renal

Question 1

corrected CA Very IMP

Answer 1

measured calcium + 0.8 (4- albumin)

in hepatic problems with low albmin ca is lowwwwwww

Question 2

analgesic induces nephropathy

Answer 2

nephrotic range present

Question 3

mixed cryoglobulinemia

Answer 3

palpable purpra
weakness
athralgia

immmune complex in small and medium size vessels: Hepatitis C and lymphoproliferative and autoimmune and other infections
high n RF and decreased in complement levels

about 20 % will have glomerulonephritis

long term management is treaing the causing factor for short term management we use prednisone and rituximab

Question 4

hyponatremia

Answer 4

water intae restriction if under 120 we can use vasoperssin 2 receptor antagonist ( tolvaptan) for chronic

for acute with symptoms hypertonis salin

Question 5

autosomal dominant PKD

Answer 5

30-40
flank pain
HTN
palpable abdominal mass
CKD
cerebral aneurysm
hepatic and pancreatic cyst
MVP AR
clinic diverticulitis
ventral and inguinal hernias
ace inhibitors and hemodialysis and renal transplant
and statins

Question 6

renovascular disease

Answer 6

resistant, malignant, onset of sever after 55
with diffuse atherosclerosis
flash pulmonary edema with sever HTN
or unexplained rise in creatinine after using ACE or ARBS

Question 7

UTI nonpregnant

Answer 7

nitro or cotri or foso

if not available or cannot be done, then fluoroquinolones
if fail UC

if complicated
first fluoroquinolones outpatients
in patient: cefteriaxon piperacilin carbapenem

Question 8

orthostatic proteinuria

Answer 8

most common cause of adolecent proteinuriaaa IMP
split day and night for PR 24H

Question 9

CKDand Phosphate

Answer 9

Restrict if not and still high selevemer which is a non calcium containing phosphate binders

Question 10

proteinuria with HTN

Answer 10

more than 500 first ace
if not more than 500 we look at edema if preset diuretics if not ace arbs or CCB then …

Question 11

acute interstitial nephritis

Answer 11

meds rheumatologic disease infections(legionella, tuberculosis,CMV)
new med acute kidney arthralgia and malaise, triad: fever, rash and eosiophilia
wbc cast
first dicontinue the drug and supportive then corton

Question 12

ileus vs small bowel obstruction

Answer 12

prior surgery weeks to years vs hours to days
metabolic in ileus ( hypokalemia) and it can be medication induced
abdominal examination :distention and increased bowel sound vs possible distention and reduced or absent bowel sounds
dilation in small bowel in both but inly in ieus is present in large bowel

Question 13

primary nocturnal enuresis

Answer 13

age 5 very IMP
first UA voiding diary
management ; comorbid conditions behavioral modification (evening fluids)
enuresis alarm , last desmopersin

Question 14

hepatorenal

Answer 14

precipitants; gastrointestinal bleed and infection
pathology; splanchnic vasodialation renal hypoperfusion
very low urin NA under 10
no other cause
treatment albumin = splachnic vasoconstrictor ( temposizing)(terliperssin norepinephrine or midodrine plus octreotide then liver trasplant

Question 15

analgesic nephropathy

Answer 15

cr increased , hematuria WBC and sterile

Question 16

health maintenance in diabetes mellitus

Answer 16

A1C every 3-6 months (under7 and 8 for limited comorbities)
annual random urine albumin/creatin ratio (normal under 30)
periodic creatinine screening
dilated eye examination every 12 years
visual inspection in every visit
annual comprehensive foot examination
annual BP and lipid
asprin and statin ( depending on the risk factors)

Question 17

renal vein thrombosis

Answer 17

hypercoagulability ( the question is usally a patient with nephrotic syndrome) or malignancy or other , or trauma
flank pain hematuria increase in LDH increase in kidney size
chronic; renal symptoms are absent may cause PE
ct Mr angio renal veno
anticoagulation local thrombectomy