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MCCQE1 > Nephrology > Flashcards

Nephrology Flashcards

1
Q

Acute ↑ Cr, BUN/Cr > 20, U Na < 10, FE Na < 1%. Dx and next step?

A

AKI pre-renal etiology.

If dry (e.g., diarrhea, dehydration, hemorrhage) –> IVF.

If wet (e.g., third space: nephrotic syndrome, malnutrition, cirrhosis) –> diuretics.

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2
Q

Acute ↑ Cr, hydronephrosis or hydroureter. Dx, posible causes and next step?

A

AKI post-renal.

Posible causes: Neoplasia, Kidney stones, Neurogenic bladder, BPH

Next step: catheter, stent, surgery

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3
Q

Acute ↑ Cr, BUN/Cr < 10, U Na > 10, FE Na > 1%, RBC casts. Dx and next step?

A

AKI: glomerulonephritis.

Next step: Rule out nephrotic syndorme ( > 3.5 g/d of proteinuria, ↑ Cholesterol, edema)

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4
Q

Acute ↑ Cr, BUN/Cr < 10, U Na > 10, FE Na > 1%, muddy brown casts . Dx and posible causes?

A

AKI: acute tubular necrosis.

Caused by ischemia and toxins (IV constrast, myoglobin)

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5
Q

Acute ↑ Cr, BUN/Cr < 10, U Na > 10, FE Na > 1%, WBC casts, WBC, eosinophils. Dx and next step?

A

AKI: Acute interstitial nephritis

Can be cause by infections and reactions to drugs (trimetropim sulfa, penicillin, cephalosporins)

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6
Q

Which drugs may generate acute interstitial nephritis?

A

trimetropim sulfa, penicillin, cephalosporins

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7
Q

Acute indications for hemodialysis?

A 
o	A: Acidosis
o	E: Electrolites (K, Ca)
o	I: Intoxication
o	O: Overload
o	U: Uremia
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8
Q

Kidney anatomical anormality + GFR > 90. Stage of CKD and management?

A

Stage I.

Prevent progression

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9
Q

GFR 60-89. Stage and management?

A

Stage II

Prevent progression

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10
Q

GFR 30-59. Stage and management?

A

Stage III

Prevent progression, manage complications

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11
Q

GFR 15-29. Stage and management?

A

Stage IV

Prevent progression, manage complications, prepare for dialysis

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12
Q

GFR < 15. Stage and management?

A

Stage V, dialysis, transplant

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13
Q

Goals of BP in CKD.

A

BP < 130/80.

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14
Q

Tx of HTN in CKD?

A

Use ACEI or ARB

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15
Q

Goals of DM in CKD?

A

Goals: HbA1C <7; glucose < 80-120

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16
Q

Tx of DM in CKD?

A

Use oral meds (excepts for metformin) and/or insulin

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17
Q

Dx of anemia in CKD

A

Hb < 12
Dx of exclusion (look first for Iron, folic, B12)
No need to ask for EPO to diagnose

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18
Q

Goal of Hb in CKD?

A

HB > 10

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19
Q

Tx of secondary HyperPTH + Mineral Bone Disease (Osteopenia) in CKD?

A
  • Phosphate binders (e.g., Sevelamer)
  • Calcium mimetics (e.g., Cinacalcet)
  • Ca + Vit D
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20
Q

Tx of volume overload in CKD?

A

Use loop diuretics (e.g., furosemide) +/- Thiazides (e.g., metolazone)

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21
Q

Na < 135, ASx. Tx?

A

Disease specific

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22
Q

Na < 135, nausea, vomiting, headache. Tx?

A

IV NS

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23
Q

Na < 135, coma, seizure. Tx?

A

IV hypertonic

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24
Q

Na > 145, ASx. Tx?

A

PO water

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25
Q

Na > 145, nausea, vomiting, headache. Tx?

A

IV NS

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26
Q

Na > 145, coma, seizure. Tx?

A

IV D5W

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27
Q

How to correct Na to prevent complications?

A
  • A correction of 4 to 6 might be enough to treat Sx.
  • Correct Na by 0.25/hr. If you correct to quick –> risk of osmotic demyelination syndrome (aka pontine and extra-pontine myelinolysis)
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28
Q

How to correct Na if glucose if high?

A

If hypertonic, for each 100 of blood glucose above
100, you add 1.6 to the Na

E.g., If Na is 130 and glucose is 500 (i.e., four 100s above 100), real Na = 130 + (1.6 x 4) = 136.4

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29
Q

Na < 135, ↓Osm, JVD, edema, CHF, anasarca. Next step?

A

Diuresis

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30
Q

Na < 135, ↓Osm, dry mocous, burns, fever, sepsis, hypotension

A

IV fluids (NS if moderate Sx, hypertonic if severe)

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31
Q

Na < 135, ↓Osm, normal volumen (aka, no edemas, no dehydration).

Possible Dxs?

A

R: Renal tubular acidosis –> Uroanalysis
A: Addison –> cortisol
T: Thyroid –> TSH
S: Sd. Inappropriate ADH –> Dx of Exclusion

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32
Q

Na < 135, ↑Osm. Next step?

A

Correct Na considering glucose levels

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33
Q

Na < 135, normal Osm. Dx?

A

PseudoHypoNa

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34
Q

Which medication is NEVER the answer to treat hypoNa?

A

Vaptans are never the answer to treat hypoNa!

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35
Q

Causes of Hyperkalemia

A

Low aldosterone (Meds: ACEI, ARB, aldo inhibitors)
Iatrogenic
Ingestion + CKD
CKD stage V
Most common: Artifact (hemolysis, fist squeezing during sample)

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36
Q

Hyperkalemia, changes in ECG?

A

Wide QRS

Picked T wave

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37
Q

Hyperkalemia workup?

A

Recheck K leves

Look for ECG changes

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38
Q

K levels high (confirmed) without ECG changes. Dx and next step?

A

Stable hyperkalemia

Next step: Kayexalate and stop ACEI, ARB, aldo inhibitors

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39
Q

K levels high (confirmed) with ECG changes. Dx and tx?

A

Unstable hyperkalemia

Tx:

  • IV Ca: stabilize
  • Insuline + glucose (D50): Shifts K into cells
  • HCO3: Shifts K into cells
  • Kayexalate: ↓ total body K
  • Loop diuretis/dialysis: ↓ total body K
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40
Q

Causes of hypokalemia?

A

Renal loses
• HyperAldo (Conn’s, renal arthery stenosis, thiazides, loop diuretics)
• Check BP and ABG

GI loses (vomiting, diarrhea)

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41
Q

ECG changes in hypokalemia?

A

flattening of T waves, U waves, depressed ST segment

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42
Q

Hypokalemia workup?

A

Recheck K leves

Look for ECG changes

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43
Q

Repletion of K in hypokalemia

A

PO preferred (e.g., K-Dur)

If IV is chosen, don’t go faster than:
• Peripheral: 10 mEq/h
• Central: 20 mEq/h

Rate: 10 mEq change serum K by 0.1

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44
Q

If refractory hypokalemia?

A

if refractory, check Mg and replace it if low

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45
Q

Gold standard for kidney stones

A

NonCon CT (used on the first episode)

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46
Q

When to use KUB in kidney stones?

A

KUB (abdominal xR) is used to track the evolution and in subsequent episodes

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47
Q

Hematuria, colicky flanck pain that radiates to the groin. Next step?

A

U/A

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48
Q

Pregnant, hematuria, colicky flanck pain that radiates to the groin, U/A with hematuria. Next step?

A

Ultrasound

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49
Q

Stone < 5mm

A

IVF + NSAIDs

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50
Q

Stone < 7mm

A

IVF + NSAIDs + alpha blocker (prazosin) / CCB (amlodipine)

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51
Q

Stone at the kidney level < 2cm

Tx?

A

Extracorporeal shock wave lithotripsy (ESWL),

52
Q

Stone at the kidney level > 2cm

A

percutaneous nephrolithotomy (PCNL)

53
Q

Stone at the urether > 1 cm

A

Extracorporeal shock wave lithotripsy (ESWL), Ureteroscopy (URS), percutaneous nephrolithotomy (PCNL), laparoscopy

54
Q

Stone at the bladder, refractory to med Tx

A

Cystolitholapaxy, ureteroscopy

55
Q

Outpatient follow-up of kidney stone

A

Once stone is out –> determine the type of stone –> modify risk factors –> 6 weeks later, do a 24-hr urine –> if stones still present keep modifying factors, if not present, cured!

56
Q

Hematuria, colicky flank pain that radiates to the groin., U/A with hematuria, KUB normal. Next step?

A

Take uric acid

57
Q

Calcium oxalate kidney stone. How to treat risk factors?

A

Thiazides, ↓ meat, ↑fruit (don’t reduce the intake of calcium!!)

58
Q

Bacteria resonsible for struvite stones

A

Proteus

59
Q

Uric acid kidney stone. How to treat risk factors?

A

Allopurinol

60
Q

Incidental finding of a small renal cyst with no loculation or septation. Next step?

A

No further workup of tx needed

61
Q

Incidental finding of a large renal cyst with heterogenous structure. Next step?

A

U/A
CT scan (US if pregnant)
Bx

62
Q

Complications of Complex renal cysts

A

pyelonephritis, pain, bleeding (hematuria)

63
Q

Classic triad of renal cancer

A

Flank pain
Flank mass
Hematuria

64
Q

Paraneoplastic sd of renal cancer

A

↓Hb
↑EPO  Polycythemia
Trombus in IVC or DVT

65
Q

Renal mass of neoplasic apearance. Next step and tx?

A

Workup: U/A, CT scan (US if pregnant), NO Bx
Tx: parcial or radical nephrectomy

66
Q

Extra renal manifestations of Autosomal dominant poly-cystic kidney disease (ADPCKD)

A
  • Hepatic cyst/hepatitis
  • Pancreatic cyst/Pancreatitis
  • Cerebral aneurism (Screen for berry aneurisms with magnetic resonance with angiogram/CT angiogram/angiogram)
  • Diverticulosis
  • Mitral valve prolapse
67
Q

Presentation of Autosomal recessive poly-cystic kidney disease (ARPCKD)

A
  • Anuria
  • Renal failure
  • Olygohydramnios
  • Bilateral flank mases
  • Perinatal death
68
Q

pH < 7.4, CO2 > 40. Dx and next step?

A 
Respiratory acidosis. Manage underlying conduction (hypoventilation)
Opiates
COPD
Asthma
OSA
Muscle strength
69
Q

pH < 7.4, CO2 < 40. Dx and next step?

A

Metabolic acidosis. Get Anion gap (Na-Cl-HCO3)

70
Q

pH < 7.4, CO2 < 40, anion gap > 12. Dx and next step?

A 
Anion gap metabolic acidosis. Treat underlying condition (MUD PILES):
Methanol
Uremia
DKA
Propylene Glycol
Iron
Lactic acidosis
Ethylene glycol
Salycilates
71
Q

pH < 7.4, CO2 < 40, anion gap < 12. Dx and next step?

A

Non-anion gap acidosis. Get Urine anion gap (Na+K-Cl).
If (+) –> Renal tubular acidosis
If (-) –> Diarrhea

72
Q

pH > 7.4, CO2 < 40. Dx and next step?

A

Respiratory alkalosis. Treat the underlying condition (hyperventilation):
Pain
Anxiety
Hypoxemia

73
Q

pH > 7.4, CO2 > 40. Dx and next step?

A

Metabolic Alkalosis. Get urine Cl

74
Q

pH > 7.4, CO2 > 40, urine Cl < 10. Dx and next step?

A 
Volume-responsive Metabolic Alkalosis. Treat underlying condition:
Diuretics
Dehydration
Emesis
NG tube
75
Q

pH > 7.4, CO2 > 40, urine Cl > 10. Dx and next step?

A

Not-Volume-responsive Metabolic Alkalosis. Check BP
If HTN –> Hyperadosteronism, renal artery stenosis, Cushing’s
If HTN –> Genetic diseases

76
Q

What type of renal tubular acidosis (RTA) is associated with abnormal H+ secretion and nephrolithiasis?

A

Type I (distal) RTA.

77
Q

Renal tubular acidosis associated with abnormal HCO3 – and rickets.

A

Type II (proximal) RTA.

78
Q

Renal tubular acidosis (RTA) associated with aldosterone defect.

A

Type IV (distal) RTA.

79
Q

“Doughy” skin .

A

Hypernatremia

80
Q

Differential of hypervolemic hyponatremia.

A

Cirrhosis, CHF, nephrotic syndrome.

81
Q

Chvostek’s and Trousseau’s signs.

A

Hypocalcemia.

82
Q

The most common causes of hypercalcemia.

A

Malignancy and hyperparathyroidism.

83
Q

T-wave fl attening and U waves. .

A

Hypokalemia

84
Q

Peaked T waves and widened QRS.

A

Hyperkalemia.

85
Q

First-line treatment for moderate hypercalcemia.

A

IV hydration and loop diuretics (furosemide).

86
Q

Type of Acute kidney injury in a patient with FeNa < 1%.

A

Prerenal.

87
Q

A 49-year-old man presents with acute-onset flank pain and hematuria.

Dx?

A

Nephrolithiasis.

88
Q

The most common type of nephrolithiasis.

A

Calcium oxalate.

89
Q

A 20-year-old man presents with a palpable fl ank mass and hematuria. Ultrasound shows bilateral enlarged kidneys with cysts. Associated brain anomaly?

A

Cerebral berry aneurysms (autosomal-dominant PCKD).

90
Q

Hematuria, hypertension, and oliguria.

A

Nephritic syndrome.

91
Q

Proteinuria, hypoalbuminemia, hyperlipidemia,

hyperlipiduria, and edema.

A

Nephrotic syndrome.

92
Q

The most common form of nephritic syndrome.

A

Membranous glomerulonephritis.

93
Q

The most common form of glomerulonephritis.

A

IgA nephropathy (Berger’s disease).

94
Q

Glomerulonephritis with deafness.

A

Alport’s syndrome.

95
Q

Glomerulonephritis with hemoptysis.

A

Wegener’s granulomatosis and Goodpasture’s syndrome.

96
Q

Presence of red cell casts in urine sediment.

Dx?

A

Glomerulonephritis/nephritic syndrome.

97
Q

Eosinophils in urine sediment.

A

Allergic interstitial nephritis.

98
Q

Waxy casts in urine sediment and Maltese crosses (seen with lipiduria).

A

Nephrotic syndrome.

99
Q

Drowsiness, asterixis, nausea, and a pericardial friction rub.

A

Uremic syndrome seen in patients with renal failure.

100
Q

A 55-year-old man is diagnosed with prostate cancer.

Treatment options?

A

Wait, surgical resection, radiation and/or androgen

suppression.

101
Q

Low urine specific gravity in the presence of high serum osmolality.

A

Diabetes insipidus.

102
Q

Treatment of SIADH?

A

Fluid restriction, demeclocycline.

103
Q

Hematuria, flank pain, and palpable flank mass.

A

Renal cell carcinoma (RCC).

104
Q

Testicular cancer associated with β-hCG, AFP.

A

Choriocarcinoma.

105
Q

The most common type of testicular cancer.

A

Seminoma, a type of germ cell tumor.

106
Q

The most common histology of bladder cancer.

A

Transitional cell carcinoma.

107
Q

Complication of overly rapid correction of hyponatremia.

A

Central pontine myelinolysis.

108
Q

Salicylate ingestion occurs in what type of acid-base

disorder?

A

Anion gap acidosis and 1° respiratory alkalosis due to central respiratory stimulation.

109
Q

Acid-base disturbance commonly seen in pregnant women.

A

Respiratory alkalosis.

110
Q

Three systemic diseases that lead to nephrotic syndrome.

A

DM, SLE, and amyloidosis.

111
Q

Elevated erythropoietin level, elevated hematocrit, and normal O2 saturation suggest?

A

Renal Cell Cancer or other erythropoietin-producing tumor; evaluate with CT scan.

112
Q

A 55-year-old male presents with irritative and obstructive urinary symptoms. Treatment options?

A

Likely BPH. Options include no treatment, terazosin,

fi nasteride, or surgical intervention (TURP).

113
Q

Patient who on POP day 1 of thyroidectomy/parathyroidectomy develops Tetany, Perioral tingling, Trousseau sign and Chvostek sign

  • ↓PTH
  • ↓ionized Ca

Dx and tx?

A

Iatrogenic HypoPTH

Tx: IV calcium (gluconate or carbonate)

114
Q

Patient with
• ↑PTH
• ↓Ca
• ↑P

Dx?

A

PseudoHypoPTH

PTH insensitivity

115
Q

Patient with osteopenia with dexa scan -2.0.

Possible dx and Next step?

A

Vitamin deficiency

Next step: ↓ 25 Vitamin D (< 30)

Tx: Ca + vit D
• Add bisphosphonates if severe osteopenia

116
Q

Patient with early stage CKD and hypoCa.

Dx and Tx?

A

Secondary hyperPTH: ↓VitD production leads to HypoCa. Therefore ↑PTH is secreted (secondary hyperPTH).

Tx:
• Ca+VitD
• Cinecalcet (to decrease PTH and prevent tertiary HyperPTH)

117
Q

Patient at the internal medicine floor. The nurse says that the patient has low Ca.

Next step and tx?

A

Next step:
- Albumin (correction of albumin corrects Ca)

Tx: If Ionized calcium remains low, IV calcium (gluconate or carbonate)

118
Q

Patient with Altered mental status (psychic moans), Abdominal pain (abdominal groans).

↑↑ Ca

Next step?

A
  • lots of IVF + early bisphosphonates

- If really high Ca and super Sx patient: Calcitonin

119
Q

Patient with Pathologic fractures, ↓Bone density. On Rx Brown tumor in a bone.

  • ↑PTH
  • ↑Ca
  • ↓P

Dx and next step?

A

HyperPTH

Next step: Sestamibi scan (nuclear Rx) to see parathyroid glands.

120
Q

Patient with Pathologic fractures, ↓Bone density. On Rx Brown tumor in a bone.

  • ↑PTH
  • ↑Ca
  • ↓P
  • Sestamibi scan (nuclear Rx) shows a single big parathyroid gland, the other three are very small

Dx and Tx?

A

Autonomous adenoma producing Primary HyperPTH

Tx: Resection

121
Q

Patient with CKD, Pathologic fractures, ↓Bone density. On Rx Brown tumor in a bone.

  • ↑PTH
  • ↑Ca
  • ↓P
  • Sestamibi scan (nuclear Rx) shows 4 big parathyroid glands

Dx and Tx?

A

autonomous multiple adenomas as a normal response to chronic hypoCa in CKD (tertiary HyperPTH).

Tx: resection

122
Q

How are Ca, PTH and P in metastatic disease of the bone?

A

o ↑Ca
o ↑P
o ↓PTH

123
Q

Patient with a mass in lung.
o ↑Ca
o ↓P
o ↓PTH

Dx and next step

A

Small cell carcinoma and Paraneoplastic syndrome

Next step:
o ↑PHT-rp (related pepetide)

124
Q

Patient with Granulomatosis (TB, sarcoid).
• ↑Ca
• ↑P
• ↓PTH

Dx and Next step?

A

Hypervitaminosis D

Next step: • ↑1,25 Vitamin D

125
Q

Patient with dx of primary hyperparathyroidism who had surgery. After the surgery he develops Perioral tingling, Trousseau sign, and Chvostek’s Sign.

Dx and tx?

A

Post-op hypocalcemia (the other glands are atrophied)

Tx: IV Ca++

MCCQE1 (19 decks)

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