Step 2 Ck - Genitourinal

Front 1

1. What drugs cannot be used in Sulfa allergic pts

2. Which loop diuretics can be taken in Sulfa allergic pts?

Back 1

1. Diuretics.

2. Ethacrynic acid

Front 2

1. Pt has increased intracranial pressure. Which diuretic should be given?

2. What Rx can be given for Acute Glaucoma

3. What is the SE of mannitol

Back 2

1. Mannitol

2. Mannitol, Acetazolamide

3. Dilutional hyponatremia ---> hypernatremia w/ continued use

Pulmonary edema, Hyperosmolarity

Front 3

1. What are the SE of loops?

2. Nephrogenic DI, which diuretic should be given?

3. Which diuretics cause hypercalcemia

Back 3

1. Ototoxicity, hypocalcemia

2. Thiazides

3. Thiazides

Front 4

Which thiazide is used for cirrhosis?

Back 4

metalazone

Front 5

1. What abx are given for Pyelonephritis?

2. Tx for pyelonephritis in Pregnany pts?

Back 5

1. Fluoroquinilones

Aminoglycosides

3rd Gen Cephalasporins (e.g. Ceftriaxone)

2. Ceftriaxone or Amp/Gent

Front 6

1. UTIs are risk factor for _____ renal stones.

2. Hyperparathyroidism is a risk factor for _____ renal stone.

3. Which type makes staghorn calculi?

4. How do you treat uric acid stones

Back 6

1. Struvite ---> Staghorn calculi

2. Calcium PO4 : PTH is PO4 trashing hormone

3. Struvite (more common), Cystine

4. By alkalizing urine

Front 7

What are the tumors that can increase EPO?

Back 7

1. Renal cell carcinoma

2. Hepatocellular carcinoma

3. Pheochromocytoma

4. Hemangioblastoma

Front 8

Eosinophilia (in urine), rash, fever, granular or epithilial casts Elevated Creatinine.

a) Dx=? b) Tx=?

Back 8

1. Acute interstitial nephritis/ Interstitial Nephropathy

2. Stop offending agent. Steroids

Front 9

Brown urine, High ASO titer, hypercellular glomeruli,

a) Dx

Back 9

Post infectious glomerularnephritis

Front 10

Hematuria, flank pain, fever, Increased serum IgA.

a) Dx

b) Tx

Back 10

a) IgA nephropathy (Berger's disease)

b) ACEI, statins for persistent proteinuria

Front 11

Linear deposition of igG ab deposition

Back 11

Goodpasture's - only one that is linear

Tx: Plasmapheresis and Corticosteroids

Front 12

Cant see, cant pee, cant hear/

(Cataracts, Nephritis, hearing loss)

Back 12

Alport syndrome

- defect in collagen IV in basement membrane

Front 13

Proteinuria > 3g/day, hypoalbuminemia, hyperlipidemia. Dx=?

Back 13

Nephrotic syndrome

Front 14

Most common glomerular disease in HIV pts

Back 14

Focal segmental glomerulosclerosis

Front 15

Most common glomerular disease in afr american pts

Back 15

Focal segmental glomerulosclerosis

Front 16

Most common nephrotic syndrome in adults?

Back 16

Membranous glomerulonephritis

Front 17

Membranoproliferative glomerulonephritis is a/w these conditions (4):

Note: all four need not be present

What is the histological presentation

Back 17

1. Hep B

2. Hep C

3. SLE

4. Subacute bacterial endocarditis

- Basement membrane thickening with double layer "train track" appearance

Front 18

Kimmelstiel Wilson nodules. Basement membrane thickening on EM

Back 18

Diabetic nephropathy

- Kimmelstiel Wilson nodules are on present in the nodular subtype.

Diffuse subtype does not have KW nodules

Front 19

Define azotemia

Back 19

Increased BUN and Cr

Front 20

Granular casts. Dx =?

Back 20

ATN (Acute tubular necrosis)

Front 21

FeNa < 1% signifies?

Back 21

Pre-renal

Front 22

FeNa > 2% suggests?

Back 22

Intrinsic/ATN or Post renal cause

Front 23

BUN: Cr > 20 (or > 15 in some literature) is indicative of ?

Back 23

Pre-renal cause

- Low urine Na (<10 meq/L (10 mmol/L))

- Low FeNa < 1%

- High urine osmolality ( >500)

Products other than Na giving high osmolality

- SG > 1.010

Front 24

Proteinuria in DM. Whats the next step

Back 24

24 hr urine protein level

- to check for nephropathy

Front 25

Whats Uremic syndrome?

Back 25

Azotemia + sx of uremia

Sx=

AMS, Peripheral neuropathy

HTN, Pericarditis

Anorexia, n/v, GI Bleeding

Brownish coloration of skin

Front 26

What electrolyte disturbance is seen with Chronic kidney disease?

Back 26

Hyperkalemia

Hyponatremia

Increased PO4

Decreased Ca

Anemia --> due to lack of EPO

Metabolic acidosis

Urine osmolality is similar to serum osmolality

Front 27

What DM med should not be taken in pts with renal disease

Whats the HbA1c goal in pts with renal disease

Back 27

1. Metformin

2. < 6.5

Front 28

What are the indications for dialysis in patients with CKD?

Back 28

1. Severe hyperkalemia

2. Severe metabolic acidosis

3. Fluid overload

4. Uremic syndrome

5. CKD with Cr > 12 mg/dL and BUN > 100 mg/dL

Front 29

In a healthy person:

a) pH =

b) PCO2 =

c) PO2 =

d) HCO3 =

Back 29

a) 7.4

b) 40

c) 100

d) 24

pH > 7.42 = Alkalosis

pH < 7.3 = Acidosis

Front 30

ACID BASE PHYSIOLOGY

1. Reasons for metabolic alkalosis

Back 30

1. vomiting, diuretics, Cushing syndrome, Hyperaldosteronism

Front 31

1. Reasons for high anion gap metabolic acidosis

Back 31

1. Methanol (MUDPILES)

2. Uremia

3. Diabetic ketoacidosis

4. Paraldehyde

5. INH, Iron toxicity

6. Lactic acidosis - a/w shock

7. Ethanol, Ethylene glycol

7. Salicylates

Front 32

1. Define hypernatremia

2. What are the causes?

Back 32

1. > 155

2. dehydration,

diuretics

Diabetes Insipidus

Docs (Iatrogenic w/ NS IVF)

Diarrhea (and vomiting)

Disease of the kidney (hyperaldosteronism)

Front 33

In a dehydrated patient with hypernatremia, how is it corrected (what fluid choice)?

Back 33

1. NS: until hemodynamically stable

1/2 NS: afterwards

Front 34

1. Tx for Central DI?

2. Tx for Nephrogenic DI?

Back 34

1. Desmopressin (ADH analogue)

2. Salt restriction

Increased H20

thiazide diuretics +/- Indomethicin

Front 35

Tx for Li induced DI?

Back 35

1. Thiazide

2. Indomethacin

3. Amiloride - effects the same channels as used by Li

Front 36

1. Definition of Hyponatremia?

2. Define types of hyponatremia and their tx?

Back 36

1. < 135. Tends to become problematic if < 120

2. Mild: asymptomatic. Irrespective of Na level.

No tx necessary

Moderate:

Severe: Sz

Tx: 3% hypertonic salien

Front 37

What is the tx for hyperkalemia

(Name the steps)

Back 37

1. Check EKG

2. D50 followed by Insulin

3. Ca-gluconate or CaCl to protect myocardium

OTHER TX:
NaHCO3, Albuterol nebulizer

Kayexalate

Lasix, consider Mg if < 2

Front 38

T-wave flattening seen in ?

Back 38

Hypokalemia

Front 39

U-waves seen in

Back 39

hypokalemia

Front 40

Tall peaked T-waves seen in

Back 40

Hyperkalemia

Front 41

Shortened QT interval

Back 41

Hypercalcemia

- Hypocalcemia prolongs QT interval

Front 42

1. Tx of hepatorenal syndrome

2. What keeps the efferent arterioles open

3. What rx dilates the efferent arterioles

4. At what Cr would you stop ACEI?

Back 42

1. Fix the underlying liver condition. BUN:Cr similar to pre-renal causes

2. Prostaglandins

3. ACEI --> good to give in patients with renal issues

4. Never

Front 43

1. MCC of pseudohyponatremia?

2. How do you tx it?

Back 43

1. Elevated serum glucose

- For every increase by 100 in glucose there is drop of 1.6 of Na

2. Fixed the elevated glucose

Front 44

What is the mechanism behind DI

a) Neurogenic

b) Nephrogenic

Back 44

a) Failure to secrete ADH by the post. pituitary

b) No response to ADH by the kidneys

Front 45

Psychogenic DI Nephrogenic DI

a) Na level?

b)Urine osm.

c)Urine Na

d) Nocturia

Back 45

Psychogenic DI Nephrogenic DI

a) Na level? Low High

b)Urine osm. Low Low

c)Urine Na Low Low

d) Nocturia + ++++

Nocturia goes away in psychogenic

Front 46

Define SIADH

Back 46

Urine osm > Serum osm in the presence of hyponatremia

Front 47

Tx for cystitis

Back 47

3 days of Fluoroquinolones or TMP-SMX

- Amoxicillin requires longer tx

Front 48

UTI in pregnancy. Tx =?

Back 48

1. Amoxicillin, Ampicillin, Cefalaxin, Nitrofuratin

Front 49

1. Most common bladder cancer?

2. Most common cause of squamous cell cancer in the bladder?

Back 49

1. Transitional cell carcinoma

2. Schistosoma Hematobium - in the developing world

Front 50

Treatment of bladder cancer?

Back 50

Transurethral cytoscopic resection

Front 51

Tx of urethritis

Back 51

Single dose Erythromycin

or

Single dose ceftriaxone with doxycycline

* Treat sexual partners also

Front 52

Tx for prostatitis?

Back 52

Sx:Perineal pain, dysuria, tender prostate

Sexually active: Ceftriaxone + Doxycycline

Otherwise: TMP-SMX

Front 53

Most common surgical therapy for BPH?

Back 53

TURP: Transuretheral resection of the prostate

Front 54

Tx of BPH

Back 54

Non selective alpha-blockers: -zosins

- if patient also has HTN

Selective alpha-1 blockers: Tamsulosin (Flomax)

- No anti-HTN effects

5-aplha reductase inhibitors: e.g. Finasteride

- reduces dihydrotestosterone levels

Front 55

Most common cancer in men

Back 55

Prostate cancer

Frequency: Prostate > Lung > Colorectal

Mortality: Lung > Prostate > Colorectal

Front 56

1. What are the prostate screening guidelines?

2. Metastasis from prostate cancer is osteo___

Back 56

1. All men > 40 yrs ==> annual DRE

Baseline PSA at age 40

2. Osteoblastic

Front 57

Sudden acute testicular pain, testicle raised and in a horizontal position. Pain not relieved by supporting the testicle.

a) Dx =?

b) Tx = ?

Back 57

a) Testicular torsion

- Often a/w physical activity

b) Tx = Surgical detorsion with bilateral orchiopexy with in 6 hours

Front 58

1. MC germ cell tumor

2. Germ cell tumor with elevated AFP?

Back 58

1. Seminoma

2. Choriocarcinoma

Front 59

Most common obstructive uretheral lesion in infants and newborn

Back 59

Posterior uretheral valves

Front 60

1. At what age can enuresis be diagnosed?

2. At what age do you give treatment?

Back 60

1. 5 years

2. 7 yo -

First - Behavior therapy - Enuresis alarm

2nd line - Imipramine

Front 61

The total urine protein excretion rate is usually less than __ g/24 h

Back 61

1

Front 62

_______ refers to protein excretion that increases during the day but decreases to a normal value (<50 mg/8 h) during recumbency.

Back 62

Orthostatic proteinuria

Front 63

_____ is the most common form of intrarenal disease that causes acute kidney injury in hospitalized patients and shows ________ casts.

Back 63

Acute tubular necrosis (ATN)

Muddy brown casts

Front 64

_____ is characterized by acute kidney injury, sterile pyuria, and leukocyte casts.

Back 64

AIN - Acute interstitial nephritis

- Drugs, particularly β-lactam antibiotics, are the most common etiology of AIN.

- Patients may also have fever, rash, and eosinophilia, although only a minority of patients will have all three features.

Front 65

Define Acute Kidney Injury

Back 65

- an increase in the serum Cr level of ≥0.3 mg/dL over 48 hours,

- an increase in Cr of ≥50%, or

- urine output <0.5 mL/kg/h for >6 hours.

Front 66

Define Chronic kidney disease

Back 66

- Chronic kidney disease (CKD) is defined by an estimated GFR <60 mL/min/1.73 m2 OR

- kidney damage (abnormal findings on urinalysis, kidney imaging, or kidney biopsy) of at least 3 months' duration.

Front 67

Define persistent hematuria?

Back 67

- presence of >= 3 erythrocytes/hpf in the urine detected on two or more samples

Front 68

Pt with 20 yr smoking history presents with persistent hematuria. Whats the next step?

Back 68

Kidney U/S and Cystoscopy

Front 69

The triad of muscle pain, weakness, and dark urine. Most likely dx =?

Back 69

Rhabdomyloysis

- A positive urine dipstick for blood in the absence of erythrocytes also suggests rhabdomyolysis

- history of predisposing factors (such as prolonged immobilization or drug toxicity) and confirmed by the presence of myoglobinuria, an increased serum CK level, and, in some cases, hyperkalemia

- consider rhabdo when CK > 5000 U/L in pts who demonstrate heme positivity on urine dipstick testing in the absence of hematuria.

Front 70

AKI, Thrombocytopenia, Microangiopathic hemolytic anemia. Dx=?

Back 70

HUS

Front 71

What are the two MCC of HUS?

Back 71

1. Shiga toxin–producingEscherichia coli (E. coli O157:H7 and other serotypes)

2. familial deficiency of factor H

- Factor H, a protein in the complement pathway, normally protects cells from damage by the alternative complement pathway. A deficiency of factor H allows C3 to potentiate autoantibody-mediated or immune complex–mediated injury to glomerular cells, leading to exposure of subendothelium and activation of both platelets and coagulation

Front 72

1. Tumor lysis syndrome may manifest as (3):

2. What's the treatment

Back 72

1. hyperkalemia, hyperphosphatemia, and hyperuricemia.

2. Tx = Rasburicase

Front 73

1. What fluids do you give for pre renal azotemia?

Back 73

1. Normal saline

Front 74

Tx of choice in uremia in stage V kidney disease

Back 74

Kidney transplantation

- Transplantation in patients who have not yet been treated with hemodialysis is associated with better patient and allograft outcomes.

Front 75

Diabetic nephropathy is also a/w with ____

Back 75

Diabetic retinopathy

- Diabetic nephropathy often is accompanied by diabetic retinopathy, particularly in type 1 diabetes. In patients with type 2 diabetes, the presence of retinopathy strongly suggests coexisting diabetic nephropathy.

Front 76

What is the Winter's formula?

Back 76

The adequacy of respiratory compensation can be checked using Winter formula:

Winter formula:

Expected Pco2 = (1.5 × [HCO3] + 8) ± 2 = 24 ± 2

If the measured Pco2 is elevated for the degree of metabolic acidosis, the diagnosis of respiratory acidosis is established

Front 77

What is the formula for corrected HCO3

Back 77

Corrected [HCO3] = measured [HCO3] + (measured anion gap – 12)

Front 78

What 5 question should be considered when approaching an acid-base problem

Back 78

* Is the patient acidemic or alkalemic?
* Is the acid-base disorder primarily metabolic or respiratory?
* Is there an anion gap?
* If a metabolic acidosis exists, is there an appropriate respiratory compensation?
* If an anion gap acidemia is present, is there an additional complicating metabolic disturbance?

Front 79

What is the normal anion gap

Back 79

12 ± 2 meq/L

Kaplan: 8-12

Front 80

1. What are the two causes of Normal anion gap metabolic acidosis?

2. How are they distinguished

Back 80

1. kidney or extrarenal disease

2. By measuring the:

Urine anion gap = (urine [Na] + urine [K]) – [urine Cl]

Normal = 30-50 mEq/L

Extrarenal (usually GI) origin: Large -ve Urine anion gap

Renal: +ve urine anion gap

Front 81

The most common renal cause of Normal anion gap metabolic acidosis =

Back 81

Renal tubular acidosis

Front 82

What is the predicted increase in HCO3 in Respiratory acidosis?

a) acute

b) chronic

Back 82

Acute: 1 meq/L (1 mmol/L) for each 10 mm Hg (1.3 kPa) increase in Pco2

Chronic: 4 meq/L (4 mmol/L) for each 10 mm Hg (1.3 kPa) increase in Pco2

Front 83

In acute respiratory alkalosis, for each 10 mm Hg decline in Pco2 the expected decline in serum HCO3 is _____

Back 83

2 meq/L

Front 84

Diuretic-induced hyponatremia most commonly occurs in patients taking________ diuretics

Back 84

thiazide

Tx =

Mildly symptomatic = NS

Severely Symptomatic = 3% saline

Front 85

diuretics are largely ineffective in individuals with an estimated glomerular filtration rate below 30 mL/min/1.73 m2

Back 85

Thiazide

Front 86

In a patient with hypokalemia, a urine potassium concentration of less than ____ meq/L (mmol/L) is suggestive of extrarenal losses, whereas a concentration higher than this value is suggestive of kidney losses.

Back 86

20

Front 87

Laxative abuse causes ____kalemia and _______osis

Back 87

hypokalemia

metabolic acidosis

- Diarrhea leads to fecal potassium wastage and is associated with a normal anion gap acidosis due to increased gastrointestinal loss of bicarbonate

Front 88

Whats the indication for Cinacalcet, a parathyroid calcium-sensing receptor, leading to decreased release of parathyroid hormone?

Back 88

Secondary and Tertiary hyperparathyroidism

Front 89

The MCC of hypercalcemia in the outpatient setting is:

Back 89

Hyperparathyroidism

Front 90

Patients with chronic alcoholism may have normal serum _____ levels on admission to the hospital but may develop severe ______ over the first 12 to 24 hours.

Sx include: confusion, rhabdomyolysis, hemolytic anemia, and severe muscle weakness that can lead to respiratory failure

Back 90

phosphorus, hypophosphatemia

Often due to IV glucose administration, which stimulates insulin release and causes phosphate to shift into cells.

Front 91

Diabetic patient with R flank pain and high fever. CVA tenderness, WBC casts, CT shows air in Right renal parenchyma

Back 91

Emphysematous pyelonephritis

- usually due to gram -ve like E. Coli

- tx includes surgical drainage and abx

Front 92

Pt with acute bacterial prostatitis. Exam shows distended bladder. Whats the next step?

Back 92

Placement of a suprapubic catheter

- Uretheral catheterization is contraindicated due to risk of sepsis

Front 93

The major signs of _____ include liver or spleen damage (splenomegaly), low red blood cell counts (anemia), low blood platelet counts, and bone problems (osteolytic lesions).

Histology reveals large histocytes with cytoplasms engorged with glycolipid.

Back 93

Gaucher disease

- deficiency in glucocerebrocidase

- tx --> imiglucirase

Front 94

1. Initial approach in a patient who has unexplained recurrent kidney stones

2. what is the tx?

Back 94

1. 24h urine with a corresponding blood sample

- to measure Ca, citrate, oxalate and creatinine

2. Thiazide diuretics

- cause reabsorption of filtered Ca.

- Goal of therapy is to reduce calciuria.

Front 95

Choice of IV fluid in hypernatremic hypovolemia?

Back 95

NS

Front 96

What is the pathophysiology of

a) Type I renal tubular acidosis

b) what is the urine pH

c) Clinical features

d) Treatment

e) Causes

Back 96

a) No distal tubular acid secretion

b) > 5.3

- Only type with > 5.3 pH

c) Renal stones , low K+

d) Oral HCO3, K+, Thiazides

e) Amphotericin, light chains in MM, chronic infection

Front 97

What is the pathophysiology of

a) Type II renal tubular acidosis

b) what is the urine pH

c) Clinical features

d) Treatment

e) Causes

Back 97

a) No proximal tubular HCO3 reabsorption

b) < 5.3

c) Low K+, Low HCO3-, Lytic bone lesions

d) Thiazides, oral HCO3

e) Carbonic anhydrase inhibitors (MCC), primary hyperparathyroidism, drugs (aminoglycoside), Fanconi syndrome

Front 98

What is the pathophysiology of

a) Type IV renal tubular acidosis

b) what is the urine pH

c) Clinical features

d) Treatment

e) Causes

Back 98

a) Aldosterone deficiency - Primary or Secondary

b) < 5.3

c) High K+ - only type with high K+

d) Fludrocortisone, K+ restriction

e) Aldosterone deficiency, DM, Interstitial disease, excess spirinolactone

Front 99

Prominent U Waves are present in ______

Back 99

hypokalemia

Front 100

The first EKG finding of hyperkalemia is _____

Back 100

Tall, peaked T-waves

- as the hyperkalemia worsens, there is

P-wave flattening

prolongation of the PR interval

Widening of QRS

Shortening of QT segment

Front 101

In post-streptococcal glomerulonephritis, hematuria develops ______ after the primary infection

Back 101

1-2 weeks

Front 102

Cause of IgA nephropathy is usually _______ (bacterial or viral)

Back 102

Viral

- Asymptomatic (gross) Hematuria 1-2 days after upper respiratory tract infection or GI infection is a common presentation of IgA nephropathy

Front 103

Pts with proteinuria due to glomerular disease should be given ____ to reduce proteinuria and HTN

Back 103

ACEI or ARBs

Front 104

Uniform and diffuse effacement of foot processes is seen in ______

Back 104

MCD

Front 105

High CK, positive Blood on urine dipstick with no RBCs. dx?

Back 105

Myoglobinuria from rhabdomyolysis

- Ethanol abuse cause hypophosphatemia and hyperkalemia - both can cause rhabdomyolysis

Front 106

______ can be given for alkalization of urine

Back 106

Potassium citrate

- given in hyperurecemic pts who have uric acid stones

Front 107

_____ kidney stones are a/w UTI

Back 107

Struvite (MgNH4PO4)

Front 108

_______ presents with spasms of pain, usually unilateral, often radiating to the groin.

Back 108

Renal colic

- tx with NSAIDS and IV hydration

Front 109

1. Hyperphosphatemia is considered significant when values reach > _____ mg/dl

2. What are oral PO4 binders used in the tx of hyperphosphatemia?

Back 109

1. 1. 5 mg/dl

2. CaCO3, Calcium acetate

Front 110

______ is a complication of EPO therapy for the tx of anemia due to chronic renal failure

Back 110

HTN - develops suddenly at initiation of therapy

Front 111

Tx of Choice to prevent contrast induced nephropathy

Back 111

IV hydration with NS

Front 112

Pts with sickle cell disease most commonly have this renal condition?

Back 112

papillary necrosis

Front 113

1. U/S of testes reveals homogenous, hypo echoic mass

Back 113

1. seminoma

Front 114

Name cancers involved with the following tumor markers:

a) CA-125 (3)

b) CA-19-9

c) PSA

d) S-100

Back 114

a) ovarian, endometrial, pancreatic

b) Pancreatic and GI malignancies

c) Prostate diseases

d) Melanoma

Front 115

What is the normal anion gap?

Back 115

5-15

Front 116

RTA - Type 2:

a) What is the pathophysiology

b) Clinical features?

c) Serum K levels?

d) Dx?

e) Tx?

Back 116

a) No prox tubular bicarb absorption

b) Osteomalacia/Rickets

c) Low K+

d) HCO3 load test (level remains low)

e) Volume restriction

Also, High dose HCO3 and/or thiazide

Front 117

Nephrocalcinosis and nephrothiliasis is a feature of RTA type _____

Back 117

RTA Type I