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194 Cards in this Set
- Front
- Back
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what does the metanephros become in an adult?
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kidney
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what does the ureteric bud give rise to?
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collecting duct, minor calyces, major calyces, renal pelvis, ureter
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what does the metanephric mesenchyme give rise to?
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glomerulus, bowman capsule, PCT, loop, DCT
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what does the mesonephros give rise to?
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male genitalia -> testes, seminal vesicles, vas deferens, epididymus
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what does the paramesonephros give rise to?
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female genitalia -> ovaries, fallopian tubes, uterus, upper vagina
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what does the urogenital sinus become in males? females?
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males: prostate, prostatic urethra, bulbourethral glands
females: lower vagina, labia minora |
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what does the urogenital tubercle become in males? females?
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males: penis
females: clitoris |
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name the enz deficiency:
hyponatremia, hyperkalemia, hypovolemia, hypoglycemia, ambiguous genitalia, hyperpigmentation |
21 hydroxylase
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name the enz deficiency:
hypernatremia, hypokalemia, hypertension, ambiguous genitalia, hyperpigmentation |
11 hydroxylase
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which drug is can reduce signs and symptoms of BPH the fastest? MOA?
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finasteride
MOA: inhibits 5alpha reductase |
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aldosterone antag also used as a diuretic
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spironolactone
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if give this drug too much, may get gynecomastia becuase it stimulates the converstion from chol to the androgens
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ketoconazole
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5 ways males can become pseudohermaphrodites
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cryptorchidism
retractile testes sertoli-only syndrome mumps (orchitis) 5 alpha reducase deficiency |
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which renal artery is longer? why?
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R - b/c aorta is on L
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which renal vein is longer? why?
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L - b/c IVC is on R
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if notice varicocele of the left testis, what do you need to rule out?
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RCC of the left kidney
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cancer near which renal vessel has the poorest prognosis? why?
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R renal vein b/c drains right into the IVC
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which nodes do gonadal infections and cancer drain into?
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para-aortic nodes
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which nodes do other cancers or infections (like STDs) drain into
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inguinal nodes
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where does testicular pain radiate? why?
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the abdomen - b/c innervation to the testis starts in the abdomen
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which part of the kidney is the first to die in a low volume state? why?
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cortex - b/c requires lots of perfusion since has lots of vessels in that area
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most common cause of 2ry HTN?
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renal artery stenosis
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most common cause of renal artery stenosis?
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atherosclerosis
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most common cause of renal artery stenosis in person <30y/o
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fibromuscular dysplasia
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looking at renin levels, how can you diagnose a renal artery stenosis?
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if there is a difference in renin levels between the 2 renal veins of 1-1.5 - higher renin level indicates stenosis
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where does ACE act and from what cells?
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lungs - from epithelial cells
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what is goldblatt kidney? what causes it?
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when a good kidney goes bad b/c of hypertrophy and hyperplasia - due to renal artery stenosis of the other kidney
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what are 9 causes of 2ry HTN?
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renal artery stenosis
coarctation conns chronic renal dz sleep obstructive apnea pheochromocytoma chronic steroid use hyperthyroidism hyperparathyroid |
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side effects of ACEI?
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CAPTOPRIL:
C = cough A = angioedema P = pregnancy contraindicated T = taste bad hypOtension P = proteinuria R = renin inc I = inc bradykinin, K and H L = low angiotensin II |
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side effects of ARBs?
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same as ACEI (CAPTOPRIL), except no cough (b/c of decr bradykinin)
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side effect of renin inhibitors?
members? |
members = aliskiren, remikiren
side effect = liver toxicity |
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which cause of large kidneys will cause HTN? which will be normotensive?
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HTN = polycystic kidney dz
Normotensive = medullary sponge and cystic dzs |
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What are pl w/ adult type polycystic kidney dz at a higher risk for?
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subarachnoid aneurysm
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difference in inheritance b/t adult type and infantile type of polycystic kidney dz? which will develop HTN? which will develop renal failure? which is only on one side?
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Adult = AD; infantile = AR
HTN = adult renal failure = adult unilateral = infantile |
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which medullary kidney problem will have polyuria, polydypsia? higher risk for kidney stones?
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both have polyuria, polydypsia, but only medullary sponge will have the higher risk for kidney stones
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which type of abdominal aortic aneurysm is more common? supra or infra renal?
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infra
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which type of abdominal aortic aneurysm is more dangerous? supra or infra renal?
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supra - will decrease perfusion to the kidneys
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differential when thinking of severe abdominal pain?
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pancreatitis
kidney stones abdominal aortic aneurysm ischemic bowel |
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MC location of ischemic bowel?
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small intenstine
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MC location of ischemic bowel if due to the inferior mesenteric artery?
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splenic flexure
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retroperitoneal organs (9 of em)
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duodenum (2nd, 3rd, 4th parts)
colon (desc and asc) kidney, ureter, adrenal pancreas (tail) aorta/IVC rectum |
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MCC abdominal aortic aneurysm?
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atherosclerosis
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which size of abdominal aneurysm requires surgery?
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>6 cm
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pt comes in complaining of tearing pain down the lower back - dx?
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abdominal aortic aneurysm
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pt comes in complaining of pain radiating area between the shoulder blades. dx?
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thoracic aneurysm
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which 4 collagen dzs can get dissections of the aorta?
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marfan's
ehlers danlos takayasu syphyllis |
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which type of thoracic aneurysm has a better prognosis - A or B?
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A
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which type of thoracic aneurysm is related to HTN or DM - A or B?
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B
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MCC of thoracic aneurysms?
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Trauma
Collagen dzs |
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3 anatomical narrowings of the ureters
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hilum
over the iliac bones ureteropelvic jxn |
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which location for a kidney stone has the poorest prognosis?
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hilum
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MC type of kidney stone?
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calcium (phosphate or oxalate)
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MCC of kidney stone
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hypercalciuria
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only kidney stone not seen on x-ray
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uric acid
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MCC hypercalciuria in outpatient
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primary hyperparathyroidism
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MCC hypercalciuria in inpatient
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malignancy
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MCC of struvite stones
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urease +ve UTI's
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MC urease +ve organism causing UTI
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proteus
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Treatment for chronic stone problem
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Thiazides
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Type of stone associated w/ rapid cell death
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Uric acid stone
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Prophylaxis against stone formation when undergoing chemo
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allopurinol
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components of cysteine stone
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cysteine
ornithine lysine arginine |
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Cause of cysteine stones
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Defective renal transport of amino acids
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Pt comes in w/ HTN and dislocated lens. You notice pt has stiff vessel walls. What kind of kidney stone are they prone to?
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cysteine stones
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This type of kidney stone is due to malabsorption in the GI tract
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oxalate stones
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Reasons for inability to absorb Ca++
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Vit D deficiency
Crohn's |
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Cause of hydronephrosis in newborns
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malimplantation of the ureters, posterior urethral valves
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Cause of hydronephrosis in children
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UTIs
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Cause of hydronephrosis in adolescents
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urethral strictures
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Cause of hydronephrosis in adult men
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BPH
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Cause of hydronephrosis in adult women
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uterine prolapse, cystocele, cervical cancer
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MCC urinary obstruction in adult men
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BPH
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DOC for BPH? MOA? SE?
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tamsulosin
MOA: alpha 1 blocker SE: orthostatic Hypotension |
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2 drugs that can cause retroperitoneal fibrosis?
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Methysergide = 5HT antagonist
Nitrofurantoins |
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mother brings newborn in to the doc, saying the baby is leaking fluid from the belly button - dx?
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urachal cyst - urachus didn't close off when cut umbilical cord
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drugs to give for urinary incontinence (4 of em)
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TCA, oxybutin, flavoxate, pseudonephrine
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drugs to give when can't pee (3 of em)
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behtanechol, carbechol, any of the stigmines
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stress vs urge incontinence:
which has inc detrussor muscle activity? |
urge
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stress vs urge incontinence:
which has NL bladder capacity? |
stress
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stress vs urge incontinence:
which has decr sphincter pressure |
stress
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stress vs urge incontinence:
which has NL sphincter pressure, but low bladder capacity? |
urge
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stress vs urge incontinence:
which can involve an UMN lesion? |
urge
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MCC stress incontinence?
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obesity (inc estrogen -> inc muscle relaxation)
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which type of incontinence involves anatomical obstruction
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overflow incontinence
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Pt comes in and says, "doc, everytime I sneeze, I pee" - dx? rx?
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stress incontinence
rx w/ kagal exercises or surgery |
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Pt comes in and says, "doc, i always feel like i have to go!" You do a culture and there's no foreign bacteria. dx?
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urge incontinence
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male pt comes in and says, "doc, sometimes I feel like there's liquid coming out my rear" - dx?
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anatomical incontinence
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You perform a routine DRE on a male pt and you can't feel a prostate. You ask questions and pt admits to trauma to genital region. Possible explanation?
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high rise prostate from trauma to the external urethra
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MC congenital genitourinary abnormaility?
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hypospadia
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Organism that causes ballanitis
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staph aureus
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one dose treatment for STDs
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Azithromycin
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treatment for simple UTI when pregnant? when not pregnant?
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pregnant: ampicillin/amoxicillin
not: TMP-SMX |
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treatment for pyeloephritis when pregnant? when not pregnant?
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pregnant: ceftriaxone
not: admit and give ciprofloxacin |
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treatment for cystitis when pregnant? when not pregnant?
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pregnant: ampicillin, amoxicillin
not: TMP-SMX |
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pt comes in w/ urgency and frequency of urination plus some flank pain - see WBC casts in urine - dx?
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pyelonephritis
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pt comes in w/ fullness, burning, fever, dysuria - feels urgency when peeing - dx?
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cystitis
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type of nephritis due to drug allergy
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interstitial nephritis
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type of nephritis causing hematuria
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glomerulonephritis
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types of drugs that can cause interstitial nephritis
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NSAIDs, PCN, cephalosporin, sulfadrugs, vancomycin, aminoglycosides
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what causes WBC casts?
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nephritis
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what causes RBC casts
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glomeronephritis
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what causes eosinophil casts
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interstitial nephritis
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what causes fat casts
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nephrotic syndrome
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what causes waxy casts?
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chronic renal failure
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what causes epithelial casts
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normal sloughing
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what causes crescents
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RPGN, goodpasture's, wegeners
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what causes muddy casts
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ATN
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causes of ATN?
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ischemia, toxin
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what's absorbed at the PCT?
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90% bicarb
60% everything else |
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which part of the nephron has the lowest osmolarity?
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DCT
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which part of the nephron is not permeable to water?
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thick ascending limb
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which part of the neprhon has the main aldosterone receptor?
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cortical collecting duct
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which part of the nephron has the main ADH receptor
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medullary collecting duct
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which part of the nephron has the PTH receptor?
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DCT
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what is the BUN:Cr ratio in pre-renal, renal, and post-renal failure?
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pre-renal: >20:1
renal: <15:1 post-renal: NL |
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which lab value measures bld perfusion to the kidney?
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BUN - comes from the liver
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which lab value measures integrity of kidney parenchyma?
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Creatinine - from muscle breakdown
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MCC decreased kidney perfusion? what are other causes?
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MCC: dehydration
others: CHF, cirrhosis, renal artery stenosis |
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NL GFR?
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>120
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substances used to measure ECF
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inulin, mannitol, sulfate
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substances used to measure TBW
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tritiated water, D2O
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substances used to measure plasma
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iodinated serum albumin, evans blue
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substances used to measure ECF
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inulin, mannitol, sulfate
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substances used to measure TBW
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tritiated water, D2O
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substances used to measure GFR
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PAH
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substances used to measure plasma
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iodinated serum albumin, evans blue
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substances used to measure filtration
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inulin
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substances used to measure GFR
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PAH
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diuretic used for trauma-induced edema of the brain
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mannitol
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diuretic used for pseudotumor cerebrii
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acetazolamide
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substances used to measure filtration
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inulin
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diuretic used for acute closed angle glaucoma
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acetazolamide
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diuretic used for trauma-induced edema of the brain
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mannitol
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MOA of acetazolamide and dorzolamide
Side effects? |
carbonic anyhydrase inhibitors
cause metabolic acidosis |
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diuretic used for pseudotumor cerebrii
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acetazolamide
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diuretic used for acute closed angle glaucoma
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acetazolamide
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only loop that's not sulfa containing
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ethacrynic acid
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MOA of acetazolamide and dorzolamide
Side effects? |
carbonic anyhydrase inhibitors
cause metabolic acidosis |
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only loop that's not sulfa containing
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ethacrynic acid
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substances used to measure ECF
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inulin, mannitol, sulfate
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substances used to measure TBW
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tritiated water, D2O
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substances used to measure plasma
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iodinated serum albumin, evans blue
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substances used to measure GFR
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PAH
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substances used to measure filtration
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inulin
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diuretic used for trauma-induced edema of the brain
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mannitol
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diuretic used for pseudotumor cerebrii
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acetazolamide
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diuretic used for acute closed angle glaucoma
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acetazolamide
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MOA of acetazolamide and dorzolamide
Side effects? |
carbonic anyhydrase inhibitors
cause metabolic acidosis |
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only loop that's not sulfa containing
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ethacrynic acid
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diuretic used or CHF or wet lung
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loops
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substance mainly reabsorbed in the PCT
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bicarb
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substances reabsorbed in the thick ascending limb
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Na, K, Cl, Mg, Ca
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substances that move through via electric potential in the thick ascending limb
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Mg and Ca
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substances that use ATP in the thick ascending limb
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Na/K/2Cl into the cell and Na/K as antiport
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substances that use gradients in thick ascending limb
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K and Cl into the basolateral side
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substances reabsorbed in the DCT
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Na, Cl, Ca
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substances that use gradients in the DCT
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Cl and Ca into the basolateral side
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REceptor located in the DCT
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PTH
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substances reabsorbed in the collecting duct
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Na, K, Cl
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substances kicked out in the collecting duct (to be peed)
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K and H
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receptors located in the collecting duct
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aldosterone, V2 (ADH)
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DOC for cirrhosis
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spironolactone
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DOC for nephrogenic DI
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amiloride
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MOA of loops
Side effects? |
block the Na/K/2Cl channel so lose all of that (decr K, Ca, Mg, Na, Cl)
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MOA of thiazides
Side effects? |
block the Na/Cl channel
get hyperGLUC |
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MOA of K sparing diuretics
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block the K and Na and H channels so K and H can't go back into the urine and Na doesn't get into the cell
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nephritic or nephrotic
which one causes loss of protein |
nephrotic
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nephritic or nephrotic
which one involves a vasculitis and hematuria |
nephritic
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nephritic or nephrotic
which one involves hyperlipidemia and fatty casts |
nephrotic
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nephritic or nephrotic
which one involves HTN |
nephritic
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MC nephrotic syndrome in adults
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Membranous glomerulonephritis
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which 2 syndromes will have both proteinuria and hematuria?
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membranoproliferative
SLE |
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MC nephrotic dz in kids
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minimal change
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MC nephritic syndrome in kids
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post strep GN
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MC nephritic syndrome in adults
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membranoproliferative GN
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5y/o child brought in by mom b/c of some bld in the urine - 2 wks ago, the child was treated for an upper respiratory issue - a biopsy of the kidney is taken - what will be seen on electron microscopy?
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lumpy bumpy (this is post strep GN)
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which nephritic syndromes cause a decr in complement?
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PSGN
MPGN |
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24 y/o male comes in b/c he's been coughing up bld and occasionally sees bld when he pees - what will you see on immunofluorescence?
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linear deposits (goodpastures)
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type of nephritic syndrome that can be caused by hep B, hep C
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MPGN
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subepithelial deposits on electron microscopy
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PSGN
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fibrin deposits on light microscopy
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RPGN
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tramtrack appearance on light microscopy
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MPGN
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wire loop appearance
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SLE
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antiglomerular basement membrane Ab
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Goodpastrues
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5y/o child comes in w/ puffy face and frothy urine - what will you see on electron microscopy?
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fused epithelial foot processes (minimal change dz)
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nephrotic syndrome that assoc w/ HIV?
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Focal segmental
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nephrotic syndromes w/ decr C3 complement?
|
focal segmental
membranous GN |
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hyalinosis seen on light microscopy?
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focal segmental
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spike dome appearance on light microscopy?
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membranous GN
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nephrotic syndrome assoc w/ carcinoma?
|
membranous GN
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nephrotic syndrome assoc with diabetes
|
nodular glomerulosclerosis
|
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MCC of primary glomerulonephritis?
|
IgA dz (Bergers)
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pt w/ kidney dz, dislocated lens, and deafness
|
alports
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3 dzs w/ lens dislocations
|
Marfans
Alports Homocysteinuria |
