UWorld

Question 1

What is the most common form of drug-induced chronic renal failure?

Answer 1

• Analgesic nephropathy
• 3-5% of ESRD in USA
• Seen in women 50-55 y/o
• See papillary necrosis (left image, white areas) and chronic tubulointerstitial nephritis (right image)
• Polyuria and sterile pyuria are early manifestations

Question 2

What is the pathology?

Answer 2

• Papillary necrosis (white areas)
• Etiology: pyelonephritis, ascending UTI, and chronic analgesic ingestion

Question 3

What is the pathology?

Answer 3

• Chronic tubulointerstitial nephritis
• The interstitium is expanded by fibrosis with distortion of tubules and periglomular fibrosis.
• Results from analgesics, cyclosporine, cisplatin, and lithium; lead; and metabolic disorders, notably hypercalcemia, potassium depletion, and hyperoxaluria.
• Dx incidentally on routine exam or work up for HTN.
• https://emedicine.medscape.com/article/243597-overview

Question 4

What are the clinical features of PCOS?

Answer 4

• Androgen excess
  
  • ance, male pattern baldness, hirsutisum
• Menstrual irregularities
• Obesity
• Polycystic ovaries on U/S

Question 5

Which hormones are imbalanced in PCOS?

Answer 5

• Testosterone increased
• Estrogen increased
• LH/FSH imbalance

Question 6

What comorbidities are associated with PCOS?

Answer 6

• Metabolic syndrome (DM, HTN)
  
  • Get OGTT
• OSA
• NASH
• Endometrial hyperplasia/cancer

Question 7

What treatments are recommended for PCOS?

Answer 7

• First line: weight loss.
• OCPs for menstrual regulation
• Clomiphene citrate for ovulation induction

Question 8

What are the symptoms of severe hypercalcemia?

Answer 8

• Weakness
• GI distress
• neuropsych (confusion, stupor, coma)
• Polyuria (and therefore increased thirst)

Question 9

Medications that cause hyperkalemia?

Answer 9

THANKS Pro Cycle

(Trimethoprim, Heparin, ACE inh/ARBs, NSAIDs, K+ sparing duretics, Succinylcholine, Propanolol (beta blockers), Cyclosporin)

1. non-selective beta-adrenergic blocker (propanolol)
   
   1. interferes with beta-2-mediated intracellular potassium uptake
2. ACE inhibitor, ARB, K+ sparing diuretics (eg, Spironolactone, Trimethoprim)
   
   1. inhibition of aldosterone or the ENaC channel
3. Digitalis
   
   1. Inhibition of Na-K ATPase pump
4. Cyclosporine
   
   1. Blocks aldosterone activity
5. Heparin
   
   1. Blocks aldosterone production
6. NSAIDs
   
   1. Decreasing renal perfusion resulting in decrased K+ delivery to the collecting ducts
7. Succinylcholine
   
   1. Causes extracelluar leakage of potassium through acetylcholine receptors

Question 10

Medications that cause hypokalemia?