Acid / Base
Hypertension
Kidney Disease
Pediatric
Electrolyte Disorders
100
What is the MUDPILES mnemonic used for?
A. Symptoms of NAGMA
B. Causes of metabolic alkalosis
C. Symptoms of salicylate overdose
D. Causes of HAGMA
D
Methanol, Uremia, Diabetic ketoacidosis, Propylene glycol, Infection/Iron/Isoniazid, Lactic acidosis, Ethylene glycol, Salicylates
100
What drug may cause this side effect?
A. Verapamil
B. Minoxidil
C. Nifedipine
D. Propranolol
B
Vasodilation via potassium channel opening
100
Muddy brown casts in the Urine signify:
A. Nephrotic syndrome
B. ATN
C. Nephritic syndrome
D. Glomerulonephritis
B. Acute tubular necrosis
100
A 6y/o patient presents with a distended bladder and incomplete voiding, but you can't really tell the gender. What gender do you write down in the chart?
A. Male
B. Female
A. Male
Likely has posterior urethral valves
100
"Bones, stones, moans, and groans" describes the symptoms of:
A. Hyperphosphatemia
B. Hypophosphatemia
C. Hypercalcemia
D. Hypocalcemia
C. Hypercalcemia
common causes: hyperparathyroidism (#1), multiple myeloma, bone metz, sarcoidosis, excess intake
Tx: IVF, loop diuretics, calcitonin and bisphosphonates
200
What type of renal tubular acidosis (RTA) involves decreased reabsorption of HCO3 in the proximal tubule?
A. Type 1
B. Type 2
C. Type 3
D. Type 4
B. Type 2
type 1 - decreased H+ secretion in LDT and CD
type 4 - decreased na/k exchange in LDT and CD
200
What is the most common cause of secondary hypertension?
A. Renovascular Disease
B. Primary Aldosteronism
C. Cushing syndrome (hypercortisolism)
D. Drugs (NSAIDs/cocaine/alcohol)
A
renal artery stenosis + fibromuscular dysplasia, causing hyperaldosteronism
200
Which of the following is NOT a cause of interstitial intrinsic azotemia?
A. AIN
B. Sjogren's
C. Sarcoidosis
D. Scleroderma
D. scleroderma (renal vascular)
200
Who is the Wilms tumor named after?
A. Max Wilms
B. Karl Wilms
C. Friedrich Wilms
D. Otto Wilms
A. Max Wilms
200
Hypokalemia can be cause by all of the following except:
A. Type 1 RTA
B. Type 2 RTA
C. Type 4 RTA
D. diarrhea
C. type 4
Urine anion gap helps differentiate cause of hypokalemia. >20 RTA, otherwise diarrhea.
Sx: ECG with U waves and decreased reflexes
Hyperkalemia causes: ACE/ARB, NSAIDs, Addisons, CKD, K sparing, tumor lysis. ECG: mild(5.5-6.5mEq/L) peaked T waves and prolonged PR segment; moderate(6.5-8mEq/L) loss of p wave, prolonged QRS, ST elevation, and ectopic beats; Severe(>8) progressive widening of QRS, sine wave, vfib, asystole, bundle branch blocks
TREATMENT!
300
What is the delta gap(no calculator)?
Na+: 1938, K+: 62, Cl-: 38, HCO3-: 1
A. 1961
B. 1899
C. 1837
D. 23
B
1938-38-1
300
Spironolactone should not be used with which class of drug?
A. beta blocker
B. ACEI/ARB
C. diuretics
D. CCBs
B
Increased risk of hyperkalemia
300
Which of the following are symptoms of hepato-renal syndrome?
A. Increased creatinine
B. Increased urine sediment
C. Increased proteinuria
D. Increased sodium excretion
A
The others are normal or decreased (but sometimes can have a little proteinurea)
300
Which genetic condition is NOT associated with Wilms Tumor?
A. WAGR syndrome
B. Denys-Drash syndrome
C. Beckwith-Wiedemann syndrome
D. Li-Fraumeni syndrome
D. Li-Frarmeni
associated with soft tissue sarcomas / carcinomas
300
Urine osmolarity becomes an important diagnostic tool for hyponatremic patients that are:
A. Hypocolemic
B. Euvolemic
C. Hypervolemic
B. Euvolemic
Uo>100 SIADH, hypothyroid, glucocorticoid def.
Uo<100 primary polydipsia
Hypo/hyper use Una and FEna
400
What are the normal lab values for (looking for):
(100 points per correct answer)
HCO3 (1 number)
pCO2 (1 number)
BUN (range)
Na (1 number)
24, 40, 6-20, 140
400
Beta-blockers are not first-line for HTN in patients over 60, UNLESS.....
MI, Heart Failure, atrial fibrillation, atrial flutter, angina
400
What does it mean if FEna <1%? Give an example of what would cause this.
prerenal, kidneys are holding onto sodium.
dehydration, heart failure, blood loss, shock, renal artery stenosis, etc
400
A 24 hour old baby is losing weight and has an elevated BUN and Cr. What is your next step?
Check the mothers BUN and Cr since it is her blood inside the baby. Losing weight is normal for the first three days.
400
Hypernatremia and hyponatremia can both present with lethargy, seizures, confusion, and coma. What is symptom help differentiate the two?
Hypernatremia - extreme thirst
Hyponatremia - nausea
500
Calculate the osmol gap!
Na 135, K 5, Cl 95, HCO3 8, BUN 32, Glucose 115, Serum osmol 308, pCO2 20, pH 7.2
308 - ((135*2) + (32/2.8) + (115/18) = 20
500
A 7592 y/o dragon comes into the clinic after just finishing a 17 year bender. They have peripheral edema and a GFR <30. Unfortunately, you used the entire stock pile of loop diuretics to treat the last patient. What drug are you choosing to treat this dragon?
Indapamide (only thiazide that works at GFR<30)
500
A 7592 y/o dragon comes into the clinic after just finishing a 17 year bender. Blood test reveals a CPK of 6.2 million. What is your top differential, a potential cause of it, and what is the treatment?
The dragon has Rhabdomyolysis from doing cocaine and should be treated with aggressive IVF / possibly dialysis.
500
A 7592 y/o dragon brings in its 12 y/o baby dragon who was previously diagnosed with Wilms tumor. You look at the chart and see that the tumor is partially in the Vena Cava. What stage is this Wilms tumor and how would you treat it?
stage 3
surgery -> radiation -> chemo
500
A 7592 y/o dragon comes into the clinic after a 17 year bender. It are having difficulty breathing, muscle pain, and bone pain/fractures. What electrolyte deficiency is the dragon experiencing, what "caused" it, and why does the deficiency cause those symptoms?
The dragon is hypophophatemic which is common in alcoholics due to poor nutrition, phosphate loss, and intracellular phosphate shift during withdrawl. Hypophosphatemia causes the first two Sx because it is in ATP(decreased) and because phos is required for bone mineralization.