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52 Cards in this Set
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25 y/o male patient c/o headaches, visual changes, weight gain, heat intolerance increase shoe size and hands seem swollen. His exam is normal except for BP of 170/100, what is a possible diagnosis? What is causing this change?
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pituitary adenoma
treatment - transsphenoidal pituitary microsurgery |
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A 22 y/o male presents with the c/o fatique dizziness and 20lb weight loss. he also has become very hyperpigmented. His BP is 90/70. His Na is low at 115 Eq/L. K is elevated at 6.2 m Eg/L. Calciu elevated at 12 mg/dl and urea elevated at 9 mg/dl. What is going on?
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Addison's disease and these findings are clssic with increased plasma ACTH and decreased cortisol. The ACTH stimulation test would hav eo response
Most commonly due to autoimmune destructio n ofthe adrenal gland |
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A 25 yo has increased thrist and urination over the past week. She is on no meds except for Lithium for her bipolar disorder which she starte 12 weeks ago. Her BP is normal. What is this?
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Patient has nephrogenic DI. The kidney is not responding to ADH becasue of the lithium. Severe hypokalemia can do this as well
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A 37 yo female has been noted by nurse at work to have BP of 190/110. She has fatigue thirst, frequency and nocturia. Na is increased at 250 and K is low. You not a hypokalemic metabolic acidosis
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Patient has conn's syndrome - primary hyperaldosteronism possibly due to adenoma of adrenal cortex (surger) or hyperplasia of the adrenal cortes. (spironolactone).
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A 40 year old female c/o pruritis, constipaton, she has hx of Peptic ulcer disease and kidney sotnes. Blood work shows elevated serum calcium, low phosphate. What is this?
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Hyperparathyoidism. These patients develop calcium oxalate stoens. Peptic ulcer disease sien cthe calcium stimulates gastrin release, acute pancreatiits since calcium activates phospholipases, bradycardia, pseduogout. Salt and skull subperiosteal resorption of bone from 2nd and 3rd middle phalanges
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Type I hypersensitivity
alternative name? Associated diseases? Mediators |
Immediate hypersensitivity
Atopy, anaphylaxis, ASthma IgE |
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Type II hypersensitivity
alternative name? Associated diseases? Mediators |
Antibody mediated hypersensitive
autoimmune hemolytic anemia, goodpasture's diease, ertyhroblastosis fetalis, IgG or Igm and complement |
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Type III hypersensitivity
alternative name? Associated diseases? Mediators |
Immune comple- mediated hypersensitivity
Serum sickness, arthus reaction, lubus nephritis IgG and complement |
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Type IV hypersensitivity
alternative name? Associated diseases? Mediators |
Delayed hypersensitivity
transplant rejection, contact dermatitis, tuberculosis T cells, macrophages, |
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37 year old femal presents with c/o swelling of hteupper lip. This started after taking her hypertension medication. Which medication may be asociated with this?
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Angioedema has been associated with ACE in hibotiors, and now ARBS, also NSAID's esp COX-2 inhibitors
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Normal range of Creatinine
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0.8 ot 1.3
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BUN measures?
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measures amount of nitrogen in the blood in the form of urea.
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What is a more precise test of kidney function
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cystatin C - not generally used
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What is normal specific gravity of urine
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1.010 to 1.030
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what is normal pH of urnie
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4.8 to 7.5
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How much is Total body water in men and women
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women 0.5 x weight
men 0.6 x weight |
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what is normal potassium
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3.5 to 5.0
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What is normalbicarbonate
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22 to 26 meq
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What is SIADH
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releaseo f ADH or enhanicemnet of ADH casuign water retetnion and hyponatremia
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what is the difference between central Diabetes Insipidus and nephrogenic diabetes insipidus
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central - not enough ADH
nephrogenic renal tubules do not respond to ADH |
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Metabolic acidosis
What is the .. prmary disturbance, compensatory factor |
primary disturbance - decreased HCO3
compensatory factor - Increase PaCO2 |
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Metabolic Alkalosis
What is the .. prmary disturbance, compensatory factor |
Primary disturbance - increases HCO3
Compensatory factor - Increased PaCO2 |
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Respiratroy aciodsis
What is the .. prmary disturbance, compensatory factor |
Primary disturbance - Incrased PaCO2
compensatory factor - Increased HCO3 |
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Respiratory alkalosis
What is the .. prmary disturbance, compensatory factor |
Primary disturbance - Decrease PaCO2
Compensatory factor - Decrase HCO3 |
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Normal PO2 is...?
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80-100
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Normal PCO2 is...?
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35-45
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Normal HCO3 is...?
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22-28
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normal pH is ...?
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7.35 - 7.45
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A 30 y/o male comes to the ER with a c/o severe right sided flank pain radiating to the groin and testicle. It siassociated with hematuria, urinary frequency, urgency and dysuria. What is a likely diagonisis
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kidney stones
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What is the most common compostion of a kidney sotne
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calcium oxalate
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What is nephrolitiasis
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formation of crystal aggragates in the urinary tract that results in kidny stones,
patietns often present with flank pian |
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What could cause metabolic acidosis
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an abnormal loss of fixed acid from the body or by abnormal accumulaito or broductionf blood base. Often cause by vomiting
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A 72 y/o male presents with COPD. During the past 2 days he ahs expeirience a worsenign of cough, fever and yellow sputum. His RR is 26/min and he is using his accssory muscle to breath.
ABG shows ph 7.24 -- paO2 -- 54 -- SaO2 88% -- PaCO2 60 -- HCO3 18 |
???
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Anion gap formula
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anion gap =
Na - (Cl + HCo3) |
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What are the two types of metabolic acidosis
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1) accumulationf fixed acid and therefore high anion gap
2) those associate with loss of base adn therefore normal anion gap |
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What are the casue of metabolic acidosis associated with increased anion gap
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Methanols intoxication
Uremia Diabetic keoacidosis Paraldehyde Isoniazide Lactic acidosis Ethanol Rhabdomyolysis Salicylates |
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treatment for ingesting ethylene glycol?
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administer crystalloids
possible bicarbonate (controversial) possibly pyrioxine and thiamine |
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What are common cause of DKA
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infection, disruption fo insulin, new onset diabetes
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Treatment of DKA
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FLUIDS, FLUIDS FLUIDS
potassium replacement insulin |
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Glomerulonephritis
is... causes of it... treatment... |
inflammation of the blood vessels of the kidney
numerous causes : infection, autoimmune isencorein, vaculitis treat underlyijng problem |
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Neprhitic syndrome is...
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a condition charaterized by having smal pores int eh podocytes of the glemreulus large enough to perit proeitns and red blood cells ot pass in to the urine
also associated with mild hypertension and uremia |
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Nephrotic syndrome
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Kidneys leak protein
>3 grams per day associate with hypoalbuminemia, hyperlipedemia and anemia can be associate with infection and malignancies |
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Diabetic Neprhopathy
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usually after 15 years of dm
glomerular sclerosis proteinuria treat with ACE or ARB |
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Stages of renal disease - associated GFR
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stage 1: GFR >90
2: 60-89 3: 30-59 4: 15-29 5: <15 |
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what happens in chronic renal disease
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gradually lose renal function, increase serum creatinine, increase blood pressure, urea accumulates leading to azodtemia and possib ly uremia, fluid overload syndroms, hyperphospatemia, metabolic acidosis
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symptoms of depression
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agitation, restlessness andirritability --dramatic change in appetite -- exteme difficult concentrating -- fatique and laco fo energy -- feelings of hopelessness and helplessnes -- feeling so f worthlessens inactivy and withdrawal from usual activities, -- thought sof death or suicide -- trouble sleeping excessive sleeping
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Post Traumatic stress disorder diagnostic symptoms
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flashback, avoaidance of stimuli associated with the taruma , nightmares, difficulty fall assleep or staying asleep, anger, hyper vigilance, anger
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Bipolar Disorder general description
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periods of elevated or irritable mood (mania) alternating with period s f depression -- mood swings between mania dn depression can be ver abrup -- usualy appears between ages 15-25
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Types of bipolar disorder
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Type I -- have had at least one fully manic episode with periods of major depresson. In the past, bipolar disorder type I was called manic depression
type II - have never expreinced full fleged mania. Instead they experience periods of hypomania (elevated levels of energy and impulsvienss that are nto as extreme ast hesymptoms of manis) The shypomanic periods alternate with episodes of depression. Type II -- mild form of bipolar disorder called cyclothymia involve sless sever mood swings with altoernating hypomania and mild depression may be misdiagnosed as depressed |
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Schizophrenia
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a mental disorder that makes it difficult to tell the difference between real and unreal experiences, to think logically, to have nomral emotion responses, and to behae normally in social situation
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symptoms of schizophrenia
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Delusions - beliefs that have no basis in reality
hallucination : especially audible hallucinations but could be any senses disorganized speech, disoragnaize behavior catatonic behavior |
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EArly signs of dementia
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language problems such as trouble finding the name of familiar objects, misplacing items, getting lost, personality changes and loss fo social skills, losing interestin things you previously enjoyed, flat mood
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