Ad Renal

Question 1

How to check persistant proteinuria

Answer 1

Initial 1+ proteinuria—-> confirm by early morning urine dipstick—-> to check persistant proteinuria - consecutive positive urine dipsticks 1-2 weeks.

Gold standard - 24 hour urinary protein.

Question 2

Management of Renal artery stenosis

Answer 2

1. Control hypertension- by ACE-I or ARB ( careful monitoring done to renal impairment, if renal signs are seen—> stop them and start CCB.
   Avoid thiazide diuretics.
2. Control cholesterol- statins
3. Revascularization by renal artery angioplasty -
   -for patient who failed medical management
   -resistant hypertension
   -dialysis dependent kidney failure
   -BL renal artery stenosis
   -SINGLE kidney with RAS.

Question 3

PSA elevating and reducing factors

Answer 3

Question 4

Sclerotic changes of vertebrae means

Answer 4

Highly suggestive of Prostate cancer with SCLEROTIC changes.

Question 5

If abnormal DRE or high PSA according to the age , what’s next

Answer 5

Transrectal ultrasound scan( TRUS) ( as a guide for biopsy) and prostate biopsy taken.

Question 6

When to do bone scan in prostate cancer

Answer 6

Positive bone scan probability is very low unless PSA >10. So unless it’s >10 ,unnecessary.

Question 7

What’s goodpasture syndrome / anti glomerular basement membrane disease ( anti- GBM disease)

Answer 7

Common in younger <30y
Affects only LUNGS and KIDNEYS.

CF- sob , cough, hemoptysis ( due to alveolar hemorrhage) reduced UOP, dark colored urin.

Question 8

Diagnostic test for goodpasture syndrome

Answer 8

Real biopsy—-> check for anti- GBM antibody

Second most accurate test - anti-GBM antibody assay.

Question 9

Commonest complication of TURP

Answer 9

Retrograde ejaculation (80-90%)

Question 10

How does TURP syndrome occur

Answer 10

By fluid overload ,electrolyte imbalance and hyponatremia.( absorption of fluid which was used to irrigate prostate during the procedure )

CF
CNS- restless, headache, confusion,N/V, cerebral edema
CVS- bradycardia,tachypnea, hypoxia, cyanosis
Hypothermia
Abdominal pain and distention.

Question 11

What’s gold standard for urine incontinence

Answer 11

Urodynamic studies.

Important not for diagnosis but when planning invasive procedures.

Question 12

Which chronic derangements in CKD are usually well tolerated by the patient

Answer 12

Hypercalcemia ( due to impaired bone metabolism)
Hyperkalemia ( failure to excrete potassium)

Hyponatremia( inability to retain sodium by kidneys) and uremia are not well tolerated

Question 13

What’s neuropathic bladder ?

Answer 13

Due to secondary neurological damage.
Symptoms- overflow incontinence ,frequency, urgency, urine retention.
It’s a cause rather than a type of UI.

Question 14

First line for urge incontinence

Answer 14

Bladder training ( first line)
But commonly combined with pelvic floor exercise

Question 15

In urge incontinence what’s the mx if pelvic floor exercises failed

Answer 15

Surgical ( high cure rates) options considered.
1. Mid urethral string (tension free vaginal tape under urethra)
2. Bladder neck sling ( suspension)
3. Urethral bulking agents injection.
4. Burch colposuspension

Question 16

Ix of choice for urolothiasis

Answer 16

CT KUB
X-RAY KUB can be used to minimize radiation

USS - can’t visualize stones but hydeonephrosis can.
MRI HAS NO PLACE HERE.

Question 17

Mechanism of urge incontinence

Answer 17

Overactive bladder due to Detrusor instability

Question 18

RF for testicular cancer

Answer 18

Question 19

What are tumor markers of testicular cancer

Answer 19

AFP
Beta HCG

Question 20

In suspected testicular tortion what to do

Answer 20

Surgery immediately
Window of necrosis 4-6 hours

Question 21

Testicular mass management

Answer 21

Initial- USS —-> of cancer suspected or cystic TUMOR MARKERS —-> if positive CT for staging and Mets —-> surgey if indicated

Question 22

What’s the most imp investigation to asses male infertility

Answer 22

FSH
>2.5 times normal FSH indicate IRREVERSIBLE TESTICULAR FAILURE.

Question 23

Commonest cause of Hematuria in symptomatic and asymptomatic

Answer 23

UTI

Question 24

Which size of rental stones will pass spontaneously

Answer 24

Less than 7mm

Question 25

What’s the symptom triad of renal cell carcinoma?

Answer 25

Gross hematuria
Flank pain
Abdominal mass

Question 26

What’s a small renal mass

Answer 26

Renal lesion of <4cm in the largest diameter is a small renal mass

Question 27

Which features of renal masses make them more likely to be malignant ?

Answer 27

Question 28

Which renal masses are eligible for partial nephrectomy / nephron sparing surgery ?

Answer 28

Smaller then 7cm

Question 29

What’s the management for small renal masses?

Answer 29

If life expectancy MORE THAN 5 YEARS and aGOOD CANDIDATE FOR SURGERY- surgical resection is the best management.

Question 30

Total nephrectomy is the choice of tx with what factors ?

Answer 30

Question 31

Who are good candidates for active surveillance of small renal masses?

Answer 31

Some with CT or MRI scans with 6-12 moth intervals.

1. Small renal masses who are not good candidates for surgery
2. Life expectancy less than 5 years
3. Renal impairment

Question 32

Ablation of small renal masses is the option in what scenarios ?

Answer 32

Question 33

How to manage infertility with absent vas deferens?

Answer 33

In vitro fertilization.
Aspirated sperm from testes are injected to oocyte.

Question 34

What’s the urinary condition caused by cyclophosphamide?

Answer 34

Causes hemorrhagic cystitis.
Hematuria is painful rather than painless.

Question 35

What are four risk factor for testicular cancer ?

Answer 35

Question 36

What’s the diagnostic test for scrotal cancers?

Answer 36

USS

Question 37

How to manage a cystic testicular mass ?

Answer 37

If a cystic lesion detected in USS, next is to tumor markers ( because 23% testicular cysts are malignant.

Question 38

I hate the next investigation for asymptomatic Hematuria ?

Answer 38

Urine culture