Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Clinical Medicine-3
Genitourinary
| Question | Answer |
|---|---|
| What are the 3 mechanisms that all work together in concert to minimize any changes in blood ph? | 1.Ec and Ic buffering. 2. Adjustment in blood pCO2 by alteration in the ventilation rate of the lungs. 3.Adjustment in renal acid excretion. ...*also restoration of the blood pH to its normal value requires correction of the underlying process. |
| What is a buffer? | A buffer prevents any change in the PH when H is removed. |
| What is a major and minor extracellular buffer and its pK? | Bicarb is major pk-6.1 phoshphate is minor pk 6.8 |
| What are some intracellular buffers? | proteins like hgb, deoxyhgb, organic phosphates liek amp, adp, atp |
| What are 3 primary systems in the body that regulate the H in body fluids? | 1. Chemical acid/base buffer systems of body fluids by combining w/SA/B to convert to weak. 2. 2nd line is respiratory center acts in few minutes to eliminate CO2. 3. Kidneys acts in hours to days . this is the most powerful which includes bbs, pbs, abs |
| What are some ways to gain H? | generation of h ions from co2 in tissue capillaries. loss of bicarb in urine, diarrhea, production of non-volatile acids from metabolism of protein and organic sourcdes. |
| What is the Henderson Haseelbach equation? | To calculate pH in a solution of a WA/WB. Its used to determine which buffer can be used in a solution at a specific pH. |
| The phosphate buffer is a minor buffer but the most important ________ | urinary buffer |
| What are the 3 fundamental processes that regulate the H in ECF? | 1.Reabsorption of filtered HCO3. 2. Production of new HCO3 3. Secretion of H in tubular lumen. |
| What is the anion gap? | Refers to concentration of unmeasured anions in the body. ie. proteins. po4.so4.organic acids |
| Metabolic acidosis associated with increased AG and Normal Cl | MUDPILES methanol, uremia, diabetic ketoacidosis, paraldehyde,phenformin, iron tablets or inh, lactic acidosis, ethylene glycol, salicylates |
| metabolic acidosis associated with normal AG but Increased CL | CARD carbonic anhydrase inhibitors,addisons disease, renal tubular acidosis, diarrhea |
| 80% of UTIs are caused by | E. Coli |
| UTI associated with renal calculi | Klebsiella, Proteus, Pseudomonas |
| UTI associated with young females | Staph. Saprophyticus |
| UTI associated with instrumentation | St. Aureus, enterococcus |
| What should you see on an EKG for a hyperkalemic patient? and which arrhythmia are you concerned about? | 1.Peaked T waves, widened QRS 2.V.Fib |
| EKG for hypokalemia | Flat T waves and U waves |
| Pulmonary hemorrhage and glomerulonephritis are features in most patients with this disease | Good Pasture Syndrome |
| Good Pasture Syndrome appears in what two extremes? | young men early 20's and men/women in their 60-70's |
| What are some clinical symptoms of GPS in the young? | Disease in young age is explosive with hemoptysis and sudden fall in Hb, fever, dyspnea and hematuria. |
| What is the most common GN worldwide with male predominance? | IgA nephropathy/Berger's disease |
| What are the two presentations of Berger's? | 1. Recurrent episodes of macroscopic hematuria during or immediatley following an URI in children (Henoch-Schonlein purpura) 2.Asymptomatic microscopic hematuria often in adults |
| Treatment for Berger's | There is no agreement on optimal treatment. Studies suggest that use of ACE inhibitors in patient w/IgA nephropathy w/proteinuria or declining renal function. Tonsillectomy, steroid thereapy have been suggested in small studies. |
| What is the hallmark of nephrotic syndrome? | Peripheral edema |
| Name the 4 most common types of nephrotic syndromes | 1. Minimal change disease 2. Membranous Nephropathy 3. Membranoproliferative GN 4. Focal Glomerulosclerosis |
| How do you treat proteinuria? | Proteinuria is treated with ACE inhibitors. |
| Treatment for MPGN | Primary MPGN in children can be treated with steroids. If proteinuria is present ACE inhibitors are helpful. Secondary MPGN treat the underlying cause. |
| Most common GN seen in children w/male predominance | Minimal Change GN |
| Treatment for children with Minimal Change GN | Although 30% have spontaneous remission, all children are treated w/steroids i.e. prednisone |
| Most common cause of nephrotic syndrome in adults | Membranous GN |
| Most common cause of chronic renal failure in the USA | Diabetic Nephropathy |
| Kimmelstiel-Wilson nodular lesions is pathognomonic | Diabetic Nephropathy |
| A previously healthy, 3-year-old female patient presents with abdominal distension and left, upper quadrant prominence. On PE the mass is firm, smooth, nontender, and does not cross the midline. The patient is hypertensive. UA:microscopic hematuria. | Nephroblastoma aka Wilm's Tumor |
| A 64-year-old man has painless hematuria. HX:similar episode 1 year ago and antibiotics resovled the bleeding. He has dec. flow and nocturia x2/night. He has smoked a pack of cigarettes QD x45yrs. PE: enlargement of the prostate. UA: 10-15RBC 5-10WBC | Bladder cancer |
| Painless hematuria is suggestive of _____ | bladder cancer |
| A 65-year-old white man in normal health. He describes nocturia 1/night and a 3-hr daytime voiding interval. He denies any incontinence, hematuria, dysuria, freq, urgency.no gI complaints. PE: smooth and symmetrical prostate, with approx vol of 40 mL. | Prostate cancer |
| A 35-year-old man presents with nonspecific testicular discomfort and the feeling of a mass in the testis.a 2 cm by 1 cm smooth, painless mass is palpated in the right testis. The mass does not transilluminate with light. There is no lymphadenopathy. | Testicular carcinoma. |
| No racial predilections are obserbed except_____ _____ which is more common in African American population. | lead nephropathy |
| Compensatory vasoconstriction may transiently maintain blood pressure but unreplaced losses of over 15% of intravascular volume can lead to ____ and ____ | 1.hypotension 2. tissue hypoxia |
| Some common causes of hypovolemia | loss of plasma:burns, 3-spacing:ascites,bowel obstruction, hemorrhage, hemothorax |
| symptoms of hypovolemia | cool/mottled extremities, oliguria, thirst, tachycardia, bowel ischemia, decreased jvp, altered mental status |
| what is orthostatic hypotension | lying to standing-systolic blood pressure drops >10-20mmHg and or an increase in pulse of more than 15BPM |
| What crystals form in acidic urine? | Uric acid and Ca oxalate stones form in acidic urine. |
| What crystals form in alkaline urine? | Calcium carbonate and Ca/Mg phosphate stones form in alkaline urine. |
| What type of urine (alkaline/acidic) does a UTI usually produce? | alkaline |
| What medication can interfere with the leukocyte esterase component of a dipstick? | Vitamin C and phenazopyridine |
| Nitrite on the dipstick reacts with which gram of bacteria? | Gram negative |
| Renal threshold for glucose | 180 |
| Most common electrolyte disturbance in hospitalized patients | HYPONATREMIA |
| Pontine Myelinolysis | Its a consequence of a rapid rise in serum tonicity following treatment with severe hyponatraemia who have made intracellular adaptations to the prevailing hypotonicity. Hyponatremia should be corrected at no more than 12 mmol/L of na/D to prevent |
| On PE the patient has dry mucus membranes and hypereflexia. What electrolye imbalance might exist? | Hypernatremia |
| S/S for hypocalcemia | Tetany-Chvostek's sign (tap TMJ-face twitches) or Trousseus sign-muscle cramps, seizures, cardiac dysrhythmia-prolonged QT |
| Causes of hyperphosphatemia | Hypoparathyroidism, renal failure (esp.ESRD on dialysis) decreased Ca, acidosis |
| Causes of hypophosphatemia | Hyperparathyroidism, inc.Ca, ETOH, alkalosis---it causes multiple organ dysfunction, acutely neurological changes, confusion, coma, cardiac-hypotension, rhabdomyolysis, hypoxia;chronic--dec.mentation, muscle weakness, arthralgias |
| Common cause of acute renal failure in the elderly | Dehydration |
| Most common physiological cause of proteinuria | pregnancy |
| Clinical findings for hypernatremia | CNS DYSFUNCTION, orthostatic hypotension, oliguria, hyperthermia, delirium, coma |
| What is the most common electrolyte disturbance seen daily in the ER? | Hypokalemia, often secondary to diuretic therapy, commonly coexist with other electrolyte imbalances particularly Mg, and may not respond to therapy until these other abnormalities are corrected |
| S/S of hypokalemia | generalized weakness, paralytic ileus, rhabdomylolysis, cardiac arrhythmia |
| What cardiac arrhythmias are associated with hypokalemia | V Tach, Torsades de Pointes |
| 3 Causes of Hyperkalemia | 1. decreased renal excretion 2.drugs which interfere with RAAS 3.Digoxin toxicity |
| EKG findings for Hypocalcemia | Prolongation of QT interval, Torsades |
| Milk is one of many treatment methods for ..... | hypophosphatemia |
| Hypomagnesemia occurs in ___people and occurs with ___ | occurs in 2/3 ICU patients, occurs with hypokalemia, hypocalcemia, metabolic acidosis |
| #1 cause of ARF | Acute tubular necrosis-after toxi of ischemic renal injuries caused by shock, surgery or rhabdomyolysis |
| Strangulated hernia | obstructed hernia in whih the blood supply is compromised. unless relieved, gangrene and perforation of the affected segment of bowel ensues. a strangulated hernia can have omentum or other viscera in the sac. |
| incarcerated hernia | term is used to refer to different types or stages including irreducible hernia, obstructed or strangulated hernias. this term lacks precision and so should not be used to describe a complicated hernia. |
| What diagnostic test do you order for testicular torsion | DOPPLER ULTRASOUND!!!! |
| Eosinophillic casts can be seen | pyelonephritis |
Created by:
pastudygroup
Popular Medical sets