Quiz 1 Flashcards
How many 24 hour urine samples should a patient supply if you are looking for abnormalities in urine (ie. kidney stones)?
Currently there is conflicting opinion regarding whether a single 24-hour urine sample is adequate and reliable to identify abnormalities within the urine. Either one or two 24-hour urine samples with the individual of his/her usual diet should be obtained and measured for calcium, oxalate, citrate, magnesium, sodium, and sulfate but two samples are preferred.
What are the 5 potential components of renal and urinary calculi? What’s the most common metabolic abnormality associated with calcium oxalate stones?
Renal and urinary calculi can be classified into 5 types based on their composition: calcium oxalate (75-80%), struvite (10-25%), calcium phosphate (5-10%), uric acid (5-10%) and cystine (1-2%). Hypercalciuria is the most common metabolic abnormality associated with calcium oxalate stones.
What should you suspect if there is high serum calcium and what else should you test for?
In the presence of elevated serum calcium per blood chemistry, primary hyperparathyroidism should be suspected and PTH levels should be measured; vitamin D levels should be assessed because low vitamin D can mask primary or secondary hyperparathyroidism.
Why is a UA and C&S important?
UA and culture and sensitivity are essential to determine pH and to identify the presence of bacteria, crystals, and red blood cells. Hematuria may be microscopic or gross and may occur with or without infection.
What diagnostic findings will tell you if a kidney stone is alkaline or acidic?
An increase in the urine pH and the presence of crystals may give clues as to the stone’s composition and whether the stone is alkaline or acidic.
What are some differential diagnoses for kidney stones?
Differential Diagnoses: appendicitis, cholecystitis, peptic ulcer, pancreatitis, ectopic pregnancy, dissecting aortic aneurysm, pyelonephritis, UTI, shingles
Common risk factor for kidney stones
One of the most common risk factors for stone formation is reduced urinary flow, and any factor that reduces urinary flow or urinary volume allows stone constituents to supersaturate and increases the risk of kidney stones.
What diagnostic study to use for suspected kidney stone if CT scan not available?
An abdominal xr of the kidneys, ureter, and bladder (KUB) is often the first imaging study used if CT is not available and will identify renal stones that are radiopaque. Only about 60% of stones are found visible on plain films, but it is helpful in documenting the number, size, and location of stones in the urinary tract.
Common symptoms and locations of kidney stones
Renal or ureteral colic is a result of obstruction of the urinary tract by the stone. The obstruction is usually in one or more of 5 locations: the calyx, ureteropelvic junction, at or near the pelvic brim, posterior pelvis, and ureterovesical junction. Fever and chills may be present if infection occurs with the stone.
Differential diagnoses for T2DM
Differential diagnosis for type 2DM include pre-diabetes, gestational diabetes, Cushing syndrome, pheochromocytoma, drug-induced hyperglycemia, acromegaly, glucagonoma, cirrhosis, cystic fibrosis, pancreatitis
How often to monitor DM med regimen? Should you wait any timeframe to intensify treatment?
Evaluate the medication regimen every 3 to 6 months and need to account for new patient factors in glycemic control. Do not delay intensification of treatment if the patient is not achieving glycemic goals.
Initial tx for DM and what lab should you periodically monitor?
Pharmacological therapy is required when lifestyle management does not result in adequate blood glucose control. Metformin is the preferred initial glucose-lowering therapy for adults with type 2 diabetes unless it is contraindicated or not tolerated. Consider periodically measuring vitamin B12 levels in patients treated with metformin since long-term metformin use may be associated with vitamin B12 deficiency.
When should you consider T1DM in older adults?
Although type 1 DM occurs infrequently in older adults, it should be considered in patients with other autoimmune disorders, patients without a family history of type 2 diabetes, or patients of normal weight.
Why, when, and what to expect when ordering the following: ESR, Rheumatoid Factor, Vitamin D level, serum CO2 level, PSA, TSH and T3/T4, HbA1c, creatinine, bone densitometry, UA C+S, helical spiral CT, CBC with diff
Important of American College of Radiology Appropriateness Criteria (understand the categories for procedures as they relate to appropriateness rating and radiation level)
- Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for a specific clinical condition
- Starting January 2020 the ACR Appropriateness Criteria used by health care providers for determining imaging studies for patient management will become the standard of care for reporting on Medicare patients.
*ACR Practice Guidelines for Communication of Diagnostic Imaging Findings:
Effective communication should
1) promote optimal patient care and support the referring physician/health care provider in this endeavor, 2) be tailored to satisfy the need for timeliness, and 3) minimize the risk of communication errors.
Specificity and sensitivity of diagnostic tests
Sensitivity: the ability of the test to determine who has the disease. A highly sensitive test means that there are few false negative results, and thus fewer cases of disease are missed. “Out of people who have the disease, how accurate is the test at detecting it?”
Specificity: the ability of the test to determine who does not have the disease. “Out of people who do not have the disease, how accurate is the test at detecting it?”
Clinical Reasoning Process
Collect H&P, complete physical exam, interpret diagnostic studies
Clinical decision making is multifaceted and encompasses the patient, clinical problem, and the practitioner’s perspectives.
Critical thinking involves application of analysis, evaluation, and inference
consider precision, accuracy, sensitivity, specificity
Differences in types of testing as they pertain to the main areas of the textbook -example,
ultrasound, MRI, vs microscopy
The 4 efficacy indicators for diagnostic tests to be recommended routinely
accuracy, precision, sensitivity, and specificity
When to prescribe more than one anti-diabetic?
Many patients with type 2 diabetes and hemoglobin A1c greater than or equal to 1.5% above glycemic target will require dual therapy and some patients may require triple therapy to achieve glycemic target.
chloride
-Does not provide much information alone
-Can help identify acid-case imbalance and hydration when used in combination with other electrolytes
-electrolyte or acid-base imbalance and 24 hour urine
creatinine
-Diagnoses impaired renal function-Used to estimate GFR
-Can become elevated with use of ACEI, aminoglycosides, certain chemotherapy agents, NSAIDs
creatinine clearance
-Used to measure GFR of kidney
-CrCl not affected if only 1 functioning kidney
-Decreases with age
Estimated GFR
-Used to determine stage of kidney disease
-Utilizes creatinine, age, gender, and body size to calculate
-eGFR <60 for 3 months or more indicates chronic kidney disease
