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Step 2/Level 2 > Nephro > Flashcards

Nephro Flashcards

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1
Q

Which diuretic should be used for acute pulmonary edema?

A

Loops

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2
Q

Which diuretic should be used for idiopathic hypercalciuria?

A

Thiazides

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3
Q

Which diuretic should be used for glaucoma?

A

Acetazolamide (carbonic anhydrase inhibitor) or mannitol if severe

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4
Q

Which diuretic should be used for mild to moderate CHF with expanded ECV?

A

loop and aldosterone antagonist

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5
Q

Which diuretic should be used for increased intracranial pressure?

A

Mannitol

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6
Q

Which diuretic should be used for hypercalcemia?

A

Loop

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7
Q

Which diuretic should be used for altitude sickness?

A

Acetazolamide (carbonic anhydrase inhibitor)

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8
Q

Which class of diuretics can cause ototoxicity?

A

Loops

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9
Q

Which diuretic is safe for a fluid overloaded patient with a sulfa allergy?

A

Ethacrynic acid (loop)

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10
Q

Sub-epithelial humps?

A

Post streptococcal glomerulonephritis

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11
Q

What two labs can be elevated in post streptococcal glomerulonephritis?

A
  • Anti-DNAse B

- ASO titer (normally NOT elevated in skin infections)

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12
Q

endothelial deposits cause “wire loops” on LM?

A

Lupus nephritis

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13
Q

Treatment for most nephrotic syndrome?

A

Steroids, ACE inhibitors, statins

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14
Q

Kidneys, lungs and upper airway involvement?

A

Granulomatosis with polyangiitis (GPA) (Wegener’s)

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15
Q

Which lab is elevated with Wegener’s?

A

cANCA

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16
Q

Linear deposits on immunofluorescence?

A

Good pasture

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17
Q

Treatment of good pasture?

A
  • plasmapheresis (to remove the IgG antibodies to the GBM)

- Glucocorticoids

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18
Q

Immunofluorescence shows mesangial deposits?

A

IgA nephropathy (Berger disease)

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19
Q

Cataracts, nephritis, high-frequency hearing loss?

A

Alports

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20
Q

Splitting of the basement membrane?

A 
Alport disease
(defect of type IV collagen)
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21
Q

Light microscopy showing crescent formation in the glomeruli; p-ANCA positive

A

Pauli-immune RPGN

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22
Q

What is the criteria for nephrotic syndrome?

A
  • proteinuria >3.5g/24 hours
  • hypoalbuminemia
  • edema
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23
Q

Most common cause of nephrotic syndrome in adults?

A

FSGS

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24
Q

Thickening of the basement membrane and a “spike and dome: appearance?

A

Membranous nephropathy

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25
Q

“tram track” appearance with sub endothelial humps of IgG along the GBM?

A

Membranoproliferazive glomerulonephritis (MPGN)

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26
Q

Which type of nephrotic syndrome can Hepatitis B lead to?

A

Membranous

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27
Q

Which type of nephrotic syndrome can Hepatitis C lead to?

A

Membranoproliferazive glomerulonephritis (MPGN)

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28
Q

Congo red stain with apple-green birefringence?

A

Amyloidosis

29
Q

Nephrotic syndrome associated with HIV?

A

FSGS

30
Q

Glomerular histology reveals multiple mesangial nodules. what disease does the presence of this lesion suggest?

A

Diabetes

31
Q

What is the equation for FENa?

A

(urine Na+/Serum Na+)/(Urine Cr/Serum Cr)

32
Q

What does a FENa

A

Likely a pre-renal problem (pt is still conserving Na+ and H2O)

33
Q

What does a BUN/Cr>20 indicate?

A

Pre renal

34
Q

How long does impaired kidney function need to be present before it can be called chronic kidney disease?

A

> = 3 months

35
Q

What are the indications for dialysis in a CKD patient?

A
  • severe hyperkalemia
  • severe metabolic acidosis.
  • fluid overload
  • uremic syndrome
  • CKD (Cr>12, BUN >100)
  • Severe overdose of toxin exposure
36
Q

What is the first-line pharmacotherapy for idiopathic intracranial HTN?

A

acetazolamide

37
Q

What should you consider if you have low serum Na+, high Urine Na+ (>20) and hypervolemia?

A

Renal failure

38
Q

What should you consider if you have low serum Na+, LOW Urine Na+ (

A
  • cirrhosis
  • nephrosis
  • CHF
39
Q

What condition may result from the rapid correction of hyponatremia?

A

Central pontine myelinolysis

40
Q

How fast can hyponatremia be corrected?

A

Only 12 mEq/L per 24 hours

41
Q

What are the causes of hypernatremia?

A

6Ds:

  • Diuretics
  • dehydration
  • diabetes insipidus
  • Docs (iatrogenic)
  • diarrhea
  • disease of the kidney (hyperaldosteronism)–> will not elevate much
42
Q

What can result of treating hypernatremia too quickly?

A

Cerebral edema

43
Q

First line treatment for nephrogenic DI?

A
  • Thiazides (causes a mild hypovolemia which causes increased H2O absorption at PCT)
  • then add indomethacin
44
Q

Treatment for lithium induced DI?

A

Amiloride

-closes the Na+ channels that let Lithium into the cell

45
Q

What is the treatment for hyperkalemia?

A
  • IV calcium gluconate (stabilize cardiac membranes)
  • Insulin + glucose
  • Beta agonists

Remove K+:

  • Hemodialysis
  • Kayexalate (Sodium polystyrene sulfonate)
  • Loop diuretics (chronic hyperkalemia)
46
Q

What are the causes of hypercalcemia?

A
  • Hyperparathyroidism
  • Neoplasms (paraneoplastic)
  • Thiazides
  • Milk-alkali syndrome
  • Sarcoidosis (granulomas secrete Vit D)
  • Hypervitaminosis A
47
Q

What are the causes of hypocalcemia?

A
  • Hypoparathyroidism
  • Hyperphosphatemia
  • Chronic renal failure
  • Vit D deficiency
  • Loop diuretics
  • pancreatitis
  • alcoholism
48
Q

Electrolyte imbalance that causes prolonged QT?

A

Hypocalcemia

49
Q

Electrolyte imbalance that causes shortened QT?

A

hypercalcemia

50
Q

What is Winter’s formula? When is it used?

A

pCO2=1.5(HCO3-)+ 8 +/-2

  • used to predict CO2 in metabolic acidosis.
  • If actual CO2 differs from predicted pCO2–> mixed disorder
51
Q

What acid-base disorder can aspirin overdose cause?

A
  • Respiratory alkalosis (stimulated the brain to hyperventilate)
  • Metabolic acidosis (leads to uncoupling of oxidative phosphorylation –> lactic acidosis)
52
Q

What is the cause of Type 1 RTA? What will the urine pH, Serum K+ be? Tx?

A
  • Impaired H+ secretion
  • High urine pH
  • Low serum K+
  • oral HCO3-
  • K+ supplements
  • Thiazides
53
Q

What is the cause of Type 2 RTA?What will the urine pH, Serum K+ be? Tx?

A
  • Impaired HCO3- reabsorption
  • Low urine pH
  • Low serum K+
  • oral HCO3-
  • K+ supplements
  • Thiazides
54
Q

What is the cause of Type 4 RTA? What will the urine pH, Serum K+ be? Tx?

A
  • hypoaldosteronism
  • Low urine pH
  • High serum K+
  • Fludrocortisone (replace aldosterone)
  • K+ restriction
55
Q

Patient with fever, rash, elevated creatinine and eosinophilia?

A

Acute interstitial nephritis

56
Q

Drugs that cause gynecomastia?

A 
STACKED
Spironolactone
THC
Alcohol (chronic) 
Cimetidine 
Ketoconazole 
Estrogen 
Digoxin
57
Q

Treatment for breast abscess?

A
  • Dicloxacillin, cephalexin, or amoxicillin/clavulanic acid
  • Bactrim if suspect MRSA
  • Metroidazole if suspect anaerobes
  • keep breastfeeding/pumping
58
Q

Multiple, bilateral breast masses that are painful and increase in size before menstruation?

A

Fibrocystic changes

59
Q

Solitary, firm, mobile breast nodule increases in size with estrogen? Next step?

A
  • Fibroadenoma
  • > 35 –> diagnostic mammogram
  • US and FNA, core biopsy or excision biopsy
60
Q

Serous, “straw-colored” nipple discharge +/- streaked with blood?

A

Intraductal papilloma (rare malignant transformation) –> surgical excision

61
Q

Large, bulky tumor with “leaf-like” projections on biopsy?

A

Phyllodes tumor

-monitor closely

62
Q

Which type of breast carcinoma in situ is ER and PR positive?

A

LCIS (lobular carcinoma in situ)

-also has a higher risk for invasive cancer in either breast (not from the LCIS but for other reasons?)

63
Q

Stellate border on mammography or biopsy?

A

Invasive ductal carcinoma

64
Q

Signet ring cells or single-file rows of cells?

A

Invasive lobular carcinoma

65
Q

Treatment of DCIS?

A

lumpectomy +/- radiation

66
Q

Treatment of LCIS?

A

observation + Tamoxifen

-consider prophylactic bilateral mastectomy

67
Q

Treatment of early, focal invasive carcinoma?

A

lumpectomy and radiation

68
Q

If a breast cancer is ER or PR positive, what should they be treated with?

A

Tamoxifen

69
Q

If a breast cancer is positive for HER2, what should they be treated with?

A

Trastuzumab (Herceptin)

Step 2/Level 2 (18 decks)

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