Urology and Renal

Question 1

What pH is considered acidodic

Answer 1

< 7.35

Question 2

what pH is considered alkalotic

Answer 2

> 7.45

Question 3

if there is a elevated CO2 levels and decreased pH level what type of acid/based disorder is this?

Answer 3

respiratory acidosis

Question 4

if there is a decreased CO2 levels and increased pH level what type of acid/based disorder is this?

Answer 4

respiratory alkalosis

Question 5

if there is a decreased HCO3 and pH level, what type of acid/based disorder is this?

Answer 5

metabolic alkalosis

Question 6

if a patient has an elevated HCO3 and pH level, what type of acid/based disorder is this?

Answer 6

metabolic alkalosis

Question 7

a 78-year-old woman, G5P5, who presents to establish care. She is healthy and denies any additional problems. However, when specifically asked, she admits to having urinary incontinence for several years and reports that symptoms have recently worsened. The patient experiences the need to void almost hourly and she now uses four to five adult incontinence pads per day to manage the urine she leaks. She has had occasional accidents while asleep at night as well. She denies leaking urine with coughing or sneezing.
what is the likely diagnosis?

Answer 7

urge incontinence

Question 8

what are the diagnostic tests for urge incontinence

Answer 8

urodynamic testing

Question 9

what is the treatment of urge incontinence

Answer 9

Bladder-training exercises
can due anticholinergics (oxybutynin) and TCAs (imipramine)

Question 10

what is stress incontience

Answer 10

weakness of pelvic floor - urine leakage due to abrupt increases in intra-abdominal pressure (ex. with coughing, sneezing, laughing, bending or lifting)

Question 11

a 68-year-old woman who presents to your office with leakage of urine when she sneezes, laughs, or coughs. She reports that these symptoms strictly occur during the day and never at night. She denies any subjective fever, dysuria, or hematuria. Pelvic examination is notable for a protrusion from the anterior vagina.
what is the likely diagnosis?

Answer 11

Stress incontinence

Question 12

what is the treatment of stress incontinence

Answer 12

kegel exercises to strengthen pelvic floor musculature
vaginal estrogens
pessary
surgery is an option for mid-urethral sling

Question 13

what is overflow incontience

Answer 13

impaired detrusor contractility - occurs when urinary retention leads to bladder distrention and overflow of urine through urethra

Question 14

a 67-year-old man comes to the clinic because of urinary incontinence with the frequent loss of small amounts of urine for the past 2 weeks. He describes having difficulty initiating urination or telling when or if his bladder is full or empty. He denies frequency, urgency, or bowel dysfunction. Past medical history is significant for stroke 1 year ago in addition to hypertension and coronary artery disease. Past surgical history is significant for lower back surgery one month ago after a car accident. Physical examination shows decreased sphincter tone and 110 ml of post-void residual urine. Diagnostic tests show normal bladder capacity, no sign of infection, normal prostate-specific antigen levels, and normal creatinine.
what is the likely diagnosis?

Answer 14

overflow incontinence

Question 15

how is overflow incontience diagnosed?

Answer 15

urodynamic testing
elevated postvoid residual volume

Question 16

what is the best management of overflow incontinence

Answer 16

intermittent self-catheterization

Question 17

what are other medical management options for stress incontinence

Answer 17

cholinergic agents (bethanechol) to increase bladder contractions
alpha blockers (terazosin, doxazosin) to decrease sphincter resistance

Question 18

a 38-year-old military veteran who served three tours in Afghanistan presents to your clinic complaining of urinary incontinence. He was injured during his last tour of duty when he stepped on an improvised explosive device and lost the bottom of both of his legs. He ambulates much of the time in a wheelchair. He lives alone with little assistance. He reports a history of hypertension and was recently prescribed lisinopril + hydrochlorothiazide. He denies tobacco and alcohol use but drinks about 4-5 cups of coffee per day. He has a normal exam with a normal urinalysis and normal prostate-specific antigen.
What is the likely diagnosis?

Answer 18

functional incontinence

Question 19

what is the treatment for functional incontinence

Answer 19

scheduled voiding times and removal of precipitating factors

Question 20

what is the number one cause of renal vascular disease

Answer 20

diabetic kidney disease

other causes: HTN, Smoking, Vascular disease aka rental artery stenosis, glomerular disease, renal cyst, genetics

Question 21

what is Azotemia

Answer 21

elevated BUN concentration

Question 22

what are causes of prerenal injury

Answer 22

due to decreased blood flow to the kidneys
- Hypovolemia
- NSAIDs, IV contrast, ACEi and ARBs
-

Question 23

what is the treatment of prerenal injury

Answer 23

IV fluids will help improve creatine

Question 24

what are causes of intrinsic kidney injury

Answer 24

Nephrotoxic drugs = aminoglycosides (gentamicin)
cyclosporine
Tumor lysis syndrome
Vasculitis (SLE, sarcoidosis)
crystsals from gout
Myoglobin from rhabdomyolysis

Question 25

what is the hallmark sign of intrinsic kidney injury

Answer 25

WBC casts

Question 26

what is the treatment of intrinsic kidney injury

Answer 26

IV fluids remove drugs if present and somteimes lasix to get the kidneys moving

Question 27

what are causes of postrenal kidney injury

Answer 27

kidney stones BPH, tumors congential/structural abnormalities

Question 28

what are RC casts indicative of

Answer 28

glomerulonephritis

Question 29

what are WBC casts indicative of

Answer 29

pyelonephritis

Question 30

what are Muddy casts indicative of

Answer 30

ATN

Question 31

what are hyaline casts indicative of

Answer 31

normal kidneys

Question 32

what are waxy casts indicative of

Answer 32

chronic renal disease

Question 33

what is interstitial nephritis

Answer 33

immune mediated response can be causes by PCN, Sulfa, NSAIDs and phenytoin

Question 34

a 31-year-old man with right flank pain radiating into the scrotum, gross hematuria, right-sided hydronephrosis, and normal abdominal x-ray what is the likely diagnosis?

Answer 34

nephrolithiasis

Question 35

a 34-year-old woman with a 3-day history of hematuria, dysuria, increased urinary frequency, and nocturia. She has had no fever, chills, or back pain. On examination, she does not look ill. Her temperature is 37.5 ° C. Her abdomen is nontender. There is no CVA tenderness. what is the most likely diagnosis?

Answer 35

Cystitis

Question 36

what is the most common pathogen associated with cystitis

Answer 36

E/coli

Question 37

what is the treatment of uncomplicated cystitis

Answer 37

short term abx: Bactrim or nitrofurantoin 3-5 days

Question 38

a 31-year-old male complaining of unilateral scrotal swelling with pain radiating to the ipsilateral groin. Examination reveals a tender swollen testicle, scrotal edema with erythema and shininess of the overlying skin. what is the most likely diagnosis?

Answer 38

Orchitis

Question 39

what is the treatment of orchitis

Answer 39

if mumps is the cause, treat mumps (+ ice/analgesia) if bacteria: treat like epididymitis

Question 40

what is the presentation of cystitis

Answer 40

dysuria, urgency, frequency, hematuria with no fever, chills, flank pian

Question 41

what is the gold standard diagnostic test for cystitis

Answer 41

urine culture

Question 42

what is the presentation of pyelonephritis

Answer 42

dysuria + fever + flank pain + nausea and vomiting + CVA tenderness + white casts on UA

Question 43

what is Prehn's sign

Answer 43

relief of scrotal pain with elevation classic sign of epididymitis

Question 44

what is the treatment of epididymitis

Answer 44

FQ/Doxycyline + ceftriaxone

Question 45

what is the presentation of prostatitis

Answer 45

sudden onset fever, chills and low back pain combined with urinary frequency, urgency and dysuria

Question 46

a 63-year-old man with a history of benign prostatic hyperplasia reports 3-days of fever, chills, and pain with urination. He was recently catheterized during admission to the hospital. Physical exam reveals a tender and enlarged prostate on digital rectal exam. Urinalysis reveals pyuria and hematuria. what is the most likely diagnosis?

Answer 46

prostatitis

Question 47

a 25-year-old male with a dull, achy scrotal pain that has been gradually increasing over the last several days. He also reports pain with urination. Physical exam reveals a swollen right testicle with substantial induration. Urinalysis reveals positive leukocyte esterase and 20 WBC/HPF. What is the most likely diagnosis

Answer 47

epididymitis

Question 48

a 32-year-old female presents with fever, chills, nausea and flank pain for 24 hours. She developed dysuria and urinary frequency 3 days prior and states that both have worsened. On physical exam, you note suprapubic abdominal pain and CVA tenderness. The urinalysis reveals white blood cell casts. What is the most likely diagnosis?

Answer 48

pyelonephritis

Question 49

what is the most common pathogen associated with pyelonephritis

Answer 49

e. coli

Question 50

what is the outpatient treatment for pyelonephritis

Answer 50

FQ (cipro/levaquin)/ bactrim for 1-2 weeks

Question 51

what is the most common cause of renal failure

Answer 51

hyperphosphatemia

Question 52

what is the treatment of hyperphosphetemia

Answer 52

IV hydration and acetazolamide

Question 53

what are causes of hypophosphatemia

Answer 53

hyperparathyroidism alcoholism burns starvation CKD diuretics

Question 54

what is the presentation of hypophosphatemia

Answer 54

anorexia and muscle weakness Heart failure seizure and coma osteomalacia

Question 55

what is the most common cause of hypocalcemia

Answer 55

hypoparathyroidism

Question 56

what is Trousseau's sign

Answer 56

flexion of wrist, thumbs and metacarpophalyngeal joints and exntesion of tingers with BP

Question 57

what is chvostek's sign

Answer 57

abdomral twitching of muscles that are activated by the facial nerve - facial nerve is tapped in front of ear and fasical muslce on the same side will contract

Question 58

what is the presentation of hypercalcemia

Answer 58

"stones, bones, abdominal groans, psychiatric moans

Question 59

what is the presentation of hyperkalemia on EKG

Answer 59

peaked T-waves

Question 60

what is the diagnostic test for diabetes insipidus

Answer 60

fluid deprivation test

Question 61

what is the treatment for diabetes insipidus

Answer 61

desmopressin (DDAVP) can treat central - non kidney related

Question 62

what is SIADH

Answer 62

increased antidiretic hormone (ADH) from the pituitary gland that makes the kidneys retain water

Question 63

what is glomerulonephritis

Answer 63

damage of renal glomeruli by deposition of inflammatory proteins in glomerular membranes as a result of immunologic response

Question 64

what is the treatment of glomerulonephritis

Answer 64

steroids and immunosuppressive drugs to control inflammatory response dietary management (satl and fluid intake decreased) disalysis if symptomatic azotemia present

Question 65

a 15-year-old boy with severe lower abdominal pain that awoke him from sleep about 3 hours ago. The pain is sharp and radiates to the right thigh. While in the emergency room, the patient experiences one episode of vomiting. He denies any fever, dysuria, or chills. The mom reports a childhood history of cryptorchidism. Physical examination reveals normal vitals with a blood pressure of 100/60 and a temperature of 98.6F. Abdominal examination is relatively benign. Scrotal examination reveals an elevated right testis that is diffusely tender. Lifting of the right testicle DOES NOT relieve pain, and there is a loss of a cremasteric reflex. The transillumination test is negative. what is the most likely diagnosis

Answer 65

testicular torsions

Question 66

what is the gold standard diagnostic test for testicular torsion

Answer 66

radionuclide study

Question 67

a 22-year-old heterosexual male who recently started having unprotected intercourse with his new girlfriend. He now reports a painful itching and burning sensation with urination and discomfort in the urethra. He says that sometimes in the morning it appears that the walls of the meatus are stuck together with evidence of dried secretions. On exam, there is no purulent discharge. The meatus does appear red. His girlfriend does not have any symptoms. what is the likely diagnosis

Answer 67

urethritis

Question 68

how is urethritis diagnosed?

Answer 68

first-void or first-catch urine and somteimes urine culture

Question 69

a 20-year-old male presents with a swelling in his right groin that has been increasing in size over the past six months. He notes that the bulge is more noticeable when standing and disappears when lying down. It is not painful but causes discomfort during physical activities. On examination, a soft mass is palpable in the right inguinal canal and extends into the scrotum what is the likely diagnosis

Answer 69

indirect inguinal hernia