Renal CIS Case 2

Question 1

Consider DDx of hemoptysis in a previously young healthy individual

Answer 1

Dat laundry list doe:

diffuse alveolar hemorrhage
infection
neoplasm (not common in young pt)
drug or toxin induced
bronchiectasis
PE
granulomatrosis with polyangiitis
mitral valve stenosis

Question 2

DDx is pt with hematuria (previously healthy)

Answer 2

laundry list 2

SLE
churg strauss syndrome
post strep glomerulonephritis
IgA nephropathy
alport syndrome

Question 3

DDx of lower extremity edema

Answer 3

laundry list 3

renal etiology
liver etiology
CHF
DVT
venous insufficiency 
obstructive sleep apnea 
medication induced

Question 4

difference btwn goodpasture and anti glomeurlar basement membrane disease

Answer 4

anti GBM has only renal involvement

Question 5

ask about exposure during history of renal pt or pulmonary pt like

Answer 5

chemical or other environmental exposures (work or hobby exposure that could be playing a role)

Question 6

vicero-somatic reflex of lungs

Answer 6

T2-T7

Question 7

vicero-somatic reflex of kidneys

Answer 7

T10-T11

Question 8

red cell casts =

Answer 8

glomerulonephritis

Question 9

if microscopic evaluation shows no RBCs but positive blood, think what

Answer 9

myoglobinuria or rhabdomyolysis

Question 10

what is an SCD and ATP

Answer 10

same thing, different name

sequential compression device

antithrombotic pumps

Question 11

what kind of catheter:

indwelling catheter, highest risk of iatrogenic infection, helpful in unconscious or altered mental stauts pt, urinary incontinence, during surgery, or pt with post renal obstrcution from prostate enlargement

Answer 11

foley

Question 12

what kind of catheter:

intermittent catheter, less risk of infection than foley but risk still present

Answer 12

straight

Question 13

what kind of catheter:

external catheter for men, significantly less risk of infection
good alternative to the others

Answer 13

condom catheter aka texas catheter

Question 14

what kind of catheter:

indwelling catheter, risk of infection, done for urinary retention secondary to urethral injuries, urethral obsturction (BPH) or prostate cancer, bladder neck masses

Answer 14

suprapubic catheter

Question 15

for suspected goodpastures, what labs to check in addition to regular labs

Answer 15

anti GBM and c-ANCA and p-ANCA

Question 16

treatment and considerations for goodpatures

Answer 16

laundry list 4

follow ABGs, hemoglobin/hct H/H
treat first with steroids
consider need for intubation with resp distress
consider need for blood transfusion
consider pulmonary and nephrology consults
CT chest no contrast
ekg 
kidney biopsy
dialysis
plasmapheresis to clear GBM antibodies

Question 17

what do you not want to give with goodpastures

Answer 17

no aspirin, nsaids or cox-2 inhibitors

Question 18

type and screen

Answer 18

determine ABO and Rh groups RBCs

look for potentially hemolyzing antibodies

Question 19

type and cross match

Answer 19

after type and screen done

final step in determination of compatibility of blood of donor and that of recipient before transfusion by placing donor’s cells in recipients serum

Question 20

what kind of catheter:

urine contanment device that fits over or adheres to genitalia and is attached to a urinary drainage bag. soft flexible sheath that fits over the penis

Answer 20

external catheter (condom catheter)