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COMLEX STEP 1 2017 > Renal + Genitourinary > Flashcards

Renal + Genitourinary Flashcards

1
Q

What is most likely disorder?
2-4 yr old child

left upper quadrant abdominal mass

histology = dense, immature islands of epithelial cells, ribbons of spindled fibroblastic stromal cells, poorly formed tubular structures

typically healthy appearing

A

Wilms Tumor

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2
Q

What is the possible presentation of Wilms tumor?

A 
abdominal mass
hypertension
nausea
hematuria
intestinal obstruction
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3
Q

What is a gene mutation a/w Wilms tumor?

A

WT1

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4
Q

What is the histological contents of a Wilms tumor

A

Embryonic glomerular structures/blastemal cells

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5
Q

What end organ damage is frequently a/w Fabry dz?

A

Cerebrovascular (transient ischemic attack, stroke)
Cardiac (left ventricular hypertrophy)
renal failure - proteinuria, polyuria

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6
Q

What are clinical features of Antiphospholipid antibody syndrome?

A

Frequently unexplained miscarriages***

Prolonged activated partial thromboplastin time

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7
Q

What is the disease:
edema
cola colored urine
PMH of skin infection

A

Poststreptococcal glomerulonephritis

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8
Q

What is the pathogen:
Indwelling Catheter
rigors, nausea, vomiting
suprapubic, costovertebral angle tenderness
Urinalysis: 3+ leukocyte esterase and numerous white blood cells
Urine blood cultures: non-lactose fermenting Gram negative rods

A

Pseudomonas aeruginosa

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9
Q

What are two causes of Nephrogenic DI?

A
  1. Inherited - gene mutation in V2 receptor, aquaporin channel
  2. Lithium toxicity
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10
Q

Which artery supplies the proximal ureter?

A

Renal artery

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11
Q

Aniline dyes (from working in the textile industry) increases the risk what type of malignancy?

A

transitional cell carcinoma of the bladder

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12
Q

Untreated Lyme disease can cause what type of heart dysfunction?

A

AV nodal block, usually second degree but can be 3rd degree

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13
Q

Which substances are able to estimate GFR?

A

Inulin
Creatinine

freely filtered at glomerulus with insignificant tubular reabsorption/secretion

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14
Q

What substances are able to estimate RPF?

A

Para-aminohippuric acid (PAH)

almost all entering kidneys are excreted in urine

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15
Q

How is the clearance of a given substance calculated when given
serum concentration
urine concentration
urine flow rate

A

Clearance = ([Urine concentration][urine flow rate])/(Plasma concentration)

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16
Q

What part of the renal tubule absorbs the majority of water?

A

Proximal tubule

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17
Q

pt recently treated w gentamicin for UTI Pt is lethargic, confused, pitting edem in lower extremities. Skin is cool to touch, mucous membranes are dry.
Serum potassium-6 (normal 3.5-5)
BUN: 45 (normal 7-18)
Creatinine 3.1 (normal 0.6-1.2)
Urinalysis: trace protein, cloudy urine with granular casts

what is dx?

A

Acute Tubular Necrosis

  • hyperkalemia
  • BUN/creatinine ratio <20:1

Granular Casts = “Muddy brown” casts = renal tubular casts = ATN

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18
Q 
pt present with abdominal pain
diffuse, severe, constant, left side
history of afib, hypertension
guaiac positive
WBC count: 18000 (normal 4500-11000)
elevated lactic acid
CT: thickening of the bowel wall in descending colon w inflammtion of surrounding mesentery
identify dz
A

Occlusion of the inferior mesenteric artery

  • –Ischemic Colitis
  • “pain out of proportion to the exam”
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19
Q

What type of Vascular disease is associated with Polycystic Kidney Disease?

A

Subarachnoid Hemorrhages a/w adult type polycystic kidney dz

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20
Q

which diuretic can cause hyperuricemic gout?

A

Thiazides

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21
Q

what is the most common site of obstruction in the kidney in the fetus? (hydronephrosis) why?

A

Ureteropelvic junction - last to canalize

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22
Q

What arteries does the ureter pass under in in men and women

A

men: ureter passes under vas deferens
women: ureter passes under uterine artery

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23
Q

What is an electrolyte side effect of loop diuretics

A

Metabolic alkalosis

–hypocalcemia

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24
Q

70 year old patient present with nasal congestion, shortness of breath, hemoptysis.
Labs show elevated ESR, elevated WBC. Urinary sediment shows red cells, red cell casts

Identify dz, what is the most specific test for this dz?

A

Granulomatosis with polyangiitis (Wegener’s)
–c-ANCA = Autoantibodies against proteinase-3 (ANTI-NEUTROPHIL cytoplasmic antibody)

–Necrotizing vasculitis that affects kidneys and upper/lower respiratory tracts

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25
Q

55 year old present with 3 day hx of hematuria, fever, left flank pain (sharp non radiating), Abdominal exam shows palpable flank mass. US reveals localized renal mass.
Identify dz and related blood findings

A 
Renal Cell Carcinoma
--increased EPO = Polycythemia
--increased renin = HTN
--increase PTHrp = hypercalcemia
anemia
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26
Q

What are histologic kidney findings in multiple myeloma?

A

Large eosinophilic casts = “Bence Jones Protein”

–increases levels of IgG, IgA`

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27
Q

pt presents with abdominal pain, bloody urine, constant aching pain along left side and back. Father and paternal uncle had ESRD. HTN bilateral flank masses, enlarged nodular liver. abdominal US - multiple anechoic hepatic and renal lesions

Identify dz and a possible comorbidity

A

Autosomal dominant polycystic kidney disease (ADPKD)

  • -defective PKD1 gene (chromosome 16)
  • -hepatic, pancreatic cysts may occur
  • -Valvular abnormalities (Mitral valve prolapse, aortic regurgitation)
  • -INTRACEREBRAL BERRY Aneurysm
  • -thoracic aortic aneurysm
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28
Q

pt presents with two day hx of hemoptysis, cough, shortness of breath, states she had a low-grade fever, chills approximately three days before her current symptoms began. Noticed hematuria. labs show negative c-anca, proteinuria, RBC casts

identify dz and serum cause

A

Goodpasture syndrome - Anti-glomerular basement membrane antibodies

–attacks type IV collagen = nephritic syndrome, hemoptysis

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29
Q

Which nerve is affect by Diabetes induced erectile dysfunction?

A

Cavernous nerves

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30
Q

Pt w RA presents with flank pain, pmh: passed a urinary stone
labs: hyponatremic, hypokalemic, hyperchloremic, low pH, low bicarb, normal pCO2. What is happening?

A

Type I renal tubular acidosis (RTA)

  • -defect of a intercalated cells to secrete H+
  • -reduced H+ in collecting tubule = increase K+ excretion into urine. this leads to elevated H+ in blood

Type I RTA patients are susceptible to calcium urinary stones (alkaline urine)
HYPOKALEMIA

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31
Q

What is the most common cause of nephrotic syndrome in children?

A

Minimal change disease

–normal renal histology, no significant lesion on light microscopy

32
Q

How does PTH affect the nephron?

A
  1. early PCT: inhibits the Na+/PO3- cotransporter = phosphate excretion
  2. early DCT: increase Ca2+/Na+ exchange = Ca2+ reabsorption
33
Q

What is fanconi syndrome in the kidney? what is the associated electrolyte disorder?

A

generalized reabsorptive defective in PCT
= increased excretion of all amnio acids, glucose, HCO3-, Po43-
–can result in metabolic acidosis (proximal renal tubular acidosis)

34
Q

What is Bartter syndrome? What is the resulting electrolyte imbalance? inheritance pattern?

A

defect in thick ascending loop of Henle (Na/K/2Cl defect)
Autosomal recessive

hypokalemia
metabolic alkalosis w hypercalciuria

35
Q

What is Gitelman syndrome? inheritance pattern? electrolyte imbalance?

A

Reabsorptive defect of NaCl in DCT
Autosomal recessive

hypokalemia, hypomagnesemia, metabolic alkalosis, hypocalciuria

36
Q

What is Liddle syndrome? inheritance pattern? symptoms/lab findings? what is Tx?

A

Collecting Tubules: Gain of function mutation = increased Na+ reabsorption (presents like hyperaldosteronism, but aldosteron is nearly undetectable)

Autosomal dominant
HTN, hypokalemia, metabolic alkalosis, decreased aldosterone

Tx: amiloride

37
Q

What is the drugs of choice for a UTI during pregnancy?

A

amoxicillin

38
Q

50 year old male present with hematuria and vague lower abdominal pain of one weeks’ duration. Hx reveals daily alcohol abuse and smoking cigarettes. Immigrated to the US from the middle east 20 years ago.
identify dz and most likely causative agent

A

Squamous cell carcinoma of the bladder
(most common cause of cancer in men, second in women in the middle east/Africa)

Schiostosoma hematobium - most common cause of bladder cancer in third world countries.

39
Q

What are factors that cause Anion Gap Metabolic Acidosis?

A 
MUDPILES
Methanol
Uremia
Diabetic Ketoacidosis
Propylene glycol
Iron, Isoniazid
Lactic acidosis
Ethylene glycol
Salicylates
40
Q

What are factors that cause Normal anion gap Metabolic acidosis

A 
HARDASS
Hyperalimentation
Addison disease
Renal tubular acidosis
Diarrhea
Acetazolamide
Spironolactone
Saline infusion
41
Q

What is Type 2 Renal tubular acidosis? mechanism, electrolyte, comorbidities, causes

A

defect in PCT HCO3- reabsorption
a/w Hypokalemia
increased risk for hypophosphatemic rickets

causes: fanconi syndrome, carbonic anhydrase inhibitors

42
Q

What is type 4 renal tubular acidosis?

A

Hypoaldosteronism - HYPERKALEMIA - decreased NH3 synthesis in PCT = decreased NH4+ secretion

43
Q

What are pregnant women at an increased risk for if they are diagnosed with acute pyelonephritis?

A

Pre-term labor - bacterial toxins can cause early contractions

–also, intrauterine infections

44
Q

What is the preferred treatment of pyelonephritis in pregnancy?

A

ceftriaxone OR cefepime OR aztreonam OR ampicillin and gentamicin

45
Q

15 year old presents w hematuria. hearing loss, HA while reading. RBC casts in urinalysis

identify dz and mechanism?

A

Alport’s sydrome

  • -Triad: nephritis, hearing loss, vision problems
  • –high freq hearing loss, develop cataracts earlier than normal

inherited defect in type IV collagen (basement membrane)

46
Q

45 pt presents w nausea, fatigue, edema, HTN, hematuria. 24 hr urine collectio shows 4.5 gm of protein. BUN/creatinine ratio of 10.0. Electron microscopy of the kidney shows an extension of a mesangial cell splitting the basement membrane

Identify dz

A

Membranoproliferative glomerulonephritis (MPGN)

  • -intrinsic renal failure (BUN/Cr <20)
  • -mixture of nephrotic (edema, proteinuria) and nephritis (htn, hematuria)

–light microscopy = mesangial proliferation

47
Q

what is the most appropriate medication to treat HTN in Cushing’s syndrome?

A

Potassium sparing diuretic - because of ability to antagonize mineralocorticoid receptors

48
Q

pt w hx of T2DM presents with HTN. Urinalysis is positive for albumin

what is the best initial drug to give for her HTN?

A

Ace inhibitor (captopril)

  • -proteinuria = initial sign of kidney dmg from DM
  • -ACEi are known to slow progression of Diabetic nephropathy (prevent constriction of efferent glomerular arteriole - decrease hyperfiltration)
49
Q

Concurrent Nephrotic-Nephritis presentation
Light microscopy: wire looping of capillaries

identify dz and cause

A

Diffuse proliferative glomerulonephritis
–due to SLE or MPGN
“wire lupus”
EM - subendothelial and sometime intramembranous IgG-based ICs often with C3 deposition.

50
Q

Retinopathy, lens dislocation
glomerulonephritis, sensorineural deafness
thinning and splitting of goomerular basement membrane

identify dz, etiology, inheritance pattern

A

Alport syndrome - mutation in type IV collagen
X-linked dominant

“cant see, cant pee, cant hear a bee”
“basket-weave” appearance on EM

51
Q

what type of hematologic state is nephrotic syndrome associated with? why?

A

Hypercoagulale state because of Antithrombin III loss in urine

increased risk for infections - loss of immunoglobins in urine

52
Q

what does minimal change disease look like under:

  1. Light microscopy
  2. Electron microscopy
A
  1. normal glomeruli

2. effacement of foot processes

53
Q

pt uses expired tetracycline and develops polyuria, polydipsia, and dehydration. What part of the kidney is causing the symptoms of her dysfunction?

A

Fanconi’s syndrome - from degraded tetracycline

  • -disorder in the PCT
  • -severe loss of proteins, glucose, essential mineral (calcium, magnesium)
54
Q

What are electrolyte findings in chronic renal failure? (K, H, PO2, Ca)

A

hyperkalemia
metabolic acidosis
hyperphosphatemia
hypocalcemia

55
Q

How do you calculate if there is sufficient respiratory compensation for metabolic acidosis?

A

Winter’s formula

pCO2 = [1.5(HCO3) +8] +/- 2

56
Q

21 year old male presents with stiffness and swelling in his right knee, hip, and back. complains of burning sensation during urination. was treated for an STI last month.

identify disease and an additional physical exam finding

A

Reiter’s syndrome - usually from untreated infection with Chlamydia
-Conjunctivitis
–(Arthritis, Urethritis, Conjunctivis)
=”cant pee, cant see, cant climb a tree”

57
Q

23 year old diabetic male presents to the clinic for hematuria. Hx shows he was seen in the office two days ago for an URI. IF reveals immune complexes in glomerular mesangium

identify dz

A

Berger disease - IgA nephropathy

  • -deposits of IgA and C3 in glomerular mesangium
  • -appears within 48-72 hours after infection begins (PSGN - renal sx occur 1-2 weeks after initial infection)
58
Q

identify dz:
39 year old African American male presents with frothy urine. HIV positive, CD4+ count of 450/mm3, adherent to his HAART regimen. bilateral 2+ pitting edema of bilateral lower extremities. Upon admission, dx is confirmed with renal bx, light microscopy

what is dz, and light microscopy findings?

A

Focal segmental glomerulosclerosis

  • -most common nephrotic syndrome in american adults (frothy urine + edema)
  • -a/w HIV, African American Males, IV drug use

Mesangial collapse with sclerosis of some glomeruli (focal)

59
Q

28 year old male presents with scrotal pain and swelling. has a 2 day history of dysuria and urgency. Physical exam shows tenderness and induration at the superior pole of the testis

what is the best treatment for this?

A

Epididymitis:

  1. in children, men >35: e. coli, p. aeruginosa, proteus, klebsiella
  2. in sexually active men: N. gonorrhea, Syphillis, chlamydia

= use Ceftriaxone + doxycycline + azithromycin

60
Q

pt presents with third degree burns over entire left lower extremity. Two days later he develops tachycardia, hypotension, oligura, Flank tenderness. Decreased urine sodium. What are urinalysis findings?

A

Prerenal acute renal failure - secondary to third degree burns
–from hypovolemia, hypoperfusion

–BUN:Cr ratio >20:1
–fractional excretion of sodium (FENa) < 1%
INCREASED HYALINE CASTS (solidified Tamm-Horsfall mucoprotein secreted from the tubular epithelial cells)

61
Q

Urine sediment: Magnesium-ammonium-phosphate signifies what?

A

“Struvite Stones”
-Proteus Mirabilis, Pseudomonas, Klebsiela
=gram neg rods capable or splitting urea into ammonium

62
Q

What form of chlamydia is responsible for infecting cells? What are culture findings?

What is the Tx for chlamydia in PREGNANT women?

A

elementary body
-gram stain shows no bacteria but many neutraphils

-Pregnant women - use Macrolide (erythromycin, azithromycin) or amoxicillin

(normal -use doxycyclin)

63
Q

What genetic dz is related to a Horseshoe kidney?

A

Turner Syndrome

64
Q

What is the management of nephrogenic DI (ie from lithium)

A

Hydrochlorothiazide

65
Q

What are staghorn calculi made of?

A

Struvite (Triple Phosphate) - Magnesium ammonium phosphate material - from UTI

proteus mirabilis
proteus vulgaris
morganella morganii

66
Q

A 27 year old pt present with vaginal pruritis and subsequently dx’d w vaginal infection. She is started on an abx but returns complaining of a metallic taste. what is the likely med? what are other adverse effects

A

Metronidazole

metallic taste, disulfiram like reaction, dark urine

67
Q

Where is B-type natriuretic peptide produced? and what is its action in the kidney?

A

produced by the ventricles of the heart when they are stretched

-BNP causes decreased sodium reabsorption in the distal tubules, collecting tubules, collecting ducts in the kidneys

68
Q

35 year old pt presents with fatigue, nausea, erythematous skin rash over trunk and extremities. for past two days. Pt is febrile. PMH of amoxicillin for sinus infection. BUN 98. Cr 2.5. Urinalysis: 2+ WBCs, 20 percent eosinophils. what is most likely finding on renal biopsy?

A

Acute Interstitial Nephritis

  • most commonly caused by rxn to medication (Abx and analgesics).
  • Interstitial edema and inflammation

-look for elevated eosinophils in urine and blood

69
Q

81 year old male presents with altered mental status. palpable kidneys, auscultation shows bibasilar crackles and S3 gallob. Lab shows hypercalcemia, proteinuria

what is dz?

A

Amyloidosis - hypercalcemia, proteinuria, altered mental status (seen in multiple myeloma)

70
Q

20 year old female presents for check up. Has fam hx of renal stones. Lab show increased serum calcium, normal sodium and potassium.

What is the diagnosis and which test will confirm

A

Familial hypocalciuric hypercalcemia (FHH) - autosomal dominant

  • -usually asymptomatic, can have constipation, polyuria, renal insufficiency
  • LABs: mild hypercalcemia, hypocalciuria, normal/high PTH, hypermagnesemia

-test = 24-hour urinary calcium excretion

71
Q

22 yr old present with headaches. Labs show hypokalemia, metabolic alkalosis, low aldosterone, elevated sodium

what is dz and mechanism?

A

Liddle Syndrome
–presents like primary hyperaldosteronism but w low aldosterone

–Gain of function in the sodium channel of the renal collecting tubule = increased sodium reabsorption and potassium secretion

72
Q

What can happen in a pt with bilateral renal artery stenosis that is administered an ACE inhibitor?

A

Flash pulmonary edema causing acute respiratory distress

73
Q

What is an adverse effect of spironolactone? what are Sx?

A

hyperkalemia = muscle cramps, weakness, diarrhea, decreased DTR’s

74
Q

What is the electrolyte imbalance:
28 year old female w hx of T1DM presents w rapid deep breathing, polyuria, abdominal pain. ECG shows wide QRS, flattened P wave

A

Hyperkalemia - pt is presenting with diabetic ketoacidosis

75
Q

Where does a neuroblastoma arise from?

A

Tumor of adrenal medulla

–Homer-Wright pseudorosettes

COMLEX STEP 1 2017 (19 decks)

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