Step 2 ck Renal

kafopaci2016's version from 2016-05-31 03:19

Section 1

Question Answer
trim pt with blood at urethral meatus +high riding prostate+suprpubic pain=Post urethral injury
mixed cryoglobuliemia is (palpable purpura+hematurea+proteinurea) assoc with hypocomlement& HCV infection
confirm dx of mixed cryoglubulinemia with demonstrating circulatory cryoglobulins
when suspect mixed cryoglobulinemia in a pt you test forHCV infection
mixed cryoglobulinemia VS Henocheline purpuracryoglubulenemia(low complement+HCV) VS Henochline(normal complement+no HCV association)
urine in incontinence (leaking with coughing,lifting,sneezing,laughing)dx?why?STRESS incontenence. cuz of loss of urethral support &intrabdominal pressure exceeded urethral sphincter pressure
sudden overwhelming or frequent need to empty bladder.dx?why?URGE incontenence. cuz of detrusor overactivity
constant involuntary dribbling of urine+ incomplete emptying.dx?why?OVERFLOW incontenence. cuz of impaired detrouser contractility,bladder outlet obstruction.
pt 6hrs post delivery(epidural anathasia) with urine dribbling+fulnees and tenderness above symphysis pubis+unable to void measurable amount+600 ml by catheter.what to do ?why?insert indwelling catheter. cuz pt can't feel bladder fullness and can't contract detrouser Ms yet cuz epidural blocked aff & eff bladder nerves.->urinary retention->overflow incontenence.after few hours bladder sensation and detrouser contractility should resume.
whats the normal bladder capacity? post void residual volume?400-600 ml is the normal capacity. PVR is <50 ml.
ttt for urge incont.?Oxybutinin . anticholinergic->inhibit smooth Ms contraction.
pessaries are used for stress incont.
what are indications of suprapubic catheter?urethral stricture, severely enlarged prostate.
pathophysiology of stress incontenence? weakening of pelvic floor musculature->Urethral hyper mobility->ineffective closure of urethral sphincter->urine leakage when intra and. pressure exceeds urethral sphincter pressure.
what test to dx urethral hyper mobility?how?cotton-tipped swap test.inserted into urethral orifice to check straining angel if >30 with increase intra abd. pressure=urethral heypermobility=stress incont.

Section 2

Question Answer
management of stress incont.?1st:Kegel 2nd:Urethroplexy (long term management)
meds used in overflow incont.?bethanechol & alpha blockers
MCC of Recurrent UTIs in infants & children is ?VUR
definitive dx of VUR by ?Voiding cystourethrogram
complications of VUR?parenchymal scarring, HTN , Renal insufficiency
meds to facilitate ureteral stone passage?alpha-blockers ( Tamsulosin ): relaxes ureteral Ms and reduce the spasm induced by stone impaction->facilitate passage of stone
first line pharmacotherapy for enuresis?2nd line?1st line:desmopressin. 2nd line: tricyclic antidepressant.
what kind of ace-base imbalance follows tonic-clonic seizures?what to do?Transient Anion-gap metabolic acidosis.observe & repeat labs in 2 hrs.
if you suspect minimal change confirm with?steroids (empiric)
MCC of nephrotic synd. in <10yrs child ?minimal change
when to do renal biopsy for a child with nephrotic?1-if age >10 yrs with nephrotic. 2-child unresponsive to steroids (with nephritic or minimal change).
in nephrotic:increase glomerular permeability to ?albumin
will IV albumin correct hypoalbumenemea in child with nephrotic(minimal)?no.
ttt of minimal change (nephrotic) in a child is?steroids
constipated child can have recurrent?why?cystitis due to urine stasis.
unilateral varicocele docent empty on supine suspectRCC
to dx RCC most sensitive and specific test is?abd CT scan
how to differentiate hypOnatremia stages (mild,moderate,sever)?with ttt for each?mild (asymptomatic or mild symptome*forgetfulness+unstable gait*->ttt:1-fluid restriction.2-salt tablets.3-loop diuretics) Moderate(confusion lethargy->ttt:hypeRtonic line for 1st 3-4hrs till sr.Na:>120 then same as mild ttt). Sever(seizures,comma,unable to communicate->ttt:bolus hypeRtonic saline till resolution of symptoms*+or _*vasopressin receptor antagonist"conivaptan")

Section 3

Question Answer
when to use bisphosphonate?1-hypercalcemia. 2-osteporosis prevention. 3-adjunctive tt of certain malignancies(MM)
what D5W? When to use it?hypotonic solution used in hypeRnatremia.
uses of mantel?increase intracerebral pressure with cerebral edema & increase intra ocular pressure
sodium bicarbonate uses?hypeRkalemia, sever metabolic acidosis, drug overdose(tricyclic antidepressant)
what is the % of types of saline?normal saline is 0.9% hypeRtonic Saline is 3%
what diuretic will lower urine calcium exsecretion?thiazide
which diuretic will increase urine calcium excecretion?loop
how to prevent urine calcium stone formation?1-thiazide. 2- low sodium-low protein diet. 3-increase fluid intake. 4-moderate calcium intake.
normal PH + abnormal paCO2 & HCO3=mixed acid-base disorder
Aspirin intoxication causes mixed rest. alkalosis & metabolic acidosis
pathophysiology of cryoglobulinemia?immune complex disorder(IgM against anti hepatitis C virus IgG)due to chronic hepatitis C ->1-Vasculitis involving(skin,kidney,nerves,joints) 2-low complement level. 3-increased (sr.cryoglobulins, RF, liver transaminases)
how to confirm Dx of cryoglobulinemia ?kidney/skin biopsy
how to confirm ureteric calculi?abd. *non contrast* CT or abd.US
what is pathophysiology of hepatorenal syndrome?sever liver cirrhosis->portal HTN->increased nitric oxide generation in splanchnic circulation->system V.D->reduced prephral resistance & BP->Renal hypOperfusion->precipitated by (reduced renal perfusion*GI bleed,vomitting,sepsis excessive diuretic use,SBP*. Reduced glomerular pressure & GFR*NSAIDs*cuz they constrict Affrent.
what are different types of hematuria and their causes?1-intial( urethral) 2-terminal (bladder or prostate) 3- total(kidney or ureter)
painless terminal hemturea with clots.suspect? test to dx?RCC. cystoscopy.
sr.BUN and Creatinine changes in pregnancy are?why?both will decrease.cuz increased renal plasma flow & GFR.
what are the most common pathologies seen in analgesic nephropathy?1-tubulo-interstetial nephritis. 2- papillary necrosis.
hypeRkalemia with ECG changes you give to reduce cardiac excitability:IV calcium chloride or calcium gluconate. *effect is transient=dosent correct potassium concentration*
hypeRkalemia with ECG changes (rapidly acting ttt)?1-beta 2 agonist(albuterol neb.). 2-insulin with glucose. 3-sodium bicarbonate.->all of them shift potassium intracellularly->rapidly correct hypeRkalemia. indicated in rapid onset hypeRkalemia(rhabdomyolysis)..*effect is transient=do not affect total body potassium.
removal of potassium from the body(slow acting)via?1-diuretics(loop)given with saline infusion 2- cation exchange resins(sodium poly stereo sulfonate). 3-hemodialysis.
so management of hypeRkalemia 3 points?1-clacium to reduce cardiac excitability. 2- (B2 agonist,insulin+glucose, NA HCO3)to shift K intracellularly. 3-to remove K from the body(loop diuretics, cation exchange resides,hemodialysis)

Section 4

Question Answer
what is the MCC of isolated proteinuria in children? next you do?transient proteinurea. repeat dipstick in 2 separate occasions.
1st generation antihistamine in a pt with BPH might lead to?why?urine retention due to Detrusor inhibiting action of Acetylcholine on muscarinic receptors found in parasympathatic system.
detrusor activity is controlled by what?where?parasympathetic from pelvic splanchnic nerves.
2 lab values to give the best picture about acid-base status in any pt are:PH & PaCO2... cuz you can calculate HCO3 from those two.
post operative oliguria or anuria. next step?IV fluid challenge by bolus of IV fluid.
recurrent renal stones since childhood & +ve family Hx of same problem suspect?screen with?Cystinurea . screen with urinary cyanide nitroprosside
Cystinurea is caused by?amino acid transport abnormality
describe stone and urine analysis on pt with cystinurea?radiopaque stones. UA: hexagonal crystals.
criteria of SIADH?1-euvolemic hypOnatremia. 2-U NA >20 mEq/L. 3-Sr.Osmol<270. 4-Uosmol> Sr.Osmol. 5-increase sodium urin koncept. failure to correct with normal saline.
pt with BPH. medical ttt is ?alpha 1-blockers (tamsulosin, doxazosin)*men has a lots of sins* 5-alpha reductase inhibitor( finusteride )
Urine analysis:blood(large). urine microscopy:no RBCs(0-1)..dx is Myoglobinurea
whats the cause of myoglubinurea?complication?rhabdomyolysis->acute renal failure.
in symptomatic moderate to sever hypeRcalcemia. immediate TTT of choice is?IV normal saline (hydration)+ calcitonin
what are types of hypercalcemia? 1-sever or symptomatic(ca>14mg/dl)(neurologic*confusion,weakness,coma*, GI symptom,back pain,high sr.calcium). 2-Moderate(12-14mg/dl)(anorexia,nausea,constipation,polurea,polydipsia,dehydration) 3-milde or asymptomatic(<12 mg/dl)
management of hypeRcalcemia?1-ttt of sever or symptomatic:short term ttt:normal saline infusion+calcitoninlong term ttt:bisphosphonate*zoledronic acid*. 2-moderate(no immediate ttt required unless symptomatic use same as sever. 3- mild: no immediate ttt required.
what to avoid in hypercalcemia?in sever hypercalcemia(avoid loop diuretics unless volume overload by eg:HF. in asymptomatic or mild:avoid thiazide, lithium, volume depletion, prolonged bed rest)
immediate ttt in sever symptomatic hypeRcalcemiea is normal saline with what?why?calcitonin->reduces in 4-6 hrs.
whats long term ttt for hypeRcalcemia?Bisphosphonate.
in pt with sever hypercalcemia+renal insufficiency +/- heart to manage?why?Hemodialysis (or peritoneal dialysis) with calcium free dialysate. cuz hydration isn't safe in this pt.
hypercalcimea in ch. granulomatous disease *not acute* you give ?why?steroids->cuz it reduces calcitonin production by activated mononuclear cell in lungs & LNs.

Section 5

Question Answer
in ch. alcoholics? what electrolytes disturbances do you expect?hypO kalemia, hypO magnesemiea, hypO phosphatemea.
what is the cause of refractory hypokalemia in ch. alcoholics?hypomagnesemia
when suspect RCC (gross or microscopic hematuria) next you do?cystoscopy
elderly pt with impaired thirst response predisposed to what ?and why?Pre renal azotemia due to intravasculer volume depletion.
pt with pneumonia complicated by hypotension tachycardia and prerenal azotemia. lead to?decreased renal perfusion->decreased renal blood flow(RBF)->activates renin-angiotensin-aldosterone system->renal arteriolar V.C
chronic condition of (bladder pain worsens with filling & relived by voiding +dysparunea+frequency & urgency) dx is ?interstitial cystitis ( painful bladder syndrome )
in interstitial cystitis urinalysis results will show?normal results
ttt of interstitial cystitis is?palliative ttt (amytriptaline, analgesics, avoid trigers)
management of simple renal cyst in CT scan is ?reassurance only.
types of hematuria based on UA are?glomerular (UA:blood+protein, RBCs cast,dysmorphic RBCs) non glomerular(blood but no protein,normal appearing RBCs)
prolonged hypotension leads to? in UA will show?ATN. UA:muddy brown granular cast.
types of casts in UA?what conditions assoc with ?RBCs cast:GN , WBCs cast:interstitial nephritis &pyelonephritis, fatty cast:nephrotic syndrome , broad and waxy casts: chronic renal failure , muddy brown casts: ATN.

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