GU

Question 1

Majority of varicoceles on what side

Answer 1

left. If found on the right side can be associated with vena cava obstruction (think malignancy!)

Question 2

Tx stress incontinence (RX)

Answer 2

A agonist (pseudoephedrine) or TCA

Question 3

Tx urge incontinence (RX)

Answer 3

oxybutynin or anticholinergics, 2nd line botox

Question 4

TX nephrolithiasis

Answer 4

Stones

Question 5

Oxalate rich foods

Answer 5

Nuts bran spinach Vit c

Question 6

Paraphimosis vs Phimosis

Answer 6

Paraphimosis: foreskin is retracted, tourniquet effect; emergency
Phimosis: cannot be retracted, not emergent

Question 7

Physical exam findings testicular torsion

Answer 7

Negative cremasteric reflex on affected side
High riding testicle
Negative Prehn sign (there is no relief when you lift the testicle. In epididymitis there is a positive Prehn sign, there is relief when lifting the testicle)

Question 8

Examples of complicated cystitis

Answer 8

pregnancy
males
s/p foley cath
structural abnormality
immunocompromised
diabetes

Question 9

Initial tx cystitis: Pregnancy

Answer 9

Macrobid

Question 10

Initial tx cystitis complicated

Answer 10

Fluoroquinolone

Question 11

Tx Pyelo

Answer 11

Fluoroquinolone until cultures are done

Question 12

Epididymitis etio more than 35 y/o

Answer 12

GC/CT less than 35 More than 35 y/o is E. Coli

Question 13

Positive Prehn sign

Answer 13

Elevating testicle provides relief of pain. Seen in epididymitis

Question 14

TX Epididymitis

Answer 14

more than 35 y/o Cipro (E Coli)

Question 15

Tx for orchitis secondary to mumps

Answer 15

Symptomatic: ice, elevate, NSAIDs

Question 16

Acute prostatitis etio and tx

Answer 16

E coli, Cipro or Septra x 2-4 weeks

Dx with urine culture

Question 17

Prostatic massage:

Answer 17

No for acute prostatitis
Yes for chronic prostatitis, culture secretions and urine but still difficult to obtain culture so tx empirically x 6 weeks with Cipro or Septra

Question 18

Most important risk factor for bladder CA

Answer 18

Smoking

Bladder CA usually transitional cell carcinoma

Question 19

Next step pt > 40 y/o painless hematuria

Answer 19

Cystoscopy, CT

Question 20

Avg age for testicular CA

Answer 20

15-35

Question 21

Most common germ cell tumor

Answer 21

Seminoma

Question 22

What labs elevated with testicular CA

Answer 22

LDH
AFP
HCG

Question 23

Eval of testicular CA

Answer 23

US

No biopsy due to risk of metastatic spread to lymph nodes

Question 24

Most common renal malignancy in children

Answer 24

Wilms Tumor

Question 25

Child with urogenital malformations (cryptorchidism, hypospadias) associated with what?

Answer 25

Wilms Tumor

Question 26

Child with unilateral painless abdominal mass?

Answer 26

US, concerned about Wilms Tumor. 10% are metastatic at the time of dx

Question 27

Most common cause Acute Kidney Injury (acute renal failure)

Answer 27

Pre-renal: decrease perfusion

Question 28

2nd most common cause acute kidney injury

Answer 28

Intrinsic: ATN

Question 29

How do NSAIDs and contrast affect the kidney?

Answer 29

Constrict afferent arteriole

Question 30

Tx pre renal acute kidney injury vs intrinsic acute kidney injury

Answer 30

Pre-renal tx: fluids, is reversible | Intrinsic: if ATN: fluids will not help

Question 31

ESRD is eGFR

Answer 31

less than 15

Question 32

Initiating an ACEI in CKD

Answer 32

Repeat labs 3d after starting ACEI/ARB. D/C if Cr increases over 30% from baseline or increased K+

Question 33

What metabolic changes with CKD?

Answer 33

Hyperphosphatemia (reduced excretion) Hypocalcemia (lack of Vit D activation) Initially leads to secondary hyperparathyroidism

Question 34

Sx post streptococcal glomerulonephritis

Answer 34

hematuria, edema, HTN

Question 35

Most common cause of glomerulonephritis

Answer 35

IgA nephropathy: presents as hematuria a few days after URI

Question 36

Renal artery stenosis in a woman less than 50?

Answer 36

Fibromuscular dysplasia

Question 37

Exaggerated rise in creatinine with an ACEI or ARB suspect what?

Answer 37

RAS

Question 38

Recurrent flash pulmonary edema suspect what condition?

Answer 38

RAS

Question 39

Nephrogenic DI

Answer 39

PP makes lots of ADH but the kidneys are insensitive to it so ADH is not working. Usually caused by lithium or hypercalcemia. Causes hypernatremia (pt have polyuria) Will have low urine osmolality and high serum osmolality (dilute urine, salty blood)

Question 40

Tx DI and how to differentiate between nephrogenic and central DI?

Answer 40

ADH If it fixes the problem (pt urinates less and then urine becomes more concentrated) then the problem was central DI (not producing enough ADH). If it does not fix the problem it is nephrogenic (insensitive to ADH)

Question 41

SIADH causes what electrolyte abnormality and what does the urine and serum look like?

Answer 41

Retain fluids, causes hyponatremia, high urine osmolality low serum osmolality

Question 42

Tx asymptomatic hyponatremia?

Answer 42

Fluid restriction. Can also treat with normal saline and possibly a loop diuretic