End of Section CIS Flashcards
Nitroglycerin
A) ADVANTAGE OVER Nitroprusside since it preferentially DILATES VEINS MORE THAN ARTERIOLES
30 y/o with DYSURIA and PERINEAL PAIN
- No fevers, PMH negative
- Intermittant past 6 weeks
- Urine negative
- Describes the pain as “WHERE HE SITS DOWN”
- What is the most likely diagnosis?
Diagnosis:
- CHRONIC PROSTATITIS
Ovarian Cancer
- It makes up the largest portion of cancers that cause ASCITES!!!!!
Ascites
- Often seen in ADVANCED LIVER DISEASE
56 y/o Male
Admitted to hospital for work‐up of BILATERAL FLANK PAIN, MILD SWELLING, a 10 lb WEIGHT LOSS over the last month and NOCTURIA approx 10 times per night. A urine dipstick showed 4+ PROTEIN in his primary care office and his blood pressure was 170/100.
A year ago he was told he had HIGH BLOOD PRESSURE and high cholesterol, but he doesn’t know his #’s.
Family history is POSITIVE for HYPERTENSION and his father died at age 45 from some kind of kidney problem. However, he doesn’t know any further details.
He has had a variety of jobs with potential toxin exposure:
1) Heavy metal MINER in Mexico eg bronze, copper, platinum
2) RANCHER eg cows, pigs, alfalfa, insecticides
3) CONSTRUCTION and roofing
No current meds, NKDA
INITIAL LABS:
1) Urine dipstick 4+ protein
2) BUN 10
3) Creatinine 0.9
4) eGFR 75.8 (Class II)
5) SERUM ALBUMIN 1.8 (LOW!!!!)
1) Which of the following would be your admitting diagnosis? A. IgA nephropathy B. Interstitial nephritis C. Tubular necrosis D. Polycystic kidney disease E. Idiopathic nephrotic syndrome
2) What additional test would confirm your initial assessment? A. Complete blood count B. Chest x‐ray C. Electrocardiogram D. Catecholamines E. 24 Hour Urine Protein
QUESTION #1:
A. IgA nephropathy: Tubular process, proteinuria is glomerular
B. Interstitial nephritis: Tubular process, proteinuria is glomerular
C. Tubular necrosis: Tubular process, proteinuria is glomerular
D. Polycystic kidney disease: More commonly associated with hematuria instead of proteinuria
E. IDIOPATHIC NEPHROTIC SYNDROME
QUESTION #2:
A. Complete blood count: Not specific
B. Chest x‐ray: Not specific
C. Electrocardiogram: Not specific
D. Catecholamines: Not episodic, usually younger
E. 24 HOUR URINE PROTEIN: Quantify how much protein to establish baseline!!!!!!
Systemic Causes of Nephrotic Syndrome
1) DM, SLE, Amyloidosis
2) DRUGS: Gold, Penicillamine, Probenecid, Captopril, NSAIDs, Heroin
3) INFECTIONS: BACTERIAL ENDOCARDITIS, Hep B, Shunts, Syphilis, Malaria
4) MALIGNANCY: Hodgkin’s, Non-Hodgkin’s Lymphoma, Leukemia, Ca: Breast and GI
Primary Glomerular Disease causes of Nephrotic Syndrome
1) BIOPSY NEEDED to Diagnose
2) MEMBRANOUS GLOMERULONEPHRITIS found in THIS PATIENT!!!!!!
** MUST RULE OUT Systemic causes FIRST, then determine type of GN by Biopsy
24 y/o Female HEROIN USER
She arrives to the ER confused, complaining of BACK PAIN and generally NOT FEELING WELL. She got scared when her URINE LOOKED PINK, starting yesterday.
She has a murmur consistent with TRICUSPID REGURGITATION!!!!!
Pregnancy test is negative, and she denies any dysuria, nausea, vomiting or diarrhea
Which of the following is the most likely cause of her hematuria?
A. E. coli 0157 aka Enterohemorrhagic E. coli infections (“EHEC)
B. Granulomatosis with polyangiitis
C. Systemic Lupus Erythematosis
D. Pyelonephritis
E. Endocarditis
Question:
E. ENDOCARDITIS: Heroin Drug user, can cause Endocarditis and Endocarditis is one of the Systemic causes of Glomerular Injury. Also her Cardiac Exam follows the ENDOCARDITIS Diagnosis too (Tricuspid Regurgitation)
25 y/o 2nd TRIMESTER in Pregnancy
BLOOD PRESSURE is 160/100, she has increasing PERIPHERAL EDEMA, and newly diagnosed PROTEINURIA
Which of the following would be the best treatment choice? A. Hydrochlorothiazide B. Enalapril C. Furosemide D. Acetazolamide E. Hydralazine
Question:
E. HYDRALAZINE!!!!!!
40 y/o Male with WHITE CELL CASTS
“ACTIVE” sediment = ANY POSITIVE FINDINGS ON MICROSCOPIC, particularly those suggesting kidney disease (vs “bland” that’s normal)
Above and a RASH with FEVER developed 24 hours AFTER STARTING ANTIBIOTIC for sinus infection
CREATININE has INCREASED by 50 % (AKI Creatinine will INCR by 50% or MORE)
Which of the following would help confirm your diagnosis? A. Hyaline casts B. Urate crystals C. Dysmorphic red cells D. Leukocyte esterase E. Eosinophils
Question:
A. Hyaline casts: “Bland” can see on NORMAL URINE
B. Urate crystals: Seen in GOUT
C. Dysmorphic red cells: Glomerular, as are RBC Casts
D. Leukocyte esterase: Positive in UTI
E. **EOSINOPHILS: Need to specifically REQUEST ON URINE!!!!!!! It DOES NOT come on Routine UA, Supports ALLERGIC INTERSTITIAL NEPHRITIS!!!!!!!!!!
- *** ATN: Muddy Brown Casts
- ** AIN: Eosinophils
72 y/o Female with CHEST PAIN
Presents to ER with INCREASING MID-STERNAL CHEST PAIN that radiates to her left arm. Previously in good health on no meds. NKDA.
Her BLOOD PRESSURE is 240/120. Heart exam is somewhat muffled, she is TACHYPNEIC and her skin is clammy
Which of the following IV medications would be the best choice to lower her blood pressure in this clinical scenario? A. Nitroprusside B. Enalaprilat C. Clonidine D. Hydralazine E. Nitroglycerine
Question:
A. Nitroprusside: GOOD RAPID ON/ OFF so titrable, but better choice
B. Enalaprilat: intravenous ACE‐I, not as rapid on/off
C. Clonidine: not titratable
D. Hydrazine: NOT AS RAPID on/off
***** E. NITROGLYCERIN: preferentially DILATES VENOUS SIDE GREATER THAN ARTERIAL SIDE, USED WITH CARDIAC!!!!!!!!!
52 y/o Female
She is being treated w/ high dose PREDNISONE for an exacerbation of her Sarcoidosis. She usually has a normal blood pressure and takes no meds. Her electrolytes were normal.
Which of the following is the MOST LIKELY CAUSE of her HYPERTENSION? A. Coarctation of aorta B. Pheochromocytoma C. Primary aldosteronism D. Fibromuscular dysplasia E. Cushings syndrome
Question:
A. Coarctation of aorta: Mainly seen in YOUNG PATIENTS
B. Pheochromocytoma: EXTENSIVE HYPERTENSION
C. Primary aldosteronism: CUSHINGS DISEASE
D. Fibromuscular dysplasia: Non Atherosclerotic, Non- inflammatory disease of Blood vessels that causes ABNORMAL GROWTH WITHIN THE WALL OF THE ARTERY
*** E. CUSHINGS SYNDROME: Means that the Increase in BP is due to some SECONDARY REASON, which is the PREDNISONE that is causing the SECONDARY HYPERCORTISOLISM!!!!!!
Cushing Syndrome Example
- BUFFALO HUMP
- Obesity
- MOON FACE
