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DIT STEP 2 > GU > Flashcards

GU Flashcards

1
Q

What class of diuretic is bumetanide?

A

Loop

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2
Q

What diuretic most helpful in acute pulmonary edema

A

Loops

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3
Q

Which diuretics most helpful in glaucoma

A

CAI or mannitol

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4
Q

Which diuretic most helpful in edema a/w nephrotic syndrome

A

Loop or metolazone (very powerful thiazide)

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5
Q

Which diuretic used in increased ICP

A

Mannitol

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6
Q

Which diuretics used in altitude sickness

A

Acetazolamide

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7
Q

Most common nephrotic syndrome in adults

A

Membranous GN

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8
Q

IF: granular pattern of immune complex deposition; LM: hyper cellular glomeruli

A

Post strep GN

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9
Q

IF: linear pattern of immune complex deposition

A

Goodpastures

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10
Q

Nephrotic syndrome associated with Hep B

A

Membranoprolif (type I)

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11
Q

EM: sub endothelial humps and tram-track appearance

A

Membranoproliferative

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12
Q

L: crescent formation in the glomeruli

A

Rapidly progressive GN

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13
Q

Which nephropathy associated with HSP?

A

IgA nephropathy

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14
Q

EM: spike and dome pattern of basement membrane

A

Membranous nephritis

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15
Q

60 yo smoker found to have a varicocele that does not empty when pt is recumbent. What are you suspicious of?

A

Renal cell CA! Get a CT. DO NOT BIOPSY

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16
Q

Dietary recommendations in treatment of nephrolithiasis

A

Adequate dietary calcium (don’t reduce)
Increase fluids
Decrease Na and oxalate

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17
Q

Young black male with painless hematuria

A

Sickle cell trait

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18
Q

Treatment for uric acid renal stones

A

Alkalinize urine with sodium bicarb or sodium citrate

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19
Q

MCC of nephrotic syndrome in AA male

A

FSGS

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20
Q

Treatment of Wegeners granulomatosis

A

Cyclophosphamide, steroids

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21
Q

MCC of morbidity/mortality in SLE?

A

Lupus nephritis

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22
Q

Defining characteristics of nephrotic syndrome

A

Proteinuria > 3.5 g/day
Hyperlipidemia
Hypoalbuminemia

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23
Q

Biggest risk factor for RCC

A

Smoking

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24
Q

5 etiologies of temporary hematuria

A 
Exercise
UTI
Nephrolithiasis
Trauma
Endometriosis
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25
Q

Most common location of renal stone impaction

A

Uretero-vesico junction

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26
Q

What size calcium renal stone has a 50% likelihood of passing without surgical intervention

A

8-9 mm

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27
Q

Metabolic acidosis, normal anion gap, and low serum potassium

A

Diuretics, renal tubular acidosis types I and II, diarrhea, Fanconis syndrome

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28
Q

Metabolic acidosis, normal anion gap, high serum potassium

A

Addison’s, RTA type IV, potassium sparing diuretics, hyperalimentation from TPN

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29
Q

Volume status after thiazides

A

Dehydrated – hypovolemic OR euvolemic

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30
Q

Volume status in SIADH

A

Euvolemic

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31
Q

Volume status in hepatic cirrhosis

A

Hypervolemic

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32
Q

Volume status in Addison’s disease

A

Hypovolemic

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33
Q

Volume status in hypothyroidism

A

Euvolemic

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34
Q

Volume status in renal failure

A

Hypervolemic

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35
Q

Volume status in psychogenic polydipsia

A

Euvolemic

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36
Q

Urine sodium and urine osmolality in SIADH

A

Urine sodium >20

Urine osmol >100

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37
Q

Urine sodium and urine osmolality in psychogenic polydipsia

A

Urine sodium

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38
Q

Urine sodium and urine osmolality in Thiazides

A

Urine sodium >20

Urine osmolality > 100

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39
Q

Urine sodium and urine osmolality in alcoholism

A

Urine sodium

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40
Q

Urine sodium and urine osmolality in hypothyroidism

A

Sodium >20

Osmolality > 100

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41
Q

Hypovolemic hyponatremia and urine sodium

A

Extrarenal losses, so GI losses, fluid sequestration (peritonitis, pancreatitis), insensible loss such as sweating or extensive burns

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42
Q

Hypovolemic hyponatremia when Urine sodium >20

A

Renal losses. Diuretics, salt-wasting renal disease, partial urinary tract obstruction, adrenal insufficiency

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43
Q

If hypervolemic hyponatremia and urine so

A

CHF, cirrhosis, nephrotic syndrome

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44
Q

If hypervolemic hyponatremia and urine sodium >20?

A

Renal disease

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45
Q

5 things that shift K out of cells

A 
Low insulin
Beta blockers
Acidosis
Digoxin
Cell lysis (i.e., leukemia)
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46
Q

4 things that shift potassium into cells

A

Insulin
Beta agonists
Alkalosis
Cell creation/proliferation

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47
Q

IVF used in hyperkalemia tx

A

D50 1 amp IV followed immediately by 10 units regular insulin IV (4-6 hr effect)

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48
Q

If K+ isn’t responding to treatment (for hyperkalemia), what should you check?

A

Magnesium.

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49
Q

Next step in mgmt if you see peaked T waves on EKG?

A

Calcium gluconate to stabilize cardiac membrane

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50
Q

Flattened T waves on EKG

A

Hypokalemia

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51
Q

U waves on EKG

A

Hypokalemia

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52
Q

QT prolongation

A

Hypocalcemia

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53
Q

QT shortening

A

Hypercalcemia

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54
Q

Urine pH, serum K and serum bicarb in Type I RTA

A

This is distal. Urine pH is classically HIGH (>5.3). Serum K is decreased and serum bicarb is variable, but usually low.

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55
Q

URine pH, serum K and serum bicarb in Type II RTA

A

Proximal. Urine pH is variable (usually normal), serum K is decreased, and serum bicarb is LOW *

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56
Q

Urine pH, serum K and serum bicarb in Type IV RTA

A

Hypoaldosteronism therefore, urine pH is normal, serum K is HIGH*, and serum bicarb is normal.

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57
Q

How rapidlly can hypernatremia be corrected?

A

No faster than 12 mEq/day

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58
Q

What are the causes of euvolemic hyponatremia

A

SIADH, polydipsia, hypothyroidism

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59
Q

Meds known to cause hyperkalemia

A

ACE/ARB
Digoxin
Beta blockers
K+ sparing

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60
Q

Meds known to cause hypokalemia

A

Albuterol
Insulin
Loops, thiazides, CAI

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61
Q

Treatment for neprogenic DI

A

HCTZ +/- indomethacin

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62
Q

Treatment for nephrogenic DI if due to lithium: HCTZ + amiloride

A

HCTZ + amiloride

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63
Q

How are sodium levels corrected for high glucose

A

For every 100 mg above 100, 1.6 mEq/L of Na. However, when glucose >400, this number becomes 2.4

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64
Q

How are total calcium levels corrected for low albumin

A

For every 1 g albumin below 4, calcium decreases by 0.8 mg/dL

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65
Q

Causes of normal AG metabolic acidosis

A

Diarrhea
RTA
TPN (hyperalminetation)

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66
Q

Why are statins used in end stage renal disease

A

Not only do they lower risk of CAD, they also decrease the sepsis risk.

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67
Q

2 alternative medications used to treat BPH

A

Isoflavone (found in soy) decrease the growth of hyper plastic prostate.
Saw palmetto is as effective as finasteride, has fewer SE and decreases prostate size without changing PSA.

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68
Q

Selective a1 blocker used in BPH

A

Tamsulosin. This is used particularly if pt does not have comorbid HTN

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69
Q

Indications for surgery to treat BPH

A 
Failure of medical therapy
Refractory urinary retention
Inability to express urine without a catheter
Recurrent infection
Persistent hematuria
Bladder stones, renal insufficiency
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70
Q

Most common surgery for BPH and most common side effect?

A

TURP. Retrograde eject seen in 70%

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71
Q

Next step in mgmt of 65 year old male that presents to ER wit hinability to urinate and painful bladder distention

A

Decompression of bladder with 14-18 gauge French Foley. If h/o BPH, may require a cath withth a firm Coude tip to “power through” narrowed erethra. If unable to pass, suprapubic cath under US guidance. If no one is trained, do suprapubic needle compression.

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72
Q

Tx of epididymitis in

A

Ceftriaxone IM then doxy or azithro x 10 days

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73
Q

Tx of Epididymitis in >35 or h/o anal intercours

A

FQ x 10-14 days

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74
Q

Tx of testicular torsion

A

Surgical detorsion with bilateral orchiopexy within 5 hours

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75
Q

Somewhat common symptom in infertile men

A

Varicocele – present in 25% of infertile men

76
Q

Ultrasound on varicocele will show?

A

Retrograde flow to scrotum

77
Q

Onset difference between torsion vs epidiymitis

A

In torsion: acute, abrupt, associated with physical activity

Epididymitis: subacute and may be associated with STDS and/or anal intercourse

78
Q

Visual changes in torsion vs. epidydmitis

A

In torsion, testicle may be raised and horizontal. In epid, normal position and lie.

79
Q

Support relieves pain in torsion or epididymitis?

A

Epididymitis!!!!

80
Q

Cremasteric reflex absent in torsion or epididymitis?

A

TORSION!

81
Q

Blood flow in epididymitis

A

Normal

82
Q

Serum lab tests to check in patient presenting with ED

A

Total T, prolactin, TSH, +/- PSA

83
Q

What age should tx for nocturnal enuresis be treated?

A

At least 7 y.o.

84
Q

Why is intranasal DDAVP no longer indicated?

A

Risk of hyponatremic seizures

85
Q

Most common cause of congenital urethral obstruction

A

Posterior urethral valves

86
Q

A patient has signs of peritonitis and his clinical scenario favors rupture of the bladder (blunt trauma to fully distended bladder). What portion of th bladder mustt have been injured to allow for a chemical peritonitis to have developed?

A

Dome of bladder.

87
Q

What med is used to reduce urotoxic effects of cyclophosphamide?

A

MESNA

88
Q

What infection increases risk for bladder cancer?

A

Schistosomiasis

89
Q

When dysmorphic red cells are described, the correct answer is?

A

Glomerulonephritis

90
Q

Most accurate test of the bladder?

A

Cystoscopy

91
Q

A woman is admitted to the hospital with trauma and dark urine. The dipstick is markedly positive for blood. What is the best initial test to confirm etiology?

A

Microscopic examination of the urine.

92
Q

Initial test to assess proteinuria

A

UA

93
Q

Most accurate to determine amount of proteinuria

A

Protein to creatinine ratio. If both P/Cr ratio and 24-hour urine are in the choices, choose the P/cr ratio. It is faster and technically easier to perform.

94
Q

2 stains that detect eosinophils in the urine

A

Wright and hansel stains

95
Q

Hyaline casts cause

A

Dehydration concentrates the urine and the normal Tamm-Horsfall protein precipitates or concentrates into a cast

96
Q

Broad waxy casts are seen in?

A

chronic renal disease

97
Q

Granular “muddy brown” casts are seen in?

A

Acute tubular necrosis.

98
Q

NSAIDs constrict what part of the arteriole?

A

Afferent. therefore, they cause pre-renal azotemia.

99
Q

ACE inhibitors do what to the arteriole?

A

Cause efferent arteriole vasodilation – > prerenal azotemia.

100
Q

3 random things that can cause retroperitoneal fibrosis

A

Bleomycin
Methylsergide
Radiation

101
Q

Pre-renal azotemia is usually a clear dx if the question describes … ?

A

BUN:cr ratio >20:1 AND clear hx of hypoperfesuion or hypotensio

102
Q

Post renal azotemia is usually a clear dx with the question describing

A 
BUN:Cr > 20:1 
AND
distended bladder/massive release of urine with cath placement
AND
Bilateral/unilateral hydronephrosis.
103
Q

Why is urine osmolality in ATN inappropriately low?

A

Normal tubule cells resorb water. in ATN, the urine cannot be concentrated because the tubule cells are damaged. The urine produced in ATN, therefore, is similar in osmolality to the blood (aboutt 300). This is called isosthenuria.

104
Q

Usual findings in ATN from nephrotoxins

A

UNa >20
FENa > 1%
Low specific gravity / urine osmolality

105
Q

Contrast induced renla failure: lab values

A

Contrast causes spasm of afferent arteriole. There is tremendous reabsorption of sodium and water, leading the specific gravity of the urine to become very high. This results in profoundly low urine sodium.
UNa

106
Q

Drug that prevents renal failure due to chemo

A

Allopurinol

107
Q

Two days after chemo, the creatinine rises in a person with a hematologic malignancy. Most likely due to ?

A

Tumor lysis syndrome which lead to hyperuricemia

108
Q

Most drug toxicities that cause rise in creatinine take how many days for the effect to be seen?

A

5-10

109
Q

Why does hypocalcemia occur in rhabdo?

A

Increased calcium binding to damaged muscle

110
Q

Tx of rhabdo

A

Saline hydration, mannitol as osmotic diuretic, and bicarb which drives potassium back into cells and may prevent precipitation of myoglobin in the kidney tubule.

111
Q

Next best step in mgmt of patient with rhabod

A

Check EKg for life threatening hyperkalemia.

112
Q

tX of hepatorenal syndrome

A

Albumin, midodrine, octreotide

113
Q

Diagnostic tests in atheroemboli-induced AKI

A

Eosinophilia
Low complement levels
Eosinophiluria
Elevated ESR

114
Q

Most accurate test for papillary necrosis

A

CT scan – shows abnormal internal structures of kidney from loss of papillae

115
Q

Which classes of diuretics are associated with hyperuricemia?

A

Thiazides and loops

116
Q

Class of diuretics associated with ototoxicity

A

Loops

117
Q

Small bowel disease causes what type of renal stones?

A

Calcium oxalate

118
Q

Some toxic causes of AIN

A

Cadmium, lead, copper, mercury, certain poisonous mushrooms

119
Q

“Split basement membrane” on EM

A

Alport syndrome

120
Q

Defect in Type 1 RTA

A

Impaired H+ secretion leading to secondary hyperaldosteronism. The distal tubule is responsible for generating new bicarb under the influence of aldosterone. If new bicarb cannot be generated, acid cannot be excreted into the tubule, thus raising the pH of the urine.

121
Q

Treatment of Type 1 RTA

A

Oral bicarb, K+, thiazides

122
Q

Defect in Type 2 RTA

A

Damage to proximal tubule decreases the ability of the kidney to reabsorb most of the filtered bicarb. Bicarb is lost in the urine until the body is so depleted of bicarb that the distal tubule can absorb the rest. When this happens, the urine pH will become low.

123
Q

Random causes of Type 2 RTA

A

Multiple Myeloma, Fanconi syndrome, Wilson disease, amyloidosis, vitamin D deficiency

124
Q

Which RTA is associated with nephrolithiasis?

A

Distal / Type 1

125
Q

Which RTA is associated with hyperkalemia

A

Type 4

126
Q

Treatment of Type 4 RTA

A

Fludrocortisone, K+ restriction

127
Q

DM is associated with which RTA?

A

Type 4.

128
Q

Sickle cell disease is associated with which RTA?

A

Type 4

129
Q

Normal anion gap acidosis suggests?

A

HCO3 loss

130
Q

Increased anion gap acidosis suggests?

A

H+ excess

131
Q

Some fun causes of respiratory alkalosis

A 
Hyperventilation/fever
High altitude
Asthma
Aspirin toxicity
Pulmonary embolism
Pain
Interstitial lung disease
132
Q

Some causes of respiratory acidosis

A 
COPD
Respiratory depression
Neuromuscular diseases
Drowning
Opiate overdose
Alpha 1 antitrypsin deficiency
Kyphoscoliosis
Sleep apnea/morbid obesity
133
Q

Causes of metabolic alkalosis

A 
Vomiting
Diuretics
Cushing syndrome
Hyperaldosteronism
Adrenal hyperplasia
134
Q

Electrolyte disturbances that can cause nephrogenic DI

A

Hypercalcemia

Hypokalemia

135
Q

Tx of urge incontinence

A

Bladder training

Anti-muscarinics (oxybutynin, tolterodine, solifenacin)

136
Q

Causes of overflow incontinence

A

Bladder outlet obstruction from BPH or urehtral strictures
Impaired detrusor contractility
Neurogenic bladder

137
Q

Where in the prostate does BPH develop>

A

Central zone.

138
Q

Which types of testicular cancers have increased B-hCG and AFP?

A

Germ cell tumors

139
Q

Whichh testicular cancers have increased estrogen?

A

Streams cell tumors

140
Q

Which testicular cancers have lower cure rates and increased risk of recurrence?

A

Nonseminomas

141
Q

Treatment for cryptorchidism

A

Exog hCG admin or orchiopexy before age 5 to reduce risk of cancer and allow testicular development

142
Q

Extra NSAID use and a history of sickle cell disease points you to what kidney problem?

A

Papillary necrosis

143
Q

Proteinuria levels correspond to ?

A

Severity of disease and likelihood of progression.

144
Q

Most accurate test to dx IgA nephropathy

A

Kidney biopsy

145
Q

Tx of Goodpasture syndrome

A

Plasapheresis and steroids. Cyclophosphamide can be helpful.

146
Q

Complement levels in PSGN

A

Low

147
Q

Defect that causes Alport syndrome

A

Type IV collagen. The loss of collagen fibers that hold the lens of the eye in place cause the visual disturbances.

148
Q

Importantly, polyarteritis nodosa spares what organ?

A

lungs

149
Q

Infectious association with PAN

A

Hep B

150
Q

Skin mx of PAN

A

Purpura and petechiae, ulcers, digital gangrene, livedo reticularis.

151
Q

Standard of care and lower mortality in PAN

A

Prednisone + cyclophosphamide

152
Q

Tx of lupus nephritis

A

Glucocorticoids with either cyclophosphamide or mycophenolate

153
Q

Amyloid kidney is associated with what 5 disease states

A 
MYELOMA
Chronci inflame disease
RA
IBD
Chronic infections
154
Q

Treatment of amyloidosis

A

Melphalan and prednisone

155
Q

UA in nephrotic syndrome

A

Maltese crosses, which are lipid deposits in sloughed off tubular cells

156
Q

Why do you see HLD in nephrotic syndrome

A

Lipid levels rise because the lipoprotein signals that turn off the production of circulating lipid are lost in the urine.

157
Q

Why does renal failure cause bleeding

A

Platelets do not work normally in a uremic environment. they do not degranulate.

158
Q

Why is there hypocalcemia in renal failure

A

Kidney transforms less active 25-hydroxy vitamin D into much more active 1,25-dihydroxyvitamin D. Without this form of vitamin D, the body will not absorb enough calcium from the guy.

159
Q

Why is there accelerated atherosclerosis and hypertension in renal failure

A

The immune system helps keep arteries clear of lipid accumulation. WBC don’t work normally in uremic environment.

160
Q

Only time EPO is ALWAYS used

A

Anemia from ESRD

161
Q

Tx of bleeding in ESRD

A

DDAVP

162
Q

Tx of hyperphosphatemia in ESRD

A

Oral phosphate binders (calcium acetate, calcium carbonate, sevelamer, and lanthanum) will prevent phosphate absorption from bowel. Tx of hypocalcemia will also help because it is the hyper PTH that causes increased phos release. When Vit D is replaced, it is critical to also give phosphate binders otherwise vitamin D will increase GI absorption of of phosphate.

163
Q

When calcium level is high, which phosphate binders should you use

A

Sevelamer and lanthanum

164
Q

Drugs assoc with TTP

A

Cyclosporine
Ticlopidine
Clopidogrel

165
Q

TTP or severe HUS treatment

A

Plasmapheresis or infusions of FFP.

STEROIDS DO NOT HELP

166
Q

MCC of death from PCKD?

A

Renal failure. Recurrent episodes of peel and nephrolithiasis cause progressive scarring and loss of renal function.

167
Q

Extra renal mx of PCKD

A 
Liver cysts
Ovarian cysts
MVP
Diverticulosis
Cerebral aneurysms
168
Q

Why is there decreased urine sodium in DI?

A

These are hypovolemic states. Apparently the body cares more about your volume status than your sodium status.

169
Q

Name some hypovolemic states

A 
Sweating
Burns
Fever
PNA (from insensible losses from hyperventilation)
Diarrhea
Diuretics
170
Q

Why does hypothyroidism lead to euvolemic hyponatremia

A

Thyroid hormone is needed to excrete water.

171
Q

Tx of chronic SIADH

A

Demeclocycline, which blocks the action of ADH at the collecting duct of the kidney tubule

172
Q

3 causes of pseudo-hyperkalemia

A

Hemolysis
Repeated fist clenching wit tourniquet in place
Thrombocytosis or leukocytosis

173
Q

2 causes of hypokalemia due to renal losses that are kind of random

A

Bartter syndrome which is a genetic disease causing salt loss in the loop of Henle
Licorice.

174
Q

Relationship between hypokalemia and hypomagnesemia

A

Magnesium dependent potassium channels. When mag is low, they open and spill potassium into urine.

175
Q

Drug classic for causing distal RTA

A

Amphotericin

176
Q

Tx of Type 2 RTA

A

Thiazides cause mild volume depletion which will enhance bicarb reabsorption.

177
Q

Most common risk factor for nephrolithiasis

A

Overexertion of calcium in the urine

178
Q

How does crohns cause kidney stones

A

Increased oxalate absorption

179
Q

Fat malabsorption and stone formation

A

Fat malabsorption increased stone formation.

180
Q

Lithotripsy is used to manage stones between what sizes?

A

0.5 and 2-3 cm

181
Q

Why does calcium restriction actually increase the risk of forming calcium stones

A

CAlcium binds oxalate in the bowel. When calcium ingestion is low, there is increased oxalate absorption in the gut because there is no calcium to bind it.

182
Q

Metabolic acidosis and stone formation

A

Metabolic acidosis removes calcium from bones and increases stone formation. In addition, it decreases citrate levels. Citrate is important as it binds calcium, making it unaviailable for stone formation

183
Q

Citrate and stone formation

A

Decrease in citrate increases risk of stone formation because citrate binds calcium.

184
Q

Flutamide is used in what dz

A

Prostate CA

185
Q

Besides minoxidil, what other drug can we use to promote hair growth

A

Finasteride

186
Q

MOA of cyproterone

A

Inhibits androgens at testosterone receptor.

DIT STEP 2 (17 decks)

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