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Med Rev Ses Flashcards

1
Q

Giant cell arteritis ft

A 
Female, > 50
Eastern europe
unilat headache in temporal area
Fatigue/jaw claudication
prominent superficial temporal artery
pain w hair brush
-polymyalgia rheumatica assoc
High ESR
***VISION LOSS w blockage of opthalamic artery
biopsy: granulomatous inflammation ft monocytes and large multinucleated cells (but can have normal, as it effects only segments of vessel)
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2
Q

Giant cell arteritis tx

A

high dose steroids

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3
Q

Takayasu arteritis ft

A 
Female >40
Asian
Affects aorta + branches
Subclavian artery --> weak arm pulses on one side (>10mmHg diff)
Carotid bruit
Visual loss/stroke
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4
Q

Takayasu arteritis tx

A

high dose corticosteroids

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5
Q

Polyarteritis nododsa ft

A

Skin, GI, Kidneys, Heart
Men middle aged
Renal - secondary HTN, renal failure, hematuria
Coronary - MI
Mesenteric - abdo pain, bloody stools
Skin - levido retucularis (mottled purplish lace luke rash) or palpable purpura
Mononeuritis multiplex - ischemia to peripheral nerves
SPARES PULM ARTERIES
30% have HepB antigen (Hep C, HIV)
Can be ANCA +ve - look for transmural inflammation and fibrinoid necrosis of arterial wall
Is segmental - small micro aneurysms

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6
Q

Polyarteritis Nodosa Tx

A

corticosteroids

cyclophsphamide

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7
Q

Kawasaki

A

Asian kids <4
CRASH and BURN
Conjunctival redness (bilat, non exudative)
Rash - desquamating, polymorphous maculopapular
Adenopathy - >1.5cm
Strawb tongue (glossitis) +oral mucosa changes
Hand/foot changes - erythema, edema, desquamation
BURN - fever >5d

Can have coronary artery aneurysms - rubture or thrombose -> MI

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8
Q

Kawasaki Tx

A

IV immunoglobulin and Aspirin

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9
Q

Buerger disease ft

A

Male <40
Ashkenazi jews
Smoking is biggest risk
Tibial and radial arteries –> intermittent claud + pain in forefoot, ischemic ulcers, loss of digits
Raynauds
Histo: thrombosis in lumnen, but blood v wall is intact
Can extend into nearby artieris, veins and nerves –> fibrosis encases these

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10
Q

Buerger disease tx

A

smoking cessation

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11
Q

ANCA associated vasculitis

A
  • Granulomatosis w polyangitis (wegners)
  • microscopic polyangitis
  • eosinophilic granulomatosis w polyangitis
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12
Q

Granulomatosis w polyangitis

A

URTI (saddle nose deformity, epistaxis, chronic sinusitis, otits media, mastoiditis, perf of nasal septum)
LRTI (hemoptysis, SOB, cavitating lung nodules)
Kidneys (hematuria - crescentic rapidly progressive glomerulonephritis - RBC casts in urine)

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13
Q

Saddle nose

A

Granulomatosis w polyangitis

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14
Q

Goodpastures

A

LRTI + Kidney, but NO URTI

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15
Q

Granulomatosis w polyangitis histology

A

c-ANCA

Non caseating granulomas

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16
Q

Granulomatosis w polyangiitis tx

A

Corticosteroids and Cyclophosphamide

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17
Q

Microscopic polyangiitis ft

A

LRTI/SOB/hemop
Crescentic glomerulonephritis
Precipitated by meds (often ABX like penicillin)

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18
Q

Microscopic polyangiitis labs

A

pANCA

no granulomas

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19
Q

Microscopic polyangiitis tx

A

corticosteroids and cyclophosphamide

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20
Q

Eosinophilic granulomatosis w polyangiitis ft

A 
Lung + Skin
Adult onset asthma
high eosinophil count
sinusitis
skin nodules 
purpura
mononeuritis multiplex (foot or wrist drop)
Transient migratory pulmonary infiltrates (opaque densitis on CXR that come and go)
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21
Q

Eosinophilic granulomatosis w polyangiitis findings

A

Eosinophilia
IgE high
pANCA

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22
Q

Immunoglobulin A vasculitis (henoch-schonlein purpura) ft

A

Abdo, renal, joints, skin
1-15y
Following mucosal infection (viral URTI, group A strep pharyngeal, gastro)
1) Palpable purpura on butt and legs
2) Abdo: colicky pain, GI bleeding
migratory arthralgia
Hematoma in intestinal well causing intussusception
3) Kidney - nephritis, chronic kidney damage, renal failure, IgA nephropathy
4) joint pain
RESOLVES wo tx

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23
Q

Bechets syndrome

A 
Turkish/Mediteranean pop
HLA B51
Happens after HSV or parvovirus
Recurrent aphthous + genital ulcers
Uveitis
Erythema nodosum
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24
Q

Cryoglobulinemia

A

Abnormal ig’s, stick together in cold temperatures
Assoc w Hep C
Deposit in small bv’s of skin: palpable purpura, cyanosis of nose/ears/digits, raynauds
Can happen in small arteries of glomerulus (glomerulonephritis)
Small arteries of periph nerves (peripheral neuropathy)

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25
cutaneous small vessel vasculitis
inflam of small bv's of skin 7-10 days after drugs (penicillin, cephalosporins, phenytoin, alopurinol, NSAID) After infx (strep pyogenes, hep C, HIV) Palpable purpura
26
Signs small vessel vasculitis
purpura petechia shallow ulcers
27
Signs of med/large vessel vasculitis
livedo reticularis nodules deep ulcers
28
Large vessel vasculitis
temporal arteritis | takayasu
29
medium vessel vasculitis
polyarteritis nodosum kawasaki buerger
30
Small vessel vasculitis ANCA +
granulomatosis w polyangitis microscopic polyangitis eosinophilic polyangitis
31
Small vessel vasc. ANCA -, immunie complex mediated
Henoch-schonlein Bechets Cryoglobinemia
32
Infectious vasculitis
rocky mountain spotted fever neisseria meningitidis Syphilis (chancher is infarction)
33
Rocky mountain spotted fever
small vessel vasculitis dog or wood ticks petechial rash on palms and soles that then spreads to trunk
34
Neisseria meningitidis
disseminated meningococcemia | petechia, purpura and hemorrhagic infarction of adrenal glands
35
Syphillis
Ischemia of small vessels supplying skin of genitals - chancre sore Ischemia to tunica media of aorta, weakens it and becomes aortic aneurysm or aortic regurgitation
36
vasculitis
immune mediated damage to blood vessels causing ischemia, hemorrhage and inflammation of the organ
37
Vasculitis general presentations
``` Purpura (purple colored non blanching spots) Joint + muscle pain Peripheral neuropathy Renal impairment GI disturbances (pain, bleed, diarrhea) Anterior uveitis, scleritis HTN ```
38
ANCA meaning
anti neutrophilic cytoplasmic antibodies P (MPO) C (PR3)
39
p-ANCA
microscopic polyangitis | Eosinophilic Granulomatosis w polyangitis
40
C-ANCA
Granulomatosis w polyangitis
41
Vasculitis steroids
Oral - prednisolone | IV - methylprednisolone, hydrocortisone
42
Vasculitis mimics
``` bacterial endocarditis meningococcus malignancies Drugs (hydralazine, PTU, abx) RA, SLE --> secondary vasculitis ```
43
p/c ANCA test
Immunofluorescence
44
MPO/PR3 test
ELISA - more reliable than p/c immunofluoresence
45
Dx Vasculitis
Clinical - ensure no malignancy or underlying sepsis Lab: eosinophils, complement (for SLE, SBE), ESR, CRP, CPK (myopathy) Immun: ANA, ANCA, antiGBM Ser: Hep B/C, HIV Tissue bx: renal, skin, muscle, artery, nerve Angiography: CT MRA (large/med vessels) PET for large vessels
46
Vasculitis induction
IV methylprednisolone Cyclophosphamide sometimes Rituximab
47
Vasculitis maintenance
``` Azatioprine or Mycophenolate, MTX Plasma exchange Plasma infusion (IV IGG) ```
48
AKI def'n
``` raised serum Cr of .3 within 48h OR raised serum Cr x 1.5 in 7d OR urine <0.5ml/kg/hr for 6h ```
49
AKI stage 1
1.5-1.9 x baseline Cr rise in Cr by .3 <0.5mg/kg/hr urine over 6-12h
50
AKI stage 2
2-2.9 x baseline Cr | 12h
51
AKI stage 3
3 x basline Cr | <0.3 mg/kg/hr >24h OR anuria (<100ml/d) for 12h
52
Prerenal AKI
decreased blood flow to kidney - hypovolemic statess - acute hemorrhage - HF - dehydration GI losses (V/D) - renal losses (diuretics, diuresis hyperglycemia) - dermal losses (burns) - third spacing (acute pancreatitis, pancreatis) EXAM; tachy, hypotensive, reduced skin turgor, cool extremities) Hypervolemic - cardiorenal syndrome (systolic heart failure leads to pump failure--> hypotension, fatigue, dyspnea, edema) - hepatorenal syndrome (hypoalbuminemia from decompensated liver disease -->hypotension, splenomeg, caput medusa, ascites, edema) MEDS Nsaids, contrast, ACE, cyclosporins
53
Intrarenal AKI causes
Damage to tubules (ATN), glomerulus, interstitium (interstitial nephritis), vascular damage (renal artery stenosis)
54
ATN
``` damage to tubules due to ischemia (pre renal AKI) OR Due to nephrotoxins: Aminoglycoside abx MTX Heavy metals Myoglobin (damaged muscles) Ethylene glycol Radiocontrast Uric acid ```
55
Nephrotic syndrome eg
membranous nephropathy | membranoproliferative glomerulonephritis
56
Nephrotic syndrome ft
``` Peripheral edema Periorbital edema Ascites Pleural effusion Lipiduria Proteinuria (>3.5g/d) High protein:cr (>3) Hypoalbuminemia (<3.5) LDL (>130) Triglycerides (>150) ```
57
Nephritic syndromes
SLE | Goodpastures
58
Nephritis syndrome ft
``` HTN edema Oliguria malaise, arthralgia, fever (goodpast) Proteinuria (1-3g/d) Dysmorphic RBCs >5 Red cell casts ```
59
Interstitial Nephritis
Inflammation of interstitium hypersensitivity to: NSAID, Pen, Diuretic esp thiazide Sx fever, rash
60
Renal artery stenosis
from atherosclerosis or fibromuscular dysplasia | Sx: persisten arterial HTN, periph edema
61
Postrenal AKI
obstruction of urine from kidneys-->build up of urine + pressure - BPH or prostate Ca (frequency, slow stream) - intra abdo tumours compressing ureter (weight loss, fatigue) - kidney stones (bilat only, renal colic, anuria, pain)
62
AKI labs
eGFR BUN CBC Electrolytes (urine not getting rid of K --> hyperkalemia) ABG (met acidosis - hyperventilating, acid excretion impaired w low eGFR) Urinalysis (FENa)
63
Prerenal AKI findings
``` Activated RAAS - water + Na retention BUN:Cr - 20:1 Urine osmol - >500 Urine Na ex - <20 FENa - <1% ```
64
Intrarenal AKI findings
BUN:Cr - below 20:1 Urine osmol - <500 Urine Na - >40 FENa > 1%
65
Glomerulonephritis findings
Hematuria proteinuria RBC casts
66
ATN
muddy brown casts | renal tub epithelial cells
67
Acute interstitial nephritis findings
eosinophilia hematuria, proteinuria, pyuria Mic: white cells, white cell casts, RBCs
68
Postrenal AKI findings
BUN:Cr below 20:1 Urine osmol <500 Urine Na >40 FENa >1%
69
AKI complications
vol overload (IV diuretic - furosemide) hyperkalemia (IV calcium gluconate, insulin + glucose & furosemide) met acidosis (IV bicarb) uremic pericarditis
70
if iv saline doesnt work
IV norepinephrine (vasopressor)
71
High bun:cr
decreased flow to kidney
72
RF for AKI
``` CKD HF DM Liver disease >65y Cog impair Meds nephrotoxic Contrast medium ```
73
Rapidly progressive glomerulonephritis (nephritic)
``` rapid decrease eGFR over 3d-3mo Fatigue Periph edema Gross hematuria HTN Oliguria Urinalysis - glomerular hematuria 24h protein - 1-2g/d ```
74
Post-strep glomerulonephritis
Nephritic 3-6w post skin strep (+ve anti hyaluron, anti-dnase B) 1-3w post throat strep (+ve antistreptolycin O, anti hyaluron, anti-NAD, anti DNAse B) Low C3, C4
75
IgA Nephropathy
``` Nephritic Gross hematuria Flank Pain w URTI mesangial prolif on light IgA deposits on micro ```
76
IgA nephropathy biopsy when:
proteinuria >500 | High serum Cr
77
Isolated hematuria or nephritic syndrome+ systemic sx (purpura, arthritis, GI, rashes)
``` IgA vasculitis (henoch schonlein) - IgA deposits ```
78
Alport syndrome
``` Nephritic Isolated persistent hematuria Genetic, in kids Renal fail + hearing loss Anterior lenticonis (lens is cone) C3 low C4 low ANA either ```
79
Nephritic syndrome tx
ACEi/ARB - lower proteinuria, maintain BP Loop diuretic - fluid overload Hemodyalisis - uremia, vol overload, hyperkalemia
80
Post strep glomer Tx
Penicillin oral | Nifedipine (avoid hyperkalemia of ACE)
81
IgA nephropathy Tx
Glucocorticoids IV methyl or oral pred. (persistent proteinuria, low eGFR)
82
Rapidly progressive glomerulonephritis
IV methylprednisolone | Oral pred + oral cyclophosphamide
83
IgA vasculitis tx
``` oral hydration bedrest naproxen oral prednisone ACE/ARB if proteinura >.5 ```
84
Alport Syndrome tx
HTN or Proteinuria - ACE/ARB | ESRD - renal transplant
85
Goodpastures sx
``` malaise weight loss arthralgias fever SOB cough Hemoptysis ```
86
Rapidly progresive glomerulonephritis types
Goodpastures Microscopic polyangiitis Granulomatosis w polyangitis
87
Goodpastures lab Ab
Anti-GBM antibodies
88
Goodpastures pattern
linear | Ab bond collagen in basement membrane
89
microscopic polyangitis pattern
negative
90
granulomatosis w polyangitis pattern
negative
91
Goodpastures tx
plasmapheresis to remove Ab from body | Immunosuppressive tx: cyclophosphamide, IV methylprednisolone
92
Microscopic polyangitis tx
No evidence of active (no hemop) -oral MTX/rituximab + oral pred Evidence of active (Cr>4, hemop, hypoxia) -IV methylprednisolone + oral pred + oral/IV cyclophos Remission - steroids decreased -azathioprine/rituximab/MTX
93
granulomatosis w polyangitis
No evidence of active (no hemop) -oral MTX/rituximab + oral pred Evidence of active (Cr>4, hemop, hypoxia) -IV methylprednisolone + oral pred + oral/IV cyclophos Remission - steroids decreased -azathioprine/rituximab/MTX
94
Nephrotic syndrome can be secondary to:
``` DM HIV Hep B/C Lupus erythematosus Antiphospholipid syndrome ```
95
Antiphospholipid syndrome
``` Hx DVT Pulm embolism TIA Miscarriages/premature Sx Levido reticularis Painful purpura Leg ulcers Splinter hem ```
96
membroproliferative glomerulonephritis
complement in endothelium
97
Membranous nephropathy
damaged basement membrane
98
Minimal change disease
podocyte damage
99
Focal segmental glomerulosclerosis
podocyte damage
100
Nephrotic syndrome
high urine protein low serum albumin edema
101
Hypersensitivity nephritis
post strep GN IgA nephropathy Diffuse proliferative GN
102
IgA nephropathy/Berger's
Abnormal IgA produced, so body sends IgG after it, they stick together and make immune complexes that trapped in kidney, in mesangium Usually w RTI or GI
103
post strep complexes deposit:
basement membrane
104
Diffuse proliferative GN
caused by SLE | Deposition of complexes: >50% glomeruli affected, in subepithelial space
105
membranoproliferative GN
prolif of mesangial and endo cells T1: idiopathic or HepB/C - immune complexes from Hep, cause complement deposition via classical path. Subendothelium. Tram track. T2: no immune complexes. Nephritic factors cause C3 conversion, deposit in BM. Tram track
106
Rapidly progressive GN
Severe inflammation, breaks BM, kidney function decreases rapidly Idiopathic T1: goodpasture - GBM antibodies. Kidney, lungs hemop. T2: t3 hypersens - from post strep or diffuse. T3: pauci immune (few anti GBM Ab), granulomatosis w polyangitis (blood vessels URT, LRT, Kid, cANCA, granulomas), Microscopic poly (caused by meds, pANCA, no granulomas) Crescent moon on light mic.
107
Alport
hearing loss retinopathy lens dislocation GBM thin and breaks
108
hemoptysis + oliguria
goodpastures
109
cola coloured urine, hematuria, edema
nephritis

My notes - med (14 decks)

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