Nephrology

Question 1

Clinical Presentation of Obstructive uropathy

Answer 1

> Flank pain

> Low volume voids with or without occasional high volume voids

> If bilateral, renal dysfunction

Question 2

Does RAS cause flank pain?

Answer 2

No

Question 3

Measures to prevent urinary calcium stone formation (5)

Answer 3

1. Increase fluid intake
2. Low sodium diet
3. Low protein diet
4. Moderate calcium intake
5. Thiazide diuretics

Question 4

Effect of high dietary sodium on hypercalciuria

Answer 4

Reduces the reabsorption of sodium and thereby reduces the passive reabsorption of calcium

Question 5

Effect of reduced dietary calcium on hypercalciuria

Answer 5

Leads to increased absorption in the gut, which is excreted into urine and binds urinary calcium to form calcium oxalate stones

Question 6

Calcium oxalate crystals can result from

Answer 6

1. Ethylene glycol (antifreeze ingestion)
2. Vitamin C abuse
3. Hypocitraturia (citrate binds calcium)
4. Malabsorption (Crohns’s, gastric bypass)

Question 7

Types of calcium stones

Answer 7

1. Ca Phosphate (precipitates at basic pH)

2. Ca Oxalate (acidic pH)

Question 8

S&S of Hydronephrosis

Answer 8

Flank pain that radiates to the groin

Question 9

Flank pain that radiates to the groin

Answer 9

Hydronephrosis

Question 10

Causes of Hydronephrosis (6)

Answer 10

Urinary Tract obstruction

1. BPH
2. Cervical Cancer
3. Renal stones
4. Ureter injury
5. Retroperitoneal fibrosis (methysergide for HA).
6. Vesicouretral reflux

Question 11

Bilateral Hydronephrosis leads to

Answer 11

Elevated creatinine

Question 12

MCC of isolate proteinuria in children

Answer 12

Transient proteinuria

Question 13

Treatment for transient proteinuria

Answer 13

Repeat urine dipstick on two separate occasions to r/o persistent proteinuria (which requires further evaluation for underlying renal dz).

Question 14

Proteinuria in children can be 1 of 3

Answer 14

1. Transient (intermittent)
2. Orthostatic
3. Persistent

Question 15

Causes of transient proteinuria in children

Answer 15

Exercise, Fever, seizures, stress or volume depletion

Question 16

Positive Urinary nitroprusside

Answer 16

Cystinuria

Question 17

Pathophysiology of Cystinuria

Answer 17

Impaired transport of cystine and diabasic aa ornithine, lysine and arginine by brush borders of renal tubular and intestinal epithelium cells. This leads to decreased reabsorption and increased urinary excretion of these aa. Cystine unlike the others are poorly soluble in water.

Question 18

Which urinary test can detect elevated cystine levels

Answer 18

Cyanide-Nitroprusside test

Question 19

UTI caused by

Answer 19

Bacteria ascending into the bladder & vaginal introitus

Question 20

S&S off UTI

Answer 20

Suprapubic pain, dysuria, pyuria, bacteriuria

Question 21

MCC of UTI

Answer 21

E.coli

Question 22

Positive leukocyte esterase signifies

Answer 22

Pyuria

Question 23

Positive nitrites signifies

Answer 23

Enterobacteriaceae

Question 24

Indications for cystoscopy

Answer 24

1. Gross hematurua with no evidence of glomerular dz or infection.
2. Microscopic hematuria w/o evidence of glomerular dz or infection but increased risk of malignancy.
3. Recurrent UTI
4. Obstructive systems with suspicion for stricture, stone
5. Irritative symptoms w/o urinary infection
6. Abnormal bladder imaging or urine cytology

Question 25

Familial Hypocalciuric hypercalcemia vs Primary HyperPTH

Answer 25

Both: hypercalcemia, elevated or high normal PTH FHH: Low urinary excretion (increased reabsorption in renal tubules 2/2 defective CaSR) HPTH: increased urinary calcium excretion (excessive mobilization of Ca from bones)

Question 26

Pathophysiology Familial Hypocalciuric Hypercalcemia

Answer 26

Mutation in CaSR

Question 27

Diffuse abdominal pain with guarding

Answer 27

Peritonitis

Question 28

Acute Chemical Peritonitis following blunt abdominal trauma can be caused by

Answer 28

Spillage of blood, bowel contents, bile, pancreatic secretions or urine into peritoneal cavity

Question 29

Which parts of the bladder are bordered by the peritoneal cavity

Answer 29

Dome (superficial n lateral surfaces) of the bladder

Question 30

Kehr sign

Answer 30

Referred pain to the ipsilateral shoulder from right or left hemidiaphragm Phrenic Nerve n sensory innervation of shoulder arise from sensory root C3 to C5

Question 31

Extraperitoneal structures of bladder

Answer 31

1. Anterior bladder wall | 2. Bladder Neck

Question 32

Damage to extraperitoneal structures of bladder lead to (s&s) and can be caused by

Answer 32

Leads to localized lower abdominal pain and can be caused by pelvic fracture

Question 33

ARF and oliguria in post op patient (immediate procedures)

Answer 33

1. Bladder scan | 2. Catheterization

Question 34

Post OP Urinary Retention (PUR) is

Answer 34

Common complication of surgery and anesthesia. Can lead to decrease detrusor muscle activity

Question 35

Most sensitive & specific test for diagnosing RCC

Answer 35

Abdominal CT

Question 36

Unilateral varicocele that fail to empty when patient is in recumbent raise suspicion for

Answer 36

Underlying mass pathology such as RCC that obstruct venous flow

Question 37

Is there screening for bladder cancer?

Answer 37

No

Question 38

What metabolic disorder can occur following tonic-clonic seizure

Answer 38

Postictal lactic acidosis 2/2 skeletal muscle hypoxia and impaired hepatic lactic acid uptake

Question 39

Management for postictal lactic acidosis

Answer 39

Observation and repeat chemistry panel after 2hrs. It is transient.