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Step 2 CK > Nephro > Flashcards

Nephro Flashcards

1
Q

Best initial test in nephrology

A

U/A and BUN and Cr

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2
Q

Only times U/A is used for screening

A

DM

HTN

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3
Q

1+ protein on U/A, next step

A

Repeat

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4
Q

What do nitrites indicate on U/A

A

G- bacteria

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5
Q

What are the 2 parts of U/A

A

Dipstick

Microscopic analysis if positive

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6
Q

What is bacteriuria

A

Bacteria w/o WBCs

Check for this in pregnancy

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7
Q

Severe proteinuria (4+) only happens in

A

Glomerular disease

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8
Q

When should a kidney Bx be performed w/ persistent proteinuria

A

When it is not associated w/ prolonged standing

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9
Q

What does a urine dipstick detect

A

Albumin

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10
Q

Normal protein per day in urine

A

Less than 300mg per 24hrs

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11
Q

Test used for total amount of protein in a day

A

Single protein to creatinine ratio

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12
Q

What determines the cause of proteinuria

A

Bx

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13
Q

What is microalbuminuria

A

30-300mg/24hrs

Seen in DM

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14
Q

Best initial therapy for Microalbuminuria in DM

A

ACEIs or ARBs

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15
Q

What does the presence of WBCs in the urine indicate

A

Inflammation
Infection
Allergic intersitital nephritis

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16
Q

Stains used to detect eosinophils in urine

A

Wright and Hansel

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17
Q

What do eosinophils in the urine indicate

A

AIN

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18
Q

Persistent WBCs on U/A w/ neg Cx indicates

A

TB

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19
Q

Normal RBCs in urine

A

Less than 5 per HPF

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20
Q

What is hematuria indicative of

A 
Stones
Coagulopathies
Infection
CA
Cyclophosphamide
Trauma
Glomerulonephritis
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21
Q

What is the different about hematuria in glomerulonephritis

A

Dysmorphic RBCs

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22
Q

Best initial test for dark urine w/ blood on dipstick

A

Microscopic examination

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23
Q

Hematuria w/o infection/trauma and renal U/S and CT neg but bladder CT shows mass

A

Cystoscopy

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24
Q

Most accurate test for bladder

A

Cystoscopy

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25
Q

When do you find RBC casts

A

Glomerulonephritis

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26
Q

When do you find WBC casts

A

Pyelonephritis, Interstitial nephritis

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27
Q

When do you find eosinophil casts

A

Allergic interstitial nephritis

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28
Q

When do you find hyaline casts

A

Dehydration, Prerenal azotemia

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29
Q

When do you find broad, waxy casts

A

Chronic renal disease

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30
Q

When do you find granular casts

A

ATN

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31
Q

What is AKI

A

Decrease in Cr clearance leading to sudden rise in BUN and Cr

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32
Q

Causes of AKI if it happens in hours

A

Rhabdo

Contrast

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33
Q

Causes of AKI if it happens in weeks

A 
Aminoglycosides
Vanco
Genti
Amphoteracin
Post-strep
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34
Q

Main issue in prerenal azotemia

A

Inadequate perfusion

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35
Q

Causes of prerenal azotemia

A 
Hypotension
Hypovolemia
Renal artery stenosis
Shock
Hypoalbuminemia
Cirrhosis
NSAIDs
ACEIs
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36
Q

How do ACEIs cause AKI

A

Dilate efferent
Decrease hydrostatic pressure in glomerulus
Decrease GFR

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37
Q

How do NSAIDs cause AKI

A

Constrict afferent
Decrease hydrostatic pressure in glomerulus
Decrease GFR

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38
Q

How to manage medication induced AKI

A

Decrease trough levels by spacing doses

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39
Q

Main cause of postrenal azotemia

A

Obstruction

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40
Q

Causes of postrenal azotemia

A 
Prostate CA or BPH
Stone
Cervical CA
Urethral stricture
Atonic bladder
Fibrosis (bleomycin, methylsergide)
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41
Q

Greatest driving force for GFR

A

Hydrostatic pressure in glomerular capsule

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42
Q

Main management for pre and postrenal azotemia

A

Treat underlying cause

Therefore it is reversible in the majority of cases

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43
Q

MCC intrinsic renal failure

A

ATN from toxins or prolonged ischemia

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44
Q

Other causes of intrinsic renal failure

A 
AIN
Rhabdo and hemoglobinuria
Drugs 
Crystal
Bence-Jones
Post-strep
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45
Q

MC toxins causing ATN

A 
NSAIDs
Contrast
Aminoglycosides
Cisplatin
Amphotericin
Cyclosporine
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46
Q

Only time AKI can present w/ specific sx

A

Postrenal
Enlargement of bladder on U/S
Massive void after cath

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47
Q

Best initial test for AKI

A

BUN and Cr

20: 1 = pre/postrenal
10: 1 = Intrinsic

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48
Q

Best initial imaging test for AKI

A

Sonogram

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49
Q

Most accurate test for AKI

A

Kidney Bx

Never done

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50
Q

Next best step if AKI etiology is unclear

A

U/A (first)
UNa
FENa
Uosm

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51
Q

Relationship between UNa and FENa

A

Low FENa means Low UNa

And vice versa

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52
Q

Why is Uosm low in ATN

A

Water cannot be reabsorbed since tubules are damaged
Urine cannot be concentrated
Extra Na is also lost

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53
Q

What is the only significant manifestation of sickle cell trait

A

Defect in renal concentrating ability (isosthenuria)

Therefore try not to get dehydrated

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54
Q

Lab value predictor for Urine specific gravity

A

Uosm

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55
Q

Best way to prevent contrast-induced nephrotoxicity

A

Saline hydration (best)
NAC
Bicarb

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56
Q

Lab changes in contrast-induced nephropathy

A

UNa very low

FENa

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57
Q

While both prerenal azotemia and ATN can be caused by hyperperfusion, how is ATN different

A

BUN:Cr = 20
FENa >1
Uosm

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58
Q

Post chemo increase in creatinine is caused by

A

Hyperuricemia (Tumor lysis syndrome)

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59
Q

How long does cisplatin take to cause elevation in creatinine

A

5-10 days

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60
Q

How to prevent tumor lysis syndrome in chemo

A

Allopurinol, hydration and rasburicase

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61
Q

How does ethylene glycol cause renal failure

A

Oxalate precipitation in kidney tubules

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62
Q

Why is there hypocalcemia in ethylene glycol poisoning

A

Precipitates as Ca oxalate

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63
Q

Loss of kidney function w/ age

A

1% loss per year over 40

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64
Q

What can increase risk of aminoglycoside or cisplatin nephrotoxicity

A

Low Mg

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65
Q

Rx ethylene glycol nephrotoxicity

A

Ethanol or Fomepizole

Remove ethylene glycol w/ dialysis

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66
Q

Management of elevated PTH w/ no renal damage or stones

A

No need to treat

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67
Q

Best initial test for rhabdomyolysis

A

U/A - blood on dipstick, no cells on microscopy

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68
Q

Most specific test for rhabdomyolysis

A

Urine test for myoglobin

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69
Q

Lab findings in Rhabdo

A

Elevated CPK
Hyperkalemia
Hyperuricemia
Hypocalcemia

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70
Q

Rx rhabdo

A

Saline hydration
Mannitol
Bicarb (PROTECT THE HEART)

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71
Q

Next best step in suspected rhabdo

A

EKG

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72
Q

Rx ATN

A

No proven therapy

Diuretics increase urine output

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73
Q

When do you do dialysis in ATN

A 
Fluid overload
Encephalopathy
Pericarditis
Metab acid
Hyperkalemia
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74
Q

AE Furosemide

A

Ototoxicity

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75
Q

What is hepatorenal syndrome

A

Renal failure 2/2 liver disease

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76
Q

What to look for in hepatorenal syndrome

A

Cirrhosis
New onset renal failure w/o explanation
Very low UNa
FENa 20:1

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77
Q

Rx Hepatorenal syndrome

A

Midodrine
Octreotide
Albumin

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78
Q

What to look for in cholesteral atheroemboli causing AKI

A

Blue/purplish lesions in fingers and toes
Livedo reticularis (Blue fishnet)
Normal peripheral pulses
Ocular lesions

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79
Q

Dx tests in cholesteral atheroemboli causing AKI

A

Eosinophilia
Low complement
Eosinophiliuria
Elevated ESR

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80
Q

Most accurate test for cholesteral atheroemboli causing AKI

A

Bx of a purplish lesion

Shows cholesterol crystals

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81
Q

Rx cholesteral atheroemboli causing AKI

A

None

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82
Q

MCC AIN

A

Drugs

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83
Q

MC drugs causing AIN

A 
PCN, Ceph
Sulfas
Phenytoin
Rifampin
Quinolones
Allopurinol
PPIs
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84
Q

Drugs causing AIN can also cause

A

Allergy, rash
SJS
TEN
Hemolysis

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85
Q

Drugs causing AIN affect what target organs

A

Skin
Kidney
Blood

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86
Q

Non-drug causes of AIN

A

SLE
Sjogren
Sarcoidosis

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87
Q

Acute presentation of AIN

A

Fever (80%)
Rash (50%)
Eosinophilia and eosinophiluria (80%)
Arthrangias

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88
Q

Dx tests in AIN

A

BUN:Cr =

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89
Q

Best initial test for eosinophiluria

A

U/A

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90
Q

Most accurate test for AIN

A

Hansel or Wright stain for eosinophils

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91
Q

Rx AIN

A

Spontaneous resolution

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92
Q

Presentation of analgesic nephropathy

A 
ATN from direct toxicity to tubules
AIN
Membranous glomerulonephritis
Vascular insufficiency from PG inhibition
Papillary necrosis
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93
Q

How do NSAIDs cause vascular insufficiency in the kidney

A

Older pts w/ DM or HTN causing renal insufficiency
NSAIDs inhibit PGs which dilate afferent arteriole
Tips them over into renal failure

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94
Q

How to Dx analgesic nephropathy

A

Exclude other causes

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95
Q

What is papillary necrosis

A

Sloughing off of renal papillae

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96
Q

Cause of papillary necrosis

A

NSAIDs in the setting of ongoing renal damage

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97
Q

When to suspect papillary necrosis

A

NSAID use w/ hx of

  • Sickle cell
  • DM
  • Urinary obstruction
  • Chronic pyelo
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98
Q

Presentation of papillary necrosis

A

Sudden onset flank pain fever and hematuria

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99
Q

Best initial test for papillary necrosis

A

U/A showing necrotic material, RBCs, WBCs

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100
Q

Most accurate test for papillary necrosis

A

CT

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101
Q

Rx papillary necrosis

A

None

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102
Q

Features of papillary necrosis

A 
Few hrs of sx
Necrotic material in urine
Neg UCx
Bumpt inner contour on CT
No Rx
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103
Q

Features of Pyelonephritis

A 
Few days of sx
Dysuria
Pos UCx
Diffusely swollen kidney on CT
Ampi/Genta/quinolone for Rx
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104
Q

Features of all tubular diseases

A 
Acute
Toxins
None nephrotic
No Bx
No Steroids
No immunosuppresives
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105
Q

Features of all glomerular diseases

A 
Chronic
Not from toxins
All potentially nephrotic
Bx needed
Steroids often
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106
Q

All forms of glomerulonephritis have

A 
Hematuria on UA
Dysmorphic RBCs
RBC casts
Proteinuria
Low UNa and FENa
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107
Q

Features of Goodpasture

A

Lung and Kidney involvement
No URT
No skin, joint, GI, eye or neuro

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108
Q

Best initial test for Goodpasture

A

Antiglomerular BM Abs

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109
Q

Most accurate test for Goodpasture

A

Lung or Renal Bx

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110
Q

Rx Goodpasture

A

Plasmapheresis and steroids

Cyclophosphamide can help

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111
Q

What does renal bx show in goodpasture’s

A

Linear deposits

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112
Q

MCC acute glomerulonephritis

A

IgA nephropathy (Berger disease)

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113
Q

Features of IgA nephropathy

A

Asian

Recurrent gross hematuria 1-2 days after URI

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114
Q

Most accurate test for IgA nephropathy

A

Bx

IgA elevated in 50%

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115
Q

Rx IgA nephropathy

A

Nothing reverses
30% spont resolve
40-50% go to ESRD
Rx proteinuria w/ ACEIs and steroids

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116
Q

MC organism leading to postinfectious glomerulonephritis

A

Strep

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117
Q

How long after strep infectious do you get PSGN

A

1-3 weeks

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118
Q

Presentation of PSGN

A

Dark (cola coloured) urine
Periorbital edema
HTN
Oliguria

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119
Q

UA in PSGN

A

Proteinuria
RBCs
RBC casts

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120
Q

Confirmation of PSGN from group A beta hemolytic strep

A

Antistreptolysin O titres

Anti-DNAse Ab

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121
Q

Most accurate test for PSGN

A

Bx (not routine)

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122
Q

Complement levels in PSGN

A

Low

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Perfectly
123
Q

Management of PSGN

A

ABX
Diuretics
This doesn’t reverse glomerulonephritis

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124
Q

What is Alport syndrome

A

Congenital defect in collagen

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125
Q

Features of Alport syndrome

A 
Sensorineural hearing loss
Visual disturbances (lens doesn't stay in place)
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126
Q

Features of PAN

A

Systemic vasculitis
Spares lungs
Associated w/ Hep B

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127
Q

Presentation of PAN

A 
Glomerulonephritis
Fever, wt loss, myalgias, arthralgias
GI - pain worse w/ eating
Neuro - Stroke in young person
Skin - Distal gangrene, livedo reticularis
Cardiac disease
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128
Q

Dx tests in PAN

A

Anemia and leukocytosis
Elevated ESR and CRP
ANCA not present
ANA and RF sometimes

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129
Q

Most accurate test for PAN

A

Bx of symptomatic area

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130
Q

How to confirm PAN when symptomatic area cannot be biopsied

A

Angiography (Renal, Mesenteric, Hepatic artery)

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131
Q

Rx PAN

A

Prednisone and Cyclophosphamide

Treat Hep B

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132
Q

Renal disease in SLE

A

Normal
Mild ASx proteinuria
Membranous glomerulonephritis
Glomerulosclerosis

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133
Q

Most accurate test in lupus nephritis

A

Bx, not to Dx but to determine stage of disease

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134
Q

Rx mild SLE nephritis

A

Glucocorticoids

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135
Q

Rx severe SLE nephritis

A

Glucocorticoids plus cyclophosphamide/mycophenolate

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136
Q

What is amyloidosis associated with

A 
Myeloma
Chronic inflammatory diseases
RA
IBD
Chronic infections
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137
Q

What conditions show large kidneys on CT and U/S

A

Amyloid
HIV
PKD
DM

138
Q

Dx amyloidosis

A

Bx

Green birefringence on congo red

139
Q

Rx Amyloidosis

A

Rx underlying disease

If fail, Melphalan and prednisone

140
Q

What is nephrotic syndrome

A

Measurement of severity of proteinuria in glomerular disease

Ie. 4+

141
Q

Sequelae from massive proteinuria

A

Edema
Hyperlipidemia
Thromgosis (Loss of protein C, S, antithrombin III)

142
Q

MCC Nephrotic syndrome

A

DM

HTN

143
Q

Other causes of nephrotic syndrome

A 
Any nephritic syndrome
CA
NSAIDs
IVDU, AIDS
SLE
144
Q

Nephrotic syndrome associated w/ CA

A

Membranous

145
Q

Nephrotic syndrome associated w/ children

A

Minimal Change Disease

146
Q

Nephrotic syndrome associated w/ IVDU/AIDS

A

Focal-segmental

147
Q

Nephrotic syndrome associated w/ NSAIDS

A

Minimal change and membranous

148
Q

Nephrotic syndrome associated w/ SLE

A

Any

149
Q

Why are infections more common in people w/ nephrotic syndrome

A

Igs and Complement lost in urine

150
Q

Difference between edema in CHF vs nephrotic

A

CHF - legs (dependent areas)

Nephrotic - Everywhere

151
Q

Why are there problems in skin healing in nephrotic syndrome

A

Loss of Zn

152
Q

Best initial test in nephrotic syndrome

A

UA

153
Q

What is iseen on UA in nephrotic syndrome

A

Maltese crosses (lipid deposits)

154
Q

Most accurate test for nephrotic syndrome

A

Renal Bx

155
Q

Nephrotic syndrome associated w/ Chronic Hep B

A

Membranoproliferative
Rx w/ IFN, Ribavirin
Dypiridamole, Aspirin

156
Q

Definition of Nephrotic syndrome

A

Hyperproteinuria (>3.5g/24hrs)
Hypoproteinemia
Hyperlipidemia
Edema

157
Q

Best initial therapy for nephrotic syndrome

A

Glucocorticoids

Cyclophosphamide if no response after wks

158
Q

Other therapies for nephrotic syndrome

A

ACEIs/ARBs to control proteinuria
Salt restriction and diurectics for edema
Statins for hyperlipidemia

159
Q

What is ESRD

A

Chronic renal failure so severe that there is need for dialysis

160
Q

MCC ESRD

A

DM

HTN

161
Q

Uremia is the presence of

A 
Metabolic acidosis
Fluid overload
Encephalopathy
Hyperkalemia
Pericarditis
162
Q

Uremia or it’s individual components are an indication for

A

DIalysis

163
Q

Complication of peritoneal dialysis

A

Peritonitis w/ S. aureus

164
Q

Manifestations of renal failure

A 
Anemia
Hypocalcemia
Osteodystrophy
Bleeding
Infection
Pruritis
Hyperphosphatemia
Accelerated atherosclerosis and HTN
Endocrinopathy
ED
165
Q

Anemia features in ESRD

A

Low EPO = normocytic normochromic

166
Q

How does osteodystrophy and hyperphosphatemia happen in ESRD

A

Low Ca → High PTH → High PO4 and Ca is removed from bone making it softer

167
Q

Why does infection and bleeding occur in ESRD

A

Platelets and WBCs do not degranulate

168
Q

Why does hypocalcemia occur in ESRD

A

Kidney can’t transform 25-OH vit D to 1,25-OH vit D and so Ca cannot be absorbed in gut

169
Q

Endocrinopathy features of ESRD

A

Women are anovulatory

Men have low testosterone

170
Q

Rx Anemia in ESRD

A

EPO replacement and Fe supplementation

171
Q

Rx hypocalcemia and osteomalacia in ESRD

A

Replace Vit D and Ca

172
Q

Rx Bleeding in ESRD

A

DDAVP

173
Q

Rx Pruritisin ESRD

A

Dialysis and UV light

174
Q

Rx Hyperphosphatemia in ESRD

A

Oral binders

175
Q

Rx Hypermagnesemia in ESRD

A

Restriction of high Mg foods

176
Q

Rx Atherosclerosis in ESRD

A

Dialysis

177
Q

Rx Endocrinopathy in ESRD

A

Dialysis, estrogen and testosterone replacement

178
Q

What oral binders are used to rx hyperphosphatemia in ESRD

A

Ca acetate
Ca carbonate
Sevelamer
Lanthanum

179
Q

What do you never use to rx hyperphosphatemia in ESRD

A

Al containing binders

Al can cause dementia

180
Q

Importance of Renal transplant in ESRD

A

Only 50% are eligible
Live donors > Cadavers
Related > Unrelated

181
Q

What are both HUS and TTP associated with

A

Intravascular hemolysis
Renal insufficiency
Thrombocytopenia

182
Q

Peripheral smear of hemolysis in TTP/HUS

A

Schistocytes
Helmet cells
Fragmented RBCs

183
Q

What is TTP associated with

A

Neuro sx

Fever

184
Q

Coagulation profile in TTP/HUS

A

NL PT and aPTT

185
Q

Rx HUS from E. coli

A

Spontaneous resolution

186
Q

Rx TTP

A

Plasmapheresis

Also for severe HUS

187
Q

Plasmapheresis not an option for TTP/severe HUS, now what

A

FFP

188
Q

Features of simple kidney cysts

A

Echo free
Smooth, thin walls
Sharp demarcation
Transmission good through to back

189
Q

Features of complex cysts (potential malignancy)

A

Mixed echogenicity
Irregular, thick walls
Low density on back wall
Debris in cyst

190
Q

What to do with renal cysts

A

Simple - Nothing

Complex - Aspirate

191
Q

Presentation of PKD

A 
Pain
Hematuria
Stones
Infection
HTN
192
Q

MCC death from PKD

A

Renal failure from recurrent pyelo and stones causing scarring

193
Q

Pts w/ PKD may also have

A

Liver cysts (MC)
Ovarian cysts
MVP
Diverticulosis

194
Q

Only true treatment for PKD

A

Transplant

195
Q

How is free water lost

A

Skin - sweat, burns
Urine - diuretics
GI - diarrhea

196
Q

How does DI occur

A

High volume water loss from insufficient/ineffective ADH

197
Q

How does CDI occur

A

Any damage to hypothalamus/post pit

198
Q

How does NDI occur

A

Loss of ADH effect on collecting duct

  • Li
  • Hypokalemia
  • Hypercalcemia
  • Demeclocycline
199
Q

First clue to presence of DI

A

High volume nocturia

200
Q

Sx of DI and hypernatremia

A

Neuro sx

  • Confusion
  • Disorientation
  • Lethargy
  • Seizures
201
Q

Best initial test for DI

A

Water deprivation test

- DI urine volume stays high and osmolality stays low

202
Q

How does DI respond to ADH

A

CDI - sharp decrease in urine volume, increase in osmolality

NDI - No change in volume or osmolality

203
Q

ADH in DI

A

Low in CDI

High in NDI

204
Q

Rx fluid loss in DI

A

Correct underlying cause

205
Q

Rx CDI

A

Replace ADH - DDAVP

206
Q

Rx NDI

A

Correct K and Ca
Stop Li or demeclocycline
Give HCTZ or NSAIDs if above fail

207
Q

What can happen from rapid correction of hypernatremia

A

Cerebral edema causing confusion and seizures

208
Q

MCC of hyponatremia w/ hypervolemia

A

CHF
Nephrotic syndrome
Cirrhosis

209
Q

Causes of hypovolemic hyponatremia

A

Same as causes for hypernatremia

They will lead to hyponatremia w/ chronic replacement with free water

210
Q

How does addison’s cause hyponatremia

A

Loss of aldosterone which normally causes Na reabsorption

211
Q

MCC hyponatremia w/ euvolemia

A

Pseudohyponatremia (hyperglycemia)
Psychogenic polydipsia
Hypothyroidism
SIADH

212
Q

How does hyperglycemia cause hyponatremia

A

Glucose draws water out of cells to correct increase osmolarity
This leads to a relative decrease in Na in the serum
Corrected by correcting glucose level

213
Q

Relationship of glucose to Na

A

Every 100mg/dL glucose above NL drops Na by 1.6meq/L

214
Q

Difference between psychogenic polydipsia and NDI

A

HypoNa in psycho

HyperNa in NDI

215
Q

Difference between psychogenic polydipsia and NDI if Na is NL

A

NDI has massive nocturia

216
Q

What in the Hx is a clue for psychogenic polydipsia

A

Bipolar disorder

217
Q

How does hypothyroidism cause euvolemic hyponatremia

A

TH needed for water excretion

218
Q

What causes SIADH

A

Any lung or brain disease
Drugs
Cancers
Pain

219
Q

What drugs cause SIADH

A 
SSRIs
Sulfonureas
Vincristine
Cyclophosphamide
TCAs
220
Q

What Pulm conditions cause SIADH

A

Malignancies (small cell)
TB, sarcoid
Abscess

221
Q

What brain conditions cause SIADH

A

Head injury

Stroke

222
Q

Urine values in SIADH

A

UNa increased

Uosm increased

223
Q

Most accurate test for SIADH

A

High ADH level

224
Q

Presentation of hyponatremia

A

Exclusively CNS sx

  • Confusion
  • Lethargy
  • Disorientation
  • Seizures
  • Coma
225
Q

Lab tests for SIADH

A

UNa innapropriately high

Uric acid and BUN are low

226
Q

Rx mild hyponatremia

A

Restrict fluids

227
Q

Rx moderate hyponatremia (minimal confusion)

A

Saline and loop diuretics

228
Q

Rx severe hyponatremia

A

Hypertonic saline, conivaptan, tolvaptan

229
Q

Rx chronic SIADH (malignancy)

A

Demeclocycline

230
Q

How fast should Na be corrected in hyponatremia

A

Under 0.5 to 1 meq per hr or 12-24meq per day

231
Q

What can happen if hyponatremia is corrected too quickly

A

Central pontine myelinosis (osmotic demyelination)

232
Q

What happens in SIADH is saline is given w/o diuretic

A

Gets worse

233
Q

What can happen is K levels are high enough

A

Stops the heart

234
Q

What causes pseudohyperkalemia

A

Hemolysis
Repeated fist clenching w/ tourniquet
Thrombocytosis or leukocytosis

235
Q

What causes decreased excretion of K

A

Renal failure

Aldosterone decrease

236
Q

What causes aldosterone decrease

A 
ACEIs/ARBs
Type IV RTA
Spironolactone/eplerenone
Tramterene, amiloride
Addison
237
Q

What causes K release from tissues

A 
Tissue destructions
Decreased insulin
Acidosis
BBs, and digoxin
Heparin
238
Q

What to look for in hyperkalemia

A

Weakness and possible paralysis
Ileus
Cardiac rhythm disorders

239
Q

Most urgent test in severe hyperkalemia

A

EKG

240
Q

EKG in severe hyperkalemia

A

Peaked T waves
Wide QRS
PR prolongation

241
Q

Rx hyperkalemia w/ abnormal EKG

A

Ca chloride or Ca gluconate
Insulin and glucose
Bicarb

242
Q

What is given to remove K from body

A

Sodium polystyrene sulfonate (Kayexalate)

Dialysis

243
Q

What is given to lower K in a non-acute setting

A

Insulin and bicarb
Inhaled beta agonists
Loops
Dialysis

244
Q

Hyperkalemia w/ abnormal EKG, most appropriate next step

A

Ca chloride or gluconate

245
Q

What causes hypokalemia

A 
Decreased intake
Shift into cells
Renal loss
Gi loss
Hypomagnesemia
RTA I, II
246
Q

What causes K to shift into cells

A

Alkalosis
Increased insulin
Beta agonists

247
Q

What causes renal loss of K

A 
Loops
Increased aldosterone
- Addison's
- Conn
- Cushing
- Licorice
Volume depletion
Bartter
248
Q

What causes GI loss of K

A

Vomitting
Diarrhea
Laxative abuse
B12/folate replacement

249
Q

Presentation of hypokalemia

A

Weakness
Paralysis - Can cause rhabdo
Loss of reflexes

250
Q

EKG findings in hypokalemia

A

U waves
PVCs
Flattened T
ST depression

251
Q

What are U waves

A

Purkinje repolerization

252
Q

Rx Hypokalemia

A

Replace K

  • Oral replacement has no max rate
  • Replace via IV too fast and risk fatal arrhythmia
253
Q

What to check if hypokalemia isn’t resolving

A

Mg levels

254
Q

Most important step in life threatening hyperkalemia

A

EKG

255
Q

Most important causes of metabolic acidosis with normal anion gap

A

RTA

Diarrhea

256
Q

Why is anion gap normal in RTA and diarrhea

A

Elevated Cl levels

257
Q

What does the distal tubule do

A

Generate new bicarb due to aldosterone

258
Q

What is affected in type I RTA

A

Distal tubule

259
Q

What damages the distal tubule

A

Amphoteracin
SLE
Sjogren

260
Q

What happens in Distal RTA

A

pH of urine increases as acid can’t be excreted

Increases formation of kidney stones

261
Q

Best initial test for Distal RTA

A

UA looking for pH > 5.5

262
Q

Most accurate test for Type I RTA

A

Infuse acid into blood w/ ammonium chloride

pH will remain >5.5 rather than decreasing as it should

263
Q

Rx Distal RTA

A

Replace bicarb

264
Q

What is damaged in Type II RTA

A

Proxmial tubule

265
Q

What causes proximal RTA

A 
Amyloidosis
Myeloma
Fanconi
Acetazolamide
Heavy metals
266
Q

What happens in proximal RTA

A

Bicarb is filtered but not reabsorbed in proximal so it is reabsorbed in distal to prevent body depletion of bicarb

267
Q

Urine pH in proximal RTA

A

Starts basic and then becomes acidic

268
Q

Most accurate test for proximal RTA

A

Give bicarb and urine pH rises

269
Q

Common finding in both proximal and distal RTA

A

Hypokalemia

270
Q

Rx proximal RTA

A

Thiazides to cause volume depletion which will enhance bicarb reabsorption

271
Q

Who gets Type IV RTA

A

DM

272
Q

How does Type IV RTA occur

A

Decreased renin leads to decreased aldosterone which causes increased K

273
Q

What is the test for Type IV RTA

A

Persistently high UNa despite Na depleted diet

Hyperkalemia

274
Q

Which RTA has High K

A

4

275
Q

Which RTA has kidney stones

A

1

276
Q

Urine pH in Type IV RTA

A
277
Q

Rx Type IV RTA

A

Fludrocortisone

278
Q

Differentiate between RTA and diarrhea

A

Na minus Cl (in urine)

  • Positive in RTA
  • Negative in Diarrhea
279
Q

Causes of elevated anion gap metabolic acidosis

A 
Methanol
Uremia
DM
Paraldehyde
INH
Lactate
Ethylene glycol
Salicylates
280
Q

Compensation for all forms of metabolic acidosis

A

Respiratory alkalosis from hyperventilation

281
Q

Test for methanol OD

A

Inflamed retina

282
Q

Rx methanol OD

A

Fomepizole, dialysis

283
Q

Test for ketoacidosis

A

Acetone levels

284
Q

Rx lactic acidosis

A

Correct hypoperfusion

285
Q

ABG in metabolic acidosis

A

pH

286
Q

Etiologies of metabolic alkalosis

A 
GI loss
Increased aldosterone 
Diuretics
Milk-alkali syndrome
Hypokalemia
287
Q

ABG in metabolic alkalosis

A

pH > 7.4
Increased pCO2 (resp acid compensation)
Increased bicarb

288
Q

Features of respiratory alkalosis

A

Decreased pCO2
Increased minute ventilation
Metab acid as compensation

289
Q

Features of respiratory acidosis

A

Increased pCO2
Decreased minute ventilation
Metab alk as compensation

290
Q

What is minute ventilation

A

RR x TV

291
Q

Causes of resp alkalosis

A 
Anemia
Anxiety
Pain
Fever
Interstitial lung disease
Pulm emboli
292
Q

Causes of resp acidosis

A 
COPD/emphysema
Drowning
Opiate OD
A1AT def
Kyphoscoliosis
OSA/morbid obesity
293
Q

MCC nephrolithiasis

A

Calcium oxalate

Forms frequently in alkaline urine

294
Q

MCC hypercalcemia

A

Hyperparathyroidism

295
Q

Why does crohn’s cause kidney stones

A

Increased oxalate absorption

296
Q

Rx pain in nephrolithiasis

A

Ketorolac

297
Q

Most accurate test for kidney stones

A

CT w/o contrast

298
Q

Best initial therapy for acute renal colic

A

Analgesics (ketorolac) and hydration

CT and sonography

299
Q

How to determine kidney stone etiology

A

Stone analysis (once passed)
Serum Ca, Na, uric acid, PTH, Mg, PO4
24hr urine for volume, Ca, oxalate, citrate, cysteine, pH, uric acid, PO4, Mg

300
Q

How to manage stones between 0.5cm and 2-3cm

A

Lithotripsy

301
Q

How to manage stones greater than 2-3cm

A

Surgical stent placement

Relieves hydronephrosis

302
Q

Stones in UTI

A

Struvite (Mg, NH4, PO4)

Remove surgically

303
Q

Recurrence of kidney stones

A

50% will recur over next 5 years

304
Q

Long term management for recurrent kidney stones

A

HCTZ to remove Ca from urine

305
Q

How does metab acid affect stone production

A

Removes Ca from bone and increases formation

Citrate binds Ca, making it unavailable

306
Q

Sx for stress incontinence

A

Painless leakage w/ coughing, laughing, lifting heavy objects

307
Q

Test for stress incontinence

A

Stand or cough and observe for leakage

308
Q

Rx stress incontinence

A

Kegel
Estrogen cream
Surgical tightening

309
Q

Sx for urge incontinence

A

Pain in bladder and overwhelming urge to urinate

310
Q

Test for urge incontinence

A

Pressure management in half-full bladder

Manometry

311
Q

Rx urge incontinence

A 
Bladder training exercises
Local anticholinergics
- oxybutinin
- tolterodine
- solifenacin
- dariferancin
Surgical tightening
312
Q

MC disease in USA

A

HTN

313
Q

MCC HTN

A

Essential

314
Q

What is HTN

A

> 140/90

Repeated at calm state over time

315
Q

HTN in DM or chronic renal disease

A

> 130/80

316
Q

Known causes of HTN

A 
Renal artery stenosis
Glomerulonephritis
Coarctation
Acromegaly
OCPs
OSA
Pheochromocytoma
Hyperaldosteronism
Cyshing
CAH
317
Q

How do Sx occur in HTN

A

End organ damage from atherosclerosis

318
Q

Sx in HTN

A 
CAD
Cerebrovascular disease
Visual disturbance
Renal insufficiency
CHF
PAD
319
Q

Sx renal artery stenosis

A

Bruit
Best initial test - U/S
Rx angioplasty

320
Q

Sx Coarctation

A

Upper extremity BP > lower extremity BP

321
Q

Sx Pheochromocytoma

A

Episodic HTN w/ flushing

Most accurate test - MIBG scan

322
Q

Sx hyperaldosteronism

A

Weakness from hypokalemia

323
Q

Dx tests for HTN

A

EKG
UA
Glucose
Cholesterol

324
Q

Best initial therapy for HRN

A 
Weight loss
Na restriction
Dietary modification
Exercise
Tobacco cessation
325
Q

How long is lifestyle modification attempted before meds in HTN

A

3-6mos

326
Q

Best initial drug therapy for HTN

A

Thiazides

327
Q

When to give 2 meds for HTN

A

> 160/100

328
Q

Most appropriate next step if thiazides aren’t controlling

A

ACEIs
ARBs
BBs
CCBs

329
Q

Pregnancy safe HTN drugs

A

BB (#1)
CCB
Hydralazine
Alpha methyldopa

330
Q

Rx HTN w/ CAD

A

BB
ACE
ARB

331
Q

Rx HTN w/ DM

A

ACE

ARB

332
Q

Rx HTN w/ BPH

A

Alpha blockers

333
Q

Rx HTN w/ depression and asthma

A

Avoid BBs

334
Q

Rx HTN w/ Hyperthyroidism

A

BB first

335
Q

Rx HTN w/ osteoporosis

A

Thiazides

336
Q

What is hypertensive crisis

A

HTN + end organ damage

337
Q

DBP in hypertensive crisis

A

120-130

338
Q

Sx hypertensive crisis

A

Confusion
Blurry vision
Dyspnea
CP

339
Q

Best initial therapy in hypertensive crisis

A

Labetalol or nitroprusside

340
Q

Alternative therapy in hypertensive crisis

A

Enalapril
CCBs - verapamil, diltiazem
Esmolol

341
Q

BP goal in acute management for hypertensive crisis

A

DBP above 95-100 (25% decrease)

342
Q

Complications of HTN

A

MI
Aneurysm
PVD
Stroke

Step 2 CK (21 decks)

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