Internal Medicine
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| What is the definition of acute renal failure? | show 🗑
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| show | protein waste products
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| show | falsely low
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| show | there is some tubular secretion of creatinine; it is not all freely filtered
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| show | 1. portal hypertension leads to splanchnic vasodilation
2. decreased volume is sensed by JG apparatus → activation of RAAS
3. renal vasoconstriction → decreased renal perfusion
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| show | orthodeoxia, characteristic of hepatopulmonary syndrome
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| How would creatinine be effected in a patient with a large renal stone obstructing a ureter? | show 🗑
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| How is postrenal azotemia diagnosed? | show 🗑
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| What is the most common cause of intrinsic acute renal failure in hospitalized patients? | show 🗑
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| 1. Patient with fever, rash and oliguria after starting a new drug? 2. What is the best initial test? | show 🗑
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| show | 1. EKG for possible cardiac complications of hyperkalemia
2. Ca2+, hydration, bicarbonate to alkalinize urine
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| 1. What is the metabolic complication of ethylene glycol overdose? 2. Treatment | show 🗑
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| show | 1. ingestion of antifreeze
2. Crohn's disease from fat and calcium malabsorption
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| show | prevents conversion of xanthine to hypoxanthine to uric acid
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| show | hyperparathyroidism
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| show | 1. AIN occurs with the first dose and presents with fever, rash, and eosinophils
2. direct toxins take several days/weeks
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| show | tobramycin
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| show | renal failure that is not severe enough to require dialysis; aka azotemia
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| Patient with recent vascular catheter develops signs of renal failure. | show 🗑
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| Which HIV drug is most associated with neprholithiasis? | show 🗑
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| Acute flank pain, hematuria, pyuria and fever: 1. patient with + urine cultures 2. patient with history of diabetes, sickle cell or NSAID use 3. What is the most accurate diagnostic test? | show 🗑
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| show | hydration
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| show | 1. glomerulonephritis
2. renal biopsy
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| 1. Patient with sinusitus and renal disease 2. best initial test 3. most accurate test 4. Treatment | show 🗑
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| show | 1. Churg-Strauss
2. glucocorticoids and cyclophosphamide
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| show | virtually every organ except the lung
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| show | 1. Henoch-Schonlein purpura
2. systemic deposition of IgA
3. supportive because disease is self-limiting
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| Characteristics of Glomerulonephritis | show 🗑
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| show | eosinophilia and positive C-ANCA
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| Churg-Strauss Syndrome: most accurate test | show 🗑
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| show | Antibasement membrane antibodies to type IV collagen
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| Goodpasture Syndrome: most accurate test | show 🗑
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| show | plasmapheresis and steroid, +/- cyclophosphamide
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| Polyarteritis Nodosa: best initial test | show 🗑
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| show | biopsy (need angiogram done before bx)
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| show | cyclophosphamine and steroid
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| show | Steroids if disease is severe or porgressive
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| show | increase IgA
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| show | renal biopsy
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| IgA nephropathy (Berger Disease): Treatments | show 🗑
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| Postinfectious Glomerulonephritis: characteristics | show 🗑
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| Postinfectious Glomerulonephritis: best initial test | show 🗑
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| Postinfectious Glomerulonephritis: most accurate test | show 🗑
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| show | 1. supportive
2. manage fluid overload and HTN with diuretics
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| show | Pentad presentation: 1. hemolytic anemia; 2. uremia; 3. thrombocytopenia; 4. fever; 5. neurologic problems
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| show | Triad presentation: 1. hemolytic anemia; 2. uremia; 3. thrombocytopenia
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| show | 1. none; if antibiotics are given, organism may release more toxins as it dies
2. do not transfuse platelets bc they precipitate and worsen the CNS and renal abnormalities
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| show | 1. rapidly progressive glomerulonephritis
2. steroids and cyclophosphamide
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| What are the two common types of amyloidosis? | show 🗑
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| What defines nephrotic syndrome? | show 🗑
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| What is the cause of hyperlipidemia in nephrotic syndrome? | show 🗑
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| show | membranous
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| Cause of casts on urinalysis: 1. hyaline 2. red cell 3. white cell | show 🗑
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| show | 1. chronic renal failure
2. acute tubular necrosis
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| show | A E I O U
1. Acid/base disorders
2. Electrolytes (↑K)
3. Intoxication
4. Overload of volume
5. Uremia (pericarditis, encephalopathy)
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| Cause of hypocalcemia in renal failure (2)? | show 🗑
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| What is used to treat hyperphosphatemia from end-stage renal disease? | show 🗑
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| What is used to treat hyperphosphatemia from end-stage renal disease when calcium mis abnormally high (from vitamin D replacement? | show 🗑
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| What happens to the levels of the following electrolytes in ESRD: 1. calcium 2. phosphate 3. magnesium | show 🗑
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| show | 1. <130/80
2. rapidly progressive coronary artery disease is the most common cuase of death
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| show | 1. uremia-induced platelet dysfunction
2. desmopressin causes release of subendothelial vWF stores and factor 8
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| show | "1. as ECT osmolality decreases, water shifts into brain cells increasing the ICP
2. blood pressure increases to maintain cerebral perfusion pressure"
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| How does hyponatremia effect intracranial pressure? | show 🗑
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| At what level does hyponatremia become symptomatic? | show 🗑
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| "What is the treatment for: 1. mild hyponatremia 2. moderate hyponatremia 3. severe hyponetremia | show 🗑
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| What neurologic disorder is caused by correcting hyponatremia too rapidly? | show 🗑
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| show | ↑ glucose osmotically draws water into the vascular space and dilutes sodium
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| Most important diagnostic test when a patient has suspected hypokalemia | show 🗑
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| What acid base status is seen following dehydration? | show 🗑
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| show | potassium is found mostly intracellularly and with rapid cell production from B12, extracellular K+ moves into cells
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| How is magnesium related to potassium metabolism? | show 🗑
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| Rx for hypovolemia from vomiting? | show 🗑
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| Rx for severe hypercalcemia? | show 🗑
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| show | 1. results in hypercalcemia because albumin binds H+ and releases Ca2+
2. results in hypocalcemia
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| Patient with multiple blood transfusions has a seizure and perioral numbness. | show 🗑
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| How can alcoholism lead to hypocalcemia | show 🗑
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| show | high glucose level causes a transcellular shift of water out of the cell into the vascular space, diluting the sodium
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| Rx for: 1. mild hypovolemic hypernatremia 2. severe hypovolemic hypernatremia | show 🗑
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| Treatment for nephrogenic diabetes insipidus | show 🗑
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| What effect does insulin have on potassium levels? | show 🗑
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| Patient with muscle weakness and peaked T waves on EKG. What is the treatment? | show 🗑
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| show | 1. normal saline
2. lactated ringer
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| show | sweat is mostly free water (hypotonic) and results in hypernatremia
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| How do you diagnose SIADH? | show 🗑
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| Treatment for SIADH 1. severe disease 2. chronic disease in which underlying cause can't be corrected | show 🗑
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| How fast can hypo or hypernatremia be corrected? | show 🗑
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| show | causes hypokalemia mainly from K+ secretion from colon and small part from kidneys
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| show | T-wave flattening and U-waves
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| show | resin that absorbs 1 mEq K per g and releases 1 mEg Na
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| show | 1. aldosterone deficiency
2. Presence of high urine sodium with oral salt restriction.
3. Fludrocortisone
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| What electrolyte changes are seen with volume contraction? | show 🗑
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| show | 1. gauge of the unmeasured anions in the bloodstream
2. positively charged cations - negatively charged anions
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| show | 1. determine urine anion gap (Na + K) - Cl
2. positive gap indicates renal tubular acidosis
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| show | 1. Na+, K+, Ca2+
2. HCO3-, Cl-, albumin, lactate, ketoacids
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| show | respiratory alkalosis + metabolic acidosis
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| show | 1. calcium oxalate
2. increased calcium, decreased oxalate
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| show | urinary infections with urease positive organisms
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| show | uric acid
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| Extra-renal manifestations of adult polycystic kidney disease | show 🗑
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| show | >3g/day = nephrotic
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| show | FeNa < 1 because there is salt and water retention
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| What is the difference between Henoch-Schonlein purpura and IgA nephropathy? | show 🗑
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| show | 1. IgA nephropathy
2. poststreptococcal glomerulonephritis
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| 1. Why must one biopsy in lupus nephritis? 2. What is the treatment? | show 🗑
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| show | 1. protein:creatinine ratio of >3.5
2. renal biopsy
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| show | elevated urine osmolality and urine sodium in a patient with hyponatremia
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| 1. Patient with flattened T waves and U waves present 2. What causes the U wave | show 🗑
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| show | no max dose because gut cannot absorb it fast enough to overload kills
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| show | 1. impaired distal secretion of H+
2. impaired proximal absorption of bicarbonate
3. aldosterone deficiency
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| 1. What 2 things cause normal anion gap metabolic acidosis? 2. What laboratory test helps distinguish between the two? | show 🗑
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| 1. How do you quantify oliguria? 2. How do you quantify anuria? | show 🗑
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| 1. When is Winter's formula used? 2. What is Winter's formula? | show 🗑
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Created by:
amichael@siumed.edu
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