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Step 2 UW > Nephrology > Flashcards

Nephrology Flashcards

1
Q

Clinical Presentation of Obstructive uropathy

A

> Flank pain

> Low volume voids with or without occasional high volume voids

> If bilateral, renal dysfunction

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2
Q

Does RAS cause flank pain?

A

No

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3
Q

Measures to prevent urinary calcium stone formation (5)

A
  1. Increase fluid intake
  2. Low sodium diet
  3. Low protein diet
  4. Moderate calcium intake
  5. Thiazide diuretics
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4
Q

Effect of high dietary sodium on hypercalciuria

A

Reduces the reabsorption of sodium and thereby reduces the passive reabsorption of calcium

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5
Q

Effect of reduced dietary calcium on hypercalciuria

A

Leads to increased absorption in the gut, which is excreted into urine and binds urinary calcium to form calcium oxalate stones

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6
Q

Calcium oxalate crystals can result from

A
  1. Ethylene glycol (antifreeze ingestion)
  2. Vitamin C abuse
  3. Hypocitraturia (citrate binds calcium)
  4. Malabsorption (Crohns’s, gastric bypass)
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7
Q

Types of calcium stones

A
  1. Ca Phosphate (precipitates at basic pH)

2. Ca Oxalate (acidic pH)

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8
Q

S&S of Hydronephrosis

A

Flank pain that radiates to the groin

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9
Q

Flank pain that radiates to the groin

A

Hydronephrosis

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10
Q

Causes of Hydronephrosis (6)

A

Urinary Tract obstruction

  1. BPH
  2. Cervical Cancer
  3. Renal stones
  4. Ureter injury
  5. Retroperitoneal fibrosis (methysergide for HA).
  6. Vesicouretral reflux
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11
Q

Bilateral Hydronephrosis leads to

A

Elevated creatinine

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12
Q

MCC of isolate proteinuria in children

A

Transient proteinuria

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13
Q

Treatment for transient proteinuria

A

Repeat urine dipstick on two separate occasions to r/o persistent proteinuria (which requires further evaluation for underlying renal dz).

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14
Q

Proteinuria in children can be 1 of 3

A
  1. Transient (intermittent)
  2. Orthostatic
  3. Persistent
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15
Q

Causes of transient proteinuria in children

A

Exercise, Fever, seizures, stress or volume depletion

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16
Q

Positive Urinary nitroprusside

A

Cystinuria

17
Q

Pathophysiology of Cystinuria

A

Impaired transport of cystine and diabasic aa ornithine, lysine and arginine by brush borders of renal tubular and intestinal epithelium cells. This leads to decreased reabsorption and increased urinary excretion of these aa. Cystine unlike the others are poorly soluble in water.

18
Q

Which urinary test can detect elevated cystine levels

A

Cyanide-Nitroprusside test

19
Q

UTI caused by

A

Bacteria ascending into the bladder & vaginal introitus

20
Q

S&S off UTI

A

Suprapubic pain, dysuria, pyuria, bacteriuria

21
Q

MCC of UTI

A

E.coli

22
Q

Positive leukocyte esterase signifies

A

Pyuria

23
Q

Positive nitrites signifies

A

Enterobacteriaceae

24
Q

Indications for cystoscopy

A
  1. Gross hematurua with no evidence of glomerular dz or infection.
  2. Microscopic hematuria w/o evidence of glomerular dz or infection but increased risk of malignancy.
  3. Recurrent UTI
  4. Obstructive systems with suspicion for stricture, stone
  5. Irritative symptoms w/o urinary infection
  6. Abnormal bladder imaging or urine cytology
25
Q

Familial Hypocalciuric hypercalcemia vs Primary HyperPTH

A

Both: hypercalcemia, elevated or high normal PTH

FHH: Low urinary excretion (increased reabsorption in renal tubules 2/2 defective CaSR)

HPTH: increased urinary calcium excretion (excessive mobilization of Ca from bones)

26
Q

Pathophysiology Familial Hypocalciuric Hypercalcemia

A

Mutation in CaSR

27
Q

Diffuse abdominal pain with guarding

A

Peritonitis

28
Q

Acute Chemical Peritonitis following blunt abdominal trauma can be caused by

A

Spillage of blood, bowel contents, bile, pancreatic secretions or urine into peritoneal cavity

29
Q

Which parts of the bladder are bordered by the peritoneal cavity

A

Dome (superficial n lateral surfaces) of the bladder

30
Q

Kehr sign

A

Referred pain to the ipsilateral shoulder from right or left hemidiaphragm

Phrenic Nerve n sensory innervation of shoulder arise from sensory root C3 to C5

31
Q

Extraperitoneal structures of bladder

A
  1. Anterior bladder wall

2. Bladder Neck

32
Q

Damage to extraperitoneal structures of bladder lead to (s&s) and can be caused by

A

Leads to localized lower abdominal pain and can be caused by pelvic fracture

33
Q

ARF and oliguria in post op patient (immediate procedures)

A
  1. Bladder scan

2. Catheterization

34
Q

Post OP Urinary Retention (PUR) is

A

Common complication of surgery and anesthesia. Can lead to decrease detrusor muscle activity

35
Q

Most sensitive & specific test for diagnosing RCC

A

Abdominal CT

36
Q

Unilateral varicocele that fail to empty when patient is in recumbent raise suspicion for

A

Underlying mass pathology such as RCC that obstruct venous flow

37
Q

Is there screening for bladder cancer?

A

No

38
Q

What metabolic disorder can occur following tonic-clonic seizure

A

Postictal lactic acidosis 2/2 skeletal muscle hypoxia and impaired hepatic lactic acid uptake

39
Q

Management for postictal lactic acidosis

A

Observation and repeat chemistry panel after 2hrs. It is transient.

Step 2 UW (1 decks)

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