Deja - Internal - Nephrology COPY

Question 1

ARF - Signs and symptoms NOT 2o to uremia:

Answer 1

1. Metabolic acidosis.
2. Hyperkalemia –> Arrhythmias.
3. Fluid overload –> Pulm. edema, CHF, HTN.
4. Hyperphosphatemia.
5. HTN 2o to excess renin secretion.

Question 2

Oliguria - Definition:

Answer 2

Less than 400cc/24h.

Question 3

What tests would you initially order to evaluate for ARF?

Answer 3

1. Urine/serum electrolytes.
2. Urine/serum BUN/Cr.
3. Urinalysis including urine osmolarity.

Question 4

What is FENa?

Answer 4

Stands for fractionals sodium excretion and is the best diagnostic test to help discriminate between the different types of ARF.

Question 5

FENa in Prerenal, renal, and post renal?

Answer 5

Pre –> >2%.

Postrenal –> >4%.

Question 6

Name the type of ARF associated with the following urinary sediment findings: Red cell casts, urine eosinophils, WBCs, granular casts.

Answer 6

Red cell casts –> GN.
Urine eosinophils –> AIN.
WBC casts –> AIN.
Granular casts –> ATN.

Question 7

What medications classically cause ATN?

Answer 7

CLAAP

Contrast
Lithium
Aminoglycosides
Amphotericin
Pentamine

Question 8

What are the causes of AIN?

Answer 8

Inflammation of the renal parenchyma caused by:

1. Medications: diuretics, NSAIDs, penicillin.
2. Infection: CMV, EBV, Toxo, Syphilis.
3. Systemic diseases: Sarco, Sjögren.

Question 9

Uremic syndrome - Cardiovascular:

Answer 9

1. HTN

2. Pericarditis

Question 10

Uremic syndrome - Pulmonary:

Answer 10

1. Pleural effusions

2. Pulm. edema.

Question 11

Uremic syndrome - CNS:

Answer 11

1. Asterixis

2. Clonus

Question 12

Uremic syndrome - Hematology:

Answer 12

1. Anemia due to low erythropoietin.

2. Incr. bleeding time due to platelet dysfunction.

Question 13

Uremic syndrome - GI:

Answer 13

1. Nausea

2. Vomiting

Question 14

Uremic syndrome - Metabolic:

Answer 14

1. Acidosis.
2. Electrolyte imbalances (especially hyperkalemia).
3. Hypocalcemia (lack of vitD).
4. Azotemia.

Question 15

What can be used to measure the severity of CRF?

Answer 15

GFR.

Question 16

In CRF, there is decreased synthesis of what 2 entities?

Answer 16

1. VitD

2. EPO

Question 17

Electrolyte abnormalities seen in CRF:

Answer 17

1. Hyperkalemia
2. Hypocalcemia
3. Hyperphosphatemia

Question 18

Indications for dialysis:

Answer 18

AEIOU

Acidosis
Electrolyte abnormalities
Ingestion of toxins
Overload of fluid
Uremic symptoms

Question 19

How can urinary cholesterol be identified?

Answer 19

If urine is seen under polarized light, there will be “MALTESE CROSSES”.

Question 20

Other names for minimal change disease?

Answer 20

Nil disease or lipoid nephrosis.

Question 21

Nephrotic syndrome - MC primary cause in adults:

Answer 21

FSGS or membranous glomerulonephritis.

Question 22

Nephrotic syndrome - 2 forms, type I is slowly progressive and type II has autoantibodies against C3 and is more rapidly progressive.

Answer 22

Membranoproliferative glomerulonephritis.

Question 23

Nephrotic syndrome - Associated with refractory HTN:

Answer 23

FSGS

Question 24

Nephrotic syndrome - Frequently recurs:

Answer 24

Minimal change disease

Question 25

Nephrotic syndrome - Granular deposits of IgG and C3:

Answer 25

Membranous glomerulonephritis.

Question 26

Nephrotic syndrome - Present in young, black men with refractory HTN:

Answer 26

FSGS

Question 27

Nephrotic syndrome - Associated with HIV, IVDA, SCA:

Answer 27

FSGS.

Question 28

Nephrotic syndrome - "Spike and dome" on histology due to excess basement membrane:

Answer 28

Membranous glomerulonephritis.

Question 29

Nephrotic syndrome - Slowly progressive with minimal response to steroids:

Answer 29

Membranous GN

Question 30

Nephrotic syndrome - Associated with hep, SLE, syphilis, malaria, penicillamine, gold, CA:

Answer 30

Membranous GN.

Question 31

Main treatment for FSGS:

Answer 31

Steroids with cyclophosphamide - Poor prognosis.

Question 32

Main treatment for membranous GN:

Answer 32

Steroids, can add cyclophosphamide in refractory cases.

Question 33

Main treatment for membranoproliferative GN:

Answer 33

Steroids. Plasmapheresis can be added.

Question 34

Name the systemic diseases that can lead to nephritic syndrome.

Answer 34

1. SLE 2. SCA 3. HIV 4. Diabetes 5. Myeloma

Question 35

Name the 5 types of GN?

Answer 35

1. Post-strep GN (PSGN) 2. RPGN 3. Mesangial proliferative GN 4. Membranoproliferative GN 5. IgA nephropathy

Question 36

Nephritic syndrome - Self-limiting disease:

Answer 36

1. PSGN | 2. Henoch-Schonlein

Question 37

Nephritic syndrome - Buerger disease:

Answer 37

IgA nephropathy

Question 38

Nephritic syndrome - Coarse, granular IgG or C3 deposits:

Answer 38

PSGN

Question 39

What is the MC glomerulonephropathy:

Answer 39

Buerger disease

Question 40

What is the MC type of kidney stone?

Answer 40

Calcium pyrophosphate

Question 41

What is the 2nd MC type of kidney stone?

Answer 41

Ammonium Mg Ph

Question 42

What are the underlying bacterial etiologies of ammonium Mg Ph stones?

Answer 42

1. Proteus 2. Pseudomonas 3. Providencia 4. Staphylococcus sapro

Question 43

How is nephrolithiasis diagnosed?

Answer 43

Plain films can identify radiopaque stones. Renal US can visualize hydronephrosis. IV pyelogram is another option. --> Non contrast CT can visualize small stones and is the GOLD standard for diagnosis.

Question 44

What is the mnemonic for common pathogens causing UTIs?

Answer 44

KEEPS: ``` Klebsiella E.coli Enterobacter Proteus S.saprophyticus ```

Question 45

What is the indication of a contaminated urinalysis?

Answer 45

Many epithelial cells or many types of bacteria present.

Question 46

Other than urinalysis, what test should be ordered in a patient suspected to have a UTI?

Answer 46

1. Urine culture | 2. Gram stain and sensitivity

Question 47

What is the 1st-line treatment for UTI?

Answer 47

3-day course of TMP-SMX. | In areas with resistance, ciprofloxacin is first choice.

Question 48

In what patient should fluoroquinolones be avoided?

Answer 48

Pregnant patients.

Question 49

How is anion gap calculated and what is a normal range?

Answer 49

Na - (Cl + HCO3). Normal range is 9-14.

Question 50

What is Winter's formula?

Answer 50

It determines if there was appropriate compensation in the setting of metabolic acidosis: 1.5x(HCO3) +8 +/-2=Pco2.

Question 51

What are the causes of anion gap metabolic acidosis?

Answer 51

MUD PILES ``` Methanol, Metformin Uremia DKA Paraldehyde INH, iron tablets Lactic acidosis Ethanol Salicylates ```

Question 52

How is the etiology of the anion gap metabolic acidosis determined?

Answer 52

Check for ketonuria.

Question 53

Anion gap metabolic acidosis - Ketonuria present:

Answer 53

1. DKA 2. Paraldehyde 3. Isopropyl alcohol ingestion 4. Starvation

Question 54

Anion gap metabolic acidosis - Ketonuria Absent:

Answer 54

1. Lactic acidosis 2. Methanol 3. Ethylene glycol 4. Salicylate poisoning

Question 55

What are the causes of normal anion gap metabolic acidosis?

Answer 55

1. Renal tubular acidosis 2. Diarrhea 3. Colostomy 4. Ileostomy 5. Ingestion of Mg sulfate 6. Calcium chloride 7. Acetazolamide 8. Hyperparathyroidism

Question 56

What is in the DDX when a patient has the classic finding of HTN with HYPOkalemia?

Answer 56

Conn vs 2o hyperaldosteronism due to renal artery stenosis.

Question 57

How is RAS diagnosed?

Answer 57

Imaging via renal arteriogram, MRA, or Doppler US.

Question 58

How is RAS treated?

Answer 58

Angioplasty and in some cases surgery.

Question 59

ARF - Signs and symptoms 2o to uremia:

Answer 59

1. Asterixis 2. Nausea 3. Vomiting 4. Anemia 5. Pericarditis 6. Pruritus 7. Urea crystals on the skin ("uremic frost"). 8. Fatigue 9. Oliguria