Usmleworld Gu&electrolyte

Front 1

what portion of bladder is most susceptible to rupture?

Back 1

dome

also only part covered by peritoneum; rupture at the dome causes leakage of urine and irritation of peritoneum

Front 2

patients with diabetes and acute renal failure must avoid what medication?

Back 2

metformin

associated with increased incidence of lactic acidosis; must be D/C'd until renal function improves

Front 3

give levels of calcium and phosphorus in the following:

pseudo- or primary hypoparathyroidism

renal failure

malabsorption

Back 3

pseudo- or primary hypoparathyroidism: low Ca2+, high phos

renal failure: leads to secondary hypoparathyroidism (see above)

malabsorption: low Ca2+, low phos (due to vitamin D deficiency)

Front 4

what is most common form of HIV nephropathy?

what is the presentation?

Back 4

focal and segmental glomerulosclerosis

heavy proteinuria with rapid development of renal failure

Front 5

how should patients at heightened risk for contrast-induced nephropathy be managed?

Back 5

non-contrast modality if possible (e.g. ultrasound)

non-ionic contrast agent

Front 6

what electrolyte abnormality may develop in patients requiring multiple transfusions?

what is clinical presentation?

Back 6

hypocalcemia

hyperactive DTRs, muscle cramps, convulsions (rare)

Front 7

give the diagnosis:

nephrotic-range proteinuria
hematuria
intramembranous deposits that stain for C3

Back 7

membranproliferative glomerulonephritis (type 2)

IgG against C3 convertase lead to persistent complement activation and kidney damage

Front 8

what does the cast indicate?

muddy brown
RBC
WBC
fatty
broad, waxy

Back 8

muddy brown: ATN

RBC: glomerulonephritis

WBC: interstitial nephritis, pyelonephritis

fatty: nephrotic syndrome

broad, waxy: chronic renal failure

Front 9

presentation of Alport's syndrome

Back 9

recurrent gross hematuria and proteinuria

sensorineural deafness

EM: alternating areas of thinned and thickened capillary loops with splitting of GBM

Front 10

features of analgesic nephropathy

Back 10

chronic tubulointerstitial damage due to long-term analgesic abuse

analgesic-mediated vasoconstriction of medullary blood vessels --> renal papillary ischemia --> papillary necrosis --> hematuria (usually painless but renal colic if massive, with clots)

Front 11

presentation of aspirin toxicity

Back 11

mixed anion gap metabolic acidosis/respiratory alkalosis

uncoupling of oxidative phosphorylation leads to increased tissue O2 utilization, hyperpyrexia

salicylate toxicity also leads to inhibition of carb/lipid metabolism leading to increases of pyruvate, lactic acid; impaired renal function due to accumulation of sulfuric, phosphoric acids

Front 12

Winter's formula

what does it tell us?

Back 12

PaCO2 = 1.5[HCO3-] + 8

expected compensatory PaCO2 value in primary metabolic acidosis

Front 13

what is the most common cause of glomerulonephritis in adults?

Back 13

IgA nephropathy (5 days or less post-URI)

post-strep GN occurs ~10 days after pharyngitis and ~21 days after impetigo

Front 14

what is the acute treatment of symptomatic hypercalcemia?

Back 14

IV fluid resuscitation

avoid HCTZ, which may exacerbate hypercalcemia

Front 15

presentation of varicocele

Back 15

dull or dragging scrotal discomfort
bag of worms texture
size increase with Valsalva

this is due to tortuous dilation of the pampiniform plexus (surrounding spermatic cord and testis), most commonly of the left side

Front 16

agents leading to drug-induced interstitial nephritis?

what is the presentation?

Back 16

penicillins, cephalosporins, sulfonamides, others

fever, rash, myalgia
peripheral eosinophilia, hematuria, sterile pyruia, eosinophiluria
WBC casts possible

Front 17

what acid-base status expected in an infant with pyloric stenosis and poor feeding?

Back 17

metabolic alkalosis due to severe vomiting, contraction alkalosis due to ECF volume contraction

decreased volume leads to RAA activation causing water retention at the expense of H+ losses, leading to increased HCO3-

Front 18

give the Dx: sudden abd pain, fever, and hematuria in the setting of membranous glomerulonephritis

Back 18

renal vein thrombosis

may occur in any form of nephrotic syndrome due to loss of antithrombin III

Front 19

what is a contraindication to use of succinylcholine?

Back 19

hyperkalemia, since succinylcholine causes significant K+ release and may result in life-threatening arrhythmias

Front 20

give the treatment:

acute hyponatremia

chronic hyponatremia

Back 20

3% saline

0.9% (normal) saline

in the chronic setting, brain cells have adjusted to the hyponatremic milieu and a rapid increase in serum sodium can cause osmotic demyelination syndrome

Front 21

strategies to shift K+ intracellularly

Back 21

insulin + glucose
bicarb
beta-2 agonists (e.g. albuterol)

Front 22

a discrepancy between dipstick finding of "Large Blood" and urine sediment microscopy showing 0-1 RBCs/HPF indicates what?

Back 22

rhabdomyolysis, since myoglobin interacts with dipstick probe for hemoglobin

Front 23

describe hepatorenal syndrome (HRS)

Back 23

decreased GFR due to end stage liver disease
presents with signs of liver failure + high creatinine
occurs in 10% of cirrhosis
fatal in 2-6 months without liver transplant

Front 24

what nephropathy is most commonly associated with carcinoma?

what nephropathy is most commonly associated with Hodgkin lymphoma?

Back 24

membranous

minimal change disease (these patients present with nephrotic syndrome due to minimal change disease)

Front 25

urine dipstick findings:

in pyelonephritis

in uncomplicated UTI

Back 25

leukocyte esterase signifies pyuria

nitrites signify presence of Enterobacteriaceae (convert urinary nitrate to nitrite)

so, pyelonephritis shows both leuk esterase and nitrites on dipstick

uncomplicated UTI shows only nitrites

Front 26

renal complication of nafcillin administration

Back 26

acute interstitial nephritis (AIN)

Front 27

renal disease associated with active Hepatitis B infection

Back 27

membranous glomerulonephritis

Front 28

MCC of nephrotic syndrome

in adults

in children

Back 28

focal segmental glomerulosclerosis, membranous glomerulonephritis

minimal change disease

Front 29

MCC of seconday hypertension in children

Back 29

fibromuscular dysplasia

also seen in premenopausal women

Front 30

angiography finding in fibromuscular dysplasia

Back 30

"string of beads" appearance of renal artery

Front 31

action of cyclosporine

Back 31

immunosuppressant that inhibits transcription of IL-2 (and other T helper cytokines)

Front 32

side effects of cyclosporine

Back 32

gingival hypertrophy and hirsutism
GI manifestations
glucose intolerance
HTN
infection
malignancy (SCC of skin, lymphoprolif)
nephrotoxicity
neurotoxicity

Front 33

major toxicity of azathioprine

Back 33

dose-related diarrhea
leukopenia
hepatotoxicity

Front 34

major toxicity of Mycophenolate

Back 34

bone Marrow suppression

Front 35

most common histological renal lesion in diabetics

Back 35

diffuse glomerulosclerosis

(nodular glomerulosclerosis with Kimmelstiel-Wilson nodules is pathognomonic)

Front 36

analgesic nephropathy may result in

Back 36

papillary necrosis

chronic tubulointerstitial nephritis

Front 37

common causes of priapism

Back 37

sickle cell disease, leukemia
trauma
neurogenic lesion
medication (trazodone, prazosin)

Front 38

typical presentation of allergic interstitial nephritis

Back 38

acute renal failure
arthralgia, rash
WBC casts, mostly eosinophils
after (often sulfonamide) abx use

Front 39

major cause of anemia in patients with end stage renal disease

Back 39

epo deficiency

try oral iron supplementation before giving epo

Front 40

common side effects of epo administration

Back 40

worsening of HTN
headache
flu-like Sx

Front 41

most common type of kidney stone

condition predispoing to this kind of stone

Back 41

calcium oxalate

fat malabsorption (e.g. due to small bowel dz, resection, or chronic diarrhea)

Front 42

mechanism of flank pain in renal pathology

Back 42

renal capsular distension

Front 43

describe cystinuria

Back 43

inherited disorder of impaired transport of cystine, lysine, arginine, ornithine by brush border (renal tubular and intestinal) cells

cystine (hexagonal) crystal accumulation leads to radio-opaque cystine renal stones

urinary cyanide nitroprusside test is +

Front 44

treatment for renal artery stenosis due to fibromuscular dysplasia

Back 44

angio w/ stent to restore perfusion to ischemic kidney

decrease BP is another goal of therapy, but ACE-Is contraindicated in bilateral renal artery stenosis

Front 45

risk factors for focal segmental glomerulosclerosis

Back 45

African American
obesity
heroin use
HIV

Front 46

coagulation studies seen in chronic renal failure with uremia

Back 46

PT normal
aPTT normal
TT normal

bleeding time prolonged (uremic toxins inhibit platelet function)

Front 47

findings in post-streptococcal glomerulonephritis

Back 47

10-20 days after strep throat or skin infxn
periorbital swelling, hematuria, oliguria, RBC casts
serum C3 complement low

Front 48

treatment for recurrent hypercalciuric renal stones

Back 48

increased fluid intake
Na+ restriction
thiazide diuretic

Front 49

usual features of vaginitis

Back 49

vaginal discharge
pruritus
dyspareunia

incr urinary frequency is unusual

Front 50

treatment of uric acid stones

Back 50

alkalinize urine with K+ bicarb or K+ citrate

Front 51

first line agents for cystitis (uncomplicated and complicated)

Back 51

uncomplicated: TMP-SMX or nitrofurantoin

complicated: levofloxacin or ciprofloxacin

Front 52

cardiovascular effects of nephrotic syndrome

Back 52

dyslipidemia
hypercoagulability

Front 53

give the treatment:

Goodpasture's

Wegener's

Back 53

emergent plasmapheresis

cyclophosphamide + steroids

Front 54

renal side effect of acyclovir therapy

Back 54

acute renal failure due to precipitation in renal tubules

presents with oliguria, elevated Cr + BUN

Front 55

painless hematuria in an otherwise healthy young black male

Back 55

sickle cell trait

Front 56

indications for hemodialysis

Back 56

refractory hyper-K+
volume overload not responding to diuretics
pH<7.2
uremic pericarditis
uremic encephalopathy/neuropathy
coagulopathy due to renal failure

Front 57

mechanism of renal injury in diabetic patients

Back 57

glomerular hyperfiltration leading to intraglomerular HTN and glomerular damage

Front 58

mechanism of ACE inhibitor effectiveness in diabetic nephropathy

Back 58

reduces intraglomerular HTN, thereby decreasing glomerular damage

Front 59

changes seen in diabetic nephropathy

Back 59

glomerular hyperfiltration happens within days of Dx of diabetes

glomerular basement membrane thickening is first quantifiable change