Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Step 1 USMLE Rx - Cardio > Renal and Urinary > Flashcards

Renal and Urinary Flashcards

(114 cards)

Start Studying
1
Q

Laboratory Findings of [Post Strep GN] / [Post infectious GN] (4)

A
  • INC ASO (Anti-Streptolysin)
  • INC [Anti-DNase B]
  • [DEC C3 and total compliment]
    • Cryoglobulins
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

3 MAIN ways to avoiding [Catheter Associated UTI]

A
  1. REMOVE CATHETER AS SOON AS IT IS NOT INDICATED ANYMORE (DURATION IS THE GREATEST RISK)
  2. Avoid Unnecessary catheterization
  3. Use Sterile technique during insert
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Most common cause of nephrOtic syndrome in Children and its Tx

A

A: Minimal Change Dz

B: REVERSIBLE with Corticosteroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is almost always associated for Acute Pyelonephritis? (2)

A

[VUR -Vesicoureteral Reflux] (Anatomical vs. Functional) and [WBC Cast]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Diabetic Autonomic Neuropathy

A: Clinical Presentation (2)

B: Dx method

C: What’s the earliest sign/detection method for Diabetic Nephropathy

D: Diabetic Nephropathy is the leading cause of _____

A

A: [Overflow incontinence 2° to inability to sense full bladder] and [incomplete emptying when voiding]

B: [PVR-PostVoid Residual] testing with US vs. Catheter to confirm [incomplete emptying when voiding]

C: [INC Albuminuria ( urine will be)]

D: [ESRD Chronic Kidney Dz]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Describe the Differential Dx for Metabolic ALKalosis

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

A: How does Multiple Sclerosis affect the Bladder?

B: Describe the 3 Different etiologies of Urinary Incontinence and their sx

A

A: [Loss of CNS inhibition on [Bladder Detrusor Contraction] allows bladder to always stay contracted –> Urge Incontinence–>eventually progresses [Bladder Atony and Dilation] –> Overflow Incontinence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

A: Most common cause of [Nephrolithiasis/Kidney Stones]

B: Most common Risk Factor

C: Other Risk Factors (3)

D: Name 2 inhibitors of [Nephrolithiasis] (2)

A

A: Idiopathic Hypercalciuria = [Normocalcemia + Hypercalcuria]

B: Hypercalcuria

C:

  1. [Crohn Dz / Fat Malabsorption / Spinach]–> HyperOxaluria
  2. [Distal RTA Type 1] –> hypOcitraturia
  3. Gout –> Hyperuricosuria

D: Citrate vs. INC Water intake

Pts are Normocalcemic due to intact serum regulations by Vitamin D and PTH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

ADPKD- Autosomal Dominant Polycystic Kidney Disease

A: Genetic MOD

B: Clinical MOD (2)

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Benign Prostatic Hyperplasia

Clinical Manifestation (3)

A
  1. [Intermittent Bladder Outlet Obstruction]–>Urinary Retention –> Reflux Nephropathy
  2. Overflow Incontinence
  3. Later: Hydronephrosis–>[Renal Interstitial atrophy] –> Chronic Renal Failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

A: How do you Calculate Anion Gap

B: What is the normal Anion Gap

C: Name the Etiologies for [INC Anion Gap Acidosis] (9)

A

A: Never Carry Hotsauce: [Na+ - (Cl + HCO3)]

B: [10 - 12]

C: “The MUDPILES INC our Gap”

Methanol

Uremia

DKA (Tx= IV normal saline + Insulin)

Paraldehyde

[Isonizid vs. Iron]

Lactic Acid

Ethylene Glycol

Salicylates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

DKA- Diabetic KetoAcidosis

A: Tx (2)

B: MOD (2 pathways)

C: What type of Anion Gap Acidosis does this cause

D: What’s the pH of the Urine during DKA? Why (2)?

A

A: [IV Normal Saline + Insulin]

B: image

C: [INC Anion Gap Acidosis] (MUDPILES)

D: Urine is ACIDIC (HCO3 is completely reAbsorbed in acidotic states by PCT & INC production of NH4 & H2PO4)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

A: Which Renal Structure is subject to Injury from Pelvic Surgery and why?

B: Clinical manifestation (3)

A

A: Ureters can become unintentially ligated during [Pelvic surgery] –> Obstruction–> [Hydronephrosis w/Flank pain]

B:

  1. [Flank pain radiating to groin (from ureter and renal pelvis distension]
  2. [Ballotable Flank Mass developing within weeks of pelvic surgery]
  3. [Normal Urine output & Serum creatinine (contralateral kidney compensates)]
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

[Post Strep Glomerulonephritis / Post infectious GN]

A: Clinical Presentation (5)

B: What part of the Kidney is affectred

A

A: [Older Child/Young Adult] with [Edema / Hematuria (Cola Colored Urine) / ProteinUria] few weeks after [Impetigo vs. pharyngeal infection]

B: Affects BOTH Kidneys (enlarged and swollen)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

[Pauci Immune ANCA-associated RPGN]

A: Histology (3)

B: Clinical Presentation (2)

A

Is a type 2 Hypersensitivity

A:

1) Absence of Ig and C3 deposit
2) Crescent formation
3) Focal Necrosis

B: [Renal Failure] + [Pulm (epistaxis vs. chronic sinusitis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Acute Tubular Necrosis

A: Clinical Course (3 Phases)

B: Outcomes (2)

A

A:

  1. Initiation phase =36 hour period = slight DEC in urine output from ischemic/toxic injury
  2. Maintenance Phase= 1-2 week period= Tubular damage is established –> [Oliguria/Fluid overload/Electrolyte abnormalitities]
  3. Recovery Phase= [Tubular Re-epithelization] which clears cast –> Transient polyuria and [loss of electrolytes from still impaired tube reabsorption]

B: ([Tubular Re-epithelization] + [Renal Function imprvmnt]) vs. [Foci of interstitial scaring associated w/permanent renal impairment (rare)]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

NephrOtic Syndrome

A: Classic Presentation (5)

B: COMMON Renal Complication from this. What are the sx (3)

A

A: CLag + [Proteinuria > 3.5 gm/day–>FOamy Urine] =

[INC Coagulability from loss of AT3]

[INC Lipidemia]

[DEC alubuminemia] –> Edema

[DEC gammaglobinemia]

B: Renal Vein Thrombosis –>

  • Acute Flank Pain
  • Hematuria
  • [RIGHT Varicocele]
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

A: Describe Histology for Hyaline Arteriolosclerosis

B: Causes (2)

A

A: [Homogenous deposition of eosinophilic hyaline in intima and media of small vessels]

B:

1) Benign HTN
2) [Diabetic Autonomic NephrOpathy:–> will also have [Kimmelsteil Wilson Nodules from Mesangial Sclerosis]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Where in the Renal Tubule is PAH secreted into?

A

PCT (but also some PAH is freely filtered by Glomerulus)

so PAH concentration is lowest in Bowman’s Capsule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

A: Which substances INCREASE along the PCT (5)

B: Which substances DEC along the PCT (3)

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Describe Tubular Solute Concentrations for PAH along the renal tubule (PCT –> Loop–>DCT –> CD)

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Describe Tubular Solute Concentrations for Creatinine along the renal tubule (PCT –> Loop–>DCT –> CD)

A

Basically the same path as [Innulin & Mannitol]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Describe Tubular Solute Concentrations for [Innulin & Mannitol] along the renal tubule (PCT –> Loop–>DCT –> CD)

A

Basically the same path as Creatinine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Describe Tubular Solute Concentrations for Urea along the renal tubule (PCT –> Loop–>DCT –> CD)

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Describe *Tubular Solute Concentrations* for **Glucose** along the renal tubule (*PCT --\> Loop--\>DCT --\> CD*)
26
Describe *Tubular Solute Concentrations* for [**Na+ and Cl**] along the renal tubule (*PCT --\> Loop--\>DCT --\> CD*)
27
**FORMULA** for: A: R**P**F: Renal **p****lasma** Flow B: R**B**F: Renal **Blood** Flow. - Also Define R**B**F C: **Filtration Fraction**
A: r**p**f = **P**AH Clearance = [(*urine* PAH) x (urine flow rate)] ÷ (plasma PAH) B: R**Blood**F = [r**p**f ÷ (1 - Hct)] = *volume of blood flowing thorugh kidneys per unit time* C: [Filtration Fraction] = [GFR ÷ r**p**f]
28
**In the absence of ADH**, what part of the *Renal Tubule* has the Highest Osmolarity?
29
**Pheochromocytoma** A: Tumor arising from the \_\_\_\_\_ B: What does it secrete C: Clinical Presentation (3)
A: Adrenal **Medulla** B: Catecholamines --\> High Epi levels --\> [hypOkalemia via B2 receptor stimulation] C: - HA - Tachycardia - Diaphoresis (*Sweating*)
30
A: Demographic for **Renal Artery Stenosis** (2) B: Manifestations (3)
A: 1. Elderly 2. [Pregnant Women 2º to fibromuscular Dysplasia] B: - Unilateral Kidney Atrophy - HTN - Abd Bruit * R Kidney Atrophy from **RAS** in image*
31
Promoters of Nephrolithiasis (8)
**IM COUGHS** - **I**njury - [**M**g+ --\> Struvite Stones] - **C**alcinuria - **O**xalate INC - [**U**ric Acid INC in urine (*Tumor lysis syndrome vs. Gout*) - **G**ravity - **H**ydrogen ions / aciditiy - **S**odium
32
A: **INHIBITORS** of Nephrolithiasis (2) B: Once a pt develops Nephrolithiasis, what are the tx (4)
1. **CITRATE** (*found in Fruits & Veggies*) 2. INC Urine Flow B: - Tamsulosin - NSAIDs - [INC Fluid Intake to 2-3 L/day] - **Proximal** Ureter location --\> Surgery
33
A: Describe Histology for [**Multiple Myeloma** Nephropathy] B: Demographic C: Other common sx with this presentation (3)
A: [Large PINK Eosinophilic light chain cast] made of [Bence Jones proteins] in tubular lumen --\> [1º **ATiN** - **A**cute **T**ubular **I**nterstitial **N**ephritis] B: Elderly C: 1. [Azotemia **COB** - ***C****reatinine INC / **O**liguria / **B**UN INC*] 2. INC Serum Protein 3. Constipation
34
A: Classic Presentation Triad for [**_Drug Induced_ -ATiN**] B: What Drugs mostly cause this (3) C: What *Wt Loss* Drug can cause this? How?
**ERF** me some **DAN** drugs ! ## Footnote A: [**E**dema & **E**osinophilia], **R**ash, **F**ever B: **D**iuretics / **A**bx / **N**SAIDs C: [Chinese Herb Aristolochic Acid] --\> RAPID ATiN!
35
A: *Describe Histology* (4) B: Dz
A: image B: [Drug induced **ATiN** - **A**cute **T**ubular **I**nterstitial **N**ephritis] (*can be chronic as well*)
36
A: How does **Transitional Cell Carcinoma of Bladder** typically present B: Risk Factors (2) C: Describe Histology (2)
A: Gross Hematuria in an elderly Man B: - Exposure to [**R****AP**-**R**ubber / [**A**romatic Amine Stuff] /**P**lastics] - Smoking C: Malignant Epithelial Cells = \*Hyperchromatic nuclei \*INC nucleus to cytoplasm ratio
37
A: Most common causes of **Acute Tubular Necrosis** (4) B:Which stage would these things lead to
- **Sepsis** = MOST COMMON - Surgery - Hemorrhage - Acute MI B: Initiation Stage (*1st stage*)
38
Describe the _Maintenance Stage_ of [Acute Tubular Necrosis] (3)
* [Oliguria --\> Volume Overload] from tubules not allowing any fluids through * INC Creatinine / BUN ratio * **Hyper**kalemia
39
Describe the _Recovery Stage_ of [Acute Tubular Necrosis] (3)
* Polyuria --\> Dilute Urine and [DEC Electrolyte] * Na+ is spared and actually --\> Hypernatremia * **hypO**kalemia (too much K+ is kicked out)
40
A: Clinical Presentation of **Papillary Necrosis** (2) B: Causes (9) C: Out of these, which is the MOST COMMON CAUSE
A: 1. Gross Hematuria (passage of small blood clots) 2. Acute Flank pain B: **POST C**_A_**RDS** for the *Pap*py! [**P**yelonephritis/**O**bstruction/**S**ickle Cell/**T**B / **C**irrhosis/ [**_A_**nalgesics vs. **A**lcohol] / [**R**enal Vein Thrombosis] / **D**M / **S**ystemic Vasculitis C: **_A_**nalgesics!
41
Classic Presentation for [**R**enal **C**ell **C**arcinoma] (4)
RCC looks like **HAWF**! [**H**ematuria PAINLESS (most common)] / [**A**bd Mass] / [**W**t loss] / [**F**lank Pain] *L RCC in image*
42
A: What conditions can [Untreated Hydronephrosis] lead to (3) B: Common cause C: Clinical Presentation (3)
A: HTN, [DEC Renal Function] & Sepsis! B: Lower Urinary Tract Obstruction C: Pain + [LE Edema] + **Palpable Kidneys**
43
A: [Tumor Lysis Syndrome] MOD B: What parts of the Nephron is involved (2) C: Tx for [**Uric Acid** Nephrolithiasis] in general (4)
A: High cell turnover from tumors --\> INC [K / Phosphorous / Uric Acid] in serum. [Uric Acid] **precipitates** in Kidneys 2° to [_Acidity_ within normal urine] B: DCT and CD (are where Uric Acid crystallizes) C: - Urine Alkalinization (use NaHCO3 vs. [K+ citrate]) - Hydration - Allopurinol (if gout) - [low purine diet (EtOH vs. seafood)]
44
A: Describe image B: Dz C: What type of Hypersensitivitiy is this D: Clinical Presentation (3)
A: IF showing [Positive **c-ANCA** in **vasculature**] = Ab against [Lysosomal PR3 antigen of neutrophil/monocytes] B: [Wegener's Granulomatosis + Polyangiitis] (*Type 3 _Crescenteric_ RPGN*) C: Type 2 D: [**ELK** = **E**NT / **L**iver / **K**idney] + [Destructive Sinusitis] + Hemoptysis
45
A: Clinical Presentation of [**BrIAN**-**B**e**r**ger's **I**g**A** **N**ephropathy] B: When does it onset C: Demographic D: Desribe the Histolgy
A-D: image ## Footnote [**H**enoch **S**choenlein **P**urpura] **H**inge problems = Joint Arthritis **S**tomach problems = NV + bloody diarrhea + Stomach Pain **P**alpable Purpura = mainly on Butt, Legs, Feet
46
What type of *Renal* Injury is associated with **Infective Endocarditis**
Glomerulonephritis 2° to [**Circulating Immune Complex deposition**]
47
A: What *Kidney Stone* is in image? B: What pH does it present in? C: Demographic. Causes. Tx
A: [Calcium Oxalate / phosphate] B: \> 7 pH C: image
48
A: What *Kidney Stone* is in image? B: What pH does it present in? C: Demographic (2). Causes (2). Tx (2)
A: [**MAPS- M**g+ **A**mmonium **P**hosphate ***S**truvite*] B: \> 7 pH C: image
49
A: What *Kidney Stone* is in image? B: What pH does it present in? C: Demographic Causes (2) Tx (3)
A: [Uric Acid] B: less than 7 pH C: image
50
A: What *Kidney Stone* is in image? B: What pH does it present in? C: Demographic Causes Tx (3)
A: Cystine B: less than 7 pH C: image
51
A: Dz in image B: Composition (3)
A: **Clear Cell Carcinoma** (*type of RCC*) B: [**Clear Cytoplasm**] / Large cells / [Round vs. Polygonal cells]
52
A: *Identify* in image (3) B: Which portions of the Nephron are MOST affected by [**ATN**-***A**cute **T**ubular **N**ecrosis*] (2) C: What Clinical Presenation is pathognomonic for **ATN**??
A: image B: PCT & [**thick aLOH**] C: Muddy Brown Cast!
53
A: What is Conn's Syndrome B: Tx
A: [Primary **Hyper**aldosteronism] 2° to [aldosterone secreting adenoma] --\> [hypOkalemia --\>metabolic alkalosis] and HTN B: Aldosterone Blockers (Spironolactone / Eplerenone)
54
Which **BP medication** is used in pts with [Diabetic Nephropathy]? (2)
[ACEK2 inhibitors] vs. ARBS
55
A: In pts with **Renal Artery Stenosis**, what renal factor do they become *Dependent* on for appropriate GFR B: What drugs are Contraindicated in these pts (2)
A: [Angiotensin 2 _efferent_ vasoconstriction] B: [ACEk2 inhibitors] vs. ARBS *Same rule applies for CHF vs. hypOvolemic vs. [Chronic Renal Dz] pts*
56
A: What is Foscarnet? Indication? B: Foscarnet SE (3)
B: [Pyrophosphate Anti-viral analog] used for **[Ganciclovir-*resistant* CMV]** 1. Chelates Ca+ 2. Promotes Nephrotoxic Mg+ Wasting! 3. (1 and 2) --\> Seizures
57
Which **Anti-Virals** cause [crystalline neprhopathy] if adequate hydration is not given? (3)
"**F**end **V**iruses with **A**gua" 1. **A**cyclovir 2. **V**alocyclovir 3. **F**amciclovir
58
A: What 3 things does **ADH** do? What receptors are used for this? B: How does this affect medullary osmotic gradient??
USES [Distal Collecting Duct **V2 Receptor**] to.. 1. INC Water Reabsorption 2. INC Urea Reabsorption --\> **INC [medullary osmotic gradient] --\> production of maximally concentrated urine!** 3. Use **V1 Receptors** to Vasoconstrict
59
Formula for : A: Excretion Rate B: [Excretion Rate *when given [Plasma Concentration Substance A] and [Tubular Reabsorption Substance A]*
A: [Urine Flow] x [Urine Concentration Substance A] B: GFR x [Plasma Concentration Substance A] - [Tubular Reabsorption Substance A]
60
A: Clinical *Triad* of DKA (3) B: What type of Anion Gap would this cause
"Too Many **FUDG**e bars --\> DKA!" ## Footnote 1. Poly**U**ria --\>POTENTIAL WT LOSS from urinating out water weight 2. Poly**D**ipsia 3. **F**ruity odor in breath vs. urine 4. **G**lasses foggy (Intermittent blurry vision) B: High Anion Gap metabolic Acidosis
61
List the *Main* Reabsorption rates for ions in the: **Early PCT** (6)
- **MOST OF WATER REABSORPTION** (done passively with solute ReAbsorption) - 98% of **Glucose** ReAbsorption - 85% of **HCO3** ReAbsorption - 70% of **Phosphate** ReAbsorption - 67% of **Na+** ReAbsorption - 67% of **K+** ReAbsorption
62
List the *Main* Reabsorption rates for ions in the: **Late PCT**
- 60% of **Ca+** ReAbsorption (mostly by PTH)
63
List the *Main* Reabsorption rates for ions in the: **thin descending LOH**
- 15% of **WATER** ReAbsorption
64
List the *Main* Reabsorption rates for ions in the: **THICK aLOH** (4)
- 25% of **Na+** ReAbsorption - 20% of **K+** ReAbsorption - Trace **Mg+** (driven by positive lumen potential) - Trace **Ca+** (driven by positive lumen potential AND PTH)
65
List the *Main* Reabsorption rates for ions in the: **Early **_D_**CT**
- 5% of **Na+** ReAbsorption
66
List the *Main* Reabsorption rates for ions in the: **[Late **_D_**CT** & **Cortical CD****]**
- 3% of **Na+** ReAbsorption
67
List the *Main* Reabsorption rates for ions in the: **Distal (Medullary) CD**
- 17% of **WATER** ReAbsorption - 3% of **Na+** ReAbsorption - 110% of **K+** SECRETION
68
Describe the relationship between **GFR** and **Serum Creatinine**
Every time GFR halves...[Serum Creatinine] doubles
69
Common Bacteria that cause **Cystitis** (6)
- *E.Coli* (MOST COMMON!!!) - *Klebsiella* - Enterobacter - Staph - Saprophyticus (Young Women) - Proteus Mirabilis (Alkaline urine + Ammonia scent)
70
Common Bacteria that cause **Pyelonephritis** (3)
- *E.Coli* (MOST COMMON!!!) - *Klebsiella* - Enterococcus Faecalis - Pseudomonas Aeruginosa (indwelling bladder catheters)
71
Which Bacteria causes **Pyelonephritis** in pts with [Indwelling Bladder Catheters]?
Pseudomonas
72
A: SE of **Amphotericin B** (2) B: Mechanism of SE
A: - hypOkalemia --\> weakness and arrhythmias (T wave flattening) - hypOmagnesemia B: INC DCT permeability (from damage) allows K+ and Mg+ to escape into urine
73
Describe Histology for [**P**ost **S**trep **GN**] / [**P**ost **i**nfectious **G****N**] (3)
1. Hypercellular Inflammed Glomerulus w/RBC Cast 2. [**Lumpy Bumpy** IgG and C3 granular deposits on IF] 3. [Electron-dense Subepi **HUMPS** of BM] (*shown in image*)
74
Chromosomal mutation associated with **Renal Cell Carcinoma**
[Chromo 3p VHL mutation/hypermethylation] ## Footnote *VHL = Tumor Suppressor Gene*
75
A: Clinical Manifestation of this Dz (4) B: Which organ does this Dz **spread to**? C: Where did this Dz **originate from**?
**Clear Cell Carcinoma** (*type of RCC*) ## Footnote A: RCC was **HAWF**! = [**H**ematuria / **A**bd Mass / **W**t loss / **F**lank pain] + [YELLOW MASS (Clear CC only)] B: Lung C: PCT of Kidney
76
A: Most common cause of [Unilateral Fetal Hydronephrosis] B: What typically causes *NON-Obstructive* Fetal Hydronephrosis
A: Inadequate canalization of **Ureteropelvic Junction** B: Vesicoureteral Reflux (incomplete closure of vesicoureteral junction during detrusor contraction)
77
A: Identify components of [Suprapubic Abd Wall] B: Is the Bladder *Extra*Peritoneal or *Intra*Peritoneal?
A: image B: Bladder is ***Extra***Peritoneal (outside of the Peritoneum)
78
A: What perfuses [**Proximal** Ureter] B: What perfuses [**Distal** Ureter]
A: Renal A. B: [SUP Vesical A.] *Middle Ureter is perfused variably*
79
From a Posterior view: where is the: A: Kidney B: Spleen C: Pancreas D: Liver
A: Deep to 12th rib B: [L abd cavity - in front of (L 9th - 11th ribs)] C: Partially retroperitoneal: Overlies 2nd lumbar Vertebra D: [RUQ - in front of (R 8th-11th) ribs]
80
Crushing Abd trauma is most likely to injur which organ?
Pancreas
81
Transplant Rejection: **Hyperacute** A: Onset Time B: Etiology
A: Minutes - Hours B: **Preformed** Ab attack graft
82
Transplant Rejection: **Acute** A: Onset Time B: Etiology
A: B: Exposure to Donor Antigens --\> Recepient Humoral & Cellular Naive immune cell Activation
83
Transplant Rejection: **Chronic** A: Onset Time B: Etiology
A: Months - Years B: continued low-grade immune response, refractory to immunosuppressants :-(
84
Transplant Rejection: **Hyperacute** Histology (2)
1. Gross mottling & Cyanosis 2. [Arterial Fibrinoid Necrosis + Capillary occlusion]
85
Transplant Rejection: **Acute** *Humoral* Histology (3)
* C4d deposition * **Neutrophilic** infiltrate * Necrotizing Vasculitis
86
Transplant Rejection: **Acute** *Cellular* Histology (2)
* **Lymphocytic** interstitial infiltrate * Endotheliits
87
Transplant Rejection: **Chronic** Histology (4)
1. Vascular Wall thickening 2. Luminal narrowing 3. Obliterative Intersitital Fibrosis 4. Parenchyma Atrophy
88
Identify
89
Lithium SE (4)
**LMNOP** **L**ithium SE: **M**ovement / Tremor **N**ephrogenic Diabetes Insipidus (blocks ADH) hyp**O**thyroidism **P**regnancy problems (teratogenic)
90
[Sirolimus Rapamycin] MOA
[**Si**rolimus **R**apamycin] Binds and forms complex with [FK506 Binding Protein] --\> inhibits mTO**R** --\> **BLOCKS [IL2 signal transduction]** --\> Prevents lymphocyte growth/proliferation
91
[Sirolimus Rapamycin] Indication (2)
[**Si**rolimus **R**apamycin] ## Footnote 1. Kidney transplant Rejection prophylaxis 2. *Helps Kidney **Sir**vive when [nephrotoxic cyclosporine] is given*
92
Mycophenolate MOA (2)
[Reversibly inhibits nucleotide synthesis], required for lymphocyte proliferation AND [promotes T-cell apoptosis]
93
Leflunomide MOA (2)
[Reversibly inhibits nucleotide synthesis], required for lymphocyte proliferation AND [promotes T-cell apoptosis]
94
A: Cyclosporine MOA B: Which organ is harmful to?
**Cyclo**sporine A: Binds to and forms complex with **Cyclo**philin --\> inhibits Calcineurin --\> [**inhibits IL2 transcription**] B: Nephrotoxic (give with [Sirolimus Rapamycin] to lessen nephrotoxicity)
95
Tacrolimus MOA
Binds to and forms complex with **Cyclo**philin --\> inhibits Calcineurin --\> [**inhibits IL2 transcription**]
96
Cyclosporine Indications (3)
1. Transplant Rejection Px 2. Psoriasis 3. Rheumatoid Arthritis
97
A: What 2 things are pts with [**Antiphospholipid Antibody Syndrome**] at risk for B: This syndrome is mostly associated with \_\_\_\_\_
A: Antiphospholipid Abs --\> 1. [Venous vs. Arterial Thromboembolism] 2. [Unexplained AND Recurrent Miscarriages] (placental insufficiency vs. preeclampsia) B: 30% of **SLE** pts have [Antiphospholipid Antibody Syndrome]
98
A: **Fabry Disease** MOD B: Mode of Inheritance
A: [**lysosomal** (**a-galactosidase A) deficiency**] --\> [sphingolipid Gb3 accumulation] --\> accumulates in multiple places B: X-linked Recessive
99
**Fabry Disease** Clinical manifestations (7) B: When do they onset
"Fabry is [**N**ever **T**oo **BRASH**]" 1. **S**weating DEC (hypOhidrosis) - occurs early on 2. **N**europathy - early on 3. **A**ngiokeratomas - late adolescence 4. **T**elangiectasias - late adolescence 5. **B**rain (TIA vs. stroke) - mid adult 6. **H**eart (LVH) - mid adult 7. [**R**enal Failure 2° to Glomerular & DCT accumulation]
100
**Acute Hemolytic Transfusion** MOD
[**Preformed** Anti-ABO IgM Ab] bind to antigens on transfused donor RBC --\> [Anaphylatoxin C3a and C5a activation] + [C5b-C9 membrane attack complex formation] --\> [Complement-mediated cell lysis] ## Footnote *Type 2 Hypersensitivity*
101
**Acute Hemolytic Transfusion** A: Manifestations (6) B: What type of Hypersensitivity is this
A: **T**ransfusions **L**eft **H**arry & **B**erry **C**old & **F**uckd! **T**achycardia **L**umbar Pain **H**emoglobinuria (Red/Brown urine) **B**leeding w/hypOtension **C**hest Constriction **F**lu-like Sx B: Type 2 Hypersensitivity
102
A: Dz B: Describe the Composition (3)
A: [Crescenteric RPGN] B: **FIBRIN** / [Glomerular Parietal Cells] / [Macrophages & Monocytes] -- all in Bowman's Space *[Macrophages & Monoctyes] pass through gaps into Bowman's Space--\> Macrophages secrete factors that INC fibrin deposition and fibrin deposition--\>[Glomerular Parietal cell proliferation]*
103
[Crescenteric RPGN] MOD
[Macrophages & Monoctyes] pass through **gaps**(from destruction) into Bowman's Space--\> Macrophages secrete factors that INC fibrin deposition and fibrin deposition--\>[Glomerular Parietal cell proliferation]
104
Name the 5 roles of **IL2**
image
105
A: Which 2 CA can **IL2** treat? B: What's the Mechanism (2)
A: [Renal Cell Carcinoma] & [Metastatic Melanoma] B: Activation of [**NK cells**] and [**T-cell Growth**]
106
A: **Potters Sequence** MOD B: Clinical Manifestation (3)
A: [Fetal Renal Agenesis vs. Dysfunction] --\> Oligohydraminos (No Amniotic Fluid) B: * Limb Deformities (low set ears) * Flattened Face * Lung hypOplasia (since lungs require fluid to inflate properly)
107
A: **ArPKD** - [**A**utosomal **r**ecessive **P**olycystic **K**idney **D**z] MOD B: Mode of inheritance
A: [Chromo 6 PKHD1 gene mutation] --\> Defective Fibrocystin (present in kidney & liver) B: Auto Recessive
108
**ArPKD** - [**A**utosomal **r**ecessive **P**olycystic **K**idney **D**z] Manifestations (4)
- Bilaterally Enlarged Kidneys with Reniform shape - [Sponge-like Cross Section] - Liver Fibrosis - Saccular Dilitation of CD
109
**ADPKD** - [**A**utosomal **D**ominant **P**olycystic **K**idney **D**z] Describe the Dz (8)
**ADPKD** ## Footnote **A**neurysm (Berry) and [**A**dults affected] **D**oomed [HTN and MVP] [**P**rOteinuria AND Hematuria] **K**idney Failure (Early vs. Late onset) **D**ifferentation problem = etiology
110
Describe Histology for [**P**ost **S**trep **GN**] / [**P**ost **i**nfectious **G****N**] (3)
1. Hypercellular Inflammed Glomerulus w/RBC Cast 2. [**Lumpy Bumpy** IgG and C3 granular deposits on IF] 3. [*Electron*-dense Subepi **HUMPS** of BM]
111
Histology for nephrOtic syndrome (2)
[Diffuse [Epithelial Podocyte foot process] effacement **ONLY SEEN ON ELECTRON MICROSCOPY**] *All other imaging is normal!*
112
**nephrOtic** syndrome MOD
Immune Dysregulation (*Cytokine Hyperproduction*) **Directly damages** [Epithelial Podocyte foot processes] --\> [Effacement and Fusion]
113
Describe Histology for **Acute** Pyelonephritis (4)
MASSIVE Infiltration of _Neutrophils_ in: ## Footnote 1) Tubular Lumen 2) Interstitium 3) Microabscesses 4) Tubulorrhexis
114
Clinical Presentation for **Acute** Pyelonephritis (8)
[**DUS FFLW**] ## Footnote [*Cysitits Sx:* **D**ysuria + (**U**rinary sx) + (**S**uprapubic pain)] AND [*Pyelonephritis Sx*: (**F**ever & Malaise) + (**F**lank pain) + (**L**eukocytosis AND {Pyruia- x\>10 WBC on hpf in urine} ) + **WBC CAST**]

Step 1 USMLE Rx - Cardio (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions