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413 Cards in this Set
- Front
- Back
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Q001. Dx:; Rapid onet of oliguria with increasing BUN and creatinine; often occurs in hospitalized patients
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A001. Acute Renal Failure
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Q002. ARF class:; weight loss or gain, poor skin turgor, edema/ascites, renal artery bruit
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A002. Pre-renal ARF
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Q003. ARF class:; weight gain, obtundation, hypotension to HTN, JVD, evidence of muscle trauma, infection, contaminated IV lines
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A003. Intrinsic ARF
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Q004. ARF class:; weight gain, enlarged prostate, pelvic mass, bladder distension
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A004. Post-renal ARF
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Q005. Etiology of pre-renal ARF; (4 and example of each)
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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)
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Q006. Etiology of Intrinsic ARF; (5)
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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
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Q007. Etiology of Post-renal ARF; (3)
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A007. 1. Urinary tract obstruction; 2. enlarged prostate; 3. bladder dysfunction
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Q008. Define:; Oliguria
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A008. Urine output < 400 mL/day
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Q009. Indications for Dialysis:; (5)
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A009. AEIOU:; Acidosis; Electrolyte abnormalities; Ingestions; Overload; Uremic symptoms (pericarditis, encephalopathy)
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Q010. Pre-renal amounts for:; 1. BUN/creatinine ratio; 2. Fe-Na; 3. Urine Na; 4. Urine Osmolality; 5. Urine specific gravity
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A010. 1. > 20; 2. < 1%; 3. < 20; 4. > 500; 5. > 1.020
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Q011. Intrinsic renal (ARF)amounts for:; 1. BUN/creatinine ratio; 2. Fe-Na; 3. Urine Na; 4. Urine Osmolality; 5. Urine specific gravity
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A011. 1. < 20; 2. > 1%; 3. > 40; 4. < 350; 5. = 1.010
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Q012. What (2) Dx test and results point to a post-renal ARF problem?
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A012. Fe-Ne > 4%; Urine Na > 40
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Q013. Equation for Fractional Excretion of Sodium (Fe-Na)
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A013. Fe-Na = (urine Na/plasma Na) / (U-creatinine/P-creatinine) x 100%
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Q014. MCC of intrinsic ARF
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A014. Tubulointerstitial diseases; (ATN and AIN)
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Q015. Dx:; Acute damage of renal tubules due to ischemic or toxic insult
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A015. Acute Tubular Necrosis
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Q016. Etiology of Ischemic (4) and Toxic (4) causes of ATN
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A016. Ischemic:; Shock;; Trauma;; Sepsis;; Hypoxia; Toxic:; Rhabdomyolysis;; Aminoglycosides;; IV contrast;; Tumor lysis
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Q017. (3) Dx findings for ATN
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A017. Muddy-brown granular casts;; High urine sodium;; Fe-Na > 1%
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Q018. Tx for ATN; (4)
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A018. - NS for volume replacement;; IV diuretic in early stages;; match I and O; manage electolyte disturbance
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Q019. Dx:; Inflammation of the renal parenchyma
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A019. Acute Interstitial Nephritis
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Q020. (3) basic classes of etiologies of AIN
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A020. Systemic diseases;; Systemic infections;; Medications
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Q021. (3) systemic diseases that causes AIN
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A021. Sarcoidosis;; Sjogren syndrome;; Lymphoma
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Q022. (4) systemic infections (bugs) that cause AIN
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A022. Syphilis;; Toxoplasmosis;; CMV;; EBV
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Q023. (3) medication classes that can cause AIN
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A023. Beta-blockers;; Diuretics;; NSAIDs
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Q024. How do NSAIDs cause AIN?
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A024. inhibit prostaglandin synthesis, which decreases GFR and start renal failure in patient with underlying renal problems
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Q025. Dx findings of allergic AIN; (3)
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A025. WBCs;; Eosinophils;; White (or red) cell casts
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Q026. Tx of allergic AIN?; (2)
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A026. 1. stop offending agent; 2. Steroids
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Q027. initial microscopic finding in ATN
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A027. blebbing of the PTC and loss of brush boarder
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Q028. microscopic finding of ischemic (2) ATN versus toxic
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A028. Ischemic: BM damage; skipped areas of damage; Toxic: no BM damage; Uniform damage with sparing of DT
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Q029. Lab:; Oxalate crystal formation in kidney
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A029. Ethylene glycol ATN
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Q030. Retention of what (3) things causes anion gap increase with CRF?
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A030. Phosphates; H+; Sulfates
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Q031. what does the ultrasound show w/:; 1. CRF; 2. Diabetes; 3. Amyloidosis; 4. Poylcyctic Kidney Disease
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A031. 1. shrunken kidneys; 2 - 4. Enlarged kidneys
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Q032. What (3) endocrine functions are lost with CRF?; what is the result of each on the patient?
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A032. Synthesis of:; 1. Vitamin D - hypocalcemia;; 2. Ammonia - anion-gap met acidosis;; 3. Erythropoietin - anemia
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Q033. Tx for Chronic renal failure; (3)
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A033. ACEi;; low-protein diet;; Dialysis
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Q034. Dx:; pale complexion, wasting, purpura, N/V, itching, tubular casts in urine
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A034. Uremic syndrome
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Q035. Waxy casts in urine
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A035. Chronic Renal Failure
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Q036. CNS problems from Uremia; (5)
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A036. Foot drop;; Carpal tunnel;; Clonus;; Asterixis;; Seziures
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Q037. Cardiac / Pulmonary problems from Uremia; (5)
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A037. HTN;; Pericarditis;; Valve calcification;; Pulmonary edema;; Pulmonary effusions
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Q038. Hematologic problems from Uremia; (3)
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A038. Normochromic, normocytic anemia;; Low platelet function (prolonged bleeding time);; low WBC - increased infections
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Q039. (2) metabolic problems from Uremia
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A039. High triglycerides;; Insulin resistance
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Q040. Dx:; Inability for kidney to concentrate urine; (stays fixed with specific gravity = 1.010)
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A040. Isostheuria
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Q041. Dx:; enlarged kidneys with multiple cysts presenting in mid 30's to 40's with flank pain; what can it lead to?
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A041. ADPKD; Berry aneurysms
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Q042. Dx:; Metabolic acidosis with normal anion gap
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A042. Renal Tubular Acidosis
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Q043. Renal Tubular Acidosis Type I:; 1. Defect; 2. bicarb level; 3. Urine pH; 4. Plasma K; 5. where in kidney
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A043. 1. H+ secretion causing Acidosis; 2. Low; 3. pH > 5.3; 4. Low; 5. DT defect
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Q044. Renal Tubular Acidosis Type II:; 1. Defect; 2. bicarb level; 3. Urine pH; 4. Plasma K; 5. where in kidney
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A044. 1. Decreased Bicarb reabsorption; 2. 12 - 20; 3. pH > 5.3; 4. Low - normal; 5. PCT defect
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Q045. Renal Tubular Acidosis Type IV:; 1. Defect; 2. bicarb level; 3. Urine pH; 4. Plasma K; 5. where in kidney
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A045. 1. Decreased Aldosterone; 2. > 17; 3. pH < 5.3*; 4. High*; 5. DT
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Q046. Etiology of Renal Tubular Acidosis Type I; (4)
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A046. Lithium;; Amphotericin B;; SLE;; Sarcoidosis
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Q047. Etiology of Renal Tubular Acidosis Type II; (3)
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A047. Heavy Metals;; Acetazolamide;; Multiple myeloma
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Q048. Etiology of Renal Tubular Acidosis Type IV; (3)
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A048. Renal transplant;; Obstructive uropathy;; Diabetic nephropathy;
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Q049. Dx:; Radiopaque stone seen in inflammatory bowel diseases, decreased citrate & uricourea; Tx?
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A049. Calcium Oxalate stone; Tx: Thiazides
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Q050. Dx:; moderately readiopaque stone common in Proteus or staph Saprophyticus UTI due to high urinary pH; Tx?
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A050. Struvite (ammonium, magnesium, phosphate) stone; Tx: lower urine pH
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Q051. Dx:; Radiolucent stone caused by myeloproliferative diseases and gout; Tx?
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A051. Uric Acid stone; Tx: raise urine pH
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Q052. Dx:; moderately radiopague stone that has hexagonal crystals and is positively birefringent; What congenital disorder is cause?; Tx?
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A052. Cystine Stones; Disorder: Cystinuria; Tx: raise urine pH
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Q053. Dx:; 39-yo man with severe back pain and hematuria, nausea and unable to find a comfortable position.
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A053. Renal stone; (Urolithiasis)
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Q054. Dx:; sudden HTN with low K+; How do you do a screening Dx?; Tx?
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A054. Renal artery stenosis; give oral captopril to induce increase of renin; Tx: surgery or angioplasty
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Q055. Etiology of renal artery stenosis; (2)
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A055. Plaque; Fibromuscular dysplasia
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Q056. Dx:; hematuria, palpable mass, flank pain, fever, secondary polycythemia
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A056. Renal Cell Tumor
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Q057. MC person to get Renal cell CA; Where does it disseminate to?; Tx? (2)
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A057. 50-70 yo Male smoker; moves to: Renal veins and Vena cava; Tx: resection, IL-2 immunotherapy
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Q058. (3) causes of Ketones in the urine
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A058. 1. DKA; 2. Alcohol intox; 3. starvation
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Q059. What does Nitrite in urine indicate?
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A059. Gram negative rods
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Q060. What does a positive Leukocyte esterase in urine indicate?
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A060. White cells and infection
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Q061. What do eosinophils in the urine indicate?
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A061. Allergic Interstitial Nephritis
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Q062. What do Squamous cells in the urine indicate?
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A062. contaminated specimen
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Q063. What does Bilirubin in the urine indicate?
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A063. Extravascular hemolysis
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Q064. What does Hemoglobin in the urine indicate?
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A064. Intravascular hemolysis
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Q065. What do Hyaline casts in the urine indicate?
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A065. Pre-renal azotemia
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Q066. MCD in ARF?
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A066. infection
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Q067. Defition of ARF?
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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
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Q068. MCC of postrenal failure
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A068. BPH - urethral obstruction
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Q069. MCC chronic renal failure
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A069. diabetes!
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Q070. azotemia refers to?
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A070. elev. of BUN
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Q071. uremia refers to?
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A071. si/sx associated with accumulation of nitrogenous wastes due to impaired renal function; usually, BUN>60mg/dL
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Q072. 3 key features of nephrotic syndrome
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A072. proteinuria; hypoalbuminemia; hyperlipidemia
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Q073. Examination of urine sediment:; RBC =; WBC =; Fatty casts =
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A073. RBC = GN; WBC = pyelonephritis & interstitial nephritis; Fatty casts = nephrotic syndrome
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Q074. Gross painless hematuria
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A074. bladder ca
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Q075. microscopic hematuria v. gross hematuria
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A075. microscopic = glomerular; gross = post renal causes - trauma, stones, malignancy)
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Q076. hyperkalemia - how can you remove K from serum? (3)
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A076. 1. dialysis; 2. diuretics; 3. cation exchange resins - kayexalate (sodium polystyrene sulfonate)
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Q077. MOA of Kayexalate
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A077. cation exchange resin - acts in the GI tract by promoting exchange of Na for K and thereby increasing excretion of K
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Q078. Indications for Dialysis
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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
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Q079. nephrotic syndrome + abdominal pain + fever + hematuria =
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A079. renal vein thrombosis;; antithrombin III is lost in urine putting patients at increased risk of venous/arterial thrombosis
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Q080. nephrotic syndrome is most commonly caused by?
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A080. adults: membranous glomerulonephritis; children: minimal change diseases
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Q081. What serum Cr level is safe for contrast CT?
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A081. <1.5; if >1.5 use non ionic contrast OR ultrasound
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Q082. MCC of glomerular hematuria
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A082. IgA nephropathy (Berger's disease)
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Q083. MCC of nephritic syndrome
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A083. poststreptococcal GN
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Q084. Poststreptococcal GN occurs after infection with ______.
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A084. group A beta-hemolytic streptococcal infection of respiratory tract
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Q085. proliferative GN + pulmonary hemorrhage + IgG anti- glomerular basement membrane antibody
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A085. Goodpasture's syndrome
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Q086. MCC of acute interstitial nephritis
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A086. acute allergic reaction to a medication
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Q087. eosinophils in urine suggest what?
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A087. acute interstitial nephritis
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Q088. What disease has a defective amino acid transporter (in the kidney)?
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A088. Hartnup syndrome - decreased intestinal and renal reabsorption of neutral aa's, such as tryptophan, causing nicotinamide deficiency
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Q089. What kidney disease manifests like pellagra?
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A089. 3 D's:; dermatitis,; dementia,; diarrhea; Hartnup syndrome
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Q090. Adult polycystic Kidney Disease - associated finding in the brain?
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A090. intracerebral berry aneurysm
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Q091. medullary sponge kidney is thought to be associated with what other disease?
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A091. hyperparathyroidism and parathyroid adenoma
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Q092. most common cause of secondary HTN?
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A092. renal artery stenosis - decreased blood flow to JG apparatus, RAA system becomes activated, HTN
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Q093. What HTN drug is contraindicated in patients with renovascular HTN?
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A093. ACEI
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Q094. MC site of nephrolithiasis impaction
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A094. ureterovesicular junction
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Q095. Prostate Ca commonly begins where in the gland?
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A095. periphery then moves centrally - obstructive symptoms LATE
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Q096. Dx:; Edema, lipiduria, foamy urine, hypoalbuminemia, hyperlipidemia, hypercoagulation, protein in urine
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A096. Nephrotic syndrome
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Q097. Dx:; "Maltese crosses" in urine
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A097. cholesterol in urine; (Nephrotic syndrome)
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Q098. Why does the nephrotic syndrome patient have edema?; hypercoaguability?
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A098. Edema - decrease ion serum proteins and oncotic pressure; Hypercoag - loss of Proteins C and S and antithrombin III
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Q099. Dx:; child with epithelial foot process loss on EM; Tx?
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A099. Minimal Change Disease; Tx: steroids
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Q100. Dx:; glomerular scarring involving limited number of glomeruli with IgG and complement deposition; Most common in what patients?; (5)
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A100. Focal Segmental Glomerulosclerosis; Common in (Halt MID Stream):; HIV;; Men (younger) with HTN; IV drug users;; DM;; Sickle cell
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Q101. What can Focal Glomerulosclerosis lead to?; (2); Tx?
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A101. HTN and Chronic Renal Disease; Tx: Cyclophosphamide
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Q102. First line of Tx for all Nephrotic syndrome
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A102. Protein and NaCl restriction
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Q103. Dx:; MCC of Nephrotic Syndrome in adults that is slow to progress and has little response to steroids; Etiology? (6)
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A103. Membranous Glomerulonephritis Etiology (****):; SLE / Syphilis;; HBV / HCV;; Idiopathic;; Tumor
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Q104. Rule of thirds for Membranous GN
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A104. 1/3 get CRF; 1/3 have spontaneous remission; 1/3 remain nephrotic without progression
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Q105. Tx for Membranous GN; (2)
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A105. Cyclophosphamide; Chlorambucil
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Q106. Dx:; Abrupt onset hematuria with RBC casts, smoky-brown urine, proteinuria, hypertension, edema and azotemia (low GRF)
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A106. Acute Glomerulonephritis; (Nephritic syndrome)
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Q107. Dx:; presents 2 weeks after pharyngitis or impetigo with dark urine and edema
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A107. Poststrep. GN
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Q108. Deposition of what causes glomerular damage in poststrep GN?; Tx?
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A108. Deposition of IgG, C3 and C4 in a granular pattern; Tx underlying infection
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Q109. Dx:; hematuria immediately after an infection or exercise
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A109. IgA nephropathy; (Berger's Disease)
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Q110. what (and where) is the immune complex deposition of IgA nephropathy?
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A110. Mesangeal deposition of IgA and C3
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Q111. Dx:; immune deposits on BM cause it to look double-layered; what is it associated w/?; (2)
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A111. Membranoproliferative ("Tram-track" appearance) Assoc with:; Hepatitis C; Cryoglobinemia
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Q112. How is type I membranoproliferative different then type II?
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A112. Type I: slowly progressive; Type II: low serum C3 due to Auto-Ab vs C3
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Q113. Tx of Membranoproliferative for adults (2) and kids
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A113. Adults: ASA, Dipyridimole; Kids: Steroids
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Q114. Dx:; Fulminant renal failure with proteinuria, hematuria and RBC casts and epithelial cell proliferation in glomeruli; (2 names)
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A114. Rapidly Progressive GN; (Cresentric GN)
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Q115. (3) types of Rapidly Progressive GN
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A115. 1. Pauci-Immune RPGN; 2. Immune complex RPGN; 3. Anti-glomerular BM Ab Disease
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Q116. Serum marker for Pauci-Immune RPGN
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A116. ANCA positive; (Wegner's = c-ANCA); (polyarteritis nodosa = p-ANCA)
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Q117. Etiology of Immune Complex RPGN; (5)
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A117. SPLIT:; Syphilis;; Post-strep GN;; Lupus nephritis;; IgA nephritis;; Tumors
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Q118. another name for Anti-GMB Ab disease; what cells cause problem?
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A118. Goodpasture's disease; Cytotoxic T-cells (CD-8)
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Q119. Tx for all RPGN; (2); what percent go on to end-stage renal disease?
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A119. Tx:; steroids; cyclophosphamide; 80%
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Q120. Renal involvement with Lupus type I - V; Which has "wire-loop" abnormality?
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A120. I: no renal involvement; II: Focal-Segmental; III: Focal-Proliferative; IV: Diffuse Proliferative (most severe - wire-loop); V: Membranous
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Q121. MCC of End-Stage Renal Disease; What is the early manifestation?; What do Biopsy show?
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A121. Diabetes; starts with microalbuminuria; Biopsy: Kimmelstiel-Wilson nodules
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Q122. Dx:; palpable purpura on buttocks and legs of kids, abdominal pain, vomiting, hematuria and GI bleeding
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A122. Henoch-Schonlein purpura
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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?
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A123. Multiple myeloma; Hypercalcemia; E.Coli infection of kidney from abnormal Ab production
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Q124. (3) major toxins that increase the serum's osmolarity
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A124. EtOH; Methanol; Ethylene glycol
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Q125. ICF is what fraction of TBW?; Major cations of ICF? (2); Major anions? (2)
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A125. ICF = 2/3 of TBW; Cations: K, Mg; Anions: Proteins, Organic Phosphates (ATP, ADP, AMP)
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Q126. ECF is what fraction of TBW?; Major cation of ECF?; Major anions? (2)
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A126. ECF = 1/3 of TBW; Cation: Na; Anions: Cl, HCO3
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Q127. What composition does interstitial fluid resemble?; What is different?
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A127. resembles Plasma; Interstitial fluid contains little protein (ultrafiltrate)
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Q128. What (2) compartments does water shift between?; If solutes (glucose, sodium, mannitol) dont cross the cell membrane, what osmolarity do they contribute to?
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A128. ECF + ICF; ECF
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Q129. Formula for Serum Osmolarity; Normal Serum Osmolarity?
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A129. SO = 2(Na+K) + Glucose/18 + BUN/2.8; 300 mOsm/kg
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Q130. Define:; Hyponatremia
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A130. plasma sodium < 134mEq/L
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Q131. What are the (3) categories of Hyponatremia?
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A131. Hypovolemic; Isovolemic; Hypervolemic
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Q132. How can you distinguish b/t renal and extrarenal causes of hypovolemic hyponatremia?
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A132. Urine Sodium:; U-Na > 20 = Renal; U-Na < 10 = Non-renal
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Q133. Extra-renal causes of hypovolemic hyponatremia; (5)
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A133. GI loss (Vomiting/Diarrhea); Extensive burns; Dehydration; 3rd spacing (pancreatitis, peritonitis)
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Q134. Renal causes of Hypotonic Hypovolemic Hyponatremia; (5)
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A134. TANAS:; Thiazides (diuretics);; ACEi;; Nephropathies;; Addisons Disease (Mineralcorticoid deficiency);; Salt-wasting nephropathies
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Q135. Etiology of Hypotonic Euvolemic Hyponatremia; (separate into 2 categories - 8 total)
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A135. Less dilute urine (****):; SIADH; Hypothyroidism; Idiosyncratic drug reaction (Thiazides, ACEi) More dilute urine (Huge PEPE):; Hypokalemia; Post-op Hyponatremia; EtOH addiction; Psychogenic polydipsia; Exercise
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Q136. "tonic" as in hypertonic refers to what?
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A136. serum osmolality
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Q137. Serum osmolality level for:; Hyponatremia; Hypernatremia
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A137. Hyponatremia: < 280 mOsm/kg; Hypernatremia: > 300 mOsm/kg
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Q138. Etiology of Hypotonic Hypervolemic Hyponatremia; (4)
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A138. CLAN:; CHF; Liver disease; Advanced Renal Failure; Nephrotic syndrome
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Q139. Etiology of Isotonic Hyponatremia; (2)
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A139. Hyperproteinemia; Hyperlipidemia
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Q140. Etiology of Hypertonic Hyponatremia; (2)
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A140. Facticious Hyponatremia:; Hyperglycemia; Hypertonic infusions; (mannitol, glucose, contrast)
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Q141. How does each 100 mL/dL increase in serum glucose above normal cause sodium to decrease?
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A141. Sodium decreases by 1.6 mEq/L
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Q142. Signs/Sx of moderate hyponatremia or gradual onset; (4)
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A142. Confusion; Muscle cramps; Anorexia; Nausea
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Q143. Signs/Sx of severe hyponatremia or rapid onset; (2); At what level is considered severe?
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A143. Seizures or Coma; Severe: < 115 mEq/L
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Q144. With low serum osmolarity (< 280), what signs should be observed to differentiate b/t Hypovolemia, Isovolemia, & Hypervolemia?
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A144. Hypovolemia:; Tachycardia; Hypotension; poor skin turgor; Isovolemia:; Normal vital signs without edema; Hypervolemia:; peripheral Edema
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Q145. Dx:; measured & calculated serum osmolarities are different; What (2) problems is it seen in?
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A145. Pseudohyponatremia; Seen in:; Multiple myeloma; Hyperlipidemia
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Q146. Tx of Hypovolemic Hyponatremia; (2)
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A146. 1. address underlying disorder; 2. replace volume with NS; (monitor Na to prevent CPM)
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Q147. Tx of Isovolemic or Hypervolemic Hyponatremia; (2)
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A147. 1. address underlying disorder; 2. Sodium + water restriction
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Q148. What is Tx for CHF-induced Hypervolemic Hyponatremia?; (2)
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A148. 1. Sodium + water restriction; 2. Combination of Captopril & Furosemide
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Q149. Rules for correcting Hyponatremia by increasing serum sodium; (2); Why?
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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
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Q150. What are pre-menopausal women at high risk for during an acute episode of Hyponatremia?
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A150. Cerebral edema
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Q151. Dx:; Osmotic demyelination syndrome occurring as a treatment complication of severe or chronic hyponatremia
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A151. Central Pontine Myelinolysis; (CPM)
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Q152. Serum sodium level that is considered Hypernatremia
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A152. Serum Na > 145 mEq/L
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Q153. Type of Hypernatremia:; Loss of both water + sodium; (water loss >> sodium loss)
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A153. Hypovolemic Hypernatremia
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Q154. Type of Hypernatremia:; Decreased TBW, normal body sodium, decreased ECF
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A154. Isovolemic Hypernatremia
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Q155. Type of Hypernatremia:; Increased TBW, markedly Inc total body Na, Inc ECF
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A155. Hypervolemic Hypernatremia
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Q156. Etiology of Hypervolemic Hypernatremia; (3)
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A156. Hypertonic fluid administration;; Mineralcorticoid excess (Cushing's, Conn's);; Excess salt ingestion
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Q157. Etiology of Isovolemic Hypernatremia; (2)
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A157. Diabetes Insipidus;; Skin losses (due to hyperthermia)
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Q158. Etiology of Renal-related Hypovolemic Hypernatremia; (3)
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A158. Diuretics;; Acute/chronic Renal failure;; Partial obstruction
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Q159. Etiology of Extra-renal-related Hypovolemic Hypernatremia; (5)
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A159. Hyperpnea;; Excessive sweating;; Diarrhea;; Burns;; Dialysis
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Q160. formula for Water Deficit in Hypernatremia patient
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A160. WD (liters) = 0.6 x body wt (kg) x (measured Na/140) -1
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Q161. Tx for Hypovolemic Hypernatremia
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A161. Fluid replacement with NS; (correct plasma osmolarity no faster then 2 mOsm/kg/hr)
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Q162. Tx for Isovolemic Hypernatremia; What additionally should you do if Dx is Central Diabetes Insipidus?
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A162. Fluid replacement with 1/2 NS; (correct only half of the deficit in first 24 hrs); C-DI: Vasopressin
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Q163. Tx for Hypervolemic Hypernatremia; (2)
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A163. 1. Fluid replacement with 1/2 NS (for hypertonicity); 2. Loop diuretic (furosemide) to inc Na excretion
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Q164. Normal range of Potassium
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A164. 3.3 - 5.5; (below is hypokalemia; above is hyperkalemia)
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Q165. Difference b/t Periodic paralysis of Hypokalemia vs. Hyperkalemia
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A165. Hypokalemia - presents in teens; Hyperkalemia - presents in infancy
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Q166. What heart drug causes a greater toxicity if patient goes into Hypokalemia?; How is this avoided?
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A166. Digitalis; check K+ regularly
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Q167. (4)* general ways we can lose potassium (become Hypokalemia)
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A167. 1. Cellular shift + undetermined mechanisms; 2. Inc renal excretion; 3. GI losses; 4. Sweating
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Q168. Cellular shift + undetermined mechanisms of Hypokalemia; (5)*
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A168. A Deadly VIBe:; 1. Alkalosis; 2. Digoxin toxicity correction (with digibind); 3. Vitamin B-12; 4. Insulin; 5. Beta-adrenergics
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Q169. in Alkalosis, how does each 0.1 increase in pH affect K+?
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A169. decreases serum K+ by 0.5 mEq/L
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Q170. What does insulin do to K+?
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A170. drives it into the cells
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Q171. Etiology of Hypokalemia due to Increased renal excretion mechanisms; (6)*
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A171. 1. Cushings (Inc Mineralcorticoid activity); 2. HypoMagnesium; 3. Bartter's syndrome; 4. Osmotic diuresis (mannitol); 5. Renal tubular acidosis; 6. Medications
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Q172. Dx:; JG-cell hyperplasia causing increased renin/aldosterone, met alkalosis, Hypokalemia, muscle weakness and tetany; seen in young adults
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A172. Bartter's syndrome
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Q173. (3) GI loss causes of Hypokalemia
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A173. 1. Vomiting; nasogastric suction; 2. Diarrhea; laxative abuse; 3. Inadequate dietary intake (anorexia)
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Q174. Dx:; Impaired gastric motility, nausea, vomiting, muscle weakness (to paralysis), rhabdomyolysis, atrial + ventricular arrhythmias
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A174. Hypokalemia
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Q175. What is the Tx for urgent Hypokalemia? (2); What works faster?; What type of patient must be monitored closely?
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A175. give IV + oral potassium simultaneously; oral works faster; monitor patient with renal failure
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Q176. At what level should K+ be peri-MI to prevent arrhythmias?
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A176. K+ > 4.0
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Q177. IV infusion of K+ should not exceed what number/hour?; How much does that raise serum K+?
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A177. IV no more then 20 mEq/hr; Increases K+ by 0.25 mEq/L
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Q178. what diagnostic procedure should be performed on patients with moderate or severe Hyperkalemia?
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A178. Stat EKG
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Q179. The only Tx of Hyperkalemia (aside from dialysis) that removes K from the body
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A179. Kayexalate
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Q180. MCC of Hyperkalemia in lab results; What should be done?
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A180. Pseudo-Hyperkalemia:; falsely elevated measurement due to hemolysis; Re-run lab test
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Q181. (4)* causes of ICF to ECF potassium shifting causing Hyperkalemia
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A181. Heavy exercise; Acidosis; Insulin deficiency; Digitalis toxicity
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Q182. (3) causes of an increased potassium load causing Hyperkalemia
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A182. IV potassium supplements; K+ medications; Increased cellular breakdown
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Q183. Causes of decreased potassium excretion causing Hyperkalemia; (3 renal and 3 drugs)*
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A183. ROB A K:; Renal failure;; Obstructive uropathies;; Beta-blockers;; Aldosterone deficiency / ACEi;; K-sparing diuretics
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Q184. Dx:; N/V/D; muscle cramps, weakness, areflexia, tetany, confusion; respiratory insufficiency; arrhythmias, cardiac arrest
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A184. Hyperkalemia
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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)
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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
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Q186. Hyperkalemia is most common with what (2) causes
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A186. Renal failure; muscle breakdown
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Q187. What are the Tx of Hyperkalemia in order of Stabilize, Shift, Remove?*
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A187. Can Get In A Bad K Day:; Stabilize - Calcium; Shift - Glucose + Insulin; Albuterol; Bicarbonate; Remove - Kayexalate; Dialysis
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Q188. When is calcium contraindicated for Hyperkalemia?
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A188. if patient is on Digoxin
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Q189. Polycystic Kidney Disease - What is it
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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
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Q190. Polycystic Kidney Disease - History/PE
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A190. Hematuria; HTN; pain - sharp & localized, from ruptured cysts,; infection,; renal calculi; large, palpable kidneys; liver cysts; berry aneurysms; mitral valve prolapse; colonic diverticula
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Q191. Polycystic Kidney Disease - Dx
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A191. US or CT
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Q192. Polycystic Kidney Disease - Tx
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A192. Prevent complications,; slow progression to ESRD: early management of UTI - prevent renal cyst infection; control BP; ESRD – dialysis, renal transplant
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Q193. Nephrolithiasis - MC in what population; Risk factors
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A193. MC in older men risk factors; family History,; low fluid intake; gout; postcolectomy; postileostomy; spec. enzyme disorder; RTA; hyperparathyroidism
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Q194. Nephrolithiasis - History/PE
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A194. Acute onset; severe colicky flank pain; may radiate to testes or vulva; n/v; pt. freq. shift position
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Q195. Nephrolithiasis - Dx
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A195. Spiral CT - test of choice; UA - best 1st test; KUB; renal US; IVP - confirm; noncontrast abdominal CT; UA – hematuria, altered urine pH
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Q196. Nephrolithiasis - Tx
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A196. Initial Tx - hydration; analgesia; < 5mm - can pass thru urethra; < 3 cm – ESWL (extracorporeal shock wave lithotripsy); percutaneous nephrolithotomy
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Q197. Nephrolithiasis - Calcium Oxalate/; Calcium Phosphate; Characteristics; Tx
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A197. MC (83%); idiopathic hypercalciuria; primary hyperparathyroidism; hyperoxaluria; hypocitraturia; alkaline urine; radiopaque; Tx – hydration, thiazide diuretic
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Q198. Nephrolithiasis - Struvite (Mg-NH4-PO4); Characteristics; Tx
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A198. "Triple phosphate stones"; due to urease-producing organism - Proteus; staghorn calculi; alkaline urine; radiopaque; Tx – hydration, treat UTI, if present
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Q199. Nephrolithiasis - Uric Acid; Characteristics; Tx
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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
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Q200. Nephrolithiasis - Cystine; Characteristics; Tx
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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
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Q201. Ureteral Reflux - What is it
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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
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Q202. Ureteral Reflux - Dx; Tx
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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)
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Q203. Renal Cell Carcinoma - What is it; Risk factors
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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
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Q204. Renal Cell Carcinoma - History/PE
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A204. Classic triad; hematuria; flank pain; palpable flank mass; polycythemia; constitutional Sxs; enlargement of left testicle
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Q205. Renal Cell Carcinoma - Tx
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A205. Surgical resection - curative if local; notoriously resistant to chemo & radiation
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Q206. Cryptorchidism - What is it
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A206. Failure of testes to descend into scrotum; bilateral associated with oligospermia & infertility; risk factor - prematurity
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Q207. Cryptorchidism - History/PE
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A207. Testes can't be manipulated into scrotal sac with gentle pressure; may be palpated anywhere along inguinal canal or in abdomen
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Q208. Cryptorchidism - Tx
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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
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Q209. Erectile Dysfunction - What is it; Risk factors
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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
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Q210. Erectile Dysfunction - History/PE
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A210. Ask about:; risk factors; meds; recent life changes; psych stressors; psychological - if pt. has nocturnal or early-morning erections; situation dependent
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Q211. Erectile Dysfunction - Dx
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A211. Check for hypogonadism; testosterone levels; gonadotropin levels; prolactin levels; evaluate for neuro dysfunction - anal tone; lower ext sensations
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Q212. Erectile Dysfunction - Tx
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A212. Psychotherapy; sex therapy; testosterone - if hypogonadism; sildenafil - PDE5 inhibitor, increased cGMP => smooth mus relaxation => increased blood flow in corpora cavernosa
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Q213. Nephritic Syndrome - What is it
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A213. Manifestation of glomerular; inflammation (glomerulonephritis)
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Q214. Nephritic Syndrome - History/PE
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A214. Hematuria - smoky-brown; HTN; oliguria; edema - low pressure areas (periorbital, scrotum)
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Q215. Nephritic Syndrome - Dx
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A215. UA – hematuria, (possible) mild proteinuria; decreased GFR; increased BUN/Cr; ANA; ANCA; anti-gbm Ab; renal Biopsy
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Q216. Nephritic Syndrome - Tx (in general)
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A216. Tx HTN, fluid overload and uremia; salt restriction; water restriction; diuretics; dialysis (if necessary); corticosteroids
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Q217. Postinfectious GN - What is it
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A217. Nephritic Syndrome; usually associated with recent strep infection, group A, B- hemolytic
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Q218. Postinfectious GN - History/PE
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A218. Smoky-brown urine; HTN; oliguria; periorbital edema
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Q219. Postinfectious GN - Labs & Histology
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A219. Low serum C3; increased ASO titer; lumpy-bumpy immunofluorescence
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Q220. Postinfectious GN - Tx & Prognosis
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A220. Supportive; almost all kids & most adults have complete recovery
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Q221. IgA Nephropathy (Berger's) - What is it
|
A221. Nephritic Syndrome; MC type worldwide; associated with URI or GI infections; young men
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Q222. IgA Nephropathy (Berger's) - History/PE
|
A222. Gross hematuria
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Q223. IgA Nephropathy (Berger's) - Labs & Histology
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A223. Increased serum IgA; Biopsy & immunofluorescence - mesangial IgA deposits
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Q224. IgA Nephropathy (Berger's) - Tx & Prognosis
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A224. Glucocorticoids; 20% progress to ESRD
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Q225. Wegener's Granulomatosis - What is it
|
A225. Nephritic Syndrome; granulomatous inflammation of respiratory tract & kidney; necrotizing vasculitis; paucimmune form of RPGN
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Q226. Wegener's Granulomatosis - History/PE
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A226. Fever; weight loss; hematuria; respiratory & sinus Sxs; cavitary pulmonary lesions - bleed => hemoptysis
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Q227. Wegener's Granulomatosis - Labs & Histology
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A227. c-ANCA
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Q228. Wegener's Granulomatosis - Tx & Prognosis
|
A228. High-dose corticosteroids; cytotoxic agents; patients tend to have freq relapses
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Q229. Alport's Syndrome - What is it
|
A229. Nephritic Syndrome; hereditary; boys 5-20 y/o
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Q230. Alport's Syndrome - History/PE
|
A230. Asymptomatic hematuria; nerve deafness; eye disorders
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Q231. Alport's Syndrome - Labs & Histology
|
A231. GBM splitting on electron microscope
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Q232. Alport's Syndrome - Tx & Prognosis
|
A232. Progress to RF; anti-GBM nephritis may recur after transplant
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Q233. Goodpasture's Syndrome - What is it
|
A233. Nephritic syndrome; GN & pulmonary hemorrhage; men in mid 20's; immune form of RPGN
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Q234. Goodpasture's Syndrome - History/PE
|
A234. Hemoptysis; dyspnea; possible respiratory failure
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Q235. Goodpasture's Syndrome - Labs & Histology
|
A235. Linear anti-GBM on IF; iron-deficient anemia; CXR - pulmonary infiltrates; sputum - hemosiderin-filled macrophages
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Q236. Goodpasture's Syndrome - Tx & Prognosis
|
A236. Plasma exchange therapy (plasmapheresis); pulsed steroids; cyclophosphamide; may progress to ESRD
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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
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Q238. Nephrotic Syndrome - History/PE
|
A238. Generalized edema; foamy urine; if severe – dyspnea, ascites, increased susceptibility to – infections, venous thrombosis; PE
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Q239. Nephrotic Syndrome - Dx
|
A239. UA - proteinuria > 3.5g/day; lipiduria; decreased albumin (< 3g/dL); hyperlipidemia; Biopsy - Dx underlying etiology
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Q240. Nephrotic Syndrome - Tx (in general)
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A240. Steroids - best initial Tx; cyclophosphamide; restrict salt; diuretics; statins
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Q241. Minimal Change Disease - What is it
|
A241. Nephrotic syndrome; common in children; idiopathic etiology
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Q242. Minimal Change Disease - History/PE
|
A242. Tendency towards – infections, thrombosis
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Q243. Minimal Change Disease - Labs & Histology
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A243. Normal under light microscope; electron microscope shows - fusion of epithelial foot processes
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Q244. Minimal Change Disease - Tx & Prognosis
|
A244. Steroids; excellent prognosis
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Q245. Focal Segmental; Glomerulosclerosis (FSGS) - What is it
|
A245. Nephrotic syndrome; idiopathic; IVDU; HIV
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Q246. Focal Segmental; Glomerulosclerosis (FSGS) - History/PE
|
A246. Especially common in black men with uncontrolled HTN
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Q247. Focal Segmental; Glomerulosclerosis (FSGS) - Labs & Histology
|
A247. Microscopic hematuria; Biopsy - sclerosis in capillary tufts
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Q248. Focal Segmental; Glomerulosclerosis (FSGS) - Tx & Prognosis
|
A248. Prednisone; cytotoxic therapy; Poor prognosis
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Q249. Membranous Nephropathy - What is it
|
A249. Nephrotic syndrome; MC white adult nephropathy; MC idiopathic form in adults; immune-complex disease
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Q250. Membranous Nephropathy - History/PE
|
A250. Associated with:; HBV; syphilis; malaria; gold (drug); penicillamine; cancer; SLE
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Q251. Membranous Nephropathy - Labs & Histology
|
A251. "spike and dome"; due to granular deposits of IgG and C3 at basement membrane
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Q252. Membranous Nephropathy - Tx & Prognosis
|
A252. Steroids are of little use
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Q253. Diabetic Nephropathy - What is it
|
A253. Nephrotic syndrome; Diffuse hyalinization; nodular glomerulosclerosis; Kimmelstiel-Wilson lesions
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Q254. Diabetic Nephropathy - History/PE
|
A254. Usually have long-standing,; poorly-controlled DM
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Q255. Diabetic Nephropathy - Labs & Histology
|
A255. Thickened glomerular basement membrane; increased mesangial matrix
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Q256. Diabetic Nephropathy - Tx & Prognosis
|
A256. Tight glucose control; protein restriction; ACEIs
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Q257. Lupus Nephritis - What is it
|
A257. Nephrotic & nephritic syndrome; WHO types I-V; severity of renal disease; determines overall prognosis
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Q258. Lupus Nephritis - History/PE
|
A258. Proteinuria or RBCs in UA
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Q259. Lupus Nephritis - Labs & Histology
|
A259. Mesangial proliferation; subendothelial immune-complex deposits
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Q260. Lupus Nephritis - Tx & Prognosis
|
A260. May reduce disease progression – prednisone, cytotoxic therapy
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Q261. Renal Amyloidosis - What is it
|
A261. Nephrotic syndrome; primary - plasma cell dyscrasia; secondary – infectious, inflammatory
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Q262. Renal Amyloidosis - History/PE
|
A262. Patients may have multiple myeloma; or chronic inflammatory disease (RA, TB)
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Q263. Renal Amyloidosis - Labs & Histology
|
A263. Abdominal fat Biopsy; congo red stain; apple-green birefringence under polarized light
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Q264. Renal Amyloidosis - Tx & Prognosis
|
A264. Prednisone; melphalan; BMT - for multiple myeloma
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Q265. Membranoproliferative; Nephropathy (MPGN) - What is it
|
A265. Nephrotic & nephritic syndrome; 3 types
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Q266. Membranoproliferative; Nephropathy (MPGN) - History/PE
|
A266. Immune deposits; low complement; associated with HCV; slow progression to RF
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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)
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Q268. Membranoproliferative; Nephropathy (MPGN) - Tx & Prognosis
|
A268. Corticosteroids; cytotoxic agents
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Q269. BPH - What is it
|
A269. Normal part of aging; seen in > 80% by age 80; patients usually > 50 y/o
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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)
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Q271. BPH - Dx
|
A271. R/o possible dangerous causes; DRE; UA/UC; Cr; Not recommended for BPH - PSA & cystoscopy
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Q272. BPH - Tx
|
A272. Mild - reassurance; mod to severe – surgery, terazosin, finasteride, TURP, open prostatectomy
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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
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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
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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
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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
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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
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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
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Q279. Bladder Cancer - History/PE
|
A279. Asymptomatic in early stages; gross hematuria; freq. urgency; dysuria
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Q280. Bladder Cancer - Dx
|
A280. UA; cytology; IVP; cystoscopy with Biopsy - diagnostic; may also – US, MRI, pelvic CT
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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
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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
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Q283. Testicular Cancer - History/PE
|
A283. Painless enlargement of testis
|
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Q284. Testicular Cancer - Dx
|
A284. B-hCG - increased in choriocarcinomas, increased in 10% of seminomas; AFP - increased in endodermal sinus, (yolk sac) tumors
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Q285. Testicular Cancer - Tx
|
A285. Seminomas - very radiosensitive, also respond to chemo; nonseminomatous germ cell - platinum-based chemo
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Q286. SIADH - What is it; What is it associated with
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A286. Euvolemic hyponatremia from nonosmotically-stimulated ADH release associated with:; CNS disease; pulmonary disease; ectopic tumor/ paraneoplastic syndromes; drugs; surgery
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Q287. SIADH - Dx
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A287. Urine osmolality > 50-100 mOsm/kg; concurrent serum hyposmolarity; no physio reason for increased ADH; urinary sodium > 20 mEq/L
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Q288. SIADH; Tx
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A288. Tx underlying cause; mild - restrict fluids; moderate - NS and furosemide; severe (Sxs) - hypertonic saline, then furosemide; if chronic - demeclocycline or lithium - ADH antag
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Q289. Diabetes Insipidus - What is it; What is it caused by
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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)
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Q290. Diabetes Insipidus - History/PE
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A290. Polydipsia; polyuria; persistent thirst; dilute urine; if don't have unlimited access to water – dehydration, hypernatremia
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Q291. Diabetes Insipidus - Dx
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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
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Q292. Diabetes Insipidus - Tx
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A292. central - DDAVP subcutaneously; nephrogenic - thiazide diuretics (HCTZ), amiloride, chlorthalidone
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Q293. Acetazolamide - Site of Action; Mechanism
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A293. Proximal convoluted tubule; inhibits carbonic anhydrase
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Q294. Acetazolamide - Clinical Use
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A294. Glaucoma; urinary alkalinization; metabolic alkalosis; altitude sickness; cysteinuria
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Q295. Acetazolamide - Toxicity
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A295. Hyperchloremic metabolic acidosis; sulfa allergy
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Q296. Loop Agents; Furosemide; Bumetanide; Torsemide; Ethacrynic Acid - Site of Action; Mechanism
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A296. Ascending loop of Henle; Inhibits Na/K/2 Cl cotransport
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Q297. Loop Agents; Furosemide; Bumetanide; Torsemide; Ethacrynic Acid - Clinical Use
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A297. HTN; hypercalcemia; edematous states - CHF; cirrhosis; nephrotic syndrome; pulmonary edema
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Q298. Loop Agents; Furosemide; Bumetanide; Torsemide; Ethacrynic Acid - Toxicity
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A298. OH DANG; Ototoxicity; Hypokalemia; Dehydration; Allergy – sulfa (not ethacrynic acid); Nephritis - interstitial; Gout
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Q299. Hydrochlorothiazide - Site of Action; Mechanism
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A299. Distal convoluted tubule; inhibits Na+/Cl- cotransporter
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Q300. Hydrochlorothiazide - Clinical Use
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A300. HTN; CHF; idiopathic hypercalciuria; nephrogenic diabetes insipidus
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Q301. Hydrochlorothiazide - Toxicity
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A301. HyperGLUC; hyperGlycemia; hyperLipidemia; hyperUricemia; hypercalcemia and; hypokalemic metabolic alkalosis; hyponatremia; sulfa allergy
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Q302. K+ Sparing Agents; Spironolactone; Triamterene; Amiloride - Site of Action; Mechanism
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A302. Cortical collecting tubule; Spironolactone - aldosterone receptor antag; triamterene & amiloride - block Na+ channels
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Q303. K+ Sparing Agents; Spironolactone; Triamterene; Amiloride - Clinical Use
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A303. Hyperaldosteronism; K+ depletion; CHF
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Q304. K+ Sparing Agents; Spironolactone; Triamterene; Amiloride - Toxicity
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A304. Hyperkalemia; gynecomastia; antiandrogen effects
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Q305. Mannitol - Site of Action; Mechanism
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A305. Entire tubule; sorbitol stereoisomer; osmotic diuretic; filtered by glomerulus; can't be reabsorbed; increased tubular fluid osmolarity => decreased water reabsorption => increased urine flow
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Q306. Mannitol - Clinical Use
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A306. Shock; drug overdose; decreased intracranial or intraocular pressure
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Q307. Mannitol - Toxicity
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A307. Pulmonary edema; dehydration; contraindicated in – anuria, CHF
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Q308. Renal Tubular Acidosis - What is it
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A308. Failure of kidneys to acidify urine; net decreased in tubular H+ secretion or HCO3 reabsorption => nonanion-gap metabolic acidosis
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Q309. RTA Type I - What is it
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A309. Distal tubule H+/K+ pump is broken => failure to secrete H+; serum K+ stays low; urinary pH > 5.3
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Q310. RTA Type I - Causes; Complications
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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
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Q311. RTA Type I - Tx; Dx/Test
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A311. Tx - potassium citrate; Dx/Test - acid load
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Q312. RTA Type II - What is it
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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
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Q313. RTA Type II - Causes; Complications
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A313. Causes:; hereditary; carbonic anhydrase inhibitors; Fanconi's syndrome; multiple myeloma; complications – rickets, osteomalacia
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Q314. RTA Type II - Tx; Dx/Test
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A314. Tx - potassium citrate; Dx/Test - bicarb load
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Q315. RTA Type IV - What is it
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A315. Adrenal insensitivity to angiotensin 2; aldosterone deficient; serum K+ is high; usually asymptomatic hyperkalemia, hyperchloremic metabolic acidosis (nonanion/normal metabolic acidosis)
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Q316. RTA Type IV - Causes; Complications
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A316. Causes; hyporeninemic hypoaldosterone:; DM (infarcts JG); ACEIs; NSAIDs; addison's; sickle cell; renal insufficiency; complication - hyperkalemia
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Q317. RTA Type IV - Tx; Dx/Test
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A317. Tx – fludrocortisone, furosemide - if HTN, kayexelate; Dx/Test - restrict salt
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Q318. Acute Renal Failure - What is it
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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
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Q319. Acute Renal Failure - History/PE
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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
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Q320. Acute Renal Failure - Dx
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A320. CBC; BUN/Cr; electrolytes; FE(Na) - if oliguric; urine sediment – RBC, WBC casts, eosinophils; urinary catheter; renal US
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Q321. Acute Renal Failure - Tx
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A321. Balance fluid & electrolytes; dialysis if indicated; acute/allergic nterstitial nephritis - adjust/discontinue offending meds; glomerulonephritis – corticosteroids, cytotoxics
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Q322. Acute Renal Failure - Complications
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A322. Chronic renal failure => dialysis; dialysis - prevent buildup of: K+, H+, toxic metabolites; increased risk for CAD
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Q323. Acute Renal Failure - What is Prerenal % for FE(Na); What is Prerenal No. for U(Na); What is Prerenal Ratio; for BUN/Cr
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A323. FE(Na) is < 1%; U(Na) is < 20; BUN/Cr is > 20
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Q324. Acute Renal Failure - FE(Na) - How do you calculate it
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A324. U/P Na divided by U/P Cr
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Q325. Dialysis - What are the indications
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A325. AEIOU; Acidosis; Electrolyte abnormalities (hyperkalemia); Ingestions; Overload of fluid; Uremic Sxs – pericarditis, encephalopathy, bleeding, nausea, pruritus, myoclonus
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Q326. Hyponatremia - What is it
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A326. Serum sodium < 135 mEq/L
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Q327. Hyponatremia - History/PE
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A327. May be asymptomatic; confusion; lethargy; muscle cramps; nausea; can progress to – seizures, status epilepticus, coma
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Q328. Hyponatremia - Dx
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A328. Classified by:; serum osmolality; volume status (by PE); urinary Na+
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Q329. Hyponatremia - What are the types; of osmolalities
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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
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Q330. Hyponatremia - Tx
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A330. Chronic hyponatremia should be corrected slowly to prevent central pontine myelinolysis
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Q331. Hypervolemic Hyponatremia - What is it; Etiologies; Tx
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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
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Q332. Euvolemic Hyponatremia - What is it; Etiologies; Tx
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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
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Q333. Hypovolemic Hyponatremia - What is it; Etiologies; Tx
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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
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Q334. Hypernatremia - What is it
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A334. Serum Na+ > 145 mEq/L
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Q335. Hypernatremia - History/PE
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A335. Thirst; oliguria or polyuria (depends on etiology); mental status changes; weakness; focal neuro deficits; seizures; "doughy" skin
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Q336. Hypernatremia - Dx
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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
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Q337. Hypernatremia - Tx
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A337. Tx underlying causes; replace free water deficit - isotonic fluids; correct gradually over 48-72 hrs (to prevent neuro damage secondary to cerebral edema)
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Q338. Hypercalcemia - What is it; What causes it
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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
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Q339. Hypercalcemia - History/PE
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A339. "Bones, stones, abdominal groans, psych overtones"; fractures; kidney stones; n/v; constipation; anorexia; weakness; fatigue; altered mental status
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Q340. Hypercalcemia - Dx
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A340. EKG - short QT; total Ca2+; ionized Ca2+; albumin; phosphate; PTH; PTHrP; vit D; TSH; serum immunoelectrophoresis
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Q341. Hypercalcemia - Tx
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A341. IV hydration; then furosemide; if severe or refractory – calcitonin, bisphosphonates (pamidronate), glucocorticoids, dialysis
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Q342. Hypocalcemia - What is it; What causes it
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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
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Q343. Hypocalcemia - History/PE
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A343. Abdominal muscle cramps; tetany; perioral & acral paresthesias; convulsions; dyspnea; Chvostek's sign; Trousseau's sign; EKG - prolonged QT
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Q344. Hypocalcemia - Dx
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A344. Ionized Ca2+; Mg2+; PTH; albumin; calcitonin; if post-thyroidectomy - check operative note to determine number of parathyroid glands removed
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Q345. Hypocalcemia - Tx
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A345. Tx underlying disorder; oral calcium supplements; if severe - IV calcium
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Q346. Hypomagnesemia - What is it; What is it caused by
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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
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Q347. Hypomagnesemia - History/PE
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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
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Q348. Hypomagnesemia - Dx
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A348. Check for concurrent hypocalcemia & hypokalemia; EKG - prolonged PR & QT
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Q349. Hypomagnesemia - Tx
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A349. IV or oral Mg2+; hypokalemia & hypocalcemia; won't correct if Mg2+, not corrected also
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Q350. Hyperkalemia - What is it; What is it caused by
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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
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Q351. Hyperkalemia - History/PE
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A351. Muscle weakness starts > 6.5; MCC of death - abnormal cardiac conduction; May be asymptomatic; n/v; intestinal colic; areflexia; weakness; flaccid paralysis; paresthesias
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Q352. Hyperkalemia - Dx
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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
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Q353. Hyperkalemia - Tx
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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
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Q354. Hypokalemia - What is it; What is it caused by
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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
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Q355. Hypokalemia - History/PE
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A355. Sxs start when K+ <2.5 - 3.0; muscle weakness; cramps; ileus; fatigue; hyporeflexia; paresthesias; if severe - flaccid paralysis, cardiac arrhythmia
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Q356. Hypokalemia - Dx
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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
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Q357. Hypokalemia - Tx
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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
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Q358. MCC dysuria 25 yo male
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A358. urethritis
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Q359. Prehn's sign
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A359. elevate testicles relieves pain in epididymitis (sp?)
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Q360. torsion evaluation
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A360. ultrasound
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Q361. renal stone evaluation
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A361. CT
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Q362. pre-renal azotemia; BUN:creatinine
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A362. >20:1 <30:1; BUN:creatinine
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Q363. CHF in ESRD treatment
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A363. Furosemide (Lasix)
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Q364. Renal stone size threshholds for surgery
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A364. 6 mm will not likely pass; 5 mm will likely pass
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Q365. GI bleed; BUN:creatinine
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A365. >30:1; BUN:creatinine
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Q366. Why is the left kidney taken during transplantation?
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A366. It has a longer renal vein
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Q367. Water breakdown?
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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
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Q368. How can you measure plasma volume?
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A368. Radiolabeled albumin
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Q369. Formula for clearance
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A369. Cx = UxV/Px
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Q370. What does the glomerular filtration barrier block, and how?
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A370. Large, negative particles; 1. Fenestrated capillary (size); 2. Heparin on basement membrane (charge); 3. Podocyte foot processes
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Q371. Calculation for free water clearance
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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.
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Q372. What is the renal threshold for glucose?
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A372. around 200 mg/dL; this is when you start to see symptoms
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Q373. Why does acidosis decrease K secretion?
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A373. It causes a shift of K outside the cell; (thus decreasing the amount of K available for transport to the lumen)
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Q374. Actions of AII
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A374. Vasoconstriction; Aldosterone synthase induction; ADH release; Stimulates hypothalamus for increasing thirst
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Q375. ANP actions
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A375. Decreases renin; Increases GFR
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Q376. What part of the kidney secretes EPO?
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A376. Endothelial cells of peritubular capillaries
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Q377. What stimulates renin secretion?
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A377. Beta 1
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Q378. Winter's formula
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A378. PCO2 = 1.5 (HCO3) + 8 +/-2
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Q379. Metabolic alkalosis
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A379. PCO2 increases .7 for every 1 mEq/L increase in HCO3
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Q380. Respiratory alkalosis; acute; chronic
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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.
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Q381. Respiratory acidosis; acute; chronic
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A381. 1mEq/L increase for every 10 mmHg increase; 3.5 mEq/L increase
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Q382. Delta delta; <1; 1; >2
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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
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Q383. WBC casts
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A383. virtually pathognomonic for pyelo, and not seen in cystitis
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Q384. Granular casts
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A384. ATN
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Q385. What stone is radiolucent
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A385. Uric acid
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Q386. Renal cell carcinoma; Host; Histology; Genetics; Paraneoplastics
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A386. Men 50-70; Likes upper pole, originates in renal tubule cells (clear cells); Associated with VHL gene on 3; EPO, ACTH, PTHrP, prolactin
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Q387. WAGR complex
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A387. Wilms' tumor; Aniridia; Genitourinary malformation; mentomotor Retardation
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Q388. What does Wilms' tumor originate from?
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A388. Primitive metanephric tissues
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Q389. Causes of transitional cell carcinoma
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A389. Phenacetin,; Smoking,; Aniline dyes,; Cyclophosphamide,; Schistosomiasis
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Q390. Where can TCC occur?
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A390. Calyces,; pelves,; ureters,; bladder
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Q391. Chronic pyelonephritis
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A391. Coarse,; asymmetric,; corticomedullary scarring,; blunted calyx,; thyroidization of kidney; Usually from chronic UT obstruction
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Q392. What causes diffuse cortical necrosis?
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A392. combination of vasospasm and DIC,; usually in sepsis or obstetric catastrophes
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Q393. What is the mechanism by which drugs induce interstitial nephritis
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A393. Haptenation
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Q394. Nephrocalcinosis
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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)
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Q395. Causes of ATN
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A395. ischemia,; myoglobinuria,; toxins (mercuric chloride, aminoglycosides, ethylene glycol (oxalosis))
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Q396. 2 phases
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A396. oliguric phase : worry hyperkalemia (deadly arrhythmia); recovery phase : vigorous diuresis
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Q397. Causes of renal papillary necrosis
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A397. DM (infection and vascular disease); Acute pyelonephritis; Chronic phenacetin use (acetaminophen, too); Sickle cell anemia
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Q398. In what condition can you see bleeding 2/2 platelet dysfunction, skin pigmentation, and fibrinous pericarditis?
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A398. uremia
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Q399. What conditions are associated with dominant mutations of APKD1.
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A399. polycystic liver disease,; berry aneurysms,; mitral valve prolapse,; secondary polycythemia
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Q400. What are dialysis cysts?
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A400. cortical and medullary cysts resulting from long-standing dialysis. Increased risk of renal cancer.
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Q401. Which has a better prognosis: medullary cystic disease or medullary sponge kidney?
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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.
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Q402. What do thiazides do to urinary calcium?
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A402. They decrease urinary calcium excretion!; They retain calcium!; Good for idiopathic hypercalciuria.
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Q403. What drug do you use for nephrogenic DI?
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A403. THIAZIDES!
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Q404. enlarged, hypercellular glomeruli, PMNs, lumpy bump EM; subepithelial humps; granular pattern
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A404. PSGN
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Q405. Crescentic GN
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A405. RPGN; I: goodpasture's; II: Post strep in 50% of all cases, Lupus IV; III: Pauci immune (ANCA)
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Q406. subendothelial humps; tram tracking
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A406. Membranoproliferative GN; tram tracks are the reduplication of the GBM ("proliferative of the membrane")
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Q407. mesangial deposits of IgA; no complement
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A407. Berger's disease
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Q408. defect in alpha-5 type IV collagen
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A408. Alports; sensorineural deafness,; hematuria,; anterior lenticonus
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Q409. Membranous GN (nephritis/nephropathy); Associations?
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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
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Q410. normal glomeruli, foot process effacement, lipid laden renal cortices
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A410. minimal change disease; responds well to steroids
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Q411. segmental sclerosis and hyalinosis; clinically similar to minimal change
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A411. FSGS
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Q412. subendothelial and mesangial deposits of apple green birefringent material... what diseases are associated?
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A412. Amyloidosis. Myeloma; Chronic inflammation; TB; Rheumatoid arthritis
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Q413. Lupus glomerulonephropathy; I; II; III; IV; V
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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
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