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Clin Med > Nephro Exam > Flashcards

Nephro Exam Flashcards

1
Q

You have a 56yo pt who has never had HTN problems until very recently. What should you suspect?

A

Renovasc HTN as the cause!

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2
Q

HyperK+ is an EMERGENCY. Order of operations for Tx?

A

IV Ca2+ gluconate or CaCl!!

Then:
IV hypertonic glucose +
IV loop or thiazide diuretic

Then:
fix underlying cause +
HD.

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3
Q

HypoMg2+ is under __ in what pt popn?

A

1.5 mEq/L usually in EtOHics

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4
Q

Why wouldn’t you PTRAS an atherosclerosis-RAS pt?

A

The data says it makes no difference to them, so stick with Rxs.

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5
Q

Stones in the kidney do NOT cause pain! They will cause __.

A

Hematuria

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6
Q

Physical exam of hydrocele?

A

scrotal swelling/pain that glows red upon transillumination

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7
Q

Who is most at risk for cryptorchidism? What else is that a risk factor for?

A

Low birth wt

Hypospadias

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8
Q

Why does Type B Lactic Acidosis occur?

A

Alcohol, DKA, CA, or MXR cause either tissue ischemia or decreased metabolism, which increases lactic acid without causing hypoperfusion.

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9
Q

Why can CKD cause anemia?

A

dec EPO (only if you r/o other causes please!)

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10
Q

We LOVE NCCT for nephrolithiasis! But what two stone types doesn’t it see?

A

Pure matrix stones, or those d/t indinavir

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11
Q

Your kidney stone pt is a frequent flyer, or they have a major FamHx of them. What do you need to do?

A

Metabolic workup to figure out why (PTH/Ca2+, 24hr urine, BMP).

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12
Q

How do kidney stone pts present? (3)

Where will tenderness to palp be?

A
  • Sudden-onset, severe unilat colicky pain, in flank (if upper stone) or groin (if lower stone)
  • With N/V, diaphoresis, can’t sit still
  • Consequently tachy and HTN
  • Abd will be nttp, but +CVAT.
  • Testes will NOT be swollen or ttp!!
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13
Q

Once the lungs or kidneys appropriately compensate for an acid-base imbalance, the HCO3- and pCO2…

A

…will BOTH be either dec or inc. They won’t be in different directions.

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14
Q

Stage __, aka ‘locally invasive RCC’, is Tx’d by __.

A

IVa

En bloc resection.

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15
Q

An RCC that’s stage IIIa has reached either __ or __.

A

IVC or main renal vein.

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16
Q

You did your metabolic workup on your frequent-flyer kidney stone pt. It came back with high Ca2+. What should you do to Tx it long-term?

A

Prescribe a thiazide, if renal fxn is good with that!

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17
Q

Phimosis is normal in infants, up to adolescence. Why should you treat it in adults?

A

If difficulty urinating or making sex fxn abnormal

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18
Q

What BMP labs will be LOW in a CKD pt? What would the U/A look like?

A

Hypocalcemia

U/A: Proteinuria, RBC/WBCs or casts.

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19
Q

Why does Type A Lactic Acidosis occur?

A

Hypoxia (like shock, poisoning) causes decreased tissue perfusion, so more lactic acid is made.

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20
Q

Lab-wise, what three(ish) things are you looking for in an RCC Dx?

A

Anemia, or high RBCs.
Hematuria
High ESR

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21
Q

Your pt is a frequent flyer struvite kidney stone pt. What long-term Tx should you consider?

A

ppx abx + urease inhibitor + perc nephrostolithotomy! (same as staghorn Tx)

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22
Q

Your pt’s BUN comes back low. What are two reasons could that have happened?

A

Liver disease

SIADH

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23
Q

How would you Tx severe or Sx hypoMg2+? What pt popn should you be careful with?

A

1-2g IV Mg2+ over 2-15min

Renal pts

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24
Q

What are the seven fxns of the kidneys?

A 
A WET BED:
Acid-base balance
Water balance
Electrolyte balance
Toxin removal
BP control
EPO
vitD metabolism
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25
Q

When we look at an excised Wilms’ tumor in histology, what do we like to see? What do we NOT like to see?

A

Good: classic ‘triphasic’
Bad: heterozygous; diffuse anaplasia

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26
Q

Sx of hyperCa2+?

A

“Stones, bones, moans, groans!”

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27
Q

HyperK+ ECG looks like…

A

Flat P’s, peaked T’s!

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28
Q

4 steps of Tx’ing hyperMg2+?

A

d/c Mg2+ drugs!
Dietary restriction
NS + loop diuretic
HD if needed

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29
Q

U/A in a pt with uric acid kidney stones could uniquely show __ and __.

A

Uric acid crystals

Low pH urine

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30
Q

Imaging shows positive Wilms’ tumor Dx. Now what?

A

Surg:
To see if it’s bilat
Liver/lymph node Bx
Tumor resection.

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31
Q

Do NOT use hypotonic soln in…

A 
Dehydration pts
Hypovol/hypotn
Trauma/burn pts
Liver disease pts
Anyone at risk for inc ICP
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32
Q

CKD is most common in what pt popns?

A

African-Americans and Hispanics

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33
Q

Tell me five-ish causes of hematuria.

A 
SLE/HSP
Nephritis
UTI
CA
Coagulopathy
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34
Q

___ is the most similar soln to blood. What’s another name for it? When would we use it?

A

LR (Hartmann’s soln)

Use in metabolic acidosis, OB/burns, V/D

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35
Q

Goal rate of correction for hypoNa+ is…

A

4-6mEq/L in a 24hr period (DEFINITELY not >8!)

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36
Q

Renal cell carcinoma comes from ___ tissue. Who gets RCC?

A

Proximal renal tubular ep.

Mostly >55yo white men>women, especially if they have a hereditary RCC thing.

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37
Q

Non-cardiac Sx of hyperMg2+ include __, __, and __.

A

Dec DTR
Flaccid paralysis
HA

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38
Q 
Normal ABG values?
pH = 
pCO2 = 
pO2 = 
HCO3- =
A 
pH = 7.35-7.45
pCO2 = 40 mmHg
pO2 = 100 mmHg
HCO3- = 24 mEq/L
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39
Q

Normal BUN is ___. Normal Cr is __.

A 
BUN= 7-20mg/dL (inc when kidney fxn dec)
Cr= 0.8-1.4 mg/dL (inc when kidney fxn dec)
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40
Q

We Tx (embolization surg) varicoceles if they…

A
  • Affect fertility
  • Are on the R side
  • It’s bilateral
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41
Q

What is the expected compensation for metabolic alkalosis? (actual numbers will be given on test, but know the general concept)

A

lungs will cause inc pCO2 as compensation.

For every 1 of HCO3- increased, pCO2 will increase by 0.5ish.

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42
Q

Urea is produced by the __, dissolved in the blood, and secreted by the __.

A

Liver

Kidneys

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43
Q

Acute kidney disease onset is hours or days, is usually reversible, and is d/t… (5)

A 
Blood loss,
Obstruction
Rxs
IV contrast
Dehydration
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44
Q

What three s/s in an RAS pt would make you suspect ischemic nephropathy? +/- __.

A

Asymmetrical kidney size + Atherosclerosis + Azotemia (unexplained)
+/- proteinuria

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45
Q

Gold standard to CONFIRM Dx RAS is…

Why would I need to confirm it?

A

Renal artery angio!

If you’re gonna do a surg

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46
Q

__ and __ losses will cause metabolic acidosis WITHOUT an anion gap. Give an example of each.

A

Intestinal (diarrhea, fistula drainage), renal (RTA)

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47
Q

Stage V Wilms’ Tumor means __.

Give chemo/rad to anyone Stage…

A

Bilateral.

Stage III and up.

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48
Q

What will metabolic acidosis look like on an ABG?

A

High H+, low HCO3-. Then lungs will cause dec pCO2 as compensation.

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49
Q

If you’ve done your U/A and HxPE and you think your pt has renal caliculi, you should Dx with ____ unless they are pregnant. What if you can’t get that?

A

NCCT!!

Second-best choice: IVP

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50
Q

Excess carbon dioxide will make pH…

A

decrease (more acidic)

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51
Q

What exam findings suggest a kid has a Wilms’ tumor?

A

Smooth/firm abd mass, inc abd girth, +/- HTN, +/- microscopic hematuria

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52
Q

HyperK+ is above __. What causes it?

A

5.0 mEq/L (draw this lab twice!)
Renal disease
Rxs! (ACEi, ARBs, aldosterone antags)

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53
Q

What biologic processes will raise pH (more basic)?

A

Emesis; hyperventilation; urination (lose H+ but bicarb too, so it balances out)

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54
Q

What is the expected compensation for respiratory acidosis? (actual numbers will be given on test, but know the general concept)

A

kidney will cause inc HCO3- as compensation.

For every 10 of pCO2 increased, HCO3- will increase by 1.5ish (if acute) or 3.5 (if chronic).

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55
Q

Why does cryptorchidism happen? (2)

A

The gubernaculum isn’t attached well so it doesn’t get pulled down
Abnormal pituitary-hypothal-gonadal axis

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56
Q

CKD leads to __. How?

A

Nephro/glomerulosclerosis and fewer nephrons

d/t dead nephrons –> hyperfiltration by remaining nephrons –> glomerular capillary HTN –> hypertrophy of remaining nephrons –> more dead nephrons :(

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57
Q

How do you Tx metabolic acidosis?

A

Tx the underlying cause!!!

+ NaHCO3 if bicarb is below 18 (until it hits 22mg/dL)

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58
Q

Hypospadias can be __, __, or __ location. There are others, but these are the general ones.

A

Subcoronal
Midshaft
Penoscrotal

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59
Q

How come CKD causes VitD-def? What do you do about it?

A

Kidney does VitD activation.

Supplement if 25OH (only measure this!) is below 30mg/mL.

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60
Q

Hypertonic solns include __, ___, and ___.

Why don’t we use them much?

A

3% saline, 5% saline, 10% dextrose

Rarely used d/t lots of complications (pulm edema, severe hypoNa+, etc.)

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61
Q

Someone has HTN. What three things do you need to do for this pt?

A
  • find an underlying cause, if there is one.
  • fundoscopy to see if it’s affecting eyes
  • listen for bruits (esp. abd) to see if it’s causing stenosis.
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62
Q

Why is Stage IV CKD so scary?

A

HyperK+
Edema
Uremia

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63
Q

Where is the external inguinal ring? How do you palpate it?

A

At the top of the spermatic cord (which connects to a testis)

Feel it while pt is doing a Valsalva like coughing

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64
Q

Venous total CO2 normal value? What is basically synonymous with that?

A

22-32mmol/L

Bicarb!

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65
Q

Cryptorchidism occurs when one of two phases of testicle descent fails. Name each, what they are dependent on.

At what age does this process normally happen?

A

Transabd - INSL3
Inguinoscrotal - androgens

4-6wks ANTEPARTUM

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66
Q

A varicocele is wayyyy more common on what side?

We’re not sure why, but what’s the general idea of why?

A

Left!
Maybe because it’s a straight shot from the left testicular vein right into the plexus, or inc pressure from being by the SMA/aorta

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67
Q

What is a hydrocele? Besides size, why is it no bueno?

A

Fluid in the scrotum

Messes with temperature regulation

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68
Q

What does GFR measure?

A

How well the kidneys are removing wastes and excess fluid from the blood.

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69
Q

HyperK+ is above __. What causes it?

A

5.0 mEq/L (draw this lab twice!)
Renal disease
Rxs! (ACEi, ARBs, aldosterone antags)

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70
Q

What happens to the foreskin in paraphimosis?

A

Stuck behind corona of penis which eventually leads to ischemia/necrosis

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71
Q

Microalbuminuria/proteinuria —> ___ –> __.

A

Tubular injury –> CKD.

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72
Q

[Na+] > __ is hyperNa+. Sx?

A

145 mEq/L

fever, sweating, V/D, primary hypodipsia

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73
Q

S/S of hypoMg2+ occur under __, and include __, __, and __.

A

1.0mg/dL

Lethargy/confusion, tremors/convulsions/hyperreflexia, paresthesia

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74
Q

S/S of HypoNa+ set in when [Na+] is…

What Sx?

A

125mEq (nausea, malaise)

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75
Q

Late-stage bladder CA Sx include __, __, and __.

A

LE swelling (unilat or bilat)
Bony/pelvic/flank pain
Palpable mass

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76
Q

Your pt’s BUN comes back elevated. What are three reasons could that have happened?

A

CHF
RF (dec GFR)
High-protein diet

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77
Q

Two lab values that = respiratory acidosis? Why does that occur?

A

pH <7.35 + paCO2 >45mmHg

d/t hypoventilation

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78
Q

KUB is quick and cheap, so why is it not necessarily a good choice?

A

Stones are frequently obscured by stool or bowel gas or bone.

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79
Q

What part of the kidney does tubular secretion take place in?

A

From the peritubular capillaries to the renal tubule

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80
Q

If the BCG implant fails to shrink the bladder CA, what three chemo options would you consider to start with?

A

Doxorubicin
Mitomycin
Valrubicin

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81
Q

Stage __, aka ‘disseminated RCC’, is Tx’d by ___.

A

IVb
It’s not. Hello, hospice. Can do palliative radical nephrectomy to help with Sx; chemo/rad are usually pretty useless in RCC.

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82
Q

Inappropriate compensation indicates ___, as does a weird…

A 
Mixed disorder
Anion gap (alkalosis with gap is mixed.)
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83
Q

Quick Tx for paraphimosis until surg?

A

D5W (or sugar)-soaked gauze pad on it
or
Poke it a ton with a 25ga needle

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84
Q

Once RAS obstructs the artery >50%, what happens to the kidney?

A

Hypoxia –> fibrosis, inflammation –> irreparable damage.

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85
Q

Locally advanced RCC (has gotten to regional lymph nodes) may cause ___. RCC at this stage needs __ for Dx, and is Tx’d by…

A

Venous tumor thrombus!
MRI
Radical nephrectomy w/ regional lymph node dissection, +/- IVC thrombectomy if needed

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86
Q

An RCC that’s stage II has reached…

A

> 7cm.

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87
Q

If the primary issue is a pCO2 change…

A

It’s respiratory!

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88
Q

RCC Stage ___ and up are not gonna have very good prognoses.

A

III (it’s reached multiple lymph nodes)

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89
Q

__ and __ are two antiinfection drugs that can cause radiolucent kidney stones.

A

Indinavir or sulfadiazine

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90
Q

Normal BUN is __, and is part of which lab set?

A

10-20mg/dL (BMP)

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91
Q

What stones are good candidates for extracorporeal shock wave lithotripsy?

A

Proximal; >5mm, but <2cm (or <1cm if in ureter) IN NONPREGNANT PTS

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92
Q

In acidosis, the kidneys…

A

Bind as much H+ as possible, excrete it with phosphate buffers, and make new bicarb.

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93
Q

The classic triad of RCC is in advanced RCC. What is it?

A

Painless hematuria + flank pain + flank mass

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94
Q

Who gets hypoNa+?

A
  • RF
  • Cirrhosis
  • CHF
  • too aggressive rehydration
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95
Q

NS is the ONLY soln that ___

A

… you can give with blood products.

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96
Q

What can severe/refractory HTN do to the lungs?

A

Flash pulm edema!

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97
Q

What is the expected compensation for respiratory alkalosis? (actual numbers will be given on test, but know the general concept)

A

kidney will cause dec HCO3- as compensation.

For every 10 of pCO2 decreased, HCO3- will decrease by 1.5ish (if acute) or 5 (if chronic).

How well did you know this?
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2
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98
Q

What Rxs put pts at risk for kidney stones?

A

Thiazides! /diuretics

VitD/C
Probenecid
Long-term steroids
Antacids x a ton
Theophylline
Acetazolamide
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99
Q

ECG of hypoMg2+ will show…

A

Arrhythmia
Wide QRS
ST depression

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100
Q

HyperMg2+ is over __ and is found in what three patients?

A

2.5mEq/L (Sx at 4mEq/L)

RF, Antacid abusers, Overcorrected hypoMg2+

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101
Q

Besides having them before and FamHx, what conditions (NOT Rxs) put pts at risk for kidney stones?

A

HyperPTH
HyperCa2+ of malignancy
Sarcoidosis

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102
Q

Electrolyte labs tell you about __, ___, and ___.

A

Volume status, acid-base, and renal fxn.

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103
Q

Where are the three abnormal locations that a testicle could be stuck at in cryptorchidism?

A

Abd, inguinal canal, or high scrotal (most)

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104
Q

ECG of a hypoCa2+ pt will likely show…

A

prolonged QT

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105
Q

Who gets hyperNa+? Why?

A

Diabetes insipidus pts (hypovolemic hyperNa+ - voiding large amounts of DILUTE URINE)

Primary hyperaldosteronism pts - Inc Na+/H2O, dec K+)

Psych/demented/old pts

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106
Q

If your pt’s Hgb falls below ___, start EPO replacement until it reaches __ mg/dL.

A

Below 10

Aim for 11-12 (not above or below!!)

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107
Q

Who gets kidney stones?

A

Old white men > women, especially if they’ve had them before.

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108
Q

Besides FMD pts, what four pt scenarios would get you to choose PTRAS?

A

HD-significant RAS PLUS one of the following:

1) CHF or flash pulm edema
2) Resistant HTN/intolerant to antiHTN Rxs
3) ASx bilat or single-fxning kidney
4) Progressive CKD, bilat RAS (or unilat RAS in single-fxning kidney)

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109
Q

What are the two types of lactic acidosis?

A

Type A Lactic Acidosis (hypoxia)

Type B Lactic Acidosis (metabolic)

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110
Q

ECG of hyperMg2+ will show…

A

Tall T
Wide QRS
Irreg
Escape beats

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111
Q

The biggest complication of CKD is __.

Name 4 others.

A

Cardiac complications!

HyperK+; imbalanced phosphorus/vitD/Ca2+
Uremic syndrome
Metabolic acidosis
Volume overload

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112
Q

Why would a pt have metabolic acidosis WITH an anion gap…?

A

Gaining acid.

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113
Q

Hypertonic soln has a ___ [solute], so solution will…

A

Higher [ ]

Draw fluid out of cell

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114
Q

IVP is good for seeing ___. What should you take caution with in IVP?

A

GU structures.

Check SrCr first d/t dye.

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115
Q

What stones are good candidates for ureteroscopy?

A

Mid/distal; hard, cystine, or impacted stones

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116
Q

Normal eGFR is at or > ___. Kidney dysfxn is below ___. Below __ needs HD and/or a transplant.

A

90mL/min
60
15

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117
Q

What are the four reasons metabolic alkalosis could occur?

A 
DISK:
Diuretics
Ingestion of too much alkali
Stomach loss of H+ (vomiting)
Kidney loss of H+ (Cushing, primary hyperaldosteronism(
118
Q

Most of total body water is…

How much water do we I&O in a normal day?

A

Intercellular

1600mL in, 1600mL out.

119
Q

U/A in a pt with caliculi will show __ most of the time. You should also look for __, __, and __.

A

Microhematuria

the pH, crystals, and bacteria.

120
Q

Tx mild hypoK+ with ___ at a rate of __. Also replete the ___ first!

A

KCl po on telemetry (no more than 10mEq/hr)

Mg2+!

121
Q

How do you Tx hypoCa2+?

A

Severe: IV Ca2+ gluconate + slow Ca2+ infusion after
ASx/mild: po Ca2+.

FIX Mg2+ FIRST!

122
Q

Diabetes is the #1 cause of ESRD so keep your pt’s HbA1c below ___!

A

7!

123
Q

Why do diuretics cause metabolic alkalosis?

A 
Contraction Alkalosis (large amounts of bicarbless fluid, or renal compensation causing decreased potassium)
Impaired Cl- reabsorption
124
Q

Caution with LR in ___. C/I pt with __.

A 
Renal disease (has K+)
Liver disease (can't metabolize lactate); pH >7.5 (will make even more alkalotic
125
Q

What are the four ‘flavors’ of nephrolithiases, in order of most common to least?

A

Ca2+
Struvite (NH4+-Mg3PO42)
Uric acid (radiolucent!)
Cystine

126
Q

Name two types of hypertensive nephropathy.

A

Primary glomerulopathy with HTN, and

Vascular/ischemic renal disease.

127
Q

How do you Tx hypospadias?

A

Nothing
or keep them uncircumcised
or quick surg +/- testosterone ppx

128
Q

In alkalosis, the kidneys…

A

Bind as much bicarb as possible, excrete it, and make less bicarb by decreasing glutamine.

129
Q

Normal Cr is __, and is part of which lab set? What does it indicate?

A

0.7-1.5 mg/dL (BMP)

eGFR/kidney fxn

130
Q

Normal [K+] is __. Where is it?

A

<3.5 mEq/L

Most in muscle.

131
Q

D5W is a __ soln that is C/I with ___.

A

Isotonic –> hypotonic!

C/I with blood products!!!!

132
Q

If someone has ESRD, what two comorbidities cause the most morbidity?

A

DM and atherosclerotic RAS

133
Q

Those most at risk for getting RCC include smokers, the obese, HTN pts, and those who are s/p __ or __.

A

Kidney transplant or dialysis

134
Q

New anemia + new renal insufficiency is __ until proven otherwise!

A

Multiple Myeloma!

135
Q

What is azotemia?

A

The ASx accumulation of toxins/BUN/Cr d/t renal dysfxn

136
Q

What electrolyte changes might you see on the labs of an RAS pt? Why?

A

HypoK+!

d/t secondary hyperaldosteronism

137
Q

What is the expected compensation for metabolic acidosis? (actual numbers will be given on test, but know the general concept)

A

lungs will cause dec pCO2 as compensation.

For every 1 unit of HCO3- decreased, pCO2 will decrease by 1.2 units.

138
Q

The diagnostic standard for bladder CA is…
What prompts you to order that?

(after Dx, get the usual staging imaging.)

A

Cystoscopy + Bx

usually ordered after U/A with cytology comes back suspicious

139
Q

Half-concentrates (hypotonic soln) include __, ___, __, and __.

A
  1. 5% dextrose
  2. 45% NS (“half normal”)
  3. 33% NS
  4. 2% NS
140
Q

When might a CCB be a better choice than an ACEi/ARB?

A

Don’t need to monitor Cr/electrolytes as closely because CCB doesn’t have the same AKI risk

Good choice for bilat RAS pts

141
Q

Normal protein in urine is about 150mg a day, so anything over ___ is proteinuria d/t kidney dysfxn. Anything over ___ is nephrotic proteinuria (bad!)

A

1g in 24hr

3.5g in 24hr

142
Q

A Cr greater than ___ for women and greater than ___ for men may be an early sign that the
kidneys are not working properly.

A
  1. 2 women

1. 4 men

143
Q

What would the urine of a pt with nephrotic syndrome look like?

A

Heavy proteinuria and lipiduria

144
Q

Normal Ca2+ level is __. Besides Ca2+ itself, what other 3 things are involved in regulating Ca2+ level?

A

8.5-10.5 mg/dL

PTH, VitD, phosphate

145
Q

RBC casts in urine sample would suggest ___ while WBC casts would indicate ___.

A

RBC - glomerulonephritis

WBC - interstitial nephritis

146
Q

Which type of hydrocele needs surg?

A

Communicating hydrocele

147
Q

What biologic processes will lower pH (more acidic)?

A

Hypoventilation
Protein metabolism
Diarrhea
Urination (lose H+ but bicarb too, so it balances out)

148
Q

What is beer potomania syndrome?

A

HypoNa+ d/t binge drinking (which suppresses ADH, and makes you void the Na+ with H2O)

149
Q

What are the levels of HypoNa+?

A

severe <120 mEq/L
moderate 120-129 mEq/L
mild 130-134 mEq/L

Acute if <48hrs. Acute is bad

150
Q

RCC often occurs with __.

A

Paraneoplastic Syndrome!

151
Q

Dx of nephrolithiasis requires __, ___, labs (2), and imaging (4).

A

HxPE (DO THE PE!!!)
U/A!
Labs: CBC, BMP (to make sure no RF)
Imaging: Get an NCCT! KUB, IVP, US if preg.

152
Q

NS is aka __

Use when…

A

0.9% NaCl

Use when intravascular volume is low!

153
Q

Why do we like extracorporeal shock wave lithotripsy?

A

It’s not very invasive and you can do it outpt

154
Q

Stage IV CKD is defined as ___ and treated by…

A

GFR 15-29

HIGH-dose loop diuretic + nephro consult!

155
Q

Diarrhea can cause what acid-base imbalance?

A

Metabolic acidosis with NORMAL anion gap, d/t loss of bicarb

156
Q

Staghorn caliculi are usually associated with __ infection, and are treated with (3).

A

Proteus

Abx + urease inhibitor + perc nephrostolithotomy!

157
Q

Hypospadias can be __, __, or __ location. There are others, but these are the general ones.

A

Subcoronal
Midshaft
Penoscrotal

158
Q

Excess bicarb will make pH…

A

increase (more alkalotic)

159
Q

Most bladder CA is of what histology? Who gets it most?

A

Transitional cell carcinoma!

White men > women, >55yo

160
Q

Use hypotonic soln in __, __, and __.

A

HyperNa+
DKA
Hyperosmolar hyperglycemia

161
Q

What are the layers of the scrotum, from testis out?

A 
Testis
Tunica vaginalis, visceral layer
Epididymis
Tunica vaginalis, parietal layer
Internal spermatic fascia
Cremasteric muscle
External spermatic fascia
Skin
162
Q

The two biggest risk factors for bladder CA are __ and __.

A

Cig smoking and occupational exposure

163
Q

__ and __ losses will cause metabolic acidosis WITH an anion gap. Give an example of each.

A

Excess acid anabolism (all the -acidosises besides RTA), impaired acid elimination (kidney dysfxn)

164
Q

Kidney stones over ___ will probably need a procedure to remove them.

A

5mm

165
Q

S/s of bladder CA include ___, and ___ if it’s a lower urinary tract site.

A

PAINLESS HEMATURIA

Urinary voiding Sx

166
Q

Who do we hospitalize for kidney stones? (3ish)

A

Old people or people with comorbidities
Severe Sx/vomiting too much to take po Rx
Emergencies! (sepsis, ARF, anuria)

167
Q

How would you Tx mild hypoMg2+?

A

po Mg2+ (MagOx, MagTab, SlowMag)

168
Q

How should you examine a varicocele?

How can you confirm Dx?

A

In warm room, upright position

Scrotal U/S or L testicular venogram

169
Q

Osmolality is…

What does a high osmolality mean?

A

[solute] per L of soln

higher mOsm/L = concentrated solute = volume depletion

170
Q

ATN stands for ___. What would it look like on urine labs?

A

Acute Tubular Necrosis

Pigmented granular casts

171
Q

For Wilms’ tumor imaging: U/S where? CT where?

A

U/S: IVC, abd

CT: Chest and liver (mets)

172
Q

If it’s your kidney stone pt’s first one, and they have no significant FamHx, you only need to give them __ when they leave.

A

Dietary counseling

173
Q

Anion gap formula and normal values?

A

Anion gap = Na+ minus (Cl- + HCO3-)

8-16 mEq/L is normal.

174
Q

To say someone has hematuria, what do you need to have seen?

A

> 3 RBCs per high-power field on more than one occasion

175
Q

While they’re in the ER, how do we Tx kidney stone pts?

A

IVF
Toradol, or narcotics if need to
Metoclopramide 10mg IV/IM (antiemetic)

+abx if infection.

176
Q

How can SIADH cause hypoNa+?

A

Excess H2O caused by hypersecretion of ADH

177
Q

Struvite stones are more common in people with __.

A

UTIs, esp. d/t proteus.

178
Q

What will metabolic alkalosis look like on an ABG?

A

Low H+, high HCO3-. Then lungs will cause inc pCO2 as compensation.

179
Q

3 findings of ECG with hypoK+?

A

Flat T, ST depression, U waves.

180
Q

An RCC that’s stage IVa has reached…

A

Adjacent organs

181
Q

Tx RCC under __cm (Stage Ia) with….

Tx RCC over that (Stage Ib or II)

A

Partial nephrectomy

Radical nephrectomy

182
Q

Shock or hypoxia leads to ___. Why? What else also does that?

A

Metabolic acidosis d/t lactic acid >4mEq/L

Seizure, exercise

183
Q

Uncontrolled DM or starvation causes ___ d/t ___.

A

Metabolic acidosis d/t ketone formation

184
Q

Labs of a Wilms’ tumor pt are usually normal. __ can occur in the CBC, or __ and __ in the U/A.

A

Anemia

Microscopic hematuria, WBCs

185
Q

Dx of RAS by U/S requires…

What additional info can help you Dx correctly?

A

3.5+ x flow velocity at stenosis site

Parvus tardus waveform or resistive indices can help.

186
Q

Your pt is a frequent flyer cystine kidney stone pt. What long-term Tx should you consider?

A

Penicillamine + high-fluid intake diet

187
Q

What four s/s are indicative of potential renovasc HTN?

A

1) BP at or > 160/100
2) Fundoscopic hypertensive retinopathy changes
3) Bruits
4) Evidence of atherosclerosis

188
Q

What four BMP labs will be HIGH in a CKD pt?

A

HyperK+
Hyperphosphatemia
BUN
Cr

189
Q

Describe the difference between the renal artery of atherosclerotic RAS and FMD.

A

athero- fat + Ca2+ + immune cells

FMD - string of beads

190
Q

Ureteroscopy will use a basket catch for stones of ___ size. What if it’s too big for that?

A

<5mm

Bigger –> intracorporeal shock wave or laser lithotripsy +/- stent

191
Q

What electrolyte imbalance is often co-occurrent with hyperMg2+?

A

HypoCa2+

192
Q

What is Uremic Syndrome?

A

Azotemia with Sx

193
Q

Your pt is a frequent flyer uric acid kidney stone pt. What long-term Tx should you consider?

A

K-citrate + allopurinol + limit dietary purines

194
Q

What are three complications of cryptorchidism?

A

CA, infertility, inguinal hernias

195
Q

Two lab values that = metabolic alkalosis? Why does that occur?

A

pH >7.45 + HCO3 26mEq/L or more

d/t vomit/gastric suction/acid loss-base-gain

196
Q

What are normal values for paO2 and paCO2?

A 
O2 = 80-100 mmHg
CO2 = 35-45 mmHg
197
Q

Normal body pH is …

What is a normal bicarb?

A

7.35-7.45

HCO3 = 22-26 mEq/L

198
Q

Uric acid stones are more common in people with __, __, or __.

A

Gout
Hyperuricosuria
Chronic diarrhea

199
Q

Leaky faucet penis =

A

Gonorrhea

200
Q

How do you find macroalbuminuria?

A

Spot or 24h urine, >300mg

201
Q

How do you Tx idiopathic hydrocele?

A

Watch and wait

202
Q

The definitive Dx for renovasc HTN is…

A

Retrospective!!! If HTN resolves when RAS is Tx’d, it’s a positive Dx.

203
Q

What fundoscopy findings would raise concern for HTN progression?

A

AV nicking, papilledema. Later stage –> stage III-IV hypertensive retinopathy (hemorrhages/exudates)

204
Q

Name six of the AUA guidelines for cryptorchidism you need to know.

A
  • check testes at each well-visit
  • refer if no spontaneous descent by 6 months
  • U/S and other imaging is useless (fyi - it’s actually ok to do)
  • hormonal therapy is not recommended.
  • urologist should do surg within a year of the failed 6-mo spontaneous descent.
  • educate the pt/parents about infertility/CA risk.
205
Q

Milk-alkali syndrome doesn’t exist anymore, but why did it used to? What was it?

A

Too much Ca2+/milk to Tx ulcers –> hyperCa2+ –> inc bicarb reabsorption –> metabolic alkalosis.

206
Q

What does ATII do?

A
  • vasoconstricts efferent arteriole
  • inc aldosterone (–> inc BP)
  • inc glomerular permeability (–> more protein etc can get through into urine)
  • proinflammatory and profibrotic!
207
Q

If you tried IL-2 or interferon-alpha monoclonal antibody Rxs and your pt failed (because most do), what’s one last class of Rxs you can try?

A

Multikinase/VEGFi (Sorafenib, Sunitinib, or Temsirolimus)

208
Q

Hyaline casts in urine sample indicate…

A

Dehydration

209
Q

Normal Na+ level is __. Where is it found?

A

135-145 mEq/L

ECF, maintaining acid-base balance and VOLUME!

210
Q

Name all the possible causes of metabolic acidosis.

A 
MUDPILES:
Methanol
Uremia (--> HD stat!!)
DKA
Prop glycol
Isoniazid
LACTIC ACIDOSIS (most)
EtOH
Starvation/salicylates.
211
Q

Conservative (noncircumcision) Tx for paraphimosis?

A

Inj lido 1%, then manually try to push it back

212
Q

The diagnostic standard for RCC is…

A

CT with contrast!

213
Q

What three urine tests should you get for your CKD pt?

A

24hr urine + U/A + urine microscopy

214
Q

Most commonly, testicular cancer appears when?

A

Teenage years

215
Q

Always get an ABG on ___ and __ pts!

A

Obtunded/unresponsive (esp. if clearly septic) and significant resp. distress!!

216
Q

Define CKD.

A

GFR < 60mL/min for more than 3 months with persistent proteinuria/hematuria/other urine sediment

217
Q

What popn is less likely to get renovasc HTN?

A

African-Americans (most likely essential HTN)

218
Q

After six months without spontaneous descent, what is the Tx for cryptorchidism?

A

Orchiopexy

can try HcG Rx, but not a high success rate and playing with hormones is scary

219
Q

What’s your three-step process for approaching an acid-base imbalance question?

A

1) acidotic or alkalotic?
2) does the pCO2 account for this?
3) is this appropriate compensation? (if not, whether too high or too low, = NO. No = mixed imbalance!)

220
Q

What four things are we generally looking for on NCCT if we expect renal caliculi?

A 
DNRs:
Dilation
Nephromegaly
Rim Sign
Stranding
221
Q

What will respiratory acidosis look like on an ABG?

A

High H+, high pCO2. Then kidney will cause inc HCO3- as compensation.

222
Q

Use 3% saline at ___mL if ASx <130mEq Na+

Use 3% saline at __mL if any Sx and Na+<130.

A

50mL

100mL, repeat in half hour

223
Q

Kidney failure is stage __ CKD, measured by…

A

V

GFR <15 or on HD

224
Q

Tx hypoNa+ by relieving Sx, avoiding __, and decreasing __.

A 
Osmotic demylination (central pontine) d/t overcorrection
Dec ICP
225
Q

Sx of hyperNa+?

How do you Tx it, and at what rate?

A

AMS and all sorts of neuro issues.

Monitor q2hr; use D5W 3-6mL/kg/hr + desmopressin if DI pt

1-2 mEq/L/hr is ideal rate

226
Q

RAS in women <40yo should add __ onto your DDx.

A

Fibromuscular dysplasia

227
Q

Most common abd tumor in peds is __, then __.

A

Neuroblastoma, then Wilms’ tumor

228
Q

Usually Stage IVb RCC is pretty untreatable, but if your pt has minimal tumor burden (kidney gone), and only lung or node mets, then you can consider ___.

A

IL-2 or interferon-alpha monoclonal antibody Rxs.

(Still, only 15% will respond to that).

229
Q

Why would a pt have metabolic acidosis WITHOUT an anion gap…?

A

Losing bicarb.

230
Q

Two lab values that = respiratory alkalosis? Why does that occur?

A

pH >7.45 + paCO2 <35mmHg

d/t hyperinflation

231
Q

What’s the difference between a BMP and CMP?

A

CMP is + LFTs

232
Q

How does a unilateral stenotic renal artery affect the RAAS?

What mediates unilateral RAS?

A

Affected side - Dec pressure distal to the stenosis –> inc renin –> inc ATII
ATII–> vasoconstriction at efferent arteriole and inc aldosterone –> inc BP!

Unaffected side - natriuresis.

Renin is ALWAYS elevated! (RENIN-MEDIATED)

233
Q

First-line Tx for RAS is…

A

Rxs.
(ACEi or ARB +/- CCB, +/- statin, +/- antiplt)
Then give them to Nephro!

234
Q

What is uremia and how do you measure it?

A

Bad inflammation d/t lots of accumulated toxins

Measured with Cr and urea.

235
Q

In men, ___ can be an additional Sx that tips you off to RCC.

A

Varicocele esp. in L side

236
Q

Bladder CA that IS muscle-invasive (stages __ and up) are Tx’d with neoadjuvant chemo (__, __, __, __) and then…

A

T2
MVAC (MTX, Vincristine, Adriamycin, Cisplatin), then
Radical cystectomy w/ regional lymph node dissection!

237
Q

Name/briefly describe three places stones can get stuck.

A

UPJ (ureteropelvic junction) - upper; won’t pass on its own
UVJ (ureterovesicular junction) - lower; most are here.
Pelvic brim - middle, where ureter goes over iliac artery

238
Q

What is a crystalloid IVF? Give an example or three.

A

Soln does cross cell membrane (requires more product)

IV NS, D5W, LR

239
Q

Cardiac Sx of hyperMg2+ include __, __, and __.

A

Brady, hypotn, cardiac arrest

240
Q

You did your metabolic workup on your frequent-flyer kidney stone pt. It came back with high PTH. Tx the hyperparathyroidism– but why did that cause stones in the first place?

A

Resorptive hypercalcuria

241
Q

What part of the kidney does tubular reabsorption take place in?

A

From the renal tubule to the peritubular capillaries

242
Q

Your pt has HTN, so you put them on either an ACEi or ARB. Suddenly they get azotemia. What is going on?

A

Bilateral renovasc HTN (or unilateral, if they only had one working kidney to start with)

This is CLASSIC board question for Renal Artery Disease!

243
Q

What is third spacing? Give two examples.

A

When fluid overload goes into tissue - eg in trauma, burns, sepsis
Pleural effusion and ascites

244
Q

What kills most RF patients?

A

CVA or MI.

245
Q

Hyperventilation leads to ___.

Hypoventilation leads to ___.

A 
Hyper = resp alkalosis
Hypo = resp acidosis
246
Q

What imaging could you order to confirm hydrocele?

A

Scrotal U/S

247
Q

We only really revasc HD-significant stenosis. What is that defined as?

A

70% blocked (as seen on angio)
-OR-
50-70% blocked (as seen on angio) PLUS one of the following: 10mmHg or less resting gradient, 20mmHg or less systolic/hyperemic gradient, or 0.8 renal fraction flow.

248
Q

Do all renovasc HTN pts have renal dysfxn?

A

No!

249
Q

Who gets Wilms’ tumors most often?

A

Kids <6yo, male>female

250
Q

What are the two most common causes of ESRD?

A

Diabetic glomerular disease, and

Hypertensive nephropathy

251
Q

CKD Sx start at stage ____ and include… (7ish)

A

Stage III or IV

N/V, sleep issues, encephalopathy, muscle twitch/cramp, swollen LE, pruritis.

252
Q

How can hyperglycemia cause hypoNa+?

A

High SrGlu –> released H2O –> diluted Na+ as a side effect

so, caution with administration of hypertonic mannitol, you may cause hypoNa+

253
Q

What is the most common cause of hypoK+?

A

Rxs! d/c these first!

Loop/thiazide diuretics, insulin, b-adrenergic

254
Q

U/A in a pt with infection + kidney stones could show __ and __. Infected stones need to be admitted, that’s bad!!

A

Pyuria WITH bacturia (pyuria alone could be no infection)
High pH urine
Nitrates/leukocyte esterase

255
Q

Hypotonic soln has a ___ [solute], so solution will…

A

Lower [ ]

Cause cell swell

256
Q

What are some options for Tx’ing phimosis?

A

Manual stretching, cool it on the aggressive jerking off, circumcision

257
Q

Mg2+ levels are controlled by __ and __.

A

Int absorption and renal excretion.

258
Q

How does bilateral stenotic renal artery affect the RAAS?

What mediates bilateral RAS?

A

Transiently inc renin/ATII/aldosterone, then inc volume –> dec renin

VOLUME-MEDIATED

259
Q

Repeated and continued activation of the RAAS –> ____.

A

Microalbuminuria and proteinuria!

260
Q

What are you listening for when you auscultate for bruits in a HTN pt? What would the presence of it indicate?

A

A systolic-diastolic bruit near epigastrium

FMD! (could also be other RAS)

261
Q

Common causes of hypoCa2+ include __, __, ___, __, and __.

A
  • Parathyroid disease/ectomy
  • Thyroid disease/ectomy
  • CRF
  • VitD-def
262
Q

In what two cryptorchidism situations would you get endocrine labs in addition to calling a consult? (they can interpret)

A

Cryptorchidism with hypospadias, or you can’t feel either testicle

263
Q

What is a colloid IVF? Give an example or two. When would we use it?

A

Soln that is too big to cross the cell membrane
Albumin, dextran
Used in shock to inc fluid very quickly

264
Q

Define staghorn stone. What are they made of?

A

Upper urinary tract stones that involve the renal pelvis and extend into at least 2 calyces, WITH INFECTION.
Struvite

265
Q

Two pathognomic physical exam findings of hypoCa2+ are __ and __!

A

Chvostek (facial tap)

Trousseau (wrist thing)

266
Q

Why do kidney stones occur?

A

Ca2+, PO43-, and uric acid get supersaturated in the urine when you’re in a low-flow state

267
Q

Under 115mEq, a hypoNa+ pt becomes at risk for… (4ish)

A
  • HA
  • Lethargy/coma
  • Respiratory arrest
  • Pulm edema
268
Q

Let’s say you can’t get a 24hr urine for whatever reason. How can you check for proteinuria and what level is your cutoff?

A

Spot urine - prot:Cr >0.2 is abnormal.d\

269
Q

ADH is secreted by ___. Malfunction of that = __.

What causes it to be released?

A

Posterior pituitary
Dysnatremia
Dec blood volume

270
Q

What will respiratory alkalosis look like on an ABG?

A

Low H+, low pCO2. Then kidney will cause dec HCO3- as compensation.

271
Q

You see that the pH is off. So it’s alka/acidosis. Great. Then, ask yourself…

A

“Does pCO2 explain the problem?”
(ie, if the pt is acidic, is the pCO2 high?
If the pt is alkalotic, is the pCO2 low?)

No?  = metabolic
Yes? = respiratory.
272
Q

Paraphimosis is an EMERGENCY. Who gets it?

A

Partially circumcised/uncircumcised men

273
Q

Besides PTRAS, the number-one recommendation for FMD pts is __.

A

Balloon angioplasty + bailout stent!

274
Q

3 Tx options for hyperCa2+?

A
  • NS
  • Salmon calcitonin + bisphosphonate
  • Zoledronic acid
275
Q

U/S is really only a great choice if stone is… (5)

A
  • in a pregnant lady or peds
  • in the actual kidney (not ureter)
  • if you think there’s hydronephrosis going on.
  • if you think it might actually be reproductive system or GB.
  • if your pt is a repeat offender and you expect this.
276
Q

Nothing you’ve tried has worked and you can’t get into the OR for your paraphimosis pt. What do you do?

A

Dorsal slit procedure. Or try DIY.

277
Q

The scrotum should be __ and __ compared to the rest of the skin.

A

Darker

Rugated

278
Q

What stones are good candidates for perc nephrostolithotomy? What if that fails?

A

Proximal; >2cm; anything complex.

Only other option is open nephrostomy (rare).

279
Q

Why might you go for renal artery bypass over revasc/just Rx? (3ish)

A

If there’s evidence of athero in the aorta, or:

  • complex FMD
  • atheroRAS that hits smaller branches of artery too
280
Q

The paroxysm of pain lasts about ___ in nephrolithiasis pts.

A

20-60min

281
Q

What part of the kidney does glomerular filtration take place in?

A

Glomerular capsule

282
Q

Bladder CA that is NOT muscle-invasive (stages __, __, and __) are Tx’d with surg (__ or __), or with ___ placement.

A

Ta, T1, or CIS
Endoscopic TURBT, or radical cystectomy
Intravesicle instillation of BCG or chemo

283
Q

Hypoalbuminemia will cause a ___ lab!

A

PseudohypoCa2+! Correct it first!

284
Q

“Bag of worms” =

A

Varicocele (dilation of pampiniform plexus)

285
Q

The most common cause of RAS is __!

A

Atherosclerosis of the renal artery!

286
Q

What other two electrolyte imbalances can cause hypoK+?

A

HypoMg2+ and hyperaldosteronism

287
Q

For microalbuminuria, you could use a spot test, a dipstick, or a 24hr urine. What would a + be on each?

A

Spot - 30-300mg/L
Dipstick - +1
24h - 30-300mg/24hr

288
Q

The most useful imaging tools to INITIALLY Dx RAS are __ and __, then U/S, then captopril scintigraphy/renography (rarely used). What are important to note about the top two choices?

A 
MRA (gad needed so avoid in CrCl<30!!!)
Spiral CT (dye needed so only for CrCl>60!!)
289
Q

The main procedure chosen for RAS revasc is __.

Who especially is a good candidate?

A

PTRA+/-stent

FMD pts

290
Q

Two lab values that = metabolic acidosis? Why does that occur?

A

pH <7.35 + HCO3 22mEq/L or less

d/t GI/acid gain-base loss

291
Q

If the primary issue is a HCO3- change…

A

It’s metabolic!

292
Q

Why do cryptorchidism pts get inguinal hernias?

A

Patent processus vaginalis

Clin Med (4 decks)

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