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USMLE STEP 2CK > Renal, GU, Electrolytes > Flashcards

Renal, GU, Electrolytes Flashcards

1
Q

Hyperactive DTRs - result of what electrolyte abnormality?

A

HypOCa

  • during or immediately after surgery in those undergoing major surgery and needing transfusions (ionized Ca decreases due to citrate binding)
  • also causes prolonged QT, spasm/tetany
  • hypOmag can mimic this - causes dec. PTH and responsiveness to PTH

Note:
HyperMag - causes decreased DTR, muscle paralysis, apnea, cardiac arrest

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2
Q

Loop Diuretics - electrolyte abnormalities?

A

Blocks NaK2Cl channel

  • HYPONA
  • HYPOK

Increased distal solute delivery -> more aldo -> more H secretion
- MET ALKALOSIS

reduction in circulating blood volume
- prerenal failure

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3
Q

Laxative Abuse/Diarrhea

VS.

Vomiting - electrolyte abnormalities?

A

Diarrhea:
HYPOK - lose in stool; bc dec. volume more aldo
Non-anion gap Metabolic ACIDOSIS

Vomiting - lose HCl
HYPOK, HYPOCl
Metabolic ALKALOSIS
1. Loss of H+ -> unbalanced retention of HCO3
2. Loss of Vol -> Aldo -> lose K and contraction alkalosis

Tx: Normal Saline + K

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4
Q

Renal Tubular Acidosis

A

Non-anion gap met acidosis.

Proximal (type II) - can’t reabsorb bicarb

  • urine pH varies
  • hypoK
  • Dx: administer bicarb - urine pH rises
  • Tx: thiazide (vol depletion increases bicarb reabsorption)

Distal (type I) - can’t secrete H

  • urine pH high
  • hypoK
  • assoc. with Ca oxalate crystals (alkalotic urine)
  • Dx: administer acid - urine pH remains high
  • Tx: Bicarb - will be absorbed at proximal tubule

Hyporenin, Hypoaldo (type IV) - no aldo

  • urine pH ACIDIC*
  • hyperK
  • Dx: U Na is high - can’t reabsorb
  • Tx: fludrocortisone (like aldo)
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5
Q

Adrenal Insufficiency - Sx and electrolytes

A

Anorexia, Fatigue, weight loss
Hypotension
GI complaints

No aldo - HyPONa, HyPERK, met ACIDOSIS

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6
Q

Causes of Nephrotic Syndrome and Associations

A

FSGS- HIV, heroin, obesity, African American
MCD - NSAIDS, Lymphoma
Membranous - solid cancers, NSAIDS, hep B, SLE
MPGN - Hep B/C, lipodystrophy
IgA - URI

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7
Q

Which pulmonary-renal syndrome should be treated with emergency plasmaphresis?

A

Goodpasture’s: anti-GBM antibodies

- lung, kidney, hemoptysis (anemia)

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8
Q

Trimethoprim - electrolyte changes?

A

HyperKalemia

Artificial increase in creatinine - GFR unchanged.

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9
Q

How to prevent acyclovir crystalline nephropathy?

A

Aggressive intravenous hydration

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10
Q

Nephrotic Syndrome + Rheumatoid Arthritis + Enlarged kidneys + Hepatomegaly = Dx?

A

Amyloidosis:
Bx: stain congo red, apple green birefringence

AL amyloidosis - light chains
- MM, Waldenstrom’s

AA amyloidosis - beta2, apolipo

  • chronic inflam: RA, IBD
  • chronic infec: osteo, TB
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11
Q

Aspirin Toxicity

A

Resp alkalosis (stimulates medullary response center to cause tachypnea/hyperventilation)

+

Met acidosis (dec. renal elimination of organic acids - lactic, keto)

Tx: Na HCO3 in the urine - speeds excretion

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12
Q

Lithium causes what?

A

Nephrogenic diabetes insipidus

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13
Q

Renal Cell carcinoma

A

Flank pain + hematuria + palpable abd mass
+ scrotal varioceles (L-sided)
+ epo secretion -> polycythemia
+ constitutional sx

Dx: CT scan

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14
Q

Nephrotic Range Proteinuria + Hematuria = Most likely what? And how does it look on microscope?

A

Membranoproliferative Glomerulonephritis

  • EM: Dense intramembranous deposits
  • Immunofluoresence: C3
  • IgG antibodies against C3 convertase -> persistent activation of complement
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15
Q

Renal disease caused by HTN vs. Diabetes

A

HTN:
Nephrosclerosis: arteriosclerotic lesions of afferent and efferent renal arterioles -> -> Glomerulosclerosis: glomerular capillary tufts fibrosis

Diabetes: leading cause of nephropathy
1st yr - glomerular hyperperfusion - inc. GFR
(note: ACEi help by reducing intraglomerular HTN and decreasing glomerular damage)
First 5 yrs - glomerular BM thickening, extracellular matrix inc, mesangial expansion, fibrosis - GFR normalizes
5-10yrs - microalbumineria, nephropathy overt

Pathognomonic: Nodular Glomerulosclerosis (Kimmelstiel-Wilson nodules)

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16
Q

Correct HyperK

A

CBIGK
Calcium gluconate - stabilize cardiac

Shift intracellularly
Beta2 agonist, Bicarb
Insulin + glucose (FASTEST)

Remove
Kayxelate
Loop diuretics

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17
Q

Familial Hypocalciuric HyperCa VS. Primary HyperPTH

A

BOTH have HyperCa
primary hyperPTH - secondary to high PTH
FHH - secondary to “normal” PTH (Ca sensors are defective)

BUT
FHH - hypOcalciuric - low Ca in urine.
urinary ca/cr ratio 0.02

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18
Q

Needle shaped crystal indicate?

A

Uric acid stones - radiolucent - evaluate with CT

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19
Q

Gross painless hematuria in a smoker?

A

Bladder cancer!
Sx: gross painless hematuria, UA to rule UTI and renal disease
RF: smoking, occupation, cyclophosphamide, chemicals, dyes
Dx: CT urogram or cystoscopy

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20
Q

Pt on multiple analgesics (naproxen and aspirin) likely to develop?

A

Analgesic Nephropathy: drug induced chronic renal failure

  1. papillary necrosis
  2. chronic tubulointerstitial nephritis

UA: polyuria, sterile pyuria, microscopic hematuria, proteinuria.

21
Q

Metformin should not be given to who and why?

A

Acute renal failure, Liver failure, Sepsis

Causes lactic acidosis.

22
Q

Types of Stones and Associations

A

Ca Oxalate

  • RTA type I (distal)
  • crohn’s, fat malabsorption (increases oxalate absorption)
  • prevent with hydrochlorothiazide - increases distal tubular absorption.
  • decrease in dietary Ca actually increases risk bc increased oxalate absorption

Uric acid - radiolucent
- Tx: alkalinization of urine (potassium citrate), low purine diet, allopurinol

Cystine stones
- Tx: alkalinize the urine, surgery

Struvite stones (mg,ammonium.phos) - assoc. with UTI
- Tx: surgery
23
Q

Palpable purpura + Arthralgia + Abnl LFTs
UA: Proteinuria, Hematuria, dysmorphic RBC
Hypocomplement

A

Cryoglobulinemia - associated with Hep C

  • IgM against viral hep c IgG
  • also low complement levels
24
Q

TB is associated with what electrolyte and acid base disturbances?

A

TB causes Addison’s disease

- no aldo -> hypoNa, HyperK, non-anion gap met acidosis.

25
In mixed GNephritis, what is the edema due to?
Mixed - IgA, Lupus, MPGN, RPGN Primary glomerular damage - dec GFR - significant volume overload (PULM edema, distended neck veins, anasarca) But eventually significant proteinuria leads to hypoalbuminemia, which further contributes. If it was just due to hypoalbuminemia, no pulmonary edema.
26
Acute oliguria + abd discomfort after surgery = ?
Postoperative urinary retention. - immediate assessment with bladder scanner - bladder catherization
27
How to manage severe hyperCa (>14) or symptomatic hyperCa?
Immediate: 1. NS 2. Calcitonin 3. Avoid Loop diuretics unless volume overload (it increases Ca excretion but use is discouraged since pt is volume depleted usually) Long term 1. Bisphosphonate (zoledronic acid)
28
Interstitial Cystitis Presentation
Painful Bladder Syndrome: - bladder pain that is worse with filling and relieved with voiding - dyspareunia, urinary freq, urgency - Tx: behavioral, trigger avoidance, analgesics VS: PID - has pelvic pain, CMT, fever. no urinary sx
29
PCKD (also vs. RCC)
PCKD: Renal - causes renal failure - most common genetic cause - intermittent flank pain (stones, infection, cyst rupture) - hematuria, HTN, proteinuria (less nephrotic..) - palpable kidneys Extrarenal: - cerebral aneurysm - hepatic/pancreatic cyst - cardiac valve (MVP, AR) - diverticulosis - ventral/inguinal hernia Dx: U/S Tx: - HTN: ACEi - ESRD: dialysis, renal transplant RCC - has weight loss, constitutional - doesn't cause renal failure alone - not intermittent flank pain
30
How to prevent contrast associated ATN?
IV hydration Non-ionic contrast agents Acetylcysteine
31
PSGN
- 10-20 days after strep infec. - periorbital swelling/proteinuria, hematuria w. RBC casts, HTN, oliguria. - serum C3 may be low.
32
Cystinuria
Cystinuria - due to impaired AA transport - recurrent renal stone formation (hard, radioopaque, hexagonal) - FHx - (+) urinary cyanide nitroprusside test
33
Dietary Recommendations And Drug Therapies for pts with Renal Stones:
1. Decreased dietary protein and oxalate 2. Decreased Na intake (Na enhances Ca excretion) 3. Increased Fluid 4. Increased Ca 5. Increased citrate Drug 1. HCTZ removes Ca from urine by increasing distal tubular reabsorption of Ca 2. urine alkalinization (K citrate/Bicarb salt) 3. Allopurinol (for hyperuricosuria stones) Best Dx test: CT abd without contrast (NOT KUB)
34
Refractory HypoK - what is likely abnl?
HypoMag
35
Cause of death in ESRD?
Cardiac disease!
36
How does the timing of hematuria in the urinary stream indicate where the lesion is?
Initial - urethra Terminal - bladder Entire cycle - kidney, ureter *Renal disease does NOT have clots*
37
What abx used to treat pyelonephritis multidrug resistant can cause acute renal failure?
Amikacin - aminoglycoside
38
Nitroprusside infusion causes what?
Cyanide Toxicity! - Cherry-colored flushing - Altered mental status - MET ACIDOSIS - Arrhythmia, Resp, GI Tx: Nitrates; Na Thiosulfate
39
How to manage nonketotic hyperglycemic coma?
1. NORMAL SALINE - initial infusion for hypovolemia. 2. Insulin 3. 5% and K once levels are normal. *presents with hyperK (DUH!)
40
Signs of Dehydration and what to administer
Dry mucous membranes, AMS Marginally high values for Hct, electrolytes, BUN/Cr >20 Give: NS (IV crystalloid)
41
Cast Type and Pathology
``` Muddy brown cast - ATN (REMEMBER prerenal cause.. -.-) RBC cast - glomerulonephritis WBC cast - interstitial nephritis, pyelonephritis Fatty cast - nephrotic Broad, waxy cast - chronic renal failure ```
42
HyperKalemia - Causes
PseudohyperK - hemolysis Decreased excretion - renal fail - Low aldo: ARB, ACEi, RTA IV, Spironolactone (aldo antagonist), Amiloride (K sparing diuretic), NSAIDS (impaired prostaglandin dec. RAA axis), Addison's Increased from tissues - tumor lysis - acidosis - low insulin - beta blockers - digoxin (blocks Na/K pump) - heparin.
43
Acyclovir causes what kind of AKI?
``` Crystal induced AKI - it precipitates in renal tubules -> direct tubular toxicity - usually asymptomatic - increase in Cr 1-7d after starting Tx: discontinue drug, volume repletion ```
44
Cushing's associated with what electrolyte abnormalities?
HypoK HyperNa Increased aldo.
45
Dialysis Indications
AEIOU: Acidosis - metabolic Electrolyte - HyperK Ingestion - salicylates, alcohols, lithium, valproate/carbamazepine Overload fluid Uremia - encephalopathy, bleeding, pericarditis
46
What is the cause of hypoNa in pt with GI bleed?
Hypovolemic HypoNa | - GI bleed - volume loss - ADH increases - overshoots because pt is still volume depleted..
47
Compensation Formulas
Met Acidosis: CO2 = 1.5 x HCO3 + 8 Met Alkalosis: Inc CO2 = 0.7 x change in HCO3 Resp Acidosis: 1 for every 10 inc PaCO2 Resp Alkalosis: 2 for every 10 dec PaCO2
48
What causes bleeding in pts with CRF?
Platelet dysfunction due to uremic environment. | Tx of choice = DDAVP.
49
Workup for someone with likely BPH
1. Urinalysis - assess for UTI, hematuria (bladder cancer, nephrolithiasis) 2. PSA if life expectancy > 10 yrs (prostate cancer)

USMLE STEP 2CK (3 decks)

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