NBME Answers : antwon's page

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submitted by step_prep5(246), visit this page

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Middle-aged woman with a recent GU surgery who develops a significant AKI with a BUN:creatinine ratio < 15 with a bland urinalysis, most concerning for a post-renal AKI secondary to ureteral damage, which would be worked-up with a renal ultrasound looking for hydronephrosis
Key idea: GU surgeries in women are highly associated with damage to the ureters, which can lead to a post-renal AKI (VERY HIGH YIELD FOR NBME EXAMS!)

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iluvlamp The question shows the labs/findings prior to the surgery, not s/p GU surgery. I think your explanation is still valid though physiologically because maybe the tumor is compressing the ureter, causing a post-renal AKI. Still agree ureter damage from GU surgery is mega high yield. +13

antwon This all makes sense, but isn't it true that renal ultrasonography cannot detect distal ureter damage? +3

submitted by step_prep5(246), visit this page

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Middle-aged woman with potential infectious disease (fever) leading to one week of uncontrolled hyperglycemia who has signs of orthostatic hypotension (drop in systolic BP >20 or diastolic BP >10 when moving from sitting to standing) and is found to have glucosuria, most consistent with intravascular volume depletion due to glucose acting as an osmotic agent and leading to polyuria
Key idea: Infections often lead to increased insulin requirement by causing a reactionary hyperglycemia

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antwon Would this be stress hyperglycemia? meaning stress would lead to gluconeogenesis, glycogenolysis, and insulin resistance. Therefore more glucose in the urine and therefore glucosuria. +