General

Question 1

Urinalysis finding in:
Glomerulonephritis
Nephrotic syndrome
Interstitial nephritis

Answer 1

GN: RBC casts, proteinuria, hematuria
Nephrotic syndrome: fatty casts, oval bodies, proteinuria
Interstitial nephritis: WBC casts without bacteria, proteinuria

Question 2

Components of nephrotic syndrome

Answer 2

Proteinuria, hypoalbuminemia, edema, hyperlipidemia, hypercoagulability
Will also see oval fat bodies in urine

Question 3

Treatment of nephrotic syndrome

Answer 3

Fluid restriction, iv diuresis,ACEi

Steroids

Question 4

Patient with nephrotic syndrome presents with hematuria, flank Pain and worsening renal function .. what complication should be considered

Answer 4

Renal vein thrombosis

Question 5

Causes of pseudohematuria

Answer 5

Foods (beers, berries, rhubarb), meds (rifampin, phenazopyridine, nitofurantoin), porphyrias

Question 6

Match clinical feature with disease. Gross hematuria with:
A) dysuria, frequency
B) hemoptysis
C) recent URTI
D) RBC casts, proteinuria
E) petechiae/purpura, schistocytes
F) nephrotic syndrome, flank pain
G) developing countries

Answer 6

A) uti
B) goodpastures, Wegener
C) glomerulonephritis
D) glomerulonephritis
E) HUS / TTP
F) renal vein thrombosis
G) schistosomiasis

Question 7

What should you consider if a dipstick is positive for heme but no RBCs are seen on microscopy

Answer 7

Rhabdomyolysis

Question 8

Who should get imaging in hematuria

Answer 8

Gross hematuria and risk factors for serious etiology (>35, abdo pain , excessive analgesic use)

Question 9

Where along GU tract should you suggest pathology for hematuria:
At beginning of stream
Throughout stream
At end of stream

Answer 9

Urethral
Proximal to urethra
Bladder neck or prosthatic urethra

Question 10

Two possible treatments to relieve bladder spasms in patients with bladder cancer and hematuria

Answer 10

Belladonna and opium suppositories

Question 11

4 renal causes of AKI

Answer 11

Glomerulonephritis
AIN
ATN
vascular

Question 12

What should be considered as a cause of AKI in a patient who just started an ACEi

Answer 12

Bilateral renal artery stenosis

Question 13

4 causes of pre renal AKI

Answer 13

Hypovolemia
Volume redistribution (third spacing, sepsis, hypoalbuminemic states eg cirrhosis)
Decreased effective cardiac output (MI, cardiomyopathy, valvular disease)
Meds limiting perfusion (ACEi, NSAIDs)

Question 14

What happens to the urine sodium and the fractional excretion of sodium in pre renal AKI

Answer 14

Low urine sodium and low fractional excretion of sodium

Question 15

Treatment of pre renal AKI

Answer 15

Correct hypovolemia, augment cardiac output
Discontinue ACEi, NSAIDs
Correct electrolyte imbalance

Question 16

Causes of glomerulonephritis

Answer 16

Primary eg Post streptococcal

Secondary to systemic disease eg SLE, Goodpasture, vasculitis

Question 17

Management of glomerulonephritis

Answer 17

Supportive care, control BP

Steroids and immunesuppressants for underlying systemic illness (not for post strep GN)

Question 18

Lab and UA findings in AIN
meds that can cause AIN
Treatment of AIN

Answer 18

Elevated Cr
WBC, WBC casts, eosinophils on UA
Meds: penicillin, anticoagulants, NSAIDs, diuretics
Treatment is supportive, stop offending agent, steroids if no improvement in 3-7d

Question 19

3 causes of acute tubular necrosis

Answer 19

Renal ischemia (surgery, sepsis, trauma)
Nephrotoxic agents (contrasts, aminoglycosides)
Pigments (myoglobin in rhabdo, hemoglobin in hemolysis)

Question 20

Diagnostic criteria for ATN

Answer 20

Loss of urine concentrating ability
UA shows granular muddy brown casts, renal tubular casts. Consider rhabdo if UA positive for heme but never for RBCs
Urine osmolality = serum osmolality

Question 21

Macro and micro vascular causes of renal AKI

Answer 21

Macro: renal artery occlusion, AAA
micro: HUS, TTP, embolus, malignant hypertension

Question 22

6 causes of bladder outlet obstruction

Answer 22

BPH
stones
Tumor
Clot
Neurogenic bladder
Posterior urethral valve
Urethral stricture
Phimosis

Question 23

How does uremic frost present

Answer 23

Deposition of urea from evaporated sweat, fine white powder on skin

Question 24

10 manifestations of CKD

Answer 24

Uremia
Volume overload, pulmonary edema
Hypertension
Pericarditis (look for tamponade in sick ESRD pt)
Anemia (decreased EPO)
Bleeding
Encephalopathy (altered mental status, hiccups, asterixis)
Peripheral neuropathy
Immunesuppression
Hyperkalemia
Systemic calcification (consider calciphylaxis in violaceous skin lesions with ESRD)

Question 25

Management of CKD

Answer 25

If not in ESRD look for AKI on CKD Manage HTN, hyperk and pulm edema Dialysis Renal transplant

Question 26

Management of actively bleeding ESRD patient

Answer 26

DDAVP is first line (releases vWF) Cryo (factors I, II, VIII, XIII, VWF) Transfuse for symptomatic under 70 Conjugated estrogens

Question 27

By what mechanism may furosemide still be helpful in cardiogenic edema in Anuric patients

Answer 27

Vasodilation

Question 28

5 indications for emergent dialysis

Answer 28

Acid base disturbance (severe metabolic acidosis) Electrolyte disturbance (hyperkalemia, hypercalcemia) Ingestions (salicylates, alcohols, lithium, barbiturates) Overload (severe HTN, pulmonary edema) Uremia symptomatic (pericarditis, encephalopathy, nausea/vomiting, twitching)

Question 29

5 renal colic mimics

Answer 29

``` AAA pyelonephritis Testicular torsion Ovarian torsion Acute papillary necrosis ```

Question 30

5 sites where renal calculi cause obstruction

Answer 30

calyx, ureteropelvic junction, uretovesicular junction, vesical orifice, pelvic brim

Question 31

This type of renal stone is caused by urea splitting bacteria (pseudomonas, klebsiella, staph, proteus) and can cause stag horn calculi

Answer 31

Struvite

Question 32

When should imaging be performed in suspected renal colic

Answer 32

Patient looks sick, diagnosis in question, first episode flank pain, suspect high grade obstruction

Question 33

What percentage of stones >8 mm will pass

Answer 33

20% only, often need lithotripsy or surgical intervention

Question 34

Criteria for admission for renal colic

Answer 34

Solitary kidney Acute renal insufficiency Obstructing stone with infection Intractable pain or vomiting

Question 35

11 factors making UTI Complicated

Answer 35

``` Men Elderly (>65) Pregnant Pyelo Indwelling catheter Recent instrumentation Structural urinary tract abnormalities Treatment failure Immunesuppressed Recent hospitalization ```

Question 36

Most likely cause of dysuria and Pyuria

Answer 36

Urethritis or prostatitis (not UTI)

Question 37

What type of bacteria do nitrites on UA

Answer 37

Gram-negative UA

Question 38

Duration of therapy for: A)Uncomplicated cystitis B)Uncomplicated cystitis with comorbidities C)Uncomplicated pyelo D)Complicated UTI E)Pregnancy (including asymptomatic bacteriuria) F)Pregnant pyelo

Answer 38

``` A) 3-5 B) 7 C) 14 D) 14 E) 7 F) 14 ```

Question 39

Admission criteria for uti

Answer 39

``` Extremes of age Systemic toxicity Renal failure Obstruction Complicated uti have lower threshold Intractable vomiting or pain ```

Question 40

Treatment of acute bacterial prostatitis

Answer 40

<35 treat at STI: ceftriaxone 250 mg IM and doxy x 10d >35 : GN predominates. Fluoroquinolone In chronic bacterial: fluoroquinolone x 4 weeks or septa x 1-3 months

Question 41

Two types of painful penile ulcers and their treatment

Answer 41

Hsv : acyclovir | Chancroid: azithro or cipro or ceftriaxone

Question 42

Presentation of lymphogranuloma venereum and treatment

Answer 42

Chlamydia. Transient, painless ulcer followed by tender unilateral inguinal adenopathy Doxy

Question 43

Differential for presenting with both oral and penile ulcers

Answer 43

Behcets, Stevens Johnson syndrome, pemphigus vulgaris, Reiter syndrome