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Clinical Medicine > Nephrology > Flashcards

Nephrology Flashcards

1
Q

��”Q001. Dx? Rapid onet of oliguria with increasing BUN and creatinine often occurs in hospitalized patients”

A

A001. Acute Renal Failure

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2
Q

Q002. ARF class:; weight loss or gain, poor skin turgor, edema/ascites, renal artery bruit

A

A002. Pre renal ARF

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3
Q

Q003. ARF class:; weight gain, obtundation, hypotension to HTN, JVD, evidence of muscle trauma, infection, contaminated IV lines

A

A003. Intrinsic ARF

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4
Q

Q004. ARF class:; weight gain, enlarged prostate, pelvic mass, bladder distension

A

A004. Post renal ARF

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5
Q

Q005. Etiology of pre renal ARF; (4 and example of each)

A

A005. 1. Hypovolemia (including hemorrhage and GI loss); 2. Third spacing (including nephrotic syndrome, burns and cirrhosis); 3. Low cardiac Output (including CHF and shock); 4. Renal hypoperfusion (including renal artery stenosis, NSAIDs + ACEi)

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6
Q

Q006. Etiology of Intrinsic ARF; (5)

A

A006. 1. Hyperviscosity (multiple myeloma); 2. Acute Tubular Necrosis (due to: meds or rhabdomyolysis); 3. Glomerular injury (Nephrotic syndrome, vasculitis, GN); 4. Acute Interstitial Nephritis; 5. Renovascular infarction

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7
Q

Q007. Etiology of Post renal ARF; (3)

A

A007. 1. Urinary tract obstruction; 2. enlarged prostate; 3. bladder dysfunction

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8
Q

Q008. Define:; Oliguria

A

A008. Urine output < 400 mL/day

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9
Q

Q009. Indications for Dialysis:; (5)

A

A009. AEIOU:; Acidosis; Electrolyte abnormalities; Ingestions; Overload; Uremic symptoms (pericarditis, encephalopathy)

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10
Q

Q010. Pre renal amounts for:; 1. BUN/creatinine ratio; 2. Fe Na; 3. Urine Na; 4. Urine Osmolality; 5. Urine specific gravity

A

A010. 1. > 20; 2. < 1%; 3. < 20; 4. > 500; 5. > 1.020

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11
Q

Q011. Intrinsic renal (ARF)amounts for:; 1. BUN/creatinine ratio; 2. Fe Na; 3. Urine Na; 4. Urine Osmolality; 5. Urine specific gravity

A

A011. 1. < 20; 2. > 1%; 3. > 40; 4. < 350; 5. = 1.010

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12
Q

Q012. What (2) Dx test and results point to a post renal ARF problem?

A

A012. Fe Ne > 4%; Urine Na > 40

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13
Q

Q013. Equation for Fractional Excretion of Sodium (Fe Na)

A

A013. Fe Na = (urine Na/plasma Na) / (U creatinine/P creatinine) x 100%

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14
Q

Q014. MCC of intrinsic ARF

A

A014. Tubulointerstitial diseases; (ATN and AIN)

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15
Q

Q015. Dx:; Acute damage of renal tubules due to ischemic or toxic insult

A

A015. Acute Tubular Necrosis

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16
Q

Q016. Etiology of Ischemic (4) and Toxic (4) causes of ATN

A

A016. Ischemic:; Shock;; Trauma;; Sepsis;; Hypoxia; Toxic:; Rhabdomyolysis;; Aminoglycosides;; IV contrast;; Tumor lysis

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17
Q

Q017. (3) Dx findings for ATN

A

A017. Muddy brown granular casts;; High urine sodium;; Fe Na > 1%

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18
Q

Q018. Tx for ATN; (4)

A

A018. NS for volume replacement;; IV diuretic in early stages;; match I and O; manage electolyte disturbance

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19
Q

Q019. Dx:; Inflammation of the renal parenchyma

A

A019. Acute Interstitial Nephritis

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20
Q

Q020. (3) basic classes of etiologies of AIN

A

A020. Systemic diseases;; Systemic infections;; Medications

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21
Q

Q021. (3) systemic diseases that causes AIN

A

A021. Sarcoidosis;; Sjogren syndrome;; Lymphoma

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22
Q

Q022. (4) systemic infections (bugs) that cause AIN

A

A022. Syphilis;; Toxoplasmosis;; CMV;; EBV

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23
Q

Q023. (3) medication classes that can cause AIN

A

A023. Beta blockers;; Diuretics;; NSAIDs

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24
Q

Q024. How do NSAIDs cause AIN?

A

A024. inhibit prostaglandin synthesis, which decreases GFR and start renal failure in patient with underlying renal problems

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25
Q

Q025. Dx findings of allergic AIN; (3)

A

A025. WBCs;; Eosinophils;; White (or red) cell casts

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26
Q

Q026. Tx of allergic AIN?; (2)

A

A026. 1. stop offending agent; 2. Steroids

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27
Q

Q027. initial microscopic finding in ATN

A

A027. blebbing of the PTC and loss of brush boarder

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28
Q

Q028. microscopic finding of ischemic (2) ATN versus toxic

A

A028. Ischemic: BM damage; skipped areas of damage; Toxic: no BM damage; Uniform damage with sparing of DT

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29
Q

Q029. Lab:; Oxalate crystal formation in kidney

A

A029. Ethylene glycol ATN

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30
Q

Q030. Retention of what (3) things causes anion gap increase with CRF?

A

A030. Phosphates; H+; Sulfates

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31
Q

Q031. what does the ultrasound show w/:; 1. CRF; 2. Diabetes; 3. Amyloidosis; 4. Poylcyctic Kidney Disease

A

A031. 1. shrunken kidneys; 2 4. Enlarged kidneys

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32
Q

Q032. What (3) endocrine functions are lost with CRF?; what is the result of each on the patient?

A

A032. Synthesis of:; 1. Vitamin D hypocalcemia;; 2. Ammonia anion gap met acidosis;; 3. Erythropoietin anemia

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33
Q

Q033. Tx for Chronic renal failure; (3)

A

A033. ACEi;; low protein diet;; Dialysis

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34
Q

Q034. Dx:; pale complexion, wasting, purpura, N/V, itching, tubular casts in urine

A

A034. Uremic syndrome

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35
Q

Q035. Waxy casts in urine

A

A035. Chronic Renal Failure

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36
Q

Q036. CNS problems from Uremia; (5)

A

A036. Foot drop;; Carpal tunnel;; Clonus;; Asterixis;; Seziures

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37
Q

Q037. Cardiac / Pulmonary problems from Uremia; (5)

A

A037. HTN;; Pericarditis;; Valve calcification;; Pulmonary edema;; Pulmonary effusions

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38
Q

Q038. Hematologic problems from Uremia; (3)

A

A038. Normochromic, normocytic anemia;; Low platelet function (prolonged bleeding time);; low WBC increased infections

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39
Q

Q039. (2) metabolic problems from Uremia

A

A039. High triglycerides;; Insulin resistance

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40
Q

Q040. Dx:; Inability for kidney to concentrate urine; (stays fixed with specific gravity = 1.010)

A

A040. Isostheuria

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41
Q

Q041. Dx:; enlarged kidneys with multiple cysts presenting in mid 30’s to 40’s with flank pain; what can it lead to?

A

A041. ADPKD; Berry aneurysms

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42
Q

Q042. Dx:; Metabolic acidosis with normal anion gap

A

A042. Renal Tubular Acidosis

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43
Q

Q043. Renal Tubular Acidosis Type I:; 1. Defect; 2. bicarb level; 3. Urine pH; 4. Plasma K; 5. where in kidney

A

A043. 1. H+ secretion causing Acidosis; 2. Low; 3. pH > 5.3; 4. Low; 5. DT defect

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44
Q

Q044. Renal Tubular Acidosis Type II:; 1. Defect; 2. bicarb level; 3. Urine pH; 4. Plasma K; 5. where in kidney

A

A044. 1. Decreased Bicarb reabsorption; 2. 12 20; 3. pH > 5.3; 4. Low normal; 5. PCT defect

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45
Q

Q045. Renal Tubular Acidosis Type IV:; 1. Defect; 2. bicarb level; 3. Urine pH; 4. Plasma K; 5. where in kidney

A

A045. 1. Decreased Aldosterone; 2. > 17; 3. pH < 5.3; 4. High; 5. DT

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46
Q

Q046. Etiology of Renal Tubular Acidosis Type I; (4)

A

A046. Lithium;; Amphotericin B;; SLE;; Sarcoidosis

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47
Q

Q047. Etiology of Renal Tubular Acidosis Type II; (3)

A

A047. Heavy Metals;; Acetazolamide;; Multiple myeloma

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48
Q

Q048. Etiology of Renal Tubular Acidosis Type IV; (3)

A

A048. Renal transplant;; Obstructive uropathy;; Diabetic nephropathy;

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49
Q

Q049. Dx:; Radiopaque stone seen in inflammatory bowel diseases, decreased citrate & uricourea; Tx?

A

A049. Calcium Oxalate stone; Tx: Thiazides

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50
Q

Q050. Dx:; moderately readiopaque stone common in Proteus or staph Saprophyticus UTI due to high urinary pH; Tx?

A

A050. Struvite (ammonium, magnesium, phosphate) stone; Tx: lower urine pH

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51
Q

Q051. Dx:; Radiolucent stone caused by myeloproliferative diseases and gout; Tx?

A

A051. Uric Acid stone; Tx: raise urine pH

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52
Q

Q052. Dx:; moderately radiopague stone that has hexagonal crystals and is positively birefringent; What congenital disorder is cause?; Tx?

A

A052. Cystine Stones; Disorder: Cystinuria; Tx: raise urine pH

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53
Q

Q053. Dx:; 39 yo man with severe back pain and hematuria, nausea and unable to find a comfortable position.

A

A053. Renal stone; (Urolithiasis)

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54
Q

Q054. Dx:; sudden HTN with low K+; How do you do a screening Dx?; Tx?

A

A054. Renal artery stenosis; give oral captopril to induce increase of renin; Tx: surgery or angioplasty

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55
Q

Q055. Etiology of renal artery stenosis; (2)

A

A055. Plaque; Fibromuscular dysplasia

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56
Q

Q056. Dx:; hematuria, palpable mass, flank pain, fever, secondary polycythemia

A

A056. Renal Cell Tumor

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57
Q

Q057. MC person to get Renal cell CA; Where does it disseminate to?; Tx? (2)

A

A057. 50 70 yo Male smoker; moves to: Renal veins and Vena cava; Tx: resection, IL 2 immunotherapy

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58
Q

Q058. (3) causes of Ketones in the urine

A

A058. 1. DKA; 2. Alcohol intox; 3. starvation

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59
Q

Q059. What does Nitrite in urine indicate?

A

A059. Gram negative rods

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60
Q

Q060. What does a positive Leukocyte esterase in urine indicate?

A

A060. White cells and infection

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61
Q

Q061. What do eosinophils in the urine indicate?

A

A061. Allergic Interstitial Nephritis

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62
Q

Q062. What do Squamous cells in the urine indicate?

A

A062. contaminated specimen

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63
Q

Q063. What does Bilirubin in the urine indicate?

A

A063. Extravascular hemolysis

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64
Q

Q064. What does Hemoglobin in the urine indicate?

A

A064. Intravascular hemolysis

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65
Q

Q065. What do Hyaline casts in the urine indicate?

A

A065. Pre renal azotemia

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66
Q

Q066. MCD in ARF?

A

A066. infection

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67
Q

Q067. Defition of ARF?

A

A067. rapid decline in renal function with an increase in Cr level; relative increase of 50% or absolute increase of 0.5 to 1.0 mg/dL

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68
Q

Q068. MCC of postrenal failure

A

A068. BPH urethral obstruction

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69
Q

Q069. MCC chronic renal failure

A

A069. diabetes!

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70
Q

Q070. azotemia refers to?

A

A070. elev. of BUN

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71
Q

Q071. uremia refers to?

A

A071. si/sx associated with accumulation of nitrogenous wastes due to impaired renal function; usually, BUN>60mg/dL

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72
Q

Q072. 3 key features of nephrotic syndrome

A

A072. proteinuria; hypoalbuminemia; hyperlipidemia

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73
Q

Q073. Examination of urine sediment:; RBC =; WBC =; Fatty casts =

A

A073. RBC = GN; WBC = pyelonephritis & interstitial nephritis; Fatty casts = nephrotic syndrome

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74
Q

Q074. Gross painless hematuria

A

A074. bladder ca

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75
Q

Q075. microscopic hematuria v. gross hematuria

A

A075. microscopic = glomerular; gross = post renal causes trauma, stones, malignancy)

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76
Q

Q076. hyperkalemia how can you remove K from serum? (3)

A

A076. 1. dialysis; 2. diuretics; 3. cation exchange resins kayexalate (sodium polystyrene sulfonate)

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77
Q

Q077. MOA of Kayexalate

A

A077. cation exchange resin acts in the GI tract by promoting exchange of Na for K and thereby increasing excretion of K

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78
Q

Q078. Indications for Dialysis

A

A078. AEIOU and sometimes Y; Acidosis, pH<7.2; Electrolytes, refractory hyperkalemia; Intoxication, methanol, ethylene glycol, ASA, lithium; Overload, hypervolemia, pulmonary edema; Uremic pericarditis/encephalopathy/neuropathy; Yhtapolugoac, secondary to renal failure

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79
Q

Q079. nephrotic syndrome + abdominal pain + fever + hematuria =

A

A079. renal vein thrombosis;; antithrombin III is lost in urine putting patients at increased risk of venous/arterial thrombosis

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80
Q

Q080. nephrotic syndrome is most commonly caused by?

A

A080. adults: membranous glomerulonephritis; children: minimal change diseases

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81
Q

Q081. What serum Cr level is safe for contrast CT?

A

A081. 1.5 use non ionic contrast OR ultrasound

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82
Q

Q082. MCC of glomerular hematuria

A

A082. IgA nephropathy (Berger’s disease)

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83
Q

Q083. MCC of nephritic syndrome

A

A083. poststreptococcal GN

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84
Q

Q084. Poststreptococcal GN occurs after infection with ______.

A

A084. group A beta hemolytic streptococcal infection of respiratory tract

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85
Q

Q085. proliferative GN + pulmonary hemorrhage + IgG anti glomerular basement membrane antibody

A

A085. Goodpasture’s syndrome

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86
Q

Q086. MCC of acute interstitial nephritis

A

A086. acute allergic reaction to a medication

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87
Q

Q087. eosinophils in urine suggest what?

A

A087. acute interstitial nephritis

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88
Q

Q088. What disease has a defective amino acid transporter (in the kidney)?

A

A088. Hartnup syndrome decreased intestinal and renal reabsorption of neutral aa’s, such as tryptophan, causing nicotinamide deficiency

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89
Q

Q089. What kidney disease manifests like pellagra?

A

A089. 3 D’s:; dermatitis,; dementia,; diarrhea; Hartnup syndrome

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90
Q

Q090. Adult polycystic Kidney Disease associated finding in the brain?

A

A090. intracerebral berry aneurysm

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91
Q

Q091. medullary sponge kidney is thought to be associated with what other disease?

A

A091. hyperparathyroidism and parathyroid adenoma

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92
Q

Q092. most common cause of secondary HTN?

A

A092. renal artery stenosis decreased blood flow to JG apparatus, RAA system becomes activated, HTN

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93
Q

Q093. What HTN drug is contraindicated in patients with renovascular HTN?

A

A093. ACEI

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94
Q

Q094. MC site of nephrolithiasis impaction

A

A094. ureterovesicular junction

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95
Q

Q095. Prostate Ca commonly begins where in the gland?

A

A095. periphery then moves centrally obstructive symptoms LATE

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96
Q

Q096. Dx:; Edema, lipiduria, foamy urine, hypoalbuminemia, hyperlipidemia, hypercoagulation, protein in urine

A

A096. Nephrotic syndrome

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97
Q

Q097. Dx:; “Maltese crosses” in urine

A

A097. cholesterol in urine; (Nephrotic syndrome)

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98
Q

Q098. Why does the nephrotic syndrome patient have edema?; hypercoaguability?

A

A098. Edema decrease ion serum proteins and oncotic pressure; Hypercoag loss of Proteins C and S and antithrombin III

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99
Q

Q099. Dx:; child with epithelial foot process loss on EM; Tx?

A

A099. Minimal Change Disease; Tx: steroids

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100
Q

Q100. Dx:; glomerular scarring involving limited number of glomeruli with IgG and complement deposition; Most common in what patients?; (5)

A

A100. Focal Segmental Glomerulosclerosis; Common in (Halt MID Stream):; HIV;; Men (younger) with HTN; IV drug users;; DM;; Sickle cell

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101
Q

Q101. What can Focal Glomerulosclerosis lead to?; (2); Tx?

A

A101. HTN and Chronic Renal Disease; Tx: Cyclophosphamide

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102
Q

Q102. First line of Tx for all Nephrotic syndrome

A

A102. Protein and NaCl restriction

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103
Q

Q103. Dx:; MCC of Nephrotic Syndrome in adults that is slow to progress and has little response to steroids; Etiology? (6)

A

A103. Membranous Glomerulonephritis Etiology (SHIT):; SLE / Syphilis;; HBV / HCV;; Idiopathic;; Tumor

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104
Q

Q104. Rule of thirds for Membranous GN

A

A104. 1/3 get CRF; 1/3 have spontaneous remission; 1/3 remain nephrotic without progression

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105
Q

Q105. Tx for Membranous GN; (2)

A

A105. Cyclophosphamide; Chlorambucil

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106
Q

Q106. Dx:; Abrupt onset hematuria with RBC casts, smoky brown urine, proteinuria, hypertension, edema and azotemia (low GRF)

A

A106. Acute Glomerulonephritis; (Nephritic syndrome)

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107
Q

Q107. Dx:; presents 2 weeks after pharyngitis or impetigo with dark urine and edema

A

A107. Poststrep. GN

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108
Q

Q108. Deposition of what causes glomerular damage in poststrep GN?; Tx?

A

A108. Deposition of IgG, C3 and C4 in a granular pattern; Tx underlying infection

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109
Q

Q109. Dx:; hematuria immediately after an infection or exercise

A

A109. IgA nephropathy; (Berger’s Disease)

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110
Q

Q110. what (and where) is the immune complex deposition of IgA nephropathy?

A

A110. Mesangeal deposition of IgA and C3

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111
Q

Q111. Dx:; immune deposits on BM cause it to look double layered; what is it associated w/?; (2)

A

A111. Membranoproliferative (“Tram track” appearance) Assoc with:; Hepatitis C; Cryoglobinemia

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112
Q

Q112. How is type I membranoproliferative different then type II?

A

A112. Type I: slowly progressive; Type II: low serum C3 due to Auto Ab vs C3

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113
Q

Q113. Tx of Membranoproliferative for adults (2) and kids

A

A113. Adults: ASA, Dipyridimole; Kids: Steroids

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114
Q

Q114. Dx:; Fulminant renal failure with proteinuria, hematuria and RBC casts and epithelial cell proliferation in glomeruli; (2 names)

A

A114. Rapidly Progressive GN; (Cresentric GN)

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115
Q

Q115. (3) types of Rapidly Progressive GN

A

A115. 1. Pauci Immune RPGN; 2. Immune complex RPGN; 3. Anti glomerular BM Ab Disease

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116
Q

Q116. Serum marker for Pauci Immune RPGN

A

A116. ANCA positive; (Wegner’s = c ANCA); (polyarteritis nodosa = p ANCA)

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117
Q

Q117. Etiology of Immune Complex RPGN; (5)

A

A117. SPLIT:; Syphilis;; Post strep GN;; Lupus nephritis;; IgA nephritis;; Tumors

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118
Q

Q118. another name for Anti GMB Ab disease; what cells cause problem?

A

A118. Goodpasture’s disease; Cytotoxic T cells (CD 8)

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119
Q

Q119. Tx for all RPGN; (2); what percent go on to end stage renal disease?

A

A119. Tx:; steroids; cyclophosphamide; 80%

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120
Q

Q120. Renal involvement with Lupus type I V; Which has “wire loop” abnormality?

A

A120. I: no renal involvement; II: Focal Segmental; III: Focal Proliferative; IV: Diffuse Proliferative (most severe wire loop); V: Membranous

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121
Q

Q121. MCC of End Stage Renal Disease; What is the early manifestation?; What do Biopsy show?

A

A121. Diabetes; starts with microalbuminuria; Biopsy: Kimmelstiel Wilson nodules

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122
Q

Q122. Dx:; palpable purpura on buttocks and legs of kids, abdominal pain, vomiting, hematuria and GI bleeding

A

A122. Henoch Schonlein purpura

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123
Q

Q123. Dx:; Tubule plugging with Bence Jones proteins; what electrolyte disorder from Dx also leads to kidney trouble?; What causes patient to go into CRF?

A

A123. Multiple myeloma; Hypercalcemia; E.Coli infection of kidney from abnormal Ab production

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124
Q

Q124. (3) major toxins that increase the serum’s osmolarity

A

A124. EtOH; Methanol; Ethylene glycol

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125
Q

Q125. ICF is what fraction of TBW?; Major cations of ICF? (2); Major anions? (2)

A

A125. ICF = 2/3 of TBW; Cations: K, Mg; Anions: Proteins, Organic Phosphates (ATP, ADP, AMP)

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126
Q

Q126. ECF is what fraction of TBW?; Major cation of ECF?; Major anions? (2)

A

A126. ECF = 1/3 of TBW; Cation: Na; Anions: Cl, HCO3

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127
Q

Q127. What composition does interstitial fluid resemble?; What is different?

A

A127. resembles Plasma; Interstitial fluid contains little protein (ultrafiltrate)

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128
Q

Q128. What (2) compartments does water shift between?; If solutes (glucose, sodium, mannitol) dont cross the cell membrane, what osmolarity do they contribute to?

A

A128. ECF + ICF; ECF

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129
Q

Q129. Formula for Serum Osmolarity; Normal Serum Osmolarity?

A

A129. SO = 2(Na+K) + Glucose/18 + BUN/2.8; 300 mOsm/kg

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130
Q

Q130. Define:; Hyponatremia

A

A130. plasma sodium < 134mEq/L

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131
Q

Q131. What are the (3) categories of Hyponatremia?

A

A131. Hypovolemic; Isovolemic; Hypervolemic

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132
Q

Q132. How can you distinguish b/t renal and extrarenal causes of hypovolemic hyponatremia?

A

A132. Urine Sodium:; U Na > 20 = Renal; U Na < 10 = Non renal

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133
Q

Q133. Extra renal causes of hypovolemic hyponatremia; (5)

A

A133. GI loss (Vomiting/Diarrhea); Extensive burns; Dehydration; 3rd spacing (pancreatitis, peritonitis)

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134
Q

Q134. Renal causes of Hypotonic Hypovolemic Hyponatremia; (5)

A

A134. TANAS:; Thiazides (diuretics);; ACEi;; Nephropathies;; Addisons Disease (Mineralcorticoid deficiency);; Salt wasting nephropathies

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135
Q

Q135. Etiology of Hypotonic Euvolemic Hyponatremia; (separate into 2 categories 8 total)

A

A135. Less dilute urine (SHiT):; SIADH; Hypothyroidism; Idiosyncratic drug reaction (Thiazides, ACEi) More dilute urine (Huge PEPE):; Hypokalemia; Post op Hyponatremia; EtOH addiction; Psychogenic polydipsia; Exercise

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136
Q

Q136. “tonic” as in hypertonic refers to what?

A

A136. serum osmolality

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137
Q

Q137. Serum osmolality level for:; Hyponatremia; Hypernatremia

A

A137. Hyponatremia: < 280 mOsm/kg; Hypernatremia: > 300 mOsm/kg

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138
Q

Q138. Etiology of Hypotonic Hypervolemic Hyponatremia; (4)

A

A138. CLAN:; CHF; Liver disease; Advanced Renal Failure; Nephrotic syndrome

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139
Q

Q139. Etiology of Isotonic Hyponatremia; (2)

A

A139. Hyperproteinemia; Hyperlipidemia

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140
Q

Q140. Etiology of Hypertonic Hyponatremia; (2)

A

A140. Facticious Hyponatremia:; Hyperglycemia; Hypertonic infusions; (mannitol, glucose, contrast)

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141
Q

Q141. How does each 100 mL/dL increase in serum glucose above normal cause sodium to decrease?

A

A141. Sodium decreases by 1.6 mEq/L

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142
Q

Q142. Signs/Sx of moderate hyponatremia or gradual onset; (4)

A

A142. Confusion; Muscle cramps; Anorexia; Nausea

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143
Q

Q143. Signs/Sx of severe hyponatremia or rapid onset; (2); At what level is considered severe?

A

A143. Seizures or Coma; Severe: < 115 mEq/L

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144
Q

Q144. With low serum osmolarity (< 280), what signs should be observed to differentiate b/t Hypovolemia, Isovolemia, & Hypervolemia?

A

A144. Hypovolemia:; Tachycardia; Hypotension; poor skin turgor; Isovolemia:; Normal vital signs without edema; Hypervolemia:; peripheral Edema

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145
Q

Q145. Dx:; measured & calculated serum osmolarities are different; What (2) problems is it seen in?

A

A145. Pseudohyponatremia; Seen in:; Multiple myeloma; Hyperlipidemia

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146
Q

Q146. Tx of Hypovolemic Hyponatremia; (2)

A

A146. 1. address underlying disorder; 2. replace volume with NS; (monitor Na to prevent CPM)

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147
Q

Q147. Tx of Isovolemic or Hypervolemic Hyponatremia; (2)

A

A147. 1. address underlying disorder; 2. Sodium + water restriction

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148
Q

Q148. What is Tx for CHF induced Hypervolemic Hyponatremia?; (2)

A

A148. 1. Sodium + water restriction; 2. Combination of Captopril & Furosemide

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149
Q

Q149. Rules for correcting Hyponatremia by increasing serum sodium; (2); Why?

A

A149. 1. only go into low normal range in forst 24 hours; 2. never correct sodium faster then 1 mEq/L/hr; Can lead to Central Pontine Myelinolysis (CPM), seizures, coma

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150
Q

Q150. What are pre menopausal women at high risk for during an acute episode of Hyponatremia?

A

A150. Cerebral edema

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151
Q

Q151. Dx:; Osmotic demyelination syndrome occurring as a treatment complication of severe or chronic hyponatremia

A

A151. Central Pontine Myelinolysis; (CPM)

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152
Q

Q152. Serum sodium level that is considered Hypernatremia

A

A152. Serum Na > 145 mEq/L

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153
Q

Q153. Type of Hypernatremia:; Loss of both water + sodium; (water loss&raquo_space; sodium loss)

A

A153. Hypovolemic Hypernatremia

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154
Q

Q154. Type of Hypernatremia:; Decreased TBW, normal body sodium, decreased ECF

A

A154. Isovolemic Hypernatremia

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155
Q

Q155. Type of Hypernatremia:; Increased TBW, markedly Inc total body Na, Inc ECF

A

A155. Hypervolemic Hypernatremia

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156
Q

Q156. Etiology of Hypervolemic Hypernatremia; (3)

A

A156. Hypertonic fluid administration;; Mineralcorticoid excess (Cushing’s, Conn’s);; Excess salt ingestion

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157
Q

Q157. Etiology of Isovolemic Hypernatremia; (2)

A

A157. Diabetes Insipidus;; Skin losses (due to hyperthermia)

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158
Q

Q158. Etiology of Renal related Hypovolemic Hypernatremia; (3)

A

A158. Diuretics;; Acute/chronic Renal failure;; Partial obstruction

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159
Q

Q159. Etiology of Extra renal related Hypovolemic Hypernatremia; (5)

A

A159. Hyperpnea;; Excessive sweating;; Diarrhea;; Burns;; Dialysis

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160
Q

Q160. formula for Water Deficit in Hypernatremia patient

A

A160. WD (liters) = 0.6 x body wt (kg) x (measured Na/140) 1

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161
Q

Q161. Tx for Hypovolemic Hypernatremia

A

A161. Fluid replacement with NS; (correct plasma osmolarity no faster then 2 mOsm/kg/hr)

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162
Q

Q162. Tx for Isovolemic Hypernatremia; What additionally should you do if Dx is Central Diabetes Insipidus?

A

A162. Fluid replacement with 1/2 NS; (correct only half of the deficit in first 24 hrs); C DI: Vasopressin

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163
Q

Q163. Tx for Hypervolemic Hypernatremia; (2)

A

A163. 1. Fluid replacement with 1/2 NS (for hypertonicity); 2. Loop diuretic (furosemide) to inc Na excretion

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164
Q

Q164. Normal range of Potassium

A

A164. 3.3 5.5; (below is hypokalemia; above is hyperkalemia)

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165
Q

Q165. Difference b/t Periodic paralysis of Hypokalemia vs. Hyperkalemia

A

A165. Hypokalemia presents in teens; Hyperkalemia presents in infancy

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166
Q

Q166. What heart drug causes a greater toxicity if patient goes into Hypokalemia?; How is this avoided?

A

A166. Digitalis; check K+ regularly

167
Q

Q167. (4)* general ways we can lose potassium (become Hypokalemia)

A

A167. 1. Cellular shift + undetermined mechanisms; 2. Inc renal excretion; 3. GI losses; 4. Sweating

168
Q

Q168. Cellular shift + undetermined mechanisms of Hypokalemia; (5)*

A

A168. A Deadly VIBe:; 1. Alkalosis; 2. Digoxin toxicity correction (with digibind); 3. Vitamin B 12; 4. Insulin; 5. Beta adrenergics

169
Q

Q169. in Alkalosis, how does each 0.1 increase in pH affect K+?

A

A169. decreases serum K+ by 0.5 mEq/L

170
Q

Q170. What does insulin do to K+?

A

A170. drives it into the cells

171
Q

Q171. Etiology of Hypokalemia due to Increased renal excretion mechanisms; (6)*

A

A171. 1. Cushings (Inc Mineralcorticoid activity); 2. HypoMagnesium; 3. Bartter’s syndrome; 4. Osmotic diuresis (mannitol); 5. Renal tubular acidosis; 6. Medications

172
Q

Q172. Dx:; JG cell hyperplasia causing increased renin/aldosterone, met alkalosis, Hypokalemia, muscle weakness and tetany; seen in young adults

A

A172. Bartter’s syndrome

173
Q

Q173. (3) GI loss causes of Hypokalemia

A

A173. 1. Vomiting; nasogastric suction; 2. Diarrhea; laxative abuse; 3. Inadequate dietary intake (anorexia)

174
Q

Q174. Dx:; Impaired gastric motility, nausea, vomiting, muscle weakness (to paralysis), rhabdomyolysis, atrial + ventricular arrhythmias

A

A174. Hypokalemia

175
Q

Q175. What is the Tx for urgent Hypokalemia? (2); What works faster?; What type of patient must be monitored closely?

A

A175. give IV + oral potassium simultaneously; oral works faster; monitor patient with renal failure

176
Q

Q176. At what level should K+ be peri MI to prevent arrhythmias?

A

A176. K+ > 4.0

177
Q

Q177. IV infusion of K+ should not exceed what number/hour?; How much does that raise serum K+?

A

A177. IV no more then 20 mEq/hr; Increases K+ by 0.25 mEq/L

178
Q

Q178. what diagnostic procedure should be performed on patients with moderate or severe Hyperkalemia?

A

A178. Stat EKG

179
Q

Q179. The only Tx of Hyperkalemia (aside from dialysis) that removes K from the body

A

A179. Kayexalate

180
Q

Q180. MCC of Hyperkalemia in lab results; What should be done?

A

A180. Pseudo Hyperkalemia:; falsely elevated measurement due to hemolysis; Re run lab test

181
Q

Q181. (4)* causes of ICF to ECF potassium shifting causing Hyperkalemia

A

A181. Heavy exercise; Acidosis; Insulin deficiency; Digitalis toxicity

182
Q

Q182. (3) causes of an increased potassium load causing Hyperkalemia

A

A182. IV potassium supplements; K+ medications; Increased cellular breakdown

183
Q

Q183. Causes of decreased potassium excretion causing Hyperkalemia; (3 renal and 3 drugs)*

A

A183. ROB A K:; Renal failure;; Obstructive uropathies;; Beta blockers;; Aldosterone deficiency / ACEi;; K sparing diuretics

184
Q

Q184. Dx:; N/V/D; muscle cramps, weakness, areflexia, tetany, confusion; respiratory insufficiency; arrhythmias, cardiac arrest

A

A184. Hyperkalemia

185
Q

Q185. EKG changes when potassium equals:; 1. 6.5 7.5 (3); 2. 7.5 8.0 (2); 3. 10 12; What does it lead to? (3)

A

A185. 1. Tall, peaked T waves; short QT; prolonged PR; 2. QRS widening; Flat P wave; 3. QRS degrades into SIN wave; leads to: V fib, complete heart block or asystole

186
Q

Q186. Hyperkalemia is most common with what (2) causes

A

A186. Renal failure; muscle breakdown

187
Q

Q187. What are the Tx of Hyperkalemia in order of Stabilize, Shift, Remove?*

A

A187. Can Get In A Bad K Day:; Stabilize Calcium; Shift Glucose + Insulin; Albuterol; Bicarbonate; Remove Kayexalate; Dialysis

188
Q

Q188. When is calcium contraindicated for Hyperkalemia?

A

A188. if patient is on Digoxin

189
Q

Q189. Polycystic Kidney Disease What is it

A

A189. AD bilateral cysts progressively develop, late onset, usually asymptomatic until 30 y/o, 50% ESRD with dialysis by 60 y/o; AR less common, more severe, often lethal in 1st few years infants and kids, renal failure, liver fibrosis, portal HTN

190
Q

Q190. Polycystic Kidney Disease History/PE

A

A190. Hematuria; HTN; pain sharp & localized, from ruptured cysts,; infection,; renal calculi; large, palpable kidneys; liver cysts; berry aneurysms; mitral valve prolapse; colonic diverticula

191
Q

Q191. Polycystic Kidney Disease Dx

A

A191. US or CT

192
Q

Q192. Polycystic Kidney Disease Tx

A

A192. Prevent complications,; slow progression to ESRD: early management of UTI prevent renal cyst infection; control BP; ESRD dialysis, renal transplant

193
Q

Q193. Nephrolithiasis MC in what population; Risk factors

A

A193. MC in older men risk factors; family History,; low fluid intake; gout; postcolectomy; postileostomy; spec. enzyme disorder; RTA; hyperparathyroidism

194
Q

Q194. Nephrolithiasis History/PE

A

A194. Acute onset; severe colicky flank pain; may radiate to testes or vulva; n/v; pt. freq. shift position

195
Q

Q195. Nephrolithiasis Dx

A

A195. Spiral CT test of choice; UA best 1st test; KUB; renal US; IVP confirm; noncontrast abdominal CT; UA hematuria, altered urine pH

196
Q

Q196. Nephrolithiasis Tx

A

A196. Initial Tx hydration; analgesia; < 5mm can pass thru urethra; < 3 cm ESWL (extracorporeal shock wave lithotripsy); percutaneous nephrolithotomy

197
Q

Q197. Nephrolithiasis Calcium Oxalate/; Calcium Phosphate; Characteristics; Tx

A

A197. MC (83%); idiopathic hypercalciuria; primary hyperparathyroidism; hyperoxaluria; hypocitraturia; alkaline urine; radiopaque; Tx hydration, thiazide diuretic

198
Q

Q198. Nephrolithiasis Struvite (Mg NH4 PO4); Characteristics; Tx

A 
A198. "Triple phosphate stones  due to urease producing organism   Proteus
 Staghorn calculi
 alkaline urine
 radiopaque
 Tx   hydration
 treat UTI
 if present"
199
Q

Q199. Nephrolithiasis Uric Acid; Characteristics; Tx

A

A199. Hyperuricemia; gout; high purine turnover states; acidic urine (pH < 5.5); radiolucent; Tx hydration, alkalinize urine with citrate, citrate converted to HCO3 in liver

200
Q

Q200. Nephrolithiasis Cystine; Characteristics; Tx

A

A200. Due to defect of tubular amino acid transporter for cystine, ornithine, lysine & arginine (COLA); yellow brown hexagonal crystal; radiopaque; Tx hydration, alkalinize urine, if neither works penicillamine

201
Q

Q201. Ureteral Reflux What is it

A

A201. Retrograde flow of urine from bladder back up, due to insuff. Submucosal length of ureter => ineffect. restricting; retrograde flow during contraction of bladder; recurrent UTIs

202
Q

Q202. Ureteral Reflux Dx; Tx

A

A202. Dx VCUG: Voiding CystoUrethroGram detects abnormality at ureteral insertion site; classifies grade of reflux; Tx tx infections aggressively �% mild reflux no dilation, often resolves spontaneously �% mod to severe reflux surgery (uret. reimplantation)

203
Q

Q203. Renal Cell Carcinoma What is it; Risk factors

A

A203. MC kidney cancer (80 90%); adenocarcinoma arises from tubular epith cells => renal vein => IVC => mets to lung & bone; risk factors men, smoking, VHL disease

204
Q

Q204. Renal Cell Carcinoma History/PE

A

A204. Classic triad; hematuria; flank pain; palpable flank mass; polycythemia; constitutional Sxs; enlargement of left testicle

205
Q

Q205. Renal Cell Carcinoma Tx

A

A205. Surgical resection curative if local; notoriously resistant to chemo & radiation

206
Q

Q206. Cryptorchidism What is it

A

A206. Failure of testes to descend into scrotum; bilateral associated with oligospermia & infertility; risk factor prematurity

207
Q

Q207. Cryptorchidism History/PE

A

A207. Testes can’t be manipulated into scrotal sac with gentle pressure; may be palpated anywhere along inguinal canal or in abdomen

208
Q

Q208. Cryptorchidism Tx

A

A208. Orchiopexy after 1 y/o & before 5 y/o; in 99%, testes descend by 1 yr; find later in life orchiectomy to avoid risk of testicular Ca

209
Q

Q209. Erectile Dysfunction What is it; Risk factors

A

A209. 10 25% of mid aged or elderly; fail to init, fill or store risk factors:; DM; atherosclerosis; meds B blockers, SSRIs; HTN; heart disease. spinal cord injury; surgery or radiation for prostate cancer

210
Q

Q210. Erectile Dysfunction History/PE

A

A210. Ask about:; risk factors; meds; recent life changes; psych stressors; psychological if pt. has nocturnal or early morning erections; situation dependent

211
Q

Q211. Erectile Dysfunction Dx

A

A211. Check for hypogonadism; testosterone levels; gonadotropin levels; prolactin levels; evaluate for neuro dysfunction anal tone; lower ext sensations

212
Q

Q212. Erectile Dysfunction Tx

A

A212. Psychotherapy; sex therapy; testosterone if hypogonadism; sildenafil PDE5 inhibitor, increased cGMP => smooth mus relaxation => increased blood flow in corpora cavernosa

213
Q

Q213. Nephritic Syndrome What is it

A

A213. Manifestation of glomerular; inflammation (glomerulonephritis)

214
Q

Q214. Nephritic Syndrome History/PE

A

A214. Hematuria smoky brown; HTN; oliguria; edema low pressure areas (periorbital, scrotum)

215
Q

Q215. Nephritic Syndrome Dx

A

A215. UA hematuria, (possible) mild proteinuria; decreased GFR; increased BUN/Cr; ANA; ANCA; anti gbm Ab; renal Biopsy

216
Q

Q216. Nephritic Syndrome Tx (in general)

A

A216. Tx HTN, fluid overload and uremia; salt restriction; water restriction; diuretics; dialysis (if necessary); corticosteroids

217
Q

Q217. Postinfectious GN What is it

A

A217. Nephritic Syndrome; usually associated with recent strep infection, group A, B hemolytic

218
Q

Q218. Postinfectious GN History/PE

A

A218. Smoky brown urine; HTN; oliguria; periorbital edema

219
Q

Q219. Postinfectious GN Labs & Histology

A

A219. Low serum C3; increased ASO titer; lumpy bumpy immunofluorescence

220
Q

Q220. Postinfectious GN Tx & Prognosis

A

A220. Supportive; almost all kids & most adults have complete recovery

221
Q

Q221. IgA Nephropathy (Berger’s) What is it

A

A221. Nephritic Syndrome; MC type worldwide; associated with URI or GI infections; young men

222
Q

Q222. IgA Nephropathy (Berger’s) History/PE

A

A222. Gross hematuria

223
Q

Q223. IgA Nephropathy (Berger’s) Labs & Histology

A

A223. Increased serum IgA; Biopsy & immunofluorescence mesangial IgA deposits

224
Q

Q224. IgA Nephropathy (Berger’s) Tx & Prognosis

A

A224. Glucocorticoids; 20% progress to ESRD

225
Q

Q225. Wegener’s Granulomatosis What is it

A

A225. Nephritic Syndrome; granulomatous inflammation of respiratory tract & kidney; necrotizing vasculitis; paucimmune form of RPGN

226
Q

Q226. Wegener’s Granulomatosis History/PE

A

A226. Fever; weight loss; hematuria; respiratory & sinus Sxs; cavitary pulmonary lesions bleed => hemoptysis

227
Q

Q227. Wegener’s Granulomatosis Labs & Histology

A

A227. c ANCA

228
Q

Q228. Wegener’s Granulomatosis Tx & Prognosis

A

A228. High dose corticosteroids; cytotoxic agents; patients tend to have freq relapses

229
Q

Q229. Alport’s Syndrome What is it

A

A229. Nephritic Syndrome; hereditary; boys 5 20 y/o

230
Q

Q230. Alport’s Syndrome History/PE

A

A230. Asymptomatic hematuria; nerve deafness; eye disorders

231
Q

Q231. Alport’s Syndrome Labs & Histology

A

A231. GBM splitting on electron microscope

232
Q

Q232. Alport’s Syndrome Tx & Prognosis

A

A232. Progress to RF; anti GBM nephritis may recur after transplant

233
Q

Q233. Goodpasture’s Syndrome What is it

A

A233. Nephritic syndrome; GN & pulmonary hemorrhage; men in mid 20’s; immune form of RPGN

234
Q

Q234. Goodpasture’s Syndrome History/PE

A

A234. Hemoptysis; dyspnea; possible respiratory failure

235
Q

Q235. Goodpasture’s Syndrome Labs & Histology

A

A235. Linear anti GBM on IF; iron deficient anemia; CXR pulmonary infiltrates; sputum hemosiderin filled macrophages

236
Q

Q236. Goodpasture’s Syndrome Tx & Prognosis

A

A236. Plasma exchange therapy (plasmapheresis); pulsed steroids; cyclophosphamide; may progress to ESRD

237
Q

Q237. Nephrotic Syndrome What is it

A

A237. Increased permeability of glomerulus to protein => proteinuria = or > 3.5 g/day; hypoalbuminemia; hyperlipidemia; hyperlipiduria; edema; predisposed to hypercoag state; 1/3 due to systemic disease DM; SLE; amyloidosis

238
Q

Q238. Nephrotic Syndrome History/PE

A

A238. Generalized edema; foamy urine; if severe dyspnea, ascites, increased susceptibility to infections, venous thrombosis; PE

239
Q

Q239. Nephrotic Syndrome Dx

A

A239. UA proteinuria > 3.5g/day; lipiduria; decreased albumin (< 3g/dL); hyperlipidemia; Biopsy Dx underlying etiology

240
Q

Q240. Nephrotic Syndrome Tx (in general)

A

A240. Steroids best initial Tx; cyclophosphamide; restrict salt; diuretics; statins

241
Q

Q241. Minimal Change Disease What is it

A

A241. Nephrotic syndrome; common in children; idiopathic etiology

242
Q

Q242. Minimal Change Disease History/PE

A

A242. Tendency towards infections, thrombosis

243
Q

Q243. Minimal Change Disease Labs & Histology

A

A243. Normal under light microscope; electron microscope shows fusion of epithelial foot processes

244
Q

Q244. Minimal Change Disease Tx & Prognosis

A

A244. Steroids; excellent prognosis

245
Q

Q245. Focal Segmental; Glomerulosclerosis (FSGS) What is it

A

A245. Nephrotic syndrome; idiopathic; IVDU; HIV

246
Q

Q246. Focal Segmental; Glomerulosclerosis (FSGS) History/PE

A

A246. Especially common in black men with uncontrolled HTN

247
Q

Q247. Focal Segmental; Glomerulosclerosis (FSGS) Labs & Histology

A

A247. Microscopic hematuria; Biopsy sclerosis in capillary tufts

248
Q

Q248. Focal Segmental; Glomerulosclerosis (FSGS) Tx & Prognosis

A

A248. Prednisone; cytotoxic therapy; Poor prognosis

249
Q

Q249. Membranous Nephropathy What is it

A

A249. Nephrotic syndrome; MC white adult nephropathy; MC idiopathic form in adults; immune complex disease

250
Q

Q250. Membranous Nephropathy History/PE

A

A250. Associated with:; HBV; syphilis; malaria; gold (drug); penicillamine; cancer; SLE

251
Q

Q251. Membranous Nephropathy Labs & Histology

A

A251. “spike and dome due to granular deposits of IgG and C3 at basement membrane”

252
Q

Q252. Membranous Nephropathy Tx & Prognosis

A

A252. Steroids are of little use

253
Q

Q253. Diabetic Nephropathy What is it

A

A253. Nephrotic syndrome; Diffuse hyalinization; nodular glomerulosclerosis; Kimmelstiel Wilson lesions

254
Q

Q254. Diabetic Nephropathy History/PE

A

A254. Usually have long standing,; poorly controlled DM

255
Q

Q255. Diabetic Nephropathy Labs & Histology

A

A255. Thickened glomerular basement membrane; increased mesangial matrix

256
Q

Q256. Diabetic Nephropathy Tx & Prognosis

A

A256. Tight glucose control; protein restriction; ACEIs

257
Q

Q257. Lupus Nephritis What is it

A

A257. Nephrotic & nephritic syndrome; WHO types I V; severity of renal disease; determines overall prognosis

258
Q

Q258. Lupus Nephritis History/PE

A

A258. Proteinuria or RBCs in UA

259
Q

Q259. Lupus Nephritis Labs & Histology

A

A259. Mesangial proliferation; subendothelial immune complex deposits

260
Q

Q260. Lupus Nephritis Tx & Prognosis

A

A260. May reduce disease progression prednisone, cytotoxic therapy

261
Q

Q261. Renal Amyloidosis What is it

A

A261. Nephrotic syndrome; primary plasma cell dyscrasia; secondary infectious, inflammatory

262
Q

Q262. Renal Amyloidosis History/PE

A

A262. Patients may have multiple myeloma; or chronic inflammatory disease (RA, TB)

263
Q

Q263. Renal Amyloidosis Labs & Histology

A

A263. Abdominal fat Biopsy; congo red stain; apple green birefringence under polarized light

264
Q

Q264. Renal Amyloidosis Tx & Prognosis

A

A264. Prednisone; melphalan; BMT for multiple myeloma

265
Q

Q265. Membranoproliferative; Nephropathy (MPGN) What is it

A

A265. Nephrotic & nephritic syndrome; 3 types

266
Q

Q266. Membranoproliferative; Nephropathy (MPGN) History/PE

A

A266. Immune deposits; low complement; associated with HCV; slow progression to RF

267
Q

Q267. Membranoproliferative; Nephropathy (MPGN) Labs & Histology

A

A267. “Tram tracks” double layered basement memb; type I subendo deposits; type II decreased C3; C3 nephritic factor; (IgG autoAb)

268
Q

Q268. Membranoproliferative; Nephropathy (MPGN) Tx & Prognosis

A

A268. Corticosteroids; cytotoxic agents

269
Q

Q269. BPH What is it

A

A269. Normal part of aging; seen in > 80% by age 80; patients usually > 50 y/o

270
Q

Q270. BPH History/PE

A

A270. Obstructive hesitancy, weak stream, intermittent stream, incomplete emptying, urinary retention, bladder fullness; irritative nocturia, daytime frequency, urge incontinence, opening hematuria; DRE uniformly enlarged, rubbery; BPH in central zone (may not be detected on DRE)

271
Q

Q271. BPH Dx

A

A271. R/o possible dangerous causes; DRE; UA/UC; Cr; Not recommended for BPH PSA & cystoscopy

272
Q

Q272. BPH Tx

A

A272. Mild reassurance; mod to severe surgery, terazosin, finasteride, TURP, open prostatectomy

273
Q

Q273. Prostate Cancer What is it; Risk factors

A

A273. MC cancer in men; second cause of cancer death in men; risk factors age, family History

274
Q

Q274. Prostate Cancer History/PE

A

A274. Usually asymp; rarely causes Sxs until advanced; urinary retention; decreased force of urine stream; lymphedema; constitutional Sxs; back pain; DRE palpable nodule, area of induration; early Ca usually not detectable; tender prostate = prostatitis

275
Q

Q275. Prostate Cancer Dx

A

A275. Clinical; markedly elevated PSA; US guided transrectal Biopsy; Gleason grade; CXR; bone scan; Gleason grade based on histology; grades 1 5 on two features level of differentiation, structural architecture, the two scores are added; Poorly differentiated tumors score 8 10, worst prognosis

276
Q

Q276. Prostate Cancer Tx

A

A276. Tx based on aggression of tumor, pt’s risk of dying; watchful waiting elderly & low grade; radical prostatectomy & RT increased risk of incontinence, increased risk of impotence; PSA use to evaluate post Tx, check for disease recurrence; metastasis chemo & androgen ablation: GnRH agonists, flutamide, orchiectomy

277
Q

Q277. Prostate Cancer Prevention

A

A277. Annual DRE > 50 y/o; > 45 y/o if Black; > 45 y/o if positive family History; also screen with PSA

278
Q

Q278. Bladder Cancer What is it; Risk factors

A

A278. 2nd MC urologic cancer; MC malignant tumor urinary tract; transitional cell Ca; men 60s & 70s risk factors:; smoking; chronic bladder infections; calculous disease; aniline dye; hair dye

279
Q

Q279. Bladder Cancer History/PE

A

A279. Asymptomatic in early stages; gross hematuria; freq. urgency; dysuria

280
Q

Q280. Bladder Cancer Dx

A

A280. UA; cytology; IVP; cystoscopy with Biopsy diagnostic; may also US, MRI, pelvic CT

281
Q

Q281. Bladder Cancer Tx

A

A281. superficial transurethral resection or intravesicular chemo with mitomycin C or BCG; CIS intravesicular chemo; large, hi grade recurrent intravesicular chemo; invasive without mets aggressive surgery, RT; distant mets chemo

282
Q

Q282. Testicular Cancer What is it; Risk factors

A

A282. Heterogenous group; 95% derive from germ cells; almost all are malignant; MC malignancy in 15 35 y/o; seminomas peak at 40 50 y/o; Klinefelter’s risk factor; cryptorchidism increased risk of neoplasia in both testes

283
Q

Q283. Testicular Cancer History/PE

A

A283. Painless enlargement of testis

284
Q

Q284. Testicular Cancer Dx

A

A284. B hCG increased in choriocarcinomas, increased in 10% of seminomas; AFP increased in endodermal sinus, (yolk sac) tumors

285
Q

Q285. Testicular Cancer Tx

A

A285. Seminomas very radiosensitive, also respond to chemo; nonseminomatous germ cell platinum based chemo

286
Q

Q286. SIADH What is it; What is it associated with

A

A286. Euvolemic hyponatremia from nonosmotically stimulated ADH release associated with:; CNS disease; pulmonary disease; ectopic tumor/ paraneoplastic syndromes; drugs; surgery

287
Q

Q287. SIADH Dx

A

A287. Urine osmolality > 50 100 mOsm/kg; concurrent serum hyposmolarity; no physio reason for increased ADH; urinary sodium > 20 mEq/L

288
Q

Q288. SIADH; Tx

A

A288. Tx underlying cause; mild restrict fluids; moderate NS and furosemide; severe (Sxs) hypertonic saline, then furosemide; if chronic demeclocycline or lithium ADH antag

289
Q

Q289. Diabetes Insipidus What is it; What is it caused by

A

A289. Central or nephrogenic Central:; post pit. doesn’t secrete ADH; causes tumor, ischemia (Sheehan’s), trauma, infection, autoimmune disorder Nephrogenic:; kidneys don’t respond to ADH; causes renal disease, drugs (lithium, demeclocycline)

290
Q

Q290. Diabetes Insipidus History/PE

A

A290. Polydipsia; polyuria; persistent thirst; dilute urine; if don’t have unlimited access to water dehydration, hypernatremia

291
Q

Q291. Diabetes Insipidus Dx

A

A291. Water deprivation test; DDAVP challenge desmopressin mimics ADH; if central DDAVP challenge => decreased urine output, increased urine osmolarity; thus, MRI (to check for mass); if nephrogenic DDAVP challenge will not decreased urine output

292
Q

Q292. Diabetes Insipidus Tx

A

A292. central DDAVP subcutaneously; nephrogenic thiazide diuretics (HCTZ), amiloride, chlorthalidone

293
Q

Q293. Acetazolamide Site of Action; Mechanism

A

A293. Proximal convoluted tubule; inhibits carbonic anhydrase

294
Q

Q294. Acetazolamide Clinical Use

A

A294. Glaucoma; urinary alkalinization; metabolic alkalosis; altitude sickness; cysteinuria

295
Q

Q295. Acetazolamide Toxicity

A

A295. Hyperchloremic metabolic acidosis; sulfa allergy

296
Q

Q296. Loop Agents; Furosemide; Bumetanide; Torsemide; Ethacrynic Acid Site of Action; Mechanism

A

A296. Ascending loop of Henle; Inhibits Na/K/2 Cl cotransport

297
Q

Q297. Loop Agents; Furosemide; Bumetanide; Torsemide; Ethacrynic Acid Clinical Use

A

A297. HTN; hypercalcemia; edematous states CHF; cirrhosis; nephrotic syndrome; pulmonary edema

298
Q

Q298. Loop Agents; Furosemide; Bumetanide; Torsemide; Ethacrynic Acid Toxicity

A

A298. OH DANG; Ototoxicity; Hypokalemia; Dehydration; Allergy sulfa (not ethacrynic acid); Nephritis interstitial; Gout

299
Q

Q299. Hydrochlorothiazide Site of Action; Mechanism

A

A299. Distal convoluted tubule; inhibits Na+/Cl cotransporter

300
Q

Q300. Hydrochlorothiazide Clinical Use

A

A300. HTN; CHF; idiopathic hypercalciuria; nephrogenic diabetes insipidus

301
Q

Q301. Hydrochlorothiazide Toxicity

A

A301. HyperGLUC; hyperGlycemia; hyperLipidemia; hyperUricemia; hypercalcemia and; hypokalemic metabolic alkalosis; hyponatremia; sulfa allergy

302
Q

Q302. K+ Sparing Agents; Spironolactone; Triamterene; Amiloride Site of Action; Mechanism

A

A302. Cortical collecting tubule; Spironolactone aldosterone receptor antag; triamterene & amiloride block Na+ channels

303
Q

Q303. K+ Sparing Agents; Spironolactone; Triamterene; Amiloride Clinical Use

A

A303. Hyperaldosteronism; K+ depletion; CHF

304
Q

Q304. K+ Sparing Agents; Spironolactone; Triamterene; Amiloride Toxicity

A

A304. Hyperkalemia; gynecomastia; antiandrogen effects

305
Q

Q305. Mannitol Site of Action; Mechanism

A

A305. Entire tubule; sorbitol stereoisomer; osmotic diuretic; filtered by glomerulus; can’t be reabsorbed; increased tubular fluid osmolarity => decreased water reabsorption => increased urine flow

306
Q

Q306. Mannitol Clinical Use

A

A306. Shock; drug overdose; decreased intracranial or intraocular pressure

307
Q

Q307. Mannitol Toxicity

A

A307. Pulmonary edema; dehydration; contraindicated in anuria, CHF

308
Q

Q308. Renal Tubular Acidosis What is it

A

A308. Failure of kidneys to acidify urine; net decreased in tubular H+ secretion or HCO3 reabsorption => nonanion gap metabolic acidosis

309
Q

Q309. RTA Type I What is it

A

A309. Distal tubule H+/K+ pump is broken => failure to secrete H+; serum K+ stays low; urinary pH > 5.3

310
Q

Q310. RTA Type I Causes; Complications

A

A310. Causes usually sporadic; lithium; amphotericin; analgesics; collagen vascular disease; cirrhosis; chronic urinary tract obstruct; sickle cell; nephrocalcinosis also a consequence complication nephrolithiasis; secondary hyperaldosteronism

311
Q

Q311. RTA Type I Tx; Dx/Test

A

A311. Tx potassium citrate; Dx/Test acid load

312
Q

Q312. RTA Type II What is it

A

A312. Proximal tubule cells don’t reabsorb HCO3; urinary pH initial > 5.3; distal tubular cells work OK => urinary pH < 5.3 when serum gets acidic

313
Q

Q313. RTA Type II Causes; Complications

A

A313. Causes:; hereditary; carbonic anhydrase inhibitors; Fanconi’s syndrome; multiple myeloma; complications rickets, osteomalacia

314
Q

Q314. RTA Type II Tx; Dx/Test

A

A314. Tx potassium citrate; Dx/Test bicarb load

315
Q

Q315. RTA Type IV What is it

A

A315. Adrenal insensitivity to angiotensin 2; aldosterone deficient; serum K+ is high; usually asymptomatic hyperkalemia, hyperchloremic metabolic acidosis (nonanion/normal metabolic acidosis)

316
Q

Q316. RTA Type IV Causes; Complications

A

A316. Causes; hyporeninemic hypoaldosterone:; DM (infarcts JG); ACEIs; NSAIDs; addison’s; sickle cell; renal insufficiency; complication hyperkalemia

317
Q

Q317. RTA Type IV Tx; Dx/Test

A

A317. Tx fludrocortisone, furosemide if HTN, kayexelate; Dx/Test restrict salt

318
Q

Q318. Acute Renal Failure What is it

A

A318. Rapid decreased in renal function over days to weeks => accum of nitrogenous products, fluid & electrolyte disorder develop. prerenal caused by decreased renal plasma flow (inadequate renal perfusion); renal caused by intrinsic renal disease or damage; postrenal caused by obstruction of urinary outflow, both kidneys must be obstructed to cause significant azotemia

319
Q

Q319. Acute Renal Failure History/PE

A

A319. History uremia, malaise, oliguria, fatigue, anorexia, n/v; PE asterixis, HTN, decreased urinary output, increased RR, pericardial friction rub if uremic pericarditis,; prerenal hypovolemia, orthostasis, oliguria; postrenal anuria, distended bladder; acute interstitial nephritis fever; rash

320
Q

Q320. Acute Renal Failure Dx

A

A320. CBC; BUN/Cr; electrolytes; FE(Na) if oliguric; urine sediment RBC, WBC casts, eosinophils; urinary catheter; renal US

321
Q

Q321. Acute Renal Failure Tx

A

A321. Balance fluid & electrolytes; dialysis if indicated; acute/allergic nterstitial nephritis adjust/discontinue offending meds; glomerulonephritis corticosteroids, cytotoxics

322
Q

Q322. Acute Renal Failure Complications

A

A322. Chronic renal failure => dialysis; dialysis prevent buildup of: K+, H+, toxic metabolites; increased risk for CAD

323
Q

Q323. Acute Renal Failure What is Prerenal % for FE(Na); What is Prerenal No. for U(Na); What is Prerenal Ratio; for BUN/Cr

A

A323. FE(Na) is < 1%; U(Na) is < 20; BUN/Cr is > 20

324
Q

Q324. Acute Renal Failure FE(Na) How do you calculate it

A

A324. U/P Na divided by U/P Cr

325
Q

Q325. Dialysis What are the indications

A

A325. AEIOU; Acidosis; Electrolyte abnormalities (hyperkalemia); Ingestions; Overload of fluid; Uremic Sxs pericarditis, encephalopathy, bleeding, nausea, pruritus, myoclonus

326
Q

Q326. Hyponatremia What is it

A

A326. Serum sodium < 135 mEq/L

327
Q

Q327. Hyponatremia History/PE

A

A327. May be asymptomatic; confusion; lethargy; muscle cramps; nausea; can progress to seizures, status epilepticus, coma

328
Q

Q328. Hyponatremia Dx

A

A328. Classified by:; serum osmolality; volume status (by PE); urinary Na+

329
Q

Q329. Hyponatremia What are the types; of osmolalities

A

A329. High > 295 mEq/L: hyperglycemia, hypertonic infusion (mannitol); Normal 280 295 mEq/L: hyperlipidemia, hyperproteinemia, pseudohyponatremia; Low < 280 mEq/L: hypervolemic hyponatremia, euvolemic hyponatremia, hypovolemic hyponatremia

330
Q

Q330. Hyponatremia Tx

A

A330. Chronic hyponatremia should be corrected slowly to prevent central pontine myelinolysis

331
Q

Q331. Hypervolemic Hyponatremia What is it; Etiologies; Tx

A

A331. Increased in Na+ & total body weight, Increased greater in TBW etiologies edematous states:; renal failure; nephrotic syndrome; cirrhosis; CHF; Tx restrict salt and water

332
Q

Q332. Euvolemic Hyponatremia What is it; Etiologies; Tx

A

A332. Total body Na+ normal, total body water has increased Etiologies:; SIADH; hypothyroidism; renal failure; drugs; psychogenic polydipsia; adrenal insufficiency; Tx restrict salt and water

333
Q

Q333. Hypovolemic Hyponatremia What is it; Etiologies; Tx

A

A333. Decreased in total body Na+ and total body water, more Na+ than water is lost etiologies; diuretics; vomiting; diarrhea; third spacing; dehydration; Tx replete volume with normal saline

334
Q

Q334. Hypernatremia What is it

A

A334. Serum Na+ > 145 mEq/L

335
Q

Q335. Hypernatremia History/PE

A

A335. Thirst; oliguria or polyuria (depends on etiology); mental status changes; weakness; focal neuro deficits; seizures; “doughy” skin

336
Q

Q336. Hypernatremia Dx

A

A336. Measure urine volume; measure urine osmolality; hypervolemic hyperNa+ increased aldosterone or excess Na+ (IV saline); min vol (500 mL/day) of max concentrated urine (> 400 mOsm/kg) adequate renal response; inadequate free water replaced; fluid loss from decreased intake, diuretics, glycosuria, 3rd spacing; large volume of dilute urine diabetes insipidus

337
Q

Q337. Hypernatremia Tx

A

A337. Tx underlying causes; replace free water deficit isotonic fluids; correct gradually over 48 72 hrs (to prevent neuro damage secondary to cerebral edema)

338
Q

Q338. Hypercalcemia What is it; What causes it

A

A338. Serum Ca2+ > 10.2 mg/dL, > 15 mg/dL = medical emergency; MCC hyperparathyroidism, malignancy common causes CHIMPANZEES:; Calcium supplementation; Hyperparathyroidism; Iatrogenic (thiazides); Immobility; Milk alkali syndrome; Paget’s disease; Addison’s; Acromegaly; Neoplasm; Zollinger Ellison syndrome; Excess vitamin A; Excess vitamin D; Sarcoidosis; and other granulomatous disease

339
Q

Q339. Hypercalcemia History/PE

A

A339. “Bones, stones, abdominal groans, psych overtones ( fracture, kidney stones, n/v ,constipation, anorexia, Weakness, Fatigue and altered mental status”

340
Q

Q340. Hypercalcemia Dx

A

A340. EKG short QT; total Ca2+; ionized Ca2+; albumin; phosphate; PTH; PTHrP; vit D; TSH; serum immunoelectrophoresis

341
Q

Q341. Hypercalcemia Tx

A

A341. IV hydration; then furosemide; if severe or refractory calcitonin, bisphosphonates (pamidronate), glucocorticoids, dialysis

342
Q

Q342. Hypocalcemia What is it; What causes it

A

A342. Serum Ca2+ < 8.5 mg/dL caused by: hypoparathyroidism (postsurgery, idiopathic); malnutrition; hypomagnesemia; acute pancreatitis; medullary thyroid cancer (excess calcitonin); vit D def. pseudohypoparathyroidism; renal insufficiency; serum Ca2+ may be falsely low in hypoalbuminemia

343
Q

Q343. Hypocalcemia History/PE

A

A343. Abdominal muscle cramps; tetany; perioral & acral paresthesias; convulsions; dyspnea; Chvostek’s sign; Trousseau’s sign; EKG prolonged QT

344
Q

Q344. Hypocalcemia Dx

A

A344. Ionized Ca2+; Mg2+; PTH; albumin; calcitonin; if post thyroidectomy check operative note to determine number of parathyroid glands removed

345
Q

Q345. Hypocalcemia Tx

A

A345. Tx underlying disorder; oral calcium supplements; if severe IV calcium

346
Q

Q346. Hypomagnesemia What is it; What is it caused by

A

A346. Serum Mg2+ < 1.5 mEq/L causes:; decreased intake: malnutrition, alcoholism, malabsorption, short bowel syndrome, TPN; increased loss: diuretics, diarrhea, vomiting; miscellaneous: DKA, pancreatitis

347
Q

Q347. Hypomagnesemia History/PE

A

A347. Sxs usually related to concurrent hypocalcemia and hypokalemia; anorexia, n/v; muscle cramps, weakness; if levels very low paresthesias, irritability, confusion, lethargy, seizures, arrhythmias

348
Q

Q348. Hypomagnesemia Dx

A

A348. Check for concurrent hypocalcemia & hypokalemia; EKG prolonged PR & QT

349
Q

Q349. Hypomagnesemia Tx

A

A349. IV or oral Mg2+; hypokalemia & hypocalcemia; won’t correct if Mg2+, not corrected also

350
Q

Q350. Hyperkalemia What is it; What is it caused by

A

A350. Serum K+ > 5 mEq/L Causes:; spurious hemolyzed blood draw, fist clenched during blood draw; extreme leukocytosis; extreme thrombocytosis; rhabdomyolysis; decreased excretion renal insufficiency, mineralocorticoid def., RTA type 4, drugs heparin, spironolactone, triamterene, ACEIs, trimethoprim, NSAIDs; cellular shifts tissue injury, insulin def., drugs succinylcholine, digitalis, arginine, B blockers; iatrogenic

351
Q

Q351. Hyperkalemia History/PE

A

A351. Muscle weakness starts > 6.5; MCC of death abnormal cardiac conduction; May be asymptomatic; n/v; intestinal colic; areflexia; weakness; flaccid paralysis; paresthesias

352
Q

Q352. Hyperkalemia Dx

A

A352. Verify with repeat blood draw (if need to); EKG tall peaked T, prolonged PR, wide QRS, loss of P can => sine waves,; ventricular fibrillation,; cardiac arrest

353
Q

Q353. Hyperkalemia Tx

A

A353. Emergent Tx if > 6.5 mEq/L or prolonged PR or wide QRS C BIG K:; Calcium gluconate or CaCl: immediate but short lived; Bicarb: not in same IV line as Ca (forms CaCO3 precipitate); Insulin and Glucose takes 30 60 min. to work; Kayexalate and loop diuretics; give sorbitol to prevent constipation; If RF or severe, refractory dialysis

354
Q

Q354. Hypokalemia What is it; What is it caused by

A

A354. Serum K+ < 3.5 mEq/L causes:; transcellular shifts insulin, B2 agonists, alkalosis, periodic paralysis; GI losses diarrhea, chronic laxative abuse, vomiting, NG suction; renal K+ losses diuretics, primary mineralocorticoid, excess secondary hyperaldosteronism, drugs, DKA, hypomagnesemia, RTA Types 1&2; licorice; clay

355
Q

Q355. Hypokalemia History/PE

A

A355. Sxs start when K+ <2.5 3.0; muscle weakness; cramps; ileus; fatigue; hyporeflexia; paresthesias; if severe flaccid paralysis, cardiac arrhythmia

356
Q

Q356. Hypokalemia Dx

A

A356. 24 hour or spot urine K to distinguish renal from GI losses; EKG flattened T, U wave, ST depression followed by AV block and cardiac arrest

357
Q

Q357. Hypokalemia Tx

A

A357. Tx underlying disorder; oral or IV K+; too fast => fatal arrhythmia; max 10 meq/hr; use 1/2 NS or NS; replace Mg2+; monitor EKG and plasma K+; freq. during replacement

358
Q

Q358. MCC dysuria 25 yo male

A

A358. urethritis

359
Q

Q359. Prehn’s sign

A

A359. elevate testicles relieves pain in epididymitis (sp?)

360
Q

Q360. torsion evaluation

A

A360. ultrasound

361
Q

Q361. renal stone evaluation

A

A361. CT

362
Q

Q362. pre renal azotemia; BUN:creatinine

A

A362. >20:1 <30:1; BUN:creatinine

363
Q

Q363. CHF in ESRD treatment

A

A363. Furosemide (Lasix)

364
Q

Q364. Renal stone size threshholds for surgery

A

A364. 6 mm will not likely pass; 5 mm will likely pass

365
Q

Q365. GI bleed; BUN:creatinine

A

A365. >30:1; BUN:creatinine

366
Q

Q366. Why is the left kidney taken during transplantation?

A

A366. It has a longer renal vein

367
Q

Q367. Water breakdown?

A

A367. Water is 60% of body weight; 2/3 is intracellular; 1/3 is extracellular; 1/4 of extracellular volume is plasma; 3/4 of extracellular volume is interstitial

368
Q

Q368. How can you measure plasma volume?

A

A368. Radiolabeled albumin

369
Q

Q369. Formula for clearance

A

A369. Cx = UxV/Px

370
Q

Q370. What does the glomerular filtration barrier block, and how?

A

A370. Large, negative particles; 1. Fenestrated capillary (size); 2. Heparin on basement membrane (charge); 3. Podocyte foot processes

371
Q

Q371. Calculation for free water clearance

A

A371. C = V (Uosm*V/Posm); it is the volume of water per unit time that is cleared by the kidneys. you get at it by taking the urine flow rate and subtracting out the volume of osmole containing fluid.

372
Q

Q372. What is the renal threshold for glucose?

A

A372. around 200 mg/dL; this is when you start to see symptoms

373
Q

Q373. Why does acidosis decrease K secretion?

A

A373. It causes a shift of K outside the cell; (thus decreasing the amount of K available for transport to the lumen)

374
Q

Q374. Actions of AII

A

A374. Vasoconstriction; Aldosterone synthase induction; ADH release; Stimulates hypothalamus for increasing thirst

375
Q

Q375. ANP actions

A

A375. Decreases renin; Increases GFR

376
Q

Q376. What part of the kidney secretes EPO?

A

A376. Endothelial cells of peritubular capillaries

377
Q

Q377. What stimulates renin secretion?

A

A377. Beta 1

378
Q

Q378. Winter’s formula

A

A378. PCO2 = 1.5 (HCO3) + 8 +/ 2

379
Q

Q379. Metabolic alkalosis

A

A379. PCO2 increases .7 for every 1 mEq/L increase in HCO3

380
Q

Q380. Respiratory alkalosis; acute; chronic

A

A380. 2 mEq/L decrease for every 10mmHg decrease in PCO2; 5 mEq/L for every 10mmHg decrease in PCO2; You’re pretty good at peeing out excess base.

381
Q

Q381. Respiratory acidosis; acute; chronic

A

A381. 1mEq/L increase for every 10 mmHg increase; 3.5 mEq/L increase

382
Q

Q382. Delta delta; 2

A

A382. change in AG from normal of 12 / change in HCO2 from normal of 24; 2 = Alk + AG acid

383
Q

Q383. WBC casts

A

A383. virtually pathognomonic for pyelo, and not seen in cystitis

384
Q

Q384. Granular casts

A

A384. ATN

385
Q

Q385. What stone is radiolucent

A

A385. Uric acid

386
Q

Q386. Renal cell carcinoma; Host; Histology; Genetics; Paraneoplastics

A

A386. Men 50 70; Likes upper pole, originates in renal tubule cells (clear cells); Associated with VHL gene on 3; EPO, ACTH, PTHrP, prolactin

387
Q

Q387. WAGR complex

A

A387. Wilms’ tumor; Aniridia; Genitourinary malformation; mentomotor Retardation

388
Q

Q388. What does Wilms’ tumor originate from?

A

A388. Primitive metanephric tissues

389
Q

Q389. Causes of transitional cell carcinoma

A

A389. Phenacetin,; Smoking,; Aniline dyes,; Cyclophosphamide,; Schistosomiasis

390
Q

Q390. Where can TCC occur?

A

A390. Calyces,; pelves,; ureters,; bladder

391
Q

Q391. Chronic pyelonephritis

A

A391. Coarse,; asymmetric,; corticomedullary scarring,; blunted calyx,; thyroidization of kidney; Usually from chronic UT obstruction

392
Q

Q392. What causes diffuse cortical necrosis?

A

A392. combination of vasospasm and DIC,; usually in sepsis or obstetric catastrophes

393
Q

Q393. What is the mechanism by which drugs induce interstitial nephritis

A

A393. Haptenation

394
Q

Q394. Nephrocalcinosis

A

A394. diffuse deposition of calcium in the kidney parenchyma which can lead to renal failure. Caused by hypercalcemia or hyperphosphatemia (this is associated with renal failure)

395
Q

Q395. Causes of ATN

A

A395. ischemia,; myoglobinuria,; toxins (mercuric chloride, aminoglycosides, ethylene glycol (oxalosis))

396
Q

Q396. 2 phases

A

A396. oliguric phase : worry hyperkalemia (deadly arrhythmia); recovery phase : vigorous diuresis

397
Q

Q397. Causes of renal papillary necrosis

A

A397. DM (infection and vascular disease); Acute pyelonephritis; Chronic phenacetin use (acetaminophen, too); Sickle cell anemia

398
Q

Q398. In what condition can you see bleeding 2/2 platelet dysfunction, skin pigmentation, and fibrinous pericarditis?

A

A398. uremia

399
Q

Q399. What conditions are associated with dominant mutations of APKD1.

A

A399. polycystic liver disease,; berry aneurysms,; mitral valve prolapse,; secondary polycythemia

400
Q

Q400. What are dialysis cysts?

A

A400. cortical and medullary cysts resulting from long standing dialysis. Increased risk of renal cancer.

401
Q

Q401. Which has a better prognosis: medullary cystic disease or medullary sponge kidney?

A

A401. Medullary sponge kidney;; multiple small cysts in the collecting ducts, associated with moderately impaired tubular function and occasional infection, but otherwise good prognosis. Medullary cystic disease patients have small kidneys. Also known as nephronopthisis.

402
Q

Q402. What do thiazides do to urinary calcium?

A

A402. They decrease urinary calcium excretion!; They retain calcium!; Good for idiopathic hypercalciuria.

403
Q

Q403. What drug do you use for nephrogenic DI?

A

A403. THIAZIDES!

404
Q

Q404. enlarged, hypercellular glomeruli, PMNs, lumpy bump EM; subepithelial humps; granular pattern

A

A404. PSGN

405
Q

Q405. Crescentic GN

A

A405. RPGN; I: goodpasture’s; II: Post strep in 50% of all cases, Lupus IV; III: Pauci immune (ANCA)

406
Q

Q406. subendothelial humps; tram tracking

A

A406. Membranoproliferative GN; tram tracks are the reduplication of the GBM (“proliferative of the membrane”)

407
Q

Q407. mesangial deposits of IgA; no complement

A

A407. Berger’s disease

408
Q

Q408. defect in alpha 5 type IV collagen

A

A408. Alports; sensorineural deafness,; hematuria,; anterior lenticonus

409
Q

Q409. Membranous GN (nephritis/nephropathy); Associations?

A

A409. Oddly, this is a NEPHROTIC syndrome. capillary and BM thickening; granular pattern; spike and dome (reactive BM forms spikes); Unknown etiology: lupus, HBV, syphilis, malaria, gold salts, penicillamine, cancers. Often accompanied by azotemia

410
Q

Q410. normal glomeruli, foot process effacement, lipid laden renal cortices

A

A410. minimal change disease; responds well to steroids

411
Q

Q411. segmental sclerosis and hyalinosis; clinically similar to minimal change

A

A411. FSGS

412
Q

Q412. subendothelial and mesangial deposits of apple green birefringent material… what diseases are associated?

A

A412. Amyloidosis. Myeloma; Chronic inflammation; TB; Rheumatoid arthritis

413
Q

Q413. Lupus glomerulonephropathy; I; II; III; IV; V

A

A413. I: no renal involvement; II: mesangial form (like FSGS); III: focal proliferative; IV: diffuse proliferative (nephrotic and nephritic presentations; crescents, mesangial hypertrophy, endothelial proliferation, subendothelial deposits); V: membranous

Clinical Medicine (7 decks)

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