Renal System

Question 1

MS patients have which type of urinary incontinence? What is the mechanism?

Answer 1

Urge incontinence.

Lesions above the sacral region of the spinal cord results in a loss of higher center control of micturition. Causes detrusor muscle hyperreflexia (“spastic bladder”)

Question 2

What is Potter Sequence?

Answer 2

P = pulmonary hypoplasia
O = oligohydramnios - stimulus
T = twisted skin (wrinkled)
T = twisted face (Potter facies/flat facies)
E = extremities defects (club foot)
R = renal agenesis, bilateral

Question 3

Cause/inciting factor for Potter Sequence?

Answer 3

Renal anomalies -> oligohydramnios -> POTTER

Question 4

Pipestem fibrosis (periportal fibrosis) + patient swam in a freshwater lake recently =

Answer 4

Hepatic schistosomiasis - S. japonicum, S. mansoni

Question 5

Blood supply of proximal, middle and distal ureter

Answer 5

Proximal = renal artery 
Middle = multiple anastamoses 
Distal = superior vesicle artery

Question 6

Which type of urinary incontinence is common in type 1 DM patients? What is the mechanism?

Answer 6

Overflow incontinence

Diabetic autonomic neuropathy -> decreased innervation of the detrusor muscle results in impaired contraction

Question 7

Chronic kidney hypoperfusion results in hyperplasia and hypertrophy of which cells?

Answer 7

Juxtaglomerular cells = modified smooth muscle cells that are part of the afferent arteriole

Question 8

Non-lactose fermenting cause of UTI?

Answer 8

Pseudomonas aeruginosa

Question 9

“Lumpy-bumpy” deposits + tea colored urine + periorbital edema =

Answer 9

Post-streptococcal glomerulonephritis

Question 10

What are the Post-Streptococcal glomerulonephritis deposits made of and where are they located?

Answer 10

IgG, IgM, C3

subepithelial deposits

Question 11

Kimmelsteil Wilson nodules =

Nephrotic vs Nephritic

Answer 11

Diabetic nephropathy

Nephrotic

Question 12

What is the first thing you should think of if someone has been taking naproxen for 3+ month daily?

Answer 12

Chronic interstitial necrosis (drug-induced)

Question 13

Dysuria definition

Answer 13

painful urination

Question 14

Which structure blocks the ascent of the kidneys in a horseshoe malformation?

Answer 14

Inferior mesenteric artery (L3)

Question 15

Clearance of which substance is used to calculate RBF and RPF?

Answer 15

PAH

Question 16

Clearance of which substances is used to calculate GFR?

Answer 16

• inulin

- creatine

Question 17

Female + glomerulonephritis + photosensitive skin rash+ arthalgias + reproductive age =

Answer 17

Systemic Lupus Erythematosus

Question 18

Female + arthralgias + african american + prolonged PTT + 2 spontaneous abortions + positive PRP test + negative Treponema pallidum immunoassay =

Answer 18

Antiphospholipid antibody syndrome

Question 19

2 causes of sterile pyuria =

Answer 19

• acute pyelonephritis - rare

- non-gonococcal urethritis + cystitis - Chlamydia or Ureaplasma

Question 20

Toddler’s painless GI bleeding =

Answer 20

Meckel’s diverticulum = failure of obliteration of the vitelline/omphalomesenteric duct

Question 21

Failure of abdominal wall closure, viscera not covered with peritoneum =

Answer 21

Gastroschisis

Question 22

internal urethral sphincter

• contraction
• relaxation

Answer 22

contraction = sympathetic
relaxation = parasympathetic

Question 23

Thyroidization of the kidney =

Answer 23

chronic pyelonephritis

Question 24

Crescent shaped proliferation within the glomerulus =

What are they made of?

Answer 24

Rapidly Progressive Glomerulonephritis

Crescents made of fibrin + plasma proteins (C3b)

Question 25

Wire looping of capillaries =

Answer 25

Diffuse Proliferative Glomerulonephritis

Question 26

Tramtracks on PAS stain + subendothelial deposits =

Answer 26

Membranoproliferative glomerulonephritis Type 1

Question 27

Pathology of Membranoproliferative glomerulonephritis Type 2 =

Answer 27

C3 convertase stabilization -> decreased levels of active C3 -> less inflammation

Question 28

Crescent glomeruli + sinusitis + lung involvement + negative IF stain =

Answer 28

Granulomatosis with polyangitis (Wegner's) -> Rapidly progressive glomerulonephritis

Question 29

Negative IF stain + proteinuria = 5 + child =

Answer 29

Minimal Change Disease

Question 30

Which phase of ATN is this? oliguric - hyperkalemia, metabolic acidosis, increased ECF volume, hyponatremia, hypocalcemia

Answer 30

``` Maintenance phase (2nd) ```

Question 31

Which phase of ATN is this? polyuric - hypokalemia

Answer 31

Recovery phase | 3rd

Question 32

How to differentiate between causes of metabolic alkalosis?

Answer 32

- Urine Cl | - Volume status

Question 33

Obliteration of what neonatal structure leads to the adult medial umbilical ligament?

Answer 33

Umbilical artery

Question 34

Obliteration of the urachus leads to what adult structure?

Answer 34

Median umbilical ligament

Question 35

Stones that form in basic urine (high pH)

Answer 35

- Calcium phosphate | - Ammonium magnesium phosphate (struvite)

Question 36

Stones that form in acidic urine (low pH)

Answer 36

- Calcium oxalate - Uric acid - Cystine

Question 37

IL-2's anti-tumor effects are due to the action of

Answer 37

IL-2 stimulates T cells and NK cells to mature and proliferate (also stimulates B cells and monocytes) NK cells and T cells help fight off tumor cells (malignant melanoma and renal cell carcinoma)

Question 38

proximal tubular cell ballooning + vacuolar degeneration + flattening of tubular epithelial cells + FENa >2% (increased)

Answer 38

Acute Tubular Necrosis

Question 39

medullary cysts lined with cuboidal or urothelial epithelium + cystic dilation of collecting ducts

Answer 39

Medullary Sponge Kidney

Question 40

Deficiency of neutral AA transporters in the PCT and enterocytes

Answer 40

Hartnup disease (AR) Can lead to a niacin deficiency (due to lack of tryptophan absorption) -> Pellagra

Question 41

Differences in presentation between post-streptococcal GN and Berger disease

Answer 41

Post-streptococcal GN = 2 weeks post-pharyngitis, mostly occurs in children Berger disease = 5 days post-URI, recurrent

Question 42

Henoch-Schonlein purpura is what type of hypersensitivity?

Answer 42

Type III - IgA immune complex deposition in small vessels

Question 43

deaf + hematuria + progressive renal failure + Xlinked Recessive

Answer 43

Alport syndrome = mutation in type IV collagen

Question 44

Most common cause of nephropathy in HIV+ patients

Answer 44

Focal segmental glomerulosclerosis | -HIV patients have a collapsing variant

Question 45

Beckwith-Wiedmann Syndrome

Answer 45

- Wilms tumor - Macroglossia - Organomegaly - Hemihypertrophy mutation in WT2

Question 46

WAGR complex

Answer 46

- Wilms tumor - Aniridia - Genitourinary malformations - mental Retardation deletion of WT1

Question 47

Papillary necrosis causes (4)

Answer 47

- Sickle cell disease or trait - Acute pyelonephritis - NSAIDs - Diabetes mellitus

Question 48

Cause of stress incontinence

Answer 48

- urethral sphincter dysfunction | - loss of urethral support