Urology / Renal / Electrolytes

Question 1

Most common cause of HTN in young person

Answer 1

renal parenchymal disease

Workup:
a urinalysis
urine culture
renal ultrasonography

Question 2

Urinary incontinence

Answer 2

5 types

Urge
Stress
Functional
Reflex
Overflow

Question 3

Urge incontinence

Answer 3

#1 in old
2/2 involuntary + uninhibited detrusor contractions
detrusor instability causes an intense urge to void, which overcomes the patient’s voluntary attempt to hold the sphincter close

Large urination, small post void, nocturnal urination

Dx: urodynamic study

Tx:

• Nonpharmacologic therapy is recommended for all patients with an overactive bladder.
• oxybutynin
• TCAs

Question 4

Stress incontinence

Answer 4

#1 in women < 70
2/2 pelvic floor weakness where urethra goes inferior and urinate with increased intraab pressure

Small post void residual

R/o infection w/ UA

Tx: Kegels
Urethropexy
estrogen replacement therapy

Question 5

Functional incontinence

Answer 5

2/2 disabling and debilitating dx

Question 6

Reflex incontinence

Answer 6

1 cause - spinal cord injury

No sense need to urinate

Question 7

Overflow incontinence

Answer 7

Common w/ diabetics, pts w/ neuro d/o, BPH

NOt enough bladder contraction or bladder outlet obstruction

Large post void residual (> 100)

Tx:

• self cath
• bethanechol
• alpha blockers

Question 8

Normal post-void residual

Answer 8

< 50 mL

Question 9

How best to image upper and lower urinary tract?

Answer 9

Upper
IVP
CT scan

Lower
Cystoscopy

Question 10

Upper vs lower urinary tract

Answer 10

Upper= kidneys and ureters

Lower= urinary bladder and urethra

Question 11

Eosinophils in urine. What could this be?

Answer 11

Interstitial nephritis

Question 12

How to reduce risk of contrast nephropathy ?

Answer 12

Premedication with

N acetycysteine
IV sodium bicarbonate

Question 13

NSAIDs induce renal injury by

Answer 13

acutely reducing renal blood flow and, in some patients, by causing interstitial nephritis.

Question 14

1 cause interstitial nephritis

Tx?

Answer 14

Abx

Corticosteroids to tx

Question 15

When proteinuria is noted on a dipstick and the history, examination, full urinalysis, and serum studies suggest no obvious underlying problem or renal insufficiency, what is recommended

Answer 15

a urine protein/creatinine ratio is recommended.

Question 16

Reducing calcium oxalate stones

Answer 16

A low-sodium, restricted-protein diet with increased fluid intake reduces stone formation.

A low-calcium diet has been shown to be ineffective.

Oxalate restriction also reduces stone formation. Oxalate-containing foods include spinach, chocolate, tea, and nuts, but not yellow vegetables.

Potassium citrate should be taken at mealtime to increase urinary pH and urinary citrate

Question 17

When suspect ethylene glycol poisoning?

Answer 17

This diagnosis should be considered in a patient who appears intoxicated but does not have an odor of alcohol, and has anion gap acidosis, hypocalcemia, urinary crystals, and nontoxic blood alcohol levels.

Question 18

Tx ethyelene glycol poisoning

Answer 18

If early, fomepizole
- Fomepizole is a competitive inhibitor of alcohol dehydrogenase

If late, sodium bicarbonate, ethanol, and hemodialysis

Question 19

First-line therapies for urge urinary incontinence include

Answer 19

behavioral therapy, such as pelvic muscle contractions,

anticholinergic therapy.

Question 20

What will provide the fastest and most consistent early lowering of serum potassium

Answer 20

Insulin and glucose IV

Question 21

What is the preferred initial test for renovascular hypertension in patients with impaired renal function?

Answer 21

Duplex Doppler ultrasonography

Tests involving intravenous radiographic contrast material may cause deterioration in renal function

Question 22

What is the gold standard for the diagnosis of renal colic

Answer 22

CT

Question 23

Although most cases of nephrotic syndrome are caused by primary kidney disease, the most common secondary cause of nephrotic syndrome in adults is

Answer 23

diabetes mellitus.

Primary causes include membranous nephropathy and focal segmental glomerulosclerosis, each accounting for approximately one third of cases

Question 24

Bulimia electrolyte disturbance =

Answer 24

hypokalemia

Question 25

Tx urge incontinence

Answer 25

Mild:
The first approach to this problem should be behavioral.

For more severe cases, various pharmacologic agents, including anticholinergics, are useful. Failure of these modalities should lead to urodynamic testing and consideration of surgery.

Question 26

Persons younger than 30 years of age who excrete less than 2 g of protein per day and who have a normal creatinine clearance should be tested for

Answer 26

orthostatic proteinuria. = increased protein excretion in the upright position, but normal protein excretion when the patient is supine.

• It is diagnosed using split urine collections as described in the question.
• The daytime specimen has an increased concentration of protein, while the nighttime specimen contains a normal concentration.

Since this is a benign condition with normal renal function, no further evaluation is necessary.

Question 27

What is the most appropriate imaging procedure for hematuria in all patients?

Answer 27

CT urography or intravenous pyelography

with the exception of those with generalized renal parenchymal disease, young women with hemorrhagic cystitis, children, and pregnant females

Question 28

Development of Acute interstitial nephritis usually becomes evident approximately how long?

Answer 28

2 weeks after starting a medication and is not dose-related.

Question 29

Microscopic hematuria in 40 yo…what next

Answer 29

clinically significant microscopic hematuria as ≥3 RBCs/hpf.

• radiographic assessment of the upper urinary tract,
• urine cytology studies.

all patients > 40 and those who are younger but have risk factors for bladder cancer undergo cystoscopy to complete the evaluation.

Question 30

For UTIs, which fluoroquinolone should not be used?

Answer 30

Moxifloxacin

When trimethoprim/sulfamethoxazole is contraindicated, a 3-day course of ciprofloxacin, levofloxacin, norfloxacin, lomefloxacin, or gatifloxacin is a reasonable alternative.

Question 31

What is the best study for confirming the diagnosis of a urinary tract stone in a patient with acute flank pain?

Answer 31

An noncontrast helical CT scan of the abdomen and pelvis

Although abdominal ultrasonography has a very high specificity, it is still not better than CT, and its sensitivity is much lower; thus, its use is usually confined to pregnant patients with a suspected stone.

Question 32

Children under the age of 5 years with a UTI, any child with a UTI and a fever, school-aged girls who have had two or more UTIs, and any boy with a UTI should have

Answer 32

a voiding cystourethrogram (VCUG) to evaluate for vesiculoureteral reflux and renal ultrasonography to evaluate the kidneys.

Question 33

The most common cause of proteinuria in children is: (check one)
A. Acute postinfectious glomerulonephritis
B. Lupus glomerulonephritis
C. Hydronephrosis
D. Orthostatic proteinuria
E. Reflux nephropathy

Answer 33

Orthostatic proteinuria accounts for up to 60% of all cases of asymptomatic proteinuria reported in children, with an even higher incidence in adolescents

Question 34

Tx SIADH

Answer 34

Hemodynamically stable –> free water restriction
- demeclocycline if cannot do water restriction

Neuro sx –> hypertonic saline