FOCUS NOTES — RENAL, RESPIRATORY,
CARDIOVASCULAR & EPIDEMIOLOGY
RENAL
Renal Calculi
● Most common: Calcium oxalate.
● Causes: Hypercalciuria (hyperparathyroidism, excess Ca/Vit D), hyperoxaluria,
hyperuricosuria (gout/high purines), dehydration, cystine disorders.
● Risk: Male 20–60, family history, previous stones; recurrence common.
● Symptoms: Severe flank pain → groin, hematuria, N/V, urgency/frequency.
● UA: Hematuria, crystals, pH, possible bacteria.
● Crystals: Calcium oxalate = envelope/dumbbell; uric acid = needle/diamond; cystine =
hexagonal.
Renal Failure
● Pre-renal: ↓perfusion → dehydration, hemorrhage, shock, HF; hypotension, tachycardia,
oliguria, BUN >20:1.
● Intra-renal: Direct kidney damage (ATN, glomerular disease, nephrotoxins); edema,
HTN, abnormal UA; BUN usually <20:1.
● Post-renal: Obstruction (stone, prostate, tumor); oliguria/anuria, flank pain, hematuria,
hydronephrosis.
● BUN: ↑ with dehydration, GI bleed, high protein; ↓ with liver dysfunction.
● Creatinine: ↑ with ↓GFR and increased muscle mass.
● GFR: Normal young adult generally ≥90; persistent <60 for ≥3 months = CKD.
● Diabetic nephropathy: Screen with UACR + eGFR.
UTI
Pyelonephritis: Kidney infection; fever/chills, flank pain, CVA tenderness, N/V; pyuria, nitrites,
hematuria, culture; risks = stones, pregnancy, DM, catheter, recurrent UTI.
Cystitis: Bladder infection; dysuria, urgency/frequency, suprapubic pain, cloudy/bloody urine;
pyuria/nitrites; usually no systemic symptoms.
, RESPIRATORY
Sinusitis
● Acute: Usually viral. Congestion, facial pressure, headache, drainage. Saline irrigation,
analgesics, intranasal steroids. Bacterial suspected with ≥10 days persistent
symptoms, severe symptoms, or double worsening.
● Chronic: ≥12 weeks; congestion, drainage, decreased smell; saline + intranasal
corticosteroids.
Pleural Disorders
● Pneumothorax: Air → pleural space; sudden dyspnea/pleuritic pain, ↓breath sounds,
hyperresonance; X-ray = pleural line/no lung markings.
● Hemothorax: Blood → pleural space; ↓breath sounds, dullness; X-ray = opacity/fluid.
● Chylothorax: Lymph → pleural space; dyspnea/dullness; diagnose with
thoracentesis/high pleural triglycerides.
Respiratory Infections
● TB: M. tuberculosis, airborne; chronic cough, night sweats, weight loss; TB test + CXR +
sputum testing/culture.
● CAP: S. pneumoniae most common; fever, cough, dyspnea, crackles; CXR
infiltrate/consolidation.
● HIV pneumonia: Risk depends on CD4; bacterial pathogens + PJP with severe
immunosuppression. PJP = dry cough, fever, progressive dyspnea, diffuse/ground-glass
infiltrates.
● HAP: S. aureus, Pseudomonas, gram-negative organisms; hospitalized/ventilated
patients; fever, hypoxemia, new infiltrate.
● Lung abscess: Usually anaerobic/mixed bacteria; aspiration risk; foul sputum, fever,
weight loss; CXR/CT = cavity + air-fluid level.
Occupational Exposures
● Silica/coal/asbestos: Pneumoconiosis.
● Mold/birds/flour/cotton: Hypersensitivity pneumonitis/asthma.
● Chlorine/ammonia: Airway injury/ARDS.
● Radon: Lung cancer.
● TB: Infection exposure.
Lung Assessment
● Egophony: "E" sounds like "A" → consolidation.
CARDIOVASCULAR & EPIDEMIOLOGY
RENAL
Renal Calculi
● Most common: Calcium oxalate.
● Causes: Hypercalciuria (hyperparathyroidism, excess Ca/Vit D), hyperoxaluria,
hyperuricosuria (gout/high purines), dehydration, cystine disorders.
● Risk: Male 20–60, family history, previous stones; recurrence common.
● Symptoms: Severe flank pain → groin, hematuria, N/V, urgency/frequency.
● UA: Hematuria, crystals, pH, possible bacteria.
● Crystals: Calcium oxalate = envelope/dumbbell; uric acid = needle/diamond; cystine =
hexagonal.
Renal Failure
● Pre-renal: ↓perfusion → dehydration, hemorrhage, shock, HF; hypotension, tachycardia,
oliguria, BUN >20:1.
● Intra-renal: Direct kidney damage (ATN, glomerular disease, nephrotoxins); edema,
HTN, abnormal UA; BUN usually <20:1.
● Post-renal: Obstruction (stone, prostate, tumor); oliguria/anuria, flank pain, hematuria,
hydronephrosis.
● BUN: ↑ with dehydration, GI bleed, high protein; ↓ with liver dysfunction.
● Creatinine: ↑ with ↓GFR and increased muscle mass.
● GFR: Normal young adult generally ≥90; persistent <60 for ≥3 months = CKD.
● Diabetic nephropathy: Screen with UACR + eGFR.
UTI
Pyelonephritis: Kidney infection; fever/chills, flank pain, CVA tenderness, N/V; pyuria, nitrites,
hematuria, culture; risks = stones, pregnancy, DM, catheter, recurrent UTI.
Cystitis: Bladder infection; dysuria, urgency/frequency, suprapubic pain, cloudy/bloody urine;
pyuria/nitrites; usually no systemic symptoms.
, RESPIRATORY
Sinusitis
● Acute: Usually viral. Congestion, facial pressure, headache, drainage. Saline irrigation,
analgesics, intranasal steroids. Bacterial suspected with ≥10 days persistent
symptoms, severe symptoms, or double worsening.
● Chronic: ≥12 weeks; congestion, drainage, decreased smell; saline + intranasal
corticosteroids.
Pleural Disorders
● Pneumothorax: Air → pleural space; sudden dyspnea/pleuritic pain, ↓breath sounds,
hyperresonance; X-ray = pleural line/no lung markings.
● Hemothorax: Blood → pleural space; ↓breath sounds, dullness; X-ray = opacity/fluid.
● Chylothorax: Lymph → pleural space; dyspnea/dullness; diagnose with
thoracentesis/high pleural triglycerides.
Respiratory Infections
● TB: M. tuberculosis, airborne; chronic cough, night sweats, weight loss; TB test + CXR +
sputum testing/culture.
● CAP: S. pneumoniae most common; fever, cough, dyspnea, crackles; CXR
infiltrate/consolidation.
● HIV pneumonia: Risk depends on CD4; bacterial pathogens + PJP with severe
immunosuppression. PJP = dry cough, fever, progressive dyspnea, diffuse/ground-glass
infiltrates.
● HAP: S. aureus, Pseudomonas, gram-negative organisms; hospitalized/ventilated
patients; fever, hypoxemia, new infiltrate.
● Lung abscess: Usually anaerobic/mixed bacteria; aspiration risk; foul sputum, fever,
weight loss; CXR/CT = cavity + air-fluid level.
Occupational Exposures
● Silica/coal/asbestos: Pneumoconiosis.
● Mold/birds/flour/cotton: Hypersensitivity pneumonitis/asthma.
● Chlorine/ammonia: Airway injury/ARDS.
● Radon: Lung cancer.
● TB: Infection exposure.
Lung Assessment
● Egophony: "E" sounds like "A" → consolidation.
