April 1 Flashcards
juxtaglomerular cells location
at Afferent Arteriole!
Macula Densa
sense Na/Cl/NaCl in DCT - communicate to JG cells at afferent
nephrotoxic
aminoglycosides and vancomycin
Beta-blockers in DM
don’t do it!
they mask feelings of hypoglycemia/awareness of low blood sugar (no jitters)
Kidney protection in DM
ACEi and ARB
dilate efferent arteriole and decrease GFR to prevent hyperfiltration injury
ADR of furosemide
contraction alkalosis - low volume –> RAAS activation –> increased ALDO –> resorb Na and dump K+ and H+ (loss of H+ in urine = alkalosis of system)
Ototoxic, HypoK, hypoMg, Alkalosis, Interstitial Nephritis, Gout
what metal are alcoholics deficient in
Mg
increased excretion and decreased intake
Bug that causes struvite staghorn calculus
Proteus - urease positive
(also Staph saprophyticus and Klebsiella)
struvite = ammonium magnesium phosphate
radiopaque coffin lid appearance
Electrolyte derrangments of renal failure
increased K increase Phos (no more PTH excretion) decreased Ca (no more active vitamin D)
metabolic acidosis (kidney stops making bicarb)
Bartter Syndrome
Affects Na+/K+/Cl-
congenital defect that functions like furosemide
Causes of Acute Tubular Necrosis
Ischemic - hypotension, cardiogenic shock, hypovolemic
Nephrotoxic - rhabdo, aminoglycosides, contrast, ethylene glycol
Intrinsic Renal Failure (causes)
Acute Tubular Necrosis
Acute Interstitial Nephritis
RPGN
HUS
FENa >2%
Non-Gap Acidosis
HARDASS - calculated gap is 8-12
(low pH low bicarb)
H- hyperalimentation (too much TPN) A - addisons disease (primary adrenal insufficiency --> increased ACTH) R - Renal tubular acidosis D - diarrhea A - aceazolamide S - spironolactone S - saline infusion
Hyper K
peaked T waves
rate limiting enzyme in gluconeogenesis (@kidney) … and also eer2place
Fructose-1,6-bisphosphatase
Prerenal azotemia
urine osmol > 500
Urine sodium < 20
FENa < 1
BUN:Cr > 20
(trying to conserve volume)
BUN is resorbed, Cr is not
Intrarenal Azotemia
urine osmol <350
urine sodium >40
FENa >2%
BUN:Cr < 15
Postrenal Azotemia
Urine osmol < 350
urine sodium > 40
FENa < 1% (mild) >2% severe
Subepithelial humps
PSGN
humps are sub epithelial
Granular subendothelial deposits
DPGN (diffuse proliferative) due to SLE
ADPKD chromosome?
16
Median umbilical ligament
allaNtoid –> urachus
pee out of the belly-button ‘straw-colored’
patent urachus
MediaNN allaNNtois
Medial umbilical ligament
umbilical arteries
necessary for differentiation and activation of all T-cells?
IL-2
blocked with cyclosporine - nephrotoxic!
AngII action at PCT
increase activity of Na/H+ exchanger
no net change in H+; acts a catalyst
increase in bicarb due to increased activity of Na/H exchanger –> more H in lumen for carbonic anhydrase to act on
AngII also constricts efferent to increase GFR
Heptatorenal syndrome
declining hepatic function –> decreased GFR –> progressive functional renal failure
splanchnic vasodilation and vasoconstriction @ renal vascular beds + RAAS activation
–> prerenal azotemia
kidney looks normal (shape and size)
Focal Segmental Glomerulosclerosis
often occurs in HIV+ pts
IF shows IgM in the affected glomeruli
massive proteinuria
Alkaptonuria
black urine on standing
increased homogentisic acid in the urine
deficiency of homogentisic acid oxidase
cartilage blue/black
Metabolic Acidosis with Anion Gap
MUDPILES
Methylene Uremia DKA Propylene glycol INH or Iron tablets Lactic acid Ethylene glycol Salicylates
Where the kidneys at?
T12-L3
left is higher than right
Low levels of DA on renal perfusion
dilate afferent and efferent
at higher levels it has alpha-one and it constricts
aspirin OD
tinitis, nausea, vomiting, lethargy
give sodium bicarb
aspirin is salicylate
acetaminophen OD
N-acetylcysteine (also for mucus-busting in CF)
hepatic necrosis
PCT glucose resorption
between 200-375 we start seeing glucose in the urine
> 375 glucose resorption is saturated, cannot uptake more in PCT; rest goes out in pee
Antibiotic safe for UTI in preg?
Cephalexin
Fibromuscular dysplasia
non-atherosclerotic, non-inflammatory disease of the blood vessels
affects renals and carotids
main symptoms: HTN and renal artery bruit
MSUD
Isoleucine
Leucine
Valine
I Love VT
deficiency in branched chain alpha keto acid dehydrogenase
infant presenting with acidosis (and sweet pee) with elevated (ILV) in the pee
Tetracyclines
tooth discoloration
hepatotoxic
nephrotoxic –> nephrogenic DI
Mechanism of Action of ADH
binds V2 at kidney (2 kidney) –> increased aquaporin channels and concentrated urine
binds V1 at periphery –> vasoconstriction and increased TPR
Tumor Lysis Syndrome Prevention
Allopurinol
prevents purines from lysed tumor cells from being converted to uric acid - inhibits production of uric acid - prevents renal failure
increased the concentration of 6-MP and azathioprine
Chronic Kidney Disease / Mineral Bone Disease
kidney is hurt, loses ability to secrete phosphate –> increased phosphate –> increased PTH –> increased bone resorption –> increased fractures, bone pain, and joint pain
increased phosphate
increased PTH and bone breakdown
decreased renal production of vitamin D –> decreased calcium uptake
binds free calcium –> hypocalcemia –> increased PTH
secondary hyperparathyroidism
Heparin Induced Thrombocytopenia
thrombocytopenia induced 5-10 days after IV heparin –> autoantibodies to platelet factor 4
tx: argatroban
Symptoms of splenic infarct
left upper quadrant pain
left shoulder pain
nausea and vomiting
from celiac trunk
Rickettsial illness
headache, fever, rash
tx: doxycycline
Typhus - starts centrally, spreads out
Rocky Mountain Spotted Fever - starts peripherally and goes trunkal
Ebstein anomaly
From Lithium exposure (Bipolar)
ASD
malformed tricuspid
atrialized RV
treatment for cerebral toxoplasmosis
pyrimethamine and sulfadiazine
HIV pt with ring enhancing lesions
schizotypal
magical thinking
Goodpasteur
antibodies to type IV collagen –> hematuria and hemoptysis
causes linear @ IF
crescent @ LM
antibiotic that causes aplastic anemia
chloramphenicol
Transthyretin
protein produced in the liver, carrier of thyroxine and retinol
mutations –> amyloidosis –> diastolic heart failure
myoedema
swelling of muscle following percussion
sign of underlying hypothyroid
hypothyroid myopathy: myalgia, proximal muscle weakness, cramping, myoedema
Targets for Chemo-induced emesis tx
Dopamine receptor antagonists: metoclopramide, prochlorperazine
Serotonin (5-HT3) antagonists: ondansetron, granisetron
Neurokinin 1 receptor antagonists: aprepitant, fosaprepitant
Targets for motion sickness and morning sickness
Antimuscarinics: scopolamine
Antihistamines: diphenhydramine, meclizine, promethazine
entacapone
decreased peripheral levodopa degradation
BH4 is a cofactor required for the synthesis of?
DA, Epi, NE, melatonin from phenylalanine and tyrosine
5-HT from tryptophan
HLA-B57.01
Abacavir
why do pts with Crohns get gallstones?
issues at terminal ileum cause poor resorption of bile –> cholesterol stones
Meglitinides (-glitinides)
Repaglinide
work like sulfonylureas
bind and close ATP-dependent K+ channels on beta cells of pancreas –> increased insulin release
oppositional defiant disorder
deliberately annoying
argumentative
landmark to differentiate between direct and indirect inguinal hernias?
inferior epigastric vessels
Iron deficiency anemia
ferritin and transferrin changes in the serum
decreased serum ferritin
increased transferrin = increased serum total iron-binding capacity
decreased hemosiderin
ferritin is a good indicator of iron status
Isoniazid and Sideroblastic Anemia
INH inhibits pyridoxine phosphokinase (converts pyridoxine B6 –> pyridoxal 5’ phosphate) which is a cofactor for ALA synthase
ALA synthase is rate limiting step for heme production
no heme -> microcytic hypochromic anemia
no heme –> cannot use iron n cells –> ringed sideroblasts
crescendo-decrescendo systolic murmur
aortic or pulmonic stenosis (due to valvular calcification)
persistent side effect of L-dopa (regardless of carbidopa/levodopa)
anxiety and agitation
increased dopamine in the brain
Mitral regurg
severe if S3 is present
holosytolic murmur (intensity doesn’t correlate well with regurgitant volume)
Folate ie necessary for which nucleic acid?
thymidine (pyrimidine)
Treatment for restless leg syndrome
Dopamine agonists (prampipexole)
differential cyanosis and clubbing
PDA
fully oxygenated blood to upper extremities
mixed blood enters to descending aorta–> cyanosis and clubbing in the feet
Cachexia (weight loss in cancer)
TNF, IFN-gamma, IL-1, IL-6
scorpion sting
acute pancreatitis
Consequences of Midgut Malrotation
Ladd’s fibrous bands that cause extrinsic compression of the gut
can also cause volvulus (twisted portion of gut –> necrosis)
locus ceruleus
norepinephrine
Raphe nucleus
serotonin
nucleus accumbens
GABA
ventral tegmentum
dopamine
basal nucleus of meynert
acetylcholine
Absolute risk reduction
ARR = ER(control) - ER(treatment)
ER = event rate
L-type calcium channel differences in skeletal vs smooth muscle and cardiac
in smooth muscle and cardiac RyR activation is dependent on an influx on Ca+ from L-type calcium channels
in skeletal muscle L-type calcium cannel is directly coupled to RyR, so contraction can occur without significant influx of calcium across the membrane
Why do some bacteria produce IgA Proteases?
destruction of IgA allows for bacterial adherence to mucosa
neisseria meningitidis, N. gonorrhoeae, strep pneumonia, haemophilus influenzae
IgA is a poor opsonin
Lactose Fermentors
Klebsiella
E. coli
Enterococcus
Serratia
Things on Chr3
VHL - hemangioblastoma @ retina, brain stem, cerebellum, cavernous hemangiomas, bilateral renal cell carcinoma, pheochromocytoma
Beta blockers (esmolol) effects on EKG
prolonged PR - decreased AV nodal conduction and increased AV node refractory period
Consequences of ions
Myocardial ischemia
no ATP
increased Na and Ca inside myocytes –> water influx and myocardial swelling
intracellular K is decreased
direct thrombin inhibitors
argatroban, bivalirudin, dabigatran
binds/blocks platelet ADP
clopidogrel, prasugrel, ticlopidine
inhibits GPIIb/IIIa
abciximab, eptifibatide, tirofiban
what causes crescent formation in RPGN
deposition of fibrin within Bowman’s space –> crescent formation
SIADH
euvolemic hyponatremia
Amphotericin B ADRs
Nephrotoxic
causes decreased K and Mg
decreased EPO –> anemia
Enzyme that converts Norepi –> Epi
PNMT = phenylethanolamine-N-methyltransferase
stimulated: ACTH –> cortisol –> increased PNMT @ adrenal medulla
Acute Interstitial Nephritis
fever, rash, low urine output
urinalysis: RBCs, WBCs, and esoiniphils
process in renal interstitium
drugs: beta-lactams, NSAIDS, sulfonamides
what provides the major proliferative stimuli for atherosclerotic plaques
Platelets!
endothelial dysfunction –> platelet adhesion and aggregation –> PDGF
PDGF is secreted by platelets and macrophages –> vascular remodeling and smooth muscle cell proliferation –> atherosclerotic plaque
dobutamine
B1-agonist
positive ionotrope positive chronotrope (weakly)
–> increased myocardial oxygen consumption
lung cancer + for neural cell adhesion molecule (NCAM = CD56)
small cell carcinoma of the lung
also enolase, chromogranin
Tetralogy of Fallot (embryological issue)
Deviation of the infundibular septum
reduced motor end-plate potential
myasthenia gravis
decreased number for functional ACh receptors
treatment of myastenia gravis
pyridostigmine (AChEi)
can cause excessvie cholinergic stim in the gut –> treatment: Scopolamine
Scopolamine- muscarinic ACh receptor antagonist fix the muscarinic stuff without changing nicotinic stuff
CN III Palsy
Ptosis - paralysis of levator palpebrae
down and out gaze
parasymp fibers in CN III innervate iris sphincter and ciliary muscle –> fixed dilated pupil
Akathisia
restlessness; extrapyramidal side effect due to antipsychotics
BeriBeri
thiamine deficiency
peripheral neuropathy and heart failure
Cholesteatoma
pearly mass behind tympanic membrane due to squamous cell debris
Wrinkles are caused by
UVA –> increased ROS –> inflammatory things –> DECREASED collagen production
decreased collagen production
increased crosslinking
increased MMPs (collagen breakdown)
vascular supply in the AV node
from dominant coronary artery
70% right coronary artery
10% left circumflex
Arsenic poisoning
garlic breath and rice-water stools
QTc elongation
tx: dimercaprol
MMR
M - Measles = Rubeola –> Paramyxo, give Vit A
M - Mumps
R - Rubella = Toga –> post=auricular LAD, congenital PDA
47 XXY
increased LH and FSH (decreased inhibition)
ADPKD
subarachnoid hemorrhage - berry aneurysm in circle of willis
