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Clin Med > Nephro / GU > Flashcards

Nephro / GU Flashcards

1
Q

microhematuria is >___RBCs/hpf

A

3

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2
Q

do NSAIDs work on afferent or efferent arteriole?

A

afferent

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3
Q

do ACE inhibitors work on afferent or efferent arteriole?

A

efferent

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4
Q

 Action site of aldosterone

A

distal convulted tubule

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5
Q

 Action site of anti-diuretic hormone

A

collecting duct

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6
Q

does ADH make you pee more or less?

A

less

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7
Q

once a CKD pt hits stage ___, there is no chance of reversal of their condition

A

4

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8
Q

most important and earliest sign of kidney damage

A

proteinuria

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9
Q

CKD finding on urine microscopy

A
  • Broad waxy casts
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10
Q

MCC of CKD

A

DM

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11
Q

2nd MCC of CKD

A

HTN

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12
Q

leading cause of morbidity and mortality in pts at every stage of CKD

A

CVD

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13
Q

preferred test to dx ckd

A
  • Urine “spot” albumin-to-creatinine ratio (UACR) preferred
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14
Q

BP goal for CKD

A

<120

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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

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16
Q

treat anemia of CKD if Hgb is <________

A

10

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17
Q

tx for Hyperphosphatemia in CKD

A

dietary phosphate binders (1st line = Ca carbonate, Ca acetate, sevelamer

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18
Q

ESRD is GFR <____

A

15

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19
Q

statins for all CKD pts >___ y/o
except do not start in ESRD

A

50 y/o

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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)
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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)
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22
Q

polycystic kidney dz is ASW what 3 CV issues

A

aortic root and cerebral aneurysms. MVP

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23
Q

tx for polycystic kidney dz

A

transplant

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24
Q

2 causes of AKI from urine casts: WBC

A

interstitial nephritis, pyelonephritis

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25
Q

1 cause of AKI from urine casts: RBC

A

glomerulonephritis

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26
Q

1 cause of AKI from urine casts: Broad/waxy casts

A

CKD

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27
Q

3 causes of AKI from urine casts: hyaline casts

A

exercise, diuretics, concentrated urine/dehydration

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28
Q

Renal tubular epithelial casts

A

acute tubular necrosis (ATN)

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29
Q

Cause of Fatty casts (oval fat bodies)

A

nephrotic syndrome, formed in distal nephron

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30
Q

Cause of muddy brown casts

A

ATN

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31
Q

FENa in pre-renal AKI

A

low (<1%)

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32
Q

FENa in intra-renal AKI

A

high (>2%)

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33
Q
  • Urine Sodium Concentration in pre-renal AKI
A

low. in attempt to conserve sodium

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34
Q
  • Urine Sodium Concentration in intra-renal AKI
A

high d/t impaired tubular function induced by tubular injury

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35
Q

most sensitive lab value for AKI and kidney function

A

GFR

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36
Q

for a HTN pt w/ AKI, should you continue or discontinue ACE-i?

A

discontinue

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37
Q

what comorbidities can cause pre-renal AKI (2)

A

o Heart failure and liver failure (intravascular volume is depleted) – “third spacing” into peritoneal cavity, soft tissue  edema

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38
Q

o Elevated BUN:Cr ratio of >20:1 indicates ____

A

pre-renal AKI

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39
Q

specific gravity in prerenal AKI

A

elevated

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40
Q

immediate fluid tx for prerenal AKI

A

1L bolus NS

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41
Q

MC type of intrarenal AKI

A

ATN

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42
Q

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

A

ATN

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43
Q

o >10 granular casts = 100% specific for ____

A

ATN

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44
Q

does ATN resolve w/ aggressive volume resus?

A

no

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45
Q

does ATN p/w hematuria?

A

no

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46
Q

test to order for suspected rhabdomyolysis

A

serum CK

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47
Q

1st line tx for rhabdomyolysis

A

aggressive fluid resus

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48
Q

edema and inflammation between renal tubules that impairs function

A
  • Acute Interstitial Nephritis (AIN):
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49
Q

MCC of AIN

A

meds (usually abx or NSAIDS)

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50
Q

NSAIDs cause what type of intrarenal AKI

A

AIN

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51
Q

classic triad of AIN sx

A

o Classic triad: rash, fever, eosinophilia

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52
Q

gold standard way to dx AIN

A

biopsy

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53
Q

MC infectious cause of glomerulonephritis

A

o Post-streptococcal glomerulonephritis

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54
Q

which AKI? o Sudden onset of hematuria (tea/cola color), proteinuria, red blood cell casts in urine

A

glomerulonephritis

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55
Q

MCC of AKI in peds

A

Hemolytic Uremic Syndrome (HUS) (rare)

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56
Q

triad of HUS

A
  • Triad: AKI, hemolytic anemia, thrombocytopenia
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57
Q

tx for HUS and TTP

A

plasmaphoresis, consider dialysis

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58
Q

MCC of post renal AKI

A

BPH

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59
Q

gold standard to quantify proteinuria

A

24 hr urine protein

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60
Q

nephritic proteinuria is ____mg to ___g /day

A

150mg-3.5g/day

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61
Q

nephrotic proteinuria is >____ / day

A

3.5g

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62
Q

order what 2 testing for suspected orthostatic proteinuria

A
  • Collect first morning UA + micro and UPCR
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63
Q

proteinuria <3.5g but no hematuria. what to order next?

A

UPEP . o Helps screen for M proteins of multiple myeloma

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64
Q

multiple myeloma will have ___ proteins on UPEP

A

M proteins of multiple myeloma

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65
Q

after protienuria detected on UA, order ____

A

microsopy of urine to look for casts, RBCs

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66
Q

1 poss complications of nephrotic syndrome

A

DVT, PE due to hypercoagulation

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67
Q

Pt w/ foamy urine and edema has protienuria on UA and low albumin and high lipids in serum. dx?

A

nephrotic syndrome

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68
Q

what type of nephrotic syndrome occurs due to loss of negative charge of membrane

A

minimal change dz

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69
Q

how to dx minimal change dz and expected result

A

biopsy (shows diffuse loss of podocytes but no immune complexes)

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70
Q

tx for minimal change dz (3)

A

o Corticosteroids (Prednisone)
o Low sodium diet
o Diuretic to manage edema

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71
Q

Focal Segmental Glomerulosclerosis (FSGS) typically presents w/ : nephritic or nephrotic syndrome?

A

nephrotic syndrome

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72
Q

how to dx Focal Segmental Glomerulosclerosis (FSGS)

A

o Renal biopsy (distinct histologic appearance)

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73
Q

is Focal Segmental Glomerulosclerosis (FSGS) reversible?

A

no

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74
Q

this tx is for?
o Corticosteroids, cyclosporine, tacrolimus
o ACE/ARB
o Low sodium diet

A

FSGS

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75
Q
  • Glomerular basement membrane thickening from deposited immunoglobulin (IgG)
A

Membranous Nephropathy (primary cause of nephrotic syndrome)

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76
Q

o Acute onset Hematuria + proteinuria + pyruria + HTN + oliguria. dx?

A

nephritic syndrome

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77
Q

MC type of nephritic syndrome

A

o IgA nephropathy (Berger’s

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78
Q

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)

A

ANA, SPEP/UPEP, hep B/C, HIV, anti-PLA2R

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79
Q

+PLA2R antibodies in serum is what type of nephrotic syndrome?

A

Membranous Nephropathy (primary cause)

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80
Q

Order these tests for what suspected dx?

ANCA, anti-GBM, C3/C4, cryoglobulins

A

for nephritic syndrome

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81
Q

what % of pts w/ SLE have nehritis?

A

50%

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82
Q

Post-streptococcal Glomerulonephritis (PSGN) is a type____ hypersensitivity reaction

A

3

83
Q

do abx prevent PSGN?

A

no

84
Q

timeframe for PSGN after acute GABHS

A

10-30 days

85
Q

gross or microhematuria in PSGN?

A

gross

86
Q

test result of C3 in PSGN

A

decreased

87
Q

order what additional blood test for suspected PSGN and expected result

A

o Increased Antistreptolysin-O titer (ASO)

88
Q
  • Most common cause of glomerulonephritis
A

IgA Nephropathy (aka Berger dz)

89
Q

for suspected IgA Nephropathy (aka Berger dz), ask about what hx?

A

URI or GI infx (usually 2 days after). Infects Gastric or Airway

90
Q

2 types of nephritic syndrome that are ANCA +

A

Vasculitis w/ Polyangiitis (Wegener’s Granulomatosis)
Henoch-Schonlein Purpura / IgA vasculitis

91
Q

Anti-GBM Disease is aka ____

A

(Goodpasture’s Syndrome)

92
Q

besides the kidneys, (Goodpasture’s Syndrome) affects what other organ?

A

lungs

93
Q

all pts w/ (Goodpasture’s Syndrome) will have a + _______ antibody result

A

o Positive anti-GBM antibody

94
Q

2 roles of the kidneys in acid-base balance

A

Kidneys excrete H+ ions AND produce/reabsorb HCO3-

95
Q

best test to assess acid base status

A

ABG

96
Q

which is worse: normal anion gap or high gap metabolic acidosis

A

high

97
Q

MC type of high anion gap metabolic acidosis in hospitalized patients

A

lactic acidosis (can be from CO poisoning, DM, malignancy, chronic alcoholism; lactic acid is produced when oxygen levels low

98
Q

tx for pt w/ CKD p/w metabolic acidosis

A

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
Q

2 blood abnormalities in excessive diarrhea

A
  • Normal anion gap metabolic acidosis (Loss of bicarbonate through alkaline stool)
  • Hypokalemia (stool also has high K concentration)
100
Q

K and acid base serum status in type 4 renal tubular acidosis (* From decreased aldosterone or aldosterone resistance )

A

high K
o Hyperchloremic metabolic acidosis

101
Q
  • Rapid isotonic saline can cause what acid-base abnormality
A

hyperchloremic acidosis

102
Q

what compensatory method will all pts have for metabolic alkalosis

A

hypoventilation (even if it results in hypoxemia)

103
Q

excessive vomiting can cause what acid base imbalance

A

hypochloremic metabolic alkalosis

104
Q

is metabolic acidosis or alkalosis more likely to cause hypokalemia?

A

alkalosis

105
Q

MUDPILES of high anion gap metabolic acidosis

A

methanol
uremia
DKA
paraldehyde/paracetamol/Propylene glycol
isoniazid
lactic acidosis
ethanol
salicylates

106
Q

is renal artery stenosis a primary or secondary cause of HTN

A

secondary

107
Q

MCC of renal artery stenosis

A

atherosclerosis

108
Q

pt has Elevation in creatinine of more than 30% after starting ACEi. suspect what dx?

A

renal artery stenosis

109
Q

best inital test for suspected renal artery stenosis

A

duplex US

110
Q

gold standard test for suspected renal artery stenosis

A

renal arteriogram

111
Q

pharm or surgery for unilateral RAS?

A

pharm

112
Q

pharm or surgery for bilateral RAS?

A

surgery

113
Q

when not to give ACE/ARB for RAS?

A

if b/l

114
Q

consider what dx in Premenopausal Caucasian female w/ refractory HTN

A

Fibromuscular Dysplasia

115
Q
  • Non-atherosclerotic, non-inflammatory dz of medium sized arteries
A

Fibromuscular Dysplasia

116
Q

1st line med for Fibromuscular Dysplasia

A

ACE/ARB

117
Q

order what imaging for Fibromuscular Dysplasia + expected result

A

CTA will show pearls on a string

118
Q

pt w/ * Generalized fatigue
* Weakness
* Paresthesia
* Depressed/absent deep tendon reflexes
* Ileus (decreased/absent bowel sounds)
* Palpitations
what electrolyte abnormality?

A

hyperK

119
Q

tx to stabilise myocardium in hyperK

A

calcium gluconate IV

120
Q

2 meds to shift K into cells in hyperK + fluid requirement during tx

A

o IV insulin, inhaled albuterol
o Give 1 amp of D50 IV before you give insulin

121
Q

1st and 2nd MC electrolyte imbalances in hospitalised pts

A

1 = hypoNa
2 = hypoK

122
Q

MC cardiac compl in hypoK

A

afib

123
Q

txing hypoK but nothing it’s not improving. give what?

A

magnesium

124
Q

o For every 10mEq KCl given, there is a serum K+ rise of ____mEq/L.

A

0.1

125
Q

rate/amount to give of KCl for hypoK for all 3 routes

A

(40 mEq PO; 10/hr via peripheral line, 20/hr via central line)

126
Q

after starting pt on a loop or thiazide diuretic, monitor ____ 2-3 wks later

A

K

127
Q

MC type of hyperNa

A

hypovolemic

128
Q

urine Na in hypovolemic hyperNa is ____

A

low

129
Q

tx for hypovolemic hyperNa

A

IV NS

130
Q

diabetes insipidus causes what type of hyperNa

A

euvolemic

131
Q
  • If labs say hyponatremia, and serum osmolality is high, this is ______
A

false hypoNa (ususally d/t high glucose)

132
Q

SIADH is which type of hypoNa

A

euvolemic

133
Q

serum and urine osmolality in SIADH

A

low serum
high urine

134
Q

hypoNa Rate of correction must be <_____mEq/day to avoid central pontine myelinolysis, especially if chronic and Na < 120-125

A

4-6

135
Q

pt w/ n/v, indigestion, lethargy, memory loss, bone pain, back back to flank pain. suspect what electrolyte abnormality?

A

hyperCa

136
Q

MCC of hyperCa in outpatient

A

hyperparathyroidism

137
Q

pt w/ arrhythmia, spasms, muscle cramps, numbness in fingers/toes/perioral. suspect what electrolyte abnormality?

A

hypoCa

138
Q

PE test to perform for suspected hypoCa

A

tap in front of ear
* Chovstek’s sign (ipsilateral cheek contraction from tapping in front of ear)

139
Q

tx for acute and symptomatic hypoCa

A

: IV calcium gluconate

140
Q

1st sign of hyperMg

A

decreased DTRs

141
Q

in DKA, don’t give insulin until K is >________

A

3.3

142
Q

weak sphincter tone causes _____ incontinence

A

stress

143
Q

detrusor muscle overactivity causes ______ incontinence

A

urge

144
Q

gold standard tx for stress incontinence

A

o Surgical placement of mesh sling

145
Q

1st line tx for urge incontinence

A

Anticholinergics (oxybutynin, tolterodine, solifenacin, festerodine, darinfenacin, trospium)

146
Q

2 tests to order for incontinence

A

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
Q

overactive bladder (OAB) has >___ at night or >___voids per 24 hrs

A

2, 8

148
Q

best tx option for overflow incontinence

A

self-cath

149
Q

kidney stones <___mm usually pass spontaneously

A

<5mm

150
Q

3 places where kidney stones get stuck

A

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
Q

MC type of kidney stone

A
  • Calcium oxalate
152
Q

what type of kidney stones are NOT visible on KUB, but visible on CT

A

uric acid stones

153
Q

For suspected stone, besides hx of kidney stones, as k about PMH of: (2)

A

gout
chronic UTIs

154
Q

for suspected kidney stone, ask pt about recent _______

A

dehydration/hydration status

155
Q

is hematuria or microhematuria more common in kidney stones?

A

micro

156
Q

o Testis/labial discomfort, abrupt urgency/frequency, bladder pressure, dribbling suggest stone is where?

A

UVJ

157
Q

gold standard for kidney stone dx

A

o Stone protocol CT (non-contrast abdomen-pelvis)

158
Q

kidney stones ___mm or more will NOT pass spontaneously

A

10

159
Q

med to assist w/ passing kidney stone

A

tamsulosin 0.4mg one PO QHS, must strain urine

160
Q

CIs for  ESWL (extracorporeal shock wave lithotripsy) (4)

A

pregnancy, UTI, NSAID use, antiplatelet and anticoagulant use

161
Q

bladder situation that contributes to bladder stones

A

voiding dysfunction that allows urine stasis
* BPH
* Neurogenic bladder
* Urethral stricture
* Incomplete emptying

162
Q

white F w/ daytime and nighttime urinary frequency, urgency, and pelvic pain . dx?

A

interstitial cystitis

163
Q

gold standard for dx of interstitial cystitis

A

cystoscopy w/ hydrodistension: Hunner’s ulcers

164
Q

MCC of obstructive AKI

A

BPH

165
Q

1st line class of meds for BPH

A

Alpha1-adrenergic blockers

166
Q

What class? tamsulosin, doxazosin, terazosin

A

Alpha1-adrenergic blockers

167
Q

which class of meds can shrink the prostate

A
  • 5-alpha reductase inhibitors (finasteride)
168
Q

for UTI/voiding issues in young men, consider _______ (dx)

A

urethral stricture

169
Q

complication of BPH: painful inability to urinatee

A

urinary retention

170
Q

look for what comorbidity in pts w/ ED

A

CVD

171
Q

1st line meds for ED

A

Phosphodiesterase-5 inhibitors (PDE5) : sildenafil (Viagra), tadalafil (Cialis), vardenafil, avanafil

172
Q

CI for PDE5 inhibitors like viagra

A

nitroglycerin, angina

173
Q

what conditions (2) in the scrotum will transilluminate?

A

hydrocele, spermatocele

174
Q
  • MCC of painless scrotal swelling
A

hydrocele

175
Q

definitive dx for hydrocele

A

US

176
Q

ok to drain hydrocele?

A

no

177
Q

varicocele aching, heavy pain happens when?

A

end of day, after standing for a long time

178
Q

what happens to varicocele when pt lays supine? think what dx if this doesn’t happen?

A
  • Goes away when lying supine (think renal rumor if not)
179
Q

do what test on PE for suspected testicular torsion and expected result?

A
  • Absence of ipsilateral cremasteric reflex
180
Q

how long until ischemia and loss of testicle in testicular torsion?

A

6 hr

181
Q

if testicle hasn’t descended by what age, refer to srugery

A

1 y/o

182
Q

uncircumcised DM pts are at risk for what penis dx?

A

balanitis

183
Q

tx for balanitis (med + supportive)

A

topical antifungals (nystatin, lotrisone) or steroids, good hygeine, warm soaks w/ epsom salts

184
Q

MCC of UTI

A

e coli

185
Q

2 abnormalities on UA from phenazopyridine (pyridium) or OTC Azo

A

orange urine, + nitrites

186
Q

3 1st line tx options for uncomplicated UTI

A

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
Q

must order ____ for complicated but not uncomplicated UIT

A

culture

188
Q

UTI tx for preg - 4 options

A

Keflex, Augmentin, fosfomycin, cefpodoxime

189
Q

clean or dirty catch UA for UTI?

A

clean

190
Q

UTI UA will be + for ___ and ___

A

o Leukocyte esterase, nitrites

191
Q

urology referral if male <___ y/o or F >40 y/o w/ _____+ UTIs in 1 year

A

M <65
F 2+

192
Q

when to tx asymptomatic bacteruira

A

preg

193
Q

expected result on urine microscipy for pyelo

A

WBC casts

194
Q

1st line tx for pyelo

A

FQ X 5 days. 7 if cipro

195
Q

epidiymitis onset: sudden or gradual?

A

gradual

196
Q
  • Gradual onset of pain
  • Edematous, erythematous scrotal skin
  • Enlarged, tender testis
A

orchitis

197
Q

if a pt has microhematuria, hx of smoking, >40, must get what 2 tests

A

cystoscopy, CT urogram

198
Q

when feeling for prostate CA, where are nodules most likely to be?

A

peripheral zone

199
Q

if you feel a psotate nodule on DRE, next steps?

A

order PSA and refer to urology

200
Q

20 y/o M p/w gynecomastia. besides meds, ask about / do PE for _______

A

masses on testes (* Irregular, firm, nontender)

201
Q

Pt can have falsely elevated fena if on what class of meds?

A

Diuretics

202
Q

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

A

D: transitional zone

203
Q

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)

A

Bumetanide (Bumex)

Clin Med (14 decks)

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