GU Flashcards
1
Q
What class of diuretic is bumetanide?
A
Loop
2
Q
What diuretic most helpful in acute pulmonary edema
A
Loops
3
Q
Which diuretics most helpful in glaucoma
A
CAI or mannitol
4
Q
Which diuretic most helpful in edema a/w nephrotic syndrome
A
Loop or metolazone (very powerful thiazide)
5
Q
Which diuretic used in increased ICP
A
Mannitol
6
Q
Which diuretics used in altitude sickness
A
Acetazolamide
7
Q
Most common nephrotic syndrome in adults
A
Membranous GN
8
Q
IF: granular pattern of immune complex deposition; LM: hyper cellular glomeruli
A
Post strep GN
9
Q
IF: linear pattern of immune complex deposition
A
Goodpastures
10
Q
Nephrotic syndrome associated with Hep B
A
Membranoprolif (type I)
11
Q
EM: sub endothelial humps and tram-track appearance
A
Membranoproliferative
12
Q
L: crescent formation in the glomeruli
A
Rapidly progressive GN
13
Q
Which nephropathy associated with HSP?
A
IgA nephropathy
14
Q
EM: spike and dome pattern of basement membrane
A
Membranous nephritis
15
Q
60 yo smoker found to have a varicocele that does not empty when pt is recumbent. What are you suspicious of?
A
Renal cell CA! Get a CT. DO NOT BIOPSY
16
Q
Dietary recommendations in treatment of nephrolithiasis
A
Adequate dietary calcium (don’t reduce)
Increase fluids
Decrease Na and oxalate
17
Q
Young black male with painless hematuria
A
Sickle cell trait
18
Q
Treatment for uric acid renal stones
A
Alkalinize urine with sodium bicarb or sodium citrate
19
Q
MCC of nephrotic syndrome in AA male
A
FSGS
20
Q
Treatment of Wegeners granulomatosis
A
Cyclophosphamide, steroids
21
Q
MCC of morbidity/mortality in SLE?
A
Lupus nephritis
22
Q
Defining characteristics of nephrotic syndrome
A
Proteinuria > 3.5 g/day
Hyperlipidemia
Hypoalbuminemia
23
Q
Biggest risk factor for RCC
A
Smoking
24
Q
5 etiologies of temporary hematuria
A
Exercise UTI Nephrolithiasis Trauma Endometriosis
25
Most common location of renal stone impaction
Uretero-vesico junction
26
What size calcium renal stone has a 50% likelihood of passing without surgical intervention
8-9 mm
27
Metabolic acidosis, normal anion gap, and low serum potassium
Diuretics, renal tubular acidosis types I and II, diarrhea, Fanconis syndrome
28
Metabolic acidosis, normal anion gap, high serum potassium
Addison's, RTA type IV, potassium sparing diuretics, hyperalimentation from TPN
29
Volume status after thiazides
Dehydrated -- hypovolemic OR euvolemic
30
Volume status in SIADH
Euvolemic
31
Volume status in hepatic cirrhosis
Hypervolemic
32
Volume status in Addison's disease
Hypovolemic
33
Volume status in hypothyroidism
Euvolemic
34
Volume status in renal failure
Hypervolemic
35
Volume status in psychogenic polydipsia
Euvolemic
36
Urine sodium and urine osmolality in SIADH
Urine sodium >20
| Urine osmol >100
37
Urine sodium and urine osmolality in psychogenic polydipsia
Urine sodium
38
Urine sodium and urine osmolality in Thiazides
Urine sodium >20
| Urine osmolality > 100
39
Urine sodium and urine osmolality in alcoholism
Urine sodium
40
Urine sodium and urine osmolality in hypothyroidism
Sodium >20
| Osmolality > 100
41
Hypovolemic hyponatremia and urine sodium
Extrarenal losses, so GI losses, fluid sequestration (peritonitis, pancreatitis), insensible loss such as sweating or extensive burns
42
Hypovolemic hyponatremia when Urine sodium >20
Renal losses. Diuretics, salt-wasting renal disease, partial urinary tract obstruction, adrenal insufficiency
43
If hypervolemic hyponatremia and urine so
CHF, cirrhosis, nephrotic syndrome
44
If hypervolemic hyponatremia and urine sodium >20?
Renal disease
45
5 things that shift K out of cells
```
Low insulin
Beta blockers
Acidosis
Digoxin
Cell lysis (i.e., leukemia)
```
46
4 things that shift potassium into cells
Insulin
Beta agonists
Alkalosis
Cell creation/proliferation
47
IVF used in hyperkalemia tx
D50 1 amp IV followed immediately by 10 units regular insulin IV (4-6 hr effect)
48
If K+ isn't responding to treatment (for hyperkalemia), what should you check?
Magnesium.
49
Next step in mgmt if you see peaked T waves on EKG?
Calcium gluconate to stabilize cardiac membrane
50
Flattened T waves on EKG
Hypokalemia
51
U waves on EKG
Hypokalemia
52
QT prolongation
Hypocalcemia
53
QT shortening
Hypercalcemia
54
Urine pH, serum K and serum bicarb in Type I RTA
This is distal. Urine pH is classically HIGH (>5.3). Serum K is decreased and serum bicarb is variable, but usually low.
55
URine pH, serum K and serum bicarb in Type II RTA
Proximal. Urine pH is variable (usually normal), serum K is decreased, and serum bicarb is LOW *
56
Urine pH, serum K and serum bicarb in Type IV RTA
Hypoaldosteronism therefore, urine pH is normal, serum K is HIGH*, and serum bicarb is normal.
57
How rapidlly can hypernatremia be corrected?
No faster than 12 mEq/day
58
What are the causes of euvolemic hyponatremia
SIADH, polydipsia, hypothyroidism
59
Meds known to cause hyperkalemia
ACE/ARB
Digoxin
Beta blockers
K+ sparing
60
Meds known to cause hypokalemia
Albuterol
Insulin
Loops, thiazides, CAI
61
Treatment for neprogenic DI
HCTZ +/- indomethacin
62
Treatment for nephrogenic DI if due to lithium: HCTZ + amiloride
HCTZ + amiloride
63
How are sodium levels corrected for high glucose
For every 100 mg above 100, 1.6 mEq/L of Na. However, when glucose >400, this number becomes 2.4
64
How are total calcium levels corrected for low albumin
For every 1 g albumin below 4, calcium decreases by 0.8 mg/dL
65
Causes of normal AG metabolic acidosis
Diarrhea
RTA
TPN (hyperalminetation)
66
Why are statins used in end stage renal disease
Not only do they lower risk of CAD, they also decrease the sepsis risk.
67
2 alternative medications used to treat BPH
Isoflavone (found in soy) decrease the growth of hyper plastic prostate.
Saw palmetto is as effective as finasteride, has fewer SE and decreases prostate size without changing PSA.
68
Selective a1 blocker used in BPH
Tamsulosin. This is used particularly if pt does not have comorbid HTN
69
Indications for surgery to treat BPH
```
Failure of medical therapy
Refractory urinary retention
Inability to express urine without a catheter
Recurrent infection
Persistent hematuria
Bladder stones, renal insufficiency
```
70
Most common surgery for BPH and most common side effect?
TURP. Retrograde eject seen in 70%
71
Next step in mgmt of 65 year old male that presents to ER wit hinability to urinate and painful bladder distention
Decompression of bladder with 14-18 gauge French Foley. If h/o BPH, may require a cath withth a firm Coude tip to "power through" narrowed erethra. If unable to pass, suprapubic cath under US guidance. If no one is trained, do suprapubic needle compression.
72
Tx of epididymitis in
Ceftriaxone IM then doxy or azithro x 10 days
73
Tx of Epididymitis in >35 or h/o anal intercours
FQ x 10-14 days
74
Tx of testicular torsion
Surgical detorsion with bilateral orchiopexy within 5 hours
75
Somewhat common symptom in infertile men
Varicocele -- present in 25% of infertile men
76
Ultrasound on varicocele will show?
Retrograde flow to scrotum
77
Onset difference between torsion vs epidiymitis
In torsion: acute, abrupt, associated with physical activity
| Epididymitis: subacute and may be associated with STDS and/or anal intercourse
78
Visual changes in torsion vs. epidydmitis
In torsion, testicle may be raised and horizontal. In epid, normal position and lie.
79
Support relieves pain in torsion or epididymitis?
Epididymitis!!!!
80
Cremasteric reflex absent in torsion or epididymitis?
TORSION!
81
Blood flow in epididymitis
Normal
82
Serum lab tests to check in patient presenting with ED
Total T, prolactin, TSH, +/- PSA
83
What age should tx for nocturnal enuresis be treated?
At least 7 y.o.
84
Why is intranasal DDAVP no longer indicated?
Risk of hyponatremic seizures
85
Most common cause of congenital urethral obstruction
Posterior urethral valves
86
A patient has signs of peritonitis and his clinical scenario favors rupture of the bladder (blunt trauma to fully distended bladder). What portion of th bladder mustt have been injured to allow for a chemical peritonitis to have developed?
Dome of bladder.
87
What med is used to reduce urotoxic effects of cyclophosphamide?
MESNA
88
What infection increases risk for bladder cancer?
Schistosomiasis
89
When dysmorphic red cells are described, the correct answer is?
Glomerulonephritis
90
Most accurate test of the bladder?
Cystoscopy
91
A woman is admitted to the hospital with trauma and dark urine. The dipstick is markedly positive for blood. What is the best initial test to confirm etiology?
Microscopic examination of the urine.
92
Initial test to assess proteinuria
UA
93
Most accurate to determine amount of proteinuria
Protein to creatinine ratio. If both P/Cr ratio and 24-hour urine are in the choices, choose the P/cr ratio. It is faster and technically easier to perform.
94
2 stains that detect eosinophils in the urine
Wright and hansel stains
95
Hyaline casts cause
Dehydration concentrates the urine and the normal Tamm-Horsfall protein precipitates or concentrates into a cast
96
Broad waxy casts are seen in?
chronic renal disease
97
Granular "muddy brown" casts are seen in?
Acute tubular necrosis.
98
NSAIDs constrict what part of the arteriole?
Afferent. therefore, they cause pre-renal azotemia.
99
ACE inhibitors do what to the arteriole?
Cause efferent arteriole vasodilation -- > prerenal azotemia.
100
3 random things that can cause retroperitoneal fibrosis
Bleomycin
Methylsergide
Radiation
101
Pre-renal azotemia is usually a clear dx if the question describes ... ?
BUN:cr ratio >20:1 AND clear hx of hypoperfesuion or hypotensio
102
Post renal azotemia is usually a clear dx with the question describing
```
BUN:Cr > 20:1
AND
distended bladder/massive release of urine with cath placement
AND
Bilateral/unilateral hydronephrosis.
```
103
Why is urine osmolality in ATN inappropriately low?
Normal tubule cells resorb water. in ATN, the urine cannot be concentrated because the tubule cells are damaged. The urine produced in ATN, therefore, is similar in osmolality to the blood (aboutt 300). This is called isosthenuria.
104
Usual findings in ATN from nephrotoxins
UNa >20
FENa > 1%
Low specific gravity / urine osmolality
105
Contrast induced renla failure: lab values
Contrast causes spasm of afferent arteriole. There is tremendous reabsorption of sodium and water, leading the specific gravity of the urine to become very high. This results in profoundly low urine sodium.
UNa
106
Drug that prevents renal failure due to chemo
Allopurinol
107
Two days after chemo, the creatinine rises in a person with a hematologic malignancy. Most likely due to ?
Tumor lysis syndrome which lead to hyperuricemia
108
Most drug toxicities that cause rise in creatinine take how many days for the effect to be seen?
5-10
109
Why does hypocalcemia occur in rhabdo?
Increased calcium binding to damaged muscle
110
Tx of rhabdo
Saline hydration, mannitol as osmotic diuretic, and bicarb which drives potassium back into cells and may prevent precipitation of myoglobin in the kidney tubule.
111
Next best step in mgmt of patient with rhabod
Check EKg for life threatening hyperkalemia.
112
tX of hepatorenal syndrome
Albumin, midodrine, octreotide
113
Diagnostic tests in atheroemboli-induced AKI
Eosinophilia
Low complement levels
Eosinophiluria
Elevated ESR
114
Most accurate test for papillary necrosis
CT scan -- shows abnormal internal structures of kidney from loss of papillae
115
Which classes of diuretics are associated with hyperuricemia?
Thiazides and loops
116
Class of diuretics associated with ototoxicity
Loops
117
Small bowel disease causes what type of renal stones?
Calcium oxalate
118
Some toxic causes of AIN
Cadmium, lead, copper, mercury, certain poisonous mushrooms
119
"Split basement membrane" on EM
Alport syndrome
120
Defect in Type 1 RTA
Impaired H+ secretion leading to secondary hyperaldosteronism. The distal tubule is responsible for generating new bicarb under the influence of aldosterone. If new bicarb cannot be generated, acid cannot be excreted into the tubule, thus raising the pH of the urine.
121
Treatment of Type 1 RTA
Oral bicarb, K+, thiazides
122
Defect in Type 2 RTA
Damage to proximal tubule decreases the ability of the kidney to reabsorb most of the filtered bicarb. Bicarb is lost in the urine until the body is so depleted of bicarb that the distal tubule can absorb the rest. When this happens, the urine pH will become low.
123
Random causes of Type 2 RTA
Multiple Myeloma, Fanconi syndrome, Wilson disease, amyloidosis, vitamin D deficiency
124
Which RTA is associated with nephrolithiasis?
Distal / Type 1
125
Which RTA is associated with hyperkalemia
Type 4
126
Treatment of Type 4 RTA
Fludrocortisone, K+ restriction
127
DM is associated with which RTA?
Type 4.
128
Sickle cell disease is associated with which RTA?
Type 4
129
Normal anion gap acidosis suggests?
HCO3 loss
130
Increased anion gap acidosis suggests?
H+ excess
131
Some fun causes of respiratory alkalosis
```
Hyperventilation/fever
High altitude
Asthma
Aspirin toxicity
Pulmonary embolism
Pain
Interstitial lung disease
```
132
Some causes of respiratory acidosis
```
COPD
Respiratory depression
Neuromuscular diseases
Drowning
Opiate overdose
Alpha 1 antitrypsin deficiency
Kyphoscoliosis
Sleep apnea/morbid obesity
```
133
Causes of metabolic alkalosis
```
Vomiting
Diuretics
Cushing syndrome
Hyperaldosteronism
Adrenal hyperplasia
```
134
Electrolyte disturbances that can cause nephrogenic DI
Hypercalcemia
| Hypokalemia
135
Tx of urge incontinence
Bladder training
| Anti-muscarinics (oxybutynin, tolterodine, solifenacin)
136
Causes of overflow incontinence
Bladder outlet obstruction from BPH or urehtral strictures
Impaired detrusor contractility
Neurogenic bladder
137
Where in the prostate does BPH develop>
Central zone.
138
Which types of testicular cancers have increased B-hCG and AFP?
Germ cell tumors
139
Whichh testicular cancers have increased estrogen?
Streams cell tumors
140
Which testicular cancers have lower cure rates and increased risk of recurrence?
Nonseminomas
141
Treatment for cryptorchidism
Exog hCG admin or orchiopexy before age 5 to reduce risk of cancer and allow testicular development
142
Extra NSAID use and a history of sickle cell disease points you to what kidney problem?
Papillary necrosis
143
Proteinuria levels correspond to ?
Severity of disease and likelihood of progression.
144
Most accurate test to dx IgA nephropathy
Kidney biopsy
145
Tx of Goodpasture syndrome
Plasapheresis and steroids. Cyclophosphamide can be helpful.
146
Complement levels in PSGN
Low
147
Defect that causes Alport syndrome
Type IV collagen. The loss of collagen fibers that hold the lens of the eye in place cause the visual disturbances.
148
Importantly, polyarteritis nodosa spares what organ?
lungs
149
Infectious association with PAN
Hep B
150
Skin mx of PAN
Purpura and petechiae, ulcers, digital gangrene, livedo reticularis.
151
Standard of care and lower mortality in PAN
Prednisone + cyclophosphamide
152
Tx of lupus nephritis
Glucocorticoids with either cyclophosphamide or mycophenolate
153
Amyloid kidney is associated with what 5 disease states
```
MYELOMA
Chronci inflame disease
RA
IBD
Chronic infections
```
154
Treatment of amyloidosis
Melphalan and prednisone
155
UA in nephrotic syndrome
Maltese crosses, which are lipid deposits in sloughed off tubular cells
156
Why do you see HLD in nephrotic syndrome
Lipid levels rise because the lipoprotein signals that turn off the production of circulating lipid are lost in the urine.
157
Why does renal failure cause bleeding
Platelets do not work normally in a uremic environment. they do not degranulate.
158
Why is there hypocalcemia in renal failure
Kidney transforms less active 25-hydroxy vitamin D into much more active 1,25-dihydroxyvitamin D. Without this form of vitamin D, the body will not absorb enough calcium from the guy.
159
Why is there accelerated atherosclerosis and hypertension in renal failure
The immune system helps keep arteries clear of lipid accumulation. WBC don't work normally in uremic environment.
160
Only time EPO is ALWAYS used
Anemia from ESRD
161
Tx of bleeding in ESRD
DDAVP
162
Tx of hyperphosphatemia in ESRD
Oral phosphate binders (calcium acetate, calcium carbonate, sevelamer, and lanthanum) will prevent phosphate absorption from bowel. Tx of hypocalcemia will also help because it is the hyper PTH that causes increased phos release. When Vit D is replaced, it is critical to also give phosphate binders otherwise vitamin D will increase GI absorption of of phosphate.
163
When calcium level is high, which phosphate binders should you use
Sevelamer and lanthanum
164
Drugs assoc with TTP
Cyclosporine
Ticlopidine
Clopidogrel
165
TTP or severe HUS treatment
Plasmapheresis or infusions of FFP.
| STEROIDS DO NOT HELP
166
MCC of death from PCKD?
Renal failure. Recurrent episodes of peel and nephrolithiasis cause progressive scarring and loss of renal function.
167
Extra renal mx of PCKD
```
Liver cysts
Ovarian cysts
MVP
Diverticulosis
Cerebral aneurysms
```
168
Why is there decreased urine sodium in DI?
These are hypovolemic states. Apparently the body cares more about your volume status than your sodium status.
169
Name some hypovolemic states
```
Sweating
Burns
Fever
PNA (from insensible losses from hyperventilation)
Diarrhea
Diuretics
```
170
Why does hypothyroidism lead to euvolemic hyponatremia
Thyroid hormone is needed to excrete water.
171
Tx of chronic SIADH
Demeclocycline, which blocks the action of ADH at the collecting duct of the kidney tubule
172
3 causes of pseudo-hyperkalemia
Hemolysis
Repeated fist clenching wit tourniquet in place
Thrombocytosis or leukocytosis
173
2 causes of hypokalemia due to renal losses that are kind of random
Bartter syndrome which is a genetic disease causing salt loss in the loop of Henle
Licorice.
174
Relationship between hypokalemia and hypomagnesemia
Magnesium dependent potassium channels. When mag is low, they open and spill potassium into urine.
175
Drug classic for causing distal RTA
Amphotericin
176
Tx of Type 2 RTA
Thiazides cause mild volume depletion which will enhance bicarb reabsorption.
177
Most common risk factor for nephrolithiasis
Overexertion of calcium in the urine
178
How does crohns cause kidney stones
Increased oxalate absorption
179
Fat malabsorption and stone formation
Fat malabsorption increased stone formation.
180
Lithotripsy is used to manage stones between what sizes?
0.5 and 2-3 cm
181
Why does calcium restriction actually increase the risk of forming calcium stones
CAlcium binds oxalate in the bowel. When calcium ingestion is low, there is increased oxalate absorption in the gut because there is no calcium to bind it.
182
Metabolic acidosis and stone formation
Metabolic acidosis removes calcium from bones and increases stone formation. In addition, it decreases citrate levels. Citrate is important as it binds calcium, making it unaviailable for stone formation
183
Citrate and stone formation
Decrease in citrate increases risk of stone formation because citrate binds calcium.
184
Flutamide is used in what dz
Prostate CA
185
Besides minoxidil, what other drug can we use to promote hair growth
Finasteride
186
MOA of cyproterone
Inhibits androgens at testosterone receptor.
