Nephrology Flashcards
A patient with stage 5 CKD presents to the ED with signs of uremia. You learn that the patient missed three dialysis appointments last week. ABG shows an uncompensated acid/base derangement. You expect that the pH will be ______ (high/low/normal) and the HCO3 will be ______ (high/low/normal).
low, low
A patient presents with a partially compensated metabolic acidosis. You expect that the patient’s minute ventilation will be ______ (increased/decreased).
Increased
A diabetic patient presents with a decreased GFR and proteinuria. In addition to treatments for diabetes, which class of medication is most appropriate for this patient?
ACE-I/ARB
You are treating a patient with AKI. Upon reviewing the patient’s labs, you find that the BUN:creatinine ratio is increased and the FENa is 0.9%. This patient’s AKI is most likely due to a ______ (prerenal/renal/postrenal) cause.
Prerenal
You are treating a patient in the ICU for septic shock. The patient develops prerenal AKI. This progression is ______ (common/uncommon). What treatment is likely to be of greatest benefit for this patient?
Common, IV fluids
A 38 year-old patient with a history of HTN refractory to aggressive medical therapy presents with bilateral flank pain. On exam, the kidneys are easily palpable. Labs show a decreased GFR. What is the most appropriate study to evaluate this patient?
Renal ultrasound
Among patients with CKD of all stages, the greatest cause of mortality is ______ ______.
Cardiovascular disease
A patient is given a saline infusion that causes a dramatic shift of fluid into the intravascular space. The concentration of the saline was probably ______ (0.45%, 0.9%, 3%). This fluid is best described as ______ (hypotonic/isotonic/hypertonic).
3%, hypertonic
An 8 year-old patient presents with hypertension, edema, and hematuria. UA is positive for protein, and the patient is hypoalbuminemic. Kidney biopsy is unremarkable. What is the most likely diagnosis?
Minimal change disease
An 8 year-old patient presents with hypertension, edema, and hematuria. UA is positive for protein, and the patient is hypoalbuminemic. Kidney biopsy is unremarkable. Which medication is most likely to be of benefit for this patient?
Prednisone
An 8 year-old patient presents with hypertension, edema, and hematuria. UA is positive for protein, and the patient is hypoalbuminemic. Kidney biopsy is unremarkable. You ______ (warn/reassure) the patient’s parents since most children ______ (do/do not) recover completely from this disorder.
Reassure, do
A patient presents with hemoptysis and acute renal failure. There is mild proteinuria and the UA is positive for dysmorphic RBCs, WBCs, and granular casts. Renal biopsy shows a linear deposition of anti-GBM antibodies. What is the most likely diagnosis?
Goodpasture’s syndrome
A patient presents with hemoptysis and acute renal failure. There is mild proteinuria and the UA is positive for dysmorphic RBCs, WBCs, and granular casts. Renal biopsy shows a linear deposition of anti-GBM antibodies. What are the three components of treatment for this patient?
Plasmapheresis
Prednisone
Cyclophosphamide
Which of the following IV fluids is least appropriate for intravascular volume replacement in a dehydrated patient? A. D5W B. Normal saline C. Lactated ringers D. 5% Albumin
A. D5W
A patient with a history of chronic renal failure on dialysis presents with lethargy and confusion. You review the patient’s EKG and notice tall, peaked t-waves. Which disorder do you suspect?
Hyperkalemia
A patient with a history of chronic renal failure on dialysis presents with lethargy and confusion. You review the patient’s EKG and notice tall, peaked t-waves. What is the most dangerous complication associated with this presentation?
Cardiac arrhythmia
A patient with a history of chronic renal failure on dialysis presents with lethargy and confusion. You review the patient’s EKG and notice tall, peaked t-waves. Name three treatments that should be considered immediately.
Calcium
Insulin/dextrose
Sodium bicarbonate
Severe, life-threatening neurological complications are most often associated with over-zealous correction of which electrolyte disorder?
Hyponatremia
A patient presents with confusion, delirium, and weakness. Serum sodium is 115 and serum osmolarity is 275. Urine sodium level is 24. What is the most likely diagnosis?
SIADH
A patient presents with polyuria, polydipsia, and nocturia. After 8 hours of water deprivation, the patient’s urine osmolality is 290. The patient is given a dose of DDAVP, and the urine osmolality increases to 500. What is the most likely diagnosis?
Central diabetes insipidus
An otherwise healthy 35 year-old male presents with HTN that has been refractory to aggressive treatment. Oddly, the patient experienced a significant rise in serum creatinine after he was started on lisinopril. What is the best study to evaluate this patient’s condition?
Renal angiography
In paramedic school, I got a 70 on my renal disorders exam. In undergrad A&P, I got a 60 on a renal anatomy test. Back in January, I got a 50 on the med phys exam for renal physiology. Last week, I got a 40 on the renal pathophysiology exam, and after tomorrow my GPA is going to require dialysis. What accounts for this progressive and apparently irreversible decline in renal function?
Chronic renal failure
A patient with a history of chronic kidney disease presents with chest pain. On examination, you note a pericardial friction rub. Cardiac workup is otherwise unremarkable. The GFR is 10. What treatment is most likely to be of benefit to this patient?
Hemodialysis
A patient presents with chronic kidney disease, HTN, and T2DM. It is most likely that the diabetes ______ (caused/was caused by) kidney disease, and that the HTN ______ (caused/was caused by) the kidney disease.
caused, was caused by
A patient with a history of SLE presents with edema, HTN, HLD, proteinuria, and lipiduria. Renal biopsy shows diffuse, granular deposits along the GBM. Electron microscopy shows a “spike and dome” pattern. What is the most likely diagnosis?
Membranous glomerulonephritis
A 30 year-old male patient presents 2 days post-URI with hematuria. Which glomerular disease is most likely to blame?
IGA nephropathy (Berger’s disease)
