USMLE Step 2 (Fach) / Renal/Genitourinary (Lektion)

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  • Hypernatremia Serum sodium > 145 mEq/L. Usually due to free water loss rather than sodium gain. Etiology:1. Hypovolemic hypernatremia- Renal loss – from diuretics, osmotic diuresis (most commonly due to glycosuria ...
  • Hyponatremia Serum sodium < 135 mEq/L. Symptoms usually begin when the sodium level falls to < 120 mEq/L. Etiology and classification:1. Hypotonic hyponatremia = "true hyponatremia" – serum osmolality < 280 mOsm/kg.- ...
  • Hyperkalemia Serum potassium > 5 mEq/L. Etiology:- Reduced excretion: acute and chronic kidney disease - Endocrine causes: hypocortisolism, hypoaldosteronism- Type IV renal tubular acidosis- Release from cells: myolysis, ...
  • Hypokalemia Serum potassium < 3.5 mEq/L. Etiology:- Transcellular shifts: Insulin, β2-agonists, and alkalosis all cause potassium shift intracellularly.- Diuretics (e.g., loop or thiazide), 1° and 2° hyperaldosteronism, ↓ ...
  • Hypocalcemia Serum calcium < 8.5 mg/dL. Etiology:- Hypoparathyroidism- Vitamin D deficiency- Pseudohypoparathyroidism (Albright hereditary osteodystrophy): PTH resistance- Hyperphosphatemia- Hypomagnesium- Chelation ...
  • Hypercalcemia Serum calcium > 10.2 mg/dL (corrected for serum albumin). Etiology:- Hyperparathyroidism- Malignancy- Granulomatous disorders- Familial hypocalciuric hypercalcemia- Pharmacologic: Vitamin D intoxication, ...
  • Hypomagnesemia Serum magnesium < 1.5 mEq/L. Etiology:- ↓ intake: Malnutrition, malabsorption, short bowel syndrome, TPN (total parental nutrition), PPIs- ↑ loss: Diuretics, diarrhea, vomiting, alcoholism.- Miscellaneous: ...
  • Acute kidney injury Defined as an abrupt ↓ in renal function leading to the retention of creatinine and BUN. Definition – KDIGO:- Increase in creatinine by ≥0.3 mg/dL within 48 hours OR- Increase in creatinine to ...
  • Chronic kidney disease Defined as > 3 months of GFR < 60 mL/min or kidney damage (structural/functional abnormalities). Etiology:- Diabetes mellitus (most common cause 45%)- Hypertension (30%)- Glomerulonephritis (8%)- Interstitial ...
  • Nephritic syndrome A disorder of glomerular inflammation, also called glomerulonephritis. Proteinuria may be present but is usually < 1.5 g/day.  History/PE:The classic findings are oliguria, macroscopic/microscopic hematuria ...
  • Nephrotic syndrome Defined as proteinuria (≥ 3.5 g/day), generalized edema, hypoalbuminemia, and hyperlipidemia. Approximately 1/3 of all cases result from systemic diseases such as DM, SLE, or amyloidosis. History/PE:- ...
  • Postinfectious glomerulonephritis Cause of nephritic syndrome. Classically associated with recent group A β-hemolytic streptococcal infection, but can be seen with any infection (usually 2-6 weeks prior). History/PE: Oliguria, edema, ...
  • Henoch-Schönlein purpura Cause of nephritic syndrome. Small vessel vasculitis, often seen in childhood. Etiology:- Preceding infection > 75% of cases preceded by viral or bacterial infection 1-3 weeks prior- Most commonly an ...
  • Microscopic polyangiitis Cause of nephritic syndrome. Small vessel vasculitis timilar to GPA. No granulomas. History/PE:Similar to GPA but no nasopharyngeal involvement.  Labs/Histology:p-ANCA. Necrotizing glomerulonephritis. ...
  • Goodpasture syndrome Cause of nephritic syndrome. Rapidly progressing glomerulonephritis with pulmonary hemorrhage. Peak incidence in men in their mid-20s.  Clinical features:- Hemoptysis- Dyspnea, possible respiratory failure.- No upper ...
  • Alport syndrome Cause of nephritic syndrome. Hereditary glomerulonephritis. Presents in boys 5-20 years of age. Pathophysiology: Genetic defect of type IV collagen chains (component of the basement membrane of the kidneys, ...
  • Minimal-change disease The most common cause of nephrotic syndrome in children. Idiopathic etiology; 2° causes include NSAIDs and hematologic malignancies (eg, Hodgkin disease). History/PE:Tendency toward infectious and thrombotic ...
  • Focal segmental glomerulonephritis The most common cause of nephrotic syndrome in black populations Etiology: Idiopathic, IV drug use (heroin), HIV, obesity, sickle cell disease  Diagnostics:- LM: segmental sclerosis- IM: IgM and C3 ...
  • Membranous nephropathy Accounts for ~30% of nephrotic syndromes in adults. Most common cause of nephrotic syndrome white populations. Primary: Autoantibodies to phospholipase A2 receptorSecondary: Associated with solid-tumor ...
  • Diabetic nephropathy Cause of nephrotic syndrom. Has 2 characteristic forms: diffuse hyalinization and nodular glomerulosclerosi (Kimmelstiel-Wilson lesions). Pathophysiology: chronic hyperglycemia → non-enzymatic glycosylation ...
  • Lupus nephritis - Most crucial prognostic factor in SLE- Can be nephritic or nephrotic- Classified as WHO types I-VI. - The severity of renal disease often determines overall prognosis.  History/PE:Proteinuria or ...
  • Renal amyloidosis Causes of nephrotic syndrome. 1° (plasma cell dyscrasia) and 2° (infectious or inflammatory) are the most common. History/PE:Patients may have multiple myeloma or a chronic inflammatory disease (eg, ...
  • Membranoproliferative nephropathy Type I: Nephritic/nephrotic syndrome.- Associated with HBV, HCV, cryoglobulinemia, SLE, and subacute bacterial endocarditis.- Labs/Histology: "Tram-track," double-layered basement membrane. Subendothelial ...
  • Types of nephrolithiasis Calcium oxalate/calcium phosphate:- Frequency: 83%- Etiology: The most common causes are idiopathic hypercalcuria and 1° hyperparathyroidism. Can also see in fat malabsorption (↑ oxalate absorption). ...
  • Autosomal dominant polycystic kidney disease Characterized by the presence of progressive cystic dilation of the renal tubules, as well as by cysts in the spleen, river, and pancreas.  Epidemiology: ∼ 1/1,000 Etiology: Inherited mutation on chromosome ...
  • Hydronephrosis Dilation of renal calyces. Usually occurs 2° to obstruction of the urinary tract. In pediatric patients, the obstruction is often at the ureteropelvic junction. In adults, it may be due to BPH, neurogenic ...
  • Scrotal swelling Painless etiologies → hydrocele (remnant of processus vaginalis), varicocele (dilatation of pampiniform plexus).Painful etiologies → epididymitis (STDs, prostatitis), testicular torsion (twisting ...
  • Erectile dysfunction Inability to achieve or sustain an erection sufficient in rigidity or duration for sexual intercourse which is present for a minimum of ∼ 6 months. Etiology:- Vascular: hypertension, diabetes mellitus, ...
  • Benign prostatic hyperplasia Benign prostatic hyperplasia (BPH) is a non-neoplastic glandular and stromal hyperplasia of the transition zone of the prostate. BPH most commonly occurs in the central (periurethral) zone of the prostate. ...
  • Prostate cancer Risk factors:- Advanced age- Positive family history- African-American race- Genetic disposition (BRCA-2, Lynch syndrome) Clinical features:- Early-stage: Typically asymptomatic- Fatigue, loss of appetite ...
  • Bladder cancer Epidemiology:- Peak incidence: 65 years- Cancer sites: Bladder (90%); Renal pelvis (8%); Ureter (esp. the lower ⅓) and urethra (2%)- Histological types: Transitional cell carcinoma (most common); Squamous ...
  • Renal cell carcinoma Epidemiology:- 85% of renal cancers in adults - Age of onset: 60-80 years Risk factors- Male gender- Smoking- Obesity- Hypertension- Acquired cystic kidney disease in ESRD- Hereditary factors: Von Hippel-Lindau ...
  • Testicular cancer Epidemiology:- Peak incidence: 20-35 years Risk factors:- Cryptorchidism- Contralateral testicular cancer- Klinefelter syndrome, Down syndrome- Subfertility/infertility, hypospadia Clinical features:- ...
  • Hypovolemia Etiolgoy:- GI loss: Vomiting, nasogastric suction, diarrhea, fistula drainage, etc.- Third-spacing: Ascites, effusions, bowel obstruction, crush injuries, burns- Inadequate intake- Polyuria: Eg, diabetic ...
  • Hypervolemia Etiology:- Iatrogenic (parenteral overhydration)- Fluid-retaining states: CHF, nephrotic syndrome, cirrhosis, ESRD Clinical features:- Weight gain- Peripheral edema, ascites, pulmonary edema- Jugular ...
  • Respiratory alkalosis ↑ In respiratory rate and/or tidal volume → alveolar hyperventilation → CO2 washout Etiology:- Pain, anxiety, panic attacks- Pulmonary embolism, pneumonia, asthma- Sepsis- Pregnancy – increased ...
  • Respiratory acidosis Defined as a reduced blood pH and PaCO2 > 40 mm Hg. Etiology: Alveolar hypoventilation → CO2 retention- Airway obstruction: COPD exacerbation, bronchial asthma- Respiratory muscle weakness- Myasthenia ...
  • Metabolic alkalosis Loss of H+ or ↑ production/ingestion of HCO3- Etiology:- Saline-responsive (urinary chloride normal [< 20 mEq/L])→ Vomiting or nasogastric suction→ Hypovolemia (contraction alkalosis)→ Loop ...
  • Metabolic acidosis ↑ Production/ingestion of H+ or loss of HCO3- Etiology:- High anion gap metabolic acidosis→ Lactic acidosis: severe tissue hypoxia, liver failure, metformin use → Ketoacidosis: diabetes mellitus, ...
  • Indications for urgent dialysis (AEIOU) Acidosis:- pH < 7.1 refractory to medical therapy Electrolyte abnormalities:- Symptomatic hyperkalemia→ ECG changes or ventricular arrhythmias- Severe hyperkalemia→ Potassium > 6.5 mEq/L refractory ...
  • Proteinuria Proteinuria = urinary protein excretion of > 150 mg/day Diagnosis: Urinalysis- First morning urine→ Elevated protein/creatinine → Evaluate for glomerular/parenchymal disease→ Normal protein/creatinine, ⊕ ...
  • Hematuria Microhematuria: hematuria that is not grossly visibleMacrohematuria: hematuria that is grossly visible  Urinalysis: - > 3 erythrocytes/HPF or > 5 erythrocytes/μL- If normal → evaluate for coagulation ...
  • Acute interstitial nephritis Etiology:- Antibiotics, NSAIDs, diuretics, allopurinol, PPIs, phenytoin Pathophysiology: Drugs, particularly antibiotics and NSAIDs, act as haptens, inducing a hypersensitivity reaction. Symptoms:- Painless ...
  • Renal papillary necrosis Coagulative necrosis of the renal medullary pyramids and papillae Etiology:- Pyelonephritis- Obstruction of the urinary tract- Sickle cell disease - Analgesic abuse: due to inhibition of prostaglandin-mediated ...
  • Type 4 renal tubular acidosis Pathophysiology: aldosterone deficiency and/or resistance Etiology:- Primary adrenal insufficiency (Addison's disease)- Diabetic nephropathy- SLE- Drugs: NSAIDs, ACE inhibitors, heparin, cyclosporin, ...
  • Autosomal recessive polycystic kidney disease Epidemiology: ∼ 1/20,000 Etiology: Inherited mutation on chromosome 6 Clinical features:- Chronic renal failure: frequently hematuria, proteinuria- Protruding abdomen due to renal enlargement or hepatomegaly- ...
  • Renal artery stenosis Etiology:- Atherosclerosis (∼ 90% of cases): occurs more often in men > 50 years of age- Fibromuscular dysplasia (∼ 10% of cases): mostly affects women < 50 years of age- Post-transplantation Clinical ...
  • Nephrolithiasis - Classification Calcium oxalate stones (most common, ∼ 80%)- Etiology: Hypercalciuria, hyperoxaluria, hypocitraturia- Urinary pH ↓- Treatment: Dietary modification, urine alkalinization, thiazide diuretics Calcium ...
  • Nephrolithiasis Clinical features:- Severe unilateral and colicky flank pain (renal colic)- Radiates anteriorly to the lower abdomen, groin, labia, testicles, or perineum - Paroxysmal or progressively worsening- The ...
  • Renal mass - Differential Benign masses:- Angiomyolipoma- Oncocytoma- Metanephric adenoma- Renal abscess- Granulomatous renal disease (e.g., renal tuberculosis, xanthogranulomatous pyelonephritis)- Renal cysts (e.g., polycystic ...

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