MSK 2 / Renal

Question 1

Ankylosing spondylitis:
presentation?
dx?
complications?

Answer 1

bilateral sacroiliitis + gradual- onset upward fusion of spine + enthesitis (pain at tendon attachment sites)

XR (bamboo spine)

restrictive lung dz, cauda equina syndrome, spine fx w/ spinal cord damage, osteoporosis, spondylodiscitis

Question 2

Reiter syndrome (reactive arthritis):
presentation?
a/w…
dx?

Answer 2

triad of anterior uveitis, urethritis, arthritis

bacterial GI infx (Salmonella, Shigella, Campy, Chlamydia, Yersinia)

Question 3

Psoriatic arthritis:
dx?
complications?

Answer 3

X-ray (pencil-in-cup deformity)

dactylitis (sausage fingers)

joint aspiration (r/o infx arthritis)

Question 4

Takayasu arteritis:
presentation?
dx?
tx?

Answer 4

young Asian woman w/ absent pulses and asymmetrical BP

arteriogram

steroids, angioplasty for stenosed veins

Question 5

Polyarteritis nodosa:
pathophys/presentation?
a/w...
dx?
tx?

Answer 5

vasculitis of renal and visceral vx → abd pain (bowel angina), fatigue, joint pain, renal failure

associated w/ HBV infx

Dx tissue bx, ↑P-ANCA

Tx steroids

Question 6

Behçet syndrome:
presentation?
dx?
tx?

Answer 6

recurrent oral and genital ulcers, arthritis, uveitis, CNS sx

Dx tissue bx

Tx steroids

Question 7

Churg-Strauss syndrome:
presentation?
dx?
tx?

Answer 7

triad of asthma + eosinophilia + granulomatous vasculitis

Dx tissue bx, ↑P-ANCA

Tx steroids

Question 8

Wegener granulomatosis:
presentation?
dx?
tx?

Answer 8

triad of necrotizing:
- vasculitis
- granulomas in lungs and upper resp tract
- glomerulonephritis 
→ hematuria + hemoptysis

Dx tissue bx (necrotizing granulomas), ↑C-ANCA

Tx cyclophosphamide

Question 9

Medullary sponge kidney:
presentation?
dx?
tx?

Answer 9

cystic dilation of collecting ducts → hematuria, recurrent UTIs, kidney stones

dx IV pyelo (sponge-like calyx)

no tx

Question 10

RA stenosis:
dx?
tx?
etiology?

Answer 10

Dx renal arteriogram (if pt is in renal failure, use MRA instead since dye is nephrotoxic)

Tx angioplasty

Etiology: fibromuscular dysplasia (young women), atherosclerosis (old men)

Question 11

RV thrombosis:
presentation?
dx?
tx?

Answer 11

intrinsic clot or extrinsic compression causes ↓renal blood outflow → flank pain, HTN, hematuria, proteinuria

Dx renal venography

Tx underlying cause

Question 12

Hypertensive nephrosclerosis:

benign vs malignant?

Answer 12

Benign nephrosclerosis: hyaline arteriolosclerosis in chronic HTN

Malignant nephrosclerosis: hyperplastic (“onion skin”) arteriolosclerosis in rapidly progressive HTN

Question 13

Sickle cell nephropathy:
presentation?
eventually results in…
tx?

Answer 13

recurrent sickling → papillary infarction

eventual papillary necrosis, renal failure, UTIs

ACE inhibitors (w/ hydroxyurea for SCD)

Question 14

Kidney stone diet:

Answer 14

high fluids (#1), low sodium, low protein, high calcium (counterintuitive), low oxalate

Question 15

Radiolucent KS?

Answer 15

Uric acid stones

Question 16

KS 2/2 gout or tumor lysis syndrome?

Answer 16

Uric acid stones

Question 17

KS 2/2 hypercalciuria or hyperoxaluria?

Answer 17

Ca stones

Question 18

Prostate cancer:
dx?
tx?

Answer 18

Dx screen w/ PSA (≥10) or DRE (firm nodule); confirm w/ U/S-guided needle bx

Tx radical prostatectomy (local), radiation + flutamide + leuprolide (invasive)

Question 19

Renal cell carcinoma (RCC):
presentation?
dx?
tx?
risk factors?
if bil?

Answer 19

abdominal mass, flank pain, hematuria, and paraneoplastic syndromes (PAPER – PTH-rP, ACTH, prolactin, EPO, renin)

CT

radical nephrectomy

smoking (#1), obesity

von Hippel-Lindau

Question 20

Bladder cancer:
presentation?
dx?
tx?
risk factors?

Answer 20

painless hematuria

Dx IV pyelo + cystoscopy w/ bx

Tx resection + close f/u for high recurrence

“Pee SAC” – pain killer abuse, smoking (#1), aniline dyes, cyclophosphamide

Question 21

Testicular cancer:
presentation?
dx?
tx?
f/u labs?

Answer 21

firm, painless testicular mass

Dx transillumination (doesn’t light up), testicular U/S (solid mass)

1. radical orchiectomy
2. CT chest/A/P for staging
3. radiation (if seminoma) vs retroperitoneal LN-ectomy (if nonseminoma)

f/u αFP + βHCG levels

Question 22

Penile cancer:

etiology?

Answer 22

HPV-16/18 infx

Question 23

Presentation of testicular torsion vs epididymitis?

Answer 23

torsion = pain + high riding testicle w/ horizontal lie

epididymitis = torsion + F/pyuria + cord tenderness

Question 24

Organism a/w bladder SCC?

Answer 24

Schistosoma haematobium