Renal > step 2 > Flashcards

step 2 Flashcards

(91 cards)

Start Studying
1
Q

underlying defect in type I, II, IV renal tubular acidosis

A

type I - defective H secretion
type II - defective bicarbonate reabsorption
type III - aldosterone deficiency or resistance

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

serum K in renal tubular acidosis

A

type I and II = low
type III = high

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

urinary PH in renal tubular acidosis

A

type I and II = < 5.5
type III = variable

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

treatment of renal tubular acidosis

A

type I: K bicarbonate
type II: treat underlying cause, K bicarbonate
type II: depends on eitology, may reuqire mineralocorticoid supplementation, Na bicarbonate or K wasting diuretics

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

causes of type I renal tubular acidosis

A

amphotericin B
hypercalciuria
autoimmune
ifosamide (cyclophosphamide analogue)

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

causes of type II renal tubular acidosis

A

aminoglycosides
acetazolamide
cisplatin
ifosfamide (cyclophosphamide analogue)

multiple myeloma
amyloidosis
all other causes fanconi syndrome

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

what metabolic derrangement does renal tubular acidosis cause

A

non-anion gap metabolic acidosis

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

fractional excretion of Na and urinary Na in pre renal vs intra-renal AKI

A

pre renal < 1% FEN (urine Na < 20)
intra-renal >2% FEN (urine Na > 40)

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

pre-renal or intra-renal AKI with urine osmolality > 500

A

pre renal
intra renal would be < 350

NOTE: pre renal does have fen < 1% and urinary Na < 20 as the kidney is retaining Na and water causing highly concentrated urine with low Na)

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

when is erythropoetin stimulating agents reommended for patients with CKD

A

Hg < 10 g/dL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

when should a statin be started in patients with CKD

A

patients 50 or older with CKD should start a statin
patients 18-49 with CKD plus history of CVD, diabetes or stroke should also start a statin

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

management of rhabdomyolysis

A

IV saline
bicarbonate
ECG (to rule out hyperkalaemia

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

what diuretics should be avoided in a patient with sulpha allergy

A

acetazolamide
loop diuretics
thiazide like diuretics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

renal impairment presenting 2 weeks post infection with low C3

A

post infectious glomerulonephritis

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

renal impairment presenting at the time of illness with normal C3

A

IgA nephropathy

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

what organs does the following conditions affect;
- granulomatosis with polyangitis

A

granulomatosis with polyangitis = kidney + lungs + sinus

chug-strauss syndrome = kidney + asthma

microscopic polyangitis = kidney + lung

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

cut off for nephrotic syndrome on protein:creatinine ratio

A

2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

patient presents with palpable purpura, arthralgia, haematuria, peripheral oedema and low C3

A

mixed cryoglobinuria
will likely have history of hep C

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

vaccination against what is required for patients with nephrotic syndrome and why

A

23-polyvalent pneumococcal vaccine due to loss of immunoglobulins in the urine

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

glomerulonephritis with positive antihospholipase A2 receptor antibodies

A

membranous glomerulopathy

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

investigations for diagnosis of minimal change disease

A

clinical diagnosis
renal biopsy required for treatment resistance or if > 12 years old

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

treatment for renal amyloidosis

A

prednisolone and melphalan (chemo)

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

gold standard for diagnosis of renal stones

A

nonconstract abdominal CT

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

what type of kidney stones are radio-lucent

A

non-visible stones = uric acid
RF: gout, high purine turnover i.e. cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
what kidney stones cause low and high urinary PH
low urinary PH: uric acid, calcium oxalate and cystine high urinary PH: struvite, calcium phosphate
26
envelope or dumbell shaped kidney stone
calcium oxalate
27
what type of kidney stone can primary hyperparathyroidism cause
calcium phsophate
28
wedge shaped prism stones
calcium phosphate
29
rhomboid shaped kidney stones
uric acid
30
hexagonal crystal kidney stones
cystine
31
describe the treatment algorithm for kidney stones
pregnant - USS non-pregnant- non-contrast CT scan stone < 5mm = may pass sponatenously stone < 10mm = medical management w/ alpha blocker or CCB >10mm = urosurgical management <20mm - shockwave lithotripsy or ureteroscopy >20mm - percutaneous nephrolithotomy
32
extra-renal features associated with ADPKD
cerebral berry aneurysms hepatic and pancreatic cysts heart: mitral valve prolapse, aortic regurgitation colonic diverticula inguinal and abdominal hernia
33
next step in an adult with finding of a simple single renal cyst
no further investigation required
34
family history of recurrent kidney stones
cystinuria cystine stones, hexagonal crystals on XR
35
mechanism of vasopressin receptor antagonists in the treatment of ADPKD /ARPKD
ADH (vasopressin) linked to cyst growth
36
decrease in scrotal pain with scrotal elevation
prehn sign positive (relief of pain) = epididymitis negative (no relief in pain) = torsion
37
painful scrotal swelling but diagnosis unclear clinicall. ?next step
doppler USS decreased flow = torsion increased flow = epididymitis
38
traetment for chronic prostatitis
acute = antibiotics chronic: alpha blockers, 5 alspha reductase inhibitors
39
management of hydrocele
majority resolve within 12 months if not resolved in 12 months then may need surgical removal due to risk of inguinal hernia
40
features of interstitial cystitis
often associated with fibromyalgia, IBS more common in females painful pelvic/bladder pain relieved with voiding urinalysis normal symptoms > 6 weeks 1st line management is behaviour modification - avoid dietary triggers
41
at what part of the prostate does BPH commonly originate
central zone (because of this may not always be detectable on DRE)
42
at what part of the prostate does prostate cancer comonly originate
lateral lobe (periphery)
43
what is terazocin and its use in BPH
terazocin is an alpha blocker 1st line for BPH (as is tamsulosin)
44
at what PSA level is cancer suspected
> 10
45
gold standard investigation for suspected prostate cancer
transrectal ultrasound guided biopsy
46
management for metastatic prostate cancer
Chemotherapy Androgen ablation methods; - GnRH agonists - orchiectomy - bicalutamide
47
what is useful for managing bone pain in metastatic prostate cancer
radiotherapy (often given post androgen ablation therapy)
48
haematuria characteristic that suggests bleeding from the bladder
bleeding at the end of voiding (terminal haematuria)
49
investigation for >35 yrs with haematuria
cystoscopy with biopsy
50
treatment for bladder carcinoma insitu
intravesicular chemotherapy or transurethral resection
51
treatment for invasive bladder cancer without mets
radical cystectomy with neoadjuvant chemo + radiosensitization or radiotherapy if deemed unfit for surgery
52
treatment for bladder cancer with distant mets
chemotherapy
53
treatment for superficial bladder cancer
transurethral resection or intravesicular chemo with BCG or mitomycin-C
54
from what route does renal cell carcinoma spread
via renal vein to IVC
55
how is renal cell carcinoma diagnosis confirmed
histology of specimen from nephrectomy
56
what is the peak age of seminomatous testicular cancers
40-50yrs
57
treatment for seminoma vs non-seminoma testicular cancer
radical orchiectomy for both seminoma: chemo or radio for low grade disease NSGCT: retroperitoneal lymph node dissection for low stage disease platinum base chemo for advanced disease of both
58
abx of choice for UTI in pregnant women
nitrofurantoin, amoxicillin or cephalexin culture follow-up to confirm resolution
59
criteria for abx prophylaxis for UTI
2 or more in 6 months or 3 or more in 1 year
60
1st line for UTI prophylaxis
behavioural modification
61
abx for UTI prophylaxis
nitrofurantoin or TMP taken after intercourse or first sign of symptoms
62
causative organisms of healthcare associated UTI
serratia marscesens enterococcus pseudomonas aurginosa
63
medication for pain in lower UTI
pentosan (relieves cystitis pain) phenazopyridine (relieves urinary tract pain)
64
what is xanthogranulomatous pyelonephritis
severe form of chronic pyelonephritis caused by infected kidney stone obstructed = granulomatous inflammation multiple round dark areas on CT
65
patient with treatment resistant UTI has CT which shows multiple dark round areas. ? diagnosis
xanthogranulomatous pyelonephritis chronic pyelonephritis caused by obstrcuted kidney stone causing granulomatous inflammation
66
symptoms of prostatitis
systemic upset perineal pain lower back pain pain on defecation dysuria, frequency, urgency, urinary retention
67
treatment for acute prostatitis
unstable - IV flouroquinolone +/-cephalosporin stable - co-trim or flouroquinolone for 4-6 weeks
68
treatment for chronic prostatitis
flouroquinolone or co-trim for 6-8 weeks
69
patient presents with nephrotic syndrome, peripheral neuropathy and dyspnoea. ?diagnosis
amyloidosis
70
gold standard test for amyloidosis
abdominal fat pad biopsy
71
in the treatment of gonorrhoea, in addition to ceftriaxone what other antibiotic should be added
doxycyline to cover concomitant chlamydia incase there is co-infection
72
most common cause of nephrotic syndrome in patients with HIV and how is this managed
focal segmental glomerulonephritis management is with: prednisolone, anti-retroviral treatment (if not already on it) and ACE/ARB inhibitors
73
USS shows wedge shaped region in the renal medulla. what does this indicate?
renal papillary necrosis treat with IV fluids
74
what lab value and CT finding would you find in renal infarction
elevated LDH wedge shaped infarct on CT
75
what is the next step if a patients PSA has risen but no sign of massess on examination
if PSA has rise >4-9.9 then re-check in 6-8 weeks
76
patient develops fever, muscle aches and worsening rahs a few hours after starting treatment for syphillis. ?diagnosis ?treatment
jarisch-herxheimer reaction manage with NSAIDS
77
post transplant patient develops AKI that doesnt respond to saline. ?cause
calcineurin inhibitors i.e. tacrolimus (would also show low FeN <1%)
78
describe WAGR syndrome
presents in infants/children with Wilms tumour Aniridia (lack of optic iris) Genitourinary abnormalities Range of developmental delays
79
baby born with duplicate left renal system, lack of optic irises and 2 vessel umbilical cord. ?diagnosis
WAGR syndrome should be screened for wilms tumour every 3 months until age of 5 yrs
80
what UTI causing organisms cause positive nitrites
urease producing bacteria which causing an alkaline urine proteus, klebsiella and staph saprophyticus can cause struvite stones
81
glomeulonephritis strongly associated with hepatitis C
membranoproliferative glomerulonephritis presents with mixed nephrotic and nephritic picture
82
patient has recurrent kidney stones. urine shows low calcium and phosphate levels. what additional management could help prevent recurrent stones
low urinary calcium and phosphate suggests calcium phosphate stones lemon juice can help prevent these
83
patient has recurrent kidney stones. urine shows raised calcium and phosphate levels. what additional management could help prevent recurrent stones
thiazide like diuretic decreases urinary Ca by increasing serum Ca
84
what complications associated with CKD dont respond well to haemodialysis
anaemia and bone disease
85
how to differentiate the underlying cause of recurrent UTI's due to posterior urethral valves vs VUJ reflux
patients will continue to have symptoms with UTI's etc all the way up to adulthood patients with VUJ will have no symptoms as they develop into adulthood
86
how to differentiate membranoproliferative GN vs focal segmental GN in a patient with HIV and hep c
membranoproliferative GN will have low complement FSGN will have normal complement
87
child with hypertension, low K and family history of early onset hypertension ?diagnosis ?treatment
liddle syndrome diuretics that block Na channel i.e. triametere, amiloride
88
diagnostic investigation for primary hyperaldosteronism
saline infusion test (aldosterone:renin ration is the screening test but not diagnostic)
89
features of RTA II
normal/low K glucosuria but normal serum glucose hyperchloraemic metabolic acidosis hypophosphataemia hyperuricaemia type I RTA wouldnt have these features and would have a low K
90
indications for starting dialysis in a patient with CKD
eGFR < 5 Acidosis Encephalopathy Intoxication i.e. hyperkalaemia refractory to treatment Overload not responding to diuretics Uraemia i.e. pericarditis
91
in addition to blood pressure control, what other medication can help slow progression of ADPKD
Tolvaptan

Renal (7 decks)

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