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Study guide 11 -------------------------------------------------------------- ? prolonged hypotension from any cause can lead to acute tubular necrosis o U A muddy brown granular casts consist of renal tubular epithelial cells o serum BUN Cr ratio o urine

-------------------------------------------------------------- ? prolonged hypotension from any cause can lead to acute tubular necrosis o U A muddy brown granular casts consist of renal tubular epithelial cells o serum BUN Cr ratio o urine osmolality - mOsm L o urine Na mEq L FENa --------------------------------------------------------------- ? broad casts a w chronic renal failure o arise in dilated tubules of enlarged nephrons that undergone compensatory hypertrophy in response to the reduced renal mass ? waxy casts chronic renal disease o shiny translucent ? RBC casts glomerulonephritis or vasculitis o Wegener ? s SLE Henoch-Schonlein ? WBC casts interstitial nephritis pyelonephritis o WBCs that originate in kidneys ? fatty casts nephrotic syndrome ? hyaline casts asymptomatics prerenal azotemia o proteins that pass unchanged along urinary tract --------------------------------------------------------------- ? meniscal ligamentous tears can both be a w a popping sensation following precipitating injury ? meniscal injury gradual joint swelling ?? hr ? ligamentous injury ACL rapid joint swelling e ?usion due to hemarthrosis ligaments have greater vascular supply than menisci which rely on di ?usion for nourishment ? de ?nitive Dx MRI --------------------------------------------------------------- ? Ulcerative colitis MC in females Ashkenazi Jew peak age - ? MC site rectum con ?ned to mucosal layer ? bloody diarrhea tenesmus pseudopolyps ? severe disease weight loss fever or anemia ? p-ANCA ? con ?rm Dx friable mucosa on colonoscopy biopsy with mucosal in ammation ? extraintestinal erythema nodosum uveitis sclerosing cholangitis spondyloarthropathy ? complications toxic megacolon colorectal ca ? surveillance annual colonoscopies beginning at - yrs after Dx for colon cancer detection o colonic dysplasia is a w progression to adenocarcinoma Rx total colectomy --------------------------------------------------------------- ? young patient aphthous ulcer chronic diarrhea abdominal pain weight loss Crohn ? s ? non- caseating granulomas ??cobblestone ? transmural in ammation skip lesions creeping fat non-lymphoid aggregates ? MC site terminal ileum rectum is spared --------------------------------------------------------------- ? primary features of Chagas disease recent immigrant from Latin America with chronic megacolon megaesophagus cardiac disease CHF pedal edema JVD S cardiomegaly ? systolic diastolic heart failure RBBB ? Rx benznidazole or nifurtimox --------------------------------------------------------------- ? weight loss most e ?ective lifestyle intervention to reduce BP DASH diet is the next most e ?ective approach in prevent treat HTN especially non-obese then exercise dietary sodium alcohol intake smoking causes a transient rise in BP --------------------------------------------------------------- ? Rheumatoid arthritis o morning sti ? min improves with activity o tenosynovitis of palms ??trigger ?nger ? o cervical joint involvement can lead to spinal subluxation ?? cervical cord compression o positive anti-cyclic citrullinated peptide anti-CCP o ?? CRP ESR correlates with disease o XR soft-tissue swelling bony erosions joint space narrowing ? greatest risk for osteoporosis ? Rx physical activity optimize Ca Vit D intake minimize corticosteroids bisphosphonates --------------------------------------------------------------- ? Paget ? s disease of bone osteitis deformans due to osteoclast overactivity leads to replacement of lamellar bone with abnormal woven bone --------------------------------------------------------------- ? Osteitis ?brosa cystica Von Recklinghausen disease of bone due to hyperparathyroidism parathyroid carcinoma ? excessive osteoclastic resorption leads to replacement with ?brous tissue