Rx_2.4 (Renal)

Question 1

Renal biopsy w/subendothelial deposits + [image] ==> dx?

Answer 1

• “wire loop” glomerular lesions ==>
• lupus nephritis [aka diffues proliferative glomerulonephritis]

Question 2

Achalasia characteristics and association

Answer 2

• achalasia = failure of smooth m. fibers of lower esophagus and LES to relax ==> problems w/swallowing
• associated w/chagas disease

Question 3

Morbilliform rash association

Answer 3

viral exanthems

Question 4

Sx characteristics of Lupus

Answer 4

• sx
  
  • malar rash
  • arthritis
  • oral and nasal ulcers
  • fever
  • malaise
• other manifestations of lupus
  
  • CV = pericarditis
  • Resp = pleural effusion
  • hemat = anemia, cytopenias

Question 5

Vomiting + diarrhea ==> acid-base dx?

Answer 5

• vomiting ==> metabolic alkalosis
  
  • due to loss of acid
• diarrhea ==> non-anion gap metabolic acidosis
  
  • due to loss of base
• vomiting + diarrhea ==> mixed acidosis and alkalosis
  
  • acute dehydration ==> elevated anion gap

Question 6

Genetic mutation ==> PKU

Answer 6

• AR
• dysfxn of phenylalanine hydroxylase: phenylalanine ==> tyrosine w/BH₄ (tetrahydrobiopterin)
• lack of enzyme ==> increase in phenylketones ==> [without low phenylalanine diet] intellectual disability

Question 7

Signs/dx of PKU

Answer 7

• perinatal screening
• musty body odor
• intellectual disability if not treated

Question 8

Dangerous adverse event associated w/NSAIDs (+ mechanism)

Answer 8

• renal failure
• pt.s on diuretics ==> release of AII (in response to decrease volume stats) ==> vasoconstriction
• kidney stimulates PG release in order to maintiain vasodilation @ afferent arteriole and maintain perfusion
• NSAIDs = COX-1/COX-2 inhibitors ==> decreased PGE ==> constriction of afferent arterioles ==> prerenal renal failure

Question 9

Characteristics of hydrochlorothiazide

Answer 9

• thiazide diuretic
• first-line to tx new-onset HTN
• MOA: inhibits Na reabsorption in hte early distal convuloted tuble of nephron ==> diuresis
• SE:
  
  • hyperuricemia (==> gout attack)
  • hyperlipidemia
  • hypercalcemia

Question 10

Acetazolamide: MOA, use, toxicity

Answer 10

• MOA: carbonic anhydrase inhibitor
  
  • ==> self-limited NaHCO₃, diuresis and decreased total-body HCO₃
• Use:
  
  • glaucoma
  • metabolic alkalosis
  • altitude sickness
  • pseudotumor cerebri
• Toxicity
  
  • hyperchloremic metabolic acidosis
  • paresthesias
  • sulfa allergy

Question 11

Mannitol: MOA, use, toxicity

Answer 11

• MOA: osmotic diuretic
  
  • increased tubular osmolarity ==> increased urine flow
  • ==> decreased intracranial/intraocular pressure
• Use
  
  • drug overdose
  • increased intracranial/intraocular pressure
• Toxicity
  
  • Pulmonary edema
  • dehydration
  • contraindicated in anuria & CHF

Question 12

Renal biopsy findings in IgA nephropathy

Answer 12

mesangial deposits