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Clin Med Comprehensive > GU Gen > Flashcards

GU Gen Flashcards

1
Q

What molecules are freely filtered at glomerulus?

A

small and positively charged

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2
Q

What molecules are NOT freely filtered at glomerulus?

A

large-protein

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3
Q

What is glomerular filtration rate

A

the volume of plasma that moves through the nephron

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4
Q

What is normal GFR?

A

100-140 ml/min

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5
Q

how to we measure or estimate GFR?

A

creatine or inulin (because they’re freely filtered and neither absorbed or secreted

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6
Q

What happens with neuronal regulation when theres an extreme DROP in BP?

A

baroreceptors activate sympathetic system, renin released, vasoconstriction, aldosterone release, conserve volume

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7
Q

What happens with neuronal regulation when theres an extreme RISE in BP?

A

stretching of atria causes ANP to release and dilation of afferent and vasoconstriction of efferent to increase GFR

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8
Q

What does a lower than normal GFR indicate?

A

loss of nephron function

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9
Q

What is normal plasma flow per minute?

A

650 mL

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10
Q

What does aldosterone do to K and Na?

A

K loss and Na resorption

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11
Q

What is the likelihood of AA to develop ESRD compared to whites?

A

AA 3.5 x more likely than whites (latinos 1.5 x more)

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12
Q

What imaging study should you use for nephrolithiasis and nephrocalcinosis?

A

plain radiography KUB

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13
Q

What imaging study should you use for determining kidney shape, size, detecting urinary obstruction, radiolucent stones, cysts, PCKD, and renal mass eval?

A

ultrasound

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14
Q

What imaging study should you use for determining kidney size, shape, calyceal anatomy, diagnosis of medullary sponge kidney and papillary necrosis, detection of site and cause of obstruction?

A

IV pyelography

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15
Q

What imaging study should you use for detection of urinary obstruction and urine leak, screening for RAS, assessing renal arterial flow?

A

radionuclide studies

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16
Q

What imaging study should you use for detection of RAS, assessing for vasculitis, distinguishing vascular versus solid masses?

A

renal arteriography

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17
Q

What imaging study should you use for detection of vesicoureteral reflex?

A

voiding cystourethrography

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18
Q

What imaging study should you use for determining size of obstruction, placement of urethral stent?

A

retrograde or antegrade pyelography

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19
Q

What imaging study should you use for detection of renal mass, or renal vein thrombosis?

A

MRI

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20
Q

How much H+ is produced daily?

A

50-100 mEq/day

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21
Q

How is H+ secreted into tubular lumen?

A

combines with NH3 to become NH4 or HPO4 to become H2PO4-

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22
Q

How do kidneys normally respond to increased acid load?

A

increasing NH$+ excretion

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23
Q

Where is HCO3- lost from the body?

A

colon (diarrhea) and urethra (tubular dysfunction)

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24
Q

What are complications of renal bx?

A

hematuria, perinephritic hematoma, infection, mortality

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25
Q

What are host defenses against UTI?

A

bladder washout, low pH urine, high osmolality, TLR11, Tramm-Horsfall protein (binds to E.coli and prevents epithelial cell attachment)

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26
Q

What is order of pathogenesis of a UTI?

A

rectal flora→perineal colonization→vaginal colonization→urethra→bladder→kidney

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27
Q

What type of Abx increase introital colonization?

A

β lactams

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28
Q

What are complications of UTI?

A

bacteremia/sepsis, perinephric abscess, emphysematous pylonephritis, xanthogranulomatous pyelonephritis, papillary necrosis, chronic pyelonephritis

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29
Q

What can you to to prevent UTI?

A

adequate fluids, avoid holding urine, proper hygiene, avoid catheters when possible

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30
Q

What is gross hematuria?

A

you can see it

reddish-brown with RBC

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31
Q

What is microscopic hematuria?

A

can’t see without microscope
>3 RBC in 2-3 specimens
check for RBC casts, dysmorphic casts and proteinuria

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32
Q

What are features of non-glomerular hematuria?

A 
Scant RBC (if any) but not dysmorphic
White cell and other casts
Pink to red color
Blood clots
Brown muddy casts
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33
Q

What are features of glomerular hematuria?

A 
Red cells
Dysmorphic (acanthocytes)
Red cell cast
Red to brown color
No blood clots
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34
Q

Why do you have to confirm with microanalysis for hematuria?

A

UA is sensitive but not specific (can pick up myoglobin and hemoglobin)

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35
Q

What are RF for bladder cancer?

A

smoking, hx ross hematuria, >40y, voiding sx, cyclophosphamide

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36
Q

What is MC cause of hematuria in a 0-20 yo pt?

A

glomerulonephritis, UTI, congenital

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37
Q

What is MC cause of hematuria in a 20-40 y?

A

UTI (F>M), calculi, bladder and renal cancer

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38
Q

What is MC cause of hematuria in a 40-60 yo?

A

UTI (F>M), bladder and renal cancer, calculi

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39
Q

What is MC cause of hematuria in a >60 yo male?

A

BPH, bladder and renal cancer, UTI

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40
Q

What is MC cause of hematuria in a >60 yo female?

A

UTI, bladder and renal cancer

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41
Q

What is the order of compensation for metabolic acidosis?

A
  1. extracellular buffering by HCO3- (immediate)
  2. respiratory buffering by lowering PCO2 (minutes to hrs)
  3. Intracell and bone buffering (2-4 hrs)
  4. Inc renal acid excretion (hrs to days)
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42
Q

What are causes of anion gap metabolic acidosis?

A 
Citrate
Uremia
Toluene
Ethanol
Diebetic Ketoacidosis
Iron
MEthanol
Paraldehyde
Lactate
Ethylene glycol
Salicylate
43
Q

What are the NON-ingestion causes of high AG acidosis?

A

uremia, ketoacidosis, lactic acidosis

44
Q

Where is Na largely confined to?

A

ECF because it cant cross cell membranes readily

45
Q

What is effective vascular volume?

A

part of the ECF which is in the vascular space and perfusing tissues (closely related to blood pressure)

46
Q

what are signs of volume expansion?

A

Edema
Pulmonary crackles Ascites
Jugular venous distention Hepatojugular reflux Hypertension

47
Q

What are signs of volume depletion?

A

Orthostatic decrease in blood pressure and increase in pulse rate
Decreased pulse volume Decreased venous pressure Loss of axillary sweating Decreased skin turgor
Dry mucous membranes

48
Q

What is the response of SNS and RAAS to volume depletion

A

↑ SNS cauing vasoconstriction, ↑ HR and contractility and ↑ Na reabsorption
↑ ANG II causing ↑ aldosterone secretion and ↑ Na reabsorption

49
Q

what stimulates the release of ANP and BNP?

A

stretch in cardiac atria (ANP) or ventricles (BNP)

50
Q

What is the effect of ANP and BNP?

A

↑ tubular delivery of Na/H20 in kidney
inhibit tubular Na/H20 reabsorption
Antagonist of ATII and SNS
Dec cardiac preload

51
Q

What can hypoalbuminemia cause?

A

Maldistribution of ECF from vascular to interstitial space
Decreased effective arterial volume
Secondary renal sodium retention (edema due to Na retention)

52
Q

How does the kidney regulate total body Na levels?

A

aldosterone which causes Na retention

53
Q

When is aldosterone released?

A

in reponse to hypovolemia and hyperkalemia

54
Q

What determined water homeostasis?

A

ADH

55
Q

What stimulated ADH?

A

hypovolemia or hyperosmolarity

56
Q

What is abnormal serum Na concentration primarily due to?

A

problems with water control

57
Q

What is abnormal ECFV due to?

A

problems with total body Na control

58
Q

What substances increase osmolality without changing the serum sodium concentration?

A

Urea, ethanol, ethylene glycol, isopropyl alcohol, methanol

59
Q

What substances increas osmolality and decrease serum sodium concentration?

A

glucose, mannitol, glycine, maltose

60
Q

How long does dilation take from onset of obstructive uropathy to develop?

A

3 days

61
Q

What happens to urine volume in unilateral obstruction?

A

does not diminish unless only functioning kidney

62
Q

When will absolute anuria occur?

A

with complete obstruction if its at the level of the bladder or urethra

63
Q

What is a solid lesion of the kidney until proven otherwise?

A

RCC

64
Q

If a spinous process appears closer to the R clavicle which was is the patient rotated?

A

toward their own left side

65
Q

What is total obligatory water intake?

A

1600 ml

  • 500 ingester
  • 800 in food
  • 300 from oxidation
66
Q

How much water does an febrile, immobile, and not eating/drinking patient require?

A

1 L daily

67
Q

What is NS composed of?

A

Osmolality: 285-308
Na: 154 mEq and Cl 154 mEq

68
Q

What is 1/s NS composed of?

A

Na: 77 mEq

69
Q

What is LR composed of?

A 
crystalloid solution
Osmolality: 250-273 - isotonic
Na: 130 mEq
Cl: 109 mEq
Lactate 28 mEq (Converts to bicarb in patient)
K: 4 mEq (can lead to hyperkalemia)
Ca: 3 mEq
70
Q

What is 1/4 NS composed of?

A

D5W

Na 38 mEq

71
Q

What is Bicarb drip composed of?

A

NaHCO3 (with 50 mEq Na) and D5W

72
Q

What is recommendation for hospitalized adult who is afebrile and not eating?

A

D5 1/s NS plus KCL 20 mEq added at 2 L/day

73
Q

What happens to K+ when acidosis is present?

A

pulls K+ into cells

74
Q

What happens to K+ when alkalosis is present?

A

pushes K+ out

75
Q

What happens to the AP when there is too much K+?

A

lowers the threshold so cells can be excited easily but they respond slowly

76
Q

What is effect of hypomagnesemia on hypokalemia?

A

causes urinary K+, and increased open ROMK channels

77
Q

What is the impact of insulin on serum potassium?

A

K+ moves into cells

78
Q

What is the impact of increasing pH on serum potassium?

A

K+ moves into cells

79
Q

What is the impact of Beta blocker on serum potassium?

A

K+ moves out of cells

80
Q

What is the impact of hyperaldosteronism on serum potassium?

A

Increased K+ excretion

81
Q

What is the impact of furosemide on serum potassium?

A

Increased K+ excretion

82
Q

What is urothelial tumor stage T1?

A

lamina propria invasion

83
Q

What is urothelial tumor stage T2?

A

Muscularis propria invasion

84
Q

What is urothelial tumor stage T3?

A

Extravesical fat invasion

85
Q

What is urothelial tumor stage T4?

A

Invasion into adjacent structures/organs

86
Q

What percentag of newly diagnosed RCC have metastasis?

A

25%

Lung>bones>lymph nodes>liver>adrenal>brain

87
Q

What is Von Hipple Lindau Syndrome?

A

loss of VHL tumor suppressor gene on chromosome 3p

40% of VHL pts develop RCC

88
Q

What is gross presentation of clear cell RCC?

A

Circumscribed mass with sharp margins
Bright yellow-orange (Due to lipid & glycogen content in cytoplasm)
Large areas of gray/white necrosis
Hemorrhage is common

89
Q

What does RIFLE stand for?

A

risk, injury, failure, loss & ESRD to diagnosis AKI

90
Q

Define oliguria

A

<400 ml urine output in 24 hrs

91
Q

define anuria

A

<100 ml urine output in 24 hrs

92
Q

define azotemia

A

accumulation of nitrogen wastes

93
Q

What can cause elevated BUN not caused by kidney?

A

steroids, tetracyclines, catabolic state, GI bleed

94
Q

When do sx of CKD present?

A

when GFR <30 ml/min

95
Q

What are sx of uremia?

A 
Fatigue
AMS
Anorexia
Nausea
Sleep Disturbance
96
Q

What is the preferred access type for dialysis>

A

AV fistula

97
Q

what is SCUF

A

Slow continuous UF over a longer interval

98
Q

What is SLED?

A

Sustained low efficiency dialysis

99
Q

What is EDD?

A

Extended daily dialysis

100
Q

What are complications of HD dialysis?

A 
Hypotension
Muscle cramps
Nausea &amp; vomiting
Headache
Chest &amp; back pain
Itching
sepsis
hemorrhage
thrombosis
heart failure
depression
101
Q

What are complications of PD?

A

peritonitis or exit site infection

102
Q

When is a pt eligible for kidney transplant?

A

GFR <15

103
Q

What is the number one cause of renoallograft failure?

A

CVD

Clin Med Comprehensive (9 decks)

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