Review 1 Flashcards
AKI
1st thing to do
try to identify the primary cause
- Prerenal - Intrarenal - Postrenal
if prerenal cause of AKI, think of ______
decreased perfusion to the kidneys
=> hypotension, hypovolemia, decreased CO, systemic vasodilation (sepsis
Pt with AKI will present most likely w
decreased urine output
3 diagnostic tests for AKI
- UA with micro
- Urine albumin/creatnine; protein; creatinin
- Renal US
General management for most cases of AKI
- Avoid nephrotoxins.
- Avoid hypotension due to ischemia (goal is for systolic to be above >130)
- Avoid dehydration, which can cause hypotension
- renally dose all meds- any drugs cleared by kidneys should be discontinued or lowerd in dose (metaformin is not toxic, but cleared by kdineys)
CKD
1st thing to do is ID primary cause
DB
HTN
-glomerulonephritis
pt with CKD will present most likely with what sx
- decrease UO**
- EDEMA **
- HTN
- Uremia
5/ Uremic frost
3 tests for CKD
- eGFR
- Urinealbimnin/Cr
- UA with micro
renal US with CKD pt will show
atrophic kidneys, cortical thinning and hydronephrosis
doppler renal US with CKD pt will show
renal artery stenosis or renal vein thrombosis
nephrotic syndrome dx
24 hour urine protein collection
Def; renal biopsy
nephritic syndrome dx
24 hour urine collection (no proteinuria)
Def; renal biopsy
Pneumococcal vaccine should be given to _______
all adults >65 and all immunocompromised individuals
_______ identify high risk patients with pneumo
CURB-65
CURB-65
Confusion U BUN >20 Respiratory rate >30 BP <90 Age >65
Enlargement of ________ or __________ lymph nodes suggest fungal or mycobacterial infection
hilar
mediastinal
_________appropriate initial imaging for PE
Either contrast-enhanced CT or VQ scanning
Normal D-dimer will _____
effectily rule out PE
if +; does not confirm
Pulmonary Embolism
Most common symptoms are:
Dyspnea Pleuritic chest pain**** Cough Hemoptysis Tachypnea Crackles Tachycardia
Pulmonary HTN
Defined as an elevation of mean pulmonary artery pressure of ____ or greater at rest
25mmHG
Over 80% of cases of pulmonary HTN are due to conditions causing elevation of what
left-sided heart filling pressures or pulmonary disease
what should we look for with pulmonary HTN
fatigue and dyspnea
Advanced pulmonary HTN has
syncope,
edema,
acites
hepatomegaly
Dx pulmonary HTN
right heart catheterization
______ provide a simple and important functional assessment of pulmonary HTN
6 min walk test
You hear a new systolic murmur in a pt post MI, what do you think it is?
- mitral valve prolapse - due to papillary muscle rupture
2. VSD
You hear a new systolic murmur in a pt post M (3-7 days later)I, what do you think it is?
- Mitral valve prolapse – due to papillary muscle rupture
- VSD
MVP will radiate to L axilla
Both MVP and VSD present with
pulmonary edema; treat with surgery
Cardiogenic shock will have
decrease CO and CI
High SVR, CVP and PCWP
Septic shock will have
decrease CO and CI
Decrease SVR, CVP and PCWP
