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Step 2 CK renal > R4 > Flashcards

R4 Flashcards

1
Q

Calcefic uremic arteriophaty(calciohlaxis) CM?

A

Painful nodule or ulcer
Skin necrosis
Common in adiposity area like the trunk
Intact pheripherial pulse(unlike atherosclerosis-related one)
Soft tissue calcification on imaging
Biopsy: arterial calcification/occlusion and subintimal fibrosis.

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2
Q

Risk factor?

A 
ESRD
Hypercalcemia and hyperphosphatemia
Hyperparathyroidism
Obesity/DM
warfarin(vitamin K increase synthesis of serum protein that prevents calcification)
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3
Q

Serum Magnesium and calciphylaxis?

A

magnesium prevent extracellularly Ca accumulation—so hypomagnesemia increase the risk

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4
Q

serum Glucose and ESRD?

A

ESRD decrease insulin clearance –recurrent hypoglycemia risk

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5
Q

the first thing to evaluate in the hyperkalemic patients?

A

Review medication

aldosterone level in case of persistent hyperkalemia

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6
Q

nuro-complication of hyperkalemia?

A

paraesthesia

paralysis

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7
Q

Hyperglycemia and hyperkalemia?

A

glucose > 300 is a risk for hyperkalemia

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8
Q

sign and symptom of Hypercalcemia?

A

Neuropsychiatric(confusion,stupor and comma)
GI distress
Muscle weakness
Nephrogenic DI–Excessive diuresis–Hypovoluma-AKI

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9
Q

Relation to lung ca?

A

SCLCa–PTH like peptide(hypercalcemia)

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10
Q

managment?

A

depend on serum Ca level and presence of a symptom

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11
Q

Serum ca> 14/presence of symptom?

A

Acute managment
Normal saline hydration plus calcitonin
Avoid loop diuretics unless fluid overloaded(HF)
Long term managment
Biposponate(zoledronic acide,pamidronate)

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12
Q

Moderate(12-14)?

A

No immediate managment required unless symptomatic

Treat similarly as sever calcimia

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13
Q

asymptomatic or Ca<12?

A

No immediate managment required

Avoid thiazide, lithium, volume depletion, and prolonged bed rest

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14
Q

Symptoms of hypocalcemia?

A 
Confusion or memory loss.
Muscle spasms.
Numbness and tingling in the hands, feet, and face.
Depression and hallucinations.
Muscle cramps.
Weak and brittle nails.
Cramping
Trousseau sign
Chovestik sign
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15
Q

Effect of serum PH on Ca level?

A

H and Ca compet to bind to albumin
Affect the free ionized Ca
Acidosis–Low Ca bind to albumin–Hypercalcimia
Alkalosis–High ca bind to albumin–Hypocalcemia

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16
Q

Effect of serum PH on Po4 level?

A

Acidosis–Increase movement of PO4 to EC–Hyperphosphatemia

Alkalosis—decrease movement of PO4 to EC–Hypophosphatemia

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17
Q

A positive troussue sign is characterized by?

A

the appearance of a carpopedal spasm which involves flexion of the wrist, thumb, and MCP joints along with hyperextension of the IP joints.

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18
Q

The Chvostek sign?

A

a contraction of ipsilateral facial muscles subsequent to percussion over the facial nerve

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19
Q

Drug to be avoided in AKI?

A

Metformin_-pricipitate LA
ACEI/ARB–worsen AKI
High dose aspirin

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20
Q

GI loss and hypokalemia?

A

UGI(Vomiting)–metabolic alkalosis–renal K loss

LGI(Diarrhea)–Contain High K–direct K loss

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21
Q

Hypokalemia symptoms?

A 
Muscle twitches.
Muscle cramps or weakness.
Muscles that will not move (paralysis)
Abnormal heart rhythms.
Kidney problems.
22
Q

Serum potassium level in accelerated hematopoiesis?

A

Hypokalemia

23
Q

clinical features of crystal-induced AKI?

A 
Usually asymptomatic
nausea/flank or abdominal pain
AKI<7 days of exposure(usually 24-48 hr)
Hematuria, Pyuria and crystal
Increase risk in volume depletion and CKD
24
Q

Risk factor?

A 
Acyclovir(usually High dose IV)
Sulphonamide
Methotrexate
Ethylene glycol
Protease inhibitor
Uric acid(TLS)
25
Q

managment?

A

Drug discontinuation
Volume repletion
Loop diuretic

26
Q

mechanism?

A

less water-soluble crystal–Precipitate in RT–tubular obstruction and direct toxicity

27
Q

Cerebral aneurysm and ADPKD?

A

Increase by age(20% at age 60)
Polycystins protein(defected protein in ADPKD) defect also affect vascular integrity
The presence of HTN(Due to renal ischemia, increase renin secretion) facilitate aneurysm progression and risk of rapture.

28
Q

How to D/T AKI from prerenal cause and ATN?

A

D/T mechanism

29
Q

BUN/Cr ratio?

A

P–>20

ATN–10-15

30
Q

Urine Na?

A

P–<20

ATN–>40

31
Q

fractional Na excretion?

A

p–<1%

ATN>2%

32
Q

urine osmolarity?

A

P–>500

ATN–<300

33
Q

Urine specific gravity?

A

P–>1.020

ATN–<1.020

34
Q

Microscopy?

A

P: bland

ATN–Muddy brown cast

35
Q

Ca level and AKI?

A

AKI–Hyperphosphatemia–hypocalcemia

Except in the case of AKI due to MM–Hypercalcemia

36
Q

Diabetic nephropathy feature?

A

Hypocalcemia
Shrunken kidney
Proteinuria

37
Q

Mixed cryoglobulinemia CM?

A

Highley associated with Hep C(can be in HIV, HBV)
Palpable purpura in lower extremity
Pheripherial neuropathy
Liver involvement(hepatomegaly and Increase TA)
Arthralgia
Systemic symptoms
Glomerulonephritis

38
Q

pathogenesis?

A

vasculitis characterized by IC deposition in small and medium sized vessels

39
Q

Diagnosis?

A

Cryoglobulins(Imunoglobuline precipitate in cold To)
Contain rheumatoid factor and polyclonal IgG
biopsy: Small vessel leukocytoclastic vasculitis

40
Q

Therapy?

A

Treat underlying cause

41
Q

another disease that causes arthralgia, glomerulonephritis, and hypocomplementimia?

A

SLE(but common in young women, malar/discoid non-palpable rash and ANA positive)

42
Q

Another disease that can cause leukocytoclastic vasculitis?

A

Microscopic polyangiitis(but normal complement and Panca +)

43
Q

urge incontinence symptoms?

A

sudden, overwhelming, and frequent need to void

44
Q

managment?

A

Lifstyle4 modification
Bladder training
Antimuscarinic drug

45
Q

a renal complication of cyanide toxicity?

A

Metabolic acidosis

AKI

46
Q

contrast-induced nephropathy risk factor?

A

Age >75
CKD
Reduced renal perfusion(e.g hypotension)
High contrast load

47
Q

Clinical manifestation?

A

an acute rise in creatinine 24-48 hr

gradual return to baseline

48
Q

pathogenesis?

A

ATN(muddy brown cast)

Renal vasoconstriction cause prerenal azotemia

49
Q

Prevention?

A

Periprocedural normal saline
Use lower amount contrast
Hold NSAID

50
Q

Why does a patient with nephrotic syndrome have a risk of MI and stroke?

A

Hyperlipidemia(TG and cholesterol)–atherosclerosis risk

hypercoagulability state

51
Q

CM of Addison disease?

A 
Hyperkalemia
metabolic acidosis
Hyponatremia(secondary to SIADH for hypovolumia)
hypoglycemia
eosinophilia

Step 2 CK renal (5 decks)

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