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Nephro Flashcards

1
Q

Best initial test nephrology?

A

UA and BUN/Cr

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2
Q

2 parts to UA

A

Dipstick or microscopic analysis

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3
Q

Etiology of mild, moderate, or severe proteinuria?

A

Mild (

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4
Q

Best initial/more accurate/most accurate for protein?

A

UA/Protein-to-creatinine ratio where number=grams/24 hour/Renal biopsy determines cause

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5
Q

What is only protein detectable on dipstick and what you do for others?

A

Albumin. Bence jones with electrophoresis.

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6
Q

Pyuria indication and etiology?

A

WBC in urine. Inflammation, infection, allergic interstitial nephritis

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7
Q

How do you confirm wbc in urine have eosinophil?

A

Wright and hansel stains

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8
Q

> 35 with painless hematuria next best step?

A

Cystoscopy and CT urogram

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9
Q

False positive tests for hematuria on dipstick, but - on microscopic analysis with no RBC?

A

Hemoglobinuria secondary to hemolytic anemia or myoglobinuria secondary to rhabdomyolysis

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10
Q

Dysmorphic RBC etiology?

A

glomerulonephritis

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11
Q

When you use cystoscopy?

A

Hematuria with no hx infection or trauma and renal U/S or CT has no etiology and bladder sonography has mass for possible biopsy or recurrent UTI or abnormal urine cytology

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12
Q

Red cell cast etiology?

A

Glomerulonephritis

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13
Q

White cell cast etiology?

A

Pyelonephritis or AIN

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14
Q

Eosinophil cast etiology?

A

AIN

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15
Q

Hyaline cast etiology?

A

Dehydration concentrates urine and normal Tamm-Horsfall protein percipitates or concentrates into a cast

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16
Q

Broad,waxy cast etiology?

A

Chronic renal disease (eg dialysis)

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17
Q

Granular “muddy brown” cast?

A

ATN; they are collection of dead tubular cells.

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18
Q

Fatty casts?

A

Nephrotic syndrome

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19
Q

Tx of elderly patients with impaired thirst response and prenal azotemia as result?

A

IV crystalloid (0.9% NS)

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20
Q

2 drugs that can cause prerenal azotemia?

A

NSAIDs (constrict afferent) and ACE (dilate efferent)

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21
Q

5 causes prerenal azotemia?

A

1) Hypotension (SHOCK-various types)
2) Hypovolemia (diuretics, burns, pancreatitis)
3) Renal artery stenosis
4) CHF/Cirrhosis/Hypoalbulinemia (leakage)
5) Drugs (NSAIDs and ACE i)

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22
Q

5 causes postrenal azotemia?

A

1) Prostate hypertrophy or cancer
2) Cervical cancer
3) Urethral stricture
4) Neurogenic bladder
5) Retroperitoneal fibrosis (bleomycin, methylsergide, or radiation)

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23
Q

5 causes intrarenal or intrinsic azotemia?

A

1) ATN (NSAIDs, aminoglycosides, cisplatin, cyclosporine, amphotericin, vancomycin, acyclovir, contrast agents, or prolonged ischemia)
2) AIN (eg penicillin or cephalosporin sulfa)
3) Rhabdo/hemoglobinuria
4) Crystals from hyperuricemia/hypercalcemia/hyperoxaluria
5) Bence jones from myeloma

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24
Q

Best initial test AKI lab and best initial imaging?

A

BUN/Cr, Renal sonogram

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25
Q

Next best test if you dont know cause

A

UA

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26
Q

What is isothenuria?

A

Defect in renal concentrating ability seen in sickle cell trait

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27
Q

What is timeline of ATN with various toxins?

A

Contrast induced (very rapid with damage within 24-48 hours). Antibiotics (vancomycin, gentamicin, and amphotericin)-slower with damage in 5-10 days.

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28
Q

Most effective in preventing contrast induced nephropathy?

A

Saline hydration prior and during case and acetylcysteine OR IV hydration with isotonic bicarbonate

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29
Q

What is exception to lab values of intrarenal azotemia that is commonly seen?

A

Contrast induced nephropathy. Causes vasospasm of afferent arteriole giving urinary lab values similar to prerenal azotemia

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30
Q

How do you know if increased creatinine is from tumor lysis syndrome or drug chemo toxicity?

A

Tumor lysis-hyperuricemia and increased creatinien 2 days after. Drug chemotoxicity-cause increased creatinine 5-10 days after

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31
Q

What happens to phosphate, potassium, calcium, and uric acid in tumor lysis?

A

Increase potassium, phosphate, and uric acid, decreased calcium from chelation

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32
Q

What should be given prior to chemo to prevent aki from tumor lysis?

A

Allopurinol, hydration, rasburicase

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33
Q

What can increase risk of aminoglycoside or cisplatin toxicity in ATN?

A

Low magnesium levels

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34
Q

Best initial most accurate rhabdo?

A

Best initial-UA (dipstick (hematuria) and nothing on microscopic analysis). Most specific is urine myoglobin

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35
Q

Course of ATN?

A

Onset (insult). 1) Oliguric phase-azotemia and uremia with avg. length 10-14 days. urine output. 2) Diuretic phase-begins when urine output is >500 mL/day and high output due to fluid overload, osmotic diruesis and tubular cell damage. 3) Recovery phase-recovery of tubular funciton.

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36
Q

Why doesnt hemolysis cause hyperuricemia?

A

RBC have no nuclei

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37
Q

Tx. rhabdomyolysis?

A

1) IV hydration
2) Mannitol as osmotic diuretic
3) Bicarb to drive potassium back into cell

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38
Q

When is dialysis indicated?

A

AEIOU (Acidosis), Electrolyte (K>6.5), Intoxication (ethylene glycol, salicylate, lithium, valproate or carbamazepine), Overload of volume refractory to diuretics, Uremia (leads to encephalopathy and pericarditis and bleeding)

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39
Q

What is hepatorenal syndrome and tx.?

A

Sudden onset renal failure secondary to liver disease with prerenal azotemia urine readings with no response to NS. Tx. Octreotide,midodrine,

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40
Q

Presentation of atheroemboli and lab values?

A

Livedo reticularis or blue toe, Mesenteric ischmia or pancreatitis as complications. Cholestero emboli lodge inkidney leading to AKI. Eosinophilia, low complement, eosinophiluria, elevated ESR.

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41
Q

Most accurate test atheroemboli?

A

Biopsy or purple skin lesion showing cholesterol crystals

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42
Q

Medications that cause AIN also cause what?

A

SJS/TEN, Hemolysis, Drug allergy and rash

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43
Q

Allerigic substances affect what 3 parts of body?

A

Skin, kidneys, rbc

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44
Q

Drugs that cause AIN?

A

Diuretics, sulfa, penicillin derivates, PPI, sulfonamides, rifampin, NSAID. Generally 1-2 wks after starting drugs

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45
Q

What is exception to eosinophils in urine from AKI?

A

NSAIDs

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46
Q

Tx AIN?

A

Stop drug. Give glucocorticoids if creatinine continues to rise

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47
Q

5 side effects in presentation of analgesic nephropathy?

A

1) ATN
2) AIN
3) Membranous glomerulonephritis
4) Vascular insufficiency (constrict afferent)
5) Papillary necrosis

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48
Q

Presentation of papillary necrosis and tests (initial and accurate)?

A

Sudden onset of flank pain, fever, and hematuria, pyuria, proteinuria in patient with one of SAAD diseases. UA shows red and white cells and may show necrotic kidney tissue. Initial is UA and accurate is CT

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49
Q

General for tubular diseases

A

Acute, NOT nephrotic, caused by toxins, biopsy not needed, not treated with steroids,generally, correc hypoperfusion and remove toxin

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50
Q

Goodpasture syndrome presentation and test (initial and accurate)?

A

young man with Hematuria and hemoptysis. Antibodies to lungs and kidneys. Initial in antiglomerular BM antibodies (Type IV collagen) and kidney or lung biopsy

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51
Q

Tx goodpasture

A

Urgent plasmapharesis and steroids and cyclophosphamide

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52
Q

IgA nephropathy presentation and tests and tx?

A

URI and intermittent hematuria 1-2 days after (vs PSGN 1-3 wks after). Renal biopsy most accurate. Proteinuria determines severity of disease with ACEi and steroids can help treat it

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53
Q

Presentation PSGN

A

Strep throat or impetigo followed by PSGN 1-3 wks after( cola urine, periorbital edema, HTN, RBC cast, milt proteinuria)

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54
Q

Alport presentation?

A

Cant see cant pee cant hear a buzzing bee (lens dislocation, glomerulonephritis, sensorineural hearing loss)

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55
Q

Tx PAN?

A

Prednisone and cyclophosphamide

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56
Q

Presentation PAN?

A

Young adults as HTN (renal artery inolvement), abdominal pain with melena (mesenteric artery involvement), neruologic disturbances (mononeuritis multiplex), and skin lesions. Spares lungs with HBsAg association.

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57
Q

Best test lupus nephritis and tx.?

A

Biopsy indispensible in determining therapy based on stage and guiding intensity of therapy. Glucocorticoids combined with either cyclophosphamide or mycophenalate

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58
Q

Tx amyloidosis and test

A

1) control underlying disease. 2) prednisone and melphalan. Abdominal fat pad aspiration showing apple green birifringence with congo red staining.

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59
Q

Symptoms of nephrotic syndrome?

A

Proteinuria>3.5 g/day, hyperlipidemia (loss of protein so liver wants to thicken blood up and makes lipid), thrombosis (loss of anticoagulants in urine), Edema, Hypoalbuminemia w/increased risk infection because Ig loss, fatty casts

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60
Q

Most common location of thrombosis from nephrotic syndrome?

A

Renal vein

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61
Q

Best initial and most accurate nephrotic?

A

Best initial-UA (maltese crosses) or urine albumin/creatinine, Most accurate-renal biopsy

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62
Q

Tx of nephrotic?

A

Initial-glucocorticoids and no response several years later can use cyclophosphamide. ACE/ARB used to control proteinuria. Edema with salt restriction and diuretics and hyperlipidemia with statin

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63
Q

ESRD is defined by collection of symptoms also known?

A

Uremia (metabolic acidosis, fluid overload, encephalopathy, hyperkalemia, pericarditis)

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64
Q

2 most common causes of ESRD?

A

HTN and diabetes

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65
Q

Clinical manifestation ESRD

A

Anemia (low EPO), Hypocalcemia (no vit D active from dead kidney so no absorb from intestine), Osteodystrophy (secondary hyperparathyroid), Bleeding (uremia inactivates platelets), Infection (same defect with neutrophils), Puritis, Hyperphosphatemia (PTH rlease from bone, but no excretion), Hypermag, Acclerated athero and HTN, endocrinopathy (no ovulation, low testosterone), ED

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66
Q

MCC death ESRD dialysis patients?

A

cardiac disease kills triple infection in ESRD

67
Q

Tx of hyperphosphatemia in ESRD and mechanism?

A

Phosphate binders bind phosphate in gut and don’t absorb. Important when give vitamin D so allows for calcium absorption but not phosphate. Calcium acetate or calcium carbonate for LOW CALCIUM. Sevelamer and lanthanum for HIGH CALCIUM

68
Q

Simple vs complex (potentially malignant) cyst in terms of echogenicity, walls, demarcation, transmission?

A

Echogenicity-Simple (echo free), Complex (mixed)
Walls-Simple (smooth and thin w no septae), Complex (irregular,thick w multiple septae thick and calcified)
Demarcation-Simple (sharp), Complex (lower density on back wall)
Transmission-Simple (good through back), Complex (debris in cyst)
Enchancement-Simple (none on CT/MRI), Complex (Contrast enhancement on CT/MRI)
Symptoms-Simple (none), Complex (pain, hematuria, hypertension possible)
Followup-Simple (none), Complex (yes)

69
Q

Symptoms PKD and MCC death?

A

Hypertension, Hematuria, Flank pain, Infection, Stones, Palpable kidneys w/ rt easier than left cause it lies lower

70
Q

Triad presentatio and Tx of aspirin overdose?

A

Fever, tinnitus, and tachypnea. Alkaliniztion of urine with bicarbonate

71
Q

When can you give bicarb to patient with acidosis?

A

When IV fluids and correction of underlying disorder fails and pH still

72
Q

Tx of hyponatremia?

A

Hypovolemic hyponatremia with NS. Euvolemic and hyper volemic with fluid restriction

73
Q

Treatment of SIADH with failed water deprivation?

A

Demeclocycline. Acute conivaptan

74
Q

When is hypertonic saline used for hyponatremia?

A

When patient has seizures from severe hyponatremia

75
Q

What causes spurious (false) hyponatremia

A

Hyperglycemia (every 100 increase after 200, 1.6 drop in Na+), Hyperproteinemia, Hyperlipidemia

76
Q

Hyponatremia in postop patinets?

A

pain and narcotics (causing SIADH) with overaggressive IV fluid administration. Also, possible adrenal insufficiency with high K+ and hypotension

77
Q

Hyponatremia in pregnant patients?

A

Oxytocin (acts like ADH effect)

78
Q

Best initial test/ Next best test DI?

A

Water deprivation test, ADH administration test

79
Q

What is the first clue to the presence of DI?

A

High volume nocturia

80
Q

Tx NDI vs CDI?

A

CDI-DDAVP or vasopressin. NDI-correct calcium and potassium, stop lithium and democlocycline, NSAID or thiazide for tx.

81
Q

Correction of volume with hypernatremia based on type of volemia?

A

Euvolemic-Free H20 supplementation

Hypovolemic-Yes symptomatic (0.9% NS till euvolemic than 5% dextrose), No not symptomatic (5% dextrose w/ 0.45% nS)

82
Q

What are same causes of hypernatremia in hyponatremia?

A

Hypovolemic hyponatremia because in this casue there is chronic replacement of free water

83
Q

Causes of hypernatremia?

A

Pneumonia, burns, pancreatitis, diuretics, dehydration, and DI

84
Q

Causes of hyponatremia?

A

Hypovolemic-same as hypernatremia but comensation with replacing free H20
Euvolemic-SIADH, Psychogenic DI, Hyperglycemia, Hypothyroid
Hypervolemic-Cirrhosis, Nephrosis, Cardiosis

85
Q

Tx. hyponatremia mild, moderate, severe?

A

Mild-no symptoms, fluid restriction
Moderate-minimal confusion, 0.9% NS w/ loop diuretic
Severe-seizures, coma, Hypertonic saline (3%) and conivaptan or tolvaptan (ADH antagonists)

86
Q

Pseudohyperkalemia vs hyperkalemia?

A

Pseudo-hemolysis, tourniquet and clenching, leukocytosis or thrombocytosis releasing K+ in sample
Hyperkalemia-renal failure, aldosterone antagonist, ACE/ARB, addison disease, type IV RTA, decreased insulin, tissue destruction (hemolysis, rhabdo, tumor lysis syndrome), acidosis

87
Q

What does EKG show in hyperkalemia?

A

Peaked T waves, wide QRS, PR interval prolongation

88
Q

Management of life threatening hyperkalemia (abnormal EKG)

A

1) Calcium gluconate (stabilize membrane)
2) Insulin AND glucose
3) Bicarb (but generally when acidosis causes hyperkalemia)
4) Remove via kayexalate through bowel

89
Q

How does low magnesium lead to low potassium?

A

Mg2+ important cofactor for K+ uptake. Decrease Mg2+–>Increase K+ channel opening–>increase K+ into urine–>decrease K+ blood

90
Q

RTA type I best initial/most accurate test and tx.?

A

Best initial-UA for pH and most accurate is NH4Cl infusion with no decrease in pH after because inability to secrete acid. Tx. bicarbonate

91
Q

RTA type II best initial/most accurate test and tx.?

A

Best initial-UA for pH and most accurate is evaluate bicarbonate malabsorption in kidney by giving bicarb and testing urine pH. high dose bicarbonate or thiazide diuretic

92
Q

RTA type IV test?

A

Urine salt loss. Fludorcortisone (steroid with highest aldosterone like effect)

93
Q

How do you differentiate RTA and diarrhea who both have normal serum anion gap metabolic acidosis?

A

Urine anion gap (Na+-Cl-)–>+ in RTA and - in diarrhea

94
Q

Metabolic acidosis normal and elevated causes?

A

Normal (HARDASS)-Hyperalimentation, Addison, RTA, Diarrhea, Acetazolamide, Spironolactone, Saline infusion
Elevated (MUDPILES)-Methanol, Uremia, DKA, Propylene glycol, Iron tablets/Isoniazid, Lactic acidosis, Ethylene glycol, Salicylates

95
Q

Presence of what acid with ethylene glycol overdose, test, and treatment?

A

Oxalic acid, crystals on UA, fomepizole and dialysis

96
Q

Presence of what acid with methanol overdose, test, and treatment?

A

Formic acid, inflamed retina, fomepizole and dialysis

97
Q

Causes of metabolic alkalosis?

A

Loop/thiazide diuretics, vomiting, antacid use, hyperaldosteronism

98
Q

Best initial therapy for acute renal colic?

A

Analgesics and hydration

99
Q

Best initial test nephrolithiasis

A

Noncontrast CT (most accurate) and sonography to detect obstruction such as hydronephrosis

100
Q

Management of stones

A
101
Q

What drug can you give to someone prone to stones with increasing calcium excretion in urine?

A

HCTZ

102
Q

Why does metabolic acidosis put you at increased risk of stones?

A

Metabolic acidosis–>increased calcium–>citrate chelates to lower calcium–>increased calcium after citrate occupied chelating–>increased risk stones

103
Q

Ppl with HTN need to be tested with?

A

EKG, UA, glucose, cholesterol screening

104
Q

Management HTN

A

1) Lifestyle
2) Thiazide, but >160/100 use 2 meds
3) Age >60, BP goal is 150/90

105
Q

What is hypertensive crisis?

A

Any hypertension level with end organ damage (confusion, blurry vision, dyspnea, chest pain). IV drug is important and can be any of them

106
Q

How can you tell location of hematuria in blood stream and etiology?

A

Initial-urethral damage. Terminal-bladder or prostatic damage. Total-damage to kidneys/ureters

107
Q

Glomerular vs nonglomerular hematuria?

A

Glomerular-microscopic, glomerulonephritis major cause with dysmorphic RBC, RBC cast, hematuria, and protein
Nonglomerular-gross, cancer, nephrolithiasis, PCKD, infection, papillary necrosis, dysuria or symptoms of urinary obstruction present and blood with NO PROTEIN

108
Q

Leading cause of euvolemic hypernatremia?

A

DI

109
Q

Lab values IgA nephropathy vs PSGN?

A

IgA nephropathy-normal complement

PSGN-low C3, anti-ASO, antiDNAse B

110
Q

What anesthetic can cause hyperkalemia?

A

Succinylcholine

111
Q

Serum potassium in RTA type 1,2,4

A

1-low to normal, 2-low to normal, 4-high

112
Q

Tx type 1, 2, 4 RTA?

A

1-HCO3-, 2- very high hco3- and thiazide diuretic, 4-fludrocortisone

113
Q

Defect in type 4 RTA?

A

Aldosterone resistance secondary to JGA damage resulting in high potassium and low sodium in serum

114
Q

What dietary measures can prevent recurrent nephrolithiasis?

A

Increased citrate (fruits/veggies), decreased oxalate (vitamin C), reduce protein, increase fluids, reduce sodium

115
Q

What drug therapy can prevent recurrent nephrolithiasis?

A

Thiazide (calcium oxalate related), urine alkalinizatoin (potassium citrate/acetazolamide), allopurinol (hyperuricosuria-related stones)

116
Q

Potentially reversible causes of urinary incontinence in elderly?

A

DIAPPERS (Delirium, infection (UTI), atrophic urethritis/vaginitis, Pharmaceutical (alpha blocker, diuretics), Psychological (eg depression), Excessive urine output (CHF and diabetes), restricted mobility (eg post surgery), stool impaction

117
Q

What is first pathologic change to be quantitated in DM?

A

GBM thickening characterized by proteinuria and progressive GFR decline

118
Q

Hallmark of DM on pathology?

A

Nodular glomerulosclerosis (kimmelstiel-wilson nodules), but diffuse glomerulosclerosis more comon

119
Q

3 stages of diabetic nephropathy?

A

1) Hyperfiltration (0-5yrs)-increased GFR, glomerular hypertrophy
2) Incipient DN (5-15 yrs)-GBM thickening (decreased GFR ton normal and proteinuria), mesangial expansion, arteriolar hyalinosis.
3) Overt DN (>15 yrs)-Nodular glomerulosclerosis (kimmelstein wilson), fibrosis, overt proteinuria to nephrotic syndrome, decrease GFR further

120
Q

Electrolytes in diuretic abuse?

A

Hypokalemia and hyponatremia with elevated urinary sodium/potassium

121
Q

Crystal induced nephropathy cause?

A

PAMES-Protease inhibitors, Acyclovir, Methotrexate, Ethylene glycol, Sulfonamides

122
Q

Crystal induced nephropathy risk factors, UA, and tx.

A

Underlying CKD or volume depletion, (hematuria, pyuria, and crystals), and D/C drug with volume repletion which if given with drug can prevent kidney injury

123
Q

AA vs. AL amyloid assoc condition and compostion?

A

AL-myeloma, waldenstrom, lambda light chains
AA-chronic inflammation (RA, IBD), chronic infection(osteo or TB), abnormally folded:B2 microglobulin, apolip or transthyretin

124
Q

FSGN vs Membranous nephropathy association and differences?

A

Association-MCC of nephrotic in adults absence of systemic disease
FSGN-AA/hispanic, HIV, heroin, sickle cell, obesity
Membneph-Caucasian, NSAID+penicillamine, adenocarcinoma (breast and lung), SLE. Most commonly will see renal vein thrombosis here

125
Q

MCD association?

A

NSAID, Hodgkin lymphoma. MCC nephrotic children

126
Q

What two values provide the best picture for acid-base status?

A

pH and PaCO2

127
Q

Primary disorder metabolic acidosis and compensation equation?

A

Arterial PaCo2=1.5 (serum Hco3)+8 +/-2

128
Q

Primary disorder metabolic alkalosis and compensation equation?

A

Increase arterial PaCO2 by 0.7 mmHg for every 1 meq/L rise in serum HCO3-

129
Q

Acute respiratory acidosis?

A

Increase serum HCO3- by 1 mEq/L for every 10 mm Hg rise in arterial PaCO2

130
Q

Acute respiratory alkalosis?

A

Decrease serum HCO3- by 2 mEq/L for every 10 mm Hg decrease in arterial PaCO2

131
Q

Metabolic alkalosis that is saline responsive?

A

Low urine chloride (

132
Q

Metabolic alkalosis that is saline unresponsive?

A

High urine chloride (>20). Euvolemic/Hypolemic (Current diuretic use or bartter and gitelman), Hypervolemia (excess mineralcorticoid activity: conn, cushing, ectopic ACTH)

133
Q

Percipitating factors of hepatorenal syndrome?

A

Reduced renal perfusion (GI bleed, vomiting, sepsis, excessive diuretic use, SBP), Reduced glomerular pressure and GFR (NSAID use constricts afferent arteriole). So numerous causes of prerenal azotemia

134
Q

When should metformin not be given?

A

Ill patients with ARF, liver failure, or sepsis b/c of lactic acidosis side effect

135
Q

Anticholinergic effect location for urinary retention?

A

Prevent detrusor contractility and relaxation of urethral sphincter

136
Q

Mild, moderate, severe SIADH tx.

A

Mild-fluid restriction, Moderate-IV hypertonic saline first 3-4 hours, Severe-Bolus hypertonic saline and vasopressin antagonists conivaptan, tolvaptan and demeclocycline

137
Q

What is painful bladder syndrome (interstitial cystitis)?

A

IBS of bladder (bladder pain with filling and relief with voiding with incrased frequency and urgency). Dyspareunia >6 weeks with normal UA. Tx. amitripyline and analgesics

138
Q

When do you see nitrites UA?

A

Presence of gram neg bacteria (converting nitrates to nitrites)

139
Q

Tx. uncomplicated cystitis in nonpregnant and when should you get urine?

A

-Nitrofurantoin for 5 days (avoid in pyelo or GFR

140
Q

Tx. complicated cystitis in nonpregnant and when you should get urine?

A

Fluoroquinolones 5-14 days or ampicilin/gentamicin for more severe with urine culture before therapy so you can adjust antibiotic

141
Q

Tx. pyelonephtritis in nonpregnant and when you should get urine?

A

Outpatient: Fluoroquinolone
Inpatient: IV antibiotics (eg fluoroquinolone, aminoglycoside +/- ampicillin)
Obtain urine before therapy

142
Q

What drugs can cause hyperkalemia?

A

NSAID (decrease prostaglandin synthesis and reduce renin and aldosterone secretion), Digoxin, Nonselective b-blockers, ACE/ARB, K+ sparing diuretic

143
Q

Sodium nitroprusside IV with underlying CKD can present as what?

A

Cyanide toxicity. Tx. with sodium thiosulfate

144
Q

Tx hypercalcemia?

A

IV fluids followed by furosemide (calcium diuresis)

145
Q

Cause, presentation, tx of hypermagnesemia?

A

Iatrogenic in preeclampsia patients or renal failure, decreased DTR, hypotension and resp failure, Stop magnesium, ABC, IV fluids and furosemide for diuresis

146
Q

Maintainence fluid for those not eating?

A

1/2 NS with 5% dextrose and KCl 10-20 mEQ/day

147
Q

CKD tx. (dialysis pts)

A

Dialysis (3 times/week), water soluble vitamins (removed during dialysis), phosphate restriction or binders (calcium carbonate, calcium acetate, or sevalamer), EPO and hypertenson control

148
Q

Gold standard diagnosis UTI?

A

Positive urine culture with at least 100k colony forming units

149
Q

What is exception to treating asymptomatic bacteriuria?

A

Pregnant patients b/c risk of pyelo

150
Q

What is only hyponatremia where UNa

A

Vomiting, diarrhea, dehydration b/c salt loss is all nonrenal!!

151
Q

Urine osmolarity in psychogenic vs SIADH?

A

300 SIADH

152
Q

What are aldosterone effects?

A

ASS PPH (Aldosterone saves sodium, pushes potassium and hydrogen)

153
Q

What confirms diagnosis for cystine stones in urine?

A

Positive urinary cyanide nitroprusside test

154
Q

How can TB present with metabolic acidosis?

A

TB to adrenal gland causing addison like effect leading to normal anion gap metabolic acidosis

155
Q

Initial tx of RAS and renovascular HTN?

A

ACEi/ARB

156
Q

Tx of hyperkalemia rapid with EKG vs slow with no EKG

A

1) IV calcium to sabilize, B-agonist, insulin and glucose, sodium bicarb and only transient decrease but not whole body
2) Diuretics (loop diuretic), cation exchange resins, or hemodialysis is slow and more progressive

157
Q

What is filtration fraction?

A

GFR/RPF

158
Q

Acetazolamide use?

A

Glaucoma, urinary alkalinization (stones), metabolic alkalosis, pseudotumor cerebri

159
Q

Loop diuretic (furosemide, bumetanide, torsemide) use?

A

Edematous states (max amount of diuresis in short amount of time for HF, cirrhosis, nephrosis, pulm edema), HTN, Hypercalcemia

160
Q

Loop diuretic toxicity?

A

Ototoxicity, Hypokalemia, Dehydration, Allergy, Nephritis (intersitital), Gout

161
Q

Furosemide with what other drugs increase chance of ototoxicity?

A

Aminoglycosides, salicylates, cisplatin

162
Q

What are the thiazide diuretics and toxicity?

A

chlorthalidone, HCTZ. Hyponatremia, Hypokalemic metabolic alkalosis, hyperGLUC

163
Q

ACEi toxicity?

A

CATCHH (Cough, Angioedema, Teratogen, Increase Creatinine (decrease GFR), Hyperkalemia, Hypotension

Step 2 CK (16 decks)

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