Additional Cards

Question 1

Which syndrome is most correlated with Hep C

Answer 1

MPGN

Question 2

Difference between HCO3 movement in PT and TAL

Answer 2

PT - basolateral membrane has a HCO3 Cl symporter

TAL - HCO3 and Cl transporter is an exchanger

Question 3

Say whether the following stimulate or reduce bicarbonate reabsorption/acid excretion: aldosterone/AII, volume expansion, hypokalemia

Answer 3

Aldosterone/AII = stimulates acid excretion
Volume expansion = reduces acid excretion
Hypokalemia = stimulates acid excretion

Question 4

Winter’s formula

Answer 4

pCO2 = (1.5*HCO3) + 8

Question 5

An acute change in pCO2 of 10 should align with a pH change of:

Answer 5

0.08

Question 6

How to get the proteinuria in a day

Answer 6

Divide urine protein by urine creatinine -> g/day

Question 7

Creatinine clearance equation

Answer 7

UcrV/Pcr

Question 8

What is a middle-of-the-road specific gravity

Answer 8

1.010 - 1.015 -> 250-300 serum osm

Question 9

Two main ethical principles that come up in transplant

Answer 9

Truth-telling for the blameless medical excuse

Non-maleficence for the harm you are inflicting on the living donor

Question 10

Main things that cause a metabolic acidosis through loss of bicarbonate

Answer 10

Diarrhea, and proximal (Type II) RTA

Question 11

Main mechanisms of metabolic acidosis that do not include losing bicarbonate

Answer 11

Kidneys not excreting acid - CKD, distal RTA (Type I, which can lead to kidney stones)
H+ intoxication
Lactic or ketoacidosis

Question 12

What DURHAM stands for

Answer 12

Diarrhea
Ureteral diversions
RTA (Type 2/proximal)
Hypocapnia
Acetazolamide/Ampho B
Mineralocorticoid deficiency (RTA Type 4)

Question 13

What offsets what in different types of metabolic acidosis (if just one)

Answer 13

Elevated anion gap -> bicarbonate is smaller and unmeasured anion is larger in equal amount

Non-elevated -> bicarbonate smaller and chloride higher to compensate

Question 14

What is a normal body temperature in Celcius

Answer 14

36.1-37.2

Question 15

Main types of RTA

Answer 15

• Type II first - proximal - patient not fully reclaiming all the bicarbonate -> so you have a systemic acidosis. Common causes are multiple myeloma and medications. Hypokalemia.
• Type I - distal - defect in pumping out hydrogen effectively - also going to make you acidotic. Hypokalemia
• Type IV RTA - systemic acidosis with hyperkalemia - not enough aldosterone - diabetic patients

Question 16

Definition of high value prescribing

Answer 16

providing simplest medication regimen that minimizes physical and financial risk while achieving the best outcome

Question 17

How to decrease out of pocket costs for prescribing

Answer 17

“GOT MeDS”
GENERICS: prescribe when possible; educate patients on safety/efficacy
ORDERING IN BULK: 3-month supplies of drugs from pharmacy or by mail
THERAPEUTIC ALTERNATIVES: OTC meds; cheaper meds in same class
MEDICATION REVIEW: regularly review med list; remove unnecessary meds
DISCOUNT DRUGS: $4 drugs (Walmart, Target, etc); discount cards
SPLITTING PILLS: prescribe higher dose and advise patients to split pills

Question 18

Difference between tonicity and osmolality

Answer 18

Tonicity excludes ineffective osmols, while osmolality includes them

Question 19

Listed approach to hyponatremia and treatment decision criteria

Answer 19

1) Osmolar status (2Na + Gl/18 + BUN/2.8)
2) volume status (clinical)
3) ADH present (Uosm > 100)
4) ADH appropriate (yes if serum osm high, secondarily low effective circ volume)
5) Treatment:
Volume depletion -> Saline
Hypoosmolarity with euvolemia or hypervolemia -> water restriction
Other things to do with hypervolemia -> diuretic
If having symptoms -> hypotonic saline

Question 20

Speed to increase SNa

Answer 20

Not more than 8 Meq/L/day

Question 21

What urine osm can tell you about hypernatremia

Answer 21

If low - DI

If high - likely losing more water through insensible losses and GI than you are taking in (decreased H20 intake)

Question 22

Main categories of hypertonic hypernatremia

Answer 22

• Hypertonic Na gain (drinking sea water)
• Polyuric (increase in clearance of free water) - solute diuresis (glucose) or pure H20 diuresis (DI)
• non-polyuric (decrease in clearance of free water) - hypodipsia, fever, sweating, GI losses

Question 23

Differences between solute and water diuresis

Answer 23

Solute diuresis starts with a high Uosm at a low flow rate, and gets lower as it speeds up because there is less time to reabsorb water - end at about 300-350 uOsm

Water diuresis starts low and gets higher as urine flow speeds up because there is less time to remove solutes - ends at about 150-200

Question 24

Postural/orthostatic proteinuria

Answer 24

Proteinuria in upright position but not supine, more common in adolescents

Question 25

Isolated proteinuria

Answer 25

Without hematuria or reduction in GFR

Question 26

Glomerular vs. tubular proteinuira

Answer 26

Glomerular is often albumin Tubular is excretion of low molecular weight proteins due to damage to tubules - might see low albumin-creatinine ratio with high protein-creatinine ratio

Question 27

Overflow proteinuria

Answer 27

Due to overproduction of immunoglobulin light chains in multiple myeloma. Increased excretion of low molecular weight proteins.

Question 28

Post-renal proteinuria

Answer 28

inflammation in urinary tract

Question 29

Prevalence of CKD

Answer 29

14%/30 million, mostly stage 1-3

Question 30

What gov't vs. private usually funds for types of research

Answer 30

NIH - basic | Private - clinical

Question 31

Exclusivity lengths of drugs

Answer 31

Exclusivity - period of time when brand-name drugs are protected from generic drug competition. Granted once the drug is approved. New chemical entity exclusivity - 5 year exclusivity for drug with new active moiety Orphan drug exclusivity - 7 year exclusivity for a drug that treats a disease/condition that affects less than 200,000 people in the US. incentive to make a new drug for rare conditions. New clinical investigation exclusivity - 3 year exclusivity added in certain circumstances when brand name drug is already approved (i.e. found new way of delivering active ingredient. Tablet form instead of liquid). Biologics get 12 year exclusivity before biosimilars can enter Even with patents/exclusivity, entities can license for drugs to be manufactured by other companies

Question 32

What does APOL1 Gene do

Answer 32

The APOL1 gene has been linked to increased risk of non-diabetic CKD and ESRD development among patients with West African ancestry.

Question 33

Names of different regions of abdomen

Answer 33

Question 34

Where the kidneys, ureters, bladder, and urethra derive from

Answer 34

Kidneys and ureter - intermediate mesoderm | Bladder and urethra - endoderm

Question 35

The two mains parts of the kidney coming from the intermediate mesoderm

Answer 35

Excretory portion of kidney: metanephros -> metanephric blastema -> nephron tubules Collecting portions of kidney/ureters: mesonephric duct -> ureteric bud

Question 36

Pronephros vs. mesonephros vs. metanephros

Answer 36

Pronephros: most cranial, 3-4 weeks, vestigial/regress completely Mesonephros - develop caudally, briefly functional and then degrade by week 8. Mesonephric duct just caudal becomes the ureteric bud though. Metanephros - start around week 5 and continue, the "true kidneys"

Question 37

Renal agenisis

Answer 37

No formation of kidney, usually associated with oligohydraminos (too little amniotic fluid

Question 38

How the bladder develops

Answer 38

Endoderm-derived cloaca -> divides into rectum and urogenital sinus (separated by urorectal septum, which is mesoderm derived)

Question 39

Exstrophy of the bladder

Answer 39

Bladder develops outside of fetus because of thin cloacal membrane

Question 40

Allantosis and issues it may cause

Answer 40

It is a connection from the gut to support tissues of the embryo. It degenerates to form the urachus (permanent fibrous cord). It's lumen may persist as a cyst, sinus, or fistula.

Question 41

Metanephric diverticulum

Answer 41

Also known as ureteric bud, comes off of the mesonephric duct