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First Aid Step 2 > Renal/GU/Nephro > Flashcards

Renal/GU/Nephro Flashcards

(130 cards)

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1
Q

Renal tubular acidosis (RTA) associated with abnormal H+ secretion and nephrolithiasis

A

Type I/distal RTA

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2
Q

RTA associated with abnormal HCO3- and rickets

A

Type II/proximal RTA

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3
Q

RTA associated with aldosterone defect

A

Type IV/distal RTA

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4
Q

Doughy skin

A

Hypernatremia

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5
Q

Differential of hypervolemic hyponatremia

A

Cirrhosis
CHF
Nephritic syndrome

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6
Q

Chvostek’s and Trousseau’s signs

A

Hypocalcemia

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7
Q

Most common causes of hypercalcemia

A

Malignancy

Hyperparathyroid

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8
Q

T wave flattening and U waves

A

Hypokalemia

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9
Q

T wave peaked and wide QRS

A

Hyperkalemia

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10
Q

First line Tx moderate hypercalcemia

A

IVF and loops (furosemide)

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11
Q

Type ARF with FeNa<1%

A

Prerenal

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12
Q

49 yo man presents with acute onset flank pain and hematuria

A

Nephrolithiasis

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13
Q

Most common type nephrolithiasis

A

Calcium oxalate

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14
Q

20 o man presents with palpable flank mass and hematuria. US shows bilat enlarged kidneys with cysts. ASsociated brain anaomly

A

PCKD- berry aneurysm

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15
Q

Hemturia, HTN, oliguria

A

Nephritic syndrome

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16
Q

Proteinuria, hypoalbuminemia, hyperlipidemia, hyperlipiduria, edema (periorbital swelling in am)

A

Nephrotic syndrom

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17
Q

Most common form nephritic syndrome

A

Membranous glomerulonephritis

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18
Q

Most common form glomerulonephritis

A

IgA nephropathy/Bergers

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19
Q

Glomerulonephritis with deafness

A

Alport’s syndrome

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20
Q

Glomerulonephritis with hemoptysis

A

Wegener’s granulomatosis and Goodpasture syndrome

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21
Q

Presence of red cell casts in urine sediment

A

Glomerulonephritis/nephritic syndrome

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22
Q

Waxy casts in urine sediment and Maltese crosses (seen with lipiduria)

A

Nephrotic syndrome

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23
Q

Drowsiness, asterixis, nausea, pericardial friction rub

A

Uremic syndrome in pts with renal failure

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24
Q

55 yo man Dx with prostate CA. Tx option?

A

Wait, surgical resection, rad/androgen suppression

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25
Low urine specific gravity with high serum osmolality
DI
26
Tx SIADH
Fluid restriction | Democlocycline
27
Hematuria, flank pain, palpable flank mass
Renal cell carcinoma
28
Testicular cancer associated with beta hCG and AFP
Choriocarcinoma
29
Most common type testicular cancer
Seminoma, type of germ cell tumor
30
Most common histology of bladder cancer
Transitional cell carcinoma
31
Complication of overly rapid correction of hyponatremia
Central pontine myelinosis
32
Salicylate ingestion occurs in what type of acid base disorder
Anion gap acidosis and primary respiratory alklosis due to central respiratory stimulation
33
Acid bas disturbance in pregnant women
Respiratory alkalosis
34
Elevated EPO, elevated HCT, normal O2 sats
Renal cell carcinoma or other EPO producing tumor | Evaluate with CT
35
55 yo man presents with irritative and obstructive urinary Sx. Tx?
Likley BPH | Options: nothing, terazosin, finasteride, TURP
36
6 D - hypernatremia causes
``` Diuresis Dehydration DI Docs (iatrogenic) Diarrhea Disease (kidney, sickle cell, etc) ```
37
Tx HyperK
C BIG K Calcium gluconate Bicarbonate or Insulin and glc Kayexalate
38
Pts with metabolic acidosis, hypokalemia, normal BP - have what conditions
Surreptitious vomiting Diuretic abuse Bartter's syndrome Gitelman's syndrome
39
Causes of hyperglycemia
CHIMPANZEES Most common: hyperparathyroidism, CA ``` Calcium supplementation Hyperparathyroidism/hyperthyroidism Iaotrogenic-thiazides, parental nutrition Immobility- esp ICU Milk alkali syndrome Paget's disease Adrenal insufficiency Acromegaly Neoplasm Zollinger Ellision syndrome - MEN I Exces Vit A Excess Vit D Sarcoidosis and other granulomatous disease ```
40
Calcium: loops vs thiazides
Loops lose calcium | Thiazide reabsorb calcium
41
Pt develops cramps and tetany following thyroidectomy
Hypocalcemia
42
Important to check in hypoalbuminemia, why
Ionized calcium | Serum Ca can be falsely low in hypoalbuminemia
43
Most common pt with hypomagnesium
Alcoholics
44
pH imbalance with ASA
Metabolic acidosis and respiratory alkalosis
45
Tx for anion gap causes of renal tubular acidosis
``` MUDPILES Methanol: fomepizole Uremia: dialysis DKA: insulin, fluids Paraldehyde, Phenformin Iron, INH: GI lavage, charcoal (INH) Lactic acidosis Ethylene glycol: fomepizole Salicylates: alkalinize urine ```
46
Calculate anion gap
Na - (Cl+HCO3)
47
RTA: Type I Type II Type IV
I: distal II: proximal IV: distal
48
prerenal, intrinsic, vs postrenal cause
Prerenal: dec renal perfusion Intrinsic: injury of nephron unit Postrenal: outflow obstruction
49
Indications for urgent dialysis
AEIOU Acidosis (<7.25 Electrolyte abnormalities (hyperkalemia) Ingestion (salicylate, theophylline, methanol, barbs, lithium, ethylene glycol) Overload (fluid) Uremic Sx (pericarditis, encephalopathy, bleeding, nausea, pruritis, myoclonus)
50
Hyaline casts Etiology Prerenal, intrinsic, postrenal
Normal, inc suggest V depletion | Prerenal
51
Red cells casts, dimorphic red cells Etiology Prerenal, intrinsic, postrenal
Glomerulonephritis | Intrinsic
52
White cells, eosinophils Etiology Prerenal, intrinsic, postrenal
Allergic interstitial nephritis, atheroembolic | Intrinsic
53
Granular cell casts, renal tubular cells, muddy brown cast
ATN | Intrinsic
54
White cells, white cells casts
Pyelonephritis | Postrenal
55
Prevention of contrast induced nephropathy
IVF before and during scan Also use N-acetylcystine and NaHCO3 - controversial
56
``` Anorexia N/V Uremic pericarditis Uremic frost Delirium Seizures Coma ```
Uremia
57
Definition of azotemia
Increased BUN and creatinine
58
Nephritic syndrome findings
PHAROAH ``` Proteinuria Hematuria Azotemia RBC casts Oliguria HTN ```
59
Nephritic syndrome cause: immune complex (2)
``` Postinfectious GMN IgA nephropathy (Berger) ```
60
Nephritic syndrome cause: pauci-immune
Wegener's granulomatosis
61
Nephritic syndrome cause: anti-GBM
Goodpasture | Alport's
62
GABHS or other infection, Low C3, +ASO, lumpy bumpy immunofluorescence of IgG and C3 Oliguria, edema, HTN, tea or cola colored urin Good recovery with diuretics Dx confirmed with RBC casts
Postinfectious GMN
63
Typically follows upper resp or GI infections, young men, deposition of IgA in mesengial cells Episodic gross hematuria or persistent microscopic Dx: increased IgA, mesangial prolix on EM, histo - looks like HSP Glucocorticoids, ACEI if proteinuria 20% to ESRD, steroids if turns to nephrotic, cyclosporine, azothioprine, mycophenolate mofetil
IgA nephropathy/Berger
64
Granulomatous inflammation of respiratory tract and kidney with necrotizing vasculitis Hematuria, hearing disturbances, resp and sinus, cavitary pulm lesions bleed and lead to hemoptysis C ANCA (cell mediated IR), biopsy shows: segmental necortizing GMN with few IG deposits immunofluorescence Tx: cyclophosphamide and steroids/methotrexate
Wegeners granulomatosis
65
Rapidly progressing GMN with pulm hemorrhage, mid 20s Hemoptysis, dyspnea, possible resp failure (anti-BM/ anti-alveolar ab also hit lungs) Linear anti-GBM (IgG) on immunofluorescence, Fe def anemia, hemosiderin macrophages in sputum, pulm infiltrates on CXR, IgG antiglomerular BM Ab Tx: plasma exchange, pulsed steroids, progress to ESRD, cyclophosphamide Methotrexate or azothioprine for maintenance
Goodpasture syndrome
66
Hereditary GMN defect of collage IV BM, boys 5-20, ASx hematuria with SENSORINEURAL DEAFNESS/ HIGH FREQUENCY HEARING LOSS and eye disorders GBM splitting on EM, red cell casts, Progresses to renal failure, may recur after transplant; corticosteroids, plasmapheresis, immunosuppression
Alport
67
Lumpy bumpy immunofluorescence
Postinfectious GMN
68
Segmental necrotizing GMN with few Ig deposits on immunofluorescence
Wegeners
69
Linear anti GBM deposits on immunofluorescnece
Goodpastures
70
GBM splitting on EM
Alports
71
Most common cause nephrotic syndrome in children Cause: NSAIDS and heme malignancy (Hodgkins) Tendency: infections and thrombotic events Lab: HLD, hypoalbumin Light micro: normal EM: fusion/flattening/effacement epi foot processes with lipid laden renal cortices Tx: steroids
Minimal change disease
72
Cause: IVDU, HIV, obesity Typical pt: young Afr Am male w/ uncontrolled HTN Labs: microscopic hematuria, biopsy shows sclerosis in capillary tufts Tx: prednisone, cytotoxic Tx, ACEI/ARBs for proteinuria
Focal segmental glomerulosclerosis
73
Most common nephropathy in Caucasian adults. 2nd causes - solid tumor malignancies and immune complex Associated HBV, syphilis, malaria, gold Labs: spike and dome appearance due to IgG and C3 deposits at BM Tx: prednisone and cytotoxic
Membranous nephropathy
74
Has 2 forms: diffuse hyalinization and nodular glomerulosclerosis (Kimmelstiel Wilson lesions) Pts poor controlled DM with retinopathy or neuropathy Labs: thick GBM, inc mesangial matrix Tx: tight control of blood sugar, ACEI for DMI, ARB for DM II
Diabetic nephropathy
75
Classified as WHO types I-IV, both nephrotic and nephritic; malar rash and arthritis Proteinuria or RBC on UA Labs: mesangial proliferation, subendothelial and/or subepithelial immune complex deposition, + ANA and Anti=DNA Ab Tx: prednisone and cytotoxic therapy may slow disease progression, ACEI and statin for proteinuria
Lupus nephritis
76
Primary cause plasma cell dyscrasia, secondary infectious or inflammation Pts may have multiple myeloma or chronic inflammatory disease (RA, TB) Labs: nodular glomerulosclerosis EM: emyloid fibrils Apple green birefringence with Congo red stain Tx: prednisone and melphalan; BM transplant MM
Renal amyloidosis
77
Nephrotic/nephritic; Type I assoc HCV, cryoglobulinemia, SLE, subacute bacterial endocarditis Slow progression renal failure Labs: tram track double layered BM - Type I: subendothelial deposits and mesangial deposits - All 3 have low serum C3 - Type II: C3 nephritic factor Tx: corticosteroids and cytotoxic Rx
Membranoproliferative nephropathy
78
Most common stones Cause idiopathic hypercalciuria and primary hyperparathyroidism, small bowel disease RADIOPAQUE, alkaline urine
Calcium oxalate/phosphate Phosphate more with hyperparathyroidism
79
Urease forming organisms like Proteus or Klebsiella Staghorn calculi Alkaline urine RADIOPAQUE
Struvite/triple phosphate
80
Associated gout, XO def, high purine turnover (chemo), acidic urine RADIOLUCENT - need CT
Uric acid Alkalinize urine with citrate Restrict purines
81
Due to defect in renal transport of certain AA (COLA- Cystine, ornithine, lysine, arginine) HEXAGONAL CRYSTALS +URINARY CYANIDE NITROPRUSSIDE TEST RADIOPAQUE
Cystine Alkalinize urine, penicillamine
82
Organs affected by PCKD
Kidney Spleen LIver Pancreas
83
AD vs AR PCKD
AD: common, no Sx until later in life, increased risk berry aneurysm AR: more severe, Sx as child
84
Most common congenital urethral obstruction
Posterior urethral valves Male with distended palpable bladder and low urine output
85
Grades of vesicoureteral reflux
Mild I and II - no dilation | Mod - severe: III-IV - ureteral dilation with caliceal blunting if severe
86
Scrotal swelling that transilluminates | 2/2 remnant of processus vaginalis
Hydrocele
87
Dilation of pampiniform venous plexus - bag of worms, does not transilluminate
Varicocele
88
Infection of epididymis from STD, prostatitis, reflux Enlarged or tender testicles, fever, erythema, pyuria; pain relieved by supporting scrotum UA shows pyuria; often 2/2 GC, E coli, Chlamydia Doppler: increased bf to testes Tx: abx - Ceftriaxone or fluoroquinolon ?tetracyclines and fluoroquinolones
Epididymitis
89
``` Twisting of spermatic cord Intense, acute onset scrotal pain N/V/ dizzines LOSS OF CREMASTERIC REFLEX Dopper: decreased bf to testes ``` Must fix immediately- manually or surgery Orchipexy- attach testes to wall
Testicular torsion
90
BPH most common zone
Central-periurethral
91
Leading causes Ca death in men
``` Lung Prostate Colorectal Pancreatic Leukemia ```
92
Prostate Ca- type of cancer
AdenoCa
93
Prostate cancer - most common zone
Peripheral zone
94
Differential for hematuria
I PEE RBCS ``` Infection/UTI PCKD Exercise External trauma Renal glomerular disease Benign prostatic hyperplasia Cancer Stones ```
95
Classic triad renal cell carcinoma
Hematuria Flank pain Palpable flank mass All 5-10% present with all 3 components of triad
96
Industrial risk factor bladder cancer
Aniline dye
97
beta hCG tumor marker
All choriocarcinomq | 10% seminomas
98
AFP tumor marker
Nonseminoma Ca like endodermal sinus/yolk sac Hepatocellular Hepatoblastoma Neuroblastoma
99
Tx seminoma
very radiosensitive
100
Bence Jones proteins/ light chains causes renal failure, can induce hypercalcemia and amyloidosis
Multiple myeloma
101
UTI causes
``` E coli - most common Staph saprophyticus Proteus Pseudomonas Klebsiella Enterobacter Enterococcus ```
102
Diuretic that would not increase risk of forming calcium stones in kideny
Thiazides- reabsorb calcium back into serum
103
Right testicular or ovarin v drains? | Left drain?
Right: IVC Left: left renal v
104
Mumps with painful swollen testis, unilat
Mumps
105
Priapism 2 types, define- which emergent Tx
Ischemic- failure of detumescene: emergent nonischemic- fistula between cavernosal a and corpus cavernosum Tx pain meds and intracavernosal injection sympathomimetic (phenylephrine)
106
Hypospadia vs epispadia
Hypo: ventral/underside Epi: dorsal/top
107
Urge incontinence | Tx
Involuntary leakage with sense of urgency due to inhibited bladder contraction = detrusor overactivity Tx: bladder training, antimuscarinics (oxybutynin, tolterodine, solefenacin)
108
Stress incontinence | Tx
Involuntary leakage with exertion, sneezing, coughing, laughing Tx: weight loss, kegel, pessaries, sling
109
Mixed incontinence | Tx
Involuntary leakage with urgency, exertion, coughing, sneezing, laughing Tx: bladder training, antimuscarinics
110
Overflow incontinence | Tx
Continuous leakage of urine with incomplete bladder emptying usu 2/2 BPH, stricture, cancer Tx: indwelling catheter, timed voiding, Tx disorder
111
Enzyme that is the catalyst for HCO3 reabsorption in PCT
Carbonic anhydrase
112
Common causes pyelonephritis
``` E coli Staph saprophyticus Klebsiella Proteus Candida in immunocompromised ```
113
Tx pyelo | Complications
IV fluoroquinolones, aminoglycoside, cephalosporin - 3rd gen for 1-2 d then outpt abx Complications: pregnant can cause low birth women and preterm labor
114
Diuretic good for pulmonary edema because has pulmonary vasodilatory effect
Loops
115
Most common site of renal stone impaction
Ureto vesical jcn
116
Impacted stone vs peritonitis activity of pt
Stone: move like crazy | Peritonitis- not moving
117
Malignancies that increase EPO
Renal cell carcinoma Pheo Hemangioblastoma
118
Kimmelstiel Wilson nodules
Diabetic nephropathy
119
Formula FeNa
((urine Na)/(serum Na))/ ((urine Cr)/(serum Cr))
120
Corrected HCO3
Measured gap - normal gap (12) - measured HCO3
121
If Corrected HCO3 high
metabolic alkalosis with high anion gap acidosis
122
If corrected HCO3 low
Nonanion gap acidosis with high anion gap acidosis
123
Central vs nephrogenic DI and testing, Tx central
Central: pituitary not making ADH Nephro: kidneys not respond ADH Test: give ADH = central will increase urine osmolality; nephro have no change Tx central DDVAP
124
Major cause SIADH, major problem
Paraneoplastic | Hyponatremia
125
Expected PCO2 formula
1.5 (HCO3) + (8 +/- 2)
126
Expected pH increase formula
if acute reps acid or alk: 1/10 x 0.08 x (PCO2 - 40) | If chronic resp acid or alk: 1/10 x 0.03 x (PCO2-40)
127
Pseudhyperkalemia
RBC hemolysis following blood collection
128
How to adjust total serum Ca if hypoalbuminemia
Ca decreases 0.8 mg/dL for each 1 g/dL albumin <4
129
FH hypercalcemia, low urine Ca, absence ostoepenia, nephrolithiasis, and metnal status changes
Familial hypocalciuric hypercalcemia
130
Tx UTI
Amoxicillina TMP SMZ Fluoroquinolones 3d

First Aid Step 2 (22 decks)

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