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Step 2 > Renal > Flashcards

Renal Flashcards

1
Q

RBC casts

A

Glomerular disease, vasculitis

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2
Q

WBC casts

A

interstitial nephritis, pyelonephritis

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3
Q

ATN

A

Hypovolemia, urine Osm >300, urine Na >20, FE Na>2% ——-> MUDDY BROWN casts/epithelium

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4
Q

CRF casts

A

Broad and waxy

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5
Q

EOSINOPHILIURIA, WBC casts, hematuria, rash, arthralgias

A

Drug-induced interstitial nephritis = lymphocytic or eosinophilic infiltration

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6
Q

Uncomplicated cystitis tx

A

Nitrofurantoin 5d, TMP-SMX 3d, Fosfomycin

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7
Q

Complicated cystitis tx (DM, CKD, obstruction, cath)

A

Fluoroquinolones + culture

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8
Q

Gross hematuria

A

Bladder cancer

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9
Q

Recurrent hematuria, child, deafness, thick+thin capillary + GBM splitting

A

Alport syndrome

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10
Q

Coffin lid shaped crystals

A

Urease producing UTI organisms

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11
Q

Most common type in elderly/nursing home

A

Urge

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12
Q

Sudden need when walking, drinking, large volume, nocturnal wetting

A

Urge

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13
Q

Causes/mech of urge incontinence

A

UTI, stroke, MS, dementia, Parkinson –> uninhibited detrusor contractions

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14
Q

Dx & Tx of urge incontinence

A

Urodynamic - timed-voiding/training –> oxybuntin, imipramine

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15
Q

Urine leak w/ laughing, sneezing, small PVRV

A

Stress - weak muscles

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16
Q

Tx stress incontinence

A

Kegel, estrogen, pessary, urethropexy

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17
Q

Urinary incontinence in woman of childbearing age

A

MS - Urge or overflow

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18
Q

Incomplete emptying, dribbling, frequency, PVRV >100ml, nocturnal

A

Overflow

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19
Q

Causes/mech of overflow incontinence

A

Poor contraction (DM, anti-cholinergics, a-agonist) or obstruction (BPH, CA, constipation)

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20
Q

Tx overflow incontinence

A

Intermittent cath, bethanachol, a-blockers

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21
Q

Can’t sense need to urinate

A

Reflex incontinence - SC injury&raquo_space; MS, DM, disc, SC compression/tumor

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22
Q

Non-inflammatory chronic prostatitis

A

WBC <10

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23
Q

Inflammatory chronic prostatitis

A

WBC >10

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24
Q

Nocturia, difficulty starting stream, Cr 0.7, smooth firm prostate next step?

A

Urinalysis - hematuria/stones, infection, cancer, obstruction

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25
Q

Difficulty starting, nocturia, hesitancy, Cr 1.2 –> 2.1, smooth firm prostate next step?

A

Abd US –> hydronephrosis –> Foley –> TURP

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26
Q

Indication for prostate bx

A

Elevated PSA or nodule

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27
Q

Causes of priapism

A

Trazodone, prazosin, sickle cell, leukemia, SC, cauda equina, cavernous a ligation

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28
Q

Urgency, frequency, NO dysuria, difficulty starting urination, dribbling

A

BPH –> U/A, Cr

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29
Q

Tx for BPH

A

a-blocker (Tamsulosin), 5-a-reductase inhib (Finasteride), Foley –> TURP

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30
Q

Fever, N/V, + urine WBC, bacteria, tender DRE

A

Bacterial prostatitis –> UA & cx –> Cipro

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31
Q

Tx aseptic prostatitis

A

High dose NSAIDs

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32
Q

Sudden testicular pain, NO fever, horizontal testis, high riding

A

Testicular Torsion –> US or surgery untwist & b/l orchipexy

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33
Q

Sudden testicular pain, NO fever, bacturia, vertical, tender cord

A

Epidimytis –> US –> abx

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34
Q

Penis fracture work-up

A

Retrograde urethrogram + surgical exploration

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35
Q

Low urine pH and stone tx

A

Uric acid = K-citrate, limit protein

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36
Q

Hypercalciuric stone tx

A

HTCZ, hydration

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37
Q

Blood at end of urine stream

A

Bladder or prostate

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38
Q

Hematuria for entire stream

A

Kidney or ureter

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39
Q

Urine sodium <10, ascities, cirrhosis

A

Renal hypoperfusion - Pre-renal failure

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40
Q

Indication for cystoscopy

A

Hematuria suggesting stone, CA, stricture

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41
Q

Flank pain, hematuria

A

Kidney stone –> CT scan, U/S

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42
Q

Tx of kidney stone

A

Small 3cm = surgical; between = lithotripsy

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43
Q

Work-up of hematuria

A

CT scan, cystoscopy

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44
Q

Causes of acute urinary retention

A

anti-histamines, BPH –> cath for 3d –> a-blocker & 5-a reductase inhibitors

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45
Q

Pneumaturia work-up

A

Diverticulitis –> CT, sigmoidoscopy to r/o CA

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46
Q

Evaluate RLQ pain + urine crystals

A

Uric acid stones –> CT or IVP

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47
Q

Blood at meatus + scrotal hematoma, high riding prostate next step

A

Retrograde URETHROGRAM - pelvic fx

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48
Q

Hematuria + flank pain + mass

A

Renal cell carcinoma –> CT, bx –> resection and chemo

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49
Q

Hematuria, varicocele not empty supine, anemia + thromboytosis

A

RCC –> CT abd

50
Q

Hematuria, hydronephrosis, hydroureter, smoking, b-alanine dye

A

Bladder CA –> US = hydro but 1st step = cystoscopy, best = bx, CT stage

51
Q

Dribbling, urgency, frequency, difficulty starting urination

A

Prostate CA = 5-DHT (testosterone responsive)

52
Q

When to get PSA

A

Firm, nodular DRE –> PSA for Dx

53
Q

Work-up for Prostate CA

A

DRE –> PSA –> Bx rectal > urethral for Gleason score –> tx

54
Q

Tx for prostate CA

A

Anti-androgens (Flutamide), GnRH analog (Leuprolide), orchiectomy, surgical +/- rads

55
Q

Germ cell, painless mass

A

Testicular CA –> transilluminate fails –> orchiectomy

56
Q

Seminoma tx

A

Platinum chemo + rad, follow LDH

57
Q

Non-seminoma (yolk sac, choriocarcinoma, teratoma)

A

Follow AFP, b-HCG, teratomas are very malignant

58
Q

Dialysis, excessive bleeding mech

A

Platelet dysfxn d/t uremic coagulopathy

59
Q

Colicky abd pain –> stones Dx and prevention

A

CT –> NSAIDs –> inc hydration >2L/d, inc Ca, reduce protein, Na and oxalate in diet

60
Q

HypoNa, low serum osmolarity, high urine

A

SIADH - NASAID use

61
Q

Dehydration, HypoNa, low serum osmolarity

A

Mineralocorticoid deficiency

62
Q

Indications for dialysis

A

HyperK, pul edema, pH<7.2, uremic pericarditis or enceph, coagulopathy

63
Q

Associations w/ ADPKD

A

1 = hepatic cysts, MVP, MR< diverticula, hernias, berry aneurysm

64
Q

Linear deposits, anti-GBM

A

Goodpasture’s (cytotoxic ab) –> emergency plasmapheresis

65
Q

Contraction alkalosis, inc bicarb

A

Dehydration from furosemide

66
Q

Prevent contrast induced kidney damage

A

Non-ionic contrast, NAC, IVFs or pre-tx w/ prednisone if allergic

67
Q

1 cause of death in dialysis pts

A

Cardiovascular (#1 overall)

68
Q

Cell mediated injury renal disease

A

Idiopathic crescentic GN

69
Q

days after strep infection –> nephropathy

A

10 - pharyngitis, 21 - impetigo + LOW complement

70
Q

Prevent urate crystal neuropathy in lymphoma and leukemia

A

Pre-tx w/ allopurinol

71
Q

Hematuria, chronic headaches and analgesic use

A

Analgesic nephropathy –> ischemic vasa recta –> papillary necrosis

72
Q

Primary glomerular damage –>

A

dec GFR –> pul edema, JVD, anasarca, proteinuria, RBCs, HTN

73
Q

Oliguria w/ inc BUN, Cr - Acyclovir nephrotoxicity mechanism

A

Renal tubular obstruction - poorly soluble d/t poor hydration

74
Q

Large amount of blood on UA but, 1 RBC on micro, hx seizure, inc Cr

A

Rhabdo –> myoglobinuria –> Acute RF

75
Q

Chronic DM, HTN, 3+ proteinuria, retinopathy, Dec BUN

A

Diabetic nephropathy = microangiopathy

76
Q

Recurrent stones, hexagonal crystals, + CN nitroprusside test

A

Cystinuria –> impaired dibasic a.a. transport

77
Q

Benign renal cyst characteristics –> reassurance

A

Thin walls, simple, no enhancement, no divisions

78
Q

1 umbilical artery assoc

A

Renal anomalies

79
Q

1 newborn abd mass

A

Hydronephrosis

80
Q

Right flank mass w/ calcification + hemorrhage, weight loss, inc HVA, VMA in urine

A

Neuroblastoma = neural crest cells, CROSSES midline (vs. nephro)

81
Q

ASx proteinuria only on dipstick

A

Repeat on 2 subsequent occasions

82
Q

Transient proteinuria causes

A

Fever, exercise, volume depletion, stress, seizure

83
Q

Nephrotic proteinuria, podocyte effacement

A

Minimal change –> steroids

84
Q

Inc serum globulin, 3+ proteinuria, edema, hyperlipidemia, periorbital swelling

A

Minimal change –> steroids

85
Q

Hodgkin lymphoma renal disease

A

Minimal change, sometimes Focal

86
Q

HIV + HepB renal disease

A

Membranouns

87
Q

Renal disease assoc w/ cancers

A

Membranous

88
Q

Nephrotic, HBV infection, sub-EPIthelial deposits

A

Membranous

89
Q

Nephrotic syndrome, sudden fever, hematuria, abd pain

A

Renal vein thrombosis = MEMBRANOUS

90
Q

A.A. HIV

A

FSGS

91
Q

Heavy proteinuria, rapid renal failure, HIV+, sickle, Black, obesity, drugs

A

FSGS

92
Q

Previous URI, now hematuria, RBC casts, normal complement GN?

A

IgA - <5d after URI, normal complement

  • Berger IgA = days after URI
  • PSGN = 1-2 WEEKS after infection
93
Q

LE purpura, abd pain, hematuria, arthralgia, scrotal swelling

A

HSP –> IgA nephropathy

94
Q

RA, enlarged kidneys, hepatomegaly, proteinuria

A

Amyloidosis - deposits under polarized light + fat pad Bx

95
Q

Slow diabetic nephropahy

A

Add ACE

96
Q

1st renal abnormality w/ DM

A

Glomerular hyperfiltration –> GBM thickening –> mesangial –> nodular sclerosis

97
Q

Kimmelstiel-wilson nodules in GBM

A

Diabetic nephropathy

98
Q

Etiology of hypercoagulation in nephrotic syndrome

A

Dec ATIII, dec protein C, S, inc platelet agg –> #1 RV thrombosis

99
Q

Complications of nephrotic syndrome (think about dec proteins/albumin)

A

Fe resistant anemia d/t transferrin loss
VitD deficiency –> HyperPTH
Dec thyroxine
Inc infection

100
Q

Systemic effects of nephrotic syndrome & hypoalbuminemia

A

Abn lipid metabolism –> faster atherosclerosis –> hypercoag –> Inc MI & Stroke

101
Q

Low complement GNs

A

Post-infectious, MPGN, Lupus, Mixed cryglobulinemia

102
Q

Acute bloody urine, edema, HTN

A

Step GN

103
Q

RBC casts, peri-orbital swelling, oliguria, low C3

A

PSGN

104
Q

Grannular deposits/immune complexes, low C3

A

SLE, PSGN

105
Q

Nephrotic 4+ proteinuria, hematuria

A

MPGN

106
Q

URI, hematuria nephropathy

A

IgA

107
Q

Dense C3 intramembranous deposits

A

IgG (C3 nephritic factor) MPGN-II = persistent complement activation

108
Q

Crescent formation

A

RPGN

109
Q

Rapid onset nephritic, hematuria, renal insufficiency

A

Crescentric

110
Q

Acidotic, hypoK, urine pH high, fam hx kidney stones

A

RTA-I

111
Q

RTA I

A

No H+ secretion in urine = low ammonium production by tubules

112
Q

Dec bicarb reabs, Fanconi

A

RTA-II

113
Q

RTA II

A

Defective bicarbonate reabsoprtion, fanconi & carbonic anhydrase inhibitors

114
Q

HyperK, hyperCl acidosis, uropathy, cystic kidneys

A

RTA-IV

115
Q

Renal insufficiency, hyperK, non-anion gap acidosis w/ low Bicarb

A

Renal tubular acidosis - 4 = aldosterone deficiency, worse w/ ACEs, DM

116
Q

UTI management

A

7-14d abx

117
Q

Renal and bladder US indications

A

<24mo, recurrent febrile, no abx response

118
Q

UTI prophylactic abx indications

A

Grade III-IV vesicoureteral reflux

119
Q

Indications for voiding cystourethrogram

A

Hydronephrosis, scarring, high reflux, obstruction, recurrent

120
Q

Chronic UTI, IVUP shows blunted calyces, scarring Dx

A

Chronic pyelo

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