Uworld Pulmonary and nephrology 9/23 Flashcards
Patient has atelectasis post op, What would the ABG reading be?
Alkalosis, DEcreased PCO2, slight PO2 decrease
Why would you get a respiratory alkalosis in atelectasis?
Atelectasis is a partial collapse of the lung, causing a decreased lung volume (decreased sounds). Happens post op from residual anesthetic effects. This causes a V/Q mismatch - hypoxemia, and INCREASED BREATHING WORK, thus HYPERVENTILATION –> decreased CO2.
In Acute exasperation of COPD - what treatments would benefit
O2, Bronchodilatory, steroids, and ANTIBIOTICS - IF they have >2 symptoms of COPD exasperation like more sputum or if they NEED INTUBATION
LIttle girl brought to ED after apparent anaphylaxis after a bee sting. She was given IM Epinephrine and got better. THEN, 10 minutes later, her hives get worse, has wheezing again, and vomits. her Respiration is 18.min. Most appropriate next step?
Intramuscular Epinephrine. Yes, again.
Why not use IM Glucocorticoids for anaphylaxis?
Would decrease inflammation, but will not provide immediate treatment due to delayed onset of action.
Patient has an anterior mediastinal mass, with elevated bHCG and chorionic gonadotropin. DX?
Nonseminous Germ Cell tumor
Anterior mediastinal mass with elevated bHCG but NO afp?
Seminoma
What is a Choriocarcinoma?
gestational trophoblastic disease thats with molar pregnancy. BHG is increased. no AFP significance
A pleural effusion is swwn with a glucose of 28 and a LDH of 252. The patient has CHF with early liver cirrhosis and rheumatic arthiritis. What kind of effusion is it? And why is there a low glucose?
Exudative - has a parapneumonic effusion. See LDH 252 so >200. Glucose is less thant <60. There is high metabolic actiity of the white blood cell.
Difference between Thymoma and Bronchogenic cysts?
Thymoma is in the ANTERIOR mediastinum. Bronchogenic syst is located in the MIDDLE medastinum
FIrst step after seeing possible allergic or NON-allergic rhinitis?
Topical intranasal glucocorticoids
Nonallergic Rhinitis vs Allergic Rhinitis
Allergic is at a much young age, seasonal, and would have other signs of allergies.
How does Chlorpheniramine improve symptoms of a dry chronic cough.
Is decreases nasal secretions
What is the one thing that causes dry cough due to due to bradykinin
Ace-I.
After treatment for some lung disease, an HIV patient gets confusion. Mucus membranes are moist, no JVD, has lung crackls. Labs show decrease in sodium ( already hyponatremic on admission, now MORE hyponatremic), K, and Calcium since admission. He has been on IVF, BP is fine. Sosm is calculated at 257. What caused the hyponatremia and why?
SIADH - Note that causes of EUVOLEMIC Hyponatremia with low serum OSM is SIADH. It worsens after getting more fluids. Patient has PCP, which is a common precipitant of SIADH.
How do you calculate Serum Osmolality
2NA + Glucose/18 + BUN/2.8. High is over 295, low is under 275
Causes of HypoOsmolar, Hypovolemic Hyponatremia?
Salt Loss
Causes f Hypoosmolar, Euvolemic Hyponatremia
Psychogenic Polydipsia, SIADH
Causes of Hypo-Osmolar, Hypervolemic Hyponatremia?
CHF, Hepatic Failure, Nephrotic Syndrome
What is the cause of Hyponatremia if osmolarity is normal?
Pseudohyponatremia
Causes of HIGH osmolarity with Hyponatremia?
Hyperglycemia
What is the A-a gradient with a pulmonary embolism?
Increased. There is a V/1 mismatch, more ventilation than perfusion. There is an increase whenever there is an impairment of gas exchange.
What is seen in a COMPLICATED Parpneumatic effusion? and what makes it complicated
pH <7.2, Glucose is LESS than 60. WBC >50,000; Fever
Describe Theophylline Toxicity
CNS stimulation like headache, insomnia, seizures, GI distrubance. Cardiac toxicity- arrhythmia.
What does Oxybutynin Do?
anticholinergic to stop URGE incontinence. Would WORSEN urinary retention
Lady post pregnancy only urinating in small amounts, dribbling. She was catheterized during labor. She has no fever, dysuria, urgency or hematuria. The Uterine fundus is palpable, and theres fullness and tenderness of the bladder. what do you do
Intra urethral Catheter
What causes postpartum urinary retention?
Post anaesthesia, bladder overdistention during labor, perineal swelling around the urethra.
WHat is a pessary?
used to manage STRESS INCONTINENCE and pelvic organ prolapse.
What is Imipramine and what is it used for?
an intidepressant for childhood bedwetting (eneuresis)
Patient is an alcoholic and just had a seizure. has a serum Cr of 2.4, UA shows trace ketones, LARGE amounts of blood, but microscopy shows only 1 RBC with 5-10 WBCs. What is the dx?
Rhabdomyolysis. This happens post seizure, The results are from an increase in myoglobin in urinary system.
Urinary complications of Sickle Cell Trait
Hyposthenuria, Papillary Necrosis, Exertional RHabdomyolosis
7 month old boy has fever, and decreased wet diapers. Has leukocytosos, and bumped Cr of 1.4. Next step?
Urethral Catheterization, UA, urine culture
What is the proper urinary collection in a diaper bound baby?
Urinary catheterization
What happens if you give a patient moprhine sulfate, IVF of Dex5, with 0.45% saline?
Iatrogenic hyponatremia.
Why see high urine ph when you have respiratory alkalosis after mechanical ventilation?
Since you are forcing hyper ventilation, you are trying to counter balance by expelling bicarb, thuse, INCREASEING BICARB EXCRETION. and retaining H protons
Palpable purpura, proteinuria, hematuria, and shows to have a underlying HCV
Mixed Cryoglobinemia
If there is hematuria THROUGHOUT the stream, where is the source?
KIDNEY
If there urine STARTS clean, then has bleeding towards the end, where is the source?
BLADDER - think prostate, bladder neck, or posterior urethra.
If the urine STARTS bloody, then the stream clears up, wheres the injury?
URETHRA
Why would you do urine cytology
high suspicion of bladder cancer
When would you do cystoscopy
in there is chronic bladder obstruction and they failed all initial management (imaging)
WHat is the next step of a lower urinary tract obstruction after the UA shows nothing specific?
Renal Ultrasound
When do you use a voiding cystorethrogram?
to dx vesicoureteral reflux in recurrent UTIs. NOTHING to do with eneuresis.
7 year old boy wets the bed often, despite trying everything “nonmedical” (alarms, positive reinforcement). Father had a history of bedwetting until 8. Next step?
Desmopressin.
what is DEsmopressing, hence why its used for bedwetting?
ADH
What do you use in bedwetters if Desmopressin fails?
Imipramine
What are the Renin, Aldosterone, and ADH levels in a Hypovolemic Hyponatremic patient?
Decreased BP –> RAS+ (more Renin) and baroreceptors cause +ADH.
RAS+ –> AngII–> INCREASED Aldosterone
How does Renin affect the efferent arterioles? Afferent arterioles?
vasoconstricts BOTH of them
What causes bleeding in a patient with chronic renal failure?
PLATELET DYSFUNCTION - due to uremic toxin buildup
What do you give in a patient with bleeding issues and CKD?
Desmopressin and cryoprecipitate
Steps for preventing calcium stones
limiting SODIUM intake, since more sodium would actually enhacne calcium excretion. Increase fluid intake, and NORMAL calcium intake.
Why shouldnt you restrict calcium in a patient to prevent calciums oxolate stones?
Calcium restriction wuld actually increased free oxalate absorption, leading to more oxalate in the urine.
