Renal/genitourinary

Front 1

How do you get hypertonic hyponatremia?

Back 1

Glucose, mannitol, hypertonic saline

Front 2

How do you get isotonic hyponatremia?

Back 2

Hyperlipidemia, hyperproteinemia (paraproteinemia), glucose, mannitol

Front 3

How do you get euvolemic, hypotonic, hyponatremia?

Back 3

Psychogenic polydipsia, SIADH, Drugs, Hypothyroidism, Glucocorticoid deficiency

Front 4

How do you get hypervolemic, hypotonic, hyponatremia?

Back 4

If the Urine Na < 10, from cirrhosis, CHF, or nephrotic syndrome.
If the Urine Na > 10, from AKI or chronic renal failure

Front 5

How do you get hypovolemic, hypotonic, hyponatremia?

Back 5

If the Urine Na < 10, from GI losses, skin losses (burns), or thirdspacing

If the Urine Na > 10, from diuretics, urinary obstruction, adrenal insufficiency, or bicarbonaturia (RTA, metabolic alkalosis)

Front 6

What can cause potassium to shift OUT of cells?

Back 6

Drugs- succinylcholine, digitalis, BB
Cell lysis, rhabdo, insulin def, acidosis, resorption of blood

Front 7

What causes potassium to shift into cells?

Back 7

Insulin, Beta2-agonists, alkalosis
GI- diarrhea, laxative, vom
Renal- Diuretics, increased mineralocorticoids, Barter's, Gitelman's, hypomagnesemia

Front 8

What is type I RTA?

Back 8

Distal- defect in H+ secretion; patients have nephrolithiasis as a complication; give bicarb

Front 9

What is type II RTA?

Back 9

Proximal- defect in HCO3 reabsorption; patients have rickets or osteomalacia as a complication; give thiazides

Front 10

What is type IV RTA?

Back 10

Distal- aldosterone deficiency or resistance; patients have hyperkalemia as a complication; give lasix, mineralo/glucocorticoid replacement

Front 11

What laboratory abnormalities suggest prerenal renal failure?

Back 11

FeNA < 1%, Urine Na < 20, urine specific gravity > 1.020, BUN/Cr > 20

Front 12

What are the indications for urgent dialysis?

Back 12

A- acid/base (acidemia)
E- Electrolyte (hyperkalemia)
I- Intoxications (ASA, methanol, barbiturates, lithium, ethylene glycol, theophylline)
O- Overload (fluid)
U- Uremic symptoms

Front 13

How do you treat IgA nephropathy?

Back 13

Steroids; ACEIs for patients with proteinuria

Front 14

What is Wegener's and how is it treated?

Back 14

Necrotizing vasculitis; affects the kidney and upper respiratory tract (sinuses); c-ANCA. Treat with high-dose steroids and cytotoxic agents

Front 15

What is Goodpasture's and how is it treated?

Back 15

Anti-GBM deposits (linear), pulmonary hemorrhage with IDA and macrophages with hemosiderin. Treat with plasma exchange and pulsed steroids

Front 16

What is membranous nephropathy associated with?

Back 16

HBV, syphilis, malaria, and gold

Front 17

What is membanoproliferative nephropathy associated with?

Back 17

HCV, cryoglobulinemia, SLE, subacute bacterial endocarditis

Front 18

Calcium oxalate stones

Back 18

The most common kind (>80%). The MCC is idiopathic hypercalciuria and primary hyperparathyroidism. The urine is ALKALINE and the stones are radioopaque. Treat with hydration and thiazide diuretics. DONT decrease Ca intake

Front 19

Struvite stones

Back 19

You will see staghorn calculi. These are a/w urease-producing organisms (proteus). ALKALINE urine. Treat with hydration and abx

Front 20

Uric acid stones

Back 20

These are associated with gout, xanthine oxidase deficiency, high purine turnover states (chemo). ACIDIC urine (< 5.5). RADIOLUCENT. Treat with hydration and alkalinization of the urine with citrate

Front 21

Cystine stones

Back 21

Due to a defect in COLA transport. Hexagonal crystals and + urinary cyanide nitroprusside test. radioopaque. Treat with hydration and alkalinization of the urine!

Front 22

What kidney stones can be passed spontaneously?

Back 22

< 5 mm in diameter

Front 23

When do you treat stones with lithotripsy, percutaneous nephrolithotomy, or retrograde uteroscopy?

Back 23

0.5 mm to 3 cm

Front 24

What features are seen in PKD?

Back 24

Hypertension, hepatic cysts, cerebral artery aneurysms, diverticulosis, mitral valve prolapse

Front 25

What is the most common congenital urethral obstruction?

Back 25

Posterior urethral valves- male infant with distended, palpable bladder and low urine output

Front 26

When do you get a VCUG?

Back 26

All boys presenting with their first UTI, girls < 3 years of age with their first UTI or < 5 years of age with a febrile UTI and older girls with pyelo or recurrent UTIs

Front 27

What do you use to treat a UTI in children under 2 months of age?

Back 27

Amoxicillin

Front 28

How do you treat cryptochordism?

Back 28

Orchiopexy at 6-12 months of age

Front 29

What medications can cause ED?

Back 29

BB, SSRIs, TCAs, diuretics

Front 30

How do you work up ED?

Back 30

Presence of nocturnal/early-morning secretions, evaluate for neurologic dysfunction (anal tone, LE sensation) and hypogonadism.

Check testosterone, FSH/LH, prolactin levels

Front 31

How do you diagnose bladder cancer?

Back 31

Cystoscopy with biopsy; also get MRI and CT to define invasion and mets

Front 32

How do you treat superficial transitional cell carcinoma?

Back 32

Compete transurethral resection or intravesicular chemo with mitomycin C or BCG (TB vaccine)

Front 33

What do you want to rule out if you see a left-sided varicocele?

Back 33

RCC- tumor blocks the left gonadal vein which empties into the left renal vein

Front 34

How do you treat RCC?

Back 34

Surgical resections, tyrosine kinase inhibitors (sorafenib, sunitinib)

Front 35

What are risk factors for testicular cancer?

Back 35

Cryptochordism, Klinefelters