Renal

Question 1

Uncommon but important side effect of loop diuretics?

Answer 1

Ototoxicity, especially at high doses.

Other side effects include hypocalcemia, hypokalemia, and hypomagnesemia

Question 2

Where does uric acid precipitate in the tubule

Answer 2

Where the pH is lowest – collecting ducts due to low urine pH

Question 3

Most cases of kidney stones due to…

Answer 3

Idiopathic hypercalciuria with normocalcemia.

Question 4

Major cause of renal failure in young children

Answer 4

HUS. Causes acute kidney damage.

May look like HSP, but HSP will always have joint pains and arthralgias.

Question 5

NSAID associated renal injury

Answer 5

Is papillary necrosis or chronic interstitial nephritis. Is reversible

Question 6

ACE inhibitor side effects

Answer 6

Cough and first dose hypertension (especially in combination with thiazide diuretics).

Question 7

Angiomyolipoma in…

Answer 7

Tuberous sclerosis (ash leaf spots, brain hamartomas, cardiac rhabdomyomas).

Question 8

Difference between finasteride and tamulosin

Answer 8

Finasteride actually shrinks prostate (6-12 months to work), tamulosin just relieves outflow (days to weeks).

Question 9

Tolterodine/oxybutinin

Answer 9

Antimuscarinic that reduces urgency in BPH.

Question 10

Toxin that causes calcium oxalate crystals?

Answer 10

Ethylene glycol

Question 11

Do beta blockers affect GFR

Answer 11

Nope, not clinically.

Question 12

Side effects of spironolactone

Answer 12

Hyperkalemia, but more importantly, gynecomastia.

Question 13

Tubular buffer systems in response to acidemia

Answer 13

H+ secreted can be buffered by PO4 and NH3 (from glutamine). NH3 is more important, but in acidemia, PO4 will decrease too.

Question 14

Physiology of continence

Answer 14

Bladder emptying is controlled by detrusor muscle contraction. Continence is maintained by the urethral sphincter muscles. The internal sphincter is under autonomic control (parasympathetic =relaxation), and external is under voluntary control (a pelvic floor muscle). EUS trauma during childbirth or damage to pudendal nerve can lead to stress incontinence. Also loss of estrogen leads to decreased tone in the EUS.

Question 15

DM effect on arterioles

Answer 15

Hyaline arteriolosclerosis.

Question 16

How to treat bladder urge instability?

Answer 16

Use antimuscarinics which relax detrusor muscle.

Question 17

Common cause of UTI in catheterized patients?

Answer 17

Klebsiella

Question 18

Diabetic autonomic neuropathy and bladder function

Answer 18

Can prevent complete emptying of bladder leading to loss of urine (overflow incontinence).

Question 19

Screen for diabetic nephropathy by monitoring…

Answer 19

Albumin

Question 20

Citrate role in kidney stones

Answer 20

Prevents their formation.

Question 21

Amphotericin renal toxicity causes

Answer 21

severe hypokalemia and hypomagnesemia

Question 22

Blood supply of proximal 1/3 of ureter?

Answer 22

Renal artery

Question 23

Renal osteodystrophy

Answer 23

Lack of active vitamin D causes hypocalcemia and hyperphosphatemia

Question 24

Conn’s Syndrome

Answer 24

Aldosterone secreting tumor. Causes hypertension, hypokalemia (low energy and muscle fatigue).

Treat with eplerenone or spironolactone

Question 25

Side effect of osmotic diuresis with mannitol?

Answer 25

Life-threatening pulmonary edema. Hypernatremia

Question 26

Kidney drugs of choice in diabetes patients?

Answer 26

ARB or ACEi

Question 27

Does spironolactone improve mortality in CHF patients?

Answer 27

Yes

Question 28

Most important prognostic factor in PSGN?

Answer 28

Age. Adults are fucked!

Question 29

Vasopressin increases the permeability of collecting duct to what substance?

Answer 29

H2O and Urea

Question 30

Regardless of hydration state, which part of the nephron absorbs the most water?

Answer 30

Proximal tubules

Question 31

Sickle cell kidney injury?

Answer 31

Papillary necrosis

Question 32

WBC Casts indicates

Answer 32

Pyelonephritis