The pathophysiology of an obstruction is as follows: 1) o______________ occurs leading to progressive dilation p_________ to the block; 2) _______ accumulates causing d_________; 3) _________ occurs and fluid is s____________; 4) transudative _______ of fluid into peritoneal space; and 5) ___________ dilation, compressing vessels and leading to i________, n__________, and p___________.
True or false: excessive vomiting with an intestinal obstruction may lead to metabolic acidosis.
Definition
False- excessive loss of electrolytes may lead to metabolic alkalosis.
Term
True or false: with an intestinal obstruction, bacterial overgrowth in the bowels and feculen emesis may be seen.
Definition
True- if the bowel is blocks and peristalsis is halted, bacteria may grow unchecked in the gut and if the blockage is complete and is not allowing for the passage of stool, feculent emesis may occur.
Term
True or false: the most common bacterias seen in intestinal obstructions include s. aureus and s. pneumoniae.
Definition
False- the most common bateria seen in intestinal obstructions include e. coli, streptococcus faecalis, and klebsiella.
Term
A volvulus is an __________ cause of mechanical obstructions and is considered to be a c___________ l___________ obstruction. A volvulus is the most common precursor for s_______________.
Definition
intrinsic; closed loop; strangulation
Term
True or false: every volvulus (closed loop obstruction) results in strangulation.
Definition
False- not every volvulus results in strangulation; however, a volvulus is the most common precursor for strangulation
Term
With a volvulus (closed loop obstruction), there is an increased risk of v_________ insufficiency, s_________ inflammation, h__________ compromise, and i____________ intenstinal i___________.
Cardinal signs for a small bowel obstruction include: c__________ abdominal pain, abdominal d__________, e_________, and o____________.
Definition
colicky; distention; emesis; obstipation
Term
True or false:
With a proximal intestinal obstruction, the patient may experience more intraluminal fluid accumulation, leading to greater abdominal distention, more discomfort, and delayed emesis.
Definition
False- with a proximal intestinal obstruction, the patient typically has less abdominal distention but more pronounced vomiting.
With a distal intestinal obstruction, the patient may experience more intraluminal fluid accumulation, leading to greater abdominal distention, more discomfort, and delayed emesis.
Term
What pertinent patient history should alert you to a possible intestinal obstruction?
Definition
recent surgery, history of cancer, radiation therapy, IBD
Term
The following may occur with a bowel obstruction as a result of severe intravascular volume depletion:
o___________, h_____________, and t_____________.
Definition
oliguria; hypotension; tachycardia
Term
What symptom in a patient with a possible intestinal obstruction would make you worry?
Definition
the presence of a fever may be worrisome, as it may indicate strangulation or systemic inflammatory changes
Term
True or false:
Colicky, intermittent pain is usually the first sign of an intestinal obstruction.
Definition
True- colicky pain that comes in waves is usually the first sign of an obstruction; when the pain progresses to constant, peritoneal irritation (i.e. ischemia, necrosis) should be suspected
Term
True or false:
A large bowel obstruction usually causes pain centered on the umbilicus, while a small bowel obstruction usually causes pain in the lower abdomen.
Definition
False- A small bowel obstruction usually causes pain centered on the umbilicus, while a large bowel obstruction usually causes pain in the lower abdomen.
Term
True or false:
Severe pain is typically indicative of strangulation.
Definition
True
Term
The more __________ the obstruction, the longer the interval between the onset of symptoms and the appearance of N/V.
Definition
distal
Term
The more _______ the lesion/obstruction, the greater the distention.
Definition
distal
Term
Absolute constipation
Definition
Absolute constipation is when neither feces or flatus is passed and is the cardinal feature of a complete intestinal block
Term
Relative constipation
Definition
relative constipation is when only flatus is passed; it can take 12-24 hours to decompress a distal bowel
Term
What does hypothermia indicate in an intestinal obstruction?
Definition
possible septicemic shock
Term
When should you be suspicious of malignancy in a patient with an intestinal obstruction?
Definition
You should be suspicious of malignancy when anemia and FOB are present; these could indicate adenocarcinoma of the rectum/colon, which is the most common malignant cause of an intestinal obstruction.
Term
How will an adenocarcinoma of the rectum/colon appear on a CT scan?
Definition
like an "apple core" shape
Term
Clincal features of strangulation include: c________ pain, tenderness w/ r_________, and s________ (indicating ischemia).
Definition
constant; rigidity; shock
Term
clinical features of intussusception include: episodes of s__________/drawing up legs in previously well infant; conspicuous v________ that is b______ stained; r___________ j___________-like stools; emptiness in __________ iliac fossa (sign of dance); bloody mucus upon r______ exam; and unrelieved, progressive d_____________ and d_____________.
False- a volvulus can occur in the small intestine or cecal area.
Term
True or false:
In a cecal volvulus, the twisting of the bowel is usually clockwise.
Definition
True
Term
True or false:
In nearly 100% of patients w/ a cecal volvulus, there will be a palpable tympanic swelling at midline or on the R side of the abdomen.
Definition
False- only 25% of patients w/ a cecal volvulus will have a palpable tympanic swelling at midline or on the R side of the abdomen.
Term
What labs would be ordered for a suspected intestinal obstruction?
Definition
1. CBC w/ diff
2. CMP
***if patient is presenting w/ systemic signs, then order ABGs, serum lactate, and blood cultures***
Term
True or false:
A plain film XR is the most commonly used modality for dx an intestinal obstruction and is >95% accurate.
Definition
False- a CT abdomen is the most commonly used modality for dx an intestinal obstruction and is >95% accurate.
A plain film XR can confirm suspicion of an intestinal obstruction in only 60% of cases.
Term
With a small bowel obstruction, you will see "s_________" on plain film, ________-filled small bowel loops >2.5cm, and little to no ______ in the colon.
Definition
"staircasing;" fluid; air
Term
With a large bowel obstruction, you will see a dilated _________ on plain film.
Definition
colon
Term
What would you think if you saw free air on a plain film XR?
Definition
possible perforation
Term
With a CT scan of the abdomen in a suspcted intestinal obstruction, you may see a "b______ b_______," a "_____-loop," or a "w_______."
Definition
"bird's beak;" c; "whirl"
Term
True or false:
While the abdominal CT is >95% accurate for most intestinal obstructions, it is only 60% accurate in closed loop cases.
Definition
True
Term
What type of dx imaging tool would you use if you suspected bowel ischemia?
Definition
abdominal CT with IV or enteral contrast
Term
When would you use a water soluble contrast enema?
Definition
to help distinguish an ileus or psuedo-obstruction from a distal large bowel obstruction
Term
True or false:
Barium studies are almost always used for the detection of intestinal obstructions.
Definition
False- barium studies are generally contraindicated (esp if perforation is suspected)
Term
The ____________ is more useful for detecting SBO d/t limited visualization of gas-filled structures but is good for checking for hernia strangulation and is safe for critically-ill or pregnant patients.
Definition
ultrasound
Term
The ______ can be useful in detecting a SBO and can locate transition points/complications but requires the patient to hold their breath for prolonged periods of time and is typically not a short test.
Definition
MRI
Term
The treatment of bowel obstructions includes: f__________ resuscitation; e___________ replacement; intestinal d____________; a__________ (if pt is an operative candidate); monitor _______ output; possible exploratory l____________; and s___________.
Definition
fluid; electrolyte; decompression; antibiotics; urine; laproscopy; surgery
Term
True or false:
The visceral peritoneum covers the anterior and posterior abdominal walls, the under surface of the diaphragm, and the cavity of the pelvis. It is supplied segmentatlly by the spinal nerves.
Definition
False- the parietal peritoneum covers the anterior and posterior abdominal walls, the under surface of the diaphragm, and the cavity of the pelvis. It is supplied segmentatlly by the spinal nerves.
The visceral peritoneum is a continuation of the parietal peritoneum, which leaves the posterior wall of the abdominal cavity to envelope certain viscera therin. It has NO nerve supply.
Term
Primary microbial peritonitis (SBP) occurs when _________ invade the normally _________ confines of the peritoneal cavity via h__________ dissemination from a distant source. It occurs most commonly is patients w/ c___________ and is invariably m____________. SBP ________ requires surgical intervention.
What symptoms will typically accompany primary microbial peritonitis (SBP)?
Definition
1. acute, severe pain that can have diffuse tenderness or have localized findings
2. fever
3. tachycardia
4. S/S of volume depletion/hypotension
5. hypoactive or absent bowel sounds
6. hepatomegaly in cirrhotic patients
7. S/S of hepatic encephalopathy in cirrhotic patients
Term
What labs will you order for suspected SBP?
Definition
1. CBC w/ diff
2. CMP
3. blood cultures
*** labs will typically reveal leukocytosis, acidosis, monomicrobic, and decreased renal function ***
Term
What is the main dx test for primary microbial peritonitis (SBP) and when should it be done?
Definition
an abdominal paracentesis should be done as soon as peritonitis is suspected and prior to any antibiotic administration
Term
The abdominal paracentesis resutls indicating primary microbial peritonitis (SBP) may include: PMN cell count >______ cells/mm3; typically m___________; ascitic albumin >____ g/dL; ______ protein concentration (<1g/dL); glucose >___mg/dL; _________ LDH; and amylase W____.
Definition
250; monomicrobial; 1.1; low; 50; increased; WNL
Term
What could dark orange or brown fluid upon examination of parecentesis fluid indicate?
Definition
the presence of bilirubin, which may indicate gallbladder perforation
Term
The common causative organisms of primary bacterial peritonitis include: e_______; s___________; and K__________ p___________.
Definition
e. coli; streptococcus; klebsiella pneumoniae
Term
True or false:
You should wait to start an antibiotic in a suspected case of primary bacterial peritonitis until the causative organism is identified.
Definition
False- you start a broad spectrum antibiotic, such as a 3rd generation cephalosporin (cefotaxime, ceftriaxone) or a beta lactam (ampicillin), which can be changed upon receiving the results of the paracentesis if the antibiotic does not cover that particular organism
Term
What broad spectrum antibiotics would be appropriate to start for a suspected case of primary bacterial peritonitis prior to performing a paracentesis?
Definition
1. 3rd generation cephalosporins- cefotaxime (claforan) or ceftriaxone
What class of antibiotics should be avoided in suspected primary baterial peritonitis? Why?
Definition
aminoglycosides should be avoided d/t risk of nephrotoxicity since a complication of peritonitis is acute kidney injury (occurs in 40% of all peritonitis patients)
Term
Once paracentesis cultures return, the administration of the antibiotic should last ___ to ___ days. Removal of any i___________ d___________ should be considered, if possible.
Definition
10; 21; indwelling devices
Term
The paracentesis should be repeated in ___ hours. You should see the ______ count decreasing; if not or count is unchanged, you should suspect __________ peritonitis, as _________ peritonitis is usually VERY responsive to antibiotics.
Definition
48; PMN; secondary; primary
Term
Secondary bacterial peritonitis occurs subsequent to c___________ of the peritoneal cavity d/t p____________ or severe i____________ and i_________ of an intra-abdominal organ.
How do you distinguish primary/SBP from secondary peritonitis?
Definition
1. PMN will be >250 cells/mm3 (will not respond greatly to antibiotics)
2. gram stain will typically reveal multimicrobial results
3. protein >1g/dL
4. glucose <50mg/dL
5. LDH > the upper limit of normal
Term
When do you do an exploratory lap for secondary peritonitis?
Definition
Only if free air is found upon imaging or surgically treatable source is identified
Term
True or false:
There is no need to repeat the paracentesis for secondary bacterial peritonitis.
Definition
False-
You need to repeat the paracentesis for BOTH primary and secondary peritonitis after 48 hours
Term
The treatment for secondary peritonitis includes: source control to repair the d_________ o_________ and the administration of a_____________ agents directed at BOTH a_______ and a__________ organisms. H_________ dynamic support is also indicated.
What antimicrobials are preferred for the treatment of secondary peritonitis?
Definition
1. 3rd generation cephalosporin
2. metronidazole
*** continue therapy until surgically treated or until microbe is identified ***
Term
Acute kidney injury can occur in up to ____% of patients w/ peritonitis. IV a_____________ can decrease kidney injury and mortality.
Definition
40; albumin
Term
How to distinguish alcholic hepatitis from peritonitis?
Definition
peritonitis can present w/ fever, peripheral leukocytosis, and abdominal pain; also, alcoholic hepatitis paracentesis fluid will not have a high PMN count
Term
What is the mortality rate for peritonitis?
Definition
30-40% (this drops to 10% with rapid diagnosis and tx)
Term
True or false:
Appendicitis typically affects patients >30 y/o.
Definition
False- appendicitis typically affects patients <30 y/o, with the most common ages between 10-20 y/o
Term
True or false:
The risk for appendiceal perforation is higher among patients <5 y/o and >65 y/o.
Definition
True
Term
The etiology of appendicitis is not clearly understood; however, f____________, incompletely d______ f_____ residue, l_________ hyperplasia, intraluminal s__________, t____________, b__________, v_________, and I____ have all been associated.
Appendicitis usually begins with nonspecific complaints at first, such as: change in b_______ h________, m_______, vague/diffuse i________ c__________ in the e__________ or p____________ region.
When does appendicitis pain usually move to the more well-known location of the RLQ?
Definition
within 24-48 hours of onset of sx
Term
True or false:
Patients with acute appendicitis typically have no peritoneal irritation and have nausea that precedes the pain.
Definition
False- pts w/ acute appendicitis typically have peritoneal irritation w/ stiffness and muscle rigidity and nausea that comes after the pain.
Term
True or false:
The pain in EARLY appendicitis is localized at the R iliac fossa; it is constant in nature and is aggravated by going over bumps, coughing and walking w/ relief from hip flexion and staying still.
Definition
False- The pain in LATE appendicitis is localized at the R iliac fossa; it is constant in nature and is aggravated by going over bumps, coughing and walking w/ relief from hip flexion and staying still.
The pain in EARLY appendicitis is considered dull and colickly and is typically centered in the periumbilical region. Vomiting and anorexia are often seen at this point.
Term
Peritoneal signs of appendicitis include: g___________, r___________ tenderness, and p_________ tenderness.
Definition
guarding; rebound; percussion
Term
What is Rovsing's sign? Would it be + or - in acute appendicitis?
Definition
Rovsing's sign is when pressure to the LLQ elicits pain in the RLQ. In acute appendicitis, Rovsing's sign would be +.
Term
What is the psoas sign? Would it be + or - in acute appendicitis?
Definition
The psoas sign involves putting pressure on the R leg above the knee and then asking the pt to raise their right leg against the pressure. Pain in the RLQ with this test is known as a + psoas sign and may indicate acute appendicitis.
Term
Where is McBurney's Point and what does it tell you?
Definition
McBurney's Point is thepoint on therightlowerflank, midwaybetweentheanterosuperioriliacspineandbellybutton, thatcorresponds to theappendix. Fingerpressure on McBurney'spointelicits a majorpainresponsefrompatientswithacuteappendicitis.
Term
What is the obturator sign? And would it be + or - with acute appendicitis?
Definition
Theinternalrotation of therightlegwiththelegflexed to 90 degrees at thehipandkneeand a resultanttightening of theinternalobturatormusclemaycauseabdominaldiscomfort. In acute appendicitis, the obturator sign would be +.
Term
True or false:
Elderly patients may have a blunted response to abdominal pain, may have pain first noted in the RLQ, and may complain more about nausea/vomiting/anorexia versus abdominal pain.
Definition
True.
Children may also have an atypical response to appendicitis by repsonding more dramatically to the pain.
Term
There are many differential dx to r/o, including: c___________ diverticulitis; M_________ diverticulitis; C_______ dz; t______-o________ abcess; P_______; ruptured o____________ cyst; e_________ pregnancy; M_______________; e_____________; renal c__________; t___________ torsion; e____________; m____________ causes; and s__________.
What labs would you run for suspcted appendicitis?
Definition
1. CBC- WBC left shift w/ increased WBC/bands/PMNs, usually mildly elevated (10000-18000)
2. sickle cell prep
3. amylase and lipase
4. urinalysis- may sometimes show blood and leukocytes
5. FOBT
6. pregnancy test
7. electrolytes- may show mild elevated serum bilirubin; all others (i.e. renal func, Hgb, platelets, liver func, coag) should be WNL
Term
True or false:
The best imaging for dx appendicitis is plain XR.
Definition
False- plain XRs are usually NOT helpful in dx appendicitis. The best imaging for appendicitis is a CT scan of the abdomen, followed by an U/S.
Term
On CT, suggesting findings for appendicitis may include: >___mm dilation w/ wall thickening; l_______ that d_________ fill with enteric contrast; fatty tissue s___________; __________ surrounding the appendix.
Definition
6; lumen; doesn't; stranding; air
Term
An U/S ______ as specific as a CT scan for appendicitis. It is good at visualizing t_________ structures and c___________ and is quite helpful in r/o e_________ pregnancy or o___________ pathologies. Suggestive findings of appendicitis may include: wall __________; _________ appendiceal diameter; and the presence of free ___________.
What imaging would you use for a pregnant pt in order to r/o appendicitis?
Definition
An MRI is preferred for pregnant pts b/c it lessens the risk of radiation exposure
Term
With a perforated appendix, the pt may present w/ a fever >_____ degrees, WBC >____k, and _________ in the RLQ upon imaging.
Definition
103; 15; fluid
Term
What type of surgery is used most often for appendectomies?
Definition
The "keyhole" laparoscopic surgery is used in 60% of all appendectomies because it has a lower complication rate and a quicker recovery time
Term
Why is the open appendectomy procedure not used as often anymore, despite being straightforward and technically easier?
Definition
The open appendectomy carries a higher risk of complications, such as hernia and adhesions, and has a much longer recovery time versus the laparoscopic "keyhole" surgery.
Term
Appendectomy patients can typically be discharged from the hospital ____-____ hours after surgery, with the most common post-op complications being f______ and l____________. If these complications persist beyond ____ days, you would want to evaluate for an intra-abdominal abscess.
Definition
24-40; fever; leukocytosis; 5
Term
What lipid abnormalities are associated with PCOS?
Definition
high LDL and high TG
Term
1.An urgent care nurse practitioner is assessing a 45 year-old Caucasian woman with a BMI of 32 for complaints of intermittent right upper quadrant pain that is precipitated by fatty meals over the past few weeks. On examination, the patient's heart and lung sounds are normal. There is no pain over the costovertebral angle (CVA). During abdominal examination, the bowels sounds are hyperactive. Murphy's sign is positive. Which of the following is best described?
A.
Acute cholecystitis
B.
Acute appendicitis
C.
Acute gastroenteritis
D.
Acute diverticulitis.
Definition
A. Acute cholecystitis
Term
True or false:
E. coli and P. mirabilis are the 2 most common pathogens in community-acquired UTIs.
Definition
False-
S. saprophyticus and E. coli are the 2 most common pathogens in community-acquired UTIs.
Term
1.Lactulose may be ordered in a patient with liver disease in order to treat which common complication:
A. Abnormal prothrombin time
B. Constipation
C. Encephalopathy
D. Infection
Definition
C. encephalopathy
Term
PCOS is characterized by o____________, m__________ small o_________ cysts, and a_________ excess.
Definition
oligo-ovulation; multiple; ovarian; androgen
Term
True or false:
Women develop intersitial cystitis more than men?
Definition
True
Term
1.In treating the patient with Interstitial Cystitis (IC), you advise the her to avoid triggers and may also prescribe medications. Which of the following would be least effective at relieving her symptoms?
A.
Amitriptyline (Elavil)
B.
Pentosan Polysulfate sodium (Elmiron)
C.
Hydroxyzine (Atarax)
D.
Ciprofloxacin (Cipro)
Definition
D. cipro- antibiotics are typically not indicated for interstitial cystitis
Initial therapies for IC include: antihistamines (i.e. hydroxyzine), pentosan polysulfate sodium, and mild analgesics. TCAs (i.e amitriptyline) may be used as second-line tx.
Term
True or false:
An acute febrile illness with jaundice, anorexia, malaise, and an incubation period of 45-160 days, having a chronic and an acute form; and transmitted by parenteral, sexual, and perinatal routes describes Hepatitis A.
Definition
False- An acute febrile illness with jaundice, anorexia, malaise, and an incubation period of 45-160 days, having a chronic and an acute form; and transmitted by parenteral, sexual, and perinatal routes describes Hepatitis B.
Hepatitis A appears as an acute febrile illness with jaundice, anorexia, malaise, and an incubation period of 2 weeks. It is not associated with chronic hepatitis and transmitted by via fecal-oral route.
Term
1.A 36 y/o afebrile woman without health problems presents with dysuria and frequency of urination. Her UA findings include results positive for nitrates and leukocyte esterase. You evaluate these results and consider that she likely has:
A.
A gram negative (-) UTI
B.
Cystitis caused by staphylococcus saprophyticus
C.
Purulent vulvovaginitis
D.
Urethral syndrome
Definition
A. a gram negative UTI
Term
Education on the prevention of transmitting Hep C should include: you ________ donate blood; there _______ a vaccine available to prevent transmission; you _______ transmit Hep C via razors and toothbrushes; and it _______ be transmitted via menstrual blood.
Definition
shouldn't; isn't; can; can
Term
What diagnositc test would be best for a 28 y/o pt reporting severe colicky pain consistent w/ a renal calculi in the distal ureter?
A. non-contrast CT
B. urinalysis
C. pelvic MRI
D. renal U/S
Definition
A. non-contrast CT
Term
A 55 y/o man c/o dysuria, urgency, perennial pain, and a temperature of 101 degrees F. What is the most likely dx?
A. uncomplicated UTI
B. epididymitis
C. urethritis
D. acute bacterial prostatitis
Definition
D. acute bacterial prostatitis
***tx w/ cipro or levofloxacin
Term
1.You suspect acute pyelonephritis in an otherwise healthy 31 year old woman who is in gestational week 27. She reports feeling nauseous for 3 days, feverish and has vomited 3 times in the last 24 hours. Your most appropriate intervention is:
A.
Prescribe oral anti emetic such as Zofran (pregnancy class B) and an antibiotic such as Macrodantin (pregnancy class B)
B.
Admit her to the hospital for further evaluation, hydration and antibiotics
C.
Give her IV hydration in your clinic
D.
Both A and C
Definition
B. you would admit this pt d/t pregnancy, which may complicate pyelonephritis
Term
1.A 29 year old female is being seen for new onset abdominal pain. She denies prior history of any medical conditions, denies surgeries, is taking no medications. She is a life long non- smoker, drinks one glass of wine on 2-3 days a week, and denies smoking. She complains of a constant "achey" pain in the LLQ, and rates it a 4 to 6 out of 10 in intensity. She denies diarrhea, constipation or vomiting. She has had nausea over the past several days. Tests ordered so far include CBC, ESR, pancreatic enzymes, metabolic profile and clotting panel; all these tests are WNL. Which of the following would be the next best test to provide necessary information to SAFELY move forward with her care:
A.
A CT of the abdomen
B.
A Beta hCG
C.
A x-ray of the abdomen, flat and upright
D.
An ultrasound of the abdomen.
Definition
B. a beta hCG-
you need to r/o pregnancy before you should perform any imaging
Term
In PCOS patients, a weight loss of just 5-7% can trigger resumed m________ and increase f__________.
Definition
menses; fertility
Term
1.A 50 year old man is diagnosed with kidney stones related to his renal tubules being unable to reabsorb filtered calcium efficiently and hypercalciuria. Which medication will the nurse practitioner order for long term therapy?
A.
HCTZ (hydrochlorothiazide)
B.
Potassium citrate (Urocit-K)
C.
Allopurinol (Zyloprim)
D.
Bethanechol (Urecholine)
Definition
A. HCTZ
Term
The elderly, children, and the immunocompromised may present w/ abdominal pain that is b__________.
Definition
blunted
Term
1.A 37 year-old has routine blood work performed during an annual exam. He is found to have elevated liver enzymes. On exam he has a tender, enlarged liver. How should the nurse practitioner proceed?
A.
Repeat the liver enzymes today.
B.
Order a hepatitis panel.
C.
Have patient return in one week for recheck.
D.
Order a CBC.
Definition
B. order a hepatits panel- you would want to r/o hepatitis d/t the c/o a tender liver
***you could repeat the liver enzymes but you would want the patient to be fasting and the results may take a few days; you wouldn't want the patient to wait one week d/t the hepatomegaly and pain; and a CBC is not the most appropriate test
Term
1.A 36 year old patient was started on Cipro 500mg q 12 hours empirically for acute prostatitis10 days ago. The urine culture initially showed gram negative bacilli. A repeat culture now is negative. Your next step would be:
A.
Continue the antibiotic for 3 more weeks
B.
Stop the antibiotic, the infection has cleared
C.
Change the antibiotic to Amoxicillan 500mg q 8 hours for 5 weeks
D.
Continue this antibiotic for a total of 6 weeks
Definition
D. continue this antibiotic for a total of 6 wks
***d/t increased antibiotic resistance, tx for bacterial prostatitis should be given for a total of 6 weeks, despite the patient's improved condition; amoxicillin is not indicated for bacterial prostatitis, first-line tx should consist of cipro or levofloxacin
Term
Sx of Hep A include: a___________, d_________, and a distaste for c__________.
Definition
anorexia; diarrhea; cigarettes
Term
What is the unwanted development of male patter hair associated with PCOS called?
Definition
hirsutism
Term
1.Which of the following increases a patients risk for developing pancreatitis?
A.
Smoking cigarettes
B.
Having an ERCP test performed
C.
Drinking alcohol
D.
All of the above
Definition
D. all of the above
Term
1.A 47 year old sexually active male patient is being evaluated for dysuria, fever, and perineal pain. The physical exam by the nurse practitioner reveals a distended bladder and an enlarged prostate that is exquisitely tender upon exam. Further workup could include all of the following except:
A.
A urine culture
B.
Prostate massage
C.
Cultures for gonorrhea and chlamydia
D.
A blood urea nitrogen (BUN) and creatinine
Definition
B. prostate massage- you would NOT do this d/t the patient's report of an "exquisitely tender" prostate upon DRE
Term
True or false:
Patients with Hep A, B, C, and D should all be referred to an internist for management d/t the high rate of chronic hepatitis.
Definition
False- you would not need to send a pt w/ Hep A to an internist b/c Hep A is NOT associated with chronic hepatitis; all others are associated w/ chronic hepatitis and should be referred to an internist
Term
Pts dx w/ PCOS are also at an increased risk for: d__________ m__________; e____________ cancer; and c_________ disease.
Definition
diabetes mellitus; endometrial; cardiovascular
Term
1.Which of the following would not be an appropriate antibiotic for empiric treatment of acute prostatitis:
A.
Nitrofurantoin 100mg qid
B.
Trimethoprim/sulfamethoxazole (DS) q 12 hours
C.
Levofloxacin 500 mg qd
D.
Ciprofloxacin 500mg q 12 hours
Definition
A. nitrofurantoin (macrobid)- this medication is not indicated for prostatitis but would be appropriate first-line tx for uncomplicated UTIs in women
***cipro and levofloxacin are first-line tx for prostatitis; trimeth/sulfameth (bactrim) is second-line for prostatitis
Term
True or false:
After a 22 y/o HIV + patient completed the Hep B 3-vaccination series, his titer is still showing no immunity. At this point, you can give him a booster and wait 3 more months for Hep B surface antibody development.
Definition
False- with HIV + and other immunocompromised pts who do not show immunity following the 3-dose series, the series would need to be repeated again
***these pts are not suitable to receive a booster and you would not want to wait 3 more months d/t their immunocompromised condition and risk of contracting HBV
Term
What would a positive iliopsoas muscle test indicate?
Definition
an acute abdomen (possible appendicitis)
Term
1.A 31 year old female presents to her physician complaining of increased facial and chest hair, deepening of her voice, irregular menses, and acne. Which of the following is the most likely cause of this clinical presentation?
A.
Polycystic ovarian disease
B.
Metastatic breast cancer
C.
Type II diabetes mellitus
D.
Rheumatoid arthritis
Definition
A. PCOS
Term
True or false:
PCOS is generally associated w/ insulin resistance.
Definition
true
Term
The usual clnical presentation of an adult w/ acute cystitis includes c/o: d____________, u_________, f__________, n____________, and s___________ pain.
Definition
dysuria; urgency; frequency; nocturia; suprapubic
Term
Which medication is often used in combination w/ oral contraceptives in a PCOS patient for its anti-androgen effects?
Definition
spironolactone
Term
1.A 30 year old is noted to have a UTI with E coli growing on culture. Her NP knows that an upper urinary tract infection leads to increased complications. Which of the following is a common manifestation of an infection of the upper structures of the urinary tract rather than simple cystitis?
A.
Fever
B.
urgency
C.
Hesitancy
D.
Dysuria
Definition
A. fever- a fever could indicate complications, such as systemic infection
***urgency, hesitancy, and dysuria are often common sx of UTIs and would not necessarily represent a complication
Term
1.A 46 year old man with a history of renal calculi presents to the ED with complaints of severe left flank pain radiating to his groin area. The pain is so severe he is unable to sit still and his skin is pale. He has not tried to take anything for this pain and he has never had this type of pain before. He is also experiencing nausea and vomiting, and his temperature is 99 degrees F. What is the best initial therapy that the nurse practitioner can provide?
A.
Morphine sulfate 2-5 mg IV
B.
Toradol 15 mg IV
C.
Begin Cephalexin
D.
Give A and B together
Definition
D. give A and B together- the best initial therapy for severe pain associated w/ renal calculi (nephrolithiasis) is pain management
***hydration, crystalloids, and an anti-emetic may also be indicated
Term
True or false:
Viral infections and cholecystitis are the most common conditions associated w/ pancreatitis.
Definition
False- gallstones and alcoholism are the most common conditions associated w/ pancreatitis.
Term
1.A 72 year old man has chronic bacterial prostatitis (type II). What is the initial drug treatment of choice for this patient?
A.
nitrofurantoin (Macrodantin)
B.
Amoxicillin (Amoxil)
C.
Coxycycline (Vibramycin)
D.
Ciprofloxacin (Cipro)
Definition
D. cipro
***the other medications listed are not indicated for the tx of prostatitis
Term
1.Of the following complaints, which would not be a typical symptom for the patient with interstitial cystitis?
A.
Pelvic pain or discomfort that is worse with a full bladder
B.
Urinary urgency
C.
swelling of the groin (inguinal) nodes
D.
urinary frequency
Definition
C. swelling of the groin (inguinal) nodes- this would indicate the presence of other conditions, such as STIs, hepatits, bacterial/viral infections, malignancies, etc.
***all other sx listed may be present w/ interstitial cystitis
Term
What is Cullen's sign and what condition does it typically indicate?
Definition
Cullen's sign is a superficial oedema and bruising in the subcutaneous fatty tissue surrounding the umbilicus and is typically indicative of acute pancreatitis
***Grey-Turner's sign (superficial bruising of the flank) may also be present and may indicate a pancreatic necrosis w/ retroperitoneal and/or intraabdominal bleeding
Term
True of false:
Exposure to the spermicide nonoxynol-9 has not been shown to increase a woman's risk of uncomplicated UTI.
Definition
False- Exposure to the spermicide nonoxynol-9 has been shown to increase a woman's risk of uncomplicated UTI.
***nonoxynol-9 has NOT been shown to increase the risk of cervical stenosis, complicated UTIs, or ovarian malignancies
Term
1.Which symptom below is NOT classic of gall bladder disease?
A.
Intense, dull pressure in the mid abdomen.
B.
Pain that radiates into the chest, back, or right shoulder blade.
C.
Pain that worsens after a fatty meal
D.
Pain that occurs when the stomach empties
Definition
D. pain that occurs when the stomach empties- w/ cholecystitis, pain is typically RELIEVED when the stomach empties (i.e. vomiting)
***all other sx are classic signs of cholecystitis
Term
With acute pancreatitis, you would expect to see an elevated a____________ level.
Definition
amylase
Term
True or false:
A pt on glucophage for PCOS must be evaluated every 3-6 months for the development of hypothyroidism.
Definition
False- a pt on glucophage for PCOS must be evaluated every 3-6 months for the development of lactic acidosis, which is a serious side effect of this medication
Term
Appropriate triple therapy treatment for Helicobacter pylori is:
Combination of H2-blockers, antacids, and omeprazole
Combination of lifestyle changes, Pepto-Bismol, and cimetidine
Combination of PPI, amoxicillin, and clarithromycin
Combination of H2 blocker, amoxicillin, and antacid
Definition
C. combination of PPI, amoxicillin, and clarithromycin
Term
Aminosalicylates (Mesalamine) are primary therapy for:
A. PUD
B. Mild UC
C. pancreatitis
D. Hep C
Definition
B. mild UC
Term
You observe your male patient with complex regional pain syndrome not wearing his right jacket sleeve. The patient reports intense, right arm pain on light touch. You as the provider recognize this pain as:
A. allodynia
B. hypoalgesia
C. neuritis
D. parasthesia
Definition
A. allodynia- the elicitation of intense pain w/ only light touch
Term
Billy is a 13 year-old who has constant periumbilical pain shifting to the right lower quadrant, one episode of vomiting, a small volume of diarrhea, absence of headache, a mild elevation of the white blood cell count with an early left shift, and white blood cells in the urine. You suspect:
A. appendicitis
b. gastroenteritis
c. acute pancreatitis
d. rocky mtn spotted fever
Definition
a. appendicitis- age of onset is correct, location of pain is correct, GI disturbances fit, and the early left shift of WBCs and WBCs in the urine would all indicate appendicitis
Term
A 43 year old patient has a severe exacerbation of his ulcerative colitis. Of the following treatment recommendations, which one is NOT appropriate for this patient?
a. NPO 24-48H or until there is clinical improvement
b. plain abdominal XR to evaluate colon dilation
c. obtain stool cultures for c. diff, CMV
d. order opioid for pain management
Definition
d. order opioid for pain management
Term
Your pt is c/o burning, stabbing, constant pain in his toes since completion of chemo for lung CA. You suspect:
a. neuropathic pain
b. reflex sympathetic dystrophy
c. nociceptive pain
d. psychogenic pain
Definition
a. neuropathic pain
***nociceptive pain is typically r/t trauma
Term
An 83 year-old patient is diagnosed with diverticulitis. Where is her pain typically located?
a. epigastric
b. R or L LQ
c. LLQ
d. RLQ
Definition
c. LLQ
Term
After treating a patient for Helicobacter pylori infection, all of the following test would show if H pylori has been successfully cleared except:
a. fecal antigen test
b. urea breath test
c. serum antibody test
d. repeat endoscopy w/ biopsy
Definition
c. serum antibody test- this test would NOT be helpful in determining if H. pylori was eradicated b/c the body will cont to produce H. pylori antibodies for several months, even after the infection is eradicated
Term
A 34 year old male stock broker complains of gnawing epigastric pain for the past 2 weeks that sometimes wakes him from sleep. He is otherwise healthy, smokes less than a ½ pack per day, and his only medication is ibuprofen 600mg once per week. Given this history you suspect peptic ulcer disease:
a. gastric r/t to H. pylori
b. duodenum r/t H. pylori
c. gastric r/t NSAID use
d. duodenum r/t NSAID use
Definition
b. duodenum r/t H. pylori- H. pylori is the most common cause of ulcers; you would suspect duodenum vs gastric d/t the fact that the pain wakes the pt at night, which is typically not seen w/ gastric ulcers; this pt's NSAID use is not significant enough to create an ulcer and NSAID use is typically associated w/ gastric ulcers
Term
True or false:
If a pt is still passing small amounts of flatus and fecal matter, it means that her bowel cannot be completely obstructed.
Definition
false- you may still be able to pass small amounts of flatus and feces, depending on duration of sx and location of the obstruction
Term
A 42 year old patient is being treated for his third flair of ulcerative colitis in the last 10 months. He takes Mesalamine daily. Prednisone was prescribed for this flair and his symptoms did initially improve. He has unsuccessfully tried to taper his prednisone for the last 2 weeks noting a worsening of his symptoms whenever his dose drops below 20mg daily. What is the most appropriate next step:
a. send pt to surgeon for consideration of colectomy
b. add infliximab
c. add sulfasalazine
d. add folic acid
Definition
b. add infliximab- for pts who cannot taper from steroids, infliximab may be needed to induce remission
Term
You suspect your patient has a peptic ulcer. You educate your patient by telling him that peptic ulcer disease has been found to be most commonly associated with:
a. anxiety and panic attacks
b. long-term NSAID use
c. H. pylori infection
d. family hx of PUD
Definition
c. H. pylori infection
Term
You would suspect a Mallory-Weiss tear in a patient with GI bleeding who has a history of:
a. PUD and reports taking NSAIDs the last 5 days
b. colonic vascular ectasias w/ coumadin use for DVT
c. diverticuli w/ recent hx of constipation/straining
d. increased ETOH intake and severe vomiting 6 hours ago
Definition
d. increased ETOH intake and severe vomiting 6 hours ago- Mallory-Weiss tears occur more commonly in alcoholics and can be precipitated by vomiting, which causes stress to the already thin epithelium lining the esophagus
Term
Your patient has an extended exacerbation of Crohns' disease. Which laboratory test value(s) would you expect to be decreased?
a. sedimentation rate
b. liver enzyme levels
c. vitamins A, B, and C
d. bilirubin
Definition
c. vitamins A, B, C- these may be decreased d/t poor absorption; sed rate, liver enzymes, and bilirubin may be elevated during an exacerbation
***remember that lab tests are a poor indicator
Term
Which of the following findings is NOT associated with diverticulitis?
a. LLQ pain
b. tender mass in the LLQ
c. fever
d. hx of IBS
Definition
d. a hx of IBS
Term
All of the following treatments are appropriate for the patient with a bowel obstruction except:
Fluid resuscitation
Electrolyte repletion
Ocreotide
Exploratory Laparotomy
Definition
c. ocreotide- decreases perfusion to bowel
Term
Paracentesis reveals ascitic fluid with LDH of 60 units/L, normal amylase, protein 1 gm/dL and a PMN count of 325 cells/mm3. What is the most likely diagnosis based on these findings:
Pancreatitis
Cirrhosis
Sepsis
Peritonitis
Definition
d. peritonitis- w/ cirrohsis, the PMN count would be significantly less; a paracentesis is not indicated for pancreatits or sepsis
Term
You are attempting to determine if your acutely ill patient has ascites related to alcoholic hepatitis or primary peritonitis. Which of these tests would be best at differentiating between the two:
CT of the abdomen
CBC
Paracentesis
Abdominal Ultrasound
Definition
c. paracentesis
Term
Which of the following statements regarding the epidemiology of inflammatory bowel disease is correct?
Oral contraceptive use decreases the incidence of Crohn's disease.
Persons of Asian descent have the highest rates of ulcerative colitis and Crohns disease.
Smoking may decrease the incidence of ulcerative colitis.
Typical age of onset for Crohn's disease is 40-50 years old.
Definition
c. smoking may decr the risk of UC- this is a poorly understood correlation; smoking incr risk of crohn's
***oral contraceptives incr risk of crohn's; whites have the highest rates of crohn's and UC; and the typical age of onset for crohns is between 15-30 y/o
Term
Your patient presents with recent onset of mild to moderate pain of the right ankle. You diagnose an ankle sprain. The most appropriate medication go give for pain would be:
Morphine
Hydromorphone
Gabapentin
Vicodin
Definition
d. vicodin- according to the WHO pain ladder, you would first start w/ nonopioid pain relievers (NSAIDs), then weak opioids (codeine, hydrocodone), and finally to strong opioids (morphine, hydromorphone) if pain is still not controlled.
Term
In a patient with active bleeding from an esophageal varice, the most appropriate initial treatment would be:
Beta blocker
Endoscopic variceal ligation
Transjugular intrahepatic portasystemic shunt
Sclerotherapy.
Definition
b. endoscopic variceal ligation- this is the preferred initial tx for active bleeding (once the pt is hemodynamically stable)
***sclerotherapy is used when the site of the bleeding cannot be visualized w/ endoscopic variceal ligation technique; TIPS is not initial therapy for this condition; and beta blockers are for long-term maintenance
Term
Palliative care is:
Care that is focused on the alleviation of pain and suffering of the chronically ill cancer and cardiovascular patient.
Care that is focused on alleviating the suffering of the acutely ill patient.
Care that is focused on the relief of pain and other symptoms with the goals of easing suffering for the dying patient.
Care that is focused on the relief of pain and other symptoms of serious illness with the goal of easing suffering, and to offer patients and their families the best quality of life possible.
Definition
d
Term
An otherwise health 57 year old patient reports to the primary care office with a new complaint of large volume painless rectal bleeding. She denies diarrhea, constipation, nausea, vomiting or fever. She has had some mild LLQ pain. The source of this bleeding is most likely:
A diverticuli
Infectious colitis
Rectal tear
Ulcer in the right colon
Definition
a. diverticuli- a sudden onset of large volume, painless rectal bleeding would indicate a diverticuli (a small outpouching)
***infectious colitis would cause pain, as well as a rectal tear
Term
What is the most common source of upper GI bleeding?
Definition
ulcer, followed by esophageal varices
***neoplasms that cause bleeding are rare
Term
Your 58 year-old male patient has a negative prostate exam by digital rectal exam, however he has a positive FOBT (fecal occult blood test) at his annual physical. The next appropriate test to determine the source of bleeding would be:
CBC
EGD
Colonoscopy
Capsule endoscopy
Definition
c. colonoscopy
***a CBC would not be helpful
Term
What does the following serological pattern mean: HBsAg -, anti-HBs +, anti-HBc -, HBeAg -, anti-HBe -?
Definition
this would demonstrate immunity to Hep B via vaccination
Term
What does the following serologic pattern indicicate: HBsAg -, anti-HBs +, anti-HBc = IgG, HBeAg -, anti-HBe + or -?
Definition
this would indicate recovery from hep B and immunity
this would indicate chronic hep B w/ active viral replication
Term
What does this serological pattern indicate: HBsAg +, anti-Hbs -, anti-HBc IgM, HBeAg +, anti-HBe -?
Definition
this would indicate acute hep B
Term
What is the only form of hepatitis that cannot be prevented via vaccine?
Definition
hep C
Term
What is the treatment for hep A and E?
Definition
nothing other than symptom management
Term
What types of hepatitis have an exclusively acute onset?
Definition
hep A and E
***HBV can be acute or insidious; HCV is insidious; HDV can be acute or insidious
Term
How are hep A and E spread?
Definition
fecal-oral route
Term
How is hep B spread?
Definition
percutaneous, perinatal, and sexual
Term
How is hep C spread?
Definition
percutaneous, perinatal, and sexual
Term
How is hep D spread?
Definition
percutaneous, pernatal, and sexual
Term
What is the incubation period of hep A?
a. 15-45 days
b. 30-180 days
c. 15-160 days
d. 14-60 days
Definition
a. 15-45 days
***HBV and HDV = 30-180 days; HCV = 15-160 days; HEV = 14-60 days
Term
What is the incubation period of hep B and D?
a. 15-45 days
b. 30-180 days
c. 15-160 days
d. 14-60 days
Definition
b. 30-180 days
Term
What is the incubation period of hep C?
a. 15-45 days
b. 30-180 days
c. 15-160 days
d. 14-60 days
Definition
c. 15-160 days
Term
What is the incubation period of hep E?
a. 15-45 days
b. 30-180 days
c. 15-160 days
d. 14-60 days
Definition
d. 14-60 days
Term
Which 2 types of hepatits do not progress to chronic hepatitis?
Definition
hep A and E do not progress to chronic hepatits
Term
Which 2 types of hepatitis commonly progress to chronic hepatitis?
Definition
Hep C and D commonly progress to chronic hepatitis
Term
A 50 y/o presents w/: sudden onset of mid-abdominal pain radiating to his back that awoke him from sleep and vomiting that did not relieve pain. He takes 1 aspirin per day, does not drink or smoke. Meds: propranolol and HCTZ. Dx w/ HTN and pre-DM. FMH: cholecystectomies, cholelithiasis, cholecystitis. Which is LEAST likely to cause his sx?
a. acute pancreatitis
b. MI
c. penetrating ulcer
d. acute cholecystitis
e. acute appendicitis
Definition
e. acute appendicitis- this condition usually has a slow onset of mid-abdom pain that eventually localizes to RLQ and is uncommon in this age group
***MI should always be considered d/t his age group; pancreatitis should be suspected d/t the fact that vomiting did NOT relieve the pain
Term
Palliative care should begin:
a. when the pt has <6 mos to live
b. when a chronic dz is dx
c. when the pt requests it
d. when the pt has <3 mos to live
Definition
b. when a chronic dz is dx
Term
You are seeing a patient presents with symptoms consistent with a flair of her ulcerative colitis. Which of the following tests would be inappropriate in this situation:
a. barium enema
b. sigmoidoscopy
c. colonoscopy
d. abdominal XR
Definition
a. barium enema- this can lead to a toxic megacolon in pt's w/ UC
Term
Of the following, which would NOT be an appropriate measure in treating the patient with peritonitis:
a.
Paracentesis prior to antibiotic administration
b. aminoglycoside antibiotic after paracentesis
c. repeat paracentesis 48 H after antibiotic admin
d. admin 3rd generation cephalosporin after paracentesis
Definition
b. aminoglycoside- you would avoid this d/t risk of nephrotoxicity, which is already higher w/ peritonitis
Term
When would you use a technetium labeled RBC scan?
Definition
in order to dx an obscure GI bleed
Term
A 36 year old male completed triple therapy for H-Pylori peptic ulcer disease. You ordered a urea breath test which returned positive showing the H pylori was not eradicated. Your next step should be:
a. retest w/ fecal antigen test
b. Rx quadruple therapy
c. Rx another course of triple therapy but changing the clarithromycin to metronidazole
d. realize that some pts never clear the H. pylori and Rx a daily PPI
Definition
b. Rx quadruple therapy- quadruple therapy consists of a proton pump inhibitor, bismuth, tetracycline, and metronidazole or tinidazole for 14 days
Term
Testing of your patient with suspected bowel disease reveals transmural inflammation, granulomas, focal involvement of the colon with some skipped areas, and sparing of the rectal mucosa. What do you suspect?
a. crohn's dz
b. UC
c. infectious colitis
d. ischemic colitis
Definition
a. crohn's dz- d/t hallmark "skip" lesions
Term
True or false:
The most common cause of bowel obstructions in all ages is adhesions.
Definition
true
Term
In a 68 year old patient who requires an anti inflammatory for arthritis but has a history of peptic ulcer disease 2 years ago, the best choice would be:
a. naproxen
b. a "coxib" (COX-2 inhibitor
c. low-dose prednisone
d. low-dose aspirin
Definition
a. naproxen
Term
A 24 year old male has recently returned from a weekend camping trip with friends. He has ulcerative colitis and history of migraine headaches. He reports a two-day history of headache, nausea, and vomiting with weakness. Which of the following is LEAST likely as a possible cause?
a. migraine
b. UC exacerbation
c. acute gastroenteritis
d. norovirus
Definition
b. UC exacerbation
Term
Duodenal and gastric ulcers have many of the same manifestations. Which of these symptoms is more common with duodenal ulcers?
a. epigastric or abdominal pain
b. vomiting
c. intermittent dyspepsia
d. pain that wakes the pt from sleep
Definition
d. pain that wakes the pt from sleep- both types cause epigastric and abdominal pain, vomiting, and intermittent dyspepsia
Term
The nurse practitioner would test the obturator and iliopsoas muscles to evaluate a possible case of which of the following conditions?
a. acute cholecystitis
b. acute appendicitis
c. inguinal hernia
d. gastric ulcer
Definition
b. acute appendicitis
Term
Your 26 year-old patient is status post elective tubal ligation. She now complains of increased intermittent abdominal pain, constipation, vomiting, and abdominal distention. You suspect:
a. PUD
b. crohn's dz
c. diverticulosis
d. small bowel obstruction
Definition
d. small bowel obstruction- the cardinal signs of a SBO include colickly abdominal pain, constipation, vomiting, and abdominal distention; these are common after surgical procedures and in hospitalized pts
Term
In a patient with known esophageal varices, the following medication would be the best choice to reduce portal pressure:
a. octreotide
b. fluroquinolones
c. 3rd gen cephalosporin
d. lactulose
Definition
a. octreotide
Term
Thalassemia:
alpha by gene d________, beta by point m_________.
Definition
deletion; mutation
Term
Thalassemia:
these disorders cause a decrease in the synthesis of g______ chains which cause a d________ in the formation of H________.
Definition
globulin; decrease; Hgb
Term
Thalassemia:
the cells appear h____________ and m__________
Definition
hypochromic; microcytic
Term
True or false:
If you have the thalassemia trait, you will have abnormal labs, moderate clinical impact, and require blood transfusions.
Definition
False- if you have the thalassemia trait, you will have abnormal labs but no significant clinical impact
***if you have INTERMEDIATE thalassemia, you will have abnormal labs, moderate clinical impact, and require blood transfusions; if you have MAJOR thalassemia, it is considered life-threatening
Term
What is the clinical impact of major thalassemia?
Definition
it is life-threatening
Term
True or false:
Thalassemias are autosomal dominant.
Definition
False- thalassemias are autosomal recessive
Term
Thalassemia:
Normal Hgb is Hgb ____; there are ____ alpha chains and ___ beta chains; there ______ a substitute for alpha globin in the synthesis for Hgb.
Definition
A; 2; 2; isn't
Term
How are thalassemias classified?
Definition
thalassemias are classified according to which Hgb molecule is affected: if you have less alpha Hgb, then you have a more severe case of thalassemia
Term
Labs for thalassemia trait/thalassemia minor include: m________ anemia; very ______ MCV; ________ RBCs; m________, h_________, a___________ (spur cells) on a peripheral blood smear; and _________ iron studies.
Definition
mild; low; normal; microcytosis; hypochromia; acanthocytes; normal
Term
Beta thalassemia can be classified into: m___________ (homozygous); i_____________ (homozygous); and m___________ (heterozygous).
Definition
minor; intermediate; major
Term
in thalassemia major, pts are _______ at birth, and develop _______ anemia around ____ months and require _______ indefinitely until an allogenic s_______ c________ b_________ m__________ transplant is able to be done,
Definition
normal; severe; 6; transfusions; stem cell bone marrow
Term
True or false:
Thalassemia intermedia pts have chronic hemolytic anemia but do not require blood transfusions except under periods of stress or illness.
Definition
True
Term
True or false:
In thalasseamia minor, pts have hemolytic anemia that is clinically significant.
Definition
False- in thalassemia minor, pts have microcytic anemia that is clinically insignificant
***hemolytic anemia is seen in thalasseamia intermedia
Term
Beta thalassemia intermedia labs show mild to moderate a_________; _______ MCV; RBCs that are n________ or i___________; and b_________ s_________ on a peripheral blood smear.
Beta thalassemia major labs include: ___________ anemia (<10%); b____________ peripheral blood smear; and Hgb _____ and a_____ 2 as the major form of Hgb in the body (the normal Hgb is Hgb ____).
Definition
severe; bizarre; F; alpha; A
Term
What are the 2 major macrocytic anemias?
Definition
1. vitamin B12 deficiency
2. folic acid deficiency
Term
With macrocytic anemia, RBCs are often ____________ and i_____________ in amount with i______________ Hgb content.
Definition
large; insufficient; insufficient
Term
What are the 3 causes of macrocytic anemias?
Definition
1. megloblasotic anemia
2. red cell membrane d/o producing codocytes (i.e. target cells)
3. ETOH
Term
True or false:
megloblastic anemias are a result of pathologies of the liver and spleen.
Definition
False- megloblastic anemias are a result of vitamin B12 and folate deficiencies, poisons, some antiviral and chemo drugs, and DNA that is not maturing fast enough.
***red cell membrane d/o (1 of the 3 causes of macrocytic anemia) result from pathologies of the liver and spleen
Term
Vitamin B 12 comes from:
a. foods that fly, walk, or swim
b. liver stores
c. green, leafy veggies
d. both A and B
e. all of the above
f. none of the above
Definition
d. both A and B- vit B12 comes from animal protein and can be taken from liver stores, which can be between 2000-5000 mcg and can take up to 3 years to deplete
Term
What do we need vitamin B12 for?
Definition
it is necessary for brain and nervous system formation and DNA sysnthesis and replication
Term
Causes of vit B12 deficiency include: not enough i__________; inadeqyate a___________ from dzs such as c_________ dz, c__________ dz, p___________ anemia, and post-g___________.
S/S of vitamin B12 deficiency include: g______________; a___________; d_______________; and p____________.
Definition
glossitis; anorexia; diarrhea; paleness
Term
Complex neurological syndrome can result from B12 deficiency and may include: impaired sensation to _______ touch/pressure/vibration; a____________/balance difficulties; and decreased/absent D________.
Definition
impaired; ataxia; DTRs
Term
True or false:
Vitamin B12 deficiency labs will reveal decreased LDH and a slight decrease in indirect billirubin.
Definition
False- Vitamin B12 labs will reveal increased LDH and a slight increase in indirect billirubin.
Treatment of vitamin B12 deficiency includes: p__________ cobalamin in the form of _____mcg d______ IM for the first week; then w_______ for ____ month(s); then __________ for the rest of life. You can use the _________ method but it is significantly less absorbed.
Definition
parenteral; 100; daily; weekly; 1; monthly; oral
Term
What lab helps to differentiate between myelodysplasia, folic acid deficiency, and B12 deficiency?
Definition
a B12 level
Term
With macrocytic anemias, reticulocytes normalize within the ______ week of treatment and the total hematologic picture normalizes within ____ monhts.
Definition
first; 2
Term
True or false:
Neurological sx of B12 deficiency can always be reversed w/ tx.
Definition
False- neurological sx of B12 deficiency are typically reversed if tx w/in the first 6 monts; however, if tx is not sought soon enough, some neurological sx can be irreversible
Term
Folic acid can be found in what foods?
Definition
citrus fruits and green, leafy veggies
Term
Which part of the intestine absorbs folic acid?
a. the sigmoid colon
b. the transverse colon
c. only the small intestine
d. only the large intestine
e. the entire intestinal tract
Definition
e. the entire intestinal tract
Term
What is the daily requirement of folic acid for a nonpregnant person?
a. 50-100 mcg
b. 50-100 mg
c. 100-150 mcg
d. 100-150 mg
Definition
a. 50-100 mcg
Term
How much folic acid can the body store?
Definition
5000 mcg (i.e. a 2-3 month supply)
Term
The most common causes of folic acid deficiency anemia include: inadequate d__________; a___________ use; a__________; _______cooked foods; and diets that exclude f__________ and v_________.
Definition
diet; alcohol; anorexics; over; fruits; veggies
Term
What medication can impair the absorption of folic acid?
a. sulfa antibiotics (bactrim)
b. macrolide antibiotics (azithromycin)
c. tetracycline antibiotics (doxycycline)
d. PCNs (amoxicillin)
Definition
a. sulfa antibiotics (bactrim)
Term
The S/S of folic acid deficiency are similar to B___ deficiency but do not cause n_____________ sx. The patient may have a b_______ tongue, g__________, a____________, d_____________, and p____________.
On a peripheral blood smear, what finding is characteristic of both folic acid and B12 deficiencies?
a. micro-ovalocyte shaped cells
b. macro-ovalocyte shaped cells
c. micro-elliptical shaped cells
d. macro-elliptical shaped cells
Definition
b. macro-ovalocyte shaped cells
Term
True or false:
The lab findings in macrocytic folic acid deficiency anemia reveal abnormally low folic acid (<150 ng/mL) and an elevated serum B12 level.
Definition
False- The lab findings in macrocytic folic acid deficiency anemia reveal abnormally low folic acid (<150 ng/mL) and a NORMAL serum B12 level.
Term
ETOH-induced macrocytic anemia results from interference with: absorption of f________ a_________; H______ synthesis; and e___________.
Definition
folic acid; Hgb; erythropoiesis
Term
What kind of macrocytic anemia is folic acid deficiency considered?
a. macrocytosis
b. microcytosis
c. megaloblastic
d. sideroblastic
Definition
c. megaloblastic
Term
True or false:
anemias that are caused by drinking can reverse themselves within weeks of quitting.
Definition
true
Term
Sideroblastic anemia occurs when Hgb synthesis is _____________ d/t failure to incorporate h________, which causes an intracellular accumulation of i_________. Sideroblastic anemia is typically a_________ and is a type of m_____________. Sideroblastic anemia can result from a____________ abuse, l___________ poisoning and blunts the ability of the b___________ m______ to make cells.
Definition
reduced; heme; iron; acquired; myelodysplasia; alcohol; lead; bone marrow
Term
Sideroblastic anemia is a precursor to what?
Definition
malignancy
Term
When is routine screening for IDA recommended?
a. during childhood
b. during puberty
c. age 50 and older
d. during pregnancy
Definition
d. during pregnancy
Term
The definition of anemia is the _______ decrease in R___ and H______ in proportion to _________ volume.
Definition
absolute; RBCs; Hgb; blood
Term
What is the normal Hct level for men?
a. >41%
b. >45%
c. >51%
d. >55%
Definition
a. >41%
Term
What is the normal Hct level for women?
a. >41%
b. >31%
c. >47%
d. >37%
Definition
d. >37%
Term
Mechanisms for iron deficient anemia include: inadequate production of e__________; excessive d_____________ of erythrocytes; and blood ______.
Definition
erythrocytes; destruction; loss
Term
Anemias are classified by M________ and M__________.
Definition
MCV; MCHC
Term
True or false:
The MCHC refers to the average size of RBCs and classifies them as micro, macro, or normocytic.
Definition
False- the MCV (mean corpuscular volume) refers to the average size of RBCs and classifies them as micro, macro, and normocytic.
***the MCHC (mean corpuscular Hgb concentration) refers to the average concentration of Hgb in RBCs
Term
What is the normal range for MCV?
a. 78-100 femtoliters
b. 100-178 femtoliters
c. 178-200 femtoliters
d. 200-278 femtoliters
Definition
a. 78-100 femtoliters
Term
What is the normal range for MCHC?
a. 28-30 g/dL
b. 30-32 g/dL
c. 32-34 g/dL
d. 34-36 g/dL
Definition
c. 32-34 g/dL
Term
Hgb measures the amount of Hgb m___________ in ________ volume.
Definition
molecules; blood
Term
The normal Hgb levels for men are:
a. 12-15.5 g/dL
b. 13.5-17 g/dL
Definition
b. 13.5-17 g/dL
***the normal Hgb levels for women are 12-15.5 g/dL
Term
Hct measures the percent of the blood occupied by ________.
Definition
RBCs
Term
The RDW measures the R______ d__________ w________, which is the measure of the range of variations in RBC v_______ and s__________. The normal value is <____%.
Definition
RBC distribution width; volume; size; 15
Term
What does MCH stand for and what does it measure?
Definition
MCH stands for mean corpuscular Hgb and measures the average mass of Hgb per RBCs
Term
If MCH is low, cells are considered to be h____________ and will appear p__________ d/t the lack of Hgb.
Definition
hypochromic; pale
Term
Which of the following are considered microcytic anemias?
a. IDA
b. thalassemias
c. anemia of chronic diseases
d. all of the above
Definition
d. all of the above- these are the 3 types of microcytic anemias
Term
True or false:
The most common physiologic cause of IDA is menstruation.
Definition
True- women typically lose an average of 50mL of blood with every menstrual cycle but some women can lose up to 5x that
Term
True or false:
The most common pathophysiological cause of IDA is menstruation.
Definition
False- the most common pathophysiological cause of IDA is GI bleed
Term
In men and postmenopausal women, IDA is a good indicator of:
a. GI bleed
b. malignancy
c. SBO
d. perforated ulcer
Definition
b. malignancy
Term
What part of the bowel absorbs iron?
Definition
the small bowel
Term
In mild anemia, you may see Hgb of ___-___ and likely _______ sx. In moderate anemia, you may see Hgb of ____-____ and likely see sx of p__________, d__________ (especially w/ e__________), s__________, g___________, and p____________. In severe anemia, you may see Hgb <___ and likely see sx of postural h_________, d__________, w____________, p__________, and l_________.
Typical lab findings in IDA show: ______ MCV (small RBCs); _____ MCH (low Hgb); _______ RDW (variability in size of RBCs); and a _________ reticulocyte count.
Definition
low; low; high; low
Term
Serum ferritin measures the i________ stores and is the most powerful indicator of d_________ and helps to determine response to t__________. The normal level for ______ is 20-250 mg/mL. The normal level for ________ is 10-120 mg/mL.
Definition
iron; dx; treatment; men; women
Term
Transferrin b________ and t___________ iron. This number is often _______ in IDA b/c there are fewer molecules bound to iron b/c there is less iron floating around. The normal range is 2___-3____ mg/mL.
Definition
binds; transports; high; 204; 360
Term
Transferrin saturation refers to the t_________ b________ s________ occupied by iron. The average range is 2__-5___%.
Definition
total binding sites; 20-50
Term
Normal serum iron levels in men are:
a. 26-170
b. 170-300
c. 65-198
d. 198-300
Definition
c. 65-198
Term
Normal serum iron levels in women are:
a. 26-170
b. 170-300
c. 65-198
d. 198-300
Definition
a. 26-170
Term
Total iron binding capacity (TIBC) refers to the capacity of iron to bind with t___________. The normal range is 2____-4____ ug/dL and is typically ___________ in IDA.
Definition
transferrin; 240-450; increased
Term
What is one way to "tease out" whether or not a pt has IDA?
Definition
try an iron supplement
Term
What is the next test you should do once IDA is suspected/confirmed?
a. repeat CBC
b. EGD
c. obtain a FOBT
d. colonoscopy
Definition
c. obtain a FOBT (fecal occult blood test)- looking for GI bleed causes of IDA
Term
As anemia worsens, a________ and p________ develop.
Definition
anisocytosis (RBCs of different sizes); poikilocytosis (weird-shaped RBCs)
Term
Tx of IDA involves what?
Definition
tx involves finding the cause- anemia is a response to some other pathology
***will also involve oral iron, parenteral iron, and EPO
Term
The 2 forms of oral iron are ferrous s_______ and ferrous g______.
Definition
sulfate; gluconate
Term
True or false:
Iron is best absorbed in an alkaline environment.
Definition
False- iron is best absorbed in an acidic environment
***iron should be taken w/ vitamin C to increase absorption
Term
Side effects that are most commonly cited for noncompliance w/ iron supplementation include:
a. nausea and alopecia
b. nausea and constipation
c. constipation and impaired taste
d. impaired taste and fatigue
Definition
b. nausea and constipation
Term
The goals of IDA tx is to fix r___________ within days so that b__________ m_______ can kick in; increase Hgb __-__ g/dL every __ weeks; serial C_____; and restoration of iron stores w/in ___-___ months.
Definition
reticulocytosis; bone marrow; 1-2; 2; CBC; 3-4
Term
What lab is the best indicator of IDA treatment response?
a. ferritin
b. transferrin
c. serum iron
d. Hgb
Definition
a. ferritin- b/c it measures the stores and is the best indicator of dx and tx response
Term
True or false:
Iron dextran (INFed, DexFerrum) is an IM iron preparation that is inexpensive, and easily tolerated.
Definition
False- Iron dextran (INFed, DexFerrum) is an PARENTERAL iron preparation that is VERY EXPENSIVE, and NOT easily tolerated
***iron dextran also has a black box warning for anaphylaxis
Term
True or false:
Iron sucrose (venofer) is an easily tolerated parenteral form of iron.
Definition
True
Term
Other cautions of iron dextran (INFed, DexFerrum) include: contraindicated in A_____; can supply entire dose of iron in _____ dose; requires a small t____ d_____ for anaphylactic response; and have several s______ e__________.
Definition
ARF; one; test dose; side effects
Term
Side effects of iron dextran include: m_________; a_________; n__________; v____________; f___________; and ________tension.
What kind of anemia is the most common type in the elderly?
a. IDA
b. anemia of chronic disease
c. thalassemia
d. all of the above
Definition
b. anemia of chronic disease
Term
ACD begins as a n__________ anemia and progresses to m__________ as it advances.
Definition
normocytic; macrocytic
Term
True or false:
The severity of ACD corresponds to the severity of the underlying dz.
Definition
True
Term
True or false:
In ACD, erythrocytes are typically microcytic and hypochromic.
Definition
False- in ACD, erythrocytes are typically normocytic and normochromic.
Term
In ACD, ferritin should be n________ or h_______, TIBC should be n_________ or l__________, and transferrin saturation can be very ________.
Definition
normal; high; normal; low; low
Term
What can distinguish between ACD and IDA?
a. bone marrow
b. a trial of iron supplmentation
c. a trial of EPO
d. both a and b
Definition
d. both a and b
Term
In ACD, iron stores are n______________ and the ferritin levels will be n_________ or h___________.
Definition
normal; normal; high
Term
Acute infections that cause ACD include:
a. TB
b. infective endocarditis
c. chronic UTI
d. chronic fungal infection
e. all of the above
Definition
e. all of the above
Term
True or false:
Acute infections that cause ACD include: OA, RA, collagen vascular dz, polymalgia rheumaica, hepatitis, and decubitus ulcers.
Definition
False- Acute infections that cause ACD include: TB, infective endocarditis, chronic UTI, and chronic fungal infections
***CHRONIC infections that cause ACD include: OA, RA, collagen vascular dz, polymalgia rheumaica, hepatitis, and decubitus ulcers.
Term
S/S of ACD are similar to that of ______ ________ anemia.
Definition
iron deficiency
Term
To treat ACD, you need to: treat the underlying d_________; administer _________ iron; E______ may be necessary; and b__________ t___________ if the disease becomes severe.
Definition
disease; parenteral; EPO; blood transfusions
Term
When increasing Hgb, caution must be used and Hgb is not to exceed:
a. 13 g/dL
b. 14 g/dL
c. 15 g/dL
d. 16 g/dL
Definition
a. 13 g/dL
***exceeding this may place the pt at risk for stroke or MI
Term
When increasing Hgb, caution should be used and Hgb should not exceed 13 g/dL due to the increased risk of what?
Definition
stroke and MI
Term
What is the most common inherited bleeding d/o?
Definition
Von Willebrand's dz
Term
Which type of VW dz is the most common: type 1 or type 2?
Definition
type 1 is more common
Term
In pre-op pts w/ coagulopathies, you should be most concerned w/ pts who have pre-existing conditions such as: l__________ dz; r________ failure; o___________ jaundice; and possible/known disseminated m__________.
Definition
liver; renal; obstructive; malignancy
Term
The VW factor works by bridging p__________ together and tethering them to the s__________ matrix. It also prolongs the 1/2 life of factor _____.
Definition
platelets; subendothelial; 8
Term
True or false:
The type of bleeding most often seen w/ VW dz is platelet-type bleeding, such as nosebleeds, bruising, bleeding gums, and bleeding mucous membranes.
Definition
True
Term
True or false:
In VW dz, joint bleeding is also common.
Definition
False- in VW dz, joint bleeding is rare, as opposed to hemophilias where joint bleeding is a common problem
***the bleeding that is common w/ VW dz includes nosebleeds, bruising, bleeding gums, and bleeding mucous membranes
Term
Another inherited bleeding d/o is h__________ A and B.
Definition
hemophilia
Term
Hemophillia A is also known as factor ____ and hemophillia B is also known as factor ____; both are ___-linked recessive.
Definition
8; 9; X
Term
Severe cases of hemophillia are often seen in:
a. infancy or early childhood
b. early childhood only
c. adolescence and early adulthood
d. early adulthood only
Definition
a. infancy or early childhood
***severe cases develop during this time when there is spontaneous bleeing into joints and soft tissues
Term
True or false:
Spontaneous bleeding is common in mild cases of hemophillia.
Definition
False- spontaneous bleeding is RARE in mild cases of hemophillia
Term
Hemophilliac arthropathy occurs when there is bleeding into j_________ s__________; can be avoided or blunted if factors are given during c__________; and are common in a________ with hemophillia.
Definition
joint spaces; childhood; adults
Term
In hemophillia, labs would reflect a _____ factor 8 and a ______ factor 9.
Definition
low; low
Term
Hemophillia is classified according to factor activity in p____________. A mild case = >____%. A moderate case = ___-____%. A severe case = <___%.
Definition
plasma; 5; 1-5; 5
Term
How is hemophillia tx?
a. blood transfusion
b. oral iron supplements
c. parenteral iron supplements
d. admin plasma-derived or recombinant factors
Definition
d. admin plasma-derived or recombinant factors
Term
If a severe case of hemophillia (<___%) develops by the age of 4, the child will prophylactically receive ___-___ infusions per week, moving to P_______ in adulthood.
Definition
5; 2-3; PRN
Term
True or false:
In severe cases of hemophillia, pts often respond well to IV or intranasal DDAVP (desmopressin acetate).
Definition
False- in severe cases of hemophillia, pts will need transfusions
***In MILD cases of hemophillia, pts often respond well to IV or intranasal DDAVP.
Term
What types of pain medications can hemophillia pts receive? (select all that apply)
a. NSAIDs (ibuprofen, acetaminophen)
b. COX-2 inhibitors (Vioxx, Celebrex)
c. oral opioids
d. aspirin
Definition
a. COX-2 inhibitors
c. oral opioids
***these pts are NOT to be given NSAIDs or aspirin, as they have anti-coagulatory effects
Term
DIC is concurrent t________ (clotting) and h__________ (bleeding), which is occurs when some kind of i_________ starts the clotting cascade and it goes c__________.
Definition
thrombosis; hemorrhaging; illness; crazy
Term
What does exposure to a procoagulant often cause?
a. hemorrhage
b. MI
c. thrombosis
d. stroke
Definition
c. thrombosis
Term
The formation of f_________ within the circulation causes widespread intravascular d__________, which causes tissue i__________, hemolytic a______, and e_______ organ damage.
Definition
fibrin; deposition; ischemia; anemia; end
Term
A diagnosis of DIC is suspected because of the h_______ (sepsis, trauma, malignancy), clinical p_________, thrombocytopenia (< 1______ platelets), the presence of h______ cells and s_______.
Definition
hx; presentation; 100,000; helmet; schistocytes
Term
Thrombin generation i__________ fibrinogen and d___________ fibrinolysis, which causes FDP and D-dimer to i___________.
Definition
increases; decreases; increase
Term
How do we tx DIC?
a. platelet transfusions
b. blood transfusions
c. surgery
d. all of the above
Definition
a. platelet transfusions
Term
When do we tx DIC w/ platelet transfusions?
a. when a pt is bleeding w/ plts <30-60k
b. when a pt is not bleeding w/ plts <30-60k
c. when a pt is bleeding w/ plts <20-50k
d. when a pt is not bleeding w/ plts <20-50k
Definition
c. when a pt is bleeding / plts <20-50k
Term
If patients are bleeding with increased I_____ and fibrinogen is < 5___ mg/dL, they should get c__________ F______,
Heparin is widely used for DIC and is considered generally safe following many control trials.
Definition
False- heparin should be used VERY JUDICIOUSLY in order to interrupt an underlying coagulopathy; its safety is questionable b/c there are no control trials
Term
The3 requirements for normal renal function are: normal f_______; functioning g__________; and clear urinary o________ t_________.
Definition
flow; glomeruli; outflow tract
Term
G_____ provides a useful index of overall kidney function and for staging of CKD. Patients w/ KD can have a n_________ or i___________ G_____.
Definition
GFR; normal; increased; GFR
Term
GFR measures the amount of p_________ u_________ across the glomerular c_____________; it is an approximate measure of the number of functioning n__________.
Definition
plasma unfiltered; capillaries; nephrons
Term
In patients w/ reanl dz, what implies stability?
Definition
stable GFR
Term
What is the maintenance of a near normal intrarenal hemodynamic environment despite large changes in the systemic BP?
a. autofiltration
b. autoregulation
c. homeostasis
d. none of the above
Definition
b. autoregulation
Term
4 vasodilators that help in autoregulation are P_____, A_____, N_____, and K______ (aka "PANK").
Definition
PGE; ANP; NO; Kinins
Term
4 vasoconstrictors that help in autoregulation are: r______; e_______; a_____________ II; and A_____ (aka "REAA").
Definition
renin; endothelin; angiotensin; ADH
Term
A decrease in MAP causes RBF to _________, PGE to _________, afferent arterioles to d___________, angiotensin II to __________, and efferent arteriols to c__________; upon completion of this process, you will have _________ glomerular perfusion pressure.
Definition
decrease; increase; dilate; increase; consrict; normal
Term
True or false:
NSAIDs affect MAP by inhibiting PGE and causing afferent arterioles to constrict, causing a drop in glomerular pressure and decreased GFR.
Definition
True
Term
ACEIs and ARBs affect renal pressure by inhibiting a____________ II and causing e__________ arterioles to constrict, which then cause a ______ in glomerular pressure and GFR.
Definition
angiotensin; efferent; drop
Term
Autoregulation breaks down at what point?
a. when MAP drops below 80mmHg
b. when MAP drops below 60mmHg
c. when MAP rises above 80mmHg
d. when MAP rises above 60mmHg
Definition
a. when MAP drops below 80mmHg
Term
True or false:
The hallmark of ARF is a significant drop in GFR.
Definition
False-
The hallmark of ARF is the failure of autoregulation to occur
Term
After what age does RBF/GFR decrease progressively?
a. 60 y/o
b. 50 y/o
c. 40 y/o
d. 30 y/o
Definition
d. 30 y/o
Term
Causes of structural changes in renal arterioles include a___________ d/t aging, H________, and C______.
Definition
atherosclerosis; HTN; CKD
Term
5 things that cause afferent vasoconstriction include: s_______; h_____calcemia; h________ syndrome; c__________ or tacrolimus; and r___________ agents.
2 things that cause efferent artiole vasoncontriction are: A______ and A______.
Definition
ACEI; ARB
Term
Renal mass declines progressively after the ____th decade of life:
a. 5th
b. 4th
c. 7th
d. 8th
Definition
b. 4th
Term
Serum creatinine values remain relatively c________ d/t decreased m_________ m_________ along with the decrease in G_______.
Definition
constant; muscle mass; GFR
Term
GFR impairment is partially d/t the thickening of the g_________ b_________ membrane (aka glomerulosclerosis).
Definition
glomerular basement
Term
Major ACUTE renal vascular dz is most commonly caused by: (select all that apply)
a. vasculitis (Wegener's granulomatosis)
b. nephrosclerosis
c. unilateral/bilateral renal artery stenosis
d. cholesterol-related atherosclerosis/embolic dz
Definition
a. vasculitis
Term
Major CHRONIC renal vascular dz is most commonly caused by: (select all that apply)
a. vasculitis (Wegener's granulomatosis)
b. nephrosclerosis
c. unilateral/bilateral renal artery stenosis
d. cholesterol-related atherosclerosis/embolic dz
Definition
b. nephrosclerosis
c. unilateral/bilateral renal artery stenosis
d. cholesterol-related atherosclerosis/embolic dz
Term
3 S/S f renal artery stenosis include: r________ HTN, n______ o______ HTN, and possible audible a__________ b________ on the affected side.
Definition
refractory; new onset; abdominal bruit
Term
Fibromuscular dysplasia primarly affects:
a. older women
b. older men
c. younger women
d. older women
Definition
c. younger women
***younger women w/ unexplained HTN should be screened for this d/o
Term
Renal artery stenosis lab findings include elevated B______ and c________ with significant renal i________.
Definition
BUN; creatinine; ischemia
Term
True or false:
With renal artery stenosis imaging, asymmetrical kidney size is often revealed.
Definition
True- this occurs d/t one renal artery being disproportionately affected in comparison w/ the other
Term
What is/are common methods for kidney imaging? (select all that apply)
a. doppler U/S
b. CT angiography
c. MRA
d. MRI
e. XR
Definition
a. doppler U/S
b. CT angiography
c. MRA
Term
What is the GOLD STANDARD for dx of kidney dz?
a. CT angiography
b. renal angiography
c. MRA
d. MRI
Definition
b. renal angiography
*** only use this when you HAVE to b/c the contrast can cause further injury to the kidneys
Term
True or false:
AKI/ARF is deteriorating renal function over months to years.
Definition
False- AKI/ARF is worsening renal function over hours to days
***CKD is deteriorating renal function over months to years
Term
Recent onset of f________, d_________ urine, o__________, a____________, and a steady _____ in plasma creatinine suggest an acute process.
Definition
fever; discolored; oliguria; anuria; rise
Term
Prolonged oliguria is consistent w/:
a. advanced renal failure
b. ARF
c. AKI
d. advanced renal stenosis
Definition
a. advanced renal failure
Term
A consistent/stable decrease in creatinine is indicative of:
a. advanced renal failure
b. AKI
c. ARF
d. CKD
Definition
d. CKD
Term
The rate of the _________ in creatinine can help w/ the DDx. A progressive rise in creatinine is more likely d/t acute t______ n_______, while a slow rise with fluctuations of creatinine is more likely d/t p_____-r_____ failure.
Definition
rise; tubular; necrosis; pre-renal
Term
True or false-
A normal sized kidney on an U/S excludes chronic dz.
Definition
False
Term
What is the most important non-invasive dx test for evaluation of the kidneys?
a. CDC
b. U/S
c. U/A w/ micro examination of sediment
d. urine culture
Definition
c. U/A w/ micro examination of sediment
Term
Muddy brown and epithelial casts in the urine are suggestive of: (select all that apply)
a. ATN (acute tubular necrosis)
b. vasculitis
c. glomerulonephritis
d. CKD
Definition
a. ATN
Term
One red cell cast is dx of: (select all that apply)
a. ATN (acute tubular necrosis)
b. vasculitis
c. glomerulonephritis
d. CKD
Definition
b. vasculitis
c. glomerulonephritis
Term
Significant protenuria is indicative of:
a. ARF
b. renal lesions
c. extrarenal bleeding
d. form of glomerular dz
Definition
d. form of glomerular dz
Term
Round, uniform RBCs are indicative of:
a. ARF
b. renal lesions
c. extrarenal bleeding
d. form of glomerular dz
Definition
c. extrarenal bleeding
Term
Red cells w/ dismorphic appearance are indicative of: (select all that apply)
a. ARF
b. renal lesions
c. extrarenal bleeding
d. form of glomerular dz
Definition
b. renal lesions
d. form of glomerular dz
Term
An abrupt fall of GFR over minutes to days w/ a rapid and sustained rise in nitrogenous waste products in the blood is indicative of:
a. ARF
b. renal lesions
c. extrarenal bleeding
d. form of glomerular dz
Definition
a. ARF
Term
The normal GFR is >___. The normal value of creatinine for _____ is 0.8-1.4 and 0.6-1.2 for ________.
Definition
60; males; females
Term
Why is serum creatinine a poor marker of renal function?
a. it does not take into account muscle mass and age
b. it does not take into account muscle mass and gender
c. it does not take into account gender and age
d. it does not take into account gender and weight
Definition
a. it does not take into account muscle mass and age
***a frail 70 y/o woman w/ a creatinine of 1 would NOT mean the same thing as a 25 y/o man with a creatinine of 1 d/t the difference in muscle mass
Term
True or false:
Oliguria is <100 mL in 24 hours.
Definition
False- oliguria is <400 mL in 24 hours
***anuria is <100 mL in 24 hours
Term
Life-threatening consequences of ARF include: volume _________; h_____kalemia; u______; and metabolic a__________.
Definition
overload; hyper; uremia; acidosis
Term
Management of ARF includes: ID/correct p____-r_____ and p____-r-_____ factors; _________ CO and RBF; s______ ACEIs, ARBs, and NSAIDs; and monitor b_______ w______/f________ balance.
Definition
pre-renal; post-renal; increase; stop; body weight; fluid
Term
To prevent ARF, pts should avoid the following nephrotoxins:
a. aminoglycosides
b. amphotericin
c. radiocontrast media
d. all of the above
Definition
d. all of the above
Term
A_______ is the term used for abnormally high levels of nitrogen-containing compounds such as creatinine, nitrogen, and urea.
Definition
azotemia
Term
Azotemia is the most common cause of A____/A_____.
Definition
AKI/ARF
Term
Prerenal azotemia secondary to renal hypoperfusion occurs via 3 mechanisms: __________ intravascular volume; change in vascular r__________; and _________ CO.
Definition
decreased; resistance; decreased
Term
Prerenal azotemia secondary to decreased intravascular volume CAUSES: h_____________; GI l________; d____________; over d____________; extravascular s____________.
Post-renal azotemia is aka o__________ and is the ______ common cause of AKI/ARF.
Definition
obstructive; least
Term
True or false:
Causes of post-renal azotemia include urethral obstruction, bladder dysfunction/obstruction, and ureter/renal pelvis obstruction.
Definition
True- post-renal azotemia is aka obstructive azotemia
Term
Examples of post-renal azotemia include: (select all that apply)
a. BPH in men
b. neoplasm
c. neurogenic bladder
d. anticholinergic drug use in the elderly
Definition
a, b, c, and d
***least common causes are clots and stones
Term
Physical findings of post-renal azotemia may include: B____; distended b__________; m_______ on pelvic exam, _______ abdominal pain; and possible a______.
Definition
BPH; bladder; mass; lower; anuria
Term
S/S of CKD: can progess s________ and are n_________; may remain a_____________ until renal failure is far advanced. S/S can include: f________, malaise, w________, p________, anorexia, n______/v______, m________ taste and h_______ are common.
Over 90% of cases of late stage (stage 5) CKD are d/t DM and HTN.
Definition
False- Over 70% of cases of late stage (stage 5) CKD are d/t DM and HTN.
Term
CKD (per the national kidney foundation) is based on abnormal U/A or U/S, as well as a GFR <____ for ____ months:
a. 40; 3
b. 40; 6
c. 60; 3
d. 60; 6
Definition
c. 60; 3
Term
Physical findings w/ CKD may include: __________ ill-appearing; H_______ common; skin may be j_______; evidence of e_______ b________; u________ f______ (fishy breath); and
c______________ and m_______ s______ changes frequently noted.
Definition
chronically; HTN; jaundiced; easy bruising; uremic fetor; cardiopulmonary; mental status
Term
Labs in CKD include: __________ of BUN and Crt; GFR <____; persistent p____________ and broad, waxy c_________ on U/A.
Definition
elevations; 60; protenuria; casts
Term
Potassium balance is usually intact until GFR drops below:
a. 5-10 mL/min
b. 10-20 mL/min
c. 20-30 mL/min
d. 30-40 mL/min
Definition
b. 10-20 mL/min
Term
Tx of chronic hyperkalemia includes: restriction of dietary p_____________ and sodium p____________ a PRN.
Definition
potassium; polystyrene
Term
With CKD, sodium intake should be reduced to:
a. 4 g per day
b. 3 g per day
c. 2 g per day
d. 1 g per day
Definition
c. 2 g per day
Term
In initial CKD, Rx _______ and _______ and then recheck labs in ____ week(s).
Definition
ACEIs; ARBs; 1
Term
The goal BP for CKD pts is:
a. 130/80
b. 130/90
c. 140/80
d. 140/90
Definition
a. 130/80
Term
Pericarditis d/t the retention of m________ toxins that aren't cleared from the body is an absolute indication for h____________.
Definition
metabolic; hemodialysis
Term
The tx for metabolic acidosis is to maintain b_______ level >2___ mEq/L.
Definition
bicarb; 21
Term
CKD pts w/ Hct <33 are treated w/ recombinant e_______.
Definition
erythropoietin (epoetin alfa)
Term
Heme complications of CKD include: a______ and c________.
