Nephrology

Question 1

Loop diuretics/thiazide diuretics adverse side effects

Answer 1

Decreased electrolytes such as hypokalemia, hypocalcemia, hypomagnesemia, ototoxicity, sulfa allgery susceptible, hyperuricemia (can precipitate gout), hyperglycemia

Question 2

K+ sparing diuretics adverse effects

Answer 2

Hyperkalemia due to retention of K+, anti androgen effects like gynecomastia, erectile dysfunction, decreased libido

Question 3

Nephrotic syndrome definition

Answer 3

Kidney disease characterized by proteinuria, hypoalbuminemia, hyperlipidemia, and edema, caused primarily by minimal change disease in children and membranous nephropathy in adults (SLE, viral hepatitis, malaria, medications)

Question 4

Most common secondary etiology of nephrotic syndrome in adults

Answer 4

DM

Question 5

Most definitive accurate test for nephrotic syndrome that is rarely done, best initial test that is often done

Answer 5

Renal biopsy, UA is best initial test and microscopy might show fatty casts

Question 6

First line management of minimal change disease

Answer 6

Glucocorticoids

Question 7

Management of nephrotic syndrome

Answer 7

Glucocorticoids or other immunomodulators, edema reduction with diuretics, proteinuria reduction with ace inhibitors, statin therapy for hyperlipidemia

Question 8

Acute glomerulonephritis (nephritic syndrome) characteristics

Answer 8

Hypertension, hematuria, azotemia (proteinuria)

Question 9

Most common causes of acute glomerulonpehritis (nephritic syndrome)

Answer 9

IgA nephropathy (Bergerr’s disease) after URI or GI infection
Post streptococcal post infectious
Goodpasture’s disease (glomerulonephritis plus hemoptysis)

Question 10

Pre renal acute kidney injury diagnosis

Answer 10

BUN:Cr ratio >20:1, FENA <1%, concentrated urine

Question 11

Most common type of intrinsic acute kidney injury

Answer 11

Acute tubular necrosis

Question 12

Intrinsic acute kidney injury diagnosis

Answer 12

BUN:Cr ratio <15:1, FENA >2%, dilute urine

Question 13

Management of acute tubular necrosis

Answer 13

Removal of offending agents and IV fluids first line

Question 14

RBC casts indicate \_\_\_
Muddy brown casts indicate \_\_\_
WBC casts indicate \_\_\_
Waxy casts indicate\_\_\_
Fatty casts indicate \_\_\_\_
Hyaline casts indicate \_\_\_

Answer 14

Acute glomerulonephritis
Acute tubular necrosis
Pyelonephritis
Chronic acute tubular necrosis or glomerulonephritis or end stage renal disease (broad waxy casts is key)
Nephrotic syndrome (hyperlipidemia)
Nonspecific (normal)

Question 15

Clinical manifestations of PKD

Answer 15

Abdominal and flank pain, nephrolithiasis, UTI, hematuria

Question 16

Most widely used diagnostic imaging test of PKD

Answer 16

Ultrasound

Question 17

Normal GFR, Stage 1-5 kidney disease

Answer 17

Normal is 120-130,
Stage 1 kidney damage with normal GFR or >90
Stage 2 60-89
Stage 3 30-59
Stage 4 15-29
Stage 5 <15

Question 18

First and second most common causes of end stage renal disease

Answer 18

DM, htn

Question 19

Single best predictor of chronic kidney disease progression

Answer 19

Spot urine albumin/ucreatinine ratio (ACR), proteinuria

Question 20

HbA1c goal for management in chronic kidney disease patients

Answer 20

<7%, regular diabetics without CKD between 7-8%

Question 21

Best initial test in evaluating a horseshoe kidney

Answer 21

CT urography

Question 22

Gold standard non invasive and invasive and therapeutic diagnostic studies for renal artery stenosis

Answer 22

CT angiography, renal catheter arteriography

Question 23

What drugs are contraindicated in a patient with bilateral renal artery stenosis or in patients with a solitary kidney

Answer 23

ACE and ARBs as may lead to AKI

Question 24

Earliest sign of hypokalemia

Answer 24

T wave flattening followed by prominent u wave development

Question 25

Management of severe hypermagnesemia (rare)

Answer 25

IV calcium gluconate plus IV fluids plus furosemide, dialysis if severe enough

Question 26

Hypokalemia and hypomagnesemia can precipitate what cardiac arrhythmia? What is the treatment of this arrhythmia?

Answer 26

Torsades de pointes, IV magnesium sulfate

Question 27

Most common initial symptom of hypernatremia

Answer 27

Thirst, followed by confusion, lethargy, dry mouth and mucus membranes

Question 28

Rapid over correction of hypernatremia with hypotonic fluids can lead to...

Answer 28

...cerebral edema

Question 29

Rapid over correction of hyponatremia with volume replacement can lead to

Answer 29

central pontine myelinolysis

Question 30

Most common initial symtpom of hyponatremia

Answer 30

Neurologic issues due to cerebral edema

Question 31

Hypomagnesemia presents with similar findings such as increased DTRs and tetany as well as signs of hypo___ because the two are connected as magneisum is needed to make a hormone that controls this

Answer 31

hypocalcemia

Question 32

Hypokalemia is associated with metabolic ___ while hyper is associated with ___

Answer 32

alkalosis, acidosis

Question 33

Hypokalemia management

Answer 33

KCl replacement and if hypomagnesemia present then replace that too

Question 34

MUDPILERS acronym and what does it mean?

Answer 34

``` Methanol Uremia DKA Propylene glycol Isoniazid Lactic acidosis Ethylene glycol Salicylates ``` Means anion gap metabolic acidosis, (too much acid or too little bicarb, true regardless if anion gap present or not)

Question 35

Steps to solve an acid base disorder

Answer 35

1) pH <7.35 is acidotic, pH >7.45 is alkalotic 2) Is the pCO2 low or high (35-45) 3) In primary respiratory disorders, pCO2 does the OPPOSITE of the pH 4) Is HCO3 low or high (22-26) 5) In primary metabolic disorders, the HCO3 does the same as the pH 6) IF metabolic acidosis is present, calculate anion gap Na - (Cl+HCO3), normal is 10-12

Question 36

A left sided varicocele can be indicative of...

Answer 36

...renal cell carcinoma

Question 37

Most common abdominal mass in children, most commonly manifested as a palpable abdominal mass that doesn't cross midline

Answer 37

Wilms tumor (nephroblastoma)

Question 38

best initial test in suspected wilm's tumor, how is it treated?

Answer 38

Abdominal ultrasound, treated with total nephrectomy followed by chemotherapy