Step 2 Ck Renal

Front 1

what is hypernatremia?

Back 1

Serum sodium > 145 mEq. Usually due to water loss

Front 2

presentation of hypernatremia

Back 2

>>thirst (due to hypertonicity) >>Neurologic symptoms ie. mental status changes, weakness, focal neurologic deficits, and seizures.
>>Examination reveals “doughy” skin

Front 3

Hypernatremia causes—

Back 3

Diuretics
Dehydration
Diabetes insipidus
Docs (iatrogenic)
Diarrhea
Disease (e.g., kidney,
sickle cell)

Front 4

treatment for hypernatremia

Back 4

>>Treat the underlying causes >>replace free-water deficit with hypotonic saline, D5W, or oral water
>>Correction of chronic hypernatremia (> 36–48 hours) should occur gradually
over 48–72 hours to prevent neurologic damage 2° to cerebral
swelling.

Front 5

Hyponatremia

Back 5

Serum sodium < 136 mEq/L.

Front 6

what are some of the causes of hypotonic hyponatremia. Osmolarity :High (> 295 mEq/L):

Back 6

Hyperglycemia, hypertonic infusion (e.g., mannitol).
■

Front 7

what are some of the causes ofnormal osmolarity with hyponatremia. Osmolarity : normal

Back 7

Normal (280–295 mEq/L): Hypertriglyceridemia, paraproteinemia
(pseudohyponatremia).

Front 8

what are the 3 types of hypotonic with Low (< 280mEq/L):osmolarity

Back 8

Hypervolemic
Euvolemic
Hypovolemic

Front 9

Hypervolemic hyponatremic hypotonic: etiology and tx

Back 9

etiology: Renal failure, nephrotic syndrome, cirrhosis, CHF.
tx:Water restriction.

Front 10

Euvolemic hyponatremic hypotonic: etiology and tx

Back 10

SIADH, hypothyroidism, renal failure, drugs, psychogenic polydipsia, adrenal insufficiency
Tx: Water restriction.

Front 11

Hypovolemic hyponatremic hypotonic: etiology and tx

Back 11

Diuretics, vomiting, diarrhea, third spacing, dehydration.
Tx:Replete volume with normal saline

Front 12

how should chronic hyponatremia be treated?

Back 12

Chronic hyponatremia (> 72 hours’ duration) should be corrected slowly (no more than 0.5–1.0 mEq/L/hr) in order to prevent central pontine
myelinolysis (quadriplegia and pseudobulbar palsy).

Front 13

Hypervolemic hyponatremia is
caused by

Back 13

“nephrOSIS,
cirrhOSIS, and cardiOSIS.”

Front 14

Hyperkalemia

Back 14

Serum potassium > 5 mEq/L

Front 15

Treatment of hyperkalemia—

Back 15

Values of > 6.5 mEq/L or ECG changes require emergent treatment.
C BIG K
Calcium
Bicarbonate
Insulin
Glucose
Kayexalate

Front 16

diagnosis of hyperkalemia

Back 16

>>Verify hyperkalemia with a repeat blood draw
>>ECG findings include tall, peaked T waves; PR prolongation; wide QRS;
and loss of P waves Can progress to sine waves, ventricular fibrillation, and cardiac arrest.

Front 17

Hypokalemia

Back 17

Serum potassium < 3.6 mEq/L

Front 18

presentation of hypokalemia

Back 18

Fatigue, muscle weakness or cramps, ileus,

Front 19

treatment of hypokalemia

Back 19

>>Treat the underlying disorder.
>>Oral and/or IV potassium repletion.
>>Replace magnesium, as this deficiency makes potassium repletion difficult.

Front 20

Causes of hypercalcemia

Back 20

CHIMPANZEES
Calcium supplementation
Hyperparathyroidism Iatrogenic (e.g., thiazides)/Immobility
Milk-alkali syndrome
Paget’s disease
Addison’s
disease/Acromegaly
Neoplasm
Zollinger-Ellison syndrome (e.g.,MEN I)
Excess vitamin A
Excess vitamin D
Sarcoidosis and other
granulomatous
disease

Front 21

Hypercalcemia

Back 21

Serum calcium > 10.2 mg/dL. The most common causes are hyperparathyroidism and malignancy

Front 22

presentation of hypercalcemia

Back 22

bones (fractures), stones (kidney stones), abdominal groans
(anorexia, constipation), and psychiatric overtones (fatigue,depression)

Front 23

treatment for hypercalcemia

Back 23

IV hydration followed by furosemide to ↑ calcium excretion.
■ Calcitonin, bisphosphonates (e.g., pamidronate), glucocorticoids, and dialysis
are used for severe or refractory cases. Avoid thiazide diuretics, which
↑ tubular reabsorption of calcium

Front 24

treatment of hypocalcemia

Back 24

TREATMENT
■ Treat the underlying disorder.
■ Magnesium repletion.
■ Administer oral calcium supplements; IV calcium for severe symptoms

Front 25

hypocalcemia presentation

Back 25

Chvostek’s sign
Trousseau’s sign
abdominal muscle cramps, dyspnea, tetany, perioral and
acral paresthesias,

Front 26

ECG hypocalcemia

Back 26

ECG may show a prolonged QT interval.

Front 27

Dx: patient who
develops cramps and tetany
following thyroidectomy.

Back 27

hypocalcemia

Front 28

how are the calcium levels in hypoalbuminemia

Back 28

Serum calcium may be falsely
low in hypoalbuminemia

Front 29

Hypomagnesemia

Back 29

Serum magnesium < 1.5 mEq/L

Front 30

treatment for hypomagnesemia

Back 30

IV and oral supplements.
■ Hypokalemia and hypocalcemia will not correct without magnesium correction

Front 31

↑ anion gap— caused by what diseases

Back 31

MUDPILES
Methanol
Uremia
DKA
Paraldehyde
Intoxication
Lactic acidosis
Ethylene glycol
Salicylates

Front 32

pH < 7.4 pCO2 >40

Back 32

Respiratory acidosis
Hypoventilation
Acute lung disease
Chronic lung disease
Opioids, narcotics, sedatives
Weakening of respiratory
muscles

Front 33

pH < 7.4 pCO2 <40 with normal anion gap

Back 33

Normal anion gap (8–12 mEq/L)
–Diarrhea
–Glue sniffing
–Renal tubular acidosis
–Hyperchloremia

Front 34

pH < 7.4 pCO2 <40

Back 34

⇧Anion gap
–Renal failure
–Lactic acidosis
–Ketoacidosis (DM)
–Aspirin ingestion

Front 35

pH > 7.4 PCO2 < 40 mmHg

Back 35

Respiratory alkalosis
–Hyperventilation
–Aspirin ingestion (early)

Front 36

pH > 7.4 PCO2 > 40 mmHg

Back 36

Metabolic alkalosis with
compensation
–Vomiting
–Diuretic use
–Antacid use
–Hyperaldosteronism

Front 37

Pre renal:

Intrinsic:

Back 37

↓ renaI Intrinsic

Injury within the nephron unit.

Front 38

Postrenal:

Back 38

Urinary outflow obstruction. Generally, both kidneys must be obstructed in order to → a significant ↑ in BUN and creatinine.

Front 39

etiology: An FeNa < 1%, a UNa < 20, a specific gravity > 1.020, or a BUN/creatinine ratio > 20

Back 39

prerenal etiology

Front 40

White cells, eosinophils: etiology and classification

Back 40

etiology: Allergic interstitial nephritis, atheroembolic disease
classification is intrinsic

Front 41

Hyaline casts: etiology and classification

Back 41

etiology: Normal finding, but ↑ amount suggests volume depletion.
classification is Prerenal

Front 42

Red cell casts, dysmorphic red cells

Back 42

Glomerulonephritis
Intrinsic

Front 43

Granular casts, renal tubular cells,

Back 43

ATN
Intrinsic

Front 44

White cells, white cell casts

Back 44

Pyelonephritis
Postrenal

Front 45

Indications for urgent dialysis

Back 45

AEIOU
Acidosis
Electrolyte abnormalities
(hyperkalemia)
Ingestions (salicylates, theophylline, methanol, barbiturates, lithium, ethylene glycol) Overload (fluid)
Uremic symptoms
(pericarditis, encephalopathy,
bleeding, nausea, pruritus, myoclonus

Front 46

hematuria, hypertension, and oliguria. DDx

Back 46

nephritic syndrome

Front 47

tx of nephrotic syndrome

Back 47

Corticosteroids are useful in reducing glomerular inflammation in some
cases

Front 48

nephrotic syndrome

Back 48

proteinuria (≥ 3.5 g/day), generalized edema, hypoalbuminemia, and hyperlipidemia

Front 49

Membranous nephropathy: most common in what group of people an biopsy

Back 49

The most common nephropathy in caucasian adults
“Spike-and-dome” appearance

Front 50

tx for nephrotic syndrome

Back 50

Protein and salt restriction, diuretic therapy, antihyperlipidemics.
■ ACEIs ↓ proteinuria and diminish the progression of renal disease in patients
with diabetic nephropathy.
■ Vaccinate with 23-polyvalent pneumococcus vaccine (PPV23), as patients
are at ↑ risk of Streptococcus pneumoniae infection.

Front 51

Dx for nephrolithiasis

Back 51

Obtain an AXR in patients with known radiopaque stones and possibly a renal ultrasound to look for obstruction as well as for pregnant patients, in

Front 52

tx for calcium oxalate stones

Back 52

Hydration, thiazide diuretic.

Front 53

(Mg-NH4-PO4) tx

Back 53

Hydration; treat UTI

Front 54

uric acid: tx and type of stone

Back 54

Hydration; alkalinize urine
Acidic urine (pH < 5.5). Radiolucent. with citrate, which is converted to HCO3 in the
liver; dietary purine restriction and allopurinol.

Front 55

cystine stones tx

Back 55

from homocytenuria
Hydration, alkalinize urine,
penicillamine.

Front 56

dx of stones

Back 56

Noncontrast abdominal CT scans may diagnose stones and other causes
of flank pain.
■ An IVP can be used to confirm the diagnosis if there is a lack of contrast
filling below the stone

Front 57

initial treatment of stones

Back 57

Hydration and analgesia are the initial treatment.

Front 58

presentation of PCKD

Back 58

Pain and hematuria,hypertension, hepatic cysts, cerebral berry
aneurysms,

Front 59

management of PCKD

Back 59

Prevent complications and ↓ the rate of progression to end-stage renal disease. Early management of UTIs and control of BP

Front 60

Dx of PCKD

Back 60

Based on ultrasound or CT scan

Front 61

management of ESRD in PCKD

Back 61

Dialysis and renal transplantation are used to manage patients with endstage renal disease.

Front 62

RTA type I: complications and tx

Back 62

Treatment: Potassium citrate.
Complications: Nephrolithiasis.

Front 63

RTA type II: complications and tx

Back 63

Treatment: Potassium citrate.
Complications: Rickets, osteomalacia.

Front 64

RTA type IV: complications and tx

Back 64

Treatment: Furosemide, fludrocortisone, and low-potassium diet in patients with aldosterone deficiency.
Complications: Hyperkalemia

Front 65

types of uretharal reflux

Back 65

■ Mild reflux (grades I–II): No ureteral or renal pelvic dilatation. Often
resolves spontaneously.
■ Moderate to severe reflux (grade III–V): Ureteral dilatation with associated
calyceal blunting in severe cases

Front 66

common presentation of urethral reflux

Back 66

Patients present with recurrent UTIs

Front 67

Dx: of urethral reflux

Back 67

Perform a voiding cystourethrogram

All children < 7 years of age presenting with their first UTI should undergo a voiding cystourethrogram
to screen for reflux.

Front 68

management of reflux

Back 68

>>Treat infections aggressively.
>>Treat mild reflux with daily prophylactic antibiotics until reflux resolves at puberty. >>Ureteral implantation may be considered in severe reflux.

Front 69

complication of reflux

Back 69

Inadequate treatment can → progressive renal
scarring and end-stage renal disease.

Front 70

how to diagnose DI

Back 70

During a water deprivation test, patients excrete a high volume of dilute urine.
■ Desmopressin acetate (DDAVP) challenge:
■ Central DI: DDAVP (a synthetic analog of ADH) challenge will ↓
urine output and ↑ urine osmolarity.
■ Nephrogenic DI: DDAVP challenge will not significantly ↓ urine output.
■ MRI may show a pituitary or hypothalamic mass in central DI

Front 71

Tx for central and nephrogenic DI

Back 71

Treat the underlying cause.
■ Central DI: Administer DDAVP intranasally.
■ Nephrogenic DI: Salt restriction and ↑ water intake are the 1° treatment.
Thiazide diuretics

Front 72

SIADH tx.

Back 72

Restrict fluid and address the underlying cause.
■ Na < 110 mEq/L) or the patient is significantly give hypertonic saline.
■ Demeclocycline can help normalize serum sodium by antagonizing the action of ADH in the collecting duct.

Front 73

BPH diagnosis

Back 73

DRE to screen for masses; if findings are suspicious, evaluate for prostate cancer.
■ UA and urine culture to rule out infection and hematuria.
■ Creatinine levels to rule out obstructive uropathy and renal insufficiency.

Front 74

tx for BPH: mild, moderate and severe symptoms

Back 74

Reassurance for mild symptoms.
■ Medical therapy with α-blockers (terazosin) and 5α-reductase inhibitors
(finasteride) to reduce mild to moderate symptoms.
■ Transurethral resection of the prostate (TURP) or open prostatectomy forpatients with moderate to severe symptoms.

Front 75

what is the major side effect of α-
blockers?

Back 75

orthostatic hypotension

Front 76

what are the Leading causes of
cancer death in men:

Back 76

1. Lung cancer
2. Prostate cancer
3. Colorectal cancer
4. Pancreatic cancer
5. Leukemia

Front 77

presentation of prostate cancer.

Back 77

Usually asymptomatic,urinary retention,back pain due to bone metastases. DRE may reveal a palpable nodule or an area of induration.

Front 78

Dx of prostate cancer

Back 78

>>↑ PSA (> 4 ng/mL)
>>Definitive diagnosis ultrasound-guided transrectal biopsy
>>Tumors are graded by the Gleason histologic system, 10 is the highest grade.
>>metastases: CXR and bone scan

Front 79

treatment for protate cancer:
>>low grade tumors:
>>↑ risk of incontinence and/or impotence:
>>metastatic disease:
>>for progress of treatment:

Back 79

>>low grade tumors: Watchful waiting
>>↑ risk of incontinence and/or impotence: Radical prostatectomy and radiation therapy
>>metastatic disease: androgen ablation
>>PSA for progress of treatment

Front 80

recommended screening method for prostate cancer

Back 80

annual DRE after the age
of 50 is the recommended
screening method for prostate
cancer.

Front 81

Differential for hematuria

Back 81

S2I3T3
Strictures
Stones
Infection
Inflammation
Infarction
Tumor
Trauma
TB

Front 82

most common presenting symptom of bladder cancer

Back 82

Gross hematuria is the most common presenting symptom.

Front 83

diagnostic test for bladder cancer

Back 83

>>UA often shows hematuria
>>IVP can examine the upper urinary tract as well as defects in bladder filling.

Front 84

tx: for bladder cancer
Carcinoma in situ:

Back 84

Carcinoma in situ: Intravesicular chemotherapy.
■ Superficial cancers: Complete transurethral resection or intravesicular
chemotherapy with mitomycin-C or BCG (the vaccine for TB).
■ Large, high-grade recurrent lesions: Intravesicular chemotherapy.
■ Invasive cancers without metastases: Radical cystectomy or radiotherapy
for patients who are deemed poor candidates for radical cystectomy or with
unresectable local disease.
■ Patients with distant metastases: Chemotherapy alone.

Front 85

tx: for bladder cancer: Superficial cancers:

Back 85

Complete transurethral resection or intravesicular
chemotherapy with mitomycin-C or BCG (the vaccine for TB).

Front 86

tx: for bladder cancer
Large, high-grade recurrent lesions:

Back 86

Intravesicular chemotherapy.

Front 87

tx: for bladder cancer
Invasive cancers without metastases:

Back 87

Radical cystectomy or radiotherapy
for patients who are deemed poor candidates for radical cystectomy or with
unresectable local disease.

Front 88

tx: for bladder cancer
Patients with distant metastases:

Back 88

Chemotherapy alone.

Front 89

hematuria, flank pain, and a palpable flank mass. Dx

Back 89

renal cell carcinoma

Front 90

presentation of renal cell carcinoma

Back 90

>>Anemia is common at presentation, but polycythemia due to ↑ erythropoietin
production may be seen in 5–10% of patients.
>>fever and Varicocele in men
>>hematuria, flank pain, and a palpable flank mass.

Front 91

Dx of renal cell carcinoma

Back 91

Ultrasound and/or CT to characterize the renal mass

Front 92

Tx for renal cell carcinoma

Back 92

>>Surgical resection may be curative in localized disease
>>chemotherapy 15%-30%

Front 93

presentation of testicular cancer

Back 93

>>painless enlargement of the testes
>>ages of 15 and 30
>>seminomas: 40 and 50 years of age.

Front 94

testicular cancer etiology and RF

Back 94

ET:germ cells, and virtually all are malignant.
RF: Cryptorchidism: ↑ risk of neoplasia in both testes. and Klinefelter’s syndrome

Front 95

diagnosis of testicular cancer: next best step, evaluation of metastasis, tumor markers

Back 95

>>Testicular ultrasound.
■ CXR and abdominal/pelvic CT to evaluate for metastasis.
■ Tumor markers are useful in diagnosis and in monitoring treatment response.

Front 96

β-hCG in testicular carcinoma: Dx

Back 96

↑ in choriocarcinoma and 10% of seminomas.

Front 97

α-fetoprotein (AFP)

Back 97

↑ nonseminomatous germ cell
tumors, particularly endodermal sinus (yolk sac) tumors.

Front 98

treatment for testicular cancer:
main therapy

Back 98

>>Radical orchiectomy.

Front 99

testicular cancer: nonseminomatous germ cell tumors tx

Back 99

>>Platinum-based chemotherapy is used for nonseminomatous germ cell tumors.

Front 100

testicular cancer: seminoma tx

Back 100

>>Seminomas are exquisitely radiosensitive and also respond to chemotherapy.

Front 101

what is cryptochodism

Back 101

Failure of the testes to fully descend into the scrotum.

Front 102

RF of cryptochodism

Back 102

Prematurity

Front 103

Bilateral cryptochodism what is it associated with

Back 103

oligospermia and infertility

Front 104

cryptochordism presentation

Back 104

>>Testes cannot be manipulated into the scrotal sac with gentle pressure
>>testes is palpated anywhere along the inguinal canal or in the abdomen.

Front 105

tx for cryptochordism

Back 105

Orchiopexy after age one but before age five (to preserve fertility).
If it is later in life: orchiectomy to decrease risk of testicular cancer

Front 106

Erectile dysfunction RF

Back 106

DM, atherosclerosis, medications

Front 107

causes of ED

Back 107

>>medication use
>>nocturnal or early-morning erections (if present, it is nonorganic)
>>neurologic dysfunction
>>hypogonadism

Front 108

test for ED

Back 108

>>Check prolactin, as elevated prolactin can →↓androgen activity
>>Testosterone and gonadotropin levels may be abnormal

Front 109

physiological ED tx

Back 109

psychotherapy or sex
therapy involving discussion and exercises with the appropriate partner.

Front 110

organic ED tx

Back 110

sildenafil (Viagra) and vardenafil (Levitra)

Front 111

when would you use testosterone therapy for tx of ED?

Back 111

Testosterone is a useful therapy for patients with hypogonadism of testicular or pituitary origin;

Front 112

tx for ED who failed medical therapy

Back 112

Vacuum pumps, intracavernosal injections, and surgical implantation of
semirigid or inflatable penile prostheses