hyperPTH secondary to CKD/ESRD
- -initial hypoCa+ and hyperPO4
- -elevated PTH (and subsequent hyperCa2+ with bone lesions)
- -anemia that is NORMOCHROMIC and NORMOCYTIC (no EPO)
- -(+) for protein and casts in urinalysis
- -hyperkalemia
value for heavy proteinuria
> 3.5g/d (24hrs)
Urinalysis Findings for Nephrotic Syndrome (differential for CKD)
proteinuria in addition to
a. ) edema
b. ) hypercholesterolemia
c. ) hypoalbuminemia
2nd trimester at 20 weeks gestation, pt presents with
a. ) rapidly-progressing HTN (severe values are anything > 160/110)
b. ) proteinuria
pre-eclampsia
peri-operative acute onset tachycardia, hypotension, elevated temperature; early conscious signs include nausea & vomiting, dehydration
Thyrotoxicosis aka Thyroid Storm
- -clinical presentation mimics Malignant Hyperthermia
- -ER intervention is same: rapid response thyroid blocking drugs, IV glucose, corticosteroids
Earliest warning sign in Malignant Hyperthermia (Auto Dominant)
hypercapnia
Eruptive Xanthomatosis
Skin lesion seen in uncontrolled diabetics, especially young men with IDDM in conjunction with hyperlipidemia/cholesterolemia. Are multiple, small, firm, yellow, raised bumps with a red halo.
- -possibly itchy
- -locations: back of hands, the feet, arms, buttocks
Digital Sclerosis
Thickening and tightening of skin on finger joints and backs of hands, associated with uncontrolled diabetes (Type 1). Stiffening creates difficulty in movement.
**differential Dx = scleroderma
Acanthosis Nigricans
Thickening and velvety darkening of skin folds (axillary) in people that are overweight and most likely pre-diabetic.
Mucormycosis
Opportunistic fungal infection in uncontrolled diabetics in which hyphae invade blood vessels, eventually resulting in local tissue necrosis.
- -most common tissues involved: sinuses, brain, lungs
- -cerebral infection most frequent; s/s include one sided headache behind the eyes, sinusitis
- -rapidly progresses in include periorbital edema, nasal discharge of black necrotic tissue
stones, bones (abdominal) moans, (psychic) groans
The clinical constellation of effects seen in Hypercalcemia.
Kayser-Fleischer Ring
Brown or coppery-yellow ring around the corneal limbus of the eye (ie junction of the sclera and cornea), seen in Wilson’s Disease.
Arcus Senilis
Opaque gray, blue or white ring around the corneal limbus that appears in adults and elders with hyperlipidemia or hypercholesterolemia.
Limbus Sign
Milky, cloudy white ring around the corneal limbus in patients with hypercalcemia. Represents dystrophic calcification.
Metastatic cancers most commonly associated with osteolysis and hypercalcemia (3):
breast, lung and myeloma
Pathognomonic sign of CHF in the presence of HTN.
Tachycardia - ie HR is constantly elevated, even at rest!
In healthy people, increased workload (ie via exercise) first triggers an increase in cardiac “contractility”, THEN next an increase in HR. However, this increased HR will quickly normalize after exercise ceases.
Changes in ion concentration that would weaken the heart: decreased HR, flaccidity and poor contractility, dilation of chambers, etc.
- HYPOCALCEMIA: obviously now a decrease in ions needed to initiate Action Potential as well as allow muscle contraction
- HYPERKALEMIA: because excess K+ diffuses through the leaky K+ channels enough to alter normal resting mV of the inner membrane of the cardiac mt cell
- -other severe consequences: AV conduction block
Congenital Heart Defects that cause severely-increased pressure in the RV (and likewise, RV hypertrophy):
- Tetralogy of Fallot: pulmonary artery constriction in conjunction with VSD (similar to the PDA in which blood from RV bypasses the lungs)
- Interventricular Septal Defect
- Transposition of Great Arteries: RV is now pumping “dirty” blood through the high-ATM aorta and into systemic circulation
- Patent Ductus Arteriosus: normal in fetal circulation since blood bypasses the lungs and goes from the Pulmonary Artery directly to the aorta (as well as from RA to LA via Foramen Ovale); however, the shunt is supposed to close at birth.
Which surface of the stethoscope is best for detecting high pitched sounds like S1, S2,
Diaphragm
