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USMLE Renal 2

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ficks's version from 2018-03-06 03:27

Kidney Stones

StoneAnswerQuestionNumber
Ca/PO4HighpH of precpitation1
Ca/OxalateLowpH of precpitation1
NH4/Mg/PO4 (struvite)HighpH of precpitation1
Uric acidLowpH of precpitation1
CystineLowpH of precpitation1
Ca/PO4RadiopaqueXray1
Ca/OxalateRadiopaqueXray1
NH4/Mg/PO4 (struvite)RadiopaqueXray1
Uric acidRadiolucentXray1
CystineRadiopaqueXray1
Ca stonesHypercalcemia (PTH/cancer) causes hypercalciuria (sometimes w/normocalcemia)Cause2
Ca/OxalateEthylene glycol/Vitamin C abuseCause2
Ca stonesThiazides/citrateTreatment2
NH4/Mg/PO4 (struvite)Infection w/urease (urea to NH3) positive (Proteus mirabilis/Staph/Klebsiella)Cause3
Uric acidStrong association with hyperuricemia/gout/often in high cell turnover (leukemia)Cause3
Uric acidAlkalinize urineTreatment1
CystineCystinuriaCause1
CystineHexagonalCrystals1
CystineAlkalinize urineTreatment1
NH4/Mg/PO4 (struvite)Rectangular prism/coffin-lidCrystals1
Ca stonesColorless octahedrals (square crossed by diagonal)Crystals1
Uric acidDiamond/rhombusCrystals1
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Renal Malignancy

CancerAnswerQuestionNumber
Renal Cell CarcinomaHypernephroma/Grawitz tumorAKA2
Renal Cell CarcinomaProximal tubule cellCell of origin1
Renal Cell CarcinomaPolygonal/clear/filled with accumulated lipids/carbohydratesHisto3
Renal Cell CarcinomaMen 50-70Epid2
Renal Cell CarcinomaHematuria/palpable mass/secondary polycythemia/flank pain/fever/weight lossSx6
Renal Cell CarcinomaLung/boneMets2
Renal Cell CarcinomaMost common renal malignancyPrevalence1
Renal Cell CarcinomaGene deletion on chromosome 3 (sporadic or Von Hippel-Lindau)Etio2
Renal Cell Carcinomaparaneoplastic (EPO/ACTH/PTHrP/Renin)Secondary Sx4
Renal Cell CarcinomaSmoking (2x)Main carcinogen1
Wilms' tumor (nephroblastoma)Most common renal malignancy of early childhoodPrevalence1
Wilms' tumor (nephroblastoma)2-4Epid1
Wilms' tumor (nephroblastoma)Huge palpable flank mass (hemihypertrophy)/hematuria/HTNSx3
Wilms' tumor (nephroblastoma)Tumor suppressor WT1 on Chromosome 11/Beckwirth-Wiedemann/WAGR complexAssociations3
Wilms' tumor (nephroblastoma)Embryonic glomerular structuresHisto1
WAGR ComplexWilms' tumor (WT1 and/or WT2 on 11)/Aniridia (PAX6 on 11)/GU malformation/mental RetardationID4
Transitional cell carcinomaMost common tumor of urinary tract (calyces to bladder)Prevalence1
Transitional cell carcinomaPainless/hematuria/no casts suggests bladder cancerSx3
Transitional cell carcinomaPSAC/Phenacetin/Smoking/Aniline/CyclophosphamideAssociations4
Transitional cell carcinomaPapillary growth/transitional epithelium/mild nuclear atypia-pleomorphismHisto3
Renal Cortical AdenomaUsually asymptomatic (found at autopsy)Sx1
Renal Cortical AdenomaDifficult to distinguish from RCC (shared cytogenetic features)Histo1
Renal Cortical AdenomaSmall/well circumscribedGross appearance2
Horseshoe kidneyTurner syndrome (in 50-60%)Associations1
AngiomyolipomaThick walled blood vessels/smooth muscle/adiposeHisto3
AngiomyolipomaTuberous sclerosisAssociations1
AngiomyolipomaRetroperitoneal hemorrhageComplication1
Potter phenotypePulmonary hypoplasia/Potter facies (parrot beak nose/low set ears/micrognathia)/feet (rocker bottom/club-talipes equinovarus)Sx3
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Misc

DiseaseAnswerQuestionNumber
Acute pyelonephritisFever/costovertebral angle tenderness/nausea/vomitingSx4
Acute pyelonephritisWBC in urineUrinalysis1
Acute pyelonephritisPatchy pale abscesses on cortex/medullaGross appearance1
Chronic pyelonephritisEosinophilic castsUrinalysis1
Chronic pyelonephritisVesicouteral reflux/obstructionPredisposition2
Drug induced interstitial nephritisAsymptomatic/fever/rash/hematuria/costovertebral angle tendernessSx5
Drug induced interstitial nephritisPenicillins/NSAIDs/Allopurinol/sulfa Diuretics (thiazide/furosemide/acetazolamide)/Cephalosporins/PPI/Sulfonamide antibiotics/Sulfasalazine/RifampinEtio8
Drug induced interstitial nephritis1-2 weeks after most/months after NSAIDsTime2
Drug induced interstitial nephritisAcute inflammation of interstitium (edema/monocytes/eosinophils)Histo3
Drug induced interstitial nephritisI/IV HypersensitivityPathogenesis2
Acute tubular necrosisMost common cause of intrinsic renal failurePrevalence1
Acute tubular necrosisInciting event/maintenance/recoveryPhases3
Acute tubular necrosisOliguric/1-3 weeks/risk of hyperkalemiaMaintenance phase3
Acute tubular necrosisPolyuric/BUN-Creatinine fall/risk of hypokalemiaRecovery phase3
Acute tubular necrosisGranular muddy brown castsUrinalysis1
Acute tubular necrosisGentamicin/mercury/ethylene glycolDrug causes3
Renal papillary necrosisHyposthenuria (inability to concentrate)/gross hematuria/proteinuria/colicky flank pain/decreased urine outflow due to obstruction by sloughed papillaeSx5
Renal papillary necrosisIschemic coagulative necrosisPathogenesis1
Renal papillary necrosisRing defect on IVP (dark lesion/bright rings)Imaging1
Renal papillary necrosisSOsAAD/Sickle cell trait/Obstruction of UT/Acute pyelonephritis/Analgesic nephropathy/Diabetes mellitusEtio5
ADPKDPKD1 on 16 (membrane protein/regulates PKD2)/PKD2 on 4 (Ca channel)Mutation2
ADPKDBerry aneurisms/MVP/benign extrarenal (hepatic>pancreas>spleen) cysts/colonic diverticulaAssociation4
ADPKDFlank pain/hematuria/HTN/UTI/progressive renal failureSx5
ARPKDCongenital hepatic fibrosis/Potter's syndromeAssociation2
ARPKDPKHD1 (polycystic kidney/hepatic disease 1) on 6Mutation1
Medullary cystic diseaseInherited/tubulointerstitial fibrosis/progressive renal insufficiency/unable to concentrate urine/small kidneys on USPathogenesis5
Medullary sponge kidneyAsymptomatic/recurrent kidney stones/hematuria/UTISx4
Medullary sponge kidneyBenign gongenital/cystic dilations of medullary collecting ducts/cortex sparedEtio3
Medullary sponge kidneySwiss cheese appearance of medullaImaging1
Diffuse cortical necrosisPale ischemic infarctionAppearance1
Diffuse cortical necrosisRenal cortex/columns of Bertin (spares medulla)Location2
Diffuse cortical necrosisCombo of vasospasm/DICEtio2
Chronic glomerulonephritisHTN/Anemia/Proteinuria/Azotemia/no gross bloody urine-microscopically present/oliguria/waxy castsSx7
Chronic glomerulonephritisRPGN>FSGN (top 2 causes)Etio2
Chronic glomerulonephritisLymphocytic infiltrate/scarring of glomeruli (collagen in glomeruli)/interstitial fibrosis (collagen between glomeruli)/hyaline arteriosclerosis (collagen stained blue with trichrome stain)Histo4
HydronephrosisStones/tumors/inflammatory (retroperitoneal fibrosis/prostatitis)/neurogenic/pregnancyEtio5
Hemorrhagic cystitisIfosfamide/cyclophosphamide (mesna adjunct)/adenovirusEtio3
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ARF/AKI

TypeValueTest
Prerenal>500Urine osmolality (mOSM/kg)
Prerenal<20Urine Na (mEq/L)
Prerenal<1%FeNa
Prerenal>20BUN/Cr
PrerenalHyaline casts/normalCasts
Acute tubular necrosis<350Urine osmolality (mOSM/kg)
Acute tubular necrosis>40Urine Na (mEq/L)
Acute tubular necrosis>2%FeNa
Acute tubular necrosis<15BUN/Cr
Acute tubular necrosisMuddy brown/tubular cells/granular castsCasts
Postrenal<350Urine osmolality (mOSM/kg)
Postrenal>40Urine Na (mEq/L)
Postrenal>2%FeNa
Postrenal>15BUN/Cr
PostrenalNormalCasts
Acute glomerulonephritis>500Urine osmolality (mOSM/kg)
Acute glomerulonephritis<20Urine Na (mEq/L)
Acute glomerulonephritis<1%FeNa
Acute glomerulonephritis>20BUN/Cr
Acute glomerulonephritisHematuria/RBCCasts
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Pharmacology

DrugAnswerQuestionNumber
MannitolPulmonary edema/dehydrationToxicity2
AcetazolamideHyperchloremic metabolic acidosis/neuropathy-parasthesias/NH3 toxicity/sulfa allergy/hypokalemiaToxicity5
FurosemideOHHHDANG/Oto/hypoK/hypoCa/hypoMg/deH2O/Allergy (sulfa)/Nephritis (interstitial)/GoutToxicity8
Ethacrynic acidOHHHDANG/Oto/hypoK/hypoCa/hypoMg/deH2O/Allergy (sulfa)/Nephritis (interstitial)/GoutToxicity8
HydrochlorathiazideHypokalemic metabolic alkalosis/hyponatremia/hyperGlycemia/Lipidemia/Uricemia/Calcemia/Sulfa allergy (hyper GLUC)Toxicity7
Potassium sparingArrhythmias from hyperkalemiaToxicity2
SpironolactoneGynecomastia/antiandrogen/amenorrheaToxicity3
ACEiCAPTOPRIL/Cough/Angioedema/Pregnancy/Taste (metallic)/hypOtension/Potassium elevation/Rash/Increased renin/Lower ATIIToxicity9
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Diuretic Effects

DrugDirectionIon
Carbonic anhydrase inhibitorsAcidemiaBlood pH
Aldosterone inhibitorsAcidemiaBlood pH
Loop diureticsAlkalemiaBlood pH
ThiazidesAlkalemiaBlood pH
Loop diureticsUpUrine Ca
ThiazidesDownUrine Ca
Loop diureticsDownBlood Ca
ThiazidesUpBlood Ca
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