Term
| What diagnostic tests can you get to diagnose lumbar prolapsed nucleus pulposus? |
|
Definition
| MRI or myelography; plain x ray may shownarrowing of the intervertebral space |
|
|
Term
| At what level is herniated puplposes most common? |
|
Definition
| L4-5 level or L5-S1 level |
|
|
Term
| What is the difference between mechanical backache and back sprains? |
|
Definition
| backcageare usually chronic and may result in a long-term debilitating illness without any definite or demonstrable cause; back sprains are usually associated with minor trauma producing ligamentous or muscular injury |
|
|
Term
| What is cauda equina syndrome? |
|
Definition
| compression of the sacral nerve bundle which forms the end of the spinal cord, with symptoms of bladder or bowel dysfunciton and/or pain or weakness in the legs. This disorder should be diagnosed at an early stage to avoid permanent injury |
|
|
Term
| What complications associated with osteo and rheumatoid arthritis are associated with chronic back pain> |
|
Definition
| ankylosing spondylitis, spinal stenosis, spondylolisthesis |
|
|
Term
| What degenerative changes can cause compression of nerves emanating from the spinal cord? |
|
Definition
| herniation of nucleus pulposis, protrusion of osteophytes |
|
|
Term
| What are the characteristic symptoms of nerve compression in the back? |
|
Definition
| pain radiating to buttock, posterior thigh or calf; coughing, sneezing, or straining increases pain; other exacerbating factors are bending, sitting, and getting in and out of a vehicle whereas lying flat characteristically relieves pain; |
|
|
Term
| What are the PE findings for patients with spinal compression? |
|
Definition
| paravertebral muscles are often in spasm, loss of normal lumbar lordosis, straight leg raising is limited on teh side of the lesion, dorosiflexion of foot exacerbates, may be tenderness to palpation of the central canal or buttock; sensory and muscular weakness may be present along appropriate dermatomes, |
|
|
Term
| If you suspect herniated disk what else should be in your differential? |
|
Definition
| fracture, joint subluxation, tumors of the bone, joint, or meninges; abscess; arachnoiditis; ankylosing spondylitis |
|
|
Term
| What is first line conservative treatment for back pain? |
|
Definition
| bed rest, application of heat pads or ice packs, NSAIDs, and muscle relaxants and/or physical therapy; back brace or corset may help |
|
|
Term
| What are the indications for surgical decompression of herniated disk? |
|
Definition
| development of an acute disabling neurologic deficit (bladder dysfunction) or intractable severe pain; a large trial failed to show superior efficacy of surgery versus conservative therapy |
|
|
Term
| What does surgery for a herniated disk entail? |
|
Definition
| laminectomy and removal of the protruding disk; if several disk spaces are involved, posterior spinal usion in addition to removal of the disks may be indicated |
|
|
Term
| What are some techniques under review for herniated disk? |
|
Definition
| dissolution of the disk by the injection of chemicals, steroid injections for short term relief |
|
|
Term
| What does HIDA scan stand for? |
|
Definition
| hepatoiminodiacetic acid scan |
|
|
Term
| What is the differential diagnosis for neonatal jaundice? |
|
Definition
| neonatal hepatitis; toxoplasmosis, other agents, ,rubella, CMV, HSV (TORCH), metabolic diseases (alpha 1 antitrypsin deficiency, cystic fibrosis, etc.), biliary atresia and choledochal cyst |
|
|
Term
| When does physiologic jaundice typically occur? |
|
Definition
| typically is evident by day 2 to 3 and resolves by day 5 to 7 of life; does not persist for more than two weeks |
|
|
Term
| At what time is surgical correction for biliary atresia typically performed? |
|
Definition
| before 8 weeks of age (12 weeks maximum) |
|
|
Term
| How common is neonatal jaundice? |
|
Definition
| 60% of term infants and 80% of preterm infants |
|
|
Term
| How should you evaluate neonatal jaundice that seems inconsistent with physiologic jaundice? |
|
Definition
| abdominal ultrasound, HIDA scan, percutaneous liver biopsy; if the imaging studies do not rule out biliary atresia, then operative exploration with intraoperative cholangiogram is indicated |
|
|
Term
| How do you treat a choledochal cyst? |
|
Definition
| cyst excision and hepaticojejunostomy, where a limb of the jejunum is attached to the bifurcating hepatic ducts at their confluence |
|
|
Term
| What is the term for biliary hypoplasia? |
|
Definition
|
|
Term
| How do you treat alagille syndrome? |
|
Definition
|
|
Term
| What are the clinical findings associated with biliary hypoplasia? |
|
Definition
| cardiovascular, spinal, eye abnormalities, and jaundice common |
|
|
Term
| What medical treatment can cause conjugated hyperbilirubinemia in the new born? |
|
Definition
|
|
Term
| What causes inspissated bile syndrome? |
|
Definition
| hemolytic diseases or cystic fibrosis |
|
|
Term
| How do you treat inspissated bile syndrome? |
|
Definition
| intraoperative cholangiogram may be both diagnostic and therapeutic |
|
|
Term
| What are some causes of unconjugated hyperbilirubinemia? |
|
Definition
| hemolytic diseases, metabolic diseases, physiologic jaundice |
|
|
Term
| What are some causes of conjugated hyperbilirubinemia? |
|
Definition
| biliary atresia, choledochal cyst, biliary hypoplasia (alagille syndrome), total parenteral nutrition, inspissated bile syndrome, sepsis/infection |
|
|
Term
| Whatis a choledochal cyst? |
|
Definition
| congenital anatomic malformation of a bile duct, including cystic dilatation of the extrahepatic bile duct or the large intrahepatic bile duct |
|
|
Term
| What causes biliary atresia? |
|
Definition
| exact cause is unknown; various theories include viral infection or autoimmune process |
|
|
Term
| What does biliary atresia look like histologically? |
|
Definition
| inflammatory cells surrounding obliterated ductules |
|
|
Term
| What does biliary atresia look like grossly? |
|
Definition
| fibrosis of the entire extrahepatic biliary tree, followed by proximal duct fibrosis with distal duct patency |
|
|
Term
| What causes choledochal cysts? |
|
Definition
| unkown; widely held theory is that common bile duct and pancreatic duct share a common channel leading to retrograde reflux of pancreatic juice into the choledochus with subsequent cystic dilation |
|
|
Term
| How many types of choledochal cysts are there? |
|
Definition
|
|
Term
| How many types of choledochal cysts are there? |
|
Definition
|
|
Term
| What is the most common tyep of choledochal cyst? |
|
Definition
| fusiform or type I is 90% |
|
|
Term
| Prior to surgical treatment of biliary atresia, patients should be evaluated for what complications? |
|
Definition
| coagulation abnormalities, anemia, and hypoproteinemia |
|
|
Term
| How is biliary atresia corrected surgically? |
|
Definition
| kasai portoenterostomy= extrahepatic biliary tree is dissected up to the level of the portal plate; a roux-en-y limb of jejunum is attached to the porta in a retrocolic manner |
|
|
Term
| What are hte three main complications of the surgical management of biliary atresia? |
|
Definition
| cholangitis, cessation of bile flow, and portal hypertension |
|
|
Term
| What is the most common complication occuring after portoenterostomy for bile duct atresia? |
|
Definition
|
|
Term
| What are the symptoms of cholangitis? |
|
Definition
| charcot's triad= RUQ pain, fever, jaundice; reynold's pentad= AMS, shock |
|
|
Term
| What is the treatment for cholangitis? |
|
Definition
| intravenous antibiotics against gram negative organisms and steroids |
|
|
Term
| What is the survival rate for biliary atresia? |
|
Definition
| before the kasai procedure it was less than 5% at 12 months; with surgery 30-50% have good long term results; however ultimately only 20% who get surgery survive into adulthood without liver transplantation |
|
|
Term
| What factors affect outcome in patients with biliary atresia? |
|
Definition
| age, immediate bile flow (technically sound operation) and degree of parenchymal disease at diagnosis; the presence and size of ductules in the hilum are of controversial prognostic significance |
|
|
Term
| What percent of cases of biliary atresia have visible normally distended gallbladders? |
|
Definition
|
|
Term
| After ___ days of life, portoenterostomy is rarely indicated. |
|
Definition
|
|
Term
| How do you treat patients with biliary atresia after they are 120 days old? |
|
Definition
|
|
Term
| What are known risk factors for squamous cell carcinoma? |
|
Definition
| caustic burns, alcohol consumption, tobacco smoking, and nitrate-and nitrate containing food |
|
|
Term
| What are the risk factors for esophageal adenocarcinoma? |
|
Definition
| GERD, western diet, and acid suppression medications |
|
|
Term
| How do you determine whether dysphagia due to a mass is due to a benign or malignant process? |
|
Definition
| rapid onset is suggestive of neoplasm |
|
|
Term
| How do you stage esophageal cancer? |
|
Definition
| endoscopic ultrasound and evluation for possible metastatic disease with CT of the chest and abdomen; in some institutions, PET CT has replaced standard CT as teh staging modality of choice |
|
|
Term
| Why is it improtant to differentiate between esophageal and stomach cancer? |
|
Definition
| they require different treatments so its important to get EGD, endoscopic ultrasound and CTs to pinpoint teh exact tumor location |
|
|
Term
| When evaluating a patient with esophageal cancer, its important to assess their... |
|
Definition
| nutritional status with quantification of weight loss, measurement of serum albumin level |
|
|
Term
| T/F Pts who can not swallow secondary to esophageal malignancy should get TPN. |
|
Definition
| false; they should get a g tube or j tube |
|
|
Term
| How are GE junction adenocarcinomas classified? |
|
Definition
|
|
Term
| Siewert classification type I= |
|
Definition
| located more than 1 cm above the GE junction |
|
|
Term
| Seiwert classification type II= |
|
Definition
| located within 1 cm proximal and 2 cm distal to the GE junction (surgical treatment would consist of esophagectomy with partial resection of the Ge junction) |
|
|
Term
| What is transthoracic esophagectomy? |
|
Definition
| resection traditionally done through an incision in the abdomen (or laparoscopic approach) and a separate incision through the right chest at approximately the level of the azygous vein and distal transection is usually at the level of the proximal stomach; the stomach is then brought into the mediastinum and anastomosed to the proximal esphagus |
|
|
Term
| What are the disadvantages ot a transthoracic esophagectomy? |
|
Definition
| anastomosis is in the mediastinum; high rate of pulmonary complications due to pain from incisions in both the chest and upper abdomen |
|
|
Term
| What is a transhiatal esophagectomy? |
|
Definition
| resection done through an abdominal incision and a cervical incision; through the abdomen= stomach is mobilized and the distal esophagus is dissected after enlargement of the hiatal opening; through the cervical= cervical esophagus is mobilized and the proximal throacic esophagus is dissected and the entire throacic esophagus and the proximal stomach are resected and the gastricconduit is brouht up through the posterior mediastinum and anastomosed to the cervical esophagus in the neck |
|
|
Term
| What are hte advantages of transhiatal esophagectomy? |
|
Definition
| reduction in pulmonary complications and reduced mortality and morbidity associated cervical anastomoticleaks |
|
|
Term
| What is the most common type of esophageal cancer? |
|
Definition
| squamous cell world wide; adenocarcinoma in north america |
|
|
Term
| Esophageal cancer is the __th leading cancer type. |
|
Definition
|
|
Term
| T/F Esophageal cancer rates are rising. |
|
Definition
| true; incidence has increased sixfold over the past 25 years |
|
|
Term
| What is the overal prognosis for cancers of the esophagus and GE junction for all affectedpatients? |
|
Definition
|
|
Term
| What percent of patients presenting with esophageal cancers are eligible for surgical resection? |
|
Definition
|
|
Term
| What kind of therapy is recommended for patients with resectable esophageal cancer? |
|
Definition
| surgery + chemo + radiation |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| tumor invades lamina propria, muscularis mucosa, submucosa, but does not penetrate through the submucosa |
|
|
Term
|
Definition
| tumor invades into but not beyond the muscularis propria |
|
|
Term
|
Definition
| tumor invades periesophageal tissue but not adjacent structures |
|
|
Term
| What is T4 esophageal cancer? |
|
Definition
| tumor invasion of adjacent structures |
|
|
Term
|
Definition
| regional lymph nodes cannot be assessed |
|
|
Term
|
Definition
| no regional lymph node metastasis |
|
|
Term
|
Definition
| regional lymph node metastasis |
|
|
Term
|
Definition
| distant metastasis cannot be assessed |
|
|
Term
|
Definition
|
|
Term
| What is M1a esophageal cancer? |
|
Definition
| upper esophageal tumor with cervical LN mets; midthoracic tumor with mediastinal LN mets; lower thoracic lesion with celiac node metastasis |
|
|
Term
| What is M1b esophageal cancer? |
|
Definition
| upper lesion with mets to mediastinum or celiac lymphnodes; midthroacic lesion with mets to cervical or celiac nodes; lower thoracic lesion with mets to cervical or mediastinal lymphnodes |
|
|
Term
| What is stage 0 esophageal cancer? |
|
Definition
|
|
Term
| What is stage 1 esophageal cancer? |
|
Definition
|
|
Term
| What is stage IIA esophageal cancer? |
|
Definition
|
|
Term
| What is stage IIB esophageal cancer? |
|
Definition
|
|
Term
| What is stage III esophageal cancer? |
|
Definition
| T3, N1, M0; T4, N0 or N1, M0 |
|
|
Term
| What is stage IVA esophageal cancer? |
|
Definition
|
|
Term
| What is stage IVB esophageal cancer? |
|
Definition
|
|
Term
| 5 yr survival of stage 0 esophageal cancer? |
|
Definition
|
|
Term
| 5y survival of stage 1 esophageal cancer= |
|
Definition
|
|
Term
| 5 yr survival of stage IIA esophageal cancer? |
|
Definition
|
|
Term
| 5 yr survival of stage IIB esophageal cancer |
|
Definition
|
|
Term
| 5 yr survival of stage III esophageal cancer? |
|
Definition
|
|
Term
| 5 yr survival of stage IVA esophageal cancer? |
|
Definition
|
|
Term
| 5 yr survival of stage IVB esophageal cancer? |
|
Definition
|
|
Term
| Do you use chemo for esophageal cancer? |
|
Definition
| good evidence for use of pre and post op chemo in tx of patients with adeno carcinoma of the esophagus and stomach but not for squamous cell |
|
|
Term
| Wht is palliative therapy for esophageal cancer? |
|
Definition
| relieving dysphagia and prevent bleeding, perforation and tracheoesopahgeal fistula formation |
|
|
Term
| What are the different types of palliative treatmentsfor dysphagia of esophageal cancer? |
|
Definition
| endoscopic therapy (laser, stent placemnt, photocoagulation), radiation therapy (external beam or intraluminal), chemotherapy, and feeding tube placement |
|
|
Term
| What are the advantages to endosocpic stent placement for palliation of esopaheal cancer? |
|
Definition
| rapid relief, treatment of choice for tracheoesophageal fistula, easy outpt procedure |
|
|
Term
| What are hte disadvantages of endoscopic stent placement? |
|
Definition
| recurrence due to stent migration, tumor overgrowth; GERD; increased risk of late hemorrhage |
|
|
Term
| What are hte advantages of using photodynamic therapy and Nd:YAG laser for esophageal cancer palliation? |
|
Definition
| works well with exophytic lesions; generally low complication rates |
|
|
Term
| What are the disadvantages to photodynamic therapy and Nd:YAG laser? |
|
Definition
| often available in specialized centers; repeat tx every 4 to 8 weeks |
|
|
Term
| What are hte advantages to single dose brachiotherapy? |
|
Definition
| long dterm dysphagia improvement is better than stent placement; longterm quality of life was better when compared with stent; lowerrate of hemorrhage than stent |
|
|
Term
| What are the disadvantages of palliative chemo for obstruction secondayr to esophageal carcinoma? |
|
Definition
| response to obstruction is variable therefore, additional treatment is for obstruction may be needed; relief from obstruction may be delayed |
|
|
Term
| What can renal U/S tell you? |
|
Definition
| renal sie and number, urinary obstruction, renal vascular obstruction, and tumor infiltration |
|
|
Term
| How do you stage renal disease? |
|
Definition
| assessment fo cr clearance allows for estimation of GFR to stage renal disease |
|
|
Term
| Half of the mortality of renal pts is due to complications of... |
|
Definition
|
|
Term
| Why should renal pts get echos? |
|
Definition
| because LVH is common in renal patients and echo can diagnose uremic pericarditis and pericardial effusion |
|
|
Term
| At what GFR should you hemodialyse? |
|
Definition
|
|
Term
| What is the definition of CRF? |
|
Definition
| kidney damage of greater than 3 months duration and/or GRF less than 60 mL/min /1.73m2 |
|
|
Term
|
Definition
| kidney damage with normal or increased GFR(>90) |
|
|
Term
|
Definition
| kidney damage with mild decrease in GFR (60-89) |
|
|
Term
|
Definition
| moderate decrease in GFR (30-59) |
|
|
Term
|
Definition
| severe decrease in GFR (15-29); predialysis day |
|
|
Term
|
Definition
| kidney fialure (GFR less than 15), indication for chronic dialysis usually |
|
|
Term
| How do you alter diets of patients with CRF? |
|
Definition
| K restriction if GFR is approaching 20 to avoid hyperkalemia; prevent hyperparathyroidism by dietary phosphate restriction, phosphate binder adinistration at meal time, syntehtic 1,25 dihydroxy vitamin D, and subtotal parathyroidectomy if needed |
|
|
Term
| What are the leading causes of LVH in pts with renal failure? |
|
Definition
|
|
Term
| What are the effects of uremia on the body? |
|
Definition
| immunodeficiency state that is not reversible with hemodialysis, uremic encephalopathy, uremic peripheral neuropathy, uremic autonomic neuropathy producing postural hypotension and hypotension during dialysis, uremic platelet dysfunction |
|
|
Term
| THe immunodeficiency state produced by uremia puts pts at greater risk for what kinds of infections? |
|
Definition
| bacterial, viral, and mycobacterial infections and anergic states |
|
|
Term
| Hemodialysis involves two spaces divided by a semipermeable membrane where blood passes through one side of the membrane and _____ passes on the other side. |
|
Definition
|
|
Term
| What kind of access is needed for dialysis? |
|
Definition
| large bore venous catheters through which blood can be drawn off at a high rate (350-400 mL/min) through one lumen and returned through a separate lumen |
|
|
Term
| What are the different classifications of HD catheters? |
|
Definition
| temporary access (days), intermediate term access (weeks to months), or permanent access |
|
|
Term
| What are intermediate-term catheters for HD access like? |
|
Definition
| they contain a cuff barrier and subcutaneous tunneled portion which are barriers against containation by skin flora and are associated with lower cather related infections and complications than the temporary dialysis catheters |
|
|
Term
| What are the pros and cons of using the femoral vein for temporary dialysis access? |
|
Definition
| rapid and safe but associated with increased infections when left in for more then a few days |
|
|
Term
| What is the ideal site for either temporary or intermediate catheter insertion for HD for most patients? |
|
Definition
|
|
Term
| What are the pros and cons of using thesubclavian vein for temporary vascular access in dialysis patients? |
|
Definition
| shouldbe avoided because of the potential for thrombosis and stenosis which would affect venous return and copromise the success of future upper extremity arterial-venous fistulas on that side |
|
|
Term
| Name soe commonly constructed AVFs? |
|
Definition
| brescia-crimino fistula (radial artery to cephalic vein), brachial artery-cephalic vein fisula in the upper arm, brachial-basilic fistula in the upper arm |
|
|
Term
| What are the major limitations to AVF creation? |
|
Definition
| inadequate size and quality of the veins; because injuries to the vein can occur with blood draws and IV insertions, it isextreely important to preserve the upper extremity veins in any pt in whom long term dialysis is to be anticipated |
|
|
Term
| How long do AVFs needed before tehy are mature enough for dialysis? |
|
Definition
|
|
Term
| What is the most commonly used material for AV grafts? |
|
Definition
|
|
Term
| Which is better, an AVF or an AVG? |
|
Definition
| grafts are less desirable because of increased complications including infection and pseudointimal hyperplasia on the venous end of the graft-vein connection leading to graft thrombosis |
|
|
Term
| What are the pros and cons of peritoneal dialysis? |
|
Definition
| allows pts to ambulate and carry on some of the activities of daily living during dialysis but is done at home so ptsneed to be functional and capable of troubleshooting problems; also there is a risk of peritoneal infection and peritoneal dialysis catheter-related complications |
|
|
Term
| Which is better for survival rates, hemodialysis or kidney transplant? |
|
Definition
| kidneytransplant has an overal improved survival of 10 yrs |
|
|
Term
| What are the three most common causes of CRF treated by renal transplantation? |
|
Definition
| diabetes mellitus (27%), hypertension (20%), glomerular disease (21%) |
|
|
Term
| What is the ratio of people on waitlist for kidney transplant and number of kidneys transplanted? |
|
Definition
|
|
Term
| What is the median time on weight list for kidney transplant before recieving kidney? |
|
Definition
|
|
Term
| When are patients considered for renal transplantation? |
|
Definition
| when their GFR falls below 20 mL/min |
|
|
Term
| What preop testing should pts undergo before getting a kidney? |
|
Definition
| psychiatric eval to determine whether they are likely to comply with imunosuppressivetherapy; valuation to rule out urinary obstructive process and reflux as a cause of CFR and ABO/HLA typing. All patients are also evaluated for possible infections such as HIV, Hep B, hep C, CMV and syphilis |
|
|
Term
| Can patients with cancer be considered for renal transplant? |
|
Definition
| they need to be at least 2 years without evidence of disease prior to being considered for transplantation |
|
|
Term
| T/F Age is a contraindication to organ transplantation. |
|
Definition
| false; up to 20% of the pts on the kidney waitlist are over 65 |
|
|
Term
| What are the two types of kidney transplants you can get and which is more common? |
|
Definition
| living donor transplantation (40%) and cadaveric transplantation (60%) |
|
|
Term
| Why does living donor transplantation have less complications than cadaveric transplantation? |
|
Definition
| overall better medical condition of the donors and short cold ischemia time |
|
|
Term
| What are the graft survival rates of living donor kidney transplants at 1, 5, and 10 yrs? |
|
Definition
|
|
Term
| What type of patients do we get cadaveric organs from? |
|
Definition
| retrieved fro brain dead donors between the ages of 3 to60 yoa and without systemic degenerative diseases such as hypertensiona dn diabetes and history of a stroke; however, because of the shortage of organs, ECDs (expanded criteria donors)= older than 60 or between 50 and 60 with a stroke, hx ofHTN, diabetes or elevated Cr |
|
|
Term
| What are the survival rates of non ECD cadaveric kidney transplant at 1 and 5 yrs? |
|
Definition
|
|
Term
| What are the survival rates of ECD cadaveric kidney transplants at 1 and 5 yrs? |
|
Definition
|
|
Term
| T/F All patients who have renal transplants need immunosuppressive agents. |
|
Definition
| false; if the kidney is from an identical twin donor you don't need immunosuppresion |
|
|
Term
| What is the MOA of cyclosporin? |
|
Definition
| inhibits the calcineurin pathway and the production of IL-2 |
|
|
Term
| What are some major side effects associated with cyclosporin? |
|
Definition
| gingival hyperplasia, hypertension, hyperkalemia, nephrotoxicity |
|
|
Term
| What is the MOA of tacrolimus? |
|
Definition
| calcineurin inhibitor causing inhibition of IL-2, IL-3, and IL-4 and gamma interferon production |
|
|
Term
| Which is more potent, tacrolimus or cyclosporin? |
|
Definition
|
|
Term
| What are the side effects of tacrolimus? |
|
Definition
| nephrotoxicity, hypertension, hyperkalemia, hypomagnesemia, CNS symptoms (headaches, tremors, seizures) and insulin resistence |
|
|
Term
| What is the MOA of sirolimus? |
|
Definition
| a T cell inhibitor that acts through a pathway that is different from the calcineurin pathway |
|
|
Term
| What is another name for sirolimus? |
|
Definition
|
|
Term
| What are the side effects of sirolimus? |
|
Definition
| less nephrotoxic than cyclosporine and tacrolimus but can cause thrombocytopenia, hyperlipidemia and poor wound healing |
|
|
Term
|
Definition
|
|
Term
| What is the MOA of mycophenolate mofetil? |
|
Definition
| inhibitor of B and T cell proliferation |
|
|
Term
| What is the MOA of azathioprine? |
|
Definition
| inhibits B and T cell proliferation |
|
|
Term
| MMF is often combined with... |
|
Definition
|
|
Term
| When is azathioprine used? |
|
Definition
| substitued for MMF when intolerance develops |
|
|
Term
|
Definition
| monoclonal murine antibiotdy agains the CD3 receptor complex on T cells |
|
|
Term
| When acuteorgan transplant rejections are resistant to steroid induction, what is the next line of therapy? |
|
Definition
| antilymphocytic antibiodies |
|
|
Term
| What percent of people get a cute graft rejetion during the first few weeks to months after tranplantation? |
|
Definition
|
|
Term
| What are the side effects of prolonged antilymphocytic therapy? |
|
Definition
| serious viral infections, thrombocytopenia, and leukopenia |
|
|
Term
| What are the symptoms of acute graft rejection? |
|
Definition
| fever, malaise, hypertension, oliguria, increase in serum creatinine, and tenderness and swelling over the transplanted kidney |
|
|
Term
| What percent of patients developsome form of infection during the first year after tranplant? |
|
Definition
|
|
Term
| What is the most common type of infection in the first month following transplantation? |
|
Definition
|
|
Term
| What are the most common types of infections seen after the first month post transplant? |
|
Definition
| CMV, PCP, aspergillosis, toxoplasmosis, cryptococcosis, nodardiosis, and blastomycosis |
|
|
Term
| What kind of prophylactic antimicrobial can be given to pts post transplant? |
|
Definition
| TMP-SMX for the first 6 months after transplant to decrease risk of PCP |
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|
Term
| Post-transplant immune suppression increases your risk of malignancy by... |
|
Definition
|
|
Term
| What kinds of neoplasms are common post transplant? |
|
Definition
| viral associated neoplasms, squamous cell carcinoma (HPV), kaposi sarcoma (EBV), non-hodgkin lymphoma (EBV), and hepatocellular carcinoma (hep B and C), lymphoma or post-transplant lymphoproliferative disorders are the most common post transplant malignancies and the occurence is related to the intensity and duration of anti T cell therapy |
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Term
| If a patient post transplant starts having lymphoproliferative disorder approaching malignancy, what should you do? |
|
Definition
| decrease immuno suppression meds because they may cause regression of the lymphoproliferation |
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Term
| What do you call the chronic fibrotic changes and accelerated loss of renal functions that occurs in transplanted kidneys? |
|
Definition
| chronic allograft nephropathy |
|
|
Term
| What lab results suggest chronic allograft nephropathy? |
|
Definition
| pogressive increase in serum Cr, proteinuria,a nd microscopic hematuria; confirm with biopsy |
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Term
| What is the treatment for chronic allograft nephropathy? |
|
Definition
| there is no effective treatment but generally immunosuppressive treatemtn is gradually tappered to limit nephrotoxicity associatedwith calcineurin inhibitors |
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|
Term
| T/F UTIs are common causes of infection after kidney transplantation. |
|
Definition
| bacterial infections are high on the list of possible infections within the first 4 weeks after transplantation |
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|
Term
| What are the initial tests and initial clinical management of patients with a diabetic foot ulcer? |
|
Definition
| biopsy the wound for culture and send blood for culture; obtain xrays of the foot to look for charcot neuroarthropathy and/or osteomyelitis; the patietn should be put on bed rest, IV antibiotics, and strict glycemic control |
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|
Term
| Inital evaluation of a foot ulcer can made with what criteria? |
|
Definition
| PEDIS= perfusion, extent, depth,infection, sensation |
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Term
| What should you send to the lab to determine whether a wound is infected? |
|
Definition
| tissue biopsy of the wound, NOT a swab (because all wounds are colonized but not necessarily infected) |
|
|
Term
| What are the most common pathogens involved in diabetic foot infections? |
|
Definition
| staph aureus and beta hemolytic strep |
|
|
Term
| What is appropriateinitial empiric therapy of diabetic foot ulcer? |
|
Definition
| amoxicililn-clavulanic acid, ciprofloxacin, cephazolin, and vancomycin |
|
|
Term
| How long should you treat diabetic foot ulcers with antibiotics? |
|
Definition
| no good range has been determined but a reasonable range would be between 7 and 14 days |
|
|
Term
| Why is it important to control blood sugars in pts with diabetic foot ulcers? |
|
Definition
| hyperglycemia contributs to leukocyte dysfunction and compromised host response to infections |
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|
Term
| When might you give 4 to 6 weeks of antibiotic therapy to a person with a diabetic foot ulcer? |
|
Definition
| if their xray shows degenerative changes that could be osteomyelitis vs. charcot's arthropathy |
|
|
Term
| What local wound care is needed for diabetic foot ulcers? |
|
Definition
| sharp debridement, larval therapy with medicinal maggots, topical agent applications, and in some cases the local infections associated with abscesses would require surgical drainage oand minor amputations; contact casting to offload pressure from the wound site |
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|
Term
| Once healing of a foot ulcer is completed the pt should be thoroughlyexamined for contributory conditions such as... |
|
Definition
| limited joint mobility of the foot and ankle, calluses, bunions, hammer toes, claw toes |
|
|
Term
| What is charcot's neuroarthropathy? |
|
Definition
| noninfective bone and joint destruction that occurs in well perfused an insensate foot; thought to be caused by repetitive trauma to an insensate portion of teh foot |
|
|
Term
| What does charcot's neuroarthropathy look likeradiographically? |
|
Definition
| extensive bone and joint destruction, fragmentation, and remodeling |
|
|
Term
| What is the clinical presentaiton of acute Charcot neuroparthropthy? |
|
Definition
| soft tissue swelling, soft tissue erythema and increased local skin temp; can be very difficult to differentiate clinically from foot infections and osteoyelitis |
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|
Term
| How does diabetic neuropathy predispose to foot ulcers? |
|
Definition
| muscle atrophy, altered biomechanics, and foot deformities, sensory neuropathy that increases susceptibility to injuries, autonoic neuropathy leading to decreased sweating, skin dryness, cracks, and increases susceptibility to infections |
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|
Term
| "diabetic foot" refers to a nuber of pathologic conditions encountered in this pt population including= |
|
Definition
| diabetic neuropathy, ischemic vascular disease, Charcot neuroarthropathy, skin ulceration, soft tissue infections and osteomyelitis |
|
|
Term
| What is the lifetie risk of foot ulcer in a diabetic? |
|
Definition
|
|
Term
| What percent of nontraumatic foot amputations are due to diabetic foot ulcers? |
|
Definition
|
|
Term
| Pts at low risk for diabetic foot ulcer= |
|
Definition
| normal sensation and pulses; annual foot exam |
|
|
Term
| Moderate risk for diabetic foot ulcer= |
|
Definition
| pts with enuropathy or absence of uplses should get exams and maintenence care every 3 to 6 months |
|
|
Term
| pts at high risk for diabetic foot ulcers= |
|
Definition
| neuroapthy or abscence of pulses in addition to foot defority, skin changes or prior history of ulcers; need evaluation every 1 to 3 months |
|
|
Term
| What are signs associated with a foot ulcer that indicate deeper infection? |
|
Definition
| pain, induration and wound drainage |
|
|
Term
| What signs with diabetic foot ulcer suggest osteomyelitis? |
|
Definition
| pain, deeper ulcers, elevated leukocyte count |
|
|
Term
| WHat is a helpful radiographic study used to diagnose acute osteomyelitis? |
|
Definition
| radionuclide scan with gallium |
|
|
Term
| Why are diabetic patients less likely to have calf claudication? |
|
Definition
| arterial occlusion occurs at the tibial-peroneal arteries so they get foot claudication but because of sensory neuropathy this may go unnoticed |
|
|
Term
| How can you assess blood flow to distal extremities? |
|
Definition
| measurement of ABI's, TBIs and duplex ultrasonography |
|
|
Term
| Why are ABIs falsely elevated in diabetics? |
|
Definition
| calcifications of tibial vessels |
|
|
Term
| What is teh best way to surgically revascularize diabetic pts with poor peripheral perfusion? |
|
Definition
| open vascular reconstruction because there is increased frequency of ultiple level occlusivedisease and tibial level occlusive disease |
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