Nephrology Review Questions - CRASH! Medical Review Series
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- เผยแพร่เมื่อ 27 ก.ย. 2024
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(Disclaimer: The medical information contained herein is intended for physician medical licensing exam review purposes only, and are not intended for diagnosis of any illness. If you think you may be suffering from any medical condition, you should consult your physician or seek immediate medical attention.)
"Injecting somebody with potassium is what they do to death row criminals when they execute them."
Brilliant. I will forever remember to get an EKG with elevated K levels because of this sentence. Thank you!!
Thank you so much Dr.Bolin! it was very very useful!
I an confused about question 13. The patient definitely has Metabolic Acidosis BUT when calculating her pCO2 for expected compensation, you get a range of 34.5 - 38.5... her measured pCO2 is LOWer than is should be so doesn't she have a respiratory alkalosis as well => Non-AG Metabolic Acidosis with Respiratory Alkalosis?
correct sir...its a wrong answer to give just simply metabolic acidosis
Yes its Non anion gap metabolic acidosis with respiratory alkalosis Since compensation of PCO2 doesn't match with HCO3 according to winters formula..there is additional respiratory alkalosis.
Thank you so much for the lectures, they are really good I follow all of your lectures.
For the question number 13, there is no doubt that patient has metabolic acidosis but if you check for appropriate respiratory compensation patient's pCO2 is lower than the calculated range ( 1.5*19)+8+-2 it comes as 36.5) she has pco2 of 20 which means she has additional respiratory alkalosis exactly like question 5 but the answer you said is only metabolic acidosis. Can you please explain? The PH hasn't normalized in patient with Q 5 who has metabolic acidosis with respi alkalosis
+Srizana uprety Re: a normal pH being indicative of a mixed disorder. It has always been my understanding that a mixed disorder occurs with an increase or decrease in pH (i.e. acidosis or alkalosis). If indeed the pt has a mixed disorder (e.g a low pH with met acidosis and resp acidosis), compensation (e.g. met. acidosis with resp. alkalosis) does not occur.
Srizana uprety rhh
Great as always. sir paul bolin...
Lisinopril.For reno protection and cardio protection. Salt restriction must have been tried since the past 2 months or earlier.
Low bicarb is acidosis
Low CO 2 is Resp alkalosis which is compensating
And therefore the pH is normal.
If its met acidosis, pH should be way below 7.374, and chloride would be high and bicarbonate would be conserved.
Met acidosis with compensatory Resp alkalosis
JNC 8 guidelines suggest AA without proteinuria first line is either a thiazide diuretic or calcium channel blocker.
Diastolic unchanged. It could be a normal ejection fraction diastolic failure.
Haemodialysis. Creatinine is 7.7.Anemia is due to renal failure.
big picture is metabolic acidosis so PCO2 should be say 33 but it is much lower so patient has additional respiratory alkalosis
Ideally an Echo. Otherwise EKG. To rule out cardiac abnormalities.
I think the answer for number 13 is E.
If we apply winter's formula in question 13 then answer becomes 'metabolic acidosis with respiratory alkalosis.plz can you explain sir?
Nephrology: And Pathology thereof.....Outstanding Narration and Examination (Simulation). MD Paul Bolin, es geht gut zu lernen und Spass machen. Prost!
I couldn't find anything on my notes saying that NSAIDs causes rhabdomyolysis. UptoDate is not helping either. Do you have a source for that?
www.ncbi.nlm.nih.gov/pmc/articles/PMC5782483/
Seems to be rare but indeed possible. Gotta admit I was also in the "WTF" mode when I saw this answer - not even Katzung mentions this SE.
Yes me too
In 2 quetion that ABG with similar number
One you said metabolic acidosis with Respiratory alkalosis
However another one just metabolic acidosis because you said PH is not normal
While the previous one PH WASNOT normal too.
Question 13 , is similar with question 5, why not mixed disorder? Using winter calculation
You are right!
Thank you so much dr. But I am not clear with the answer for Q5. as for my understanding we first check the PH if acidic or alkaline, then we go which go with that, that is if HCO3, we say metabolic, and Pco2, respiratory and the one opposite to PH is called compensatory. Can you comment? thank you.
Would you give a thiazide or ARB to a black patient without DM?
Livvy Liv - Nephrologist I worked under liked to use Norvasc in black patients. I'm not sure how much evidence is behind that but I trust this particular nephrologist.
Paul Bolin, M.D. Thanks for your reply as usual, Dr. Bolin.
Good pasteur.
Why waste money on CT first if USG can be done.
Metabolic acidosis.But why is the PCO2 low.
Your question 13 is being narrated while still displaying the answer of 12 th question. I think recording has to be rectified.
B. This is nephrotic range.
Amazing
Diuretics and Fludrocortisone is for type 4 RTA
Hi regarding Question 9 why is hydrochlorothiazide used instead of verapamil?
Verapamil/Diltiazem not good for hypertension as they cause less vasodil and more bradycardia and good choices for Afib or SVT - if you wana use calcium channel blocker use Didhydropyridine calcium channel blockers like Felodipine . Usually the 2nd drug to add for blood pressure control is a thiazide diuretic for normal GFR and for stage 3-4 CKD a loop diuretic .
In short these two verapamil and diltiazem work to reduce heart rate different from other ca channel blockers.
34:55 Question 10 - According to your other video Goodpasture would present with microhematuria; in the presented case the patient notices blood in the urine.
Great review!
Pelvicalyceal stone. Stag horn.
KUB or US
Cystinuria
B
A
Poor blacks! Valsartan is very expensive.
bioxcell reviews
Diastolic on the rise.
In question 9, aren't afrocarribean people meant to be started on a Ca channel blocker not an ARi/ARB?
That's true but ACEi/ARBs are nephro-protective in diabetics, including Africans and Caribbeans. CCBs are not. That should take priority. In real life (outside of board exams) you can start both. For example, there are amlodipine- losartan (Cozaar brand) and amlodipine-benazepril (Lotrel brand) combination pills.
I love these CRASH Reviews. I just wish the slides would keep up with you talking! You give the answer before I even get a chance to see the slide.
Great lecture..professional person ..
Regarding #9, according to JNC 8 wouldn't you give a CCB or thizide as 1st line for blacks?
Great job Dr Bolin but in question 12, you have not calculated using the Winter's formula hence you cannot guess if the pCO2 is appropriately low. The picture looks more like Metabolic acidosis and Respiratory alkalosis
Ammonium phosphate stone. Or some metabolic error.Lesch Nyhann, struvite, triple phosphate stag horn, hyoercalcemia
Why not treat first with insulin and calcium gluconate to drive the potassium into the intracellular space and then carry out haemodialysis. Hyperkalemia increases cardiac excitability and therefore predisposes to arrhythmias.
Thank you soo much Dr.
I really want to know how can i download these videos as slides. (power point)
thank you again.
wish you all best.
Nephro pains are colicky not constant.
Medullary sponge disease.
Ketorolac to relieve pain.
2020
Type 1 RTA
Wow man. Amazing!
love your work man