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PANCE > GU/Nephrology 6% > Flashcards

GU/Nephrology 6% Flashcards

1
Q

Proximal convoluted tubules (resorb/secrete) ____

What medication work here?

A 
Resorb
All organic nutrients (glucose, AA)
Bicarb
Na, Cl
75-90% of H2O

Acetazolamide
Mannitol

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2
Q

Thin Descending Limb of Loop of Henle (resorbs/secretes) ___

A

Resorbs
H20 passively

Impermeable to Na and solutes

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3
Q

Thick Ascending Limb of Loop of Henle (resorbs/secretes) ___

What medication work here?

A

Resorbs
Actively Na+, K+, Cl-
Indirectly resorbs Mg+ and Ca+

Loop diuretics –> inhibit water, Na, K, Cl cotransport

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4
Q

Early distal convoluted tubule (resorbs/secretes) ____

Other functions?

What medication work here?

A

SECRETES
Organic acids, toxins, drugs
K+, H+

Dilutes urine by actively resorbing Na+ and Cl-

Thiazide diuretics –> impairs urinary dilution

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5
Q

____ determine final osmolarity of urine via ____

What medication work here?

A

Distal collecting tubules
Via Aldosterone, ADH

K-sparing diuretics: inhibit aldosterone mediated Na/H2O absorption –> hyperkalemia, metabolic acidosis

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6
Q

Nephrotic syndrome is characterized by ___ (4)

A

Proteinuria
Hypoalbuminemia
Hyperlipidemia
Edema

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7
Q

80% of nephrotic syndrome in children =

Microscopy findings:

Tx:

A

Minimal change disease

Loss of foot processes of podocytes
Loss of negative charge of glomerular basement membrane

Tx: Prednisone

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8
Q

Sclerosis(fibrosis) within glomerulus

Seen in ___

Tx:

A

Focal segmental glomerulosclerosis

Seen in HTN in blacks

Tx: steroids

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9
Q

Thickened glomerular basement membrane

Caused by:

A

Membranous Nephropathy

Caused by SLE, viral hepatitis, malaria, drugs (Pencillamine)
D/t immune complex deposition

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10
Q

MC cause of nephrotic syndrome in adults

A

Diabetes mellitus

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11
Q

Gold standard of dx of nephrotic syndrome

Urinalysis shows:

A

24 hrs urine protein collection > 3.5 g/d

Oval fat bodies “maltese cross shaped”

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12
Q

Acute glomerulonephritis is characterized by (4)

A

HTN
Hematuria (RBC casts)
Dependent edema (proteinuria)
Azotemia (build up of nitrogen waste in blood)

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13
Q 
All of the following are causes of Acute glomerulonephritis EXCEPT:
A. IgA Nephropathy (Berger's dz)
B. Goodpasture's syndrome
C. Post infectious 
D. Membranousproliferative GN
E. Vasculitis
A

TRICK QUESTION. All are causes of AGN.

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14
Q

IgA Nephropathy (a.k.a. ____)

T/F: MC cause of AGN in children worldwide

When does it usually occur? Why?

Dx?

Tx?

A

Berger’s dz

False. MC cause of AGN in ADULTS worldwide

Young men within days after URI or GI infection d/t IgA overproduction

Dx: IgA depositis in mesangium w/ immunostaining

Tx: ACE-I + Corticosteroids

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15
Q

Post infectious AGN occurs MC after ____

Presentation:

Dx:

Tx:

A

Group A Beta-hemolytic Strep (can occur after any infection)

Skin/pharyngeal infection
2-14 y/o boys w/ puffy eyelids, facial edema, cola colored/dark urine

Dx: Increased antistreptolysin (ASO) titers
Low serum complement (C3)

Tx: supportive, abx

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16
Q

Rapidly progressive glomerulonephritis (RPGN) is (good/bad) prognosis

Bx findings?

Tx?

A

bad prognosis –> rapid progression to ESRD

Cresent formation d/t fibrin and plasma protein deposition

Tx: steroids + cyclophosphamide

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17
Q

+ Anti-GBM antibodies seen in ____

Results in ___

Often occurs ____

Dx:

Tx:

A

Goodpasture’s syndrome

Kidney failure and HEMOPTYSIS (d/t ab against type 4 collagen of GBM in kidney and lung alveoli)

Often occurs after URI

Dx: Linear IgG deposits

Tx: High dose steroid immunosuppression + Cyclophosphamide + plasmapharesis

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18
Q

Vasculitis AGN is characterized by ___

2 types:

A

lack of immune deposits, + ANCA ab

Microscopic polyangiitis = vasculitis of small renal vessels –> + P-ANCA
Granulomatosis w/ polyangiitis (Wegener’s) = necrotizing vasculitis –> + C-ANCA

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19
Q

Gold standard dx of AGN

A

renal bx

Urinalysis: RBC casts, high specific gravity > 1.020osm

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20
Q

WBC casts are pathognomonic for ___

Other clinical features?

A

acute tubulointerstitial nephritis (AIN)

EOSINOPHILIA
fever
maculopapular rash
arthralgia

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21
Q

4 causes of intrinsic AKI

MC type?

A

Acute Tubular Necrosis (ATN) = MC type of intrinsic AKI
Acute tubulointerstitial nephritis (AIN)
Glomerular (AGN)
Vascular

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22
Q

Medication that may cause Acute Tubular Necrosis

A

Aminoglycosides

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23
Q

Inflammatory or allergic response in interstitium, sparing glomeruli and blood vessels =

Commonly caused by ____

A

Acute tubulointerstitial nephritis (AIN)

PCN, NSAIDs, Sulfa drugs

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24
Q

All of the following are features of ATN EXCEPT:
A. Epithelial cell casts and muddy brown casts
B. High specific gravity
C. Hypokalemia
D. High phosphate

A

B, C
LOW specific gravity
HYPERkalemia

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25
Q

Narrow waxy casts seen in ___

Broad waxy casts seen in ___

A

Chronic ATN/Glomerlonephritis

End stage renal disease

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26
Q 
ATN or Prerenal?
Low specific gravity
Creatinine rapidly improves w/ IVF
BUN:Cr > 20:1
UNA > 40 , FeNa > 2% 
Cr increases at 0.3-0.5 mg/dL/day
A

Low specific gravity: ATN

Creatinine rapidly improves w/ IVF: Prerenal
Creatinine does NOT improve w/ IVF = ATN

BUN:Cr > 20:1 = Prerenal
BUN:Cr 10-15:1 = ATN

UNA > 40 , FeNa > 2% = ATN

Cr increases at 0.3-0.5 mg/dL/day = ATN
Cr increases slower than 0.3 mg/dL/day = prerenal

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27
Q

Causes of HYPERphosphatemia

Associated Ca, Phosphate and PTH levels of each?

A

Renal failure (MC) : dec. Ca, inc. phosphate, inc. PTH

Primary hypoparathyroidism: dec. Ca, inc. phosphate, dec. PTH

Vit D intoxication: inc. Ca, inc. phosphate, dec. PTH

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28
Q

Causes of HYPOphosphatemia

A 
Primary HYPERparathyroidism
Excessive IV glucose, Tx for DKA
Refeeding syndrome in ETOHics
Respiratory alkalosis
Vit D deficiency (dec Ca and dec phosphate)
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29
Q

Polycystic Kidney Dz = autosomal (dominant/recessive) d/o d/t mutation of ____ gene(s).

Characterized by ___

Extrarenal manifestations:

A

AD
PKD1, PKD2

formation and enlargement of kidney cysts in other organs (LIVER, spleen, pancreas)
Vasopressin stimulates cystogenesis –> ESRD

Cerebral “berry” aneurysms**
Mitral valve prolapse **

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30
Q

Chronic kidney disease staging

Normal GFR =

A 
0 = at risk; normal GFR and urine
1 = kidney damage w/ normal GFR (>90)
2 = GFR 89-60
3 = GFR 59-30
4 = GFR 29-15
5 = GRF < 15

Normal GFR = 120-130

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31
Q

Best predictor of disease progression in CKD

A

Proteinuria

32
Q

Hematologic complications of CKD

A

Anemia of chronic disease = normochromic, normocytic anemia
Inc. ferritin, dec. serum Fe, dec. TIBC

Tx: Oral FeSO4
Erythropoietin or Darbepoetin-alpha

33
Q

“salt and pepper” appearance of skull on x ray

Labs:

A

Osteitis Fibrosis Cystica d/t CKD

Increased osteoclast activity

Increased PO4, HYPOcalcemia (d/t decreased vit D production from kidney) –> Inc PTH –> 2ndary hyperparathyroidism

34
Q

SIADH causes (iso/hypo/hyper)volemic (hyper/hypo)tonic (hyper/hypo)natremia

Become clinically symptomatic w/ (increased/decreased) oral free H2O intake

(increase/decrease) serum osm
(increase/decrease) NA
(hyper/hypo)uricemia
(increase/decrease) BUN
(increase/decrease) urine osm
(increase/decrease) UNa
A

SIADH causes ISOvolemic HYPOtonic HYPOnatremia
–> increase free water retention + impaired water excretion

Become clinically symptomatic w/ INCREASED oral free H2O intake

DECREASED serum osm <280
DECREASED Na<135
HYPOuricemia
DECREASED BUN
INCREASED urine osm >300
INCREASED UNa > 20
35
Q

Central DI =
Nephrogenic DI =

Become clinically symptomatic w/ (increased/decreased) oral free H2O intake

What happens?

A

Central DI = ADH (Vasopressin) deficiency
Nephrogenic DI = ADH insensitivity

Become clinically symptomatic w/ DECREASED oral free H2O intake

Both end with production of LARGE amount of DILUTE urine

36
Q

Lithium causes (central/nephrogenic) DI

A

Nephrogenic DI

37
Q

Dx of Diabetes Insipidus

A

Fluid deprivation test: continued production of dilute urine

Desmopressin Stimulation test: differentiates nephrogenic vs central DI
Central: reduction of urine output, increase Uosm –> response to ADH
Nephrogenic: continued production of dilute urine

38
Q

Tx of
Central DI:
Nephrogenic DI:

A

Central DI: Desmopressin/DDAVP, Carbamazepine

Nephrogenic DI: Na/protein restriction –>HCTZ, indomethacin

39
Q

Alpha-1 activation causes afferent arteriole (dilation/constriction) which (increases/decreases) GFR. This causes (more/less) water to be excreted, thus H2O (conservation/depletion).

A

Alpha-1 activation causes afferent arteriole CONSTRICTION which DECREASES GFR. This causes LESS water to be excreted, thus H2O CONSERVATION.

40
Q

Water homeostasis is determined by ___. Stimuli include ___(2)

Na homeostasis is determined by ___. Stimuli include ___(2)

A

Water: ADH; hypovolemia, hyperosmolarity*

Na: Aldosterone; hypovolemia, hyperkalemia

41
Q

Tx of:
Isovolemic hypotonic hyponatremia
Hypervolemic hypotonic hyponatremia
Hypovolemic hypotonic hyponatremia

Hypertonic hyponatremia
Severe Iso/hypervolemic hyponatremia

A

Isovolemic hypotonic hyponatremia: H2O restriction
Hypervolemic hypotonic hyponatremia: H20 + Na restriction
Hypovolemic hypotonic hyponatremia: Normal saline

Hypertonic hyponatremia: Normal saline until hemodynamically stable –> 1/2 normal saline
Severe Iso/hypervolemic hyponatremia: Hypertonic saline w/ Furosemide

42
Q

Hypomagnesemia causes (increased/decreased) DTR, (hypo/hyper)calcemia

A

HYPOmagnesemia causes INCREASED DTR, HYPOcalcemia –> Trousseau’s, Chvostek’s sign

43
Q

Tx of hypermagnesemia

A

Mild-moderate: IV fluids, Furosemide

Severe: calcium gluconate –> antagnoizes toxic effects of magnesium, stabilizes cardiac membrane

44
Q

PPI, amphotericin B, cisplatin, cyclosporine, aminoglycosides can cause ____

A

HYPOmagnesemia

45
Q

Metabolic acidosis may cause (hypo/hyper)kalemia

A

HYPERkalemia

Metabolic alkalosis causes HYPOkalemia

46
Q

Tx of hyperkalemia

A

IV calcium gluconate
Insulin w/ glucose: shift K+ intracellularly
Beta2 agonists (4-8x dose for asthma)
Kayexalate: enhances GI potassium excretion

47
Q

MC cause of epididymitis/orchitis in children and men >35

Tx:

A

Enteric organisms: E. coli, Klebsiella

Fluoroquinolones
Cephalexin, amoxicillin in children

48
Q

Acute orchitis MC caused by

A

Mumps**

49
Q

Dx of testicular torsion
Best initial:
Gold standard:

A

Best initial: Testicular doppler US

Gold standard: Radionuclide scan

50
Q

Sudden onset of left-sided varicocele in older men may possibly suggest ____

Right sided varicocele in children <10 y/o may possibly suggest ___

A

Renal cell carcinoma

Retroperitoneal malignancy

51
Q

Orchiopexy recommended for cryptorchidism in ____

A

6 month old, before 1 year old

52
Q

MC type of testicular cancer

A

Seminoma (germinal cell tumors)

53
Q

T/F: Seminomas are radiosensitive and show elevated alpha-fetoprotein and beta-HCG

A

False: seminomas are radiosensitive BUT lack tumor markers

“Seminomas are Simple & Sensitive”

Nonseminomatous Germ Cell Tumors are RADIORESISTENT and have ELEVATED alpha-fetoprotein and beta-HCG

54
Q

Tx of complicated cystitis in pregnancy

A

Amoxicillin, nitrofurantoin x 7-14 days

55
Q

T/F: Phimosis is a urologic emergency

A

False. Paraphimosis is a urologic emergency

56
Q

Tx of acute prostatitis

A

Fluoroquinolones, Bactrim
Ampicillin w/ gentamicin
x 1 month

57
Q

Tx for BPH that has positive effect on clinical course of BPH

A

5-alpha reductase inhibitors (Finasteride)

Vs. alpha-1 blockers (Tamsulosin) provides rapid sx relief but NO effect on BPH clinical course

58
Q

90% of bladder cancers are ___

A

transitional cell

59
Q

MC abdominal malignancy in children

A

Wilm’s tumor (Nephroblastoma)

MC in children w/i 1st 5 years of life

60
Q

Dx of Renovascular HTN

A

Renogram (best noninvasive)
Captopril test: increase plasma renin activity 1 hr p administration

Renal angiography = gold standard

61
Q

Tx of Renovascular HTN

A

Sx: angioplasty w/ stent = definitive

ACE-I/ARB
BUT CI in pts w/ bilateral stenosis or solitary kidney b/c ACEI markedly reduces renal blood flow + GFR

62
Q

Tx of priapism

A 
Terbutaline* = beta-adrenergic agonist
Phenylephrine = selective α1-adrenergic receptor
63
Q

Infant that develops urethritis, neonatal pneumonia and neonatal conjunctivitis 2-5 days after birth, think ___ pathogen.

5-7 days after birth, think ___

A

2-5 days: Gonococcal

5-7 days: Chlamydia

64
Q

Tx of
Stress incontinence:

Urge incontinence:

Overflow incontinence:

A

Stress incontinence: Alpha agonists (Midodrine, Pseudoephedrine) –> increase urethral sphincter tone/urethral urine flow resistance

Urge incontinence:

  • -Antichoinergic (Oxybutynin, Tolterodine, Propantheline) –> block cholinergic receptors in bladder –> decrease involuntary contraction strength (overactive detrusor mm)
  • -TCAs: central and peripheral anticholinergic effect + alpha adrenergic agonist
  • -Mirabegron (beta-3 agonist) –> bladder relaxant

Overflow incontinence: Cholinergics (Bethanacol) –> increase detrusor mm activity

65
Q

Bence Jones protein in urine is seen in ____.

A

Multiple Myeloma

66
Q

Glucose is excreted into urine when blood glucose exceeds ____

A

180-200 mg/dL

67
Q

Unilateral small kidney on US describes ___

A

renal artery stenosis

68
Q

Bactrim can cause (hyper/hypo)kalemia, (increase/decrease) serum creatinine, cause ___ kidney injury, thus a poor choice in CKD 4 patients.

A

HYPERkalemia
DECREASED Cr
Acute interstitial nephritis (AIN)

69
Q 
Phototherapy treats \_\_\_\_ by \_\_\_\_\_. 
SE include (4)
A

Physiologic jaundice in newborns
converts bilirubin to lumirubin

SE: fever, rash, diarrhea, dehydration

70
Q

Type of kidney stone that is radiolucent

A

Uric acid

71
Q

Best dx of diverticulosis

A

Barium edema

MORE specific than colonoscopy

72
Q

Nitrites on UA indicates presence of ___

A

Enterobacteriaceae: E. coli, Klebsiella, Proteus, Serratia, Salmonella

73
Q

Tx of enterobiasis (a.k.a ___)

A

Pinworms

Mebendazole, albendazole

74
Q

Uncomplicated pyelonephritis tx

A

fluoroquinolone

Cipro x 14 days

75
Q

Chronic renal disease is characterized by (hyper/hypo)kalemia, (hyper/hypo)calcemia, (hyper/hypo)phosphatemia, metabolic (acidosis/alkalosis).

A

HYPERkalemia
HYPOcalcemia
HYPERphosphatemia
Metabolic ACIDOSIS

PANCE (20 decks)

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