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413 Cards in this Set

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Q001. Dx:; Rapid onet of oliguria with increasing BUN and creatinine; often occurs in hospitalized patients
A001. Acute Renal Failure
Q002. ARF class:; weight loss or gain, poor skin turgor, edema/ascites, renal artery bruit
A002. Pre-renal ARF
Q003. ARF class:; weight gain, obtundation, hypotension to HTN, JVD, evidence of muscle trauma, infection, contaminated IV lines
A003. Intrinsic ARF
Q004. ARF class:; weight gain, enlarged prostate, pelvic mass, bladder distension
A004. Post-renal ARF
Q005. Etiology of pre-renal ARF; (4 and example of each)
A005. 1. Hypovolemia (including hemorrhage and GI loss); 2. Third-spacing (including nephrotic syndrome, burns and cirrhosis); 3. Low cardiac Output (including CHF and shock); 4. Renal hypoperfusion (including renal artery stenosis, NSAIDs + ACEi)
Q006. Etiology of Intrinsic ARF; (5)
A006. 1. Hyperviscosity (multiple myeloma); 2. Acute Tubular Necrosis (due to: meds or rhabdomyolysis); 3. Glomerular injury (Nephrotic syndrome, vasculitis, GN); 4. Acute Interstitial Nephritis; 5. Renovascular infarction
Q007. Etiology of Post-renal ARF; (3)
A007. 1. Urinary tract obstruction; 2. enlarged prostate; 3. bladder dysfunction
Q008. Define:; Oliguria
A008. Urine output < 400 mL/day
Q009. Indications for Dialysis:; (5)
A009. AEIOU:; Acidosis; Electrolyte abnormalities; Ingestions; Overload; Uremic symptoms (pericarditis, encephalopathy)
Q010. Pre-renal amounts for:; 1. BUN/creatinine ratio; 2. Fe-Na; 3. Urine Na; 4. Urine Osmolality; 5. Urine specific gravity
A010. 1. > 20; 2. < 1%; 3. < 20; 4. > 500; 5. > 1.020
Q011. Intrinsic renal (ARF)amounts for:; 1. BUN/creatinine ratio; 2. Fe-Na; 3. Urine Na; 4. Urine Osmolality; 5. Urine specific gravity
A011. 1. < 20; 2. > 1%; 3. > 40; 4. < 350; 5. = 1.010
Q012. What (2) Dx test and results point to a post-renal ARF problem?
A012. Fe-Ne > 4%; Urine Na > 40
Q013. Equation for Fractional Excretion of Sodium (Fe-Na)
A013. Fe-Na = (urine Na/plasma Na) / (U-creatinine/P-creatinine) x 100%
Q014. MCC of intrinsic ARF
A014. Tubulointerstitial diseases; (ATN and AIN)
Q015. Dx:; Acute damage of renal tubules due to ischemic or toxic insult
A015. Acute Tubular Necrosis
Q016. Etiology of Ischemic (4) and Toxic (4) causes of ATN
A016. Ischemic:; Shock;; Trauma;; Sepsis;; Hypoxia; Toxic:; Rhabdomyolysis;; Aminoglycosides;; IV contrast;; Tumor lysis
Q017. (3) Dx findings for ATN
A017. Muddy-brown granular casts;; High urine sodium;; Fe-Na > 1%
Q018. Tx for ATN; (4)
A018. - NS for volume replacement;; IV diuretic in early stages;; match I and O; manage electolyte disturbance
Q019. Dx:; Inflammation of the renal parenchyma
A019. Acute Interstitial Nephritis
Q020. (3) basic classes of etiologies of AIN
A020. Systemic diseases;; Systemic infections;; Medications
Q021. (3) systemic diseases that causes AIN
A021. Sarcoidosis;; Sjogren syndrome;; Lymphoma
Q022. (4) systemic infections (bugs) that cause AIN
A022. Syphilis;; Toxoplasmosis;; CMV;; EBV
Q023. (3) medication classes that can cause AIN
A023. Beta-blockers;; Diuretics;; NSAIDs
Q024. How do NSAIDs cause AIN?
A024. inhibit prostaglandin synthesis, which decreases GFR and start renal failure in patient with underlying renal problems
Q025. Dx findings of allergic AIN; (3)
A025. WBCs;; Eosinophils;; White (or red) cell casts
Q026. Tx of allergic AIN?; (2)
A026. 1. stop offending agent; 2. Steroids
Q027. initial microscopic finding in ATN
A027. blebbing of the PTC and loss of brush boarder
Q028. microscopic finding of ischemic (2) ATN versus toxic
A028. Ischemic: BM damage; skipped areas of damage; Toxic: no BM damage; Uniform damage with sparing of DT
Q029. Lab:; Oxalate crystal formation in kidney
A029. Ethylene glycol ATN
Q030. Retention of what (3) things causes anion gap increase with CRF?
A030. Phosphates; H+; Sulfates
Q031. what does the ultrasound show w/:; 1. CRF; 2. Diabetes; 3. Amyloidosis; 4. Poylcyctic Kidney Disease
A031. 1. shrunken kidneys; 2 - 4. Enlarged kidneys
Q032. What (3) endocrine functions are lost with CRF?; what is the result of each on the patient?
A032. Synthesis of:; 1. Vitamin D - hypocalcemia;; 2. Ammonia - anion-gap met acidosis;; 3. Erythropoietin - anemia
Q033. Tx for Chronic renal failure; (3)
A033. ACEi;; low-protein diet;; Dialysis
Q034. Dx:; pale complexion, wasting, purpura, N/V, itching, tubular casts in urine
A034. Uremic syndrome
Q035. Waxy casts in urine
A035. Chronic Renal Failure
Q036. CNS problems from Uremia; (5)
A036. Foot drop;; Carpal tunnel;; Clonus;; Asterixis;; Seziures
Q037. Cardiac / Pulmonary problems from Uremia; (5)
A037. HTN;; Pericarditis;; Valve calcification;; Pulmonary edema;; Pulmonary effusions
Q038. Hematologic problems from Uremia; (3)
A038. Normochromic, normocytic anemia;; Low platelet function (prolonged bleeding time);; low WBC - increased infections
Q039. (2) metabolic problems from Uremia
A039. High triglycerides;; Insulin resistance
Q040. Dx:; Inability for kidney to concentrate urine; (stays fixed with specific gravity = 1.010)
A040. Isostheuria
Q041. Dx:; enlarged kidneys with multiple cysts presenting in mid 30's to 40's with flank pain; what can it lead to?
A041. ADPKD; Berry aneurysms
Q042. Dx:; Metabolic acidosis with normal anion gap
A042. Renal Tubular Acidosis
Q043. Renal Tubular Acidosis Type I:; 1. Defect; 2. bicarb level; 3. Urine pH; 4. Plasma K; 5. where in kidney
A043. 1. H+ secretion causing Acidosis; 2. Low; 3. pH > 5.3; 4. Low; 5. DT defect
Q044. Renal Tubular Acidosis Type II:; 1. Defect; 2. bicarb level; 3. Urine pH; 4. Plasma K; 5. where in kidney
A044. 1. Decreased Bicarb reabsorption; 2. 12 - 20; 3. pH > 5.3; 4. Low - normal; 5. PCT defect
Q045. Renal Tubular Acidosis Type IV:; 1. Defect; 2. bicarb level; 3. Urine pH; 4. Plasma K; 5. where in kidney
A045. 1. Decreased Aldosterone; 2. > 17; 3. pH < 5.3*; 4. High*; 5. DT
Q046. Etiology of Renal Tubular Acidosis Type I; (4)
A046. Lithium;; Amphotericin B;; SLE;; Sarcoidosis
Q047. Etiology of Renal Tubular Acidosis Type II; (3)
A047. Heavy Metals;; Acetazolamide;; Multiple myeloma
Q048. Etiology of Renal Tubular Acidosis Type IV; (3)
A048. Renal transplant;; Obstructive uropathy;; Diabetic nephropathy;
Q049. Dx:; Radiopaque stone seen in inflammatory bowel diseases, decreased citrate & uricourea; Tx?
A049. Calcium Oxalate stone; Tx: Thiazides
Q050. Dx:; moderately readiopaque stone common in Proteus or staph Saprophyticus UTI due to high urinary pH; Tx?
A050. Struvite (ammonium, magnesium, phosphate) stone; Tx: lower urine pH
Q051. Dx:; Radiolucent stone caused by myeloproliferative diseases and gout; Tx?
A051. Uric Acid stone; Tx: raise urine pH
Q052. Dx:; moderately radiopague stone that has hexagonal crystals and is positively birefringent; What congenital disorder is cause?; Tx?
A052. Cystine Stones; Disorder: Cystinuria; Tx: raise urine pH
Q053. Dx:; 39-yo man with severe back pain and hematuria, nausea and unable to find a comfortable position.
A053. Renal stone; (Urolithiasis)
Q054. Dx:; sudden HTN with low K+; How do you do a screening Dx?; Tx?
A054. Renal artery stenosis; give oral captopril to induce increase of renin; Tx: surgery or angioplasty
Q055. Etiology of renal artery stenosis; (2)
A055. Plaque; Fibromuscular dysplasia
Q056. Dx:; hematuria, palpable mass, flank pain, fever, secondary polycythemia
A056. Renal Cell Tumor
Q057. MC person to get Renal cell CA; Where does it disseminate to?; Tx? (2)
A057. 50-70 yo Male smoker; moves to: Renal veins and Vena cava; Tx: resection, IL-2 immunotherapy
Q058. (3) causes of Ketones in the urine
A058. 1. DKA; 2. Alcohol intox; 3. starvation
Q059. What does Nitrite in urine indicate?
A059. Gram negative rods
Q060. What does a positive Leukocyte esterase in urine indicate?
A060. White cells and infection
Q061. What do eosinophils in the urine indicate?
A061. Allergic Interstitial Nephritis
Q062. What do Squamous cells in the urine indicate?
A062. contaminated specimen
Q063. What does Bilirubin in the urine indicate?
A063. Extravascular hemolysis
Q064. What does Hemoglobin in the urine indicate?
A064. Intravascular hemolysis
Q065. What do Hyaline casts in the urine indicate?
A065. Pre-renal azotemia
Q066. MCD in ARF?
A066. infection
Q067. Defition of ARF?
A067. rapid decline in renal function with an increase in Cr level; relative increase of 50% or absolute increase of 0.5 to 1.0 mg/dL
Q068. MCC of postrenal failure
A068. BPH - urethral obstruction
Q069. MCC chronic renal failure
A069. diabetes!
Q070. azotemia refers to?
A070. elev. of BUN
Q071. uremia refers to?
A071. si/sx associated with accumulation of nitrogenous wastes due to impaired renal function; usually, BUN>60mg/dL
Q072. 3 key features of nephrotic syndrome
A072. proteinuria; hypoalbuminemia; hyperlipidemia
Q073. Examination of urine sediment:; RBC =; WBC =; Fatty casts =
A073. RBC = GN; WBC = pyelonephritis & interstitial nephritis; Fatty casts = nephrotic syndrome
Q074. Gross painless hematuria
A074. bladder ca
Q075. microscopic hematuria v. gross hematuria
A075. microscopic = glomerular; gross = post renal causes - trauma, stones, malignancy)
Q076. hyperkalemia - how can you remove K from serum? (3)
A076. 1. dialysis; 2. diuretics; 3. cation exchange resins - kayexalate (sodium polystyrene sulfonate)
Q077. MOA of Kayexalate
A077. cation exchange resin - acts in the GI tract by promoting exchange of Na for K and thereby increasing excretion of K
Q078. Indications for Dialysis
A078. AEIOU and sometimes Y; Acidosis, pH<7.2; Electrolytes, refractory hyperkalemia; Intoxication, methanol, ethylene glycol, ASA, lithium; Overload, hypervolemia, pulmonary edema; Uremic pericarditis/encephalopathy/neuropathy; Yhtapolugoac, secondary to renal failure
Q079. nephrotic syndrome + abdominal pain + fever + hematuria =
A079. renal vein thrombosis;; antithrombin III is lost in urine putting patients at increased risk of venous/arterial thrombosis
Q080. nephrotic syndrome is most commonly caused by?
A080. adults: membranous glomerulonephritis; children: minimal change diseases
Q081. What serum Cr level is safe for contrast CT?
A081. <1.5; if >1.5 use non ionic contrast OR ultrasound
Q082. MCC of glomerular hematuria
A082. IgA nephropathy (Berger's disease)
Q083. MCC of nephritic syndrome
A083. poststreptococcal GN
Q084. Poststreptococcal GN occurs after infection with ______.
A084. group A beta-hemolytic streptococcal infection of respiratory tract
Q085. proliferative GN + pulmonary hemorrhage + IgG anti- glomerular basement membrane antibody
A085. Goodpasture's syndrome
Q086. MCC of acute interstitial nephritis
A086. acute allergic reaction to a medication
Q087. eosinophils in urine suggest what?
A087. acute interstitial nephritis
Q088. What disease has a defective amino acid transporter (in the kidney)?
A088. Hartnup syndrome - decreased intestinal and renal reabsorption of neutral aa's, such as tryptophan, causing nicotinamide deficiency
Q089. What kidney disease manifests like pellagra?
A089. 3 D's:; dermatitis,; dementia,; diarrhea; Hartnup syndrome
Q090. Adult polycystic Kidney Disease - associated finding in the brain?
A090. intracerebral berry aneurysm
Q091. medullary sponge kidney is thought to be associated with what other disease?
A091. hyperparathyroidism and parathyroid adenoma
Q092. most common cause of secondary HTN?
A092. renal artery stenosis - decreased blood flow to JG apparatus, RAA system becomes activated, HTN
Q093. What HTN drug is contraindicated in patients with renovascular HTN?
A093. ACEI
Q094. MC site of nephrolithiasis impaction
A094. ureterovesicular junction
Q095. Prostate Ca commonly begins where in the gland?
A095. periphery then moves centrally - obstructive symptoms LATE
Q096. Dx:; Edema, lipiduria, foamy urine, hypoalbuminemia, hyperlipidemia, hypercoagulation, protein in urine
A096. Nephrotic syndrome
Q097. Dx:; "Maltese crosses" in urine
A097. cholesterol in urine; (Nephrotic syndrome)
Q098. Why does the nephrotic syndrome patient have edema?; hypercoaguability?
A098. Edema - decrease ion serum proteins and oncotic pressure; Hypercoag - loss of Proteins C and S and antithrombin III
Q099. Dx:; child with epithelial foot process loss on EM; Tx?
A099. Minimal Change Disease; Tx: steroids
Q100. Dx:; glomerular scarring involving limited number of glomeruli with IgG and complement deposition; Most common in what patients?; (5)
A100. Focal Segmental Glomerulosclerosis; Common in (Halt MID Stream):; HIV;; Men (younger) with HTN; IV drug users;; DM;; Sickle cell
Q101. What can Focal Glomerulosclerosis lead to?; (2); Tx?
A101. HTN and Chronic Renal Disease; Tx: Cyclophosphamide
Q102. First line of Tx for all Nephrotic syndrome
A102. Protein and NaCl restriction
Q103. Dx:; MCC of Nephrotic Syndrome in adults that is slow to progress and has little response to steroids; Etiology? (6)
A103. Membranous Glomerulonephritis Etiology (SHIT):; SLE / Syphilis;; HBV / HCV;; Idiopathic;; Tumor
Q104. Rule of thirds for Membranous GN
A104. 1/3 get CRF; 1/3 have spontaneous remission; 1/3 remain nephrotic without progression
Q105. Tx for Membranous GN; (2)
A105. Cyclophosphamide; Chlorambucil
Q106. Dx:; Abrupt onset hematuria with RBC casts, smoky-brown urine, proteinuria, hypertension, edema and azotemia (low GRF)
A106. Acute Glomerulonephritis; (Nephritic syndrome)
Q107. Dx:; presents 2 weeks after pharyngitis or impetigo with dark urine and edema
A107. Poststrep. GN
Q108. Deposition of what causes glomerular damage in poststrep GN?; Tx?
A108. Deposition of IgG, C3 and C4 in a granular pattern; Tx underlying infection
Q109. Dx:; hematuria immediately after an infection or exercise
A109. IgA nephropathy; (Berger's Disease)
Q110. what (and where) is the immune complex deposition of IgA nephropathy?
A110. Mesangeal deposition of IgA and C3
Q111. Dx:; immune deposits on BM cause it to look double-layered; what is it associated w/?; (2)
A111. Membranoproliferative ("Tram-track" appearance) Assoc with:; Hepatitis C; Cryoglobinemia
Q112. How is type I membranoproliferative different then type II?
A112. Type I: slowly progressive; Type II: low serum C3 due to Auto-Ab vs C3
Q113. Tx of Membranoproliferative for adults (2) and kids
A113. Adults: ASA, Dipyridimole; Kids: Steroids
Q114. Dx:; Fulminant renal failure with proteinuria, hematuria and RBC casts and epithelial cell proliferation in glomeruli; (2 names)
A114. Rapidly Progressive GN; (Cresentric GN)
Q115. (3) types of Rapidly Progressive GN
A115. 1. Pauci-Immune RPGN; 2. Immune complex RPGN; 3. Anti-glomerular BM Ab Disease
Q116. Serum marker for Pauci-Immune RPGN
A116. ANCA positive; (Wegner's = c-ANCA); (polyarteritis nodosa = p-ANCA)
Q117. Etiology of Immune Complex RPGN; (5)
A117. SPLIT:; Syphilis;; Post-strep GN;; Lupus nephritis;; IgA nephritis;; Tumors
Q118. another name for Anti-GMB Ab disease; what cells cause problem?
A118. Goodpasture's disease; Cytotoxic T-cells (CD-8)
Q119. Tx for all RPGN; (2); what percent go on to end-stage renal disease?
A119. Tx:; steroids; cyclophosphamide; 80%
Q120. Renal involvement with Lupus type I - V; Which has "wire-loop" abnormality?
A120. I: no renal involvement; II: Focal-Segmental; III: Focal-Proliferative; IV: Diffuse Proliferative (most severe - wire-loop); V: Membranous
Q121. MCC of End-Stage Renal Disease; What is the early manifestation?; What do Biopsy show?
A121. Diabetes; starts with microalbuminuria; Biopsy: Kimmelstiel-Wilson nodules
Q122. Dx:; palpable purpura on buttocks and legs of kids, abdominal pain, vomiting, hematuria and GI bleeding
A122. Henoch-Schonlein purpura
Q123. Dx:; Tubule plugging with Bence-Jones proteins; what electrolyte disorder from Dx also leads to kidney trouble?; What causes patient to go into CRF?
A123. Multiple myeloma; Hypercalcemia; E.Coli infection of kidney from abnormal Ab production
Q124. (3) major toxins that increase the serum's osmolarity
A124. EtOH; Methanol; Ethylene glycol
Q125. ICF is what fraction of TBW?; Major cations of ICF? (2); Major anions? (2)
A125. ICF = 2/3 of TBW; Cations: K, Mg; Anions: Proteins, Organic Phosphates (ATP, ADP, AMP)
Q126. ECF is what fraction of TBW?; Major cation of ECF?; Major anions? (2)
A126. ECF = 1/3 of TBW; Cation: Na; Anions: Cl, HCO3
Q127. What composition does interstitial fluid resemble?; What is different?
A127. resembles Plasma; Interstitial fluid contains little protein (ultrafiltrate)
Q128. What (2) compartments does water shift between?; If solutes (glucose, sodium, mannitol) dont cross the cell membrane, what osmolarity do they contribute to?
A128. ECF + ICF; ECF
Q129. Formula for Serum Osmolarity; Normal Serum Osmolarity?
A129. SO = 2(Na+K) + Glucose/18 + BUN/2.8; 300 mOsm/kg
Q130. Define:; Hyponatremia
A130. plasma sodium < 134mEq/L
Q131. What are the (3) categories of Hyponatremia?
A131. Hypovolemic; Isovolemic; Hypervolemic
Q132. How can you distinguish b/t renal and extrarenal causes of hypovolemic hyponatremia?
A132. Urine Sodium:; U-Na > 20 = Renal; U-Na < 10 = Non-renal
Q133. Extra-renal causes of hypovolemic hyponatremia; (5)
A133. GI loss (Vomiting/Diarrhea); Extensive burns; Dehydration; 3rd spacing (pancreatitis, peritonitis)
Q134. Renal causes of Hypotonic Hypovolemic Hyponatremia; (5)
A134. TANAS:; Thiazides (diuretics);; ACEi;; Nephropathies;; Addisons Disease (Mineralcorticoid deficiency);; Salt-wasting nephropathies
Q135. Etiology of Hypotonic Euvolemic Hyponatremia; (separate into 2 categories - 8 total)
A135. Less dilute urine (SHiT):; SIADH; Hypothyroidism; Idiosyncratic drug reaction (Thiazides, ACEi) More dilute urine (Huge PEPE):; Hypokalemia; Post-op Hyponatremia; EtOH addiction; Psychogenic polydipsia; Exercise
Q136. "tonic" as in hypertonic refers to what?
A136. serum osmolality
Q137. Serum osmolality level for:; Hyponatremia; Hypernatremia
A137. Hyponatremia: < 280 mOsm/kg; Hypernatremia: > 300 mOsm/kg
Q138. Etiology of Hypotonic Hypervolemic Hyponatremia; (4)
A138. CLAN:; CHF; Liver disease; Advanced Renal Failure; Nephrotic syndrome
Q139. Etiology of Isotonic Hyponatremia; (2)
A139. Hyperproteinemia; Hyperlipidemia
Q140. Etiology of Hypertonic Hyponatremia; (2)
A140. Facticious Hyponatremia:; Hyperglycemia; Hypertonic infusions; (mannitol, glucose, contrast)
Q141. How does each 100 mL/dL increase in serum glucose above normal cause sodium to decrease?
A141. Sodium decreases by 1.6 mEq/L
Q142. Signs/Sx of moderate hyponatremia or gradual onset; (4)
A142. Confusion; Muscle cramps; Anorexia; Nausea
Q143. Signs/Sx of severe hyponatremia or rapid onset; (2); At what level is considered severe?
A143. Seizures or Coma; Severe: < 115 mEq/L
Q144. With low serum osmolarity (< 280), what signs should be observed to differentiate b/t Hypovolemia, Isovolemia, & Hypervolemia?
A144. Hypovolemia:; Tachycardia; Hypotension; poor skin turgor; Isovolemia:; Normal vital signs without edema; Hypervolemia:; peripheral Edema
Q145. Dx:; measured & calculated serum osmolarities are different; What (2) problems is it seen in?
A145. Pseudohyponatremia; Seen in:; Multiple myeloma; Hyperlipidemia
Q146. Tx of Hypovolemic Hyponatremia; (2)
A146. 1. address underlying disorder; 2. replace volume with NS; (monitor Na to prevent CPM)
Q147. Tx of Isovolemic or Hypervolemic Hyponatremia; (2)
A147. 1. address underlying disorder; 2. Sodium + water restriction
Q148. What is Tx for CHF-induced Hypervolemic Hyponatremia?; (2)
A148. 1. Sodium + water restriction; 2. Combination of Captopril & Furosemide
Q149. Rules for correcting Hyponatremia by increasing serum sodium; (2); Why?
A149. 1. only go into low-normal range in forst 24 hours; 2. never correct sodium faster then 1 mEq/L/hr; Can lead to Central Pontine Myelinolysis (CPM), seizures, coma
Q150. What are pre-menopausal women at high risk for during an acute episode of Hyponatremia?
A150. Cerebral edema
Q151. Dx:; Osmotic demyelination syndrome occurring as a treatment complication of severe or chronic hyponatremia
A151. Central Pontine Myelinolysis; (CPM)
Q152. Serum sodium level that is considered Hypernatremia
A152. Serum Na > 145 mEq/L
Q153. Type of Hypernatremia:; Loss of both water + sodium; (water loss >> sodium loss)
A153. Hypovolemic Hypernatremia
Q154. Type of Hypernatremia:; Decreased TBW, normal body sodium, decreased ECF
A154. Isovolemic Hypernatremia
Q155. Type of Hypernatremia:; Increased TBW, markedly Inc total body Na, Inc ECF
A155. Hypervolemic Hypernatremia
Q156. Etiology of Hypervolemic Hypernatremia; (3)
A156. Hypertonic fluid administration;; Mineralcorticoid excess (Cushing's, Conn's);; Excess salt ingestion
Q157. Etiology of Isovolemic Hypernatremia; (2)
A157. Diabetes Insipidus;; Skin losses (due to hyperthermia)
Q158. Etiology of Renal-related Hypovolemic Hypernatremia; (3)
A158. Diuretics;; Acute/chronic Renal failure;; Partial obstruction
Q159. Etiology of Extra-renal-related Hypovolemic Hypernatremia; (5)
A159. Hyperpnea;; Excessive sweating;; Diarrhea;; Burns;; Dialysis
Q160. formula for Water Deficit in Hypernatremia patient
A160. WD (liters) = 0.6 x body wt (kg) x (measured Na/140) -1
Q161. Tx for Hypovolemic Hypernatremia
A161. Fluid replacement with NS; (correct plasma osmolarity no faster then 2 mOsm/kg/hr)
Q162. Tx for Isovolemic Hypernatremia; What additionally should you do if Dx is Central Diabetes Insipidus?
A162. Fluid replacement with 1/2 NS; (correct only half of the deficit in first 24 hrs); C-DI: Vasopressin
Q163. Tx for Hypervolemic Hypernatremia; (2)
A163. 1. Fluid replacement with 1/2 NS (for hypertonicity); 2. Loop diuretic (furosemide) to inc Na excretion
Q164. Normal range of Potassium
A164. 3.3 - 5.5; (below is hypokalemia; above is hyperkalemia)
Q165. Difference b/t Periodic paralysis of Hypokalemia vs. Hyperkalemia
A165. Hypokalemia - presents in teens; Hyperkalemia - presents in infancy
Q166. What heart drug causes a greater toxicity if patient goes into Hypokalemia?; How is this avoided?
A166. Digitalis; check K+ regularly
Q167. (4)* general ways we can lose potassium (become Hypokalemia)
A167. 1. Cellular shift + undetermined mechanisms; 2. Inc renal excretion; 3. GI losses; 4. Sweating
Q168. Cellular shift + undetermined mechanisms of Hypokalemia; (5)*
A168. A Deadly VIBe:; 1. Alkalosis; 2. Digoxin toxicity correction (with digibind); 3. Vitamin B-12; 4. Insulin; 5. Beta-adrenergics
Q169. in Alkalosis, how does each 0.1 increase in pH affect K+?
A169. decreases serum K+ by 0.5 mEq/L
Q170. What does insulin do to K+?
A170. drives it into the cells
Q171. Etiology of Hypokalemia due to Increased renal excretion mechanisms; (6)*
A171. 1. Cushings (Inc Mineralcorticoid activity); 2. HypoMagnesium; 3. Bartter's syndrome; 4. Osmotic diuresis (mannitol); 5. Renal tubular acidosis; 6. Medications
Q172. Dx:; JG-cell hyperplasia causing increased renin/aldosterone, met alkalosis, Hypokalemia, muscle weakness and tetany; seen in young adults
A172. Bartter's syndrome
Q173. (3) GI loss causes of Hypokalemia
A173. 1. Vomiting; nasogastric suction; 2. Diarrhea; laxative abuse; 3. Inadequate dietary intake (anorexia)
Q174. Dx:; Impaired gastric motility, nausea, vomiting, muscle weakness (to paralysis), rhabdomyolysis, atrial + ventricular arrhythmias
A174. Hypokalemia
Q175. What is the Tx for urgent Hypokalemia? (2); What works faster?; What type of patient must be monitored closely?
A175. give IV + oral potassium simultaneously; oral works faster; monitor patient with renal failure
Q176. At what level should K+ be peri-MI to prevent arrhythmias?
A176. K+ > 4.0
Q177. IV infusion of K+ should not exceed what number/hour?; How much does that raise serum K+?
A177. IV no more then 20 mEq/hr; Increases K+ by 0.25 mEq/L
Q178. what diagnostic procedure should be performed on patients with moderate or severe Hyperkalemia?
A178. Stat EKG
Q179. The only Tx of Hyperkalemia (aside from dialysis) that removes K from the body
A179. Kayexalate
Q180. MCC of Hyperkalemia in lab results; What should be done?
A180. Pseudo-Hyperkalemia:; falsely elevated measurement due to hemolysis; Re-run lab test
Q181. (4)* causes of ICF to ECF potassium shifting causing Hyperkalemia
A181. Heavy exercise; Acidosis; Insulin deficiency; Digitalis toxicity
Q182. (3) causes of an increased potassium load causing Hyperkalemia
A182. IV potassium supplements; K+ medications; Increased cellular breakdown
Q183. Causes of decreased potassium excretion causing Hyperkalemia; (3 renal and 3 drugs)*
A183. ROB A K:; Renal failure;; Obstructive uropathies;; Beta-blockers;; Aldosterone deficiency / ACEi;; K-sparing diuretics
Q184. Dx:; N/V/D; muscle cramps, weakness, areflexia, tetany, confusion; respiratory insufficiency; arrhythmias, cardiac arrest
A184. Hyperkalemia
Q185. EKG changes when potassium equals:; 1. 6.5 - 7.5 (3); 2. 7.5 - 8.0 (2); 3. 10 - 12; What does it lead to? (3)
A185. 1. Tall, peaked T-waves; short QT; prolonged PR; 2. QRS widening; Flat P-wave; 3. QRS degrades into SIN wave; leads to: V-fib, complete heart block or asystole
Q186. Hyperkalemia is most common with what (2) causes
A186. Renal failure; muscle breakdown
Q187. What are the Tx of Hyperkalemia in order of Stabilize, Shift, Remove?*
A187. Can Get In A Bad K Day:; Stabilize - Calcium; Shift - Glucose + Insulin; Albuterol; Bicarbonate; Remove - Kayexalate; Dialysis
Q188. When is calcium contraindicated for Hyperkalemia?
A188. if patient is on Digoxin
Q189. Polycystic Kidney Disease - What is it
A189. AD – bilateral cysts progressively develop, late onset, usually asymptomatic until 30 y/o, 50% - ESRD with dialysis by 60 y/o; AR - less common, more severe, often lethal in 1st few years infants and kids, renal failure, liver fibrosis, portal HTN
Q190. Polycystic Kidney Disease - History/PE
A190. Hematuria; HTN; pain - sharp & localized, from ruptured cysts,; infection,; renal calculi; large, palpable kidneys; liver cysts; berry aneurysms; mitral valve prolapse; colonic diverticula
Q191. Polycystic Kidney Disease - Dx
A191. US or CT
Q192. Polycystic Kidney Disease - Tx
A192. Prevent complications,; slow progression to ESRD: early management of UTI - prevent renal cyst infection; control BP; ESRD – dialysis, renal transplant
Q193. Nephrolithiasis - MC in what population; Risk factors
A193. MC in older men risk factors; family History,; low fluid intake; gout; postcolectomy; postileostomy; spec. enzyme disorder; RTA; hyperparathyroidism
Q194. Nephrolithiasis - History/PE
A194. Acute onset; severe colicky flank pain; may radiate to testes or vulva; n/v; pt. freq. shift position
Q195. Nephrolithiasis - Dx
A195. Spiral CT - test of choice; UA - best 1st test; KUB; renal US; IVP - confirm; noncontrast abdominal CT; UA – hematuria, altered urine pH
Q196. Nephrolithiasis - Tx
A196. Initial Tx - hydration; analgesia; < 5mm - can pass thru urethra; < 3 cm – ESWL (extracorporeal shock wave lithotripsy); percutaneous nephrolithotomy
Q197. Nephrolithiasis - Calcium Oxalate/; Calcium Phosphate; Characteristics; Tx
A197. MC (83%); idiopathic hypercalciuria; primary hyperparathyroidism; hyperoxaluria; hypocitraturia; alkaline urine; radiopaque; Tx – hydration, thiazide diuretic
Q198. Nephrolithiasis - Struvite (Mg-NH4-PO4); Characteristics; Tx
A198. "Triple phosphate stones"; due to urease-producing organism - Proteus; staghorn calculi; alkaline urine; radiopaque; Tx – hydration, treat UTI, if present
Q199. Nephrolithiasis - Uric Acid; Characteristics; Tx
A199. Hyperuricemia; gout; high purine turnover states; acidic urine (pH < 5.5); radiolucent; Tx – hydration, alkalinize urine with citrate, citrate converted to HCO3 in liver
Q200. Nephrolithiasis - Cystine; Characteristics; Tx
A200. Due to defect of tubular amino acid transporter for cystine, ornithine, lysine & arginine (COLA); yellow-brown hexagonal crystal; radiopaque; Tx – hydration, alkalinize urine, if neither works - penicillamine
Q201. Ureteral Reflux - What is it
A201. Retrograde flow of urine from bladder back up, due to insuff. Submucosal length of ureter => ineffect. restricting; retrograde flow during contraction of bladder; recurrent UTIs
Q202. Ureteral Reflux - Dx; Tx
A202. Dx - VCUG: Voiding CystoUrethroGram detects abnormality at ureteral insertion site; classifies grade of reflux; Tx - tx infections aggressively ■ mild reflux - no dilation, often resolves spontaneously ■ mod to severe reflux – surgery (uret. reimplantation)
Q203. Renal Cell Carcinoma - What is it; Risk factors
A203. MC kidney cancer (80-90%); adenocarcinoma arises from tubular epith cells => renal vein => IVC => mets to lung & bone; risk factors – men, smoking, VHL disease
Q204. Renal Cell Carcinoma - History/PE
A204. Classic triad; hematuria; flank pain; palpable flank mass; polycythemia; constitutional Sxs; enlargement of left testicle
Q205. Renal Cell Carcinoma - Tx
A205. Surgical resection - curative if local; notoriously resistant to chemo & radiation
Q206. Cryptorchidism - What is it
A206. Failure of testes to descend into scrotum; bilateral associated with oligospermia & infertility; risk factor - prematurity
Q207. Cryptorchidism - History/PE
A207. Testes can't be manipulated into scrotal sac with gentle pressure; may be palpated anywhere along inguinal canal or in abdomen
Q208. Cryptorchidism - Tx
A208. Orchiopexy - after 1 y/o & before 5 y/o; in 99%, testes descend by 1 yr; find later in life – orchiectomy to avoid risk of testicular Ca
Q209. Erectile Dysfunction - What is it; Risk factors
A209. 10-25% of mid-aged or elderly; fail to init, fill or store risk factors:; DM; atherosclerosis; meds - B-blockers, SSRIs; HTN; heart disease. spinal cord injury; surgery or radiation for prostate cancer
Q210. Erectile Dysfunction - History/PE
A210. Ask about:; risk factors; meds; recent life changes; psych stressors; psychological - if pt. has nocturnal or early-morning erections; situation dependent
Q211. Erectile Dysfunction - Dx
A211. Check for hypogonadism; testosterone levels; gonadotropin levels; prolactin levels; evaluate for neuro dysfunction - anal tone; lower ext sensations
Q212. Erectile Dysfunction - Tx
A212. Psychotherapy; sex therapy; testosterone - if hypogonadism; sildenafil - PDE5 inhibitor, increased cGMP => smooth mus relaxation => increased blood flow in corpora cavernosa
Q213. Nephritic Syndrome - What is it
A213. Manifestation of glomerular; inflammation (glomerulonephritis)
Q214. Nephritic Syndrome - History/PE
A214. Hematuria - smoky-brown; HTN; oliguria; edema - low pressure areas (periorbital, scrotum)
Q215. Nephritic Syndrome - Dx
A215. UA – hematuria, (possible) mild proteinuria; decreased GFR; increased BUN/Cr; ANA; ANCA; anti-gbm Ab; renal Biopsy
Q216. Nephritic Syndrome - Tx (in general)
A216. Tx HTN, fluid overload and uremia; salt restriction; water restriction; diuretics; dialysis (if necessary); corticosteroids
Q217. Postinfectious GN - What is it
A217. Nephritic Syndrome; usually associated with recent strep infection, group A, B- hemolytic
Q218. Postinfectious GN - History/PE
A218. Smoky-brown urine; HTN; oliguria; periorbital edema
Q219. Postinfectious GN - Labs & Histology
A219. Low serum C3; increased ASO titer; lumpy-bumpy immunofluorescence
Q220. Postinfectious GN - Tx & Prognosis
A220. Supportive; almost all kids & most adults have complete recovery
Q221. IgA Nephropathy (Berger's) - What is it
A221. Nephritic Syndrome; MC type worldwide; associated with URI or GI infections; young men
Q222. IgA Nephropathy (Berger's) - History/PE
A222. Gross hematuria
Q223. IgA Nephropathy (Berger's) - Labs & Histology
A223. Increased serum IgA; Biopsy & immunofluorescence - mesangial IgA deposits
Q224. IgA Nephropathy (Berger's) - Tx & Prognosis
A224. Glucocorticoids; 20% progress to ESRD
Q225. Wegener's Granulomatosis - What is it
A225. Nephritic Syndrome; granulomatous inflammation of respiratory tract & kidney; necrotizing vasculitis; paucimmune form of RPGN
Q226. Wegener's Granulomatosis - History/PE
A226. Fever; weight loss; hematuria; respiratory & sinus Sxs; cavitary pulmonary lesions - bleed => hemoptysis
Q227. Wegener's Granulomatosis - Labs & Histology
A227. c-ANCA
Q228. Wegener's Granulomatosis - Tx & Prognosis
A228. High-dose corticosteroids; cytotoxic agents; patients tend to have freq relapses
Q229. Alport's Syndrome - What is it
A229. Nephritic Syndrome; hereditary; boys 5-20 y/o
Q230. Alport's Syndrome - History/PE
A230. Asymptomatic hematuria; nerve deafness; eye disorders
Q231. Alport's Syndrome - Labs & Histology
A231. GBM splitting on electron microscope
Q232. Alport's Syndrome - Tx & Prognosis
A232. Progress to RF; anti-GBM nephritis may recur after transplant
Q233. Goodpasture's Syndrome - What is it
A233. Nephritic syndrome; GN & pulmonary hemorrhage; men in mid 20's; immune form of RPGN
Q234. Goodpasture's Syndrome - History/PE
A234. Hemoptysis; dyspnea; possible respiratory failure
Q235. Goodpasture's Syndrome - Labs & Histology
A235. Linear anti-GBM on IF; iron-deficient anemia; CXR - pulmonary infiltrates; sputum - hemosiderin-filled macrophages
Q236. Goodpasture's Syndrome - Tx & Prognosis
A236. Plasma exchange therapy (plasmapheresis); pulsed steroids; cyclophosphamide; may progress to ESRD
Q237. Nephrotic Syndrome - What is it
A237. Increased permeability of glomerulus to protein => proteinuria = or > 3.5 g/day; hypoalbuminemia; hyperlipidemia; hyperlipiduria; edema; predisposed to hypercoag state; 1/3 due to systemic disease - DM; SLE; amyloidosis
Q238. Nephrotic Syndrome - History/PE
A238. Generalized edema; foamy urine; if severe – dyspnea, ascites, increased susceptibility to – infections, venous thrombosis; PE
Q239. Nephrotic Syndrome - Dx
A239. UA - proteinuria > 3.5g/day; lipiduria; decreased albumin (< 3g/dL); hyperlipidemia; Biopsy - Dx underlying etiology
Q240. Nephrotic Syndrome - Tx (in general)
A240. Steroids - best initial Tx; cyclophosphamide; restrict salt; diuretics; statins
Q241. Minimal Change Disease - What is it
A241. Nephrotic syndrome; common in children; idiopathic etiology
Q242. Minimal Change Disease - History/PE
A242. Tendency towards – infections, thrombosis
Q243. Minimal Change Disease - Labs & Histology
A243. Normal under light microscope; electron microscope shows - fusion of epithelial foot processes
Q244. Minimal Change Disease - Tx & Prognosis
A244. Steroids; excellent prognosis
Q245. Focal Segmental; Glomerulosclerosis (FSGS) - What is it
A245. Nephrotic syndrome; idiopathic; IVDU; HIV
Q246. Focal Segmental; Glomerulosclerosis (FSGS) - History/PE
A246. Especially common in black men with uncontrolled HTN
Q247. Focal Segmental; Glomerulosclerosis (FSGS) - Labs & Histology
A247. Microscopic hematuria; Biopsy - sclerosis in capillary tufts
Q248. Focal Segmental; Glomerulosclerosis (FSGS) - Tx & Prognosis
A248. Prednisone; cytotoxic therapy; Poor prognosis
Q249. Membranous Nephropathy - What is it
A249. Nephrotic syndrome; MC white adult nephropathy; MC idiopathic form in adults; immune-complex disease
Q250. Membranous Nephropathy - History/PE
A250. Associated with:; HBV; syphilis; malaria; gold (drug); penicillamine; cancer; SLE
Q251. Membranous Nephropathy - Labs & Histology
A251. "spike and dome"; due to granular deposits of IgG and C3 at basement membrane
Q252. Membranous Nephropathy - Tx & Prognosis
A252. Steroids are of little use
Q253. Diabetic Nephropathy - What is it
A253. Nephrotic syndrome; Diffuse hyalinization; nodular glomerulosclerosis; Kimmelstiel-Wilson lesions
Q254. Diabetic Nephropathy - History/PE
A254. Usually have long-standing,; poorly-controlled DM
Q255. Diabetic Nephropathy - Labs & Histology
A255. Thickened glomerular basement membrane; increased mesangial matrix
Q256. Diabetic Nephropathy - Tx & Prognosis
A256. Tight glucose control; protein restriction; ACEIs
Q257. Lupus Nephritis - What is it
A257. Nephrotic & nephritic syndrome; WHO types I-V; severity of renal disease; determines overall prognosis
Q258. Lupus Nephritis - History/PE
A258. Proteinuria or RBCs in UA
Q259. Lupus Nephritis - Labs & Histology
A259. Mesangial proliferation; subendothelial immune-complex deposits
Q260. Lupus Nephritis - Tx & Prognosis
A260. May reduce disease progression – prednisone, cytotoxic therapy
Q261. Renal Amyloidosis - What is it
A261. Nephrotic syndrome; primary - plasma cell dyscrasia; secondary – infectious, inflammatory
Q262. Renal Amyloidosis - History/PE
A262. Patients may have multiple myeloma; or chronic inflammatory disease (RA, TB)
Q263. Renal Amyloidosis - Labs & Histology
A263. Abdominal fat Biopsy; congo red stain; apple-green birefringence under polarized light
Q264. Renal Amyloidosis - Tx & Prognosis
A264. Prednisone; melphalan; BMT - for multiple myeloma
Q265. Membranoproliferative; Nephropathy (MPGN) - What is it
A265. Nephrotic & nephritic syndrome; 3 types
Q266. Membranoproliferative; Nephropathy (MPGN) - History/PE
A266. Immune deposits; low complement; associated with HCV; slow progression to RF
Q267. Membranoproliferative; Nephropathy (MPGN) - Labs & Histology
A267. "Tram tracks" - double-layered basement memb; type I - subendo deposits; type II - decreased C3; C3 nephritic factor; (IgG autoAb)
Q268. Membranoproliferative; Nephropathy (MPGN) - Tx & Prognosis
A268. Corticosteroids; cytotoxic agents
Q269. BPH - What is it
A269. Normal part of aging; seen in > 80% by age 80; patients usually > 50 y/o
Q270. BPH - History/PE
A270. Obstructive – hesitancy, weak stream, intermittent stream, incomplete emptying, urinary retention, bladder fullness; irritative – nocturia, daytime frequency, urge incontinence, opening hematuria; DRE - uniformly enlarged, rubbery; BPH in central zone (may not be detected on DRE)
Q271. BPH - Dx
A271. R/o possible dangerous causes; DRE; UA/UC; Cr; Not recommended for BPH - PSA & cystoscopy
Q272. BPH - Tx
A272. Mild - reassurance; mod to severe – surgery, terazosin, finasteride, TURP, open prostatectomy
Q273. Prostate Cancer - What is it; Risk factors
A273. MC cancer in men; second cause of cancer death in men; risk factors – age, family History
Q274. Prostate Cancer - History/PE
A274. Usually asymp; rarely causes Sxs until advanced; urinary retention; decreased force of urine stream; lymphedema; constitutional Sxs; back pain; DRE - palpable nodule, area of induration; early Ca usually not detectable; tender prostate = prostatitis
Q275. Prostate Cancer - Dx
A275. Clinical; markedly elevated PSA; US-guided transrectal Biopsy; Gleason grade; CXR; bone scan; Gleason grade - based on histology; grades 1-5 on two features – level of differentiation, structural architecture, the two scores are added; Poorly differentiated tumors - score 8-10, worst prognosis
Q276. Prostate Cancer - Tx
A276. Tx based on - aggression of tumor, pt's risk of dying; watchful waiting - elderly & low-grade; radical prostatectomy & RT - increased risk of incontinence, increased risk of impotence; PSA - use to evaluate post-Tx, check for disease recurrence; metastasis - chemo & androgen ablation: GnRH agonists, flutamide, orchiectomy
Q277. Prostate Cancer - Prevention
A277. Annual DRE - > 50 y/o; > 45 y/o if Black; > 45 y/o if positive family History; also screen with PSA
Q278. Bladder Cancer - What is it; Risk factors
A278. 2nd MC urologic cancer; MC malignant tumor - urinary tract; transitional cell Ca; men - 60s & 70s risk factors:; smoking; chronic bladder infections; calculous disease; aniline dye; hair dye
Q279. Bladder Cancer - History/PE
A279. Asymptomatic in early stages; gross hematuria; freq. urgency; dysuria
Q280. Bladder Cancer - Dx
A280. UA; cytology; IVP; cystoscopy with Biopsy - diagnostic; may also – US, MRI, pelvic CT
Q281. Bladder Cancer - Tx
A281. superficial - transurethral resection or intravesicular chemo with mitomycin-C or BCG; CIS - intravesicular chemo; large, hi-grade recurrent - intravesicular chemo; invasive without mets - aggressive surgery, RT; distant mets - chemo
Q282. Testicular Cancer - What is it; Risk factors
A282. Heterogenous group; 95% derive from germ cells; almost all are malignant; MC malignancy in 15-35 y/o; seminomas peak at 40-50 y/o; Klinefelter's - risk factor; cryptorchidism - increased risk of neoplasia in both testes
Q283. Testicular Cancer - History/PE
A283. Painless enlargement of testis
Q284. Testicular Cancer - Dx
A284. B-hCG - increased in choriocarcinomas, increased in 10% of seminomas; AFP - increased in endodermal sinus, (yolk sac) tumors
Q285. Testicular Cancer - Tx
A285. Seminomas - very radiosensitive, also respond to chemo; nonseminomatous germ cell - platinum-based chemo
Q286. SIADH - What is it; What is it associated with
A286. Euvolemic hyponatremia from nonosmotically-stimulated ADH release associated with:; CNS disease; pulmonary disease; ectopic tumor/ paraneoplastic syndromes; drugs; surgery
Q287. SIADH - Dx
A287. Urine osmolality > 50-100 mOsm/kg; concurrent serum hyposmolarity; no physio reason for increased ADH; urinary sodium > 20 mEq/L
Q288. SIADH; Tx
A288. Tx underlying cause; mild - restrict fluids; moderate - NS and furosemide; severe (Sxs) - hypertonic saline, then furosemide; if chronic - demeclocycline or lithium - ADH antag
Q289. Diabetes Insipidus - What is it; What is it caused by
A289. Central or nephrogenic Central:; post pit. doesn't secrete ADH; causes – tumor, ischemia (Sheehan's), trauma, infection, autoimmune disorder Nephrogenic:; kidneys don't respond to ADH; causes - renal disease, drugs (lithium, demeclocycline)
Q290. Diabetes Insipidus - History/PE
A290. Polydipsia; polyuria; persistent thirst; dilute urine; if don't have unlimited access to water – dehydration, hypernatremia
Q291. Diabetes Insipidus - Dx
A291. Water deprivation test; DDAVP challenge - desmopressin mimics ADH; if central - DDAVP challenge => decreased urine output, increased urine osmolarity; thus, MRI (to check for mass); if nephrogenic - DDAVP challenge will not decreased urine output
Q292. Diabetes Insipidus - Tx
A292. central - DDAVP subcutaneously; nephrogenic - thiazide diuretics (HCTZ), amiloride, chlorthalidone
Q293. Acetazolamide - Site of Action; Mechanism
A293. Proximal convoluted tubule; inhibits carbonic anhydrase
Q294. Acetazolamide - Clinical Use
A294. Glaucoma; urinary alkalinization; metabolic alkalosis; altitude sickness; cysteinuria
Q295. Acetazolamide - Toxicity
A295. Hyperchloremic metabolic acidosis; sulfa allergy
Q296. Loop Agents; Furosemide; Bumetanide; Torsemide; Ethacrynic Acid - Site of Action; Mechanism
A296. Ascending loop of Henle; Inhibits Na/K/2 Cl cotransport
Q297. Loop Agents; Furosemide; Bumetanide; Torsemide; Ethacrynic Acid - Clinical Use
A297. HTN; hypercalcemia; edematous states - CHF; cirrhosis; nephrotic syndrome; pulmonary edema
Q298. Loop Agents; Furosemide; Bumetanide; Torsemide; Ethacrynic Acid - Toxicity
A298. OH DANG; Ototoxicity; Hypokalemia; Dehydration; Allergy – sulfa (not ethacrynic acid); Nephritis - interstitial; Gout
Q299. Hydrochlorothiazide - Site of Action; Mechanism
A299. Distal convoluted tubule; inhibits Na+/Cl- cotransporter
Q300. Hydrochlorothiazide - Clinical Use
A300. HTN; CHF; idiopathic hypercalciuria; nephrogenic diabetes insipidus
Q301. Hydrochlorothiazide - Toxicity
A301. HyperGLUC; hyperGlycemia; hyperLipidemia; hyperUricemia; hypercalcemia and; hypokalemic metabolic alkalosis; hyponatremia; sulfa allergy
Q302. K+ Sparing Agents; Spironolactone; Triamterene; Amiloride - Site of Action; Mechanism
A302. Cortical collecting tubule; Spironolactone - aldosterone receptor antag; triamterene & amiloride - block Na+ channels
Q303. K+ Sparing Agents; Spironolactone; Triamterene; Amiloride - Clinical Use
A303. Hyperaldosteronism; K+ depletion; CHF
Q304. K+ Sparing Agents; Spironolactone; Triamterene; Amiloride - Toxicity
A304. Hyperkalemia; gynecomastia; antiandrogen effects
Q305. Mannitol - Site of Action; Mechanism
A305. Entire tubule; sorbitol stereoisomer; osmotic diuretic; filtered by glomerulus; can't be reabsorbed; increased tubular fluid osmolarity => decreased water reabsorption => increased urine flow
Q306. Mannitol - Clinical Use
A306. Shock; drug overdose; decreased intracranial or intraocular pressure
Q307. Mannitol - Toxicity
A307. Pulmonary edema; dehydration; contraindicated in – anuria, CHF
Q308. Renal Tubular Acidosis - What is it
A308. Failure of kidneys to acidify urine; net decreased in tubular H+ secretion or HCO3 reabsorption => nonanion-gap metabolic acidosis
Q309. RTA Type I - What is it
A309. Distal tubule H+/K+ pump is broken => failure to secrete H+; serum K+ stays low; urinary pH > 5.3
Q310. RTA Type I - Causes; Complications
A310. Causes - usually sporadic; lithium; amphotericin; analgesics; collagen vascular disease; cirrhosis; chronic urinary tract obstruct; sickle cell; nephrocalcinosis - also a consequence complication - nephrolithiasis; secondary hyperaldosteronism
Q311. RTA Type I - Tx; Dx/Test
A311. Tx - potassium citrate; Dx/Test - acid load
Q312. RTA Type II - What is it
A312. Proximal tubule cells don't reabsorb HCO3; urinary pH initial > 5.3; distal tubular cells work OK => urinary pH < 5.3 when serum gets acidic
Q313. RTA Type II - Causes; Complications
A313. Causes:; hereditary; carbonic anhydrase inhibitors; Fanconi's syndrome; multiple myeloma; complications – rickets, osteomalacia
Q314. RTA Type II - Tx; Dx/Test
A314. Tx - potassium citrate; Dx/Test - bicarb load
Q315. RTA Type IV - What is it
A315. Adrenal insensitivity to angiotensin 2; aldosterone deficient; serum K+ is high; usually asymptomatic hyperkalemia, hyperchloremic metabolic acidosis (nonanion/normal metabolic acidosis)
Q316. RTA Type IV - Causes; Complications
A316. Causes; hyporeninemic hypoaldosterone:; DM (infarcts JG); ACEIs; NSAIDs; addison's; sickle cell; renal insufficiency; complication - hyperkalemia
Q317. RTA Type IV - Tx; Dx/Test
A317. Tx – fludrocortisone, furosemide - if HTN, kayexelate; Dx/Test - restrict salt
Q318. Acute Renal Failure - What is it
A318. Rapid decreased in renal function over days to weeks => accum of nitrogenous products, fluid & electrolyte disorder develop. prerenal caused by - decreased renal plasma flow (inadequate renal perfusion); renal caused by - intrinsic renal disease or damage; postrenal caused by - obstruction of urinary outflow, both kidneys must be obstructed to cause significant azotemia
Q319. Acute Renal Failure - History/PE
A319. History – uremia, malaise, oliguria, fatigue, anorexia, n/v; PE – asterixis, HTN, decreased urinary output, increased RR, pericardial friction rub - if uremic pericarditis,; prerenal - hypovolemia, orthostasis, oliguria; postrenal – anuria, distended bladder; acute interstitial nephritis - fever; rash
Q320. Acute Renal Failure - Dx
A320. CBC; BUN/Cr; electrolytes; FE(Na) - if oliguric; urine sediment – RBC, WBC casts, eosinophils; urinary catheter; renal US
Q321. Acute Renal Failure - Tx
A321. Balance fluid & electrolytes; dialysis if indicated; acute/allergic nterstitial nephritis - adjust/discontinue offending meds; glomerulonephritis – corticosteroids, cytotoxics
Q322. Acute Renal Failure - Complications
A322. Chronic renal failure => dialysis; dialysis - prevent buildup of: K+, H+, toxic metabolites; increased risk for CAD
Q323. Acute Renal Failure - What is Prerenal % for FE(Na); What is Prerenal No. for U(Na); What is Prerenal Ratio; for BUN/Cr
A323. FE(Na) is < 1%; U(Na) is < 20; BUN/Cr is > 20
Q324. Acute Renal Failure - FE(Na) - How do you calculate it
A324. U/P Na divided by U/P Cr
Q325. Dialysis - What are the indications
A325. AEIOU; Acidosis; Electrolyte abnormalities (hyperkalemia); Ingestions; Overload of fluid; Uremic Sxs – pericarditis, encephalopathy, bleeding, nausea, pruritus, myoclonus
Q326. Hyponatremia - What is it
A326. Serum sodium < 135 mEq/L
Q327. Hyponatremia - History/PE
A327. May be asymptomatic; confusion; lethargy; muscle cramps; nausea; can progress to – seizures, status epilepticus, coma
Q328. Hyponatremia - Dx
A328. Classified by:; serum osmolality; volume status (by PE); urinary Na+
Q329. Hyponatremia - What are the types; of osmolalities
A329. High - > 295 mEq/L: hyperglycemia, hypertonic infusion (mannitol); Normal - 280-295 mEq/L: hyperlipidemia, hyperproteinemia, pseudohyponatremia; Low - < 280 mEq/L: hypervolemic hyponatremia, euvolemic hyponatremia, hypovolemic hyponatremia
Q330. Hyponatremia - Tx
A330. Chronic hyponatremia should be corrected slowly to prevent central pontine myelinolysis
Q331. Hypervolemic Hyponatremia - What is it; Etiologies; Tx
A331. Increased in Na+ & total body weight, Increased greater in TBW etiologies - edematous states:; renal failure; nephrotic syndrome; cirrhosis; CHF; Tx - restrict salt and water
Q332. Euvolemic Hyponatremia - What is it; Etiologies; Tx
A332. Total body Na+ normal, total body water has increased Etiologies:; SIADH; hypothyroidism; renal failure; drugs; psychogenic polydipsia; adrenal insufficiency; Tx - restrict salt and water
Q333. Hypovolemic Hyponatremia - What is it; Etiologies; Tx
A333. Decreased in total body Na+ and total body water, more Na+ than water is lost etiologies; diuretics; vomiting; diarrhea; third spacing; dehydration; Tx - replete volume with normal saline
Q334. Hypernatremia - What is it
A334. Serum Na+ > 145 mEq/L
Q335. Hypernatremia - History/PE
A335. Thirst; oliguria or polyuria (depends on etiology); mental status changes; weakness; focal neuro deficits; seizures; "doughy" skin
Q336. Hypernatremia - Dx
A336. Measure urine volume; measure urine osmolality; hypervolemic hyperNa+ - increased aldosterone or excess Na+ (IV saline); min vol (500 mL/day) of max concentrated urine (> 400 mOsm/kg) - adequate renal response; inadequate free water replaced; fluid loss from - decreased intake, diuretics, glycosuria, 3rd spacing; large volume of dilute urine - diabetes insipidus
Q337. Hypernatremia - Tx
A337. Tx underlying causes; replace free water deficit - isotonic fluids; correct gradually over 48-72 hrs (to prevent neuro damage secondary to cerebral edema)
Q338. Hypercalcemia - What is it; What causes it
A338. Serum Ca2+ > 10.2 mg/dL, > 15 mg/dL = medical emergency; MCC – hyperparathyroidism, malignancy common causes – CHIMPANZEES:; Calcium supplementation; Hyperparathyroidism; Iatrogenic (thiazides); Immobility; Milk alkali syndrome; Paget's disease; Addison's; Acromegaly; Neoplasm; Zollinger-Ellison syndrome; Excess vitamin A; Excess vitamin D; Sarcoidosis; and other granulomatous disease
Q339. Hypercalcemia - History/PE
A339. "Bones, stones, abdominal groans, psych overtones"; fractures; kidney stones; n/v; constipation; anorexia; weakness; fatigue; altered mental status
Q340. Hypercalcemia - Dx
A340. EKG - short QT; total Ca2+; ionized Ca2+; albumin; phosphate; PTH; PTHrP; vit D; TSH; serum immunoelectrophoresis
Q341. Hypercalcemia - Tx
A341. IV hydration; then furosemide; if severe or refractory – calcitonin, bisphosphonates (pamidronate), glucocorticoids, dialysis
Q342. Hypocalcemia - What is it; What causes it
A342. Serum Ca2+ < 8.5 mg/dL caused by: – hypoparathyroidism (postsurgery, idiopathic); malnutrition; hypomagnesemia; acute pancreatitis; medullary thyroid cancer (excess calcitonin); vit D def. pseudohypoparathyroidism; renal insufficiency; serum Ca2+ may be falsely low in hypoalbuminemia
Q343. Hypocalcemia - History/PE
A343. Abdominal muscle cramps; tetany; perioral & acral paresthesias; convulsions; dyspnea; Chvostek's sign; Trousseau's sign; EKG - prolonged QT
Q344. Hypocalcemia - Dx
A344. Ionized Ca2+; Mg2+; PTH; albumin; calcitonin; if post-thyroidectomy - check operative note to determine number of parathyroid glands removed
Q345. Hypocalcemia - Tx
A345. Tx underlying disorder; oral calcium supplements; if severe - IV calcium
Q346. Hypomagnesemia - What is it; What is it caused by
A346. Serum Mg2+ < 1.5 mEq/L causes:; decreased intake: malnutrition, alcoholism, malabsorption, short bowel syndrome, TPN; increased loss: diuretics, diarrhea, vomiting; miscellaneous: DKA, pancreatitis
Q347. Hypomagnesemia - History/PE
A347. Sxs usually related to concurrent hypocalcemia and hypokalemia; anorexia, n/v; muscle cramps, weakness; if levels very low – paresthesias, irritability, confusion, lethargy, seizures, arrhythmias
Q348. Hypomagnesemia - Dx
A348. Check for concurrent hypocalcemia & hypokalemia; EKG - prolonged PR & QT
Q349. Hypomagnesemia - Tx
A349. IV or oral Mg2+; hypokalemia & hypocalcemia; won't correct if Mg2+, not corrected also
Q350. Hyperkalemia - What is it; What is it caused by
A350. Serum K+ > 5 mEq/L Causes:; spurious - hemolyzed blood draw, fist clenched during blood draw; extreme leukocytosis; extreme thrombocytosis; rhabdomyolysis; decreased excretion - renal insufficiency, mineralocorticoid def., RTA type 4, drugs – heparin, spironolactone, triamterene, ACEIs, trimethoprim, NSAIDs; cellular shifts - tissue injury, insulin def., drugs – succinylcholine, digitalis, arginine, B-blockers; iatrogenic
Q351. Hyperkalemia - History/PE
A351. Muscle weakness starts > 6.5; MCC of death - abnormal cardiac conduction; May be asymptomatic; n/v; intestinal colic; areflexia; weakness; flaccid paralysis; paresthesias
Q352. Hyperkalemia - Dx
A352. Verify with repeat blood draw (if need to); EKG - tall peaked T, prolonged PR, wide QRS, loss of P can => sine waves,; ventricular fibrillation,; cardiac arrest
Q353. Hyperkalemia - Tx
A353. Emergent Tx if - > 6.5 mEq/L or prolonged PR or wide QRS C BIG K:; Calcium gluconate or CaCl: immediate but short-lived; Bicarb: not in same IV line as Ca (forms CaCO3 precipitate); Insulin and Glucose - takes 30-60 min. to work; Kayexalate and loop diuretics; give sorbitol to prevent constipation; If RF or severe, refractory - dialysis
Q354. Hypokalemia - What is it; What is it caused by
A354. Serum K+ < 3.5 mEq/L causes:; transcellular shifts – insulin, B2-agonists, alkalosis, periodic paralysis; GI losses – diarrhea, chronic laxative abuse, vomiting, NG suction; renal K+ losses – diuretics, primary mineralocorticoid, excess secondary hyperaldosteronism, drugs, DKA, hypomagnesemia, RTA Types 1&2; licorice; clay
Q355. Hypokalemia - History/PE
A355. Sxs start when K+ <2.5 - 3.0; muscle weakness; cramps; ileus; fatigue; hyporeflexia; paresthesias; if severe - flaccid paralysis, cardiac arrhythmia
Q356. Hypokalemia - Dx
A356. 24-hour or spot urine K - to distinguish renal from GI losses; EKG - flattened T, U wave, ST depression followed by AV block and cardiac arrest
Q357. Hypokalemia - Tx
A357. Tx underlying disorder; oral or IV K+; too fast => fatal arrhythmia; max 10 meq/hr; use 1/2 NS or NS; replace Mg2+; monitor EKG and plasma K+; freq. during replacement
Q358. MCC dysuria 25 yo male
A358. urethritis
Q359. Prehn's sign
A359. elevate testicles relieves pain in epididymitis (sp?)
Q360. torsion evaluation
A360. ultrasound
Q361. renal stone evaluation
A361. CT
Q362. pre-renal azotemia; BUN:creatinine
A362. >20:1 <30:1; BUN:creatinine
Q363. CHF in ESRD treatment
A363. Furosemide (Lasix)
Q364. Renal stone size threshholds for surgery
A364. 6 mm will not likely pass; 5 mm will likely pass
Q365. GI bleed; BUN:creatinine
A365. >30:1; BUN:creatinine
Q366. Why is the left kidney taken during transplantation?
A366. It has a longer renal vein
Q367. Water breakdown?
A367. Water is 60% of body weight; 2/3 is intracellular; 1/3 is extracellular; 1/4 of extracellular volume is plasma; 3/4 of extracellular volume is interstitial
Q368. How can you measure plasma volume?
A368. Radiolabeled albumin
Q369. Formula for clearance
A369. Cx = UxV/Px
Q370. What does the glomerular filtration barrier block, and how?
A370. Large, negative particles; 1. Fenestrated capillary (size); 2. Heparin on basement membrane (charge); 3. Podocyte foot processes
Q371. Calculation for free water clearance
A371. C = V - (Uosm*V/Posm); it is the volume of water per unit time that is cleared by the kidneys. you get at it by taking the urine flow rate and subtracting out the volume of osmole-containing fluid.
Q372. What is the renal threshold for glucose?
A372. around 200 mg/dL; this is when you start to see symptoms
Q373. Why does acidosis decrease K secretion?
A373. It causes a shift of K outside the cell; (thus decreasing the amount of K available for transport to the lumen)
Q374. Actions of AII
A374. Vasoconstriction; Aldosterone synthase induction; ADH release; Stimulates hypothalamus for increasing thirst
Q375. ANP actions
A375. Decreases renin; Increases GFR
Q376. What part of the kidney secretes EPO?
A376. Endothelial cells of peritubular capillaries
Q377. What stimulates renin secretion?
A377. Beta 1
Q378. Winter's formula
A378. PCO2 = 1.5 (HCO3) + 8 +/-2
Q379. Metabolic alkalosis
A379. PCO2 increases .7 for every 1 mEq/L increase in HCO3
Q380. Respiratory alkalosis; acute; chronic
A380. 2 mEq/L decrease for every 10mmHg decrease in PCO2; 5 mEq/L for every 10mmHg decrease in PCO2; You're pretty good at peeing out excess base.
Q381. Respiratory acidosis; acute; chronic
A381. 1mEq/L increase for every 10 mmHg increase; 3.5 mEq/L increase
Q382. Delta delta; <1; 1; >2
A382. change in AG from normal of 12 / change in HCO2 from normal of 24; <1 = Acid + AG acid; 1 = pure AG; >2 = Alk + AG acid
Q383. WBC casts
A383. virtually pathognomonic for pyelo, and not seen in cystitis
Q384. Granular casts
A384. ATN
Q385. What stone is radiolucent
A385. Uric acid
Q386. Renal cell carcinoma; Host; Histology; Genetics; Paraneoplastics
A386. Men 50-70; Likes upper pole, originates in renal tubule cells (clear cells); Associated with VHL gene on 3; EPO, ACTH, PTHrP, prolactin
Q387. WAGR complex
A387. Wilms' tumor; Aniridia; Genitourinary malformation; mentomotor Retardation
Q388. What does Wilms' tumor originate from?
A388. Primitive metanephric tissues
Q389. Causes of transitional cell carcinoma
A389. Phenacetin,; Smoking,; Aniline dyes,; Cyclophosphamide,; Schistosomiasis
Q390. Where can TCC occur?
A390. Calyces,; pelves,; ureters,; bladder
Q391. Chronic pyelonephritis
A391. Coarse,; asymmetric,; corticomedullary scarring,; blunted calyx,; thyroidization of kidney; Usually from chronic UT obstruction
Q392. What causes diffuse cortical necrosis?
A392. combination of vasospasm and DIC,; usually in sepsis or obstetric catastrophes
Q393. What is the mechanism by which drugs induce interstitial nephritis
A393. Haptenation
Q394. Nephrocalcinosis
A394. diffuse deposition of calcium in the kidney parenchyma which can lead to renal failure. Caused by hypercalcemia or hyperphosphatemia (this is associated with renal failure)
Q395. Causes of ATN
A395. ischemia,; myoglobinuria,; toxins (mercuric chloride, aminoglycosides, ethylene glycol (oxalosis))
Q396. 2 phases
A396. oliguric phase : worry hyperkalemia (deadly arrhythmia); recovery phase : vigorous diuresis
Q397. Causes of renal papillary necrosis
A397. DM (infection and vascular disease); Acute pyelonephritis; Chronic phenacetin use (acetaminophen, too); Sickle cell anemia
Q398. In what condition can you see bleeding 2/2 platelet dysfunction, skin pigmentation, and fibrinous pericarditis?
A398. uremia
Q399. What conditions are associated with dominant mutations of APKD1.
A399. polycystic liver disease,; berry aneurysms,; mitral valve prolapse,; secondary polycythemia
Q400. What are dialysis cysts?
A400. cortical and medullary cysts resulting from long-standing dialysis. Increased risk of renal cancer.
Q401. Which has a better prognosis: medullary cystic disease or medullary sponge kidney?
A401. Medullary sponge kidney;; multiple small cysts in the collecting ducts, associated with moderately impaired tubular function and occasional infection, but otherwise good prognosis. Medullary cystic disease patients have small kidneys. Also known as nephronopthisis.
Q402. What do thiazides do to urinary calcium?
A402. They decrease urinary calcium excretion!; They retain calcium!; Good for idiopathic hypercalciuria.
Q403. What drug do you use for nephrogenic DI?
Q404. enlarged, hypercellular glomeruli, PMNs, lumpy bump EM; subepithelial humps; granular pattern
A404. PSGN
Q405. Crescentic GN
A405. RPGN; I: goodpasture's; II: Post strep in 50% of all cases, Lupus IV; III: Pauci immune (ANCA)
Q406. subendothelial humps; tram tracking
A406. Membranoproliferative GN; tram tracks are the reduplication of the GBM ("proliferative of the membrane")
Q407. mesangial deposits of IgA; no complement
A407. Berger's disease
Q408. defect in alpha-5 type IV collagen
A408. Alports; sensorineural deafness,; hematuria,; anterior lenticonus
Q409. Membranous GN (nephritis/nephropathy); Associations?
A409. Oddly, this is a NEPHROTIC syndrome. capillary and BM thickening; granular pattern; spike and dome (reactive BM forms spikes); Unknown etiology: lupus, HBV, syphilis, malaria, gold salts, penicillamine, cancers. Often accompanied by azotemia
Q410. normal glomeruli, foot process effacement, lipid laden renal cortices
A410. minimal change disease; responds well to steroids
Q411. segmental sclerosis and hyalinosis; clinically similar to minimal change
A411. FSGS
Q412. subendothelial and mesangial deposits of apple green birefringent material... what diseases are associated?
A412. Amyloidosis. Myeloma; Chronic inflammation; TB; Rheumatoid arthritis
Q413. Lupus glomerulonephropathy; I; II; III; IV; V
A413. I: no renal involvement; II: mesangial form (like FSGS); III: focal proliferative; IV: diffuse proliferative (nephrotic and nephritic presentations; crescents, mesangial hypertrophy, endothelial proliferation, subendothelial deposits); V: membranous