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35 Cards in this Set
- Front
- Back
How do you get hypertonic hyponatremia?
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Glucose, mannitol, hypertonic saline
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How do you get isotonic hyponatremia?
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Hyperlipidemia, hyperproteinemia (paraproteinemia), glucose, mannitol
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How do you get euvolemic, hypotonic, hyponatremia?
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Psychogenic polydipsia, SIADH, Drugs, Hypothyroidism, Glucocorticoid deficiency
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How do you get hypervolemic, hypotonic, hyponatremia?
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If the Urine Na < 10, from cirrhosis, CHF, or nephrotic syndrome.
If the Urine Na > 10, from AKI or chronic renal failure |
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How do you get hypovolemic, hypotonic, hyponatremia?
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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) |
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What can cause potassium to shift OUT of cells?
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Drugs- succinylcholine, digitalis, BB
Cell lysis, rhabdo, insulin def, acidosis, resorption of blood |
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What causes potassium to shift into cells?
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Insulin, Beta2-agonists, alkalosis
GI- diarrhea, laxative, vom Renal- Diuretics, increased mineralocorticoids, Barter's, Gitelman's, hypomagnesemia |
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What is type I RTA?
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Distal- defect in H+ secretion; patients have nephrolithiasis as a complication; give bicarb
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What is type II RTA?
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Proximal- defect in HCO3 reabsorption; patients have rickets or osteomalacia as a complication; give thiazides
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What is type IV RTA?
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Distal- aldosterone deficiency or resistance; patients have hyperkalemia as a complication; give lasix, mineralo/glucocorticoid replacement
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What laboratory abnormalities suggest prerenal renal failure?
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FeNA < 1%, Urine Na < 20, urine specific gravity > 1.020, BUN/Cr > 20
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What are the indications for urgent dialysis?
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A- acid/base (acidemia)
E- Electrolyte (hyperkalemia) I- Intoxications (ASA, methanol, barbiturates, lithium, ethylene glycol, theophylline) O- Overload (fluid) U- Uremic symptoms |
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How do you treat IgA nephropathy?
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Steroids; ACEIs for patients with proteinuria
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What is Wegener's and how is it treated?
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Necrotizing vasculitis; affects the kidney and upper respiratory tract (sinuses); c-ANCA. Treat with high-dose steroids and cytotoxic agents
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What is Goodpasture's and how is it treated?
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Anti-GBM deposits (linear), pulmonary hemorrhage with IDA and macrophages with hemosiderin. Treat with plasma exchange and pulsed steroids
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What is membranous nephropathy associated with?
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HBV, syphilis, malaria, and gold
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What is membanoproliferative nephropathy associated with?
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HCV, cryoglobulinemia, SLE, subacute bacterial endocarditis
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Calcium oxalate stones
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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
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Struvite stones
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You will see staghorn calculi. These are a/w urease-producing organisms (proteus). ALKALINE urine. Treat with hydration and abx
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Uric acid stones
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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
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Cystine stones
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Due to a defect in COLA transport. Hexagonal crystals and + urinary cyanide nitroprusside test. radioopaque. Treat with hydration and alkalinization of the urine!
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What kidney stones can be passed spontaneously?
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< 5 mm in diameter
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When do you treat stones with lithotripsy, percutaneous nephrolithotomy, or retrograde uteroscopy?
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0.5 mm to 3 cm
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What features are seen in PKD?
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Hypertension, hepatic cysts, cerebral artery aneurysms, diverticulosis, mitral valve prolapse
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What is the most common congenital urethral obstruction?
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Posterior urethral valves- male infant with distended, palpable bladder and low urine output
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When do you get a VCUG?
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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
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What do you use to treat a UTI in children under 2 months of age?
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Amoxicillin
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How do you treat cryptochordism?
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Orchiopexy at 6-12 months of age
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What medications can cause ED?
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BB, SSRIs, TCAs, diuretics
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How do you work up ED?
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Presence of nocturnal/early-morning secretions, evaluate for neurologic dysfunction (anal tone, LE sensation) and hypogonadism.
Check testosterone, FSH/LH, prolactin levels |
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How do you diagnose bladder cancer?
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Cystoscopy with biopsy; also get MRI and CT to define invasion and mets
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How do you treat superficial transitional cell carcinoma?
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Compete transurethral resection or intravesicular chemo with mitomycin C or BCG (TB vaccine)
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What do you want to rule out if you see a left-sided varicocele?
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RCC- tumor blocks the left gonadal vein which empties into the left renal vein
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How do you treat RCC?
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Surgical resections, tyrosine kinase inhibitors (sorafenib, sunitinib)
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What are risk factors for testicular cancer?
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Cryptochordism, Klinefelters
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