Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Step 2 CK > Renal & Electrolytes > Flashcards

Renal & Electrolytes Flashcards

1
Q

Treatment of patients with severe hypovolemic hypernatremia

A

1st correct the hypovolemia with 0.9% saline.

Then switch to 0.45% saline + 5% dextrose to correct the hypernatremia no faster than 1mEq/L/hour

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

Earliest renal abnormality in patients with diabetes? Earliest observable abnormality in these patients?

A

Earliest abnormality = glomerular hyperfiltration

Earliest observable abnormality = GBM thickening

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

Imaging modalities of choice for patients with suspected kidney stones

A

Non contrast helical CT and ultrasound (preferred if alternate dx is unlikely or pregnant)

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

Treatment of choice for uric acid stones

A

Alkalinization of the urine to a pH of 6 to 6.5 with potassium citrate.

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

Stones not observable on imaging

A

Calcium stones

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

Most common type of nephrotic syndrome where you see renal vein thrombosis?

A

Membranous glomerulopathy

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

Differentiating benign renal cysts from malignant renal cysts

A

Simple: smooth, homogenous, do not enhance with contrast, asymptomatic and unilocular.

Malignant: thick, irregular walls, loculated, heterogenous, enhance with contrast, cause pain/hematuria/HTN

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

Most common causes of anion gap metabolic acidosis

A 
Methanol
Uremia
DKA
Propylene glycol
INH
Lactic acid
Ethylene glycol
Salicylates
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Appropriate rate of correction of serum sodium for patients with hyponatremia

A

No more than 0.5mEq/dL/hr and not exceeding 12mEq in 24 hours.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How to calculate serum osmolarity

A

2Na + BUN/2.8 + Glc/18

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

Calculate serum osmolar gap

A

Measured Sosm - Calculated Sosm. This is typically done when you suspect ethanol, methanol or ethylene glycol toxicity.

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

Diagnostic criteria for SIADH

A

Sosm Sosm

Una > 20

Absence of hypovolemia

Normal renal, adrenal and thyroid function

No obvious stimulus to activate the neuroendocrine hormonal response that increases ADH secretion

Absence of other known causes of hyponatremia

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

Why is metabolic acidosis due to renal disease rarely seen in patients with an eGFR > 20?

A

The remaining nephrons compensate greatly for decreased H+ secretion by increasing NH3 production that gets secreted in the urine as NH4 to get rid of the H+.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Dietary recommendations for patients with renal calculi?

A

Increased fluid to >2L urine/day, decreased Na+ to

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

Definitive measures used to reduce serum K+

A

Cation exchange resins like sodium polystyrene sulfonate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How to confirm the diagnosis of cystinuria in a patient with stones?

A

Hexagonal crystals and urinary cyanide nitroprusside test showing elevated cystine levels.

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

Post-void residual volume that is significant for bladder outlet obstruction

A

> 50 mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Complete vs. partial DI

A

Complete: urine osmolarity is > 600

Partial: urine osmolarity is 300-600

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Common causes of nephrogenic DI

A

Hypercalcemia, hypokalemia, tubulointerstitial renal disease, Li, demeclocycline, foscarnet, cidofovir and amphotericin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Why do saline-resistant causes of metabolic alkalosis have a high urine Cl- concentration?

A

Excess mineralocorticoid stimulation results in excess serum Na+ and volume retention. The kidneys respond by secreting more Na+ and Cl-, resulting in increased Cl- concentration.

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

Treatment of UTIs and pyelonephritis in non-pregnant women?

A

Acute uncomplicated cystitis: nitrofurantoin x 5 days (avoid if GFR 20%). Fosfomycin x1. Culture urine only if treatment fails.

Complicated cystitis: fluoroquinolones 5-14 days. Amp-gent for more severe cases. Culture urine to confirm correct antibiotic choice.

Pyelo: fluoroquinolones as outpatient therapy. IV fluoroquinolones or aminoglycoside +/- ampicillin for inpatient therapy. Culture urine to confirm correct antibiotic choice.

22
Q

What constitutes a case of complicated cystitis?

A

DM, CKD, pregnancy, immunocompromised, urinary tract obstruction, hospital-acquired infection, procedure-associated infection or catheter-associated infection.

23
Q

Management of hypercalcemia?

A

Severe (sx or Ca > 14): NS at 200mL/hr with goal urine output of 100-150mL/hr + calcitonin immediately. Give bisphosphonates for long-term treatment.

Moderate (Ca 12-14): no treatment

Mild (Ca

24
Q

Tests to get in patients with BPH

A

Urinalysis and PSA if life expectancy is > 10 years

25
Q

Most common type of kidney stone

A

Ca-oxalate

26
Q

Acid-base abnormality seen with chronic vomiting

A

Hypochloremic, hypokalemic metabolic alkalosis. This is because for each H+ lost in vomit, one HCO3- is formed. Additionally, hypovolemia leads to RAAS activation, H+/K+ wasting and HCO3- retention.

27
Q

Common extrapulmonary manifestations of Tb

A

Liver disease, splenic infiltration, renal disease, Pott’s disease and adrenal insufficiency (very common in endemic regions).

28
Q

NSAID effects on kidneys

A

Prostaglandin inhibition prevents afferent arteriole dilation and can cause renal failure.

Also, it potentiates the action of ADH and can cause SIADH.

29
Q

ECG characteristics in hyperkalemia

A

Peaked T-waves, short QT, long PR and wide QRS that can progress to sine wave morphology.

30
Q

Kidney stones that will likely pass spontaneously

A
31
Q

Most common histology seen in patients with diabetic nephropathy?

A

Diffuse glomerulosclerosis

32
Q

Most common causes of nephrotic syndrome in adults with no evidence of systemic disease?

A

Membranous nephropathy and FSGS

33
Q

How do you know a patient has FHH vs. primary hyperparathyroidism?

A

They have very low urine Ca ( 0.02 due to high urinary Ca levels.

34
Q

Factors that may precipitate hepatorenal syndrome

A

Those that reduce renal perfusion or GFR

35
Q

How to diagnose hepatorenal syndrome

A

Confirm renal hypoperfusion with FeNa

36
Q

Nephrotic range proteinuria, hematuria and dense intramembranous deposits that stain positive for C3

A

Membranoproliferative GN. This is due to IgG antibodies against C3 convertase that constitutively activate C3 and the alternative complement pathway.

37
Q 
Muddy brown granular casts
RBC casts
WBC casts
Fatty casts
Broad and waxy casts
A 
Muddy brown granular casts - ATN
RBC casts - GN
WBC casts - AIN, pyelo
Fatty casts - nephrotic syndrome 
Broad and waxy casts - chronic renal failure
38
Q

Cardinal features of nephrotic syndrome

A

Proteinuria (glomerular injury), hypoproteinemia, hyperlipidemia (increased liver synthesis of albumin and lipids), edema (decreased oncotic pressure), hypercoaguability (loss of AT III and increased protein C/S) and hypovolemia

39
Q

Drugs that commonly cause interstitial nephritis?

A

Cephalosporins, PCN, sulfonamides, sulfa diuretics, NSAIDs, rifampin, phenytoin and allopurinol.

40
Q

Antibiotic that can cause hyperkalemia by blocking the eNaC and decreases creatinine secretion?

A

Trimethoprim

41
Q

Characteristics of interstitial cystitis? Treatment?

A

Bladder pain with filling that is relieved by voiding with no other attributable cause for > 6 weeks. Treat by avoiding triggers + amitriptylene and analgesics during flares.

42
Q

Why are loop diuretics associated with metabolic alkalosis?

A

They increase Na delivery to the DCT. This leads to increased Na resorption and K/H secretion -> metabolic alkalosis.

43
Q

How to prevent at-risk patients from getting contrast-induced nephropathy if they really need imaging done.

A

Adequate IV hydration with isotonic NaHCO3 or 0.9% NS + acetylcysteine.

44
Q

Extra-renal manifestations of ADPKD

A

Berry aneurysms
MVP/AR
Colonic diverticula
Abdominal wall/inguinal hernia

45
Q

Aspects of patients on dialysis that increase their risk of dying from heart disease?

A

Elevated homocysteine levels

Hyperphosphatemia w/elevated PTH levels

Anemia

ESRD

Accelerated atherogenesis from enhanced oxidant stress

Enhanced Ca intake

NO inhibition

46
Q

Patient has gross hematuria, low serum C3 and subepithelial humps consisting of C3 complement on renal biopsy

A

Post-strep GN

47
Q

AA amyloidosis vs. AL amyloidosis

A

AA = chronic inflammatory conditions, beta-2 microglobulin, apolipoprotein or transthyretin gets abnormally folded and deposited.

AL = MM, Waldenstroms. Lambda light chains get deposited.

48
Q

Nephritic syndromes with associated low C3 levels

A

Post-strep GN, lupus, MPGN, mixed cryoglobulinemia

49
Q

Immune complexes that form in mixed cryoglobulinemia

A

IgM complexes with anti-HCV IgG, HCV RNA and complement.

50
Q

Drugs that can cause crystal-induced nephropathy

A

Acyclovir, sulfonamides, MTX, ethylene glycol and protease inhibitors

51
Q

What do +LE and nitrites on UA mean?

A

+LE = pyuria. Nitrites = enterobacter is present.

Step 2 CK (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions