FARR Renal/Geniourinary

Question 1

Renal tubular acidosis (RTA) associated with abnormal H+ secretion and nephrolithiasis.

Answer 1

Type I (distal) RTA.

Question 2

RTA associated with abnormal HCO3– and rickets.

Answer 2

Type II (proximal) RTA.

Question 3

RTA associated with aldosterone defect.

Answer 3

Type IV (distal) RTA.

Question 4

“Doughy” skin

Answer 4

Hypernatremia.

Question 5

Differential of hypervolemic hyponatremia.

Answer 5

Cirrhosis, CHF, nephritic syndrome.

Question 6

Chvostek’s and Trousseau’s signs.

Answer 6

Hypocalcemia.

Question 7

The most common causes of hypercalcemia.

Answer 7

Malignancy and hyperparathyroidism.

Question 8

T-wave flattening and U waves.

Answer 8

Hypokalemia.

Question 9

Peaked T waves and widened QRS.

Answer 9

Hyperkalemia.

Question 10

First-line treatment for moderate hypercalcemia.

Answer 10

V hydration and loop diuretics (furosemide).

Question 11

Type of ARF in a patient with FeNa < 1%.

Answer 11

Prerenal.

Question 12

A 49-year-old man presents with acute-onset flank pain and hematuria.

Answer 12

Nephrolithiasis.

Question 13

The most common type of nephrolithiasis.

Answer 13

Calcium oxalate.

Question 14

A 20-year-old man presents with a palpable flank mass and hematuria. Ultrasound shows bilateral enlarged kidneys with cysts. Associated brain anomaly?

Answer 14

Cerebral berry aneurysms (autosomal-dominant PCKD).

Question 15

Hematuria, hypertension, and oliguria.

Answer 15

Nephritic syndrome.

Question 16

Proteinuria, hypoalbuminemia, hyperlipidemia, hyperlipiduria, and edema.

Answer 16

Nephrotic syndrome.

Question 17

The most common form of nephritic syndrome.

Answer 17

Membranous glomerulonephritis.

Question 18

The most common form of glomerulonephritis.

Answer 18

IgA nephropathy (Berger’s disease).

Question 19

Glomerulonephritis with deafness.

Answer 19

Alport’s syndrome.

Question 20

Glomerulonephritis with hemoptysis.

Answer 20

Wegener’s granulomatosis and Goodpasture’s syndrome.

Question 21

Presence of red cell casts in urine sediment.

Answer 21

Glomerulonephritis/nephritic syndrome.

Question 22

Eosinophils in urine sediment.

Answer 22

Allergic interstitial nephritis.

Question 23

Waxy casts in urine sediment and Maltese crosses (seen with lipiduria).

Answer 23

Nephrotic syndrome.

Question 24

Drowsiness, asterixis, nausea, and a pericardial friction rub.

Answer 24

Uremic syndrome seen in patients with renal failure.

Question 25

A 55-year-old man is diagnosed with prostate cancer. Treatment options?

Answer 25

Wait, surgical resection, radiation and/or androgen suppression.

Question 26

Low urine specific gravity in the presence of high serum osmolality.

Answer 26

Diabetes insipidus.

Question 27

Treatment of SIADH?

Answer 27

Fluid restriction, demeclocycline.

Question 28

Hematuria, flank pain, and palpable flank mass.

Answer 28

Renal cell carcinoma (RCC).

Question 29

Testicular cancer associated with β-hCG, AFP.

Answer 29

Choriocarcinoma.

Question 30

The most common type of testicular cancer

Answer 30

Seminoma, a type of germ cell tumor.

Question 31

The most common histology of bladder cancer.

Answer 31

Transitional cell carcinoma.

Question 32

Complication of overly rapid correction of hyponatremia.

Answer 32

Central pontine myelinolysis.

Question 33

Salicylate ingestion occurs in what type of acid-base disorder?

Answer 33

Anion gap acidosis and 1° respiratory alkalosis due to central respiratory stimulation.

Question 34

Acid-base disturbance commonly seen in pregnant women.

Answer 34

Respiratory alkalosis.

Question 35

Three systemic diseases that lead to nephrotic syndrome.

Answer 35

DM, SLE, and amyloidosis.

Question 36

Elevated erythropoietin level, elevated hematocrit, and normal O2 saturation suggest?

Answer 36

RCC or other erythropoietin-producing tumor; evaluate with CT scan.

Question 37

A 55-year-old male presents with irritative and obstructive urinary symptoms. Treatment options?

Answer 37

Likely BPH. Options include no treatment, terazosin, finasteride, or surgical intervention (TURP).

Question 38

Hypernatremia causes—

Answer 38

The 6 D’s Diuresis Dehydration Diabetes insipidus Docs (iatrogenic) Diarrhea Disease (e.g., kidney, sickle cell)

Question 39

Hypervolemic hyponatremia is caused by

Answer 39

“nephrOSIS, cirrhOSIS, and cardiOSIS.”

Question 40

Hyperkalemia HISTORY/PE

Answer 40

May be asymptomatic or may present with nausea, vomiting, intestinal colic, areflexia, weakness, flaccid paralysis, and paresthesias.

Question 41

Treatment of hyperkalemia—

Answer 41

C BIG K | Calcium Bicarbonate Insulin Glucose Kayexalate

Question 42

Hypokalemia HISTORY/PE

Answer 42

Presents with fatigue, muscle weakness or cramps, ileus, hypotension, hyporeflexia, paresthesias, rhabdomyolysis, and ascending paralysis.

Question 43

Causes of hypercalcemia—

Answer 43

CHIMPANZEES Calcium supplementation Hyperparathyroidism/ Hyperthyroidism Iatrogenic (e.g., thiazides, parenteral nutrition)/Immobility Milk-alkali syndrome Paget’s disease Adrenal insufficiency/ Acromegaly Neoplasm Zollinger-Ellison syndrome (e.g., MEN 1) Excess vitamin A Excess vitamin D Sarcoidosis and other granulomatous disease

Question 44

Loops

Answer 44

(furosemide) Lose calcium. Avoid thiazide diuretics, which ↑ tubular reabsorption of calcium.

Question 45

↑ anion gap caused by—

Answer 45

MUDPILES Methanol Uremia DKA Paraldehyde Intoxication Lactic acidosis Ethylene glycol Salicylates

Question 46

Symptoms of uremia include

Answer 46

malaise, fatigue, confusion, oliguria, anorexia, and nausea.

Question 47

Exam of remia may show

Answer 47

a pericardial rub, asterixis, hypertension, ↓ urine out- put, and an ↑ respiratory rate (compensation of metabolic acidosis or from pulmonary edema 2° to volume overload)

Question 48

Indications for urgent dialysis—

Answer 48

AEIOU Acidosis Electrolyte abnormalities (hyperkalemia) Ingestions (salicylates, theophylline, methanol, barbiturates, lithium, ethylene glycol) Overload (fluid) Uremic symptoms (pericarditis, encephalopathy, bleeding, nausea, pruritus, myoclonus)

Question 49

CHRONIC KIDNEY DISEASE (CKD) | Most commonly due to

Answer 49

diabetes mellitus (DM), hypertension, and glomerulo- nephritis.

Question 50

Autosomal dominant (ADPKD):

Answer 50

I Most common. I Usually asymptomatic until patients are > 30 years of age. I One-half of ADPKD patients will have ESRD requiring dialysis by age 60. I Associated with an ↑ risk of cerebral aneurysm, especially in patients with a

Question 51

Autosomal recessive (ARPKD):

Answer 51

Less common but more severe. Presents in infants and young children with renal failure, liver fibrosis, and portal hypertension; may lead to death in the first few years of life.

Question 52

Differential for hematuria—

Answer 52

S2I3T3 Strictures Stones Infection Inflammation Infarction Tumor Trauma TB

Question 53

Testicular cancer | DIAGNOSIS

Answer 53

I Testicular ultrasound. I CXR and abdominal/pelvic CT to evaluate for metastasis. I Tumor markers are useful for diagnosis and in monitoring treatment re- sponse. I β-hCG is always elevated in choriocarcinoma and is elevated in 10% of seminomas. I α-fetoprotein (AFP) is often elevated in nonseminomatous germ cell tu- mors, particularly endodermal sinus (yolk sac) tumors. It is also elevated in hepatocellular carcinoma, hepatoblastoma, and neuroblastoma.