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Renal 2 Final > Clinical Medicine Part 3 > Flashcards

Clinical Medicine Part 3 Flashcards

1
Q

S4 heart sound consistent with

A

hypertension

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2
Q

HTN Target organ damage

A
  • TIA, stroke
  • retinopathy
  • PVR
  • renal failure
  • LVH, CHD, HF-TIA, stroke
  • retinopathy
  • PVR
  • renal failure
  • LVH, CHD, HF
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3
Q

Hypertensive Urgency

A
  • a systolic BP >180
  • or a diastolic BP >130
  • and NO evidence of end organ damage
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4
Q

Hypertensive Emergency

A

-may occur at any BP, but involves damage to at least one organ system

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5
Q

CV Signs of target organ involvement

A
  • MI
  • angina
  • aortic dissection
  • aneurysmal dilation of large vessels,
  • LVH
  • CHF
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6
Q

Renal signs of target organ involvement

A

hematuria, proteinuria, AKI

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7
Q

CNS signs of target organ involvement

A

Cerebral edema, altered mental status, bleed, stroke or TIA

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8
Q

Ophthalmologic signs of target organ involvement

A
  • retinal hemorrhages or exudates, papilledema

- AV nicking

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9
Q

Atherosclerosis

A
  • over 50 years old
  • male predominance
  • progressive
  • 33% bilateral
  • associated risks–tobacco, lipids, diabetes, etc.
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10
Q

Fibromuscular dysplasia

A
  • age less than 40
  • female predominance
  • 60% bilateral
  • responds to angioplasty
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11
Q

Renovascular HTN associated with renal artery stenosis

A
  • stenosis is a progressive obstructive disease
  • stenosis rate of 1.5%/month
  • if untreated, can lead to total occlusion
  • causes of stenosis and HTN are atherosclerosis and fibromuscular dysplasia
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12
Q

Medial Fibromuscular dysplasia

A
  • most common
  • 9/1 females to males
  • ages 25-45
  • can be seen in carotids and iliac arteries
  • 70% bilateral
  • may appear as solitary mid and distal stenotic lesions or multiple constrictions with intervening aneurysmal dilations
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13
Q

Perimuscular dysplasia

A

-usually mid-distal portion of renal artery

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14
Q

Intimal fibromuscular dysplasia

A
  • males and females equally affected

- infants and young adults more frequently

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15
Q

Unilateral Renal artery stenosis, 2 kidneys

A
  • decreased intravascular volume
  • more renin mediated (increased) than the others
  • BP usually falls with ACE-Is
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16
Q

Bilateral renal artery stenosis

A
  • increased intravascular volume
  • renin mediation more varied
  • ACE response unpredictable and may worsen HTN
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17
Q

Unilateral renal artery stenosis, 1 kidney

A
  • increased intravascular volume
  • renin mediation is more varied
  • ACE response unpredictable and may worsen HTN
18
Q

Diagnosis of renovascular HTN

A
  • renal US with arterial dopplers
  • Captopril test–reactive rise in renin and large fall in BP after administration
  • Digital subtraction angiography
  • MRI-angiogrpahy
  • arteriography
  • renal vein renin ratio greater than 1.5
19
Q

Renovascular HTN treatment

A
  • aimed at BP control and preservation of renal function
  • antihypertensive meds
  • stenting
  • grafting
20
Q

Contraindications to ACE inhibitors

A
  • bilateral renal artery stenosis
  • unilateral renal artery stenosis with solitary kidney
  • pregnancy
  • known angioneurotic edema with prior ACE administration
  • relative contraindication–ACE induced cough
21
Q

Secondary HTN

A
  • sleep apnea
  • drug induced causes
  • primary aldosteronism
  • renovascular disease
  • steroid therapy or Cushing’s syndrome
  • pheochromocytoma
  • coarctation fo the aorta
  • thyroid disease
  • parathyroid disease
22
Q

Cardiovascular causes of HTN

A
  • MI
  • acute left ventricular failure
  • vasculitis
  • coarctation of the aorta
  • aortic dissection
  • volume overloading (including pulmonary edema)
23
Q

Coarctation of the aorta

A
  • narrowing of medial layer of aorta
  • commonly ligament arteriosum
  • interrupted, preductal, postductal
24
Q

Diagnosis of Coarctation

A
  • differences in upper and lower extremities
  • blood pressure: systolic HTN in an infant; 20 mmHg difference between arms
  • heart sounds–if isolated, a systolic ejection murmur in the aortic outlet and between scapulae
  • cardiomegaly, rib notching, 3-sign on lateral chest view
25
Q

Primary Hyperaldosteronism

A
  • located in adrenal gland without exogenous stimulus
  • elevated aldosterone and low renin levels decrease potassium
  • aldosterone producing adenoma, idiopathic, bilateral adrenal hyperplasia, aldosterone producing cancer, aldosterone producing renin-responsive adenoma, ectopic aldosterone producing tumor, dexamethasone suppressible hyperaldosteronism
26
Q

Secondary hyperaldosteronism

A
  • elevated aldosterone and elevated renin levels

- diuretics, CHF, cirrhosis, ascites, nephrosis, others

27
Q

Treatment after MI

A

-beta blocker, ACE inhibitor

28
Q

Contraindicated treatment after MI

A

direct vasodilators

29
Q

Treatment of CHF

A

ACE inhibitor, diuretics

30
Q

Contraindicated treatment of CHF

A

beta blockers, CCB

31
Q

Treatment of angina

A

-beta blockers, CCB, nitroglycerin

32
Q

Treatment of aortic dissection

A

-nitroprusside, beta blockers

33
Q

Contraindicated drugs in bilateral renal artery stenosis

A

-ACE inhibitors, angiotensin blockers

34
Q

Treatment of Chronic renal insufficiency

A
  • ACE inhibitors with serum creating less than 2.5
  • loop diuretics
  • CCB
35
Q

Contraindicated drugs in chronic renal insufficiency

A

ACE inhibitors, ARBs

36
Q

Contraindicated drugs in Renal transplants

A

ACE inhibitors

37
Q

Nitroglycerin

A
  • advantage over nitroprusside since it preferentially dilates veins more than arterioles, thus enhancing oxygenation of myocardial cells
  • CABG, MI, unstable angina, left ventricular failure
38
Q

Systemic Causes of Nephrotic Syndrome

A
  • DM, SLE, amyloidosis
  • drugs: gold, penicillamine, probenecid, captopril, NSAIDs, heroin
  • infections: bacterial endocarditis (can also get hematuria), Hep B, shunts, syphilis, malaria
  • malignancy: hodgkins, non-hodgkins lymphoma, leukemia, breast and GI cancers
39
Q

Active sediment

A

-any positive findings on microscopic, particularly those suggesting kidney disease

40
Q

Bland sediment

A

-normal

Renal 2 Final (5 decks)

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