Block 65, 66: Renal

Question 1

bladder pain that is worsened by filing and relieved by voiding, diagnosis? other symptoms?

Answer 1

interstitial cystitis

- urgency, frequency, and chronic pelvic pain

Question 2

cystocele

Answer 2

bladder prolapse into anterior vaginal wall

Question 3

what sodium level do patients have severe SIADH and how do you treat? how do you treat mild SIADH

Answer 3

less than 120
hypertonic (3percent) saline

normal fluids

Question 4

Diagnosis of SIADH

Answer 4

• hyponatremia
• serum osmo less than 275
• urine osm less than 100
  euvolemic patient

Question 5

initial corner stone therapy for renal stone diasese

Answer 5

Hydration

Question 6

left lower abdominal pain radiating to the groin, vomiting, and unremarkable findings on abdominal exam has

Answer 6

obstructive ureterolithiasis

Question 7

perferred modality for diagnosing ureteral stone are

Answer 7

ultrasonography or noncontrast spiral CT of abdomen

Question 8

what does tuberculosis causing chronic primary adrenal insufficiency cause in the body

Answer 8

Addisions: Aldosterone deficiency

• non-anion gap
• hyperkalemic and hyponatremic metabolic acidosis

Question 9

Aminioglycosides coveres what

Answer 9

serious gram-negative infections

Question 10

toxicity of aminoglycosides

Answer 10

nephrotoxic

Question 11

amikacin is what type of drug

Answer 11

aminoglycoside abs

Question 12

type of drug: Levofloxacin

Answer 12

fluoroquinolone

Question 13

Asymptomatic hypercalcemia
elevated or inappropriately normal PTH
low urinary calcium excretion

Answer 13

Familial hypocalciuric hypercaclemia

Question 14

how is primary hyperparathyroidism different from familial hypocalciuric hypercalcemia

Answer 14

primary hypeparathyroidism has increase urinary calcium excretion ( urine calcium/creatinine clearance ratio)

Question 15

treatment for hyperkalemia with significant ECG changes

Answer 15

calcium gluconate

Question 16

how do beta adrenergic impact potassium

Answer 16

shifts potassium intracellular

- watch out in COPD patients

Question 17

acidosis impact on potassium

Answer 17

hyperkalemia

Question 18

3 ways K enters a cell

Answer 18

• insulin, beta-adrenergic, hematopoiesis
• GI loss
• hyperaldosteronism, diuretics

Question 19

what 2 values are needed for best picture of acid-base status

Answer 19

pH

CO2

Question 20

contrast-induced nephropathy

Answer 20

• transient spike in creatinine within 24 hours of contrast

- return to normal within 5-7 days

Question 21

what can be given to minimize the risk of contrast-induced nephropathy

Answer 21

• IV hydration with isotonic bicarbonate or normal saline

- acetylcysteine

Question 22

what should you suspect with large amounts of blood on urinalysis with relative absence of RBCs on urine microscopy

Answer 22

Myoglobinuria caused by rhabdomyolysis

Question 23

when is anion gap calculated

Answer 23

metabolic acidosis

Question 24

what is normal anion gap

Answer 24

6-12

Question 25

when is osmolar gap calculated

Answer 25

ethanol, methanol or ethylene glycol toxicity

Question 26

risk of correcting hyponatremia too quickly

Answer 26

CNS osmotic demyelination syndrome

Question 27

triad for renal cell carcinoma

Answer 27

flank pain hematuria palpable abdominal renal mass

Question 28

Unilateral varicoceles that fail to empty when a patient is recumbent raise suspicion for?

Answer 28

underlying mass pathology, such as renal cell carcinoma

Question 29

characterize diabetic nephropathy

Answer 29

proteinuria | progressive decline in GFR

Question 30

pathologic hallmark of diabetic nephropathy

Answer 30

nodular glomerulosclerosis | - diffuse glomerulosclerosis is more common

Question 31

aspirin causes what acid base disturbance

Answer 31

respiratory alkalosis | metabolic acidosis

Question 32

what is low urine sodium

Answer 32

less than 10

Question 33

membranoproliferative glomerulonephritis is associated with what

Answer 33

hep C

Question 34

hepatorenal syndrome is seen in patients with

Answer 34

severe liver cirrhosis secondary to system and renal hypoperfusion

Question 35

does renal function improve with acute renal failure

Answer 35

no

Question 36

typical findings for acute renal failure

Answer 36

- creatinine greater than 1.5 - low urine sodium - no blood, casts, protein in urine,

Question 37

Recurrent stones since childhood, positive family history, typical hexagonal crystals on urinalysis, and positive cyanide nitroprusside test

Answer 37

cystinuria

Question 38

when should a person not get metformin

Answer 38

- ill patients with acute renal failure - liver failure - sepsis

Question 39

common medications that cause hyperkalemia

Answer 39

- nonselective bet-adrenergic blockers - potassium-sparing diuretics - ACE inhibitors - ARBS - NSAID

Question 40

what type of drug is amiloride?

Answer 40

potassium sparing diuretic

Question 41

renal vein thrombosis is a complication of what nephrotic syndrome

Answer 41

membranous glomerulopathy

Question 42

metabolic changes with vomiting

Answer 42

hypochloremic metabolic alkalosis hypokalemia increase bicarbonate

Question 43

treatment for vomiting induced metabolic alkalosis

Answer 43

isotonic sodium chloride | potassium

Question 44

patient with headache, sunburns, thrombocytopenia, glomerulonephritis, low C3 and C4 levels has

Answer 44

SLE

Question 45

what causes membranoproliferative glomerulonephritis

Answer 45

persistent activation of the alternative complement pathway

Question 46

microscopic finding for membranoproliferative glomerulonephritis

Answer 46

dense intramembranous deposits that stain C3

Question 47

nephrotic-range proteinuria and hematuria, diagnosis

Answer 47

membranoproliferative glomerulonephritis

Question 48

side effect of rifampin

Answer 48

red urine

Question 49

after taking TCA, have abdominal pain and fullness/tenderness along the midline below the umbilicus ?

Answer 49

urinary retention - prevent destrusor contraction and sphincter relaxation - urinary cath and discontinue meds

Question 50

when do you see asterixis

Answer 50

- hepatic encephalopathy - uremic encephalopathy - CO2 retention

Question 51

AEIOU

Answer 51

``` acidosis electrolytes (K) ingestion overload uremia ```

Question 52

electrolyte problems in alcoholics ? how

Answer 52

hypomagnesemia that causes hypokalemia - intracellular Mg, inhibit K secretion by renal outer medullary potassium channels into urine - No Mg, no K

Question 53

hypertension, palpable bilateral abdominal masses and microhematuria

Answer 53

ADPCKD

Question 54

Dysuria, urinary frequency, suprapubic tenderness suggests

Answer 54

uncomplicated cystitis

Question 55

treatment for complicated cystitis

Answer 55

oral fluroquinolones

Question 56

treatment for uncomplicated cystitis

Answer 56

- Trimethoprim-sulfamethoxazole - nirtofurantion - fofomycin

Question 57

men with what have an higher increase of anticholinergic problems when they have what

Answer 57

benign prostatic hyperplasia

Question 58

most common renal vascular lesions seen in hypertension are

Answer 58

arteriosclerotic lesions of afferent and efferent arterioles and glomerular capillary tufts

Question 59

characterize diabetes mellitus nephropathy

Answer 59

- increased extracellular matrix - basement membrane thickening - mesangial expansion - fibrosis

Question 60

patients with nephrotic syndrome has increased risk for what

Answer 60

1. atheroscloerosis ( due to hyperlipidemia) | 2. arteriovenous thrombosis ( loss of antithrombin III)

Question 61

Saline-responsive metabolic alkalosis is associated with

Answer 61

low urinary chloride excretion | volume contraction

Question 62

saline-unresponsive metabolic alkalosis associated

Answer 62

urinary chloride greater than 20

Question 63

what is used to treat severe metabolic acidosis

Answer 63

IV sodium bicarbonate