1A: Dt 15 - 1

Front 1

Which immunosuppressant:
Derivative of 6-mercaptopurine

Back 1

Azathioprine

Front 2

Which immunosuppressant:
Causes phocomelia

Back 2

Thalidomide

Front 3

Which immunosuppressant:
Nephrotoxic in 75% of pts

Back 3

Cyclosporine--preventable with mannitol diuresis

Front 4

Which immunosuppressant:
SE: acne, osteoporosis, HTN, hyperglycemia, immunosuppression -- infection

Back 4

Glucocorticoids

Front 5

Which immunosuppressant:
Inhibits secretion of IL-2 and other cytokines

Back 5

Tacrolimus and cyclosporine

Front 6

Which immunosuppressant:
Alkylating agent that requires bioactivation in liver

Back 6

Cyclophosphamide

Front 7

Which immunosuppressant:
Inhibits dihydrofolate reductase

Back 7

MTX

Front 8

What arachidonic acid product has actions that oppose that of prostacyclin?

Back 8

Thromboxane

Front 9

What substances are well known for causing hemolytic anemia in patients with G6PD deficiency?

Back 9

Fava beans
Sulfonamides
PRimaquine
INH
High dose ASA
Ibuprofen
Nitrofurantoin
Dapsone
Naphthalene

Front 10

Which enzyme deficiency:
Fructose intolerance

Back 10

Aldolase B

Front 11

Which enzyme deficiency:
Essential fructosuria

Back 11

Fructokinase deficiency

Front 12

Which enzyme deficiency:
Classic galactosemia

Back 12

Galactose-1-phosphate uridylyltransferase deficiency

Front 13

What might you see in a first trimester ultrasound of a fetus with Down syndrome?

Back 13

Inc'd nuchal translucency

Front 14

Which protozoan:
Diarrhea in campers and hikers

Back 14

Giardia

Front 15

Which protozoan:
Itchy vaginitis

Back 15

Trichomonas

Front 16

Which protozoan:
Sandfly is the vector

Back 16

Leishmania

Front 17

Which protozoan:
Anopheles mosquito is the vector

Back 17

Plasmodium

Front 18

Which protozoan:
Sodium stibogluconate is the treatment

Back 18

Leishmania

Front 19

Which protozoan:
Suramin or melarsoprol is the treatment

Back 19

Trypanasoma

Front 20

Which protozoan:
Maltese cross seen in RBCs

Back 20

Babesia

Front 21

Which protozoan:
Treat with metronidazole

Back 21

Giardia, entameba, or trichomonas

Front 22

Which protozoan:
Severe diarrhea in AIDS patients

Back 22

Cryptosporidium

Front 23

What is the result of a glycolytic enzyme deficiency?

Back 23

RBC hemolysis

Front 24

What is the result of a deficiency in pyruvate dehydrogenase?

Back 24

Neurologic defects

Front 25

What co-factors are required for the function of pyruvate dehydrogenase? What other enzyme requires the same co-factors?

Back 25

TLC for No One
Thiamine pyrophosphate
Lipoic Acid
CoA
FAD
NAD
alpha-ketoglutarate DH

Front 26

How does the presentation of a right parietal lobe lesion differ from the presentation of a left parietal lobe lesion?

Back 26

Non-dom lesion: Right; hemi-spatial neglect

Dom lobe lesion (left): agraphia, acalculia, left to right disorientation

Front 27

What is the clinical appearance of internuclear ophthalmoplegia? With what disorder is it commonly
associated?

Back 27

Lateral gaze paralysis of adduction
Nystagmus in abductor

Assocd w/MS

Front 28

Which protozoan:
Ixodes tick is the vector

Back 28

Babesia

Front 29

Juxtaglomerular apparatus:
Components
Role

Back 29

JG cells of afferent arteriole and macula densa (Na+ sensor, part of DCT)

JG cells secrete renin in response to low renal BP, dec'd Na+ delivery to distal tubule, and inc'd symp tone (beta-1)

Front 30

What are the functions of Ag-II?

Back 30

Vasoconstriction-->Inc BP

Constricts efferent arteriole of
glomerulus-->Inc'd FF to preserve renal fn

Aldosterone release from adrenal gland

ADH release posterior pituitary-->H2O reabsorption

Stimulates hthal-->thirst

Front 31

Which kidney is taken during living donor transplantation? Why?

Back 31

Left kidney taken because it has a longer renal vein

Front 32

Describe the anatomic path the ureters take.

Back 32

Pass UNDER uterine artery and UNDER ductus deferens (Water--ureters--under the bridge--artery, ductus deferens)

Front 33

Describe the breakdown of the body's fluid compartments (water, potassium, and sodium).

Back 33

HIKIN: 60-40-20: HIgh K Intracellular

60% total body water
40% ICF (high K+)
20% ECF (high Na+)

Front 34

Glomerular filtration barrier:
Role
Composition

Back 34

Responsible for filtration of plasma according size and net charge

Composed of:
-Fenestrated capillary endothelium (size barrier)
-Fused BM with hepran sulfate (neg charge barrier)
-Epithelial layer consisting of podocyte foot processes

Front 35

Equation for renal clearance of substance x.

What does it mean in relation to GFR (relatively)?

Back 35

Cx = UxV/Px (UV over P)--
Cx is clearance ox X
Ux is urine [ ] of X
V = urine flow rate
Px is plasma concentration of X

Cx<GFR: Net tubular reabsoprtion of X

Cx>GFR: Net tubular secretion of X

Cx = GFR: No net secretion or reabsorption

Front 36

What substance can be used to measure GFR?

Why?
What's a normal GFR?
Backup measure of GFR?

Back 36

Inulin can be used to caluclate GFR because it is freely filtered and is neither reabsorbed nor secreted

NL GFR ~100

Can also use creatinine, but it slightly overestimates GFR bc creatinine is moderately secreted by renal tubules

Front 37

What substance can be used to measure effective renal plasma flow?

Why?

Back 37

ERPF can be estimated using PAG clearance because it's both filtered and actively secreted in proximal tubule.

ALL PAH entering kidney is excreted.

Front 38

Equation for filtration fraction.

Normal FF?

Back 38

Filtration Fraction = GFR/RPF

Note: GFR can be estimated with Cr
RPF best estimated w/PAH

Front 39

What is the effect of NSAIDs on filtration fraction? How?

Back 39

NSAIDs decrease prostaglandin synthesis

PGs impt for dilation of afferent renal arteriole

Fewer PGs-->constriction of afferent arteriole and dec'd filtration.

In other words: Dec'd RPF, dec'd GFR, so FF remains constant)

Front 40

What is the effect of ACE inhibitors on filtration fraction? How?

Back 40

ACE inhibitors inhibit formation of Ag-II

Ag-II constricts efferent arterioles.
Inhibiting this will:
Dec RPF
Inc GFR
so FF increases

Front 41

Effect on RBF, GFR, FF:
Constriction of the afferent arteriole

Back 41

Dec GFR
Dec RBF
No change to FF

Front 42

Effect on RBF, GFR, FF:
Constriction of the efferent arteriole

Back 42

Inc GFR
Dec RBF
Inc FF

Front 43

Effect on RBF, GFR, FF:
Dilation of the afferent arteriole

Back 43

Inc GFR
Inc RBF
No change to FF

Front 44

Effect on RBF, GFR, FF:
Dilation of the efferent arteriole

Back 44

Decd GFR
Inc RBF
Dec FF

Front 45

Effect on RBF, GFR, FF:
Increase in serum protein

Back 45

Dec GFR
No change to RBF
Dec FF

Front 46

Effect on RBF, GFR, FF:
Ureter stone obstruction

Back 46

Dec GFR
No change RBF
Dec FF

Front 47

Effect on RBF, GFR, FF:
ACE inhibitors

Back 47

Dec GFR
Inc RBF
Dec FF

Front 48

Effect on RBF, GFR, FF:
Indomethacin, Naprosyn, ibuprofen

Back 48

Dec GFR
Dec RBF
No change FF

Front 49

Equations for filtered load and excretion rate.

How can you use this to determine rates of reabsorption and secretion?

Back 49

Filtered load = GFR x Px
Excretion rate = V x Ux

Reabsorption: filtered - excreted
Secretion: excreted - filtered

Front 50

Where does glucose reabsorption occur in the kidney?

Back 50

Proximal tubule by Na/glucose co-transport

Front 51

Where does amino acid reabsorption occur in the kidney?

Back 51

Proximal tubule by various carrier systems

Front 52

Equation for determining plasma osmolality.

Back 52

Plasma osmolality =
2[Na]plasma + [Gluc]/18 + [BUN]/2.8

Front 53

Which segment of renal tubule:
Reabsorbs 67% of the fluid and electrolytes filtered by the glomerulus

Back 53

Proximal tubule

Front 54

Which segment of renal tubule:
Segment responsible for concentrating urine

Back 54

Collecting Duct

Front 55

Which segment of renal tubule:
Site of secretion of organic anions and cations

Back 55

Proximal Tubule

Front 56

Which segment of renal tubule:
Always impermeable to water

Back 56

Thick Ascending Limb

Front 57

Which segment of renal tubule:
Permeable to water only in the presence of ADH

Back 57

Late Distal Tubule, Collecting Duct

Front 58

Which segment of renal tubule:
Site of the Na/2CI/K co-transporter

Back 58

Thick Ascending Limb

Front 59

Which segment of renal tubule:
Site of isotonic fluid reabsorption

Back 59

Proximal Tubule

Front 60

Which segment of renal tubule:
Site responsible for diluting urine

Back 60

Thick Ascending Limb

Front 61

Which segment of renal tubule:
Only site where glucose and amino acids are reabsorbed

Back 61

Proximal Tubule

Front 62

Which segment of renal tubule:
Water reabsorption in the Loop of Henle

Back 62

Thin Descending Limb

Front 63

How substances are reabsorbed by the kidneys at a greater rate than water?

List in order of greatest difference to least difference.

Back 63

Glucose
Amino Acids
Bicarb
Phosphate

Front 64

How substances are reabsorbed by the kidneys at a lesser rate than water?

List in order of greatest difference to least difference.

Back 64

PAH
Creatinine
Inulin
Urea
Cl-
K+
Na+

("lesser rate" = excreted)

Front 65

How does sodium absorption differ in the:
First half of proximal tubule
Second half of proximal tubule
Thick ascending limb
Early distal tubule

Back 65

First half prox tubule: Na coupled with bicarb absorption

Second half prox tubule: Cl- coupled with bicarb absorption

Thick ascending limb: active reasborption of Na+ via K+/Cl-/Na+ pumps, and Na+/H+ pumps, Na/K/ATPase

Early distal tubule: active reabsorption of Na via Na/K/ATPase

Front 66

What class of drugs inhibits the Na/2Cl/K symporter in the thick ascending limb?

Back 66

Loop diuretics

Front 67

Where in the kidney is calcium reabsorbed?

What other organic cation is absorbed here?

Back 67

Calcium and magnesium both absorbed in thick ascending limb

Calcium is also absorbed in the early distal tubule WHEN PTH IS PRESENT

Front 68

This region of the kidney is impermeable to water.

Back 68

Thick ascending limb

Front 69

What determines how much water is reabsorbed in the distal tubules and collecting ducts?

Back 69

ADH--increases reabsorption of water

Front 70

What two types of cells compose the collecting duct and the last segment of the distal tubule?

What do they do?

Back 70

Principle cells--reabsorb water and Na, secrete K+

Intercalated cells--secrete H+ or HCO3-, reabsorb K+

Front 71

What are the two types of intercalated cells?

Back 71

alpha cells--H+ secreting; a for acid
beta cells--HCO3- secreting; b for base

Front 72

What class of diuretic directly affects principle cells?

Back 72

Potassium-sparing diuretics

Front 73

What drug antagonizes aldosterone's action on the principle cells of the collecting duct thereby promoting Na+ excretion and inhibition K+ excretion?

Back 73

Aldosterone antagonist--spironolactone and eplereonone

Front 74

Aldosteorne:
When is it secreted?
Effects?

Back 74

Secreted in response to dec'd blood volume (via ATII) and inc'd plasma [L+]

Causes inc'd Na+ reabsorption, inc'd K+ secretion, inc'd H+ secretion

Front 75

Atrial natriuretic peptide:
When is it secreted?
Effects?

Back 75

Secreted in response to inc'd atrial pressure

Causes inc'd GFR and inc'd Na+ filtration with NO COMPENSATORY Na+ REABSORPTION IN DISTAL NEPHRON

Net effect: Na+ loss and volume loss

Front 76

ADH:
AKA
When is it secreted?
Effects?

Back 76

ADH (vasopressin)
Secreted in response to inc'd plasma osmolarity and dec'd blood volume

Binds receptors on PRINCIPAL CELLS of distal tubules and collecting duct to inc number of water channels

Thus increases water reabsorption

Front 77

What effect does aldosterone have on the intercalated cells and principle cells of the collecting duct?

Back 77

Intercalated cells--stimulates acid secretion

Principle cells--increases Na+ reabsorption and K+ secretion

Front 78

What are the critical steps involved in excreting dilute urine?

Back 78

Dilution in thick ascending limb as solute reabsorbed and water remains in lumen (impermeable to water)

Absence of ADH-->distal tubule and collecting duct impermeable to water

Front 79

What are the critical steps involved in excreting concentrated urine?

Back 79

Dilution of fluid in thick ascending segment as solute reabsorbed and water remains in lumen (impermeable to water)

Presence of ADH-->distal tubule and CD permeable to water

Front 80

What factors shift K+ out of cells?

Back 80

Low insulin
beta-blockers (inhaled albuterol?)
Acidosis (H+ into cell, K+ out of cell)
Digoxin
Cell lysis (leukemia)

Front 81

What factors shift K+ into cells?

Back 81

Insulin
beta-agonists
Alkalosis
Cell creation/proliferation

Front 82

Mannitol:
MOA
Use
AE

Back 82

Osmotic diuretic; inc'd tubular fluid osmolality, inc'd urine flow

Use in shock, drug OD, elevated ICP

AE: Dehydration

Front 83

Acetazolamide:
MOA
Use
AE

Back 83

Carbonic anhydrase inhibitor; causes self-limited NaHCO3 diuresis and reduction in total body HCO3- stores

Use in glaucoma, urinary alkalinization, alkalosis, altitude sickness

AE: Hyperchloremic metabolic acidosis

ACIDazolamide causes ACIDosis

Front 84

Furosemide:
MOA
Use
AE

Back 84

Sulfonamide LOOP DIURETIC

Inhibits cotransport system (Na/K/2Cl) of thick ascending limb of loop of Henle

Prevents concentration of urine, results in inc'd CALCIUM EXCRETION (LOOPS LOSE CALCIUM)

Use: Edematous states (CHF, cirrhosis, nephrotic syndrome), HTN, hyperCa2+

AE: OH DANG
Ototoxicity, hypokalemia, dehydration, Allergy (sulfa), Nephritis (interstitial), gout

Front 85

HCTZ:
MOA
Use
AE

Back 85

Thiazide diuretic; inhibits NaCl reabsorption in early distal tubule, reducing diluting capacity of nephron

dec'd Ca2+ excretion (RETAINS CALCIUM!!)

Use: HTN, CHF, hypercalciuria, diabetes insipidus

AE: Hypokalemic metabolic alkalosis, hyponatremia, hyperglycemia, hyperlipidemia, hyperuricemia, hypercalcemia, sulfa allergy (HyperGLUC)

Front 86

What are the 2 strongest classes of diuretics? AE related to this?

Back 86

Loops and thiazides, can cause contraction alkalosis

Front 87

ACE inhibitors:
Prefix/suffix
MOA
use
AE
Effect on GFR

Back 87

-pril
MOA: inhibit ACE, reduce levels of Ag-II, prevent inactivation of bradykinin (potent vasodilator)

Renin release is increased due to loss of feedback inhibition

Use: HTN, CHF, diabetic renal dz

AE: Cough, angioedema, proteinuria, taste changes, hypotn, pregnancy problems (fetal renal damage!!!)******, rash, inc'd renin, lower AgII, hyperkalemia

"CAPTOPRIL"

Significantly decrease GFR by preventing constriction of efferent arterioles

Front 88

Patients with calcium kidney stones should avoid this diuretic.

Back 88

Loop diuretics (would put more Ca2+ in urine)

Thiazides would help!