Things I Can Nevr Remember

Question 0

What is the MOA of an acute transplant rejection?

Answer 0

Donor T cells are activated due to MHC incompatibilty?

Question 1

How quickly does an acute transplant rejection take to happen?

Answer 1

Weeks

Question 2

What are the symptoms of GVHD?

Answer 2

Gradual loss of organ function: maculopapular rash, jaundice, LFTs, HSM, diarrhea,desquamation

Question 3

What is the pathogenesis of chronic transplant rejection?

Answer 3

T cell and Ab mediated vascular damage –> fibrosis

Question 4

Systolic flow murmur that does not change with preload
Wide pulse pressure
Brisk carotid upstroke

Answer 4

High output heart failure

Question 5

What is the defect in RTA 1?

Answer 5

Defect in the collecting tubule’s ability to secrete H+

Question 6

What are the associated features of RTA 1?

Answer 6

Urine Ph greater than 5.5
Hypokalemia
Increased risk for calcium phosphate kidney stones due to increased urine PH and bone resorption

Question 7

What is the defect in RTA 2?

Answer 7

Defect is in the proximal tubule’s ability to reabsorb bicarb

Question 8

What are the associated features of RTA II?

Answer 8

Hypokalemia

Urine ph below 5.5

Question 9

What are people with RTA 2 at risk for?

Answer 9

Hypophosphatemic rickets

Question 10

What is the defect in RTA 4?

Answer 10

Hypoaldosteronism or lack of collecting tubule response to hypoaldosteronism –> get hyperkalemia which impairs ammoniagenesis in the proximal tubule so you have decreased buffering capacity and decreased urine ph. (Less than 5.3)

Question 11

What is the complication with RTA I?

Answer 11

Nephrolithiasis with calcium phosphate kidney stones.

Phosphate is no longer being used to buffer because no acid being secreted, so binds calcium instead

Question 12

What is the complication with RTA II?

Answer 12

Rickets and osteomalacia due to hypophosphatemia

Question 13

What is the complication with RTA 4?

Answer 13

Hyperkalemia

Question 14

What drugs can cause RTA 1?

Answer 14

Lithium

Amphotericin

Question 15

What drugs can cause RTA 2?

Answer 15

Carbonic anhydrase inhibitors

Question 16

What drugs can cause RTA 4?

Answer 16

Amiloride
Spironolactone
Heparin

Question 17

What does pre renal AKI look like?

Answer 17

Urine sodium less than 20
BUN/Cr is increased (above 20 because of increased Aldo, increased absorption of Na and H2O so additional BUN in the blood because BUN follows water)
FeNa is less than 1% because normally you don’t want to excrete too much sodium. Tubules are still working
Urine osmolality is over 500

Question 18

What does intrinsic renal failure look like?

Answer 18

Urine osmolality will be less than 350 (because cant concentrate the urine
Urine Na will be greater than 40 because cant reabsorb properly due to damaged tubules
FeNa will be greater than 2 %
BUN/Cr will be decreased (less than 15) because wasting everything

Question 19

What does post renal AKI look like?

Answer 19

Urine osmolality will be decreased less than 350
Urine sodium will be greater than 40
FeNa will be greater than 2
All because back up is causing damage to the tubules so looks like intrinsic but BUN/Cr is above 15

Question 20

What are the sx of a nonhemolytic febrile rxn to a transfusion?

Answer 20

Fevers, chills, rigors, malaise 1-6 hours after

Question 21

What is the tx of a nonhemolytic febrile transfusion rxn?

Answer 21

Stop the transfusion

Acetaminophen

Question 22

What is the mechanism behind a nonhemolytic febrile transfusion reaction?

Answer 22

Cytokine formation in storage

Question 23

What is the mech behind a minor allergic rxn to a transfusion?

Answer 23

Ab formation against other donor proteins

Question 24

What are the sx of minor allergic rxn to a transfusion?

Answer 24

Urticaria

Question 25

What is the tx of minor allergic rxn to a transfusion?

Answer 25

Antihistamines

Question 26

What is the mech of a hemolytic transfusion rxn?

Answer 26

Antibody formation after donor RBCS from ABO incompatibility or antigen mismatch

Question 27

What is the tx of a hemolytic transfusion rxn?

Answer 27

Stop the transfusion immediately | Give IVF and maintain good urine output

Question 28

What are the sx of a hemolytic transfusion rxn?

Answer 28

Fever, chills, nausea, flushing, burning at IV site, tachy, hypotension DURING or shortly after transfusion

Question 29

What is lentigo maligna?

Answer 29

Melanoma that arises in a lentigo on sun damaged skin of the face Stays at the junction of dermis and epidermis and only grows radially

Question 30

What is supeficial spreading melanoma?

Answer 30

Most common type Has a dominant radial growth Affects younger adults Presents on trunk in men and on legs in women

Question 31

What is nodular melanoma?

Answer 31

Rapid early vertical growth Appear as reddish-brown nodule with ulceration or hemorrhage Poor prog

Question 32

What is acral lentiginous melanoma?

Answer 32

Begins on the hands and feet in dark skimmed people. Slowly spreading patch Not related to UVB

Question 33

What does L4 do?

Answer 33

Motor: foot dorsiflexion (tibial is anterior) Sensory: medial aspect of the lower leg

Question 34

What does L5 do?

Answer 34

``` Motor: big toe dorsiflexion (extensor hallucis longus) Foot eversion (Peroneus) Sensory: dorsum of foot and lateral leg ```

Question 35

What does S1 do?

Answer 35

Motor: Plantar flexion, hip extension Sensory: plantar and lateral foot

Question 36

What are normal right atrial pressures?

Answer 36

Between 4-6 mmHg

Question 37

What is a normal pulmonary artery pressure?

Answer 37

25/15 mmHg

Question 38

What is a normal PCWP?

Answer 38

6-12 mmHg

Question 39

What are the sx of transfusion related lung injury?

Answer 39

RDS and pulmonary edema

Question 40

What is the cause of transfusion related lung injury?

Answer 40

Donor antileukocyte abs

Question 41

What is an anaphylactic rxn to transfusion due to?

Answer 41

Recipient anti-IgA abs

Question 42

What is a primary hypotension reaction to a transfusion?

Answer 42

Transient hypotension within minutes of transfusion

Question 43

What causes primary hypotension reaction to transfusion?

Answer 43

Bradykinin in blood products (normally degraded by ACE)

Question 44

Who usually gets primary hypotension reaction?

Answer 44

People on ACEi

Question 45

How does bacterial sepsis from transfusions present?

Answer 45

Fever, chills, shock, DIC within minutes

Question 46

How do you treat anaphylactic rxns?

Answer 46

IM epi Glucocorticoids Antihistamines Vasopressors and mechanical ventilation

Question 47

What should patients with IgA deficiency receive for blood products?

Answer 47

IgA deficient plasma and washed red cells

Question 48

What are the sx of a delayed hemolytic transfusion reaction?

Answer 48

Fever Hemolytic anemia 2-10 days after transfusion

Question 49

What is a delayed hemolytic transfusion reaction caused by?

Answer 49

Anamnestic Ab Response against minor RBCS antigen

Question 50

What are the diagnostic criteria for acute hemolytic transfusion rxn?

Answer 50

Happens within a hour Positive direct Coombs Pink plasma Hburia

Question 51

What is the tx for delayed hemolytic reaction?

Answer 51

None

Question 52

Low serum C3, lumpy bumpy appearance on EM, after a skin or throat infection

Answer 52

Post infectious GN