Nephrology Flashcards
1
Q
How does IV contrast cause renal failure?
A
vasospasm of afferent arteriole (decrease perfusion to glomeruli)
2
Q
How long after an infection does post-Strep glomerulonephritis occur?
A
1-2 weeks after infection
3
Q
Renal toxicity of a medication is due to the …. of the medication
A
trough (space interval of medications to decrease toxicity of medication)
4
Q
What is the side effect of aminoglycosides (gentamicin)?
A
- renal toxic
2. ototoxicity
5
Q
What is the difference between azotemia and uremia?
A
azotemia: renal insufficiency but no need for dialysis
uremia: renal insufficiency resulting in need for dialysis
6
Q
What are complications of uremia? (9)
A
- need for dialysis
- anemia (decrease epo production)
- hyperkalemia
- pericarditis
- hypocalcemia (decrease active vitamin D)
- infections (wbc cant degranulate)
- metabolic acidosis & fluid overload (b/c cant get rid of organic acid)
- altered mental status
- bleeding (platelets cant degranulate)
7
Q
What is the treatment for uremia induced bleeding?
A
DDAVP (desmospressin causes release of subendothelial stores of vWf and factor 8)
8
Q
What are causes of pre-renal azotemia?
A
- dehydration/ shock/ blood loss
- renal artery stenosis
- hepatorenal syndrome
- ACE inhibitor effect on kidney
- low albumin states (nephrotic and liver disease)
9
Q
What are causes of post-renal azotemia?
A
- bladder stone/clot
- bladder cancer
- prostate hypertrophy/ cancer
- bilateral ureteral disease
10
Q
What is the driving force of GFR in kidney?
A
hydrostatic pressure in the glomeruli capillary
11
Q
What is the initial clue to pre-renal azotemia?
A
BUN: creatinine ratio >20
b/c more time for urea to be reabsorbed b/c slow flow
12
Q
What can falsely elevate BUN?
A
- increased protein in diet
2. GI bleeding (protein release)
13
Q
What happens to urine sodium in pre-renal azotemia?
A
urine sodium < 10 (low b/c body reabsorbs sodium to increase intravascular volume)
14
Q
What happens to the urine osmolality in pre-renal azotemia?
A
urine osmolality is high (>500); concentrated urine
high specific gravity >1.010
15
Q
A pt presenting with hypertension with renal insufficiency most likely suffers from …
A
- primary hyperaldosteronism
- renal artery stenosis
(distinguish w/ aldosterone/renin ratio)
16
Q
A pt with liver disease who develops renal insufficiency that does not respond to 1.5 liters of colloid (albumin) most likely suffers from …
A
hepatorenal syndrome
17
Q
What dilates the afferent arteriole of the glomeruli?
A
Prostaglandins
18
Q
How does NSAIDs result in pre-renal azotemia?
A
inhibit prostaglandins which prevent afferent arteriole dilation (results in constriction of arteriole)
19
Q
What constricts the efferent arteriole of the glomeruli?
A
Angiotensin 2
20
Q
How do ACE inhibitors result in pre-renal azotemia?
A
inhibit conversion of angiotensin 1 to angiotensin 2 preventing constriction of efferent arteriole (results in dilation of efferent arteriole)
21
Q
Why is it that ACE inhibitors diminish the rate of progression to renal failure and uremia in pts with diabetes, HTN, multiple myeloma?
A
dilation of efferent –> decreased hydrostatic pressure in glomeruli –> decrease intraglomerular HTN
(never withhold ACE inhibitor)
22
Q
What is the best blood pressure medication for pt with diabetes?
A
ACE inhibitors
23
Q
What is orthodeoxia?
A
Change positions (sitting up) cause oxygen desaturation
24
Q
What disease is associated with orthodeoxia?
A
hepatopulmonary syndrome
25
What medications can cause retroperitoneal fibrosis (leading to post-renal azotemia)?
1. bleomycin (along with pulmonary fibrosis)
| 2. methotrexate
26
What chemo medication results in hemorrhagic cystitis?
cyclophosphamide
27
What are the most common causes of neurogenic bladder?
1. diabetes
| 2. multiple sclerosis
28
What is the normal post-voiding residual volume?
50 ml of urine (if elevated, implies obstruction to flow out of bladder)
29
What are causes of interstitial renal insufficiency?
1. allerigic
2. toxic
3. pigments (hemogloin/ myoglobin)
4. proteins (bence jones)
5. crystals
30
A pt with a BUN/cr of 10, high urine sodium, urine osmolarity (similiar to serum osmolarity; isothenuria), and FeNa > 1% most likely suffers from ...
acute tubular necrosis
31
What type of casts/ sediment is associated with acute tubular necrosis?
granular, muddy brown, pigmented cast
| dead tubular cells sloughed off
32
What drugs can result in allergic interstitial nephritis, drug induced hemolysis, and/ or rash?
1. penicillins
2. cephalosporins
3. sulfa drugs
4. allopurinol
5. rifampin
6. quinolones
(1 dose can cause problem)
33
What medications can result in acute tubular necrosis?
1. aminoglycosides (gentamicin)
| 2. amphotericin
34
A pt presents with renal insufficiency with associated fever, rash, and eosinophils most likely suffers from ...
Allergic interstitial nephritis
35
What is the most accurate test for eosinophils in the urine?
Hansel stain (or Wright stain)
36
What are causes of myoglobinuria (rhabdomyloysis)?
1. severe crush injury
2. seizures
3. statins
4, severe exertion
37
What is the initial best step in management of a pt with severe crush injury or seizure?
EKG or potassium level (hyperkalemia causes peaked t waves)
38
What is treatment for hyperkalemia with peaked T waves on EKG?
calcium chloride/ gluconate
39
What is the initial best test for rhabdomyolysis?
urinalysis (dipstick positive for blood but no RBCs seen)
40
What is treatment for rhabdomyolysis?
1. hydration (decrease contact time)
2. mannitol (osmotic diuretic-> decrease contact time)
3. alkalinize urine w/ bicarb
41
What is confirmatory test for rhabdomyolysis?
elevated CPK (>10,000)
42
What is treatment for hyperkalemia without EKG changes?
1. insulin with glucose
| 2. bicarbonate
43
A pt presents with metabolic acidosis with gap due to ethylene glycol develops renal insufficiency due to...
calcium oxalate stone formation (enveloped shaped)
| oxalate is toxic metabolite of ethylene glycol
44
What is the treatment for ethylene glycol intoxication?
1. ethanol or fomepizole (prevents formation of oxalate)
| 2. dialysis
45
A pt with Crohn disease develops renal insufficiency due to ...
oxalate crystals (calcium bound to fat in gut instead of w/ oxalate)
46
A pt with cancer being treated with chemotherapy develops renal insufficiency due to ...
tumor lysis syndrome (uric acid release leading to urate crystals)
47
What treatment should pt with cancer being treated with chemotherapy be given to prevent urate crystal associated renal insufficiency?
allopurinol and hydration
48
What is the most common cause of hypercalcemia?
primary hyperparathyroidism
49
When should primary hyperparathyroidism need to be treated?
if associated with renal stones and renal insufficiency
50
A pt who underwent a vascular catheter procedure (angioplasty) who develops renal failure, bluish discoloration of extremities and livedo reticularis most likely suffers from ...
atheroembolic disease
51
What is the most accurate test for atheroembolic disease?
skin biopsy showing cholesterol crystals in skin
52
What can be done to prevent contrast induced renal failure?
1. hydration
2. N-acetyl cysteine
3. bicarbonate
53
A pt with hx of diabetes/ sickle cell disease/ NSAID use presents with sudden flank pain, hematuria, pyuria and fever most likely suffers from ...
papillary necrosis
54
What is the most accurate test for papillary necrosis?
CT scan (bumpy contours in the renal pelvis where papillae have sloughed off)
55
What is the next best step in management of a diabetic pt found to have microalbuminuria?
Start ACE inhibitor (or ARBs)
56
What is consider nephrotic range proteinuria?
3.5 grams/day or more
57
What is the best step in management of a pt with trace amounts of protein in urine?
repeat urinalysis or split 24 hour urine sample (if no protein in first 8 hours, but in second part --> orthostatic proteinuria)
58
How do you distinguish hematuria due to glomerular disease versus other causes?
glomeruli disease results in dysmorphic RBCs
59
What does nitrite positive urinalysis suggests?
gram negative bacteria presence (infection if WBCs)
60
What pt should be screened and treated for bacteriruia despite presence of WBCs or symptoms?
pregnant patients
61
What do hyaline casts signify?
dehydration/ pre-renal
| accumulation of normal amount of tubular/Tomm-Horsfall protein
62
What is the most common complication of peritoneal dialysis?
peritonitis
63
Why does anemia develop in ESRD and what is the treatment?
decreased production of epo; replace epo
64
What do eosinophilic casts suggest?
Allergic interstitial nephritis
65
What do broad, waxy casts suggest?
chronic renal disease
66
What is the cause of hypocalcemia and hyperphosphatemia in ESRD?
decrease production of active vitamin D so decrease calcium absorption --> elevated PTH stimulating bone breakdown and release of phosphate (kidney can't excrete)
67
What is treatment for hypocalcemia in ESRD?
vitamin D replacement
68
What is treatment for hyperphosphatemia in ERSD?
1. phosphate binders (calcium carbonate/ acetate/ sevelamer)
| 2. Cinacalcet (decreased PTH to decrease release of phosphate from bone)
69
What is cause of osteodystrophy in ERSD?
1. decrease active vitamin D --> decrease Ca --> increased PTH --> increase bone resorption to increase Ca
2. bone resorption to buffer acidosis
70
Why does hypermagnesium occur in ERSD and what is treatment?
decreased excretion; restrict magnesium intake
71
What is the most common cause of death in pt with ERSD on dialysis?
accelerated athersclerosis (coronary artery disease)
72
Why is there increased infections in pts with ERSD and what is the most common organism?
WBCs cant degranulate in uremic environment; S. aureus due to dialysis
73
Why is there increased bleeding in patient with ERSD?
uremia induced platelet dysfunction
74
What is the blood pressure goal for pt with diabetes or renal disease?
BP < 130/80
75
What are the indications for dialysis in pts with renal disease?
1. hyperkalemia
2. fluid overload (refractory to diuretics)
3. encephalopathy
4. pericarditis
76
What are medications used to prevent post-transplantation renal graft rejection?
1. cyclosporine
2. tacrolimus
3. mycophenolate
(calcineron inhibitors)
77
A pt presenting with edema, hematuria, red cell casts, hypertension and dysmorphic red cells in urine most likely suffers from ...
Glomerulonephritis
78
What is the most accurate test for glomerulonephritis?
renal biopsy
79
What is the best initial test for glomerulonephritis?
urinalysis
80
A pt presents with recurrent URI and lung infections with hematuria most likely suffers from ...
Wegener granulomatosis
81
What is the best initial test that is specific for Wegener granulomatosis?
C-ANCA (anti-proteinase 3 antibody)
82
A pt presenting with adult onset asthma, atopy, eosinophilia and hematuria most likely suffers from ...
Churg-Strauss syndrome
83
What is treatment for Churg-Strauss syndrome?
steroids and cyclophosphamide
84
What is the treatment for Wegener granulomatosis?
steroids and cyclophosphamide
85
A young adult or child presents with periorbital edema, cola/tea colored urine and hypertension 1-2 weeks after recent Strep infection most likely suffers from ..
Post-infectious glomerulonephritis
86
What is the best initial test for post-infectious glomerulonephritis?
Antistreptolysin test (ASO) and antihyaluronic acid (AHT)?
87
What are findings on renal biopsy for post-infectious glomerulonephritis?
subepithelial humps on electron microscopy with IgG and C3 deposited in mesangium
88
What is treatment for post-infectious GN?
fluid overload and diuretics
89
A pt presents with hematuria and lung disease without other manifestations (no skin or eye involvement) and hemosiderin laden macrophages most likely suffers from ...
Goodpasture syndrome
90
What is the best initial test for Goodpasture syndrome?
antibasement membrane antibodies to type 4 collagen
91
What is treatment for Goodpasture?
plasmapheresis and steroids
92
An asian pt presents with hematuria 1-2 days after a viral URI most likely suffers from ...
IgA nephropathy (Berger disease)
93
What is the diagnostic finding in Berger's disease?
IgA deposit in kidney
94
A pt presenting with hematuria along with manifestations in every organ except lung most likely suffers from ...
Polyarteritis Nodosa (PAN)
95
What infection is associated with Polyartritis Nodosa?
Hep B infection (especially in IV drug users)
96
What antibody is associated with polyarteritis nodosa (PAN)?
P-ANCA
97
What nerve is frequently biopsied for polyarteritis nodosa?
sural nerve (most accurate test)
98
What is the treatment for polyarteritis nodosa?
steroids and cyclophosphamide
99
A pt presents with palpable purpura, hematuria, abdominal pain, and arthralgias most likely suffers from ...
Henoch-Schonlein purpura (self-limited so no biopsy needed)
100
What can be seen on biopsy of a patient with henoch schonlein purpura (HSP)?
IgA deposits in blood vessels along with leukocytoclastic vasculitis
101
A pt presents with hemolytic anemia (schistocytes), uremia and thrombocytopenia most likely suffers from ...
Hemolytic Uremic Syndrome (HUS associated with E. Coli 0157:H7)
102
A pt presents with altered mental status, fever, hemolytic anemia (schistocytes), uremia, and thrombocytopenia most likely suffers from ...
Thrombotic thrombocytopenic purpura (TTP)
103
What is treatment for thrombotic thrombocytopenic purpura?
plasmapheresis (can use dipyridamole to prevent platelet aggregation)
104
A pt with hx of hep C presenting with hematuria, joint pain, neuropathy and purpura most likely suffers from ..
Cryoglobulinemia (no GI symptoms unlike HSP)
105
What should be used to screen for renal disease in diabetics?
1. microalbuminuria
| 2. creatinine
106
What is the treatment for albuminuria in a diabetic patient?
ACE inhibitor (ACE)
107
What is the essential diagnostic test for lupus nephritis and why is it essential?
biopsy; to assess whether proliferative disease
108
What is the treatment for renal sclerosis in lupus and for renal proliferative disease in lupus?
no therapy; mycophenolate w/ steroids
109
What is difference between cryoglobulinemia and cold-agglutinin?
Cryo: pupura & renal disease, associated w/ hep C
| cold agglutinin: hemolytic anemia, associated w/ EBV and mycoplasma
110
What is treatment for cryoglobulinemia?
treat hep C (interferon and ribavirin)
111
A pt presenting with hematuria with sensorineural hearing loss and congential eye problems most likely suffers from ..
Alport syndrome (family hx)
112
What is the finding on renal biopsy in a pt with Goodpasture syndrome?
linear deposits
113
What diagnostic test can be done in a pt with polyarteritis nodosa with abdominal pain?
angiogram of GI vessels
114
What is the diagnostic finding associated with amyloidosis?
green birefringence with congo red staining
115
What is diagnostic criteria for nephrotic syndrome?
1. > 3.5 grams of protein in urine in day
2. hypoalbuminemia
3. edema anywhere including non-dependent areas like face (due to low oncotic pressure)
4. hyperlipidemia
116
What tests can be done to detect nephrotic syndrome level protein?
1. 24 hour urine collection
| 2. spot urine protein:creatinine ratio >3.5
117
What is nephrotic syndrome a hypercoagulable state?
due to urinary loss of anti-thrombotic proteins (anti-thrombin, protein S, protein C) more than thrombotic proteins
118
What is the most common cause of nephrotic syndrome in adults?
Membranous glomerulonephrits
119
What is the most common cause of nephrotic syndrome in children?
Minimal Chane disease (Nil Lesion)
120
What are two things that are associated with Minimal Change Disease?
1. NSAIDs
| 2. Hodgkin's Lymphoma
121
What is biopsy finding associated with Minimal Change disease?
fusion of foot processes on electron microscopy
122
.... is a steroid-resistant type nephrotic syndrome that has IgM deposits in an expanded mesangium on immunofluorecent staining of biopsy
Mesangial glomerulonephritis
123
A pt with hematuria with crescent formation on biopsy is most likely ...
Rapidly progressive glomerulonephritis
| tx w/ steroid and cyclophosphamide
124
A pt with restrictive cardiomyopathy, nephritis, carpal tunnel syndrome (peripheral neuropathy), and macroglossia most likely suffers from ...
Amyloidosis
125
What is the treatment for Amyloidosis?
melphalan and prednisone
| correct underlying infection/ cancer
126
What is the treatment for mild hyponatremia (aymptomatic low Na)?
fluid restriction
127
What is the treatment for moderate hyponatremia (low Na with symptoms)?
normal saline with furosemide (free water loss)
128
What do maltese crosses signify?
droplet of lipids forming cross signifying hyperlipiduria
129
What is the treatment for severe/ chronic hyponatremia (Na<120, coma/seizure)?
1. 3% hypertonic saline
| 2. V2 receptor-antagonist (conivaptin or tolvaptan)
130
What disease can result if the sodium is corrected too rapidly in hyponatremia?
Central Pontine Myelinolysis
131
What conditions/diseases are associated with focal-segmental glomerulonephritis?
1. HIV
| 2. Heroin
132
What rate should sodium be corrected in order to avoid central pontine myelinolysis?
0.5-1 meq per hour
133
What are causes of pseudohyponatremia (low Na serum level but total Na is normal)?
1. Hyperglycemia (glucose osmotic causing water to move out of cell--> dilutional)
2. hyperlipidemia (lab error)
134
What are causes of hyponatremia in pt who is in hypervolemic state (increased extracellular fluid w/ intravascular volume depletion leading to increased ADH)?
1. CHF
2. Nephrotic syndrome & low albumin
3. cirrhosis
4. renal insufficiency (impaired free water excretion)
135
What are causes of hyponatremia in pt who is in hypovolemic state (decreased ECF)?
1. GI loss
2. burns/sweating replacing w/ free water
3. diuretics
4. renal sodium loss
5. adrenal insufficiency (no aldosterone to reabsorbs Na)
6. ACE inhibitors
(high urine Na: diuretics, ACEI, renal salt wasting, adrenal insufficiency, cerebral salt wasting)
(low urine Na b/c body retains Na to retain volume: dehydration, vomiting, diarrhea, sweating)
136
What are causes of hyponatremia in euvolemic state?
1. psychogenic polydipsia (drink too much water)
2. hypothyroidism
3. diuretics
4. ACE inhibitors (increase ADH)
5. endurance exercise
6. SIADH
137
A pt presents with hyponatremia in the setting of elevated urine osmolality (>100) and elevated urine Na most likely suffers from ...
SIADH (syndrome of inappropriate ADH)
138
What are causes of SIADH?
1. anything brain related
2. anything in lung
3. meds (SSRIs, TCAs)
4. cancer
139
What is the most accurate test for SIADH?
ADH level
140
What causes hypernatramia?
1. skin, urine or GI loss of fluid
| 2. diabetes insipidus
141
How do you distinguish central diabetes insipidus versus nephrogenic diabetes insipidus?
decrease in urine volume in response to ADH suggests central diabetes insipidus
142
What are the causes of nephrogenic diabetes insipidus?
1. hypokalemia
2. hypercalcemia
3. lithium
4. demeclocycline
143
What is the treatment for nephrogenic diabetes insipidus?
1. diuretics
| 2. NSAIDs (inhibit prostaglandins that can impair concentrating ability; increase action of ADH)
144
What are causes hypokalemia?
1. GI loss (colon)
2. alkalosis (H+ come out and K in)
3. insulin (drives K into cells)
4. low magnesium
5. beta agonist (increases ATPase)
6. aldosterone (Na in, K out of kidney; Conn/ Cushing/ licorice)
7. Vitamin B12/ folate treatment (b/c increase cell formation adding K into cells)
145
What are causes of hyperkalemia?
1. diabetes (low insulin)
2. digoxin
3. beta blockers (decrease ATPase)
4. acidosis (H+ into, K out)
5. hemolysis/ cell lysis
6. low aldosterone (addisons; ACEI; type 4 RTA)
7. renal failure
8. potassium sparing diuretics (amiloride, spironolactone)
146
What is seen on EKG in hypokalemia?
1. T wave flattening
| 2. U waves (purkinje fiber)
147
What type of saline should be used in a pt with hypokalemia being repleted with IV KCl?
saline (avoid dextrose bc increases insulin that pushes K into cell)
148
What are EKG findings associated with hyperkalemia?
1. peaked T waves
| 2. widened QRS, short QT, prolonged PR
149
What is the treatment for hyperkalemia with associated changes in EKG?
1. calcium chloride/ gluconate (stabilizes cardiac membrane)
| 2. insulin & glucose
150
What are treatments for hyperkalemia without EKG changes?
1. NaHCO3 (drives K into cell)
2. Glucose & insuline (drives K into cell)
3. Kayexalate (removes from body)`
151
What is type 1 (distal) renal tubular acidosis?
inability to develop high H+ concentrate in urine (can't excrete H+; so urine basic)
152
What are complications of type 1 (distal) renal tubular acidosis?
1. stones in kidney (nephrocalcinosis and nephrolithiasis)
| 2. hypokalemia
153
What is the diagnostic test for type 1 (distal) renal tubular acidosis?
give ammonium chloride (acid) and urine stays basic
154
What is treatment for type 1 (distal) renal tubular acidosis?
bicarbonate
155
What is type 2 (proximal) renal tubular acidosis?
inability to absorb bicarbonate
| initially urine pH basic then becomes acidic once bicarb depleted
156
What are complications associated with type 2 (proximal) renal tubular acidosis?
1. bone lesions (osteomalacia, rickets; acid sucks calcium out of bone)
2. hypokalemia
157
What is diagnostic test for type 2 (proximal) renal tubular acidosis?
give sodium bicarbonate (urine becomes basic initially b/c can't absorb it)
158
What is treatment for type 2 (proximal) renal tubular acidosis?
1. diuretic (decrease volume of body
| 2. bicarbonate
159
What is type 4 (hyporeninemic/ hypoaldosteronism) renal tubular acidosis?
occurs in diabetic pt with low renin and low aldosterone
160
What are complications of type 4 (hyporeninemic/ hypoaldosteronism) renal tubular acidosis?
1. hyperkalemia (no aldosterone to cause K excretion)
161
What is treatment for type 4 (hyporeninemic/ hypoaldosteronism) renal tubular acidosis?
fludrocortisone
162
What are the two causes of non-anion gap metabolic acidosis?
1. diarrhea
| 2. renal tubular acidosis
163
How do you distinguish between diarrhea and RTA as causes of non anion gap metabolic acidosis?
urinary anion gap
diarrhea: negative
RTA: positive
164
What are causes of metabolic alkalosis (HCO3 > 24 w/ pH high)?
1. loss of H+ (vomiting, renal loss)
2. hypokalemia (K comes out of cell, driving H into cell)
3. HCO3 retention (volume contraction -> aldosterone excrete H; milk-alkali w/ antacids)
165
What are causes of respiratory alkalosis?
hyperventilation (anemia, salicylate stimulate respiratory drive, PE, anxiety)
166
What is the formula for anion gap and what is considered increased?
AG= Na - (HCO3+ Cl)
| AG > 14 is increased
167
What are causes of anion-gap metabolic acidosis?
MUDPILES
1. methanol
2. uremia
3. DKA
4. Propylene glycol/ paraldehyde
5. INH/ isopropyl alcohol
6. Lactate (sepsis, ischemia)
7. ethylene glycol
8. Salicylic acid (aspirin)
168
What are causes of respiratory acidosis?
hypoventilation (COPD, opiates, sleep apnea, aspiration, myopathies, obesity)
169
What type of kidney stones are radiolucent?
uric acid stones
170
What type of infections are associated with struvite stones (magnesium/ aluminum/ phosphate)?
kidney infection with urease producing organisms (Proteus, Staph, Pseudomonas, Klebsiella) which increase pH
171
Enveloped shaped crystals in a pt attempting suicide most likely suffers from ...
oxalate crystals secondary to ethylene glycol intoxication
172
A pt presents with constant excruciating flank pain, hematuria, and pain radiating to groin most likely suffers from ..
Nephrolithiasis (kidney stones)
173
A pt who was in motor vehicle accident who received large amount of transfusion fast who develops seizure most likely had seizure due to ...
hypocalcemia due to citrate (used to preserve blood) binds up all the calcium
174
What is the best initial step in management for suspected kidney stones?
pain medications
| ketolorac
175
What is the best initial test for kidney stone?
X-ray
176
What is the most accurate test for kidney stone?
spiral CT
177
What is the treatment for kidney stones that are 5mm to 2 cm in size?
shockwave lithotripsy (if bigger, percutaneous removal)
178
What is the most common cause of death in adult polycystic kidney disease?
ESRD due to chronic infections and stones
179
What is the next best step in management of a simple renal cyst with irregular walls or debris inside?
aspiration to exclude malignancy
180
What is malignant hypertension?
encephalopathy or nephropathy with accompanying papilledema
| DBP > 130
181
What is the treatment for hypertensive crisis/ urgency/ emergency?
IV labetolol and nitroprusside and enalapril
| no lower than DBP <95 in initial hours
182
What is the initial drug of choice for hypertension?
thiazide diuretics
183
What is the best anti-hypertensive medication in a pt with diminished LV systolic function?
beta blockers (avoid in asthmatics)
184
A older pt or young women with hypertension and upper abdominal bruit radiating laterally most likely suffers from ....
renal artery stenosis
185
What is the best initial diagnostic test for renal artery stenosis?
```
abdominal ultrasound
(other options captopril renogram- decreased uptake)
```
186
What is the most accurate diagnostic test for renal artery stenosis?
arteriogram
187
What is the best treatment for renal artery stenosis?
percutaneous transluminal angioplasty (ACE inhibitor if fails)
188
A pt presenting with hypertension in there upper extremities but decreased blood pressure in lower extremities most likely suffer from ..
Coarctation of Aorta
189
What is treatment for primary hyperaldosteronism (Conn's syndrome)?
1. surgical resection (if unilateral adenoma)
| 2. Spironolactone (bilateral hyperplasia)
190
A pt presenting with hypertension in setting of hypokalemia most likely suffers from ...
primary hyperaldosteronism (Conn's syndrome)
191
A pt presenting with episodic hypertension with associated headaches, sweating, palpitations and tachycardia most likely suffers from ..
pheochromocytoma
192
What is the best initial test for pheochromocytoma?
1. urinary vanillylmandelic acid (VMA)
2. metanephrines 3. free urinary catecholamines
(detect location via CT/MRI)
193
what is treatment for pheochromocytoma?
alpha blocker followed by surgery
194
A pt presents with hypertension in the setting of cushiongoid characteristics (truncal obesity, buffalo hump, menstrual abnormalities, straie, etc) most likely suffers from ...
Cushing Disease (ACTH hypersecretion by pituitary adenoma)
195
What is the best initial test for Cushing disease?
1. dexamethasone suppression
| 2. 24 hour urine cortisol
196
What is the most common side effects of diuretics?
1. hypokalemia
| 2. hypomagnesium
197
What are the most common side effects of beta blockers?
1. worsening asthma (bronchospasm)
| 2. heart block
198
What is the most accurate test for detecting location of pheochromocytoma when CT/MRI negative?
MIBG scan
199
What are the most common side effects of ACE inhibitors?
1. cough
2. angioedema
3. hyperkalemia
200
What are the most common side effect of calcium channel blockers?
1. peripheral edema
2. constipation
3. reflex tachycardia
201
What is treatment of hypertension in pregnant women with eclampsia?
hydralazine
202
What is minoxidil used?
treat baldness
203
What is most common side effect of alpha blockers?
orthostatic hypotension
204
When are alpha blockers used for hypertension?
in pt with simultaneous prostatic hypertrophy
