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USMLE Step 2 CK > Nephrology > Flashcards

Nephrology Flashcards

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USMLE® Step 1 flashcards
1
Q

tamm horsfall protein is

A

normal <30-50 mg/24 hrs

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2
Q

very large amounts of protein =

A

glomerular disease

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3
Q

persistent proteinuria requires

A

biopsy

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4
Q

urine dipstick only detects what proteins

A

albumin

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5
Q

to detect bence jones proteins use

A

immunoelectrophoresis

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6
Q

best 24 hr protein measure

A

protein to creatinine ratio

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7
Q

tx for proteinuria in DM

A

ACEi and ARBs

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8
Q

microalbuminuria values

A

30-300mg/24 hrs

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9
Q

eosinophils in urine =

A

allergic or acute interstitial nephritis

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10
Q

wright stain detects

A

eosinophils in urine

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11
Q

hansel stain detects

A

eosinophils in urine

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12
Q

are there eosinophils in the urine of NSAID induced renal disease

A

no

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13
Q

persistent WBCs in urine with negative culture

A

TB

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14
Q

dysmorphic RBCs in urine =

A

glomerulonephritis

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15
Q

IV pyelogram is the answer when

A

NEVER

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16
Q

most accurate test of bladder

A

cytoscopy

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17
Q

do cystoscopy when

A

hematuria w/o infection or prior trauma and renal US or CT does not show etiology or bladder US shows mass (possible biopsy)

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18
Q

red cell casts =

A

glomerulonephritis

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19
Q

white cell casts =

A

pyelonephritis

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20
Q

eosinophil casts =

A

acute interstitial nephritis

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21
Q

hyaline casts =

A

tamm horsfall protein from dehydration

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22
Q

broad waxy casts =

A

chronic renal disease

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23
Q

granular muddy brown casts =

A

ATN

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24
Q

urine osmolality in ATN

A

In ATN urine cannot be concentrated because cells are damaged → inappropriately low urine osmolality (isosthenuria – same osmolality as blood) aka renal tubular concentrating defect

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25
Q

BUN:creatinine >20:1

UNa 500

A

prerenal azotemia

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26
Q

BUN:creatinine 10:1
UNa >20, FeNa >1%
Urine osmolality <300

A

Intrinsic renal disease (ATN)

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27
Q

NSAIDs constrict

A

afferent arteriol

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28
Q

ACEi cause vasodilation of

A

efferent arteriol

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29
Q

retroperitoneal fibrosis is caused by

A

bleomycin, methylsergide, radiation

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30
Q

prevention of contrast renal toxicity

A

saline hydration

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31
Q

low magnesium can increase risk of renal toxicity from

A

aminoglycosides or cisplatin

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32
Q

time frame for drugs causing ATN

A

5-10 days

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33
Q

prevent tumor lysis syndrome with

A

allopurinal, hydration, and rasburicase prior to chemo

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34
Q

ethylene glycol causes precipitation of what in tubules

A

oxalic acid, calcium oxalate

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35
Q

best initial test for rhabdomyolysis

A

UA

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36
Q

most specific test for rhabdomyolysis

A

urine for myoglobin

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37
Q

tx of rhabdomyolysis

A

saline hydration, mannitol, bicarb

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38
Q

how does bicarb help in rhabdomyolysis

A

drives K back into cells preventing precipitation of myoglobin in kidney tubule

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39
Q

best initial test for ATN

A

BUN and creatinine

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40
Q

best initial imaging test for ATN

A

renal US

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41
Q

most accurate test for allergic interstitial nephritis

A

renal biopsy

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42
Q

most accurate test for poststreptococcal glomerulonephritis

A

renal biopsy

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43
Q

furosemide adverse effect

A

ototoxicity, dose and how fast its given dependent

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44
Q

dialysis if

A

fluid overload, encephalopathy, pericarditis, metabolic acidosis, hyperkalemia

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45
Q

things that do NOT help ATN

A

Low dose dopamine, diuretics, mannitol, steroids

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46
Q

Cirrhosis, low urine sodium, FeNA 20:1

A

hepatorenal syndrome

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47
Q

tx for hepatorenal syndrome

A

midodine, octreotide, albumin

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48
Q

After catheter procedure, blue/purplish skin lesion in fingers/toes, livedo reticularis, ocular lesions

A

atheroemboli

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49
Q

most accurate test for atheroemboli

A

biopsy of purplish skin lesion

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50
Q

tx of atheroemboli

A

no specific tx

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51
Q

dx of atheroemboli

A

eosinophilia, low complement, eosinophiluria, elevated ESR

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52
Q

most common meds causing allergic interstitial nephritis

A

PCN, cephalosporins, sulfa (diuretics), phenytoin, rifampin, quinolones, allopurinol, PPIs

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53
Q

the meds that cause allergic interstitial nephritis also cause

A

drug allergy and rash, stevens Johnson syndrome, TEN, hemolysis

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54
Q

rising BUN/creatinine, fever, rash, arthralgias, eosinophilia, eosinophiluria

A

acute interstitial nephritis

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55
Q

most accurate test for acute interstitial nephritis

A

hansel or wright stain

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56
Q

acute interstitial nephritis, inciting drug stopped, but creatinine continues to rise, tx?

A

glucocorticoids

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57
Q

Sudden flank pain, fever, hematuria, grossly necrotic material in urine

A

analgesic nephropathy (papillary necrosis)

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58
Q

best initial test for analgesic nephropathy

A

UA

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59
Q

most accurate test for analgesic nephropathy

A

CT

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60
Q

tx for analgesic nephropathy

A

no specific tx

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61
Q

Acute, toxins, none nephrotic, no biopsy, no steroids, never immunosuppressive agents

A

tubular disease

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62
Q

Chronic, not from toxins, all potentially nephrotic, biopsy, steroids

A

glomerular diseases

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63
Q

best initial test for goodpasture syndrome

A

antiglomerular basement membrane antibodies

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64
Q

most accurate test for goodpasture syndrome

A

lung or kidney biopsy

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65
Q

goodpasture syndrome affects what organs

A

lungs and kidney

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66
Q

tx for goodpasture syndrome

A

plasmapheresis and steroids

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67
Q

kidney biopsy in goodpasture disease shows

A

linear deposits

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68
Q

most common cause of glomerulonephritis

A

IgA nephropathy (berger disease)

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69
Q

Recurrent gross hematuria 1-2 DAYS post URI

A

IgA nephropathy

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70
Q

tx of IgA nephropathy

A

ACEi and steroids if severe proteinuria

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71
Q

hematuria 1-2 WEEKS Post URI

A

postinfectious glomerulonephritis

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72
Q

dark (cola) urine, periorbital edema, HTN, oligouria

A

postinfectious glomerulonephritis

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73
Q

tx for postinfectious glomerulonephritis

A

supportive (antibiotics and diuretics)

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74
Q

dx of postinfectious glomerulonephritis

A

confirm with ASO titer and anti DNAse antibody titers

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75
Q

hematuria, Sensorineural hearing loss, visual disturbances

A

alport syndrome

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76
Q

alport syndrome is d/t

A

congenital defect of type IV collafen

77
Q

tx for alport syndrome

A

no specific therapy

78
Q

best initial test for polyarteritis nodosa

A

Angiogrpahy of renal, mesenteric, or hepatic artery showing aneurysmal dilation in association with new onset HTN and characteristic symptoms

79
Q

biopsy is done in lupus nephritis to

A

gage tx, not to dx, but is most accurate test

80
Q

tx for lupus nephritis

A

glucocorticoids with cyclophophomide or mycophenolate

81
Q

most accurate test for amyloidosis

A

biopsy

82
Q

Green birefringence with congo red

A

amyloidosis

83
Q

tx of amyloidosis

A

control underlying disease, then melphalan and prednisone

84
Q

edema, hyperlipidemia, thrombosis, infection

A

nephrotic syndrome

85
Q

thrombosis in nephrotic syndrome is d/t

A

urinary loss of protein C, S and antithrombin

86
Q

infection in nephrotic syndrome is d/t

A

urinary loss of Ig and complement

87
Q

most common cause of nephrotic syndrome

A

DM and HTN

88
Q

nephrotic syndrome in CA of solid organs

A

membranous

89
Q

nephrotic syndrome in children

A

minimal change disease

90
Q

nephrotic syndrome in IV drug users and AIDS

A

focal segmental

91
Q

nephrotic syndrome SLE

A

any

92
Q

best initial test for nephrotic syndrome

A

UA (maltese crosses)

93
Q

Hyperproteinuria (>3.5/24hr), hypoproteinemia, hyperlipidemia, edema

A

nephrotic syndrome

94
Q

best initial tx for nephrotic syndrome

A

glucocorticoids –> cyclophosphamide

95
Q

end stage renal disease most commonly from

A

DM and HTN

96
Q

metabolic acidosis, fluid overload, encephalopathy, hyperkalemia, pericarditis

A

uremia

97
Q

hypocalcemia in end stage renal disease d/t

A

decreased conversion of 25 to 1,25 vit D

98
Q

osteodystrophy in end stage renal disease d/t

A

low Ca leads to secondary hyperparathyroidism

99
Q

bleeding in end stage renal disease d/t

A

failure of platelet degranulation

100
Q

infection in in end stage renal disease d/t

A

failure of neutrophil degranulation

101
Q

hyperphosphatemia in end stage renal disease d/t

A

high PTH releases phosphate from bones

102
Q

hypermagnesemia in end stage renal disease d/t

A

loss of ability to excrete

103
Q

why are aluminum phosphate binders never used

A

cause dementia

104
Q

when Vit D replaced for hypocalcemia always give

A

phosphate binders or vit D will increase GI absorption of phosphate

105
Q

phosphate binders used in end stage renal disease

A

calcium acetate, Calcium carbonate, sevelamer, lanthanum

106
Q

most common cause of death in end stage renal disease

A

atherosclerosis and HTN –> cardiac

107
Q

next step in management of complex renal cysts

A

aspirate to r/o malignancy

108
Q

TTP is associated with

A

HIV, CA, cyclosporine, ticlopidine, clopidogrel

109
Q

intravascular hemolysis, renal insufficiency, thrombocytopenia

A

HUS and TTP

110
Q

TTP is associated with what symptoms in addition to the ones seen in HUS

A

neuro symptoms and fever

111
Q

PT and PTT in HUS and TTP

A

normal

112
Q

tx of TTP or severe HUS

A

plasmapheresis

113
Q

best initial test for diabetes insipidus

A

water deprivation test

114
Q

high volume nocturia =

A

diabetes insipidus

115
Q

tx of nephrogenic diabetes insipidus

A

correct K and Ca, hydrochlorothiazide or NSAIDs

116
Q

causes of hyponatremia with hypervolemia

A

CHF, nephrotic syndrome, cirrhosis

117
Q

causes of hyponatremia with euvolemia

A

hyperglycemia, psychogenic polydipsia, hyopthyroidism, SIADH

118
Q

aldosterone causes

A

Na reabsorption

119
Q

for every 100 mg/dL glucose above normal, sodium …

A

decreases 1.6 mEq/L

120
Q

thyroid hormone effect on water

A

needed to excrete it

121
Q

msot accurate test for SIADH

A

high ADH

122
Q

tx of acute hyponatremia

A

hypertonic saline, conivaptan, tolvaptan

123
Q

conivaptan, and tolvaptan (MOA)

A

antagonists of ADH

124
Q

tx of chronic hyponatremia

A

demeclocycline

125
Q

demeclocycline MOA

A

blocks ADH at collecting ducts

126
Q

insulin effect on K

A

drives K into cells

127
Q

acidosis effect on K

A

cells pick up H and release K

128
Q

beta blocker and digoxin effect on K

A

inhibit Na/K/ATPase increasing K

129
Q

most urgent test in severe hyperkalemia

A

EKG

130
Q

EKG changes in hyperkalemia

A

peaked T waves, wide QRS, PR prolongation

131
Q

tx of hyperkalemia that is cardioprotective

A

Calcium chloride and calcium gluconate

132
Q

tx of hyperkalemia that removes K from body via bowel

A

Kayexalate (sodium polystyrene sulfonate)

133
Q

tx of hyperkalemia best used in acidosis

A

bicarb - drives K into cells

134
Q

primary hyperaldosteronism aka

A

conn syndrome

135
Q

conn syndrome K level

A

hypokalemic

136
Q

barter syndrome d/t

A

salt loss in loop of henle

137
Q

EKG changes in hypokalemia

A

U waves, flattened T waves, ST depression

138
Q

tx of hypokalemia

A

IV K, but too fast can cause fatal arrhythmia. Oral K – can’t give too much

139
Q

anion gap =

A

Na - (Cl + HCO3)

140
Q

causes of metabolic acidosis with normal anion gap

A

RTA and diarrhea

141
Q

tx for lactic acidosis

A

correct hypoperfusion

142
Q

dx for anion gap from ketoacids

A

acetone level

143
Q

tx for anion gap from ketoacids

A

insulin and fluids

144
Q

dx for anion gap from oxalic acid

A

crystals on UA

145
Q

RTA type I is d/t

A

Distal tubule – normally generates new bicarb (under aldosterone)

146
Q

best initial test for RTA type I

A

infuse acid into blood with ammonium chloride. Cannot excrete acid so urine pH remains basic

147
Q

urine pH >5.5, nephrocalcinosis, hypokalemic

A

RTA type I

148
Q

tx of RTA type I

A

replace bicarb

149
Q

RTA type II d/t

A

Proximal tubule - normally 85-90% filtered bicarb reabsorbed

150
Q

variable urine pH, hypokalemic, metabolic acidosis

A

RTA type II

151
Q

tx for RTA type II

A

thiazides cause volume depletion which enhances bicarb reabsorption

152
Q

most accurate test for RTA type II

A

give bicarb and test urine pH. Cannot absorb bicarb so urine pH rises

153
Q

RTA type IV d/t

A

Most often in DM. Decreased amount or effect of aldosterone on kidney tubule

154
Q

test for RTA type IV

A

persistently high urine Na despite Na depleting diet

155
Q

urine pH <5.5, hyperkalemia

A

RTA type IV

156
Q

tx for RTA type IV

A

fludrocortisone (highest mineralcorticoid or aldosterone like effect)

157
Q

urine anion gap =

A

Na - Cl

158
Q

positive UAG =

A

RTA

159
Q

negative UAG =

A

diarrhea

160
Q

minute ventilation =

A

RR*tidal volume

161
Q

most common cause of kidney stones

A

calcium oxalate

162
Q

chrons disease is associated with what type of kidney stone

A

calcium oxalate, from increased oxalate absorption

163
Q

kidney stones associated with UTI

A

struvite stones

164
Q

struvite stones are composed of

A

magnesium, ammonium, phosphate

165
Q

kidney stones that are radiotranslucent

A

uric acid stones

166
Q

most accurate test for nephorlithiasis

A

CT

167
Q

best initial tx for nephrolithiasis

A

analgesics and hydration

168
Q

tx for kidney stones <5 mm

A

let pass spontaneously

169
Q

tx for kidney stones 5-7 mm

A

nifedipine and tamsulosin – helps pass

170
Q

tx for kidney stones .5-2 cm

A

lithotripsy

171
Q

tx for hydronephrosis d/t nephrolithasis

A

stent placement

172
Q

tx for chonic nephrolithaisis

A

hydrochlorothiazide - removes Ca from urine

173
Q

metabolic acidosis/alkalosis increases kidney stone formation

A

acidosis

174
Q

tx for cystine stones

A

alkalinize urine

175
Q

tx for struvite stones

A

surgical

176
Q

best initial tx for HTN

A

weight loss

177
Q

how long should lifestyle modification be tried before treating HTN

A

3-6 mo

178
Q

best initial drug tx for HTN

A

thiazides

179
Q

best tx for HTN in pregnancy

A

BB

180
Q

best tx for HTN in CAD

A

BB, ACE, ARB

181
Q

best tx for HTN in DM

A

ACE, ARB (<130/80)

182
Q

best tx for HTN in BPH

A

alpha blockers

183
Q

best tx for HTN in depression

A

NOT BB

184
Q

best tx for HTN in asthma

A

NOT BB

185
Q

best tx for HTN in hyperthyroidism

A

BB

186
Q

best tx for HTN in osteoporosis

A

thiazides

187
Q

tx for hypertensive crisis

A

labetolol

188
Q

why isn’t nitroprusside used first in hypertensive crisis

A

needs monitoring with arterial line

189
Q

if BP is lowered to normal in hypertensive crisis, increased risk of

A

stroke

USMLE Step 2 CK (11 decks)

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