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My notes - med > Med Rev Ses > Flashcards

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
Q

cutaneous small vessel vasculitis

A

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

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26
Q

Signs small vessel vasculitis

A

purpura
petechia
shallow ulcers

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27
Q

Signs of med/large vessel vasculitis

A

livedo reticularis
nodules
deep ulcers

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28
Q

Large vessel vasculitis

A

temporal arteritis

takayasu

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29
Q

medium vessel vasculitis

A

polyarteritis nodosum
kawasaki
buerger

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30
Q

Small vessel vasculitis ANCA +

A

granulomatosis w polyangitis
microscopic polyangitis
eosinophilic polyangitis

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31
Q

Small vessel vasc. ANCA -, immunie complex mediated

A

Henoch-schonlein
Bechets
Cryoglobinemia

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32
Q

Infectious vasculitis

A

rocky mountain spotted fever
neisseria meningitidis
Syphilis (chancher is infarction)

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33
Q

Rocky mountain spotted fever

A

small vessel vasculitis
dog or wood ticks
petechial rash on palms and soles that then spreads to trunk

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34
Q

Neisseria meningitidis

A

disseminated meningococcemia

petechia, purpura and hemorrhagic infarction of adrenal glands

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35
Q

Syphillis

A

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

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36
Q

vasculitis

A

immune mediated damage to blood vessels causing ischemia, hemorrhage and inflammation of the organ

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37
Q

Vasculitis general presentations

A 
Purpura (purple colored non blanching spots)
Joint + muscle pain
Peripheral neuropathy
Renal impairment
GI disturbances (pain, bleed, diarrhea)
Anterior uveitis, scleritis
HTN
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38
Q

ANCA meaning

A

anti neutrophilic cytoplasmic antibodies
P (MPO)
C (PR3)

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39
Q

p-ANCA

A

microscopic polyangitis

Eosinophilic Granulomatosis w polyangitis

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40
Q

C-ANCA

A

Granulomatosis w polyangitis

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41
Q

Vasculitis steroids

A

Oral - prednisolone

IV - methylprednisolone, hydrocortisone

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42
Q

Vasculitis mimics

A 
bacterial endocarditis
meningococcus
malignancies
Drugs (hydralazine, PTU, abx)
RA, SLE --> secondary vasculitis
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43
Q

p/c ANCA test

A

Immunofluorescence

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44
Q

MPO/PR3 test

A

ELISA - more reliable than p/c immunofluoresence

45
Q

Dx Vasculitis

A

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
Q

Vasculitis induction

A

IV methylprednisolone
Cyclophosphamide
sometimes Rituximab

47
Q

Vasculitis maintenance

A 
Azatioprine or Mycophenolate, MTX
Plasma exchange
Plasma infusion (IV IGG)
48
Q

AKI def’n

A 
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
Q

AKI stage 1

A

1.5-1.9 x baseline Cr
rise in Cr by .3
<0.5mg/kg/hr urine over 6-12h

50
Q

AKI stage 2

A

2-2.9 x baseline Cr

12h

51
Q

AKI stage 3

A

3 x basline Cr

<0.3 mg/kg/hr >24h OR anuria (<100ml/d) for 12h

52
Q

Prerenal AKI

A

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
Q

Intrarenal AKI causes

A

Damage to tubules (ATN), glomerulus, interstitium (interstitial nephritis), vascular damage (renal artery stenosis)

54
Q

ATN

A 
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
Q

Nephrotic syndrome eg

A

membranous nephropathy

membranoproliferative glomerulonephritis

56
Q

Nephrotic syndrome ft

A 
Peripheral edema
Periorbital edema
Ascites
Pleural effusion
Lipiduria
Proteinuria (>3.5g/d)
High protein:cr (>3)
Hypoalbuminemia (<3.5)
LDL (>130)
Triglycerides (>150)
57
Q

Nephritic syndromes

A

SLE

Goodpastures

58
Q

Nephritis syndrome ft

A 
HTN
edema
Oliguria
malaise, arthralgia, fever (goodpast)
Proteinuria (1-3g/d)
Dysmorphic RBCs >5
Red cell casts
59
Q

Interstitial Nephritis

A

Inflammation of interstitium
hypersensitivity to: NSAID, Pen, Diuretic esp thiazide
Sx fever, rash

60
Q

Renal artery stenosis

A

from atherosclerosis or fibromuscular dysplasia

Sx: persisten arterial HTN, periph edema

61
Q

Postrenal AKI

A

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
Q

AKI labs

A

eGFR
BUN
CBC
Electrolytes (urine not getting rid of K –> hyperkalemia)
ABG (met acidosis - hyperventilating, acid excretion impaired w low eGFR)
Urinalysis (FENa)

63
Q

Prerenal AKI findings

A 
Activated RAAS - water + Na retention
BUN:Cr - 20:1
Urine osmol - >500
Urine Na ex - <20
FENa - <1%
64
Q

Intrarenal AKI findings

A

BUN:Cr - below 20:1
Urine osmol - <500
Urine Na - >40
FENa > 1%

65
Q

Glomerulonephritis findings

A

Hematuria
proteinuria
RBC casts

66
Q

ATN

A

muddy brown casts

renal tub epithelial cells

67
Q

Acute interstitial nephritis findings

A

eosinophilia
hematuria, proteinuria, pyuria
Mic: white cells, white cell casts, RBCs

68
Q

Postrenal AKI findings

A

BUN:Cr below 20:1
Urine osmol <500
Urine Na >40
FENa >1%

69
Q

AKI complications

A

vol overload (IV diuretic - furosemide)
hyperkalemia (IV calcium gluconate, insulin + glucose & furosemide)
met acidosis (IV bicarb)
uremic pericarditis

70
Q

if iv saline doesnt work

A

IV norepinephrine (vasopressor)

71
Q

High bun:cr

A

decreased flow to kidney

72
Q

RF for AKI

A 
CKD
HF
DM
Liver disease
>65y
Cog impair
Meds nephrotoxic
Contrast medium
73
Q

Rapidly progressive glomerulonephritis (nephritic)

A 
rapid decrease eGFR over 3d-3mo
Fatigue
Periph edema
Gross hematuria
HTN
Oliguria
Urinalysis - glomerular hematuria
24h protein - 1-2g/d
74
Q

Post-strep glomerulonephritis

A

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
Q

IgA Nephropathy

A 
Nephritic
Gross hematuria
Flank Pain
w URTI
mesangial prolif on light
IgA deposits on micro
76
Q

IgA nephropathy biopsy when:

A

proteinuria >500

High serum Cr

77
Q

Isolated hematuria or nephritic syndrome+ systemic sx (purpura, arthritis, GI, rashes)

A 
IgA vasculitis (henoch schonlein)
- IgA deposits
78
Q

Alport syndrome

A 
Nephritic
Isolated persistent hematuria
Genetic, in kids
Renal fail + hearing loss
Anterior lenticonis (lens is cone)
C3 low
C4 low
ANA either
79
Q

Nephritic syndrome tx

A

ACEi/ARB - lower proteinuria, maintain BP
Loop diuretic - fluid overload
Hemodyalisis - uremia, vol overload, hyperkalemia

80
Q

Post strep glomer Tx

A

Penicillin oral

Nifedipine (avoid hyperkalemia of ACE)

81
Q

IgA nephropathy Tx

A

Glucocorticoids IV methyl or oral pred. (persistent proteinuria, low eGFR)

82
Q

Rapidly progressive glomerulonephritis

A

IV methylprednisolone

Oral pred + oral cyclophosphamide

83
Q

IgA vasculitis tx

A 
oral hydration
bedrest
naproxen
oral prednisone
ACE/ARB if proteinura >.5
84
Q

Alport Syndrome tx

A

HTN or Proteinuria - ACE/ARB

ESRD - renal transplant

85
Q

Goodpastures sx

A 
malaise
weight loss
arthralgias
fever
SOB
cough
Hemoptysis
86
Q

Rapidly progresive glomerulonephritis types

A

Goodpastures
Microscopic polyangiitis
Granulomatosis w polyangitis

87
Q

Goodpastures lab Ab

A

Anti-GBM antibodies

88
Q

Goodpastures pattern

A

linear

Ab bond collagen in basement membrane

89
Q

microscopic polyangitis pattern

A

negative

90
Q

granulomatosis w polyangitis pattern

A

negative

91
Q

Goodpastures tx

A

plasmapheresis to remove Ab from body

Immunosuppressive tx: cyclophosphamide, IV methylprednisolone

92
Q

Microscopic polyangitis tx

A

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
Q

granulomatosis w polyangitis

A

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
Q

Nephrotic syndrome can be secondary to:

A 
DM
HIV
Hep B/C
Lupus erythematosus
Antiphospholipid syndrome
95
Q

Antiphospholipid syndrome

A 
Hx
DVT
Pulm embolism
TIA
Miscarriages/premature
Sx
Levido reticularis
Painful purpura
Leg ulcers
Splinter hem
96
Q

membroproliferative glomerulonephritis

A

complement in endothelium

97
Q

Membranous nephropathy

A

damaged basement membrane

98
Q

Minimal change disease

A

podocyte damage

99
Q

Focal segmental glomerulosclerosis

A

podocyte damage

100
Q

Nephrotic syndrome

A

high urine protein
low serum albumin
edema

101
Q

Hypersensitivity nephritis

A

post strep GN
IgA nephropathy
Diffuse proliferative GN

102
Q

IgA nephropathy/Berger’s

A

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
Q

post strep complexes deposit:

A

basement membrane

104
Q

Diffuse proliferative GN

A

caused by SLE

Deposition of complexes: >50% glomeruli affected, in subepithelial space

105
Q

membranoproliferative GN

A

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
Q

Rapidly progressive GN

A

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
Q

Alport

A

hearing loss
retinopathy
lens dislocation
GBM thin and breaks

108
Q

hemoptysis + oliguria

A

goodpastures

109
Q

cola coloured urine, hematuria, edema

A

nephritis

My notes - med (14 decks)

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