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Step 2/Level 2 > Nephro > Flashcards

Nephro Flashcards

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1
Q

Which diuretic should be used for acute pulmonary edema?

A

Loops

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2
Q

Which diuretic should be used for idiopathic hypercalciuria?

A

Thiazides

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3
Q

Which diuretic should be used for glaucoma?

A

Acetazolamide (carbonic anhydrase inhibitor) or mannitol if severe

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4
Q

Which diuretic should be used for mild to moderate CHF with expanded ECV?

A

loop and aldosterone antagonist

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5
Q

Which diuretic should be used for increased intracranial pressure?

A

Mannitol

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6
Q

Which diuretic should be used for hypercalcemia?

A

Loop

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7
Q

Which diuretic should be used for altitude sickness?

A

Acetazolamide (carbonic anhydrase inhibitor)

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8
Q

Which class of diuretics can cause ototoxicity?

A

Loops

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9
Q

Which diuretic is safe for a fluid overloaded patient with a sulfa allergy?

A

Ethacrynic acid (loop)

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10
Q

Sub-epithelial humps?

A

Post streptococcal glomerulonephritis

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11
Q

What two labs can be elevated in post streptococcal glomerulonephritis?

A
  • Anti-DNAse B

- ASO titer (normally NOT elevated in skin infections)

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12
Q

endothelial deposits cause “wire loops” on LM?

A

Lupus nephritis

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13
Q

Treatment for most nephrotic syndrome?

A

Steroids, ACE inhibitors, statins

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14
Q

Kidneys, lungs and upper airway involvement?

A

Granulomatosis with polyangiitis (GPA) (Wegener’s)

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15
Q

Which lab is elevated with Wegener’s?

A

cANCA

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16
Q

Linear deposits on immunofluorescence?

A

Good pasture

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17
Q

Treatment of good pasture?

A
  • plasmapheresis (to remove the IgG antibodies to the GBM)

- Glucocorticoids

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18
Q

Immunofluorescence shows mesangial deposits?

A

IgA nephropathy (Berger disease)

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19
Q

Cataracts, nephritis, high-frequency hearing loss?

A

Alports

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20
Q

Splitting of the basement membrane?

A 
Alport disease
(defect of type IV collagen)
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21
Q

Light microscopy showing crescent formation in the glomeruli; p-ANCA positive

A

Pauli-immune RPGN

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22
Q

What is the criteria for nephrotic syndrome?

A
  • proteinuria >3.5g/24 hours
  • hypoalbuminemia
  • edema
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23
Q

Most common cause of nephrotic syndrome in adults?

A

FSGS

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24
Q

Thickening of the basement membrane and a “spike and dome: appearance?

A

Membranous nephropathy

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25
"tram track" appearance with sub endothelial humps of IgG along the GBM?
Membranoproliferazive glomerulonephritis (MPGN)
26
Which type of nephrotic syndrome can Hepatitis B lead to?
Membranous
27
Which type of nephrotic syndrome can Hepatitis C lead to?
Membranoproliferazive glomerulonephritis (MPGN)
28
Congo red stain with apple-green birefringence?
Amyloidosis
29
Nephrotic syndrome associated with HIV?
FSGS
30
Glomerular histology reveals multiple mesangial nodules. what disease does the presence of this lesion suggest?
Diabetes
31
What is the equation for FENa?
(urine Na+/Serum Na+)/(Urine Cr/Serum Cr)
32
What does a FENa
Likely a pre-renal problem (pt is still conserving Na+ and H2O)
33
What does a BUN/Cr>20 indicate?
Pre renal
34
How long does impaired kidney function need to be present before it can be called chronic kidney disease?
>= 3 months
35
What are the indications for dialysis in a CKD patient?
- severe hyperkalemia - severe metabolic acidosis. - fluid overload - uremic syndrome - CKD (Cr>12, BUN >100) - Severe overdose of toxin exposure
36
What is the first-line pharmacotherapy for idiopathic intracranial HTN?
acetazolamide
37
What should you consider if you have low serum Na+, high Urine Na+ (>20) and hypervolemia?
Renal failure
38
What should you consider if you have low serum Na+, LOW Urine Na+ (
- cirrhosis - nephrosis - CHF
39
What condition may result from the rapid correction of hyponatremia?
Central pontine myelinolysis
40
How fast can hyponatremia be corrected?
Only 12 mEq/L per 24 hours
41
What are the causes of hypernatremia?
6Ds: - Diuretics - dehydration - diabetes insipidus - Docs (iatrogenic) - diarrhea - disease of the kidney (hyperaldosteronism)--> will not elevate much
42
What can result of treating hypernatremia too quickly?
Cerebral edema
43
First line treatment for nephrogenic DI?
- Thiazides (causes a mild hypovolemia which causes increased H2O absorption at PCT) - then add indomethacin
44
Treatment for lithium induced DI?
Amiloride | -closes the Na+ channels that let Lithium into the cell
45
What is the treatment for hyperkalemia?
- IV calcium gluconate (stabilize cardiac membranes) - Insulin + glucose - Beta agonists Remove K+: - Hemodialysis - Kayexalate (Sodium polystyrene sulfonate) - Loop diuretics (chronic hyperkalemia)
46
What are the causes of hypercalcemia?
- Hyperparathyroidism - Neoplasms (paraneoplastic) - Thiazides - Milk-alkali syndrome - Sarcoidosis (granulomas secrete Vit D) - Hypervitaminosis A
47
What are the causes of hypocalcemia?
- Hypoparathyroidism - Hyperphosphatemia - Chronic renal failure - Vit D deficiency - Loop diuretics - pancreatitis - alcoholism
48
Electrolyte imbalance that causes prolonged QT?
Hypocalcemia
49
Electrolyte imbalance that causes shortened QT?
hypercalcemia
50
What is Winter's formula? When is it used?
pCO2=1.5(HCO3-)+ 8 +/-2 - used to predict CO2 in metabolic acidosis. - If actual CO2 differs from predicted pCO2--> mixed disorder
51
What acid-base disorder can aspirin overdose cause?
- Respiratory alkalosis (stimulated the brain to hyperventilate) - Metabolic acidosis (leads to uncoupling of oxidative phosphorylation --> lactic acidosis)
52
What is the cause of Type 1 RTA? What will the urine pH, Serum K+ be? Tx?
- Impaired H+ secretion - High urine pH - Low serum K+ - oral HCO3- - K+ supplements - Thiazides
53
What is the cause of Type 2 RTA?What will the urine pH, Serum K+ be? Tx?
- Impaired HCO3- reabsorption - Low urine pH - Low serum K+ - oral HCO3- - K+ supplements - Thiazides
54
What is the cause of Type 4 RTA? What will the urine pH, Serum K+ be? Tx?
- hypoaldosteronism - Low urine pH - High serum K+ - Fludrocortisone (replace aldosterone) - K+ restriction
55
Patient with fever, rash, elevated creatinine and eosinophilia?
Acute interstitial nephritis
56
Drugs that cause gynecomastia?
``` STACKED Spironolactone THC Alcohol (chronic) Cimetidine Ketoconazole Estrogen Digoxin ```
57
Treatment for breast abscess?
- Dicloxacillin, cephalexin, or amoxicillin/clavulanic acid - Bactrim if suspect MRSA - Metroidazole if suspect anaerobes * keep breastfeeding/pumping
58
Multiple, bilateral breast masses that are painful and increase in size before menstruation?
Fibrocystic changes
59
Solitary, firm, mobile breast nodule increases in size with estrogen? Next step?
- Fibroadenoma - >35 --> diagnostic mammogram - US and FNA, core biopsy or excision biopsy
60
Serous, "straw-colored" nipple discharge +/- streaked with blood?
Intraductal papilloma (rare malignant transformation) --> surgical excision
61
Large, bulky tumor with "leaf-like" projections on biopsy?
Phyllodes tumor | -monitor closely
62
Which type of breast carcinoma in situ is ER and PR positive?
LCIS (lobular carcinoma in situ) | -also has a higher risk for invasive cancer in either breast (not from the LCIS but for other reasons?)
63
Stellate border on mammography or biopsy?
Invasive ductal carcinoma
64
Signet ring cells or single-file rows of cells?
Invasive lobular carcinoma
65
Treatment of DCIS?
lumpectomy +/- radiation
66
Treatment of LCIS?
observation + Tamoxifen | -consider prophylactic bilateral mastectomy
67
Treatment of early, focal invasive carcinoma?
lumpectomy and radiation
68
If a breast cancer is ER or PR positive, what should they be treated with?
Tamoxifen
69
If a breast cancer is positive for HER2, what should they be treated with?
Trastuzumab (Herceptin)

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