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51 Cards in this Set
- Front
- Back
benefits of alpha blockers?
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- e.g. prazosin, terazosin
- tx of HTN, BPH, increases insulin sensitivity, decreases LDL, increases HDL |
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Side effects of BB?
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- worsens BPH, bronchoconstriction, decreases insulin sensitivity, masks hypoglycemia symptoms
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treatment of erectile dysfunction?
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- phosphodiesterase inhibitor e.g. sildenafil
- careful with combining with alpha blocker for BPH --> hypotension. Give four hours apart |
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First line imaging of nephrolithiasis?
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- CT
- next best is IVP - if pregnant do ultrasonogram |
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right flank pain, no renal calculus, increase BUN, Cr?
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- look for hx of ASA, acetaminophen, phenacetin or NSAIDs = analgesic nephropathy
- see acute papillary necrosis --> actue renal colic - UA: hematuria, pyuria, proteinuria |
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AIN
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- acute interstitial nephritis = azotemia, skin rash, eosinophilia, see eosinophils in urine
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nephrolithiasis with temp, WBC, hypotension, hydronephrosis?
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- life threatening --> percutaneous nephrostomy
- don't put stent b/c increased risk of pushing infected material into other parts - shockwave is for uncomplicated proximal ureteral stones |
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Hx raynauds and GERD presenting with malignant hypertension?
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- scleroderma renal crisis --> abnormal collagen deposition --> narrows renal arterioles --> ischemia --> increased renin-angiotensin system--> HTN
- tx with ACE-I (which is usually avoided in RF except in this case) to reverse angiotensin and nitroprusside |
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Pheo symptoms
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- tachycardia, palpitations, HA, HTN
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HUS CBC
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- s/p diarrhea
- thrombocytopenia, microangiopathic hemolytic anemia |
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pt presents with erectile dysfunction, next step?
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- do ABI before rx PDI
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Major causes of hyperK+
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1. increase K out of cells: pseudohyperK+, met acidosis, hyperglycemia, increase tissue catabolism, BB, exercise
2. decrease urinary K excretion: hypoaldo, renal failure, volume depletion, RTA4, ureterojejunostomy |
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Major causes of hyperNa+
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1. unreplaced water loss: sweating, GI loss, DI, osmotic diuresis, hypothalamic lesions
2. water into cells: severe exercise, seizures 3. Na overload: hypertonic NA intake |
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Major causes of hypoCa2+
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-1. hyperphosphatemia, acute pancreatitis, osteoblastic metastases, resp alkalosis, hypoPTH, Mg metabolism, vit D def, sepsis, flouride intoxication
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aspiration pneumonitis
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- obtunded pt with hx of vomiting --> respiratory distress after aspiration event with NO hx of foreign body --> supportive care (no abx)
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Pt after episode of hypotension w/ decreased UOP, what kind of casts?
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- muddy brown casts -> ATN secondary to hypotension, hypovolemia, shock, sepsis, decreased cardiac output states
- also see increased BUN, Cr, anion gap acidosis |
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prerenal azotemia- what do you see from urine Na?
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- decreased fractional excretion of Na
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AIN
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- eosinophils in urine
- 3-5 days after abx is given, rarely seen in 1st 2 days |
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Red cell casts
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- think glomerulonephritis
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pt who is ologuric, hyperkalemic, and acidotic?
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- D5% with bicarb --> if this doesn't work then dialysis
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hematuria or RBC casts 2 weeks after URI vs during or immediately after URI?
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- 1. poststreptococcal GN
- 2. IgA nephropathy |
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heavy smoker with palpable renal mass and CVA tenderness?
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- renal cell cancer
- look for increased hg/hct secondary to paraneoplastic syndrome (EPO secretion from hypernephroma) - if high suspicion, get CT |
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hepatorenal syndrome
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- dx of exclusion
- cirrhosis --> splanchnic vasodilation --> peripheral vascular resistance --> decreased renal perfusion --> pre-renal BUN:Cr > 20:1 - first bolus fluids to r/o renal failure secondary to intravascular fluid depletion --> if no responde then tx with octreotide, midodrine, NE, and continue giving albumin |
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Dx of SBP?
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- peritoneal cell count > 250 c/mm2
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PSA
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- if 2.5- 4: repeat testing several weeks/months later to trend = <10 %PPV
- if >4, order transrectal prostate biopsy = 25%PPV - if >10, PPV 42-64% |
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Priapism tx?
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- ice pack
- phenylephrine inj or epinephrine (alpha-adrenergic agonist) |
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Tx RCC
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- confined within renal capsule (Stage 1) --> partial nephrectomy
- extends through renal capsule but not Gerota's fascia (Stage II) --> radical nephrectomy |
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Which drugs increase serum Cr
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- cimetidine, probenecid, trimethoprim
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urethral diverticulum
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- can be acquired secondary to vaginal trauma (e.g. lots of v-births) or instrumentation of uretheral tract
- sx: post void dribbling --> dysuria, dyspareunia, UA that looks like UTI - test: transvaginal U/S |
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Man from Africa with hematuria, dysuria and polyuria?
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- schistosomiasis (one of the most common infx dz worldwide)
- also see anemia - do urine microscopy --> see eggs - do bx if high suspicion and don't see eggs |
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Most common long term complication of TURP (surgical tx of BPH)
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- dry ejaculate due to retrograde ejaculation
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pt with PCKD wants peritoneal dialysis --> next step?
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- colonoscopy to r/o diverticulosis
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other complications of PCKD?
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- cysts in liver, pancreas, spleen, lung
- cerebral aneurysms - aortic aneurysm - colonic diverticula - MVP - inguinal, abdominal hernias |
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chronic nonbacterial prostatitis
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- same clinical feature as bacterial prostattis
- +UA but neg cx and no hx of UTI - no bacteria involved - tx: sitz baths and NSAIDS, transurethral microwave thermotherapy, psychotherapy for sexual sx |
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next step in pt with renal failure secondary to HTN?
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- get urine protein excretion
- if + protein (500-1000mg/d) start on ACE-I or ARB (no benefit if no protein) also non-dihydropyridine CCB - goal of <500 mg/day protein |
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24 hour urine protein of 7g
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- nephrotic syndrome --> look for analgesic use = analgesic induced nephropathy
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best kidney donor?
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- sibling with no HLA mismatch
- also adequate: blood relations with up to 3 HLA mismatch or non-relatives with up to 4 HLA mismatch - cadavers must have no mismatch to be considered suitable |
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pt is dx with ADPKD, what the next step?
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- monitor BP <130/80
- no need for yearly Ct/US - no need for head MRI to look for berry aneurysm unless family hx of subarachnoid hemorrhage ** HY |
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Most common extrarenal manifestation of ADPKD?
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- hepatic cysts
** HY |
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Pt dx with ADPKD, what do family members do?
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- get US for asympt family members --> 3-5 cysts in each kidney is +dx
** HY |
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viagra and pilots
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- viagra effects blue-green color vision so pilots must wait 6 hrs after taking viagra to fly
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increased serum Cr after starting ACE-i?
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- highly suggestive of RAS, b/c ACE-I decreases angiotensin II --> decreases GFR
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HTN after renal transplant
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- develops in most pts with renal transplant
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hx of alcohol abuse or IVDU presents with diffuse joint pain, fatigue, skin rash, peripheral neuropathy, next step?
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- think cryoglobulinemia
- UA: hematuria, proteinuria, casts (RBC) - see decrease C3, C4, CH50, increased cryoglobulin levels - tx: alpha interferon and ribavarin, only the former if renal impairment |
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renal dzs with +C-ANCA vs +ASO vs + cryoglobulin
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- +C-ANCA: granulomatosis with polyangiitis (Wegener's ) see normal complement levels
- +ASO: post streptococcal GN, nl C4 levels (low C3 is possible) - +cryoglobulin = cryoglobulinemia low C3, C4, CH50, +cryoglobulin |
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prostatitis with sx of urinary tract obstruction
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- do suprapubic catheterization, not foley cath b/c can cause bacteremia
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risks for female kidney donors?
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- increased gestational complications compared to prior to donor but rate is still the same as the general population
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gold standard for detecting bladder ca?
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- cystoscopy
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work up of extraglomerular hematuria
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- e.g. UA shows no casts, dysmorphic cells, proteinuria
- IVP --> if negative then no further studies if young; if old and highly suspect cancer then U/S or CT for malignancy |
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eosinophils in urine
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- think AIN
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eosinophilia w/ asthma and renal disease?
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- churg strauss
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