Term
| GFR in chronic renal failure |
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Definition
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Term
| Significance of proteinuria |
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Definition
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Term
| Significance of RBCs and RBC casts in urine |
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Definition
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Term
| Significance of protein casts |
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Definition
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Term
| Characteristics of nephrotic disease (3) |
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Definition
1. heavy proteinuria
2. free fat droplets / oval fat bodies
3. fatty casts |
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Term
| Charactaristics of nephritic disease |
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Definition
1. variable proteinuria
2. RBCs, or RBC casts
3. WBCs
4. Granular casts |
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Definition
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Definition
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Definition
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Definition
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Definition
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Definition
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Definition
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Definition
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Definition
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Definition
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Definition
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Definition
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a) Name a few causes of ATN
b) Resolution? |
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Definition
1. Ischemia
2. Nephrotoxins (AG, IV contrast, heme pigments, heavy metals)
Resolves in 1-3 weeks |
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Term
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Definition
Prostaglandin inhibition → ↓ GFR, water retention, ↑ K+
Direct toxicity → interstitial nephritis or GN w/ heavy proteinuria or rapidly progressive ARF |
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Term
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Definition
| 2 Na + gluc / 18 + BUN / 2.8 |
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Term
| Adjusting Na for hyperglycemia |
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Definition
| ↑ in glucose of 100 over normal, Na ↓ by 1.5 |
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Term
| Indications for dialysis (acute and chronic) |
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Definition
a. Acute:
A (acid / base),
E (electrolyte),
I (intoxication),
O (Overload),
U (uremic sx’s; occur if BUN > 300)
b. Chronic: GFR < 10-15 |
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Term
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Definition
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Term
| Treatment of DM nephropathy (3) |
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Definition
1. low protein diet
2. BP control (ACEI)
3. BG control |
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Term
Acute lung injury
a. xray findings
b. PaO2 / FiO2 ratio
c. |
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Definition
Acute, persistent lung inflammation with VASCULAR PERMEABILITY (KEY POINT) with:
a. Bilateral infiltrates on CXR
b. PaO2 / FiO2 ratio < 300 mmHg
c. No e/o increased LA pressure |
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Term
ARDS
PaO2 / FiO2 ratio
PCWP |
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Definition
1. CAPILLARY PERMEABILITY is key
iv. PaO2 / FiO2 ratio < 200 mmHg
v. PCWP < 15 mmHg |
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Term
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Definition
1. Ventilation (PEEP and low TV 6-7cc/kg)
2. Rx V/Q mismatch: NO or prostacyclin (rx of PHTN) prone position and partial liquid ventilation
3. Diuretics for P edema
4. Steroids |
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Term
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Definition
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Term
| Antihypertensive for AAA, why? |
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Definition
| labetolol: combined alpha and beta blockade |
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Term
| Antihypertensive for recurrent stroke prevention |
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Definition
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Term
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Definition
1. FPG > 110
2. Abdominal obesity: > 40” in men, > 35” in women
3. TG > 150
4. HDL < 40 for men, < 50 for women
5. BP > 130 / 85 (or on anti-HTN meds) |
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Term
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Definition
| BB, CCB (diuretics a bit) |
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Term
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Definition
| ACEI, alpha-blockers, CCB, vasodilators, diuretics (mostly) |
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Term
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Definition
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Term
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Definition
| Ang II will eventually ↑ on ACEI due to alternative pathways of Ang II formation → “ACE escape” |
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Term
Transfusion:
1. HIV risk
2. HCV risk
3. Bacterial infection risk |
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Definition
HIV risk: 1 in 2 million
Hep C risk: 1 in 200,000
Bacterial: 1 in 12,000 in platelets |
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Term
| Patienst with elevated ferritin are at risk for what infection? |
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Definition
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Term
| Pts with iron overload ON chelation therapy are at risk what infection? |
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Definition
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Term
1. When to transfuse platelets?
2. In chemo patient?
3. What 3 dz should NOT be transfused? |
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Definition
1. when bleeding
2. at 10,000
3. TTP, HIT, HUS |
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Term
| Precautionary measures for patient with thrombocytopenia |
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Definition
1. ASA
2. Use electric razor
3. Soft toothbrush
4. WBC-filtered platelets |
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Term
Treatment of liver disease coagulopathy
1. First line?
2. When do you give FFP? |
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Definition
1. Vitamin K
2. FFP if PT > 18, PTT > 55-60, factor activity < 25% or no response to Vitamin K (also if on warfarin or if suspect TTP) |
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Term
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Definition
1. Steroids
2. Transfusion of platelets is NOT necessary unless patient is bleeding
3. IVIG w/ plts |
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Term
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Definition
1. Family history (man before 55, woman before 65)
2. DM
3. Smoking
4. Hypertension
5. Low HDL
6. Age: male > 45, female >55 |
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Term
| LDL goals and thresholds for treatment |
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Definition
1. Low risk (0-1 risk factors)
Goal <160, treat @ 190
2. Medium, low risk (2+ RF)
Goal <130, treat @ 160
3. Medium, high risk (2+ RF)
Goal < 130, treat @ 130
4. High (CHD or risk equivalent)
Goal < 100 (70), treat @ 100
5. Very high (CHD + ACS or DM or smoking or metabolic syndrome)
same as above |
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Term
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Definition
1. Statin
2. Bile Acid sequestrant (colestipol) or ezetimibe (Zetia) |
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Term
| Non-HDL combo (Cholesterol, TG) |
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Definition
1. Statin
2. Fibrate [NOT gemfibrizil, can use Tricor (fenofibrate)]
or
3. Niacin
or
4. Fish oil |
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Term
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Definition
1. Hydrocortisone 100mg
2. Prednisone 20mg
3. Dexamethasone 3mg |
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Term
1. Stress dose of hydrocortisone
2. Maintenance dose of hydrocortisone |
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Definition
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Term
| Diagnosis of Addison's disease |
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Definition
1. Check serum cortisol and ACTH levels
2. ACTH stim test --> cortisol < 20 mg /dl after 1 hr |
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Term
Autoimmune polyglandular failure
1. Type I
2. Type II |
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Definition
1. Addison’s + mucocutaneous candidiasis + low PTH (AR; rare; AIRE gene)
b. heterogeneous combo of primary diseases of endocrine end-organs (AD) |
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Term
| OCP can result in what thyroid test abnormality? |
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Definition
| elevated T4 due to high binding globulin (TSH and free T4 will be normal) |
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Term
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Definition
1. Cognitive impairment in two domains (e.g. memory, word-finding) plus
2. functional impairment |
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Term
| Reversible causes of dimentia (8) |
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Definition
1. Thyroid dz
2. NPH
3. Infections: HIV, Syphilis
4. Depression
5. Vitamin B12 Deficiency
6. Alcohol
7. Tumors
8. Hyperparathyroidism |
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Term
| Pathophysiology of dimentia |
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Definition
1. Protein tau (neurofibrillary tangles)
2. B-amyloid plaques
4. ACh deficiency (similar to delirium) |
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Term
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Definition
1. AChE inhibitors: Donepezil, Rivastigmine, Galantamine (prolongs dvlpt of dementia); SE=↓ HR
2. NMDA receptor antagonist: Memantine (use w/ AChE inhibitors)
3. Acute: haldol; chronic – trazadone, valproate, carbamazepine, propranolol |
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Term
| Pathophysiology of delirium |
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Definition
1. ACh deficiency
2. DA excess
3. increased cortisol / endorphins |
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Term
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Definition
1. Change from baseline PLUS
2. Inattention PLUS
3. Disorganized speech OR Altered level of consciousness |
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Term
| Labs in dimentia blood work |
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Definition
| H&P; CBC, lytes, blood sugar; UA; CT if indicated; EKG; CXR; O2 sat |
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Term
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Definition
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Term
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Definition
A – hospitalizations (10 years work)
B – outpatient premium, $100 deductible, covers 80% of services
C - HMO’s; can join and pay a premium
D – drugs; must pay into this, then pay % of pharm fees |
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Term
| Average MELD score for transplantation |
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Definition
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Term
| SAAG indicative of portal hypertension |
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Definition
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Term
| Diagnosis and treatment of spont. bacterial peritonitis |
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Definition
1. PMN > 250
2. give ABX (quinolone or cephalosporin) 3. PLUS ALBUMIN 1.5 mg / kg on days 1 and 3 (reduces mortality) |
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Term
| Treatment of mild to moderate ascites |
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Definition
1. low sodium diet (4g)
2. Spironolactone 100-400 mg daily
3. lasix 40 - 160 mg daily |
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Term
| Treatment of tense ascites |
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Definition
1. Large volume paracentesis
2. Replace 1 liter albumin for every liter removed
3. Diuretics: spironocatone 100-400 mg daily, and lasix 40-160mg/day |
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Term
| Treatment of hepatorenal syndrome |
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Definition
| within 6 hours, give albumin (1.5 g / kg) and NE to raise SBP by 15 mmHg |
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Term
| Indicators of severity of varices |
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Definition
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Term
| Primary prophylaxis of esophageal varices |
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Definition
1. propanolol 160mg/day
2. band ligation |
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Term
| Management of acute esophageal variceal bleed |
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Definition
1. Fluids
2. PPI to help blood clot
3. ABX
4. Octreotide
5. Endoscopy, sclerotherapy and band ligation
6. Blakemore-sengstaken tube |
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Term
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Definition
1. propanolol
2. band ligation |
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Term
| Contraindications to TIPS |
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Definition
1. Emergently for bleed
2. Bilirubin > 3
3. ALT > 100
4. Encephalopathy
5. Contraindicated if MELD > 18 or CHILD > 11 |
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Term
| Pathophysiology of hepatic encephalopathy |
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Definition
| Normally liver transforms ammonia produced by colonic bacteria into urea excreted into urine |
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Term
| Treatment of hepatic encephalopathy |
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Definition
1. No protein diet
2. Lactulose
3. Enemas
4. Antibiotics: neomycin, rifaximin |
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Term
Gardisil
1. Recommended for what ages?
2. Prevents x % of cancers? |
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Definition
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Term
| Hormonal changes of menopause |
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Definition
1. Rise in FSH
2. Drop in estradiol |
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Term
HRT increases or decreases risk of the following:
1. VTE
2. CHD
3. Hip fracture
4. CVA
5. Breast cancer
6. Dimentia
7. Colorectal cancer |
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Definition
1. VTE: increase
2. CHD: increase
3. Hip fracture: decrease
4. CVA: increase
5. Breast cancer +/_
6. Dimentia: increase
7. Colorectal cancer: decrease |
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Term
| How is CAD prevention different for men and women? |
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Definition
| ASA may not be as effective in primary prevention of AMI for women |
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Term
Osteoporosis
1. prevention
2. Screening
3. Treatment |
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Definition
1. exercise, calcium + Vitamind D, NO SMOKING
2. DEXA > 65 (60 if risks)
3. Treatment: HT; bisphosphonates, SERMs (raloxifene); PTH, Denosumab |
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Term
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Definition
1. SSRI/SNRI
2. Clonidine
3. Gabapentin
4. if you use HRT use low dose or transdermal estrogen + progesterone for shortest time possible |
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Term
Intervention for domestic violence:
RADAR |
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Definition
Routine assessment
Ask direct questions
Document
Assess safety (kids? guns?)
Resources and referrals |
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Term
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Definition
| 0.9mg/kg (max = 90mg) given in two phases (blus of 10% of dose then remaining 90% over 1 hr) |
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Term
| What medicines reduce risk of stroke? |
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Definition
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Term
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Definition
1. Improving or minor sx
2. Pre-rx HTN (BP > 185 / 110)
3. Sx’s suggestive of SAH
4. Previous h/o intracranial hemorrhage
5. Recent stroke or head injury within 3 mos
6. Recent surgery within 14 d
7. Anticoagulants within 48 hrs
8. Platelets < 100,000
9. Glucose < 50 or > 400 |
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Term
| Risks and benefits of tPA |
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Definition
1. Benefits: 39% (t-PA) vs. 26% (placebo) showed improvement in disability
2. Risks: 6% rate of symptomatic hemorrhage in t-PA group vs. 0.6% in placebo group |
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Term
| Treatment: Cushing’s sx’s, not on PO steroids, found to have pituitary tumor |
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Definition
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Term
| Antibiotic prophylaxis of neutropenic fever |
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Definition
| third or 4th generation of ceftriaxone |
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Term
| 40 y/o w/ Cushing’s sx, not on PO steroids, first step in diagnosis |
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Definition
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Term
Worst HA of life, dazed, normal CT.
1. most likely diagnosis
2. how do you diagnosis this?
3. most likely cause |
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Definition
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Term
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Definition
| Plasma exchange (plasmapharesis followed by FFP transfusion) |
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