Renal, Liver and Pancreas

Question 1

Nephrogenic DI

Answer 1

1. ADH receptor does not respond to ADH
2. dilute urine
   3 lithium a common cause

Question 2

Most common site of ischemia in kidney

Answer 2

medullary component

proximal tubule and loop of henle

Question 3

Complications of polycystic kidney disease

Answer 3

1. liver cysts
2. berry aneurysm
3. mvp

Question 4

SIADH

Answer 4

Causes:

1. chlorpropamide
2. carbamesapine
3. cyclophasphamide

Labs:
Urine osm > serum osm

Question 5

ATN

Answer 5

Cannot reabsorb Na

1. reversible
2. muddle brown casts in urine
3. low K

Fena >1
Urine Na >30
Low urine osm

Question 6

Most common nephrotic syndrome in adults

Answer 6

Membranous

Question 7

Kidney disease in DN

Answer 7

1. nodular hyaline glomerulosclerosis
2. KW nodule
3. commonly leads to papillary necrosis
4. mesangial hyperplasia

Question 8

Alport Sx

Answer 8

1. X lined

2. pt is deaf and has nephritis with hematuria

Question 9

Pyelonephritis

Answer 9

WBC casts in urine
CVA tenderness

Veicoureteral reflesx

Question 10

Minimal change disease

Answer 10

EM: effacement of foot processes of podocytes
LM: normal

tx: steroids

Question 11

Renal artery stenosis

Answer 11

JGA hyperplasia

due to fibromuscular dysplasia

Question 12

Ace inhibitor

Answer 12

dilates efferent arteriole

decrease in GFR and FF

Question 13

Fabry’s disease

Answer 13

Def alpha galactosidase
Accumulation of ceramide trihxoside

angiokeratomas
renal failure

Question 14

Membranous nephropathy

Answer 14

Loss of heparin sulfate negative charge

loss of albumin

IF: granular
Loss of antithrombin III
EM: subepithelial hump

thickened capillary wall from immune complexes

Question 15

Renal cell carcinoma

Answer 15

1. Origin: proximal tubule
2. commonly leads to left varicocele
3. Histology: clear cytoplasm with glycogen and lipids

Common in VHL

Question 16

marker for renal blood flow

Answer 16

PAH

Question 17

Potter syndrome

Answer 17

Low amniotic fluid (oligohydraminos)
1. b/l renal agenesis
2 hypoplastic lung

Question 18

Horseshoe kidney

Answer 18

1 stuck on IMA

2. turner syndrome

Question 19

Ureter passes ____ to uterine artery

Answer 19

posterior

water under the bridge

Question 20

PTH

Answer 20

Decrease PO4 reabsorbed

Increased Ca absorbed

Enhances alpha 1 hydroxylase in hidney

Question 21

AIN

Answer 21

Caused by drugs and pregnancy

NSAIDs, Narcotics, OTC pain meds
WBC in urine

Question 22

REnal papillary necrosis

Answer 22

1. sickle cell
   2 DM
   3 AIN

Question 23

Focal segmental glomerular sclerosis

Answer 23

Common in HIV pts and drug users

Question 24

Membranoproliferative

Answer 24

hap B

Question 25

PSGN

Answer 25

1 cola colored urien 2. periorbital edema 3. Resolves spontaneously 4. Anti strep o and low C3 5. M protein is virulence factor

Question 26

IgA nephropathy

Answer 26

most common 1. deposits in mesangium 2. painless hematuria (2-3 days post URI) 3. paapable purpura then henoch schonlein purpura

Question 27

Wilm's tumor

Answer 27

1. child 2. palpable flank mask U/L 3. Mutat WT-1 gene

Question 28

Angiomyolipoma

Answer 28

``` B/l renal mass Tuberous sclerosis (with cerebella hamartoma, ash leaf spots, and facial angioma) ```

Question 29

SCC of bladder

Answer 29

from shistosoma hematobium (middle east)

Question 30

Transitional cell carcinoma

Answer 30

tobacco, rubber plants, dye

Question 31

Cyclosporin

Answer 31

inhibits calcineurin | Decreases level of iL-1

Question 32

Acetazolamide

Answer 32

inhibits carbonic anhydrase HCO3 in urine

Question 33

Thiazides

Answer 33

work at dCT Hypercalcemia

Question 34

High Bilirubin in newborn

Answer 34

Low conjugating activity of UGT enzyme High Unconjugated Can enter brain and cause kernicterus at basal ganglia tx: UVB exposure makes UCB more soluble

Question 35

Gilbert syndrome

Answer 35

1. stress leads to jaundice | 2. low UGT activity (AR)

Question 36

Crigler Najjar syndrome

Answer 36

1. high levels UCB 2 Absent UGT enzyme FATAL

Question 37

Dubin Johnson

Answer 37

1. defective protein carrier in bile canicular membrane 2. black pigment in liver due to increased UCB Urine coproporphyrine

Question 38

Alcoholic fatty liver

Answer 38

1. reversible 2. acetaldehyde mediated injury 3. ballooning degeneration 4. mallory bodies (intra cytoplasmic eosinophilic hyaline inclusions)

Question 39

Echinococcus Granulosus

Answer 39

Tape worm | hydatid cysts

Question 40

Entamoeba histolytica

Answer 40

1. amebic abscess 2. trophozoites in stool 3. south america

Question 41

fasciola hepatica

Answer 41

liver flukes | Cholangiocarcinoma

Question 42

Schistosoma mansoni

Answer 42

larvae portal hypertension eggs in stool

Question 43

Hereditary hemochromatosis

Answer 43

1. Mut of HFE gene on chr 6 2. cx: arrhythmias, Diabetes, cirrhosis, hypothyroid, pigmentaion 3. die from dilated cardiomyopathy 4. increased ferritin

Question 44

Wilson's disease

Answer 44

1. copper accumulation in liver 2 damage by free radical 3. deposits in the basal ganglia -> temors 4 deposits in cornea -> kayser fleischer rings 5 decreased ceruloplasmin and increased transaminase tx: d-pencillamine

Question 45

PBC

Answer 45

Primary billiary cirrhosis AI disease of intrahepatic bile ducts 1. associated with sjoogrens 2.pruritis and xanthelasma 3. anti-mitochondrial antibodies 4 granulomatous bile duct destruction and heavy lymphocytes

Question 46

PSC

Answer 46

Primary sclerosing cholangitis Associated with ulcerative colitis Increased risk of cholangiocarcinoma P-ANCA positive

Question 47

Hepatic angiosarcoma

Answer 47

Vinyl chloride | CD31+

Question 48

Hepatocellular carcinoma

Answer 48

Hep C Increased AFP

Question 49

Management of cirrhosis

Answer 49

restrict fluid | low protein

Question 50

Hepatic encephalopathy

Answer 50

tx: lactulose to acidify GI tract

Question 51

Annular pancreas

Answer 51

1. head forms ring around duodenum 2 abnormal migration of ventral pancreatic bud 3 dark green vomit (bile)

Question 52

Acute pancreatitis

Answer 52

Liquefactive necrosis and fat necrosis with calcium deposits 1 alcohol or trauma Increased lipase and amylase

Question 53

Pancreatic carcinoma

Answer 53

secretes gastrin | CA-19-9

Question 54

Biliary colic

Answer 54

pain due to CCK