R1

Question 1

1. Renal artery stenosis is common in?

Answer 1

2. Patient with diffuse atherosclerosis

Question 2

1. First-line treatment in case of RAS induced HTN

Answer 2

2. ACE inhibitor (safe in unilateral (just follow RFT) and bilateral until CR raise less than 30%)

Question 3

1. Mechanism

Answer 3

2. Inhibit the RAAS which cause the HTN in RAS

Question 4

. Why is RAAS activated in case of RAS

Answer 4

2. (to maintain GFR by constricting efferent arteriole)

Question 5

1. Benefit

Answer 5

2. Reduce HTN, decrease the risk of Ce. V and Ca. V complication

Question 6

1. Other additional Tx

Answer 6

2. Treat DM, Additional antihypertensive for control of B/P, Tx hyperlipidemia and smoking section

Question 7

1.When to consider Surgical revascularization and stunting

Answer 7

2. Failure of medical therapy, recurrent flash pulmonary edema, and CHF secondary to HTN

Question 8

1. Why we didnt consider as primary therapy

Answer 8

2. No outcome d/c with that of medical therapy

Question 9

1. Symptom and sign of salicylate toxicity

Answer 9

2. Tinnitus, fever and tachypnea

Question 10

1. Acid base disturbance?

Answer 10

2. Respiratory alkalosis(stimulate respiratory center) with metabolic acidosis(decoupling of oxidative phosphorylation)—Near normal PH, Low pco2 and low HCO3

Question 11

How we asses presence of Respiratory alkalosis in presence of Metabolic acidosis?

Answer 11

Use winter formula to asses expected Paco2 level?

Question 12

winter formula?

Answer 12

PaCO2=1.5xHCO3 + 8 +-2

if PaCO2< expecter suspect concomitant respiratory alkalosis

Question 13

How to asses concomitant respiratory acidosis in case of metabolic alkalosis?

Answer 13

Change in PaCO2=0.7 x change in HCO3(assuming the Normal HCO3 is 24)
Took the normal CO2 range of 33-45

Question 14

metabolic acidosis classification?

Answer 14

normal anion gap(8-12)

high anion gap(>12)

Question 15

anion gap calculation?

Answer 15

Na -(Cl + Hco3)

Question 16

High anion gap cause?

Answer 16

GOLDMARK
Glycol(ethylene and proline)
Oxopeoline(a metabolite of acetaminophen)
Lactic Acidosis
D-Lactate(exogenous)
M-methanol and other alcohol
Asprin
Renal failure
Ketone

Question 17

Normal AGMA?

Answer 17

HARDASS
Hyperlimation(hypochloremia)
Addison disease
Renal tubular acidosis
Diharoa
Acetazolamide
Saline infusion
Spironolactone

Question 18

Menifestation of diuretic abuse?

Answer 18

hypovolemia
Hyponatremia
Hypokalemia
Hopoclorimia
But will have high urinary Na, K but vary CL

Question 19

A disease that causes high urine NA despite hyponnatremia?

Answer 19

Diuretics
Adrenal insufficiency
Cerebral salt wasting syndrome

Question 20

Disease that cause high urine K level despite hypokalimia?

Answer 20

Diuretics
Primary adrenal insuficiency
Renal tubular acidosis

Question 21

cause of hypochloremia?

Answer 21

Diuretics
Contraction alkalosis
In both cases, the urine concentration can vary

Question 22

the factor that causes hypokalemia, alkalosis, and normotension?

Answer 22

1-sever vomiting
2-Diuretics abuse
3-Gitelman’s syndrome
4-Bartter syndrome

Question 23

1-serpitious vomiting evidence ?

Answer 23

scar/callus in dorsum of hand
dental erosion
hypochlorimia and low urine CL

Question 24

2-Diuretics abuse, Gitelmans syndrome

and Bartter syndrome?

Answer 24

High urine CL level

Question 25

What about primary primary hyperaldostronism?

Answer 25

Hypokalemia.Metabolic alkalosis but have HTN

Question 26

Bartter syndrome?

Answer 26

``` Reabsorption defect in thick ascending loop of Henle (affects Na+/K+/2Cl– cotransporter) Metabolic alkalosis, hypokalemia, hypercalciuria Autosomal recessive Presents similarly to chronic loopdiuretic usage ```

Question 27

Gitelman syndrome?

Answer 27

``` Reabsorption defect of NaCl in DCT Metabolic alkalosis, hypomagnesemia, hypokalemia, hypocalciuria Autosomal recessive Presents similarly to lifelong thiazide diuretic use Less severe than Bartter syndrome ```

Question 28

How to d/t barrtner from gitelman?

Answer 28

B-Hypercaceiuria | G-Hypocalciuria

Question 29

Hepatorenal syndrome manifestation?

Answer 29

End-stage liver disease w/o clear cause identified minimal haematuria lack of improvement with resuscitation

Question 30

pathophysiology?

Answer 30

difiuse pheripherial vasodilation mainley splancnic---RAAS activation==Renal hypoperfusion---decrease renal perfusion and low GFR--AKI

Question 31

managment?

Answer 31

Liver transplantatioin candidate stop liver injuring practice Splancnic vasoconstricting agent(octeriotide, midodrine,NE) and albumine

Question 32

Common initiating factor?

Answer 32

upper GI bleeding | SBP

Question 33

winter formula?

Answer 33

asses RA compensation in case of MA

Question 34

change in HCO3)x 0.7?

Answer 34

respiratory acidosis Compensation in case of Metabolic alkalosis

Question 35

when to intubate patient with metabolic acidosis?

Answer 35

shalow and fast breathing | concomitant respiratory acidosis

Question 36

ECG feucher of hyperkalemia?

Answer 36

``` Tall picked T wave Prolonged PR, wide QRS, and short QT Disappearance of P wave Conduction block bradycardia Ectopic beat Sine wave pattern ```

Question 37

Emergency hyperkalemia managmnt?

Answer 37

Indicated when K level >6.5 mEq/L Iv calcium Cloride/gluconate--Membrane stabilization IV inuline with glucose Beta agonist(albuterol)

Question 38

mechanism to lower body K level?

Answer 38

1) Reversal of etiology like prerenal azotemia 2) Diuretics 3) Exchange resins 4) Heamodialysis

Question 39

use of serum osmolar GAP?

Answer 39

To identify causes(methanol,ethanol, and ethylene glycol) suspected in case of anion gap MA.

Question 40

use of urine anion gap ?

Answer 40

To identifi cause of non anion gap MA | calculated as urine Na+K-CL

Question 41

If posetive?

Answer 41

caused by renal loss like RTA and Acetazolamide

Question 42

If negative ?

Answer 42

Caused by GI bicarbonate loss

Question 43

Renal complication of SLE?

Answer 43

DNA and anti DNA IC deposition If above BM--Glomerulonephritis If below BM--Nephrotic syndrome

Question 44

first generation antihistamin in BPH/older patient?

Answer 44

can cause AUR b/c of anticolinergic effect Durtusor muscle dysmotility Impaired IUS relaxation

Question 45

cause of hyponatremia evaluation?

Answer 45

asses urine and serum osmolarity

Question 46

serum osmolarity > 290

Answer 46

marked hyperglycemia | ARF

Question 47

if urine osmolarity <100 (diluted)

Answer 47

primary polydipsia | malnutrition(post alcohol protiomania)

Question 48

if urine osmolarity > 100

Answer 48

asses urine Na

Question 49

if urine Na <25 meq/l?

Answer 49

DHN CHF Cirhosis

Question 50

If urine Na >25 meq/L

Answer 50

SIADH HYpothyroiism Adrenal insuficienct

Question 51

CM of ADPKD?

Answer 51

``` flank pain hematuria HTN palpapele abdominal mass CKD nocturia and frequency due to defect in renal consentration of urine capablity ```

Question 52

extrarenal feaucher?

Answer 52

``` cerebral anurythm liver and pancriatic cyst MVP and AR colonic diverticulosis ventral and inguinal hernia ```

Question 53

managment of HTN in ADPKD?

Answer 53

ACE inhibitors

Question 54

How to d/t glomerular from non glomerular hematuria?

Answer 54

IN GH protine positive dysmorphic RBC RBC cast

Question 55

managment of acute cystitis in NP womens?

Answer 55

``` Nitrofurantoin TM-CTM fosomycine single dose FQ if abovw managment fails Urine culture if initial tx failure ```

Question 56

complicated cystiti?

Answer 56

prolonged FQ broad spectrum ab(ampi genta) urine culture

Question 57

pyelonephritis?

Answer 57

FQ IV ceftra urine culture and sensitivity

Question 58

RCC sighn and symptome?

Answer 58

``` flank hematuria flank pain palpable mass left side scrotal varicosele paraneoplastic syndrome ```

Question 59

paraneoplastic syndrome?

Answer 59

``` erythrocytosis and anemia thrombocytosis fever hypercalcemia cachexia ```