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OPT 537 > Exam 3 -- Randomized List of All Exam 3 Flashcards > Flashcards

Exam 3 -- Randomized List of All Exam 3 Flashcards

1
Q

Since there is no cure for Marfan syndrome, what can you do to reduce the potential for morbidity and mortality for a patient with this condition?

A

Decrease cardiac contractility and blood pressure to lower pressure on aorta (with beta blockers, ACE inhibitors, ARBs), grafts to replace aortic valve and region with aneurysm, avoid contact sports and strenuous exercise, pain meds for aches and pains

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2
Q

What is the addition of substances into the filtrate called?

A

Secretion

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3
Q

Fabry disease is an error of glycosphingolipid metabolism caused by a defect in which enzyme?

A

Alpha-galactosidase A

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4
Q

True or false: the tingling due to polyneuropathy in CKD extends only as far as the wrists and ankles

A

False; it extends up most of the arm/leg (stocking-glove pattern)

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5
Q

Diagnosis of arrhythmias may involve case history, clinical exam, EKC, echocardiogram, even monitor, and what other type of device?

A

Holter monitor (24-48 hour time period in which patient wears the device and it monitors for irregularities of heart beat)

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6
Q

True or false: patients with acute pyelonephritis usually respond well to antibiotics

A

True.

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7
Q

Sinus tachycardia is due to an increased rate of the SA node. It can be caused by exercise, fear, fight, stress, etc (due to catecholamine release). What are some diseases or conditions that might cause sinus tachycardia?

A

Anemia, hyperthyroidism, heart failure

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8
Q

Truly or false: untreated hypertension reduces life expectancy by 10-20 years

A

True.

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9
Q

Which heart sound corresponds to the closing of the mitral and tricuspid valves?

A

S1

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10
Q

What are different ways an arrhythmia could be classified?

A

Tachyarrhythmia (too fast) vs. bradyarrhythmia (too slow); supraventricular (atrial or nodal) vs. ventricular; regular vs. irregular

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11
Q

What specific drugs (not corticosteroids) are used as immunosuppressants for renal transplantation? Which pair of these drugs is the most common?

A

Cyclosporine or tacrolimus (calcineurin inhibitors) and azathioprine and mycophenolate (anti-metabolites); tacrolimus and mycophenolate is the most common combination

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12
Q

What are some of the symptoms that CKD can cause in the bones?

A

Osteomalacia, bone pain, hyperparathyroidism

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13
Q

What glaucoma concerns should be considered for patients being treated for hypertension?

A

If patient is already on an oral beta-blocker, a topical beta-blocker won’t help with IOP; nocturnal hypotension increases risk of progression of POAG and NTG (some people’s IOP naturally drops overnight, so taking HTN meds at night may make this worse).

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14
Q

What are some advantages of peritoneal dialysis over hemodialysis?

A

Takes less time, requires less dietary restrictions, filtration is more consistent, residual kidney function is retained longer, is more cost efficient.

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15
Q

What is the basis of the glomerular filtration rate test?

A

You have the patient ingest a known amount of a substance that they can’t get anywhere else, one that will be put into the filtrate by the glomerulus but not reabsorbed by the tubules, and take timed urine and blood samples to see how quickly this substance is eliminated from the body.

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16
Q

Which substances are secreted in the descending loop of Henle?

A

None

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17
Q

What sorts of ocular symptoms may occur with renal disease?

A

Calcium deposits, lid edema, corneal changes, aniridia, cataracts, uveitis, optic nerve head edema, drusen around macula, retinal changes.

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18
Q

What cardiovascular concerns would you have about a patient with Marfan’s syndrome?

A

Ascending aortic dilation*/aneurysm/dissection, aortic regurgitation, mitral valve prolapse

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19
Q

Contracility is the force of ventricular contraction. It is independent of loading conditions. Calcium and beta-blockers affect contractility.

A

Free card

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20
Q

Malignant hypertension is characterized by…?

A

Diastolic BP > 120mmHg (systolic is even more elevated above normal), optic nerve head edema, encephalopathy (confusion, non-responsiveness), high BP leading to cardiovascular abnormalities. This is caused by renal failure!

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21
Q

What causes the edema seen in nephrotic syndrome? Which structures are often affected first?

A

Decreased albumin in the blood shifts the osmotic balance so fluid stays in tissues (this can cause pitting edema). Eyelids are most often affected first.

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22
Q

Review the chart for management hypertension in patients younger than 18 years.

A

Free card (kind of)

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23
Q

True or false: less than 10% of US adults have some sort of chronic kidney disease (CKD)

A

False; greater than 10%

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24
Q

In third degree AV block, what mechanism compensates for the block?

A

AV node can take over the pacemaker job, or the ventricles can start to spontaneously depolarize.

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25
Q

What stimulates erythropoietin release from the kidneys, and what effect does it have?

A

Hypoxia is the most common stimulant of erthyropoietin release; erythropoietin stimulates bone marrow production of RBCs

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26
Q

One of the first signs of nephritic syndrome may be ___________

A

Oliguria (reduction in urine output)

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27
Q

What would you use to treat TINU?

A

Oral corticosteroids (not topical, as you would normally use for uveitis)

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28
Q

ACE inhibitors and angiotensin receptor blockers (ARBs) are part of the treatment plan for individuals with nephrotic syndrome. What effects do they have?

A

They cause a decrease in renin, which means that the efferent arteriole vasodilates more. This puts less pressure on the glomerulus, thus decreasing the GFR. They also improve the charge and size selectivity of the glomerular basement membrane by keeping the slit material between podocytes more intact.

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29
Q

What type of inheritance pattern causes Fabry disease?

A

X-linked recessive, so more common in males

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30
Q

Which classes of diuretics are commonly used in treatment of glaucoma?

A

Osmotic diuretics (mannitol, urea, isosorbide)

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31
Q

If a patient’s systolic BP is <80 (i.e., normal), what is the recommended follow up plan?

A

Recheck in two years

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32
Q

Signs and symptoms of ARF reflect loss of regulatory, excretory, and endocrine function, but these can take a while to present. What is the most common first sign of ARF?

A

Decrease in urine output

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33
Q

It has been suggested that dialysis may increase a patient’s risk of death from heart attack due to ion imbalance. What are a few criteria (other than GFR) that may possibly be used to judge when dialysis should be used?

A

Pericarditis, neuropathy, encephalopathy, heart failure, acidosis, loss of weight, persistant hyperkalemia, edema not responsive to diuretics

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34
Q

What are some of the symptoms that CKD can cause in the CNS?

A

Confusion, coma, seizures (due to ion imbalance in the blood)

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35
Q

If a patient’s systolic BP is 160-179 or their diastolic BP is 100-109 (i.e., stage 2 hypertension prior to the urgent point), what is the recommended follow up plan?

A

Refer to PCP within one month

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36
Q

What is the systolic/diastolic BP measurement for the normal category?

A

Adults: <90th percentile

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37
Q

Nephrolithiasis can cause what substance to appear in the urine? This is similar to which other condition mentioned in class? What fact about this feature in nephrolithiasis that might help differentiate it from this other condition?

A

Blood (hematuria), which is also found in nephritic syndrome. Hematuria in nephrolithiasis can be accompanied by sharp pain; in nephritic syndrome, it is usually painless.
(Note: hematuria can also happen in renal cell carcinoma.)

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38
Q

True or false: malignant hypertension is not a very big deal

A

False; it is a medical emergency, requiring immediate and aggressive anti-hypertensive therapy

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39
Q

What is the most common cause of kidney failure? Second most common? What immune conditions may trigger kidney disease?

A

Diabetes is #1, HTN is #2; SLE, Sjogren’s, scleroderma can also cause kidney failure

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40
Q

What is the purpose of a stress test?

A

A stress test determines the heart’s response to physical exertion by measuring ECG, BP, and pulse during exercise. Changes in the ECG during the exercise as compared to rest indicate presence and severity of the ischemia.

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41
Q

True or false: renal cell carcinoma is less common among cigarette smokers than non cigarette smokers?

A

False; it is more common

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42
Q

What type of substance makes up most kidney stones? Second most common?

A

Calcium; magnesium

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43
Q

Nephritic syndrome most commonly follows strep throat infection in the ______________ (northern/southern) US, and most commonly follows impetigo in the _______________ (northern/southern) US.

A

Northern; southern

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44
Q

True or false: the kidney has little, if any, endocrine function

A

False; it is involved with calcium regulation and uptake (calcitriol), RBC production (erythropoietin), autoregulation of blood flow and water reabsorption (prostaglandins, NO, and endothelins have one or both of these functions)

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45
Q

The renin-angiotensin-aldosterone system acts to increase BP. As briefly as possible, outline this system.

A

Renin from kidney combines with angiotensinogen from liver to form angiotensin I, which is converted by ACE from lungs to angiotensin II. Angiotensin II increases thirst and causes vasoconstriction; it acts on the proximal tubule to increase sodium and water retention; it also acts on the pituitary to release vasopressin. Vasopressin acts on the kidney to increase water reabsorption. Pituitary also stimulates release of aldosterone from adrenal gland, which acts to increase sodium and water retention

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46
Q

What are some of the symptoms that CKD can cause in the skin?

A

Pigmentation (due to MSH not being excreted as well) and pruritus (due to increased levels of calcium and phosphate drying out tissue)

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47
Q

What is a form of ARF that may be seen first by an optometrist (due to the presenting symptoms)?

A

Malignant hypertension

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48
Q

Anticoagulation medications are used in atrial fibrillations because clots can easily form in the left atrial appendage. Which medications might be used? Which of these can be offset with vitamin K should an overdose occur?

A

Warfarin, dabigatran, apixaban, rivaroxaban. Warfarin OD can be treated with vitamin K; the other three would need blood transfusion in case of OD.

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49
Q

Hypersensitivity reactions to certain drugs can be a cause of ARF. Which drugs or classes of drugs can do this? What type of hypersensitivity reaction is possible?

A

Penicillin, ciprofloxacin, sulfonamides, NSAIDs; type I (anaphylactic) and type IV (delayed) are both possible

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50
Q

True or false: nephritic syndrome commonly progresses to chronic renal failure

A

False.

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51
Q

Know that the structure of the glomerulus is similar to the structure of choriocapilaris and the RPE cells, so things that affect the glomerulus could affect the eye too.

A

Free card

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52
Q

True or false: Wilms’ tumor is the second most common kidney malignancy and the third most common organ cancer in children

A

True.

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53
Q

Define: arrhythmia

A

Irregularity in rate or rhythm

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54
Q

The atrial and ventricular myocytes form two syncytia. What is this and what does mean?

A

The cell membrane of the myocytes are fused together, meaning that if one of them depolarizes, they all depolarize. This allows them to all contract together (important for regular heart beats.

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55
Q

The blood, urea, nitrogen (BUN) test is one that can be used to indicate kidney function. It measures levels of urea in the blood. Generally, how much urea should be reabsorbed, and how much should be excreted? A/An ______________ (increased/decreased) value of a BUN test compared to the normal would indicate reduced kidney function. What causes this value to change?

A

50% should be reabsorbed, 50% should be excreted. Increased BUN value would indicate reduced kidney function. This is because decreased glomerular filtration rate allows more reabsorption of urea.

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56
Q

What is the systolic/diastolic BP measurement for the hypertension stage 2 category?

A

Adults: >=160/>=100; less than 18 years: >5 mmHg above 99th percentile

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57
Q

What are the three most common replacement therapies in the US?

A

Hemodialysis, peritoneal dialysis, renal transplantation

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58
Q

Since severe bradycardia can occur in third degree AV block (15-40 bpm), a pacemaker should be implanted in these patients.

A

Free card

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59
Q

True or false: nephritic syndrome, if caused by a prior streptococcal infection, is most common in children and occurs most often in the winter

A

False; it is indeed more common in children but it occurs most commonly in summer and autumn.

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60
Q

Briefly describe how peritoneal dialysis works

A

Catheter placed in peritoneal cavity allows installation of dialysate into cavity. Peritoneum acts as semipermeable membrane to allow ions/waste to be pulled into dialysate. The dialysate is removed after a period of time and more is instilled.

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61
Q

What values tend to increase with kidney failure? Which tend to decrease?

A

Increase: serum potassium and phosphate; Decrease: serum calcium, pH, and bicarbonate

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62
Q

Briefly describe how hemodialysis works.

A

Blood is circulated into artificial kidney machine, in an opposite direction to another fluid (dialysate). These two fluids are separated by a semipermeable membrane which allows diffusion of ions and low molecular weight substances into the dialysate. Blodo then circulates back into the body.

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63
Q

Multiple-gated acquisition scan (MUGA scan) is a radioactive test. What part of the heart is monitored, and what is being measured?

A

The left ventricular wall is monitored for the left ventricle’s ability to eject blood. This tests the function of the heart and the heart’s cardiac output

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64
Q

True or false: Wolff-Parkinson-White syndrome is inherited

A

True, but not 100% true; it can random (doesn’t have to be inherited)

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65
Q

Which substances are secreted in the collecting duct?

A

Potassium (in exchange for NaCl reabsorption; increased by aldosterone)

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66
Q

If a patient’s systolic BP is 120-139 or their diastolic BP is 80-89 (i.e., pre-hypertensive), what is the recommended follow up plan?

A

Recheck in 1 year, discuss lifestyle modifications

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67
Q

What are a few categories of antihypertensive drugs?

A

Diuretics (increase water excretion, relax smooth muscle), beta-blockers (decrease HR and renin release), calcium channel blockers (relax smooth muscle), ACE inhibitors, ARBs, and renin inhibitors for inhibiting the renin system

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68
Q

What structures are damaged by the immune system in membranoproliferative glomerulonephritis?

A

Capillaries and supporting mesangium

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69
Q

Renal cell carcinoma is associated with what disease?

A

Von Hippel-Lindau disease

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70
Q

The endothelins are peptides that are kidney autocrine hormones. What do endothelins do in the kidneys?

A

They increase BP through vasoconstrition and salt/water retention.

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71
Q

If a stone is too large to pass, what other treatments may be tried?

A

Shockwave lithotripsy (shockwaves to break up the stone into smaller stones, which all then have to pass); failing that, surgery.

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72
Q

AV block occurs when not all of the signals generated by the SA node make it to the ventricles. Three degrees of AV block were discussed in class. Which degree features an overall slower HR that is otherwise normal?

A

First degree; this is due to the AV node sending signals on more slowly.

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73
Q

From an eyecare point of view, why should a patient on amiodarone be monitored carefully?

A

SE include corneal microdeposits (in 90%, but doesn’t cause vision loss), lens opacities, disc edema (concerning), optic neuritis (very concerning;)

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74
Q

What is the treatment plan for nephritic syndrome? How many patients with this syndrome experience complete recovery?

A

Salt restriction, diuretics and other hypertensives. Most patients (90-95%) experience complete recovery.

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75
Q

Which gender has a higher prevalence of renal cell carcinoma?

A

Male

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76
Q

What are key features in diagnosing Marfan sydrome?

A

Family history (fam hx + bilateral ectopia lentis or fam hx + ascending aortic dilation is enough to make diagnosis), ophthalmologic exam, echocardiography/EKG, CT/MRI to assess aorta size, physical exam. DNA analysis of fibrillin gene on chromosome 15 can also be done.

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77
Q

The constant depolarization of the atria in atrial fibrillation is based down to the ventricles as well, though these beat at a much slower rate. (Atria = 300-600 bpm, ventricles = 120-170 bpm). Where does the signal come from causing the constant atrial depolarization?

A

Usually near the pulmonary vessels

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78
Q

Laughter can help decrease BP through decreasing sympathetic activity and dilating blood vessels

A

Free card.

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79
Q

Acute renal failure is an abrupt decrease in renal function. What are a few general causes of ARF? Which cause is the most common cause? Which is most deadly?

A

Some medications (interference with function, hypersensitivity reactions, toxicity), ischemia, autoimmune disease, infections. Ischemia due to heart surgery is the most common cause, and ischemia in general is the most deadly cause.

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80
Q

In normal function, all of the ions and molecules of the filtrate experience some amount of reabsorption, except one. Which is it?

A

Creatinine

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81
Q

How much (%) of the glomerular filtrate ends up becoming urine?

A

1%

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82
Q

Cardiac arrhythmias can be accompanied by several symptoms. What are some of these symptoms?

A

Palpitations, dizziness, lightheadedness, syncope, anxiety, chest or neck discomfort, dyspnea, weakness.

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83
Q

What pulmonary concerns would you have about a patient with Marfan’s syndrome?

A

Pneumothorax, obstructive sleep apnea

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84
Q

Sustained ventricular tachycardia is when the ventricles beat between 120-220 bpm but have a regular rhythm, for longer than 30 seconds. What is the cause? How does this effect cardiac output? What is done to correct this condition?

A

Cause is unknown; cardiac output is decreased; direct current cardioversion helps correct

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85
Q

What systemic issues could a patient with Fabry disease have?

A

Renal failure due to glycolipid deposition in renal vessels (evidenced by proteinuria, azotemia, uremia); cardiovascular or cerebrovascular disease, GI dysfunction

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86
Q

What class of medication interferes with the autonomic nervous system innervation of the heart by blocking epinephrine? What is the result of this blockage? You wouldn’t want to use this class of drugs in patients with what type of condition?

A

Beta-blockers; these decrease HR and contracility. They also slow conduction time, so you wouldn’t want to use them in a patient with severe heart block (their heart rate is already too slow).

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87
Q

True or false: cardiac catheterization is used to detect pressures and patterns of blood flow.

A

True. You can also inject contrast for angiography

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88
Q

What are the four categories of descriptors that can be used to describe a case of kidney disease?

A

Time (acute vs. chronic); structure affected (glomerular, tubular, etc); where issue is located (pre-renal, interstitial, post-renal); cause of issue (diabetic)

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89
Q

Which chemical mediators affect renal blood vessels?

A

Renin (indirectly through angiotensin II), prostaglandins, NO, endothelin

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90
Q

True or false: if a patient with Wilms’ tumor survives for at least two years, they usually have a normal lifespan

A

True.

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91
Q

What substances would you not expect to find in the urine of a healthy individual? What else could you use a urinalysis to look for?

A

You expect no protein, no blood, and no glucos. You could use urinalysis to look a patient’s pH (amount of dehydration) or look for presence of WBCs (possible infection)

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92
Q

Lifestyle modification for hypertensive patients includes what?

A

Smoking cessation, dietary sodium less than 2.3g/d (6g NaCl), maintenance of adequate dietary potassium, calcium, magnesium, and vitamin D, limitation of alcohol intake

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93
Q

If a patient’s systolic BP is 180-219 or their diastolic BP is 110-119, what is the recommended follow up plan?

A

Refer to PCP within one week

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94
Q

When would a condition be considered end stage renal disease (ESRD)?

A

When something extra is needed to keep the patient alive

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95
Q

Name the four valves of the heart in the order in which the blood passes through them, along with the structures each valve separates

A

Tricuspid valve (blood from right atrium –> right ventricle), pulmonic valve (blood from right ventricle –> pulmonary artery), bicuspid/mitral (blood from left atrium –> left ventricle), aortic valve (blood from left ventricle –> aorta)

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96
Q

Marfan syndrome is a connective tissue disorder. It is an autosomal dominant disease. If a person with this condition is untreated, around what age might they die?

A

Fourth or fifth decade

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97
Q

True or false: cardiac arrhythmias are always accompanied by some amount of lightheadedness

A

False; arrhythmias can in fact be asymptomatic.

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98
Q

Which substances are secreted in the ascending loop of Henle?

A

None

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99
Q

Acute tubular necrosis can result in damage to renal vasculature. What is the result of damaged renal vasculature?

A

Endothelin release is increased, NO and prostaglandin release are decreased, all of which result in vasoconstriction. This vasoconstriction results in reduced urine volume, increased body fluid, and increased blood waste products.

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100
Q

What is the JNC8 guideline for general black population in terms of first line hypertensive medication?

A

Thiazide, calcium channel blocker

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101
Q

What is the treatment plan for patients with Fabry disease?

A

IV agalsidase beta given for four hours every two weeks (for the rest of patient’s life); this protects kidney function from the lipid deposits. This can change life expectancy of these patients.

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102
Q

Contractility of heart muscle is increased by what?

A

Increased free (unbound) calcium

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103
Q

True or false: African Americans are more likely to have ESRD than Caucasians

A

True; this may have some connection with uneven distribution of healthcare

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104
Q

Which condition is the single most important cause of ESRD in the US?

A

Diabetic nephropathy

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105
Q

What is the overall effect of renal prostaglandins?

A

They increase renal bloodflow by prevent vasoconstriction; they also impair water reabsorption by blocking vasopressin in the collecting duct, prevent water and sodium reabsorption in the tubules, prevent potassium excretion

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106
Q

Briefly describe conduction of electrical impulses in the heart, starting with the SA node.

A

SA node fires, sending signals simultaneously to AV node and left/right atria. The atria contract; AV node delays the signal slightly before sending it on through the bundle of His. Bundle of His separates into right and left bundle branches, which each become Purkinje fibers and cause the ventricles of their respective sides to contract.

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107
Q

Corticosteroids (prednisone) used to be used as immunosuppressants in kidney transplants. Now, what classes of drugs are used? What do these classes do?

A

Calcineurin inhibitors (decrease IL-2 production by T-cells) and anti-metabolites (decrease lmphocyte proliferation and activation)

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108
Q

90% of kidney stones pass spontaneously. What can be done to help ease the passage?

A

Pain relief meds, alpha adrenergic blockers and calcium channel blockers to relax smooth muscle of ureter, antibiotics.

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109
Q

What is the NGAL test good for?

A

It is useful for detecting acute kidney damage so we can catch the issue earlier and have a better chance at fixing it. The other tests don’t catch damage until it is worse.

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110
Q

What changes cause some of the pathology of diabetic nephropathy?

A

Glomerulus capillary BM thickening, renal atherosclerosis (affecting afferent and efferent arterioles), and pyelonephritis.

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111
Q

What is another name for membranoproliferative glomerulonephritis?

A

Dense deposit disease

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112
Q

Increasing either peripheral resistance or cardiac output increases blood pressure. What factors increase cardiac output?

A

Blood volume (increased blood volume, for example through renin release increases BP); heart rate (increased HR increases BP)

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113
Q

In Wolff-Parkinson-White syndrome, there is an accessory pathway between the atria and the ventricles that allows impulses to quickly travel between the atria and the ventricles (in either direction). This syndrome is more prone to atrial fibrillation than is AVNRT. Atrial fibrillation can lead to life-threatening ventricular fibrillation.

A

Free card

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114
Q

What are some of the symptoms that CKD can cause in the blood?

A

Anemia (pallor, lethargy, breathlessness on exercise) and platelet abnormalities (epistaxis and bruising) due to low levels of erythropoietin

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115
Q

Patients with ventricular fibrillation have no cardiac output, requiring CPR or defibrillation to sustain life. Survivors are at risk for sudden cardiac death and have cardioverter-defibrillators implanted.

A

Free card

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116
Q

Which imaging technique is the only one that can give an idea of kidney function, rather than only structure? What concern may there be with the contrast agent used?

A

Intravenous pyelogram (IVP); its contrast agent is related to iodine, so it can’t be used with patients allergic to iodine

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117
Q

What sorts of ocular side effects might a patient on warfarin experience? What tests should be performed to check how their clotting times are affected by the medication?

A

Subconjunctival hemmorage, retinal or vitreous hemorrhage, spontaneous hyphema, cerebral hemorrhage. Patient should have PT and INR done

118
Q

What major class of medications can cause ARF?

A

NSAIDs, by interfering with prostaglandin synthesis and thus preventing vasodilation. This basically causes the kidney to become ischemic.

119
Q

Nephrotic syndrome seems to be caused by injury of some sort followed by an immune response. What are a few common causes of nephrotic syndrome?

A

Diabetes, HTN, lupus, NSAIDs (toxic effect), membranoproliferative glomerulonephritis.

120
Q

In a person with nephritic syndrome, what substance might you find in the urine that would not be there in a normal person?

A

Blood (hematuria)

121
Q

A patient being sent out for an MRI of the orbit would be at greater risk of developing ARF if they have failed to do what?

A

Drink enough water.

122
Q

Serum enzyme tests are done to detect enzymes released by dying heart muscle. Creatinine phosphokinase (CK-MB), lactate dehydrogenase (LDH-1), and troponin I are three such tests. Levels of these substances start increasing how long after the myocardial infarction (MI)? When do levels peak? When do they return to normal?

A

CK-MB: increased 2-6 hours after, peak at 12-24 hours, normal in 3 days; LDH-1: increased in 24-72 hours after, peak at 2-5 days, normal in 14 days; Troponin I: increased 4-6 hours after, peak at 10-24 hours, normal in 10-15 days

123
Q

Symptomatic nephrolithiasis is more common in which gender?

A

Male, due to length of the urethra

124
Q

Nephrotic syndrome is characterized by a reduction of podocytes around the glomerulus, making the capillary walls leaky. What are some urine or blood characteristics you might observe in a patient with this syndrome?

A

Proteinuria (protein in the urine), hypoalbuminemia (because protein is leaving the body through the urine); low blood levels of albumin trigger production of all plasma proteins, leading to hyperlipiuria and hyperlipidemia. Low levels of albumin also make the patient clot more, increasing risk of thromboembolism.

125
Q

What are some disadvantages of peritoneal dialysis over hemodialysis?

A

More complex in terms of patient’s responsibilities; possibility of peritonitis (easier route of infection)

126
Q

True or false: carriers of Fabry disease never show manifestations of the disease

A

False; carriers can show some manifestations

127
Q

What are some of the roles of vascular endothelium?

A

Blood tissue permeability, coagulation/clotting control, vessel repair, blood flow modulation, inflammation and cell growth regulation, oxidation of LDL

128
Q

What are the autocrine hormones or molecules that act in the kidneys?

A

Endothelins, NO, prostaglandins

129
Q

Increasing either peripheral resistance or cardiac output increases blood pressure. What factors increase peripheral resistance?

A

Vessel size (vasoconstriction increases BP), vessel elasticity (decreased elasticity increases BP), blood viscosity (increased viscosity increases BP)

130
Q

What characteristics of the glomerulus contribute to its filtration ability?

A

Fenestrated endothelium, incomplete basement membrane, podocytes with foot processes.

131
Q

How would you describe the heartbeat of a patient with a irregularly irregular arrhythmia?

A

The rhythm is completely unpredictable.

132
Q

How would you describe the heartbeat of a patient with a regular arrhythmia?

A

One that is either too fast or too slow, but still a predictable beat with the two heart sounds.

133
Q

Stress thallium (DIP-thal) is a test that involves injection of thallium 201. It is used to image the heart. What types of tissue take up the radioactive thallium?

A

Healthy myocardial tissue, but not infarcted or scarred tissue, and not blood.

134
Q

Bradycardia usually results from ________________ or _________________.

A

Inadequate SA node activity (sinus bradycardia), blocked conduction (AV block)

135
Q

What non-ocular findings could a patient with Marfan’s syndrome have?

A

Narrow face, long legs/arms/fingers, tall/slender, loose joints, narrow high-arched palate, curvature of spine, chest deformities, dimished reflexes and muscle tone, skins folds/stretch marks with no previous weight gain or loss.

136
Q

True or false: nephritic syndrome, unlike nephrotic syndrome, does not have edema as one of its signs

A

False; nephritic syndrome can manifest with mild edema (of eyelids and face first), but it doesn’t progress to pitting edema like nephrotic syndrome does.

137
Q

Normal heart rate is 60-100 bpm. Above 100 bpm is called _______________, below 60 is called _______________

A

Tachycardia, bradycardia

138
Q

End stage renal disease (ESRD) is defined by kidney function reduced to ____________% of normal.

A

15

139
Q

Treatment of sinus bradycardia, if needed, may consist of what?

A

If the condition is extreme enough to cause symptoms, you can use atropine to increase the sinus rate. A pacemaker can also be implanted.

140
Q

What is the basis of the creatinine clearance rate? What important use does this test have for optometrists (or any doctor)?

A

Have the patient collect their urine for 24 hours, then you draw their blood. Measure the creatinine in the urine and the creatinine in the blood to see how well the kidney is excreting the creatinine (none should be reasbsorbed). You would use this test to adjust a patient’s dosage of medications.

141
Q

What is preload? Within limits, what does increased preload do? What is this relationship called?

A

Amount of blood in the ventricle at the end of diastole (end diastolic volume, EDV). Increased preload (within limits) stretches the ventricle more, which leads to a more rapid and forceful ventricle contraction. This is called the Frank-Starling relationship. (Think of ventricle as a rubber band: more stretch = more energy = further distance when shot; but if too much stretch would not be good.)

142
Q

What are the ocular signs or symptoms that can accompany cardiovascular disease?

A

Retinal artery or vein occlusion, macroaneurysms, TIA, retinopathy, ocular ischemic syndrome

143
Q

Of the blood received by the kidney, how much is actually filtered?

A

20%; the other 80% is for the kidney tissue itself and to transport the substances that are saved.

144
Q

Which three kidney conditions discussed in class are diseases that affect the glomerulus?

A

Nephrotic syndrome, (acute glomerulonephritis (aka nephritic syndrome), membranoproliferative glomerulonephritis

145
Q

Where are the macula densa cells located, and what is their function?

A

They are located at the junction of the ascending loop of Henle with the distal tubule. Their function is to taste the filtrate to sense the concentration of NaCl. If [NaCl] is low, they tell the juxtaglomerular cells to release more renin so as to reabsorb more water.

146
Q

Which two characteristics are major modifiers of reabsorption?

A

Concentration of substances (there more there are, the more that can be reabsorbed), rate of flow (faster flow decreases time for transporter to get its job done)

147
Q

Renal replacement therapy is a general term that includes dialysis and kidney transplant. What GFR might indicate that renal replacement therapy should be initiated?

A

15 ml/min for diabetics, 10 ml/min for nondiabetics

148
Q

What happens to renal blood flow with sympathetic nervous system activation?

A

Afferent arteriole constricts and renin is released. Renin end result (through angiotensin II) is more vasoconstriction, especially of the efferent arteriole.

149
Q

What sorts of molecular transport are involved in reabsorption from the filtrate?

A

Exchange, shared transport, solvent drag

150
Q

Which substances are secreted in the distal tubule?

A

Potassium, hydrogen

151
Q

Which substances are reabsorbed in the distal tubule?

A

Water, NaCl (increased by aldosterone), calcium (increased by PTH)

152
Q

When would you refer a patient with Marfan syndrome?

A

If their condition is undiagnosed, for annual cardiac evaluation, moderate scoliosis, pregnancy, genetic counseling. Severe or unusual chest pain development, send patient to hospital in case of pneumothroax and aortic dissection.

153
Q

Toxicity (i.e. drug overdose) is one possible cause of ARF that typically occurs within one week of treatment. Which classes of drugs are common causes of renal toxicity?

A

Aminoglycosides (theorized that 10% of patients on this class have nephrotoxicity); radiographic contrast agents

154
Q

True or false: ocular signs of TINU often precede renal signs

A

True (in 35% of cases); this may be an important diagnostic tool in catching TINU

155
Q

The transport of many filtrate substances is related to reabsorption of which ion?

A

Sodium

156
Q

True or false: you would expect a patient with nephrotic syndrome to have hypertension

A

False; nephrotic patients are not necessarily hypertensive (because the extra fluid is in the interstitial fluid, not the vasculature).

157
Q

What are the three “classic” causes of atrial fibrillation? What are the most common causes of atrial fibrillation?

A

Rheumatic heart disease, excessive alcohol, and thyrotoxicosis are the “classic” causes but aren’t very common due to these conditions being treated before they tend to cause fibrillation. Hypertension and heart failure are the most common causes.

158
Q

True or false: nephrolithiasis occurs in the 20-45 age range but only occurs with symptoms in 1% of people

A

False; it does occur in this age range (20-45) but occurs with symptoms in 5% of people (1 in 20).

159
Q

What is the systolic/diastolic BP measurement for the pre-hypertension category?

A

Adults: 120-139/80-89; younger than 18 years: between 90th-120/80

160
Q

Secondary hypertension is attributable to a known cause. What are some of these causes? Which cause is the most common in individuals younger than 20 years?

A

CKD, endocrine disorders, sleep apnea or sleep deprivation, meds (contraceptives, cold remedies or appetite suppressants, NSAIDs). CKD is the most common cause of hypertension in individuals less than 20 years old

161
Q

Acute tubular necrosis occurs in response to acute ischemia or nephrotoxic insult. The glomerular filtration rate declines abruptly and tubular epithelial cells are damaged or destroyed, decreasing ion transport.

A

Free card

162
Q

The glomerulus can be thought of as a negatively charged colander. What are the two main factors that characterize glomerulus selective permeability?

A

Size and charge (big things can’t fit through and negatively charged things are repelled)

163
Q

The majority of patients with TINU present with what sign? What other symtpoms might these patients have?

A

Bilateral uveitis (conjunctival injection, fine keratitic precipitates, iridocyclitis); half of patients present with fever, weight loss, and fatigue

164
Q

How would you diagnosis nephrolithiasis?

A

With a CAT scan.

165
Q

Type II membranoproliferative glomerulonephritis is often found in teens. Finding bilateral central clustered drusen in a teenager should make you think about this condition when trying to make a diagnosis.

A

Free card

166
Q

What ocular findings could a patient with Marfan’s syndrome have?

A

Axial myopia, bilateral ectopia lentis* (lens pulled up superior temporal), strabismus, iris transillumination, retinal detachment, glaucoma, cataracts, peripheral retinal degenerations, blue sclera

167
Q

Acute pyelonephritis is an inflammation of the kidney and renal pelvis. What is most commonly the cause for this condition? In which gender does it most often occur?

A

Caused by bacteria entering kidney via bladder and ureters; most common in women due to length an dlocation of urethra.

168
Q

What are some of the symptoms that CKD can cause in the endocrine system?

A

Amenorrhea, erectile dysfunction, infertility (due to hormonal imbalance)

169
Q

What qualifies a patient as in the hypertensive urgency category?

A

BP >180/>110 (which is stage 2 HTN)

170
Q

The presence of which protein in the urine may be the first sign of kidney involvement in DM?

A

Albumin

171
Q

Malignancy is one of the possible complications of renal transplantation. Which specific types of cancer were mentioned in class?

A

Skin cancer, Kaposi’s sarcoma (treat with Rapamune), ocular squamous cell carcinoma

172
Q

None of the hypertensive medications is inherently superior to the others. What factors can influence the choice of medication? Which medication should be avoided in African Americans?

A

Comorbidities (CKD), ethnicity, cost, tolerance/compliance. ACE inhibitors should not be used in African Americans.

173
Q

Besides verticillata, what other ocular signs can be seen in Fabry disease?

A

Conjunctival vessel tortuosity in inferior conjunctiva; retinal venous dilation with possible hemorrhages; cataracts (often spoke-like)

174
Q

What is the most common presenting manifestation of renal cell carcinoma? What other condition discussed in class mentions this manifestation?

A

Painless hematuria; nephritic syndrome also features painless hematuria

175
Q

Where are juxtoglomerular cells located, and what is their function?

A

They are next to the glomerulus in the afferent arteriole; they are specialized smooth muscle cells that interact with baroreceptors to release renin in response to decrased blood pressure.

176
Q

AV nodal re-entry tachycardia is more common in which gender?

A

Female

177
Q

By what age do half of patients with Fabry disease suffer from renal failure? By what age do virtually all Fabry disease patients suffer from renal failure?

A

Age 35; age 55

178
Q

What is a normal value for cardiac output?

A

5-6 L/min

179
Q

Which substances are reabsorbed in the collecting duct?

A

Urea, water (increased by vasopressin), NaCl (in exchange for potassium secretion; increased by aldosterone)

180
Q

What is afterload? What factors affect it?

A

The force against which ventricles must contract to eject blood. Arterial pressure is the main factor, but thickness of blood and vessel elasticity (among other things) play a role too. (More elastic vessels = decreased afterload = easier to push blood out; think of as a new balloon, which is less elastic than an old balloon; you, the heart, would have to work harder to fill a new balloon than an old balloon)

181
Q

What are the treatment options for renal cell carcinoma?

A

Surgical removal of kidney, percutaneous cryoablation, anti-VEGF, anti-PDGFR

182
Q

True or false: ventricular fibrillation is associated with a very rapid and irregular heart rate.

A

True.

183
Q

What is the JNC8 guideline for general nonblack population in terms of first line hypertensive medication?

A

Thiazide, calcium channel blocker, ACE inhibitor, angiotensin receptor blocker

184
Q

Which substances are reabsorbed in the descending loop of Henle?

A

Water, due to hyperosmolarity

185
Q

Premature ventricular contraction (PVC) is extremely common and usually does not effect the eatria or the SA node. Which factors may incrase the frequency of PVC?

A

Age, infection, emotional stress, caffeine, tobacco, alcohol.

186
Q

Which factors can affect a blood pressure measurement?

A

Time of day, level of anxiety, recent activity, caffeine intake, etc.

187
Q

What are the treatment options for Wilms’ tumor?

A

Radiotherapy, nephrectomy, chemotherapy

188
Q

Reminder: get the drug chart on Moodle; learn the action of the major categories, specific indications, optometric interests, and mechanism of action

A

Not-so-free card

189
Q

Besides ACE inhibitors and ARBs, what can be done to treat a patient with nephrotic syndrome?

A

Remove fluid with diuretics (loop diuretics especially), restrict fluid and sodium intake, have patient on a prophylactic blood thinner during the first 6 months (time of highest risk of clotting).

190
Q

Which imaging technique involves a camera being worked up into the bladder?

A

Cytoscopy

191
Q

Briefly describe mechanism of AV nodal re-entry tachycardia.

A

In some individuals, there are two paths through the AV node, when normally there is only one. The “extra” path depolarizes slower but repolarizes more quickly than the normal path. Normally, signals sent through the AV node go through the normal path and any depolarization of the extra path is cancelled out. However, if the AV node is stimulated again while the normal path is still in its refractory period, the signal will get passed through the extra path into the AV node, then the signal travels retrograde back to cause the atria to contract. This contraction passes a new signal back to the AV node, where the second (extra) path is again stimulated since it repolarizes more quickly and the normal path has not yet repolarized. This cycle continues until it is stopped by very good timing of the normal path repolarization (to stop the extra signal) or extraneous methods by health care professionals.

192
Q

Chronic pyelonephritis is slowly progressive. What underlying disorder commonly causes this condition?

A

UTI (urinary tract infection) from obstruction, vesicoureteric reflux (urine traveling retrograde) or diabetic nephropathy

193
Q

Relaxation of heart muscle depends on removal of calcium from the myocyte cytoplasm. How does this occur?

A

Through exchange with sodium (sodium in for calcium out) and through uptake into sarcoplasmic reticulum and mitochondria

194
Q

True or false: milk chocolate can lower BP about as much as one medication (5.2 mmHg systolic and 1.8 mmHg diastolic)

A

False; dark chocolate has this effect, not milk chocolate

195
Q

Ultrasonography shows structure and movement of the heart, and doppler is a special form of ultrasonography used for blood vessels to show bloodflow.

A

Free card

196
Q

What are some of the symptoms that CKD can cause in the renal system?

A

Nocturia (due to lying down at night and fluid in legs being filtered by kidneys), salt and water retention, edema

197
Q

One of the common causes of nephritic syndrome is post streptococcal infection. What occurs to cause the syndrome?

A

10-14 days after the strep infection, the body is still fighting bits and pieces of strep that is left over in the body. Some of the pieces end up in the kidneys, and inflammation there causes damage. (Ag-Ab complex is thought to be what is causing the inflammatory response.)

198
Q

Which substances are secreted in the proximal tubule?

A

Uric acid, organic acids

199
Q

Name a medication that interferes with the sodium-potassium pump in the heart. What effects (including side effects) does this drug have?

A

Digitalis; slows HR (through delayed AV node signal conduction), increases contractility (through increased inctracellular calcium). SE include blurred vision, color perception alteration, halos on dark objects

200
Q

How would you treat AV nodal re-entry tachycardia?

A

Increase vagal (parasympathetic) stimulation to the SA/AV nodes so they can reassert control. This can be attempted through mechanical maneuvers (carotid sinus massage, valsalva maneuver, head immersion in cold water) and/or with medication (adenosine). You can use long-acting beta-blockers, calcium channel blockers, and digitalis to prevent AVNRT episodes. Radiofrequency ablation can be done to block signals going down the “extra” (slow) AV pathway.

201
Q

Which medications should be avoided if possible in a patient with renal compromise?

A

Anything toxic to kidney; aminoglycosides and tetracyclines (except doxycycline) specifically mentioned

202
Q

If a patient’s systolic BP is >220 or their diastolic BP is >120, what is the recommended follow up plan?

A

Refer to PCP within 24-48 hours if there are no end organ effects; refer within a few hours if end organ effects are present

203
Q

NO has autocrine functions in the kidneys. What do they do?

A

They cause more water to excreted; it are also involved in the macula densa feedback loop.

204
Q

What are some of the symptoms that CKD can cause in the cardiovascular system?

A

Pericarditis (due to ion imbalance), HTN, peripheral vascular disease, heart failure (due to fluid buildup)

205
Q

Atrial fibrillation increases a patient’s risk for what other conditions?

A

Ischemic stroke (due to poor cardiac output), embolization, and non-stroke dementia (poor blood flow)

206
Q

What testing can be done in the diagnosis of Fabry disease?

A

Enzyme assay to measure amount of alpha-GAL activity; genetic testing for mutation

207
Q

Good blood sugar control is critical in delaying diabetic nephropathy. Often, the first sign of diabetic nephropathy is microalbuminuria. What medications are used in diabetics to try and reduce the amount of protein in the urine? What stages of the disease occur once microalbuminuria has happened?

A

ACE inhibitors and ARBs are used to decrease protein in the urine. Once albumin gets into the urine, patient develops nephrotic syndrome and azotemia 3-5 years later, and ESRD 1-5 years after that.

208
Q

Which substances are reabsorbed in the proximal tubule?

A

Water, NaCl, bicarbonate, potassium, glucose, amino acids

209
Q

AV block occurs when not all of the signals generated by the SA node make it to the ventricles. Three degrees of AV block were discussed in class. Which degree involves none of the atrial impulses reaching the ventricles?

A

Third degree (aka complete)

210
Q

Which has a higher sodium concentration, the renal medulla or cortex?

A

Medulla

211
Q

What are the three excretory functions of the kidney?

A

Removal of waste products, excretion of foreign substances (drugs, etc), regulate blood composition (amount of water, ion balance, acid-base balance)

212
Q

Where are the mesangial cells and what is their function?

A

They are between the glomerular capillaries and function to hold the capillaries together. They also play a phagocytic role and have contractile capabilities to control blood flow.

213
Q

How many medications do most hypertensive patients require to achieve control?

A

Two

214
Q

What are the major stimulators for vasopressin release?

A

Decreased blood volume (sensed by baroreceptors in many places), increased blood osmolarity (primarily sodium and mannitol, but also glucose)

215
Q

Which substances are reabsorbed in the ascending loop of Henle?

A

NaCl and potassium, through active transport

216
Q

What signs/symptoms might a patient with acute pyelonephritis experience?

A

Fever, dysuria, flank/back pain, pyruia (pus in urine)

217
Q

How would you describe the heartbeat of a patient with a irregular arrhythmia?

A

The beat is still predictable but the heart sounds are abnormal (could be three heart sounds, for example).

218
Q

Renal cell carcinoma makes up what percentage of all malignant kidney tumors? What percentage of all adult cancers?

A

80-90% of renal tumors; 2% of all adult cancers

219
Q

Wilms’ tumor has a high incidence in children with what ocular condition?

A

Aniridia

220
Q

Which classes of diuretics are commonly used in treatment of kidney, heart, and high BP?

A

Thiazides, loop diuretics, potassium-sparing diuretics

221
Q

True or false: glomerulonephritis (aka nephritic syndrome) is characterized by inflammation of the glomerulus and nephron that follows injury.

A

False; it is thought that nephritic syndrome is inflammation right from the start.

222
Q

Atrial fibrillation is the most common sustained rhythm disturbance and is what type of arrhythmia? (i.e., regular, irregular, or irregularly irregular)

A

Irregularly irregular

223
Q

What are some ocular effects of corticosteroid use?

A

Cataracts, risk of glaucoma, papilledema

224
Q

Which class of diuretic is commonly used in treatment of glaucoma and disc edema?

A

Carbonic anhydrase inhibitor (acetazolamide

225
Q

True or false: you would expect HTN in nephrotic and nephritic syndromes

A

False; HTN is not common in nephrotic syndrome (fluid is retained in tissue) but is in nephritic syndrome (fluid is retained in vasculature)

226
Q

True or false: nephrotic syndrome, with time, tends to remit as the body heals itself

A

True, unless there has been permanent injury done to the kidneys such as can happen with diabetes or HTN.

227
Q

How would you treat atrial fibrillation?

A

Treat any underlying cause; use beta blockers or calcium channel blockers (slow ventricle contractions); use amiodarone or dronedarone (prolong action potential); radiofrequency ablation (of the cells causing the irregular stimulation); possible electrical cardioversion

228
Q

Serum creatinine is a useful screening test for kidney disease. If a person’s serum creatinine level is twice the normal value, what does this indicate about their kidney function?

A

2x the creatinine level means 50% kidney function (3x would mean 25%, and 4x would mean 12.5%, etc.)

229
Q

What is the flow rate of blood through the kidneys?

A

About 1.2 L/min

230
Q

What are some of the symptoms that CKD can cause in the GI tract?

A

Anorexia, N&V, diarrhea (due to acid-base imbalance and ion imbalance)

231
Q

Acute pyelonephritis is more common in people with what condition?

A

Pregnancy (fetus pushes bladder into a more horizontal position so it’s easier for bacteria to get in)

232
Q

The signs/symptoms of Fabry disease are variable, making it difficult to diagnose. What are some of these signs/symptoms? Which sign is often the first sign?

A

Burning sensation in hands, raised rash on butt/groin/thighs, decreased ability to sweat. Most common first sign is corneal whorl (verticillata), which is present in over 90% of males with this condition.

233
Q

Acute kidney failure can be brought about by which classes of common medications?

A

NSAIDs and steroids; these interfere with initial filtration, resulting in edema

234
Q

AV block occurs when not all of the signals generated by the SA node make it to the ventricles. Three degrees of AV block were discussed in class. Which degree features a pulse that feels normal but would every so often skip a beat?

A

Second degree; this is due to intermitten failure of the signal to reach the ventricles.

235
Q

Which three kidney conditions discussed in class are diseases that affect the tubules and inserstitium?

A

Tubular interstitial nephropathy, pyelonephritis, acute tubular necrosis

236
Q

What are some of the common first symptoms of kidney disease?

A

High BP, swelling of legs, pulmonary edema, fatigue, HA, weight loss, N&V, itching (due to calcium and phosphate build up in tissues leading to drying), increased tendency to bleed (due to lower erythropoietin and therefore lower RBCs), cognitive impairment

237
Q

The parasympathetic nervous system affects heart rate and contractility. How does this occur?

A

It decreases heart rate through the nodes. Through the vagus nerve it also innvervates the atria but not the ventricles, causing only a slight decrease in contractility

238
Q

Long-term use of diuretics is more useful in treatment HTN in a patient with chronic renal disease than one with normal kidney function. Why is this?

A

In healthy kidneys, the renal system eventually balances out and returns blood volume to normal, countering the effect of the diuretic. In renal failure, this feedback mechanism is missing, allowing for long-term use of diuretics in HTN treatment.

239
Q

Cardiac index is cardiac output divided by body surface area. What range is the normal range of values?

A

2.6-4.2 L/min/square meter

240
Q

Systole is contraction of the walls of the ventricles to empty the heart of blood. Which valves are closed during systole?

A

Mitral and Tricuspid (heart is eMpTying)

241
Q

What are some drawbacks of hemodialysis? Some risks?

A

3.5 hours, 3x a week; creatinine is not well cleared; diet need to be modified due to protein effect of dialysis. Risks include anemia, pulmonary edema, ionic dysfunction, infection, heart dysfunction, high mortality rate.

242
Q

True or false: symptoms of kidney disease tend to occur early on in the disease and always are acute

A

False; they tend to occur later on and can occur either acutely or slowly progressive

243
Q

True or false: if a patient survives the initial episode of ARF, they will likely recover full kidney function

A

True.

244
Q

There is a “classic triad” of signs/symptoms of renal cell carcinoma, though it is not common for a patient to have all three. What are these three signs/symptoms? What other symptoms may occur?

A

Hematuria (painless), dull flank pain (as opposed to the sharp flank pain of nephrolithiasis), palpable flank mass. Other symptoms inlcude a long-standing fever, elevated ESR (due to increased erythropoietin from tumor), weight loss and fatigue (classic cancer signs)

245
Q

What is the JNC8 guideline for patients with CKD and HTN in terms of first line hypertensive medication?

A

ACE inhibitors, angiotensin receptor blocker

246
Q

Name a medication that interferes with calcium channels in the heart. What effects does this drug have?

A

Verapamil; decreases afterload (through vasodilation of vascular system via delayed calcium influx into vascular smooth muscle); decreases contractility; delays removal of calcium from pacemaker cells, thus slowing HR (through interfence of SA/AV node repolarization)

247
Q

True or false: the kidneys can convert lactic acid to glucose

A

True.

248
Q

Should other medical treatments not work, what type of medication might be used as a “last stand” in treating nephrotic syndrome? What types of patients are most commonly placed on this type of medication?

A

Immune suppressive drugs (normally corticosteroids). Children most commonly. (This treatment works pretty well.)

249
Q

In acute tubular necrosis, intratubular pressure can rise. What is the mechanism of this spike in pressure? What happens as the pressure continues to rise?

A

Dead tubular epithelial cells slough off and start blocking the tubule, backing up the fluid that is still coming. As the pressure gets great enough, fluid can be forced into the tissue of the medulla, raising the pressure there enough to collapse other tubules; this raised pressure can also damage the renal vasculature.

250
Q

Tubulointerstitial nephropathy (TIN) is a group of inflammatory kidney diseases involving the interstitium and the tubules but sparing the glomeruli and renal vessels. If caused by a bacterial infection of the renal pelvis, what would that be called? What if the origin is noninfectious?

A

If caused by renal pelvis infection, = pyelonephritis. If noninfectious, interstitial nephritis.

251
Q

Which portion of the nephron does renal cell carcinoma develop from? Is this condition vascular?

A

It develops from the proxiimal tubules and is highly vascular.

252
Q

What treatment might be considered for a patient with second degree AV block?

A

Pacemaker

253
Q

True or false: TINU rarely recurs.

A

False; it recurs in 50%

254
Q

An EKG doesn’t indicate anything about heart disease; it only analyzes the electric circuitry of the heart. How many peaks/deflections should show on a normal EKG? What is indicated by each peak?

A

5 peaks: P (atrial cell depolarization), QRS (ventricle depolarization), and T (ventricular repolarization). [FYI: PR interval measures AV conduction time, or the time from the onset of atrial depolarization to the time of onset of ventricular depolarization.]

255
Q

What conditions are considered end organ effects of hypertension?

A

Cardiovascular (atherosclerosis, coronary artery disease, heart failure, left ventricular hypertrophy, MI, unstable angina, aneurysm); brain (hemorrhagic stroke, Alzheimer’s, confusion), CKD, pulmonary edema, eye (retinopathy, optic nerve head edema), peripheral artery disease

256
Q

What is azotemia?

A

An increase in BUN without symptoms.

257
Q

Patients with chronic pyelonephritis usually end up on renal dialysis.

A

Free card

258
Q

The sympathetic nervous system affects heart rate and contractility. How does this occur?

A

It stimulates beta-1 receptors of SA and AV nodes, causing them to pass signals along faster (increased heart rate), also shortening conduction time through the AV node. It also innervates the atria/ventricles and increases their contractility by increasing calcium concentration

259
Q

The kidneys influence blood pH by excreting __________ when the blood is too acidic and ___________ when the blood is too basic.

A

Hydrogen ions; bicarbonate

260
Q

What sort of structures are changed in membranoproliferative glomerularnephritis?

A

The basement membrane (membrano) has thick deposits on it (proliferative) in the glomerulus and the nephron (glomeruloneph); caused by immune damage (itis).

261
Q

True or false: the signs/symptoms of chronic pyelonephritis are quite specific, so it is usually diagnosed early on

A

False; the signs/symptoms are often vague (“don’t feel well”), so diagnosis usually occurs late

262
Q

True or false: sinus bradycardia can occur in response to cardiovascular conditioning of athletes, hypothyroidism or drugs, and is highly concerning.

A

False; it can indeed occur in response to cardiovascular conditioning of athletes, hypothyroidism or drugs, but it is typically of limited concern.

263
Q

There are three subtypes of membranoproliferative glomerulonephritis. Type II is associated with what kind of retinal finding?

A

Bilateral central clustered drusen

264
Q

True or false: patients on dialysis experience less visual impairment than is expected for their age.

A

False; they experience more visual impairment than is expected for their age.

265
Q

How would you treat sinus tachycardia?

A

Treat the underlying condition (i.e., treat the hyperthyroidism, if that is the cause) or use a med that slows AV node: beta blockers or calcium antagonists.

266
Q

How long must there be a structural or functional kidney abnormality in order to consider the condtion as chronic?

A

3 months

267
Q

Wolff-Parkinson-White syndrome is more common in which gender?

A

Male

268
Q

Primary hypertension is the most common form of HTN in adults. What is its cause?

A

Cause is unknown, though there may be some influence from environment/genetic factors (excess salt intake, obesity, lack of exercise, abnormal peripheral resistance, renin-angiotensin-aldosterone abnormalities, impaired natriuresis [naturiuresis = ability to remove salt from body])

269
Q

What qualifies a patient as a hypertensive emergency?

A

Urgent BP (>180/>110) with organ damage

270
Q

Initially, the VA and VF of a patient with type II membranoproliferative glomerulonephritis are unchanged. What long term ocular complications may arise?

A

Poor night vision, subretinal neovascular membranes, macular detachment, central serous retinopathy, and retinal atrophy.

271
Q

Suppose a patient has azotemia. Once the patient has signs or symptoms (or we are able to identify the signs or symptoms), then call it what?

A

Uremia

272
Q

Calcitriol helps absorb calcium from the gut and is important for building bone. What molecule does it act on? What bone issue might a person with CKD have?

A

Calcitriol converts vitamin D to its metabolically active form (D3); CKD can cause osteoporosis

273
Q

A coronary calcium scan is a CT used to evaluate calcium buildup in coronary arteries. Generally, people with risk but no symptoms are evaluated with this test. What is the range of possible scores on this test? What kind of score is more likely to be indicative of coronary artery disease?

A

Score range: 0-400; greater than 100 means likely to have CAD

274
Q

If a patient’s systolic BP is 140-159 or their diastolic BP is 90-99 (i.e., stage 1 hypertension), what is the recommended follow up plan?

A

Confirm within two months

275
Q

Of the serum enzyme tests, which is probably most specific?

A

Troponin I

276
Q

Antihypertensive drugs usually work through decreasing cardiac output and/or peripheral resistance. Which categories are suggested as first line by the JNC8?

A

Thiazides, ACE inhibitors, angiotensin receptor blockers, calcium channel blockers. Beta-blockers and renin inhibitors can also be used but are not on the JNC8 first line list.

277
Q

True or false: the glomerulus plays a large role in reabsorption

A

False; it plays no role in reabsorption. It’s like when you clean out your dresser drawer; you just dump everything out onto the bed. Glomerulus just dumps stuff into the rest of the nephron, which then reabsorbs most of it.

278
Q

TINU is an acute form of tubulointerstitial nephritis with uveitis. What age range and which gender have a higher prevalence of TINU?

A

10-33 years, female

279
Q

Risk factors for hypertension include family hx, obesity, renal disease, increased age, alcohol abuse, cigarette smoking, diabetes mellitus, lack of sleep, some medications. Which gender has a higher prevalence for hypertension?

A

Males, but once women hit menopause the prevalence evens out between the genders.

280
Q

True or false: the heart valves have muscles to aid in blood passage through the heart

A

False; they work on a passive basis

281
Q

Corticosteroids are sometimes used as a last stand treatment for nephrotic syndrome. Their use is, however, controversial. Why?

A

The disease tends to come back when you try to take the patient off the steroids.

282
Q

What are the two most common cause of preventable deaths in the US?

A

Smoking is #1, hypertension is #2

283
Q

Besides post-strep infection, what else can cause nephritic syndrome?

A

Staphylococci/gram-negative bacterial infections (sub-acute bacterial endocarditis, dental abscess, shutn infections); lupus

284
Q

AV block occurs when not all of the signals generated by the SA node make it to the ventricles. Three degrees of AV block were discussed in class. Which degree seldom has symptoms or requires treatment?

A

First degree.

285
Q

What is the name of the structure that connects the kidney to the bladder?

A

Ureter; it connects at the hilus

286
Q

Nephrolithiasis/urolithiasis is formation of a stone in the urine collecting system, usually in the ureter. This condition usually occurs when a patient becomes deheydrated. What conditions or medications might cause formation of stones?

A

Gout and acetazolamide were the things mentioned in class as making stone formation more likely.

287
Q

What is the systolic/diastolic BP measurement for the hypertension stage 1 category?

A

Adults: 140-159/90-99; younger than 18 years: >= 95th percentile to 5 mmHg above 99th percentile

288
Q

What are the symptoms of malignant hypertension?

A

Occipital HA, N&V, visual scotoma and spots

289
Q

What are a few complications that may arise from renal transplantation?

A

Immunosuppressive disorders, secondary HTN (prednisone and/or native renin production), infection (UTI, hepatitis, pneumonia), graft rejection, malignancy

290
Q

Filtrate in the kidney is mainly composed of what?

A

Water, ions, glucose, amino acids, bicarbonate

OPT 537 (21 decks)

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