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My Step 2 CK > Nephrology > Flashcards

Nephrology Flashcards

1
Q

How does IV contrast cause renal failure?

A

vasospasm of afferent arteriole (decrease perfusion to glomeruli)

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2
Q

How long after an infection does post-Strep glomerulonephritis occur?

A

1-2 weeks after infection

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3
Q

Renal toxicity of a medication is due to the …. of the medication

A

trough (space interval of medications to decrease toxicity of medication)

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4
Q

What is the side effect of aminoglycosides (gentamicin)?

A
  1. renal toxic

2. ototoxicity

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5
Q

What is the difference between azotemia and uremia?

A

azotemia: renal insufficiency but no need for dialysis
uremia: renal insufficiency resulting in need for dialysis

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6
Q

What are complications of uremia? (9)

A
  1. need for dialysis
  2. anemia (decrease epo production)
  3. hyperkalemia
  4. pericarditis
  5. hypocalcemia (decrease active vitamin D)
  6. infections (wbc cant degranulate)
  7. metabolic acidosis & fluid overload (b/c cant get rid of organic acid)
  8. altered mental status
  9. bleeding (platelets cant degranulate)
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7
Q

What is the treatment for uremia induced bleeding?

A

DDAVP (desmospressin causes release of subendothelial stores of vWf and factor 8)

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8
Q

What are causes of pre-renal azotemia?

A
  1. dehydration/ shock/ blood loss
  2. renal artery stenosis
  3. hepatorenal syndrome
  4. ACE inhibitor effect on kidney
  5. low albumin states (nephrotic and liver disease)
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9
Q

What are causes of post-renal azotemia?

A
  1. bladder stone/clot
  2. bladder cancer
  3. prostate hypertrophy/ cancer
  4. bilateral ureteral disease
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10
Q

What is the driving force of GFR in kidney?

A

hydrostatic pressure in the glomeruli capillary

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11
Q

What is the initial clue to pre-renal azotemia?

A

BUN: creatinine ratio >20

b/c more time for urea to be reabsorbed b/c slow flow

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12
Q

What can falsely elevate BUN?

A
  1. increased protein in diet

2. GI bleeding (protein release)

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13
Q

What happens to urine sodium in pre-renal azotemia?

A

urine sodium < 10 (low b/c body reabsorbs sodium to increase intravascular volume)

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14
Q

What happens to the urine osmolality in pre-renal azotemia?

A

urine osmolality is high (>500); concentrated urine

high specific gravity >1.010

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15
Q

A pt presenting with hypertension with renal insufficiency most likely suffers from …

A
  1. primary hyperaldosteronism
  2. renal artery stenosis

(distinguish w/ aldosterone/renin ratio)

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16
Q

A pt with liver disease who develops renal insufficiency that does not respond to 1.5 liters of colloid (albumin) most likely suffers from …

A

hepatorenal syndrome

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17
Q

What dilates the afferent arteriole of the glomeruli?

A

Prostaglandins

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18
Q

How does NSAIDs result in pre-renal azotemia?

A

inhibit prostaglandins which prevent afferent arteriole dilation (results in constriction of arteriole)

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19
Q

What constricts the efferent arteriole of the glomeruli?

A

Angiotensin 2

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20
Q

How do ACE inhibitors result in pre-renal azotemia?

A

inhibit conversion of angiotensin 1 to angiotensin 2 preventing constriction of efferent arteriole (results in dilation of efferent arteriole)

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21
Q

Why is it that ACE inhibitors diminish the rate of progression to renal failure and uremia in pts with diabetes, HTN, multiple myeloma?

A

dilation of efferent –> decreased hydrostatic pressure in glomeruli –> decrease intraglomerular HTN
(never withhold ACE inhibitor)

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22
Q

What is the best blood pressure medication for pt with diabetes?

A

ACE inhibitors

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23
Q

What is orthodeoxia?

A

Change positions (sitting up) cause oxygen desaturation

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24
Q

What disease is associated with orthodeoxia?

A

hepatopulmonary syndrome

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25
Q

What medications can cause retroperitoneal fibrosis (leading to post-renal azotemia)?

A
  1. bleomycin (along with pulmonary fibrosis)

2. methotrexate

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26
Q

What chemo medication results in hemorrhagic cystitis?

A

cyclophosphamide

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27
Q

What are the most common causes of neurogenic bladder?

A
  1. diabetes

2. multiple sclerosis

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28
Q

What is the normal post-voiding residual volume?

A

50 ml of urine (if elevated, implies obstruction to flow out of bladder)

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29
Q

What are causes of interstitial renal insufficiency?

A
  1. allerigic
  2. toxic
  3. pigments (hemogloin/ myoglobin)
  4. proteins (bence jones)
  5. crystals
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30
Q

A pt with a BUN/cr of 10, high urine sodium, urine osmolarity (similiar to serum osmolarity; isothenuria), and FeNa > 1% most likely suffers from …

A

acute tubular necrosis

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31
Q

What type of casts/ sediment is associated with acute tubular necrosis?

A

granular, muddy brown, pigmented cast

dead tubular cells sloughed off

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32
Q

What drugs can result in allergic interstitial nephritis, drug induced hemolysis, and/ or rash?

A
  1. penicillins
  2. cephalosporins
  3. sulfa drugs
  4. allopurinol
  5. rifampin
  6. quinolones
    (1 dose can cause problem)
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33
Q

What medications can result in acute tubular necrosis?

A
  1. aminoglycosides (gentamicin)

2. amphotericin

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34
Q

A pt presents with renal insufficiency with associated fever, rash, and eosinophils most likely suffers from …

A

Allergic interstitial nephritis

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35
Q

What is the most accurate test for eosinophils in the urine?

A

Hansel stain (or Wright stain)

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36
Q

What are causes of myoglobinuria (rhabdomyloysis)?

A
  1. severe crush injury
  2. seizures
  3. statins
    4, severe exertion
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37
Q

What is the initial best step in management of a pt with severe crush injury or seizure?

A

EKG or potassium level (hyperkalemia causes peaked t waves)

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38
Q

What is treatment for hyperkalemia with peaked T waves on EKG?

A

calcium chloride/ gluconate

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39
Q

What is the initial best test for rhabdomyolysis?

A

urinalysis (dipstick positive for blood but no RBCs seen)

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40
Q

What is treatment for rhabdomyolysis?

A
  1. hydration (decrease contact time)
  2. mannitol (osmotic diuretic-> decrease contact time)
  3. alkalinize urine w/ bicarb
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41
Q

What is confirmatory test for rhabdomyolysis?

A

elevated CPK (>10,000)

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42
Q

What is treatment for hyperkalemia without EKG changes?

A
  1. insulin with glucose

2. bicarbonate

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43
Q

A pt presents with metabolic acidosis with gap due to ethylene glycol develops renal insufficiency due to…

A

calcium oxalate stone formation (enveloped shaped)

oxalate is toxic metabolite of ethylene glycol

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44
Q

What is the treatment for ethylene glycol intoxication?

A
  1. ethanol or fomepizole (prevents formation of oxalate)

2. dialysis

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45
Q

A pt with Crohn disease develops renal insufficiency due to …

A

oxalate crystals (calcium bound to fat in gut instead of w/ oxalate)

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46
Q

A pt with cancer being treated with chemotherapy develops renal insufficiency due to …

A

tumor lysis syndrome (uric acid release leading to urate crystals)

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47
Q

What treatment should pt with cancer being treated with chemotherapy be given to prevent urate crystal associated renal insufficiency?

A

allopurinol and hydration

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48
Q

What is the most common cause of hypercalcemia?

A

primary hyperparathyroidism

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49
Q

When should primary hyperparathyroidism need to be treated?

A

if associated with renal stones and renal insufficiency

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50
Q

A pt who underwent a vascular catheter procedure (angioplasty) who develops renal failure, bluish discoloration of extremities and livedo reticularis most likely suffers from …

A

atheroembolic disease

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51
Q

What is the most accurate test for atheroembolic disease?

A

skin biopsy showing cholesterol crystals in skin

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52
Q

What can be done to prevent contrast induced renal failure?

A
  1. hydration
  2. N-acetyl cysteine
  3. bicarbonate
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53
Q

A pt with hx of diabetes/ sickle cell disease/ NSAID use presents with sudden flank pain, hematuria, pyuria and fever most likely suffers from …

A

papillary necrosis

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54
Q

What is the most accurate test for papillary necrosis?

A

CT scan (bumpy contours in the renal pelvis where papillae have sloughed off)

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55
Q

What is the next best step in management of a diabetic pt found to have microalbuminuria?

A

Start ACE inhibitor (or ARBs)

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56
Q

What is consider nephrotic range proteinuria?

A

3.5 grams/day or more

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57
Q

What is the best step in management of a pt with trace amounts of protein in urine?

A

repeat urinalysis or split 24 hour urine sample (if no protein in first 8 hours, but in second part –> orthostatic proteinuria)

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58
Q

How do you distinguish hematuria due to glomerular disease versus other causes?

A

glomeruli disease results in dysmorphic RBCs

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59
Q

What does nitrite positive urinalysis suggests?

A

gram negative bacteria presence (infection if WBCs)

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60
Q

What pt should be screened and treated for bacteriruia despite presence of WBCs or symptoms?

A

pregnant patients

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61
Q

What do hyaline casts signify?

A

dehydration/ pre-renal

accumulation of normal amount of tubular/Tomm-Horsfall protein

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62
Q

What is the most common complication of peritoneal dialysis?

A

peritonitis

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63
Q

Why does anemia develop in ESRD and what is the treatment?

A

decreased production of epo; replace epo

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64
Q

What do eosinophilic casts suggest?

A

Allergic interstitial nephritis

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65
Q

What do broad, waxy casts suggest?

A

chronic renal disease

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66
Q

What is the cause of hypocalcemia and hyperphosphatemia in ESRD?

A

decrease production of active vitamin D so decrease calcium absorption –> elevated PTH stimulating bone breakdown and release of phosphate (kidney can’t excrete)

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67
Q

What is treatment for hypocalcemia in ESRD?

A

vitamin D replacement

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68
Q

What is treatment for hyperphosphatemia in ERSD?

A
  1. phosphate binders (calcium carbonate/ acetate/ sevelamer)

2. Cinacalcet (decreased PTH to decrease release of phosphate from bone)

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69
Q

What is cause of osteodystrophy in ERSD?

A
  1. decrease active vitamin D –> decrease Ca –> increased PTH –> increase bone resorption to increase Ca
  2. bone resorption to buffer acidosis
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70
Q

Why does hypermagnesium occur in ERSD and what is treatment?

A

decreased excretion; restrict magnesium intake

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71
Q

What is the most common cause of death in pt with ERSD on dialysis?

A

accelerated athersclerosis (coronary artery disease)

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72
Q

Why is there increased infections in pts with ERSD and what is the most common organism?

A

WBCs cant degranulate in uremic environment; S. aureus due to dialysis

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73
Q

Why is there increased bleeding in patient with ERSD?

A

uremia induced platelet dysfunction

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74
Q

What is the blood pressure goal for pt with diabetes or renal disease?

A

BP < 130/80

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75
Q

What are the indications for dialysis in pts with renal disease?

A
  1. hyperkalemia
  2. fluid overload (refractory to diuretics)
  3. encephalopathy
  4. pericarditis
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76
Q

What are medications used to prevent post-transplantation renal graft rejection?

A
  1. cyclosporine
  2. tacrolimus
  3. mycophenolate

(calcineron inhibitors)

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77
Q

A pt presenting with edema, hematuria, red cell casts, hypertension and dysmorphic red cells in urine most likely suffers from …

A

Glomerulonephritis

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78
Q

What is the most accurate test for glomerulonephritis?

A

renal biopsy

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79
Q

What is the best initial test for glomerulonephritis?

A

urinalysis

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80
Q

A pt presents with recurrent URI and lung infections with hematuria most likely suffers from …

A

Wegener granulomatosis

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81
Q

What is the best initial test that is specific for Wegener granulomatosis?

A

C-ANCA (anti-proteinase 3 antibody)

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82
Q

A pt presenting with adult onset asthma, atopy, eosinophilia and hematuria most likely suffers from …

A

Churg-Strauss syndrome

83
Q

What is treatment for Churg-Strauss syndrome?

A

steroids and cyclophosphamide

84
Q

What is the treatment for Wegener granulomatosis?

A

steroids and cyclophosphamide

85
Q

A young adult or child presents with periorbital edema, cola/tea colored urine and hypertension 1-2 weeks after recent Strep infection most likely suffers from ..

A

Post-infectious glomerulonephritis

86
Q

What is the best initial test for post-infectious glomerulonephritis?

A

Antistreptolysin test (ASO) and antihyaluronic acid (AHT)?

87
Q

What are findings on renal biopsy for post-infectious glomerulonephritis?

A

subepithelial humps on electron microscopy with IgG and C3 deposited in mesangium

88
Q

What is treatment for post-infectious GN?

A

fluid overload and diuretics

89
Q

A pt presents with hematuria and lung disease without other manifestations (no skin or eye involvement) and hemosiderin laden macrophages most likely suffers from …

A

Goodpasture syndrome

90
Q

What is the best initial test for Goodpasture syndrome?

A

antibasement membrane antibodies to type 4 collagen

91
Q

What is treatment for Goodpasture?

A

plasmapheresis and steroids

92
Q

An asian pt presents with hematuria 1-2 days after a viral URI most likely suffers from …

A

IgA nephropathy (Berger disease)

93
Q

What is the diagnostic finding in Berger’s disease?

A

IgA deposit in kidney

94
Q

A pt presenting with hematuria along with manifestations in every organ except lung most likely suffers from …

A

Polyarteritis Nodosa (PAN)

95
Q

What infection is associated with Polyartritis Nodosa?

A

Hep B infection (especially in IV drug users)

96
Q

What antibody is associated with polyarteritis nodosa (PAN)?

A

P-ANCA

97
Q

What nerve is frequently biopsied for polyarteritis nodosa?

A

sural nerve (most accurate test)

98
Q

What is the treatment for polyarteritis nodosa?

A

steroids and cyclophosphamide

99
Q

A pt presents with palpable purpura, hematuria, abdominal pain, and arthralgias most likely suffers from …

A

Henoch-Schonlein purpura (self-limited so no biopsy needed)

100
Q

What can be seen on biopsy of a patient with henoch schonlein purpura (HSP)?

A

IgA deposits in blood vessels along with leukocytoclastic vasculitis

101
Q

A pt presents with hemolytic anemia (schistocytes), uremia and thrombocytopenia most likely suffers from …

A

Hemolytic Uremic Syndrome (HUS associated with E. Coli 0157:H7)

102
Q

A pt presents with altered mental status, fever, hemolytic anemia (schistocytes), uremia, and thrombocytopenia most likely suffers from …

A

Thrombotic thrombocytopenic purpura (TTP)

103
Q

What is treatment for thrombotic thrombocytopenic purpura?

A

plasmapheresis (can use dipyridamole to prevent platelet aggregation)

104
Q

A pt with hx of hep C presenting with hematuria, joint pain, neuropathy and purpura most likely suffers from ..

A

Cryoglobulinemia (no GI symptoms unlike HSP)

105
Q

What should be used to screen for renal disease in diabetics?

A
  1. microalbuminuria

2. creatinine

106
Q

What is the treatment for albuminuria in a diabetic patient?

A

ACE inhibitor (ACE)

107
Q

What is the essential diagnostic test for lupus nephritis and why is it essential?

A

biopsy; to assess whether proliferative disease

108
Q

What is the treatment for renal sclerosis in lupus and for renal proliferative disease in lupus?

A

no therapy; mycophenolate w/ steroids

109
Q

What is difference between cryoglobulinemia and cold-agglutinin?

A

Cryo: pupura & renal disease, associated w/ hep C

cold agglutinin: hemolytic anemia, associated w/ EBV and mycoplasma

110
Q

What is treatment for cryoglobulinemia?

A

treat hep C (interferon and ribavirin)

111
Q

A pt presenting with hematuria with sensorineural hearing loss and congential eye problems most likely suffers from ..

A

Alport syndrome (family hx)

112
Q

What is the finding on renal biopsy in a pt with Goodpasture syndrome?

A

linear deposits

113
Q

What diagnostic test can be done in a pt with polyarteritis nodosa with abdominal pain?

A

angiogram of GI vessels

114
Q

What is the diagnostic finding associated with amyloidosis?

A

green birefringence with congo red staining

115
Q

What is diagnostic criteria for nephrotic syndrome?

A
  1. > 3.5 grams of protein in urine in day
  2. hypoalbuminemia
  3. edema anywhere including non-dependent areas like face (due to low oncotic pressure)
  4. hyperlipidemia
116
Q

What tests can be done to detect nephrotic syndrome level protein?

A
  1. 24 hour urine collection

2. spot urine protein:creatinine ratio >3.5

117
Q

What is nephrotic syndrome a hypercoagulable state?

A

due to urinary loss of anti-thrombotic proteins (anti-thrombin, protein S, protein C) more than thrombotic proteins

118
Q

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

A

Membranous glomerulonephrits

119
Q

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

A

Minimal Chane disease (Nil Lesion)

120
Q

What are two things that are associated with Minimal Change Disease?

A
  1. NSAIDs

2. Hodgkin’s Lymphoma

121
Q

What is biopsy finding associated with Minimal Change disease?

A

fusion of foot processes on electron microscopy

122
Q

…. is a steroid-resistant type nephrotic syndrome that has IgM deposits in an expanded mesangium on immunofluorecent staining of biopsy

A

Mesangial glomerulonephritis

123
Q

A pt with hematuria with crescent formation on biopsy is most likely …

A

Rapidly progressive glomerulonephritis

tx w/ steroid and cyclophosphamide

124
Q

A pt with restrictive cardiomyopathy, nephritis, carpal tunnel syndrome (peripheral neuropathy), and macroglossia most likely suffers from …

A

Amyloidosis

125
Q

What is the treatment for Amyloidosis?

A

melphalan and prednisone

correct underlying infection/ cancer

126
Q

What is the treatment for mild hyponatremia (aymptomatic low Na)?

A

fluid restriction

127
Q

What is the treatment for moderate hyponatremia (low Na with symptoms)?

A

normal saline with furosemide (free water loss)

128
Q

What do maltese crosses signify?

A

droplet of lipids forming cross signifying hyperlipiduria

129
Q

What is the treatment for severe/ chronic hyponatremia (Na<120, coma/seizure)?

A
  1. 3% hypertonic saline

2. V2 receptor-antagonist (conivaptin or tolvaptan)

130
Q

What disease can result if the sodium is corrected too rapidly in hyponatremia?

A

Central Pontine Myelinolysis

131
Q

What conditions/diseases are associated with focal-segmental glomerulonephritis?

A
  1. HIV

2. Heroin

132
Q

What rate should sodium be corrected in order to avoid central pontine myelinolysis?

A

0.5-1 meq per hour

133
Q

What are causes of pseudohyponatremia (low Na serum level but total Na is normal)?

A
  1. Hyperglycemia (glucose osmotic causing water to move out of cell–> dilutional)
  2. hyperlipidemia (lab error)
134
Q

What are causes of hyponatremia in pt who is in hypervolemic state (increased extracellular fluid w/ intravascular volume depletion leading to increased ADH)?

A
  1. CHF
  2. Nephrotic syndrome & low albumin
  3. cirrhosis
  4. renal insufficiency (impaired free water excretion)
135
Q

What are causes of hyponatremia in pt who is in hypovolemic state (decreased ECF)?

A
  1. GI loss
  2. burns/sweating replacing w/ free water
  3. diuretics
  4. renal sodium loss
  5. adrenal insufficiency (no aldosterone to reabsorbs Na)
  6. ACE inhibitors

(high urine Na: diuretics, ACEI, renal salt wasting, adrenal insufficiency, cerebral salt wasting)

(low urine Na b/c body retains Na to retain volume: dehydration, vomiting, diarrhea, sweating)

136
Q

What are causes of hyponatremia in euvolemic state?

A
  1. psychogenic polydipsia (drink too much water)
  2. hypothyroidism
  3. diuretics
  4. ACE inhibitors (increase ADH)
  5. endurance exercise
  6. SIADH
137
Q

A pt presents with hyponatremia in the setting of elevated urine osmolality (>100) and elevated urine Na most likely suffers from …

A

SIADH (syndrome of inappropriate ADH)

138
Q

What are causes of SIADH?

A
  1. anything brain related
  2. anything in lung
  3. meds (SSRIs, TCAs)
  4. cancer
139
Q

What is the most accurate test for SIADH?

A

ADH level

140
Q

What causes hypernatramia?

A
  1. skin, urine or GI loss of fluid

2. diabetes insipidus

141
Q

How do you distinguish central diabetes insipidus versus nephrogenic diabetes insipidus?

A

decrease in urine volume in response to ADH suggests central diabetes insipidus

142
Q

What are the causes of nephrogenic diabetes insipidus?

A
  1. hypokalemia
  2. hypercalcemia
  3. lithium
  4. demeclocycline
143
Q

What is the treatment for nephrogenic diabetes insipidus?

A
  1. diuretics

2. NSAIDs (inhibit prostaglandins that can impair concentrating ability; increase action of ADH)

144
Q

What are causes hypokalemia?

A
  1. GI loss (colon)
  2. alkalosis (H+ come out and K in)
  3. insulin (drives K into cells)
  4. low magnesium
  5. beta agonist (increases ATPase)
  6. aldosterone (Na in, K out of kidney; Conn/ Cushing/ licorice)
  7. Vitamin B12/ folate treatment (b/c increase cell formation adding K into cells)
145
Q

What are causes of hyperkalemia?

A
  1. diabetes (low insulin)
  2. digoxin
  3. beta blockers (decrease ATPase)
  4. acidosis (H+ into, K out)
  5. hemolysis/ cell lysis
  6. low aldosterone (addisons; ACEI; type 4 RTA)
  7. renal failure
  8. potassium sparing diuretics (amiloride, spironolactone)
146
Q

What is seen on EKG in hypokalemia?

A
  1. T wave flattening

2. U waves (purkinje fiber)

147
Q

What type of saline should be used in a pt with hypokalemia being repleted with IV KCl?

A

saline (avoid dextrose bc increases insulin that pushes K into cell)

148
Q

What are EKG findings associated with hyperkalemia?

A
  1. peaked T waves

2. widened QRS, short QT, prolonged PR

149
Q

What is the treatment for hyperkalemia with associated changes in EKG?

A
  1. calcium chloride/ gluconate (stabilizes cardiac membrane)

2. insulin & glucose

150
Q

What are treatments for hyperkalemia without EKG changes?

A
  1. NaHCO3 (drives K into cell)
  2. Glucose & insuline (drives K into cell)
  3. Kayexalate (removes from body)`
151
Q

What is type 1 (distal) renal tubular acidosis?

A

inability to develop high H+ concentrate in urine (can’t excrete H+; so urine basic)

152
Q

What are complications of type 1 (distal) renal tubular acidosis?

A
  1. stones in kidney (nephrocalcinosis and nephrolithiasis)

2. hypokalemia

153
Q

What is the diagnostic test for type 1 (distal) renal tubular acidosis?

A

give ammonium chloride (acid) and urine stays basic

154
Q

What is treatment for type 1 (distal) renal tubular acidosis?

A

bicarbonate

155
Q

What is type 2 (proximal) renal tubular acidosis?

A

inability to absorb bicarbonate

initially urine pH basic then becomes acidic once bicarb depleted

156
Q

What are complications associated with type 2 (proximal) renal tubular acidosis?

A
  1. bone lesions (osteomalacia, rickets; acid sucks calcium out of bone)
  2. hypokalemia
157
Q

What is diagnostic test for type 2 (proximal) renal tubular acidosis?

A

give sodium bicarbonate (urine becomes basic initially b/c can’t absorb it)

158
Q

What is treatment for type 2 (proximal) renal tubular acidosis?

A
  1. diuretic (decrease volume of body

2. bicarbonate

159
Q

What is type 4 (hyporeninemic/ hypoaldosteronism) renal tubular acidosis?

A

occurs in diabetic pt with low renin and low aldosterone

160
Q

What are complications of type 4 (hyporeninemic/ hypoaldosteronism) renal tubular acidosis?

A
  1. hyperkalemia (no aldosterone to cause K excretion)
161
Q

What is treatment for type 4 (hyporeninemic/ hypoaldosteronism) renal tubular acidosis?

A

fludrocortisone

162
Q

What are the two causes of non-anion gap metabolic acidosis?

A
  1. diarrhea

2. renal tubular acidosis

163
Q

How do you distinguish between diarrhea and RTA as causes of non anion gap metabolic acidosis?

A

urinary anion gap
diarrhea: negative
RTA: positive

164
Q

What are causes of metabolic alkalosis (HCO3 > 24 w/ pH high)?

A
  1. loss of H+ (vomiting, renal loss)
  2. hypokalemia (K comes out of cell, driving H into cell)
  3. HCO3 retention (volume contraction -> aldosterone excrete H; milk-alkali w/ antacids)
165
Q

What are causes of respiratory alkalosis?

A

hyperventilation (anemia, salicylate stimulate respiratory drive, PE, anxiety)

166
Q

What is the formula for anion gap and what is considered increased?

A

AG= Na - (HCO3+ Cl)

AG > 14 is increased

167
Q

What are causes of anion-gap metabolic acidosis?

A

MUDPILES

  1. methanol
  2. uremia
  3. DKA
  4. Propylene glycol/ paraldehyde
  5. INH/ isopropyl alcohol
  6. Lactate (sepsis, ischemia)
  7. ethylene glycol
  8. Salicylic acid (aspirin)
168
Q

What are causes of respiratory acidosis?

A

hypoventilation (COPD, opiates, sleep apnea, aspiration, myopathies, obesity)

169
Q

What type of kidney stones are radiolucent?

A

uric acid stones

170
Q

What type of infections are associated with struvite stones (magnesium/ aluminum/ phosphate)?

A

kidney infection with urease producing organisms (Proteus, Staph, Pseudomonas, Klebsiella) which increase pH

171
Q

Enveloped shaped crystals in a pt attempting suicide most likely suffers from …

A

oxalate crystals secondary to ethylene glycol intoxication

172
Q

A pt presents with constant excruciating flank pain, hematuria, and pain radiating to groin most likely suffers from ..

A

Nephrolithiasis (kidney stones)

173
Q

A pt who was in motor vehicle accident who received large amount of transfusion fast who develops seizure most likely had seizure due to …

A

hypocalcemia due to citrate (used to preserve blood) binds up all the calcium

174
Q

What is the best initial step in management for suspected kidney stones?

A

pain medications

ketolorac

175
Q

What is the best initial test for kidney stone?

A

X-ray

176
Q

What is the most accurate test for kidney stone?

A

spiral CT

177
Q

What is the treatment for kidney stones that are 5mm to 2 cm in size?

A

shockwave lithotripsy (if bigger, percutaneous removal)

178
Q

What is the most common cause of death in adult polycystic kidney disease?

A

ESRD due to chronic infections and stones

179
Q

What is the next best step in management of a simple renal cyst with irregular walls or debris inside?

A

aspiration to exclude malignancy

180
Q

What is malignant hypertension?

A

encephalopathy or nephropathy with accompanying papilledema

DBP > 130

181
Q

What is the treatment for hypertensive crisis/ urgency/ emergency?

A

IV labetolol and nitroprusside and enalapril

no lower than DBP <95 in initial hours

182
Q

What is the initial drug of choice for hypertension?

A

thiazide diuretics

183
Q

What is the best anti-hypertensive medication in a pt with diminished LV systolic function?

A

beta blockers (avoid in asthmatics)

184
Q

A older pt or young women with hypertension and upper abdominal bruit radiating laterally most likely suffers from ….

A

renal artery stenosis

185
Q

What is the best initial diagnostic test for renal artery stenosis?

A 
abdominal ultrasound
(other options captopril renogram- decreased uptake)
186
Q

What is the most accurate diagnostic test for renal artery stenosis?

A

arteriogram

187
Q

What is the best treatment for renal artery stenosis?

A

percutaneous transluminal angioplasty (ACE inhibitor if fails)

188
Q

A pt presenting with hypertension in there upper extremities but decreased blood pressure in lower extremities most likely suffer from ..

A

Coarctation of Aorta

189
Q

What is treatment for primary hyperaldosteronism (Conn’s syndrome)?

A
  1. surgical resection (if unilateral adenoma)

2. Spironolactone (bilateral hyperplasia)

190
Q

A pt presenting with hypertension in setting of hypokalemia most likely suffers from …

A

primary hyperaldosteronism (Conn’s syndrome)

191
Q

A pt presenting with episodic hypertension with associated headaches, sweating, palpitations and tachycardia most likely suffers from ..

A

pheochromocytoma

192
Q

What is the best initial test for pheochromocytoma?

A
  1. urinary vanillylmandelic acid (VMA)
  2. metanephrines 3. free urinary catecholamines
    (detect location via CT/MRI)
193
Q

what is treatment for pheochromocytoma?

A

alpha blocker followed by surgery

194
Q

A pt presents with hypertension in the setting of cushiongoid characteristics (truncal obesity, buffalo hump, menstrual abnormalities, straie, etc) most likely suffers from …

A

Cushing Disease (ACTH hypersecretion by pituitary adenoma)

195
Q

What is the best initial test for Cushing disease?

A
  1. dexamethasone suppression

2. 24 hour urine cortisol

196
Q

What is the most common side effects of diuretics?

A
  1. hypokalemia

2. hypomagnesium

197
Q

What are the most common side effects of beta blockers?

A
  1. worsening asthma (bronchospasm)

2. heart block

198
Q

What is the most accurate test for detecting location of pheochromocytoma when CT/MRI negative?

A

MIBG scan

199
Q

What are the most common side effects of ACE inhibitors?

A
  1. cough
  2. angioedema
  3. hyperkalemia
200
Q

What are the most common side effect of calcium channel blockers?

A
  1. peripheral edema
  2. constipation
  3. reflex tachycardia
201
Q

What is treatment of hypertension in pregnant women with eclampsia?

A

hydralazine

202
Q

What is minoxidil used?

A

treat baldness

203
Q

What is most common side effect of alpha blockers?

A

orthostatic hypotension

204
Q

When are alpha blockers used for hypertension?

A

in pt with simultaneous prostatic hypertrophy

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