTT
plasmapharesis and steroid
96
Wegner granulomatosis:
Affection of 3 organs:
1.)URT……
.sinusitis, epistaxis, otitis
97
Wegner granulomatosis:
Affection of 3 organs
2.)LRT……
..cough and hemoptysis
98
Wegner granulomatosis:
Affection of 3 organs
3.) Kidney…
hematuria
99
Wegner granulomatosis
| Best initia
.C-ANCA antibody
100
Wegner granulomatosis
| Best accurate
..renal biopsy
101
Wegner granulomatosis
| TTT
steroid and cyclophosphamide
102
Renal failure:
Types:
Prerenal……
.most common type
103
Renal failure:
Types:
Hypotension e.g:
anaphylaxis
104
Renal failure:
Types:
Hypovolemia e.g:
burn
105
Renal failure:
Types:
Intrinsic:
Toxins
| Ischemia
106
Renal failure:
Types:
Post renal:
Stones
| BPH
107
Renal failure
| Cp:
Weakness, malaise, nausea , vomiting, confusion
108
Renal failure
| Complications…………
….vvvvvvvvvvvvvvvvvvvvvvvvv imp
109
1-anemia
| Type
.Iron defiency anemia
110
1-anemia
| TTT
erythropoietin
111
2- hypocalcemia……
osteoporosis
112
2- hypocalcemia…
| TTT……
.ca and vit D
113
3-bleeding
| Cause
..platelets dysfunction
114
4-hyperphosphatemia
…vvvvvvvvvvvvvvv imp
115
4-hyperphosphatemia
| TTT…
.dietary restriction and oral phosphate binders
116
5- pericarditis
…vvvvvvvvvvvv imp
117
5- pericarditis
| Cp……
sharp chest pain increases with respiration and decreases with leaning forward
118
5- pericarditis
| ECG
ST segment elevation in all leads
119
5- pericarditis
| TTT………
.immediate dialysis
120
ECG……
.Tall T-wave
121
TTT…….
| First step
Ca gluconate till dialysis is ready
122
Second step…
dialysis
123
Dialysis:
Indications:
Hyperkalemia
Metabolic acidosis
Pericarditis
Fluid overload
124
Complications of dialysis:
| 1-hypotension:
Most common complication with dialysis
125
Complications of dialysis:
1-hypotension:
Cause
over removal of fluid
126
1-hypotension:
| TTT
.IV bolus fluid
127
2-HTN
| Cp……
headache
128
2-HTN
| Cause
.over fluid infusion
129
Types of Transplant: (4)
Autograft: transfer of tissue from and to the same person
Allograft: transfer between two genetically non-identical
Syngraft: transfer of tissues or organs from an identical twin
Xenograft: transfer of tissues or organs across species
130
Types of graft rejections:
| Rejection on table
1-.hyperacute
| 2-acute rejection
131
Types of graft rejections:
| 1-Rejection on table
.hyperacute
132
2-acute rejection
| Timing of acute rejection
Timing of acute rejection....days to months
133
2-acute rejection
| Most common pathology
..acute tubular necrosis….vvvvv imp
134
TTT of choice for acute rejection
steroid
135
3-chronic rejection
.months to year
136
TTT of chronic rejection
re transplantation
137
Best ttt of renal failure?
Best donor for transplantation?
Most common cause of death with dialysis?
Antihypertensive contraindicted in renal impairment?
Best way to asses patient with renal failure?
Best ttt of renal failure…….transplantation
Best donor for transplantation…….living relative donor
Most common cause of death with dialysis…..CVS
Antihypertensive contraindicated in renal impairment…ACEI
Best way to asses patient with renal failure…..body weight
138
Renal artery stenosis:
Causes:
Young Age?
Old Age?
Young age……fibromuscular dysplasia
| Old age…….atherosclerosis (over 90% of cases)
139
Renal artery stenosis
| Cp:
Majority……asymptomatic
140
Renal artery stenosis
| HTN
Impaired renal functions
| Exam…….abdominal bruit
141
Renal artery stenosis
| Labs:
Rennin…….increased (activation of rennin angiotensinogen
| system)
142
Renal artery stenosis
| Investigation of choice
angiography
143
Renal artery stenosis
| TTT:
Unilateral………ACEI
| Bilateral……..angioplasty and STENT……of choice
144
Renal artery stenosis
| ACEI
.CONTRAINDICATED WITH BILATERAL RENAL ARTERY STENOSIS
145
Sterile pyuria:
| Pus or organism
Pus but nooo organism
146
Sterile pyuria
| Causes:
TB ……vvvvvv imp
| Incomplete ttt
147
Overload in patients of renal failure:
Most common symptoms?
Most important inv?
Most imp ttt?
Most common symptom……….dyspnea
Most important inv………….ABG……vvvvvvvvvvvvvv imp
Most imp ttt…………dialysis
148
Additional notes
Rash after URTI after receiving antibiotics???
Raised above surface and non blanching?
Raised above surface+joint pain + abd pain+hematuria?
Maculopapular rash after ampicillin?
Rash+wheezy chest +vomiting?
Raised above surface and non blanching…….vasculitis
Raised above surface+joint pain + abd pain+hematuria…….HSP
Maculopapular rash after ampicillin………EBV
Rash+wheezy chest +vomiting………anaphylaxis
149
Most accurate way to asses fluid input and output in renal failure and cardiac patients
weight followed by 24 h urine
150
HIV patient on antiretrovial drugs developed renal colic
.CT without contrast
| The nephrotoxic combination of antibiotic is gentamycin+cephalexin.
