Nephro/GU Flashcards
An 18 month old girl has periorbital swelling. Her albumin is 26. Her urine is negative for protein. What do you do for diagnosis?
a) Serum trypsin
b) Stool alpha anti-trypsin
c) Urine creatinine excretion
d) ECHO
b) Stool alpha anti-trypsin
Other potential causes of hypoalbuminemia include liver disease (reduced production) and inadequate protein intake. Very rarely hypoalbuminemia can result from an extensive skin disorder causing protein loss via the skin. Measurement of stool α1-antitrypsin is a useful screening test for protein-losing enteropathy.
What is important to know in order to determine if BP is within normal range?
a) Weight
b) Ethnicity
c) Height
d) Age
age, sex, and height percentile.
11 year old boy who has never been dry at night. Father had nocturnal enuresis until age 10. Having difficulty and not able to spend time at his friends’ houses for sleepovers. What is the best advice regarding management?
a. Alarm
b. Imipramine
c. DDAVP
d. Oxybutynin
DDAVP
Synthetic analogue of ADH. Not curative. Desmopressin acetate’s greatest value may be for short-term treatment, in settings such as camp or sleepovers, rather than as an attempt at a cure
Alarm - Alarm therapy requires a commitment from parents and other siblings because the alarms are sufficiently loud that often all members of the household are wakened when the alarm goes off. Alarms are impractical for ‘sleepovers’ and camp.
A child is receiving high dose prednisone for nephrotic syndrome. He is due for his DPTP-Hib. When can you give it? Today 1 month 6 months 11 months
today
NON LIVE
Inactivated vaccines and toxoids can be administered to all immunocompromised patients in usual doses and schedules, although the response to these vaccines may be suboptimal.
16 year old girl comes to your office. Her BMI is 27 and she has stage 1 hypertension. No protein present on urinalysis. What is the next step in managing her high blood pressure?
1) Beta blocker
2) Calcium channel blocker
3) Lifestyle
4) ACEi
lifestyle
The mainstay of therapy for children with asymptomatic mild hypertension without evidence of target-organ damage is therapeutic lifestyle modification with dietary changes and regular exercise. Weight loss is the primary therapy in obesity-related hypertension.
Indications for pharmacologic therapy include symptomatic hypertension, secondary hypertension, hypertensive target organ damage, diabetes (types 1 and 2), and persistent hypertension and STAGE 2 HTN (>99th) -despite nonpharmacologic measures.
Which of the following is seen in distal RTA?
a. Hyperkalemia
b. Hyponatremia
c. Hypophosphatemia
d. Hypercalciuria
d. Hypercalciuria
can also get hypokalemia
Renal tubular acidosis is characterized by non-anion gap (hyperchloremic) metabolic acidosis in the setting of normal GFR. There are 4 types:
Type I - classic distal RTA- cant secrete H
Type II - proximal RTA - cant absorb bicarb
Type III - combined proximal and distal
Type IV - hyperkalemic RTA
Most common renal stone in children
a) Calcium oxalate
b) Cystine
c) Urate
d) Struvite
calc oxalate
4 year old girl with glomerulonephritis, hypertension, and vomiting x3 days. Most probable test to determine diagnosis
a) C3
b) Renal Biopsy
C3
GN with Low C3:
Systemic diseases: Lupus nephritis, subacute bacterial endocarditis, shunt nephritis, essential mixed cryoglobulinemia, visceral abscess
Renal disease: Acute post-infectious GN, membranoproliferative GN type I
GN with Normal C3
Systemic diseases: Polyarteritis nodosa, hypersensitivity vasculitis, granulomatosis with polyangitis, HSP, goodpasture
Renal: IgA nephropathy, idiopathic rapidly progressive GN (type I - anti GBM, type II - immune complex, type III - pauciimmune), postinfectious GN (non-strep)
15 yo with 3+ proteinuria.
a) Check Protein twice each am
check three times in a row
What is the result when you have a diagnosis of central DI post water deprivation test?
a) Decreased Urine osmolality
b) Increased urine osmolality
c) Decreaed Serum osmolality
d) Increased serum osmolality
increased serum osmolality
and urine will stay LOW as u keep spilling water
with ADH deficiency, high serum osmolality and low urine osmolality
this just diagnosis DI- next step give DDAVP to determine central vs peripheral
Boy with enuresis, what is a good non pharm way to treat it
a) Positive reinforcement
b) Bed Alarm
c) Ddavp
d) Bladder training
bed alarm
DO not reward them
Children with turners have which renal abnormality at rates higher than healthy population?
a -horseshoe kidney
b -MCDK
c -Vesicoureteral reflux
A horseshoe kidney
What glomerular disease is associated with a low C3?
a. Membranous nephropathy
b. Alports
c. IgA nephropathy
d. Membranoproliferative glomerulonephritis
MPGN
GN with Normal C3
Systemic diseases: Polyarteritis nodosa, hypersensitivity vasculitis, granulomatosis with polyangitis, HSP, goodpasture, Alports (hematuria, sensorineural hearing loss)
Renal: IgA nephropathy, idiopathic rapidly progressive GN (type I - anti GBM, type II - immune complex, type III - pauciimmune), postinfectious GN (non-strep)
A child presents with hypertension, urine dip shows blood and protein, creatinine and urea are elevated, C3 and C4 are normal. What is the most likely diagnosis?
a. SLE
b. Membranoproliferative glomerulonephritis
c. Post-infectious glomerulonephritis
d. IgA nephropathy
d. IgA nephropathy
LOW C3- SLE, MPGN, Post infectios
4 year old child with nephrotic syndrome on steroids. Presents with a swollen and tender abdomen. Looks septic. What test would give you the diagnostic: a. Paracentesis b. CT scan c. MRI D. Laparotomy
parecentesis
Child with distal RTA who doesn’t take his meds. 2 months after last visit, presents with bilateral leg weakness and doesn’t want to walk. What does he have?
a. Chronic acidosis
b. Hypokalemia
c. Hypocalcemia
d. Hypomagnesemia
hypokalemia - gives bilat weakness
severe metabolic acidosis, urine pH cannot be reduced < 5.5, hyperchloremia (because of loss of HCO3-), hypokalemia (because of inability to secrete H+), hypercalciuria, hypocitraturia (chronic metabolic acidosis leads to impaired urinary citrate excretion, which worsens hypercalciuria)
7 y.o boy presents with left-sided night time flank pain. An US reveals left-sided hydronephrosis. what do you do next?
a. VCUG
b. Nuclear scan with lasix washout
c. DMSA scan
d. CT abdomen with contrast
nuclear scan with lasix washout
MAG-3 administered with lasix - looks at differential renal function to assess for obstruction
chool aged child with pH 7.15, HCO3 9, Na 138, Cl 121, PO4 0.7, K 3.0. Also has urine pH of 5 and glucose in urine. What do you check? Which test is most likely to reveal the diagnosis?
a. Leukocyte for cystine
b. Urine ca/cr ratio
leukocyte for cysteine
metabolic acidosis, non-aniongap
either RTA or diarrhea
distal RTA DO NOT have acidic urine.
RTA with pH <5.5, glucosuria = proximal RTA
Proximal RTA almost always = fanconi
Most common cause of fanconi = cystinosis
RTA proximal vs distal
proximal - acidic urine,
distal
pRTA presents with polyuria, dehydration, anorexia, vomiting, constipation, hypotonia and FTT in first year of life. Non-anion gap metabolic acidosis, normal urinalysis (except in Fanconi), urine pH < 5.5 because distal acidification mechanisms are intact, +/- renal failure.
severe metabolic acidosis, urine pH cannot be reduced < 5.5, hyperchloremia (because of loss of HCO3-), hypokalemia (because of inability to secrete H+), hypercalciuria, hypocitraturia (chronic metabolic acidosis leads to impaired urinary citrate excretion, which worsens hypercalciuria)
You are asked to assess a 10 day old baby with weak abdominal muscles and cryptorchidism. The baby is also found to have bilateral flank masses. What is the most likely association with this picture to explain the flank masses?
a. polycystic kidneys
b. multicytic dysplastic kidneys
c. hydronephrosis
d. bilateral wilms tumors
hydronephrosis
Shows picture of genitalia (looks labial adhesions) in an 18mo girl. What to do?
Estrogen cream to the affected area
b. Abdo US
c. Call CAS
d. Refer to urology
estrogen cream to affect area
6 yr American African girl presented with blood in underwear. She has some trouble urinating, no fever, no other symptoms. On exam there is a red mass coming out of vagina..
a. Urethral prolapse
b. Cancer
black + blood spotting
it is URETHRAL PROLAPSE
and give estrogen cream 2-3 times daily
Patient presents with edema, abdominal distension, and proteinuria. Patient also has fever and is found to have spontaneous bacterial peritonitis. What is the MOST likely pathogen causing the SBP.
a. Steptococcal pneumoniae
b. E. Coli
c. Enterococcus
d. Listeria
strep pneumo
e coli #2
Patient with history of sore throat. Urine shows microscopic hematuria. What is the natural course?
a. It will resolve over time
b. Progress to chronic renal disease
c. microscopic hematuria
d. proteinuria and hypertension
resolve over time
Progress to chronic renal disease - very rare
c. microscopic hematuria - can last up to a year
d. proteinuria and hypertension - in acute phase
Antenatal diagnosis of hydronephrosis. What to do before d/c?
a. VCUG
b. MAG scan
c. Ultrasound
ultrasound at 48 hours
if persistent then VCUG and nephro referal
A 14 year old boy presents with an acutely painful scrotum. You suspect testicular torsion. Which of the following is true?
a. absence of the cremasteric reflex is common
b. blue discoloration of the scrotum is pathognomonic
c. you have 36 hours to treat before losing the testes
absence of crem reflex ommon
non viable after 24 hours
he reason we do orchidopexy?
a. reduce the chance of testicular cancer
b. allow better testicular examination
c. increase fertility potential - JELD says best as per their lecture
ALL technically correct
increase fertility
A 10 month old boy comes to ER. Acute onset of scrotal swelling. Parents have noted on and off swelling in the past few days. Today a bit irritable. VSS stable. On exam, swollen scrotum, does not reduce; transilluminates well, testicle palpable separately. Likely diagnosis?
a. epididmytis
b. testicular torsion
c. acute hydrocele
d. incarcerated hernia
acute hydrocele
not super upset
Smooth, firm, tubular mass in scrotum that transilluminates, not febrile, irritable for a week. Discomfort with examination, testes palpable and are distinct from this mass. Not reducible, no vomiting.
a. incarcerated inguinal hernia
b. acute non-communicating hydrocoele
c. epididymitis
d. testicular torsion
acute non-communicating hydrocoele
as it transilluminates
3 mo baby boy with right inguinal mass. Anorexia and irritabiliy x 3days. Mass transilluminates, soft and separate from testes. Diagnosis:
a. acute non-communicating hydrocele
b. incarcerated inguinal hernia
c. Tumor
d. torsion of testes
INCARCERATED INGUINAL HERIA - could also be hydrocele
tunica vaginalis communicates, maybe they have hydrocele and inguinal hernia
Which of the following is important in measuring blood pressure:
a. height
b. weight
c. Tanner stage
height
BP varies with age, sex, and height in children
ABPM uses a portable automated device that records blood pressure (BP) over a specific time period (usually 24 hours).
Kid with hypertension confirmed by ambulatory blood pressure monitoring. Has BP 121/86. What do you do?
a. start him on captopril
b. observe and repeat an ambulatory blood pressure test
c. renal ultrasound
renal u/s
ABPM if positive over 24 hours that is diagnostic
if its by visits 3x
consider starting amlodipine
DONT do ace inhibitor/pril - with renal artery stenosis, causes hyperK, aki, and inc cr
Periorbital swelling with no tenderness, no fever and normal blood pressure. What do you do?
a. reassure
b. check for proteinuria
c. start antibiotics
check for proteinuria
tests for hypertension?
RENAL lytes and renal function
uurinalysis, renal ultrasound
HEART fasting glu and lipids
END ORGAN echo, acr, retinal exam
Periorbital swelling with no tenderness, no fever and normal blood pressure. What do you do?
a. reassure
b. check for proteinuria
c. start antibiotics
check proteinuria
Which of the following is a presentation of HUS?
a. Coombs + anemia
b. Thrombocytopenia
c. Myoglobinuria
thromboycypeona
Characterized by the triad of microangiopathic hemolytic anemia, thrombocytopenia and renal insufficiency.
2 major categories of disease:
Infection associated (E. coli O157:H7, Shigella dysenteriae type 1, HIV, neuraminidase producing Strep pneumo)
Genetic (atypical HUS)
Recurrent hematuria in a young male with a speech delay
a. IgA nephropathy (usu occurs within 2 days of getting ill)
b. Alport syndrome
c. PSGN
d. MPGN
alport
hematuria
often associated with sensorineural hearing loss and ocular abnormalities
C3 normal
xlinked
IF a GIRL - consider IgA nephropathy
6 y.o. girl with a history of bilateral VUR and recurrent UTIs, including two febrile illnesses. Has been off antibiotics and infection-free for two years. Repeat u/s and VCUG show normal kidneys, but grade 1-2 reflux bilaterally. What do you recommend:
a. consider operative repair
b. repeat cystogram every 2 years
c. restart prophylactic antibiotics
d. continue non-interventional observation
continue non-interventional observation
if put on abx, reasses 3-6 mo
12y old with diabetes Type I since the age of 5 with microalbuminuria despite optimum control of his diabetes. What should you start him on :
a. hydrochlorothiazide
b. nifidepine
c. enalapril
enalapril
Diabetic with microalbuminuria. What would you prescribe?
a. Enalapril
b. Hydrochlorothiazide
c. Nifedipine
d. Salt and water restriction
enalapril
14 year old boy in office for pre-camp physical, 3+ protein in urine x2, exam is normal, what is most likely cause?
a. exercise induced -
b. IgA nephropathy -
c. nephritic syndrome -
d. Orthostatic
a. exercise induced - also possible but less common
b. IgA nephropathy - persistent microscopic hematuria more common
c. nephritic syndrome - would have other symptoms
d. Orthostatic
Patient to ER with following labs: Na 135, K 2.3, Cl 116, Bicarb 9, pH 7.14, most likely cause?
a. RTA
b. DKA
c. lactic acidosis
d. Vomiting
RTA
Non- anion gap metabolic acidosis, hypokalemia, normal sodium, hyperchloremia
Anion gap = Na - HCO3 - Cl = 10 (normal)
RTA: RTA is a disease state characterized by a normal anion gap (hyperchloremic) metabolic acidosis
