Potpourri
Don't eat yellow snow
Glow paths
D is for..
R-Ta ta
Acid Jazz
100
Testes should be descended by what age? And Surgery should be done by what age if still not descended? Need both for full credit!
What is Down by age 1 years old. Surgery by age 2 years old
100
The etiology for Brown urine is? Need any 3 for credit.
What is RBC, myoglobin, additives (Red dye), Drugs, Food (beets), Porphyrins, and Hemoglobin.
100
In Acute poststreptococcal glomerulonephritis (APSGN) what complement component will likely return to normal by 6-8 weeks
What is C3 concentration
100
19 year-old junior in college presents with chief complaint of waking up once, sometimes twice a night (for a month), by the need to go to the bathroom. More recently, she has noticed that she needs to go to the bathroom during her school day much more frequently than before, sometimes as often as once every hour. Denies excess water consumption, coffee consumption or any new meds. On physical examination no abnormalities. Labs: plasma sodium level to be 149 mEq/L, plasma osmolarity was 308 mOsm/L, and her fasting plasma glucose was 85 mg/dl. Urine osmolarity of 200 mOsm/L. The urine sample was negative for the presence of glucose. Diagnosis?
What is Diabetes Inspidous
100
Teen admitted to PICU overnight for overdose. A quick look at the arterial blood gas of this patient upon admission reveals.. ph 7.62 pCO2 20 HCO3 22 what acid base disorder is this (For full credit what is the likely substance absorbed. Need both for credit)
What is Respiratory Alkalosis with begining compensation. Aspirin or Salicyclic acid could do this
200
Of the following two conditions Wegener's Granulomatosis Vs. Goodpasture Disease Which is most likely associated with C-ANCA
What is Wegener's Granulomatosis
200
Evidence based data reveals that what frequently encountered Primary care condition is most likely to increase risk of developing UTI in childhood.
What is Constipation
200
A 10-year-old female patient was found positive for urine protein and occult blood on Japanese school urinary screening. Examination of the blood was normal except low values of the complement system with CH50 13.5 U/ml, C3 45 mg/dl and C4 3 mg/dl. Renal biopsy will likely demonstrate what condition?
What is focal membranoproliferative glomerulonephritis (MPGN).
200
Going back to that 19 year old patient. New work up included a two-hour water deprivation test. After two hours of not being able to drink water, the osmolarity of her plasma and urine were measured a second time. This time her urine osmolarity was unchanged; however, the osmolarity of her plasma increased to 315 mOsm/L. She was then injected with DDAVP. One hour after the injection, the osmolarity of her plasma decreased to 290 mOsm/L and the osmolarity of her urine increased to 425 mOsm/L. Specific type of diabetes inspidous?
What is Central Diabetes insipidous (Best get an MRI)
200
Is it type I Renal Tubula Acidosis, type 2 Renal tubular acidosis, or type 4 Renal tubular acidosis? Galactosemia will cause?
What is Proximal RTA 2 RTA I: Distal RTA is characterized by a failure of acid secretion by the alpha intercalated cells of the cortical collecting duct of the distal nephron RTA 2: Proximal RTA (pRTA) is caused by a failure of the proximal tubular cells to reabsorb filtered bicarbonate from the urine, leading to urinary bicarbonate wasting and subsequent acidemia RTA 4: distal tubular ammonium excretion, which is secondary to hypoaldosteronism. Its cardinal feature is hyperkalemia, and measured urinary acidification is normal
300
Which nephrogenic condition has IgA deposited in mesangium?
What is Berger's Disease
300
Bladder control during the day is usually achieved between the ages of?
What is of two and three years of age.
300
A previously well 6 year old male presents to your office with the chief complaint of facial puffiness. His mother noticed this a few days ago and it seems to be worsening. He has no other symptoms, but about two weeks ago had "a bad cold." Exam: VS T 37, HR 90, RR 20, BP 92/55. He is alert and cooperative with the examination. His face shows moderate periorbital edema. His eyes are non-injected, his conjunctiva are not edematous and his throat is not red. His heart is regular without murmurs. Heart sounds are normal. His lung exam shows good aeration, with no crackles or rhonchi. Abdomen is soft, non-tender, non-distended and without masses or shifting dullness. No hepatosplenomegaly. He has normal male genitalia with no scrotal edema. The dorsal surfaces of his hands and feet have mild pitting edema. He has brisk capillary refill and 2+ pulses. No rashes are noted. Urinalysis shows 4+ protein, and a specific gravity of 1.030. His chemistry panel is remarkable for protein of 2 g/dL, serum albumin of 1.4 g/dL and cholesterol of 350 mg/dL. BUN and creatinine are normal. He is not ill enough to require hospitalization. He is started on oral prednisone BID. He is followed as an outpatient clinically and by daily urine dipsticks. His edema and proteinuria gradually resolve with treatment. His corticosteroids are tapered off and he remains stable What condition did this patient have (I.e the specific type of nephrotic syndrome)
What is Minimal-change disease (MCD) -the most common cause of the nephrotic syndrome (NS) in children. It accounts for 70 to 90% of the NS in children. Note if responsive to steroids walk away with those minimal" points!
300
A 3 month old is admitted to the PICU for shock with a 2 day history of fever and irritability. Blood and CSF cultures are positive for Streptococcus pneumoniae. He has had decreasing urine output over the last 24 hours (< 0.5 ml/kg/hr) Labs: Na 126 mEq/L serum osmo 260mOsmo/L Cl 98 mEq/L Bun 4mg/dl K 3.7 mEq/L Cr 0.4 mg/dl CO2 25mEq/L glucose 129 mg/dl Urine sp gr 1.025 What is the treatment?
What is Fluid Restriction (DX SIADH)
300
Is it type I Renal Tubula Acidosis, type 2 Renal tubular acidosis, or type 4 Renal tubular acidosis? Wilson's Disease
What is RTA 2 (Proximal)
400
14 year-old African American male presented with a chief complaint of shortness of breath and chest pain. The patient states that he noticed that when he played basketball he tired with only minimal exertion. His exercise tolerance had been gradually decreasing over the past six months. The patient also complained of paroxysmal nocturnal dyspnea and new two-pillow orthopnea. The patient's chest pain was described as worse with inspiration and stabbing in nature. The patient's past medical history included an episode of hematuria at age 9 years old. The patient was evaluated with a renal biopsy which was determined to be inconclusive. On physical exam the patient was tachycardic with an elevated blood pressure of 205/148. Pulmonary exam revealed absent breath sounds at the bases and bilateral coarse crackles in the mid and lower lung fields. The rest of the physical exam was unremarkable. Laboratories were pertinent for a BUN of 57 and creatinine of 5.8. A urinalysis revealed 500 mgs of protein. A chest x-ray revealed bilateral pleural effusions and hazy, patchy opacifications in the mid and lower lung zones bilaterally consistent with pulmonary edema. In subsequent discussion with the patient's mother it was learned that the patient had 2 uncles who received kidney transplants. The renal service was consulted but declined to biopsy the patient given his strong family history and previous biopsy which had been inconclusive. A 24-hour urine revealed 1800 mg of total protein and a creatinine clearance of 15 ml/min. A renal ultrasound revealed normal sized kidneys with increased echogenicity consistent with medical renal disease. The ophthamology service was consulted and an eye exam revealed anterior lenticonus and corneal lesions. Medical records (Was a pain in the butt to get from PCP, thanks HIPA!) showed hearing tests revealed high-pitched sensorineural hearing loss. Diagnosis?
What is Alport's Disease
400
15 y/o previously healthy patient presented to your office for school physical. Random urine revealed positive protein to urine. Following completion of your otherwise benign history and physical. Which condition most likely explains reason for urine having protein in it?
What is Orthostatic proteinuria
400
9 year old patientkeeps having these recurrent episodes of gross hematuria after dealing with URI symptoms of 1-2 days duration. what's the likeley diagnosis here?
What is Berger's Disease
400
5 year old (15kg) boy is admitted to the PICU with a history of MVA 2 days ago. He sustained an isolated head injury with an intraventricular hemorrhage and multiple cerebral contusions. Three hours ago he had an episode of severe intracranial hypertension (ICP 90mmHg, MAP 50 mmHg) requiring volume and an epi drip for hypotension. Over the last 2 hours his uo has increased to 130-150 ml/hr (~8ml/kg/hr.) Labs: Na 155mEq/L BUN 13 mg/dl Cl 114 mEq/L Cr 0.6 mg/dl K 4.2 mEq/L glu 86 mg/dl CO2 22 mEq/L se osmo 320 mOsmo/L Urine sp gr 1.005 what is the diagnosis?
What is diabetes Inspidous
400
Is it type I Renal Tubula Acidosis, type 2 Renal tubular acidosis, or type 4 Renal tubular acidosis? Nephrocalcinosis?
What is Distal RTA I
500
What is gold standard diagnostic test for renal artery stenosis?
What is the Renal arteriography with low-osmolar contrast material.
500
The triad of Coombs-negative microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure represent what condition?
What is Hemolytic uremic syndrome (HUS)
500
Which type of Lupus nephropathy is associated with Diffuse proliferative glomenulonephritis?
What is Type 4 Note: Tpe 1 normal, 2-mesangial, 3-focal proliferative, 5 is membranous!
500
Name any 4 lab findings (Lab or exam findings) consistent with SIADH
What is ..... Low urine output in absence of hypovolemia Hyponatremia (serum sodium<135mEq/L) Low Serum osmolality (<285 mOsm/L) High urine specific gravity (>1.020) Nausea and vomiting Mental status changes
500
19 year-old female with history of Crohn's disease is admitted to you inpatient.Her presenting complaint to the ED 4 hours earlier was of a four day history of bloody-watery diarrhea. A blood gas was obtained to assess her acid/base balance: pH 7.28 CO2 43 pO2 88 HCO3 20 SaO2 96% What is your interpretation? What interventions would be appropriate at this time. Both needed for credit!
What is Uncompensated metabolic acidosis. Control of the diarrhea and bowel rest. It should not be necessary to administer bicarbonate in her present condition. The patient has an uncompensated metabolic acidosis. This is due to excessive bicarbonate loss from her diarrhea. It is interesting to note that she has no compensation. Normally, the respiratory center compensates quickly for metabolic disorders. However, in the patient's case she would have to hyperventilate in order to compensate. This may not be possible in her present condition, and should be evaluated further. Treatment would consist of control of the diarrhea and bowel rest.
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