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on 14-Apr-2016 (Thu)

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jaded4fox:

terrorism has no religion pass it on

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perception deception
け物 です me uploads favourties home contact profile index credit <span>jaded4fox: terrorism has no religion pass it on Posted April 11th at 11:10 am with 25,010 notes (2 days ago) Reblogged from sahrawia, but originally posted by jaded4fox. Next Post → ← Previous Post




Flashcard 1332523437324

Question
Sigmund Freud wrote: "By accepting the existence of these two (or three) psychical systems,
psycho-analysis has departed a step further from the descriptive
"psychology of consciousness" and has raised new problems and acquired a new content."
What did he mean by that and what problems are likely to arise because of that?
Answer
He meant that lack of resistance equals acceptance.
As long as either analysand accepts analyst's content or analyst accepts analysand's, analysis proves successful,
however, both parties could be trapped in circulus in probando, logical fallacy known as circular reasoning.


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Flashcard 1332536282380

Tags
#nephrology
Question
Approach to AKI
Answer
Causes:
1) pre-renal
2) renal
3) post-renal


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Flashcard 1332538117388

Tags
#nephrology
Question
What are pre-renal causes of AKI?
Answer
↓ renal blood flow d/t:

1) ↓ ECF volume (volume depletion)
2) ↓ effective ECF volume (volume overloaded - CHF - but not getting to kidneys; fluid shift to interstitial space - liver ds)
3) disruption of hemodynamics/autoregulation​
-drugs (NSAIDs, RAAS blockers)
-endogenous mediators (accumulation of vasoactive compounds in liver failure - hepatorenal syndrome)

NB: could be losing Na or ↓ intake


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Flashcard 1332539952396

Tags
#exam #nephrology
Question
What is a renal cause of AKI?
Answer
inj d/t dysfn of renal parenchyma.

look for:
-systemic ft's (ds could also be affecting kidneys)
-HTN (NB: hypo for pre-renal)
-mild to mod ECF volume overload
-anemia/thrombocytopenia
-***abn urine sediment (RBC, WBC, protein, abn casts)***


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Flashcard 1332541787404

Tags
#nephrology
Question
What is a cause of post-renal AKI?
Answer
inj secondary to not passing urine from kidneys (urine backs up)

dx = imaging (kidney & bladder u/s)


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Flashcard 1332543622412

Tags
#exam #nephrology
Question
What are 2 methods of urine evaluation?
Answer
1) dip stick → **alb, Hg, WBC**, others (glu, pH, urobilinogen, specific gravity)
2) microscopy → cells, crystals, casts


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Flashcard 1332546243852

Tags
#exam #nephrology
Question
What are 3 types of renal AKI causes?
Answer
1) tubulo-interstitial → acute tubular necrosis (atn), allergic/acute interstitial nephritis (ain), tubular obstruction
2) glomerular → prolif ds, non-prolif ds (rarely causes aki)
3) vascular → arteries (renal a stenosis, vasculitis), arterioles (atheroembolic ds, vasculitis), capillaries (thrombotic microangiopathies, vasculitis), veins/venules (thrombosis)


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Flashcard 1332548078860

Tags
#nephrology
Question
pre-renal aki vs atn:
Testpre-renalatn
urine dipstick[...][...]
urine microscopynormalhemegranular casts
urinary [Na]<20mmol/L>20mmol/L
FENa<1%>1%
Answer
pre-renal aki vs atn:
Testpre-renalatn
urine dipsticknormalHg +/- alb
urine microscopynormalhemegranular casts
urinary [Na]<20mmol/L>20mmol/L
FENa<1%>1%


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Flashcard 1332549913868

Tags
#nephrology
Question
pre-renal aki vs atn:
Testpre-renalatn
urine dipsticknormalHg +/- alb
urine microscopy[...][...]
urinary [Na]<20mmol/L>20mmol/L
FENa<1%>1%
Answer
pre-renal aki vs atn:
Testpre-renalatn
urine dipsticknormalHg +/- alb
urine microscopynormalhemegranular casts
urinary [Na]<20mmol/L>20mmol/L
FENa<1%>1%


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Flashcard 1332552797452

Tags
#nephrology
Question
pre-renal aki vs atn:
Testpre-renalatn
urine dipsticknormalHg +/- alb
urine microscopynormalhemegranular casts
urinary [Na][...][...]
FENa<1%>1%
Answer
pre-renal aki vs atn:
Testpre-renalatn
urine dipsticknormalHg +/- alb
urine microscopynormalhemegranular casts
urinary [Na]<20mmol/L>20mmol/L
FENa<1%>1%


statusnot learnedmeasured difficulty37% [default]last interval [days]               
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Flashcard 1332554632460

Tags
#nephrology
Question
pre-renal aki vs atn:
Testpre-renalatn
urine dipsticknormalHg +/- alb
urine microscopynormalhemegranular casts
urinary [Na]<20mmol/L>20mmol/L
FENa[...][...]
Answer
pre-renal aki vs atn:
Testpre-renalatn
urine dipsticknormalHg +/- alb
urine microscopynormalhemegranular casts
urinary [Na]<20mmol/L>20mmol/L
FENa<1%>1%


statusnot learnedmeasured difficulty37% [default]last interval [days]               
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Flashcard 1332556467468

Tags
#exam #nephrology
Question
What is ATN (acute tubular necrosis)?
Answer
  • 2nd most common cause of AKI
  • d/t ischemia/toxins
  • look for signs of ↓ volume (pre-renal hypotension can cause ATN)
  • **hemegranular casts** = dx


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Flashcard 1332558302476

Tags
#exam #nephrology
Question
What is allergic/acute interstitial nephritis (ain)?
Answer
interstitial inflm d/t:
  • usually allergic rxn to drugs (abx, NSAIDS, PPIs, etc)
    • usually present 7-10d post-exposure
    • urine → RBC, WBC, protein, **WBC casts**
  • autoimmune ds
  • inf's


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Flashcard 1332560137484

Tags
#exam #nephrology
Question
What is prolif glomerulonephritis?
Answer
  • too many cells in glomerulus so can't filter → AKI
  • present w/:
    • rapid ↓ in GFR
    • ​HTN, anemia
    • ↑ inflm markers
    • other systemic ft's (if 2ndary)
    • ECF volume full/mildy overloaded
  • urine → **RBC casts** (nephrologic emerg)


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Flashcard 1332564856076

Tags
#nephrology
Question
What is non-prolif glomerular ds?
Answer
structural problem - rarely causes AKI - just see proteinuria


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Flashcard 1332568526092

Tags
#nephrology
Question
What are causes of thrombotic microangiopathies?
Answer
TTP, hemolytic uremic syndrome (HUS), hypertensive emerg


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Flashcard 1332570361100

Tags
#nephrology
Question
How do you manage AKI?
Answer
general
  • prevent additional nephrotoxins (drugs, contrast)
  • rx ECF volume status
  • avoid complications
    • ECF volume overload (↓Na intake, ↑ diuretics)
    • avoid ↑K (↓ intake, diuretics, laxatives, shift into ICF)
    • renally dose meds
​pre-renal aki
  • improve hemodynamics
    • ↑ ECF w/ IV fluids
    • ↑ cardiac output
​renal AKI
  • ATN → time
  • AIN → remove offending agent, consider corticosteroids
  • glomerulonephritis → maybe immunosuppresive therapy (urgent)


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Flashcard 1332978781452

Tags
#nephrology
Question
Drugs with Renal Effects
Answer
• Renin‐Angiotensin‐Aldosterone System (RAAS) blockers
• Diuretics
• Antidiuretic Hormone (ADH)


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pdf

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Flashcard 1333178273036

Question
Angiotensin II stimulation causes:
Answer
↑ aldo
vasoconstriction
↑ Na reabsorption


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Flashcard 1333184040204

Tags
#nephrology
Question
Direct renin inhibitors (i.e. aliskiren) do what?
Answer
Blocking Renin Action


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Flashcard 1333186399500

Tags
#nephrology
Question
ACE inhibitors do what?
Answer
Blocking Angiotensin II production


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Flashcard 1333188758796

Tags
#nephrology
Question
Angiotensin receptor blockers do what?
Answer
Blocking Angiotensin II action


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Flashcard 1333193477388

Tags
#nephrology
Question
Spironolactone/Eplerenone does what
Answer
Blocking action of Aldosterone

NB: spironolactone = K+ sparing diuretic


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Flashcard 1333200555276

Tags
#nephrology
Question
Diuretics do what?
Answer
  • ↓ Na to ↓ ECF volume
  • can cause over-diuresis
  • if acts prox to CCD = K wasting
  • if acts @ CCD = K sparing


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Flashcard 1333202390284

Tags
#nephrology
Question
Weak diuretics..
Answer
  • work at prox tubule
  • carbonic anhydrase inhibitors (not used much as diuretics) - blocks reabsorption of HCO3 (Na stays out with it)


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Flashcard 1333204225292

Tags
#nephrology
Question
Potent diuretics..
Answer
loop diuretics (furosemide, bumetanide)
work on asc limb of loop
blocks NKCC2
can add to thiazide diuretics


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Flashcard 1333206060300

Tags
#nephrology
Question
Thiazides..
Answer
hydrochlorothiazide (HCTZ), Chlorthalidone, Indapamide, Metolozone
works on DCT (distal convoluted tubule)
imp s/e:
  • Dyslipidemia
  • Hyponatremia
  • Hyperuricemia
  • Hypercalcemia


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Flashcard 1333207895308

Tags
#nephrology
Question
Potassium Sparing Diuretics..
Answer
weak
2 mechanisms:
  • block aldosterone from binding its receptor (spironolactone, epeleronone)
  • bind ENaC


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Flashcard 1333209730316

Tags
#nephrology
Question
ADH..
Answer
aquaporin insertion in CD
VAPTANS (new)
  • Competitive inhibitors for ADH


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Flashcard 1333211565324

Tags
#nephrology
Question
Nephrotoxic drugs contributing to pre-renal AKI
Answer
diuretics → ↓ ECF volume d/t ↑ Na loss
RAAS blockade → Block either the formation or action of AngII (which maintains GFR) → efferent vasodilation
NSAID → Inhibit the formation of prostaglandins (which vasodilate afferents)


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Flashcard 1333213400332

Tags
#nephrology
Question
What are tubulo-toxic drugs causing ATN?
Answer
Aminoglycosides Antibiotics (Gentamicin, Tobramycin, Amikacin)
Amphotericin B (antifungal)
Cisplatin (chemo)
IV radiocontrast dye


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Flashcard 1333215235340

Tags
#nephrology
Question
medications implicated with AIN
Answer
Acute interstitial nephritis:
  • NSAIDS
  • abx
  • PPI
  • allopurinol

Chr interstitial fibrosis:
  • lithium (most common), etc


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