FPC: physical exam findings in renal disease Flashcards
What is considered the extracellular fluid volume?
Interstitial fluid and intravascular compartments.
What are signs of ECFV overload in the lungs?
Rales, wheezes, dullness to percussion at base, and diminished breath sounds at base from pleural effusion.
What are physical exam findings of ECFV overload?
HTN, hepato-jugular reflex, lower extremity pitting edema, periorbital edema, jugular-venous distension on internal jugular veins.
What are signs of ECFV depletion?
Hypotension, tachycardia, orthostatic vitals, dry mucous membranes, diminished skin turgor.
What is seen on physical exam in the lungs with ECFV depletion?
Nothing - normal.
What is seen when measuring JVD in ECFV depletion?
The internal jugular veins will be flat.
What are the orthostatic vital signs?
SBP drops by 20, DBP drops by 10, pulse increases by 10.
What is the pathophysiology of nephritic syndrome?
Acute overload of intravascular space from glomerular inflammation that results in loss of glomerular filtration.
What is the pathophysiology of nephrotic syndrome?
Chronic overload in the interstitial space due to loss of serum oncotic pressure from proteinuria that results in salt retention.
Compare BP in nephrotic vs nephritic.
Elevated in nephritic, normal in nephrotic.
Compare LE edema in nephrotic and nephritic.
Both have it!
Compare JVD in nephrotic and nephritic.
Elevated JVD in nephritic, absent in nephrotic.
Compare rales in nephrotic vs nephritic.
Present in nephritic, absent in nephrotic.
Compare lung dullness/decreased breath sounds in nephrotic and nephritic.
Present in both!
What are physical exam findings of end stage renal disease?
Pale/yellowish skin, excoriations on the skin, uremic odor/skin crystals, asterixis, arteriovenous fistula.
What are cardiac signs of end stage renal disease?
Pericardial friction rub and pulsus paradoxus.
What defines pulsus paradoxus?
SBP on expiration is greater than on inspiration by 10.
What are symptoms of acute urinary obstruction?
Supra-pubic distention and tenderness to palpation.
What must be true for symptoms of acute urinary obstruction such as supra-pubic distention to be experienced?
The obstruction has to be at or below the level of the bladder neck.
What are symptoms of acute pyelonephritis?
Fever, tachycardia, warm/moist skin, tenderness of palpation of costo-vertebral angle.
What are signs of malignant HTN?
Very high BP (200/120), disorientation, focal weakness, retinal abnormality, peri-umbilical bruit if there is renal artery stenosis.
What can be seen in the eyes with malignant HTN?
Nicking of veins by arterioles, cotton wool spots, hemorrhages, papilledema.
What is the pathophysiology of renal artery stenosis?
The kidney senses low flow distal to the stenosis, making it respond as if the body were in hypovolemic shock.
