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GU Flashcards

1
Q

Spike and dome basement membrane thickening?

A

membranous glomerulonephritis

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2
Q

uncommon cause of chronic nephritis that occurs primarily in children and young adults

  • tram track appearance (double glomerular basement membrane)
  • may be idiopathic, result from antibodies against complement components, or be secondary to chronic infections, especially hepatitis B or C
A

membranoproliferative glomerulonephritis

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3
Q

hematuria and increasing azotemia (increased BUN and creatinine)
- crescentic glomerulonephritis and a linear pattern along the glomerular basement membrane

A

rapidly progressive glomerulonephritis

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4
Q

Antibodies directed against the glomerular basement membrane typically cause rapidly progressive glomerulonephritis with hematuria and increasing azotemia (increased BUN and creatinine)
- antibodies also attack the pulmonary basement membranes, causing hemoptysis

A

Goodpasture’s syndrome

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5
Q

MCC nephrotic syndrome in children

  • absence of glomerular foot processes on podocytes
  • light microscopy of the glomeruli is normal
A

minimal change dz

- effectively treated w/ steriods!

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6
Q

what do ACE-I’s and ARB’s prevent?

A

progression of kidney disease

- best tx for proteinuria* (have antiproeinuric effects)

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7
Q

mesangial matrix becomes more abundant and forms masses of pink-staining, hyaline material among the capillary loops

A

Kimmelstiel-Wilson nodules

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8
Q

flank pain, hematuria, hypertension, and progressive renal failure in their 30s

  • Renal cysts located in cortex and medulla
  • 50% of pts require dialysis by age 60
  • cardiac problems MCCOD
  • berry aneurysms/SAH are serious complication
A

ADPKD

- Gene mutations in PKD inhibit production of polycystin 1 and 2

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9
Q

self-limited epidermal infection caused by a Poxviridae virus

  • flesh-colored, dome-shaped papules that are firm and umbilicated
  • transmitted by skin to skin contact
A

molloscum contagiosum

- widespread infection indicates immunocomp (HIV/aids)

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10
Q

flat, cauliflower-shaped, filiform, and verrucous warts

- can be white, erythematous, violaceous, brown, hyperpigmented, and even skin-colored

A

HPV

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11
Q

what transplant drug creates a complex with intracellular immunophilins (FKBP) and binds to mTOR inhibiting T-cell proliferation in response to IL-2

A

sirolimus

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12
Q

urinalysis positive for blood with no red blood cells seen on microscopy?
- can occur with trauma, severe dehydration, seizures, or confinement in a fixed position for a prolonged period of time

A

rhabdomyolysis (muscle breakdown)

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13
Q

abrupt decline in renal function, manifested by an increase in plasma BUN and serum creatinine, occurring hours to days after injury

  • BUN:Cr< 15
  • hyperkalemia
  • muddy brown casts in the urine
A

acute tubular necrosis

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14
Q

MC kidney stone?

A

calcium oxalate

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15
Q

what causes hematuria?

A

When the glomerulus is damaged, red blood cells can squeeze their way through the glomerulus and enter the urine

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16
Q

a healthy patient receiving antibiotics for a joint infection, who suddenly has an increased creatinine level 2 days after starting antibiotics should be worked up for what?

A

acute tubular necrosis

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17
Q

what is 2nd MCC of UTI in young females?

A

staph saprophiticus

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18
Q

what does finasteride inhibit?

A

5a-reductase (decreasing conversion of T -> DHT)

NOTE: finasteride is a teratogen and should not be handled by pregnant women

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19
Q

tamsulosin, terazosin, or prazosin can alleviate the symptoms of BPH by inhibiting smooth muscle contraction on the prostate via what receptor?

A

alpha-1-antagonism

- can also be used for women w/ overflow incontinence (relaxes the bladder neck)

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20
Q

hematuria, proteinuria, hypertension, or evidence of renal impairment
- CT scan showing bilaterally enlarged kidneys with multiple cystic lesions as well as several small hepatic cysts

A

ADPKD

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21
Q

what are the tx options for mercury poisoning?

A

dimercaprol, penicillamine, unithiol, or succimer

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22
Q

what drug class is a common cause of acute tubular necrosis and acute renal failure due to the buildup of myoglobin in the kidneys?

A

statins

- affect ATP production by impairing the electron transport chain of mitochondria

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23
Q

what is the gold standard of measurement of GFR?

A

inulin

- more accurate than creatinine, although measuring creatinine is much easier (don’t need to inject tracer dye)

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24
Q

what vessel causes horseshoe kidney?

A

IMA

  • A horseshoe kidney occurs due to fusion of the inferior poles of the kidneys during fetal development
  • As the kidneys ascend from the pelvis, the horseshoe kidney becomes entrapped under the inferior mesenteric artery (IMA)
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25
Q

what type of stone?

  • high urine pH (8+)
  • recent URI w/urease producing organism (Proteus, Klebsiella)
A

Magnesium ammonium phosphate stones

- aka struvite stones

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26
Q

ratio of glomerular filtration rate (GFR) to renal plasma flow (RPF)

A

Filtration Fraction: FF = GFR/RPF

- proportion of the fluid reaching the kidneys

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27
Q

what preferentially constricts the EFFERENT arteriole?

A

Ang II

- stimulates aldosterone secretion by the adrenal cortex

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28
Q

efferent arteriole constriction will lead to an increase or decrease in GFR?

A

increase

NOTE: ANG II -> efferent constriction will decrease RPF (less blood flow), but increases GFR -> leading to an overall increase in FF

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29
Q

afferent arteriole constriction will lead to an increase or decrease in GFR?

A

decrease

- NSAIDs inhibit prostaglandins -> thus decreasing GFR

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30
Q

what dilates the afferent arteriole?

A

prostaglandins

- causes increase in FF and GFR

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31
Q

BPH, or constriction of the ureter will have what change on FF, GFR, RPF?

A

decreases GFR -> decreases FF

- no change in RPF (no change in blood reaching glomerulus)

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32
Q

what is the imaging study of choice for nephrolithiasis?

A

CT

- US will not pick up small stones

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33
Q

what should a psoas sign make you think of? (lower back pain radiating to groin)?

A

nephrolitiasis

- as the ureter passes just over the psoas muscle

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34
Q

why is PCR or ELISA typically used to confirm the diagnosis of C. trachomatis?

A

chlamydia is difficult to culture (gram-indeterminate)

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35
Q

what is the form of Chlamydia trachomatis that infects cells?

A

elementary body

- inclusion bodies replicate once inside cells

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36
Q

genetic disorder with renal, auditory, and ocular manifestations due to type 4 collagen defects

A

Alport syndrome (x-linked)

  • hemturia
  • sensorineural hearing loss
  • anterior lenticonus (conical protrusion d/t lens thinning)
  • other type 4 collagen defects (splitting of GBM)
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37
Q

children, 2 weeks after pharyngitis or skin infection

  • Dark urine (tea/cola-colored)
  • HTN
  • periorbital edema
  • ↑ anti-DNase B/ASO titers
  • ↓ C3 complement
  • subepithelial humps (lumpy bumpy!)
A

PSGN

subepithelial humps = irregular, finely granular pattern with small deposits on the GBM overlying the mesangium

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38
Q

IgA deposits lodge in the mesangium of the renal corpuscle
- occurs concurrently with an upper respiratory or gastrointestinal infection, with normal compliment levels (unlike PSGN)

A

Bergers disease (IgA nephropathy)

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39
Q

MCC of nephrotic syndrome in AA’s

  • in children, it is most often idiopathic
  • in adults, heroin use and HIV infection are common associations
A

Focal segmental glomerulosclerosis (FSGS)

- segmental areas of mesangial collapse with sclerosis in some glomeruli

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40
Q

rapid loss of renal function over days to weeks

  • bx shows glomerular “crescent” formation
  • if left untreated, progresses into acute renal failure and death within months
A

RPGN

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41
Q
  • significant proteinuria (> 3.5 g/day)
  • edema
  • hypoalbuminemia
  • hyperlipidemia
A

nephrOtic

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42
Q
  • hematuria with dysmorphic red blood cells and red blood cell casts
  • edema (due to salt retention)
  • proteinuria (< 3.5 g/day)
  • HTN
A

nephritic

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43
Q

where does aldosterone exert its effects?

A

distal tubules and collecting ducts

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44
Q

what effect does ANP have on the kidneys?

A

tells the renal tubule to decrease sodium absorption

- triggered in response to high Na (HTN)

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45
Q

what effect do kidney stones have on GFR?

A

decreases GFR

  • fluid buildup increases the hydrostatic pressure within the kidney tubules and Bowman’s space
  • an increase in the hydrostatic pressure of Bowman’s space leads to a decrease in net ultrafiltration pressure -> decreasing GFR
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46
Q

what is the most common renal malignancy in children?

A 
Wilms tumor (nephroblastoma)
- epithelial, blastemal, and stromal cells = mesoderm (NOT neural crest)
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47
Q

Wilms tumor in association with:

  • organomegaly
  • macroglossia (large tongue)
  • neonatal hypoglycemia (d/t excess insulin production)
A

Beckwith-Wiedemann syndrome

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48
Q

lack of ADH?

A

can’t concentrate urine (stays dilute)

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49
Q

what is the drug of choice for a UTI during pregnancy?

A

macrolides: amoxicillin, erythromycin, azithromycin

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50
Q

what is the anterior Chapman point for the prostate?

A

POSTERIOR edge of the proximal IT band near the TFL muscle

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51
Q

bladder contractions are weak or nonexistent, causing incomplete voiding, urinary retention, and over-distension of the bladder

A

overflow incontinence

- bladder fullness, incomplete voiding

52
Q

typically caused by surgical procedures that result in urethral stenosis or obstruction, or excessive urethral scarring either from surgeries or recurrent UTIs

A

outflow obstruction

53
Q

increase in the intra-abdominal pressure, either from laughing, sneezing, or exercise

A

stress incontinence

54
Q

what med counteracts acetylcholine, acting on the bladder and making the wall muscles contract?

A

oxybutinin

55
Q

hyperactive detrusor muscle that causes incontinence regardless of bladder urine volume

A

urge incontinence

56
Q

autoimmune vasculitis with:

  • recurrent oral aphthous ulcers
  • genital ulcers
  • uveitis
  • panniculitis/erythema nodosum (skin infection)
A

Behçet syndrome

57
Q

crescents of fibrin and plasma proteins on LM?

A

rapidly progressive (crescentic) glomerulonephritis

58
Q

Diffuse capillaries and GBM thickening on LM?

  • present with edema, nonspecific complaints of anorexia, malaise, and fatigue
  • strong granular capillary wall staining for IgG, complement component 3, and kappa and lambda light chains
A

membranous glomerulonephritis

59
Q
  • enlarged hypercellular glomeruli
  • starry sky appearance
  • subepithelial immune complex “humps”
A

PSGN

60
Q

metronidazole causes disulfram rxn

A

:)

61
Q

chronic renal disease leads to a decrease in what?

- ultimately leading to hypocalcemia

A

1,25-dihydroxy vitamin D

62
Q

edema, hyperkalemia, metabolic acidosis, hyperphosphatemia, hypocalcemia, renal osteodystrophy, hypertension, pruritis

A

chronic renal failure

- due to decrease in GFR

63
Q

chronic renal failure results in alkalosis or acidosis?

A

high anion gap metabolic ACIDOSIS

- due to loss of renal mass, which decreases NH4+ excretion, and the kidney’s inability to excrete H+

64
Q

palpable purpura on the buttocks and lower extremities of a young child

  • subcutaneous non-pitting edema
  • IgA immune complexes on small vessel walls (type 3 HSRxn)
A

Henoch-Schonlein Purpura (small vessel dz)

65
Q

elderly (50+) w/fever, fatigue, temporal headache, and high erythrocyte sedimentation rate
- granulomas and giant cells will be seen within the large vessel walls

A

giant cell arteritis (large vessel dz)

66
Q

immune destruction of medium-sized blood vessels

  • vasculitis generally occurs secondary to either hepatitis B, hepatitis C, or hairy cell leukemia
  • The tetrad for diagnosis is fever, hypertension, abdominal pain with melena, and renal disease
A 
polyarteritis nodosa (PAN)
- Kussmaul disease
67
Q

positive p-ANCA?

A
  • hypersensitivity arteritis
  • microscopic polyarteritis
  • Churg-Strauss
68
Q
  1. ENT complaints (sinusitis, rhinitis, otitis media, rhinorrhea, oral and nasal ulcers, hearing loss)
  2. pulmonary complaints (wheeze/cough/hemoptysis)
  3. renal involvement (glomerulonephritis; crescents of fibrin, epithelial cells, and white blood cells in the glomeruli)
    - positive c-ANCA
    - segmental crescentic necrotizing glomerulonephritis with little or no immunoglobulin or complement deposition (pauci-immune)
A

GPA (WeCeners)

- need immunosuppressive tx

69
Q

what is ketorolac?

A

NSAID that inhibits prostaglandin synthesis

- will cause a decrease in RPF and a subsequent decrease in GFR

70
Q

what xsome deletion for Wilms tumor?

A

deletion of the WT1 gene on chromosome 11

71
Q

papular eruptions that appear pearly, filiform, fungating, cauliflower, or plaquelike
- can be quite smooth, verrucous, or lobulated

A

condyloma acuminata

- HPV 6, 11

72
Q

Coffin lid shaped stones; seen in the setting of infection with a urease-producing bacteria

A

struvite stones

73
Q

Hexagonal shaped stones; found in acidic urine

A

cysteine stones “six”-teine

74
Q

Rhomboid shaped stones; seen in the setting of hyperuricemia

- precipitate out in acidic urine (pH < 5.5)

A

uric acid stones

75
Q

Envelope/dumbbell shaped stones

- seen in hypercalciuria

A

calcium oxalate

76
Q

wedge shaped

- seen in hypercalciuria

A

calcium phosphate

77
Q

what type of HsRxn is PSGN?

A

type 3

- high concentrations of M protein (targeting s. pyogenes) and antibody form immune complexes that affect the kidney

78
Q

cholinergic agonist that can increase detrusor muscle tone

- used to treat overflow incontinence of neurogenic cause (diabetic neuropathy)

A

Bethanechol

79
Q

when do you see kimmelstiel-wilson lesions?

A

glomerular sclerosis seen in membranous nephropathy secondary to diabetes mellitus

80
Q

what causes edema in nephrotic syndrome?

A

Decreased plasma proteins leads to decreased oncotic pressure
- less force for pulling fluids back into the capillaries

81
Q

what is the MOA of thiazide diuretics?

A

they inhibit NaCl cotransporters in the distal convoluted tubule

  • prevent hypercalciuria by decreasing calcium excretion
  • good for people with recurrent calcium kidney stones! (less calcium in urine)
82
Q

what is the MOA of spironolactone?

A

inhibits aldosterone in the collecting duct

  • leads to hyponatremia and hyperkalemia (K-sparing)
  • good for pts with heart failure or ascites
83
Q

what is the MOA of furosemide?

A

blocks the Na-K-2Cl transporter in the descending loop of henle

  • increased sodium, calcium, and magnesium excretion (bad for calcium stones)
  • can lead to hyponatremia, hypocalcemia, and hypomagnesemia
84
Q

what are carbonic anhydrase inhibitors used for?

A

altitude sickness, glaucoma, and idiopathic intracranial hypertension
- decreases formation of bicarbonate -> metabolic acidosis

85
Q

what causes mesangial expansion, glomerular basement membrane thickening, podocyte injury, and ultimately, glomerulosclerosis?

A

diabetic nephropathy

86
Q

what tests for high urine cysteine levels

A

cyanide nitroprusside test

- cystinuria causes hexagonal urine crystals

87
Q

where does ADH work?

A

collecting tubule

- binds V2 receptors on the principal cells in the distal convoluted tubule and collecting duct

88
Q

what stimulates 1-alpha-hydroxylase in the kidneys to increase 1,25 (OH)2 vitamin D production?

A

PTH

89
Q

what stimulates adenylate cyclase to increase cAMP in the renal tubules?

A

PTH

  • increases calcium reabsorption in the distal tubule
  • decreases phosphate reabsorption in the proximal tubule
90
Q

what is the tx for nocturnal enuresis?

A

desmopressin (ADH)

- to increase urine osmolarity

91
Q

what is the virulence factor for Gram-negative rod sepsis?

A

lipid A portion of LPS

92
Q

what is the virulence factor of cholera?

A

cAMP inducing exotoxin -> influx of Ca

93
Q

what type of RTA causes a defect in the proximal tubule resulting in impaired bicarbonate reabsorption?

A

type 2

94
Q

what type of RTA is caused by a defect in the distal tubule resulting in acidosis, generally hypercalciuria, autoimmune diseases in adults, or hereditary defects in children?

A

type 1

95
Q

what type of RTA is caused by an aldosterone problem which can be due to either decreased aldosterone secretion or aldosterone resistance
- pts generally have a minor metabolic acidosis in the setting of hyperkalemia

A

type 4

96
Q

how do you calculate renal clearance?

A

Renal Clearance = (Urine concentration of substance) X (Urine formation rate) / (Plasma concentration of substance)

97
Q

chronic schistosomiasis can lead to what type of cancer?

  • painless gross hematuria with vague lower abdominal/suprapubic pain
  • eosinophilia
A

squamous cell carcinoma

look out for travel to the Middle East and East Africa, especially with agricultural and/or fresh water interaction, smoking, aniline dyes, and petroleum byproducts

98
Q

what is DES exposure in utero linked to?

A

clear cell carcinoma of the vagina

99
Q

Urinalysis revealing epithelial cells and granular casts is pathognomonic for what?

A

acute tubular necrosis

100
Q

what do white blood cell casts suggest?

A

pyelonephritis

  • white = neutrophils (infection)
  • casts = formed in renal tubules (infection in kidney)
101
Q

ANP and BNP cause what?

A

an increase in glomerular filtration rate and an increase in sodium filtration/excretion
- released in response to stretch -> goal is to lower BP

102
Q

what are the water permeable sections of the nephron?

A
  1. proximal convoluted tubule
  2. thin descending limb of the loop of Henle
  3. collecting duct
103
Q

radiolucent stone, rhomboid shaped?

A

uric acid

104
Q

radiopaque stones, envelope shaped?

A

calcium oxalate

105
Q

why are patients with diabetes, especially those with DKA, at a greatly increased risk for mucormycosis infection?

A

those organisms have an enzyme, ketone reductase, which favors their growth in the high glucose, acidic environment created in the DKA state

106
Q

tamsulosin?

A

alpha-1 antagonist that will inhibit smooth muscle contraction of the prostatic urethra

107
Q

oxybutinin?

A

antispasmodic, antimuscarinic medication that affects smooth muscle
- increases bladder capacity, decreases uninhibited contractions, and delays the desire to void

108
Q

hemangioblastomas of the central nervous system and the retina, usually presenting in early adults

  • hematuria, visual deficits or visceral symptoms
  • bilateral renal cell carcinoma in 50% of patients
  • can also have tumors in pancreas and adrenals
A

von Hippel-Lindau (AD)

H: hemangioblastoma
I: increased risk of renal cell cancer
P: pheochromocytoma
P: pancreatic lesions (cyst, cystadenoma, cystadenocarcinoma)
E: eye dysfunction (retinal hemangioblastoma), endolymphatic sac tumors
L: liver, renal and pancreatic cysts

109
Q
  • cutaneous lesions (“cafe-au-lait” spots, inguinal/axillary freckles)
  • benign and malignant CNS neoplasms (neurofibromas and gliomas)
  • eye lesions (iris hamartomas)
A

neurofibromatosis

110
Q

where is the macula densa located?

A

in the early distal convoluted tubule

  • macula densa is part of the JG aparatus
  • where renin is released
  • is where ARBs (-sartans) and ACEI’s (-prils) exert effects
111
Q

hypercalcemia from metastatic cancer, what should you give to manage fluid levels? (other than biphosphonates and calcitonin)

A

loop diuretics (loops loose calcium)

  • cause an increase in Ca and Mg excretion
  • adverse effects: ototoxicity (vertigo, nausea, and hearing loss), hypokalemia, photosensitivity, hypersensitivity
112
Q

what diuretic re-acidifies the blood and alkalinizes the urine?

A

carbonic anhydrase inhibitors (acetazolamide)

113
Q

what would paCO2 be of someone hyperventilating?

A

less than 40

- breathing harder = more CO2 expelled = less in blood

114
Q

what does an aspirin overdose cause?

A

metabolic acidosis via uncoupling of the electron transport chain and converting to anaerobic metabolism

115
Q

rhabdomyolysis would cause what type of acid/base disturbance?

A

metabolic acidosis

  • toxic myoglobin breakdown products injure the kidneys
  • kidneys would not be able to produce or retain adequate stores of bicarbonate to offset the accumulation of anaerobic metabolism byproducts, leading to an acidotic state
116
Q

angiomylipomas, renal cysts

  • seizures, intellectual disability
  • subependymal astrocytoma
  • ash leaf spots (hypopigmented macules)
  • ungual fibromas
A 
tuberous sclerosis (AD)
- CNS most commonly affected, then kidneys and skin
117
Q

hydronephrosis on fetal US?

A

posterior urethral valves

118
Q

what does Wilms tumor WAGR stand for?

A
  • Wilms tumor
  • Aniridia
  • GU abnormalities
  • mental Retardation
119
Q

what effect do burns have on plasma proteins?

A

proteins leaks into the tissue, decreasing the oncotic pressure within the glomerular capillaries resulting in an increase in glomerular filtration rate

120
Q

what organism causes punctate hemorrhages of the cervix and vagina?

A

trichonomas (strawberry cervix!)

121
Q

nephrotic syndrome and anti–double-stranded DNA

- biopsy demonstrating diffuse capillary thickening and mesangial hypercellularity

A

diffuse proliferative glomerulonephritis

122
Q

Anechoic renal parenchymal lesions?

A

cysts!

- a stone would be distinctly seen as a hyperechogenic foci with posterior shadowing

123
Q

T. vaginalis only exists in what form?

A

trophozoite! no cyst form exists

124
Q

A high sodium diet predisposes to what type of stone?

A

calcium oxalate stones
- causes increased urinary excretion of calcium.

NOTE: decreased sodium intake DECRE`ASES stone formation

125
Q

what blood gas levels are expected n chronic kidney disease?

A

anion gap metabolic acidosis w/ respiratory compensation

126
Q

phospholipase A2 receptor antibodies are high specific for what nephrotic syndrome?

A

membranous nephropathy

COMLEX (14 decks)

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