Renal System

Front 1

3 embryonal nephrogenic elements found in a Wilms Tumor (Nephroblastoma)

Back 1

Triphasic neoplasm of pediatrics
1. Blastema
2. Epithelium
3. Stroma

Front 2

What are the rules of 5 for Wilms Tumor

Back 2

5% of childhood cancers
5% bilateral
5% multicentric
5% anaplastic - worse prognosis

-lung metastases are common

Front 3

What 3 syndromes are associated with Wilms Tumor

Back 3

-Bechwith-Wiedeman
-WAGR Syndrome
-Denys-Drash Syndrome

Front 4

Presentation and Prognosis of Wilms Tumor

Back 4

child presents with abdominal mass

80-90% overall cure rate (remove and chemo)

Front 5

Genes associated with Wilms Tumor

Back 5

WT1 and WT2
(loss or mutation in tumor suppressor genes on chromosome 11)

Front 6

What are the 2 tumors associated with children

Back 6

1. Wilms Tumor
2. Congenital Mesoblastic Nephroma

Front 7

What are Congenital Mesoblastic Nephromas composed of?

Back 7

spindled cells with varying resemblance to immature tissues from mesoderm

Front 8

When is Congenital Mesoblastic Nephromas found?

Back 8

infancy

Front 9

Is metastases rare or common with Congenital Mesoblastic Nephromas?

Back 9

rare

Front 10

Name the 3 benign adult renal neoplasms

Back 10

1. papillary adenoma
2. renal oncocytoma
3. angiomyolipoma

Front 11

Tumor _____ distinguishes papillary adenoma from carcinoma

Back 11

size
<0.5 cm = adenoma
>0.5 cm = papillary renal cell carcinoma

Front 12

What is the most common renal tubular epithelial neoplasm?

Back 12

Renal Papillary Adenoma
(acquired from cystic renal disease - eg. from hemodialysis)

Front 13

Describe the appearance of a Renal Oncocytoma

Back 13

-well circumscribed, tan/yellow/mahogany brown
-6cm
-central stellate scar

Front 14

Hereditary disorders associated with Angiomyolipoma

Back 14

-Tuberous sclerosis
-von Recklinghausen disease (NF1)
-von-Hippel Linau syndrome
-Autosomal dominant polycystic kidney disease

Front 15

What would multifocality in Angiomyolipoma suggest

Back 15

Tuberous Sclerosis

Front 16

LM of mixture of mature adipose tissue, spindled cells with smooth muscle features and thick-walled blood vessels

Back 16

Angiomyolipoma

Front 17

Most common malignant renal neoplasm in adults

Back 17

Renal Cell Carcinoma

-most common is clear cell

Front 18

Risk factor for Renal Cell Carcinoma

Back 18

Tobacco - cigarette smoking

Front 19

Classic clinical triad of Renal Cell Carcinoma

Back 19

flank pain, palpable mass, and hematuria

-25% metastases at time of presentation

Front 20

Treatment for Renal Cell Carcinoma

Back 20

-surgical resection
-chemotherapy minimally effective

Front 21

Gene associated with Renal Cell Carcinoma

Back 21

VHL gene
-tumor supressor gene

Front 22

Size of Papillary Renal Cell Carcinoma

Back 22

>0.5 cm

Front 23

Which has the worst prognosis of typical RCC subtypes

Back 23

collected duct carcinoma

Front 24

Neoplasms of transitional cell epithelium

Back 24

Renal Urothelial Carcinoma

Front 25

Hydronephrosis =

Back 25

dilation of the renal pelvis and calyces associated with progressive atrophy of the kidney due to obstruction to the outflow of urine

Front 26

4 main types of calculi

Back 26

1. calcium
2. struvite
3. uric acid
4. cystine

Front 27

Are uric acid calculi radiopaque or radiolucent?

Back 27

radiolucent
- associated with gout

Front 28

What 3 compounds make up struvite calculi and what are these calculi normally associated with?

Back 28

Magnesium Ammonium Phosphate
-associated with bacterial infection - Proteus

Front 29

Which calculi are due to a genetic defect in renal absorption of amino acids

Back 29

Cystine calculi
-stones form at low urine pH

Front 30

Exstrophy of the bladder =

Back 30

anterior bladder wall and abdominal wall are absent
-congenital anomalie

Front 31

Urachal abnormalities are prone to developing which type of cancer

Back 31

Adenocarcinoma

Front 32

Large macrophages with granular PAS-positive cytoplasm with round Michaelis-Gutmann bodies

Back 32

Malacoplakia

Front 33

Which type of bladder cancer is associated with schistosomiasis?

Back 33

Squamous cell carcinoma

Front 34

Classic urinary bladder cancer presentation

Back 34

painless hematuria

Front 35

Normal blood pH

Back 35

7.36 - 7.44

Front 36

Anion Gap =

Back 36

Na - (Cl - HCO3)

Front 37

Most common causative community acquired agent for UTIs

Back 37

Escherichia coli
(Gram- Rods)

Front 38

2 Biochemical characteristics of E.coli

Back 38

-indole +
-lactose fermentation+

Front 39

Most common causative hospital acquired agent for UTIs

Back 39

Pseudomonas aeruginosa
(due to catherization)

Front 40

What defenses do we have against UTIs

Back 40

-micturation
-pH of urine (acidic)
-phagocytosis
-urinary secretory IgA
-prostatic secretions in males

Front 41

Urethritis

Back 41

dysuria and mucopurulent discharge caused by sexually transmitted agents
(Trichomonas the most common)

Front 42

Cystitis

Back 42

dysuria, frequency, and urgency caused by multiplication of enteric organisms within the bladder

Front 43

Increased Nitrite on a dip stick is indicative of....

Back 43

E.coli

Front 44

Pyelonephritis

Back 44

fever, flank pain, and systemic signs caused by invasion of the kidney tissue by enteric organisms

Front 45

Why is a Proteus mirabilis infection likely to cause struvite stones

Back 45

due to urease production

Front 46

Addition of acid to the body results in a ______ Anion Gap Metabolic Acidosis

Back 46

High

Front 47

Loss of bicarb from body results in a _______ Anion Gap Metabolic Acidosis

Back 47

Normal

Front 48

Delta Delta

Back 48

ratio between the change in the anion gap and the change in the plasma HCO3 concentration
= (change in AG)/(change in HCO3)
= (change in AG) + HCO3

Front 49

Delta Delta ratio 1-2 or 22-28

Back 49

pure high AG
metabolic acidosis

Front 50

Delta Delta < 1 or <22

Back 50

high AG acidosis + hyperchloremic metabolic acidosis

Front 51

Delta Delta > 2 or >28

Back 51

high Ag + metabolic alkalosis

Front 52

Causes of High AG Metabolic Acidosis

Back 52

Methanol
Uremia
Diabetic Ketoacidosis
Paraldehyde
Isoniazid
Lactic acidosis
Ethylene glycol
Salicylates

Front 53

Causes of Normal AG Metabolic Acidosis

Back 53

1. gastrointestional loss of HCO3
2. Renal loss of HCO3
3. HCl/HCl precousor ingestion or infusion
4. Other
(status post hyperventilation, recovery from diabetic ketoacidosis, toluene inhalation)

Front 54

Causes of metabolic alkalosis
-low urinary chloride (<20mEq.L)

Back 54

Diuretics (remote)
Vomiting
Gastrointestional suction
Status post chronic hypercabia

Front 55

Causes of metabolic alkalosis
-high urinary chloride (>20mEq/L)

Back 55

Diuretics (recent)
High BP
Low BP

Front 56

Causes of Respiratory Acidosis

Back 56

1. CNS depression
2. Neuromuscular disorder
3.Thoracic cage restriction
4. Impaired lung motion
5. Acute obstructive Pulmonary Disease
6. Chronic obstructive lung disease
7. misc.... ventilator malfunction, cardiopulmonary resuscitation

Front 57

Causes of Respiratory Alkalosis

Back 57

1. anxiety
2. CNS disorders
3. Hormones
4. Drugs (progesterone, catacholamines)
5. Sepsis and endotoxemia
6. Hyperthyroidism
7. Hypoxia
8. Pregnancy
9. Cirrhosis
10. Pulmonary edema
11. Lung disease (pulmonary emboli, restrictive lung disorders)
12. Pneumonia
13. Ventrilator induced

Front 58

For each gram drop in serum albumin, the anion gap decreases by a factor of ~____

Back 58

2.5

Front 59

As urinary ammonium excretion increases urinary ________ excretion ________ as well

Back 59

Chloride
increases

Front 60

As chloride excretion increases Urinary AG becomes more _______

Back 60

negative

Front 61

Urinary AG =

Back 61

Na + K - Cl

Front 62

DOC for acute uncomplicated cystitis

Back 62

Trimethoprim + sulfamthoxazole

Front 63

MOA of sulfanamides

Back 63

work as antimetabolites
competitive inhibitors of PABA (essential for folate production)

Front 64

Causes of resistance in Sulfonamides

Back 64

-overproduction of PABA
-lower affinity of enzyme for drug
-decreases entry of drug into bacteria

Front 65

Adverse Effects of Sulfonamides

Back 65

-Urinary tract disturbances
-Hematopoietic disturbance
(G6PD deficiency)
-Aplastic anemia
-Hypersensitivity reactions
-Kermicterus - displacement of bilirubin from plasma albumin

Front 66

Are you able to use Trimethoprim to treat prostatitis?

Back 66

YES

Front 67

Causes of resistance to Trimethroprim

Back 67

-reduced cell permeability
-overexpression of DHFR
-altered DHFR with decreased drug binding (most common)

Front 68

Adverse effects of Trimethoprim

Back 68

-GI... NV
-dermatologic reactions
-folate deficiency impacting bone marrow

Front 69

Clinical uses for Trimethoprim/Sulfamethoxazole (TMP/SMX)

Back 69

-UTIs
-prostatitis
-pneumocystis (carinii) jiroveci pneumonia (PCP)
-enterocolitis... caused by shigella
-travelers diarrhea due to E. coli and Shigella
-otitis media (alt to amoxicillin)
-resp. tract infections
(H. influenzae - DOC non-life threatening)

Front 70

4 Quinolones

Back 70

-Ciprofloxaxcin
-Levofloxacin
-Moxifloxacin
-Norfloxacin

Front 71

DOC for Klebsiella

Back 71

Fluoroquinolones

Front 72

Ciproflaxacin has a significant effect against _______

Back 72

pseudomonas

Front 73

MOA for fluroquinolones

Back 73

-block bacterial DNA synthesis
(inhibit DNA gyrase, topoisomerase IV)
-bactericidal

Front 74

First line treatment in post-exposure inhalation anthrax

Back 74

Ciprofloxacin

Front 75

DOC for mycoplasma pneumoniae

Back 75

Ciprofloxacin

Front 76

Clinical uses of Fluoroquinolones

Back 76

-UTIs including some MDR bugs
-bacterial diarrhea
-infections of the soft tissue, bones and joints. intra-abdominal and respiratory tract infections including MDR bugs
-post inhalation exposure to anthrax
-upper and lower respiratory tract infections

Front 77

Causes of resistance in Flouroquinolones

Back 77

-change in drug binding region of enzyme
-change in permeability of organism

Front 78

How are Fluoroquinolones cleared from the body

Back 78

most cleared renally
-dose adjustment for renal failure
(Moxifloxacin metabolized in the liver - not good for UTIs)

Front 79

Adverse effects of Fluroquinolones

Back 79

-NV
-CNS - headache dizziness
-Achilles tendon rupture or tendinitis
-may damage growing cartilage
-QTc prolongation
(avoid if pt has hypokalemia)

Front 80

Nitrofurantoin

Back 80

Urinary Antiseptics
-prevention of UTIs
-treatment of uncomplicated UTIs
-not a first line drug

Front 81

Resistant species to Nitrofurantoin

Back 81

most species of Pseudomonas and Proteus
many species of Enterobacter and Klebsiella

Front 82

Adverse reactions of Nitrofurantoin

Back 82

-NVD
-hypersensitivity
-hemolytic anemia in G6PD deficiency
-acute pneumonitis

Front 83

Filtration Fraction =

Back 83

GFR/RPF

(FF is greater at low plasma flow than at high flow)

Front 84

Where does ANGII and NE work in the kideny

Back 84

proximal tubule
-promote Na reabsorption

Front 85

Where does aldosterone work in the kidney

Back 85

cortical collecting duct on the ENaC (aquaporin channel)

Front 86

What is used in vasodilatory shock... vasopressin or desmopressin

Back 86

Vasopressin because work on V1 receptors on smooth muscle

Front 87

What is used to treat nephrogenic diabetes insipidus

Back 87

hydrochlorothiazide

Front 88

What is used to treat central diabetes insipidous

Back 88

desmopressin

Front 89

What may cause hyponatremia... Vasopressin or desmopressin

Back 89

both

Front 90

Aldosterones affect on potassium in the kidney

Back 90

Increases secretion into the tubule lumen