Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

PANCE > PANCE Prep- Nephro/Uro > Flashcards

PANCE Prep- Nephro/Uro Flashcards

1
Q

Most active secretion happens in ___

Most reabsorption happens in ___

A

DCT

PCT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

If serum glucose rises about ___, it reaches saturation and spills into the urine

A

180mg/dL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

SE of loop diuretics

Site of action and most unique use

A
  1. *HypoK+, hypoCa++, hypoMg++
  2. HypoNa+ (less than thiazides)
  3. Hyperglycemia
  4. Hyperuricemia- caution in gout
  5. Ototoxicity
  6. Sulfa allergy
  7. Hypochloremic metabolic alkalosis

Thick ascending loop of henle
Use: hyperCa++

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

SE of thiazide diuretics

Site of action and most unique use

A
  1. *HypoNa+ (more than loop diuretics)
  2. HyperCa++
  3. HypoK+
  4. Hyperglycemia
  5. Hyperuricemia- caution in gout
  6. Sulfa allergy

DCT
Use: nephrogenic DI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

SE of K+ sparing diuretics

Site of action and most unique use

A
  1. HyperK+
  2. Metabolic acidosis
  3. gynecomastia (w/ spironolactone)

Collecting ducts/tubules- inhibits aldosterone
Use: CHF and hyperaldosteronism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

SE of Mannitol

Site of action and most unique use

A
  1. Pulmonary edema

PCT
Use: intracranial HTN/shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

SE of acetazolamide

Site of action and most unique use

A
  1. hyperchloremia metabolic acidosis
  2. kidney stones

PCT
Use: intracranial HTN and Glaucoma*

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What hormones affect kidney absorptions and secretion?

A
  1. PTH- increases phosphate excretion in PCT and Ca++ resportion in DCT
  2. Angiotensin II- increases Na/H20 resportion in PCT
  3. Aldosterone- increases Na resorption in Collecting ducts/tubules
  4. ADH- inhibits H20 resportion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Diagnostic Components of Nephrotic Syndrome

A
  1. Proteinuria (>3.5g/day on 24hr urine or 3-4+ on dip, UA shows “OVAL FAT BODIES “MALTESE CROSS SHAPED)
  2. Hypoalbuminemia (<3.4g.dl)
  3. Hyperlipidemia
  4. Edema (often periorbital in kids)- worse in AM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

80% of nephrotic syndrome in children is due to ___.

Dx and Tx?

A

Minimal change disease
-etiologies: idiopathic, allergies, viral infection

DX: podocyte damage on electron microscope, loss of neg. charge of glomerular basement membrane

TX: prednisone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

MC cause of focal segmental glomerulosclerosis (FSGS)

TX?

A
  1. HTN esp. in AA

tx: Corticosteroids/prednisone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Clinical manifestations of acute glomerulonephritis (AGN)

Dx and tx?

A
  1. HTN
  2. Hematuria*** (RBC casts and “cola-colored urine)
  3. Dependent edema (periorbital in kids)
  4. Proteinuria
  5. Azotemia (nitrogen in urine)
  6. fever
  7. Oliguria (decreased UOP)

DX: hematuria (RBC casts), proteinuria, high specific gravity
**Renal biopsy is GOLD STANDARD

TX: usually self-limited
-Rapidly progressive AGN or severe: corticosteroids + Cyclophosphamide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Causes of acute glomerulonephritis

A
  1. IgA Nephropathy (Berger’s Disease)- MC cause in adults worldwide (young males s/p URI or GI infection)
  2. Post infection- GABHS
  3. Membranoproliferative
  4. Rapidly progressive glomerulonephritis
  5. Goodpastures’s Disease
  6. Vasculitis/ Wegener’s
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Dx and Tx of IgA Nephropathy (Berger’s Disease)

A

DX: IgA mesangial deposits on immunostaining

TX: ACEI +/- Corticosteroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Nephrotic vs Nephritic Syndrome

A

Nephrotic:

  1. increased urinary protein loss
  2. Proteinuria, HYPOALBUMINEMIA, EDEMA**, HYPERLIPIDEMIA
  3. UA: FATTY CASTS, OVAL FAT BODIES “Maltese cross”
  4. Biopsy: HYPOcellular

Nephritic: via inflammation

  1. increased urinary protein loss AND RBC loss
  2. Proteinuria, HTN, AZOTEMIA, OLIGURIA, HEMATURIA (RBC CASTS), FEVER, FLANK PAIN
  3. UA: Hematuria, RBC casts
  4. Biopsy: HYPERcellular, crescent shaped in RPGN
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

RIFLE Criteria for AKI

and phases of AKI

A

Risk, Injury, Failure:, Loss and ESRD

Phases: Oliguric (maintenance)–> diuretic–> recovery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Hallmark of Intrinsic AKI: ____

Causes of intrinsic AKI:

A

hallmark: CELLULAR CAST FORMATION

Causes:

  1. **Acute tubular Necrosis (ATN): prolong ischemia/hypovolemia vs nephrotoxic
    - aminoglycosides, contrast dye, gout crystals, rhabdomylolysis, MM (Bence-Jones)
  2. Acute tubulointerstital nephritis (AIN): inflammatory or allergic response
    - PCN, NSAIDS, sulfa drugs, infections, autoimmune/idiopathic
  3. Glomerular (AGN)
  4. Vascular
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Dx and TX:

  1. Acute tubular necrosis
  2. Acute tubulointerstital nephritis
A
  1. ATN
    DX: UA: epithelial cell cast and Muddy brown cast*
    TX: remove offending agent, IVF (recovers in 7-21 days)
  2. AIN
    DX: UA: WBC casts are pathognomonic*, EOSINOPHILIA, increases serum IgE
    TX: remove offending agent (recovers in 1 yr)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the following casts seen in?

  1. RBC casts
  2. Muddy brown casts
  3. WBC casts
  4. Waxy casts
  5. Hyaline casts:
A
  1. RBC casts- AGN or vasculitis
  2. Muddy brown casts- ATN
  3. WBC casts- AIN or pyelonephritis
  4. Waxy casts- (narrow) CHRONIC ATN or (broad) ESRD*
  5. Hyaline casts: nonspecific
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Describe the urine Na+ and specific gravity in prerenal AKI and ATN AKI

A

Prerenal: LOW urine Na+ and HIGH specific gravity

ATN: HIGH urine Na+ and LOW specific gravity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

DX:

  • Abdominal/flank pain, palpable flank mass, HTN, hematuria,
  • CERBRAL “berry” aneurysm, hepatic cysts, MVP, colonic diverticula
A

Adult Polycystic Kidney Disease (AD disorder)

DX: renal US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What can cause Hyper and hypo-phosphatemia

A

Hyper: causes muscle weakness/flaccid paralysis

  1. Renal failure (MC)
  2. Primary HypoPTH
  3. Vit. D. INTOX

Hypo: causes soft tissue calcifications

  1. Primary HyperPTH
  2. Refeeding
  3. Antacids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Causes of Chronic kidney disease

*first presenting sx/ single best predictor of disease progression

A
  1. DM (MC)
  2. HTN (2nd MC)
  3. Glomerulonephritis

1st: proteinuria- microalbumuria
**Best to test w/ SPOT U.Albumin/U. Creatinine ratio
(use spot over 24hr)

*metabolic acidosis seen later on

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the 2 most important modifiable risk factors for CKD

A
  1. HTN (goal <140/90 w/ ACEI)
  2. proteinuria- restrict protein in diet (w/ ACEI)

*goal HgbA1c <6.5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Complications of CKD
1. Anemia of chronic disease (normochromic, normocytic) * TX: oral FeSO4+/- EPO or Darbepoetin-alpha 2. Coagulopathy- platelet dysfunction, increased bleeding 3. Osteodystrophy (bone and prox. muscle pain and pathologic fx) - Osteitis fibrosis Cystica- periosteal erosions ("salt and pepper on skull xray") - Increased PO4 and HYPOCALEMEMIA - LOW Vit. D (cannot be produced by kidney) and High PTH
26
When is dialysis indicated for CKD
GFR = 10mL/min or serum creatinine >/= 8mg/dL
27
What is SIADH and its etiologies?
increased ADH--> hypoNa and free water retention ***ISOVOLEMIC, Hypotonic, hyponatremia ``` Etiologies: 1. Stroke (MC), head trauma, post-op 2. Small cell lung CA 3. Meds: narcotics, anticonvulsants, Carbamazepine, IV cyclophosphamide, antidepressants (TCA/SSRIs), hydrochlorothiazide, ectasy "AC-CANE" ```
28
Tx of SIADH
1. H20 restriction* 2. Demelocycline (inhibits ADH) 3. IV HYPERTONIC saline w/ furosemide
29
Etiologies of diabetes inspidius
1. Central- decreased ADH production (MC) 2. Nephrogenic- partial/complete insensitivity to ADH *Large amounts of dilute urine (polyuria, polydipsia, nocturia, HYPERNATREMIA)
30
DX and TX DI
DX: 1. fluid deprivation test- continues to produce dilute urine 2. Desmopressin (ADH) stimulation test - Central DI- reduction in UOP - Nephrogenic- no change TX: 1. Central DI: Desmopressin/DDAVP or carbamazepine 2. Nephrogenic: HCTZ, restrict Na+ and protein in diet *if sx--> hypotonic fluid (oral is best)
31
The following conditions will cause what type of HypoNA+? 1. CHF 2. SIADH 3. HyperTG or Hyperproteinemia 4. Hyperglycemia or mannitol infusion 5. Cirrhosis 6. Nephrotic Syndrome
1. CHF: HYPERvolemic hypoNa+ 2. SIADH: Iso/eu+olemic hypoNa+ 3. HyperTG or Hyperproteinemia: Isotonic HypoNa+ 4. Hyperglycemia or mannitol infusion: Hypertonic hypoNa+ 5. Cirrhosis: HYPERvolemic hypoNa+ 6. Nephrotic Syndrome: HYPERvolemic hypoNa+ *HYPOTONIC HYPONA+ IS CLINICALLY SIGNIFICANT (volume depletion)
32
What values go into calculating serum Osm?
2x [Na+] + glucose/18 + [BUN]/2.8
33
Etiologies, lab findings, and EKG findings for Hypo and Hyper- Mg++
Hypo: 1. etiologies: malabsportion, ETOHics, PPIs, Loop/thiazide diuretics 2. Labs: HypoMg, HypoK, HypoCa++ (increased DTRs), low PTH 3. EKG: Prolonged QT and PR interval, Torsades Hyper: 1. etiologies: renal insuff./AKI/CKD, lithium 2. Labs: HyperMg, HyperK+, HyperCa++ (decreased DTRs) 3. EKG: Prolonged QT and PR interval, Hyper K- peaked T waves, short QR, wide QRS
34
EKG changes with Hypo and Hyper- K+ | and TX
Hypo: EKG: Flat T waves, prominent U waves ****ASSOCIATED risk with increased risk of Digoxin toxicity TX: K+ replacement- tx hypoMg++ if present Hyper: EKG: Peaked T waves, flat P waves, short QR, wide QRS TX: IV Calcium gluconate- stabilizes cardiac membranes -Insulin w/ glucose (shifts K+ intracellularly) -Kayexalate -B2agonists
35
Epididymitis is usually caused by: ____ Orchitis is usually caused by: ___
Epididymitis: bacterial, >35y/o and kids: enteric organism (E. coli or Klebsiella), if <35y/o: Chlamydia*, gonorrhea Orchitis: viral, Mumps**
36
DX and TX: - gradual onset of scrotal pain, erythema, swelling, +/- fever - Positive Prehn's sign: relief of pain w/ elevation of affected scrotum - Positive/normal cremasteric reflex
Epididymitis and Orchitis DX: scrotal US: enlarged epididymis, increased testicular blood flow* UA: pyuria/bacteriuria TX: bed rest, elevate scrotum, cool compresses, NSAIDS - Acute epididymitis s/s C and GN: Doxycycline + Ceftriaxone - Acute epididymitis >35y/o: Fluoroquinolones, or cephalexin or amox for kids
37
DX and TX: - abrupt onset of scrotal, inguinal or lower abdominal pain (usually <6hr), N/V - Negative Prehns sign: no relief of pain w/ elevation of affected scrotum - Negative cremasteric reflex - Blue dot sign at upper pole
Testicular torsion DX: testicular doppler US TX: Detorsion and orchiopexy within 6 HOURS!
38
Who is at risk for cryptorchidism complications? Tx?
Risk: premature infants, low birth weight (MC on RIGHT SIDE**) Complications: 1. testicular CA (in both testes) 2. subfertility 3. testicular torsion TX: Orchiopexy as early as 6 months (ideally before 1 y/o)
39
Types of testicular CA
MC 15-40y/o- MC on right side 1. Germinal cell tumor (97%)- usually malignant - Seminoma *MC- Simple (lack tumor markers), sensitive (to radiation), Slow growing, stepwise spread - Nonseminomatous (increased AFP, BhCG and RADIOresistance 2. Nongerminal cell tumors - Leydig - Sertoli
40
MC cause of painless scrotal swelling
Hydrocele if communicating: swelling worse w/ valsalva TX: self-limiting or repair if persists beyond 1 y/o or communicating
41
Cystic testicular mass, "bag of worms" superior to testicle, dilation worsens when patient is upright or w/ valsalva
Varicocele (MC on LEFT SIDE) *MC surgically corrected cause of male infertility
42
MC causes of cystitis and pyelo TX
E. coli Staph. saprophyticus in sexually active women TX: Phenazopyridine- no longer than 48 hrs (riske of methmoglobinuria, hemolytic anemia 1. Uncomplicated: Nitrofurantoin, Fluoroquinolone (Cipro, Bactrim-DS) 2. Complicated cystitis (prior tx failure or males): Fluoroquinolone PO or IV, Aminoglycoside 3. Pregnancy: Amoxicillin or nitrofurantoin 4. Pyelo: Fluoroquinolone PO or IV, Aminoglycoside
43
Urine culture must show how much growth for it to be a positive UTI
Women: >/= 10^5 (100,000) Males: >/= 10^2-4 + symptoms
44
foreskin becomes trapped behind the corona of glans and forms a tight band, constricting penile tissue: ____ Inability to retract foreskin over the glans: ___
Paraphimosis- Urologic emergency!! tx is manual reduction +/- dorsal slit Phimosis- tx is circumcision
45
DX and TX Prostatitis
DX: acute: equisitely tender, normal/hot, boggy prostate chronic: NONtender, boggy prostate 1. UA/culture: + in acute 2. AVOID PROSTATIC MESSAGE in ACUTE prostatitis TX: Acute: >35y/o (E. coli MC): fluoroquinolones or bactrim <35 (C, G MC): Ceftriaxone + doxy Chronic: fluoroquinolones or bactrim x6-12 wks -Transurethral resection of the prostate (TURP) for refractory chronic
46
DX and TX: | uniformly enlarged, firm, rubbery prostate with irritative sx or obstructive sx
DX: DRE, PSA TX: 1. observe: avoid antihistamines and anti-cholinergics 2. 5-alpha reductase inhibitors (finasteride, duasteride)- reduces size but not immediate relief) 3. alpha1 blocker (tamsulosin, doxazosin, terazosin)- relaxes smooth muscles- immediate relief 4. TURP
47
Risk factors for prostate CA
1. high fat diet, obesity, AA, adenocarcinoma* ***back/bone pain (increase incidence of METS to bones)
48
MC type of bladder CA and risk factors for bladder CA
``` Transitional cell (TCC) **highest recurrance rates of call cancers ``` RF: smoking (MC), occupational exposure to dyes, rubbers or leather, age >40, white males, Cyclophosphamide, pioglitazone
49
DX and TX: | hematuria, flank/abdominal pain, palpable mass, weight loss, L-sided varicocele, HTN, hyperCalcemia
Renal cell carcinoma RF: smoking, dialysis, HTN, obesity, males DX: CT scan usually first test TX: radical nephrectomy
50
Nephroblastoma is MC in ______ presents as ____ DX and TX?
- kids w/in 1st 5 yrs of life - painless, palpable abdominal mass, hematuria, HTN, anemia - DX: abdominal US (best initial), CT w / contrast or MRI - TX: nephrectomy followed by chemo * 80-90% cure rate
51
types of kidney stones and their cause
1. Calcium oxalate (MC)- increased protein, salt- inhibits Ca resorption 2. Uric acid- high protein, increased purines 3. Struvite stones (Mg ammonium phosphate)- may form staghorn calculi due to urea-splitting organisms (proteus, Klebsiella, psueudomonas, Serratia, enterobacter) 4. Cystine (genetic)
52
kidney stone w/ urine pH >7.2 (alkaline) is mostly likely ___
associated w/ struvite stones
53
DX and TX kidney stones
DX: 1. Noncontrast CT abd/pelvis (MC initial test) 2. Renal US- look for hydronephrosis 3. KUB radiograph: only for calcium and struvite stones 4. Intravenous pyelography- Gold standard TX: <5mm in diameter: 80% chance of sponatenous passage -IVF, analgesic, antiemetics, tamsulosin) >7mm: Extracorpeal shock wave lithotripsy 2. Uretoscopy +/- stent- immediate relief for high risk 3. percutaneous nephrlithotomy- large stones or struvite
54
Flaccid penile state is achieved by ____ stimulation | Erected penile state is achieved by ____ stimulation
``` flaccid= sympathetic stimulation erected= parasympathetic stimulation ```
55
Types of priapism and etiologies
Ischemic/low flow (MC): decreased venous outlfow Nonischemic/high flow: increased arterial flow Etiologies: 1. idiopathic (MC) 2. sickle cell
56
TX of low-flow and high-flow priapism
low-flow: 1. phenylephrine* 2. Terbutaline 3. needle aspiration (esp. if >4hrs) 4. shunt surgery high-flow: 1. observation
57
MC causes of urethritis TX?
gonococcal- abrupt--> TX: ceftriaxone or azithro non-gonoccal-chlamydia- 5-8 days --> TX: azithro or doxy DX: nucleic acid amplification for both
58
Infant neonatal conjuncvitits (ophthalmia neonatorium) Presents: -2-5 DOL: ____ TX? -5-7 DOL: ___ TX?
2-5 DOL: gonococcal- erythromycin ointment- risk for blindness otherwise 5-7 DOL: chlamydia: azithro
59
DX and TX of renovascular hypertension (renal artery stenosis)
DX: CT or MRA -renal arteriography is gold standard* TX: angioplasty w/ stent- definitive -ACEI/ARBs- however CI if bilateral stenosis or solitary kidney
60
TX of enuresis
1. Behavioral- motivation, education, reassurance 2. Enuresis alarm- use if failed behavioral tx 3. Desmopressin (DDAVP)- best for short-term use 4. TCA (ex. Imipramine)- use if failed above
61
What type of urinary incontinence and cause? 1. from sneezing, coughing, laughing 2. nocturia*, frequency, small volume voids 3. Small volume voids, frequency, dribbling, increased post-void residual >200
1. Stress incontinence (increased intra-abdominal pressure, laxity of pelvic floor muscles ie child birth) 2. Urge incontinence (detrusor muscle overactivity, overactive bladder) 3. Overflow incontinence (decreased detrusor muscle activity/atony, underactive bladder)
62
TX 1. Stress incontinence 2. Urge incontinence 3. Overflow incontinence
1. stress- pelvic floor exercises, alpha agonists (midodrine, pseudoephedrine) , surgery, devices, estrogen 2. Urge- bladder training, anticholinergics (oxybutynin, tolterodine), TCA (imipramine), Miragegron (B3 agonist-relaxant), surgical, diet 3. Overflow- intermittent/indwelling cath*, cholinergics (bethanacol), BPH (alpha-1 blockers: tamsulosin)

PANCE (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions