UW 7 Flashcards
Hepatorenal Syndrome
Acute renal failure in the setting of liver disease. (Prerenal)
Cause by splanic vasodilation and decresed blow flow to the kidneys
“Healthy kidneys in an unhealthy enviroment”
Midodrine, octreotide to decrese splanic circulation
Amyloidosis types
AL: plasma cell dyscrasia (Multiple myeloma and Waldenstrom macroglobulinemia) due to monoclonal light chain fragments
AA: chronic disease/infections (AR, Chrons, Lymphoma, vasculitis, TB). Amyloid A is an acute phase reactant
Dialysis: B2-microglobulin deposition
Crioglublinemia vs Cold agglutins disorder
Both caused by increased levels of IgM
Crioglobulinemia: Hep C patients with articular pain and renal involvement
Cold aglglutins: finger and toe numness, hemolytic anemia on cold expossure, reynaud phenomenon. Seen on EBV, mycoplasma and waldestrom macroglobulinemia
Secondary amyloidosis clinical manifestations
Neprhotic sd or asymptomatic proteinuria Cardiomegaly with CHF Hepatomegaly Organomegaly (eg. macroglosia) Peripheral neuropathy (mixed motor and autonomic dysfunction) Bleeding diathesis Waxy skin and easy brusing
Hypertensive neprhosclerosis
Patients with HTN Ritinopathy Left ventricular hypertrophy Progresive renal failure Mild proteinuria (<1gr/day) Usually small kidneys
Risk factors for 1 dysmenorrhea (6)
BMI <20 Age >30 Menarche <12 Heavy/long menstrual periods Sexual abuse Tobacco use
Non anion gap metabolic acidosis
HARDASS
Hyperalimentation Adisons Renal tubular acidosis Diarrhea Azetazolamide Spirnolactone Saline infusion
Renal tubular acidosis type IV
Low aldosterone or resistance
High potasium. Metabolic acidosis
Etiologies: hypoaldosteronism, agiontensin II inhibition (ACEI, ARA II i), urinary tract obstruction, heparine
Old people have decrease function of the juxtaglomerular aparatus… low renin.. low aldosterone
Acid base disorder in diarrhea vs. laxative abuse
Normally causes Metabolic acidosis
Laxative abuse===> loss of K in stool
High aldosterone due to volume loss worsens hypokalemia
Imparied HCO3 excretion and CL reabsorption
MATABOLIC ALKALOSIS
Biobsy of Reye sd.
Microvesicular fatty infiltration
Ottawa ankle rules
When to do ankle xray
a. Pain in malleolar area + tendernes in posterior margin/tip of lat or med malleolus OR unable to bear weight 4steps 2each.
b. Pain in mid foot area + tendernes in navicular (medial) OR 5th metatarsal (lat) OR unable to bear weight.
Howell-Jolly bodies
Persistance of RBC precursor nuclei.
Present in patients with funtional/surgical asplenectomy
Sickle cell disease patient have functional asplenia by age 5
Schystocyte significance and other name
Helment cell
Mechanical hemolisis
DIC, TTP/HUS
Heinz body
Hb precipitation in G6PD deficiency…. bite cells
Complications of Sickle cell (2)
Splenic secuestration: severe acute anemia. tachycardia, pallor, shock (pool of blood into the spleen resulting in hypovolemia) (low hematocrit and low platelets)
Aplastic crisis: usually secondary to Parvo infection.
Both present with anemia but aplastic crisis has a low reticulocyte count
Complication in patients with sickle cell trait
Renal complications:
a. Hematuria: renal papilary necrosis
b. hypostenuria: inability to concentrate urine
c. increased risk of UTI
HELLP syndrome (clinical presentation, labs, management)
a. Headache, nausea, vomiting; RUQ pain (liver capsule distention), preclampsia
b. Hemolitic anemia, elevated liver enzimes, low platelet count
c. Lower BP, Mg drip, delivery
Spinal stenosis presentation
Most common in neck and lumbar region.
Pain that radiates to the arms or legs
Numbness and weakness
Lumbar stenosis:
Worse with extension: going down the stairs, standing, walking
Better with flexion: going up the stairs, sitting
MRI of the spine is gold standard
Most common cause of lumbar spinal stenosis
Degenerative joint disease
Managment of an agitated patient
Benzo +/- antispychotic (usually haloperidol)
Multiple sclerosis findings on CSF (PL)
Oligoclonal bands
Normal opening pressure
Normal proteins. Relative elavation of IgG
14-3-3 protein on PL (CSF)
Prion disease (Creuztfeld-Jacob)
Albumincytologic dissociation on PL (CSF)
Finding of Guillian Barre.
High proteins, normal cells
Possible complications of occlusion of the right coronary artery
SA and AV node dysfunction (bradycardia, heart block) Papillary muscle rupture Ventricular septum (posterior 1/3)
Presentation of papillary muscle rupture
Acute mitral regurge (holcystolic murmur)
Pulmonary edema
It does not cause structural changes (increase atrial/ventricular size or compliance)
Number needed to treat
1/absolute risk reduction
ARR: difference between % in not treated group minus treated group vs. %
Erythematous tender nodule at the lid marging
Hordeolum (stye)
Lichen planus
pg. 80
ECG of a ventricular aneurysm
persistent ST elevation, deep Q waves
Management of penile fracture
Surgery (its an emergency
Retrograde cystography before surgery if: Hematuria Dysuria Urinary retention Blood at the meatus
Creanial hematomas that cross suture lines
Caput sucedaneum
Subgaleal hemorrhage: massive hemorrhage that can cause anemia, pallor and shock. Can reach the neck. Due to scalp traction
Complications of ulcerative colitis
Toxic megacolon Primary sclerosing cholangitis Erythema nodoso Pyoderma gangrenoso Spondyloarthritis Colon cancer
Age of onset of IBD
bimodal
15-40
50-80
Target cells
Thalasemia
