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Internal Medicine > Nephrology > Flashcards

Nephrology Flashcards

1
Q

___

affects the Efferent arteriole causing increase in GFR but with compensatory Na reabsorption

A

Angiotensin = responds due to decrease BP

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2
Q

____ facilitate dilation of Afferent arteriole causing increase in GFR but no Na reabsorption

A

ANP = responds due to increase atrial pressure

Na loss and volume loss

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3
Q

Parathyroid hormone is secreted in response to a decrease in [Ca], increase [PO4], or decrease 1,25OH D3. in response, ___

A
  1. Increase Ca reabsorption in DCT
  2. Decrease PO4 reabsorption in PCT
  3. Increase 1,25-OHD3 production
  4. Increase Ca and PO4 absorption from the gut
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4
Q

Most frequent cause of hyperkalemia

A

decrease in renal K excretion

  1. RAAS system
  2. Hyporeninemic, hypoaldosteronism
  3. Addison disease
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5
Q

What is the most urgent step if hyperkalemia is suspected?

A

ECG

since hyperkalemia can lead to life threatening arrythmia

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6
Q

[Hyperkalemia ECG changes]

Tall, peaked T waves

A

5.5 - 6.5

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7
Q

[Hyperkalemia ECG changes]

Loss of P waves

A

6.5 - 7.5

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8
Q

[Hyperkalemia ECG changes]

widened QRS

A

7-8

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9
Q

[Hyperkalemia]

Used for immediate antagonism of the cardiac effects

A
  1. IV calcium gluconate
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10
Q

[Transcellular Potassium Shift]

K enters the cell due to

A
  1. Insulin
  2. Beta agonist
  3. Alkalosis
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11
Q

[Transcellular Potassium Shift]

K exits the cell due to

A
  1. Hyperosmolarity
  2. Exercise
  3. Cell lysis
  4. Acidosis
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12
Q

[Bartter vs Gitelman]

Mimics loop diuretic

A

Bartter

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13
Q

[Bartter vs Gitelman]

(+) Polyuria
(+) polydipsia
(-) HPN
Hypokalemia
normal Mg
Increased urinary Ca excreation
A

Bartter Syndrome

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14
Q

[Bartter vs Gitelman]

(-) polyuria
(-) polydipsia
(+) tetany
(-) growth retardation

Low urinary CA
Low serum Mg

A

Gitelmann

Low MG due to TPMR 6 defect

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15
Q

[Bartter vs Gitelman]

mimic Na-Cl co transporter

A

Gitelman

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16
Q

What is the first step in diagnostic evaluation of hypercalcemia?

A

Check albumin

Corrected Ca = 40 - albumin x 0.02 + measure Ca

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17
Q

What is the main hormone that regulates Ca levels in the body

A

Parathyroid hormone

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18
Q

What are the effects of parathyroid hormone in the body?

A
  1. Bone resorption to increase serum Ca and P
  2. Increase Vit D synthesis
  3. Increase Ca reuptake but increase P excretion in the kidneys
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19
Q

Hypercalcemia in malignancy is usually due to overproduction of what hormone?

A

PTHrp

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20
Q

Most common PTHrp secreting tumor

A
  1. Squamous cell tumors
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21
Q

Vitamin D secreting tumor

A

Lymphoma

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22
Q

Granulomatous diseases like TB, Fungal infections and sarcoidosis increase Ca absorption in the gut by ___

A

ectopic production of alpha-1 hydroxylase that converts calcidiol to 1,25OHD3

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23
Q

Paget Disease causes hypercalcemia by ___

A

abnormal production of RANKL by osteoblast

High RANKL increases osteoclast activity

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24
Q

What is the defect in Familial Hypocalciuric Hypercalcemia which is a cause of hyperparathyroidism leading to hypercalcemia?

A

Calcium sensing receptor dysfunction

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25
Q

Increased urine volume associated with hypercalcemia is due to

A

Ca directly inhibits insertion of aquaporin channels in the collecting duct membrane

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26
Q

Inhibition of ROMK in the TAL luminal membrane increases urine volume leading to polyuria and the polydipsia is due to

A

Osmotic drag of water by increase NaCl in tubule lumen

ROMK facilitates movement of K to the tubule lumen. K drives NaKCl cotransported. Without this, NaCl accumulates in the tubule lumen

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27
Q

[Hypocalcemia]

QT prolongation is due to

A

Delay in repolarization due to increased myocyte depolarization since myocyte is very permeable to Na influx

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28
Q

[Hypocalcemia]

Laryngospasm, Chvostek sign, Trosseau sign, associated with hypocalcemia is due to

A

skeletal muscle tetany due to spontaneous action potential.

Hypocalcemia makes the cell permeable to Na influx thereby increasing excitability.

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29
Q

[Hypocalcemia]

Eliciting the Trosseau sign is due to spontaneous action potential in what nerve?

A

Median nerve

first tetanic sign to develop with hypocalcemia

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30
Q

[Diagnosis]

Low ADH secretion

H2O deprivation test
Positive AVP response

A

Central DI

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31
Q

[Diagnosis]

increased renal resistance to ADH,

H2O deprivation test no AVP response

A

Nephrogenic DI

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32
Q

What regulates the plasma [Na] level

A

Water intake or excretion

33
Q

Chronic hyponatremia can lead to ___-

A

Osmotic demyelination syndrome

34
Q

[Acid-base disorders]

What are the normal ABG values. Cite all

A 
pH = 7.4
H = 40
pCO2 = 40
HCO3 = 24
35
Q

What is the formula to calculate AG

A

AG = Na - (Cl + HCO3)

36
Q

What are the 4 principal causes of HAGMA?

A
  1. Lactic Acidosis
  2. Ketoacidosis
  3. Toxins
  4. Renal failure
37
Q

What are the causes of HAGMA?

A 
Methanol
Uremia
DKA
Paraldehyde
Iron, INH
Lactate
Ethylene glycol
Salicylates
38
Q

What are the 2 causes of NAGMA?

A
  1. Bicarbonate loss from GIT

2. RTA

39
Q

What are the causes of NAGMA?

A 
Hyperalimentation/ Hyperventilation
Acetazolamide
RTA
Diarrhea
Ureteral divesion
Pancreatic fistula
40
Q

What is the best treatment for Sjogren’s Syndrome presenting as RTA I?

A

HCO3 and Potassium replacement

41
Q

[RTA type]

Basic urine pH
Present urine stone
Low serum K

A

Type I - Distal
Dx: Acid load by giving NH4Cl

Tx: HCO3 + K tabs

42
Q

[RTA type]

Acidic urine pH
Absent stones
Low serum K

A

Type II - Proximal
Dx: Bicarb load by giving HCO3

Tx: HCO3 + K tabs + diuretics (HCTZ)

43
Q

RTA type II is associated with what diseases

A
  1. Amyloidosis

2. Multiple myeloma

44
Q

[RTA type]

Acidic urine pH
Absent urine stones
High serum K

Patient is diabetic

A

Type IV (Hypoaldosteronism

Dx: Na restriction since high urine Na

Tx: Fludrocortisone (highest mineralocorticoid effect)

45
Q

What is the RTA with ELEVATED potassium?

A

RTA IV

Look for a DM patient with NAGMA

46
Q

Increase in Crea that is suggestive of AKI

A
  1. At least 0.3mg/dL in 48 hours

2. 50% or higher in 1 week

47
Q

AKI can be inferred if there is a reduction of UO of

A

<0.5mL/kg/hr for >6 hours

48
Q

Complete anuria in the early course of AKI can be seen in ____

A
  1. Complete UTO
  2. Renal artery occlusion
  3. Overwhelming shock
  4. Severe proliferative GN
49
Q

Combining NSAID with what antihypertensive medications poses a high risk for AKI

A

ACEI or ARBs

50
Q

What are the most common causes of intrinsic AKI?

A
  1. Sepsis
  2. Ischemia
  3. Nephrotoxin
51
Q

Congestive heart failure can cause AKI since there is ____

A

decreased effective circulating volume

52
Q

Drugs that can cause impairment of renal autoregulation leading to prerenal AKI.

A
  1. NSAID
  2. ACEI/ARB
  3. Cyclosporine
53
Q

Drugs that can cause Intrinsic AKI

A
  1. Aminoglycosides
  2. Cisplatin
  3. Amphotericin B
54
Q

What are the electrolyte disturbances in rhabdomyolysis?

A
  1. Hyperkalemia
  2. Hyperphosphatemia
  3. Hyperuricemia
  4. Hypocalcemia
  5. Elevated CPK
55
Q

Hypocalcemia from rhabdomyolysis is due to

A

Damaged muscle binds to calcium lowering its blood level

56
Q

What is the best initial test for rhabdomyolysis?

A

Urinalysis

57
Q

What is the most accurate test to diagnose rhabdomyolysis?

A

Urine myoglobin

58
Q

Recovery due to iodinated contrast nephropathy happens within ___

A

7 days

59
Q

Contrast nephropathy peaks within ____

A

3-5 days

60
Q

Kidney damage for ___ months can suggest CKD

A

> / 3 months

61
Q

What is the most common cause of CKD?

A

DM nephropathy

62
Q

What disease entities presents with CKD but has normal-sized kidneys

A
  1. DM nephropathy
  2. Amyloidosis
  3. HIV nephropathy
  4. PKCD
63
Q

What disease entities presents with CKD but has normal-sized kidneys

A
  1. DM nephropathy
  2. Amyloidosis
  3. HIV nephropathy
  4. PKCD
64
Q

Normocytic, normochromic anemia can be seen as early as what CKD stage?

A

Stage 3 CKD

65
Q

What are the absolute indications for maintenance dialysis?

A
  1. Acidosis
  2. Electrolytes
  3. Intoxication
  4. Overload
  5. Uremia

Uremia, Intractable hyperkalemia, persistent volume expansion despite diuretics, refractory acidosis, bleeding diathesis, eGF 10

66
Q

[UTI]

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

A

Acute uncomplicated cystitis

Tx: empiric tx

UA is not a prerequisite

67
Q

[UTI]

Healthy women, fever, chills, flank pain, CVA tenderness, nausea and vomiting

A

AUC

Dx: UA and urine culture recommended
Tx: FQ x 14 days

68
Q

[UTI]

Renal transpant, significant bacteriuria with urologic abnormality, renal transplant, diabetes, sepsis, older male

A

Complicated UTI

69
Q

What are the drugs safe for UTI in pregnancy

A
  1. Amoxicillin
  2. Cephalosporin
  3. Nitrofurantoin
70
Q

What is the length of treatment for UTI in men

A

7 to 14 days of a FQ

71
Q

What is the length of treatment for acute bacterial prostatitis

A

2-4 weeks

72
Q

What is the length of treatment for chronic bacterial prostatitis?

A

4-6 weeks

73
Q

What is the length of treatment for recurrent UTI in men?

A

12 weeks

74
Q

[Diagnose]

sudden onset unilateral flank pain, painless gross hematuria

A

nephrolithiasis

75
Q

What is the most common type of stone that causes nephrolithiasis?

A

calcium oxalate

76
Q

What is the most common site of impaction of nephrolith?

A

Ureterovesivular junction

77
Q

What is the gold standard in diagnosing nephrolithiasis?

A

Helical CT without contrast

78
Q

What is the most urgent step needed in an acute case of rhabdomyolysis

A

ECG to check for hyperkalemia

79
Q

What are the cardiac arrythmias associated with hyperkalemia?

A
  1. Sinus bradycardia
  2. Sinus arrest
  3. Slow idioventricular rhythmns
  4. Ventricular tachycardia
  5. Ventricular fibrillation
  6. Asystole

Internal Medicine (10 decks)

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