Nephrology Quiz 2 Flashcards Preview

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Flashcards in Nephrology Quiz 2 Deck (97):
1

regarding urinary casts, RED CELL CASTS are markers of what?

glomerular injury

2

IgA Nephropathy is also known as?

Berger Disease/IgA

3

on physical exam, combination HTN + abdominal mass is suggestive of which renal disease?

polycystic kidney disease

4

Which gene (on which chromosome) is responsible for slower progression of polycystic kidney disease?

ADPKD2 on chromosome 4

5

which diagnostic test is performed first when evaluating polycystic kidney disease

Ultrasound (if unclear, CT scan)

6

What is the criteria regarding number of cysts on each kidney, diagnosing polycystic kidney disease?

age < 60: 2+ cysts on each kidney
age > 60: 4+ cysts on each kidney

7

hematuria that is persistent and recurring in someone with polycystic kidney disease suggests what?

renal cell carcinoma

8

Patient with polycystic kidney disease endorses flank pain + fever + leukocytosis. What do you suspect?

renal infection
(on CT, infected cysts have increased wall thickness)

9

kidney stones in polycystic kidney disease are which type?

calcium oxalate

10

cerebral aneurysms are commonly located where in the brain?

Circle of Willis

11

This disease is benign at birth, and then diagnosed at age 40-50

Medullary Sponge Kidney

12

What area of the kidney is affected in medullary sponge kidney?

enlarged at interpapillary collecting ducts

13

you'll see a "swiss cheese appearance" on imaging of this disorder

medullary sponge kidney

14

can you transplant a non-PKD kidney to a PKD patient with success?

YES - they will NOT develop PKD

15

what does gross hematuria in PKD patient typically represent?

rupture of a cyst into the renal pelvis (resolves within 7 days)

16

in a patient with suspected renal infection, you get a UA. It is normal, but you can't rule out infection...why?

UA may be normal because cyst may not communicate with the urinary tract

17

True or false: 50% patients with PKD present with hypertension, but it will develop in most patients at some point in the course of the disease anyways.

TRUE

18

True or false: aggressive BP control seems to help slow the decline in GFR with a patient who has PKD

false - it does not stop the decline in GFR

19

this common, BENIGN disorder is present at birth and diagnosed at age 40-50

medullary sponge kidney

20

symptoms of medullary sponge kidney

hematuria
recurrent UTI
nephrolithiasis
nephrocalcinosis
tubular acidosis

21

Diagnosing medullary sponge kidney? (what is seen on this imaging?)

CT - cystic dilation of distal collecting tubule, striated appearance, calcifications i collecting duct

22

medullary sponge treatment?

none - keep hydrated, add thiazide diuretics to decrease calcium excretion

23

common cause of ESRD in young individuals

juvenile nephronophthisis

24

patient aged 14 with ESRD, suspicious of what?

juvenile nephronophthisis

25

what do kidneys look like on CT/US in patient with juvenile nephronophthisis?

small, scarred

26

kidneys look small and scarred on imaging, but what is diagnostic for medullary cystic kidney disease?

open biopsy

27

____ are contractile cells that constitute the central stalk of the glomerulus

mesangial cells

28

what is the glomerular basement membrane made of?

Type 4 collagen fibers

29

pan relief for acute uncomplicated bacterial cystitis?

Phenazopyridine

30

Treatment for uncomplicated bacterial cystitis?

Nitrofuratnoin
-sulf/trim
fluoroquinolones

31

pyelonephritis is also known as

acute complicated bacterial cystitis - upper and lower tract

32

patient presents with an obstruction of urination, NO tenderness on prostate exam, chills/rigors. What do you suspect?

acute complicated bacterial cystitis

33

Diagnostic for acute complicated bacterial cystitis

UA + microscopy/culture

34

Treatment for outpatient acute COMPLICATED bacterial cystitis?

ceftriaxone + Bactrim/augmentin/fluoroquinolone (broad coverage until culture comes back)

35

interstitial cystitis/bladder pain syndrome (IC/BPS) requires what duration of bladder symptoms for diagnosis?

> 6 weeks

36

discomfort associated w/ bladder filling, relieved by emptying. Patient explains he prefers to maintain lower bladder bolumes.

Interstitial cystitis/bladder pain syndrome

37

Allodynia is when non-noxious stimuli is perceived as painful stimuli. It is a hallmark symptom in?

IC/BPS

38

what will you see on UA and prostate exams of possible IC/BPS patient?

unremarkable

39

most common pathogens for urethritis

gonorrhea & chlamydia

40

patient presents with burning and mucopurulent discharge. you obtain UA and it reveals leukocyte esterases and WBC. Suspected diagnosis?

urethritis

41

urethritis treatment of gonorrhea?

ceftriaxone + azithro

42

urethritis treatment chlamydia

azithro or doxy

43

higher risk of acute bacterial prostatitis with what ?

HIV

44

what to be aware of if prostatitis is from s. aureus?

s. aureus infection elsewhere too

45

results of acute bacterial prostatitis prostate exam

firm, edematous, exquisitely tender

46

what other labs would you see in patient with acute bacterial prostatits

UA: bacteremia, pyuria, hematuria
elevated PSA
elevated ESR/CRP

47

gram positive cocci in chains (bacterial prostatitis) indicates what type of infection?

enterococcal infection
(amox and ampicillin treatment)

48

gram positive cocci in clusters indicates?

s. aureus
*treat with cephalosporin)

49

ok to use nitrofurantoin in acute or chronic bacterial prostatitis?

NO - poor penetration

50

staph aureus infections in patients with valvular disease are at high risk for what?

endocarditis

51

in order to diagnose CHRONIC bacterial prostatitis, how long do they need to have symptoms?

> 3 months (OR recurrent urogenital symptoms)


AND bacteriuria is present

52

treatment chronic bacterial prostatitis?

Fluoroquinolones - even if they previously had it

53

risks of using fluoroquinolones?

c.diff, CNS toxicity, tendon rupture

54

patient has chronic pelvic pain for 3 of past 6 months, and inflammatory cells post prostatic massage. NO bacteriuremia Thoughts?

chronic prostatitis

55

pt presents with 4 month pelvic pain, ED, hx fibromyalgia. Prostate exam and UA unremarkable. differential?

chronic prostatitis

56

what is the most common cause of scrotal pain?

epididymitis/orchitis

57

commonest pathogen of epididymitis?

gonorrhea, chlamydia

58

when would you perform the NAAT test?

with UA + culture for suspected epididymitis

59

what other virus could cause epididymitis?

Mumps

60

treatment of epididymitis?

Abx + NSAIDs+ local heat/ice

61

how long should it take patient to improve with Abx therapy for epididymitis?

48-72 hours. If doesn't improve, do scrotal US and refer

62

are there serologic tests for IgA nephropathy?

no - do renal biopsy + immunofluorescence

63

treatment IgA nephropathy

depends on risk for progression to renal failure. Low risk - monitor
high risk - ACE/ARB

64

when would you see elevated antistreptolysin O titer?

post-streptococcal glomerulus

65

where would you see anti GBM antibodies?

goodpastures/IgG

66

what does immunofluorescence look like for goodpastures?

linear, smooth outline of capillaries.

67

treatment of IgG

plasmapheresis + oral prednisone + cyclophosphamide

68

will kidney transplant in a patient with IgG be successful?

ONLY if there are no more antibodies present, otherwise they will get it again

69

what causes hyperlipidemia in patients with minimal change disease?

reduction in plasma oncotic pressure which directly stimulates hepatic APOPROTEIN B gene transcription, increasing levels of LDL

70

treatment minimal change

prednisone HIGH DOSE

71

immune complex deposition in SUBEPITHELIAL of glomerular capillary walls

membranous nephropathy

72

IgG and C3 are found in which disorders?

IgG and membranous nephropathy

73

in which glomerular disease is it especially important to monitor for thrombosis/DVT?

membranous nephropathy

74

higher risk of hypercoagulable state in patients with membranous nephropathy where?

Renal vein thrombosis

75

treatment of membranous nephropathy

antiprotein + ACE

-immunosuppressants for high risk patients with salvageable kidney function

76

persistent albuminuria on 2 occasions 3-6 months apart

diabetic nephropathy

77

what are kimmelstiel-wilson nodules and where would you see them?

large accumulations in glomerulus,forms thickened nodules

78

what kind of finding might you see in the urine of someone with diabetic nephropathy?

foamy urine

79

this disorder, most common in African americans, progresses to ESRD in 6-8 years

focal segmental

80

treatment focal segmental glomerularsclerosis

diuretics + ACE+ statins

81

2 most common glomerular diseases in kinds and young adults

IgA nephropathy
minimal change disease

82

which hormones are involved in BPH?

testosterone, dihydrotestosterone, estrogen

83

BPH occurs in the ______ zone of the urethra while prostate cancer occurs in the _____ zone

central/transitional zone; peripheral zone

84

gold standard diagnostic for kidney stones?

noncontrast helical CT (US and XRAY can only identify small stones)

85

what size kidney stone is usually passed on own?

<5 mm
(>10 mm needs surgical intervention)

86

treatment calcium kidney stones <10 mm

hydration, pain manage (NSAID/opioids)
alpha blockers/CCBs to help it pass

strain the urine to collect!

87

between lithotripsy and laparoscopic stone removal of stones, which is preferred?

laparoscopic - lithotripsy has lower success rates

88

what is the correlation between parathyroid hormone (PTH) and stones?

elevated PTH puts patient at higher risk of making stones (related to calcium levels)

89

childhood stones are likely what type

cysteine - will see cysteinuria and hexagon stones

90

hexagonal stones?

cysteine

91

which stone types do you treat with potassium citrate?

cysteine and uric acid stones

92

uric acid stones are radiolucent, and correlate to a pH of less than what?

5.5

93

these stones form in the presence of upper UTI, and look like a coffin lid

struvite

94

treatment for struvite stones?

surgical removal - can't pass

95

this anatomical structure is an enlargement of the vas deferens and a reservoir for sperm

ampulla (of the vas)

96

these cells exist outside of the testicular cell and produce testosterone

leydig cells

97

what is a common autoimmune disease that affects sperm production/fertility?

cystic fibrosis