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MCCQE1 > Nephrology > Flashcards

Nephrology Flashcards

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1
Q

Acute ↑ Cr, BUN/Cr > 20, U Na < 10, FE Na < 1%. Dx and next step?

A

AKI pre-renal etiology.

If dry (e.g., diarrhea, dehydration, hemorrhage) –> IVF.

If wet (e.g., third space: nephrotic syndrome, malnutrition, cirrhosis) –> diuretics.

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2
Q

Acute ↑ Cr, hydronephrosis or hydroureter. Dx, posible causes and next step?

A

AKI post-renal.

Posible causes: Neoplasia, Kidney stones, Neurogenic bladder, BPH

Next step: catheter, stent, surgery

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3
Q

Acute ↑ Cr, BUN/Cr < 10, U Na > 10, FE Na > 1%, RBC casts. Dx and next step?

A

AKI: glomerulonephritis.

Next step: Rule out nephrotic syndorme ( > 3.5 g/d of proteinuria, ↑ Cholesterol, edema)

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4
Q

Acute ↑ Cr, BUN/Cr < 10, U Na > 10, FE Na > 1%, muddy brown casts . Dx and posible causes?

A

AKI: acute tubular necrosis.

Caused by ischemia and toxins (IV constrast, myoglobin)

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5
Q

Acute ↑ Cr, BUN/Cr < 10, U Na > 10, FE Na > 1%, WBC casts, WBC, eosinophils. Dx and next step?

A

AKI: Acute interstitial nephritis

Can be cause by infections and reactions to drugs (trimetropim sulfa, penicillin, cephalosporins)

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6
Q

Which drugs may generate acute interstitial nephritis?

A

trimetropim sulfa, penicillin, cephalosporins

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7
Q

Acute indications for hemodialysis?

A 
o	A: Acidosis
o	E: Electrolites (K, Ca)
o	I: Intoxication
o	O: Overload
o	U: Uremia
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8
Q

Kidney anatomical anormality + GFR > 90. Stage of CKD and management?

A

Stage I.

Prevent progression

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9
Q

GFR 60-89. Stage and management?

A

Stage II

Prevent progression

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10
Q

GFR 30-59. Stage and management?

A

Stage III

Prevent progression, manage complications

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11
Q

GFR 15-29. Stage and management?

A

Stage IV

Prevent progression, manage complications, prepare for dialysis

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12
Q

GFR < 15. Stage and management?

A

Stage V, dialysis, transplant

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13
Q

Goals of BP in CKD.

A

BP < 130/80.

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14
Q

Tx of HTN in CKD?

A

Use ACEI or ARB

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15
Q

Goals of DM in CKD?

A

Goals: HbA1C <7; glucose < 80-120

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16
Q

Tx of DM in CKD?

A

Use oral meds (excepts for metformin) and/or insulin

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17
Q

Dx of anemia in CKD

A

Hb < 12
Dx of exclusion (look first for Iron, folic, B12)
No need to ask for EPO to diagnose

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18
Q

Goal of Hb in CKD?

A

HB > 10

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19
Q

Tx of secondary HyperPTH + Mineral Bone Disease (Osteopenia) in CKD?

A
  • Phosphate binders (e.g., Sevelamer)
  • Calcium mimetics (e.g., Cinacalcet)
  • Ca + Vit D
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20
Q

Tx of volume overload in CKD?

A

Use loop diuretics (e.g., furosemide) +/- Thiazides (e.g., metolazone)

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21
Q

Na < 135, ASx. Tx?

A

Disease specific

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22
Q

Na < 135, nausea, vomiting, headache. Tx?

A

IV NS

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23
Q

Na < 135, coma, seizure. Tx?

A

IV hypertonic

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24
Q

Na > 145, ASx. Tx?

A

PO water

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25
Na > 145, nausea, vomiting, headache. Tx?
IV NS
26
Na > 145, coma, seizure. Tx?
IV D5W
27
How to correct Na to prevent complications?
* A correction of 4 to 6 might be enough to treat Sx. * Correct Na by 0.25/hr. If you correct to quick --> risk of osmotic demyelination syndrome (aka pontine and extra-pontine myelinolysis)
28
How to correct Na if glucose if high?
If hypertonic, for each 100 of blood glucose above 100, you add 1.6 to the Na E.g., If Na is 130 and glucose is 500 (i.e., four 100s above 100), real Na = 130 + (1.6 x 4) = 136.4
29
Na < 135, ↓Osm, JVD, edema, CHF, anasarca. Next step?
Diuresis
30
Na < 135, ↓Osm, dry mocous, burns, fever, sepsis, hypotension
IV fluids (NS if moderate Sx, hypertonic if severe)
31
Na < 135, ↓Osm, normal volumen (aka, no edemas, no dehydration). Possible Dxs?
R: Renal tubular acidosis --> Uroanalysis A: Addison --> cortisol T: Thyroid --> TSH S: Sd. Inappropriate ADH --> Dx of Exclusion
32
Na < 135, ↑Osm. Next step?
Correct Na considering glucose levels
33
Na < 135, normal Osm. Dx?
PseudoHypoNa
34
Which medication is NEVER the answer to treat hypoNa?
Vaptans are never the answer to treat hypoNa!
35
Causes of Hyperkalemia
Low aldosterone (Meds: ACEI, ARB, aldo inhibitors) Iatrogenic Ingestion + CKD CKD stage V Most common: Artifact (hemolysis, fist squeezing during sample)
36
Hyperkalemia, changes in ECG?
Wide QRS | Picked T wave
37
Hyperkalemia workup?
Recheck K leves | Look for ECG changes
38
K levels high (confirmed) without ECG changes. Dx and next step?
Stable hyperkalemia Next step: Kayexalate and stop ACEI, ARB, aldo inhibitors
39
K levels high (confirmed) with ECG changes. Dx and tx?
Unstable hyperkalemia Tx: - IV Ca: stabilize - Insuline + glucose (D50): Shifts K into cells - HCO3: Shifts K into cells - Kayexalate: ↓ total body K - Loop diuretis/dialysis: ↓ total body K
40
Causes of hypokalemia?
Renal loses • HyperAldo (Conn’s, renal arthery stenosis, thiazides, loop diuretics) • Check BP and ABG GI loses (vomiting, diarrhea)
41
ECG changes in hypokalemia?
flattening of T waves, U waves, depressed ST segment
42
Hypokalemia workup?
Recheck K leves | Look for ECG changes
43
Repletion of K in hypokalemia
PO preferred (e.g., K-Dur) If IV is chosen, don’t go faster than: • Peripheral: 10 mEq/h • Central: 20 mEq/h Rate: 10 mEq change serum K by 0.1
44
If refractory hypokalemia?
if refractory, check Mg and replace it if low
45
Gold standard for kidney stones
NonCon CT (used on the first episode)
46
When to use KUB in kidney stones?
KUB (abdominal xR) is used to track the evolution and in subsequent episodes
47
Hematuria, colicky flanck pain that radiates to the groin. Next step?
U/A
48
Pregnant, hematuria, colicky flanck pain that radiates to the groin, U/A with hematuria. Next step?
Ultrasound
49
Stone < 5mm
IVF + NSAIDs
50
Stone < 7mm
IVF + NSAIDs + alpha blocker (prazosin) / CCB (amlodipine)
51
Stone at the kidney level < 2cm Tx?
Extracorporeal shock wave lithotripsy (ESWL),
52
Stone at the kidney level > 2cm
percutaneous nephrolithotomy (PCNL)
53
Stone at the urether > 1 cm
Extracorporeal shock wave lithotripsy (ESWL), Ureteroscopy (URS), percutaneous nephrolithotomy (PCNL), laparoscopy
54
Stone at the bladder, refractory to med Tx
Cystolitholapaxy, ureteroscopy
55
Outpatient follow-up of kidney stone
Once stone is out --> determine the type of stone --> modify risk factors --> 6 weeks later, do a 24-hr urine --> if stones still present keep modifying factors, if not present, cured!
56
Hematuria, colicky flank pain that radiates to the groin., U/A with hematuria, KUB normal. Next step?
Take uric acid
57
Calcium oxalate kidney stone. How to treat risk factors?
Thiazides, ↓ meat, ↑fruit (don't reduce the intake of calcium!!)
58
Bacteria resonsible for struvite stones
Proteus
59
Uric acid kidney stone. How to treat risk factors?
Allopurinol
60
Incidental finding of a small renal cyst with no loculation or septation. Next step?
No further workup of tx needed
61
Incidental finding of a large renal cyst with heterogenous structure. Next step?
U/A CT scan (US if pregnant) Bx
62
Complications of Complex renal cysts
pyelonephritis, pain, bleeding (hematuria)
63
Classic triad of renal cancer
Flank pain Flank mass Hematuria
64
Paraneoplastic sd of renal cancer
↓Hb ↑EPO  Polycythemia Trombus in IVC or DVT
65
Renal mass of neoplasic apearance. Next step and tx?
Workup: U/A, CT scan (US if pregnant), NO Bx Tx: parcial or radical nephrectomy
66
Extra renal manifestations of Autosomal dominant poly-cystic kidney disease (ADPCKD)
* Hepatic cyst/hepatitis * Pancreatic cyst/Pancreatitis * Cerebral aneurism (Screen for berry aneurisms with magnetic resonance with angiogram/CT angiogram/angiogram) * Diverticulosis * Mitral valve prolapse
67
Presentation of Autosomal recessive poly-cystic kidney disease (ARPCKD)
* Anuria * Renal failure * Olygohydramnios * Bilateral flank mases * Perinatal death
68
pH < 7.4, CO2 > 40. Dx and next step?
``` Respiratory acidosis. Manage underlying conduction (hypoventilation) Opiates COPD Asthma OSA Muscle strength ```
69
pH < 7.4, CO2 < 40. Dx and next step?
Metabolic acidosis. Get Anion gap (Na-Cl-HCO3)
70
pH < 7.4, CO2 < 40, anion gap > 12. Dx and next step?
``` Anion gap metabolic acidosis. Treat underlying condition (MUD PILES): Methanol Uremia DKA Propylene Glycol Iron Lactic acidosis Ethylene glycol Salycilates ```
71
pH < 7.4, CO2 < 40, anion gap < 12. Dx and next step?
Non-anion gap acidosis. Get Urine anion gap (Na+K-Cl). If (+) --> Renal tubular acidosis If (-) --> Diarrhea
72
pH > 7.4, CO2 < 40. Dx and next step?
Respiratory alkalosis. Treat the underlying condition (hyperventilation): Pain Anxiety Hypoxemia
73
pH > 7.4, CO2 > 40. Dx and next step?
Metabolic Alkalosis. Get urine Cl (To determine if patient is Volume responsive)
74
pH > 7.4, CO2 > 40, urine Cl < 10. Dx and next step?
``` Volume-responsive Metabolic Alkalosis. Treat underlying condition: Diuretics Dehydration Emesis NG tube ```
75
pH > 7.4, CO2 > 40, urine Cl > 10. Dx and next step?
Not-Volume-responsive Metabolic Alkalosis. Check BP If HTN --> Hyperadosteronism, renal artery stenosis, Cushing's If HTN --> Genetic diseases
76
What type of renal tubular acidosis (RTA) is associated with abnormal H+ secretion and nephrolithiasis?
Type I (distal) RTA.
77
Renal tubular acidosis associated with abnormal HCO3 – and rickets.
Type II (proximal) RTA.
78
Renal tubular acidosis (RTA) associated with aldosterone defect.
Type IV (distal) RTA.
79
“Doughy” skin .
Hypernatremia
80
Differential of hypervolemic hyponatremia.
Cirrhosis, CHF, nephrotic syndrome.
81
Chvostek’s and Trousseau’s signs.
Hypocalcemia.
82
The most common causes of hypercalcemia.
Malignancy and hyperparathyroidism.
83
T-wave fl attening and U waves. .
Hypokalemia
84
Peaked T waves and widened QRS.
Hyperkalemia.
85
First-line treatment for moderate hypercalcemia.
IV hydration and loop diuretics (furosemide).
86
Type of Acute kidney injury in a patient with FeNa < 1%.
Prerenal.
87
A 49-year-old man presents with acute-onset flank pain and hematuria. Dx?
Nephrolithiasis.
88
The most common type of nephrolithiasis.
Calcium oxalate.
89
A 20-year-old man presents with a palpable fl ank mass and hematuria. Ultrasound shows bilateral enlarged kidneys with cysts. Associated brain anomaly?
Cerebral berry aneurysms (autosomal-dominant PCKD).
90
Hematuria, hypertension, and oliguria.
Nephritic syndrome.
91
Proteinuria, hypoalbuminemia, hyperlipidemia, | hyperlipiduria, and edema.
Nephrotic syndrome.
92
The most common form of nephritic syndrome.
Membranous glomerulonephritis.
93
The most common form of glomerulonephritis.
IgA nephropathy (Berger’s disease).
94
Glomerulonephritis with deafness.
Alport’s syndrome.
95
Glomerulonephritis with hemoptysis.
Wegener’s granulomatosis and Goodpasture’s syndrome.
96
Presence of red cell casts in urine sediment. Dx?
Glomerulonephritis/nephritic syndrome.
97
Eosinophils in urine sediment.
Allergic interstitial nephritis.
98
Waxy casts in urine sediment and Maltese crosses (seen with lipiduria).
Nephrotic syndrome.
99
Drowsiness, asterixis, nausea, and a pericardial friction rub.
Uremic syndrome seen in patients with renal failure.
100
A 55-year-old man is diagnosed with prostate cancer. | Treatment options?
Wait, surgical resection, radiation and/or androgen | suppression.
101
Low urine specific gravity in the presence of high serum osmolality.
Diabetes insipidus.
102
Treatment of SIADH?
Fluid restriction, demeclocycline.
103
Hematuria, flank pain, and palpable flank mass.
Renal cell carcinoma (RCC).
104
Testicular cancer associated with β-hCG, AFP.
Choriocarcinoma.
105
The most common type of testicular cancer.
Seminoma, a type of germ cell tumor.
106
The most common histology of bladder cancer.
Transitional cell carcinoma.
107
Complication of overly rapid correction of hyponatremia.
Central pontine myelinolysis.
108
Salicylate ingestion occurs in what type of acid-base | disorder?
Anion gap acidosis and 1° respiratory alkalosis due to central respiratory stimulation.
109
Acid-base disturbance commonly seen in pregnant women.
Respiratory alkalosis.
110
Three systemic diseases that lead to nephrotic syndrome.
DM, SLE, and amyloidosis.
111
Elevated erythropoietin level, elevated hematocrit, and normal O2 saturation suggest?
Renal Cell Cancer or other erythropoietin-producing tumor; evaluate with CT scan.
112
A 55-year-old male presents with irritative and obstructive urinary symptoms. Treatment options?
Likely BPH. Options include no treatment, terazosin, | fi nasteride, or surgical intervention (TURP).
113
Patient who on POP day 1 of thyroidectomy/parathyroidectomy develops Tetany, Perioral tingling, Trousseau sign and Chvostek sign * ↓PTH * ↓ionized Ca Dx and tx?
Iatrogenic HypoPTH Tx: IV calcium (gluconate or carbonate)
114
Patient with • ↑PTH • ↓Ca • ↑P Dx?
PseudoHypoPTH | PTH insensitivity
115
Patient with osteopenia with dexa scan -2.0. Possible dx and Next step?
Vitamin deficiency Next step: ↓ 25 Vitamin D (< 30) Tx: Ca + vit D • Add bisphosphonates if severe osteopenia
116
Patient with early stage CKD and hypoCa. Dx and Tx?
Secondary hyperPTH: ↓VitD production leads to HypoCa. Therefore ↑PTH is secreted (secondary hyperPTH). Tx: • Ca+VitD • Cinecalcet (to decrease PTH and prevent tertiary HyperPTH)
117
Patient at the internal medicine floor. The nurse says that the patient has low Ca. Next step and tx?
Next step: - Albumin (correction of albumin corrects Ca) Tx: If Ionized calcium remains low, IV calcium (gluconate or carbonate)
118
Patient with Altered mental status (psychic moans), Abdominal pain (abdominal groans). ↑↑ Ca Next step?
- lots of IVF + early bisphosphonates | - If really high Ca and super Sx patient: Calcitonin
119
Patient with Pathologic fractures, ↓Bone density. On Rx Brown tumor in a bone. * ↑PTH * ↑Ca * ↓P Dx and next step?
HyperPTH Next step: Sestamibi scan (nuclear Rx) to see parathyroid glands.
120
Patient with Pathologic fractures, ↓Bone density. On Rx Brown tumor in a bone. * ↑PTH * ↑Ca * ↓P * Sestamibi scan (nuclear Rx) shows a single big parathyroid gland, the other three are very small Dx and Tx?
Autonomous adenoma producing Primary HyperPTH Tx: Resection
121
Patient with CKD, Pathologic fractures, ↓Bone density. On Rx Brown tumor in a bone. * ↑PTH * ↑Ca * ↓P * Sestamibi scan (nuclear Rx) shows 4 big parathyroid glands Dx and Tx?
autonomous multiple adenomas as a normal response to chronic hypoCa in CKD (tertiary HyperPTH). Tx: resection
122
How are Ca, PTH and P in metastatic disease of the bone?
o ↑Ca o ↑P o ↓PTH
123
Patient with a mass in lung. o ↑Ca o ↓P o ↓PTH Dx and next step
Small cell carcinoma and Paraneoplastic syndrome Next step: o ↑PHT-rp (related pepetide)
124
Patient with Granulomatosis (TB, sarcoid). • ↑Ca • ↑P • ↓PTH Dx and Next step?
Hypervitaminosis D Next step: • ↑1,25 Vitamin D
125
Patient with dx of primary hyperparathyroidism who had surgery. After the surgery he develops Perioral tingling, Trousseau sign, and Chvostek's Sign. Dx and tx?
Post-op hypocalcemia (the other glands are atrophied) Tx: IV Ca++

MCCQE1 (19 decks)

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