Med C CBLs - Renal and Rheum Flashcards

1
Q

How would you establish a diagnosis of nephrotic syndrome?

A

Proteinuria > 3.5

Hypoalbuminaemia

KIDNEY BIOPSY NEEDED

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2
Q

Complications of nephrotic syndrome

A
  1. Hypercoagulability
    - loss of inhibitors of coagulation in urine
    - increase synthesis of procoagulatory factors by liver

VTE!

  1. Oedema
    - decrease in oncotic pressure from hypalbuminaemia
    - primary renal sodium retention in collecting tubules
  2. Increased risk of infection
    - loss of immunoglobulins
    - SEPSIS
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3
Q

Causes of nephrotic syndrome

A

DIRTY MONKEYS FLING MUD, SMEARING ALL

Diabetic nephropathy

Membranous Glomerular nephritis

Focal glomerular sclerosis

Minimal change disease

SLE

Amyloidosis

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4
Q

Features of nephritic syndrome

A

Presence of haematuria in association with
- hypertension
- oliguria
- fluid retention

may have proteinuria

Haematuria
- caused by autoantibodies or immune complex deposition

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5
Q

Management of a patient with severe nephrotic syndrome?

A

Treat underlying cause

  1. Dietary sodium restriction
  2. loop diuretic (furosemide)
  3. ACEi
    - reduce proteinuria by lowering glomerular capillary filtration pressure
  4. Regular monitor blood pressure and renal function
  5. Beware prolonged bed rest –> VTE, LMWH?
  6. Increased susceptibility to infection –> consider pneumococcal infection
  7. Lipid abnormalities –> statin
  8. May require some form of immune suppressive treatment
    - high dose corticosteroid
    If this fails
    - ciclosporin or tacrolimus
    Or
    - cyclophosphamide
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6
Q

Terminology to describe patterns of joint disease:

A
  1. Speed of onset: acute, subacute or chronic
  2. Number of joints involved: monoarticular (one joint), Oligoarticular (2 - 3 joints) , polyarticular ( > 4 joints)
  3. Type of joints involved
    - axial (spine or sacro-iliac joints)
    - large joint (knees, ankles, shoulders)
    - small joint (MCPJs, PIPJs)
    - symmetrical vs asymmetrical
  4. Pattern
    - relapsing / remitting
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7
Q

Risk factors for septic arthritis

A
  • age ( > 80)
  • joint prosthesis / foreign material
  • immunosuppression: medication, HIV infection
  • diabetes mellitus
  • existing joint disease e.g. (OA, RA)
  • causes of transient bacteraemia (e.g. IVDU)
  • joint instrumentation e.g. intra-articular infection, arthroscopy
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8
Q

Key differentials for red-hot swollen joint

A
  1. Septic arthritis
  2. Acute crystal arthropathy (gout or pseudogout)
  3. Pre-patellar bursitis
  4. Hemarthrosis: history of trauma, bleeding disorders, medication
  5. Flare of RA
  6. Reactive arthritis
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9
Q

Key investigations for red, hot and swollen knee joint

A
  1. Inflammatory markers: FBC, ESR, CRP
  2. Renal profile: nephrotoxic, sepsis related AKI, CKD risk factor for crystal arthropathy
  3. Clotting: deranged clotting –> risk of hemarthrosis
  4. serum uric acid –> gout?
  5. plain X-Ray –> chondrocalcinosis? in patients with calcium pyrophosphate deposition
  6. Joint aspiration before ABx
  7. Prosthetic joints –> JOINT ASPIRATION BY ORTHO ONLY!
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10
Q

Joint fluid should be examined for:

A
  1. Cell count - WBC > 50,000 –> septic arthritis?
  2. Differential cell count - predominantly neutrophils present in bacterial joint infection
  3. Gram stain
  4. Culture
  5. Polarised light microscopy
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11
Q

Common bugs causing septic arthritis
- most common
- most common in prosthetic joints
- most common in elderly

A

Most common: gram + staph aureus

Elderly –> E.coli (UTI)

Prosthetic joints –> coagulase negative staphylococci

Neisseria Gonorrhoea

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12
Q

Classification system used for Hip fractures

A

GARDEN SYSTEM

Type I: Stable fracture with impaction in valgus

Type II: Complete fracture but undisplaced

Type III: Displaced fracture, usually rotated and angulated, but still has boney contact

Type IV: Complete boney disruption

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13
Q

Management of an intracapsular hip fracture

A

Undisplaced –> Internal fixation or hemiarthroplasty if unfit

Displaced –> replacement arthroplasty (total hip replacement or hemiarthroplasty)

Total hip replacement favoured
- if patients can walk independently out of doors, not cognitively impaired and are medically fit for anaesthesia

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14
Q

Management of extracapsular fracture

A

Management
- stable intertrochanteric fractures: dynamic hip screw

if reverse oblique, transverse or subtrochanteric fractures: intramedullary device

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15
Q
A
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