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Nephrology Fellowship Reviewer > Fluid and Electrolytes/Acid Base > Flashcards

Fluid and Electrolytes/Acid Base Flashcards

1
Q

Principal cation in the ECF

A

Na

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2
Q

Principal cation in the ICF

A

K

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3
Q

major determinant of LV filling volume, CO, MAP

A

intravascular volume

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4
Q

diagnostic hallmark of decrease EABV

A

Urine sodium < 15

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5
Q

principal anion lostin diarrhea

A

bicarbonate

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6
Q

acid base in diarrhea

A

hyperchloremic acidosis

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7
Q

acid base in diuretics, bartter, Gitelman

A

hypokalemic alkalosis

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8
Q

K and acid base in adrenal insufficiency

A

hyperkalemia and met acidosis

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9
Q

urine parameters in hypovolemia

A

u.spg > 1.020, Una < 10, Uosm > 400 mOsm/Kg

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10
Q

Fena of hypovolemia

A

less than 1%

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11
Q

FeNa of hypvolemia with diuretics

A

less than 30-35%

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12
Q

mainstay for volume replacement

A

crystalloids isotonic 0.9%

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13
Q

fluid of choice for burns/trauma

A

colloids

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14
Q

clilnical detection of edema occurs when interstitial fluid is

A

> 2 to 3 L

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15
Q

sine qua non for Na and water retention in cirrhosis with portal hypertension

A

intrasinusoidal hypertension > 12 mmHg

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16
Q

halmark of fluid retention in cirrhosis

A

peripheral arterial vasodilation with vasoconstriction

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17
Q

standard of care for heart failure

A

B blocker

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18
Q

vasoconstrictor of choice for liver cirrhosis

A

terlipressin

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19
Q

a-adrenergic agonist inhibits release of glucagon, no effect on renal fxn

A

ocreotide

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20
Q

treatment of choice for HRS

A

liver transplantation

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21
Q

daily insensible water loss

A

8-10 ml/kg

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22
Q

primary determinant of free water excretion in regulation of H20

A

AVP

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23
Q

most important stimulus of AVP secretion

A

hypertonicity, oncotic pressure of plasma

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24
Q

most sensitive osmoreceptor cells

A

anterior hypothalamus

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25
Q

absolute level of Posm at which a person develops a conscious urge to drink

A

osmotic thirst threshold

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26
Q

Osmotic thirst threshold

A

295 mOsm/kg/H20

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27
Q

rare autosomal recessive causing DI, DM, optic atrophy, deafness

A

Wolfram syndrome

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28
Q

primary osmoreceptors controlling AVP secretion and thirst

A

anterior hypothalamus

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29
Q

lack of osmoreceptors that regulate thirst and impaired osmoregulation of AVP

A

osmoreceptor dysfunction

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30
Q

hallmark of osmoreceptor dysfunction

A

abnormal thirst response

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31
Q

enzyme enhanced in gestational DI

A

oxycytocinase and vasopressinase

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32
Q

treatment of gestational DI

A

vasopressin

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33
Q

resistance of ADH due to defect within the kidney

A

nephrogenic DI

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34
Q

most common cause of drug induced NDI

A

lithium

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35
Q

characteristic clinical symptom of DI

A

polyuria, polydipsia

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36
Q

solute excretion rate in solute diuresis

A

> 15 mOsm

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37
Q

differentiate CDI and NDI

A

fluid deprivation test

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38
Q

increase in U Osm after vasopressin

A

CDI

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39
Q

<10% increase in Uosm after vasopressin

A

NDI

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40
Q

drug of choice for acute and chronic CDI

A

desmopressin

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41
Q

paradoxic antidiuretic effect in NDI

A

Thiazide

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42
Q

major comploication of desmopressin

A

hyponatremia

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43
Q

hyponatremia, normal osm

A

pseudohyponatremia, factitious hyponatremia

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44
Q

potent stimulus to AVP secretion

A

volume depletion

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45
Q

most common of hospitalized hyponatremia

A

SIADH

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46
Q

Uosm in sIADH

A

> 100 mOsm/Kg H20

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47
Q

most common malignancy with sIADH

A

bronchogenic Ca and small cell lung cancer

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48
Q

Na increase in 100 ml hypertonic saline

A

2 to 4 mmol/L

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49
Q

treatment of choice for depletional hyponatremia

A

isotonic saline

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50
Q

most dreadful complication in acute hyponatremia

A

brain herniation

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51
Q

allowable increase in Na in 24 hours in high risk ODS

A

8 mmol/L

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52
Q

max daily rate of increase in Na

A

10-12 mmol/L

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53
Q

TTKG 2-3

A

redistributive hypokalemia

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54
Q

TTKG>4

A

renal K wasting

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55
Q

Urine K/Crea signifying poor dietary intake

A

< 13 meq/g Crea

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56
Q

Most common cause of hypokalemia in hospitalized

A

GI losses, diuretics, hypomagnesemia

57
Q

renal compression by subscapular mass or hematoma causing increase in renin

A

page kidney

58
Q

unusual presentation of renal artery stenosis and renal ischemia

A

hyponatremic hypertensive syndrome + hypokalemia

59
Q

Familial Hyperaldosteronism Type I

A

Glucocorticoid remediable hyperaldosteronism

60
Q

suppresion of aldosterone after dexamethasone suppression test: FH I

A

< 4 ng/dL

61
Q

Findings in primary hyperaldosteronism after saline loading test

A

UNa > 200 mmol/day, Ualdo > 33 mmol/day

62
Q

PAC in PA

A

> 277 pmol/L

63
Q

preferred surgical management for APA or PAH

A

laparoscopic adrenalectomy

64
Q

Most common cause of hyperKalemia in the ER

A

Renal Failure

65
Q

Ingestion of K rich clay

A

Geophagia

66
Q

Ingestion of burnt matchstick

A

Cautopyreiophagia

67
Q

combined alpha and betablocker common to cause hyperkalemia

A

Labetalol

68
Q

most common cause of adrenalitis in hiv disease

A

cmv

69
Q

loss of function mutation in mineralocorticoid receptor: unc in aldosterone, ang II and renin; Asymptomatic in adulthood

A

Pseudohypoaldosteronism (PHA-1) autosomal dominant

70
Q

recessive form of pha-1, mutation

A

EnaC

71
Q

PHA-II, gain of function in NCC

A

Gordon syndrome

72
Q

Htn, hyperK, Nagma, suppressed pra and aldosterone, hypercalciuria reduced bone density

A

Gordon syndrome

73
Q

Tx Gordon syndrome

A

Thiazide

74
Q

first line drug in Er management of hyperkalemia

A

Calcium IV

75
Q

most constant and reliable medication to induce redistribution of K

A

Insulin with glucose

76
Q

transporters affected by B agonists

A

Na K ATPase and NKCC1

77
Q

preferred mode when rapid correction of hyperkalemic episode is desired

A

Hemodialysis

78
Q

low plasma K can alter the rate of tissue metabolism, decrease tissue oxygen consumption, promoting arteriolar constriction, reduce efficiency of hd

A

Solandt Effect

79
Q

Excess of this hormone is responsible for hyperca of malignancy

A

PTHrp

80
Q

Most common cause of hypercalcemia in hospitalized patients

A

Malignancy

81
Q

Most common cause of hypercalcemia in outpatient clinic

A

PHPT

82
Q

positive family history, hypercalcemia at a young age, low Uca

A

Familial hypocalciuric hypercalcemia

83
Q

excessive and incompletely regulated secretion of pth with hypercalcrmia and hypophosphatemia

A

primary hyperparathyroidism

84
Q

Cause of PhPT in 80-85% of cases

A

Parathyroid adenoma

85
Q

classic bone lesion in phpt

A

osteitis fibrosa cystica

86
Q

standard therapy for phpt

A

surgery

87
Q

most popular and most sensitive technique to localize pth glands

A

sestamibi scanning

88
Q

endocrine tumors in 2 of 3: Parathyroid gland, pituitary gland, enteropanxreatic tissue; most common form of familial phpt

A

MEN1

89
Q

syndrome of heritable predisposition to medullary thuroid carcinoma, pheochrokocytoma and phpt

A

Men 2A

90
Q

glycoprotein that inhibits wnt b catenin signaling

A

sclerostin

91
Q

fully humanized monoclonal antibody that prevents bunding of rank to rankl

A

denosumab

92
Q

most common granulomatous disease with hypercalcemia

A

sarcoidosis

93
Q

most effective therapy for hypercalcemia in hematologic malignancies

A

glucocorticoids

94
Q

most common causes of hypocalcemoa in the nonacute setting

A

hypoparathyroidisn, hypomagnesemia, ckd and vitamin d deficiencies

95
Q

pth resistance with short stature, round face, mental retardation, brachydactyly, lack of phosphaturic response to parathyroid extract

A

albright hereditart osteodystrophy

96
Q

php with complete resistance to effects if pth

A

PHP-1

97
Q

php without hypocalcemia and endocrine dysfunction

A

pseudohypoparathyroidism

98
Q

php with reduced phosphaturic response to pth but normal increase in urinary camp levels

A

php-2

99
Q

most common cause of acquired hypoparathyroidism in adults

A

surgical removal or damage to the pth glands

100
Q

prolonged hypocalcemia after parathyroidectomy

A

hungry bone or recalcification syndrome

101
Q

best indicator of vitamin d status

A

25 (OH)D

102
Q

tumor lysis

A

hyperphos, hyperuric

hypocalcemia

103
Q

best test of overall magnesium status

A

magnesium tolerance test

104
Q

FeMg suggestive of magnesium wasting

A

> 24 mg per day

105
Q

earliest manifestation of hypermg

A

hypotension

106
Q

rare autosomal recessive disorder characterized by hyperphos and progressive deposition pf ca phos crystals

A

familial tumor calcinosis

107
Q

acquired paraneoplastic syndrome of kidney phos wasting - hypophos, normal serum calcium, pth levels, low calcitriol, decreased bone mineralization

A

tumor induced osteomalacia

108
Q

First line of defense against acid or base

A

buffers

109
Q

major buffer system in the body

A

CO2/Hco3

110
Q

second line of defense against acid base

A

respiratory system

111
Q

3rd line of defense

A

renal

112
Q

most common cause of drug induced respiratory alkalosis

A

salicylates

113
Q

surrugate for ammonium excretion

A

urine anion gap

114
Q

principal defect in acidification of advanced renal failure

A

reduced ammoniagenesis, impaired NH4 accumulation

115
Q

most common cause of acquired pRTA

A

multiple myeloma

116
Q

most common drug causing of acquired pRTA

A

ifosfamide

117
Q

acid base in fanconi syndrome

A

chronic hyperchloremic metabolic acidosis

118
Q

Type 1 RTA

A

classical distal RTA

119
Q

Type 2 RTA

A

proximal RTA

120
Q

hallmark of cDRTA

A

hypokalemia distal RTA

121
Q

reliable marker for cDRTA

A

nephrocalcinosis

122
Q

Type 4 RTA

A

hyperkalemic RTA

123
Q

glucocorticoid and mineralocorticoud deficiency

A

addison’s disease

124
Q

most common congenital adrenal defect

A

21 hydroxylase deficiency

125
Q

most frequently associated renal disease with hyporeninimic hypoaldosteronism

A

DM nephropathy and tubulointerstitial disease

126
Q

drugs that inhibits EnaC

A

amiloride, triamterene

127
Q

inhibited by cyclosporine and tacrolimus

A

Na K ATPase, ROMK channel

128
Q

target hco3 concentration

A

> 22 meq/L

129
Q

PHA-2

A

Gordon syndrome

130
Q

most common lactic acidosis

A

L-lactic

131
Q

lactic acidosis from tissue hypoperfusion

A

Type A

132
Q

most common cause of type A acidosis

A

bowel ischemia

133
Q

most widely reported drug that can cause lactic acidosis

A

metformin

134
Q

treatment for salicylate

A

activated charcoal

135
Q

treatment for ethylene glycol

A

fomepizole

136
Q

mutation in Bartter Syndrome

A

NKCC2

137
Q

Gitelman

A

NCC DCT

138
Q

Gitelman vs Barter

A

hypocalciuria and hypomagnesemia for Gitelman

139
Q

mutation in Liddle

A

Enac principal cells CCD

Nephrology Fellowship Reviewer (29 decks)

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