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MQW U5 > Robbins Q > Flashcards

Robbins Q Flashcards

1
Q

71 y/o man w/ 3 day oliguria. BP 85/60, peripheral edema, diffuse rales, Cr 3.3, BUN 62, FENa less than 1%. What is it?

A

Dilated cardiomyopathy = prerenal azotemia = BUN/Cr over 20, low FENa, high urine specific gravity

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2
Q

What type of hypersensitivity is Goodpasture’s syndrome?

A

Type 2

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3
Q

What kind of hypersensitivity produces a granular pattern on immunofluorescence?

A

Type 3 = immune complex deposition

Eg: Membranous nephropathy, Membranoproliferative nephropathy

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4
Q

Renal biopsy: hypercellular glomeruli w/ lobulation and a double-contour appearance to split basement membranes adjacent to subendothelial immune complex.
What cell type is likely proliferated?

A

Mesangial cells – Membranoproliferative nephropathy Type 1 = subendothelial deposits

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5
Q

There is over 3.5g protein in 24hr urine. Dysfunction of what cell is responsible for the proteinuria?

A

Podocytes

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6
Q

What is the pattern of occurence (patient population wise) for Goodpasture syndrome?

A

Bimodal = younger and older men

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7
Q

Sinus problems + cANCA = ___

A

Granulomatosis with polyangiitis

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8
Q

What is the only nephrotic syndrome that responds o corticosteroids and what is the pathogenic mechanism?

A

Minimal change disease (MCD) – cytokine-mediated visceral epithelial cell injury

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9
Q

Hep B (HBV) is associated with what nephritic/nephrotic syndrome(s)

A

Membranoproliferative nephropathy Type 1

Membranous nephropathy

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10
Q

6y/o girl, increasingly lethargic over 2wks, puffiness around eyes, Cr 0.7, BUN 12, Cholesterol 217, Urine pH 6.5, sp. gravity 1.011, 4+ proteinuria, lipiduria, no blood or glucose in urine, 24hr urine protein 3.8g.
What disease? What treatment?

A

MCD, glucocorticoid

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11
Q

Corticosteroid-resistant hematuria and proteinuria leading to HTN and renal failure caused by slit diaphragm dysfunction.
What disease?

A

FSGS

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12
Q

What is the most common inheritance pattern for Alport syndrome?

A

X-linked = 85% of cases

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13
Q

Diffuse proliferative glomerulonephritis associated with SLE has what kind of deposits at what location?

A

Granular immune deposits of IgG and C1q in capillary loops and mesangium

“wire looping” of capillaries

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14
Q

Why do patients with acute tubular injury have polyuria for weeks even after treatment?

A

Takes weeks for tubular epithelial cells to regenerate. In the mean time, they have less ability to reabsorb filtrate.

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15
Q

What to suspect when you see WBC and RBC casts in a sexy lady?

A

Pyelonephritis from ascending UTI

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16
Q

29 y/o woman w/ fever sore throat for 3 days is treated w/ ampicillin and recovers in 7 days. 2 weeks later, she develops fever 37.7C, erythematous rash, slight oliguria, urine pH 6, 1+ proteinuria, 1+ hematuria, no glucose or ketones, WBCs and RBCs including eosinophils in urine, no casts or crystals.
What caused this?

A

Acute drug-induced interstitial nephritis – AMPICILLIN!!!

Post-strep glomerulonephritis w/ immune complexes would not have rash or eosinophils

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17
Q

A guy takes phenacetin, aspirin and acetominophen for fun a lot for 20 years. What’s he at risk for?

A

Renal papillary necrosis = chronic result of analgesic nephropathy (acute interstitial nephritis)

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18
Q

Patient with 160/110 from renal artery stenosis is treated with an CEI. He takes an ibuprofen once and becomes oliguric. Why did the ibuprofen cause that?

A

Renal artery stenosis = low GFR
ACEI = efferent arteriole constriction
Physiologic prostaglandins = afferent arteriole dilation
NSAIDS = inhibit prostaglandins –> lower GFR

19
Q

5 y/o girl eats a lot at a BBQa and 4 days later develops: abdom pain, diarrhea, 90/50, occult blood in stool, Cr 2.2, BUN 20, Hb 10.8, HCT 32.4%, Plt 64k, schistocytes, D-dimer elevated, urine pH 6, 2+hematuria. Renal biopsy shows small thrombi within glomerular capillary loops.
What is it?

A

E. Coli infection (O157:H7) –> HUS –> acute renal failure

Most common cause of acute renal failure in children

20
Q

Adult autosomal dominant polycystic kidney disease often has a mutation that causes a defect in this protein component of cilia

A

Polycystin-1 – PKD1 (most)
Or
Polycystin-2 – PKD2 (15%)

21
Q

Aryl hydrocarbon receptor-interacting protein (AIP) gene mutations is associated with what disease?

A

GH-producing adenomas in young persons in familial cases –> gigantism or acromegaly

22
Q

Cyclin D1 mutations are associated with what endocrine disease?

A

Parathyroid adenomas

23
Q

Cystic dilation of inner medullary and papillary collecting ducts.
Classic presentation: renal stones, infection, or recurrent hematuria in 3rd of 4th decade.
What disease?

A

Medullary Sponge Kidney

24
Q

Autosomal recessive mutation in NPHP1 to NPHP11 genes.

MCC of end-stage renal disease in children and adolescents

A

Nephronophthisis

25
Q

What bugs can cause Ammonium magnesium phosphate stones?

A

Urease Positive:
Proteus mirabilis
Klebsiella
S. saprophyticus

26
Q

What 2 kinds of stones can cause staghron calculi?

A

Ammonium magnesium Phosphate

Cystine

27
Q 
39 y/o non pregnant woman: amenorrhea for 6 months, galactorrhea, BMI 28, normal 2ndary sex characteristics, normal GH stimulation test, MRI: fluid density within a normal-sized sella turcica
A) Craniopharyngioma
B) Empty sella syndrome
C) Hereditary hemochromatosis
D) Prader-Willi syndrome
E) Prolactinoma
F) Sheehan syndrome
A

B) Empty sella syndrome = herniation of arachnoid through diaphragma sellae –> “Stalk section” effect –> loss of prolactin inhibition –> hyperprolactinemia

MRI ruled out prolactinoma

28
Q

Family history of bilateral renal masses is associated with what gene?

A

MET gene mutation –> papillary renal cell carcinoma (2nd most common carcinoma of kidney)

29
Q 
39 y/o non pregnant woman: amenorrhea for 6 months, galactorrhea, BMI 28, normal 2ndary sex characteristics, normal GH stimulation test, MRI: fluid density within a normal-sized sella turcica
A) Craniopharyngioma
B) Empty sella syndrome
C) Hereditary hemochromatosis
D) Prader-Willi syndrome
E) Prolactinoma
F) Sheehan syndrome
A

B) Empty sella syndrome = herniation of arachnoid through diaphragma sellae –> “Stalk section” effect –> loss of prolactin inhibition –> hyperprolactinemia

MRI ruled out prolactinoma

30
Q

Failure to thrive since infancy, short, coarse facial features, protruding tongue, umbilical hernia.
What disease?

A

Cretinism = congenital hypothyroidism

31
Q

45 y/o woman living in the mountains has gradual and painless enlargment of thyroid gland, normal T4, slightly increased TSH.
What is it?

A

Diffuse nontoxic goiter = MCC is iodine deficiency

32
Q

Tall Columnar epithelium w/ papillary infolding and scalloping of colloid.
What disease?

A

Graves disease = autoantibofdies binding to TSH receptor to mimic TSH

33
Q

45 y/o woman living in the mountains has gradual and painless enlargment of thyroid gland, normal T4, slightly increased TSH.
What is it?

A

Diffuse nontoxic goiter = MCC is iodine deficiency

34
Q

Chronic renal failure can lead to what kind of parathyroid dysfunction?

A

Secondary hyperparathyroidism

35
Q

Amyloid stroma is common in what type of thyroid tumor?

A

Medullary carcinoma – look for Calcitonin

36
Q

Chronic renal failure can lead to what kind of parathyroid dysfunction?

A

Secondary hyperparathyroidism

37
Q

You see amyloid deposition in islets in Type [1/2] Diabetes

A

Type 2

38
Q

What is the mechanism for diabetic neuropathy?

A

Metabolism of Glucose–> sorbitol –> fructose uses NADPH–> prevents regeneration of glutathione–>increased oxidative stress–> neuropathy

Myelin cells don’t need insulin for glucose uptake

39
Q

What is Conn syndrome?

A

Adrenal cortical adenoma that secretes aldosterone –> hyperaldosteronism –> reflex low renin

40
Q

What is the mechanism for diabetic neuropathy?

A

Metabolism of Glucose–> sorbitol –> fructose uses NADPH–> prevents regeneration of glutathione–>increased oxidative stress–> neuropathy

Myelin cells dont need insulin for glucose uptake

41
Q

What is Conn syndrome?

A

Adrenal cortical adenoma that secretes aldosterone –> hyperaldosteronism –> reflex low renin

42
Q

What do most adrenal nodules do?

A

NOTHING– most are non-functional incidental findings

Some can produce hyperaldosteronism or Cushing’s syndrome

43
Q

What 3 neoplasms in MEN2A

A

Medullary Carcinoma of Thyroid
Pheochromocytoma
Parathyroid adenoma

44
Q

What 3 neoplasms in MEN1

A

Pancreatic tumors
Pituitary adenomas
Parathyroid adenomas

MQW U5 (8 decks)

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