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USLME > MTB Nephro > Flashcards

MTB Nephro Flashcards

1
Q

The “best initial test” in nephrology is

A

a urinalysis and the blood urea nitrogen (BUN) and creatinine.

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2
Q

Severe proteinuria means

A

glomerular damage.

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3
Q

White blood cells in UA

A

inflammation, infection, or allergic interstitial nephritis. You cannot distinguish neutrophils from eosinophils on a UA. Neutrophils indicate infection. Eosinophils indicate allergic or acute inter- stitial nephritis.

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4
Q

Hematuria is indicative of:

A
  • Stonesinbladder,ureter,orkidney
  • Hematologic disorders that cause bleeding (coagulopathy) • Infection (cystitis, pyelonephritis)
  • Cancerofbladder,ureters,orkidney
  • Treatments (cyclophosphamide gives hemorrhagic cystitis)
  • Trauma; simply “banging” the kidney or bladder makes them shedred cells
  • Glomerulonephritis
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5
Q

When “dysmorphic” red cells are described, the correct answer is

A

glomerulonephritis.

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6
Q

The answer is cystoscopy when there is

A

hematuria without infection or prior trauma and:
• The renal ultrasound or CT does not show anetiology.
• Bladder sonography shows a mass for possible biopsy.

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7
Q

White cell cast

A

pylonephritis

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8
Q

red cell cast

A

Glomerulonephritis

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9
Q

AKI is categorized into 3 types:

A
  • Prerenal azotemia (decreasedperfusion)
  • Postrenal azotemia (obstruction)
  • Intrinsic renal disease (ischemia and toxins)
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10
Q

prerenal azotemia

A

BUN rising more than the creatinine.

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11
Q

AKI presentation

A 
AKI may present with only an asymptomatic rise in BUN and creatinine. When symptomatic, the patient feels:
• Nauseated and vomiting 
• Tired/malaise
• Weak
• Shortofbreathandedemafromfluidoverload

Very severe disease presents with:
• Confusion
• Arrhythmia from hyperkalemia and acidosis
• Sharp, pleuritic chest pain from pericarditis

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12
Q

Urine osmolality in ATN is inappropriately .

A

low

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13
Q

nephrotoxic antibiotics

A

Vancomycin, gentamicin, and amphotericin

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14
Q

Urine dipstick cannot tell the difference between:

A
  • Hemoglobin
  • Myoglobin
  • Red blood cells
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15
Q

Acute (allergic) interstitial nephritis (AIN) is

A

a form of acute renal failure that damages the tubules occurring on an idiosyncratic (idiopathic) basis. Antibodies and eosinophils attack the cells lining the tubules as a reaction to drugs (70%), infection, and autoimmune disorders.

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16
Q

Tubular disease doesnt cause

A

nephrotic syndrome ie no proteinuria

17
Q

Tubular Diseases

A
  • Acute
  • Toxins
  • None nephrotic
  • No biopsy usually
  • No steroids
  • Never additional immunosuppressive agents
18
Q

Glomerular Diseases

A
  • Chronic
  • Not from toxins/drugs
  • All potentially nephrotic
  • Biopsy sample
  • Steroids often

• UA with hematuria
• “Dysmorphic” red cells (deformed as they “squeeze” through an abnormal
glomerulus)
• Red cell casts
• Urine sodium and FENa are low • Proteinuria

19
Q 
Cancer (solid organ): 
Children: 
Injection 
NSAIDs: 
SLE:
A

Cancer (solid organ): membranous
Children: minimal change disease
Injection drug use and AIDS: focal-segmental NSAIDs: minimal change disease and membranous SLE: Any of them

20
Q

Both TTP and HUS are associated with:

A
  • Intravascularhemolysis • Renalinsufficiency

* Thrombocytopenia

21
Q

Polycystic kidney disease (PCKD) presents with:

A

Pain Hematuria Stones Infection Hypertension

22
Q

The most common causes of hyponatremia with a hypervolemic state are:

A
  • CHF
  • Nephroticsyndrome
  • Cirrhosis
23
Q

The most common causes of hyponatremia with euvolemia (normal volume status) are:

A
  • Pseudohyponatremia (hyperglycemia)
  • Psychogenic polydipsia
  • Hypothyroidism
  • Syndrome of inappropriate ADH release (SIADH)
24
Q

The EKG in severe hyperkalemia shows:

A
  • Peaked T waves
  • Wide QRS
  • PR interval prolongation
25
Q

Distal RTA (Type I)

A

The distal tubule is responsible for generating new bicarbonate under the influence of aldosterone.

26
Q

Proximal RTA (Type II)

A

Normally 85% to 90% of filtered bicarbonate is reabsorbed at the proximal tubule.

27
Q

The most common cause of kidney stones (nephrolithiasis) is calcium

A

oxalate, which forms more frequently in an alkaline urine. The most common risk factor is the overexcretion of calcium in the urine.

28
Q

Crohn disease causes kidney stones because of

A

increased oxalate absorption.

29
Q

Uric acid stones are not detectable on

A

x-ray but are visualized on CT.

30
Q

NSAID-induced renal disease does not show

A

eosinophils.

31
Q

Furosemide causes

A

ototoxicity by damaging the hair cells of the cochlea, resulting in sensorineural hearing loss

USLME (41 decks)

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