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USMLE Step 2 > Renal > Flashcards

Renal Flashcards

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1
Q

purpose of voiding cystourethrogram?

A

look for presence of reflux

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2
Q

PUV

A

post obstructive urpathy

can see hydro and oligohydramnios on prenatal US

after birth: no UOP, distended bladder

tx= VCUG –> cath –> surgery

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3
Q

whast important to know about epi/hypospadias?

A

DO NOT CIRC! need skin to rebuild

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4
Q

teenager binge drinks and has colicky abd pain that eventually resolves

A

consider UPJO –> surgery or stent

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5
Q

ectopic ureter

A

young girl with nl bladder function but is NEVER dry –> looks like a fistula but she’s too young for that

dx test is radionucleotide scan

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6
Q

BUN/cr ratio prerenal vs intrarenal

A

Pre= >20

Intra= <15, FeNA >2%

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7
Q

utility or Pr/Cr ratio on UA?

A

will essentially give you 24hour protein but it is easier and more reliable

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8
Q

why doesn’t hemolysis cause hyperuricemia?

A

no nuclei in RBC

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9
Q

in general, tubular disease is:

A

acuTe and caused by Toxins.

Think of it like an allergic reaction. Remove the insult, correct hypoperfusion. Do not treat with steroids.

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10
Q

in general, glomerular disease is:

A

slow, and chronic
-not cause by toxins

tx with steroids but need bx to confirm dx

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11
Q

lab findings in RAS

A

Cr inc >30% after initiation of ACE/ ARB

Hypokalemia

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12
Q

bug that causes UTI with alkaline pH?

A

proteus

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13
Q

treatment for MCD?

A

oral pred x 12 weeks

bonus: if not resolving/immobile sate, consider heparin as loss of ATIII puts pt in hypercoag state

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14
Q 
managment of stones:
<5mm
<7mm
>10mm
>1.5cm
A

<5 - hydrate!

<7 - medical expulsive therapy with dilating agents (bb blockers, alpha bockers

> 10 - proximal= lithotripsy, distal/ overweight= ureteroscopy

> 1.5= surgery

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15
Q

patients with untreated VUR at risk for?

A

renal scarring

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16
Q

complciation of cyclophasphamide?

A

hemmorhagic cystitis –> tx with MESNA (mercaptopethane sulfonate)

CHOP = chemo combo commonly used in lymphoma

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17
Q

treatment for pyleo/complicated pylo?

A

IV FQ 7-14 days inpatient

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18
Q

cyanide nitroprusside test

A

confirmatory test for cyteinuria

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19
Q

cystinuria

A

AR tubular defect in transpaort of dibasic amino acids (COAL)

  • excrete them through urine
  • causes acidic urine
  • HEXAGONAL crystals
  • dx with nitroprusside test
  • tx with urine alkalinization

***cysteine stones are one of the few stones that DO NOT show up wel on xray

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20
Q

classic triad of RCC

A

hematuria –> suggest invasion into collecting sys
flank pain
flank mass

**only 5% of patients present this way, most come in with paraneoplastic complaints

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21
Q

paraneoplastic syndromes of RCC

A

hypertension
polycythemia –> flushing, head ache
hypercalcemia –> pth-rp

look for NO RBC casts but +RBC to suggests its not a glomerular cause and you need to look elsewhere

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22
Q

chronic tubulointerstitial nephritis

A

why: chronic analgesia –> NSAIDS inhibit prostacylcins –> restrict renal blood flow –> papillary necrosis
imaging: shrunken kidneys, calcifications from papillary necrosis

**multiple myeloma can also cause this, but instead from xs light chains (bence jones protein)

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23
Q

stones that cause low urine pH?

A

calc ox
uric acid –> radiolucent!
cysteine

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24
Q

cause of UTIs in pregnancy?

A

progeserone dilates everything, including ureters, –> urinary stasis

This makes women with asyx bacteruria (>100,000 CFU) at greatest risk for ascending infection, so treat

Use cephalexin, augmentin, nitro

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25
how does management differ in RAS between fibromuscular dysplasia and atherosclerotic etiologies?
fibromuscular dysplasia= PTA w/o stent athersclerosis= PTA ++++ stent! both should also be controlled with an ACEi. Just make sure to closely monitor and stop if functoin decreases
26
e coli vs staph sappro UTI?
ecoli= + nitrites staph= - nitrites! cannot convert nitrates to nitrites
27
high blood pressure, pulsatile tinitus, carotid stenosis?
no- cerebrovascular FMD
28
tx fr pregnant pylo?
iv ceftriaxone 10-14 days
29
treatment for posterior urethral valves? VUR?
PUV = ablation!! (vesicostomy if unable to do ablation) VUR= reimplantation of the ureter
30
mechanism of AKI with acyclovir
crystal deposition nephropathy --> poorly soluble drug that deposits crystals which obstruct tubules **side note: immunocompromised pt who develops shingles needs inpt IV acyclovir
31
DKA gas
metabolic acidosis with attempts towards repiratory compensation (blow ff CO2) gap acidosis with low bicarb (bicarb becomes rapidly used up to buffer the ketone acids)
32
RPGN basics
nephritic syndrome think of: Good pastures (anti GBM), Immune complex ( lupus, PSGN), Wegner's treat with steroids -----> steroids plus plasmapheresis if antiGBM
33
wilms vs beuroblastoma
neuroblastoma - crosses midline - irregular surface - presents ~age 2 wilms - does NOT cross midline - smooth surface
34
urine of nephrtic syndrome
frothy fatty casts (maltese cross) 3.5g/day
35
urinary retention after surgery but everything is normal
don't forget to check the foley for kinking.
36
interstitial cystitis (bladder pain syndrome)
noninfectious cause of UTI - sx inc urgency/frequency > 6 weeks - relief with voiding * **dyspaurenia is common too * **assoc with psych do
37
tx of urge incont?
oxybutinin (anticholinergic) -- decrease detrusor tone first line is bladder training, pelvic floor excercises due to urethra HYPERMOBILITY
38
approach to management of bladder cancer
non muscle invasive - low risk: TURBT - high risk: TURBT with chemo muscle invasive with or without nodes -radical cystectomy metastatic -palliative chemo
39
med management of BPH
alpha blocker: immediate relief fin-a5-teride: 5 a reductase inhibitor --> blocks testosterone to dihydrotest which shrinks the prostae - -- takes a few months to work - --can cause sexual side effects
40
scleroderma renal crisis
causes MAHA --> dec haptoglobin, inc ldh
41
stages of ATN
olig/anuric polyuric recovery muddy brown casts PRINCIPLE cause of AKI in hospitalized patients
42
AIN
eosinophils!! think of this like an allergic reaction
43
PSGN
immune complex deposition damage to glomerular capilary wall
44
subepithelial deposits along the basement membrane
membranous nephropathy "spike and dome" nephrotic syndrome most common in white people! Hep b! solid malignancies!
45
assocaitions with ADPKD
bilat flank mass with inc Cr arterial HTN berry aneursyms MVProlapse **many patients have multiple liver cysts or cysts in other locations
46
VHL
bilat RCC pheo renal/panc cysts
47
mechanism of incont in NPH?
compression to periventricular white matter leads to central inhibition of detrussor contraction
48
hep b kidney path?
membranous nephropathy --> subepi deposits membranoproliferative --> basement membrane thickening/ splitting (tram tracks) from IgG and C3 deposits
49
urethral hypermobility
most common cause of stress incont | -assoc with post menopause estrogen, childbirth
50
approach to stress incont:
conservative measures: kegels, alcohol cessation, pessary surgery: if above fail --> urethral sling - -> urethropexy (colposuspension) used to be popular but more invase/ more complications --> used when simultaneous repair of prolapsed organ
51
igA nephropathy
generally presents as otherwise asyx microhematuria - presents DURING or IMMEDIATELY after mucosal infection - presents in 2nd/3rd decade - --> use this info to r/o PSGN which from 10-14 days after strep
52
diabetic nephropathy
- kimmelstil wilson nodule- eosinophilic nodular glomerulosclerosis - microvascular damage
53
repeated UTIs from sex. Rec?
oral bactrim for 6 months | -poistcoital voiding is a sfety measure
54
causes of renal papillary necrosis
POSTCARDS ``` PYELO obstruction SICKLE CELL DZ/TRT tb cirhossis ANALGEIA dm ```
55
causes of renal papillary necrosis
POSTCARDS ``` PYELO obstruction SICKLE CELL DZ/TRT tb cirhossis ANALGEIA dm ``` usu presents with colicky bilat flank pain and mild hemturia
56
why does good pasture's attack lung and kidneys?
attacks type IV collagen, which makes up basement membranes
57
orthostatic proteinuria
overweight, adolescent boys - increased protein as the day gos on - resolves with lying down overnight - benign
58
alportss
ears eyes kidneys abscence of type IV collagen
59
4 glass test is for...
chronic prostatitis
60
ADPKD
presents in adulthood with: - hypertension - flank pain - hematuria - palpable kidneys assoc with liver cysts and sometime cysts in other places too
61
lithium cause....
DI!!!!!!!!!!!!!!! not siadh
62
unilateral varicocele that does not resolve with standing, with flank pain and fatigue?
RCC, or mass in the retroperitoneum, can cause a varicocele by compression of pampiniform plexus *be suspicious of a right sided one because they are more common on the LEFT
63
OAB after spinal anesthesia, prolonged labor, etc? Or put another way, oliguria after surgery. What should be the next step?
Overflow incont. If distended, painful bladder --> put in a cath! If there is no associated pain or distention, do a quick US to r/o post obstructive (this is if they don't give you lab values to tell you its prerenal due and they just need IVF)
64
``` casts: WBC Pigmented Waxy Fatty Muddy brown Hyaline Fatty ```
``` WBC- pyelo Pigmented- rhabdo --> tamm horsefall Waxy- non specific Fatty- nephrotic syndrome Muddy brown - ATN Hyaline - non specific, can be seen in healthy people after vigorous exercise or dehydration, TTP!! ```
65
ESRD tx
living donor transplant | better prognosis than cadaver
66
renal bx with congo red shows apply green bif.
amyloid *consider in relation to multiple myeloma.
67
tx for heat stroke?
immediate ice water immersion
68
PAN
fatigue, myalgia, weight loss, renal involvement, abd pain -spares lungs!! effects MEDIUM vessels
69
microscpic polyangitis
necrotizing vasc with NO granuloma - effects lungs, kidney, skin - palpable purpura - diff from Wegner's because of no nasal invovlement and lack of granulomas
70
BUN / Cr effect by orthostatic syncope?
elevated BUN **elevated Cr after LOC is indicative of postictal state
71
tx hypovolemic hypernatremia 2/2 to lithium tox
first, correct to euvolemia!! Give NS, then switch to 5% dextrose if hemodynamically stable: amiloride if lithium cannot be d./c
72
hyperkalemia that require emergent therapy
EKG changes, >7, rapidly rising If <7 and on pot sparing diuretics with no EKG change, just swtich them
73
metformin in AKI?
withhold in hospitalized patient with AKI as first step
74
rhabdo and renal failure?
ATN due to myoglobin
75
clue to hepatorenal syndrome?
very low urine sodium, <10, with renal function that doesn't improve with appropriate fluid resusc -poor perfusion of kidneys
76
acute urinary retention risk
``` post surgical men history of BPH older MCI ```
77
dietary recs for renal calculi with calcium oxalate stones
- inc fluids - dec sodium (helps with Ca reabsorption --> inc sodium causes inc Ca in the urine) - normal calcium
78
presentation of barter's/gittlemans
hypokalemia, normotension, alkalosis, HIGH urine Cl *contrast to surreptitious vomiting which will have low urine chloride
79
most common kideny stone pres:
calcium ox with hypercalciuria and normal blood calcium encourage increased fluids!

USMLE Step 2 (18 decks)

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