Nephro / GU Flashcards
1
Q
microhematuria is >___RBCs/hpf
A
3
2
Q
do NSAIDs work on afferent or efferent arteriole?
A
afferent
3
Q
do ACE inhibitors work on afferent or efferent arteriole?
A
efferent
4
Q
Action site of aldosterone
A
distal convulted tubule
5
Q
Action site of anti-diuretic hormone
A
collecting duct
6
Q
does ADH make you pee more or less?
A
less
7
Q
once a CKD pt hits stage ___, there is no chance of reversal of their condition
A
4
8
Q
most important and earliest sign of kidney damage
A
proteinuria
9
Q
CKD finding on urine microscopy
A
- Broad waxy casts
10
Q
MCC of CKD
A
DM
11
Q
2nd MCC of CKD
A
HTN
12
Q
leading cause of morbidity and mortality in pts at every stage of CKD
A
CVD
13
Q
preferred test to dx ckd
A
- Urine “spot” albumin-to-creatinine ratio (UACR) preferred
14
Q
BP goal for CKD
A
<120
15
Q
nutritional counseling for CKD. limit 4 things. take 2 things
A
o Limit protein intake to 1.3mg/kg/day. 0.8mg if DM or GFR<30 and not on dialysis.
o Limit salt (<2g/day), K+, phosphate intake
o Ca supplementation + cholecalciferol/ergocalciferol
16
Q
treat anemia of CKD if Hgb is <________
A
10
17
Q
tx for Hyperphosphatemia in CKD
A
dietary phosphate binders (1st line = Ca carbonate, Ca acetate, sevelamer
18
Q
ESRD is GFR <____
A
15
19
Q
statins for all CKD pts >___ y/o
except do not start in ESRD
A
50 y/o
20
Q
AEIOU indications for dialysis
A
- A – acidosis (metabolic)
- E – electrolytes, K+ >6.5-7 or EKG changes w/ hyperkalemia
- I – intoxication (acute poisoning w/ dialyzable substance) SLIME
- O – overload of fluid (pulm edema; loop diuretic if renal function can tolerate it)
- U – uremia complications (pericarditis, encephalopathy, seizure, vomiting)
21
Q
what are the SLIME dialysable substances if ingested?
A
- S – Salicylic acid/salicylate (aspirin)
- L – lithium
- I – isopropanol
- M – magnesium laxatives (renal pts should avoid laxatives)
- E – ethylene glycol (anti-freeze)
22
Q
polycystic kidney dz is ASW what 3 CV issues
A
aortic root and cerebral aneurysms. MVP
23
Q
tx for polycystic kidney dz
A
transplant
24
Q
2 causes of AKI from urine casts: WBC
A
interstitial nephritis, pyelonephritis
25
1 cause of AKI from urine casts: RBC
glomerulonephritis
26
1 cause of AKI from urine casts: Broad/waxy casts
CKD
27
3 causes of AKI from urine casts: hyaline casts
exercise, diuretics, concentrated urine/dehydration
28
Renal tubular epithelial casts
acute tubular necrosis (ATN)
29
Cause of Fatty casts (oval fat bodies)
nephrotic syndrome, formed in distal nephron
30
Cause of muddy brown casts
ATN
31
FENa in pre-renal AKI
low (<1%)
32
FENa in intra-renal AKI
high (>2%)
33
* Urine Sodium Concentration in pre-renal AKI
low. in attempt to conserve sodium
34
* Urine Sodium Concentration in intra-renal AKI
high d/t impaired tubular function induced by tubular injury
35
most sensitive lab value for AKI and kidney function
GFR
36
for a HTN pt w/ AKI, should you continue or discontinue ACE-i?
discontinue
37
what comorbidities can cause pre-renal AKI (2)
o Heart failure and liver failure (intravascular volume is depleted) – “third spacing” into peritoneal cavity, soft tissue edema
38
o Elevated BUN:Cr ratio of >20:1 indicates ____
pre-renal AKI
39
specific gravity in prerenal AKI
elevated
40
immediate fluid tx for prerenal AKI
1L bolus NS
41
MC type of intrarenal AKI
ATN
42
what type of AKI from these meds:
IV contrast dye (onset is 24-48 hrs after; one of most common causes)
Aminoglycosides
Methotrexate
Ethylene glycol (antifreeze)
Amphotericin B
ATN
43
o >10 granular casts = 100% specific for ____
ATN
44
does ATN resolve w/ aggressive volume resus?
no
45
does ATN p/w hematuria?
no
46
test to order for suspected rhabdomyolysis
serum CK
47
1st line tx for rhabdomyolysis
aggressive fluid resus
48
edema and inflammation between renal tubules that impairs function
* Acute Interstitial Nephritis (AIN):
49
MCC of AIN
meds (usually abx or NSAIDS)
50
NSAIDs cause what type of intrarenal AKI
AIN
51
classic triad of AIN sx
o Classic triad: rash, fever, eosinophilia
52
gold standard way to dx AIN
biopsy
53
MC infectious cause of glomerulonephritis
o Post-streptococcal glomerulonephritis
54
which AKI? o Sudden onset of hematuria (tea/cola color), proteinuria, red blood cell casts in urine
glomerulonephritis
55
MCC of AKI in peds
Hemolytic Uremic Syndrome (HUS) (rare)
56
triad of HUS
* Triad: AKI, hemolytic anemia, thrombocytopenia
57
tx for HUS and TTP
plasmaphoresis, consider dialysis
58
MCC of post renal AKI
BPH
59
gold standard to quantify proteinuria
24 hr urine protein
60
nephritic proteinuria is ____mg to ___g /day
150mg-3.5g/day
61
nephrotic proteinuria is >____ / day
3.5g
62
order what 2 testing for suspected orthostatic proteinuria
* Collect first morning UA + micro and UPCR
63
proteinuria <3.5g but no hematuria. what to order next?
UPEP . o Helps screen for M proteins of multiple myeloma
64
multiple myeloma will have ___ proteins on UPEP
M proteins of multiple myeloma
65
after protienuria detected on UA, order ____
microsopy of urine to look for casts, RBCs
66
1 poss complications of nephrotic syndrome
DVT, PE due to hypercoagulation
67
Pt w/ foamy urine and edema has protienuria on UA and low albumin and high lipids in serum. dx?
nephrotic syndrome
68
what type of nephrotic syndrome occurs due to loss of negative charge of membrane
minimal change dz
69
how to dx minimal change dz and expected result
biopsy (shows diffuse loss of podocytes but no immune complexes)
70
tx for minimal change dz (3)
o Corticosteroids (Prednisone)
o Low sodium diet
o Diuretic to manage edema
71
Focal Segmental Glomerulosclerosis (FSGS) typically presents w/ : nephritic or nephrotic syndrome?
nephrotic syndrome
72
how to dx Focal Segmental Glomerulosclerosis (FSGS)
o Renal biopsy (distinct histologic appearance)
73
is Focal Segmental Glomerulosclerosis (FSGS) reversible?
no
74
this tx is for?
o Corticosteroids, cyclosporine, tacrolimus
o ACE/ARB
o Low sodium diet
FSGS
75
* Glomerular basement membrane thickening from deposited immunoglobulin (IgG)
Membranous Nephropathy (primary cause of nephrotic syndrome)
76
o Acute onset Hematuria + proteinuria + pyruria + HTN + oliguria. dx?
nephritic syndrome
77
MC type of nephritic syndrome
o IgA nephropathy (Berger’s
78
order what 5 tests for nephrotic syndrome to find cause. (After UA with micro) (2 infectious tests, a protein test, a rheum test, and antibody)
ANA, SPEP/UPEP, hep B/C, HIV, anti-PLA2R
79
+PLA2R antibodies in serum is what type of nephrotic syndrome?
Membranous Nephropathy (primary cause)
80
Order these tests for what suspected dx?
ANCA, anti-GBM, C3/C4, cryoglobulins
for nephritic syndrome
81
what % of pts w/ SLE have nehritis?
50%
82
Post-streptococcal Glomerulonephritis (PSGN) is a type____ hypersensitivity reaction
3
83
do abx prevent PSGN?
no
84
timeframe for PSGN after acute GABHS
10-30 days
85
gross or microhematuria in PSGN?
gross
86
test result of C3 in PSGN
decreased
87
order what additional blood test for suspected PSGN and expected result
o Increased Antistreptolysin-O titer (ASO)
88
* Most common cause of glomerulonephritis
IgA Nephropathy (aka Berger dz)
89
for suspected IgA Nephropathy (aka Berger dz), ask about what hx?
URI or GI infx (usually 2 days after). Infects Gastric or Airway
90
2 types of nephritic syndrome that are ANCA +
Vasculitis w/ Polyangiitis (Wegener’s Granulomatosis)
Henoch-Schonlein Purpura / IgA vasculitis
91
Anti-GBM Disease is aka ____
(Goodpasture’s Syndrome)
92
besides the kidneys, (Goodpasture’s Syndrome) affects what other organ?
lungs
93
all pts w/ (Goodpasture’s Syndrome) will have a + _______ antibody result
o Positive anti-GBM antibody
94
2 roles of the kidneys in acid-base balance
Kidneys excrete H+ ions AND produce/reabsorb HCO3-
95
best test to assess acid base status
ABG
96
which is worse: normal anion gap or high gap metabolic acidosis
high
97
MC type of high anion gap metabolic acidosis in hospitalized patients
lactic acidosis (can be from CO poisoning, DM, malignancy, chronic alcoholism; lactic acid is produced when oxygen levels low
98
tx for pt w/ CKD p/w metabolic acidosis
o Oral bicarbonate sodium supplements
o Protein restriction in diet (35-40g/day)
Breakdown of protein causes H+ production
Renal diet = low sodium, low protein
99
2 blood abnormalities in excessive diarrhea
* Normal anion gap metabolic acidosis (Loss of bicarbonate through alkaline stool)
* Hypokalemia (stool also has high K concentration)
100
K and acid base serum status in type 4 renal tubular acidosis (* From decreased aldosterone or aldosterone resistance )
high K
o Hyperchloremic metabolic acidosis
101
* Rapid isotonic saline can cause what acid-base abnormality
hyperchloremic acidosis
102
what compensatory method will all pts have for metabolic alkalosis
hypoventilation (even if it results in hypoxemia)
103
excessive vomiting can cause what acid base imbalance
hypochloremic metabolic alkalosis
104
is metabolic acidosis or alkalosis more likely to cause hypokalemia?
alkalosis
105
MUDPILES of high anion gap metabolic acidosis
methanol
uremia
DKA
paraldehyde/paracetamol/Propylene glycol
isoniazid
lactic acidosis
ethanol
salicylates
106
is renal artery stenosis a primary or secondary cause of HTN
secondary
107
MCC of renal artery stenosis
atherosclerosis
108
pt has Elevation in creatinine of more than 30% after starting ACEi. suspect what dx?
renal artery stenosis
109
best inital test for suspected renal artery stenosis
duplex US
110
gold standard test for suspected renal artery stenosis
renal arteriogram
111
pharm or surgery for unilateral RAS?
pharm
112
pharm or surgery for bilateral RAS?
surgery
113
when not to give ACE/ARB for RAS?
if b/l
114
consider what dx in Premenopausal Caucasian female w/ refractory HTN
Fibromuscular Dysplasia
115
* Non-atherosclerotic, non-inflammatory dz of medium sized arteries
Fibromuscular Dysplasia
116
1st line med for Fibromuscular Dysplasia
ACE/ARB
117
order what imaging for Fibromuscular Dysplasia + expected result
CTA will show pearls on a string
118
pt w/ * Generalized fatigue
* Weakness
* Paresthesia
* Depressed/absent deep tendon reflexes
* Ileus (decreased/absent bowel sounds)
* Palpitations
what electrolyte abnormality?
hyperK
119
tx to stabilise myocardium in hyperK
calcium gluconate IV
120
2 meds to shift K into cells in hyperK + fluid requirement during tx
o IV insulin, inhaled albuterol
o Give 1 amp of D50 IV before you give insulin
121
1st and 2nd MC electrolyte imbalances in hospitalised pts
1 = hypoNa
2 = hypoK
122
MC cardiac compl in hypoK
afib
123
txing hypoK but nothing it's not improving. give what?
magnesium
124
o For every 10mEq KCl given, there is a serum K+ rise of ____mEq/L.
0.1
125
rate/amount to give of KCl for hypoK for all 3 routes
(40 mEq PO; 10/hr via peripheral line, 20/hr via central line)
126
after starting pt on a loop or thiazide diuretic, monitor ____ 2-3 wks later
K
127
MC type of hyperNa
hypovolemic
128
urine Na in hypovolemic hyperNa is ____
low
129
tx for hypovolemic hyperNa
IV NS
130
diabetes insipidus causes what type of hyperNa
euvolemic
131
* If labs say hyponatremia, and serum osmolality is high, this is ______
false hypoNa (ususally d/t high glucose)
132
SIADH is which type of hypoNa
euvolemic
133
serum and urine osmolality in SIADH
low serum
high urine
134
hypoNa Rate of correction must be <_____mEq/day to avoid central pontine myelinolysis, especially if chronic and Na < 120-125
4-6
135
pt w/ n/v, indigestion, lethargy, memory loss, bone pain, back back to flank pain. suspect what electrolyte abnormality?
hyperCa
136
MCC of hyperCa in outpatient
hyperparathyroidism
137
pt w/ arrhythmia, spasms, muscle cramps, numbness in fingers/toes/perioral. suspect what electrolyte abnormality?
hypoCa
138
PE test to perform for suspected hypoCa
tap in front of ear
* Chovstek’s sign (ipsilateral cheek contraction from tapping in front of ear)
139
tx for acute and symptomatic hypoCa
: IV calcium gluconate
140
1st sign of hyperMg
decreased DTRs
141
in DKA, don't give insulin until K is >________
3.3
142
weak sphincter tone causes _____ incontinence
stress
143
detrusor muscle overactivity causes ______ incontinence
urge
144
gold standard tx for stress incontinence
o Surgical placement of mesh sling
145
1st line tx for urge incontinence
Anticholinergics (oxybutynin, tolterodine, solifenacin, festerodine, darinfenacin, trospium)
146
2 tests to order for incontinence
Urinalysis to rule out UTI
Postvoid residual urine volume to identify urinary retention
Overflow has a high PVR
Stress and urge have a normal/low PVR
147
overactive bladder (OAB) has >___ at night or >___voids per 24 hrs
2, 8
148
best tx option for overflow incontinence
self-cath
149
kidney stones <___mm usually pass spontaneously
<5mm
150
3 places where kidney stones get stuck
o Ureterovesical junction (UVJ) entrance of ureter into bladder. Causes abrupt urgency, freq, bladder pressure, dribbling small amounts, testis/labial discomfort
o Ureteropelvic junction (UPJ) junction between renal pelvis and ureter
o Where ureter crosses iliac vessels
151
MC type of kidney stone
* Calcium oxalate
152
what type of kidney stones are NOT visible on KUB, but visible on CT
uric acid stones
153
For suspected stone, besides hx of kidney stones, as k about PMH of: (2)
gout
chronic UTIs
154
for suspected kidney stone, ask pt about recent _______
dehydration/hydration status
155
is hematuria or microhematuria more common in kidney stones?
micro
156
o Testis/labial discomfort, abrupt urgency/frequency, bladder pressure, dribbling suggest stone is where?
UVJ
157
gold standard for kidney stone dx
o Stone protocol CT (non-contrast abdomen-pelvis)
158
kidney stones ___mm or more will NOT pass spontaneously
10
159
med to assist w/ passing kidney stone
tamsulosin 0.4mg one PO QHS, must strain urine
160
CIs for ESWL (extracorporeal shock wave lithotripsy) (4)
pregnancy, UTI, NSAID use, antiplatelet and anticoagulant use
161
bladder situation that contributes to bladder stones
voiding dysfunction that allows urine stasis
* BPH
* Neurogenic bladder
* Urethral stricture
* Incomplete emptying
162
white F w/ daytime and nighttime urinary frequency, urgency, and pelvic pain . dx?
interstitial cystitis
163
gold standard for dx of interstitial cystitis
cystoscopy w/ hydrodistension: Hunner’s ulcers
164
MCC of obstructive AKI
BPH
165
1st line class of meds for BPH
Alpha1-adrenergic blockers
166
What class? tamsulosin, doxazosin, terazosin
Alpha1-adrenergic blockers
167
which class of meds can shrink the prostate
* 5-alpha reductase inhibitors (finasteride)
168
for UTI/voiding issues in young men, consider _______ (dx)
urethral stricture
169
complication of BPH: painful inability to urinatee
urinary retention
170
look for what comorbidity in pts w/ ED
CVD
171
1st line meds for ED
Phosphodiesterase-5 inhibitors (PDE5) : sildenafil (Viagra), tadalafil (Cialis), vardenafil, avanafil
172
CI for PDE5 inhibitors like viagra
nitroglycerin, angina
173
what conditions (2) in the scrotum will transilluminate?
hydrocele, spermatocele
174
* MCC of painless scrotal swelling
hydrocele
175
definitive dx for hydrocele
US
176
ok to drain hydrocele?
no
177
varicocele aching, heavy pain happens when?
end of day, after standing for a long time
178
what happens to varicocele when pt lays supine? think what dx if this doesn't happen?
* Goes away when lying supine (think renal rumor if not)
179
do what test on PE for suspected testicular torsion and expected result?
* Absence of ipsilateral cremasteric reflex
180
how long until ischemia and loss of testicle in testicular torsion?
6 hr
181
if testicle hasn't descended by what age, refer to srugery
1 y/o
182
uncircumcised DM pts are at risk for what penis dx?
balanitis
183
tx for balanitis (med + supportive)
topical antifungals (nystatin, lotrisone) or steroids, good hygeine, warm soaks w/ epsom salts
184
MCC of UTI
e coli
185
2 abnormalities on UA from phenazopyridine (pyridium) or OTC Azo
orange urine, + nitrites
186
3 1st line tx options for uncomplicated UTI
Bactrim BID x 3 days, nitrofurantoin (Macrobid) BID x 5 days (esp if hx of C diff or on coumadin), Fosfomycin 3g sachet single dose
187
must order ____ for complicated but not uncomplicated UIT
culture
188
UTI tx for preg - 4 options
Keflex, Augmentin, fosfomycin, cefpodoxime
189
clean or dirty catch UA for UTI?
clean
190
UTI UA will be + for ___ and ___
o Leukocyte esterase, nitrites
191
urology referral if male <___ y/o or F >40 y/o w/ _____+ UTIs in 1 year
M <65
F 2+
192
when to tx asymptomatic bacteruira
preg
193
expected result on urine microscipy for pyelo
WBC casts
194
1st line tx for pyelo
FQ X 5 days. 7 if cipro
195
epidiymitis onset: sudden or gradual?
gradual
196
* Gradual onset of pain
* Edematous, erythematous scrotal skin
* Enlarged, tender testis
orchitis
197
if a pt has microhematuria, hx of smoking, >40, must get what 2 tests
cystoscopy, CT urogram
198
when feeling for prostate CA, where are nodules most likely to be?
peripheral zone
199
if you feel a psotate nodule on DRE, next steps?
order PSA and refer to urology
200
20 y/o M p/w gynecomastia. besides meds, ask about / do PE for _______
masses on testes (* Irregular, firm, nontender)
201
Pt can have falsely elevated fena if on what class of meds?
Diuretics
202
In what part of the prostate does benign prostatic hyperplasia most commonly develop?
A: central zone
B: fibromuscular stroma
C: peripheral zone
D: transitional zone
D: transitional zone
203
When instituting diuretic therapy for patients with heart failure, which of the following is considered the treatment of choice as first-line therapy in a failing kidney due to its improved sodium clearance?
Hydrochlorothiazide (Diuril)
Bumetanide (Bumex)
Spironolactone (Aldactone)
Acetazolamide (Diamox)
Bumetanide (Bumex)
