patho test 4 - GI, pulmonary, renal Flashcards
1
Q
pulmonry function test used for diagnosis of restrictive disease
A
Forced expiratory volume (FEV)
shows obstruction -> asthma or COPD
2
Q
if FEV improves with bronchodilator
A
asthma
3
Q
chronic night time cough may be ____
A
asthma
4
Q
symptoms of asthma
A
Recurrent and intermittent*
tachycardia
chest tightness
SOB at night and w/ exercise
5
Q
asthma diagnostic tests
A
Peak Expiratory Function
6
Q
what drugs may exacerbate asthma attacks?
A
beta blockers
cholinergics
7
Q
why is early dx of asthma important?
A
inflammatory disease - leukotrienes cause bronchoconstriction and histamine causes mucus production
cell irritation ->changes and adaption leads to bronchial remodeling - which is irreversible
8
Q
how often should a patient with asthma use their albuterol inhaler?
A
2x week or less
9
Q
assessment of asthma patient
A
“How often do you use your rescue inhaler?”
percuss - less resonance = less air
10
Q
Sputum, spasm, and swelling = ____
A
Chronic Bronchitis
11
Q
Chronic Bronchitis physical exam may look similar to ___
A
CHF*
12
Q
likely organism indicated in PNA in a smoker?
A
H flu
13
Q
Chronic Bronchitis hallmark feature
A
Chronic excessive mucus secretion
easily colonized by microorganisms
14
Q
elastace is responsible for _____
A
Emphysema
inflammation - macrophages release elastatase
breaks down alveoli’s elastic lamina
15
Q
S3 – heart sound of _____
A
pulmonary edema
- chronic broch, chf
16
Q
tactile fremitus will be _____ in chronic bronchitis
A
decreased
17
Q
percussion of thorax results in hyperresonance
A
Emphysema
over inflated lungs
18
Q
Emphysema signs and diagnostics
A
Prolonged expiration
X Ray shows hyperinflation of lungs
19
Q
common first signs of respiratory disease
A
CNS symptoms
agitation
anxiety
restlessness
20
Q
main problem with pulmonary edema arises due to ____
A
increased pressure within the lungs changes CO2 and O2 exchange
21
Q
pulmonary HTN in COPD patho
A
chronic hypoxia leads to
vasoconstriction increases pressure in the lungs
fluid shift d/t pressure shift - crackles
back up of blood to the lungs in the R side of the heart
22
Q
pulmonary edema sx
A
sudden SOB Orthopnea paroxysmal nocturnal dyspnea Cough Fine crackles at bases, CHF/intravascular volume overload JVD (very late sign) Cardiac murmurs and gallops (S3) – fluid murmur
23
Q
causes of pulmonary edema
A
hypoalbumemia
increased permeability d/t inflammation
24
Q
green sputum in bronchitis means ____
A
nothing!
likely viral no ABX
25
Cholecystitis
| risk factors
fat
fertile
forty
female
26
Most gallstones are formed from ______. Created in the liver and stored in the gallbladder
cholesterol
27
_____ is specific for liver injury
ALT
28
mechanism of action in Lactose Intolerance
Diarrhea occurs because nondigested lactose is not absorbed and retains water
which raises volume and also provides a medium for bacterial fermentation
29
Would you give opiates for diverticulitis pain?
no!
| Opioids and NSAIDS raise the intraluminal pressure and raise the risk of perforation
30
what should be given for diverticulitis pain?
tylenol
31
dysfunctional GI motility =
Gastroparesis
32
Crohn's effects what parts of GI tract?
GI tract from mouth to anus, typically in patches
33
signs of Ulcerative colitis
```
blood in stool
rarely other GI symptoms
involves colon
almost always involves the rectum
involves whole area vs spots like Crohn's
```
34
NSAIDs role in peptic ulcers
loss of GI protective prosteglandins
| and increase in plt aggregation
35
peptic ulcers are caused by _____
H pylori
excessive acid and ETOH
36
patient presents with pain after eating and substernal pain what should you suspect?
what should you do first?
suspect GERD
but get EKG and always assess cardiac first!
37
why do we treat GERD?
to prevent complications
38
definitive diagnostic test for celiac
Biopsy
39
initial test for celiac disease
Tissue transglutaminase antibody (tTG IgA) and total IgA
40
why may a patient with celiac test negative on work up?
tTG may be negative d/t adhering to a gluten free diet
41
patho of celiacs
Gliadin is produced by acid or enzymatic treatment of gluten. The enzyme tissue transglutaminase (tTG) converts some of the glutamines to glutamic acid.
body produces antibodies against tTG
42
Tests for hepatocellular damage
AST, ALT
Transaminases = Enzymes found in Hepatocytes and released when liver cells damaged (ALT specific)
43
sx of celiac
```
Oral ulcers
Anemia
elevated liver enzymes
Osteopenia/Osteoporosis
Fatigue
Neuropathy
Arthralgias
Dermatoses
Malnutrition
```
44
Alkaline Phosphatase is high in ______
measure of cholestasis
(stretching the biliary canaliculi)
seen in...
Obstruction (stones, neoplasm, biliary cirrhosis)
Hepatitis
Heavy ETOH use
Fatty liver
mono
generally considered clinical significant until 3x normal
45
An increase in ____ bilirubin indicates a prehepatic cause
indirect
prehepatic = newborns lots of RBC lysis
Unconjugated = indirect
46
leukoesterase in urine means..?
enzyme produced by leukocytes (white blood cells).
a urine test for the presence of white blood cells and other abnormalities associated with infection.
47
ALT elevated 5x or more may be which diseases?
```
Chronic Hep B / C
Acute Hep A-E
EBV
Medications / Toxins
Celiac Disease
```
48
AST >5x elevated could be what diseases?
Alcohol-related liver dz
| Cirrhosis
49
Severe AST & ALT elevation is ...
> 15x normal
50
An increased ____ bili indicates _____ cause.
direct (conjugated)
| hepatic cause.
51
Tests for Liver synthetic Function
Albumin
| PT/INR
52
Tests for hepatocellular Function
ALT and AST
53
Conjugated bili =
direct
54
when deciding that elevated INR is r/t liver disease what can you do to check?
Before you believe that prolonged INR is due to liver disease just
make sure the patient has adequate Vitamin K by giving 10mg sc
Giving Vitamin K has no effect on INR if patient has impaired synthetic function
55
low albumin also occurs in _____
hepatic dysfunction
and
NEPHROTIC syndrome, so always check the urine for protein
56
low albumin think ___ & ____
liver and kidney
57
EBV, CMV, Herpes viruses can all cause ____
acute hepatitis
58
Hep E dangerous in ____
pregnancy
59
pt with autoimmune disease present with lethargy, itching and increased ALP, may have hyperlipidemia
Primary Biliary Cirrhosis
- chronic inflammation of bile ducts
unable to excrete bile
60
pt presents with constipation what might we want o rule out?
```
diabetes
hyperparathyroidism
hypokalemia
hypothyroidism
pregnancy
```
calcium channel blockers
61
diarrhea without blood or mucus
Without urgency
Less frequent and larger amount
comes from ____
small intestine
62
A touch of blood or mucus
urgency
Stool is frequent with small portions
is caused by _____
large intestine
63
Steatorrhea
fatty stools, foul smelling, pale, float, hard to flush
d/t fat malabsorption - pancreas, sm bowel disease (celiac, Crohn’s) Cholestatic liver disease, Post gastrectomy
64
The anemia of Chronic Renal Failure is primarily caused by _____
impaired erythropoietin production
65
If the BP rises, the afferent arteriole _____
constricts
66
If BP drops, afferent arteriole _____
dilates
67
Glomerulonephritis causes
follows a beta-streptococcal infection
autoimmmune disease
(when immune complexes trapped in glomeruli)
68
```
sx = increased BP
fatigue
oliguria
proteinureia
dysuria
lethergy
low grade temp
periorbital edema
HA
```
Glomerulonephritis
69
Arteriolar Nephrosclerosis caused by _____
severe HTN
arterioles undergo thickening from carrying blood at a much higher pressure than normal
Glomeruli and tubules undergo secondary degenerative changes causing narrowing of lumen and reduction in blood flow
70
Diabetic Nephropathy
d/t poorly managed diabetes
Thickening of glomerular basement membranes (glomerulosclerosis)
Progressive impairment of renal function
Protein loss may lead to nephrotic syndrome
No specific treatment can arrest progression of disease
71
Childhood polycystic kidney disease, ______ form has poorer prognosis
Recessive
72
sx of pyelonephritis
```
WBC and bacteria in urine
malaise
frequency and urgency and dysuria
flank pain* (CVA tenderness)
high fever*
```
73
cystitis sx
```
urgency
frequency
dysuria
pain in pubic region
WBC and bacteria in urine
```
74
Vesicoureteral Reflux predisposes pt to ___ & ____
uti
and
pyelonephritis
75
Chronic UTI’s may make you suspicious for _____
Obstruction and hydronephrosis
76
Major clinical feature of kidney stones
colicky pain
77
UTI’s and obstruction can predispose pt to ___
kidney stones
78
Nephrotic Syndrome manifestations
edema
Proteinuria and therefore hypoalbuminemia
Causes edema due to low plasma osmotic pressure
79
Renal Cysts are worrisome when they occur ____ rather than _____
in multiples
solitarily
80
when is hematuria a red flag finding?
painless
| - think bladder or kidney cancer
81
Oliguria
daily urine output < 400 mL
82
Treat scleroderma renal crisis with _______
ACE inhibitor
83
CKD common causes
DM
HTN
less frequently - Glomerular diseases
84
CKD manifestations
systemic
Weakness, loss of appetite, nausea, vomiting
Anemia
Toxic manifestations from retained waste products
Edema: retention of salt and water
Hypertension ** (causes the problem and then is sx of the problem)
85
CKD stage 1
GFR >90
86
CKD stage 5 =
Kidney Failure
| GFR < 15
87
CKD complications
```
hyperlipidemia
HTN
anemia
electrolyte imbalance
acid base imbalance
osteoporosis
cardiac abnormalities
raises to insulin resistance
```
88
CKD management
renal dosing - d/t decreased filtration
protein restriction
Treatment of Hypertension and Hyperlipidemia
Erythropoietin replacement
Treatment of electrolyte imbalances (Phosphorus and Calcium, K+)
89
brown urine
```
bili
myoglobin (muscle breakdown)
levodopa
```
90
green or blue urine
pseudoonal UTI
| amitriptyline
91
red urine
hematuria, hemoglobinuria
| beets
92
orange urine
bili
| dehydration
93
increased specific gravity usually means ____
dehydration
94
decreased specific gravity
lots of hydration
| poorer kidney function
95
increased specific gravity may be due to ____
contrast dye
proteins
glucose
96
UTI and alkaline urine may mean
gram negative bacteria
97
Hematuria, proteinuria, RBC casts, dysmorphic RBCs will be cause by ____
Glomerular dysfunction
98
Hematuria in children usually means ____
UTI
99
proteinuria and hematuria likely points to ____ cause
renal
100
Positive protein in the urine associated with _____
glomerular damage
101
when you have a patient with DM or HTN may want to order a ____
micro UA - which will detect smaller amounts of protein
102
what other test may be good to order for pt's with DM or HTN to check kidney/glomerular function
urine microalbumin creatinine ratio
103
trace - +2 Proteinuria what should you do?
retest
104
3+ to 4+ Proteinuria follow-up
```
you have to do something right away
serum testing
creatinine
24 hr urine
Protein electrophoresis
```
105
glucose in the urine means ____
glucose > 160
106
Ketones in urine =
Diabetes, starvation, anorexia, prolonged N&V, low carb diets
107
+ Nitrites in urine =
Produced by Gram neg bacteria
108
Leukocyte esterase in urine =
WBCs have been there
| or contaminated with vaginal cells
109
Epithelial casts in urine =
inflammatory processes
auto-immune or infection
110
Granular or Waxy casts =
ominous sign - advanced renal disease
111
if you see a lot of WBCs and Epithelial cells in the urine think ____
contaminated - get another specimen
112
abnormally shaped RBC in UA indicates ....
Glomerular disease (shape comes from squeezing through glomerulus)
