Mod3

Question 1

Secondary causes of HTN

Answer 1

Sleep apnea 
Sns drugs
CKD increases RAAS
Primary aldosteronism
Plaques 
Cushing
Pheo 
Thyroid / pth 
Coarctation

Question 2

Normotensive value

Answer 2

Less than 120

Question 3

Pre HTN value

Answer 3

120-139

Question 4

Stage 1 HTN

Answer 4

140-159

Question 5

Stage 2 htn

Answer 5

160+

Question 6

Other stuff to reduce htn

Answer 6

Reduce Na intake and increase k (DASH diet)
Limit alc
For CV get Ca and Mg
Reduce sat fat and cholesterol

Question 7

What drugs do you give for stage 1 HTN

Answer 7

Without other issue

Give thiazides and maybe ACI ARB CC BB combo tx

Question 8

Drugs given for stage 2 htn

Answer 8

2 drug combo first

Thiazide and other (see prev)

Question 9

Drugs for HTN with comorbid conditions?
Thiazides 
CKD
Post MI
HF

Answer 9

Give thiazides in all but post MI or 
CKD 
CKD give ACEI/ ARB
Post MI BB ACEI or Aldo ant 
HF is all but CCB

Question 10

Resistant HTN and causes

Answer 10

Uncontrolled BP despite 3 drug tx including diuretic
Could be from improper bp measurement, excess sodium intake, inadequate diuretic tx (may need loop instead of thiazide), med interaction (eg NSAIDS or herbal supplements), excess alc, diseases etc
Or could have secondary HTN due to sleep apnea etc

Question 11

Clinical features of primary hyperaldo
Na 
K
H
Bp
Renin 
ARR

Answer 11

Aldo incr
So Na incr and k decr and h decr so alkalosis
Bp incr
Renin indep increase in aldo so low or normal renin
Aldo Renin Ratio should be > 30 to be primary hyperaldo

Question 12

Active form of vitamin D?

Answer 12

1,25 aka calcitriol

Question 13

What is CaSR and what does Ca do to it/ result?

Answer 13

So calcium stimulates CaSR to decrease PTH thus decreasing Ca keeping calcium in check (vitamin D can do this too!)

Question 14

CASR

Answer 14

When stimulated by calcium CASR lowers pth

Question 15

Pth effects on vitMin D and results

Answer 15

Increases vitamin d which increases ca in blood from bone resorption and DECREASES blood P.O.

Question 16

Forms of vitamin D

Answer 16

Calciferol obtained via diet or skin
Liver forms 25 or Calcidiol (measured in this form)
Converted to calcitriol in kidney via 1 a hydroxylase

Question 17

What does vitamin d do to ca P.O. and pth

Answer 17

Increases absorption of ca and P.O.

Reduces synth of pth

Question 18

Central factor in Ca and P.O. blood homeostasis?

Answer 18

PTH!

And PTH itself is regulated by ca they CaSR

Question 19

PTH effect on bone P.O. vs kidney P.O.

Answer 19

Opposite
PTH increases P.O. reabs in bone and decreases it in kidney
Increases in gut ( ca also incr in gut)
See img

Question 20

What does low P.O. do to vitamin d and results in gut and bone?

Answer 20

Low P.O. increases vitamin d in kidney conversion which increases P.O. release from bone and P.O. reabs from gut

Question 21

What does low calcium do to PT and results of ca and P.O. in bone kidney and gut?

Answer 21

low ca stimulates pth
which stimulates ca/P.O. reabs from bone and increases eats but decr P.O. from kidney (and increased vitamin d from kidney which is What increases ca absorption in gut and increased P.O. abs in gut)

Question 22

What does P.O. do to pth

Answer 22

Stimulates pth release

Question 23

What happens to phosphate PTH vitamin d and ca in CKD

Answer 23

less renal function means less vitamin d which increases pth
Have to excrete higher filtered load fraction of P.O. but caps at 60% so hyperphosphatemia
This further elevates pth
Ca can increase then decrease

Question 24

Main drug for secondary HPT

Answer 24

cinacalcet

Decreases pth by acting on CaSR

Question 25

What else can you give to decrease P.O. in HPT

Answer 25

P.O. binders

Question 26

Citrate role in stones

Answer 26

Low citrate leads to stones

Question 27

Genetics of 
ADPKD
ARPKD
RCC
Prostatic adenocarcinoma

Answer 27

AD: PKD1 or PKD2
AR: PKDH1 6p arm
RCC: VHL tsg and 3p arm loss
Prostate cancer: 1q24-25

Question 28

Other itises and their cell types:
Allergic interstitial nephritis
Xanthogranulomatous polynephritis
Malakoplakia

Answer 28

Allergic- eosinophils (from drugs/antibios)
Xanth- sheets of foamy histiocytes (macros), (chronic, assoc with stones and UTIs, mimics RCC with yellow nodules)
Malako- MG michaelis gutnamm bodies (from UTIs gram neg)

Question 29

What does Translocation RCC involve and who is it with/clin pres?
Oncocytomas?

Answer 29

Translocation RCC is mut in TFE3 tf (fusion) on Xp11.2, in younger women, high stage/aggro

Question 30

Wilm’s cell phases?

Answer 30

Triphasic
stromal cells (bckd)
epith/tubular cells (circles)
and blastemal cells (prim)

Question 31

What K+ state can cause Torsades, and inhibits renin release?

Answer 31

HYPO!

Question 32

How does digoxin cause hyperkalemia?

Answer 32

By blocking the Na/K-ATPase!

Question 33

What K+ state can cause rhabdo?

Answer 33

HYPO!

Question 34

What K+ state can BBs cause?

Answer 34

hyPER bc inhibit renin release!

Question 35

What can albuterol do?

Answer 35

B agonist that can treat hyperkal

Question 36

Examples of PO binders?

Answer 36

aluminum containing
Ca containing
Selvamer
Lanthanum

Question 37

Most common prostate sarcoma in kids vs adults

Answer 37

kids: rhabdomyo
adults: leiomyo

Question 38

Testosterine can do what to tumors?

Answer 38

increase it