Internal Disorders 2 Exam 3 Combined Quizlets
Struvite stones are due to what
Kidney infection
Struvite stones are due to what?
Kidney infection
Struvite stones are due to?
Kidney infection
When Vitamin D is taken in excess, the organ that can be permanently damaged is:
Kidneys
Potter's syndrome
Lack of amniotic fluid leads to deformities of limbs, face, and ears
Most common heavy metal toxicity in US
Lead
A 5 year-old patient presents to your office with delayed learning, fatigue, abdominal pain, loss of appetite, anemia, paleness, and irritability. You order labs for the patient, and they showed bland urinary sediment and hyperuricemia (renal insufficiency). What does your patient have:
Lead based nephropathy
A child presents with signs of delayed learning and pseudo lines upon imaging, what is this indicative of
Lead nephropathy
A child presents with signs of delayed learning and pseudolines upon imaging, what is this indicative of?
Lead nephropathy
Child presents w/ signs of delayed learning and pseudolines upon imaging. Dx?
Lead nephropathy
Patient presents post stroke with reduced desire to urinate and difficulty stoping micturition once started
Lesion of superior frontal gyrus
Patient presents post stroke with reduced desire to urinate and difficulty stopping micturition once started?
Lesion of the superior frontal gyrus
Acute kidney disease timing
Less than 7 days
A 44 year-old Caucasian female presents to your clinic complaining of bilateral wrist and hand pain with apparent ulnar deviation. Upon palpation and joint assessment of the hands, you find the deformities of the hands can be reversed with manipulation. Inspection reveals a rash beneath the eyes and over the bridge of the nose. If this patient presented with swelling of the extremities, history of hypertension, and decreased urine output, you could suspect:
Lupus Nephritis
M/c/c of nephrotic syndrome in adults
Membranous glomerulonephropathy
Patient presents with fever, anorexia, purpura, and livedo racemose. What should be at the top of your differential?
Microscopic polyangiitis
Patient presents with fever, anorexia, purport, and livedo racemose. What should be at the top of your differential
Microscopic polyangitis
Pt presents w/ fever, anorexia, purpura, and livedo racemose
Microscopic polyangitis
A 3 year old child is brought to the office with severe peripheral edema, exertional dyspnea, and abnormal fluid retention within her abdomen despite her recent loss of appetite. Lab work is immediately indicated and the results were as follows: heavy proteinurea, hypoalbuminemia, and hyperlipidemia. Which of the following differentials should be at the top of your list?
Minimal change disease
A child presents with full blown nephrotic syndrome, what should be at the top of your differential
Minimal change disease
A child presents with full blown nephrotic syndrome, what should be at the top of your differential?
Minimal change disease
M/c/c of nephrotic syndrome in children?
Minimal change disease
Punched out lesions seen on x-rays are seen in which pathology?
Multiple Myeloma
Thomas, 71 year old male, presents to the office with persistent back pain which began two weeks ago. The patient denies any recent trauma or injury. He notes he feels more fatigued than normal because the pain has been keeping him up at night. Thomas has a history of low back pain in which he used chiropractic care to manage his pain, but Thomas states this is a different type of pain because his "bones hurt." Lower lumbar and pelvis series were completed. Punched out lesions were noted on Thomas's femurs and ilia bilaterally. Based on the patient's presentation, what condition would you put at the top of your differential diagnosis?
Multiple Myeloma
What condition is classically characterized by the presence of bence jones proteins
Multiple myeloma
What condition is classically characterized by the presence of bence jones proteins?
Multiple myeloma
Mrs. Amy Schumer, a 33 year-old Caucasian female, BMI 24, presented to your office complaining of unexplained low back pain. She also complained of "bone pain" and described it as a deep boring ache in her thigh. You decide to do a CBC and an x-ray series. On her x-ray you notice punched out lesions, and on the CBC you note she is hypercalcemic with normochromic anemia. Based off of the above findings, what is your diagnosis?
Multiple myeloma leading to chronic tubulointerstitial nephritis
Which of the following is associated with hypercalcemia? Select all that apply.
Muscle weakness Bradycardia Nephrocalcinosis Arrhythmias
Patient presents w/ flank pain and Smokey brown urine
Nephritic Syndrome
What condition is characterized by hematuria, oliguria, HTN, and edema?
Nephritic Syndrome
What condition is categorized by hematuria, oliguria, HTN, and edema?
Nephritic syndrome
Jonathan, 55 year old male, presents to the clinic today complaining of generalized "puffiness" in his face, hands, and ankles as well as abdominal pain. The patient states he did not eat breakfast this morning because he lacks an appetite. Two weeks ago Jonathan noticed that he became short of breath while walking his dog after work and it has progressively worsened since then. Jonathan denies a history of recent infection or antibiotic use. Upon initial inspection, you note his eyelids appear swollen and his abdomen distended. During the peripheral vascular exam, there is notable edema in his hands and ankles. Urinalysis indicates proteinuria (4000 mg/24 Hours) and lipoprotein analysis indicates hypercholesterolemia. Based on the patient's presentation and lab findings, what is the most likely diagnosis?
Nephrotic Syndrome
What condition is characterized by proteinuria, hyboalbuminemia, edema, hyperlipidemia?
Nephrotic syndrome
Post-renal disease indicates?
Obstruction
What is the most concerning complication of congenital abnormalities?
Obstruction Infection and stone formation
What is the most concerning complication congenital abnormalities?
Obstruction Infection Stone formation
Which type of pt would need to be screened for renal artery stenosis?
Onset of HTN <30 y/o Severe HTN >55 y/o Accelerated HTN Sudden unexplained pulmonary edema
sHPT nephrosclerosis
Pathological bone fractures due to CDK is most likely the result of ... Select TWO answers. a.) sHPT b.) decreased renal erythropoietin production c.) nephrosclerosisrenal d.) metabolic acidosis e.) azotemia
Pt presents 1-4 weeks after a strep infection w/ HTN and smoky-brown urine
Post-infectious glomerulonephritis
Patient presents 1-4 weeks after a strep infection with HTN and smoky brown urine
Post-infectious glomerulonephropathy
Patient presents 1-4 weeks after a strep infection with HTN and smoky brown urine?
Post-infectious glomerulonephropathy
Benign prostatic hyperplasia and kidney stones are a common cause of what type of renal failure?
Post-renal
BPH and kidney stones are common causes of what type of acute failure?
Post-renal Post-renal indicates obstruction
BPH and kidney stones are common causes of what type of acute failure
Post-renal/obstruction
A mother brings her 6 year-old son into your office due to a history of frequent URTIs and ear infections. His most recent infection was 2 weeks ago, however since it was not as severe as other infections he has had, so instead of the usual antibiotic therapy, his MD suspected a virus and suggested she let it "run its course" with increased fluids and bed rest, but this time, his mother reports, "he is still not 100%" She states his urine has had a cloudy, brownish appearance despite increasing water and Pedialyte intake, but bowel movements remain normal. Physical exam reveals temperature of 100.2 F, mild edema of the extremities, and pain with muscle guarding upon palpation of the costovertebral region. Eyes, skin, and oral mucosa are all clear and within normal limits with visual inspection. The most likely diagnosis is:
Post-streptococccal glomerulonephritis
A 64 year-old African American man with a 3 year history of hypertension and diabetes mellitus, for which he takes hydrochlorthiazide and metformin respectively, presents to your clinic with shoulder pain and stiffness of insidious onset, that he has been addressing using 300mg acetaminophen 3x per day. Upon postural exam and palpation, he expresses deep, aching pain in his thoracolumbar junction and paraspinal musculature. He denies having vomited, or feeling feverish. Upon urinalysis you would expect his etiology and GFR to be.
Pre-renal; Decreased
A female has a UTI that hasn't gone away in two weeks. Top of differential?
Pyelonephritis
How do patients present w/ an allergic reaction to medication?
Rash, fever, oliguria, proteinuria, swelling
A lesion to the superior frontal gyrus can be the result of a stroke and lead to?
Reduced desire to urinate, difficultly stopping micturition once started
ACE inhibitors
Relax blood vessels and help reduce amount of water reabsorbed by kidney
A 72 year old male patient presents to your office after "peeing blood this morning", associated symptoms include fatigue, weight loss, fever and acute flank pain. Your top differential diagnosis would be?
Renal Cell Carcinoma
Mrs. Frida Kahlo, a 29 year-old female, presented complaining of abdominal pain. She has a 10-pack year history of smoking, and a 3-month history of hypertension. After completing a focused history and physical exam, you find that the patient is healthy without any additional or unusual risk factors. What would be at the top of your differential diagnosis?
Renal artery stenosis: Fibromuscular dysplasia
60 y/o male present w/ flank and back pain. He has a low-grade fever. He notes that he does not struggle w/ urinating. There is hematuria found w/ urinalysis. Dx?
Renal cell carcinoma
64 y/o male present w/ right-sided mass and hematuria but no change in urine. Dx?
Renal cell carcinoma
64 year old male presents with a painful right sided mass and hematuria but no change in pee, what is the diagnosis
Renal cell carcinoma
64 year old male presents with a painful right sided mass and hematuria but no change in pee. What is the diagnosis?
Renal cell carcinoma
What is the m/c benign renal tumor?
Renal fibrous/hamartoma
Young boy w/ sickle cell dz presents to office w/ flank pain, hematuria, and polyuria. What should you consider?
Renal infarct
What condition presents w/ damage to skeletal muscle and breakdown of fibers that lead to release of myoglobin in blood and cola-colored urine?
Rhabdomyolysis
What condition presents with damage to SKM and breakdown of the fibers that lead to the release of myoglobin into the blood
Rhabdomyolysis
What condition presents with damage to skeletal muscle and breakdown of the fibers that lead to the release of myoglobin into the blood?
Rhabdomyolysis
Young woman w/ joint pain and malar rash
SLE
Pt had a URTI and now has hematuria and a fever for two weeks, following what condition?
Secondary glomerulonephritis (nephritic syndrome)
What physical exam finding would you expect to see in a patient who has nephrotic syndrome?
Severe peripheral edema
Acute pyelonephritis is more common in ___and the patient will present with ____.
Sexually active females, general malaise and flank pain
Features of hypokalemia
Spastic paralysis Fatigue Constipation
Post-menopausal woman presents w/ involuntary leak of small amounts of urine when she coughs or sneezes. Dx?
Stress incontinence
Postmenopausal woman presents with involuntary leak of small amounts of urine when she coughs or sneezes.
Stress incontinence
Postmenopausal woman presents with involuntary leak of small of urine when she coughs or sneezes
Stress incontinence
When are kidney stones most prevalent
Summer
All of the following are true relative to a newborn diagnosed with autosomal recessive polycystic kidney disease except:
The cysts associated with the disorder can develop anywhere along the nephron
A 35 year old female presents with fever, CNS involvement, hemolytic anemia, and thrombocytopenia. Upon a urinalysis, proteinuria, hematuria, and renal insufficiency are noted. What does your patient have:
Thrombotic Thrombocyptopenic Purpura
What is the triad of hemolytic anemia, thrombocytopenia, and acute kidney injury indicative of?
Thrombotic microangiopathies More specifically hemolytic uremic syndrome
What is the triad of hemolytic anemia, thrombocytopenia, and acute kidney injury indicative of?
Thrombotic microangiopathies (hemolytic uremic Syndrome)
<40 y//o F w/ fever, CNS involvement, hemolytic anemia, thrombocytopenia
Thrombotic thrombocytopenia purpura
Lola Bunny a 35 year old female presents to your office today with a fever, hemolytic anemia, thrombocytopenia, a noticeable CNS involvement along with purpura bilaterally on the lower legs. A histological exams reveals thrombi consisting of fibrin and platelets in the terminal interlobular arteries, the afferent arterioles and glomerular capillaries. What is the most likely condition pertaining to Mrs. Bunny?
Thrombotic thrombocytopenia purpura
nephritic Wegener's granulomatosis
Timmy presents at the nephrology ward 2 weeks after a throat infection. Findings see picture. Timmy shows signs of the _______ syndrome. The most likely DDx is _______
What symptoms are associated with chronic kidney disease
- Anemia - Polyneuropathies - CNS disturbances
What are the m/c/c of chronic kidney disease
- HTN - DM
What are the common signs and symptoms of chronic pyelonephritis
- HTN - Frequency/dysuria - Flank pain
What is the most concerning complication of congenital anomalies
- Obstruction - Infection and stone formation
Which type of patient would need to be screened for RAS
- Onset of HTN under age 30 - HTN age 55+ - Malignant HTN - Accelerated HTN - Sudden unexplained pulmonary edema
What is the triad of hemolytic anemia, thrombocytopenia, and acute kidney injury indicative of
- Thrombotic microangiopathies - Hemolytic uremic syndrome
Glomerulonephritis
3 weeks after an episode of GABHS pharynngitis, a nine-year-old male presents with oliguria, BUN-to-serum Cr 15:1, and FENa 2.5%, and urine sediment positive for dysmorphic RBCs with casts. What renal disease is most likely? a.) Hemolytic-uremic syndrome b.) HUS is caused by E. coli, not GABHS. c.) Glomerulonephritis d.) Tubulointerstitial nephritis e.) Acute tubular necrosis
Intrinsic AKI
3 weeks after an episode of GABHS pharynngitis, a nine-year-old male presents with oliguria, BUN-to-serum Cr 18:1, and FENa 2.5%, and urine sediment positive for dysmorphic RBCs with casts. What category of renal disease is most likely? a.) Intrinsic AKI b.) Prerenal AKI c.) Nephrolithiasis d.) Postrenal AKI
Which of the following are indicators for testing someone w/ renal artery stenosis?
55 y/o w/ accelerated HTN
Segmental sclerosis of the glomeruli
A 36-year-old African-American man comes to the physician for a 4-week history of swollen legs. He has difficulty putting on socks because of the swelling. Two years ago, he was diagnosed with sleep apnea. He takes no medications. He is 171 cm (5 ft 6 in) tall and weighs 115 kg (253 lb); BMI is 39 kg/m2. His pulse is 91/min and blood pressure is 135/82 mm Hg. Examination shows periorbital and bilateral lower extremity edema. A renal biopsy is obtained. Which of the following is most likely to be seen under light microscopy of the patient's renal biopsy specimen? a.) Diabetic hyaline arteriolosclerosis b.) Amyloid deposition in the mesangium c.) Diffuse thickening of glomerular capillaries d.) Fibrin crescents within the glomerular space e.) Segmental sclerosis of the glomeruli f.) Eosinophilic nodules within the glomeruli
Salt retention
A 40-year-old woman comes to the physician because of a 1-week history of fatigue, dark urine, and a feeling of heaviness in her legs. Two weeks ago, she returned from a vacation to Brazil, where she spent most of her days exploring the city of Rio de Janeiro on foot. She also gained 3 kg (7 lb) during her vacation. She has systemic lupus erythematosus. Her only medication is hydroxychloroquine. Her temperature is 37.5°C (99.5°F), pulse is 78/min, and blood pressure is 162/98 mm Hg. Physical examination shows 2+ pretibial edema bilaterally. Urinalysis shows: Which of the following is the most likely cause of this patient's leg findings? a.) Hypoalbuminiemia b.) Reduced cardiac stroke volume c.) Increased capillary permeability d.) Salt retention e.) Venous insufficiency
Acute tubular necrosis
A 52-year-old female undergoes IV urography (pyelogram) for diagnosis of suspect kidney stones. The woman has had several episodes of left lower back pain and macroscopic hematuria for two weeks. During the week after the procedure, the patient develops continuously decreasing urine volume. Lab positive for BUN-to-serum Cr 10:1, urine osmolality < 300 mOsm, urine Na 45, FENa 2.5%, and a urine sediment positive for granular casts with brown pigment and epithelial cells. What is the most likely differential diagnosis? a.) Uremia b.) Tubulointerstitial nephritis c.) Glomerulonephritis d.) Acute tubular necrosis
Fatty casts
A 6-year-old boy is brought to the physician because of increasing swelling around his eyes for the past 3 days. During this period, he has had frothy light yellow urine. He had a sore throat 12 days ago. He appears tired. His temperature is 37°C (98.6°F), pulse is 90/min, and blood pressure is 105/65 mm Hg. Examination shows periorbital edema and pitting edema of the lower extremities. Cardiopulmonary examination shows no abnormalities. Which of the following findings on urinalysis is most likely associated with this patient's condition? a.) Waxy casts b.) Hyaline casts c.) Fatty casts d.) WBC casts e.) RBC casts f.) Muddy brown casts
Normal glomeruli on light microscopy
A 6-year-old girl is brought to the physician because of increasing swelling around her eyes for the past 3 days. Her vital signs are within normal limits. Physical examination shows periorbital edema and abdominal distention with shifting dullness. Laboratory studies show a serum albumin of 2 g/dL and a serum cholesterol concentration of 290 mg/dL. Urinalysis shows 4+ proteinuria and fatty casts. Histological examination of a kidney biopsy specimen is most likely to show which of the following findings? a.) Granular subepithelial deposits of IgG, IgM, and C3 on immunofluorescence b.) Normal glomeruli on light microscopy c.) Deposits of IgG and C3 at the glomerular basement membrane on immunofluoresence d.) Subepithelial dense deposits on electron microscopy e.) Mesangial proliferation on light microscopy f.) Effacement of foot processes of podocytes on light microscopy
BUN/serum creatinine ratio 25:1
A 68-year-old man is admitted to the intensive care unit after open abdominal aortic aneurysm repair. The patient has received 4 units of packed red blood cells during the surgery. During the first 24 hours following the procedure, he has only passed 200 mL of urine. He has congestive heart failure and hypertension. Current medications include atenolol, enalapril, and spironolactone. He appears ill. His temperature is 37.1°C (98.8°F), pulse is 110/min, respirations are 18/min, and blood pressure is 110/78 mm Hg. Examination shows dry mucous membranes and flat neck veins. The remainder of the examination shows no abnormalities. Laboratory studies show a serum creatinine level of 2.0 mg/dL and a BUN of 48 mg/dL. His serum creatinine and BUN on admission were 1.2 mg/dL and 18 mg/dL, respectively. Further evaluation of this patient is most likely to reveal which of the following findings? a.) Decreased urine osmolality b.) Proteinuria c.) Hematuria d.) RBC casts e.) BUN/serum creatinine ratio 25:1
GABHS
A patient experiences acute kidney injury (failure) after a recent episode of scarlet fever. What is the most likely cause of kidney injury in this case?
Samantha, 29 year old female, presents to the office with a chief complaint of general malaise and severe right flank pain. The patient states she has been experiencing nausea, chills, and dysuria for the past three days. Upon examination you note her temperature is slightly elevated and she reports tenderness along her costovertebral angle during palpation. The patient states she suffered from a urinary tract infection two weeks ago in which she took antibiotics prescribed by her primary care physician. Elevated leukocytes and bacteria were both reported on the patient's urinalysis. Based on the patient's presentation and laboratory findings, what is the most likely diagnosis?
Acute Pyelonephritis
What disease is commonly caused by an allergic reaction to a medication and presents w/ a rash and arthralgia?
Acute drug induced interstitial nephritis
What disease is commonly caused by an allergic reaction to a medication and presents with a rash and arthralgia?
Acute drug induced interstitial nephritis
What disease is commonly caused by an allergic reaction to medication and presents with a rash and arthralgia
Acute drug induced interstitial nephritis
A patient presents post-URTI and presents w/ joint pain, malar rash, and dark urine. Dx?
Acute glomerulonephritis
Bob Billings, a 10 year-old male, presented complaining of joint pains, dark urine and lack of appetite. His mother also reports that he had an upper respiratory tract infection 2 weeks ago. After completing a urine analysis, you find blood in his urine. Based off of the above findings, what is at the top of your differential?
Acute glomerulonephritis
Jim Morrison presents to your clinic today with an acute onset of pain in the right posterior upper quadrant. He reports that he has just began a new regiment of antibiotics that he has never taken before. After sending his blood out for lab work it returns revealing he has elevated potassium, hypercalcemia and hyperuricemia. What is the most likely cause for his pain.
Acute interstitial nephritis
A 44 year old female presents with flank pain, costovertebral angle tenderness, fever, chills, nausea and vomiting. The patient also describes recent dysuria and increased urgency. A urine sample is taken and sterile urine is found. Your top differential diagnosis would be:
Acute pyelonephritis
JoAnne Hart presents distressed and in a great deal of pain (7/10) that has progressed to this point within 3 hours. The pain is shown to be underneath the ribs on the right side. She reports feeling feverish at one point but then having chills as well. She vomited and then made a call to the office. Further history taking revealed that she has dysuria and also saw a "tinge of pink" in her urine. An abdominal exam was done and found a positive Murphy's punch.
Acute pyelonephritis
Sexually active female presents w/ costovertebral angle tenderness, fever, chills. Dx?
Acute pyelonephritis
Sexually active female presents with costovertebral angle tenderness, fever, chills
Acute pyelonephritis
What condition is characterized by ischemia that is prolonged over 6 hours?
Acute tubular necrosis
What conditions is characterized by ischemia that is prolonged over 6 hours
Acute tubular necrosis
Caused by overabundance of urate cells formed by breakdown
Acute urate nephropathy
Tumor lysis syndrome is the m/c/c of what condition
Acute urate nephropathy
Which of the following conditions is associated with tumor lysis syndrome?
Acute urate nephropathy
A patient with Aplort's syndrome may present with which of the following symptoms?
All of the above
Heavy Metal Nephropathy is caused by ingestion, inhalation or absorption through the skin or mucous membranes of which metals?
All of the above
Thomas Pickels is a 76 year old that presents to your office with severe diarrhea for the last three days. He states it has blood in it and he's vomited several times, starting two days ago. Thomas believed that he had food poisoning from undercooked meat but then noticed his urine output was also very little to none. He mentioned that he feels irritable and "out of my wits". You order a CBC and find what?
All of the above
Which type of patient would need to be screened for RAS?
All of the above (Onset of HTN at age <30 or severe HTN at age 55+, malignant HTN, accelerated HTN, and sudden unexplained pulmonary edema)
What symptoms are associated with chronic kidney disease?
All the above--> Anemia, Polyneuropathy, CNS confusion, coma, fits
Arnold Shortman is a 5 year old with congenital cataracts. His parents brought him in to see you because they has recently noticed blood in his urine. Arnold has had trouble hearing and eyesight which was diagnosed when he was 2. A urinalysis found proteinuria and hematuria while a CBC found thrombocytopenia and enlarged platelets. What condition does Arnold have?
Alport Syndrome
Child presents with cataracts and sensorineural deafness
Alport's syndrome
Kenny McCormick is a 23 year old that has been experiencing sudden unexplained shortness of breath. He has a history of hypertension that he has been compliantly taking his medications for this but it seems to be getting worse. On lung exam we find transmitted voice sounds and dull percussion note B/L in lower lobes. He mentioned that his urine out out has been slightly decreased even though he's been drinking more water. Kenny's findings fall under what category?
American College of Cardiology/American Heart Association guidelines for screening a Renal Artery Stenosis
Pt presents w/ peripheral neuropathy, SOB, arrhythmia, proteinuria, swelling of legs/feet
Amyloidosis
Renal artery stenosis
An individual presents with oliguria and azotemia due to severe narrowing of the kidney's main arteries due to atherosclerosis. The name of the disease is
renal artery stenosis prerenal
An individual presents with oliguria and azotemia due to severe narrowing of the kidney's main arteries due to atherosclerosis. The name of the disease is _________ This disease causes _________
S&S associated w/ chronic kidney disease?
Anemia, polyneuropathies, CNS disturbances
Lillian DeVille is a 7 year old female that presents with complaints of nausea. Her mom states that she's been feeling poorly for 4 weeks and has had a sore throat. Her mom also shared that Lillian complained of blood in her urine but is not voiding a lot. During inspection a mild fever was noted as well as moderate hypertension with peripheral edema. A throat exams revealed erythematosus with swollen tonsils A urinalysis discovered proteinuria, gross hematuria, azotemia and a low GFR. What is found in the blood to help confirm diagnosis?
Anti-streptomycin O antibodies
The most common medication in children that can cause rhabdomyolysis is:
Antihistamines
A 26 year old female patient presents with general malaise, slightly febrile with chills, flank plain, nausea, and dysuria. She has never experienced this before and it has progressively worsened. Lab work is ordered and reveals neutrophilic leukocytosis, elevated ESR and CRP, as well as hematuria. Acute pyelonephritis is now at the top of your diagnostic differential, which of the following would have likely caused this disorder in this patient?
Ascending/retrograde E. coli infection
What is the m/c/c of renal artery stenosis?
Atherosclerosis
What disease presents with hepatic abnormalities that are more problematic than the kidney problems
Autosomal recessive polycystic disease
What disease presents with hepatic abnormalities that are more problematic than the kidney problems?
Autosomal recessive polycystic disease
Patient presents post URTI and now complains of chest pain and heart murmur
Bacterial endocarditis
Patient presents post URTI and now complains of chest pain and heart murmur?
Bacterial endocarditis
What condition is due to longstanding essential HTN?
Benign nephrosclerosis
What is the m/c/c of acute urinary retention in men
Benign prostatic hyperplasia
What is the most common cause of acute urinary retention in men?
Benign prostatic hyperplasia
What are the m/c/c of acute urinary retention syndrome?
Benign prostatic hyperplasia Bladder Pelvic/urethral masses
What is the m/c hyperplastic lesion leading to urinary obstruction?
Benign prostatic hypertrophy
What is the m/c/c of acute urinary retention in men?
Benign prostatic hypertrophy
What condition is due to longstanding essential HTN
Bening nephrosclerosis
nephrotic Minimal change disease
Brian, 10 years old and stung by a bee, presents at the nephrology ward . He also has hypoalbuminemia, hyperlipidemia, and frothy urine with fatty casts. 24 hour urine collection shows massive proteiuria (> 3.5 g protein lost in urine/24 hr). Brian shows signs of the ______ syndrome. The most likely DDx is ______
Heavy metal toxicity linked w/ breast cancer, cardiovascular dz, chronic kidney dz
Cadmium
What is the m/c type of kidney stone?
Calcium oxalate
An established patient of yours presents to your office complaining of joint pain after spending a week in the hospital for acute tubular necrosis. She is a 50 year-old, overweight, African American female who underwent surgery for a cholecystectomy a month ago. She had been diagnosed with Atrial Fibrillation and had been taking Warfarin prior to her surgery, but did not cease usage appropriately before surgery which resulted in a hemorrhage, and led to ATN. This patient is now at greater risk of which renal disorder:
Chronic kidney disease
What disease is characterized by 3 month progression of kidney damage
Chronic kidney disease
What disease is characterized by 3 month progression of kidney damage?
Chronic kidney disease
What condition is caused by parenchymal scarring, recurring infections, obstructions, and reflux nephropathy
Chronic pyelonephritis
What condition is caused by parenchymal scarring, recurring infections, obstructions, and reflux nephropathy?
Chronic pyelonephritis
Involuntary twitching of the facial muscles when the facial nerve is lightly tapped just anterior to the external auditory meatus, indicating hypocalcemia is:
Chvostek sign
Mrs. Jenny Monae, a 33 year-old female, presented to your office complaining of muscle cramps in her back and legs. She also complained of muscle spasms in her throat. You elicit an involuntary twitching of the facial muscles by light tapping on the facial nerve. What sign have you elicited and what is it associated with?
Chvostek sign, Hypocalcemia
What is the most significant risk factor in regard to bladder cancer
Cigarette smoking
What is the most significant risk factor in regard to bladder cancer?
Cigarette smoking
What is the most significant risk factor in regards to bladder cancer?
Cigarette smoking
What is a common cause of hypokalemia
Diuretics
What is a common cause of hypokalemia?
Diuretics
Acquired or Congenital sac-like outpouchings through a weak point in the bladder are known as:
Diverticula
nephritic Goodpasture disease
Dorothy presents at the nephrology ward presenting with hemoptysis and oliguria.. Findings see picture. Dorothy shows signs of the _______ syndrome. The most likely DDx is _______
What physical exam finding would you find in both Nephritic and Nephrotic syndromes?
Edema
Tim Little is a patient that has an embryonic tumor that has areas of necrosis and hemorrhage. These tumors are aggressive and often metastasize to the lung. Choose from below everything else that would apply to this patient:
Elevated heart rate Hematuria Age 2
Hemolytic crisis, rhabdomyolysis & crush syndrome are seen in which category of acute tubular necrosis:
Endogenous toxic
Pt has burning and tingling discomfort
Fabry's syndrome
Features of hyperkalemia
Flaccid paralysis Bradycardia Asystole
Pt presents w/ nephrotic syndrome, recent URTI, Hodgkin's lymphoma
Focal segmental glomerulosclerosis
Michael, 31 year old Caucasian male, presents to the office complaining of shortness of breath any time he exerts himself as well as a productive cough which began three weeks ago. He states that he often notices blood in his sputum. On general inspection he appears pale and his temperature measures 38˚C. A chest series was performed and you note fluffy infiltrates in the lung fields. You order a blood analysis to test for HLA-BR2 which comes back positive. Based on the patient's presentation and lab findings, what is the most likely diagnosis?
Goodpasture's Syndrome
What disease is predominantly seen in young, white, male smokers
Goodpasture's syndrome
What disease is predominantly seen in young, white, male smokers?
Goodpasture's syndrome
nephrotic Focal segmental glomerulonephrosclerosis
Gregory, 55-year-old Hispanic male, presents at the nephrology ward. He has hypoalbuminemia, hyperlipidemia, and frothy urine with fatty casts. 24 hour urine collection shows massive proteiuria (> 3.5 g protein lost in urine/24 hr). Gregory shows signs of the ______ syndrome. The most likely DDx is ______
What is the most common complication of kidney hypoplasia
HTN
What is the most common complication of kidney hypoplasia?
HTN
What are the most common causes of chronic kidney disease?
HTN and diabetes
What are the common signs and symptoms of chronic pyelonephritis?
HTN, frequency/dysuria, and flank pain
Clinical features that indicate rapidly progressive glomerulonephritis
Hematuria, oliguria, HTN
Your patient comes in complaining of back pain. After running labs and tests, you notice the patient has hemolysis, thrombocytopenia, and an acute kidney injury. What does your patient have:
Hemolytic uremic syndrome
Craig, 6 year old male, presents to the office today with raised reddish-purple spots mainly on his legs, feet, and buttocks. His mother states he has been complaining of abdominal pain and nausea for the past two days. Craig had two episodes of diarrhea this morning. Upon physical examination, there is notable ankle edema. Based on the patient's presentation, what condition would you put at the top of your differential diagnosis?
Henoch-Schonlein Purpura
The most dangerous classic complication of Autosomal Recessive Polycystic Kidney Disease is:
Hepatic Fibrosis
Susie Carmichael has come to your office with complaints of persistent back pain. She has delt with the pain but recently noticed numbness and weakness which seems to be suggestive of a cord or nerve root compression. She also states that she has had multiple bacterial infections over the last 3 months. You take X-rays and notice "punched out lesions" in her pelvis. A blood sample would reveal what finding leading to renal failure?
Hypercalcemia
What is caused by vitamin D toxicity, cancer, HPT and is associated with nephrogenic diabetes insipidus
Hypercalcemia
What is caused by vitamin d toxicity, cancer, HPT and is associated with nephrogenic diabetes insipidus?
Hypercalcemia
Which of the following is not a clinical presentation of a patient with multiple myeloma?
Hyperkalemia
Which of the following signs/symptoms would a patient diagnosed with Goodpasture's syndrome most likely NOT complain of?
Hypertension
Charles Finster is a 47 year old Caucasian male who presents with exertional dyspnea. During the physical exam, peripheral edema along with eyelid edema are noted on inspection. He is hypertensive. The abdominal findings included a fluid wave while a urinalysis displayed high levels of proteinuria. What other abnormal finding would be present?
Hypoalbuminemia
What are pre-renal cause of acute renal failure
Hypoperfusion due to low blood pressure and ischemia
What are pre-renal causes of acute renal failure?
Hypoperfusion due to low blood pressure and ischemia
Brian, 22 year old male, presents today with a complaint "tea colored urine," which he noticed Tuesday morning. The patient states that he has experienced flank pain and swelling in his feet since Tuesday as well. He was diagnosed with an upper respiratory infection by his primary care physician one week ago. The patient was prescribed an antibiotic by his PCP, but states it has not helped. Urinalysis indicates hematuria. Based on the patient's clinical presentation, what immunoglobulin is most likely to be build up in the patient's mesangium?
IgA
Apolo Ohno is a 27 year old Asian-Pacific male that presents with recurrent bouts of flank pain. His physical exam was unremarkable except for a slightly elevated blood pressure. He was diagnosed with an upper respiratory tract infection two weeks ago and has noticed blood in his urine episodically. A urinalysis found mild proteinuria and macroscopic hematuria and a biopsy was performed. What defining feature is present?
IgA deposits
What is the most common cause of glomerulonephritis in young (15-30) male Asian pacific males?
IgA nephropathy (bergers)
What is the m/c/c of glomerulonephritis worldwide
IgA nephropathy/Bergers
What is the m/c/c of glomulonephritis in young (15-30) Asian pacific males
IgA nephropathy/Bergers
What is the most common cause of glomerulonephritis worldwide?
IgA nephropathy/bergers
When are kidney stones most prevalent?
In the summer
Hyper-excitability or inflammation of the lower urinary tract comes from?
Infection or stones
Patients diagnosed with hypocalcemia will experience (Choose all that apply)
Irritability & anxiety Muscle cramps Tetany
What is a common cause of urate nephropathy?
Tophaceous gout
What is a common cause of chronic urate nephropathy
Tophacious gout
What is a common cause of chronic urate nephropathy?
Tophacious gout
Jim Henson a 65 year old patient presents to your office today with right posterior upper quadrant pain. While gathering the history you discover that he has various preexisting conditions such as diabetes mellitus, hypovolemia, and chronic kidney disease. based on the patients history what is the most likely cause of his pain?
Tubular necrosis
According to the European consortium published criteria, which of the following does not validate the diagnosis of Henoch-Schonlein Purpura along with the finding of lower limb predominant purpura
Under the age of 20 at onset of first symptoms
What is the most significant problem immediately after birth with Autosomal Recessive Polycystic Kidney Disease?
Underdeveloped lungs
What type of UTI presents when the urinary tract is not sterilized during therapy
Unresolved
The symptoms that occur following an acute kidney injury occur because of:
Uremia
What condition is described as gonococcal or non-gonococcal and presents with dysuria and cloudy pee that "smells weird"?
Urethritis
What condition is described as gonococcal or non-gonococcal and presents with dysuria and cloudy pee that smells weird
Urethritis
What is cause by hyperexcitability/inflammation of the lower urinary tract from infection or stones?
Urge incontinence
What is caused by hyper-excitability/inflammation fo the lower urinary tract from infection of stones
Urge incontinence
What condition is characterized by necrotizing granulomatous lesions of respiratory tract?
Wegener's granulomatosis
What condition is characterized by necrotizing granulomatous lesions of the respiratory tract?
Wegener's granulomatosis
What condition is characterized by necrotizing granulomatous lesions of the respiratory tract
Wegner's granulomatosis
Oliguria
What finding is indicative of prerenal KI? a.) Hypertension b.) Oliguria c.) FENa > 3% d.) Hydronephrosis on ultrasonogram
Unmanaged prerenal AKI
What is the most common cause of intrinsic acute kidney injury? a.) Rhabdomyolysis b.) Ascending UTI c.) Glomerulonephritis d.) Unmanaged prerenal AKI
renal artery stenosis (RAS)
What is the most common cause of secondary hypertension?
Azotemia
What is the term for elevated BUN & serum creatinine? a.) Uremia b.) Azotemia c.) Chronic kidney disease d.) Decreased GFRAcute kidney failure
ACE inhibitor
What kidney-protective drug is recommended in individuals who have acute or chronic kidney disease, hypertension and proteinuria? a.) aminoglycocide b.) loop diuretic (furosedmide) c.) NSAID d.) ACE inhibitor
CT scans reveal indentations on the curvature of the kidney in those with AN. CT scans reveal papillary calcification in those with AN. NSAIDs tend to decrease GFR.
Which of the following are true? Select all that apply. a.) CT scans reveal indentations on the curvature of the kidney in those with AN. b.) CT scans reveal papillary calcification in those with AN. c.) NSAIDs tend to increase blood flow to the kidney. d.) Prostaglandins cause vasoconstriction of glomerular afferent arterioles. e.) Those with analgesic nephropathy (AN) tend to have enlarged kidneys. f.) NSAIDs tend to decrease GFR.
A child presents with a nontender abdominal mass and HTN, what is at the top of your differential
Wilm's tumor
Child presents w/ non-tender abdominal mass and HTN. Top of differential?
Wilm's tumor
A child presents with a nontender abdominal mass and HTN. What is at the top of your differential?
Wilms tumor
Your patient, Inigo Montoya, has been complaining of back pain for a while now. It's origin is unexplained. Their history shows that they have kidney problems diagnosed by their M.D. and they remember their doctor saying the terms "hypercalcemia" and "anemia". You are also aware of your patient having had many bacterial infections since you have known them. You finally are able to get down to a diagnosis with the help of a new finding. Which of these were found?
X-ray revealed punched out lesions
A 32 year old female presents with hematuria, mild proteinuria, adn pyuria. Clinical signs revealed fever peripheral eosinophilia, and a skin rash that developed about two weeks after stopping an antibiotic.
acute drug induced interstitial nephritis
A 35 year old male presents with anemia, hypercalemia, and imparted renal function. The radiograph shows punched out lesions. What is the most likely diagnosis?
chronic myeloma
A 5 year old female has presented with fatigue, anemia, weight loss, vomiting, and constipation. Opaque metaphyseal bands are present in the lower femur and upper tibia. What is the most likely diagnosis?
lead poisoning
A 62 year old male comes in with sever flank pain, hematuria, and fever. He also has a history of congenital urologic structural disorder. What is the most likely diagnosis?
pyelonephritis
John is a 28-year-old male with a BMI of 26 you have been treating for 3 months for various sport related injuries. He works as a Funeral Director but has taken a part time job at the Crossfit gym two doors down from your practice after "being bitten by the crossfit bug." He is usually very upbeat and energetic at his appointments, but today he presents feeling fatigued, achy in his limbs, more so than usual for a workout, and states he has had dark urine for the past 24 hours. Physical exam indicates moderate decreases in upper and lower extremity ranges of motion and increased swelling leading to less muscle definition than noted in the past. Laboratory workup consistent with rhabdomyolysis would NOT include
serum hypokalemia
Patient presents post URTI and presents with joint pain, malaria rash, dark urine
Acute glomerulonephritis
Girl had previous bladder infection and then experienced malaise, fever, flank pain, and tenderness. Dx?
Acute pyelonephritis
Tumor lysis syndrome is the m/c/c of what condition?
Acute urate nephropathy
Child presents w/ cataracts and sensorineural deafness
Alport's syndrome
What is a multi-system disorder that commonly results in intracranial aneurysm which can cause stroke and intracranial hemorrhage
Autosomal dominant polycystic kidney disease
What is a multi-system disorder that commonly results in intracranial aneurysm which can cause stroke and intracranial hemorrhage?
Autosomal dominant polycystic kidney disease
What disease presents with hepatic abnormalities that are more problematic than kidney problems?
Autosomal recessive polycystic disease
Pt presents post-URTI and now complains of chest pain and heart murmur. Dx?
Bacterial endocarditis
What condition is d/t longstanding essential HTN?
Benign nephrosclerosis
Caused by deposition of sodium urate crystals in medullary interstitium
Chronic urate nephropathy
S&S of hypocalcemia
Chvostek sign Trousseau sign
Obstruction to urine flow can occur at the level of the posterior urethra and presents with?
Distended bladder Dribbling Vomiting Failure to thrive
What structures in the kidney could be damaged through an allergic or toxic reaction to medications?
Glomerulus, nephrons, interstitium
Triad of glomerulonephritis, pulmonary hemorrhage, and antibody to basement membrane antigens
Goodpasture's Syndrome
What disease is predominately seen in young, white, male smokers?
Goodpasture's Syndrome
M/c complication of kidney hypoplasia
HTN
What are common signs and symptoms of chronic pyelonephritis?
HTN Frequency/dysuria Flank pain
What are the two m/c/c of chronic kidney disease?
HTN and DM
Child presents w/ palpable purpura in LE, abdominal pain, arthralgia/arthritis
Henoch-Schonlein purpura
Obstruction in the ureter will most commonly lead to?
Hydronephritis
What is caused by vitamin D toxicity, cancer, hyperparathyroidism and is associated w/ nephrogenic diabetes insipidus?
Hypercalcemia
What are pre-renal causes of renal failure?
Hypoperfusion d/t low blood pressure and ischemia
Most common cause for glomerulonephritis worldwide?
IgA nephropathy (Berger's disease)
What is the m/c/c of glomerulonephritis in young (15-30) Asian pacific males?
IgA nephropathy (Berger's disease)
Malignant nephrosclerosis
Increase in diastolic pressure over 130mmHg
Group A beta hemolytic strep, tonsillar abscess, Janeway lesion, causing valvular heart disease
Infective endocarditis
Congenital abnormalities of kidney lead to increased risk of what?
Kidney stones and UTI
A child presents w/ full blown nephrotic syndrome. What should be at the top of your differential?
Minimal change disease
What condition is classically characterized by the presence of Bence-Jones proteins?
Multiple Myeloma
What condition is categorized by hematuria, oliguria, HTN, and edema
Nephritic syndrome
Chronic kidney disease timing
Over 3 months
D/t chronic urination retention via weak detrusor or peripheral nerve damage
Overflow incontinence
What type of UTI presents when the urinary tract is not sterilized during therapy?
Unresolved
Epispadias
Urethral opening of penis on topside "pee on glasses"
Hypospadias
Urethral opening of penis on underside "pee on boots"
What condition described as gonococcal or non-gonococcal presents w/ dysuria and cloudy pee that smells weird?
Urethritis
What is the cause of hyperexcitability/inflammation of the lower urinary tract from infection or stones?
Urge incontinence
Why are diverticula of bladder important?
Urine stasis, increased risk of bladder infection, increased risk of stone formation, and increased risk of obstruction
