GU/RENAL FINAL REVIEW

Question 1

What are key dietary restrictions in late-stage chronic kidney disease?

Answer 1

Restrict potassium, sodium, and phosphorus to reduce electrolyte imbalance and complications.

Question 2

A patient presents with bilateral flank pain and a family history of CKD. What diagnosis is likely based on ultrasound findings?

Answer 2

Polycystic kidney disease — characterized by multiple renal cysts, often hereditary.

Question 3

Which endocrine disorder can lead to calcium-containing kidney stones?

Answer 3

Hyperparathyroidism increases calcium levels, promoting stone formation.

Question 4

What is the most common cause of hypercalcemia in outpatient settings?

Answer 4

Malignancy, particularly due to PTHrP-secreting tumors or bone metastases.

Question 5

What is the primary risk factor for developing prostate cancer?

Answer 5

Age — risk increases significantly after age 50.

Question 6

Explain the pathophysiology of prerenal acute kidney injury.

Answer 6

Decreased renal perfusion triggers RAAS and ADH, leading to sodium and water retention.

Question 7

Where in the prostate does prostate cancer most commonly originate?

Answer 7

In the peripheral zone, making it palpable during DRE.

Question 8

In a patient with subdural hemorrhage and hyponatremia, what condition should be suspected?

Answer 8

Cerebral salt wasting — leads to true hypovolemia and hyponatremia.

Question 9

A patient on HCTZ develops absent reflexes and prolonged QT with normal magnesium. What is likely?

Answer 9

Hypercalcemia due to increased calcium reabsorption.

Question 10

What is a common pathogen in chronic bacterial prostatitis with recurrent UTIs?

Answer 10

E. coli or Pseudomonas — often in men with incomplete treatment of prior infections.

Question 11

What is the empiric treatment for suspected gonorrhea and chlamydia in a young male?

Answer 11

Ceftriaxone IM + Doxycycline PO for 7 days.

Question 12

How long should a patient abstain from sex after STD treatment?

Answer 12

At least 7 days after initiation of therapy to prevent transmission.

Question 13

What medication relieves lower urinary tract symptoms in BPH?

Answer 13

Tamsulosin — an alpha-1 blocker that improves urine flow.

Question 14

How should hypernatremia be corrected in a stable patient?

Answer 14

Administer isotonic saline and correct sodium at 4-6 mEq/L per day.

Question 15

What imaging is first-line for a child with recurrent UTIs?

Answer 15

Renal ultrasound — to evaluate for structural abnormalities.

Question 16

A smoker presents with bilateral hydronephrosis and hematuria. What is a likely cause?

Answer 16

Bladder cancer — especially transitional cell type.

Question 17

What is the best imaging for suspected repetitive nephrolithiasis?

Answer 17

Ultrasound — especially in patients with history of stones or pregnancy.

Question 18

What medications are used for initial management of kidney stone pain in the ED?

Answer 18

IV Ketorolac for pain and Ondansetron for nausea.

Question 19

What is the typical presentation of Wilms tumor in children?

Answer 19

Painless abdominal mass, usually in a child under 5 years old.

Question 20

What is the initial emergent treatment for hyperkalemia with ECG changes?

Answer 20

IV insulin with dextrose, calcium gluconate if cardiotoxicity is suspected.

Question 21

What condition causes necrosis of renal tubule epithelial cells and presents with muddy brown casts?

Answer 21

Acute tubular necrosis — often due to ischemia or nephrotoxins.

Question 22

A man presents with painless penile lesion and inguinal lymphadenopathy. What is the concern?

Answer 22

Penile cancer — often squamous cell carcinoma.

Question 23

What is the next step in evaluating a man with a suspicious prostate exam?

Answer 23

Order a PSA test to assess for prostate cancer.

Question 24

A patient has penile pain and curvature during erection. What is the likely diagnosis?

Answer 24

Peyronie’s disease — due to fibrous plaques in the tunica albuginea.

Question 25

On digital rectal exam, what finding is typical of BPH?

Answer 25

Symmetrically enlarged, smooth, non-tender prostate.

Question 26

A boy has a scrotal mass that transilluminates and is worse during the day. What is it?

Answer 26

Hydrocele — fluid accumulation in the tunica vaginalis.

Question 27

What is the imaging test of choice for a painless testicular mass?

Answer 27

Scrotal ultrasound — helps differentiate cystic vs solid masses.

Question 28

What condition presents in a child with a non-palpable testis and inguinal fullness?

Answer 28

Cryptorchidism — undescended testis, often felt in the abdomen.

Question 29

What is the emergency urologic condition involving retracted foreskin?

Answer 29

Paraphimosis — requires immediate manual reduction or surgery.

Question 30

Patient with euvolemic hyponatremia, high urine osmolality, no edema. What’s the likely diagnosis?

Answer 30

SIADH — syndrome of inappropriate antidiuretic hormone.

Question 31

Where is the urethral opening in hypospadias?

Answer 31

On the ventral (underside) of the penis.

Question 32

What is the first-line treatment for a 6-year-old with pathologic phimosis and inflammation?

Answer 32

Topical corticosteroids; surgical referral if refractory.

Question 33

What diagnostic test can differentiate psychogenic from organic erectile dysfunction?

Answer 33

Nocturnal penile tumescence and rigidity test.

Question 34

What is the treatment of choice for chronic bacterial prostatitis?

Answer 34

Ciprofloxacin — long duration for adequate prostate penetration.

Question 35

What lab finding supports post-streptococcal glomerulonephritis?

Answer 35

Elevated ASO titers — confirms recent streptococcal infection.

Question 36

A smoker with hemoptysis and hematuria likely has what condition?

Answer 36

Goodpasture syndrome — anti-GBM disease affecting lungs and kidneys.

Question 37

What is the treatment for epididymitis in older men?

Answer 37

Levofloxacin for 10 days — covers common urinary pathogens.

Question 38

A man has curd-like penile discharge with erythema. What’s the likely cause?

Answer 38

Candida balanoposthitis — common in diabetics.

Question 39

What is the testicular emergency in a child after a bike crash?

Answer 39

Testicular torsion — requires immediate ultrasound and surgery.

Question 40

What is the recommended treatment for acute pyelonephritis?

Answer 40

Start with IV/IM ceftriaxone, then transition to PO fluoroquinolone.

Question 41

What antibiotic is first-line for uncomplicated UTI in women?

Answer 41

Nitrofurantoin — effective and has minimal resistance.

Question 42

What is the most important lifestyle recommendation for patients with CKD?

Answer 42

Tight control of blood glucose to slow disease progression.

Question 43

Explain how hypertension causes kidney damage in CKD.

Answer 43

Vascular thickening → decreased perfusion → ischemia of renal tubules.

Question 44

Who is most likely to develop prerenal AKI?

Answer 44

Elderly patient with volume loss or sepsis, e.g., 75-year-old with urosepsis.

Question 45

A woman complains of a bulge and heaviness in her pelvis. What's the likely diagnosis?

Answer 45

Cystocele — prolapse of the bladder into the vaginal canal.

Question 46

How is 'true' hyponatremia defined?

Answer 46

Serum osmolality is low, confirming hypotonic hyponatremia.

Question 47

What labs are necessary in a patient with HTN, anemia, and uremia?

Answer 47

Order renal panel, CBC, electrolytes, and GFR to assess CKD severity.

Question 48

A teen with hematuria after URI likely has what condition?

Answer 48

IgA nephropathy (Berger’s disease) — most common glomerulonephritis.

Question 49

What findings support a diagnosis of pyelonephritis?

Answer 49

CVA tenderness, fever, and positive urine culture.

Question 50

A male smoker with painless hematuria needs what next diagnostic step?

Answer 50

Refer for cystoscopy — evaluate for bladder cancer.

Question 51

What is first-line management for urge incontinence?

Answer 51

Pelvic floor physical therapy and bladder training exercises.

Question 52

What is the classic triad for renal cell carcinoma?

Answer 52

Flank pain, hematuria, and a palpable mass — though all three are rare together.

Question 53

How do you diagnose polycystic kidney disease in someone with family history?

Answer 53

Renal ultrasound — multiple bilateral cysts, especially if symptomatic.

Question 54

What lab value is often elevated in glomerulonephritis?

Answer 54

Urinary protein or red blood cell casts — indicates glomerular damage.

Question 55

When should you avoid IV contrast in imaging?

Answer 55

In patients with acute kidney injury or advanced CKD — due to risk of nephropathy.

Question 56

What imaging is safest for evaluating suspected renal pathology in pregnancy?

Answer 56

Renal ultrasound — no radiation risk.

Question 57

What are signs of uremic syndrome?

Answer 57

Fatigue, nausea, pericarditis, asterixis, encephalopathy — due to toxin buildup.

Question 58

Which hormone level is decreased in CKD, leading to anemia?

Answer 58

Erythropoietin — kidneys produce less, causing normocytic anemia.

Question 59

What is the mechanism of action of tamsulosin in BPH?

Answer 59

Alpha-1 antagonist — relaxes smooth muscle in bladder neck and prostate.

Question 60

What type of kidney stone is radiolucent and associated with gout?

Answer 60

Uric acid stone — not visible on plain X-ray.

Question 61

What infection is a common cause of struvite stones?

Answer 61

Proteus species — urease-producing bacteria increase urine pH.

Question 62

What is the most common organism in acute cystitis?

Answer 62

Escherichia coli — responsible for 75-95% of UTIs.

Question 63

What distinguishes complicated from uncomplicated UTI?

Answer 63

Complicated UTIs occur with structural/functional urinary tract issues or in men.

Question 64

How do you manage a patient with severe hyponatremia and seizures?

Answer 64

Give 3% hypertonic saline — correct sodium slowly.

Question 65

What is the recommended initial evaluation for hematuria?

Answer 65

Urinalysis, urine culture, and imaging — then cystoscopy if persistent.

Question 66

What is the best next step in suspected testicular torsion?

Answer 66

Immediate scrotal ultrasound with Doppler, followed by surgical consult.

Question 67

What is the first-line medication for urge incontinence?

Answer 67

Oxybutynin or tolterodine — antimuscarinic agents.

Question 68

What fluid is preferred in early sepsis with AKI?

Answer 68

Isotonic crystalloid like normal saline — for volume resuscitation.

Question 69

What does a 'bag of worms' on scrotal exam indicate?

Answer 69

Varicocele — dilated pampiniform plexus, can impair fertility.

Question 70

Which nephropathy presents days after infection and has mesangial IgA deposits?

Answer 70

IgA nephropathy (Berger’s disease).