Usmle 3 Genitourinary

Front 1

benefits of alpha blockers?

Back 1

- e.g. prazosin, terazosin
- tx of HTN, BPH, increases insulin sensitivity, decreases LDL, increases HDL

Front 2

Side effects of BB?

Back 2

- worsens BPH, bronchoconstriction, decreases insulin sensitivity, masks hypoglycemia symptoms

Front 3

treatment of erectile dysfunction?

Back 3

- phosphodiesterase inhibitor e.g. sildenafil
- careful with combining with alpha blocker for BPH --> hypotension. Give four hours apart

Front 4

First line imaging of nephrolithiasis?

Back 4

- CT
- next best is IVP
- if pregnant do ultrasonogram

Front 5

right flank pain, no renal calculus, increase BUN, Cr?

Back 5

- look for hx of ASA, acetaminophen, phenacetin or NSAIDs = analgesic nephropathy
- see acute papillary necrosis --> actue renal colic
- UA: hematuria, pyuria, proteinuria

Front 6

AIN

Back 6

- acute interstitial nephritis = azotemia, skin rash, eosinophilia, see eosinophils in urine

Front 7

nephrolithiasis with temp, WBC, hypotension, hydronephrosis?

Back 7

- life threatening --> percutaneous nephrostomy
- don't put stent b/c increased risk of pushing infected material into other parts
- shockwave is for uncomplicated proximal ureteral stones

Front 8

Hx raynauds and GERD presenting with malignant hypertension?

Back 8

- scleroderma renal crisis --> abnormal collagen deposition --> narrows renal arterioles --> ischemia --> increased renin-angiotensin system--> HTN
- tx with ACE-I (which is usually avoided in RF except in this case) to reverse angiotensin and nitroprusside

Front 9

Pheo symptoms

Back 9

- tachycardia, palpitations, HA, HTN

Front 10

HUS CBC

Back 10

- s/p diarrhea
- thrombocytopenia, microangiopathic hemolytic anemia

Front 11

pt presents with erectile dysfunction, next step?

Back 11

- do ABI before rx PDI

Front 12

Major causes of hyperK+

Back 12

1. increase K out of cells: pseudohyperK+, met acidosis, hyperglycemia, increase tissue catabolism, BB, exercise
2. decrease urinary K excretion: hypoaldo, renal failure, volume depletion, RTA4, ureterojejunostomy

Front 13

Major causes of hyperNa+

Back 13

1. unreplaced water loss: sweating, GI loss, DI, osmotic diuresis, hypothalamic lesions
2. water into cells: severe exercise, seizures
3. Na overload: hypertonic NA intake

Front 14

Major causes of hypoCa2+

Back 14

-1. hyperphosphatemia, acute pancreatitis, osteoblastic metastases, resp alkalosis, hypoPTH, Mg metabolism, vit D def, sepsis, flouride intoxication

Front 15

aspiration pneumonitis

Back 15

- obtunded pt with hx of vomiting --> respiratory distress after aspiration event with NO hx of foreign body --> supportive care (no abx)

Front 16

Pt after episode of hypotension w/ decreased UOP, what kind of casts?

Back 16

- muddy brown casts -> ATN secondary to hypotension, hypovolemia, shock, sepsis, decreased cardiac output states
- also see increased BUN, Cr, anion gap acidosis

Front 17

prerenal azotemia- what do you see from urine Na?

Back 17

- decreased fractional excretion of Na

Front 18

AIN

Back 18

- eosinophils in urine
- 3-5 days after abx is given, rarely seen in 1st 2 days

Front 19

Red cell casts

Back 19

- think glomerulonephritis

Front 20

pt who is ologuric, hyperkalemic, and acidotic?

Back 20

- D5% with bicarb --> if this doesn't work then dialysis

Front 21

hematuria or RBC casts 2 weeks after URI vs during or immediately after URI?

Back 21

- 1. poststreptococcal GN
- 2. IgA nephropathy

Front 22

heavy smoker with palpable renal mass and CVA tenderness?

Back 22

- renal cell cancer
- look for increased hg/hct secondary to paraneoplastic syndrome (EPO secretion from hypernephroma)
- if high suspicion, get CT

Front 23

hepatorenal syndrome

Back 23

- dx of exclusion
- cirrhosis --> splanchnic vasodilation --> peripheral vascular resistance --> decreased renal perfusion --> pre-renal BUN:Cr > 20:1
- first bolus fluids to r/o renal failure secondary to intravascular fluid depletion --> if no responde then tx with octreotide, midodrine, NE, and continue giving albumin

Front 24

Dx of SBP?

Back 24

- peritoneal cell count > 250 c/mm2

Front 25

PSA

Back 25

- if 2.5- 4: repeat testing several weeks/months later to trend = <10 %PPV
- if >4, order transrectal prostate biopsy = 25%PPV
- if >10, PPV 42-64%

Front 26

Priapism tx?

Back 26

- ice pack
- phenylephrine inj or epinephrine (alpha-adrenergic agonist)

Front 27

Tx RCC

Back 27

- confined within renal capsule (Stage 1) --> partial nephrectomy
- extends through renal capsule but not Gerota's fascia (Stage II) --> radical nephrectomy

Front 28

Which drugs increase serum Cr

Back 28

- cimetidine, probenecid, trimethoprim

Front 29

urethral diverticulum

Back 29

- can be acquired secondary to vaginal trauma (e.g. lots of v-births) or instrumentation of uretheral tract
- sx: post void dribbling --> dysuria, dyspareunia, UA that looks like UTI
- test: transvaginal U/S

Front 30

Man from Africa with hematuria, dysuria and polyuria?

Back 30

- schistosomiasis (one of the most common infx dz worldwide)
- also see anemia
- do urine microscopy --> see eggs
- do bx if high suspicion and don't see eggs

Front 31

Most common long term complication of TURP (surgical tx of BPH)

Back 31

- dry ejaculate due to retrograde ejaculation

Front 32

pt with PCKD wants peritoneal dialysis --> next step?

Back 32

- colonoscopy to r/o diverticulosis

Front 33

other complications of PCKD?

Back 33

- cysts in liver, pancreas, spleen, lung
- cerebral aneurysms
- aortic aneurysm
- colonic diverticula
- MVP
- inguinal, abdominal hernias

Front 34

chronic nonbacterial prostatitis

Back 34

- same clinical feature as bacterial prostattis
- +UA but neg cx and no hx of UTI
- no bacteria involved
- tx: sitz baths and NSAIDS, transurethral microwave thermotherapy, psychotherapy for sexual sx

Front 35

next step in pt with renal failure secondary to HTN?

Back 35

- get urine protein excretion
- if + protein (500-1000mg/d) start on ACE-I or ARB (no benefit if no protein) also non-dihydropyridine CCB
- goal of <500 mg/day protein

Front 36

24 hour urine protein of 7g

Back 36

- nephrotic syndrome --> look for analgesic use = analgesic induced nephropathy

Front 37

best kidney donor?

Back 37

- sibling with no HLA mismatch
- also adequate: blood relations with up to 3 HLA mismatch or non-relatives with up to 4 HLA mismatch
- cadavers must have no mismatch to be considered suitable

Front 38

pt is dx with ADPKD, what the next step?

Back 38

- monitor BP <130/80
- no need for yearly Ct/US
- no need for head MRI to look for berry aneurysm unless family hx of subarachnoid hemorrhage
** HY

Front 39

Most common extrarenal manifestation of ADPKD?

Back 39

- hepatic cysts
** HY

Front 40

Pt dx with ADPKD, what do family members do?

Back 40

- get US for asympt family members --> 3-5 cysts in each kidney is +dx
** HY

Front 41

viagra and pilots

Back 41

- viagra effects blue-green color vision so pilots must wait 6 hrs after taking viagra to fly

Front 42

increased serum Cr after starting ACE-i?

Back 42

- highly suggestive of RAS, b/c ACE-I decreases angiotensin II --> decreases GFR

Front 43

HTN after renal transplant

Back 43

- develops in most pts with renal transplant

Front 44

hx of alcohol abuse or IVDU presents with diffuse joint pain, fatigue, skin rash, peripheral neuropathy, next step?

Back 44

- think cryoglobulinemia
- UA: hematuria, proteinuria, casts (RBC)
- see decrease C3, C4, CH50, increased cryoglobulin levels
- tx: alpha interferon and ribavarin, only the former if renal impairment

Front 45

renal dzs with +C-ANCA vs +ASO vs + cryoglobulin

Back 45

- +C-ANCA: granulomatosis with polyangiitis (Wegener's ) see normal complement levels
- +ASO: post streptococcal GN, nl C4 levels (low C3 is possible)
- +cryoglobulin = cryoglobulinemia low C3, C4, CH50, +cryoglobulin

Front 46

prostatitis with sx of urinary tract obstruction

Back 46

- do suprapubic catheterization, not foley cath b/c can cause bacteremia

Front 47

risks for female kidney donors?

Back 47

- increased gestational complications compared to prior to donor but rate is still the same as the general population

Front 48

gold standard for detecting bladder ca?

Back 48

- cystoscopy

Front 49

work up of extraglomerular hematuria

Back 49

- e.g. UA shows no casts, dysmorphic cells, proteinuria
- IVP --> if negative then no further studies if young; if old and highly suspect cancer then U/S or CT for malignancy

Front 50

eosinophils in urine

Back 50

- think AIN

Front 51

eosinophilia w/ asthma and renal disease?

Back 51

- churg strauss