Renal

Question 1

Side effects of immunosuppressants. (Cyclosporine, Tacrolimus, mycophenolate)

Answer 1

Cyclosporine: Nephrotoxicity, hyperkalemia, tremors, hypertension, GUM HYPERTROPHy, HIRSUTISM.
Tacrolimus: Same as cyclosporine except does not cause gum hypertrophy and hirsutism.
Aziathioprine:diarrhea, leukopenia and hepatotoxicity
Mycophenolate: Marrow suppression

Question 2

Renal vein thrombosis is most seen in which nephrotic syndrome

Answer 2

Can be seen in all but most associated with membranous nephropathy

Question 3

Dietary recommendations for people with recurrent renal colick

Answer 3

Reduce dietary protien and oxalate
Increase calcium intake
Decreases Na intake
Increase fluid intake

Question 4

HIV associated nephropathy

Answer 4

Focal and segmental glomeruloscerosis

Question 5

What is the most common type of kidney stone

Answer 5

Calcium oxalate

Question 6

Gold standard for diagnosing kidney stones

Answer 6

Non contrast CT

Question 7

Which type of kidney stone is radio lucent

Answer 7

Uric acid stone

Question 8

What medication is used to treat the syndrome of inappropriate antidiuretic hormone secretion if water restriction fails

Answer 8

Demeclocycline which induces nephrogenic diabetes insipidus

Question 9

What are some causes a false hyponatremia

Answer 9

Things that cause hyper osmolarity

Hyperglycemia, hypoproteinemia, hyper lipidemia.

Question 10

Causes of hyponatremia in postoperative with patients

Answer 10

Combination of pain and narcotics with overaggressive administration of IV fluids
Adrenaline sufficiency may also Cause this (expect high potassium)

Question 11

Cause of hyponatremia in pregnant patients about to deliver

Answer 11

Oxytocin, has antidiuretic hormone like effect

Question 12

What type of IV fluid should not be used for hypernatremia

Answer 12

D5W should not be used for hypernatremia

Question 13

Relationship between Digoxin and potassium

Answer 13

The heart is particularly sensitive to hypokalemia in patients take digoxin. Monitor potassium levels in patients taking digoxinr

Question 14

What other electrolyte abnormality impairs potassium absorption or correction

Answer 14

Low magnesium. Low magnesium impairs the bodies ability to retain potassium. Correction of low magnesium levels allows potassium levels return to normal

Question 15

Patient presents with Tetany, Chvostek sign (pain with tapping on jaw), trousseau sign (muscle spasm with inflation of tourniquet or blood pressure cuff).
What EKG abnormalities is seen

Answer 15

Hypocalcemia
QT prolongation(The opposite is seen in Hypercalcemia)

Question 16

What other Electrolyte abnormality might interfere with calcium correction

Answer 16

Low magnesium. Must correct magnesium to correct calcium

Question 17

How does pH affect calcium

Answer 17

Alkalosis causes calcium to shift intracellularly and thus mimick hypocalcemia

Question 18

Patient develops a clot 5-10 days after starting heparin.

Answer 18

Think heparin induced thrombocytopenia type II. Unlike HIT 1, HIT 2 increased risk for thrombosis
HIT 1 is not immune mediated.
HIT2 is anti-body mediated, cause anti-bodies to heparin-platelet factor 4. It causes platelet activation, thrombocytopenia and prothrombotic state

Question 19

Urine sodium and osmolarity in SIADH

Answer 19

High osmolarity and high urine sodium due to increased water absorption

Question 20

Patient presents with elevated serum calcium as well as urine calcium to creatinine ratio less than 0.01

Answer 20

Think familial Hypocalciuric hypercalcemia

urine calcium to creatinine ratio in primary hyper parathyroidism is greater than 0.02

Question 21

Main mechanism of renal damage is multiple myeloma

Answer 21

Toxic effect of light chains cast on the renal tubules.

Less significant are the damages to glomeruli (amyliodosis and monoclonal Ig deposits)

Question 22

Cause and serologic finding of lupus nephritis

Answer 22

Caused by immune complex mediated damage

Serum C3 level is decreased

Question 23

Metastatic germ cell tumor with increased serum beta hCG

Answer 23

Choriocarcinoma