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#‼️INTERNAL MEDICINE - PLE TOPNOTCH 2020 > NEPHROLOGY > Flashcards

NEPHROLOGY Flashcards

1
Q

The first step in the diagnostic evaluation of hyper- or hypocalcemia is to ensure that the alteration in serum calcium levels is not due to abnormal ______ concentrations.

A

ALBUMIN

So the first step in the diagnostic evaluation of hypercalcemia is to check albumin concentration

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2
Q

Vasoconstricts EA increasing GFR

A

ANP, ANGIOTENSIN II, NOREPINEPHRINE

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3
Q

rish for osmotic demyelination syndrome (ODS) is increased in ____

A

Chronic hyponatremia

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4
Q

What type RTA has predisposition to stone formation?

A

Distal (Type) I

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5
Q

Significant bacteriuria with urologic abnormality, renal transplant, diabetes, sepsis or older male

A

complicated UTI.

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6
Q

Classic ECG changes in hyperkalemia

A

o Tall, peaked T waves (5.5-6.5 mM),

o Loss of P waves (6.5-7.5 mM)

o Widened QRS (7-8 mM)

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7
Q

Syndrome that mimic THIAZIDE DIURETICS.

  • Genetic defect in the distal tubule
  • Defect in Na-Cl cotransporter in the distal tubule
A

GITELMAN SYNDROME

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8
Q

Bilaterally small kidneys supports the diagnosis of CKD , EXCEPT:

A

o Diabetic nephropathy

o Amyloidosis

o HIV nephropathy

o Polycystic kidney disease

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9
Q

What causes intracellular shift of potassium?

A

Insulin

Beta agonist

Alkalosis

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10
Q

most common site of renal stone impaction

A

Ureterovesicular junction

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11
Q

What type of RTA?

  • decreased aldosterone
  • Assoc with Diabetes
  • low (acidic) urine pH
  • (-) stones
  • high potassium
  • Tx: Fludrocortisone
A

Type IV (Hypoaldosteronic) RTA

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12
Q

Examples of High anion gap metabolic acidosis

A

“MUDPILES”

Methanol

Uremia

DKA

Paraldehyde

Iron or INH

Lactate

Ethylene glycol

Salicylates

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13
Q

What type of RTA?

  • Inability to reabsorb HCO3
  • Assoc with Multiple myeloma and Amyloidosis
  • low (acidic) urine pH
  • (-) stones
  • low potassium
  • Tx: HCO3 + K+ tabs + diuretics (HCTZ)
A

Type II (Proximal) RTA

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14
Q

Vasodilates AA increasing GFR

A

ANP, Prostaglandin

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15
Q

Syndrome characterized with:

  • Chloride-resistant metabolic alkalosis
  • Hypokalemia
  • Hypomagnesemia
  • Decreased urinary calcium excretion
  • Hypocalciuric so no increased risk for kidneys stones or nephrocalcinosis
A

GITELMAN SYNDROME

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16
Q

Syndrome characterized with:

  • Chloride-resistant metabolic alkalosis
  • Hypokalemia
  • Normal serum magnesium (may be low)
  • Increased urinary calcium excretion

(hypercalciuric so at risk for kidney stones or nephrocalcinosis

A

BARTTER SYNDROME

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17
Q

CKD definition

A

Abnormality of kidney structure or function, present for >3 months, with implications for health

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18
Q

syndrome that is MINERALOCORTICOID-LIKE

  • ENaC upregulation
  • (+) HTN
A

LIDDLE’S SYNDROME

19
Q

Premenopausal non-pregnant women with acute onset dysuria, frequency, urgency without vaginal discharge

A

acute uncomplicated cystitis.

20
Q

vasodilates EA decreasing GFR

A

ACEI/ARB

21
Q

Healthy women with fever, chills, flank pain and costovertebral angle tenderness with nausea and vomiting

A

acute uncomplicated pyelonephritis

22
Q

The most common causes of intrinsic AKI

A

sepsis, ischemia, and nephrotoxins

23
Q

What is the best treatment for type I RTA?

A

HCO3 and Potassium replacement

24
Q

What electrolyte abnormality can occur?

  • GI loss: diarrhea (most common)
  • Renal loss: osmotic diuresis, excess urea, mannitol
  • Diabetes insipidus

Presents with change in sensorium

A

Hypernatremia

25
Q

mainly has an effect in the efferent arteriole causing increase Glomerular Filtration Rate but with compensatory Na reabsorption

A

ANGIOTENSIN

26
Q

Severe hyponatremia may present with ____

A

seizures, cerebral edema, coma, death

27
Q

The combined use of NSAIDs with ACEIs or ARB poses high risk for AKI. True or false.

A

True

28
Q

facilitate dilation of the Afferent arteriole causing increase GFR but no Na + reabsorption (net effect is Na + loss and volume loss)

A

ANP (Prostaglandins)

29
Q

What treatment do you recommend if with hyperkalemic ECG changes?

A

Calcium gluconate IV

30
Q
A
31
Q

Favors CHRONIC kidney disease

A
  • History of kidney disease, hypertension, abnormal urinalysis, edema
  • Small kidney on renal ultrasound
  • Anemia, hyperkalemia, acidemia
  • Urinalysis with broad cast
32
Q

syndrome that mimics LOOP DIURETICS.

  • Genetic defect in the thick ascending limb of the Loop of Henle
  • Defects in Na-K-2Cl co-transporter, K or Cl channels result in lack of concentrating ability

Often presents with sensorineural deafness, triangular facies with drooping mouth, large eyes

A

BARTTER SYNDROME

33
Q

Criteria for AKI

A
  • Increase in sCr (serum creatinine) by > 0.3 mg/dl (>26.5 umol/l) within 48 hours;
  • Increase in sCr from baseline within 1 week;
  • Urine volume <0.5 ml/kg/h for 6 hours
  • Anuria: Complete absence of urine formation (<100 mL)
  • Oliguria: 24-h urine output <400 mL
34
Q

Favor AKI instead of CKD

A
  • Return of renal function to normal with time
  • Anemia, hyperkalemia, acidemia
  • Sudden decrease in urine output
35
Q

What causes extracellular shift of potassium?

A

Hyperosmolarity

Exercise

Cell lysis

Acidosis

36
Q

What type of RTA?

  • Inability to secrete H+
  • associated with Sporadic and Hep B or C
  • High (basic) urine pH
  • (+) stones
  • low potassium
  • Tx: HCO3 + K+ tabs
A

Type I (Distal) RTA

37
Q

Bartter or Gitelman syndrome?

Increased renal PGE2 production

A

BARTTER SYNDROME

38
Q

Vasoconstricts AA decreasing GFR

A

NSAIDs

39
Q

The “gold standard” diagnostic test for nephrolithiasis

A

helical CT without contrast

40
Q

STAGES OF CHRONIC KIDNEY DISEASE

A
41
Q

absolute indications for dialysis

A
  • Acidosis, intractable
  • Electrolyte imbalance (hyperkalemia), intractable
  • Intoxication
  • Overload (volume), intractable
  • Uremi
42
Q

treatment regimen recommended for UTI in men

A

7- to 14-day course of a fluoroquinolone or TMP-SMX is recommended

43
Q

ECG changes in hypokalemia

A

U waves

#‼️INTERNAL MEDICINE - PLE TOPNOTCH 2020 (10 decks)

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