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Renal Medi > 11-12 > Flashcards

11-12 Flashcards

1
Q

Metabolic acidosis is pH< ____
Reduced ____
____ compensation by ___

A

7.36
HCO3
Respiratory, by hyperventilating resulting in reduced PCO2

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2
Q

In metabolic acidosis, an anion gap develops when the accumulating acid contains ___

A

An anion other than Cl

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3
Q

The most common cause of increased anion gap is ____.

What is a normal anion gap?

A

Metabolic acidosis

12

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4
Q

Most of the unmeasured anion is ___.

A

Albumin (normal anion gap is 3x the albumin)

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5
Q

Anion gap calculation:

A

Na-(Cl+HCO3)

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6
Q

Causes of anion gap acidosis:

A 
L-Lactic acidosis
Uremia
D-Lactic acidosis
Alcoholic and diabetic ketoacidosis 
Toluene
Ethylene glycol and methanol
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7
Q

If the anion gap is >30, the most common anions are ____

A

Lactate (lactic acidosis) and B-hydroxybutyrate and acetoacetate (ketoacidosis) of

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8
Q

Metformin can cause ___

A

Type B/D-Lactic acidosis

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9
Q

How do you distinguish between extrarenal and renal causes of metabolic acidosis?

A

Urinary anion gap = U.Na + U.K - U.Cl
Normally 30-50
-negative value suggests increased renal excretion of unmeasured cation such as NH4
-positive for renal origin, NH4 excretion is minimal
-large negative is extrarenal, increased NH4

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10
Q

Type 1 RTA
Type 2 RTA
Type 4 RTA

A
  1. Classical distal, low plasma K, high Urine pH,
  2. Proximal, low plasma K, low Urine pH
  3. Generalized distal defect, high plasma K, low or high Urine pH
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11
Q

Mineral acid-induced acidosis ____ K.

Organic acid-induced acidosis ____ K.

A

Increases

Does not change

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12
Q

Metabolic alkalosis is serum bicarbonate ___

A

Greater than 28 (total CO2 greater than 30)

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13
Q

Metabolic alkalosis ___ respiration

A

Inhibits

*do not extubate

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14
Q

PCO2 increases by ____ for each 1 mmol/L increase in HCO3

A

0.7 mmHg

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15
Q

____ is due to defective Na-K-2Cl cotransporter. It presents as hypokalemic, hypochloremic metabolic alkalosis

A

Bartters syndrome

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16
Q

____ is due to defected channels and is characterized by severe hypomagnesemia and hypocalcemia and predominantly neuromuscular symptoms such as cramping or tetany

A

Gitelmans syndrome

17
Q

____ is due to increased activity of a collecting duct Na channel, and presents as HTN due to volume expansion, hypokalemic acidosis, and normal aldosterone levels

A

Liddles syndrome

18
Q 
Chloride resistant alkalosis 
Treatment for 
1. Liddles syndrome
2. Bartters syndrome
3. Gitelmans syndrome
A
  1. Amiloride
  2. NSAIDs
  3. NSAIDs and Ca and Mg replacement
19
Q

USPSTF recommendations:

Grade A

A

Strongly recommended

Good evidence that benefits substantially outweigh harms

20
Q

USPSTF recommendations:

Grade B

A

Recommended

Fair evidence that benefits outweigh harms

21
Q

USPSTF recommendations:

Grade C

A

No recommendation for or against

Fair evidence, but balance of benefits and harms is too close

22
Q

USPSTF recommendations:

Grade D

A

Recommends against routinely providing

Fair evidence that it is ineffective or harms outweigh benefits

23
Q

USPSTF recommendations:

Grade I

A

Insufficient evidence

24
Q

Three criteria are important when deciding what conditions to screen for:

A
  1. Burden of suffering (consider prevalence and severity)
  2. Effectiveness, safety, and cost
  3. Performance of test
25
Q

Screening for tobacco?

A

Screen ALL

26
Q

Screening for AAA?

A

Men 65-75 who have ever smoked should be screened once with US (grade B)
*recommends against screening women who have never smoked

27
Q

Screening for Carotid A. Stenosis?

A

Recommends against in asymptomatic (grade D)

28
Q

Screening for Diabetes?

A

40-70 years who are overweight or obese

29
Q

Criteria for Diabetes dx?

A
  1. HbA1c 6.5 or higher
  2. Fasting plasma glucose 126 or higher
  3. 2 hour plasma glucose of 200 or higher during 75g oral glucose tolerance test
  4. Random plasma glucose 200 or higher with classic symptoms of hyperglycemia
30
Q

Screening for lung cancer?

A

Annual with low dose CT
55-80 years
30 pack year smoking hx who currently smoke or have quit within 15 years

31
Q

Screening for breast cancer?

Normal risk or low risk?

A
  • Mammo every 2 years for women 50-74
  • Women with family hx of breast, ovarian, tubal, or peritoneal cancer
  • yearly after 45
32
Q

Screening for breast cancer?

High risk

A

MRI and mammo every year

33
Q

Screening for cervical cancer?

A

21-65 every 3 years
30-65 every 5 years
*Against screening women >65 or those who have had a hysterectomy with cervix removal

34
Q

Screening for colon cancer?

A

50-75 years (grade A)

>85 not recommended

35
Q

Screening for colon cancer?

1. Tests that find polyps and cancer

A

Flexible sigmoidoscopy every 5 years
Colonoscopy every 10 years
Double contrast barium enema every 5 years
CT colonography every 5 years

36
Q

Screening for colon cancer?

2. Tests that find primarily cancer

A

Annual gFOBT
Annual iFOBT/FIT
Stool DNA test, interval uncertain

Renal Medi (11 decks)

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