Types of optical disks used for image storage include all of…
Questions
Types оf оpticаl disks used fоr imаge storаge include all of the following except:
Durbin-Wаtsоn test is used tо test:
Renаl Artery Stenоsis / Renоvаsculаr Hypertensiоn (Study Outline) 1. Background Definition: Narrowing of one or both renal arteries causing reduced renal perfusion, activating RAAS → secondary hypertension. Etiologies (high-yield): Atherosclerotic RAS (most common): older adults, cardiovascular risk factors. Fibromuscular dysplasia (FMD): younger women; “string of beads” appearance. Pathophysiology: ↓ Renal blood flow → ↑ renin → ↑ angiotensin II & aldosterone → vasoconstriction + sodium retention → hypertension. Persistent ischemia can lead to CKD and small, shrunken kidney on affected side. 2. History Resistant hypertension: uncontrolled on ≥3 antihypertensive agents. Onset clues: Sudden worsening of previously stable hypertension. New severe HTN in young woman (FMD). Medication-related clues: Acute rise in creatinine after starting RAAS blockade suggests RAS. Ischemic kidney symptoms: recurrent flash pulmonary edema (“Pickering syndrome”). Atherosclerotic risk factors: smoking, hyperlipidemia, diabetes, PAD. 3. Exam Findings Hypertension: often severe or refractory. Abdominal bruit: systolic–diastolic bruit lateralized to one side (classic but not always present). Evidence of diffuse atherosclerosis: diminished peripheral pulses, carotid bruits. Signs of volume overload: edema, crackles (in episodes of flash pulmonary edema). 4. Making the Diagnosis Initial labs: May show elevated creatinine; BUN/Cr ratio variable. Possible reduced GFR in unilateral or bilateral disease. Urinalysis: typically bland (no significant proteinuria or hematuria). Imaging (high-yield order): Renal duplex Doppler ultrasound: first-line, noninvasive. CT angiography (CTA) or MRA: excellent anatomic definition; used if high suspicion. Conventional renal angiography: Gold Standard; definitive visualization but invasive. Clues on imaging: Atherosclerotic RAS: proximal narrowing. FMD: “string of beads” pattern in mid-distal renal artery. Functional clue: rise in creatinine after RAAS-modulating therapy. 5. Management (Exam Concepts) General principles: Blood pressure management conceptually; avoid nephrotoxins; adjust renally cleared drugs. Optimize cardiovascular risk reduction (atherosclerotic disease is systemic). Atherosclerotic RAS: Many cases managed with medical therapy; revascularization considered in select cases. Indications for revascularization (exam-level): Recurrent flash pulmonary edema. Refractory hypertension despite optimal therapy. Progressive kidney dysfunction with suspected bilateral RAS or RAS in a solitary kidney. FMD: Percutaneous angioplasty considered effective (exam concept; no procedural details). Monitoring: Renal function, BP trends, cardiovascular complications. Referral: nephrology or vascular specialists for diagnostic confirmation, intervention decisions, or unclear cases. QUESTION A 68-year-old man with a history of coronary artery disease and peripheral vascular disease presents for evaluation of worsening hypertension. His blood pressure remains elevated despite taking amlodipine, lisinopril, and hydrochlorothiazide. He recently developed dyspnea and leg swelling, and was hospitalized twice in the past month for flash pulmonary edema. He does not have diabetes. On exam, blood pressure is 172/94 mmHg, and a systolic–diastolic bruit is heard over the right upper abdomen. Serum creatinine has increased from 1.2 to 2.0 mg/dL over the past month. Which of the following is the most appropriate next step in evaluation? A) Renal biopsyB) Renal duplex Doppler ultrasoundC) 24-hour urine protein measurementD) Serum ANA and complement levels
Rаpidly Prоgressive Glоmerulоnephritis (RPGN) (Study Outline) 1. Bаckground Definition: A clinicаl syndrome of glomerular injury characterized by rapid loss of kidney function over days to weeks, often leading to ESRD if untreated. Pathophysiology: Severe glomerular inflammation → crescent formation in Bowman’s space (proliferation of parietal epithelial cells + macrophages). Loss of filtration barrier → hematuria, proteinuria, rapid GFR decline. Major etiologic categories (exam-high yield): Type I: Anti-GBM disease (Goodpasture syndrome) Anti–glomerular basement membrane antibodies; lung involvement common. Type II: Immune Complex–mediated PSGN, IgA nephropathy, lupus nephritis. Type III: Pauci-immune (ANCA-associated vasculitis) Granulomatosis with polyangiitis (c-ANCA), microscopic polyangiitis (p-ANCA), eosinophilic granulomatosis with polyangiitis. 2. History Rapid onset hematuria (tea/cola-colored). Oliguria or anuria—strong warning sign. Systemic symptoms depending on cause: Goodpasture: cough, hemoptysis. ANCA vasculitis: sinusitis, pulmonary symptoms, constitutional complaints. Immune complex diseases: rash (SLE), recent infection (PSGN), arthralgias. Hypertension from fluid retention. Edema (periorbital, peripheral). 3. Exam Findings Vital signs: hypertension common; may see tachypnea if acidosis. Edema: periorbital, dependent. Pulmonary involvement: crackles, hemoptysis (Goodpasture, GPA). Skin findings: purpura (vasculitis), malar rash (SLE). Signs of severe kidney failure: asterixis, uremic symptoms in advanced cases. 4. Making the Diagnosis Urinalysis: Hematuria with RBC casts (nephritic). Proteinuria (usually
Hоrseshоe Kidney (Study Outline) 1. Bаckgrоund Definition: A congenitаl renаl fusion anomaly where the inferior poles of both kidneys fuse, forming a U- or horseshoe-shaped structure. Epidemiology: Most common renal fusion abnormality. More common in males; often discovered incidentally. Pathophysiology: Fusion prevents normal ascent of kidneys → trapped under the inferior mesenteric artery (IMA). Altered renal position and rotation predispose to obstruction, reflux, and stones. Associated conditions: Turner syndrome, trisomy 18/21, neural tube defects. Higher risk of Wilms tumor (pediatric association). 2. History Many patients asymptomatic. Flank or abdominal pain from obstruction or hydronephrosis. Recurrent UTIs or pyelonephritis. Nephrolithiasis symptoms: colicky pain, hematuria. Voiding dysfunction in some pediatric presentations. 3. Exam Findings Frequently normal exam. Abdominal mass may be palpable in thin patients. CVA tenderness if infected or obstructed. Hypertension may occur in chronic obstruction/hydronephrosis. Associated congenital anomalies may have external manifestations (e.g., Turner syndrome features). 4. Making the Diagnosis Urinalysis: may show hematuria or pyuria depending on stones/UTI. Labs: renal function usually normal unless obstruction. Imaging (high-yield): Renal ultrasound: first-line; shows fused lower poles and abnormal renal position. CT or MRI: clearly shows renal fusion, isthmus, and associated abnormalities. VOIDING cystourethrogram (VCUG): used if vesicoureteral reflux suspected. Complications to assess: hydronephrosis, stones, obstruction. Gold Standard: Cross-sectional imaging (CT/MRI) demonstrating fusion of the renal poles and malrotated kidneys. 5. Management (Exam Concepts) General principles: Asymptomatic patients often require no intervention. Monitor renal function and watch for complications. Management of complications (conceptual): Hydronephrosis/obstruction: evaluate for relief of obstruction. Nephrolithiasis: manage stones via general exam concepts (evaluation, prevention, intervention as indicated). UTIs: recognize predisposition and manage infections at conceptual level. Vesicoureteral reflux: evaluate in pediatric recurrent UTIs. Surgical considerations: Usually not required unless symptomatic obstruction or recurrent stones. Referral: nephrology/urology for recurrent infections, obstruction, or impaired renal function. QUESTION A 9-year-old girl is brought to the pediatrician for evaluation of recurrent urinary tract infections. She has had three documented UTIs in the past year, all with similar symptoms of dysuria and low-grade fever. Her past medical history includes learning difficulties and a cardiac murmur noted at birth. Physical exam is unremarkable except for mild suprapubic tenderness. Her blood pressure is 112/72 mmHg. Urinalysis shows pyuria and bacteriuria; renal function is normal. Renal ultrasound reveals kidneys located lower than expected with fusion of the inferior poles and anteriorly facing renal pelvises. Which of the following is the most appropriate next step in evaluation? A) Begin daily prophylactic antibioticsB) Order a voiding cystourethrogramC) Refer for surgical resection of the fused isthmusD) Schedule renal biopsy to assess for scarring