UW Flashcards
1
Q
MCC of painless hematuria (evaluation)
A
bladder cancer
if older than 35 –> CT and cytoscopy
2
Q
gross hematuria - prostate?
A
BPH
not cancer
3
Q
hematuria - best initial test
A
urinalysis to rule out and confirm microhematuria (more than 3 RBCs)
4
Q
reccomendations for patient with renal calculi
A
- increased fluids
- low sodium
- normal calcium
5
Q
medication that cause urinary retention (and manegment)
A
anticholinergics
stop them + cathetirization
6
Q
ethylen glycol (antifreeze) - stones?
A
calcium oxalate
7
Q
osmolar gap?
A
measured serum osm - calculated serum osm
8
Q
causes of combination of osmolar gap and and high anion gap met acidosis
A
acute ethanol (MC)
methanol
ethylen glycol
9
Q
methanol toxicity
A
blindness
10
Q
management of acute oliguria
A
bedside bladder scan to assess for urinary retention
- retention (MORE THAN 300 ml) –> catheter to decompress –> serum + urine bioch +/- image –> treat underling
- no retention –> serum + urine bioch +/- image:
a. pre-renal (IV fluids or treat underling)
b. renal cause -> treat underling
11
Q
oliguria means
A
less than 250 ml in 12 hours
12
Q
hepaternal vs pre-renal
A
hepatorenal does not respond to fluids
13
Q
hepatorenal syndrome treatment
A
- address precipitating factor
- splachninc vasoconstrictor
- liver transplantation
14
Q
MCC of death in dyalisis patients
A
Cardiovascular
15
Q
MCC of death in patients with renal transplantation
A
cardiovascular
16
Q
MC extrarenal manifestation of ADPKD
A
hepatic cysts
17
Q
GI complication of ADPKD
A
colonic diverticula
18
Q
urate crystals - shape
A
needle
19
Q
GI symptoms of ureteral colic
A
vagal reaction –> ileus
20
Q
aspirin intoxitation - ph
A
normal
21
Q
medication to fascilate stone passage
A
a1 blocker (tamsulosin) –> act on distal ureter
22
Q
management of ureteral stones
A
symptomatic relief –> urosepsis, acute renal failure or complete obstructiion?
yes –> urology consult
no –> stone siize:
less than 10 mm –> hydration pain control, a blocker
bigger than 10 –> urology consult
uncontrolled pain or no stone passage in 4-6 weeks –> urology consult
23
Q
bladder cancer screening
A
not recommended (even if RFs)
24
Q
MC nephrotic syndrome associated with thromboembolism
A
membranous nephropathy
25
glomerular vs non glomerulal hematuria regarding type
glomerular usually microscopic
| nonglomerular usually gross
26
glomerular vs non glomerular hematuria regarding urinalysis
glom: blood + protein, RBCs casts, dysmoprhic RBCs
| non -glom: blood but no protein, normal appearing RBCs
27
SE of acyclovir on kidneys (treatment)
crystaluria --> renal tubular obstruction
| administer fluids with the drug
28
etiology of crystal induced acute kidney injury
```
acyclovir
sulfonamides
MTX
ethylene glycol
protease inh
Uric acid
```
29
clinical presentation of crystal induced acute kidney injury
usually asymptomatic
AKI in less than 7 days from the starting drug
hematuria, pyuria, crystals
30
treatment of crystal induced induced acute kidney injury
stop medication
fluids
loop duretics
31
evaluation of met alkalosis
urine chloride
low --> vomiting / NG aspiration, prior diuretics
high --> hypervolemia (aldosterone), hypovolemia/evolemia (current diuretics, Barrter, gitelman)
32
medications that causes SIADH
SSRI, carbamazepine, Cyclophosphamide, NSAID
33
hypokalemia in alcohoics is refractory - why
hypogmagnesemia (removal of inhibition of renal excretion)
34
stones - best initial test
U/S (NOT URINALYSIS)
35
causes of edema in nephritis
FLUID RETENTION
36
urinary retention due to anticholinergics
detrusor hypocotractility
37
Most sensitive screen for nephropathy
RANDOM urine for microalbumin/creatinine ratio
| 24h is more accurate but it is inconvenience
38
how to correct low Na+
3% salide solution
| not exceed 0.5 mEg/L/hr to
39
best options for renal transplantation
in order
1. living related donor
2. living unrelated
3. cadaveric
40
advantages of renal transplantation over dyalysis
1. better survival + quality
2. autonomic neuropathy stabilzes or improves in diabetics
3. return to normal endocrine, sexual and reproductive functions
2. anemia, bone disease and hypertension better control
41
drug induced intestitial nephritis - treatment
stop the related drug (not steroids)
42
evaluation of hyponatremia
serum osm more than 290?
yes --> marked hypogl / advanced renal failure
no --> urine osm less than 100?:
- yes (polydipsia, malnutriotion)
- no --> check urine sodium
if if less than 25 --> SIADH, adrenal ins, hypoth
if it is more than 25 --> vloume depltion, cirrhosis, CHF
43
psychiatric disorder associated with 1ry polydipsia
schizophrenia
44
Acute hyponatremic encephalopathy - treatment
3% saline solution with close monitoring of electrolytes
| increase sodium 6-8 in first 24 h
45
nephrotic syndrome can cause accelerated atherosclerosis - mechanism
1. loss of anthothrombin III
2. due to low albumin, liver overproduce lipid proteins
affects veins more (esp renal veins)
46
MCC of abnormal hemostasis in patients with chronic renal failure / characteristics / treatment
platelet dysfunction
BT in elevated. PT and PTT are normal
desmoprasin is the treatment
(no transfusion)
47
metabolic acidosis - compensation
PaCO2 = 1.5 (serum HCO3-) + 8 +/- 2
48
metabolic alkalosis - compensation
increase PaCO2 by 0.7 for every rise in serum HCO3b
49
acute resp acidosis - compensation
increase serum HCO3 by 1 for every 10 rise in PCO2
50
acute resp alkalosis
decrease serum HCO3 by 2 for every 10 decrease in PaCO2
51
clinical manifestation of cyanide toxicity
skin: cherry red flashing, cyanosis comes later
CNS: altered mental status, Headache, coma, seizures
Cardiovascular: arrhythmia
Resp: tachypnia following by resp depression, pulm edema
GI: abd pain, nausea, vomiting
Renal: metabolic acidosis (lactate), renal failure
52
skin in cyanide toxicity
cherry red flashing, cyanosis comes later
53
cyanide poisoning - treatment
treat with induced methemoglobinemia --> 1st give nitrates: oxidize Hb to methemoblobin which can trap cyanide as cyanmethemoglobin, then thiosulfates (convert caynide to thyocyanate --> which is renally excreted)
1st: NITRATES
THEN: THIOSULFATES
54
treatment of hypertension and renal artery stenosis
ACI are indicated for iniitlay therapy
renal artery stenting or surgical revasculization is resewed for patients with resistant HTN or recurrent flash pulm endam and/or refractory HF due to severe hypertension
BE VERY CAREFUL IF BILATERAL
55
SIADH - management
fluid restriction +/- salt tablets
| if severe: hypertonic (3%) saline
56
Most frequent vessel manifestation of nephrotic syndrome
venous thrombosis
57
nephrotic syndrome - anemia?
iron resistant microcytic hypochromic anemia
| DUE TO TRANSFERRIN LOSS
58
cystine stones - urine crystal shape / test to diagnose
hexagonal
| - sodium cyanide nitroprusside test
59
b-agonists - K+
low
60
GI loses - K+
both vomiting and diarrhea causes hypokelamie
61
medications that can cause hyperkalemia
1. β-blockers
2. ACEi
3. K+ sparing diuretics
4. digitalis
5. cyclosporin
6. heparin
7. NSAID
8. succinylcholine
9 . Trimethorpime
62
NSAID mediated hyperkalemia - mechanism
decreases renal perfusion --> decreased K delivery to the collecting ducts
63
Heparin mediated hyperkalemia - mechanism
blocks aldosterone production
64
Cyclosporine mediated hyperkalemia - mechanism
blocks aldosterone activity
65
Trimethoprime mediated hyperkalemia - mechanism
blockage of epithelium Na2+ channel in the collecting ducts --> also blocks the creatinine secretion (artificially), without affecting the GFR
66
pyelonephritis treatment
- outpatient: fluoroquinolones
- inpatient: IV antibiotics (fluoroquinolone, aminoglycoside +/- ampicillin)
- urine culture prior to treatment
67
uncomplicated cystitis - treatment
- Nitrofurantoin for 5 fays (avoid if pyelonephritis or Cr clearance less than 60)
- TMP - sxm for 3 days
- fluoroquinolones (2nd option)
- Culture only if initial treatment fails
68
complicated cystitis - treatment
- fluoroquinolones (5-14d),
- extended spectrum antibiotics (ampicillin/gentamycin) for for severe
- culture before
69
when is complicated cystitis
DM, kidney disease, pregnancy immunocompromised, urinary tract obstruction, hopsital acquired, assoiacetd with procedure, indwelling foreign body
70
severe hyperkalemia - best initial step
calcium gluconate --> then insulin, glucose, HCO3-, β-agonists
71
hyperkalemia - ECG
- tall peaked T waves with short QT
- PR prolongation + QRS widening
- No P waves
- conduction block, ectopy, or sine wave pattern
72
urinalysis - blood?
cannot distinguish Hb from myoglobin
73
treatment of uric acid stones
1. hydration
2. alkalinization of urine (POTASSIUM CITRATE)
3. low-purine
diet
4. allopurinol if resistant
74
how to alkalinize urine in uric acid stones
potassium citrate
75
grades of hypercalcemia - grade
severe (more than 14) or symptomatic)
moderate: 12-14
mild or asymptomatic (less than 12)
76
severe hypercalcemia - treatment
```
short term (immediate) treatment
- normal saline + calcitonin
- avoid loop diuretics unless volume overload
Long term
- bisphosphonate
```
77
moderate hypercalcemia - treatment
usually no immediate treatment required unless symptomatic
| - similar to severe
78
asymptomatic or mild hypercalcemia
no immediate treatment required
| avoid thiazide, lithium, volume depletion + prolonged bed rest
79
amiloride mediated hyperkalemia - next step
change the medication
| low diet K+ does not change anything
80
cocaine - acute renal failure?
due to rhabdomyolisis (CPK causes ARF id more than 20.000)
81
post-streptoc vs IgA nephropathy regarding complement
low C3 in post-strept
| normal in IgA
82
bladder outlet obstruction (eg. from BPH) - next step
renal U/S to assess function and check for hydronephrosis
83
MCC of renal artery stenosis
HTN
84
postictal lactic acidosis
anion gap metab acidosis following a tonic clonic seizure --> resolves in 90 mins without treatment
85
metabolic acidodis - give HCO3-?
if ph less than 7.1
86
which 2 lab values provide the best picture for acid-base status
pH + pCO2
| HCO3- can be calculated fro henderson hesselbach equation
87
common presentation of cryobulinemia
palpable purpura, glomerulonephritis, non-specific systemic symptoms, arthralgias, hepatosplenomegaly, peripheral neuropathy, hypocomplementiemiia
MC in HCV
88
the quickest way to low the K+
insulin
89
mechanism of hepatorenal syndrome
splanchnic arterial dilation, decreaesd vascular resistance, local renal vasocnstriction with decreased perfusion
90
characteristic of varicoceles due to underlying mass pathology
unilateral varicoceles that fail to empty when a patient s recumbent
91
Interstitial cystisis (bladder pain syndrome) - epidimiology
- More common in women
| - associaed with psychiatric + pain disorders (eg. fibromyalgia)
92
interstitial cystitis (bladder pain syndrome) - clinical presentation
1. bladder pain with filling, releif with voiding
2. urinary frequency + urgency
3. Dyspareunia
93
interstitial cystitis (bladder pain syndrome) - diagnosis
- bladder pain with no other cause for 6 or more weeks
| - normal urinalysis
94
interstitial cystitis (bladder pain syndrome) - treatment
1. not curative: focus to improve quality of lide
2. behavioral modification, avoid triggers, physical therapy
3. TCA, pentosan polysulfate sodium
4. Analgesics for acute exacerbations
95
acute kidney injury causes acidosis - anion or non anion gap
both:
anion gap: uremic toxins
non-anion gap: impaired acid excretion
96
Obstructive uropathy - presentation
1. flank pain
2. low-volume voids iwth or without occasonal high-volume voids
3. if bilateral: renal dysfunction
97
Genitourinary manifestations of diabetic autonomic neuropathy
1. erectile dysfunction + retrogratde ejaculation in men, decreased libio + dyspareunia in owmen
2. decreased ability to sense full bladder leading to incomplete emptying + decreased urination
3. eventual reccurent UTI and /or overflow incontinence (dribbling, porr urinary streem
98
analgesic nephroapathy
MC form of drug induced chronic renal failure
| Ppaillay necrosis + chronic tubulointestitial nephritis are the MC pathologies seen
99
causes of asterixis
1. Hepatic encephalopathy
2. Uremic encephalopathy
3. CO2 retention
100
indications for urgent dialysis
1. refractory acidosis with ph under 7.1
2. volume overload refractory to diuretics
3. symptomatic uremia (bleeding, encephalopathy, pericarditis
4. ingestion: toxic alcohols, salicylate, lithium, sodium valproate, carbamazepine
5. elect abnormalities: severe or symptomatic hyperkalemia refractory to medications
101
recommendations for blood tranfusion
under 7: always
7-8: if cardiac surgery, HF, oncology patients in treatment
8-10: symptomatic anemia, noncardiac surgery, ongoing bleeding, ACS
102
post-void redidual volume in obstruction
more than 50 ml
103
reduce Ca intake - stones
reduce ca intake increases oxalate absorption
104
GFR in DM
increases in the beginning (hyperfiltration)
| then goes down
105
renal transplantation - treatment id signs of rejection
IV steroids
106
renal transplant dysfunction - cuases
1. utreteral obstruction (U/S to rule out)
2. cyclosporine toxicity (drug level)
3. vascular obstruction (renal biopsy)
4. acute tubular necrosis
acute rejection is treated with IV steroids
107
treatment of hypernatriemia
hypovolemic: O.9% saline (but if mild can give 5% dextrose in 0.45 saline)
euvolemic: hypotonic
108
lithium - hemodialysis?
if more than 4, or more than 2.5 with signs of toxicities
109
simple vs malignant renal cyst in contrast CT
only malignant has enhancement
