Usmle Step 2/ Renal/ Urology

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MOST COMMON CAUSE OF DEATH FROM PCKD? EXTRA-RENAL COMPLICATIONS? (4)

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- RENAL FAILURE
- SAH, LIVER/OVARIAN CYSTS, MVP, DIVERTICULOSIS

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HEMATURIA W/ LOW RBC COUNT ON URINE MICROSCOPY SUGGESTS..?

Back 2

MYOGLOBINURIA 2/2 RHABDOMYOLISIS

Front 3

PT C/O HEMATURIA AT THE END OF THE STREAM. WHERE'S THE LESION?

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BLADDER
BEGINNING OF STREAM--URETHRAL INJURY
THROUGHOUT--URETERS/KIDNEYS

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CHILD W FAILURE TO THRIVE HAS ALKALINE URINE W HIGH SERUM CHLORIDE AND LOW BICARB. MLDX?

Back 4

RTA 2 (THINK FANCONI'S ANEMIA)

Front 5

IN A PT W/ INDWELLING CATHETER AND ALKALINE URINE, WHATS THE MOST LIKELY BUG?

Back 5

PROTEUS. (E.COLI DOESNT AFFECT URINE PH)

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CHARACTERISTICS OF MALIGNANT RENAL CYST? (3)

Back 6

ECHOGENIC, THICK AND IRREGULAR WALL, DEBRIS INSIDE.

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MOST COMMON TYPE OF RENAL STONE?

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CA++ OXALATE
* CA++ PHOSPHATE IS AS/W RTA AND PRIMARY HYPERPARATHYROIDISM

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PT P/W A TESTICULAR MASS AS/W GYNESCOMASTIA. DX? WHAT FINDING IS COMMON IN CHILDREN?

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LEYDIG CELL TUMOR.
CHILDREN CAN P/W PRECOCIOUS PUBERTY

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PT P/W MASS SECRETING B-HCG AND AFP. DX?

Back 9

NON-SEMINOMATOUS GERM CELL TUMOR
*SEMINOMAS NEVER PRODUCE AFP

Front 10

PT W HX/O NEPHROTIC SYNDROME P/W FEVER, FLANK PAIN AND HEMATURIA OF SUDDEN ONSET. DX?

Back 10

RENAL ARTERY THROMBOSIS
* SPILLING OF CLOTTING FACTORS IN THE URINE IN NEPHROTIC SYNDROME AND MEMBRANOUS GLOMERULONEPHRITIS CAN CAUSE THROMBOTIC EVENTS

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HEAVY PROTEINURIA IN A NEGRO IS SUGGESTIVE OF WHAT KIDNEY DISORDER?

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FOCAL SEGMENTAL GLOM..

Front 12

CALICES BLUNTING AND SCARRING ARE FEATURES OF WHAT RENAL PATHOLOGY?

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CHRONIC PYELONEPHRITIS

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8 COMMON DRUGS THAT CAUSE HYPERKALEMIA

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ACE-I, BB, DIGOXIN, HEPARIN, NSAIDS, BACTRIM, CYCLOSPORIN AND SUX

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6 INDICATIONS FOR HEMODIALYSIS

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REFRACTORY:
-HYPERKALEMIA
-ACIDOSIS
-FLUID OVERLOAD
UREMIC:
-PERICARDITIS
-ENCEPHALOPATHY
-NEUROPATHY
COAGULOPATHY

Front 15

WHAT DIFFERENTIATES BATTER SYNDROME FROM RENIN SECRETING TUMOR?

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NA..ITS NORMAL IN BARTER WHILE HIGH IN RST

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HIGH ALDOSTERONE, RENIN W A LOW NA LEVEL IS SUGGESTIVE OF...

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BARTTER SYNDROME

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PT W/ H/O CHRONIC BACK PAIN AND HYPERTENSION DEVELOPS HEMATURIA. CT SHOWS "BUMPY KIDNEY" DX?

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ANALGESIC NEPHROPATHY W/ PAPILLARY NECROSIS

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MOST COMMON CAUSE OF ESRD IN BOYS?

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POSTERIOR URETHRAL VALVES

Front 19

DDX OF BARTTER SYNDROME?
DIFFERENCES?

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1- EMESIS (LOW CL- VS HIGH IN BARTTER'S
2- DIURETICS (URINE TOX WILL SHOW DRUG)
3- GITELMAN'S SYNDROME (SEVERE HYPOMAGNESEMIA AND HYPOCALCIURIA)

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NEXT STEP IN MGT OF PT W/ ACUTE PYELONEPHRITIS WHO FAILS ABX TX AFTER 48 HRS?

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RENAL U/S OR CT TO R/O OBSTRUCTION OR ABSCESS FORMATION

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INPATIENT TX FOR ACUTE PYELONEPHRITIS? OUTPT?

Back 21

AMPICILLIN + GENTAMYCIN.
CIPRO

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PT < 30 YO P/W HEMATURIA AND PROTEINURIA. THERE'S HX /O URI A WEEK AGO. SEROLOGY REVEALS HYPOCOMPLEMENTEMIA W/ (+) C3 NEPHRITIC FACTOR. DX? WHAT'S SEEN ON BX?

Back 22

MEMBRANOPROLIFERATIVE GLMNP.
BX SHOWS TRAM-TRACK APPEARANCE

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WHAT MAKES OVERFLOW INCONTINENCE DIFFERENT FROM OVERACTIVE BLADDER INCONTINENCE? 4

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1 MORE COMMON IN MALES W BPH
2 PT UNAWARE OF LEAKAGE VS CONSTANT WORRY (URGENCY) IN OAB
3 PT MUST STRAIN TO VOID
4 OAB HAS NOCTURIA

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PT W A HO TOTAL HYSTERECTOMY P/W WATERY VAGINAL DC. DX? DX TEST?

Back 24

VESICULO-VAGINAL FISTULA.
TAMPON INSIDE VAGINA AND METHYLENE BLUE DYE INFUSED IN URETHRA. BLUE TAMPON IS + RESULT

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DX? PHYSICAL FINDINGS?

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FMD.
FLANK BRUIT, REFRACTORY HTN IN YOUNG F.

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PT W THIS FINDINGS HAS H/O BACK PAIN AND TRUNCAL STIFFNESS, URETHRITIS AND PHOTOPHOBIA. DX? FIRST DX TEST? MT?

Back 26

UVEITIS.
SLIT LAMP TEST.
STEROIDS TOPICAL
* CONJUNCTIVITIS HAS NO DECREASED VISION OR PHOTOPHOBIA.

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PT P/W DECREASED URINATION. CR IS TWICE HIS BASELINE 2 DAYS AGO. DX? 2 COMMON DDX? FIRST AND 2ND IMAGING TEST?

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ARF.
GI BLEED AND RHABDOMYOLYSIS.
U/S 1, KUB 2.

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PT W H/O BIPOLAR DIS., WILSON DZ AND CHRONIC HA TX/W DICLOFENAC P/W GENERALIZED EDEMA, HIGH CHOLESTEROL. LABS SHOW LOW ALBUMIN, HIGH TRIGS AND PROTEINURIA. DX? MT?

Back 28

MEMBRANOUS GLOMERULONEPHRITIS.
CYCLOPHOSPHAMIDE+STEROIDS.

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MT OF RPGN?

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STEROIDS + CYCLOPHOSPHAMIDE

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PT W/ HO DM AND HTN DEVELOPS RENAL INSUFFICIENCY. BX SHOWS INCREASED EXTRACELLULAR MATRIX, THICKENING OF THE BM AND FIBROSIS. DX? 3 FEATURES OF THE OTHER CAUSE?

Back 30

DM NEPHROPATHY.
- DECREASED KIDNEY SIZE
- NARROWING AND ARTERIOSCLEROSIS OF RENAL VESSELS
- INTIMAL THICKENING

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PT P/W 41 DEGREES TEMP, ALTERED MENTATION AND SWEATY AND PALE SKIN. DX?

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HEATSTROKE.
*SKIN CAN ALSO BE FLUSHED AND DRY*
*R/O HEAT EXHAUSTION:
- TEMP < 40
- NO AMS
- USUALLY PRECEDES HEATSTROKE

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5 WAYS TO ASSESS VOLUME STATUS ON HYPO-NA PT?

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1. TURGOR
2. PULSE
3. POSTURAL BP
4. EDEMA
5. JVP

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3 MAIN CAUSES OF HYPOVOLEMIC HYPO-NA+?

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1. RENAL LOSSES:
- DIURETICS
- ADRENAL INSUFFICIENCY
- CEREBRAL SALT WASTING SYNDROME (HX/O HEAD TRAUMA)
2. NON-RENAL LOSSES:
- VOMITING/DIARRHEA
- SWEATING
3. FLUID SEQUESTRATION:
- SBO
- BURNS
- PANCREATITIS
- RHABDO

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WHAT DIFFERENTIATES SIADH FROM CEREBRAL SALT WASTING SYNDROME?

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VOLUME STATUS:
- SIADH IS EUVOLEMIC STATE W DILUTIONAL HYPO-NA+ VS CSW SYNDROME WHERE NA+ IS "WASTED" AND PT GETS DEHYDRATED

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PT P/W HYPO-NA+ AND HYPERVOLEMIC STATE. WHAT'S THE CAUSE IF URINE NA+ IS < 30? HOW ABOUT > 30?

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- URINE NA+ < 30 = EXTRA-RENAL CAUSE: CIRRHOSIS, CHF, PREGNANCY...
- URINE NA+ > 30 IS CKD OR ARF

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3 CAUSES OF HYPONA+ IN EUVOLEMIC PT?
3 DRUGS WHICH CAUSE IT TOO?

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1. SIADH
2. WATER INTOXICATION
3. HYPOTHYROIDISM
DRUGS:
1. SSRI
2. CHEMO AGENTS
3. ANTI-EPILEPTICS (CARBAMAZEPINE)

Front 37

TX FOR LITHIUM INDUCED NEPHROGENIC DI?

Back 37

AMILORIDE
* PREVENTS LITHIUM REABSORPTION AT DCT AND CT

Front 38

URINE OSM > SERUM OSM + LOW NA+ IS?

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SIADH

Front 39

2 ELECTROLYTES AFFECTED BY LOW MG+?

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K+, Ca+ BOTH DECREASED

Front 40

PT P/W HYPOVOLEMIA. HE'S LATER FOUND TO HAVE A METABOLIC ALKALOSIS. MGT?

Back 40

BY REPLACING IVF IN A HYPOVOLEMIC PT, THE GFR INCREASES HENCE THE EXCRETION OF HCO3 CORRECTING THE ALKALOSIS.

Front 41

IN AN OLDER PT W/ HEMATURIA, WHAT CLUE CAN LEAD TO THINK IGA NEPHROPATHY VS BLADDER CA?

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PROTEINURIA. NOT PRESENT IN BLADDER CA. REMEBER IGA IS MOST COMMON CAUSE OF HEMATURIA AND FOLLOWS A URI BY DAYS VS WEEKS AS IN PSGN

Front 42

PT UNDERGOES ANGIOGRAPHY AND DEVELOPES LIVEDO RETICULARIS AND RENAL FAILURE. HIS LABS SHOW HIGH ESR, EOSINOPHILS AND HYPOCOMPLEMETEMIA. DX? WHAT PHYSICAL FINDING ON FUNDOSCOPY IS SUGGESTIVE OF THIS DX?

Back 42

- ATHEROEMBOLIC RENAL FAILURE.
- HOLLENHORST PLAQUES
*TX IS SUPPORTIVE, ANTICOAGULANTS NOT BENEFICIAL **WARFARIN USE IS A RISK FACTOR

Front 43

PT W/ ACIDOSIS AND ALKALINE URINE IS SUGGESTIVE OF...?

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RTA1 OR RTA2 - ACIDOSIS SHOULD LEAD TO H+ URINE EXCRETION SO URINE PH IS EXPECTED TO BE LOW.
*RTA2 ALSO HAS A ALKALINE URINE BUT SINCE THERE'S A PCT DISORDER, OTHER SUBSTANCES LIKE GLUCOSE, PO4 SHOULD GET SPILLED.

Front 44

IN A PT W/ HYPONATREMIA, WHAT VALUE INDICATES A RENAL SOURCE?

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HIGH URINE NA INDICATES FAILURE OF THE KIDNEYS TO RETAIN NA+ AS MEANS OF MAINTAIN VOLUME

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WHAT LEADS TO ANEMIA AND THROMBOCYTOPENIA IN A CKD PT?

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ANEMIA IS 2/2 LOW EPO AND LOW PLATELETS 2/2 CONSUMPTION FROM FACTOR EXCRETION

Front 46

TX FOR PROTEUS UTI?

Back 46

TMP-SMX, GENTAMICIN OR AMPICILLIN

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NURSE ASKS YOU WHY HER 2 MO OLD SON'S TESTES HAVENT DESCENDED. SO?

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WAIT UNTIL 3 MO

Front 48

PT W/ VARICOCELE AND HEMATURIA SUSPECT...

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RENAL CELL CA

Front 49

GLOMERULAR DZ WHERE YOU'LL SEE HYPOCOMPLEMETEMIA?

Back 49

PSGN AND MPGN

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GLOMERULAR PATHO SHOWS GRANULAR IMMUNO DEPOSITION. WHAT TWO DZ?

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PSGN AND MEMBRANOUS NEPHROPATHY