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87 Cards in this Set
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What is the osmolarity of NS, LR, |
Isotonic |
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What is the osmolarity of 3%NS, D5W 1/2NS, D5W LR? |
Hypertonic |
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What is the osmolarity 1/2 NS and D5W 1/2 NS and D5W |
Hypotonic |
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What is the normal range of serum osmolarity?tt |
280-300 mOsm/kg |
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What condition does normal saline causes? |
Hyperclorimic acidosis, which is associated with AKI and Inc mortality |
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What does the patient's osmolality tell you? |
Whether they are dehydrated, has excess water in serum or have access or deficiency in sodium, glucose and urea |
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What is the normal range of serium sodium? |
135-145 |
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Associated with briard range of neurological manifestation |
Hyponatremia |
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Hyponatremia diagnostic labs |
BMP, serum osmolality, plasma osmolality, triglycerides, TSH, urine sodium, urine osmolality |
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Isotonic hyponatremia |
Lab error-toomuch protein or triglyceride |
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Hypertonic hyponatremia |
Hyperglycemia, mannitol, sorbitol, glycerol, Maltese and radioconstrast agents |
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Treatment for hypertonic hyponatremia? |
Trest the underlying issue ( give fluid, insulin in DKA pts) |
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Pts comes into the hospital with diabetic ketoacidosis. You check a blood sugar and it come back 600, and the sodium BMP comes back at 126 |
Hypertonic hyponatremia |
How do you treat-give insulin |
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Hypotonic hyponatremia hypervolemic |
Congestive HF, liver disease, Arenal failure |
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Hypotonic hyponatremia hypovolemic |
Dehydration, vomit, diarrhea, sweat and renal salt loss (diuretics, ace inhibitors, nephropathy, sodium wasting syndrome, mineralocorticoid deficiency) |
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Low urine sodium concentration <10-20 meq/L |
Nonmetallic cause- dehydration, vomiting, diarrhea and sweat |
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High urine sodium >20 meq/L |
Renal cause ( diuretic mc thiazides, Ace inhibitors) |
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Euvolemic hypotonic hyponatremia |
Problem with ADH ( SIADH) MC |
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Inc. ADH ( inappropriately concentrated urine >100 |
MC cause is SIADH, hypothyroidism, postoperative hyponatremia |
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Decreased ADH (diluted urine with urine osmolality <100 |
MC Primary polydipsia. Beer potomania (alcohol inhibits ADH) |
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Treatment for hypotonic hyponatremia |
Acutely-hypertonic saline (3%NS) Chronic-sodium chloride tablets and fluid restriction, NS |
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Fast rate correction can lead to what condition? |
Osmotic demyelination syndrome (ODS) |
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What labs do you want for hypernatremia? |
BMP, serum osmolality, urine osmolality and urine electrolytes |
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Hypernatremia |
Too much salt, diabetes insipid, mineralocorticois excess ( hyperaldosteroism, Cushing disease) |
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Treatment for hypernatremia |
Goal is to replace free water deficit ( isotonic fluid) |
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Normal potassium range? |
3.5-5 meq/L |
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What are the most common way to lose potassium (hypokalemia)? |
1. Not enough intake (alcoholic patient), or too much loss through kidney and gut 2.K+ shift from blood to cells 3. Hyperalosteronism (rare) |
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What cause K+ to shift from blood to cells |
Insulin, beta adrenergic activity, alkalosis, Elevated PH in the cells |
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What are drugs that inc K+ excretion? |
Steroid, diuretic |
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Drugs that push K+ into the cells? |
Insulin administration and beta agonist (IV or nebulized) |
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What are the causes of hyperkalemia? |
Inc K+ release from cells, renal impairment, medication ( insulin deficiency, beta blockers, metabolic or respiratory acidosis) |
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Seroius manifestation of hyperkalemia |
>7meq/L. Muscle weakness of paralysis, cardiac manifestation, reduced urinary acid excretion-metabiloc acidosis |
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Hyperkalemia treatment? |
IV calcium gluconate ( stabilize ecg), insulin and beta agonist, diuretics and prevention |
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Ekg findings in hypokalemia |
St segment depression, flattened T wave and U wave |
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Ekg finding in hyperkalemia |
Peaked T wave, prolong PR intervals, ST depression, widened QRS |
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Normal calcium |
8.5-10.5 |
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Hypercalcemia cause |
Malignancy and hyperparathyroidism |
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Hypercalcemia symptoms |
Bones, stones, groans (constipation), moans (peptic ulcer, pancreatitis)pancreatic, overtones ( depression, confusion) |
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Hypercalcemia treatment |
Isotonic saline, IV loop diuretics, Calcitonjn, IV bisphosphonates (in cancer pts), glucocorticoids |
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Causes of hypocalcemia |
Low PTH, vitamin D deficiency, low magnesium, tissue consumption of calcium |
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Hypocalcemia manifestation |
Tetanus, papilledema, and seizures |
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Treatment for hypocalcemia |
Iv or oral calcium |
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Treatment for hypophosphatemia |
Milk or oral phosphorous ( can jnduce diarrhea) |
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Causes of hypophosphatemia |
Dec intake, inc renal wasting, fluid shift from cells to blood |
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Treatment for hyperphosphatemia |
Restrict dietary intake, phosphate binders, inc dialysis |
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Normal phosphate |
4.5 |
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CKD definition |
-presence of kidney damage for 3 months: albuminuria= ACR >30, abnormalities, kidney transplant -GFR <60 |
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Acute prostatitis treatment for non sexual active men |
Bacterium or fluoroquinolone for 4-6 weeks |
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Acute prostatitis for sexual active men |
Cetriaxone and doxy for 4-6 weeks |
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Firm and tender prostate, constitutional symtoms |
Acute bacterial prostatitis |
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Painless hematuria, urothelial carcinoma, cigarette smoking MC risk factor |
Bladder cancer |
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Renal cell carcinoma triad |
Flank pain, hematuria, palpable abdominal renal mass |
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Gleason is a 60 year old AA men who present with back pain, LUTS. What is the lost likely dx? |
Prostate cancer |
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Flank pain radiating to groin, patient can't lie still, hematuria, noncontract CT is definitive dx |
Nephrolithiasis <5mm pass, >5 (medication tamsulosin), >10 urology consult |
Calcium oxalate MC Struvite-proteus infection Uric acid- gout and radiolucent xray Cistine-FH |
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Painless swelling of the testicle, crytochidism MC risk factor Labs: elevated beta hcg, AFP or LDH |
Testicular cancer |
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Dilated and tortuous veins of the scrotum, heavy sensation, swelling decrease with supine position. left side>right. Infertility |
Varicocele |
Bag of worm |
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Abdominal, flank and back pain, hematuria, bilateral enlarged kidney, autosomal dominant |
Polycystic kidney disease |
Tx: BP control, hydration, sodium restriction diet, Tolvaptan |
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Peritoneal fluid, translluminates, painless, children, increase in size with Valhalla maneuver |
Hydrocele |
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WBC cast |
Pyelonephritis, interstitial nephritis |
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RBC cast |
Glomerulonephritis |
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Fatty cast |
Nephrotic syndrome, minimal change syndrome |
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Muddy brown casts |
Acute Tubularnephritis |
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Renal stenosis |
Inc aldosterone, ADH and angiotensin |
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Abdominal bruit, refractory hypertension |
Renal stenosis |
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Low C3 comp, cola color urine, post strep/impetigo, |
PSGN |
Positive ASO titer, supportive care |
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E coli 0157h7, shiga toxin, bloody diarrhea, petechial rash, thrombocytopenia |
Hus |
School age |
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Chronic sinusitis, saddle deformity, skin rash, |
Wegners |
+C-ANCA |
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Good pastures |
Anti GBM, hemoptysis, hematuria, steroid |
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Gross hematuria, post URI or GI, young men |
IgA |
Control bp |
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Acute prostatitis risk factors |
Catheters, instrumentation, prostate bx |
Tx for 6 weeks |
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Twist score for torsion |
Hard testis, swelling testis, negative crematorium reflex, high riding testis, N/V |
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Mc acite scrotal pain in Prepubescent boys, blue dot spot, supportive care |
Appendix torsion |
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Failure to produce ADH, resulting in inc extracellular fluid osmolaity-> vasopresin challenge Dec urine volume and Inc urine osmolality |
Central diabetes insipidus |
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High ADH, no change in using volume or osmolality |
Nephrogenic diabetes insipidus |
Drug: lithium, demeclocycline, amphotericin B |
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MC inherited cause of kidney disease, mutation in pkd1 |
Polycystic kidney disiease |
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When to dialyse |
Acidosis, electrolytes, ingestion (SLIME), overload, uremia, gfr<15 |
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Cause of anion gab metabolic acidosis |
Cardia output, Methanol, Uremix, Dka, Ethylene glycol, Salicylate (asapirin), |
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SIADH |
Hyponatremia |
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Trousseau, chvostek sign |
Hypocalcemia |
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Hyperparathyroid, malignancy |
Hypercalcemia |
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Treatment for hyperkalemia |
Insulin, Calcium, Bicarbonate, Kayexalate, xation exchange resins |
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Inulin, urea, glucose, acid and K+ |
Filtration only, filtration and partial reabsorption, filtration ND complete reabsorption, filtration and secretion |
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Mc solid tumor in men 15-35 |
Testicular cancer |
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Hydronephrosis on US |
Kidney stones |
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AKI pre renal cause and values |
Dehydration and hypoperfususion Bun/Cr=20:1 U NA= <20 FeNA= <1 SG= >1.010 |
High urine osmolality |
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AKI renal cause and values |
Glomerular, tubular and interstitial Bun/Cr = 15:1 U NA >40 FeNA <2 SG normal Urine osmolality is low |
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