Usmle Ck - Renal

Front 1

pt with annual exam, increased fatigue, taking increased analgesics, now with chronic increased BUN, Cr? path?

Back 1

- ARF due to tubulointerstitial nephritis
- see papillary necrosis, hematuria, sterile pyuria

Front 2

pt with very acute increase in BUN/Cr? urinalysis?

Back 2

- ARF due to ATN
- muddy brown casts

Front 3

pt post-strep now with hematuria, edema, HTN, oliguria?

Back 3

- nephrotic syndrome due to post-strep glomerulonephritis

Front 4

pt with radioopaque stones, no previous hx, no fhx?

Back 4

- calcium oxalate

Front 5

when do you see calcium phosphate stones?

Back 5

- primary hyperPTH or RTA

Front 6

pt with long hx of DM now presents with urinary incontinence? tx?

Back 6

- diabetic neuropathy causing detrusor weakness
- denerated bladder ==> urinary retention ==> bladder overdisteneds until greater than urethral pressure ==> dribbles out
- tx: cath, cholinergic meds (bethanechol)

Front 7

which meds causes urinary retention?

Back 7

anticholenergics (psych meds)

Front 8

older male s/p abdominal surgery, POD#4, presents with oliguria (200ml over 24hrs). dx? next step?

Back 8

- ARF 2/2 post-op urinary retention 2/2 BPH
- first step in ARF is always to cath to r/o post renal causes then work up pre and intrinsic

Front 9

woman w/ sx of UTI, dipstic +WBC, neg bacteria and UCx, mucopurulent d/c at urethral os?

Back 9

- chlamydia urethritis

Front 10

pt with hyperK+ on HTN meds, which meds is the pt on?

Back 10

K+ sparing diuretic e.g. amiloride

Front 11

pt with K+ >6.5 or increased K with EKG changes. tx?

Back 11

- 10 ml 10% calcium gluconate to stabilize myocardial memebrane
- immediate: insulin, B2 agaonist, NaBicarb to drive K+ into cells
- to remove K+ from body, give kayexalate (Na polysturene sulfonate, cation exchange resin)
- slower methods to decrease K+: loop and thiazide diuretics

Front 12

pt with palpable purpura, proteinuria, hematuria?

Back 12

- mixed cryoglobulinemia
- pt most likely has hx of HCV
- other nonspecific systemic sx: arthralgia, hepatosplenomegaly, hypocomplementuria

Front 13

pt with seizures, acute increase Cr, large blood on dipstick but only 0-1 RBC in urine microscopy?

Back 13

- rhabdomyolysis, b/c UA can't ddx myoglobin and hemoglobin
- increased Cr2/2 rhabdomyolysis causing tubular injury ==> ATN

Front 14

pt with HTN and palpable kidney

Back 14

- ADPKD
- often have palpable cystic liver

Front 15

old man with urinary frequency, urgency, incomplete voiding, normal UA. dx? tx?

Back 15

- BPH: grows from center to peripheral
- tx: alpha blockers or cath if significant obstruction (ARF)

Front 16

pt with priapism. which meds?

Back 16

- prazosin and trazadone

Front 17

pt with sx urinary retention that just took diphenhydramine. mechanism?

Back 17

- 1st gen H1 antihis (diphenhydramine, chlorpheniramin, hydroxyzine, doxepin) have anticholinergic effects ==> dry mouth, urinary retention
- detrusor inactivity 2/2 inhibition of ACh on muscarinic receptors

Front 18

pt presents with sx of pericarditis and uremia/renal failure. tx?

Back 18

- hemodyalysis

Front 19

indications for hemodyalsis?

Back 19

- refractory hyperK, volume oerload, refractory met acidosis, uremic pericarditis, uremic encephalopathy/renopathy, coagulopathy 2/2 renal failure

Front 20

pt with renal biopsy showing increased extracellular matrix, BM thickening, mesangial expansion, fibrosis?

Back 20

DM nephropathy

Front 21

MCC death in dialysis pt?

Back 21

CV disease

Front 22

pt with decreased FENa. which renal dz?

Back 22

prerenal

Front 23

pt with renal failure w/ urinalsis showing epithelial cells and eosinophils? if urinarlysis were negative for epithelial cells and eosinophils?

Back 23

- AIN 2/2 penicillin/naficillin
- aminoglycosides

Front 24

pt on acyclovir now with ARF/increased Cr? prevention?

Back 24

- aggressive hydration to prevent crystallization

Front 25

pt with radiolucent stone. what stone and tx?

Back 25

- uric acid stone, seen in decreased pH urine
- tx: hydration, alkalize urine with KBicarb or K citrate

Front 26

pt with hepB and nephrotic syndrome 2/2?

Back 26

- membranous glomerulonephritis

Front 27

pt with HIV and nephrotic syndrome 2/2?

Back 27

- FSGN

Front 28

child with nephrotic syndrome?

Back 28

- minimal change dz

Front 29

pt with proteinuria and DM. what pathology?

Back 29

- diffuse glomerulosclerosis, BM changes
- nodular gomerulosclerosis = Kimmelstiel Wilson nodules

Front 30

pt with focal glomerulosclerosis?

Back 30

analgesic abuse nephropathy

Front 31

- pt with increased ca and normal phos?
- pt with increase ca and decreased phos?
-pt with increased ca and phos?

Back 31

- paraproteinemia
- primary hyperPTH
- secondary hyperPTH

Front 32

ddx pulm-renal syndromes?

Back 32

- goodpasture, wegener's, SLE associated nephritis, polyarteritis nodosa, RPGN

Front 33

tx goodpastures? path?

Back 33

- emergent plasmapheresis
- anti-GBM ab

Front 34

pt with rash, arthralgias, sterile pyuria and eosinophilia? which drugs?

Back 34

- cephalosporin, PCN, sulfonamides, NSAIDs, rifampin, phenytoin, allopurinol

Front 35

pt with CRF now w/ bleeding problem, why? tx?

Back 35

- platelet dxfx is common in CRF
- labs: normal everything but increased BT
- tx: DDAVP to increase factor VIII vonwillebrand factor

Front 36

with w/ azotemia and BUN:Cr >20?

Back 36

dehydration

Front 37

pt with nephrotic syndrome is at risk for what? tx?

Back 37

- accelerated atherosclerosis w/ increased LDL, decreased HDL, and hypercaog
- tx statins
- also risk of hyperPTH with urine loss vitD

Front 38

pt with amyloidosis and new onset edema?

Back 38

- amyloidosis is common cause of nephrotic syndrome

Front 39

pt with painless hematuria and no other sx?

Back 39

- gross hematuria is always ca of kidney, ureter, bladder; bladder > renal cell ca
- always check microscopically b/cmay be myoglobinuria, hemoglobinuria

Front 40

pt with hx of RA or any chronic inflammatory dz now with nephrotic syndrome, why?

Back 40

- increased risk of amyloidosis ==> causing nephrotic syndrome

Front 41

pt with biopsy showing linear Ig deposits on immunofluorescence
- if biopsy showing granular depositis of Ig?

Back 41

- antiGBM dz e.g. goodpasture's syndrome (tx emergent plasmaphereisis)
- immune complex GN 2/2 SLE, PSGN

Front 42

labs of ATN?

Back 42

- BUN/Cr <20:1, Urine osm 300-350 (never <300) urine Na >20, FeNa >2%

Front 43

pt with: 1. waxy casts? 2. RBC casts? 3. WBC casts? 4. fatty casts? 5. hyaline casts?

Back 43

1. CRF; 2. glomerular dz, vasculitis, glomerulonephritis; 3. interstitial nephritis, pyelonephritis,; 4. nephrotic syndrome; 5. pre-renalazotema (composed of protein)

Front 44

pt with nephrotic dz following URI?

Back 44

IgA nephropathy

Front 45

pt with nephrotic syndrome and hx obesity or heroin use or HIV or african american?

Back 45

FSGN

Front 46

red casts?

Back 46

- NOT AIN (see white casts) but +hematuria
- yes PSGN

Front 47

deformed RBCs on urinalysis?

Back 47

glomerular dz
- would also see proteinuria, casts
- not AIN

Front 48

1. IgE renal damage? 2. cytotoxic ab renal damage? 3. delayed hypersensitivity?

Back 48

1. AIN; 2. goodpasture; 3. nonspecific chronicGN