Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
172 Cards in this Set
- Front
- Back
|
When is the notocord developed embryologically?
|
2 weeks
|
|
|
When is the brain formed?
|
4 weeks
|
|
|
When is the renal system formed?
|
12 weeks
|
|
|
What gives rise to the kidneys?
|
metanephros
|
|
|
What gives rise to the entires collecting system?
|
ureteric bud
|
|
|
What must the ureteric bud make contact with in order for the kidneys to develop?
|
metanephros
|
|
|
What gives rise to male genitalia?
|
metanephros
|
|
|
What is another name for the metanephros?
|
Wolffian duct
|
|
|
What does the wolffian duct develop into?
|
testes, seminal vesicle, vas deferens, and epididymus
|
|
|
WHat gives rise to the female genitalia?
|
paramesonephros
|
|
|
What is another name for the paramesonephros?
|
Mullurian duct
|
|
|
What does the Mullurian duct develop into?
|
ovaries, fallopian tubes, uterus and upper vagina
|
|
|
What is need for male differentiation?
|
y chromosome and MIF
|
|
|
In males, what does the urogential sinus develop into?
|
prostate, prostatic urethra and bulbourethral (Cowper's) glands
|
|
|
In females, what does the urogential sinus develop into?
|
lower vagina and labia minora
|
|
|
In males, what does the urogential tubercle become?
|
the penis
|
|
|
In females, what does the urogential tubercle become?
|
the clitoris
|
|
|
What is the vertebral level of the kidneys?
|
L1-L2
|
|
|
Which kidney is lower- the right or left?
|
right
|
|
|
What is the outermost layer of the kidneys called?
|
cortex
|
|
|
What does the cortex contain?
|
nephrons, PCT, DCT
|
|
|
What is the center of the kidney called?
|
medulla
|
|
|
What is the medulla responsible for?
|
hypertonic urine
|
|
|
What is the cortex responsible for?
|
isotonic urine
|
|
|
Where does the right gonadal vein drain?
|
directly into the IVC
|
|
|
Where does the left gonadal vein drain?
|
into the left renal vein
|
|
|
Why does right sided infection or cancer have a worse prognosis?
|
because the right gonadal vein drains directly into the IVC and goes tot he heart
|
|
|
What percent of CO goes to the kidneys?
|
20%
|
|
|
What percent of kidney blood flow goes tot he cortex?
|
90%
|
|
|
What is the first place in the kidney to infarct during a low volume state?
|
medulla
|
|
|
What part of the kidney handle 80% of reabsorption?
|
PCT
|
|
|
What concentrates urine in the kidney?
|
collecting tubule
|
|
|
What is psychogenic DI caused by?
|
excessive fluid intake
|
|
|
What is central DI caused by?
|
no ADH
|
|
|
What is nephrogenic DI caused by?
|
no response to ADH
|
|
|
If you administer ADH and the urine become concentrated, what DI is it?
|
central DI
|
|
|
If you administer ADH and the urine is still dilute, what DI is it?
|
nephrogenic DI
|
|
|
For burn patients, once fluid replacement is calculated, how much fluid are they given in the first 8 hours?
|
1/2
|
|
|
How much are burned patients given in the next 16 hours?
|
1/2
|
|
|
How much do you give on the second day?
|
1/2 the calculated amount
|
|
|
How much do you give on the 3rd day?
|
nothing
|
|
|
Intracellular fluid accounts for what volume of body water?
|
2/3
|
|
|
Extracellular accounts for what volume of body water?
|
1/3
|
|
|
What is extracellular broken down into?
|
interstitial fluid and vascular fluid
|
|
|
What side of the blood vessel in the kidney does ADH act?
|
basolateral
|
|
|
Where does ADH act? What cell?
|
principle cell of the collecting duct
|
|
|
Where is renin secreted?
|
JG cells of the afferent arteriole in the kidney
|
|
|
What is the function of angiotensin 2?
|
vaso constricts, stimulates aldosterone release from adrenal fasiculata, stimulates ADH release from posterior pituitary and activates the CNS thirst center
|
|
|
Where is AT1 converted to AT2? By what enzyme?
|
in the lungs by ACE
|
|
|
What is Bartter's syndrome?
|
JG cell hyperplasia with renin excess
|
|
|
What defect in the kidney does Bartter's cause?
|
defect in ability to reabsorb K- causes K wasting
|
|
|
What is the treatment of diabetic ketoacidosis?
|
normal saline, insulin, k
|
|
|
Where is magnesium reabsorbed?
|
in the jejunum
|
|
|
When trying to asses acid/base disorder, what do you look at first? Second?
|
first- pH
second- HCO3- |
|
|
How do you calculate anion gap?
|
Na - (Cl + HCO3)
|
|
|
What is the pneumonic for an increased anion gap?
|
MUD PILES
m- methanol u- uremia d- DKA p- paraldehyde or phenformin i- iron tablets or INH l- lactic acidosis e- ethylene glycol s- salicylates |
|
|
When do you check anion gap?
|
in metabolic acidosis
|
|
|
What is a normal anion gap?
|
8-12
|
|
|
Metabolic acidosis with a normal anion gap is associated with what?
|
diarrhea, renal tubular acidosis, hyperchloremia
|
|
|
What 2 diuretics block carbonic anhydrase?
|
acetazolamide and dorzolamide
|
|
|
Where does acetazolamide and dorzolamide act?
|
PCT
|
|
|
What diuretic increases preload?
|
mannitol
|
|
|
What are the loop diuretics?
|
ethacrynic acid and furosemide
|
|
|
What do the loop diuretics block?
|
Na, K, Cl pump
|
|
|
What diuretics work in the DCT?
|
hydrochlorothiazide and indapamine
|
|
|
What does hydrochlorothiazine and indapamine block?
|
Na Cl pump in the DCT
|
|
|
What diuretics work in the principle cell? Block?
|
spironolactone, amiloride, trianterene
block- Na, K pump |
|
|
What diuretic can you give to obese patients?
|
indapamine
|
|
|
What is the major side effect of hydrochlorothiazide?
|
hypokalemia
|
|
|
What are the major side effects of loop diuretics?
|
K wasting, metabolic acidosis, hypotension, ototoxicity
|
|
|
What is the major side effect of acetazolamide?
|
acidosis
|
|
|
What is the major side effect of furosemide?
|
ototoxicity, hypokalemia, dehydration, allergy, nephritis, gout "OH DANG"
|
|
|
In acute renal failure, what do you see an increase in?
|
creatinine, BUN and/or decreased urine output
|
|
|
Oliguria is urine output less than what?
|
400 cc/day
|
|
|
Anuria is urine output less than what?
|
100 cc/day
|
|
|
A pre-renal problems are caused by what?
|
anything that decreases blood flow to the kidney
|
|
|
In pre-renal, what is the BUN/Cr ratio?
|
> 20/1
|
|
|
In pre-renal failure, what is the urine Na?
|
< 10
|
|
|
In pre-renal, what is the urine OSM?
|
> 500
|
|
|
Renal problems are caused by what?
|
autoimmune, toxins or drugs
|
|
|
What drugs cause renal problems?
|
gentamicin, amphoteracin B, Cisplatin
|
|
|
In a renal problem, what is the BUN/Cr ratio?
|
< 20/1
|
|
|
What is urine Na levels in renal problems?
|
> 20
|
|
|
What is the specific gravity of urine in renal problems?
|
low specific gravity, can't concentrate urine
|
|
|
What causes post-renal problems?
|
a blockage past the kidneys
|
|
|
What is a clue to glomerulonephritis?
|
red cast- infection
|
|
|
What test can distinguish between a pre-renal and renal problem?
|
FeNa +
|
|
|
What is FeNa in pre-renal?
|
< 1%
|
|
|
What is FeNa in renal?
|
> 2%
|
|
|
If the vignette says eosinophils were found in urinalysis, what is the answer?
|
drug induced hypersensitivity- mcc is cephalosporins
|
|
|
If the urinalysis has RBC casts, what is the answer?
|
glomularnephritis
|
|
|
If the urinalysis has WBCs and bacteria, what is the answer?
|
infection
|
|
|
Bence jones and proteinuria indicate what disease?
|
multiple myeloma
|
|
|
If a blood dipstick is +, but there are no RBCs in urine, what is the problem?
|
myoglobinuria
|
|
|
If proteinuria is >3.5, what is the diagnosis?
|
nephrotic syndrome
|
|
|
What does fat casts indicate?
|
nephrotic syndrome
|
|
|
If proteinuria is < 3.5, what is the diagnosis?
|
nephritic syndrome
|
|
|
With the edema push test, what disease does a +1-+2 mean?
|
nephritic
|
|
|
With the edema push test, what does a +3-4 mean?
|
nephrotic syndrome
|
|
|
A BUN > 40 indicates what?
|
pericarditis
|
|
|
What are the 5 nephritic syndromes?
|
Post Strep GN, Good Pasture, RPGN, IgA Nephropathy, Membranoproliferative GN
|
|
|
What is the mcc of nephrotic syndrome in children?
|
minimal change disease
|
|
|
What is the mcc of nephrotic syndrome in adults?
|
membraneous nephropathy
|
|
|
What is the mcc of nephrotic syndrome in blacks and hispanics?
|
focal segmental GN
|
|
|
What are the 5 nephrotic syndromes?
|
membranous GN, minimal change disease, focal segmental GN, amyloidosis, nodular glomular sclerosis
|
|
|
What is common in the names of ACE inhibitors?
|
all end in 'pril'
|
|
|
How do ACE inhibitors work?
|
block aldosterone
|
|
|
What do ACE inhibitors have in them that can cause anaphylaxis?
|
sulfur
|
|
|
What are the 3 most common ACE inhibitors?
|
captopril, lisenopril, enalopril
|
|
|
Besides anaphylaxis, what else can ACE inhibitors cause?
|
angioedema
|
|
|
What are the serum levels of Na, K, and H when a patient is on ACE inhibitors?
|
decreased Na, increased K, and decreased H+
|
|
|
What is used to estimate GFR?
|
creatinine clearance
|
|
|
What is used in the lab to calculate GFR?
|
inulin
|
|
|
Where is blood flow and plasma flow in the kidney?
|
blood flow is in the afferent and plasma flow is in the efferent
|
|
|
Can proteins normally be filtered through the kidney?
|
no
|
|
|
What percent is normal kidney filtration?
|
20%
|
|
|
What is the filtered fraction?
|
fraction of material that enters the kidney that is filtered normally
|
|
|
What is the filtered fraction (FF) equation?
|
FF = GFR/RPF
|
|
|
What happens to filtration fraction if you constrict the efferent arteriole?
|
FF increases
|
|
|
How is PAH handled in the kidney?
|
it is partially filtered and fully secreted
|
|
|
What two substances are filtered and not secreted or reabsorbed?
|
inulin and mannitol
|
|
|
What is the equation for clearance?
|
Clearance of x = [Ux] * V/ [Px]
|
|
|
What does each kidney measure?
|
about 3-7 inches
|
|
|
If the kidneys are too small, what do you expect?
|
renal artery stenosis
|
|
|
If the kidneys are too large, what do you suspect?
|
polycystic kidney disease, medullary sponge kidneys, or medullary cystic kidneys
|
|
|
What is the mcc of secondary hypertension?
|
renal artery stenosis
|
|
|
Adult type polycystic kidney disease is what inheritance?
|
AD
|
|
|
Infantile type polycystic kidney disease is what inheritance?
|
AR
|
|
|
Adult type polycystic kidney disease if different from infantile type polycystic kidney disease how?
|
in adult- bilateral, HTN, RF
infantile- unilateral, NO HTN, NO RF |
|
|
What are the 3 common narrowings in the ureter?
|
hilum, mid ureter (caused by going over the iliac bones), ureteropelvic junction
|
|
|
What is the most common type of kidney stones?
|
calcium
|
|
|
What is the most common cause of calcium kidney stones?
|
hypercalciuria
|
|
|
What is the treatment for kidney stones?
|
normal saline, opiates, thiazides
|
|
|
What is a big clue to a kidney stone?
|
flank cholicky pain
|
|
|
What kidney stones can't be passed?
|
struvite stones- look like moose horns
|
|
|
What is the pneumonic for urease + bugs? What are they?
|
P PUNCHES B
p- proteus p- pseudomonas u- ureoplasma n- nocardia c- cryptococcus h- h. pylori s- staph saprophyticus b- brucellosis |
|
|
What are the only kidney stones you can't see on xray?
|
uric acid stones
|
|
|
What are uric acid stones associated with?
|
rapid cellular death
|
|
|
What 4 things cause cystinuria?
|
cystein, ornithine, lysine, arginine
|
|
|
Cystine kidney stones are what inheritance?
|
AD
|
|
|
What do cystine kidney stones look like?
|
coffin lid
|
|
|
Oxalate stones are caused by what?
|
malabsorption in the GI
|
|
|
What opiate do you give for kidney stones?
|
morphine
|
|
|
What opiate do you give for abdominal pain? Why?
|
meperadine- no contraction of the sphincter of Odi
|
|
|
if a kidney stone is less than 5 mm, what is treatment?
|
let it pass
|
|
|
If the kidney stone is 5 mm to 1 cm, what is treatment?
|
lithotripsy- whorl pool
|
|
|
If a kidney stone is > 1 cm, what is treatment?
|
cut them out- open laparotomy
|
|
|
Hydronephrosis in the newborn is caused by what?
|
malimplantation of the ureters
|
|
|
Hydronephrosis in children is caused by what?
|
UTIs
|
|
|
Hydronephrosis in adolescents is caused by what?
|
urethral strictures (from STDs)
|
|
|
Hydronephrosis in adult men is caused by what?
|
BPH
|
|
|
Hydronephrosis in adult women is caused by?
|
uterine prolapse and cystocele
|
|
|
If there is semen found in the urine, what does that mean?
|
the posterior urethral valve is destroyed
|
|
|
What is the most common cause of urinary obstruction in adult men?
|
BPH
|
|
|
Where is the obstruction with BPH?
|
central- periurethral
|
|
|
What is the treatment for BPH?
|
terazosin or doxazosin to loosen sphincter (alpha 1 blockers)
tamsulosin has the least side effects 2 nd line is fenestride- blocks 5 alpha reductase |
|
|
Unilateral hydronephrosis is caused by what?
|
kidney stones
|
|
|
Bilateral hydronephrosis is caused by?
|
retroperitoneal fibrosis
|
|
|
What is a clue to select urachal cyst?
|
urine drains from the umbilicus
|
|
|
What is the mcc of abdominal aortic aneurism?
|
atherosclerosis
|
|
|
Where do 90% of abdominal aortic aneurisms occur?
|
below renal arteries
|
|
|
If an abdominal aortic aneurism is less than 4 cm, what is the treatment?
|
control HTN, follow up
|
|
|
If an abdominal aortic aneurism is > than 6 cm, what is the treatment?
|
control HTN, surgery
|
|
|
In urge incontinence, what muscle activity is increased?
|
detrusser muscle
|
|
|
What is the popular slogan for urge incontinence?
|
gotta go, gotta go, gotta go
|
|
|
What is the treatment for urge incontinence?
|
imipramine- children- TCA
oxybutynin- adults- blocks Ach |
|
|
What is stress incontinence due to?
|
weak pelvic floor muscles
|
|
|
What hormone has a connection to stress incontinence?
|
estrogen
|
|
|
What causes a sudden loss of urine in stress incontinence?
|
any increase in abdominal pressure- laughing, sitting down, etc
|
|
|
What is the most common cause of stress incontinence?
|
obesity, estrogen
|
|
|
What is the treatment for stress incontinence?
|
weight loss, Kegle exercises to tighten pelvic floor muscles, pseudoephedrine to tighten up sphincter
|
|
|
What is the treatment for chlamidia and gonorrhea?
|
azythromycin
ceftriaxone cefixeme cefoxitin |
