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First Aid Step 2 > Renal/GU/Nephro > Flashcards

Renal/GU/Nephro Flashcards

1
Q

Renal tubular acidosis (RTA) associated with abnormal H+ secretion and nephrolithiasis

A

Type I/distal RTA

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2
Q

RTA associated with abnormal HCO3- and rickets

A

Type II/proximal RTA

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3
Q

RTA associated with aldosterone defect

A

Type IV/distal RTA

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4
Q

Doughy skin

A

Hypernatremia

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5
Q

Differential of hypervolemic hyponatremia

A

Cirrhosis
CHF
Nephritic syndrome

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6
Q

Chvostek’s and Trousseau’s signs

A

Hypocalcemia

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7
Q

Most common causes of hypercalcemia

A

Malignancy

Hyperparathyroid

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8
Q

T wave flattening and U waves

A

Hypokalemia

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9
Q

T wave peaked and wide QRS

A

Hyperkalemia

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10
Q

First line Tx moderate hypercalcemia

A

IVF and loops (furosemide)

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11
Q

Type ARF with FeNa<1%

A

Prerenal

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12
Q

49 yo man presents with acute onset flank pain and hematuria

A

Nephrolithiasis

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13
Q

Most common type nephrolithiasis

A

Calcium oxalate

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14
Q

20 o man presents with palpable flank mass and hematuria. US shows bilat enlarged kidneys with cysts. ASsociated brain anaomly

A

PCKD- berry aneurysm

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15
Q

Hemturia, HTN, oliguria

A

Nephritic syndrome

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16
Q

Proteinuria, hypoalbuminemia, hyperlipidemia, hyperlipiduria, edema (periorbital swelling in am)

A

Nephrotic syndrom

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17
Q

Most common form nephritic syndrome

A

Membranous glomerulonephritis

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18
Q

Most common form glomerulonephritis

A

IgA nephropathy/Bergers

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19
Q

Glomerulonephritis with deafness

A

Alport’s syndrome

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20
Q

Glomerulonephritis with hemoptysis

A

Wegener’s granulomatosis and Goodpasture syndrome

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21
Q

Presence of red cell casts in urine sediment

A

Glomerulonephritis/nephritic syndrome

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22
Q

Waxy casts in urine sediment and Maltese crosses (seen with lipiduria)

A

Nephrotic syndrome

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23
Q

Drowsiness, asterixis, nausea, pericardial friction rub

A

Uremic syndrome in pts with renal failure

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24
Q

55 yo man Dx with prostate CA. Tx option?

A

Wait, surgical resection, rad/androgen suppression

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25
Q

Low urine specific gravity with high serum osmolality

A

DI

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26
Q

Tx SIADH

A

Fluid restriction

Democlocycline

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27
Q

Hematuria, flank pain, palpable flank mass

A

Renal cell carcinoma

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28
Q

Testicular cancer associated with beta hCG and AFP

A

Choriocarcinoma

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29
Q

Most common type testicular cancer

A

Seminoma, type of germ cell tumor

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30
Q

Most common histology of bladder cancer

A

Transitional cell carcinoma

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31
Q

Complication of overly rapid correction of hyponatremia

A

Central pontine myelinosis

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32
Q

Salicylate ingestion occurs in what type of acid base disorder

A

Anion gap acidosis and primary respiratory alklosis due to central respiratory stimulation

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33
Q

Acid bas disturbance in pregnant women

A

Respiratory alkalosis

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34
Q

Elevated EPO, elevated HCT, normal O2 sats

A

Renal cell carcinoma or other EPO producing tumor

Evaluate with CT

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35
Q

55 yo man presents with irritative and obstructive urinary Sx. Tx?

A

Likley BPH

Options: nothing, terazosin, finasteride, TURP

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36
Q

6 D - hypernatremia causes

A 
Diuresis
Dehydration
DI
Docs (iatrogenic)
Diarrhea
Disease (kidney, sickle cell, etc)
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37
Q

Tx HyperK

A

C BIG K
Calcium gluconate
Bicarbonate or Insulin and glc
Kayexalate

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38
Q

Pts with metabolic acidosis, hypokalemia, normal BP - have what conditions

A

Surreptitious vomiting
Diuretic abuse
Bartter’s syndrome
Gitelman’s syndrome

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39
Q

Causes of hyperglycemia

A

CHIMPANZEES

Most common: hyperparathyroidism, CA

Calcium supplementation
Hyperparathyroidism/hyperthyroidism
Iaotrogenic-thiazides, parental nutrition
Immobility- esp ICU
Milk alkali syndrome
Paget's disease
Adrenal insufficiency 
Acromegaly
Neoplasm
Zollinger Ellision syndrome - MEN I
Exces Vit A
Excess Vit D
Sarcoidosis and other granulomatous disease
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40
Q

Calcium: loops vs thiazides

A

Loops lose calcium

Thiazide reabsorb calcium

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41
Q

Pt develops cramps and tetany following thyroidectomy

A

Hypocalcemia

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42
Q

Important to check in hypoalbuminemia, why

A

Ionized calcium

Serum Ca can be falsely low in hypoalbuminemia

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43
Q

Most common pt with hypomagnesium

A

Alcoholics

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44
Q

pH imbalance with ASA

A

Metabolic acidosis and respiratory alkalosis

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45
Q

Tx for anion gap causes of renal tubular acidosis

A 
MUDPILES
Methanol: fomepizole
Uremia: dialysis
DKA: insulin, fluids
Paraldehyde, Phenformin
Iron, INH: GI lavage, charcoal (INH)
Lactic acidosis
Ethylene glycol: fomepizole
Salicylates: alkalinize urine
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46
Q

Calculate anion gap

A

Na - (Cl+HCO3)

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47
Q

RTA:
Type I
Type II
Type IV

A

I: distal
II: proximal
IV: distal

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48
Q

prerenal, intrinsic, vs postrenal cause

A

Prerenal: dec renal perfusion
Intrinsic: injury of nephron unit
Postrenal: outflow obstruction

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49
Q

Indications for urgent dialysis

A

AEIOU

Acidosis (<7.25
Electrolyte abnormalities (hyperkalemia)
Ingestion (salicylate, theophylline, methanol, barbs, lithium, ethylene glycol)
Overload (fluid)
Uremic Sx (pericarditis, encephalopathy, bleeding, nausea, pruritis, myoclonus)

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50
Q

Hyaline casts
Etiology
Prerenal, intrinsic, postrenal

A

Normal, inc suggest V depletion

Prerenal

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51
Q

Red cells casts, dimorphic red cells
Etiology
Prerenal, intrinsic, postrenal

A

Glomerulonephritis

Intrinsic

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52
Q

White cells, eosinophils
Etiology
Prerenal, intrinsic, postrenal

A

Allergic interstitial nephritis, atheroembolic

Intrinsic

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53
Q

Granular cell casts, renal tubular cells, muddy brown cast

A

ATN

Intrinsic

54
Q

White cells, white cells casts

A

Pyelonephritis

Postrenal

55
Q

Prevention of contrast induced nephropathy

A

IVF before and during scan

Also use N-acetylcystine and NaHCO3 - controversial

56
Q 
Anorexia
N/V
Uremic pericarditis
Uremic frost
Delirium
Seizures
Coma
A

Uremia

57
Q

Definition of azotemia

A

Increased BUN and creatinine

58
Q

Nephritic syndrome findings

A

PHAROAH

Proteinuria
Hematuria
Azotemia
RBC casts
Oliguria 
HTN
59
Q

Nephritic syndrome cause: immune complex (2)

A 
Postinfectious GMN
IgA nephropathy (Berger)
60
Q

Nephritic syndrome cause: pauci-immune

A

Wegener’s granulomatosis

61
Q

Nephritic syndrome cause: anti-GBM

A

Goodpasture

Alport’s

62
Q

GABHS or other infection, Low C3, +ASO, lumpy bumpy immunofluorescence of IgG and C3

Oliguria, edema, HTN, tea or cola colored urin

Good recovery with diuretics

Dx confirmed with RBC casts

A

Postinfectious GMN

63
Q

Typically follows upper resp or GI infections, young men, deposition of IgA in mesengial cells

Episodic gross hematuria or persistent
microscopic

Dx: increased IgA, mesangial prolix on EM, histo - looks like HSP

Glucocorticoids, ACEI if proteinuria
20% to ESRD, steroids if turns to nephrotic, cyclosporine, azothioprine, mycophenolate mofetil

A

IgA nephropathy/Berger

64
Q

Granulomatous inflammation of respiratory tract and kidney with necrotizing vasculitis

Hematuria, hearing disturbances, resp and sinus, cavitary pulm lesions bleed and lead to hemoptysis

C ANCA (cell mediated IR), biopsy shows: segmental necortizing GMN with few IG deposits immunofluorescence

Tx: cyclophosphamide and steroids/methotrexate

A

Wegeners granulomatosis

65
Q

Rapidly progressing GMN with pulm hemorrhage, mid 20s

Hemoptysis, dyspnea, possible resp failure (anti-BM/ anti-alveolar ab also hit lungs)

Linear anti-GBM (IgG) on immunofluorescence, Fe def anemia, hemosiderin macrophages in sputum, pulm infiltrates on CXR, IgG antiglomerular BM Ab

Tx: plasma exchange, pulsed steroids, progress to ESRD, cyclophosphamide
Methotrexate or azothioprine for maintenance

A

Goodpasture syndrome

66
Q

Hereditary GMN defect of collage IV BM, boys 5-20, ASx hematuria with SENSORINEURAL DEAFNESS/ HIGH FREQUENCY HEARING LOSS and eye disorders

GBM splitting on EM, red cell casts,

Progresses to renal failure, may recur after transplant; corticosteroids, plasmapheresis, immunosuppression

A

Alport

67
Q

Lumpy bumpy immunofluorescence

A

Postinfectious GMN

68
Q

Segmental necrotizing GMN with few Ig deposits on immunofluorescence

A

Wegeners

69
Q

Linear anti GBM deposits on immunofluorescnece

A

Goodpastures

70
Q

GBM splitting on EM

A

Alports

71
Q

Most common cause nephrotic syndrome in children

Cause: NSAIDS and heme malignancy (Hodgkins)

Tendency: infections and thrombotic events
Lab: HLD, hypoalbumin
Light micro: normal
EM: fusion/flattening/effacement epi foot processes with lipid laden renal cortices

Tx: steroids

A

Minimal change disease

72
Q

Cause: IVDU, HIV, obesity

Typical pt: young Afr Am male w/ uncontrolled HTN

Labs: microscopic hematuria, biopsy shows sclerosis in capillary tufts

Tx: prednisone, cytotoxic Tx, ACEI/ARBs for proteinuria

A

Focal segmental glomerulosclerosis

73
Q

Most common nephropathy in Caucasian adults. 2nd causes - solid tumor malignancies and immune complex

Associated HBV, syphilis, malaria, gold

Labs: spike and dome appearance due to IgG and C3 deposits at BM

Tx: prednisone and cytotoxic

A

Membranous nephropathy

74
Q

Has 2 forms: diffuse hyalinization and nodular glomerulosclerosis (Kimmelstiel Wilson lesions)

Pts poor controlled DM with retinopathy or neuropathy

Labs: thick GBM, inc mesangial matrix

Tx: tight control of blood sugar, ACEI for DMI, ARB for DM II

A

Diabetic nephropathy

75
Q

Classified as WHO types I-IV, both nephrotic and nephritic; malar rash and arthritis

Proteinuria or RBC on UA

Labs: mesangial proliferation, subendothelial and/or subepithelial immune complex deposition, + ANA and Anti=DNA Ab

Tx: prednisone and cytotoxic therapy may slow disease progression, ACEI and statin for proteinuria

A

Lupus nephritis

76
Q

Primary cause plasma cell dyscrasia, secondary infectious or inflammation

Pts may have multiple myeloma or chronic inflammatory disease (RA, TB)

Labs: nodular glomerulosclerosis
EM: emyloid fibrils
Apple green birefringence with Congo red stain

Tx: prednisone and melphalan; BM transplant MM

A

Renal amyloidosis

77
Q

Nephrotic/nephritic; Type I assoc HCV, cryoglobulinemia, SLE, subacute bacterial endocarditis

Slow progression renal failure

Labs: tram track double layered BM

  • Type I: subendothelial deposits and mesangial deposits
  • All 3 have low serum C3
  • Type II: C3 nephritic factor

Tx: corticosteroids and cytotoxic Rx

A

Membranoproliferative nephropathy

78
Q

Most common stones
Cause idiopathic hypercalciuria and primary hyperparathyroidism, small bowel disease
RADIOPAQUE, alkaline urine

A

Calcium oxalate/phosphate

Phosphate more with hyperparathyroidism

79
Q

Urease forming organisms like Proteus or Klebsiella
Staghorn calculi
Alkaline urine
RADIOPAQUE

A

Struvite/triple phosphate

80
Q

Associated gout, XO def, high purine turnover (chemo), acidic urine
RADIOLUCENT - need CT

A

Uric acid

Alkalinize urine with citrate
Restrict purines

81
Q

Due to defect in renal transport of certain AA (COLA- Cystine, ornithine, lysine, arginine)
HEXAGONAL CRYSTALS
+URINARY CYANIDE NITROPRUSSIDE TEST
RADIOPAQUE

A

Cystine

Alkalinize urine, penicillamine

82
Q

Organs affected by PCKD

A

Kidney
Spleen
LIver
Pancreas

83
Q

AD vs AR PCKD

A

AD: common, no Sx until later in life, increased risk berry aneurysm
AR: more severe, Sx as child

84
Q

Most common congenital urethral obstruction

A

Posterior urethral valves

Male with distended palpable bladder and low urine output

85
Q

Grades of vesicoureteral reflux

A

Mild I and II - no dilation

Mod - severe: III-IV - ureteral dilation with caliceal blunting if severe

86
Q

Scrotal swelling that transilluminates

2/2 remnant of processus vaginalis

A

Hydrocele

87
Q

Dilation of pampiniform venous plexus - bag of worms, does not transilluminate

A

Varicocele

88
Q

Infection of epididymis from STD, prostatitis, reflux
Enlarged or tender testicles, fever, erythema, pyuria; pain relieved by supporting scrotum
UA shows pyuria; often 2/2 GC, E coli, Chlamydia
Doppler: increased bf to testes
Tx: abx - Ceftriaxone or fluoroquinolon ?tetracyclines and fluoroquinolones

A

Epididymitis

89
Q 
Twisting of spermatic cord
Intense, acute onset scrotal pain
N/V/ dizzines
LOSS OF CREMASTERIC REFLEX
Dopper: decreased bf to testes

Must fix immediately- manually or surgery
Orchipexy- attach testes to wall

A

Testicular torsion

90
Q

BPH most common zone

A

Central-periurethral

91
Q

Leading causes Ca death in men

A 
Lung
Prostate
Colorectal
Pancreatic
Leukemia
92
Q

Prostate Ca- type of cancer

A

AdenoCa

93
Q

Prostate cancer - most common zone

A

Peripheral zone

94
Q

Differential for hematuria

A

I PEE RBCS

Infection/UTI
PCKD
Exercise
External trauma
Renal glomerular disease
Benign prostatic hyperplasia
Cancer
Stones
95
Q

Classic triad renal cell carcinoma

A

Hematuria
Flank pain
Palpable flank mass

All 5-10% present with all 3 components of triad

96
Q

Industrial risk factor bladder cancer

A

Aniline dye

97
Q

beta hCG tumor marker

A

All choriocarcinomq

10% seminomas

98
Q

AFP tumor marker

A

Nonseminoma Ca like endodermal sinus/yolk sac

Hepatocellular
Hepatoblastoma
Neuroblastoma

99
Q

Tx seminoma

A

very radiosensitive

100
Q

Bence Jones proteins/ light chains causes renal failure, can induce hypercalcemia and amyloidosis

A

Multiple myeloma

101
Q

UTI causes

A 
E coli - most common
Staph saprophyticus
Proteus
Pseudomonas
Klebsiella
Enterobacter
Enterococcus
102
Q

Diuretic that would not increase risk of forming calcium stones in kideny

A

Thiazides- reabsorb calcium back into serum

103
Q

Right testicular or ovarin v drains?

Left drain?

A

Right: IVC
Left: left renal v

104
Q

Mumps with painful swollen testis, unilat

A

Mumps

105
Q

Priapism
2 types, define- which emergent
Tx

A

Ischemic- failure of detumescene: emergent
nonischemic- fistula between cavernosal a and corpus cavernosum

Tx pain meds and intracavernosal injection sympathomimetic (phenylephrine)

106
Q

Hypospadia vs epispadia

A

Hypo: ventral/underside
Epi: dorsal/top

107
Q

Urge incontinence

Tx

A

Involuntary leakage with sense of urgency due to inhibited bladder contraction = detrusor overactivity

Tx: bladder training, antimuscarinics (oxybutynin, tolterodine, solefenacin)

108
Q

Stress incontinence

Tx

A

Involuntary leakage with exertion, sneezing, coughing, laughing

Tx: weight loss, kegel, pessaries, sling

109
Q

Mixed incontinence

Tx

A

Involuntary leakage with urgency, exertion, coughing, sneezing, laughing

Tx: bladder training, antimuscarinics

110
Q

Overflow incontinence

Tx

A

Continuous leakage of urine with incomplete bladder emptying usu 2/2 BPH, stricture, cancer

Tx: indwelling catheter, timed voiding, Tx disorder

111
Q

Enzyme that is the catalyst for HCO3 reabsorption in PCT

A

Carbonic anhydrase

112
Q

Common causes pyelonephritis

A 
E coli
Staph saprophyticus
Klebsiella
Proteus
Candida in immunocompromised
113
Q

Tx pyelo

Complications

A

IV fluoroquinolones, aminoglycoside, cephalosporin - 3rd gen for 1-2 d then outpt abx

Complications: pregnant can cause low birth women and preterm labor

114
Q

Diuretic good for pulmonary edema because has pulmonary vasodilatory effect

A

Loops

115
Q

Most common site of renal stone impaction

A

Ureto vesical jcn

116
Q

Impacted stone vs peritonitis activity of pt

A

Stone: move like crazy

Peritonitis- not moving

117
Q

Malignancies that increase EPO

A

Renal cell carcinoma
Pheo
Hemangioblastoma

118
Q

Kimmelstiel Wilson nodules

A

Diabetic nephropathy

119
Q

Formula FeNa

A

((urine Na)/(serum Na))/ ((urine Cr)/(serum Cr))

120
Q

Corrected HCO3

A

Measured gap - normal gap (12) - measured HCO3

121
Q

If Corrected HCO3 high

A

metabolic alkalosis with high anion gap acidosis

122
Q

If corrected HCO3 low

A

Nonanion gap acidosis with high anion gap acidosis

123
Q

Central vs nephrogenic DI and testing, Tx central

A

Central: pituitary not making ADH
Nephro: kidneys not respond ADH

Test: give ADH = central will increase urine osmolality; nephro have no change

Tx central DDVAP

124
Q

Major cause SIADH, major problem

A

Paraneoplastic

Hyponatremia

125
Q

Expected PCO2 formula

A

1.5 (HCO3) + (8 +/- 2)

126
Q

Expected pH increase formula

A

if acute reps acid or alk: 1/10 x 0.08 x (PCO2 - 40)

If chronic resp acid or alk: 1/10 x 0.03 x (PCO2-40)

127
Q

Pseudhyperkalemia

A

RBC hemolysis following blood collection

128
Q

How to adjust total serum Ca if hypoalbuminemia

A

Ca decreases 0.8 mg/dL for each 1 g/dL albumin <4

129
Q

FH hypercalcemia, low urine Ca, absence ostoepenia, nephrolithiasis, and metnal status changes

A

Familial hypocalciuric hypercalcemia

130
Q

Tx UTI

A

Amoxicillina
TMP SMZ
Fluoroquinolones
3d

First Aid Step 2 (22 decks)

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