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65 Cards in this Set
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- Back
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What type of diuretic is the following drug?
- Triamterene - Hydrochlorothiazide - Spironolactone - Ethacrynic acid - Metolazone - Furosemide - Torsemide - Acetazolamide - Bumetanide - Chlorothiazide - Mannitol - Chlorthalidone - Amiloride |
Triamterene: K-sparing
Hydrochlorothiazide: Thiazide Spironolactone: K-sparing Ethacrynic acid: Loop Metolazone: Thiazide Furosemide: Loop Torsemide: Loop Acetazolamide: Carbonic-anhydrase inhibitor Bumetanide: Loop Chlorothiazide: Thiazide Mannitol: Osmotic agent Chlorthalidone: Thiazide Amiloride: K-sparing |
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What diuretic or class of diuretic would be most useful in the following situation?
- Acute pulmonary edema - Idiopathic hypercalciuria (-> Calcium stones) - Glaucoma - Mild to moderate CHF with expanded ECV - In conjunction with loop or thiazide diuretics to retain K+ - Edema a/w nephrotic syndrome - Increased intracranial pressure - Mild to moderate hypertension - Hypercalcemia - Altitude sickness - Hyperaldosteronism |
Acute pulmonary edema: Loop
Idiopathic hypercalciuria (-> Calcium stones): Thiazide Glaucoma: Acetazolamide, Mannitol Mild to moderate CHF with expanded ECV: Loop (+K-sparing) In conjunction with loop or thiazide diuretics to retain K+: K-sparing Edema a/w nephrotic syndrome: Loop diuretic, Metolazone Increased intracranial pressure: Mannitol Mild to moderate hypertension: Thiazides Hypercalcemia: Loop Altitude sickness: Acetazolamide Hyperaldosteronism: Spironolactone, eplerenone |
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Which glomerular disease would you suspect most in a pt with the following findings?
- Most common nephrotic syndrome in children - IF: granular pattern of immune complex deposition; LM: hypercellular glomeruli - IF: linear pattern of immune complex deposition - Kimmelstiel-Wilson lesions (nodular glomerulosclerosis) - Most common nephrotic syndrome in adults - EM: Loss of epithelial foot processes |
Most common nephrotic syndrome in children
- Minimal change disease IF: granular pattern of immune complex deposition; LM: hypercellular glomeruli - Post-infectious IF: linear pattern of immune complex deposition - Goodpasture's Kimmelstiel-Wilson lesions (nodular glomerulosclerosis) - Diabetic nephropathy Most common nephrotic syndrome in adults - Focal segmental (or Membranous?) EM: Loss of epithelial foot processes - Minimal change |
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Which glomerular disease would you suspect most in a pt with the following findings?
- Nephrotic syndrome a/w hepatitis B - Nephrotic syndrome a/w HIV - Anti-GBM antibodies, hematuria, hemoptysis - EM: Subendothelial humps and tram-track appearance - Nephritis, deafness, cataracts - LM: Crescent formation in the golmeruli |
Nephrotic syndrome a/w hepatitis B
- Membranoproliferative Nephrotic syndrome a/w HIV - Focal Segmental GS Anti-GBM antibodies, hematuria, hemoptysis - Goodpasture's EM: Subendothelial humps and tram-track appearance - Membranoproliferative Nephritis, deafness, cataracts - Alport's LM: Crescent formation in the glomeruli - Rapidly progressive (Crescentic) |
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Which glomerular disease would you suspect most in a pt with the following findings?
- LM: Segmental Sclerosis and hyalinosis - Purpura on back of arms and legs, abdominal pain, IgA nephropathy - Apple-green birefringence with Congo-red stain under polarized light - Positive ANCA - Anti-dsDNA antibodies - EM: Spike and dome pattern of the basement membrane |
LM: Segmental Sclerosis and hyalinosis
- Focal Segmental GS Purpura on back of arms and legs, abdominal pain, IgA nephropathy - Henoch-Schonlein Apple-green birefringence with Congo-red stain under polarized light - Renal amyloidosis Positive ANCA - Crescentic GN Anti-dsDNA antibodies - Lupus nephritis EM: Spike and dome pattern of the basement membrane - Membranous GN |
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60 year-old male smoker is found to have a varicocele that does not empty when the patient is recumbent. What should you be suspicious of in this patient?
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Renal Cell Carcinoma
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Glomerulonephritis + bilateral sensorineural deafness. Diagnosis?
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Alport's syndrome
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What are the dietary recommendations in the treatment of nephrolithiasis?
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Lots of hydration
Adequate dietary calcium Decrease sodium intake Decrease dietary protein and oxalate |
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Young black male presents with painless hematuria. What do you suspect?
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Sickle cell trait
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What is the treatment for uric acid renal stones?
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Alkalinize the urine with sodium bicarbonate or sodium citrate.
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What is the most common cause of nephrotic syndrome in African American males?
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Focal Segmental Glomerulosclerosis
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What medications are used in the treatment of Wegener's granulomatosis?
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Cyclophosphamide
Corticosteroids |
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What is the classic presentation of post-streptococcal glomerulonephritis?
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Hematuria (brown urine)
Hypertension History of strep throat (1-3 weeks prior) Anti-Streptolysin O titer |
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What is the most common cause of morbidity and mortality in patients with SLE?
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Lupus nephritis
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What are the defining characteristics of nephrotic syndrome?
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Proteinuria > 3g/day
Hyperlipidemia Hypoalbuminemia |
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Fever + rash + elevated creatinine + eosinophilia -> What is the diagnosis?
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Acute interstitial nephritis
Most commonly due to medications |
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What is the biggest risk factor for renal cell carcinoma?
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Smoking
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What are 5 etiologies of temporary hematuria?
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UTI
Nephrolithiasis Exercise Endometriosis Trauma |
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What is the most common location of renal stone impaction?
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Ureterovesicular junction
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What class of diuretic is commonly used in patients with renal stones due to hypercalciuria in patients with a normal serum calcium level?
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Thiazide diuretics
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What are 4 potassium sparing diuretics?
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Spironolactone
Eplerenone Amiloride Triemterene |
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What size calcium renal stone has a 50% likelihood of passing without surgical intervention?
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8-9 mm
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Determine what is wrong in patients with the following lab values
pH: 7.40 HCO3-: 23 pCO2:40 pH: 7.50 HCO3-: 35 pCO2: 42 |
pH: 7.40
HCO3-: 23 pCO2:40 Normal pH: 7.50 HCO3-: 35 pCO2: 42 Metabolic alkalosis w/ no compensation |
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Determine what is wrong in patients with the following lab values
pH: 7.33 HCO3-: 13 pCO2: 28 pH: 7.42 HCO3-: 32 pCO2: 64 |
pH: 7.33
HCO3-: 13 pCO2: 28 Metabolic acidosis with respiratory compensation pH: 7.42 HCO3-: 32 pCO2: 64 Mixed metabolic alkalosis with respiratory acidosis |
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Determine what is wrong in patients with the following lab values
pH: 7.24 HCO3-: 18 pCO2: 40 pH: 7.24 HCO3-: 24 pCO2: 54 |
pH: 7.24
HCO3-: 18 pCO2: 40 Metabolic acidosis w/ no compensation pH: 7.24 HCO3-: 24 pCO2: 54 Respiratory acidosis w/ no compensation |
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Determine what is wrong in patients with the following lab values
pH: 7.50 HCO3-: 22 pCO2: 22 pH: 7.58 HCO3-: 36 pCO2: 30 |
pH: 7.50
HCO3-: 22 pCO2: 22 Respiratory alkalosis w/ no compensation pH: 7.58 HCO3-: 36 pCO2: 30 Combined metabolic and respiratory alkalosis |
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Determine what is wrong in patients with the following lab values
pH: 7.47 HCO3-: 14 pCO2: 22 pH: 7.46 HCO3-: 35 pCO2: 53 |
pH: 7.47
HCO3-: 14 pCO2: 22 Respiratory alkalosis with metabolic compensation pH: 7.46 HCO3-: 35 pCO2: 53 Metabolic alkalosis with respiratory compensation |
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Determine what is wrong in patients with the following lab values
pH: 7.39 HCO3-: 12 pCO2: 22 pH: 7.34 HCO3-: 31 pCO2: 62 pH: 7.10 HCO3-: 15 pCO2: 50 |
pH: 7.39
HCO3-: 12 pCO2: 22 Mixed metabolic acidosis and respiratory alkalosis pH: 7.34 HCO3-: 31 pCO2: 62 Respiratory acidosis with metabolic compensation pH: 7.10 HCO3-: 15 pCO2: 50 Combined respiratory and metabolic acidosis |
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What is the differential diagnosis for metabolic acidosis with a normal anion gap? How can serum potassium be useful in narrowing the differential diagnosis?
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Low serum potassium: diuretics, renal tubular acidosis types I and II, diarrhea, Fanconi's syndrome
High serum potassium: Addison's disease, renal tubular acidosis type IV, potassium sparing diuretics, hyperalimentation (TPN) |
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What volume status would you expect to find in a patient with hyponatremia due to the following causes?
- Thiazide diuretics - SIADH - Hepatic cirrhosis - Addison's disease - Hypothyroidism - Renal failure - Psychogenic polydipsia |
Thiazide diuretics
- Hypovolemia or euvolemia SIADH - Euvolemia Hepatic cirrhosis - Hypervolemia Addison's disease - Hypovolemia Hypothyroidism - Euvolemia Renal failure - Hypervolemia Psychogenic polydipsia - Euvolemia |
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What urine and serum osmolality would you expect to see with the following causes of euvolemic hyponatremia?
- SIADH - Psychogenic polydipsia - Thiazides - Alcoholism - Hypothyroidism |
SIADH
Urine sodium: > 20 (FeNa >1%) Urine osmolality: > 100 Psychogenic polydipsia Urine sodium: < 20 Urine osmolality: < 100 Thiazides Urine sodium: > 20 Urine osmolality: > 100 Alcoholism Urine sodium: < 20 Urine osmolality: < 100 Hypothyroidism Urine sodium: > 20 Urine osmolality: > 100 |
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What is the differential diagnosis for hypervolemic hyponatremia based on urine sodium levels?
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Urine Na < 20:
CHF, Cirrhosis, Nephrotic syndrome Urine Na > 20: Renal failure |
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What shifts K+ out of cells and causes hyperkalemia?
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- Low insulin
- Beta-blockers - Acidosis - Digoxin - Cell lysis (ie leukemia) |
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What shifts K+ into cells and causes hypokalemia?
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- Insulin
- Beta-agonists - Alkalosis - Cell creation/proliferation |
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Hyponatremia + low serum osmolality + high urine osmolality. What is the diagnosis?
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SIADH
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What is the next step in the management of a patient with peaked T waves on EKG due to hyperkalemia?
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Calcium gluconate
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What is the most common cause of death in dialysis patients?
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Cardiovascular disease
(must be on Aspirin, statin daily) |
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What electrolyte abnormality fits the following description?
- Peaked T waves on EKG - Flattened T waves on EKG - U waves on EKG - QT prolongation - QT shortening |
Peaked T waves on EKG
- Hyperkalemia Flattened T waves on EKG - Hypokalemia U waves on EKG - Hypokalemia QT prolongation - Hypocalcemia QT shortening - Hypercalcemia |
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What are the distinguishing characteristics of each type of renal tubular acidosis (RTA)?
(Urine pH, Serum K, Serum Bicarb) |
Type I
Urine pH: > 5.3 Serum K: Decreased Serum Bicarb: Variable Type II Urine pH: > 5.3 Serum K: Decreased Serum Bicarb: Decreased Type IV Urine pH: < 5.3 (normal urine pH) Serum K: Increased Serum Bicarb: Normal |
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What is the consequence of correcting hypernatremia too rapidly? How rapidly can it safely be corrected?
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Cerebral edema
12 mEq/24 hours |
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What is the consequence of correcting hyponatremia too rapidly? How rapidly can it safely be corrected?
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Central pontine myelinolysis
12 mEq/24 hours (Definitely < 20) |
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What medications can be used to rapidly correct hyperkalemia by shifting potassium into cells?
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Insulin with glucose
Alkalinizing the serum Calcium gluconate (or chloride) Sodium bicarb Albuterol Loop diuretics Kayexalate |
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What are the causes of euvolemic hyponatremia?
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SIADH
Hypothyroidism Polydipsia |
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What medications are known for causing hyperkalemia? Hypokalemia?
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Hyperkalemia
- ACE-I/ARBs - K-sparing diuretics - Beta-blockers, digoxin Hypokalemia - Albuterol - Insulin - Diuretics (loops, thiazide, etc.) |
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What is the treatment for nephrogenic diabetes insipidus?
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Hydrochlorothiazide +/- indomethacin
For lithium caused: Hydrochlorothiazide + amiloride |
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How are sodium levels corrected for high glucose?
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As glucose gets over 100, for every 100 mg/dL, add 1.6 mEq of Na.
Above 400, add 2.4 mEq Na |
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What are the causes of a normal anion gap metabolic acidosis?
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Diarrhea
Renal tubular acidosis TPN |
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What medications are necessary in patients with end stage renal disease?
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Daily aspirin, statins to prevent CAD
Vitamin D supplementation Iron supplementation EPO (keep Hg between 11-12) Phosphate binders (Ca agents) Manage BP < 130/80 Manage Glucose (HbA1c <6.5) Loop diuretics (for near end-stage renal disease) |
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How are total calcium levels corrected for low albumin?
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As albumin drops < 4, for every 1g/dL below 4, Ca is expected to decrease by 0.8 mg/dL.
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A 60 year old male presents to the clinic for a well male exam and on digital rectal exam a hard nodule is palpated on the prostate. Lab work-up shows an elevated PSA. What is the next step in the management of this patient?
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Transrectal needle biopsy
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A patient has signs of peritonitis and his clinical scenario favors rupture of the bladder (blunt trauma to a fully distended bladder). What portion of his bladder must have been injured to allow for a chemical peritonitis to have developed?
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Dome of the bladder
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What is the next step in the management of a woman with an uncomplicated cystitis?
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Antibiotics (TMP-SMX) for 3 days
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Newborn male has a distended palpable bladder and oliguria. What is the most common cause of congenital urethral obstruction?
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Posterior urethral valves
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What is the treatment for epididymitis?
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Under age 35: Doxycycline and Ceftriaxone
Over age 35: TMP-SMX, Fluoroquinolone (For E. coli, Klebsiella, Proteus) |
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What lab work is included in the work-up for erectile dysfunction?
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Total testosterone
TSH Prolactin PSA |
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What are the recommended therapies for nocturnal enuresis?
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Scheduled bathroom visits
Limit water intake at night Enuresis alarm Medications: Imipramine, indomethacin |
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What medications are used in the treatment of BPH?
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Nonselective alpha-antagonists
(Prazosin, etc.) Tamsulosin + 5alpha-reductase inhibitor (Finasteride) |
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What are the risk factors for bladder cancer?
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Smoking
Schistosomiasis (3rd world countries) Anyline dyes Petroleum byproducts Cyclophosphamide (use MESNA) |
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What is the treatment for urethritis in men?
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Ceftriaxone + Doxycycline
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How do the signs and symptoms of testicular torsion differ from epididymitis?
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Torsion:
Acute onset; No cremasteric reflex; testicle raised and horizontal, support will not relieve pain Epididymitis: Signs of infection (discharge, erythema), support may relieve pain |
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What is the classic presentation of a varicocele?
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Infertility
Scrotal mass that transilluminates +/- scrotal pain, atrophy |
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Three year old with an abdominal mass, hematuria, and hypertension. What is the most likely diagnosis?
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Wilm's tumor
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What is the defining characteristic of a hydrocele?
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Transillumination
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What is the next step in the management of testicular torsion confirmed with US?
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Attempt manual detorsion, then surgical detorsion, bilateral orchioplexy
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What is the treatment for prostatitis?
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Doxycycline 10 days + Ceftriaxone IM
Over 35 (or h/o anal sex): Fluoroquinolone or TMP-SMX (4-6 weeks) |
