Renal/GU

Question 1

Rate of correction of chronic hyponatremia and hypernatreima and consequence

Answer 1

Hypernatremia correction-> cerebral edema
Hyponatremia correction-> central pontine myelinolysis
0.5meq/L

Question 2

Presents with thirst, neuro sx, doughy skin

Answer 2

hypernatremia

Question 3

presents with confusion, lethargy, muscle cramp, hyporeflexia, nausea

Answer 3

hyponatremia

Question 4

presents with n/v, intestinal colic, areflexia, weakness, flaccid paralsis, arrythmia paresthesia

Answer 4

hyperkalemia

Question 5

presents with fatigue, muscle weaknes, ileus, hypotension, yporeflexia, rhabdo, asc paralysis

Answer 5

hypokalemia

Question 6

EKG for hypokalemia

Answer 6

T wave flattening, U waves, ST-segm depr

Question 7

treatment hypercalcemia

Answer 7

IV hydration + furosemide, avoid thiazide diuretics

Question 8

Type I vs II vs IV RTA: Defect, K+, urine pH, tx

Answer 8

Type I: H+ secr (distal), urine ph >5.3, replace HCO3
Type II: HCO3 reabs (proximal), urine ph 5.3 initially, thiazides and volume depletion
Type IV: aldost def (distal), high K, urine ph

Question 9

indications of pre renal AKI (FeNa, UNa, Spec grav, BUN/Cr)

Answer 9

FeNa 1.02, BUN/Cr >20

Question 10

Consequences of AKI

Answer 10

metabolic acidosis, hyperkalemia–> arrythmia

HTN, volume overload

Question 11

Definition CKD (time and GFR); when symptomatic?

Answer 11

> 3mo, GFR

Question 12

Consequences and tx of CKD

Answer 12

Metabolic derangement: azotemia, metabolic acidosis, hyperkalemia, ACD, hypocalcemia, hyperphosphatemia, impaired coag
Tx: ACEi/ARB, DDAVP for abn bleeding, low fluid/Na/K/PO diet, PO4/calcitriol, EPO

Question 13

Nephritic syndrome: sx and workup

Answer 13

hematuria, mild proteinemia

Complement, ANA, ANCA, anti-GBM

Question 14

Ca levels loop vs thiazide diuretcs

Answer 14

Loop: decr Ca
Thiazide: Incr Ca

Question 15

Nephrotic syndrome: sx and workup

Answer 15

proteinuria (>3.5), edema, hypoalb, hyperlip

Question 16

Low serum C3, lumpy-bumpy immunofluorescence: dx and tx

Answer 16

PSGN, nephritic; supportive/diuretics

Question 17

microscopic hematuria following resp or GI infxn; normal C3: dx and tx

Answer 17

IgA nephropathy; Tx: glucocort, ACEIs

Question 18

cANCA+, segmental necrotizing glomerulonephritis: dx and tx

Answer 18

Wegener’s, high-dose corticosteroids, cytotoxic agents

Question 19

linear anti-GBM deposid, hemosiderin-filled macrophages in sputum

Answer 19

Good pasture

plastma exchange + steroids

Question 20

GBM splitting on EM: dx and tx

Answer 20

Alport’s, progresses to renal failure

Question 21

microscopic hematuria, bx shows sclerosis in capillary tufts; hx HIV/ IVDU: dx and tx

Answer 21

dx: FSGS
Tx: prednisone, cytotoxic, ACE/ARB

Question 22

renal bx: spike and dome appearance, HBV/ syphilis: tx and dx

Answer 22

dx: membranous nephropathy
tx: prednisone and cytotoxic

Question 23

thickened GBM and mesangial matrix: dx and tx

Answer 23

diabetic nephropathy
Type 1: ACEi
Type 2: ARB

Question 24

Mesangial prolif, subendothel/epithl IC deposition: dx and tx

Answer 24

lupus nephritis

prednisone and cytotoxic

Question 25

nodular glomerulosclerosis, apple-green birefringence with Congo red stain

Answer 25

renal amyloidosis | prednisone melphalan

Question 26

tram track appearance, hx of HCV, SLE, endocarditis

Answer 26

membranoproliferative nephropathy | corticosteroids and cytotoxic

Question 27

Stones: square shape, radio opaque: dx and tx

Answer 27

calcium oxalate/PO4 | hydration, Na, thiazide diuretic

Question 28

Stones: staghorn calculi, assoc with infxn, rectangle crystal, radioopaque

Answer 28

dx: struvite tx: treat infxn, surgical removal, hydration

Question 29

stones: diamond shape crystal , radiolucent, hx gout

Answer 29

uric acid crystal | hydration, alkalinize with citrate, purine restriction

Question 30

Stones: hexagon, radioopaque: dx, workup, tx

Answer 30

cystine +cyanide nitroprusside hydration, alk urine, pnicillamine

Question 31

When treat kidney stone?

Answer 31

>0.5cm

Question 32

Other sites of cyst in PKD

Answer 32

spleen, liver, pancreas

Question 33

male infant with distended, palpable bladder and low UOP

Answer 33

posterior urethral valves

Question 34

Recurrent UTIs in children: dx and tx

Answer 34

voiding cystourethrogram | daily prophylactic abx (amoxicillin for

Question 35

hydrocele vs varicocele: sx, tx

Answer 35

hydrocele: transluminaes, treat for hernia or >12-18mo varicocele: "bag of worms", may disappear when supine, does not transluminate, treat if symptomatic, varicocelectomy or ligation or embolization dx with ultrasound

Question 36

Painful scrotal swelling: dx if pain improves with scrotal elevation vs no

Answer 36

improves with elevation: epididymitis tx with abx (tetracyclines, flouroquinolones) Does not improve: testicular torsion: immediate surgery within 6hr, orchipexy of both testes to prevent torsion

Question 37

Tx options for BPH

Answer 37

terazosin, finasteride, TURP or open prostatectomy

Question 38

workup for prostate cancer

Answer 38

dx with ultrasound-guided transrectal bx | CXR and bone scan for mets (osteoblastic lesion)

Question 39

Dx and tx for bladder cancer

Answer 39

Dx: cystoscopy with bx, UA, cytology, MRI, CT, bone scan Tx: intravesicular chemo, complete transurethral resection, mitomycin C or BCG, radical cystectomy or radiotherapy

Question 40

workup and tx: testicular mas

Answer 40

Dx: testuclar ultrasound, CXR, tumor markers (Bhcg- choriocarcinoma, AFP- nonseminomatous GCT) Tx: radical orchiectomy, seminoma: radiosens, pt based chemo for seminomaotus GCT