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Question 1

A 69 yr old came with confusion. He had nausea, vomiting, back pain. His serum calcium level is 14.1mg/dL
What’s the most appropriate next step?
Long term Rx

Answer 1

IV hydration with NS to restore IV volume n promote urinary Ca excretion. + calcitonin (inhibits osteoclasts mediated bone resorption)
Long term Rx- bisphosphonates

Question 2

Emergent Rx of hyperkalemia is indicated if (3 indications)
Emergent Rx is with?
Then slow acting (removal of k from the body) is with?

Answer 2

1. Rapidly rising serum K+
2. K+>6.5
3. EKG changes
   Iv calcium gluconate or CaChloride,b2 adrenergic agonists, insulin with glucose
   Hemodialysis, cation exchange resins, diuretics

Question 3

A 57 yr old HIV pt developed chest infection n started on ceftriaxone, azithromycin, trimethoprim- sulfamethoxazole, albuterol
On the third day his k+ is 5.9 n creatinine is 1.5
Which of the above meds is responsible?

Answer 3

Trimetoprim- it blocks the epithelial sodium channel in the collecting tubules similar to amiloride, a k+ sparing diuretic
It can also cause an artificial increase in creatinine by blocking its secretion

Question 4

A 71yr old man with hypernatremia came with decreased mentation. BP-90/60, PR- 98, dry oral mucosa
Most appropriate next step in the mx?
Different mx options based on hydration status

Answer 4

IV 0.9% saline since the pt has severe hypovolemia
Mild cases can b treated with 5% dextrose in 45% saline and euvolemic/hypervolemic hypernatremia can b treated with 5%dextrose in water

Question 5

Nephropathies secondary to 1.DM

2. Htn r cxd by?

Answer 5

1. DM- increased extracellular matrix, basement mem thickening, mesangial expansion, and fibrosis
2. Htn- arteriolosclerotic lesions of afferent n efferent arterioles n glomerular capillary tufts

Question 6

In a normotensive pt with hypokalemia n met alkalosis

What r the 4 ddx? What’s the place of urinary chloride concentration in differentiating one from the rest?

Answer 6

1. Surreptitious vomiting- low urine chloride. 
The rest- high urine Cl 
  - diuretic abuse
  - bartter syndrome
  - gitelman’s syndrome

Question 7

Rapid correction of hyponatremia and hypernatremia would each cause?

Answer 7

Hyponatremia- osmotic demyelination/ central pontine myelinolysis
Hypernatremia- cerebral edema

Question 8

A 47yr old female came with lower abdominal pain that is relieved with voiding for over 2 months. She also has frequency n dyspareunia. On p/E no cervical motion tenderness, palpating the anterior vaginal wall elicits severe pain. U/A is normal. Most likely Dx?
The disease is commonly associated with?
Clinical presentation?

Answer 8

Painful bladder syndrome (interstitial cystitis)
Associated with anxiety, fibromyalgia…
Bladder pain with filling n relief with voiding, frequency, dyspareunia

Question 9

Difference between IgA nephropathy n Postinfectious GN

• onset after URTI
• complement levels, kidney biopsy

Answer 9

IgA- within 5 days of URTI
      - normal complement 
      - mesangial IgA deposits seen 
PSGN- 10-21 days
          - low C3, 
          - subepithelial humps consisting of C3

Question 10

1. Normal PH, HCO3, PaCO2 range
2. Normal anion gap, AG formula
3. 6 most common causes of anion gap metabolic acidosis

Answer 10

1. PH - 7.35-7.45; HCO3- 22-28; PaCO2- 33-45 mm hg
2. AG= 6-12
   AG=Na-(HCO3 + Cl)
3. Lactic acidosis; Ketoacidoais; uremia, toxic alcohol(methanol) ingestion; salicylate toxicity; ethylene glycol ingestion

Question 11

How does vomiting cause metabolic alkalosis, generation n maintenance phases? Initial Rx for such pts?

Answer 11

Generation- acid is lost thru the vomitus along with
Na,Cl,K. —> bicarb accumulation (Normally gastric acid is responsible for stimulating the pancreas to secrete(excretion) HCO3 ) —> met alkalosis.
Maintenance- loss of fluid—> RAAS—> contraction alkalosis
Rx- iv NS( stops RAAS activation), K+ supplement

Question 12

Associated conditions with

1. Minimal change dis
2. Membranous nephropathy
3. Membranoproliferative GN
4. FSGS

Answer 12

1. NSAIDs, lymphoma
2. Adenocarcinoma, NSAIDs, SLE, Hep B
3. HepB n C, lipodystrophy
4. HIV, heroin use, obesity

Question 13

The most common form of nephrotic syndrome in Hodgkin lymphoma is?

Answer 13

Minimal change

Question 14

A 40 yr old man came with nephrotic range proteinuria, hematuria, dense deposits within the glomerular BM on electro microscope, immunofluorescence shows C3, no Igs
Dx? Mechanism?

Answer 14

Nephrotic syndrome secondary to membranoproliferative GN type 2, AKA, dense deposit disease
IgG ab(termed C3 nephritic factor) directed against C3 convertase —> persistent complement activation n kidney damage

Question 15

The most common extrarenal manifestation of ADPKD is?

Answer 15

Hepatic cyst

Question 16

A pt developed anion gap metabolic acidosis after seizure episode. No other apparent cause of the acidosis.
Cause of acidosis?
Mx?

Answer 16

Postictal lactic acidosis- due to sk mm hypoxia n impaired hepatic lactic acid uptake
- is self limited n typically resolves within 90minutes so the mx of such pts is repeat the ABG measurement after 2hrs

Question 17

Succinylcholine is contraindicated in pts with which electrolyte abnormality?

Answer 17

Hyperkalemia

Question 18

A psychiatric pt presented with hyponatremia, urine osmolality of <100, serum osmolality <90
Dx is?

Answer 18

Primary polydipsia

Question 19

Initial therapy for hypertension secondary to unilateral renal aa stenosis

Answer 19

ACEI or ARBs

Question 20

75-90%of kidney stones r composed of ?

Answer 20

Calcium oxalate stones