Renal CIS Case 1

Question 1

the most accurate place to check for skin tenting

Answer 1

forehead

Question 2

when do acute phase reactants increase

Answer 2

during acute and chronic inflammatory states associated with infection, trauma, infarction, neoplasms

Question 3

acute phase proteins that go up during infection/inflammation

Answer 3

ESR, CRP, Ferritin, WBC, Haptoglobin, ceruloplasmin

Question 4

acute phase proteins that decrease during infection inflammation

Answer 4

albumin, transferrin

Question 5

what is reactive thrombocytosis

Answer 5

thrombocytosis in absence of chronic myeoloproliferative or myelodysplastic disorder in pts who have medical or surgical condition likely to be associated with an incareased platelet count and whom platelet count normalizes after resolution of condition

Question 6

examples causing reactive thrombocytosis

Answer 6

surgery, bacterial infection, trauma

Question 7

prerenal Acute kidney injury from

Answer 7

dehyrdation, hypotension
bun/cr 20:1
hypoperfusion from decreased cardiac output and decreased effective aterial blood volume

Question 8

renal actue kidney injury from

Answer 8

acute glomerulonephritis (inflammation and damage to glomerular membrane)

acute intersitial nephritis (allrgic rxn from drugs)

acute tubular necrosis (nephrotoxic agents, prolonged renal hypoperfusion)`

Question 9

postrenal acute kidney injury is from

Answer 9

think obstruction, stone, BPH

Question 10

increase in serum creatinine of ____mg/dL developing over ____ hours or >____% developing over ___ days

(criteria for acute kidney injury)

Answer 10

0.3 mg/dL
48 hours
50%
7 days

Question 11

urine output of ____hrs

criteria for AKI

Answer 11

0.5 mL for > 6 hrs

Question 12

how to recognize hyperkalemia

symptoms and caused how

Answer 12

muscle weakness and ventricular arrhythmias

• from increased release from cells
  
  • hyperglycemia, rhabdomyolysis, succinylcholine

-reduced potassium excretion in urine from hypoaldosteronism or renal failure

Question 13

ecg findings in hyperkalemia

Answer 13

peaked T wave

prolonged PR and QRS interval, small p wave

loss of p wave, prolnoged QRS interval, and
conduction delay as bundle branch or AV nodal block

V fib or asystole can result

Question 14

what must you exclude before confirming hyperkalemia

Answer 14

pseudohyperkalemia from hemolysis of blood specimen

Question 15

treating hyperkalemia

Answer 15

give adults calcium chloride or calcium gluconate
give children calcium gluconate

give insulin and glucose
give beta 2 agonist
give sodium bicarb

remove potassium

Question 16

how to remove potassium from hyperkalemic pt

Answer 16

cation exchange resin (sodium polystyrene sulfonate)
loop or thiazide diuretic
hemodialysis

Question 17

differential diagnosis of a renal mass

Answer 17

renal cell carcinoma

benign renal tumor: oncocytoma, angiomyolipoma, metanephric adenoma

metastatic disease

xanthogranulomatous pyelonephritis

Question 18

DDx of atrophic kidney

-in utero

Answer 18

in utero: vascular event, urinary tract abnormaltities, posterior urethral valve, vesicoureteral refulx, ureteropelvic junction obstruction, ACEI use, genetic abnormality

Question 19

DDx of atrpohic kidney first year of life symptoms

Answer 19

persistent anorexia and vomiting, failure to thrive

Question 20

DDx of atrophic kidney after 1st year of life symptoms

Answer 20

frequent pyelonephritis, renal scarring disorders, and ESRD

Question 21

indications for dialysis therapy

Answer 21

fluid overload that is refractory to diuretics

hyperkalemia (over 6.5 mEq/L

metabolic acidosis of pH under 7.1, in whom administration of bicarb not indicated like those with volume overload or those with lactic acidosis or ketoacidisos

signs of uremia like pericarditis, neuropathy

Question 22

systemic inflammatory resposne syndrome is defined as 2 or more of following conditiosn

SIRS criteria

Answer 22

temp over 38 degrees C or less than 36 degrees C

HR>90
RR >20
PaCO2<32 mm Hg
WBC count > 12,000, <4000 or > 10% immature bands forms

Question 23

severe sepsis

Answer 23

sepsis associated with organ dysfunction, hypoperfusion or hypotension

Question 24

septic shock

Answer 24

sepwis induced hypotension

Question 25

sepsis

Answer 25

systemic response to an infection defined by 2 or more SIRS criteria

Question 26

Multiple organ dysfunction syndrome

Answer 26

presence of altered organ dysfunciton in an actuely ill pt

Question 27

what do you always do in a sepsis pt

Answer 27

get blood cultures before antibiotics if possible

Question 28

most common cause of UTI and pyelonephritis

Answer 28

E coli
staph saprophyticus (honeymoon cystitis)

Question 29

viscero-somatic reflex of kidenys

Answer 29

T10-T11

Question 30

calculate anion gap

Answer 30

Na- (CL + HCO3)

Question 31

gravidity

Answer 31

of time woman has been pregnant

Question 32

parity

Answer 32

of pregnancies that led to birth at or beyond 20 weeks or of an infant weighing more than 500 g