Brainscape's Knowledge GenomeTM

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


See full index

Priya's Board Review > Cases (Day 1) > Flashcards

Cases (Day 1) Flashcards

1
Q

What is your first step?
- pamidronate 30mg IV over 6 hrs
- IV NS bolus + 150cc/hr
- furosemide 40mg IV
- Denosumab
- Calcitonin

What is the mostly cause of hyperCa?
- primary HPTH
- secondary HPTH
- malignancy
- Vit D intoxication

A
  1. fluids
  2. Malignancy
  • seen in SCC head, neck, lung (MCC), esophagus
  • breast
  • RCC
  • lymphoma/myeloma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How is calcium reabsorbed?
What is the effect of loop diuretics?

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

What is the drug of choice/Level I evidence supported medication for hyperCa of malignancy?

A

Bisphosphonates - high affinity for hydroxyapatite, inhibit resorption/bone turnover
- more potent: zoledronate, pamidronate, ibandronate - higher rate of Ca normalization and lower rate of relapse

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

What is a useful adjunct with bisphosphonates in rapidly reducing calcium?

A

Calcitonin - inhibits osteoclasts
- rapid, short half-life
- tachyphylaxis around 48hrs
4-8IU/kg IM/SQ q6 hrs

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

Which hyperCa therapy doesn’t require dose adjustment for low GFR?

A

Denosumab - RANKL-Ab, inhibits rank-l mediated resorption
*can cause hypoCa if Vit D not replete

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

Review of tx of HyperCa of malignancy

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

What’s the dx?
- Light chain nephropathy (MM)
- acute uric acid nephropathy (TLS)
- acute nephrocalcinosis (Ca/phos dep)
- Acute granulomatous interstitial nephritis from NSAIDS
- acute infiltrating nephritis from lymphoma

A

fractured glassy casts

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

Pathology review

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

Prior to chemo, which should be administered?
- HD
- Urine alkalization
- glucose/insulin
- IV Calcium
- IV Fluid challenge

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

Flip for treatment of TLS

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

Which of the following labs explain his lab abnormalities?
- aldo
- cortisol
- ACTH
- TSH
- glucagon

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

Pathophysiology of HTN, HypoK, Met. Alkalosis in Small Cell lung CA (flip)

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

Kidney US with 18cm size bilaterally.

What is the most likely cause of AKI?
- obstructive uropathy
- AIN
- lymphomatous infiltration
- MN 2ndary to neoplasm
- renal vein thrombosis

A

Renal lymphoma
- enlarged on US/CT
- RP can cause obstruction or masses in kidney

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

What is the most likely cause of this condition?
- cisplatin induced renal salt wasting
- SIADH
- Bleomycin induced renal salt wasting
- Paclitaxel autonomic neuropathy

A

Cisplatin
- dose-related nephrotoxicity (primarily tubular) and ototoxicity

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

How can you prevent/treat Cisplatin-AKI/tubulopathy?

A

IV NS or 3% for forced diuresis
Amifostine (glutathione analog)
change to carbo/oxaplatin (don’t use OCT-2)
Na-thiosulfate

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

What is the likely cause of her electrolytes disorder?
- Paclitaxel toxicity
- 2ndary hyperaldo
- stimulation of FGF23 by tumor
- Ifosfamide toxicity
- obstructive uropathy

A

Ifosfamide
vs. cyclophosphamide - hemorrhagic cystitis
- toxic metabolite of ifos is chloroacetaldehyde = causes problem in PCT

causes fanconi/neph DI, AKI/ATN

Tx: dose reduction/supportive care

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

What is the cause of kidney disease?
- naproxen
- breast cancer
- pamidronate
- gemcitabine
- paclitaxel

A

Pamidronate - seen in long term, high doses
- AKI with nephrotic syndrome, collapsing FSGS and chronic tubulointerstitial disease

Zolendronate - after several doses, AKI/ATN
- CI if eGFR <30

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

What is the most likely cause of hypoMg?
- irinotecan
- oxaliplatin
- cetuximab
- pantoprazole
- leucovorin

A

Cetuximab
- PPI cause GI Mg wasting, not renal
- EGFR inhibitor to treat epithelial cell malignancies (colorectal, head and neck, breast, lung)

Panitumumab also (cousin)

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

What is the likely lesion seen in this patient?
- TMA
- FSGS
- crystalline-induced tubular injury
- AIN
- ATI/ATN

A

Immune checkpoint AIN
- CTLA-4 blockers and PD-L1 Ab

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

Other pathologies associated with immune checkpoint inhibitors

A

<4% from ICPI induced AKI
usually AIN, can be GN/vasculitis
- no labs helpful, needs biopsy
- can be steroid responsive
- re-challenge reasonable with close monitoring (23% recurrence)

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

Other pathologies associated with immune checkpoint inhibitors

A

<4% from ICPI induced AKI
usually AIN, can be GN/vasculitis
- no labs helpful, needs biopsy
- can be steroid responsive
- re-challenge reasonable with close monitoring (23% recurrence)

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

UA: SG-1.018, pH 6, protein 1+, blood 3+, gluc neg, LE trace
Hb 10, WBC 8.7 w/ 3% eos

A

What is present on urine micro?
- dysmorphic RBC
- budding yeast
- renal tubular epithelial cells
- isomorphine RBCs
- WBC

What is the most likely diagnosis?
- IgA
- AIN
- bladder cancer
- ATN
- acute pyelonephritis

see next question in order

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Lytes: ok, alb 3.2
BUN 75, Cr 4.9
WBC 18/5, eos. 5%
UA: SG 1.010, pH 5.5, prot 2+, gluc 1+, blood neg, LE, neg

A

What is the cell on urine micro?

Based on type of cell, what is the diagnosis?
- TMA
- ATI/ATN
- AIN
- HCV GN
- Uroepithelial cancer

see next question in order

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

single nucleus

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q
A

What on the urine micro?

What’s the diagnosis?
- pre-renal AKI from SGLT2
- ATI/ATN
- AIN
- UTI
- progressive DKD

see next question in order

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q
A

Whats seen on microscopy?

What is the Dx?

see next question in order

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q
A

What’s the cell on micrscopy?

What is the diagnosis?
- renal limited anti-GBM
- ATI/ATN
- AIN
- IgA vasculitis
- candida pyelonephritis

see next question in order

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

name the cast

A

hyaline cast

34
Q

name the cast

A

waxy cast

35
Q

name the cast

A

renal epithelial cast

36
Q

name the cast

A

granual cast

37
Q

name the cast

A

RBC cast

38
Q
A

What crystals are present?
- sulfonamide
- Ca phos
- Ca Ox
- Uric acid
- Hippurate

see next question for answer

39
Q
A
40
Q
A
41
Q
A
42
Q
A
43
Q
A
44
Q

seen in what clinical scenario?

A

urease producing UTI
struvite stones

45
Q
A
46
Q
A

genetic disorder
- tx allopurinol to block XDH

47
Q

Associated with which organ dysfunction/failure?

A

cirrhosis/acute liver failure

48
Q

What drug are you concerned about in this patient?
- acyclovir
- ciprofloxacin
- amoxicillin
- sulfamethoxazole
- atazanavir

A

sulfa crystals

49
Q

name these crystals

A

acyclovir, very thin - usually seen in bolus, not really with PO

ciprofloxacin - more starburst pattern, develop in 1. excessive dose in CKD for GFR or 2. in alkaline urine precipitation

50
Q

name the crystals

A

Amox - thicker than acyclovir

sulfa

51
Q
A

indinavir - HIV treatment, thicker rod in starburts, could form stones, now replaced

atazanavir - more used, lesser degree of crystallization/stones

52
Q

Associated with treatment of lymphoma/malignancies

A

MTX
- prevent with urinary alkalization

53
Q
A
54
Q

Right kidney with two branches - large with stenosis with darkening in upper 2/3 hypoperfused/darker
- severe RAS

A
55
Q

MR w/ stenosis, still see blood flow past lesions, so tight but not completely occluded
- kidney on that side smaller and shrunken, ischemic

A
56
Q

Tight stenosis with post-obst dilatation on angiogram

A
57
Q

Stenosis noted in the setting of AAA stent related stenosis, improved with renal stent placed

A
58
Q

RAS pearls

A
59
Q
A

Fibromuscular dysplasia

60
Q

FMD Pearls

A
61
Q

Name the lesion

A

Adrenal adenoma

62
Q
A
63
Q
A

PAN

64
Q
A

Page Kidney

65
Q
A

Renal Infarction

66
Q

What kind of stones can be seen on XR?

A

can see calcium
may not see uric acid/cystine

67
Q
A

Staghorn Calculi
- associated with chronic UTI/struvite forming

68
Q
A

acoustic shadowing

69
Q
A
70
Q
A
71
Q

RCC

A
72
Q

Angiomyolipoma
- can differentiate by HF units
- doesn’t need to be resected unless causing pain
- treat if >4cm, mTOR
- associated with TSC

A
73
Q

Type of scan best for detecting infected cysts?

A

CT-PET

74
Q

What is the most likely diagnosis?

A

Medullary Sponge kidney

75
Q

Name the diagnosis

A

Nephrocalcinosis

76
Q
A
77
Q

What is seen on left? (Right is normal)

A

Papillary Necrosis

78
Q
A
79
Q

Labs: Na 131, K 6.5, HCO3 13, BUN 98, Cr 9, Hb 9, phos 7, alb 3
CXR w/ inc interstital edema/CHF
UA 1+ prot, 1+ blood, 1+ LE
sediment: 10-15 RBC, 5-10 WBC, 5-10 RTE, 1-2. gran cast, amorphous crystals

A

see next question for answer/image

80
Q
A
81
Q
A

Idiopathic RP Fibrosis
- fibrotic tissue around aorta w/in RP with associated hydronephrosis

82
Q
A

Priya's Board Review (19 decks)

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