Renal

Question 1

First step in Invx flowchart of hypernatremia

Answer 1

Urine osm

Question 2

Minimal change causes

Answer 2

Leukemia, NSAID, or Ideopathic

Question 3

Alport patients usually have progression to ESRD… but what medication can slow this

Answer 3

ACEI

Question 4

Even after transplant, 10% of alport patients get what?

Answer 4

Recurrence

Question 5

Goodpastures syndrome patient, with flare up… Tx?

Answer 5

Plasma exchange, steroids, and cyclophosphamide

Question 6

Membranoprolif I

Causes??

Answer 6

Cryglob (HCV) or even HBV, SLE

Question 7

C3 nephritic factor is associated with which diseasee

Answer 7

Membranoprolif II

Question 8

Membranorpolif Tx

Answer 8

Steroid or other immunotherapy and RAAS inhibition

Question 9

Tx overview for IgA nephropathy

Answer 9

RAAS inhibition first and then steroid in few patients.

Question 10

Focal segmental GS, causes

Answer 10

IVDU, HIV, SCD, obesity

Question 11

Most common nephrotic in white adults

Answer 11

Membranous

Question 13

Most common nephrotic in black adults

Answer 13

FSGS

Question 14

Causes of membranous nephropathy

Answer 14

Anti phospholipase AB. Cancer, hepatitis, RA (tx).

Question 15

Spike and dome seen in which disease

Answer 15

Membranous

Question 16

Our 24 hour urine protein for nephrotic is >3.5 g/day. But what’s the cutoff for spot protein to creatinine ratio

Answer 16

2

Question 17

How to manage infection risk in nephrotic patients

Answer 17

Strep vaccine.

Question 18

What diuretic can be added to help calcium ox stones

Answer 18

THZ

Question 19

What supplement can be given to help Tx calcium ox stones

Answer 19

CITRATE

Question 20

Ph difference in the urine of calcium oxolate vs calcium phosphate stones

Answer 20

Low and high resp

Question 21

Cysteine stones cause which ph

Answer 21

Low… acidic

Question 22

Any time there is low ph stones…. Can give what?

Answer 22

Something to alkaline ie the urine.

Question 23

If stone recur despite good mx of cysteine stones… what can be given

Answer 23

Penciliimaine or tiopronin

Question 24

ARPKD main other finding

Answer 24

Liver fibrosis

Question 25

Urine cyanide nitropursside test is positive for which stones

Answer 25

Cysteine

Question 26

Which medication can decrease the formation of new cysts in ADPKD

Answer 26

ADH antag…

Question 27

Scrotal swelling first test… if painful vs non painful

Answer 27

Non painful, best to do the flashlight test Painful, do US with Doppler

Question 28

Prehn sign positive in what

Answer 28

Epididymitis

Question 29

How many hours to do sx in teste torsion

Answer 29

6

Question 30

Tx of chronic prostatic/chronic pelvic pain syndrome

Answer 30

Alpha blocker or 5 alpha red inhib

Question 31

30 year old woman with painful pelvis area when holding to toilet. Better when urinates. Also painful when runs and during sex. Has history of IBS. Occurring for few months. Urine analysis is normal

Answer 31

Interstitial cystitis. Avoid trigger, analgesics and maybe TCA if refractory.

Question 32

Prostate cancer mets to the spine. Tx for the lesions and for pain

Answer 32

Give androgen ablation (-tamide or -relin). Radiation helps pain

Question 33

What age and above, with painless hematuria…. Do we go straight for the cystoscopy

Answer 33

35 and above

Question 34

Tell me when and when not to biopsy RCC before nephrectomy

Answer 34

Usually CT is very clear and obvs if malignant. Therefore we usually biopsy the pathology specimen. Biopsy if we plan to do active surveillance, uncertain Dx, biopsy of potential mets.

Question 35

How divide up teste cancers

Answer 35

Germ cell: seminoma, Choriocarcinoma, yolk sac, teratoma Non germ cell: Sertoli, leydig, lymphoma

Question 36

For any germ cell tumour in the teste that is advances, we do orchiectomy and Platinum chemo. But if low stage disease, what do we do orchiectomy and…. Seminoma: ? Non seminoma: ?

Answer 36

Chemo and radiation Retroperitoneal LN dissection

Question 37

Define non complicated UTI

Answer 37

Cystitis (and normal symptoms) with no sign of spread to prostate, kidney etc. Not a chronic illness person or a preg lady. Not a man (i dont think) Not failed ABX, and not had recurrence.

Question 38

Tx of uncomplicated UTI

Answer 38

No need to culture… just give nitroF for 5-7 days or TMP SMX for 3 days.

Question 39

Complicated UTI Tx (but not pyelonephritis, prostatitis

Answer 39

OP oral quinolones or TMP SMX or ceph

Question 40

Preg patient with assymp bacteruria vs no preg… mx

Answer 40

Non preg = nothing Preg = nitro or amox

Question 41

Who gets UTI proplhaxis and what are the different things we can do for it

Answer 41

2 or more in 6 mo, 3 or more in 12 mo. Behavioural first (post void urine, cranberry, increase fluid intake). Post coital spermicide.vag estrogen in post menopausal. If above ineffective, give TMP SMX or nitroF, after sex or continuously

Question 42

Only circumstance we do not invx a uti before Tx

Answer 42

Non preg woman, uncomplicated and symptoms clear. Anyone else, do UA

Question 43

Pyelonephritis, what invx do we do first

Answer 43

Blood and urine culture

Question 44

Main two abx therapy in pyelonephritis

Answer 44

PO outpatient or IV inpatient (unstable patient) But in both we give TMP SMx (more PO), ceph, quinolone

Question 45

If someone is a high complication risk in pyelonephritis, what do we do

Answer 45

CT, looking for abscess, emphysematous, chronic pyelonephritis or anatomical causes

Question 47

What is xantho granulomatous pyelonephritis

Answer 47

A type of chronic disease caused by infected stones. See the bear paw sign on the CT (multiple dark round areas on CT)

Question 48

Blunting of calyxes on CT and corticomedullary scarring esp in the upper and lower poles. Dx? And likely pathology finding

Answer 48

Chronic pyelonephritis and would see thyroidization

Question 49

Emphysematous pyelonephritis causes and seen in which patients

Answer 49

Due to gas producing bacteria and is seen in DM patients

Question 50

Name as many symptoms of acute prostatitis

Answer 50

Fever, chills, systematically unwell. Perineal pain, pain when pooing, dysfunction is, frequency, urgency, tender boggy prostate.

Question 51

acute prostatitis Tx

Answer 51

mild: OP TMP SMX, or quinolones, for > 1mo Severe: IV quinolones and ceph If young man/gay cover with doxy foxy also

Question 52

Symptoms of acute prostatitis

Answer 52

Perineal pain, fever, chills, unwell, pain on urine action and pooing. LUTS. Boggy and tender prostate.

Question 53

Tx of acute prostatitis If mild/moderate? If severe? If young man or gay man

Answer 53

Mild/moderate: OP PO TMP SMX, quinlone Severe: IV quinlone, ceph Young or gay man: doxy foxy Most treatment needs at least a month (takes time to reach therapeutic conc in prostate)

Question 54

V