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Flashcards in Renal / GU Deck (113):
1

What is the likely diagnosis in a boy who participates in vigorous sports who has dark urine and 1-2 RBC on urinalysis ?

Myoglobinuria

2

What should you do in a patient who presents with isolated asymptomatic microscopic hematuria?

Repeat UA in 2 weeks

3

What 2 things should be checked in a patient with persistent microscopic hematuria?

blood pressure and calcium/creatinine ratio

4

What is an abnormal calcium/creatinine ratio?

Greater than 0.25

5

What lab and imaging studies should be ordered in a patient with persistent microscopic hematuria and normal calcium/creatinine ratio? (7 answers)

Bun/creatinine
Electrolytes
C3/C4
ANA
ASO
ANCA
Renal/bladder US

6

What could be the cause of hematuria in a patient on LASIX?

Hypercalciuria

7

What is the next step in a patient with elevated calcium/creatinine ratio? What result would be diagnostic?

24 hour collection
>4 mg/day confirms hypercalciuria

8

What diagnosis should you consider in a one day old patient who presents with palpable flank mass and unilateral mass on ultrasound?

UPJ obstruction

9

What diagnosis should you consider in a patient with microscopic hematuria after a MVA? How would this present on imaging?

UPJ obstruction
Hydronephrosis

10

How do you confirm UPJ obstruction? What's the next test after the diagnosis is confirmed?

Renal scan shows delayed excretion

Vcug should be done to look for reflux in other kidney

11

When should cystoscopy be performed in a child with hematuria ?

Never - only indicated in adults

12

What are the common causes of gross hematuria in children? (9 answers)

H (HSP or hereditary nephritis)
E (bEnign familial)
M (membranoproliferative)
A (Alport or IgA nephropathy)
T (trauma)
U (UPJ obstruction)
R (renal stones)
I (infectious - strep)
A (abnormal sickle cells)

13

What diagnosis would you consider in a patient with painless tea colored urine?

Glomerulonephritis

14

What is the next step in a patient with isolated proteinuria that resolves on first void urine?

3 month follow up

15

What is the appropriate next step in a patient with isolated proteinuria even on first morning void? What finding would be considered abnormal?

Protein creatinine ratio (renal disease suggested if ratio >0.2)

16

What are 3 common causes of benign transient proteinuria?

Fever
Exercise
dehydration

17

What is the inheritance of Alport syndrome?

X linked dominant

18

What diagnosis should you consider in a patient with bilateral sensorineural hearing loss, ocular defects and renal failure ?

Alport syndrome

19

What is the likely diagnosis in a patient with a unilateral flank mass who has oligohydramnios in utero?

Multicystic dysplastic kidney

20

What is the gross pathology of a multicystic dysplastic kidney?

Enlarged kidney with non communicating cysts with thin parenchyma and dysplasia

21

What are other urinary tract anomalies that occur in 50% of patients with unilateral multicystic dysplastic kidney disease ? (4 answers)

UPJ obstruction
Vesicoureteral reflux
Posterior urethral valves
Megaureter and duplication

22

What is the best initial study to diagnose multicystic dysplastic kidney?

Renal ultrasound

23

What is the next best step in a patient with confirmed multicystic dysplastic kidney disease ?

Vcug to rule out other urinary tract anomalies

24

What diagnosis should you consider in a patient with kidney mass, palpable liver, thrombocytopenia and hematemesis?

Multicystic dysplastic kidney or autosomal recessive polycystic kidney disease
and resulting portal hypertension

25

What diagnosis should you consider in an infant with bilateral flank masses and hx of oligohydramnios ?

Autosomal recessive polycystic kidney disease

26

What other malformation is associated with autosomal dominant (adult) polycystic kidney disease?

Intracranial aneurysm

27

What diagnosis presents with polyuria, enuresis and low specific gravity as well as short stature, anemia and eye problems?

Juvenile onset medullary cystic disease aka nephronopththisis

28

What eye problem is associated with nephronophthisis?

Retinitis pigmentosa

29

What diagnosis presents with dysuria, hematuria and abdominal pain as well as a mass from the urethral meatus?

Ureterocele

30

What is the appropriate management for grade 1 and 2 vesicoureteral reflux?

Periodic cultures

31

What is the appropriate management for grade 3 VUR?

Prophylactic antibiotics

32

What is the appropriate management for grade 4 and 5 VUR?

Surgery

33

What is the most common cause of urinary retention in females?

Ureterocele

34

What is the likely diagnosis in a male with urinary symptoms after recent surgical procedure?

Urethral stricture secondary to catheter placement

35

What diagnosis presents in a male newborn with palpable bladder and weak urinary stream?

Posterior urethral valves

36

What is the treatment for posterior urethral valves?

Immediate urological consult for surgery

37

What is the most appropriate step in an infant with palpable bladder and no urinary output?

Catheter

38

How does posterior urethral valves typically present in females?

It only occurs in males

39

What is the prognosis of posterior urethral valves after surgical correction ?

ESRD within 5 years

40

What is the most common viral cause of UTi?

Adenovirus

41

When is an ultrasound indicated after a UTI? (3 answers)

Symptoms of pyelonephritis
Male gender
Newborns

42

What syndrome presents with soft abdominal musculature, bilateral undescended testicles and distended bladder?

Prune belly (eagle Barrett) syndrome

43

Why are children with prune belly syndrome prone to chronic UTI, distended bladder and dilated ureter ?

Posterior urethral valves

44

What is the appropriate empiric antibiotic in suspected acute pyelonephritis ? (2 options)

Bactrim or 3rd generation cephalosporin

45

What are the 3 main findings in nephrotic syndrome ?

Hypoproteinemia
Proteinuria
Edema

46

What are 6 common laboratory abnormalities found in patients with nephrotic syndrome?

High LDL
High factor 5 & 7 (hypercoagulability)
Decreased immunoglobulins
Low albumin
Hypocalcemia
Low thyroid function

47

What are 3 important complications of nephrotic syndrome?

Hyponatremia
Thrombosis
Peritonitis

48

What should you suspect in a patient with nephrotic syndrome who develops abdominal pain, hematuria and decreased urine output?

Vascular thrombosis

49

What is the best next step in a patient with new onset nephrotic syndrome who does not respond to steroids?

Renal biopsy

50

Which 3 causes of glomerulonephritis present with low complement levels?

Post streptococcal
Membranoproliferative
Lupus

51

What are the 4 main symptoms of glomerulonephritis ?

Hematuria
Azotemia (high BuN)
Proteinuria
Oliguria

52

Which causes of glomerulonephritis present with normal complement levels? (5 answers)

HSP
Idiopathic vasculitis
Rapidly progressive GN
IgA nephropathy
Focal segmental glomerulosclerosis

53

What diagnosis should you consider in a patient who presents with hypertension, edema and hematuria?

Post strep glomerulonephritis

54

What's the difference in complement levels between post strep glomerulonephritis and lupus nephritis?

Post strep only causes low complement levels for 2 months but in lupus (and membranoproliferative GN) low c3 levels are sustained

55

In a patient with IgA nephropathy, What correlates with worsening disease?

Persistent proteinuria

56

What diagnosis presents with painless hematuria several days after URI?

IgA nephropathy (Berger disease)

57

What is the difference in the fractional excretion of sodium when differentiating pre-renal vs renal causes of acute renal failure ?

FeNa is low in pre-renal causes
FeNa is high in renal causes

58

What are options for management of hyperkalemia in patients with acute renal failure ? (3 answers)

Calcium gluconate
Insulin & glucose
Sodium polystyrene sulfonate

59

What type of infant formula should be used if an infant has acute renal failure ?

Formula that is low in phosphorus

60

When is erythropoietin indicated in patients with chronic renal failure?

When hgb <8

61

Why do patients with chronic renal failure develop metabolic acidosis? (3 answers)

Bicarb loss
Decreased production of bicarb
Decreased acid excretion

62

What happens to calcium and phosphate in chronic kidney disease and why?

1,25 dihydroxyvitamin D3 decreases -- decreased calcium absorption -- high PTH but phosphate levels can't be excreted -- high phosphate suppresses calcitriol -- decreased absorption of Ca

63

What is the GFR in stages 4 and 5 of kidney failure?

Stage 4 = GFR 15-29
Stage 5 = GFR <15 or dialysis

64

What is the GFR in stages 1 and 2 of kidney failure?

Stage 1 = high GFR > 90
Stage 2 = GFR 60-89

65

What diagnosis should you consider in a patient who presents with pallor, decreased urinary output and bruising ?

HUS

66

What happens to serum complement levels in patients with HUS?

They are normal

67

What is the definition of hypertension ?

BP >95th%ile for age and sex on 3 separate occasions

68

What 4 classes of medications can cause HTN ?

Albuterol
Contraception
Corticosteroids
Decongestants

69

What might be the cause of HTN in a patient who also complains of muscle cramps and weakness ?

Hyperaldosteronism - causes hypokalemia and HTN

70

What may be the cause of HTN in a patient with elfin facies, high calcium and friendly personality?

Supra valvular aortic stenosis (in patient with William syndrome )

71

What is the treatment for pheochromocytoma?

Alpha blocker (phenoxybenzamine) then surgical correction

72

What diagnosis should you consider in a short obese patient with HTN?

Cushing syndrome

73

What medication is contraindicated in patients with pheochromocytoma and why?

Beta blockers - leads to unopposed alpha effects and increased BP

74

What is the equation for determination of bladder capacity?

Age + 2

75

What are 4 common classes of nephrotoxic medications ?

Aminoglycosides
Cyclosporine
Tacrolimus
Chemotherapeutics

76

What is the difference between an incarcerated inguinal hernia and inguinal lymphadenitis?

Both present with painful inguinal mass but lymphadenitis should be red and warm to the touch with distal site of infection

77

When is estrogen cream indicated for labial adhesions?

Pain or bacterial infections

78

How can you differentiate imperforate hymen from tubo-ovarian abscess?

Both present with intermittent abdominal pain but only an imperforate hymen has a palpable midline mass

79

What is the most appropriate step in a patient with symptoms of imperforate hymen?

Physical exam of genitalia

80

What are 4 non sexually transmitted causes of vulvovaginitis?

Pinworms
Group A strep
Staph
Candida

81

What is a soft skin colored vaginal mass that presents with vaginal discharge?

Bartholin gland cyst

82

What is the appropriate treatment in a male with Undescended testicle?

Orchiopexy by age 1

83

What is the risk of malignancy in a patient with in descended testicle?

High risk despite orchiopexy - the opposite descended testicle also has high malignancy risk

84

What is the appropriate next step in a patient who was documented to have bilateral descended testicles who you now notice has one testicle that is Undescended?

Examine in frog leg position to help bring down the retractile testicle

85

What are 4 syndromes associated with hypospadias?

Russell silver syndrome
Laurence moon biedl syndrome
Opitz syndrome
Beckwith wiedemann syndrome

86

What is appropriate management of hypospadias in a newborn?

Surgical correction at 6 months

87

What is the incidence of renal anomalies with a distal hypospadias?

Low - no intervention is needed

88

What syndrome presents with micropenis, poor feeding and hypotonia?

Prader Willi

89

What syndrome is associated with micropenis, hypoglycemia, anosmia and Septo-optic dysplasia?

Kallmann syndrome

90

At what newborn penile length should an endocrine / genetic workup be performed?

Length <2.5 cm

91

What diagnosis presents with unilateral testicular pain and fever but no testicular mass?

Epididymitis

92

What is the difference between Orchitis and epididymitis?

Orchitis does not present with dysuria

93

What diagnosis should you consider in a child with recent immigration to the US and testicular pain and fever without dysuria?

Mumps

94

How can you determine the difference between epididymitis and testicular torsion on physical exam?

Torsion has loss of cremasteric reflex and testicle is high
In epididymitis, the testicle is low lying and reflex is still illicited

95

What is appropriate treatment of epididymitis in teenagers?

IM rocephin and PO doxycycline

96

When is phimosis considered clinically significant ?

In children >4 y/o

97

What is likely cause of tiny white bumps on the tip of the penis in a 4y/o male?

Inclusion cysts

98

What is the definition of balanitis?

Inflammation of the glans penis

99

What is the likely diagnosis in a male with penile pain and culture that reveals gram negative diplococci?

Gonorrhea

100

What diagnosis should you consider in a sexually active male with dysuria and conjunctivitis but negative gram stain?

Chlamydia causing Rieter syndrome (autoimmune response to chlamydia causing urethritis, conjunctivitis and arthritis)

101

What imaging and lab studies should be done in a patient with testicular mass? (4 answers)

Bilateral US
LDH
B-HCG
Alpha fetoprotein

102

What are 4 major risk factors for testicular Cancer?

Cryptorchidism
Previous testicular cancer
Family hx
Klinefelter syndrome

103

What is the cause of condyloma acuminata and how would you treat?

HPV - vaccinate

104

What diagnosis should you consider in a patient with whitish gray papules in the genital area that coalesce and typically present with fever?

Condyloma Lata (secondary syphilis)

105

What is the treatment in a patient with vulvovaginitis who has no signs of abuse, trauma or pinworms?

Sitz bath & reassurance

106

Up until what age can a patient present with congenital condyloma acuminata?

Age 3

107

What is the best diagnostic test to do when suspecting HSV?

Viral culture for herpes

108

What is the appropriate treatment for a patient with red crusted suprapubic macules and blue-gray dots?

Permethrin or malathion (for treatment for "crabs")

109

What diagnosis should you consider in a female with sudden lower abdominal pain with radiation to the back, nausea and vomiting? How would you confirm diagnosis?

Ovarian torsion
Doppler US

110

What is the appropriate treatment for a teenager with left sided abdominal pain and US showing 5 cm ovarian cyst?

Follow up US for all cysts smaller than 6 cm

111

What is the appropriate management for an ovarian cyst that is 7 cm and causing significant pain?

Laparoscopic cyst aspiration

112

What diagnosis should you consider in a female teenager with RUQ pain and vomiting who takes OCPs?

Fitz Hugh Curtis / perihepatitis

113

What is the definition of hematuria?

3 or more RBC per high power field