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Question 1

In a pt with calcium oxalate stones, what is the recommendation regarding dietary sodium n calcium intake? Y?

Answer 1

Normal calcium n low sodium intake. Because increased Na intake enhances Ca excretion (hypercalciuria) n low Na promotes Na n Ca reabsorption.

Question 2

A pt with renal colic, Hard radioopaque hexagonal crystals, urinary cyanide nitroprusside test is positive
Dx?

Answer 2

Cystinuria

Question 3

Uric acid stone Rx includes — for alkalinizing urine and — diet

Answer 3

Oral potassium citrate

Low protein diet

Question 4

In conservative mx of ureteral stone, what drug facilitates passage of stone?

Answer 4

Alpha 1 blockers like tamsulosin ( helps ureteral mm relax n decreases intraureteral pressure

Question 5

Type 4 renal tubular acidosisis characterized by? Mechanism/cause?
Most commonly occurs in elderly pts with—?

Answer 5

Non anion gap metabolic acidosis, hyperkalemia
Impaired function of the cortical collecting tubule due to aldosterone deficiency or resistance
Elderly pts with poorly controlled DM—> damage to the juxtaglomerular apparatus

Question 6

A 5month old is brought with a complaint of poor growth n failure to gain wt. despite increasing the caloric density of her formula. On ABG she has a non anion gap metabolic acidosis, K+ of 3,urine PH is 7.9(high)
Dx?

Answer 6

All types of RTA can present with failure to thrive due to poor growth n cell devision in an acidic environment
This pt has type 1 RTA , often a genetic problem, commonly associated with nephrolithiasis. Is due to poor hydrogen secretion and high urinary PH is typical

Question 7

Type 2 renal tubular acidosis is commonly a component of?

The primary defect is?

Answer 7

Aka proximal RTA
ā with fanconi syndrome ( glucosuria, phosphaturia, aminoaciduria)
Poor bicarbonate reabsorption is the defect

Question 8

Meds that can cause SIADH mention 3

Answer 8

SSRIs, carbamazepine, NSAIDs

Question 9

A 40 yr old pt who has recently been started on SSRI for depression came with confusion. She has hyponatremia, serum osmolality < 275, urine osmolality >100 and is euvolemic
Dx
Mx options

Answer 9

SIADH
fluid restriction +/- salt tablets
Hypertonic 3% saline for severe hyponatremia

Question 10

A 17yr old African American boy came with painless hematuria which resolved by itself. No other abnormalities were found on P/E and labs. Which of the following is the most likely cause?
A) acute cystitis B) ATN C) acute interstitial nephritis D) renal papillary necrosis

Answer 10

Renal papillary necrosis, one of the complication of sickle cell trait as seen in this pt

Question 11

An incidental finding of proteinuria in an otherwise normal child with acute febrile upper respiratory infection is suggestive of? Mx?

Answer 11

Transient proteinuria
Repeat deep stick two times and reassure if negative.
Orthostatic proteinuria is also common in adolescent boys

Question 12

Acute rejection is best treated with?

Answer 12

Iv steroids

Question 13

A 45 yr old male is brought to the ER after a pelvic fracture. He has high riding prostate on PR examination and blood at the urethral meatus. Dx?
Mx?

Answer 13

Posterior urethral injury

Retrograde urethrogram

Question 14

Stress incontinence

• sxs
• Rx

Answer 14

Leakage of urine with coughing, laughing, lifting

Rx- pelvic floor ex, pessary, surgery

Question 15

Urge incontinence is the result of —
Sxs
Risk factors
Rx

Answer 15

Detrusor overactivity
Sxs- sudden, overwhelming, frequent need to empty the bladder
Risk factors- age>40, female, pelvic surgery
Rx- pelvic mm exercise, bladder training, if these fail antimuscarinic drugs like oxybutynin

Question 16

Dipstick findings of positive leukocyte esterase n nitrites each indicates?
Which one is expected to be positive in acute pyelonephritis?

Answer 16

LE- indicates significant pyuria
Nitrites- enterobacteriaceae which converts nitrates to nitrites
Both positive

Question 17

A 23 month old female came with UTI n is started on abx after culture had been taken. She showed clinical improvement on the next day of abx initiation. What’s the next step in the mx?

Answer 17

A child <2yr with even 1st episode of UTI should undergo renal n bladder U/S to look for predisposing anatomical abnormalities

Question 18

Renal vein thrombosis as a complication of nephrotic syndrome is most commonly seen in which type of glomerulopathies?

Answer 18

Membranous glomerulopathy

Question 19

Long term complication of vesicoureteral reflux?

Answer 19

Renal scaring

Question 20

A contrast induced renal failure is a form of ATN. The expected lab values are
Urine sodium? FENa? Urine specific gravity?

Answer 20

ATN from nephrotoxins other than contrast- UNa>20, FENa>1%, low specific gravity. Contrast induced ATN on the other hand would cause spasm of the afferent arterioles—> renal tubular dysfunction. Tremendous reabsorption of Na n water—> high specific gravity of urine, low urine sodium

Question 21

Drug Rx of SIADH - in cases of severe hyponatremia for acute Rx together with hypertonic saline?
Chronic therapy for SIADH

Answer 21

Acute- conivaptan, tolvaptan - IV ADH antagonists

Chronic Rx - demeclocycline, which blocks ADH at the collecting duct

Question 22

EKG findings in severe hyperkalemia

Answer 22

Peaked T waves
Wide QRS
PR prolongation

Question 23

Oral potassium binding agents

Answer 23

Kayexalate, patiromer

Question 24

What other electrolyte abnormality would hypomagnesemia cause? How?

Answer 24

Hypokalemia

When Mg is low, Mg dependent K channels open n spill potassium into the urine

Question 25

Topiramate, an anticonvulsant, what renal problem does it cause?

Answer 25

Distal(type 1) RTA

Question 26

Recurrent UTI predisposes to which type of Renal stone?

Answer 26

Struvite stone