Renal Diagnostics

Question 1

PSA level blood test should be done BEFORE what exam and why?

Answer 1

Following a prostate manipulation of some kind because it will raise levels

Question 2

What can be a quick test for dehydration?

Answer 2

Increased BUN

Question 3

Increased protein in the urine is an early sign of what?

Answer 3

Glomerular disease

Question 4

RBC casts equal what?

Answer 4

Glomerulonephritis

Question 5

WBC casts equal what?

Answer 5

Acute pyelonephritis

Question 6

Epithelial cell casts (tubular) are signs of what?

Answer 6

Acute tubular necrosis (most common type of acute renal disease)

Question 7

Urine that is positive for LE, nitrites, and WBCs should be sent for what?

Answer 7

culture and sensitivity

Question 8

What is a 24 hour urine culture used for?

Answer 8

quantitative protein

Question 9

Nephrotic syndrome has greater than 3g of protein in the urine in 24 hours. Nephritic is what amount?

Answer 9

less than 3g

Question 10

What is the ONE type of radioleucent stone? What study will you NOT see it on?

Answer 10

Uric Acid stone. Can’t see it if it’s around a bone because they would both be leucent, KUB (radiography)

Question 11

What is the appropriate initial test in patients with renal failure of unknown etiology? What is it the test of choice for?

Answer 11

Renal ultrasonography; to excude urinary obstruction

Question 12

Doppler U/S is used if you’re worried about what? What would you follow it up with?

Answer 12

Anything that is involving BLOOD and vasculature; CTAngio is next

Question 13

If you order a CT for kidney stone, what kind do you get?

Answer 13

a NON-CONTRAST CT because the contrast will hide it, will even pick up uric acid stone, Contrast is considered an exogenous toxin anyway

Question 14

When is a CT useful in renal dx?

Answer 14

to distinguish between benign and malignant cysts, find a stone you couldn’t get on KUB

Question 15

What disease will allow you to palpate the kidney (only one)?

Answer 15

Polycystic kidney disease

Question 16

What is used if US or CT is nondiagnostic?

Answer 16

MRI, watch Gadolinium toxicity in Stage 3 renal failure

Question 17

What is the intravenous pyelogram used for?

Answer 17

Size and shape of the kidneys, ureters, and bladder, highly sensitive and specific for kidney stones, CT is still used before this one, though

Question 18

What does hematuria mean in an adult (until proven otherwise)?

Answer 18

Bladder cancer, terminal stream hematuria is sometimes related to enlarged prostate. DO A CYSTOSCOPY TO LOOK FOR CANCER

Question 19

What is renal angiograph used for?

Answer 19

Pre-op vasculature eval. Renal angiography can show you stenosis, but not used that often because other things are available

Question 20

What is a cystourethrogram used to evaluate?

Answer 20

vesicoureteral reflux up into the urine from the bladder, also can be used to evaluate voiding

Question 21

What is the indication for a cystoscopy?

Answer 21

To assess bladder and ureteral involvement due to malignancies

Question 22

How is a prostate ultrasound and biopsy performed?

Answer 22

transrectally

Question 23

What stage of CKD is associated with a GFR less than 15?

Answer 23

5, renal failure

Question 24

What stage of CKD is associated with GFR of 15-29?

Answer 24

4, severe GFR decrease

Question 25

What stage of CKD is associated with GFR of 30-59?

Answer 25

3, moderate GFR decrease

Question 26

What stage of CKD is associated with GFR of 60-89?

Answer 26

2

Question 27

What stage of CKD is associated with GFR of 90-119?

Answer 27

1

Question 28

If you have a decreased GFR, what are some tests that might tell you the cause?

Answer 28

ANA, ANCA, anti-glomerular basement membrane AB, Hep B&C antibodies, antistreptolysin O RF, complement, or SPEP

Question 29

When are urinary eosinophils seen most often?

Answer 29

in acute interstitial nephritis

Question 30

What urine test do you perform if you suspect multiple myeloma?

Answer 30

urine immunoelectrophoresis

Question 31

What is the test of choice for nephrolithiasis?

Answer 31

Non-contrast CT

Question 32

You see bilateral hypodense streaks on a non-contrast CT. What do you suspect?

Answer 32

bilateral pyelonephritis

Question 33

What test would you do to follow up with a renal doppler ultrasound to evaluate vascular disease?

Answer 33

CTA

Question 34

When is MRI gadolinium contraindicated?

Answer 34

in stage 4 chronic renal failure and any type of acute renal failure

Question 35

What should you suspect if you see a "string of pearls" on renal angiography?

Answer 35

fibromuscular dysplasia

Question 36

What is used to evaluate renal mass, nephrotic syndrome, acute nephritic syndrome, any unexplained acute renal failure, and transplant rejection eval?

Answer 36

Renal biopsy +/- U/S

Question 37

What are three main indications for using a cystoscopy?

Answer 37

To assess bladder and renal involvement due to malignancies, to diagnose intrinsic bladder disease, to evaluate urogynecological conditions

Question 38

What is a testicular u/s used for?

Answer 38

testicular torsion dx

Question 39

What is a TRUS? When is it indicated?

Answer 39

transrectal ultrasound; to detect prostate cancer in pts with high PSA