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Clin Med Comprehensive > GU Gen > Flashcards

GU Gen Flashcards

(103 cards)

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1
Q

What molecules are freely filtered at glomerulus?

A

small and positively charged

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2
Q

What molecules are NOT freely filtered at glomerulus?

A

large-protein

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3
Q

What is glomerular filtration rate

A

the volume of plasma that moves through the nephron

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4
Q

What is normal GFR?

A

100-140 ml/min

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5
Q

how to we measure or estimate GFR?

A

creatine or inulin (because they’re freely filtered and neither absorbed or secreted

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6
Q

What happens with neuronal regulation when theres an extreme DROP in BP?

A

baroreceptors activate sympathetic system, renin released, vasoconstriction, aldosterone release, conserve volume

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7
Q

What happens with neuronal regulation when theres an extreme RISE in BP?

A

stretching of atria causes ANP to release and dilation of afferent and vasoconstriction of efferent to increase GFR

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8
Q

What does a lower than normal GFR indicate?

A

loss of nephron function

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9
Q

What is normal plasma flow per minute?

A

650 mL

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10
Q

What does aldosterone do to K and Na?

A

K loss and Na resorption

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11
Q

What is the likelihood of AA to develop ESRD compared to whites?

A

AA 3.5 x more likely than whites (latinos 1.5 x more)

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12
Q

What imaging study should you use for nephrolithiasis and nephrocalcinosis?

A

plain radiography KUB

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13
Q

What imaging study should you use for determining kidney shape, size, detecting urinary obstruction, radiolucent stones, cysts, PCKD, and renal mass eval?

A

ultrasound

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14
Q

What imaging study should you use for determining kidney size, shape, calyceal anatomy, diagnosis of medullary sponge kidney and papillary necrosis, detection of site and cause of obstruction?

A

IV pyelography

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15
Q

What imaging study should you use for detection of urinary obstruction and urine leak, screening for RAS, assessing renal arterial flow?

A

radionuclide studies

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16
Q

What imaging study should you use for detection of RAS, assessing for vasculitis, distinguishing vascular versus solid masses?

A

renal arteriography

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17
Q

What imaging study should you use for detection of vesicoureteral reflex?

A

voiding cystourethrography

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18
Q

What imaging study should you use for determining size of obstruction, placement of urethral stent?

A

retrograde or antegrade pyelography

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19
Q

What imaging study should you use for detection of renal mass, or renal vein thrombosis?

A

MRI

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20
Q

How much H+ is produced daily?

A

50-100 mEq/day

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21
Q

How is H+ secreted into tubular lumen?

A

combines with NH3 to become NH4 or HPO4 to become H2PO4-

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22
Q

How do kidneys normally respond to increased acid load?

A

increasing NH$+ excretion

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23
Q

Where is HCO3- lost from the body?

A

colon (diarrhea) and urethra (tubular dysfunction)

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24
Q

What are complications of renal bx?

A

hematuria, perinephritic hematoma, infection, mortality

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25
What are host defenses against UTI?
bladder washout, low pH urine, high osmolality, TLR11, Tramm-Horsfall protein (binds to E.coli and prevents epithelial cell attachment)
26
What is order of pathogenesis of a UTI?
rectal flora→perineal colonization→vaginal colonization→urethra→bladder→kidney
27
What type of Abx increase introital colonization?
β lactams
28
What are complications of UTI?
bacteremia/sepsis, perinephric abscess, emphysematous pylonephritis, xanthogranulomatous pyelonephritis, papillary necrosis, chronic pyelonephritis
29
What can you to to prevent UTI?
adequate fluids, avoid holding urine, proper hygiene, avoid catheters when possible
30
What is gross hematuria?
you can see it | reddish-brown with RBC
31
What is microscopic hematuria?
can't see without microscope >3 RBC in 2-3 specimens check for RBC casts, dysmorphic casts and proteinuria
32
What are features of non-glomerular hematuria?
``` Scant RBC (if any) but not dysmorphic White cell and other casts Pink to red color Blood clots Brown muddy casts ```
33
What are features of glomerular hematuria?
``` Red cells Dysmorphic (acanthocytes) Red cell cast Red to brown color No blood clots ```
34
Why do you have to confirm with microanalysis for hematuria?
UA is sensitive but not specific (can pick up myoglobin and hemoglobin)
35
What are RF for bladder cancer?
smoking, hx ross hematuria, >40y, voiding sx, cyclophosphamide
36
What is MC cause of hematuria in a 0-20 yo pt?
glomerulonephritis, UTI, congenital
37
What is MC cause of hematuria in a 20-40 y?
UTI (F>M), calculi, bladder and renal cancer
38
What is MC cause of hematuria in a 40-60 yo?
UTI (F>M), bladder and renal cancer, calculi
39
What is MC cause of hematuria in a >60 yo male?
BPH, bladder and renal cancer, UTI
40
What is MC cause of hematuria in a >60 yo female?
UTI, bladder and renal cancer
41
What is the order of compensation for metabolic acidosis?
1. extracellular buffering by HCO3- (immediate) 2. respiratory buffering by lowering PCO2 (minutes to hrs) 3. Intracell and bone buffering (2-4 hrs) 4. Inc renal acid excretion (hrs to days)
42
What are causes of anion gap metabolic acidosis?
``` Citrate Uremia Toluene Ethanol Diebetic Ketoacidosis Iron MEthanol Paraldehyde Lactate Ethylene glycol Salicylate ```
43
What are the NON-ingestion causes of high AG acidosis?
uremia, ketoacidosis, lactic acidosis
44
Where is Na largely confined to?
ECF because it cant cross cell membranes readily
45
What is effective vascular volume?
part of the ECF which is in the vascular space and perfusing tissues (closely related to blood pressure)
46
what are signs of volume expansion?
Edema Pulmonary crackles Ascites Jugular venous distention Hepatojugular reflux Hypertension
47
What are signs of volume depletion?
Orthostatic decrease in blood pressure and increase in pulse rate Decreased pulse volume Decreased venous pressure Loss of axillary sweating Decreased skin turgor Dry mucous membranes
48
What is the response of SNS and RAAS to volume depletion
↑ SNS cauing vasoconstriction, ↑ HR and contractility and ↑ Na reabsorption ↑ ANG II causing ↑ aldosterone secretion and ↑ Na reabsorption
49
what stimulates the release of ANP and BNP?
stretch in cardiac atria (ANP) or ventricles (BNP)
50
What is the effect of ANP and BNP?
↑ tubular delivery of Na/H20 in kidney inhibit tubular Na/H20 reabsorption Antagonist of ATII and SNS Dec cardiac preload
51
What can hypoalbuminemia cause?
Maldistribution of ECF from vascular to interstitial space Decreased effective arterial volume Secondary renal sodium retention (edema due to Na retention)
52
How does the kidney regulate total body Na levels?
aldosterone which causes Na retention
53
When is aldosterone released?
in reponse to hypovolemia and hyperkalemia
54
What determined water homeostasis?
ADH
55
What stimulated ADH?
hypovolemia or hyperosmolarity
56
What is abnormal serum Na concentration primarily due to?
problems with water control
57
What is abnormal ECFV due to?
problems with total body Na control
58
What substances increase osmolality without changing the serum sodium concentration?
Urea, ethanol, ethylene glycol, isopropyl alcohol, methanol
59
What substances increas osmolality and decrease serum sodium concentration?
glucose, mannitol, glycine, maltose
60
How long does dilation take from onset of obstructive uropathy to develop?
3 days
61
What happens to urine volume in unilateral obstruction?
does not diminish unless only functioning kidney
62
When will absolute anuria occur?
with complete obstruction if its at the level of the bladder or urethra
63
What is a solid lesion of the kidney until proven otherwise?
RCC
64
If a spinous process appears closer to the R clavicle which was is the patient rotated?
toward their own left side
65
What is total obligatory water intake?
1600 ml - 500 ingester - 800 in food - 300 from oxidation
66
How much water does an febrile, immobile, and not eating/drinking patient require?
1 L daily
67
What is NS composed of?
Osmolality: 285-308 Na: 154 mEq and Cl 154 mEq
68
What is 1/s NS composed of?
Na: 77 mEq
69
What is LR composed of?
``` crystalloid solution Osmolality: 250-273 - isotonic Na: 130 mEq Cl: 109 mEq Lactate 28 mEq (Converts to bicarb in patient) K: 4 mEq (can lead to hyperkalemia) Ca: 3 mEq ```
70
What is 1/4 NS composed of?
D5W | Na 38 mEq
71
What is Bicarb drip composed of?
NaHCO3 (with 50 mEq Na) and D5W
72
What is recommendation for hospitalized adult who is afebrile and not eating?
D5 1/s NS plus KCL 20 mEq added at 2 L/day
73
What happens to K+ when acidosis is present?
pulls K+ into cells
74
What happens to K+ when alkalosis is present?
pushes K+ out
75
What happens to the AP when there is too much K+?
lowers the threshold so cells can be excited easily but they respond slowly
76
What is effect of hypomagnesemia on hypokalemia?
causes urinary K+, and increased open ROMK channels
77
What is the impact of insulin on serum potassium?
K+ moves into cells
78
What is the impact of increasing pH on serum potassium?
K+ moves into cells
79
What is the impact of Beta blocker on serum potassium?
K+ moves out of cells
80
What is the impact of hyperaldosteronism on serum potassium?
Increased K+ excretion
81
What is the impact of furosemide on serum potassium?
Increased K+ excretion
82
What is urothelial tumor stage T1?
lamina propria invasion
83
What is urothelial tumor stage T2?
Muscularis propria invasion
84
What is urothelial tumor stage T3?
Extravesical fat invasion
85
What is urothelial tumor stage T4?
Invasion into adjacent structures/organs
86
What percentag of newly diagnosed RCC have metastasis?
25% | Lung>bones>lymph nodes>liver>adrenal>brain
87
What is Von Hipple Lindau Syndrome?
loss of VHL tumor suppressor gene on chromosome 3p | 40% of VHL pts develop RCC
88
What is gross presentation of clear cell RCC?
Circumscribed mass with sharp margins Bright yellow-orange (Due to lipid & glycogen content in cytoplasm) Large areas of gray/white necrosis Hemorrhage is common
89
What does RIFLE stand for?
risk, injury, failure, loss & ESRD to diagnosis AKI
90
Define oliguria
<400 ml urine output in 24 hrs
91
define anuria
<100 ml urine output in 24 hrs
92
define azotemia
accumulation of nitrogen wastes
93
What can cause elevated BUN not caused by kidney?
steroids, tetracyclines, catabolic state, GI bleed
94
When do sx of CKD present?
when GFR <30 ml/min
95
What are sx of uremia?
``` Fatigue AMS Anorexia Nausea Sleep Disturbance ```
96
What is the preferred access type for dialysis>
AV fistula
97
what is SCUF
Slow continuous UF over a longer interval
98
What is SLED?
Sustained low efficiency dialysis
99
What is EDD?
Extended daily dialysis
100
What are complications of HD dialysis?
``` Hypotension Muscle cramps Nausea & vomiting Headache Chest & back pain Itching sepsis hemorrhage thrombosis heart failure depression ```
101
What are complications of PD?
peritonitis or exit site infection
102
When is a pt eligible for kidney transplant?
GFR <15
103
What is the number one cause of renoallograft failure?
CVD

Clin Med Comprehensive (9 decks)

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