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261 Cards in this Set
- Front
- Back
|
vertebral level of kidney
|
t12-l2
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what part of kidney makes basement membrane
|
visceral epithelium
|
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|
describe the flow of blood from the renal a to the renal v
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renal a -> interlobar a -> arcuate a -> interlobular a -> afferent a -> glomerulus -> efferent a -> peritubular capillaries -> interlobular v -> arcuate -> interlobar -> renal v
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|
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relationship of external iliac to internal iliac
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medial to gonadal av, lateral to internal iliac
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|
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describe the distribution of water in the different body compartments
|
60% of body is water, 40% in ICF, 20% in ECF. 1/4 of ECF is plasma, rest is interstitial space
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osmolarity of body solution
|
290
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how can you measure plasma volume
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radiolabeled albumin, RISA, evans blue
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how can you measure extracellular volume
|
inulin, mannitol, sulfate
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what forms the size barrier in glomerular filtration
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fenestrated capillary endothelium
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what forms the charge barrier in glomerular filtration
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fused basement membrane with heparan sulfate (has a negative charge)
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does creatinine overestimate or underestimate the GFR
|
overestimate
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does the ERPF over or underestimate the RPF
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underestimate by 10%
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how is renal blood flow regulated
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autoregulation by 1) myogenic mechanism 2) tubuloglomerular feedback
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what is a normal filtration fraction
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20%
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effect of increased filtration fraction on glomerulotubular balance
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increased ff will lead to
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what factors can dilate afferent arteriole
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prostaglandin, dopamine, NO
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what factors can constrict the efferent arteriole
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ATII
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when does glucosuria begin. When are glucose transporters fully saturated
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200. 350
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what is splay
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difference between transporter threshold and full saturation is due to difference in nephrons
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what is hartnup's disease
|
difficiency of tryptophan transporter in GI and kidney
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what hormones can act on the PCT
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PTH, ATII
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action of ATII on PCT
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stimulates Na/H exchange
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draw out nephron physiology
|
p461
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action of PTH on PCT
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1. inhibits Na/PO4, which results in phosphate and bicarb excretion 2. activates 1alpha hydroxylase
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early PCT vs late PCT
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late PCT also has Cl absorption
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what is the main pump in the TAL
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Na K 2CL (NKCC)
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what is the potential difference in the lumen of the TAL, and what is the ion that creates it
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positive, K
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what hormones can act on the DCT
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PTH
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effect of PTH on the DCT
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increased Ca/Na pump
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|
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what hormones can act on the CT
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aldosterone, ADH
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effect of aldosterone on the CT
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increased Na/K pump (principal cell), increased H+ ATPase (intercalated cell)
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management for person with tachycardia, decreased blood pressure, long capillary refill who complains of feeling faint after working outside
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give saline until euvolemic, then give hypotonic solution
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increased GFR will result in more or less absorption
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more (glomerulotubular balance)
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decreased ECF volume will result in more or less absoprtion
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more (glomerulotubular balance)
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know relative concentrations along PCT graph
|
p462
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|
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rank the following by most secreted to most absorbed: glucose, amino acids, inulin, urea, Cl,Pi, K, Na, HCO3, creatinine, PAH, Osm
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PAH>creatinine>inulin>urea>Cl>K>Na>Osm>Pi>HCO3>AA>Glucose
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effect of ATII on baroreceptor
|
limits reflex bradycardia
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effect of ANP
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1. relaxes vascular smooth muscle 2. increases GFR (arteriolar manipulation) 3. decreases sodium reabsoprtion
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what cells secrete epo
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endothelial cells of peritubular capillaries
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|
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what cells secrete vitamin D
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PCT
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what can cause K shift into cell
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insulin, beta adrenergic, alkalosis, hypo-osmolarity
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effect of digitalis on intracellular K
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blocks Na/K, so increased extracellular
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effect of low k+
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u wave on ckg, flattened T, arrythmia, paralysis
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effect of high k
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peak t wave, wide QRs, arrythmia
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effect of low ca
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tetany, neuromuscular irritability
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effect of high ca
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delirium, renal stone, abdominal pain, short QT
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sx of low Mg
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neuromuscular irritiblity, arythmia
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sx of high mg
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decreased DTR, cardiopulmonary arrest
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sx of low phosphate
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bone loss, low atp
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causes of increased K
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iatrogenic, CRF, K+ sparing diuretic, ACEi
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draw out acid-base physiology
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p465
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|
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what is the henderson hasselback eq
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ph = pka + log acid/base; for acid-base: [h][hco3]/Pco2=24
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what are the causes of anion gap metabolic acidosis
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MUDPILES = methanol, uremia, DKA, paraldehyde/phenformin, iron/INH, lactic acidosis, ethylene glycol, salicylate
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|
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describe the acid base state in: airway obstruction
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respiratory acidosis
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describe the acid base state in: diarrhea
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metabolic acidosis
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describe the acid base state in: glue sniffing
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metabolic acidosis
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describe the acid base state in: renal tubular acidosis
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metabolic acidosis
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describe the acid base state in: diuretic use
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metabolic alkalosis
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describe the acid base state in: hyperaldosteronism
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metabolic alkalosis
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describe the acid base state in: pregnancy
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respiratory alkalosis
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describe the acid base state in: anxiety
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respiratory alkalosis
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describe the acid base state in: early salicylate toxicity
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respiratory alkalosis
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effect of acid on calcium levels
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acid kicks calcium off -> increased calcium
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osmol gap equation
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2*Na + glucose / 18 + urea / 2.8
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what anions are important for anion gap
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Na - (Cl + HCO3)
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defect in rta1
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distal - CT cannot excrete H+, oft caused by hypokalemia
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defect in rta2
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proximal - PCT cannot reabsorb bicarb. Assoc w/ hypokalemia (k+ binds HCO3) and hypophosphatemic rickets
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complication of rta1
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calcium stones
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defect in rta4
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hyperkalemic -- lack of response to aldosterone. Assoc w/ hyperkalemia and inhibition of ammonion excretion in prox tubule
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causes of rbc casts
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glomerulonephritis, ischemia, malignant htn
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causes of wbc casts
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TIN, acute pyelo, transplant rejection
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muddy brown granular cast
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acute tubular necrosis
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|
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review definitions of nomenclature of glomerular dz
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p466
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what is fanconi's syndrome
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PCT malabsoprtion (of everything incl amino acids, phosphate, etc) due to wilson's, glycogen storage dz, heavy metal, drugs (cisplatin, tetracycline)
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LM findings in poststreptococcal nephritis
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hypercellular glomeruli w/ neutrophils, "lumpy bumpy"
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which glomerular dz has supepithelial deposits
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poststreptococcal, membranous nephritis
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which glomerular dz has subendothelial deposits
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diffuse proliferative glomerulonephritis, membranoproliferative glomerulonephritis
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nephritic or nephrotic: azotemia
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nephritic
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nephritic or nephrotic: oliguria
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nephritic
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nephritic or nephrotic: htn
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nephritic
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nephritic or nephrotic: proteinuria
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both, but nephrotic has >3.5g/day
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what do crescents consist of in crescentic glomerulonephritis
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fibrin & plasma proteins (complement), parietal cells, mononuclear infiltrate
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what dzz can have rapidly progressive glomerulonephritis
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goodpasture, wegener, microscopic polyangiitis, SLE
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wire looping of capillaries
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diffuse proliferative glomerulonephritis (SLE)
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most common nephritic syndrome
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berger's dz
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where do Ics deposit in berger's dz
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mesangium
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what is iga nephropathy assoc w
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henoch schonlein
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mutation in alports syndrome
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type 4 collagen
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triad of alport
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eye + ear + nephritic syndrome
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which dzz will have lower levelsl of complement
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poststreptococcal, SLE, membanoproliferative
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nephritic or nephrotic: fatty casts
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nephrotic
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nephritic or nephrotic: hyperlipidemia
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nephrotic
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nephritic or nephrotic: edema
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nephrotic
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nephritic or nephrotic: thromboembolism
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nephrotic
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nephritic or nephrotic: infection
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nephrotic
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what can cause membranous glomerulonephritis
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drugs, infection, SLE, tumor
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MCC adult nephrotic
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membranous
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spike and dome EM
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membranous
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glomerular dz triggered by infection
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minimal change, poststreptococcal, iga nephropathy
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foot process effacement on EM
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minimal change
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selective loss of albumin only
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minimal change
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pathogenesis of diabetic glomerulonephropathy
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NEG of GBM -> increased permeability; NEG of efferent arterioles leads to increased GFR. Hyperfiltration and nodular glomerulosclerosis
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glomerular dz assoc w hiv
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focal segmental
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glomerular dz assoc w sickle cell
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focal segmental
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glomerular dz assoc w heroin use
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focal segmental
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which glomerular dz have useful IF
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membranous, streptococcal, crescentic, diffuse proliferative, berger's
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type 1 vs type 2 membranoproliferative
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1. type 1 = tram track, type 2 = dense deposits 2. type 1 = assoc with heptatitis, cryoglobulin, IE; 2 = C3 nephritic factor 3. Type 1 has Ig, Type 2 doesn't have Ig
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does nephrotic syndrome always have antibodies
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no
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review glomerular histopathology
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p468
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rank the kidney stones in terms of frequency
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calcium, struvite, uric acid, cysteine
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which kidney stones are radioopaque
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calcium, struvite, cyesteine
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which kidney stones worsen with alkaline? Acid?
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struvite is worse with alkaline. Cysteine, and uric acid is worse with acid
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what substances can increase oxalate cyrstal formation
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ethylene glycol, vitamin C
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what can help to manage calcium stone
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hydration
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components of struvite stone
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ammonium, mg, phosphate
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where are the renal tubules most acidic
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DCT, CT
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what test can use to dx cysteinuria
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cyanide nitroprusside test
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shape of cysteine crystal
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hexagon
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where does RCC originate from
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PCT (i.e. in cortex)
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epidemiology of RCC
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male, elderly
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risk factors for RCC
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smoking, obesity
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cbc in rcc
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increased epo -> polycythemia
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what paraneoplastic can rcc secrete
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epo, acth, PTHrP, prolactin
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mechanism of spread for rcc
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invasion of IVC, hematogenous spread
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where can rcc spread
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lung, bone
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RCC is associated with what dzz
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vhl (deletion on chromosome 3), ADPKD
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histology of wilm's tumor
|
embryonic glomerular structures
|
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gene defect in wilm's tumor
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WT1, chromosome 11
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WAGR complex
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wilm's tumor, aniridia, GU malformation, mental-motor retardation
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is wilm's tumor unilateral or bilateral
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unilateral
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risk factors for TCC
|
Pee SAC - phenacetin, smoking, aniline dyes, cyclophosphamide
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what area of kidney is most affect by acute pyelonephritis
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cortex, spares glomeruli, vessels
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structural changes in chronic pyelonephritis
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asymmetric corticomedullary scarring underneath blunted calyx w/ thyroidized tubules
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what types of cells are seen in drug induced interstitial nephritis
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eosinophils
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what can minimize drug nephrotoxicity
|
intensive IV hydration
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what drugs can cause TIN
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diuretic, NSAID, penicillin, sulfonamide, rifamin
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cause of diffuce cortical necrosis
|
vasospasm and DIC from obstretic issues and spetic shock
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when does death occur most often in ATN
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oliguric phase
|
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3 stages of ATN
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1. inciting event 2. maintenance (oliguria + hyperkalemia, potential uremia) 3. recovery (vigorous diureses, hypokalemia, hypovolemia)
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ischemic ATN vs toxic ATN
|
ischemic ATN can cause permanent damage because it can destroy the BM
|
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causes of ATN
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1. renal ischemia 2. crush injury 3. toxins (eg aminoglycoside -- so calculate dosage based on GFR, or IV dye and metformin)
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what can cause renal papillary necrosis
|
1. dm 2. acute pyelo (abscess formation) 3. chronic phenacetin use or aspirin 4. sickle cell
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where do kidney infarcts tend to affect
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cortical infarct, coagulative necrosis
|
|
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what is nephrocaclinosis
|
hypercalcemia can cause metastatic calcificaiton of BM of CT which leads to inability to concentrate urine and polyuria
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what can cause intrinsic AKD
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ATN, glomerulonephritis
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can you get postrenal AKD with unilateral ureter obstruction
|
no
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|
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prerenal AKD: urine osmolality, urine na, FENa, Serum BUN/Cr
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>500, <10, <1%, >20
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|
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intrinsic AKD: urine osmolality, urine na, FENa, Serum BUN/Cr
|
<350, >20, >2%, <15
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postrenal AKD: urine osmolality, urine na, FENa, Serum BUN/Cr
|
<350, >40, >4%, >15
|
|
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review consequences of renal failure
|
p471
|
|
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lipid profile for CKD
|
increase TG, decrease HDL
|
|
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cause of death in AKPKD
|
complications of CKD, HTN
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what is AKPKD assoc w
|
berry aneurysm, polycystic liver dz, MVP
|
|
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what kidney dz is assoc w congenital hepatic fiborisis
|
ARPKD
|
|
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size of cysts in ARPKD vs ADPKD
|
ARPKD = small bilateral cysts. ADPDK = large bilateral cysts
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|
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where do cysts from dialsys occur
|
cortex and medulla
|
|
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in what population do simple cysts occur
|
benign and common. Fluid filled, but may look like rcc
|
|
|
complication of medullary cystic dz
|
fibrosis and progressive kidney failure
|
|
|
prognosis of medullary cystic dz
|
poor
|
|
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medullary sponge kidney dz histology
|
cystic dilation of one or more collecting ducts
|
|
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risk of what in medullary sponge kidney
|
risk of ctones, assoc with nephrocalcinosis
|
|
|
what diuretic can be used for cranial edema
|
mannitol
|
|
|
what drug can be used to tx drug overdose
|
mannitol
|
|
|
CI of mannitol
|
CHF, anuria
|
|
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what drug can be used to alkalinize urine
|
acetazolamide
|
|
|
what diuretic can cause pulmonary edema
|
mannitol
|
|
|
what drug can be used for altitude sickness
|
acetazolamide
|
|
|
what drug can cause neuropathy
|
acetazolamide
|
|
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what drug can cause nh3 toxicity
|
acetazolamide
|
|
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what drug is sulfa-reactive
|
acetazolamide, furosemide, HCTZ
|
|
|
what is the most potent diuretic
|
loop diuretic
|
|
|
mechanism of loop diuretic
|
blocks NKCC pump
|
|
|
what drug has ototoxicity
|
furosemide
|
|
|
what drug can cause nephritis
|
furosemide
|
|
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what is bumetanide, and is it more or less potent than others
|
loop, more potent
|
|
|
what is ethacrynic acid
|
loop diuretic, but not sulfa
|
|
|
what drug can cause hyperuricemia
|
HCTZ, furosemide
|
|
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what drug can cause hypokalemia
|
loop, thiazide
|
|
|
only diuretic that can result in net electrolyte secretion
|
thiazide
|
|
|
what is chlorthalidone
|
longest duration thiazide
|
|
|
what drug can cause alkalosis
|
loop, thiazide
|
|
|
what drug can cause acidosis
|
carbonic anhydrase inhib, k+ sparing
|
|
|
what drug can tx hypercalciuria
|
thiazide
|
|
|
what drug can tx nephrogenic DI
|
thiazide
|
|
|
what drug can cause hyperlipemia
|
thiazide
|
|
|
what drug can cause hyperglycemia
|
thiazide
|
|
|
what drug can be used in gout
|
ethacrynic acid
|
|
|
mechanism of spirinolactone
|
aldosterone antagonist
|
|
|
mechanism of tramterene, amiloride
|
blocks Na channels in CT (doesn't need aldosterone, so can be used in salt wasting dz)
|
|
|
what is eplerenone
|
K sparing diuretic
|
|
|
which drug improves mortality in CHF pts
|
spirinolactone
|
|
|
which drug can increase salt in urine
|
all diuretics
|
|
|
3 mechanisms of alkalemia in loop and thiazide diuretic
|
1. volume contraction increases ATII 2. hypokalemia causes cells to suck up protons 3. hypokalemia means hydrogen cannot be absorbed in CT ("paradoxical aciduria")
|
|
|
what enzyme helps to synthesize kallikrein that can be affected with ACEi
|
C1 esterase
|
|
|
effect of ACEi on GFR
|
decreases (can't constrict efferent)
|
|
|
which drug can cause hyperkalemia
|
K sparing, ACEi
|
|
|
CI for ACEi
|
pregnancy, renal artery stenosis
|
|
|
can ACEi cause proteinuria
|
yes
|
|
|
what intracellular signaling pathway does PTH use
|
cAMP
|
|
|
where does Mg reabsorption take place
|
PCT, TAL, DT. Mg and Ca compete for reabsorption in TAL
|
|
|
what amino acid is used to synthesize ammonia in kidney
|
glutamine
|
|
|
why does hypokalemia occur with most diuretics
|
fluid coming to DCT has higher sodium concentration, which causes increased Na/K exchange
|
|
|
what determines creatinine production physiologically
|
age, muscle mass
|
|
|
what is horseshoe kidney assoc w
|
turner
|
|
|
causes of toxic ATN
|
aminoglycoside, radiocontrast, heavy metal (lead, mercury)
|
|
|
causes of drug related TIN
|
methicillin, NSAID, rifampin, sulfonamides, furosemide
|
|
|
causes of chronic renal failure
|
DM, HTN, chronic glomerulonephritc, cystic renal dz
|
|
|
cystatin C
|
increased in CKD
|
|
|
predisposing factor malignant htn
|
benign nephrosclerosis
|
|
|
what is benign nephrosclerosis
|
htn that leads to hyaline arteriosclerosis - "grain leather" kidney
|
|
|
traid of malignant htn
|
bp > 210/120, encephalopathy/paiplledma, renal fail
|
|
|
petechiae visible on surface of kidney
|
malignant htn
|
|
|
sudden flank pain and hematuria in person with afib
|
renal infarct -- irregular, wedge shaped pale coagulation in cortex
|
|
|
what is congenital megaloureter assoc w
|
hirschsprung
|
|
|
what is ureteritis cystica
|
cysts from mucus and lumen, risk of adenocarcinoma
|
|
|
complication of exstrophy of bladder
|
adenocarcinoma
|
|
|
dysuria + frequency + urgency
|
lower UTI
|
|
|
what is gold std for UTI
|
>10^5 colonies/HPF
|
|
|
what is sterile pyuria
|
neutrophils in urine (chalmydia, renal TB, acute TIN)
|
|
|
causes of acute cystitis
|
ecoli, adenovirus, staph saphro, chlam
|
|
|
when do you tx asymptomatic uti
|
pregnancy, elderly woman
|
|
|
urethral caruncle
|
occurs in women, red mass at orifice
|
|
|
inability to void w/ full sensation of bladder, high riding boggy prostate, blood at urethral meatus
|
trauma to uretrha
|
|
|
what is phimosis
|
prepuce can't retract
|
|
|
what is balanoposthitis
|
infection of glans and prepuse
|
|
|
circumcision is protective against what
|
scc of penis
|
|
|
2 phases of descent of testes
|
1. transabdominal (down to pelvic brim which requires anti mullerian hormone) 2. inguinoscrotal (through inguinal canal - requires androgen and hcg)
|
|
|
complication of cryptorchidism
|
seminona, infertility, even in normal testes
|
|
|
complications of varicocele
|
infertility (warmth of pampinform plexus)
|
|
|
what age does testicular torsion occur
|
teen
|
|
|
sx of testicular torsion
|
1. abscent cremaster reflex 2. testes rises up in inginal canal
|
|
|
age range of seminoma
|
30's, >65
|
|
|
age range of embryonal carconoma
|
20-25
|
|
|
age range of yolk sac tumor
|
<4
|
|
|
age range of choriocarcinoma in male
|
20-30
|
|
|
age range of maligant lymphoma in male
|
>60
|
|
|
which male gonadal tumor might see gynecomastia
|
choriocarcinoma (cuz hcg is like lh), leydig cell tumor
|
|
|
is acute or chronic prostitis more common
|
chronic
|
|
|
mcc of chronic prostatitis
|
abacterial (eg trauma)
|
|
|
role of estrogen in BPH
|
estrogen thought to be co-mediator
|
|
|
causes of leydig cell dysfunction
|
alcohol, ckd, orchitis, radiation
|
|
|
for male infertility, how to distinguish leydig cell cause vs both leydig and sertoli
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if sertoli affect, will increase fsh. Both will have decreased sperm count
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causes of 2* hypogonadism
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decreased LH and testosterone. Growth delay, kallman, hypopituitary
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components of ejaculate
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sperm, coagulant from seminal vesicle, liquid from prostate
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causes of ED
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psycogenic, decreased testosterone, vascular insufficiency, neurologic, drugs, endocrine, penis dz
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what is bartter syndrome
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defect in nkcc. Increased renin, normotensive (cuz of increased prostaglandin), hypokalemia and hyponatremia and alkalosis
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neural control of bladder contraction
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sacral micturition center (S234). CEREBRAL CORTEX CAN INHIBIT
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neural control of bladder external sphincter
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pontine micturition center in reticular formation
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what are complications of kidney stones
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hydronephrosis
pyelonephritis |
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what drug can block pump located on macula densa
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loop diuretics
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describe the blood supply to the ureters from proximal to distal
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renal, gonadal, branches of aorta and iliac, uterine, vesical aa
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what muscle borders ureter posteriorly as it descends to the pelvic brim
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psoas m
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what 3 locations are most likely to have stones in ureter
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1. ureteropelvic junction 2. crossing at pelvic brim 3. most important -- ureterovesical junction
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as the ureter descends to the bladder, what vessel crosses it proximal to the pelvic brim
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gonadal vessels cross it anteriorly
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as the ureter goes to the pelvic brim, what vessels are seen nearby
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ureter passes anterior to bifurcation of common iliac
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unilateral vs bilateral renal a stenosis
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unilateral - atherosclerosis. bilateral - fibromuscular dysplasia -- common in middle age women
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size of kidney in medullary cystic kidney vs ADPKD
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ADPKD is large. medullary cystic is small
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are cysts in kidney common
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yes, more than 40% of elderly have benign cysts
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size of cysts in medullary sponge kidney
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small
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when does medullary sponge kidney present
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20's-30's
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what hormone is often increased in medullary sponge kidney
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pth
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