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PANCE prep > Deck 2 > Flashcards

Deck 2 Flashcards

1
Q

What are the 3 layers of the adrenal gland?

A

GFR
Glomerulosa: Aldosterone controls Na balance (outer layer)
Fasciulata: Cortisol (middle layer)
Reticularis: produces androgen/estrogen (inner layer)

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2
Q

Cushing’s Syndrome:

A

S/s related to cortisol excess

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3
Q

Cushing’s disease:

A

cushing’s syndrome caused specifically by pituitary incr ACTH secretion

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4
Q

What are EXOGENOUS causes of Cushing’s syndrome

A

Iatrogenic - long term high dose corticosteroid use

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5
Q

What are ENDOGENOUS causes of Cushing’s syndrome

A 
Cushing's Disease (70%)
Ectopic ACTH (15%) 
Adrenal Tumor (15%)
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6
Q

What is the lung cancer that is an endogenous cause of cushing’s syndrome

A

Small Cell Lung Cancer secreting ACTH

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7
Q

What are the Clinical Presentations of Cushing’s Syndrome:

A
  1. Redistribution of Fat
    - central obesity
    - moon facies
    - buffalo hump
    - supraclavicular fat pads
  2. catabolism of protein
    - wasting (thin) of extremities
    - prox muscle weakness
    - increased infections
    - skin atrophy
    - hyperpigmentation
  3. Hypertension
  4. Androgen excess (hirsutism)
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8
Q

How do you diagnose Cushing’s syndrome?

A
  1. Low-dose dexamethasone suppression test
  2. Incr 24hr urinary free cortisol levels
  3. Incr salivary cortisol levels
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9
Q

What would you expect CMP lab results to be if a patient is in Addison’s crisis?

A

HYPOnatremic
HYPOglycemic
HYPERkalemic
HYPERcalcemic

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10
Q

How do you treat someone in Addison’s crisis:

A
  • IV normal saline for Hypovolemia (D5NS if hypoglycemic)
  • Replenish Sodium
  • Give K-exylate to decrease potassium
  • Florinef (to replace aldosteron)
  • if known addisons = hydrocortisone
  • if undiagnosed = dexamethasone
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11
Q

At what serum glucose level, does glucose start spilling into the urine?

A

180mg/dL.

-normally the kidney reabsorbs nearly all glucose, the renal threshold for glucose is 180mg/dL.

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12
Q

Where in the kidney (nephron) does Acetazolamide work?

A

-the proximal tuble

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13
Q

What is the primary function of the proximal tubule?

A

-reabsorption of vital substances

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14
Q

Where does Mannitol work in the nephron?

A

-proximal tuble

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15
Q

What substances are reabsorbed in the proximal convoluted tubule?

A
  • 75% Na
  • glucose
  • Amino acids
  • most bicarbonate (HCO3)
  • Chloride
  • 75-90% of H2O
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16
Q

The Thick Ascending Limb (TAL) of Loop of Henle is IMPERMEABLE to H20, but absorbs what substances?

A

Actively reabsorbs: Na+, K+, & Cl-

Indirectly reabsorbs Mg+ & Ca+

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17
Q

Where do diuretics like furosemide, bumetanide, ethacrynic acid, & torsemide work in the kidney?

A

Furosemide, Bumetanide, Ethacrynic acid, and torsemide are all examples of Loop Diuretics.

Loop Diuretics work in the Thick Ascending Limb of the Loop of Henle.

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18
Q

What is the MOA for Loop Diuretics?

A

They work on the Thick Ascending Limb, to inhibit the reabsorption of solutes.

When Na+, Cl-, K+, Mg+ and Ca+ are not reabsobed, a person becomes:
Hyponatremic
Hypochloremic > incr. biocarb reabsorption >met. alkalosis
Hypokalemic
Hypocalcemic
Hypomagnesemic

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19
Q

Concentrated urine means:

1. physiologically what is happening?
2. resulting in a solute to H2O ratio?
3. High or low specific gravity?
A

Something is happening in the kidneys causing solutes (Na, K, Cl, Ca, Mg, glucose) to not be reabsorbed into the body…thus causing increased amounts being excreted through the urine & decreased amount in the blood.

more solute > H2O ratio.

concentrated urine = high specific gravity

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20
Q

What does Dilute Urine mean?

  1. What is happening physiologically?
  2. what is the solute to H2O ratio?
A

When urine is more dilute it means there is a physiologic process occurring in the kidneys increasing the amount of solutes (Na, K, Cl, Ca, Mg, glucose) that are being reabsobed.

21
Q

Where do chlorothiazide, chlorthalidone, HCTZ, indapamide, methyclothiazide, and metolazone work in the kidney?

A 
chlorothiazide
chlorthalidone
HCTZ
indapamide
methyclothiazide
metolazone
are all examples of Thiazide Diuretics they work on:
the cortical-diluting segment of the ascending loop of Henle
22
Q

What is the MOA of Thiazide Diuretics?

A

inhibits sodium and chloride reabsorption in the cortical-diluting segment of the ascending loop of Henle

23
Q

Where does Angiotensin II act on the kidneys?

What does it cause?

A

Proximal Tubules

Causing Incr. Na & H2O reabsorption.

24
Q

Where does Aldosterone work in the Kidneys?

What does it do?

A

Collecting Duct, (Distal)!

Incr. reabsorption of Na+ in exchange for decr. reabsorption of K+ & H+

25
Q

Hyperaldosteronism is commonly associated with what electrolyte disorder(s)?

A

Hypokalemia
Metabolic alkalosis
because K+ and H+ are being excreted through the urine, so Na is spared.

26
Q

Where does Spironolactone work in the kidney?

A

the distal collecting ducts of the renal tubules.

27
Q

What is the MOA for potassium-sparing diuretics?

A

Competes with aldosterone for receptor sites in the distal renal tubules –>
less aldosterone ->
decr. reabsorption of Na+, Cl-, H2O –>
Incr. Na+, Cl-, & H2O excretion,
while conserving potassium and hydrogen ions; may block the effect of aldosterone on arteriolar smooth muscle as well

28
Q

What are common SE of Spironolactone?

A

HYPERkalemia & Metabolic Acidosis

Hyponatremia, Hypochloremia

29
Q

Vasopressin is an example of what class of medication?

A

Antidiuretic Hormone.

30
Q

What is the MOA of Vasopressin?

A

Vasopressin stimulates a family of arginine vasopressin (AVP) receptors, oxytocin receptors, and purinergic receptors (Russell 2011). Vasopressin, at therapeutic doses used for vasodilatory shock, stimulates the AVPR1a (or V1) receptor and increases systemic vascular resistance and mean arterial blood pressure; in response to these effects, a decrease in heart rate and cardiac output may be seen. When the AVPR2 (or V2) receptor is stimulated, cyclic adenosine monophosphate (cAMP) increases which in turn increases water permeability at the renal tubule resulting in decreased urine volume and increased osmolality. Vasopressin, at pressor doses, also causes smooth muscle contraction in the GI tract by stimulating muscular V1 receptors and release of prolactin and ACTH via AVPR1b (or V3) receptors.

31
Q

What are nephrotoxic causes of Acute Tubular Necrosis?

A

Exogenous:

  • Aminoglycosides (amikacin, gentamicin, streptomycin, tobramycin).
  • contrast dye
  • Cyclosporine

Endogenous:

  • gout (crystal precipitation),
  • myoglobin (rhabdomyolysis)
  • lymphoma
  • leukemia
  • Bence Jones (multiple myeloma)
32
Q

What is common findings of Acute Tubular Necrosis cause of intrinsic AKI?

A

Muddy brown casts on UA because of tubular damage, epithelial casts, waxy/grannular casts.

33
Q

What are common Medications that can cause Acute interstitial Nephritis (AIN)?

A 
Penicillins
NSAIDs
Sulfa drugs
cephalosporins
ciprofloxacin
rifampin
allopurinol
34
Q

What is a PATHOGNOMIC finding on UA for AIN?

A

WBC casts

Urine Eosinophils

35
Q

Urinalysis results:
RBC Casts
Hematuria
Dysmorphic Red cells

A

Acute Glomerulonephritis or Vasculitis

Also expect to see: Urine Spec gravity 1.010 - 1.020 & BUN:Cr ratio <15:1

Patient is in Acute Kidney Injury with Intrinsic cause

36
Q

Urinalysis results:
Granular (muddy brown) casts
+/- epithelial cell casts

A

Acute Tubular Necrosis

37
Q

UA results with:
WBC casts
pyuria

A

Acute Interstitial Nephritis (AIN) or Pyelonephritis or tubular disease

38
Q

UA with narrow waxy casts

A

Chronic - Acute Tubular Necrosis or Glomerulonephritis

39
Q

UA with Broad waxy casts

A

END STAGE RENAL DISEASE (tubal dilation)

40
Q

UA with Fatty casts or maltese crosses, oval fat bodies

A

Nephrotic Syndrome (d/t hyperlipidemia)

41
Q

Hyaline casts

A

non-specific & may be normal

42
Q

Hematuria & pyuria without red cell casts

A

UTI
Acute interstitial Nephritis
Glomerular disease
vasculitis

43
Q

GFR of 60 - 89 is:

A

Stage 2 CKD

44
Q

GFR >90 in presence of proteinuria, abnormal UA, serum or imagining kidney damage

A

Stage 1 CKD

45
Q

GFR 30 to 44 is

A

Stage 3b CKD

46
Q

GFR of 45 to 59 is

A

Stage 3a CKD

47
Q

GFR <15 is

A

ESRD = uremia requiring dialysis and/or transplant

48
Q

GFR 15-29 is

A

Stage 4

PANCE prep (2 decks)

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