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Front 1

72 yo man complains of increased urinary frequency causing him to wake up every two hours at night to urinate. He had these symptoms for past six months. He denies any burning or pain with urination but does have to strain more than usual to initiate his urinary stream. He has a history of hypertension but denies diabetes, heart disease, or stroke. His medications include one baby aspirin and lisinopril daily. He has a 25 pack year smoking history but denies alcohol or illicit drug use. He has no family history of cancer. Rectal examination shows smooth and firm enlargement of prostate. His serum creatinine level is 0.7. Most appropriate next step in evaluation?

Back 1

72 yo man complains of increased urinary frequency causing him to wake up every two hours at night to urinate. He had these symptoms for past six months. He denies any burning or pain with urination but does have to strain more than usual to initiate his urinary stream. He has a history of hypertension but denies diabetes, heart disease, or stroke. His medications include one baby aspirin and lisinopril daily. He has a 25 pack year smoking history but denies alcohol or illicit drug use. He has no family history of cancer. Rectal examination shows smooth and firm enlargement of prostate. His serum creatinine level is 0.7. Most appropriate next step in evaluation? --- Urinalysis. Evaluate probably benign prostatic hyperplasia based on history and rectal examination with a urinalysis and serum creatinine measurement to assess for urinary infection, obstruction, or hematuria. Pt with an elevated creatinine level or abnormal urinalysis warrant further investigation.

Front 2

What are lower urinary tract symptoms? Evaluation?

Back 2

What are lower urinary tract symptoms? Evaluation? --- Increased urinary frequency, nocturia, hesitancy, and a weak urinary stream. Lower urinary tract symptoms can be due to 1 Benign prostatic hyperplasia, or 2 Advanced prostate cancer. Rectal exam differentiate prostate cancer from BPH. Prostate nodules, induration, and asymmetry - malignancy. Smooth and firm enlargement of prostate - BPH. BPH - next step - Urinalysis and Serum creatinine - evaluate for hematuria (Bladder cancer and Kidney stones), Infection, or Obstruction. Abnormal urinalysis or elevated creatinine level - Ultrasound of kidneys or CT Abdomen for Bladder Outlet obstruction, Hydronephrosis, or Underlying renal disease.

Front 3

Contrast BPH and Prostate cancer.

Back 3

Contrast BPH and Prostate cancer. Lower urinary tract symptoms can be due to 1 Benign prostatic hyperplasia, or 2 Advanced prostate cancer. Rectal exam differentiate prostate cancer from BPH. Prostate nodules, induration, and asymmetry - malignancy. Smooth and firm enlargement of prostate - BPH.

Front 4

What Creatinine level is considered renal insufficiency?

Back 4

What Creatinine level is considered renal insufficiency? Creatinine Greater than 1.5 or Diabetes.

Front 5

Pt with creatinine 1.7, requires contrast CT scan. Next step?

Back 5

Pt with creatinine 1.7, requires contrast CT scan. Next step? --- Non-ionic contrast agents Decrease incidence of contrast-induced nephropathy compared to older ionic hyperosmolar agents. In addition to using Non-ionic contrast agents, adequate IV hydration and Acetylcysteine can Decrease the incidence of nephropathy.

Front 6

36 yo man complains of fatigue and generalized edema. Recently diagnosed with Hodgkin lymphoma. Serum sodium 145, serum potassium 3.8, serum albumin 2, serum globulin 4.6, total serum bilirubin 0.9, serum creatinine 1.2. Urinalysis shows proteinuria 4+. Glomerulopathies more likely to be present in this pt?

Back 6

36 yo man complains of fatigue and generalized edema. Recently diagnosed with Hodgkin lymphoma. Serum sodium 145, serum potassium 3.8, serum albumin 2, serum globulin 4.6, total serum bilirubin 0.9, serum creatinine 1.2. Urinalysis shows proteinuria 4+. Glomerulopathies more likely to be present in this pt? --- Minimal change disease. Membranous nephropathy is most common nephropathy asso with carcinoma. However, nephrotic syndrome is a well-known complication of Hodgkin lymphoma, and is usually caused by Minimal change disease.

Front 7

What nephrotic syndrome is Carcinoma? Hodgki Lymphoma?

Back 7

What nephrotic syndrome is Carcinoma? Hodgki Lymphoma? ---- Membranous nephropathy is most common nephropathy asso with carcinoma. However, nephrotic syndrome is a well-known complication of Hodgkin lymphoma, and is usually caused by Minimal change disease.

Front 8

17 yo man in ER with intensive left flank pain that radiates to groin. He refers to his symptom as Stone Passage, which he has experienced For So Many Times Since Childhood. His uncle has the same problem. Urinalysis shows Hexagonal crystals. The urinary cyanide nitroprusside test is positive. Most likely cause of pt condition?

Back 8

17 yo man in ER with intensive left flank pain that radiates to groin. He refers to his symptom as Stone Passage, which he has experienced For So Many Times Since Childhood. His uncle has the same problem. Urinalysis shows Hexagonal crystals. The urinary cyanide nitroprusside test is positive. Most likely cause of pt condition? --- Amino acid transport abnormality (Cystinuria). Cystinuria is an inherited disease causing Recurrent renal stone formation. Personal history of recurrent kidney stones from childhood and a positive family history. Characteristic stones are Hard and Radioopaque. Uninalysis shows typical Hexagonal crystals. Urinary cyanide nitroprusside test positive.

Front 9

What is Cystinuria? Etiology? Px? Lx?

Back 9

What is Cystinuria? Etiology? Px? Lx? Amino acid transport abnormality (Cystinuria). Cystinuria is an inherited disease causing Recurrent renal stone formation. Personal history of recurrent kidney stones from childhood and a positive family history. Characteristic stones are Hard and Radioopaque. Uninalysis shows typical Hexagonal crystals. Urinary cyanide nitroprusside test positive.

Front 10

Hard and Radioopaque. Uninalysis shows typical Hexagonal crystals. Urinary cyanide nitroprusside test positive. Dx?

Back 10

Hard and Radioopaque. Uninalysis shows typical Hexagonal crystals. Urinary cyanide nitroprusside test positive. Dx? --- Cystinuria

Front 11

How is uric acid stone formed?

Back 11

How is uric acid stone formed? Excessive uric acid excretion in urine due to hyperuricemia and Excessive intestinal reabsorption of oxalate due to intestinal diseases.

Front 12

65 yo woman with two-month history of fatigue and weight gain. She has rheumatoid arthritis and hypertension. She takes hydrochlorothiazide and naproxen. Generalized edema, Liver is palpated 2 cm below costal margin. Urinalysis shows 4+ proteinuria. Ultrasound of kidneys shows slight enlargement. Renal biopsy was performed. Most likely finding on renal specimen analysis?

Back 12

65 yo woman with two-month history of fatigue and weight gain. She has rheumatoid arthritis and hypertension. She takes hydrochlorothiazide and naproxen. Generalized edema, Liver is palpated 2 cm below costal margin. Urinalysis shows 4+ proteinuria. Ultrasound of kidneys shows slight enlargement. Renal biopsy was performed. Most likely finding on renal specimen analysis? --- Deposits revealed under polarized light. Amyloidosis has Renal Amyloid deposits with Apple-Green Birefringence under Polarized Light after Staining with Congo Red. History of Rheumatoid arthritis (predisposes to amyloidosis), enlarged kidneys, and hepatomegaly.

Front 13

What is Amyloidosis? Etiology? Px? Lx?

Back 13

What is Amyloidosis? Etiology? Px? Lx? --- Amyloidosis is associated with 1 Multiple Myeloma, 2 Chronic Inflammatory disease, 3 Rheumatoid arthritis, 4 Inflammatory Bowel disease, 5 Chronic infections. Amyloidosis has Renal Amyloid deposits with Apple-Green Birefringence under Polarized Light after Staining with Congo Red. Deposits revealed under polarized light.

Front 14

Nephrotic syndrome. Crescent formation on light microscopy. Dx?

Back 14

Nephrotic syndrome. Crescent formation on light microscopy. Dx? --- Rapidly progressive glomerulonephritis (RPGN).

Front 15

Granular deposits. Dx?

Back 15

Granular deposits. Dx? Immune complex glomerulonephritis (Lupus Nephritis, or Poststreptococcal Glomerulonephritis)

Front 16

65 yo male noticed blood in his urine. His past medical history is significant for hypertension and a transient ischemic attack. He takes baby aspirin and hydrochlorothiazide daily. Most likely cause of his symptoms?

Back 16

65 yo male noticed blood in his urine. His past medical history is significant for hypertension and a transient ischemic attack. He takes baby aspirin and hydrochlorothiazide daily. Most likely cause of his symptoms? --- Bladder mass - most common cause of Painless Hematuria in adults.

Front 17

Most common cause of painless hematuria in adults?

Back 17

Most common cause of painless hematuria in adults? --- Bladder tumors

Front 18

What are causes of red urine?

Back 18

What are causes of red urine? Hematuria, Myoglobinuria, Hemoglobinuria, Porphyria, Eating alot of Beets, AE of Rifampin.

Front 19

Gross painless hematuria. Next step?

Back 19

Gross painless hematuria. Next step? Gross hematuria - Kiney, Ureter, or Bladder Malignancy. Next step - Assess Upper urinary tract - Contrast CT or IV, Endoscopoic assessment of Bladder and Urethra. Most common causes of hematuria in US - Neoplasms, Infections, Trauma, Nephrolithiasis, Glomerulonephritis, and Prostatic disease.

Front 20

Schistosoma Px?

Back 20

Schistosoma Px? Scistosoma causes Dysuria, Urinary frequency followed by Gross Hematuria and Bladder Pain later in disease. Common in Middle East and Africa.

Front 21

What is Acyclovir AE?

Back 21

What is Acyclovir AE? Acyclovir can cause Renal Tubular obstruction due to Crystalluria during High-Dose Parenteral therapy, especially in Inadequately hydrated pts.

Front 22

Acute Renal Failure Px?

Back 22

Acute Renal Failure Px? Oliguria with Elevated Creatinine and BUN

Front 23

50 yo man with skin rash, joint pains, malaise and fatigue. He has a history of intravenous drug abuse. Temp 98.9 F, BP 140 by 90, Pulse 80, RR 14. Palpable purpura and hepatosplenomegaly. Urinalysis shows hematuria, RBC casts and proteinuria. BUN 30, Creatinine 2, Serum complement Low, Anti-HCV Positive. Most likely diagnosis?

Back 23

50 yo man with skin rash, joint pains, malaise and fatigue. He has a history of intravenous drug abuse. Temp 98.9 F, BP 140 by 90, Pulse 80, RR 14. Palpable purpura and hepatosplenomegaly. Urinalysis shows hematuria, RBC casts and proteinuria. BUN 30, Creatinine 2, Serum complement Low, Anti-HCV Positive. Most likely diagnosis? --- Mixed Essential Cryoglobulinemia. Common Cryoglobulinemia Px - Palpable Purpura, Glomerulonephritis, Non-Specific Systemic Symptoms, Arthralgias, Hepatosplenomegaly, Peripheral Neuropathy, and HypoComplementemia. Most pt also have Hepatitis C.

Front 24

Cryoglobulinemia Px?

Back 24

Cryoglobulinemia Px? Palpable Purpura, Glomerulonephritis, Non-Specific Systemic Symptoms, Arthralgias, Hepatosplenomegaly, Peripheral Neuropathy, and HypoComplementemia. Most pt also have Hepatitis C.

Front 25

Palpable purpura, Proteinuria, Hematuria. Dx?

Back 25

Palpable purpura, Proteinuria, Hematuria. Dx? --- Mixed Cryoglobulinemia. Palpable Purpura, Glomerulonephritis, Non-Specific Systemic Symptoms, Arthralgias, Hepatosplenomegaly, Peripheral Neuropathy, and HypoComplementemia. Most pt also have Hepatitis C.

Front 26

What is Henoch-Schonlein Purpura?

Back 26

What is Henoch-Schonlein Purpura? Henoch-Schonlein Purpura usually presents in childhood as palpable purpura on Buttocks, Abdominal Pain, Arthralgias, Proteinuria, and Hematuria with RBC casts on Urinalysis. Serum Complement levels are normal.

Front 27

Child with palpable purpura on Buttocks, Abdominal Pain, Arthralgias, Proteinuria. Dx?

Back 27

Child with palpable purpura on Buttocks, Abdominal Pain, Arthralgias, Proteinuria. Dx? --- Henoch-Schonlein Purpura - Child with palpable purpura on Buttocks, Abdominal Pain, Arthralgias, Proteinuria, and Hematuria with RBC casts on Urinalysis. Serum Complement levels are normal.

Front 28

What is SLE Px? Lx?

Back 28

What is SLE Px? Lx? --- SLE usually occurs in Young Adult Females. Skin manifestations include Malar or Discoid Rash. Serology is Positive for Anti-Nuclear Antibodies. Anti-DNA and Anti-Sm antibodies are very specific for SLE. Renal involvement is quite common.

Front 29

Anti-DNA antibodies. Dx?

Back 29

Anti-DNA antibodies. Dx? SLE

Front 30

Anti-Sm antibodies. Dx?

Back 30

Anti-Sm antibodies. Dx? SLE

Front 31

62 yo man in ER with severe back pain that began suddenly after he attempted to lift a heavy box. He says the pain radiates down his right thigh and leg and that coughing and moving make the pain Unbearable. Pt also complains of an inability to urinate since the pain started. On physical exam, he has no focal lower extremity weakness or numbness, and pinprick testing in the perianal area elicits a quick spasm of the anal sphincter. Rectal exam reveals an enlarged, smooth, nontender prostate. Best explains urinary retention?

Back 31

62 yo man in ER with severe back pain that began suddenly after he attempted to lift a heavy box. He says the pain radiates down his right thigh and leg and that coughing and moving make the pain Unbearable. Pt also complains of an inability to urinate since the pain started. On physical exam, he has no focal lower extremity weakness or numbness, and pinprick testing in the perianal area elicits a quick spasm of the anal sphincter. Rectal exam reveals an enlarged, smooth, nontender prostate. Best explains urinary retention? ---- Severe pain. Severe pain in a pt with a Mild Urinary Obstruction, such as BPH, may cause Urinary Retention due to Inability to Valsalva.

Front 32

Severe back pan that began suddenly after attempted to lift a heavy box, pain radiates down right thigh and leg. Dx?

Back 32

Severe back pan that began suddenly after attempted to lift a heavy box, pain radiates down right thigh and leg. Dx? --- Herniated an intervertebral disk (Disk prolapse), most likely L4 or L5, and most likely suffering from Spinal nerve impingement. Disk prolapse symptoms - unilateral radicular pain in a dermatomal distribution. Back tenderness due to spasm of paraspinous muscles is common, symptoms worsened with Straight leg raise testing.

Front 33

What is Cauda equina syndrome?

Back 33

What is Cauda equina syndrome? Cauda equina (aka Nerve root injury) Saddle anesthesia, Loss of sphincter tone, Bladder atony with overflow incontinence, Bilateral Sciatica.

Front 34

What is another name for Detrusor instability?

Back 34

What is another name for Detrusor instability? Detrusor instability is aka Urge Incontinence. Incontinence preceded by sudden urinary urgency.

Front 35

Blood at urethral meatus. Dx?

Back 35

Blood at urethral meatus. Dx? Urethral injury typically occurs following trauma. Urethral meatus has blood and perineal ecchymosis and hematoma.

Front 36

Acute febrile illness, Costovertebral tenderness, Pyuria, and Bacteriuria. Dx? Tx?

Back 36

Acute febrile illness, Costovertebral tenderness, Pyuria, and Bacteriuria. Dx? Tx? Acute Pyelonephritis. Tx - Empiric antibiotics (Oral ciprofloxacin. Severe or cannot take oral - IV Ampicillin plus Gentamicin). When there is No adequate response to 72-hr treatment (Febrile - Obstruction, Abscess, complications) with appropriate antibiotics, urological imaging (CT scan or Ultrasound) is performed to search for any underlying pathologies (Obstruction) or complications (Renal, perirenal abscess).

Front 37

Pyelonephritis do not respond after 48-72 hours of appropriate antibiotic therapy. Next step?

Back 37

Pyelonephritis do not respond after 48-72 hours of appropriate antibiotic therapy. Next step? Febrile after 72 hours, Ultrasound or CT to search for underlyiing pathologies (Obstruction), or Complications (Renal, Perirenal abscess).

Front 38

Pyelonephritis secondary to multi-drug resistant organism. Dx? Tx?

Back 38

Pyelonephritis secondary to multi-drug resistant organism. Dx? Tx? --- Multi-drug resistant organism for pyelonephritis is Gram Negative infections. Tx - Aminoglycosides. Aminoglycosides are potentially nephrotoxic and drug levels and renal function must be monitored closely during therapy.

Front 39

72 yo woman with poorly controlled type 2 diabetes mellitus presents to your clinic one week after being discharged from hospital. SHe had been admitted with pyelonephritis seconary to a multi-drug resistant organism, and received several days of intravenous antibiotics. Her serum creatinine on admission had been 2.1. Today it is found to be 4.9. Urinalysis reveals rare epithelial casts and no white blood cells. FeNa is greater than 2 perc. What antibiotic did she most likely receive during her hospitalization?

Back 39

72 yo woman with poorly controlled type 2 diabetes mellitus presents to your clinic one week after being discharged from hospital. SHe had been admitted with pyelonephritis seconary to a multi-drug resistant organism, and received several days of intravenous antibiotics. Her serum creatinine on admission had been 2.1. Today it is found to be 4.9. Urinalysis reveals rare epithelial casts and no white blood cells. FeNa is greater than 2 perc. What antibiotic did she most likely receive during her hospitalization? --- Amikacin. Multi-drug resistant organism for pyelonephritis is Gram Negative infections. Tx - Aminoglycosides. Aminoglycosides are potentially nephrotoxic and drug levels and renal function must be monitored closely during therapy.

Front 40

What can severe benign prostatic hyperplasia proress to? Next step?

Back 40

What can severe benign prostatic hyperplasia proress to? Next step? --- Severe BPH can eventually progress to urinary obstruction and renal failure (Increase creatinine). Abdominal ultrasound is the initial test of choice to assess for Hydronephrosis. If hydronephrosis is present, placement of a Foley catheter will likely help to improve pt urinary obstruction. Surgical intervention (TURP) is a good option for improving urinary obstruction over long term.

Front 41

What are the renal transplant dysfunction in early post-operative period?

Back 41

What are the renal transplant dysfunction in early post-operative period? --- Renal transplant dysfunction in early post-operative period can be explained by a variety of causes - 1 Ureteral Obstruction, 2 Acute Rejection, 3 Cyclosporine Toxicity, 4 Vascular Obstruction, and 5 Acute Tubular Necrosis.

Front 42

Renal transplant dysfunction in early post-operative period Px?

Back 42

Renal transplant dysfunction in early post-operative period Px? --- Renal transplant dysfunction in early post-operative period Px - 1 Oliguria, 2 Hypertension, 3 Increased Creatinine to BUN ratio.

Front 43

56 yo man develops oliguria three days after having a kidney transplantation. His postoperative course was uncomplicated. His blood pressure is 160 by 100 and HR is 90. Palpation of the transplant reveals mild tenderness. Serum sodium 145, potassium 5.5, calcium 8.6, creatinine 3.2, BUN 30. His serum cyclosporine level is normal. Renal ultrasonography does not detect dilatation of the calyces. Biopsy of the transplant shows heavy lymphocyte infiltration and vascular involvement with swelling of intima. Most appropriate next step?

Back 43

56 yo man develops oliguria three days after having a kidney transplantation. His postoperative course was uncomplicated. His blood pressure is 160 by 100 and HR is 90. Palpation of the transplant reveals mild tenderness. Serum sodium 145, potassium 5.5, calcium 8.6, creatinine 3.2, BUN 30. His serum cyclosporine level is normal. Renal ultrasonography does not detect dilatation of the calyces. Biopsy of the transplant shows heavy lymphocyte infiltration and vascular involvement with swelling of intima. Most appropriate next step? --- IV steroids for Acute rejection

Front 44

73 yo man presents to ER complaining of lower abdominal pain and nausea. Several days ago he began taking amitriptyline for chronic neck ain. BP 160 over 70 and HR 100. Palpation of abdomen reveals fullness and tenderness along midline below umbilicus. Best initial management for this pt?

Back 44

73 yo man presents to ER complaining of lower abdominal pain and nausea. Several days ago he began taking amitriptyline for chronic neck ain. BP 160 over 70 and HR 100. Palpation of abdomen reveals fullness and tenderness along midline below umbilicus. Best initial management for this pt? --- Urinary catheterization. Drug with anticholinergic properties (amitriptyline) can cause acute urinary retention by preventing detrusor muscle contraction and urinary sphincter relaxation. The treatment is medication discontinuation and urinary catheterization.

Front 45

45 yo man comes to ER with severe right flank pain. He is tossing in bed due to the pain. KUB done in ED shows no abnormalities. however, abdominal ultrasond shows a 5 mm stone in right ureter. Urinalysis shows - Urine pH 4.5, WBC absent, RBC 2-3 on HPF, Bacteria Absent, Nitrites Negative, Esterase Negative. Most beneficial next step in management?

Back 45

45 yo man comes to ER with severe right flank pain. He is tossing in bed due to the pain. KUB done in ED shows no abnormalities. however, abdominal ultrasond shows a 5 mm stone in right ureter. Urinalysis shows - Urine pH 4.5, WBC absent, RBC 2-3 on HPF, Bacteria Absent, Nitrites Negative, Esterase Negative. Most beneficial next step in management? --- Potassium citrate for Uric acid stones (low urine pH. Normal pH is 5-6). Uric acid stones are highly soluble in alkaline urine. therefore, alkalinization of urine to pH More than 6.5 with oral potassium bicarbonate or potassium citrate is the treatment of choice. Low urine pH (defect in renal ammonia secretion) and Hyperuricosuria. Uric acid stones are radiolucent, but can be seen on USG and CT. Tx - Hydration, alkalinization of urine, and Low Purine diet with or without Allopurinol, depending on presence of hyperuricosuria. Uric acid is highly soluble in alkaline urine, alkalinization of urine to pH Greater than 6.5 with oral potassium bicarbonate or potassium citrate is indicated.

Front 46

Reasons why flat film of abdomen (KUB xray) and pelvis does Not show a stone in a pt with typical colic?

Back 46

Reasons why flat film of abdomen (KUB xray) and pelvis does Not show a stone in a pt with typical colic? --- 1 Radiolucent stone disease (Uric acid stones), 2 Calcium stones Less than 1-3 mm in diameter, 3 Non-stone causes (Obstruction by a blood clot or tumor).

Front 47

Severe right flank pain, tossing in bed, KUB is normal, abdominal ultrasound shows 5 mm stone in right ureter. Dx? Tx?

Back 47

Severe right flank pain, tossing in bed, KUB is normal, abdominal ultrasound shows 5 mm stone in right ureter. Dx? Tx? --- Uric acid stones are highly soluble in alkaline urine. therefore, alkalinization of urine to pH Greater than 6.5 with oral potassium bicarbonate or potassium citrate is treatment of choice.

Front 48

26 yo man in ER due to a sudden onset of severe right-sided flank pain. The pain is colicky and radiates from the flank to scrotum. He also has nausea, vomiting and dark-colored urine. He is given adequate analgesia. Non-contrast helical CT shows a 4 mm radiopaque stone in right upper ureter. Serum calcium 9.8, serum creatinine 0.9, BUN 15. Urinalysis shows hematuria but no casts. Most appropriate next step?

Back 48

26 yo man in ER due to a sudden onset of severe right-sided flank pain. The pain is colicky and radiates from the flank to scrotum. He also has nausea, vomiting and dark-colored urine. He is given adequate analgesia. Non-contrast helical CT shows a 4 mm radiopaque stone in right upper ureter. Serum calcium 9.8, serum creatinine 0.9, BUN 15. Urinalysis shows hematuria but no casts. Most appropriate next step? --- Fluid intake greater than 2L per day. Hydration is the cornerstone of therapy for renal stone disease. A detailed metabolic evaluation is not needed when pt presents with his first renal stone.

Front 49

Nephrolithiasis management?

Back 49

Nephrolithiasis management? 1 Imaging study (CT scan of abdomen WithOut Contrast is Investigation of choice because of its high sensitivity and specificity. It has advantage over Plain abdominal xray (KUB) in detecting Radiolucent stones). 2 Narcotics and NSAID (Eually effective in relieving pain of acute renal colic. Normal renal function - NSAIDS preferred over Narcotics because latter can exacerbate nausea and vomiting.) 3 Size of stone (Stone Less than 5 mm in diameter - pass spontaneously with conservative management - Fluid intake of Greater than 2L daily. Increased hydration increases urinary flow rate and lowers urinary solute concentration, thus preventing stone formation). 4 Urology referral (Urgent urologic evaluation is warranted in pt with anuria, urosepsis, or acute renal failure).

Front 50

What is varicocele?

Back 50

What is varicocele? Varicocele is veins above scrotum (Bag of worms)

Front 51

Varicoceles that fail to empty when pt is recumbent. Next step?

Back 51

Varicoceles that fail to empty when pt is recumbent. Next step? --- Varicoceles (left side. Blockage of gonadal vein where it enters renal veins.) that fail to empty when pt is recumbent raises the suspicion for renal cell carcinoma. May have constitutional symptoms (Fever, night sweats, anorexia.) Increased erythropoietin by kidney mass (Polycythemia and thrombocytosis) CT scan of abdomen is most sensitive and specific for diagnosing Renal cell carcinoma.

Front 52

Renal cell carcinoma Px? Lx?

Back 52

Renal cell carcinoma Px? Lx? Flank pain, Hematuria, Palpable abdominal renal mass. Lx - Abdominal CT

Front 53

60 yo male is hospitalized with generalized tonic-clonic seizures. He is a heavy alcohol user and he has had previous hospitalizations for alcohol withdrawal and alcohol-related seizures. On the second day of his hospitalization, his temperature is 98.9F, bp 155 over 92, pulse 108, respiration 14. Serum sodium 140, potassium 5.4, bicarbonate 20, BUN 36, creatinine 2.4, urinalysis glucose negative, ketones trace, leukocyte esterase negative, blood large. Urine sediment microscopy shows 5-10 WBCs, 0-1 RBC and some epithelial cells. Most likely diagnosis?

Back 53

60 yo male is hospitalized with generalized tonic-clonic seizures. He is a heavy alcohol user and he has had previous hospitalizations for alcohol withdrawal and alcohol-related seizures. On the second day of his hospitalization, his temperature is 98.9F, bp 155 over 92, pulse 108, respiration 14. Serum sodium 140, potassium 5.4, bicarbonate 20, BUN 36, creatinine 2.4, urinalysis glucose negative, ketones trace, leukocyte esterase negative, blood large. Urine sediment microscopy shows 5-10 WBCs, 0-1 RBC and some epithelial cells. Most likely diagnosis? --- Rhabdomyolysis. Large amount of blood on urinalysis, although there are only 0-1 RBC seen on sediment microscopy - myoglobin in the urine - Rhabdomyolysis from Tonic-Clonic seizure. Large amount of myoglobin in urinary system can result in Tubular injury and acute renal failure (Creatinine increase).

Front 54

Tonic-Clonic seizure, Urinalysis blood large, urine microscopy shows 0-1 RBC. Dx?

Back 54

Tonic-Clonic seizure, Urinalysis blood large, urine microscopy shows 0-1 RBC. Dx? --- Rhabdomyolysis - Acute Renal failure