Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Nephrology > Clinical Exam > Flashcards

Clinical Exam Flashcards

1
Q

What are the signs of uraemia?

A

Uraemic tinge/fetor

Hiccups

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What to look out for in a patient with kidney problem for general appearance?

A
  1. Uraemic signs - fetor/tinge/hiccups
  2. Acidosis - hyperventilation
  3. Hypocalcemia - tetany (Chvostek/Trosseau), twitching, myoclonic jerks
  4. Fluid balance - signs of dehydration & fluid overload (JVP, pulmonary oedema, ascites, peripheral oedema)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are signs of hypocalcaemia?

A

Calcium > muscle not working > twitching, myoclonic jerks, tetany (Chvostek sign, Trousseau sign)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

As part of fluid balance check, what should you measure during exam?

A

The patient’s weight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How to check for fluid balance?

A
  1. AKI due to dehydration: look for signs of dehydration - dry mucous membranes, reduced skin turgor, postural hypotension
  2. Fluid overload: JVP, signs of pulmonary oedema, ascites, peripheral oedema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How to check for urinary incontinence?

A

Look for stains on bed or patient’s clothing before balloting the kidneys.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What do Muehrcke’s (mew-rook’s) nails indicate?

A

Nephrotic syndrome/hypoalbuminemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What do Mee’s lines indicate?

A

Renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What to look for in the hands after general appearance?

A
  1. Nail changes: e.g. Muehrcke’s lines (hypoalbuminemia), Mee’s lines (renal failure), half-and-half nails (CKD), capillary refill*
  2. Anemia - palmar crease pallor
  3. Asterixis - severe CKD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How do half-and-half nails look like?

A

Distally its red, proximally its white colour.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What cause anaemia in CKD?

A
  1. Chronic disease

2. Lack of erythropoietin prdtion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the difference between an AV fistula and a shunt?

A

AV fistula is an anastomosis between an artery and a vein (direct connection)
Whereas a shunt is an extra graft extending between the artery and vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Why are dialysis patients more prone to carpal tunnel syndrome?

A

Due to AV fistula and uraemic neuropathy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is a sign of carpal tunnel syndrome in dialysis patients? However do patients usually present with such specific numbness? If not then what do they present with.

A

Numbness over the median nerve distribution - radial side 3 fingers.
Often present with numbness of the whole hand.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

After examining the hands and moving up to the arms in renal patients, what should you look for?

A

in the arms:

  1. scars - signifying previous thrombosed shunts
  2. AV fistulas/shunts
  3. check for signs of CTS i.e. numbness
  4. Scratch marks/excoriations
  5. Bruising
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Scratch marks and excoriations on a renal patient indicates what?

A

Uremic pruritis > uremia > renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Why do patients with kidney dysfunction have bruising on their arms?

A

Nitrogen retained in the body affects platelet aggregation resulting in bruising

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the signs of vasculitis in renal patients?

A

Vasculitis may present as:

  1. sensory or motor neuropathy e.g. weakness, diminished sensation
  2. palpable purpura
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What additional exams would you like to do to complete the renal exam?

A
  1. Neurological exam: specifically for peripheral neuropathy (sensation, reflexes)
    2.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What does rash indicate as the cause of renal disease?

A

SLE and systemic sclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

After examining the arm and moving to face, what signs to look out for in the renal patient?

A
  1. Rash: indicate SLE, systemic sclerosis
  2. Conjunctival pallor (indicative of anaemia)
  3. Eyes: band keratopathy (hyperparathyroidism), conjunctival pallor
  4. Mouth: gingival hyperplasia (calcineurin inhibitors), uremic fetor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is band keratopathy and how is it related to renal disease?

A

Band keratopathy is a white smudge across the eyes (caused by calcium deposition). Get this because of secondary/tertiary hyperparathyroidism. Secondary hyperparathyroidism is caused by hypocalcemia of renal disease and low vitamin D levels.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Why do patients with CRF get hyperphosphatemia, hypocalcemia, and secondary hyperparathyroidism.

A

Because impaired kidneys cannot properly excrete phosphate, calcium phosphate forms binding to all the calcium and decreasing serum calcium. Parathyroid hormone secretion increases to correct the hypocalcemia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What do normal kidneys do to Vitamin D? How does this relate to hyperparathyroidism and its sign on clinical examination?

A

Normal kidneys convert vitamin D into its active form. With impaired renal function, active vitamin D levels decrease, stimulating parathyroid secretion. Patient may have band keratopathy (calcium deposition in eyes) as a result of parathyroid hormone increasing calcium absorption.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

While inspecting the face, what do you want to look for in the mouth that can suggest that this is a post-transplant patient on a particular class of drugs?

A

Gingival hyperplasia is the result of taking calcineurin inhibitors (e.g. tacrolimus and cyclosporin), which are immunosuppressant drugs used for post-renal transplant.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What does a scar at the jugular vein suggest in a renal patient?

A

This patient has been on haemodialysis before as access was obtained to the jugular vein for ‘VasCath’.

27
Q

After examining the face of a renal patient, what signs are there to look for in the neck?

A
  1. JVP - fluid status
  2. Jugular vein access - haemodialysis
  3. Scars - parathyroidectomy for tertiary hyperparathyroidism
28
Q

What is tertiary hyperparathyroidism?

A

When secondary hyperparathyroidism is sustained for prolonged period till serum calcium levels become elevated.

29
Q

Signs and Ix results of CKD-MBD are?

A

Bone pain, fractures

Vascular calcification on imaging, hypercalcemia

30
Q

What are signs on examination that the patient has CKD rather than AKI?

A
  1. Small kidneys instead of enlarged i.e. not ballotable with the exception of PCKD, diabetic nephropathy, myeloma and amyloidosis which are chronic kidney diseases but result in large kidneys)
  2. Associated with renal osteodystrophy (CKD-MBD)
  3. Peripheral neuropathy means chronic
  4. Anaemia (of chronic disease)
31
Q

After examining the neck and moving on to the chest exam of a renal patient, what should you look for? Wat are the 2 main organs associated with kidney disease?

A

Heart and Lungs:

  1. Congestive cardiac failure, fluid overload, pulmonary oedema
  2. Lung infection (CKD causes immunosuppression and so do post-transplant drugs)
32
Q

Why does pericarditis occur in renal disease and what’s its most dangerous complication?

A

Kidneys impaired > can’t remove metabolic toxins > pericarditis and pericardial effusion > accumulates enough > becomes cardiac tamponade = fatal

33
Q

How can you look for signs of pericarditis and its associated complication cardiac tamponade in a renal patient?

A

Pericarditis - pericardial friction rub

Cardiac tamponade - haemodynamic compromise, breathless, tachy, hypotension

34
Q

How to assess haemodynamic stability? Why is it important in patients who present to ED with possible AKI?

A
  1. Oliguria
  2. Cap refill time
  3. Vitals - temperature, HR, RR, BP
    The cause of AKI may be renal hypoperfusion which will manifest as signs of inadequate organ perfusion like oliguria and low cardiac output like cap refill time and tachycardia.
35
Q

After inspecting the chest, move on to the abdomen of the renal patient, what should you look for?

A
  1. Observe for Tenckhoff catheter suggestive of peritoneal dialysis
  2. Scars: dialysis, transplant, nephrectomy
  3. Palpate for distension, mass, tenderness and enlarged bladder
  4. Ballot kidneys: feel for enlargement
  5. Percuss for ascites (shifting dullness) and enlarged bladder
36
Q

What are the different scars visible on the abdomen of a renal patient?

A
  1. Peritoneal dialysis scars: usually at lower abdomen near the midline small enough for cathether to go through
  2. Kidney transplant scars: right and left illiac fossae, moon-shaped down each side
  3. Nephrectomy scars: posteriorly
37
Q

After inspecting the abdomen, move on to the genitals, what are you looking for in a renal patient?

A
  1. Genital oedema: can be caused by fluid overload in kidney disease
38
Q

Why is it relevant to palpate for a triple AAA (abdominal aortic aneurysm) in renal patients?

A

Fibrosis around the aneurysm may cause ureteric obstruction and thus kidney disease.

39
Q

Renal colic is a sign pointing towards what disease?

A

Kidney stones

40
Q

When palpating a possible renal mass in the abdomen, what discriminating factors should you feel for and what disease do they suggest?

A
  1. Enlarged mass close to the skin - transplanted kidneys
  2. Mass enlarged in the forward direction - more likely enlarged kidneys VS
  3. Mass enlarged at the back, posteriorly - more likely a perinephric abscess
41
Q

What are the possible causes of abdominal distension in a renal patient?

A
  1. Peritoneal dialysis fluid
  2. Ascites from fluid overload / nephrotic syndrome
    3, Polycystic kidneys
42
Q

Post-renal transplant patient, when palpating you should ask the patient about _? Because?

A

Tenderness

Because it suggests transplant rejection

43
Q

When palpating the abdomen for distension/masses, tenderness should be asked too particularly for _ and at _?

A

Tenderness shld be enquired for transplanted kidneys and at the loin.

44
Q

When palpating the abdomen of a renal patient, shun bian palpate which other organ? Why?

A

Palpate the liver too for hepatomegaly as a result of hepatic cysts, as this can be associated with PCKD.

45
Q

When balloting the kidneys, ask the patient to?

A

Breathe in and out and feel the kidneys move.

46
Q

What are the 3 organs in the abdomen that can be enlarged in kidney disease?

A

Kidneys, duh - polycystic etc.
Bladder - urinary retention
Liver - hepatic cysts associated with PCKD

47
Q

How to percuss for an enlarged bladder?

A

Percuss from top to down the midline noting when the percussion note changes from resonant to dull; this point marks the point of the bladder > is it high? > distended.

48
Q

What are the causes of unilateral ballotable kidney?

A
  1. Hydronephrosis (lvl of obstruction above bladder)
  2. Polycystic kidney disease, renal cyst
  3. Renal cell carcinoma
  4. Renal abscess
  5. Renal vein thrombosis
  6. Hyperfunctioning of remaining kidney post-nephrectomy or congenital absence of one kidney
49
Q

What are the causes of bilateral ballotable kidneys?

A
  1. Polycystic kidney disease
  2. Hydronephrosis (obstruction at or below level of bladder)
  3. Renal cell carcinoma
  4. DM nephropathy > compensatory renal hypertrophy
  5. Infiltrative diseases e.g. amyloidosis, lymphoma
50
Q

When palpating a renal mass, what features should be noted?

A
  1. Size (spreaded fingers 14cm)
  2. Consistency (hard, soft)
  3. Surface (nodular, smooth)
  4. Shape (kidney-shaped, irregular)
  5. Tender?
  6. Are you able to get ABOVE the mass?
51
Q

Why is it important when palpating an abdominal, possibly renal, mass to try and get above it?

A

If cannot get above it, it is connected to some other structure e.g. hernia connected to colon
If can get above it, it’s a solid organ structure e.g. kidney

52
Q

Once abdominal mass is felt, should ask patient to do what to feel if mass moves with _?

A

Respiration

Breathe in and out

53
Q

How will a splenic mass feel different from a renal mass?

A

Splenic mass will have a distinct splenic notch, kidneys do not.

54
Q

When mass is felt, if it is a renal mass, percussing over it will sound _? Because?

A

Resonant

Because of overlying bowel loops

55
Q

Auscultate in a renal exam for?

A

Bowel sounds and renal bruits.

56
Q

Determine the cause of a renal mass - what signs can you check?

A
  1. Renal abscess: positive Murphy’s sign, tenderness
  2. PCKD: hepatosplenomegaly, signs of ESRF
  3. RCC: cachexia
  4. Diabetic nephropathy: diabetic dermopathy
57
Q

Abdominal exam for renal mass - what are the general steps?

A

Inspection
Palpation
Percussion
Auscultation

58
Q

What are the signs of ESRF?

A
  1. Uraemia - scratch marks, bruising, asterixis
  2. Fluid overload - raised JVP*, unable to lie flat, ascites, bibasal inspiratory crepitations, peripheral oedema
  3. Conjunctival pallor, sallow appearance
  4. AVF/AVG
59
Q

When examining a patient with ballotable kidney(s), what additional exam should you request for?

A
  1. Vitals
  2. Urinalysis: haematuria, glycosuria
  3. Fundoscopy: diabetic or hypertensive retinopathy
  4. APKD: CVS (MVP) + neurological exam (3rd nerve palsy, focal neuro deficit)
60
Q

Cerebral aneurysms are associated with which kidney disease?

A

APKD

61
Q

Differentials for bilaterally enlarged kidneys

A
  1. APKD
  2. Early diabetic nephropathy
  3. Bilateral hydronephrosis (obstruction below bladder)
62
Q

For completion’s sake, what exams should be suggested after examining the kidneys?

A
  1. Temperature chart for fever
  2. Blood pressure chart for hypertension
  3. Fundoscopy for hypertensive changes
  4. Cardiovascular exam - MVP & AR (APKD)
63
Q

What can cause a unilaterally enlarged kidney?

A
  1. RCC
  2. Hydronephrosis / pyonephrosis
  3. Acute renal vein thrombosis
  4. Hyperfunctioning of a single remaining kidney
64
Q

What can cause bilaterally enlarged kidneys?

A
  1. APKD
  2. Hydronephrosis
  3. Endocrine: Acromegaly, DM
  4. Infiltrative: amyloidosis, lymphoma
  5. Rare: VHL, tuberous sclerosis

Nephrology (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions