UWORLD-STEP2 (BA) > IM- Nephro > Flashcards

IM- Nephro Flashcards

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1
Q

Causes for primary adrenal insufficiency (4)

A
  • Autoimmune
  • Infections (HIV, TB, disseminated fungal)
  • Hemorrhagic infarction (meningococcemia, anticoagulants)
  • Metastatic cancer (lung)
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2
Q

Clinical presentation for acute adrenal insufficiency (4)

A
  • Shock
  • Abd tenderness with deep palpation
  • Unexplained fever
  • N/V, weight loss and anorexia
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3
Q

Lab findings for acute adrenal insufficiency (4)

A
  • Hyponatremia, hyperkalemia, hypercalcemia and eosinophilia
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4
Q

Clinical presentation for chronic adrenal insufficiency (5)

A
  • Fatigue, weakness and anorexia
  • GI (N/V, abd pain)
  • Weight loss
  • Hyper pigmentation or vitiligo
  • Hypotension
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5
Q

Lab findings for chronic adrenal insufficiency (5)

A

-Hyponatremia, hyperkalemia, hypercalcemia, eosinophilia & anemia

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6
Q

How to diagnose adrenal insufficiency

A
  • measure ACTH and Serum cortisol with high-dose (250microgram) ACTH stimulation test
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7
Q

What do you expect to see in primary adrenal insufficiency during ACTH stimulation test

A

low cortisol

high ACTH

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8
Q

What do you expect to see in secondary adrenal insufficiency during ACTH stimulation test

A

low cortisol

low ACTH

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9
Q

what acid-base imbalance is seen in Primary adrenal insufficiency (Addison disease)?

A

normal anion gap metabolic acidosis

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10
Q

Causes of Hyponatremia with
<290 serum osmolarity and
<100 urine osmolality (2)

A
  • Primary polydipsia

- Malnutrition (beer drinker’s potomania)

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11
Q

Causes of Hyponatremia with

>290 serum osmolarity (2)

A
  • Marked hyperglycemia

- Advanced renal failure

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12
Q

Causes of Hyponatremia with
<290 serum osmolarity
>100 urine osmolality &
Urine sodium <25 (3)

A
  • Volume depletion
  • CHF
  • Cirrhosis
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13
Q

Causes of Hyponatremia with
<290 serum osmolarity
>100 urine osmolality &
Urine sodium >25 (3)

A
  • SIADH
  • Adrenal insufficiency
  • Hypothyroidism
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14
Q
  • 5 days of URI
  • Young adult men (20-30)
  • Recurrent gross hematuria
A

IgA nephropathy

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15
Q
  • 10-21 days after URI
  • Children (6-10)
  • gross hematuria
  • Adults can be asymptomatic or develop an acute nephritic syndrome
A

Post-infectious glomerulonephritis

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16
Q
  • Normal Complement

- Mesangial IgA deposits on kidney biopsy

A

IgA nephropathy

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17
Q
  • Low C3 complement
  • Elevated anti-streptolysin O &/or anti-DNAse B
  • Kidney biopsy with subepithelial humps consisting of C3 complement
A

Post-infectious glomerulonephritis

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18
Q

What lab value differentiates Familial hypocalciuric hypercalcemia (FHH) with primary hyperparathyroidism?

A

Urinary calcium level

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19
Q

High serum Calcium
High serum PTH
Low urinary calcium

A

Familial hypocalciuric hypercalcemia (FHH)- AD mutation of calcium-sensing receptor (CaSR)

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20
Q

High serum Calcium
High serum PTH
High urinary calcium

A

Primary Hyperparathyroidism

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21
Q

What are the 4 types of urinary incontinence

A

Stress
Urgency
Mixed
Overflow

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22
Q

Constanct involuntary dribbling and incomplete emptying? Dx? Tx(3)?

A

Overflow urinary incontinence

  • Correct underlying cause
  • Cholinergic agonists
  • Intermittent self-catheterization
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23
Q

Leakage with Valsalva (coughing, sneezing, laughing). Dx? Tx(4)?

A

Stress urinary incontinence

  • Lifestyle modification
  • Pelvic floor exercises
  • Pessary
  • Pelvic floor surgery
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24
Q

Sudden, overwhelming, or frequent need to void. Dx? Tx (3)?

A

Urgency urinary incontinence

  • Lifestyle modifications
  • Bladder training
  • Antimuscarinic drugs (Oxybutynin therapy)
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25
24F, worsening headache, fatigue, sunburn on the face, bilateral pitting ankle edema, UA- protein+, RBC+, RBC casts+
-SLE
26
- Gradula symptom onset - Joint, renal, serosal &/or neurologic involvement - Rash
SLE
27
Dx for SLE
- Anemia. leukopenia, thrombocytopenia - + ANA, Anti-double-stranded DNA, anti-smith - Low complement levels, increased immune complexes
28
The onset of Acute interstitial nephritis (AIN) caused by meds like beta lactams and PPI
7-10days after exposure
29
AKI = 7 days of starting drug, WA with hematuria, pyuria and crystals, increased risk with volume depletion and CKD
Crystal-induced AKI
30
Drugs that can cause Crystal-induced AKI (6)
``` Acyclovir Sulfonamides Methotrexate Ethylene glycol protease inhibitors Uric acid (tumor lysis syndrome) ```
31
Hypochloremia hypokalemia elevated bicarbonate level
GI losses due to vomiting
32
Causes of metabolic alkalosis that are saline-responsive (5)
- Vomiting - Gastric suctioning - Diuretics - Laxative abuse - Decreased oral fluid intake (volume depletion)
33
Causes of metabolic alkalosis that are saline-resistant (3)
- Primary hyperaldosteronism - Cushing's syndrome - Severe hypokalemia
34
easy fatigability, postural dizziness, muscle cramps
volume depletion
35
Muscle weakness and arrhythmias
Hypokalemia
36
Hypernatremic- hypovolemic and symptomatic. Tx?
0.9%NS until euvolemic and the 5% dextrose
37
Hypernatremic- hypovolemic and Asymptomatic. Tx?
5% dextrose (preferred hypotonic fluid than 0.45%)
38
Hypernatremic- Euvolemic. Tx?
Free water preferred
39
The most common electrolyte abnormality in Chronic alcoholism? Cause (3)
Hypomagnesemia | - Poor nutritional intake, alcohol-induced renal losses, diarrhea)
40
Hypokalemia that cannot be corrected with potassium replacement is called? Caused by?
refractory hypokalemia - Intracellular magnesium (inhibit potassium secretion by renal outer medullary potassium (ROMK) channels - causing excessive renal potassium loss )
41
Organ systems affected by diabetic autonomic neuropathy (4)?
Cardiovascular Peripheral nerves GI GU
42
The most common cause of chronic primary adrenal insufficiency (Addison disease) in endemic areas is
TB
43
Aldosterone deficiency that presents with a non-anion gap and hyperkalemic and hyponatremic metabolic acidosis
Addison's disease
44
The metabolic acidosis caused by aspirin intoxication is due to (2)
increased production | decreased renal elimination of organic acids (lactic acid, ketoacids)
45
Drugs that cause Acute interstitial nephritis (4)
NSAIDS PCN TMP-SMX cephalosporines
46
Drugs that cause hyperkalemia (8)
``` TMX(trimethoprim) Nonselective beta-adrenergic blockers ACE inhibitors, ARB, K sparing diuretics Digitalis Cyclosporine Heparin NSAIDS Succinylcholine ```
47
Three conditions that predisposes to the formation of calcium oxalate stones ?
- Small bowel disease - Surgical resection - Chronic diarrhea leading to malabsorption of fatty acids and bile salts
48
What kind of hypernatremia is caused by diabetes insipidus (DI)?
Euvolemic
49
4 causes of nephrogenic DI resulting from renal ADH resistance
- Hypercalcemia - Sever hypokalemia - Tubulointerstitial renal disease - mediation
50
Flushing (Cherry-red color), cyanosis, headache, altered mental status, seizures, coma, arrthymia, tachypnea followed by respiratory depression, pulmonary edema, abd pain, N/V, metabolic acidosis (from lactic acidosis), renal failure
Cyanide accumulation and toxicity
51
what can cause cyanide toxicity (3)
- Wool, silk - Metal extraction in mining - sodium nitroprusside
52
2 risk factors for Hepatorenal syndrome
- Advanced cirrhosis with portal HTN | - Edema
53
No RBC, Protein, or granular casts in urine No improvement in renal function with fluids Absence of tubular injury FeNa <1% (or Urine Na < 10mEQ/L) Renal hypo perfusion
Hepatorenal syndrome
54
splanchnic vasoconstrictors (3)
- Midodrine - Octreotide - NE
55
Renal transplant dysfunction early post-operative period can have 5 causes
- Ureteral obstruction - Acute rejection - Cyclosporine toxicity - Acute tubular necrosis
56
how is acute renal transplant rejection treated?
IV steroids
57
Tinnitus Fever Tachypnea
Salicylate intoxication
58
Acid-base imbalance in aspirin intoxication
Mixed respiratory alkalosis | anion gap metabolic acidosis
59
What is the type of hematuria in patient with | Glomerular hematuria vs nonglomerular hematuria
G; Microscopic>gross | Non-G; Gross >microscopic
60
common disease that cause glomerular hematuria (3)
Poststreptococcal IgA nephropathy Alport syndrome
61
common disease that cause non-glomerular hematuria (5)
``` Nephrolithiasis Cancer Polycystic kidney disease infection (cystitis) papillary necrosis ```
62
UA finding in Glomerular hematuria (4)
Blood Protein RBC casts dysmorphic RBCs
63
UA finding in Nonglomerula hematuria (2)
Blood | Normal-appearing RBCs
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