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131 Cards in this Set

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First sign tubule cell dysfunction
inability to concentrate urine
Fixed specific gravity
chronic renal failure; cannot concentrate or dilute urine
Negative urine bilirubin + trace urobilinogen
normal urine
Positive urine bilirubin, absent urobilinogen
obstructive jaundice
Positive urine bilirubin + increased urobilinogen
hepatitis
Negative urine bilirubin + increased urobilinogen
extravascular hemolytic anemia
Positive urine nitrite + positive urine leukocyte esterase
urinary tract infection
Sterile pyuria
positive urine leukocyte esterase but negative standard culture; TB, C. trachomatis
Prerenal azotemia
inc BUN and creatinine; dec renal blood flow (e.g., heart failure, hypovolemia)
Renal azotemia
inc BUN and creatinine due to intrinsic renal disease (acute tubular necrosis)
Postrenal azotemia
inc BUN and creatinine due to obstruction to urine flow
Serum BUN:creatinine ratio
< 15:1 (renal failure); > 15:1 (prerenal or postrenal azotemia)
BUN 80 mg/dL:creatinine 8 mg/dL
ratio 10/1- renal failure
BUN 80 mg/dL:creatinine 2 mg/dL
ratio 40/1- prerenal azotemia or postrenal azotemia
Creatinine clearance
measures GFR
Proteinuria
important sign of renal dysfunction
RBC casts
nephritic type of glomerulonephritis
WBC casts
acute pyelonephritis, acute tubulointerstitial nephritis
Fatty casts with Maltese crosses
nephrotic syndrome
Hyaline casts
normal unless associated with proteinuria
Renal tubular cell casts
acute tubular necrosis
Waxy or broad casts
chronic renal failure
Cystinuria
hexagonal crystals
Horseshoe kidney
Turner's syndrome; lower poles fused
Renal dysplasia
MC childhood cystic disease; abnormal development; flank mass
MC childhood cystic disease; abnormal development; flank mass
fetal juvenile polycystic kidney disease; Potter's facies in newborn
fetal juvenile polycystic kidney disease; Potter's facies in newborn
AD; hypertension MC sign; cerebral berry aneurysms
Visceral epithelial cells
synthesize basement membrane
Glomerular BM
negative charge due to heparan sulfate
Nephritic syndrome
oliguria; RBC casts; hypertension; mild to moderate proteinuria
Nephrotic syndrome
proteinuria > 3.5 g/day; ascites and pitting edema; fatty casts; fusion of podocytes
Immunofluorescence
linear (anti-glomerular BM antibodies); granular (IC deposition)
IgA GN
MC GN; usually nephritic; episodic hematuria; mesangial IC (IgA-anti-IgA) deposits
Post-streptococcal GN
nephritic; subepithelial deposits; skin/pharyngeal infections; anti-DNAase B SLE
type IV GN
nephritic; subendothelial deposits; anti-DNA antibodies
Crescentic GN
crescents from parietal cell proliferation; worst GN; Goodpasture's, Wegener's
Goodpasture's:
nephritic; anti-BM antibodies (glomerular + pulmonary capillary); crescentic GN
S/S of Goodpasture's:
young male with hemoptysis progressing to renal failure
Minimal change disease (lipoid nephrosis)
MCC childhood nephrotic syndrome
Lipoid nephrosis
podocyte fusion; loss of negative charge in glomerular BM
Focal segmental glomerulosclerosis
nephrotic syndrome; AIDS and IV heroin abuse
Membranous GN
MCC adult nephrotic syndrome; subepithelial deposits; epimembranous spikes
Causes of membranous GN
HBV, ACE inhibitors, cancer
Type I Membranoproliferative GN
nephrotic; subepithelial deposits; HCV association; tram tracks
Type II Membranoproliferative GN:
nephrotic; C3 nephritic factor; intramembranous ICs (dense deposit disease)
DM nodular glomerulosclerosis
microalbuminuria first sign
DM glomerulosclerosis
nodules with collagen in mesangium; hyaline arteriolosclerosis of arterioles
ACE inhibitors DM glomerulosclerosis
inhibit angiotensin II vasoconstriction of efferent arterioles
Alport's syndrome
XD hereditary nephritis with sensorineural hearing loss
Ischemic ATN
prerenal azotemia MCC; renal tubular cell casts; BUN:creatinine ratio < 15:1
Ischemic ATN
disruption of BM in proximal tubule and thick ascending limb
Nephrotoxic ATN
aminoglycosides, IVP dye, Pb/mercury poisoning
aminoglycosides, IVP dye, Pb/mercury poisoning
proximal tubule dysfunction; intact BM
Oliguria
prerenal azotemia, ATN, glomerulonephritis, postrenal azotemia
Acute pyelonephritis
vesicoureteral reflux with ascending infection; WBC casts, fever, flank pain
Chronic pyelonephritis
U-shaped scars overlying blunt calyces
Drug-induced tubulointerstitial nephritis
type I/IV reaction; e.g., penicillin
S/S of Drug-induced tubulointerstitial nephritis
ARF, fever, rash, eosinophilia, eosinophiluria, WBC casts
Analgesic for nephropathy
aspirin plus acetaminophen; renal papillary necrosis; IVP with ring defect
Myeloma kidney
BJ protein produces foreign body reaction in tubules
Urate nephropathy
prevent by giving allopurinol prior to chemotherapy
Chronic renal failure
fixed specific gravity; BUN:creatinine < 15:1; waxy and broad casts
Renal osteodystrophy Chronic renal failure
hypovitaminosis D (no 1-a-hydroxylase) produces osteomalacia
Renal osteodystrophy Chronic renal failure
osteoporosis from metabolic acidosis
Renal osteodystrophy Chronic renal failure
secondary HPTH with increased osteoclastic activity
S/S of Chronic renal failure
pericarditis, prolonged bleeding time, normocytic anemia, pathologic fractures
Benign nephrosclerosis
kidney of hypertension; shrunken kidneys due to hyaline arteriolosclerosis
Malignant hypertension
renal failure; encephalopathy; BP >210/ >120 mmHg; IV nitroprusside
Renal findings in malignant hypertension
necrotizing arteriolitis; "flea bitten" kidney; hyperplastic arteriolosclerosis
Renal infarction
pale infarcts; hematuria; common in polyarteritis nodosa
Hydronephrosis
renal stone MCC; atrophy of cortex/medulla; postrenal azotemia
Renal stones
most contain calcium (calcium oxalate/phosphate); hypercalciuria MC risk factor
S/S of renal stones
colicky pain radiating into groin, hematuria; x-ray usually shows stone
Staghorn calculus
due to urease producing organisms (Proteus); alkaline urine pH; ammonia smell
Angiomyolipoma
hamartoma; associated with tuberous sclerosis
Renal cell carcinoma
smoking MCC; invasion renal vein/vena cava; lung, bone mets; yellow colored
S/S of Renal Cell carcinoma
flank mass, hematuria; ectopic hormones (EPO, PTH related peptide), left-sided varicocele
Renal pelvis transitional cell carcinoma
smoking MCC, phenacetin, aniline dyes, cyclophosphamide
Wilm's tumor
hypertension, unilateral abdominal mass in child; aniridia/hemihypertrophy in AD types
Urine draining from umbilicus
persistent urachus
Retroperitoneal fibrosis
produces hydronephrosis
Bladder extrophy
abdominal wall defect + epispadias
Bladder diverticula
most commonly due to prostatic hyperplasia with urethral obstruction
Acute cystitis
E. coli; females > males; no fever, flank pain, or WBC casts
Bladder transitional cell carcinoma
smoking MCC, aniline dyes, cyclophosphamide; papillary
S/S of Bladder transitional cell carcinoma
hematuria; hydronephrosis
Bladder adenocarcinoma
risk factors- persistent urachus, extrophy
Bladder squamous cell carcinoma
Schistosoma hematobium infection
Hypospadias
ventral opening on penis due to failure closure of urethral folds
Epispadias
dorsal opening on penis due to defect in genital tubercle
Peyronie's disease
painful curvature penis due to fibromatosis
Priapism
persistent/painful erection; HbSS
Squamous cell carcinoma penis
HPV and lack of circumcision most important risk factors
Cryptorchidism
undescended testis; risk for seminoma applies to cryptorchid testis and normal testis
Orchitis
mumps usually unilateral (infertility uncommon)
Epididymitis
< 35: N. gonorrhoeae, C. trachomatis; > 35 E. coli, P. aeruginosa
S/S of Epididymitis
scrotal pain relieved by elevation of scrotum (Prehn's sign)
Varicocele
left-sided scrotal mass; spermatic vein drains into left renal vein; infertility common
Varicocele
may be due to invasion of left renal vein by renal cell carcinoma
Hydrocele
persistent tunica vaginalis; scrotum transilluminates
Torsion of testicle
testicle high in canal; absent cremasteric reflex
Testicular cancer
unilateral painless mass that does not transilluminate
Risk factors for Testicular cancer
cryptorchid testis, Klinefelter's, testicular feminization
Seminoma
MC testicular cancer; radiosensitive; large cells with lymphoid infiltrate; small percentage have hCG
Spermatocytic variantm of seminoma
> 65 yrs of age
Embryonal carcinoma
hemorrhage/necrosis; hematogenous spread before lymphatic; inc AFP, hCG
Yolk sac tumor
MC testicular cancer in boys; inc AFP
Choriocarcinoma:
most aggressive testicle cancer; inc hCG
Teratoma
more often benign in children than adult
Teratocarcinoma
teratoma + embryonal carcinoma
Malignant lymphoma in testicles
MC type in elderly; metastasis not primary cancer
Prostate
DHT derived stimulation embryo; periurethral area- hyperplasia; peripheral area- cancer
Prostatitis
perineal pain, fever; WBCs at end of voiding
Benign prostatic hyperplasia
DHT/estrogen-mediated; glandular/smooth muscle hyperplasia
S/S of Benign prostatic hyperplasia
all men develop; urethral obstruction MC (hesitancy, dribbling, nocturia), hematuria, dysuria
Rx for BPH
a-adrenergic blockers, 5-a-reductase inhibitors
Prostate cancer
DHT-mediated; palpable with rectal exam; osteoblastic metastasis (inc AP)
PSA
sensitive but not specific for prostate cancer; inc in hyperplasia
Kallmann's syndrome
absent GnRH, anosmia, absence of taste
Impotence
failure to sustain an erection; psychogenic in most cases (erections present at night)
Erection
parasympathetic response
Ejaculation
sympathetic response
Leydig cell failure
inc LH; dec testosterone, sperm count; normal FSH
Seminiferous tubule failure
inc FSH (dec inhibin); dec sperm count; normal LH and testosterone
Leydig and seminiferous tubule failure
inc FSH and LH; dec testosterone and sperm count
Y chromosome
Y chromosome
Testosterone
develops seminal vesicles, epididymis, vas deferens
Dihydrotestosterone
develops prostate and male external genitalia
Male pseudohermaphrodite
genetic male; phenotypically female
Testicular feminization
XR; deficient androgen receptors; MCC male pseudohermaphrodite
Klinefelter's syndrome
XXY; 1 Barr body; female secondary sex characteristics