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INTERNAL MEDICINE - PLE TOPNOTCH 2020 > NEPHROLOGY > Flashcards

NEPHROLOGY Flashcards

1
Q

The first step in the diagnostic evaluation of hyper- or hypocalcemia is to ensure that the alteration in serum calcium levels is not due to abnormal ______ concentrations.

A

ALBUMIN

So the first step in the diagnostic evaluation of hypercalcemia is to check albumin concentration

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2
Q

Vasoconstricts EA increasing GFR

A

ANP, ANGIOTENSIN II, NOREPINEPHRINE

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3
Q

rish for osmotic demyelination syndrome (ODS) is increased in ____

A

Chronic hyponatremia

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4
Q

What type RTA has predisposition to stone formation?

A

Distal (Type) I

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5
Q

Significant bacteriuria with urologic abnormality, renal transplant, diabetes, sepsis or older male

A

complicated UTI.

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6
Q

Classic ECG changes in hyperkalemia

A

o Tall, peaked T waves (5.5-6.5 mM),

o Loss of P waves (6.5-7.5 mM)

o Widened QRS (7-8 mM)

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7
Q

Syndrome that mimic THIAZIDE DIURETICS.

  • Genetic defect in the distal tubule
  • Defect in Na-Cl cotransporter in the distal tubule
A

GITELMAN SYNDROME

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8
Q

Bilaterally small kidneys supports the diagnosis of CKD , EXCEPT:

A

o Diabetic nephropathy

o Amyloidosis

o HIV nephropathy

o Polycystic kidney disease

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9
Q

What causes intracellular shift of potassium?

A

Insulin

Beta agonist

Alkalosis

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10
Q

most common site of renal stone impaction

A

Ureterovesicular junction

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11
Q

What type of RTA?

  • decreased aldosterone
  • Assoc with Diabetes
  • low (acidic) urine pH
  • (-) stones
  • high potassium
  • Tx: Fludrocortisone
A

Type IV (Hypoaldosteronic) RTA

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12
Q

Examples of High anion gap metabolic acidosis

A

“MUDPILES”

Methanol

Uremia

DKA

Paraldehyde

Iron or INH

Lactate

Ethylene glycol

Salicylates

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13
Q

What type of RTA?

  • Inability to reabsorb HCO3
  • Assoc with Multiple myeloma and Amyloidosis
  • low (acidic) urine pH
  • (-) stones
  • low potassium
  • Tx: HCO3 + K+ tabs + diuretics (HCTZ)
A

Type II (Proximal) RTA

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14
Q

Vasodilates AA increasing GFR

A

ANP, Prostaglandin

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15
Q

Syndrome characterized with:

  • Chloride-resistant metabolic alkalosis
  • Hypokalemia
  • Hypomagnesemia
  • Decreased urinary calcium excretion
  • Hypocalciuric so no increased risk for kidneys stones or nephrocalcinosis
A

GITELMAN SYNDROME

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16
Q

Syndrome characterized with:

  • Chloride-resistant metabolic alkalosis
  • Hypokalemia
  • Normal serum magnesium (may be low)
  • Increased urinary calcium excretion

(hypercalciuric so at risk for kidney stones or nephrocalcinosis

A

BARTTER SYNDROME

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17
Q

CKD definition

A

Abnormality of kidney structure or function, present for >3 months, with implications for health

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18
Q

syndrome that is MINERALOCORTICOID-LIKE

  • ENaC upregulation
  • (+) HTN
A

LIDDLE’S SYNDROME

19
Q

Premenopausal non-pregnant women with acute onset dysuria, frequency, urgency without vaginal discharge

A

acute uncomplicated cystitis.

20
Q

vasodilates EA decreasing GFR

21
Q

Healthy women with fever, chills, flank pain and costovertebral angle tenderness with nausea and vomiting

A

acute uncomplicated pyelonephritis

22
Q

The most common causes of intrinsic AKI

A

sepsis, ischemia, and nephrotoxins

23
Q

What is the best treatment for type I RTA?

A

HCO3 and Potassium replacement

24
Q

What electrolyte abnormality can occur?

  • GI loss: diarrhea (most common)
  • Renal loss: osmotic diuresis, excess urea, mannitol
  • Diabetes insipidus

Presents with change in sensorium

A

Hypernatremia

25
mainly has an effect in the efferent arteriole causing increase Glomerular Filtration Rate but with compensatory Na reabsorption
ANGIOTENSIN
26
Severe hyponatremia may present with \_\_\_\_
**seizures, cerebral edema,** coma, death
27
The combined use of NSAIDs with ACEIs or ARB poses high risk for AKI. True or false.
True
28
facilitate dilation of the Afferent arteriole causing increase GFR but no Na + reabsorption (net effect is Na + loss and volume loss)
ANP (Prostaglandins)
29
What treatment do you recommend if with hyperkalemic ECG changes?
Calcium gluconate IV
30
31
Favors CHRONIC kidney disease
* History of kidney disease, hypertension, abnormal urinalysis, edema * Small kidney on renal ultrasound * Anemia, hyperkalemia, acidemia * Urinalysis with broad cast
32
**syndrome that mimics LOOP DIURETICS.** * Genetic defect in the thick ascending limb of the Loop of Henle * Defects in Na-K-2Cl co-transporter, K or Cl channels result in lack of concentrating ability Often presents with sensorineural deafness, triangular facies with drooping mouth, large eyes
BARTTER SYNDROME
33
Criteria for AKI
* **Increase in sCr (serum creatinine) by \> 0.3 mg/dl (\>26.5 umol/l) within 48 hours;** * **Increase in sCr from baseline within 1 week;** * **Urine volume \<0.5 ml/kg/h for 6 hours** * **Anuria: Complete absence of urine formation (\<100 mL)** * **Oliguria: 24-h urine output \<400 mL**
34
Favor AKI instead of CKD
* Return of renal function to normal with time * Anemia, hyperkalemia, acidemia * Sudden decrease in urine output
35
What causes extracellular shift of potassium?
**Hyperosmolarity** **Exercise** **Cell lysis** **Acidosis**
36
What type of RTA? * **Inability to secrete H+** * associated with Sporadic and Hep B or C * High (basic) urine pH * **(+) stones** * low potassium * Tx: HCO3 + K+ tabs
**Type I (Distal) RTA**
37
Bartter or Gitelman syndrome? Increased renal PGE2 production
BARTTER SYNDROME
38
Vasoconstricts AA decreasing GFR
NSAIDs
39
The “gold standard” diagnostic test for nephrolithiasis
helical CT without contrast
40
STAGES OF CHRONIC KIDNEY DISEASE
41
absolute indications for dialysis
* Acidosis, intractable * Electrolyte imbalance (hyperkalemia), intractable * Intoxication * Overload (volume), intractable * Uremi
42
treatment regimen recommended for UTI in men
7- to 14-day course of a fluoroquinolone or TMP-SMX is recommended
43
ECG changes in hypokalemia
U waves

INTERNAL MEDICINE - PLE TOPNOTCH 2020 (10 decks)

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