Renal Clinical Medicine (except MDM)

Question 1

What conditions increase a patient’s bleeding risk during kidney biopsy?

Answer 1

Anemia

Thrombocytopenia

Hypertension

Obesity

Question 2

Which special test is used to assess for acute cholecystitis?

Answer 2

Murphy’s Sign

Place fingers under the right costal margin. Ask the patient to take a deep breath. A sharp increase in pain when inspiration stops indicates a positive Murphy’s sign for acute cholecystitis

Question 3

How do you evaluate a patient’s abdominojugular reflux (aka hepatojugular reflux)?

Answer 3

• Push on the liver for 15-30 seconds
  
  • -> Increased venous return to the right heart
• If there is a sustained rise of >4 cm 10 seconds after releasing the liver, the test is positive
  
  • High specificity
  • Low sensitivity
  • => If this happens, the patient is volume overloaded, but if it doesn’t happen the patient might still be volume overloaded

Question 4

What defines orthostatic hypotension>

Answer 4

A decrease of 20 mmHg systolic or 10 mmHg diastolic within 3 minutes of sitting up from lying down or sitting

Question 5

How should a patient be prepared for renal biopsy?

Answer 5

• Minimize bleeding complications
  
  • Platelet count ≥50k
  • Normal PT/PTT (INR ≤1.5)
  • BP controlled
  • Desmopressin
    
    • May improve platelet function in uremic patients but statistical significant is not proven

Question 6

What conditions result in loss of hypotonic fluid?

Answer 6

Sweating

Excessive urination

Question 7

What defines orthostatic tachycardia?

Answer 7

Pulse increase of 30 bpm or more when going from sitting -> standing

Very sensitive for volume depletion from blood loss, but a patient who is volume depleted for other reasons may not have orthostatic tachycardia

Question 8

What condiditons result in loss of isotonic fluid?

Answer 8

• Vomiting
• Diarrhea
• Blood loss (Laceration, GI bleed, bone fracture)

Fluid loss from ECF only

Question 9

Which special tests are used to asses for appendicitis?

Answer 9

• Obturator sign
  
  • Rotate the leg internally at the hip
  • Increased abdominal pain indicates appendicitis
• Psoas sign
  
  • Place hand above the patient’s right knee, ask the patient to flex their right hip against resistance
  • Increased abdominal pain indicates a positive sign