Brainscape's Knowledge GenomeTM

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


See full index

Medicine > Renal, Urinary Systems and Electrolytes II > Flashcards

Renal, Urinary Systems and Electrolytes II Flashcards

1
Q

What acid-base disorders are associated with aspirin (salicylate) toxicity?

[…] (early) and […] (late)

A

What acid-base disorders are associated with aspirin (salicylate) toxicity?

respiratory alkalosis (early) and metabolic acidosis (late)

respiratory alkalosis due to increased respiratory drive; metabolic acidosis due to increased production/decreased elimination of organic acids

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

What acid-base disturbance is associated with primary adrenal insufficiency (Addison disease)?

A

Normal anion gap metabolic acidosis

decreased aldosterone results in retention of H+

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

What antibiotic is associated with hyperkalemia and elevated serum creatinine?

A

Trimethoprim

due to blockade of epithelial Na+ channels (ENaC) in the collecting tubule; elevated creatinine is an artificial increase due to inhibition of renal creatinine secretion (GFR remains the same)

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

What are the most common renal pathologies (2) seen with analgesic nephropathy?

A

papillary necrosis and chronic tubulointerstitial nephritis

may have sterile pyuria, WBC casts, microscopic hematuria, and/or mild proteinuria on urinalysis

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

What BUN:creatinine ratio is suggestive of prerenal acute kidney injury?

A

> 20:1 BUN:creatinine

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

What class of anti-depressants is commonly associated with SIADH?

A

SSRIs

especially in elderly patients

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

What class of antibiotics used to treat severe gram-negative infections is potentially nephrotoxic?

A

Aminoglycosides

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

What class of drugs are useful for patients with urge incontinence?

A

Anti-muscarinics (e.g. oxybutynin)

first-line treatments include bladder training and pelvic floor muscle exercises; medical therapy is reserved for those who don’t respond

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What classes of medications (2) are used for pain management in patients with kidney stones?

A

narcotics and NSAIDs (preferred with normal renal function)

e.g. morphine (narcotic) and ketolorac (NSAID)

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

What complication may result from correcting hypernatremia too quickly?

A

Cerebral edema

“high to low, your brain will blow”

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

What complication may result from correcting hyponatremia too quickly?

A

Osmotic demyelination syndrome (central pontine myelinolysis)

“low to high, your pons will die”

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

What does a positive leukocyte esterase on urine dipstick indicate?

A

Significant pyuria

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

What does positive nitrites on urine dipstick indicate?

A

Gram negative bacteria

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

What drug class is useful for the management of recurrent nephrolithiasis secondary to idiopathic hypercalciuria?

A

Thiazide diuretics

other preventive measures include increased fluid intake and a low Na+/protein diet

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

What drug should be discontinued in an acutely ill patient with sepsis and acute renal failure taking low-dose aspirin, atorvastatin, metformin, and sitagliptin?

A

Metformin

nephrotoxins, such as NSAIDs and metformin, should NOT be given to patients with acute renal failure or sepsis; low-dose aspirin has not been shown to precipitate or worsen renal failure

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

What effect does intracellular magnesium have on renal K+ secretion?

A

Decreased K+ secretion

via inhibition of renal outer medullary potassium (ROMK) channels

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

What formula is used to calculate the anion gap in patients with metabolic acidosis?

A

AG = (Na+) - (HCO3- + Cl-)

should be calculated in all patients with metabolic acidosis to narrow the differential

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

What formula is used to calculate the osmolal gap?

A

measured serum osmolality - calculated serum osmolality

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

What formula is used to calculate the serum osmolality?

A

the normal osmolal gap (measured - calculated) is < 10

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

What hematologic laboratory values are consistent with abnormal hemostasis due to chronic renal failure?

PT: […]

PTT: […]

Platelet count: […]

Bleeding time: […]

A

What hematologic laboratory values are consistent with abnormal hemostasis due to chronic renal failure?

PT: Normal

PTT: Normal

Platelet count: Normal

Bleeding time: Prolonged

underlying cause is platelet dysfunction

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

What imaging modalities (2) are preferred for detecting kidney stones?

A

CT scan of the abdomen without contrast (preferred) or ultrasound

high sensitivity and specificity; also can detect radiolucent stones, which are missed on abdominal X-ray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What imaging modality is preferred for diagnosis of renal cell carcinoma?

A

CT scan of the abdomen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is recommended treatment for an acute rejection of a renal transplant?

A

IV steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the best test to screen for the initial stages of diabetic nephropathy?

A

Urine test for microalbumin:creatinine ratio

either spot or timed urine collection; dipsticks only detect excess urinary protein when > 300mg/24hr (macroalbuminuria) and thus are not useful for screening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the current recommended screening regimen for bladder cancer?

A

Not recommended, even in patients with significant smoking and family histories

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the earliest renal abnormality seen in diabetic nephropathy?

A

Glomerular hyperfiltration

hyperfiltration is also the major pathophysiologic mechanism of glomerular injury; GBM thickening is the first change that can be quantitated

27
Q

What is the immediate treatment for severe hypercalcemia (> 14mg/dL or symptomatic)?

A

saline hydration + calcitonin

hypercalcemia may induce nephrogenic diabetes insipidus leading to polyuria and fluid loss; other symptoms include weakness, GI distress, and neuropsychiatric symptoms

28
Q

What is the initial step in management for a post-operative patient with acute renal failure and oliguria (< 250 mL urine in 12 hours)?

A

Bedside bladder scan to assess for urinary retention

29
Q

What is the initial therapy for patients with hypertension and renal artery stenosis?

A

ACE inhibitors or ARBs

an acceptable rise in serum creatinine is < 30%; renal artery stenting or surgical revascularization is reserved for patients who fail to achieve adequate BP control with medical therapy

30
Q

What is the initial treatment for acute hyponatremic encephalopathy (e.g. headache, nausea/vomiting, AMS)?

A

Hypertonic (3%) saline

may occur as a complication of hypotonic fluid administration (iatrogenic hyponatremia)

31
Q

What is the initial treatment for prerenal acute kidney injury?

A

IV normal saline

need to restore renal perfusion and prevent development of acute tubular necrosis

32
Q

What is the likely cause of acute kidney injury in patients receiving IV acyclovir?

A

Renal tubular obstruction (crystal-induced AKI)

most patients develop AKI within 24 - 48 hours after drug exposure

33
Q

What is the likely cause of acute renal failure in a patient with high anion and osmolal gap metabolic acidosis and calcium oxalate crystals on urinalysis?

A

Ethylene glycol poisoning

calcium oxalate crystals are described as envelope-shaped

34
Q

What is the likely cause of anion gap metabolic acidosis in a patient with a recent generalized tonic-clonic seizure?

A

Post-ictal lactic acidosis

transient and typically resolves without treatment within 90 minutes following resolution of seizure activity

35
Q

What is the likely cause of metabolic alkalosis in a young woman with low urine Cl-?

A

Self-induced vomiting

other etiologies include nasogastric suctioning and prior diuretic use

36
Q

What is the likely diagnosis in a cirrhotic patient with decreasing GFR, normal urinalysis, lack of improvement with IV fluids, and no other renal dysfunction?

A

Hepatorenal syndrome

common inciting factors include spontaneous bacterial peritonitis and GI bleeding

37
Q

What is the likely diagnosis in a euvolemic patient with high serum osmolality and low urine osmolality?

A

Diabetes insipidus (central or nephrogenic)

common cause of euvolemic hypernatremia

38
Q

What is the likely diagnosis in a euvolemic patient with low serum osmolality (< 275 mOsm/kg) and normal/high urine osmolality (> 100 mOsm/kg)?

A

SIADH

also typically have elevated urine sodium concentration (> 40 mEq/L)

39
Q

What is the likely diagnosis in a female with bladder pain that is relieved with voiding, as well as dyspareunia, urinary frequency/urgency, and normal urinalysis?

A

Interstitial cystitis (painful bladder syndrome)

treatment is palliative and includes trigger avoidance, amitriptyline, and analgesics

40
Q

What is the likely diagnosis in a hepatitis C patient with palpable purpura, hematuria, proteinuria, and low serum complement?

A

Mixed cryoglobulinemia

other symptoms include arthralgias, hepatosplenomegaly, peripheral neuropathy, and non-specific systemic symptoms

41
Q

What is the likely diagnosis in a middle-aged patient with chronic renal failure, a palpable right flank mass, and an enlarged liver?

A

Autosomal dominant polycystic kidney disease (ADPKD)

the right kidney, which is lower and easier to palpate than the left; other symptoms of ADPKD include intermittent flank pain, hematuria, UTIs, and nephrolithiasis

42
Q

What is the likely diagnosis in a patient on RIPE therapy for tuberculosis who presents with painless “red” urine?

A

Drug reaction

rifampin may result in red to orange discoloration of bodily fluids (e.g. urine, saliva, sweat, tears)

43
Q

What is the likely diagnosis in a patient started on nitroprusside who presents with flushing, confusion, and metabolic acidosis?

A

Cyanide toxicity

risk factors for cyanide toxicity due to nitroprusside include prolonged infusion (> 24 hours) and high rates (5-10 μg/kg/min), as well as chronic kidney disease

44
Q

What is the likely diagnosis in a patient who develops a spike in creatinine a day after having a CT with IV contrast?

A

Contrast-induced nephropathy

transient increase that normalizes within 5-7 days; higher risk in patients with elevated baseline creatinine and diabetes

45
Q

What is the likely diagnosis in a patient who overdosed on cocaine and presents with elevated K+ and creatine phosphokinase (CPK)?

A

Rhabdomyolysis

another key clinical feature is a positive urine dipstick for blood, but no RBCs seen on microscopy (due to myoglobin in the urine)

46
Q

What is the likely diagnosis in a patient who presents with periorbital swelling and hematuria three weeks after a skin infection?

A

Post-streptococcal glomerulonephritis

urinalysis may show hematuria with RBC casts and mild proteinuria; additionally, C3 complement levels are low

47
Q

What is the likely diagnosis in a patient with a recent infection who presents with fever and rash with WBC casts and eosinophiluria on urinalysis?

A

Drug-induced interstitial nephritis

the patient’s infection is likely being treated with an antibiotic that precipitated the nephritis; treatment is to discontinue the offending agent

48
Q

What is the likely diagnosis in a patient with a recent seizure who has a large amount of blood on urinalysis with few RBCs on microscopy?

A

Myoglobinuria (secondary to rhabdomyolysis)

urinalysis cannot detect the difference between hemoglobin and myoglobin but microscopic exam for RBCs can add clarity

49
Q

What is the likely diagnosis in a patient with a renal transplant for 3 days who presents with oliguria, elevated creatinine/BUN, lymphocytic infiltration on biopsy, and normal serum cyclosporine levels?

A

Acute transplant rejection

50
Q

What is the likely diagnosis in a patient with a unilateral varicocele that fails to empty when the patient is recumbent, as well as hematuria, fever, and thrombocytosis?

A

Renal cell carcinoma

unilateral varicoceles that fail to empty when a patient is recumbent should raise suspicion for an underlying mass that obstructs venous flow

51
Q

What is the likely diagnosis in a patient with an elevated serum Ca2+ and low urine Ca2+/Cr clearance ratio (< 0.01)?

A

Familial hypocalciuric hypercalcemia

due to abnormal calcium-sensing receptors (CaSR); differentiated from primary hyperparathyroidism by low urine Ca2+ excretion (< 0.01)

52
Q

What is the likely diagnosis in a patient with an elevated serum PTH/Ca2+ and normal urine Ca2+/Cr clearance ratio (> 0.02)?

[…]

A

Primary hyperparathyroidism

differentiated from familial hypocalciuric hypercalcemia by increased urine Ca2+ excretion (> 0.02)

53
Q

What is the likely diagnosis in a patient with anasarca, pulmonary edema, hematuria, and proteinuria (1+)?

A

Acute nephritic syndrome

the presence of hematuria and pulmonary edema helps distinguish nephritic syndrome from other causes of edema (e.g. hypoalbuminemia, cirrhosis, heart failure)

54
Q

What is the likely diagnosis in a patient with colicky flank pain that radiates to the groin?

A

Nephrolithiasis

55
Q

What is the likely diagnosis in a patient with cor pulmonale treated with loop diuretics that develops elevated creatinine and BUN?

A

Prerenal acute kidney injury

suggested by BUN:creatinine ratio > 20

56
Q

What is the likely diagnosis in a patient with elevated BUN and creatinine (< 20:1 ratio) after an episode of hypovolemic shock?

A

Acute tubular necrosis

characterized by muddy brown casts; distinguishing features from pre-renal AKI include BUN:creatinine ratio < 20:1, urine Na+ > 20 mEq/L, and FeNA > 2%

57
Q

What is the likely diagnosis in a patient with hematuria a few days after an upper respiratory infection with normal complement levels?

A

IgA nephropathy (synpharyngitic glomerulonephritis)

quicker onset (within 5 days) and normal complement levels help differentiate IgA nephropathy from PSGN

58
Q

What is the likely diagnosis in a patient with intermittent flank pain, low-volume voids, and occasional episodes of high-volume voids?

A

Obstructive uropathy

e.g. due to renal calculi; high-volume voids occur due to large volume of retained urine overcoming the obstruction (post-obstructive diuresis)

59
Q

What is the likely diagnosis in a patient with lethargy and asterixis, and the laboratory findings below?

BUN: 78 mg/dL

Albumin: 3.8 g/dL

AST: 38 U/L

ALT: 44 U/L

Creatine kinase: 32,000 U/L

A

What is the likely diagnosis in a patient with lethargy and asterixis, and the laboratory findings below?

BUN: 78 mg/dL

Albumin: 3.8 g/dL

AST: 38 U/L

ALT: 44 U/L

Creatine kinase: 32,000 U/L

Uremic encephalopathy

60
Q

What is the likely diagnosis in a patient with lower extremity edema, 4+ proteinuria, and a kidney biopsy demonstrating dense deposits within the GBM?

A

Membranoproliferative glomerulonephritis (MPGN) type II

also known as “dense deposit disease”

61
Q

What is the likely diagnosis in a patient with poorly controlled diabetes that presents with overflow incontinence with a high post-void residual volume (> 50 mL)?

A

Diabetic autonomic neuropathy

symptoms include dribbling and poor urinary stream

62
Q

What is the likely diagnosis in a patient with QRS widening and peaked T waves on ECG?

A

Hyperkalemia

other EKG changes include loss of the P wave and prolonged PR and/or shortened QT interval

63
Q

What is the likely diagnosis in a patient with tuberculosis who presents with hyponatremia, hyperkalemia, and eosinophilia?

A

Primary adrenal insufficiency

64
Q

What is the likely diagnosis in a young female with hypokalemia, metabolic alkalosis, normotension, and low urine Cl-?

A

Surreptitious vomiting

low urine Cl- helps distinguish vomiting from other causes of hypokalemia, alkalosis, and normotension (e.g. diuretic abuse, Bartter syndrome, and Gitelman’s syndrome)

Medicine (33 decks)

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