Term
|
Definition
| A solute content of a body of water |
|
|
Term
| Na+ concentration disorders are usually due to what? |
|
Definition
|
|
Term
| What are the general characteristics of a Na+ concentration disorder |
|
Definition
| Serum Na+ <130, treatement depends on underlying cause, Frequent in hospitalized patients on IV |
|
|
Term
| What is the single best test to order when faced with hyponatremia?* |
|
Definition
|
|
Term
| What constitutes isotonic hyponatremia? |
|
Definition
| Serum osmolality of 285-295 or normal osmolality, exhibits hyperproteinemia or hyperlipidemia |
|
|
Term
| What constitutes hypertonic hyponatremia? |
|
Definition
| Serum osmolality >295, elevated osmolality showing hyperglycemia, mannitol, sorbitol, or radiocontrast dyes |
|
|
Term
| What is "true hyponatremia""? |
|
Definition
| Hypotonic hyponatremia with a serum osmolality <280 |
|
|
Term
| What is the most common form of hyponatremia? |
|
Definition
| Hypotonic hyponatremia ("true hyponatremia") |
|
|
Term
| What are the three forms of hypotonic hyponatremia? |
|
Definition
| Hypovolemic, Euvolemic, Hypervolemic |
|
|
Term
| What might cause hypovolemic hypotonic hyponatremia |
|
Definition
| Extrarenal salt loss or renal salt loss due to diuretics, ACI-I, dehydration, etc. |
|
|
Term
| What might cause euvolemic hypotonic hyponatremia? |
|
Definition
| Postoperative hyponatremia, hypothyroidism, psychogenic polydipsia, beer potomania, drug reactions, endurance exercise |
|
|
Term
| What might cause hypervolemic hypotonic hyponatremia? |
|
Definition
| CHF, liver disease, nephrotic syndrome, or renal failure |
|
|
Term
| How do you treat asymptomatic hyponatremia? |
|
Definition
| Fluid restriction, normal saline infusion, diuretics, demeclocycline, fludrocortisone, or vasopressin antagonists |
|
|
Term
| How do you treat symptomatic hyponatremia? |
|
Definition
| Same as asymptomatic but give HYPERTONIC saline (3%) at a rate of 1mEq/L/hr |
|
|
Term
| Increased Uosm >400 in hypernatremia is indicative of what? |
|
Definition
| Renal concentration is preserved |
|
|
Term
| Decreased Uosm <250 in hypernatremia is indicative of what? |
|
Definition
| Central or nephrogenic diabetes insipidus |
|
|
Term
| What causes central diabetes insipidus? |
|
Definition
| Absence or decrease of ADH |
|
|
Term
| What causes nephrogenic diabetes insipidus? |
|
Definition
| Renal tubular insensitivity to ADH |
|
|
Term
| How do you treat hypernatremia? |
|
Definition
| Correct fluid loss over 48hrs, if hypervolemic give D5W with Lasix, no Lasix if Euvolemic, and D5NS to replace volume followed by D5W as needed if Hypovolemic |
|
|
Term
|
Definition
|
|
Term
| What is adrenal insufficiency? |
|
Definition
| Insufficient secretion of adrenal hormones, usually both glucocorticoids and mineralcorticoids |
|
|
Term
| What is the difference between type I and type II adrenal insufficiency? |
|
Definition
I = Autoimmune polyglandular failure syndrome
II = Schmidt's syndrome |
|
|
Term
| What is the primary cause of adrenal insufficiency? |
|
Definition
|
|
Term
| What are the signs and symptoms of adrenal insufficiency |
|
Definition
| Weakness, abdominal pain, fever, headache, progression to coma, nausea, low BP can progress to SHOCK, dehydration, hypoglycemia |
|
|
Term
| How do you treat an adrenal crisis? |
|
Definition
| CANNOT BE DELAYED, give high flow IV NS infusion, Vasopressors as needed, and broad spectrum antibiotics that cover Neisseria |
|
|
Term
| What are the signs of chronic adrenal insufficency? |
|
Definition
| Others alongside anorexia, weight lause, myalgia, arthralgia, sparse axillary hair, increased pigmentation of flexors, nevi, emotional changes |
|
|
Term
| How do you diagnose adrenal insufficiency? |
|
Definition
| Corsyntropin stimulation test after fasting cortisol. Cortisol should rise to at least 20mcg/dL or higher above baseline. ACTH will be elevated in primary, lower in secondary |
|
|
Term
| How do you treat renal insufficiency? |
|
Definition
| Hydrocortisone for life, florinef, DHEA if serum levels are elevated |
|
|
Term
| What causes congenital adrenal hyperplasia? |
|
Definition
| Elevated ACTH, leads to overproduction of DHEA, adrostenedione, progesterone, and 17-hydroxyprogesterone |
|
|
Term
| The vast majority of congenital adrenal hyperplasia is due to what? |
|
Definition
| 21-hydroxylase deficiency which causes deficient cortisole and aldosterone |
|
|
Term
| How do you diagnose congenital adrenal hyperplasia? |
|
Definition
| Plasma 17-hydroxyprogesterone >200ng/dL, elevates after cortisol stimulation |
|
|
Term
| How do you treat adrenal hyperplasia? |
|
Definition
| Replace cortisol and aldosterone, suppress androgens with flutamide and an aromatase inhibitor |
|
|
Term
| What causes hyporoeninemic hypoaldosteronism? |
|
Definition
| Decreased renin secretion from kidneys, exhibits non-gapped metabolic acidosis, can bec aused by NSAIDs, ACE-I, and B-Blockers |
|
|
Term
| How do you treat hyporoeninemic hypoaldosteronism? |
|
Definition
| Fludrocortisone or midodrine (an alpha agonist) |
|
|
Term
| What is Cushing's Syndrome? |
|
Definition
| Isolated hypersecretion of cortisol or via exogenous administration |
|
|
Term
| The majority of Cushing's Syndrome cases are due to what? |
|
Definition
| ACTH hypersecretion, most often through pituitary hypersecretion. May also be secreted in small cell lung cancer |
|
|
Term
| All ACTH independent cases of Cushing's Syndrome are due to what? |
|
Definition
| Adrenal adenoma or carcinoma |
|
|
Term
| What is the difference between Cushing's disease and Cushing's syndrome? |
|
Definition
| Disease meanst here is an ACTH producing pituitary tumor |
|
|
Term
| What are the symptoms of Cushing's? |
|
Definition
| Central obesity, moon face, buffalo hump, muscle wasting, bruising, hursutism, osteoporosis, HTN, delayed healing, diabetes |
|
|
Term
| How do you diagnose Cushing's? |
|
Definition
| Dexamethasone suppression test given at bedtime followed by a morning cortisol level draw. You can also use 24hr urine observation |
|
|
Term
| How do you treat Cushing's? |
|
Definition
| Remove offending tumor and supplement with replacement therapy if necessary. Ketoconazole, metyrapone, or octreotide can suppress ACTH |
|
|
Term
| What is Nelson's syndrome? |
|
Definition
| Rapidly enlarging pituitary tumor causing loss of feedback from unopposed ACTH. Results following a bilateral adrenalectomy,treated with pituitary resection or radiation suppresssion |
|
|
Term
| Hyperaldosteronism is most often due to what? |
|
Definition
| Adrenal adenoma 1st, hyperplasia 2nd |
|
|
Term
| What are the symptoms of hyperaldosteronism? |
|
Definition
| Hypertension, polyuria, polydipsia, muscle weakness/parasthesias, headache, hypokalemia, metabolic alkalosis |
|
|
Term
| What kind of labs indicate hyperaldosteornism? |
|
Definition
| Hypokalemia with hypertension combined with a high sodium intake. Aldosterone levels will be high |
|
|
Term
| How is hyperaldosteronism treated? |
|
Definition
| Excision of tumor or spironolactone for bilateral adrenal hyperplasia |
|
|
Term
| What characterizes adrenal medulla hyperfunction? |
|
Definition
| Norepinephrine, epinephrine, or dopamin excess |
|
|
Term
| How is adrenal medulla hyperfunction treated? |
|
Definition
| Removal of offending tumor and replacement therapy |
|
|
Term
| What is pheochromocytoma? |
|
Definition
| A rare condition where hypertension is caused by excessive amounts of plasma norepinephrine |
|
|
Term
| What is the most common cause of pheochromocytoma? |
|
Definition
|
|
Term
| What are the symptoms of pheochromocytoma |
|
Definition
| Headache, diaphoresis, palpitations, anxiety, tremor, PAROXYSMAL HTN!!, retinal hemorrhage, CVA, postural HTN |
|
|
Term
| How is pheochromocytoma diagnosed? |
|
Definition
| Plasma fractionated free metanephrines, urine analysis following an attack, clonidine suppression test, CT or MRI imaging to locate tumors, treated with excision |
|
|
Term
| What might cause lab errors in the detection of pheochromocytoma? |
|
Definition
| Drugs, foods, is common, appears similar to cocain or amphetamine use |
|
|
Term
| What causes Marfan's syndrome? |
|
Definition
| Autosomal dominant mutation on chromosome 15 coding for fibrillin-1. A minority due to inactivating mutation in TGFBR |
|
|
Term
| What are the symptoms of Marfan's? |
|
Definition
| Tall stature, long limbs, thin digits, pectus carinatum, scoliosis, kyphosis, hindfoot valgus, joint hypermobility, ocular problems, repeated pneumothorax |
|
|
Term
| What kind of ocular problems occur in Marfan's |
|
Definition
| Superiorly displaced lens, retina detachment or tears (bilateral), risk of glaucoma and early cataracts |
|
|
Term
| What is the Marfan's criteria ("Ghent nosology")? |
|
Definition
| Used in the absence of a family history of MFS to diagnose. An aortic diameter 7>2 or aortic root dissection coupled with ectopic lentis, a FBN1 mutation or a systemic score >7 is diagnostic. Ectopic lentis combined with an FBN1 mutation and an aortic aneurysm is also diagnostic |
|
|
Term
| In the presence of a family history for Marfan's, what criteria is necessary to make a diagnosis? |
|
Definition
| Ectopic lentis, a systemic score >7, aortic criterion (diameter 7>2 if 20yo+, 7>3 if 20yo-, or aortic root dissection) |
|
|
Term
| What kind of diagnostic tests could you perform to determine Marfan's? |
|
Definition
| Ophthalmic exam with dilation, transthoracic echocardiogragm at time of diagnosis and 6 months after |
|
|
Term
| How do you treat Marfan's? |
|
Definition
| Prophylactic beta-blockers to slow rate of aortic dilation, surgical repair when aortic diameter is 5cm, orthoscopy on knees, physical therapy, etc |
|
|
Term
| What causes Ehlers-Danlos (EDS)? |
|
Definition
| A defect in collagen and other ECM proteins causing fragility of tissues, joint hypermobility, skin laxity, and atrophic skin |
|
|
Term
| How is hypermobility determined? |
|
Definition
| Via the Beighton hypermobility score. >4pts indicates hypermobility |
|
|
Term
| Which type of EDS cannot be distinguished from generalized joint hypermobility? |
|
Definition
| Type III due to the absence of skin findings |
|
|
Term
|
Definition
| Characterized by spontaneous rupture of large arteries and hollow organs, shows thickened arteries and is a concern in pregnancy |
|
|
Term
| What is kyphoscoliotic EDS? |
|
Definition
| EDS with cardiovascular features such as aortic root dilation and aortic regurgitation as well as progressive scoliosis |
|
|
Term
|
Definition
| Supportive, high doses of Vit C if kyphoscoliotic, cardioselective beta blockers, genetic counseling |
|
|
Term
| What causes Osteogenesis Imperfecta? |
|
Definition
| Autosomal dominant mutations in COL1A1 which code for type I collagen |
|
|
Term
| What are the symptoms of osteogenesis imperfecta? |
|
Definition
| Excessive atypical features, short stature, scoliosis, blue sclerae, hearing loss, opalascent teeth, wormian bones, bruisability. Ca and phosphate are typically normal |
|
|
Term
| Describe type II osteogenesis imperfecta |
|
Definition
| Most severe, infants are stillborn or die soon after due to respiratory failure or multiple fractures |
|
|
Term
| Describe type III osteogenesis imperfecta |
|
Definition
| Severe bone deformity and compromised stature, limited mobility, respiratory complications, compressed brain stem and craniocervical junction |
|
|
Term
| Describe type IV osteogenesis imperfecta |
|
Definition
| Reduced stature with some bone deformity and abnormal teeth. Sclera is NORMAL |
|
|
Term
| What is the most common type of osteogenesis imperfecta? |
|
Definition
| Type I, least severe, blue or gray sclera, risk of fracture reduces during adulthood until menopause, hearing impairment is common |
|
|
Term
| How do you treat osteogenesis imperfecta? |
|
Definition
| Bisphosphonates to increase BMD, rods in long bones, physical therapy, genetic counseling |
|
|
Term
| What causes Pseudoxanthoma Elasticum? |
|
Definition
| A typically autosomal recessive mutation in ABCC6 on chromosome 16 which causes progressive calcification and fragmentation of elastic fibers |
|
|
Term
| What are the symptoms of Pseudoxanthoma Elasticum? |
|
Definition
| Manifestations in all elastic tissues, skin, eyes, vasculature, causes yellowish papules in flexor surfaces with a plucked chicken look, mottled retina, visual loss, accelerated atherosclerosis, artery occlusion, hypertension |
|
|
Term
| How is Pseudoxanthoma Elasticum treated? |
|
Definition
| Avoid gastric irritants, monitor for cardiac conditions, genetic counseling |
|
|
Term
| What are the parameters defining hypertension? |
|
Definition
Normal: <120/80
Prehypertension: <140/90
Stage I: <160/100
Stage II: >160/100 |
|
|
Term
| What is essential hypertension? |
|
Definition
| AKA primary or idiopathic, has unknown cause |
|
|
Term
| What are the parameters that determine obesity? |
|
Definition
Overweight = BMI 25-29.9
Obese = BMI >30 |
|
|
Term
| What type of heart manifestations arise due to hypertension? |
|
Definition
| Left ventricular hypertrophy, PMI displacement, murmuers, bruits, CHF, arrhythmias, MI |
|
|
Term
| What kind of kidney manifestations arise due to hypertension? |
|
Definition
| Nephrosclerosis, more common in African Americans |
|
|
Term
| What is the goal BP in chronic kidney disease? |
|
Definition
|
|
Term
| What kind of eye manifestations arise due to hypertension? |
|
Definition
| Narrowing of the arterial diameter causes AV nicking, a copper wire appearance, papilledema, and exudates and hemorrhages |
|
|
Term
| What do you give for kidney manifestations of hypertension? |
|
Definition
| ACE-I or ARB unless Cr >30% baseline |
|
|
Term
| What is the most common secondary cause of hypertension? |
|
Definition
|
|
Term
| When should chronic renal disease be suspected? |
|
Definition
| When renal insufficiency accompanies hypertension, proteinuria is found on the dipstick, and creatinine is elevated >1.2 in women or 1.4 in men |
|
|
Term
| What is renovascular hypertension? |
|
Definition
| HTN caused by decreased perfusion of the renal tissue due to stenosis of main or branching renal arteries which activated the RAA system |
|
|
Term
| When should renovascular hypertension be suspected? |
|
Definition
| If onset is before 20 or after 50, the HTN is resistant to 3 or more drugs, renal artery bruits, atherosclerotic disease is present, abrupt deterioration of renal function after ACE-I or ARB use, pulmonary edema associated with BP surges |
|
|
Term
| How is renovascular hypertension diagnosed? |
|
Definition
| Duplex doppler ultrsound, CT or MR angiography, ACE-I renography |
|
|
Term
| How does pheochromocytoma cause HTN? |
|
Definition
| Catecholamine producing tumor is suspected alongside HTN with episodic palpitaations. Requires both alpha and beta blockade |
|
|
Term
| How does hyperaldosteronism cause HTN? |
|
Definition
| Excessive aldosterone >30 |
|
|
Term
| What is resistant hypertension? |
|
Definition
| Failure to meet BP control in patients who are adherent to full doses of an appropriate 3-dose regiment |
|
|
Term
| What does HTN increase with age? |
|
Definition
| Reduced elasticity and compliance of large arteries, atherosclerosis associated accumulation of calcium and ollagen, degradation of arterial elastic, give diuretics, ACE-I, ARB, B-Blockers, Ca++ Channel Blockers |
|
|
Term
| Hypertension in adolescents requires what for diagnosis? |
|
Definition
| High BP on 3 or more separate occasions |
|
|
Term
| Which hypertension drugs are contraindicated in pregnancy? |
|
Definition
| ACE, ARB, and Renin blockers |
|
|
Term
| What is chronic hypertension? |
|
Definition
| BP >140/90 prior to pregnancy or before 20 wks gestation |
|
|
Term
| What is gestational hypertension? |
|
Definition
| HTN w/o proteinuria after 20 wks gestation |
|
|
Term
|
Definition
| HTN and proteinuria after 20 wks gestation in a previously normotensive patient |
|
|
Term
|
Definition
| Hemolysis, elevated liver enzymes, and low platelets |
|
|
Term
| How do you treat hypertension in pregnancy? |
|
Definition
| Methyldopa, Ca++ channel blockers, labetalol |
|
|
Term
| What is the first line treatment for diabetes induced hypertension? |
|
Definition
| ACE inhibitors, ARB if ACE-I is not well tolerated or contraindicated as in angioedema |
|
|
Term
| What would be reason to stop ACE-I or ARB administration in diabetes induced hypertension? |
|
Definition
| Increased creatinine and potassium levels >30% or hyerpkalemia |
|
|
Term
| What is considers a hypertensive emergency? |
|
Definition
| BP >180/110, must lower within 24-48 hrs, goal is 10-15% reduction over 30-60minutes |
|
|
Term
| What might be the chief complaints in a patient undergoing a hypertensive emergency? |
|
Definition
| Chest pain, dyspnea, neurologic deficit, blurred vision, headache |
|
|
Term
|
Definition
| A Dietary Approach to Stop Hypertension, aims to reduce SBP by 6mm Hg |
|
|
Term
| What are the characteristics of Thiazide diuretics when used to treat hypertension? |
|
Definition
| Contraindicated in gout and erectile dysfunction, often used for stage 1 HTN, more potent in blacks and elderly, has cross sensitivity to sulfonamides except Ethacrynic acid |
|
|
Term
| What are the characteristics of loop diuretics when used to treat hypertension? |
|
Definition
| Includes Furosemide, Ethacrynic acid, and Bumetabide, better in patients with renal insufficiency, may cause hypokalemia so potassium supplements may be necesary |
|
|
Term
| What are the characteristics of Triamterene and Amiloride when used for hypertension? |
|
Definition
| Are potassium sparing diuretics, can cause hyperkalemia or kidney stones, contraindicated in elevated k+ |
|
|
Term
| What are the characteristics of Spironolactone and Eplerenone when used for hypertension? |
|
Definition
| Potassium sparing, mineral corticoid receptor antagonist diuretics, used for CHF and resistant hypertension, contraindicated in elevated K+, may cause gynecomastia |
|
|
Term
| When are beta blockers used to treat hypertension? |
|
Definition
| In patients with MI, angina, or migraine headache. Contraindicated in heart block, asthma, COPD, depression, and amphetamine use. Cautioned in type I diabetes |
|
|
Term
| What are the characteristics of Ca++ channel blockers used in the treatment of hypertension? |
|
Definition
| Amlodipine, Nifedipine, Felodipine, etc, causes peripheral vasodilation, useful in blacks and elderly, do NOT use as monotherapy if proteinuria is present, do not mix with grapefruit |
|
|
Term
| What are the characteristics of ACE inhibitors used in the treatment of hypertension? |
|
Definition
| Benazepril, Captopril, Enalapril, etc. Used for diabetes and CHF associated HTN, contraindicated in pregnancy, bilateral renal stenosis, and hyperkalemia |
|
|
Term
| What are the characteristics of angiotensin receptor blockers (ARBs) used to treat hypertension? |
|
Definition
| Candesartan, Irbesartan, Losartan, Valsartan, etc., used in diabetes and CHF induced HTN, contraindicated in pregnancy, bilateral renal stenosis, and hyperkalemia |
|
|
Term
| What are the characteristics of the alpha-blockers used in the treatment of hypertension? |
|
Definition
| Prazosin, Terazosin, Doxazosin, etc., lowers peripheral vascular resistance, not first line, used with urinary outflow obstructions, contraindicated in left ventricular dysfunction |
|
|
Term
| What drug is used in EtOH withdrawal induced hypertension? |
|
Definition
|
|
Term
| What central alpha andrenergic agonist is used to treat hypertension in pregnant women? |
|
Definition
|
|
Term
| Beta Blockers are used to treat hypertension alongside what comorbidities? |
|
Definition
| Heart failure, post MI, high CVD risk |
|
|
Term
| ACE Inhibitors are used to treat hypertension alongside what comorbidities? |
|
Definition
| Heart failure, post MI, diaetes, chronic kidney disease, recurrent stroke prevention |
|
|
Term
| Angiotensin Receptor Blockers (ARBs) are used to treat hypertension alongside what comorbidities? |
|
Definition
| Heart failure, diabetes, chronic kidney disease |
|
|
Term
| Aldosterone antagonists are used to treat hypertension alongside what comorbidities? |
|
Definition
|
|
Term
| Thiazides are used to treat hypertension alongside what comorbidities? |
|
Definition
| Heart failure, high CVD risk, diabbetes, recurrent stroke prevention |
|
|
Term
| Ca++ Channel blockers are used to treat hypertension alongside what comorbidities? |
|
Definition
|
|
Term
| What drugs can cause an increase in blood pressure? |
|
Definition
| Oral contraceptives and NSAIDS as well as EtOH and sympathomimetics such as meth |
|
|
Term
| What does ABCD and HE MAN stand for (treatments for HTN) |
|
Definition
| ACEI/ARB, B-Blockers, Ca++ Ch blockers, Diuretics, Hydralzine, Eplerenone/spironolactone, Minoxidil, Alpha blockers, Nitrates |
|
|
Term
|
Definition
| The MOST COMMON bone disorder characterized by low bone mass and microarchitectural deterioration of bone tissue, more common in white and asian women |
|
|
Term
| Bone mass density loss reflects what? |
|
Definition
| An imbalance between resorption and formation |
|
|
Term
| How is estrogen related to osteoporosis? |
|
Definition
| Estrogen reduces bone resorption, lack of estrogen such as in menopause contributes to osteoporosis |
|
|
Term
| What is the rate of bone loss during menopause? |
|
Definition
| 2.5% per year for 2-5 years following menopause with a gradual tapering afterwards |
|
|
Term
| What are the nonmodifiable risk factors for osteoporosis? |
|
Definition
| Age, female gender, history of fracture, family history, GI disease |
|
|
Term
| What are the modifiable risk factors for osteoporosis? |
|
Definition
| Low body weight, estrogen deficiency, poor nutrition, smoking, alcohol, sedentary lifestyle, low calcium, hyperthyroidism, hypercortisolism, hyperparathyroidism |
|
|
Term
| What are the most morbid and deadly type of fracture? |
|
Definition
|
|
Term
| What is the most common type of fracture? |
|
Definition
| Vertebral fracture, 2/3 of all fractures are silent |
|
|
Term
| What measures can be taken to prevent osteoporosis? |
|
Definition
| Adequate dietary Ca++ and vit D, phosphorus, and magnesium. Exercise! |
|
|
Term
| How is osteoporosis diagnosed? |
|
Definition
| DEXA scan following an acute fracture |
|
|
Term
| A DEXA scan measures what? |
|
Definition
| Bone density, not quality, via detecting changes in trabecular bone central measurements are more reliable |
|
|
Term
| What is a T-score on a DEXA scan? |
|
Definition
| Compared current BMD to mean peak BMD of normal young adults of the same gender. Normal = above 1 stdev, Osteopenia = 1 to -2.5 stdev, Osteoporosis = below 2.5 stdev, used in postmenopausal women |
|
|
Term
| What is a Z score on a DEXA scan? |
|
Definition
| Based on the difference between an individuals BMD and the mean of reference population of same gender, age, ethnicity, used in premenopausal women under 50 |
|
|
Term
| DEXA is recommended for whom? |
|
Definition
| Women over 65, men over 70, women under 65 w/1 or more risk factor, postmenopausal womenw ith fractures |
|
|
Term
| How do you treat osteoporosis? |
|
Definition
| Ca++, vit D, exercise, estrogen modulaters, terparatide (PTH), calcitonin, estrogen, Denosumab, bisphosphonates |
|
|
Term
| What are the characteristics of Central Diabetes Insipidus |
|
Definition
| No secretion or production of ADH. Primary is idiopathic, secondary is due to trauma to the hypothalamus or pituitary stalk |
|
|
Term
| What are the characteristics of vasoprssinase induced diabetes insipidus? |
|
Definition
| Occurs in 3rd trimester of prgnancy accompanied by oligohydramnios, preeclampsia, and hepatic dysfunction, An enzyme within the blood destroys native vasopressin |
|
|
Term
| What are the characteristics of nephrogenic Diabetes Insipidus? |
|
Definition
| A defect in kidney tubules interferes with response to ADH and water resorption. Congenital due to aberrant expression of renal vasopressin V2 receptors |
|
|
Term
| What can cause nephrogenic D.I.? |
|
Definition
| Acquired through pyelonephritis, amyloidosis, myeloma, Sjogren's syndrome, SICKLE CELL**, or use of corticosteroids, demeclocycline, lithium, foscarnet, or methicillin |
|
|
Term
| What is the difference between diabetes insipidus and primary polydipsia? |
|
Definition
| DI prefers cold beverages and results in urine osmolarity that is LESS than plasma, unlike polydipsia |
|
|
Term
| What would you expect in a water depletion test in individuals with diabetes insipidus? |
|
Definition
High dilute urine output with suppressed ADH levels if central, normal or increased levels of nephrogenic
When ADH is administered after urine omsolarity plateau, central DI urine osmolarity increases above plasma, nephrogenic DI increases by < 50% |
|
|
Term
| When should you stop administering a water depletion test? |
|
Definition
| If the patient goes hypertensive |
|
|
Term
| How do you treat central Diabetes Insipidus? |
|
Definition
|
|
Term
| Now do you treat nephrogenic Diabetes Insipidu? |
|
Definition
| Treat underlying cause, maintain sodium and water balance |
|
|
Term
| What are the characteristics of inappropriate ADH secretion? |
|
Definition
| Water retention, hyponatremia, decreased plasma osmolarity, urine osmolarity is inappropriately concentrated in relation to low plasma osmolarity, is higher than plasma |
|
|
Term
| How is inappropriate ADH secretion diagnosed? |
|
Definition
In the absence of nephrogenic syndrome, cirrhosis, or CHF
In the presence of normal renal, adrenal, and thyroid function |
|
|
Term
| What causes inappropriate ADH secretion? |
|
Definition
| Small cell cancer, Tb, pneumonia, abscess, meningitis, head trauma, tumors, lymphoma, etc. |
|
|
Term
| How do you treat inappropriate ADH secretion? |
|
Definition
|
|
Term
| What is oxytocin used for? |
|
Definition
| Inducing labor and controlling post-partum uterine hemorrhage, induces the secretion of vasopressin in response to low pressure atrial volume receptors |
|
|
Term
|
Definition
| Disorder of iron metabolism and deposition characterized y excessive Fe absorption |
|
|
Term
| What causes Hemochromatosis? |
|
Definition
| HFE gene mutation, usually an autosomal recessive mutation |
|
|
Term
| What are the clinical manifestations of hemochromatosis? |
|
Definition
| Hepatomegaly, cirrhosis, diabetes, GRAY HYPERPIGMENTATION, arthropathy, pseudogout, cardiac involvement, hypogonadism, increased risk of infection |
|
|
Term
| What is the classic presentation of hemochromatosis? |
|
Definition
| Cirrhosis, bronzed diabetes, and grey skin hyperpigmentation |
|
|
Term
| Due to awareness, what has become the typical presentation for hemochromatosis? |
|
Definition
| Fatigue, impotence, destructive arthropathy in the 2nd or 3rd metacarpophalangeal joints |
|
|
Term
| What is the best screening test for hemochromatosis? |
|
Definition
| >45% transferrin saturation, is more common in men, 20-40% is normal |
|
|
Term
| What is the gold standard for diagnosing hemochromatosis? |
|
Definition
| Liver biopsy for ferritin >1000 (otherwise not required_ |
|
|
Term
| How is hemochromatosis treated? |
|
Definition
Phlebotomy every week until ferritin <50ng/ml
Desferoxamine if iron overload is secondary due to dyserythropoiesis
Avoid vitamin C supplements! Liver transplants don't work |
|
|
Term
| What are the characteristics of Wilson's disease? |
|
Definition
| Defective exretion of copper due autosomal recessive mutation in gene ATP7b |
|
|
Term
| How is copper normally metabolized? |
|
Definition
| Absorbed in small intestine, stored in liver, bound in serum to ceruloplasmin, excreted into bile canaliculi |
|
|
Term
| What are the symptoms of Wilson's disease? |
|
Definition
| Coomb's negative hemolytic anemia, nephrolithiasis, cardiac arrhythmias, rabdomyolysis arthralgia, endocrine dysfunction, Kayser-Fleischer ring in the cornea**, face of a giant panda on MRI |
|
|
Term
| How is Wilson's disease treated? |
|
Definition
| Lifelong treatment, low copper diet, D-penicillamine, zine acetate/sulfate to produce copper chelator metallothionein, vitamin E to reduce oxydative damage |
|
|
Term
| What is Fulminant Wilson's disease? |
|
Definition
| Severe hemolytic anemia accompanying Wilson's disease, liver transplant is only treatment/cure |
|
|
Term
|
Definition
| Genetic acquired disease associate dwith enzyme deficiencies in the heme synthesis pathway |
|
|
Term
| What are the two classes of porphyrias? |
|
Definition
| Bone marrow (85%) and hepatic |
|
|
Term
| What defines acute intermittent porphyria? |
|
Definition
| Autosomal dominant, has 50% or greater deficiency of porphobilinogen deaminase, causing the accumulation of ALA and BPG. Causes abdominal pain, neuropathy, sympathetic tone, CNS symptoms |
|
|
Term
| What can trigger a porphyria attack? |
|
Definition
| Parbituates, carbamazepine, sulfonamides, estrogens, ethanol, caloric restrictions, stressors |
|
|
Term
| How do you treat acute intermittent porphyria? |
|
Definition
| Opiates, beta blockers, hematin to reduce duration and severity, increased CHO intake to amerliorate attacks |
|
|
Term
| What defines porphyria cutanea tarda? |
|
Definition
| Uroporphyrinogen decarboxylase deficiency, is the most common porphyria |
|
|
Term
| How does Porphyria Cutanea Tarda manifest? |
|
Definition
| Accumulation of uroporphyrinogen in skin as it absorbs light, causes vesicles, bullae, fragile skine. Triggered by alcohol, hormones, iron overload (hemochromatosis), hep C |
|
|
Term
| How do you treat porphyria cutanea tarda? |
|
Definition
| Avoid triggers, phlebotomy, hematin, and chloroquine. Monitor total plasma porphyrin concentration and follow hematocrit and ferritin to prevent Fe-deficiency anemia |
|
|
Term
| What causes erythropoietic porphyria? |
|
Definition
| A ferrochelatase deficiency that causes the accumulation of protoporphyrin in response to brief sun exposure |
|
|
Term
| Lead exposure is accumulated with what? |
|
Definition
| Neurotoxicity, bone marrow and renal toxicity, hypertension, low birth weight, developmental defects |
|
|
Term
| How do you treat lead poisoning? |
|
Definition
| Chelation with DMSA, edentate calcium disodium, dimercaprol |
|
|
Term
| How does mercury poisoning progress? |
|
Definition
| INhalation, pneumonitis, noncardiogenic pulmonary edema, death. Birth exposure causes poor neurobehavioral performance or derangement |
|
|
Term
| How is mercury poisoning treated? |
|
Definition
| Emesis, gastric lavage, dimercaprol, DMSA, penicillamine |
|
|
Term
| How does symptomatic renal disease present? |
|
Definition
| High BP, Edema, Gross Hematuria, “bubbly urine” (Proteinuria or nephrotic) |
|
|
Term
| What is the first step in the evaluation of renal disease and nephrology? |
|
Definition
|
|
Term
| What do you use to stage the patient during evaluation of renal disease? |
|
Definition
|
|
Term
| How long does acute renal failure last? |
|
Definition
|
|
Term
| How long does chronic renal failure last? |
|
Definition
|
|
Term
| What qualifies as end stage renal disease? |
|
Definition
|
|
Term
| What are the characteristics of acute renal failure? |
|
Definition
| Acute rise in BUN and creatinine, decreased GFR, reversible, usually due to renal insult |
|
|
Term
| What are the characteristics of chronic renal failure |
|
Definition
| Progressive loss of renal function, history of renal disease, previously documented BUN/Creatinine rise, small kidneys, irreversible, end stage renal disease |
|
|
Term
| When do kidneys reach their peak GFR? |
|
Definition
| 40yo, declines 1cc/min per year thereafter |
|
|
Term
| What is the difference between azoetemia and uremia? |
|
Definition
| Both have increased BUN and creatine but uremia is symptomatic and signified end stage renal disease |
|
|
Term
| What is oliguria? Anuria? |
|
Definition
| Oliguria is decreased urine output (500cc is normal), anuria is almost zero urine output |
|
|
Term
| What are the indications for dialysis |
|
Definition
| Poisoning, uremia, uremic encephalopathy, fluid w/ pulmonary edema, CHF, acidosis, hyperkalemia, pericarditis |
|
|
Term
| Urinalysis is also colloquially referred to as what? |
|
Definition
| "A poor man's renal biopsy" |
|
|
Term
| What constitutes abnormal proteinuria? |
|
Definition
|
|
Term
| What is nephrotic syndrome? |
|
Definition
Proteinuria with >3.5gm/24hr urine
Urine is usually bubbly |
|
|
Term
| What is known as the index of overall renal function? |
|
Definition
|
|
Term
| What is the best test for measuring GFR? |
|
Definition
|
|
Term
| What is the most common test used for measuring GFR? |
|
Definition
Creatine Clearance Test
CrCl = [(140-age) x KBW]/(72 x Creatinine) x 0.85 for females |
|
|
Term
| What radionuclide study assesses functional renal mass? |
|
Definition
| Technetium dimercaptosuccinate |
|
|
Term
| What radionuclide study assesses renal plasma flow |
|
Definition
| Radioiodinated orthoiodohippurate |
|
|
Term
| What are the characteristics of renal ultrasounds? |
|
Definition
| non-invasive, no contrast, assess size & # of kidneys, mass/cyst, assess obstruction, screen congenital diseases i.e. PCKD, evaluate perirenal space, guide in invasive procedures: biopsy, assess bladder for urinary retention: post void residual volume, Assess calculi |
|
|
Term
| What is the function of Intravenous Pyelography? |
|
Definition
| Assess function & structure of the urinary tract. Is unfortunately very nephrotoxic, IV contrast is preferred |
|
|
Term
| What are the pros and cons of CT vs. MRI renal studies? |
|
Definition
| CT for masses, MRI for solid lesions |
|
|
Term
| What are the indications for performing a renal biopsy? |
|
Definition
| Unexplained ARF, Unexplained hematuria, Nephrotic/Nephritic syndrome, Treatment guidelines i.e.SLE, Suspect renal transplant rejection* |
|
|
Term
| What is Microscopic Hematuria? |
|
Definition
| More than 2 RBCs per HPF in microscopic examination of urine |
|
|
Term
| What causes microscopic hematuria? |
|
Definition
| Red cells lyse when urine is spun, hence lower numbers in centrifuged urine. HPF’s are given in ranges since different fields will have a different RBC count. No truly normal number of RBC’s in urine except zero |
|
|
Term
| What are the risk factors for urothelial (transitional cell) carcinoma? |
|
Definition
| Age, Male sex, Cigarette smoking, Occupational carcinogen exposure, Aristolochic acid, Radiation, Analgesics, upper urinary tract cancer |
|
|
Term
|
Definition
| red/brown urine. Does not necessarily mean much blood is lost in the urine. |
|
|
Term
| Red urine with no hematuria signifies what? |
|
Definition
| Hemoglobin and Myoglobin in the urine (Hemolysis – Rhabdomyolysis) |
|
|
Term
| What are the classic examples of drug-induced red urine? |
|
Definition
| Phenazopyridine and rifampine |
|
|
Term
| What would rule out glomerular bleeding? |
|
Definition
| The presence of clots, likely source is bladder |
|
|
Term
| What indicates glomerular bleeding? |
|
Definition
|
|
Term
| What might cause urine to turn brown? |
|
Definition
| The conversion of hemoglobin (red) to methemoglobin (brown) during the long transit time and chemical environment in the tubules |
|
|
Term
| What is the primary concern with CT urography |
|
Definition
| A major concern with CTU is the relatively high radiation dose |
|
|
Term
| What is the primary concern with IV pyelograms? |
|
Definition
| IV contrast exposure is a concern in patients with abnormal renal function, not performed anymore |
|
|
Term
| What is the best test for looking at renal veins or arteries? |
|
Definition
|
|
Term
| Renal cytoscopy is best used for what? |
|
Definition
| Very sensitive for malignancies, can visualize the entire bladder. It is the only modality that permits visualization of the prostate and urethra |
|
|
Term
| What three disorders account for most cases of persistent isolated hematuria due to glomerular disease |
|
Definition
| IgA nephropathy, Hereditary nephritis (Alport syndrome), and thin basement membrane nephropathy |
|
|
Term
| What is is the most common cause of primary glomerulonephritis? |
|
Definition
| IgA nephropathy, more common in females, most common in asians and |
|
|
Term
| The presence of IgA nephropathy is established via what? |
|
Definition
|
|
Term
| The pathognomonic finding of IgA nephropathy is found how? |
|
Definition
| immunofluorescence microscopy |
|
|
Term
| How does IgA nephropathy present? |
|
Definition
| One or recurrent episodes of gross (or microscopic) hematuria*, usually following an upper respiratory infection. Also usually has mild proteinuria |
|
|
Term
| How do you treat IgA nephropathy? |
|
Definition
| Angiotensin converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARB) both for blood pressure control and to slow progression of the renal disease. Immunosuppressive therapy using glucocorticoids and cytotoxic agents also works |
|
|
Term
| Hereditary Nephritis, aka Alport syndrome, is often accompanied by what seemingly unrelated symptom? |
|
Definition
| Sensorineural hearing loss and ocular abnormalities |
|
|
Term
| How does Alport syndrome initially present? |
|
Definition
| Asymptomatic persistent microscopic hematuria, which is present in early childhood in affected patients |
|
|
Term
| What causes Alport syndrome? |
|
Definition
| X-linked basement membrane disorder arising from mutations in genes encoding several members of the type IV collagen protein family |
|
|
Term
| What is characteristic of thin basement membrane nephropathy? |
|
Definition
| Persistent or intermittent asymptomatic microscopic hematuria, long-term prognosis is excellent in most patients, relatively benign |
|
|
Term
| Exercise-induced gross hematuria should be differentiated from what two other potential causes of red to brown urine following exercise? |
|
Definition
| Myoglobinuria due to rhabdomyolysis and march hemoglobinuria (soldiers marching for a long time may cause enough trauma to the RBCs) |
|
|
Term
| When is evaluation of exercise induced hematuria warranted? |
|
Definition
| If age is over 50 or it persists over a week |
|
|
Term
| 28 year old man, previously healthy, presented with gross hematuria and severe left flank pain, U/A microscopy reported as packed RBCs and 20 WBCs per HPF, LE positive, Nitrite negative |
|
Definition
|
|
Term
| 18 year old previously healthy woman presented with Cola-colored urine, BP:185/92cr:2.8, had a sore throat 9 days ago, urine shows Acantocytes |
|
Definition
| Post-infectious glomerulonephritis |
|
|
Term
| 26 year old man, admitted under your service for fever and gross hematuria, he tells you that he gets this “urine infections” whenever he has a cold and it goes away in a few days with Antibiotics, he is under care of a urologist and extensive workup has been inconclusive |
|
Definition
|
|
Term
| 29 year old healthy pregnant woman, 20 weeks pregnant, comes to your office complaining of seeing clots in her urine, she is anxious otherwise feels ok |
|
Definition
| UTI, clots in the urine without other symptoms is the classical presentation of UTI in pregnant women |
|
|
Term
| What is the normal range of serum calcium? |
|
Definition
|
|
Term
| What is the most common cause of outpatient hypercalcemia? |
|
Definition
| Primary hyperPTH, more than 1/2 are asymptomatic |
|
|
Term
| What is the primary regulator of VitD absorption and processing? |
|
Definition
|
|
Term
| What is the main target of activated VitD? |
|
Definition
| Ca++ absorption in the gut |
|
|
Term
| Lack of VitD causes what? |
|
Definition
| Secondary hyperparathyroidism |
|
|
Term
| How might you observe both primary and secondary hyperPTH in a patient? |
|
Definition
| Gently correct Vit. D deficiency and see how patient respond. If PTH is still elevated, they have both primary and secondary |
|
|
Term
| How are calcium and albumin connected? |
|
Definition
| Because calcium is at least 40% protein bound, alteration of serum albumin levels may affect the total calcium reading |
|
|
Term
| What is Milk-Alkalai Syndrome? |
|
Definition
| HypoPTH caused by excessive intake of Ca2 |
|
|
Term
| How do the majority of hyperPTH patients present? |
|
Definition
| Asymptomatically, Renal calculi or nephrocalcinosis as well as hypertension are found in upwards of 50% of symptomatic hyperPTH patients |
|
|
Term
| What is the most common cause of hyperPTH? |
|
Definition
|
|
Term
| How does MEN I PHP present? |
|
Definition
| HyperPTH (>95%), pancreatic (Gastrin or Insulin), pituitary (Prolactin) |
|
|
Term
| How does MEN II PHP present? |
|
Definition
| Medullary Thyroid cancer (100%), parathyroid hyperplasia (50-70%) and bilateral pheochromocytomas (50%) |
|
|
Term
| What is the most common cause of hypercalcemia in hospitalized patients? |
|
Definition
|
|
Term
| What are some rare causes of hypercalcemia? |
|
Definition
| Thiazides: lower urinary calcium excretion, HypervitD (both types): increases calcium absorption and promoting bone resorption, Lithium: increases set point for CaSR to suppress PTH |
|
|
Term
| The VITAMIN TRAP mnemonic for hypercalcemia represents what? |
|
Definition
Vitamins, Immobilizatin, Thyrotoxicosis, Addison's, Milk-alkali, Inflammatory, Neoplasm, Sarcoidosis,
Thiazides, Rhabdomyolysis, AIDS, Pagets
and lithium |
|
|
Term
| What is the ONLY cure for primary hyperparathyroidism |
|
Definition
| Parathyroidectomy, replace Vit D stores in deficient patients |
|
|
Term
| How doe Calcimimetics help treat hyperparathyroidism? |
|
Definition
| Increases the sensitivity of the CaSR to ionized calcium |
|
|
Term
| What might cause a phosphate deficiency? |
|
Definition
| Malnutrition, ICU, breast cancer, prostate cancer, DKA treatment via glu 6-phos |
|
|
Term
| What might magnesium depletion cause in long term hospital patients? |
|
Definition
|
|
