nephrology

Question 1

Electrolyte abnormalities with primary hyperaldosteronism/conn syndrome

Answer 1

hypernatremia, hypokalemia, metabolic alkalosis

Aldosterone Saves Sodium and Pushes Potassium out

Question 2

A pt gets a contrast CT and also tarted on Amikacin. How would AKIs associated with each present differently?

Answer 2

Contrast = EARLY
Amikacin = aminoglycosdie = 5-10 days after initiation
BOTH = intrinsic AKI, suspect normal BUN:Cr

Question 3

What type of AKI may pancreatitis lead to? What labs would you see?`

Answer 3

Pre-renal due to LOW volume. 
BUN: Cr > 20:1
FeNa < 1
Urine sodium < 20
Urine osmoles > 500

Question 4

You start a diuretic for a volume overloaded patient. What electrolye abnormalities can you expect?

Answer 4

hypokalemia
hyponatremia
metabolic alkalosis
(Diuretic blocks NaK2Cl of LofH = Na into urine = H and K to follow)

Question 5

Mental illness, seizures, hyponatremia

Answer 5

primary polydipsia

*urine is super dilute

Question 6

Older pt cannot pee and is taking rx to help sleep

Answer 6

Urinary retention 2/2 anti-cholinergic effect of first-generation anti-histamine (diphenhydramine)

Question 7

First line rx in renal transplant dysfunction in early post-op period

Answer 7

IV steroids

Question 8

*** DM nephropathy: earliest abnormality, screening, tx, complications

Answer 8

Glomerular hyperfiltration
Microalbuminuria
ACEi
Frank nephrotic syndrome, eventual ESRD requiring transplantation or dialysis

Question 9

Rx used in Tb and Meningitis ppx that causes red body excretions, including urine

Answer 9

Rifampin

Question 10

*** What blood/bleeding abnormality can develop in chronic renal failure?

Answer 10

prolonged BT due to platelet dysfunction from uremia

tx = desmopressin

Question 11

*** When and why to give calcium gluconate to patient with hyperkalemia?

Answer 11

Stabilizes cardiac myocytes
Give when K > 7 -OR- arrhythmia by EKG
If neither, try to correct with insulin and glucose

Question 12

5 rx that can cause hyperkalemia

Answer 12

ACEi
ARBs
K+ sparing diuretics (spironolactone) 
Cardiac glycosides (digoxin)
NSAIDs - through inhibition of local prostaglandin

Question 13

Abx with new rash and urine with WBCs, RBCs, white cell casts, and eosinophils

Answer 13

AIN, stop offending agent

*Penicillins, Cephalosporins, Sulfonamide diuretics

Question 14

*** Electrolyte abnormalities with vomiting

Answer 14

Hypochloremic metabolic alkalosis and hypokalemia

Question 15

OD and seizures can result in rhabdomyolysis. List two complications.

Answer 15

ATN

Arrhythmias due to hyperkalemia

Question 16

OD with fever, tinnitus, tachypnea

Answer 16

Aspirin! Combo AG metabolic acidosis and respiratory alkalosis
***clue for combo is a normal pH in a acid-base disturbance

Question 17

Pt has a metabolic alkalosis (pH > 4.5 HCO3 > 24). What lab to look at next to determine cause?

Answer 17

Urine chloride - if low, vomiting as cause

Question 18

AD + abdominal mass + HTN + risk of berry aneurysm

Answer 18

ADPKD

Question 19

periorbital swelling + nephrotic range proteinuria + HIV/IVdrugs/AfricanAmerican

Answer 19

FSGS