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Professional Development > Part 30 > Flashcards

Part 30 Flashcards

1
Q
A
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2
Q

Edema definition

A

Palpable swelling produced by expansion of insterstitial fluid volume in the tissue itself

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3
Q

Pitting vs nonpitting edema

A

Pitting edema leaves an indentation when pressed with a finger and indicates less severe fluid buildup, nonpitting edema bounces back from indentation when pressed with a finger and indicates severe fluid buildup

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4
Q

Anasarca definition

A

Massive and generalized fluid build up, extreme edema

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5
Q

Capillary hydrostatic pressure definition

A

Pressure pushed on the capillary walls due to blood pressure to release fluid into the tissue bed, increased in cases of inflammation and venous congestion

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6
Q

Capillary osmotic pressure definition

A

The pressure pulling water back into the capillary vessel due to plasma proteins within the vessel

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7
Q

Lymphatic obstruction and it generally manifests ___laterally

A

Tumors, parasites, fibrosis, or removal of lymph nodes that cause obstruction of the flow and edema, generally manifests unilaterally

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8
Q

Interstitial osmotic pressure definition

A

The pressure Inward pulling force of fluid from the capillary into the interstitial space where proteins drive the fluid

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9
Q

Interstitial hydrostatic pressure

A

The pressure pushing fluid out of the interstitial space and back into the capillaries

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10
Q

Cardiac signs of generalized edema (5)

A
  • dyspnea upon exertion
  • paroxysmal nocturnal dyspnea
  • JVD
  • displaced apical pulse
  • cool extremities
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11
Q

Cardiac labs of generalized edema, how is BUN/Cr ratio? How is sodium level? How is BNP level?

A

Elevated BUN/Cr ratio

  • Decreased Na+
  • Elevated BNP
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12
Q

Brain natriuretic peptide (BNP) definition

A

A protein released in the body when the heart is working very hard and failing

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13
Q

Often a patient with paroxysmal nocturnal dispnea will have to do this to sleep

A

Prop pillows underneath them

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14
Q

Hepatic signs of generalized edema (4)

A
  • history of alcohol abuse
  • ascites
  • jaundice
  • asterixis
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15
Q

Ascites definition

A

Excessive fluid retention in peritoneal space, often resulting from portal hypertension, has large tortuous veins called caput medusa

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16
Q

Asterixis definition

A

Flapping fingers when holding hand outright due to nervous system effect

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17
Q

Renal signs of generalized edema (4)

A
  • Uremia
  • metalic or fishy taste
  • uremic frost
  • elevated BP
  • periorbital edema
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18
Q

Uremic frost definition

A

Uremic crystal formation on skin due to renal failure, smells foul

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19
Q

Renal labs of generalized edema, how is albuminuria? RBC count? K+ levels?

A
  • Positive for albuminuria
  • Normocytic anemiaRBC count
  • Hyperkalemic
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20
Q

Edema can be caused by increased hydrostatic pressure caused by these 2 mechanisms

A

1) impaired venous return
2) arteriolar dilation

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21
Q

Edema can be caused by reduced plasma osmotic pressure caused by these 3 mechanisms

A

1) protein losing gastroenteropathy or glomerulopathy
2) liver cirrhosis
3) Malnutrition

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22
Q

Edema can be caused by lymphatic obstruction caused by these 3 mechanims

A

1) inflammation
2) post surgical
3) post irradiation

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23
Q

Edema can be caused by increased capillary permeability or sodium retention caused by these 2 mechanisms

A

1) exccess salt intake or reabsorption
2) inflammation/immune rxn

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24
Q

Hydrothorax definition

A

A type of edema with accumulation of excess fluid in chest cavity

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25
Q

Hydropericardium definition

A

A type of edema with fluid in the pericardial sac that can lead to compression of heart

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26
Q

Exudate definition

A

A type of edema with inflammatory fluid spilling out of skin

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27
Q

Some common causes of anasarca (4)

A
  • nephrotic syndrome
  • cirrhosis
  • myxedema (hypothyroidism)
  • anaphylaxis
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28
Q

Nephrotic syndrome can cause edema because of the…

A

….massive proteinuria diminishing the colloid oncotic pressure

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29
Q

An early and a late finding in cirrhosis

A

Early - telangiectasias, broken sensitive vessels seen on face
Late - jaundice

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30
Q

A left sided congestive heart failure sees back up in the ___ while a right sided sees backup in the _____

A

lungs, extremities

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31
Q

Dependent edema definition

A

Edema that works with gravity via venous insufficiency and failure of valves causing blood to pool in veins increasing venous pressure and leading to edema that usually resovles when legs are elevated

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32
Q

Dependent edema treatment (3)

A
  • restricted sodium intake
  • stockings
  • weight loss
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33
Q

Brawny edema definition

A

Edema caused by chronic venous insufficiency causing thickened, dark colored skin with pectachiae and ulcerations

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34
Q

Idiopathic cyclic edema definition and treatment

A

Edema that occurs on a predictable cycle possibly related to hormones, normally seen in female menstrual cycle with weight change during day around period
Treated with sodium restriction or diuretics with caution

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35
Q

Drug class known to be a source of edema

A

Calcium channel blockers

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36
Q

If edema is worse in the morning, think of ___ edema origin

A

Renal

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37
Q

Facial involvement of edema, think of one of these 3 types involvement

A
  • renal
  • myxedema
  • allergic
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38
Q

Increased edema at end of day improving at night think of ___ edema origin

A

Cardiac

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39
Q

What type of edema is often treated with stockings?

A

Dependent edema

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40
Q

How does cirrhosis of liver progress regarding edema?

A

To ascites then to generalized edema

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41
Q

Nephrotic syndrome definition

A

Kidney disorder that causes excretion of too much protein in the urine resulting from damage to the glomeruli, with the predominant protein being found being albumin

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42
Q

When albumin leaks into urine, the blood loses ____ pressure, which can result in ___

A

Plasma osmotic, edema

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43
Q

Normal urinary protein excretion should be less than ___mg/day

A

150

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44
Q

Common causes of transient proteinuria (3)

A
  • Exercise
  • Fever
  • UTI
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45
Q

Persistent proteinuria definition

A

Protein excretion greater than 150mg/day on 2 more more occassions

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46
Q

A positive urinalysis for proteinuria indicates urinary protein excretion above ___mg/day. A urine dipstick only measures what protein?

A

300, albumin

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47
Q

Nephrotic syndrome range is when proteinuria loss is greater than ___mg/day

A

3500

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48
Q

3 symptoms of nephrotic syndrome

A
  • hyperlipidemia
  • hypoalbuminemia
  • edema of legs feet and ankles
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49
Q

Orthostatic proteinuria definition, how do we test for it?

A

A condition characterized often in children by increased protein excretion in the upright position, but normal protein excretion after periods of laying flat. 1st urine collection in the morning is the best way to test for it

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50
Q

Nephrotic range proteinuria test and confirmatory diagnostic test

A

24 hr urine sample, diagnosis confirmed by a kidney biopsy

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51
Q

Primary vs secondary nephrotic syndrome

A

Primary has an absence of identifieable systemic disease
Secondary has presence of identifiable systemic disease causing damage to the kidneys (diabetes, SLE, amyloidosis)

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52
Q

6 sources that account for 90% of nephrotic syndrome

A
  • minimal change disease (childhood onset)
  • Focal segmental glomerulosclerosis
  • membranous glomerulopathy
  • membranoproliferative glomerulonephritis
  • diabetic neuropathy (most common in US)
  • amyloidosis
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53
Q

Minimal change disease accounts for majority of cases of nephrotic syndrome in this population

A

Children under 10

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54
Q

Minimal change disease symptoms (3)

A
  • Severe edema
  • ascites
  • pleural effusions (crackles heard on PE)
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55
Q

Minimal change disease pathophysiology

A

Often idiopathic, potentially immunologically mediated and related to abnormal T cell function

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56
Q

Minimal change disease treatment and prognosis

A

Corticosteroid therapy, excellent prognosis

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57
Q

Focal segmental glomerulosclerosis (FSGS) definition

A

Scarring of the glomeruli of the kidney resulting in decreased renal function and eventually failure

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58
Q

Focal segmental glomerulosclerosis treatment and prognosis

A

Corticosteroids, very poor, high rate of progression to end stage renal disease

59
Q

Membranous nephropathy definition, what disease is it most commonly associated with?

A

-An often autoimmune reaction in the glomeruli’s basement membrane that results in decay in renal function, most commonly associated with nephrotic syndrome in adults

60
Q

What does the sediment of centrifuge urine contain?

A
  • RBCs
  • WBCs
  • RBC casts
  • Lipids
  • WBC casts
61
Q

Membranoproliferative glomerulonephritis definition, typical presentation (what do we see in sediment?)

A

An abnormal antibody response where immune complexes build up in the basement membrane of the glomeruli causing damage
Typically see RBC casts, lipidemia, etc in the analysis

62
Q

1 systemic disease causing nephrotic syndrome

A

Diabetic glomerulosclerosis

63
Q

Treatment for nephrotic syndrome induced edema cannot be treated by just adding more fluids. Why?

A

-This won’t fix the pressure gradient that is missing as a result of proteinuria, it will just put strain on the heart and exacerbate the problem

64
Q

Why is hypothyroidism seen in nephrotic syndrome? Why does nephrotic syndrome put an individual at risk for infection? Why is it a hypercoaguable state?

A

Thyroid hormone leaves with the proteins out to the urine/periphery
Some immunoglobins are also lost to the periphery/urine
It involves a loss of antithrombin III, protein C causes a risk of hypercoaguability

65
Q

Frothy urine even aftersitting for a period of time is indicative of…

A

…high proteinuria and potentially nephrotic syndrome

66
Q

Nephrotic syndrome hyperlipidemia (oval fat bodies) mechanism of action

A

Decreased oncotic pressure and hypoalbuminemia causes increased hepatic synthesis of proteins and lipids concurrent with decreased peripheral metabolism

67
Q

Nephrotic syndrome may lead to metabolic ___ (acidosis or alkalosis?

A

alkalosis

68
Q

Serum creatinine will not be a good marker for gross renal function in ___ renal impairment

A

early

69
Q

Azotemia definition

A

Higher than normal level of blood urea nitrogen, might be indicative of kidney’s inability to excrete these compounds

70
Q

Membranous glomerulopathy treatment

A

Corticosteroids

71
Q

What drugs should be avoided in the treatment of nephropathies

A
  • ASA
  • NSAIDS
  • certain antibiotics
72
Q

Edema dietary management

A

Decrease Na+
fluid restriciton if hyponatremic
Decrease fat
Adequate protein in diet

73
Q

Drug indicated for nephrotic syndrome treatment

A

Prednisone

74
Q

Total body water (TBW) definition

A

The summation of all the different forms of water in the body, approx 60% of body weight in males and 50% in females

75
Q

Intracellular fluid definition

A

Summation of fluid that lies intracellularly in the body, composes 40% of total body weight or 2/3 of total body water

76
Q

Extracellular fluid definition

A

Summation of fluid that lies extracellularly in the body, composes 20% of total body weight or 1/3 of total body water

77
Q

Intravascular space definition

A

Summation of fluid that lies within the vessels as part of extracellular fluid and composes 25% of extra cellular fluid or 5% of total body weight

78
Q

Interstitial space definition

A

Summation of fluid that lies within the body between cells as part of extracelluar fluid and compses 75% of extracellular flulid or 15% of body weight

79
Q

Osmosis definition

A

Movement of water from low solute conc. to higher solute conc. passively to attain equilibirrum

80
Q

Total body water is directly related to ___ and inversely related to ____. Infants, for example…

A

Lean body mass, fat content

…have higher percentage of body water because not as much fat

81
Q

Arterial vs venous end of vessel filtration vs absorption state

A

At arterial end hydrostatic pressure is greater than plasma osmotic pressure (which is constant), resulting in net filtration, hydrostatic pressure progressively drops off eventually causing favor of absorption from plasma osmotic pressure on venous side

82
Q

Osmolality definition

A

of milimose of solute particles per liter of solution, the greater the osmolallity the stronger urge water has to dilute the material

83
Q

A very frequent cause of death in hospitalization is cerebral edema, this is when individuals vessels become ___tonic to the tissue surrounding them causing fluid buildup in the brain tissues

A

Hypo

84
Q

Hypertonic by definition means ___solute compared to fluid, hypo means ____

A

more, less

85
Q

Sensible water losses vs insensible water losses

A

Sensible losses are measurable and take the form of urine, include 1-2 L per day. Insensible loss is immeasurable and due to evaporative loss thru skin and respiratory tract and includes of to 600-900mL/day

86
Q

3 factors that increase insensible losses

A
  • add 10% for each degree of fever above 99 degrees
  • increase with tracheostomies
  • decrease with humidified ventilatory support
87
Q

Daily sodium intake required, daily potassium intake required, why does hyperkalemia kill?

A

1 to 2 MEQ/kg/day
.5-1 MG/kg/day
Hyperkalemia causes arrhythmia and can stop a heart beat

88
Q

Na+ HCO3-, and cl- are predominantly stored in ___cellular fluid, while K+, Mg2+, protein, and phosphates are stored in __cellullar fluid

A

Extra, intra

89
Q

Na/K+ ATPase transports…

A

3 sodium ions outside the cell, and 2 potassium ions into the cell

90
Q

Most common cause of hyponatremia is from…

A

….H2O gain

91
Q

Isotonic hyponatremia definition

A

Also knwon as factitous or pseudohyponatremia, this occurs when sodium levels are normal but measured low due to fats and proteins in the blood

92
Q

Hypertonic hyponatremia definition

A

Increased solutes in plasma such as glucose or mannitol redistribute the volume of fluid from intra to extracellular space causing dilution resulting in hyponatremia

93
Q

Hypotonic hyponatremia definition

A

Occurs when excess of H2O exceeds Na+ conc.

94
Q

Euvolemic hyponatremia conundrum and how to evidence increased body H2O

A

-Occurs when patients have pure H2O excess extracellularly but not intravascularly, and appear euvolemic with the only evidence of increased total H2O is a lowered BUN

95
Q

Central pontine myelinolysis definition

A

Demyelination that occurs resulting in irreversible neurological defect after treatment of Na+ over 10 MEQ in 24 hrs or 18MEQ in 48 hrs

96
Q

When treating a patient with hypernatremia need to give a __tonic solution first because…

A

isotonic, because it prevents cells from expanding too quickly and bursting by introducing fluid back in slowly until it can equally distribute and stabilize the BP

97
Q

Glucose and insulin administration can help drive ___ back into cells

A

K+

98
Q

European black licorcie has the same effect in the body as…

A

…aldosterone

99
Q

Bartter syndrome definition

A

Rare inherited defect in thick ascending limb of loop of henle characterized by low K+ levels and high pH

100
Q

Correction for hypokalemia if <40k, what about if >40kg

A

.25 MEQ/kg/hr
10 MEQ/kg/2hrs

101
Q

Symptoms of hyperkalemia (3)

A
  • weakness
  • flaccid paralysis
  • hyperactive DTR’s
102
Q

An EKG with a flat “T” wave and shortened QRS complex is a sign of… What about with peaked T waves and widened QRS complex

A

Hypokalemia, hyperkalemia

103
Q

Calculation for fluid replacement therapy maintenance

A
  • first 10 kg 100ml/kg/day
  • 2nd 10 kg 50ml/kg/day
  • remaining 20ml/kg/day
104
Q

With a functioning kidney, an individual should intake approx ___L per day and urinate out that same amount

A

1.5-2L

105
Q

Fluid replacement therapy’s formula is chosen to ensure good urine output in hospitalized patient, what is the minimal output to ensure good renal perfusion?

A

720mL/day

106
Q

Almost ___ L is lost each day to skin evaporation, respiration, and GI tract

A

1

107
Q

IV fluid in mL/hr is summation of 5 items

A
  • baseline maintenance
  • deficit
  • ongoing losses
  • 3rd spacing
  • compensatory
108
Q

Calculation for fluid replacement therapy deficit

A

Acute loss give 1/2 deficit over first 8 hours, 1/4 deficit over next 8 hrs

Chronic loss give 1/2 deficit over 24 hours

109
Q

BUN will have increased concentration if…

A

…there is decreased blood flow to kidney

110
Q

Azotemia definition

A

Presence of elevated BUN

111
Q

Uremia definition

A

Advancing azotemia with increased BUN and Cr, indicates renal failure

112
Q

Vasopressor definition

A

The name of the local paracrine factor secreted by macula densa cells to communicate with juxtaglomerular cells thru mesangial cells indicating the JG cells need to release renin

113
Q

When blood pressure is too high, macula densa cells can secrete ___ that inhibit ___ release from JG cells

A

Paracrine factors, renin

114
Q

Nephrotic syndrome results from injury to the ___ (cells) while nephritic syndrome is ____ based, involving ____

A

Podoctyes, inflammation, blood in the urine

115
Q

Most nephrotic syndromes have a ___basis

A

Immunologic

116
Q

Does antibiotic treatment prevent glomerular disease in post strep glomerulonephritis?

A

Nope, immune mediated doesn’t have to do when treatment was sought after

117
Q

A strep infection often goes on to cause either ____ or ____ but rarely both

A

rheumatic fever, acute glomerulonephritis

118
Q

Treatment of post strep glomerulonephritis (3)

A
  • supportive diuretics
  • control hypertension
  • dialysis in extreme cases
119
Q

Prognosis of post strep glomerulonephritis

A

Very good, see recovery often within 2 months

120
Q

Goodpasture’s syndrome definition

A

A type II hypersensitivity invoolving antibody formation against the glomerular basement membrane, rapidly progressive to renal failure

121
Q

Most common glomerular cause of hematuria

A

IgA nephropathy/berger’s disease

122
Q

IgA nephropathy/berger’s disease definition

A

Attacks of hematuria following nonspecific illness, exercise, or immunization that is benign and result of excessive IgA antigen complex formation

123
Q

IgA nephropathy/berger’s disease treatment (2)

A
  • supportive care of hypertension
  • steroids if progressive to suppress immune response
124
Q

Rapidly progressive glomerulonephritis (RPGN) definition

A

Acute glomerulonephritis marked by rapid loss of renal function >50% over a period of 3 months with renal crescents upon biopsy

125
Q

75-80% of all nephrotic syndromes in kids and 20% in adults is from…

A

…minimal change disease

126
Q

Minimal change disease definition

A

Nondamaging cause of proteinuria leading to nephrotic syndrome, sometimes seen with allergies, malignancies, or certain drugs

127
Q

Minimal change disease presents as ___onset of nephrotic syndrome

A

abrupt

128
Q

Focal segmental glmoerulosclerosis definition

A

Scarring of some of the glomeruli of the kidney either idiopathic or due to infection, or drug, or a disease

129
Q

Focal segmental glmoerulosclerosis prognosis

A

Poor

130
Q

Most common primary cause of nephrotic syndrome in adults is…

A

…membranous glomerular disease

131
Q

Captopril drug class

A

ACEI

132
Q

Causes of membranous glomerular disease are typically ___ and include (3), how does it present (3)?

A

Autoimmune

  • nephrotic syndrome
  • cancers
  • Hep B

Presents with proteinuria and sometimes hematuria or malaise

P

133
Q

Membranoproliferative glomerulonephritis (MPGN) results in ___ GFR and ____ mesangial cellularity

A

decreased, increased

134
Q

Mostcommon cause of end stage renal disease in US

A

Diabetes

135
Q

Kimmelsteil Wilson lesion definition

A

Hallmark change seen in kidney from mesangial matrix expansion, nodular appearance indicative of glomerulonephropathy from diabetes

136
Q

Cortical nephrons focus on controlling ____ while medullary ones are focused on ____

A

BP, reabsorption

137
Q

Acute interstitial nephritis definition, what 3 things does it lack compared to glomerular disease?

A

Acute decline in renal function due to inflammation of the nephron, lacks HTN, proteinuria, or edema unlike glomerulonephritis

138
Q

Acute interstitial nephritis triad

A
  • fever
  • skin rash
  • peripheral eosinophilia
139
Q

Acute interstitial nephritis can present as TINU syndrome, which is…

A

…tubulointerstitial nephritis and uveitis syndrome

140
Q

Acute interstitial nephritis urine appears…

A

…coke colored

141
Q

Causes of acute interstitial nephritis (4)

A
  • antibiotis
  • NSAIDS
  • systemic infections
  • autoimmune
142
Q

Chronic tubulointerstitial nephropathy definition, what does it frequently present with?

A

Disease of the nephron tubule, frequently presents with hyperkalemia

143
Q

Sequelae of chronic tubulointerstitial nephropathy

A

Fanconi syndrome

144
Q

Fanconi syndrome definition

A

dysfunction of proximal tubules of kidney resulting in renal glycosuria, water and bicarb loss, and metabolic acidosis

Professional Development (32 decks)

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