Step 2 Nephro

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Author:
matt.hoffman
ID:
15549
Filename:
Step 2 Nephro
Updated:
2010-04-21 17:11:19
Tags:
USMLE Step Nephrology Kidneys
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Description:
Prep for step 2
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  1. BUN / Creatinine ratio in prerenal ARF?
    greater than 15 or 20
  2. Causes of prerenal ARF?
    • Dehydration
    • Sepsis
    • Heart Failure
    • Liver failure
  3. Renal causes of ARF?
    • 1. Glomerulonephritis
    • 2. Goodpastures Syn
    • 3. IV contrast
    • 4. Lupus
    • 5. Rhabdomyolysis
    • 6. Toxins and meds
    • 7. Wegener Granulomatosis
  4. Causes of Nephritic Syndromes.
    • Postinfectious Glomerulonephritis
    • IgA Nephropathy
    • Goodpastures Syn
    • Alports Syn
    • Idiopathic Crescentic Glom..
    • Lupus Nephritis
    • Wegeners Granulomatosis
  5. Causes of Nephrotic Syndrome
    • Minimal Change disease
    • Focal segmental glomerular sclerosis
    • Membranous Glomerulonephritis
    • Membranoproliferative Glomerulonephritis
    • Diabetic Nephropathy
  6. Child or adolescent with strep infection 10-20 days previously, oliguria, dark urine, HTN; high streptolysin titer, low C3; IgG and C3 on basement membrane. Dx?
    Postinfectious Glomerulonephritis
  7. Rx for postinfectious glomerulonephritis?
    Supportive (treat edema and htn)
  8. Adult patient, low fever, dark urine and flank pain, oliguria, infection < 5 days previously; increased serum IgA. Dx?
    • IgA Nephropathy
    • (Bergers Disease)
  9. Rx for IgA nephropathy?
    • ACE-I
    • Statins
    • Corticosteroids if proteinuria increases
  10. Young man with dyspnea, hemoptysis, myalgias, oliguria, dark urine. Dx?
    Goodpastures Syn
  11. Rx for Goodpastures?
    • Plasmapheresis
    • Corticosteroids
    • Immunosuppressive agents
  12. Oliguria, dark urine, high-frequency hearing loss; + BUN and Cr; proteinuria, hematuria, pyuria; basement membrane breaking up. Dx?
    Alports Syn
  13. Cause of Alports Syn?
    Hereditary defect in collagen IV
  14. Rx for Alports Syn?
    • Nothing to stop RF
    • ACE-I can stop proteinuria
    • Transplant can lead to Goodpastures
  15. Very rapid renal failure; weakness, nausea, weight loss; dyspnea, hemoptysis, myalgias, fever; + ANCA.
    Idiopathic Crescentic Glomerulonephritis
  16. Rx for Lupus Nephritis?
    • Corticosteroids or immunosuppressive agents can delay failure
    • ACE-I and statins reduce proteinuria
  17. Pt over 40 with weight loss, hemoptysis, nasal perforation, hematuria, fever; + c-ANCA. Dx?
    Wegeners Granulomatosis
  18. Rx for Wegeners Granulomatosis?
    • Corticosteroids
    • Cyclophosphamide
  19. Young child post infection with edema and dark urine; proteinuria, hematuria, hyperlipidemia; flattening of foot processes. Dx?
    Minimal Change disease
  20. Adult with edema, foamy urine, dyspnea, hx of IV drug use / HIV risks; hematuria, proteinuria, HTN, Hyperlipid; kidney sclerotic changes. Dx?
    Focal Segmental Glomerular sclerosis
  21. Rx for Focal Segmental Glomerular sclerosis?
    Corticosteroids, cytotoxic agents, ACE-I, Statins
  22. Causes of Focal Segmental glomerular sclerosis?
    Associated with drug use or HIV
  23. Causes of membranous glomerulonephritis?
    • Infection
    • SLE
    • Neoplasm
    • Drugs
  24. Causes of Membranoproliferative glomerulonephritis?
    • Systemic Infection
    • Autoimmune Disease
  25. Kidney changes seen on Diabetic nephropathy?
    • Basement membrane and Mesangial thickening
    • (round nodules seen on nodular type)
  26. Rx for Diabetic nephropathy?
    • Treat DM
    • Restrict dietary protein
    • ACE-I
    • tight BP control
  27. Medicine causes of interstitial nephropathy?
    • 1. B-lactams or sulfonamides
    • 2. aminoglycosides
    • 3. NSAIDs
    • 4. PPI
    • 5. Allopurinol
    • 6. Diuretics
  28. What can interstitial nephropathy lead to?
    ATN
  29. Adult pt reports with hx of mutiple UTIs, flank pain, dark urine; palpable kidneys, hematuria and proteinuria, HTN; +BUN and Cr, anemia. Dx?
    Polycystic Kidney Disease
  30. Rx for PKD?
    • Vasopressin receptor antagonists and amiloride (- cyst size)
    • Treat UTI and HTN
    • Drain cysts to control pain
  31. What complications are seen with polycystic kidney disease?
    • Renal failure
    • hepatic cysts
    • intracranial aneurysms c subarachnoid hemorrhage
    • mitral valve prolapse
  32. Name the 5 different diuretic Types and the impact they have on electrolytes.
    • Carbonic Anhydrase Inhibitors: +H -K
    • Osmotic Agents: relative +Na
    • Loop Diuretics: -K -Ca +Urea
    • Thiazides: -K, +Ca, +Urea
    • K sparing: +K
  33. Name five different diuretic types with possible side effects.
    • Carbonic Anhydrase Inhibitors: Mild metabolic acidosis, Nephrolithiasis
    • Osmotic Agents: relative +Na
    • Loop Diuretics: Ototoxicity
    • Thiazides: Hypercalcemia
    • K-Sparing: Gynecomastia, menstrual irregularity
  34. Give an example of each type of diuretic.
    • 1. Carbonic Anhydrase: Acetazolamide
    • 2. Osmotics: Mannitol
    • 3. Loop: Furosemide
    • 4. Thiazide: Hydrochlorothiazide
    • 5. K-sparing: Sprionolactone

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