Chronic kidney disease
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Ø Kidney damage for greater or equal to 3 months as defied by structural or
functional abnormalities of the kidney with or without decreased GFR.
- GFR < 60 for greater than or equal to 3 months with or without kidney
damage.
- Microalbumin
- Microalbumin.
Ø Stages
- Stage 1: GFR > 99
- Stage 2: GFR 60-89
- Stage 3: GFR 30-59
- Stage 4: GFR 15-29
- Stage 5: GFR < 15 (dialysis)
Ø Testing for kidney disease
- CMP
- Urine (proteins)
, - Albumin
- Urine protein/creatinine
- Condition marked by very high levels of protein in the urine, low levels of
protein in the blood, sweating, especially around the eyes, feet, and hands,
and high cholesterol.
- Nephrotic syndrome is a set of symptoms, not a disease itself.
Pneumothorax
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Ø Air in the pleural space between lung and ribcage
- Commonly found with traumatic MOI
- Spontaneous rupture of bullous emphysema (Blebs)
- Barotrauma during resuscitation/CPR
Ø Tension pneumothorax particularly deadly
- Air gets in pleura, but can't get out.
- Shifts mediastinum and IVC kinks, causing fatal drops in preload/filling
pressure.
Ø Signs and symptoms
- Tracheal deviated to unaffected side
- Absent lung sounds on affected side
- Tympanic lung sounds on affected side
Ø Treatment
- Needle decompression (temporary)
- Chest tube thoracostomy (definitive).
Depression
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, - Persistent feeling of sadness and loss of interest
- May be secondary to inadequate neurotransmitter response to stressors, or
cyclical (bipolar disorder).
- Treatment: SSRIs, SNRIs, atypical antidepressants, tricyclic antidepressants,
MOAIs. (anticholinergic side effects).
Diabetes
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Ø Type 1
- Destruction of B-Cells in the islets of Langerhans results in cessation in
insulin production.
- Classic presentation is polyuria, polydipsia, and polyphagia, weight loss, with
hyperglycemia and ketonuria.
Ø Type 2
- Progressive decrease in secretion of insulin with peripheral insulin resistance,
results in chronic hyperglycemia and hyperinosemia.
- Most patients asymptomatic with hyperglycemia, noted on labs.
Ø Preventative care
- Lifestyle interventions
- Immunizations: PNA, Influenzas, Tdap, Hep B, zoster
- Yearly eye exam (with dilation)
- Annual podiatry exam
- BP goal: 130-/8p
- Dental care
- Annual microalbumin urine test
pancreatic cancer
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, Ø Hight mortality rate
Ø Fourth leading cause of cancer, related death in the US.
Ø Secondly only to colorectal cancer
Ø Painless Jaundice.
Visual defects
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- Homonymous clemianopsia: visual field involving either the two right or the
two left halves of the visual fields of both eyes. Cause is typically stroke.
Diverticulitis
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Ø Infected diverticula (pouch-like herniations of the external surface of the
colon)
- High risk of rupture and bleeding.
Ø Symptoms/PE findings
- Constant LLQ pain present for several days
- Associated with fever, nausea, and vomiting.
- May have constipation or diarrhea
- Rebound tenderness, positive Roving's sign, and board-like abdomen.
Ø Labs
- Leukocytosis, neutropenia, and possible shift to the left FOBT positive.
Ø Treatment
- Uncomplicated cases can be treated outpatient with liquid diet and oral
analgesia (reassess in 2-3 days to assess for resolution of symptoms).
- Oral antibiotics only indicated if patient is at higher risk (i.e
immunocompromised, major comorbidities, etc).
- If no response in 2-3 days, or patient develops severe symptoms, refer to ED.
Give this one a go later!
Ø Kidney damage for greater or equal to 3 months as defied by structural or
functional abnormalities of the kidney with or without decreased GFR.
- GFR < 60 for greater than or equal to 3 months with or without kidney
damage.
- Microalbumin
- Microalbumin.
Ø Stages
- Stage 1: GFR > 99
- Stage 2: GFR 60-89
- Stage 3: GFR 30-59
- Stage 4: GFR 15-29
- Stage 5: GFR < 15 (dialysis)
Ø Testing for kidney disease
- CMP
- Urine (proteins)
, - Albumin
- Urine protein/creatinine
- Condition marked by very high levels of protein in the urine, low levels of
protein in the blood, sweating, especially around the eyes, feet, and hands,
and high cholesterol.
- Nephrotic syndrome is a set of symptoms, not a disease itself.
Pneumothorax
Give this one a go later!
Ø Air in the pleural space between lung and ribcage
- Commonly found with traumatic MOI
- Spontaneous rupture of bullous emphysema (Blebs)
- Barotrauma during resuscitation/CPR
Ø Tension pneumothorax particularly deadly
- Air gets in pleura, but can't get out.
- Shifts mediastinum and IVC kinks, causing fatal drops in preload/filling
pressure.
Ø Signs and symptoms
- Tracheal deviated to unaffected side
- Absent lung sounds on affected side
- Tympanic lung sounds on affected side
Ø Treatment
- Needle decompression (temporary)
- Chest tube thoracostomy (definitive).
Depression
Give this one a go later!
, - Persistent feeling of sadness and loss of interest
- May be secondary to inadequate neurotransmitter response to stressors, or
cyclical (bipolar disorder).
- Treatment: SSRIs, SNRIs, atypical antidepressants, tricyclic antidepressants,
MOAIs. (anticholinergic side effects).
Diabetes
Give this one a go later!
Ø Type 1
- Destruction of B-Cells in the islets of Langerhans results in cessation in
insulin production.
- Classic presentation is polyuria, polydipsia, and polyphagia, weight loss, with
hyperglycemia and ketonuria.
Ø Type 2
- Progressive decrease in secretion of insulin with peripheral insulin resistance,
results in chronic hyperglycemia and hyperinosemia.
- Most patients asymptomatic with hyperglycemia, noted on labs.
Ø Preventative care
- Lifestyle interventions
- Immunizations: PNA, Influenzas, Tdap, Hep B, zoster
- Yearly eye exam (with dilation)
- Annual podiatry exam
- BP goal: 130-/8p
- Dental care
- Annual microalbumin urine test
pancreatic cancer
Give this one a go later!
, Ø Hight mortality rate
Ø Fourth leading cause of cancer, related death in the US.
Ø Secondly only to colorectal cancer
Ø Painless Jaundice.
Visual defects
Give this one a go later!
- Homonymous clemianopsia: visual field involving either the two right or the
two left halves of the visual fields of both eyes. Cause is typically stroke.
Diverticulitis
Give this one a go later!
Ø Infected diverticula (pouch-like herniations of the external surface of the
colon)
- High risk of rupture and bleeding.
Ø Symptoms/PE findings
- Constant LLQ pain present for several days
- Associated with fever, nausea, and vomiting.
- May have constipation or diarrhea
- Rebound tenderness, positive Roving's sign, and board-like abdomen.
Ø Labs
- Leukocytosis, neutropenia, and possible shift to the left FOBT positive.
Ø Treatment
- Uncomplicated cases can be treated outpatient with liquid diet and oral
analgesia (reassess in 2-3 days to assess for resolution of symptoms).
- Oral antibiotics only indicated if patient is at higher risk (i.e
immunocompromised, major comorbidities, etc).
- If no response in 2-3 days, or patient develops severe symptoms, refer to ED.
