Medicine Flashcards
A 38 yr old is brought after a witnessed seizure. She participated in a high altitude marathon at the end of which she had nausea n vomiting. She had hydrated aggressively before during n after the race. The only drug she took in the last 24 hrs is ibuprofen. Serum sodium is 116, others r normal
Cause of her current condition?
Exercise induced hyponatremia
1) ingestion of large amount of hypotonic fluid before n after prolonged exercise is the major cause
2) SIADH which is triggered by nonosmotic stimuli(eg, exertion, pain, hypoglycemia, nausea)
Calciphylaxis(AKA calcific uremic arteriolopathy)
Is characterized by?
Most commonly occurs in pts with—?
Other risk factors
Systemic arteriolar calcification and soft tissue calcium deposition with local ischemia n necrosis
- commonly seen in those with long standing ESRD who r on dialysis.
- HyperPHOSPHATEMIA, hyperparathyroidism, obesity, DM, warfarin
A 55 yr old man comes with generalized weakness for the past 7 days. He has htn n dm for which he takes medications. BP- 160/98 moist mucous membranes, bilateral basal crackles, bilateral 2+ lower extremity edema
K-7.4, bicarbonate- 14, BUN -82 , Cr- 8( 3 months ago 1.1), Ca- 10.3
U/A- protein 1+, casts- none
Urine Na- 70
Normal sized kidneys on U/S
The pt has?
AKI secondary to ATN( acute tubular necrosis), which is an intrinsic renal injury( urine Na>40, BUN/Cr ratio is normal, I.e, 10-15
- renal injury usually causes hypocalcemia because of reduced phosphate clearance leading to calcium phosphate salt formation
But this patient has hypercalcemia, suggesting ATN secondary to multiple myeloma
A42 yr old man comes after stumbling n falling several times. He had been binge drinking for the past 2 days. He also had cocaine the previous night. Bilateral thighs n calves r mildly swollen n tender. Lower extremity muscle strength is decreased, normal sensation. Other examinations r normal. He is at greatest risk for which complication of his current condition?
AKI
- he is having rhabdomyolysis- alcohol binges can cause acute alcohol myopathy that predominantly affects the lower extremities causing pain, weakness, swelling
- cocaine further contributes to mm damage
A 32 old man with a known hx of recreational drug abuse is found on the floor confused. Pupils are small,skin is mottled over the upper back buttocks. He has been previously hospitalized for alcohol intoxication.
K- 6.1, Ca- 7.5, AST-262, ALT-189 inorganic phosphate- 5.5
Dx
Complication
Rhabdomyolysis
opioids n other CNS depressants cause impaired consciousness n prolonged immobilization n ischemic compression of dependent parts( mottled skin over the back…)
- hyperkalemia n hyperphosphatemia - released from the lysed mm
- hypocalcemia- deposition of Ca in the damaged mm cells
The 2 preferred modalities for diagnosing a ureteral stone are?
Non contrast CT( the best) and
U/S
- IVP was used in the past but now non contrast CT is preferred.
A pt is diagnosed with hypertension. CT angiography shows 80%atherosclerotic narrowing of the rt renal aa. In addition to antilipids n aspirin, the best next step in the mx?
ACEIs or ARBs
are 1st line therapy in Renal aa stenosis - dilate the efferent arterioles n control hypertension
- in bilateral RAS, the drugs can cause a significant reduction in GFR but most pts can tolerate with only mild rise in Cr(<30%) which is acceptable.
- surgery or stenting is reserved for failed intolerable medical therapy ( degree of stenosis doesn’t matter)
A pt presents with mm wkness, dark urine, elevated Cr n K. He takes ASA, simvastatin, lisinopril, colchicine. What other lab test is used to establish the dx?
Creatinine phosphokinase
Rhabdomyolysis
The two lab values that provide the best picture of acid base status are?
PaCo2 and pH; HCO3- can b calculated using the Henderson-Hasselbalch equation
A 72 yr old women comes with increasing fatigue n bilateral leg swelling for the past 3months. She has scattered ecchymosis. She has long standing joint pain( RA) and features of nephrotic syndrome. Renal biopsy would show?
Congo-red positive glomerular deposits -
- RA, skin involvement (ecchymosis), nephrotic syndrome- amyloidosis
A 46 yr old man comes with intermittent severe flank pain. Has decreased urination with occasional episodes of high urine output. He underwent a left total nephrectomy following RTA many yrs ago. Urinalysis is normal
Cause of his sxs?
Obstructive uropathy due to renal calculi
AKI secondary to calcineurin inhibitors ( tacrolimus, cyclosporine) is due to?
Their vasoconstrictor effect - prerenal features, reversible with adjustment of dosing
A 65 yr old man with known hx of CAD, DM, hyperlipidemia on low dose ASA, atrovastatin, metformin n sitagliptin presents with sepsis of chest focus( CAP) . He has dry mucous membranes, Cr is 2, BUN is 48
Which of the above drugs must b discontinued?
Metformin should b discontinued temporarily.
This pt is having pre renal azotemia but this can progress into acute tubular necrosis if other nephrotoxic agents like NSAIDs, metformin r used
