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Internal Med > OME - Nephro > Flashcards

OME - Nephro Flashcards

1
Q

Respiratory acidosis is a result of what?

D/t what causes?

A

Hypoventilation

Opiates, COPD, asthma, OSA, muscle weakness (GB)

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3
Q

What defines CKD stage IV?
Need to to do what?

V?
Need to do what?

A

Severe, GFR 15-29
Prepare for dialysis/transplant —> put AV fistula

Kidney failure, GFR < 15
Dialysis or DIE

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4
Q

MUDPILES = ?

A 
Methanol
Uremia
DKA
Propylene glycol 
INH/Iron 
Lactic acidosis
Ethylene glycol
Salicylates
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5
Q

What are the 3 effects of PTH?

A

1 - activates osteoclasts to clear bone: Inc Ca, Inc P
2 - directly reabsorbs Ca, excretes P in the kidney
3 - indirectly absorbs Ca and P from the gut via Vit D

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6
Q

Acid/Base disturbance question for resp acidosis, what is the 1st step?

2nd?

3a?

3b?

3c?

A

Check pH, < 7.4 = acidosis

Resp or Metabolic —> look at CO2, normal is 40

Check AG

Acute (.08) or chronic (.04): 7.4 - (dimes *.04/.08) for CO2
1 or 3 for bicarb

Is there metabolic derangement?
24 + (dimes * 1/3) = expected bicarb

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8
Q

What does pancreatitis cause in reference to calcium?

A

Calcium sequestration:

Dec Ca, Inc PTH, Dec PO4

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10
Q

At what size will kidney stones pass spontaneously?

What size req medical therapy?
What meds?

What size for lithotripsy?

What size surgery?

A

0.5 mm

0.7 mm
Amlodipine or Terazosin

< 1.5 cm

> 1.5 cm

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13
Q

Best Treatment for hypokalemia?

If treating it and still doesn’t change do what?

A

PO > IV

Check Mg levels

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15
Q

Metabolic acidosis determined, what is the next step?

Then what?

Also have to check what?

A

AG

Is CO2 appropriate for bicarb: Winter’s formula
Expected CO2 = 1.5*bicarb + 8 +/-2

Another metabolic derangement?
Take AG - 12, then take that number and add it to the # of Bicarb you have. Take that total and then compare it to normal bicarb of 24, (> 24 = alkalosis, < 24 = acidosis)

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16
Q

Severe Hypo/hyper natremia has what symptoms?

To fix Hypo do what?

To fix Hyper?

A

Coma, seizures, death

IV Hypertonic Saline (3%)

IV D5W

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18
Q

Hypertonic hyponatremia may occur in diabetics, how must you correct?

A

Every 100mg/dL of glucose above 100, adult for Na by 1.6 Increase

Ex: 500 bG = 4 x 1.6 Na, add 6.4 Na to given level

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19
Q

Multiple adenomas of the parathyroid glands means what?

Due to what?

What lab values?

A

Tertiary hyperparathyroidism

Chronic RF

Inc PTH
Inc Ca
Dec P

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22
Q

What is winter’s formula?

Used for what?

A

Expected CO2 = 1.5*bicarb + 8 +/-2

Metabolic acidosis derangement + another Respiratory disturbance

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24
Q

ADPKD can produce what other symptoms?

What are the extrarenal manifestations?

A

Pain, hematuria
Malignant HTN d/t activation of RAS

Cirrhosis, pancreatitis, SAH

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25
Q

The decision for dialysis is based on what?

A 
AEIOU
Acidosis 
Electrolytes (Na/K)
Ingestion (toxins)
Overload (CHF, edema)
Uremia (pericarditis)
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26
Q

What is another name for kayexalate?

Used for what?

A

Sodium polystyrene sulfonate

Elim K+ in the stool

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28
Q

Pt that has euvolemic hyponatremia, what could be the causes?

A 
RATS
RTA
Addison’s
Thyroid
SIADH
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29
Q

What is the serum osmolar equation?

Normal is what?

A

(2xNa) + (glucose/18) + (BUN/2.8)

280

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30
Q

Moderate Hypo/hyper natremia has what symptoms?

To fix Hypo do what?

To fix Hyper?

A

N/V/HA

IV NS

IV NS

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31
Q

Secondary hyperparathyroidism due to what?

Lab values:
PTH
Ca
P
Vit D?

Treat how?

A

Renal Failure, Vit D NOT Made

Inc PTH
Dec Ca
Inc P
Dec Vit D

Cinacalcet

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32
Q

What does pseudohypoparathyroidism mean?

Lab values:
PTH
Ca
P

A

PTH-end organ RESISTANCE

Inc PTH
Dec Ca
Inc P

PTH is not working properly

33
Q

Resp alkalosis, what is the difference bw it and resp acidosis in terms of adjusting?

A

Find acute/chronic

Then adjust expected bicarb of:
24 - (dimes x 2) acute
24 - (dimes x 4) chronic

34
Q

Pt that has Non-Gap Acidosis w/hypokalemia can only be caused by what?

A

RTA

Diarrhea

35
Q

What is meloxicam?

What can it cause?

A

NSAID

AKI

36
Q

Pt w/metabolic acidosis w/NON-AG, what is next step?

If + means what?
If - means what?

A

Urine AG

RTA
Diarrhea

37
Q

What has radially aligned cysts in the kidney?

Presents how?

A

ARPKD

At birth w/oliguria/Anuria

38
Q

How to calculate Urine AG?

A

URINE Na + K - Cl

39
Q

Symptoms of hypercalcemia?

Treatment?

If need to be very aggressive?
BEST long-term tx?

A

Stones, bones, groans, psychic moans (AMS)

LOTS of IVF

Calcitonin
Bisphosphonates

41
Q

Complex cyst found on US, next step?

A

Surgery to remove

42
Q

Pt that has a large kidney stone (> 3cm) and rising Cr, what is the next step?

Then what?

A

Nephrostomy tubes to bypass stone

Then surgery

43
Q

What causes Familial Hypocalciuric hypercalcemia?

Lab values:
Ca
PTH

Diagnose How?

A

Abnormal CaSR

Inc
Inc

FHx and LOW Urine Ca

46
Q

What causes metabolic alkalosis?

Check what next?

If low what?
High?

A

High aldosterone

Urine Chloride

(<10), Pt is volume responsive —> give IVF
(>10), not volume, check for HTN —> RAS/Conn’s OR Bartter/Gitelman (if no HTN)

48
Q

What presents w/flank pain, hematuria, and flank mass?

1st step in workup?
Next?

What may be some additional problems?

A

RCC

UA, then CT/US

Renal vein thrombosis, anemia, polycythemia

51
Q

How to confirm Dx of kidney stones?

If pregnant?

A

Non-Con CT

US

52
Q

Respiratory alkalosis is a result of what?

D/t what causes?

A

Hyperventilation

Pain, anxiety, hypoxemia (PNA, PE, ARDS)

53
Q

How do you account for Ca levels when albumin is below 4?

A

Every 1 point below 4 add back 0.8 Ca

Normal Ca is 10

57
Q

What is the cause of secondary hyperparathyroidism?

Lab values of:
P?
Ca?
PTH?

Treat how?

A

Kidney failure —> phosphate retention, Vit D def

Inc P
Dec Ca
Inc PTH

Phosphate binders - sevelamer
Calcimimetics - cinacalcet

58
Q

Typical pt presentation for kidney stones?

Workup starts with what?

A

Colicky flank pain that radiates to the groin
N/V
Hematuria

UA

65
Q

When do you need 1,25-Vit D to make a diagnosis in parathyroid cases?

Will be what?

Ca?
P?
PTH?

A

Granulomatous disease (Sarcoidosis, TB)

High

High
High
Low

67
Q

What are the 3 stages of treatment in HyperK+?

A

I - stabilize myocardium: give IV Calcium gluconate

II - dec serum K: give insulin and glucose

III - decrease total body K: Kayexlate or loop diuretics

68
Q

What are the 3 main causes of intrarenal AKI?

What distinguishing characteristics of each?

A

ATN - muddy brown casts

AIN - wbc, wbc casts

GN - rbc casts (glomerular diseases)

73
Q

What defines CKD stage I?

II

III?

A

GFR > 90

Mild, GFR 60-89

Mod, GFR 30-59

76
Q

What SE does EPO have in ESRD pts?

A

Worsens HTN

83
Q

Post-renal failure caused by what?

Results in what?

Diagnose how?

A

Obstruction to outflow

Hydroureter/Hydronephrosis

US

86
Q

What substances can be dialyzed?

A 
SLIME
Salicylates
Lithium
Isopropanol
Methanol / Mg
Ethylene glycol
88
Q

What is the cause of pre-renal AKI?
Due to what?

What lab values?

A

Decreased perfusion
Dec CO, 3rd spacing, Dec vessel diameter

UNa < 10, FeNa < 1%, BUN/Cr > 20

90
Q

What lab values indicate intra-renal AKI?

A

BUN/Cr < 10
UNa > 20
FeNa > 1%

91
Q

Type 1 RTA has what urine pH?

K+ status?

Pathology?

A

> 5.5

Hypokalemia

Alpha-intercalated cells canNOT secrete H+

92
Q

Type 2 RTA has what urine pH?

K+ status?

Path?

A

< 5.5

Hypokalemia

PCT defect of HCO3 reabsorption

93
Q

Type 4 RTA has what urine pH?

K+ status?

Path?

A

Urine pH < 5.5

HyperKalemia

D/t hypoaldosteronism or CKD (DM pts)

Prevents CD from generating NH4+
Will have low bicarbonate

Internal Med (7 decks)

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