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Caleb's Step 1 > April 1 > Flashcards

April 1 Flashcards

1
Q

juxtaglomerular cells location

A

at Afferent Arteriole!

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2
Q

Macula Densa

A

sense Na/Cl/NaCl in DCT - communicate to JG cells at afferent

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3
Q

nephrotoxic

A

aminoglycosides and vancomycin

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4
Q

Beta-blockers in DM

A

don’t do it!

they mask feelings of hypoglycemia/awareness of low blood sugar (no jitters)

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5
Q

Kidney protection in DM

A

ACEi and ARB

dilate efferent arteriole and decrease GFR to prevent hyperfiltration injury

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6
Q

ADR of furosemide

A

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

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7
Q

what metal are alcoholics deficient in

A

Mg

increased excretion and decreased intake

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8
Q

Bug that causes struvite staghorn calculus

A

Proteus - urease positive
(also Staph saprophyticus and Klebsiella)

struvite = ammonium magnesium phosphate
radiopaque coffin lid appearance

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9
Q

Electrolyte derrangments of renal failure

A 
increased K
increase Phos (no more PTH excretion)
decreased Ca (no more active vitamin D)

metabolic acidosis (kidney stops making bicarb)

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10
Q

Bartter Syndrome

A

Affects Na+/K+/Cl-

congenital defect that functions like furosemide

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11
Q

Causes of Acute Tubular Necrosis

A

Ischemic - hypotension, cardiogenic shock, hypovolemic

Nephrotoxic - rhabdo, aminoglycosides, contrast, ethylene glycol

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12
Q

Intrinsic Renal Failure (causes)

A

Acute Tubular Necrosis
Acute Interstitial Nephritis
RPGN
HUS

FENa >2%

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13
Q

Non-Gap Acidosis

A

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
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14
Q

Hyper K

A

peaked T waves

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15
Q

rate limiting enzyme in gluconeogenesis (@kidney) … and also eer2place

A

Fructose-1,6-bisphosphatase

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16
Q

Prerenal azotemia

A

urine osmol > 500
Urine sodium < 20
FENa < 1
BUN:Cr > 20

(trying to conserve volume)

BUN is resorbed, Cr is not

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17
Q

Intrarenal Azotemia

A

urine osmol <350
urine sodium >40
FENa >2%
BUN:Cr < 15

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18
Q

Postrenal Azotemia

A

Urine osmol < 350
urine sodium > 40
FENa < 1% (mild) >2% severe

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19
Q

Subepithelial humps

A

PSGN

humps are sub epithelial

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20
Q

Granular subendothelial deposits

A

DPGN (diffuse proliferative) due to SLE

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21
Q

ADPKD chromosome?

A

16

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22
Q

Median umbilical ligament

A

allaNtoid –> urachus

pee out of the belly-button ‘straw-colored’

patent urachus

MediaNN allaNNtois

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23
Q

Medial umbilical ligament

A

umbilical arteries

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24
Q

necessary for differentiation and activation of all T-cells?

A

IL-2

blocked with cyclosporine - nephrotoxic!

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25
Q

AngII action at PCT

A

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

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26
Q

Heptatorenal syndrome

A

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)

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27
Q

Focal Segmental Glomerulosclerosis

A

often occurs in HIV+ pts

IF shows IgM in the affected glomeruli

massive proteinuria

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28
Q

Alkaptonuria

A

black urine on standing

increased homogentisic acid in the urine

deficiency of homogentisic acid oxidase

cartilage blue/black

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29
Q

Metabolic Acidosis with Anion Gap

A

MUDPILES

Methylene 
Uremia 
DKA
Propylene glycol 
INH or Iron tablets
Lactic acid
Ethylene glycol
Salicylates
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30
Q

Where the kidneys at?

A

T12-L3

left is higher than right

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31
Q

Low levels of DA on renal perfusion

A

dilate afferent and efferent

at higher levels it has alpha-one and it constricts

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32
Q

aspirin OD

A

tinitis, nausea, vomiting, lethargy

give sodium bicarb

aspirin is salicylate

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33
Q

acetaminophen OD

A

N-acetylcysteine (also for mucus-busting in CF)

hepatic necrosis

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34
Q

PCT glucose resorption

A

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

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35
Q

Antibiotic safe for UTI in preg?

A

Cephalexin

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36
Q

Fibromuscular dysplasia

A

non-atherosclerotic, non-inflammatory disease of the blood vessels

affects renals and carotids

main symptoms: HTN and renal artery bruit

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37
Q

MSUD

A

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

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38
Q

Tetracyclines

A

tooth discoloration
hepatotoxic
nephrotoxic –> nephrogenic DI

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39
Q

Mechanism of Action of ADH

A

binds V2 at kidney (2 kidney) –> increased aquaporin channels and concentrated urine

binds V1 at periphery –> vasoconstriction and increased TPR

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40
Q

Tumor Lysis Syndrome Prevention

A

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

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41
Q

Chronic Kidney Disease / Mineral Bone Disease

A

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

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42
Q

Heparin Induced Thrombocytopenia

A

thrombocytopenia induced 5-10 days after IV heparin –> autoantibodies to platelet factor 4

tx: argatroban

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43
Q

Symptoms of splenic infarct

A

left upper quadrant pain
left shoulder pain
nausea and vomiting

from celiac trunk

44
Q

Rickettsial illness

A

headache, fever, rash

tx: doxycycline

Typhus - starts centrally, spreads out
Rocky Mountain Spotted Fever - starts peripherally and goes trunkal

45
Q

Ebstein anomaly

A

From Lithium exposure (Bipolar)

ASD
malformed tricuspid
atrialized RV

46
Q

treatment for cerebral toxoplasmosis

A

pyrimethamine and sulfadiazine

HIV pt with ring enhancing lesions

47
Q

schizotypal

A

magical thinking

48
Q

Goodpasteur

A

antibodies to type IV collagen –> hematuria and hemoptysis

causes linear @ IF
crescent @ LM

49
Q

antibiotic that causes aplastic anemia

A

chloramphenicol

50
Q

Transthyretin

A

protein produced in the liver, carrier of thyroxine and retinol

mutations –> amyloidosis –> diastolic heart failure

51
Q

myoedema

A

swelling of muscle following percussion

sign of underlying hypothyroid

hypothyroid myopathy: myalgia, proximal muscle weakness, cramping, myoedema

52
Q

Targets for Chemo-induced emesis tx

A

Dopamine receptor antagonists: metoclopramide, prochlorperazine

Serotonin (5-HT3) antagonists: ondansetron, granisetron

Neurokinin 1 receptor antagonists: aprepitant, fosaprepitant

53
Q

Targets for motion sickness and morning sickness

A

Antimuscarinics: scopolamine

Antihistamines: diphenhydramine, meclizine, promethazine

54
Q

entacapone

A

decreased peripheral levodopa degradation

55
Q

BH4 is a cofactor required for the synthesis of?

A

DA, Epi, NE, melatonin from phenylalanine and tyrosine

5-HT from tryptophan

56
Q

HLA-B57.01

A

Abacavir

57
Q

why do pts with Crohns get gallstones?

A

issues at terminal ileum cause poor resorption of bile –> cholesterol stones

58
Q

Meglitinides (-glitinides)

A

Repaglinide

work like sulfonylureas

bind and close ATP-dependent K+ channels on beta cells of pancreas –> increased insulin release

59
Q

oppositional defiant disorder

A

deliberately annoying

argumentative

60
Q

landmark to differentiate between direct and indirect inguinal hernias?

A

inferior epigastric vessels

61
Q

Iron deficiency anemia

ferritin and transferrin changes in the serum

A

decreased serum ferritin
increased transferrin = increased serum total iron-binding capacity
decreased hemosiderin

ferritin is a good indicator of iron status

62
Q

Isoniazid and Sideroblastic Anemia

A

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

63
Q

crescendo-decrescendo systolic murmur

A

aortic or pulmonic stenosis (due to valvular calcification)

64
Q

persistent side effect of L-dopa (regardless of carbidopa/levodopa)

A

anxiety and agitation

increased dopamine in the brain

65
Q

Mitral regurg

A

severe if S3 is present

holosytolic murmur (intensity doesn’t correlate well with regurgitant volume)

66
Q

Folate ie necessary for which nucleic acid?

A

thymidine (pyrimidine)

67
Q

Treatment for restless leg syndrome

A

Dopamine agonists (prampipexole)

68
Q

differential cyanosis and clubbing

A

PDA

fully oxygenated blood to upper extremities

mixed blood enters to descending aorta–> cyanosis and clubbing in the feet

69
Q

Cachexia (weight loss in cancer)

A

TNF, IFN-gamma, IL-1, IL-6

70
Q

scorpion sting

A

acute pancreatitis

71
Q

Consequences of Midgut Malrotation

A

Ladd’s fibrous bands that cause extrinsic compression of the gut

can also cause volvulus (twisted portion of gut –> necrosis)

72
Q

locus ceruleus

A

norepinephrine

73
Q

Raphe nucleus

A

serotonin

74
Q

nucleus accumbens

A

GABA

75
Q

ventral tegmentum

A

dopamine

76
Q

basal nucleus of meynert

A

acetylcholine

77
Q

Absolute risk reduction

A

ARR = ER(control) - ER(treatment)

ER = event rate

78
Q

L-type calcium channel differences in skeletal vs smooth muscle and cardiac

A

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

79
Q

Why do some bacteria produce IgA Proteases?

A

destruction of IgA allows for bacterial adherence to mucosa

neisseria meningitidis, N. gonorrhoeae, strep pneumonia, haemophilus influenzae

IgA is a poor opsonin

80
Q

Lactose Fermentors

A

Klebsiella
E. coli
Enterococcus
Serratia

81
Q

Things on Chr3

A

VHL - hemangioblastoma @ retina, brain stem, cerebellum, cavernous hemangiomas, bilateral renal cell carcinoma, pheochromocytoma

82
Q

Beta blockers (esmolol) effects on EKG

A

prolonged PR - decreased AV nodal conduction and increased AV node refractory period

83
Q

Consequences of ions

Myocardial ischemia

A

no ATP

increased Na and Ca inside myocytes –> water influx and myocardial swelling

intracellular K is decreased

84
Q

direct thrombin inhibitors

A

argatroban, bivalirudin, dabigatran

85
Q

binds/blocks platelet ADP

A

clopidogrel, prasugrel, ticlopidine

86
Q

inhibits GPIIb/IIIa

A

abciximab, eptifibatide, tirofiban

87
Q

what causes crescent formation in RPGN

A

deposition of fibrin within Bowman’s space –> crescent formation

88
Q

SIADH

A

euvolemic hyponatremia

89
Q

Amphotericin B ADRs

A

Nephrotoxic
causes decreased K and Mg
decreased EPO –> anemia

90
Q

Enzyme that converts Norepi –> Epi

A

PNMT = phenylethanolamine-N-methyltransferase

stimulated: ACTH –> cortisol –> increased PNMT @ adrenal medulla

91
Q

Acute Interstitial Nephritis

A

fever, rash, low urine output

urinalysis: RBCs, WBCs, and esoiniphils

process in renal interstitium

drugs: beta-lactams, NSAIDS, sulfonamides

92
Q

what provides the major proliferative stimuli for atherosclerotic plaques

A

Platelets!

endothelial dysfunction –> platelet adhesion and aggregation –> PDGF

PDGF is secreted by platelets and macrophages –> vascular remodeling and smooth muscle cell proliferation –> atherosclerotic plaque

93
Q

dobutamine

A

B1-agonist

positive ionotrope 
positive chronotrope (weakly)

–> increased myocardial oxygen consumption

94
Q

lung cancer + for neural cell adhesion molecule (NCAM = CD56)

A

small cell carcinoma of the lung

also enolase, chromogranin

95
Q

Tetralogy of Fallot (embryological issue)

A

Deviation of the infundibular septum

96
Q

reduced motor end-plate potential

A

myasthenia gravis

decreased number for functional ACh receptors

97
Q

treatment of myastenia gravis

A

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

98
Q

CN III Palsy

A

Ptosis - paralysis of levator palpebrae

down and out gaze

parasymp fibers in CN III innervate iris sphincter and ciliary muscle –> fixed dilated pupil

99
Q

Akathisia

A

restlessness; extrapyramidal side effect due to antipsychotics

100
Q

BeriBeri

A

thiamine deficiency

peripheral neuropathy and heart failure

101
Q

Cholesteatoma

A

pearly mass behind tympanic membrane due to squamous cell debris

102
Q

Wrinkles are caused by

A

UVA –> increased ROS –> inflammatory things –> DECREASED collagen production

decreased collagen production
increased crosslinking
increased MMPs (collagen breakdown)

103
Q

vascular supply in the AV node

A

from dominant coronary artery

70% right coronary artery
10% left circumflex

104
Q

Arsenic poisoning

A

garlic breath and rice-water stools
QTc elongation
tx: dimercaprol

105
Q

MMR

A

M - Measles = Rubeola –> Paramyxo, give Vit A
M - Mumps
R - Rubella = Toga –> post=auricular LAD, congenital PDA

106
Q

47 XXY

A

increased LH and FSH (decreased inhibition)

107
Q

ADPKD

A

subarachnoid hemorrhage - berry aneurysm in circle of willis

Caleb's Step 1 (16 decks)

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