Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Josh's RC Questions > Nephro/Uro SAQ > Flashcards

Nephro/Uro SAQ Flashcards

1
Q
  1. A child presents with signs of glomerulonephritis. He was treated for a pharyngeal infection 2 weeks ago. List two investigations that would support your diagnosis of post streptococcal GN and describe if they are increased, decreased or normal.
A
  1. C3 low, C4 normal
  2. ASOT high
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q
  1. School age girl. 2 weeks ago, was diagnosed with pharyngitis. What are two laboratory tests to do to confirm post strep GN. Table given with two lines and two columns. X test, (up, down, normal)
A
  1. C3 low, C4 normal
  2. ASOT high
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q
  1. A three year old boy has left sided flank pain. Ultrasound shows a 4mm stone at the left ureteropelvic junction as well as grade 2 hydronephrosis on the left side. Urinalysis shows RBCs and WBCs with 1+ protein.
    a. What are three things you will do for him in the emergency room?
    b. What two things he can do to prevent future stones?
A

a)

  1. Pain management - tylenol, PO morphine
  2. Give mainteance IVF (bolus if hemodynamically unstable)
  3. Work up for stones:
    • serum lytes, BUN, Cr, iCa, phos, uric acid, ALP
    • U/A + UCx, Urine Ca:Cr
    • 24H collection for Ca, PO4, oxalate, uric acid
    • Spot test for cystinuria
  4. Antiemetic if needed
  5. Arrange good F/U

b)

  1. Increase fluid intake (teens with nephrolithiasis 2-2.5L/d)
  2. Low salt
  3. Normal calcium
  4. Low protein
  5. Lemonade
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q
  1. 7 year old girl with “confirmed” hypertension (didn’t say how it was confirmed). Has had normal CBC urea creatinine electrolytes. Name 4 investigations you would do at this point (did not specify for investigation vs treatment/evaluation).
A
  1. Opthalmology to assess for retinopathy
  2. Renal ultrasound to assess kidneys
  3. ECHO to assess for LVH
  4. Urinalysis to assess for proteinuria + hematuria. FIrst morning albumin:cr
  5. fasting glucose, serum lipids
  • Routine tests for all children with HTN
    1. lytes, BUN, Cr, gas
    2. fasting BG, serum lipids (to assess cardiovascular risk)
    3. U/A
    4. Renal U/S
    5. Assess end organ damage
      1. ECHO
      2. Retinal exam
      3. First morning Albumin:Cr
  • Consider depending on Hx
    • TSH + fT4 if suspect hyperthyroidism
    • Metanephrines if concern for pheochromocytoma
    • ECHO + 4limb BP to look for CoA
    • Sleep study for OSA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q
  1. Match the following blood gases with the following scenarios:

A. 5 day old lethargic baby with ammonia of 654

B. 4 year old with obstructive sleep apnea on AM waking gas

C. 7 month old with CHF on furosemide

D. 14 year old boy post-op after receiving Ringers at 80ml/hr for a few hours

A

A. 5 day old lethargic baby with ammonia of 654

  • UCD. Respiratory alkalosis.
  • UOA: severe AG metabolic acidosis
  • FAOD: hypoketotic hypoglycemia

B. 4 year old with obstructive sleep apnea on AM waking gas

  • resp acidosis (high pCO2)

C. 7 month old with CHF on furosemide

  • metabolic alkalosis. High bicarb, low K

D. 14 year old boy post-op after receiving Ringers at 80ml/hr for a few hours

  • High lactate -> metabolic acidosis. BUT apparently, high lactate is metabolized to bicarb, so get metabolic alkalosis….

Ringers: Na 130, Cl 109, K 4, Ca 3, Lactate 28

NS: Na 154, Cl 154, K 0, Ca 0, Lactate 0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q
  1. A 10 year old boy has 2+ proteinuria at his family doctor’s office on a dipstick. He is referred to you. He continues to have 2+ proteinuria on a dipstick in your office.
    a. What are the 2 most likely causes of his proteinuria?
    b. What are 3 further steps you would take to investigate the cause of his proteinuria?
A

A.

  1. Orthostatic proteinuria
  2. Transient proteinuria (triggered by fever, exercise, dehydration, cold exposure, heart fialure, sz, stress. Resolves on serial testing. If persistent, need further evaluation)
  3. Nephrotic syndrome

B.

  1. Lytes, BUN, Cr, albumin, cholesterol
  2. 24H protein collection
  3. First AM U/A and urine protein:Cr
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q
  1. A 12 year old girl with Crohn’s disease has a 0.8mm renal stone obstructing her ureter resulting in a grade 3 hydronephrosis.
    a. What is the most likely composition of the stone?
    b. What are 2 indications for surgical removal of the stone?
    c. What are 3 recommendations you could give her to avoid future stone formation?
A

A. Calcium oxalate

  • Crohn’s has fat malabsorption -> fat binds Ca -> leaves oxalate free -> deposits in kidney into stones

B.

  1. Urosepsis
  2. Complete obstruction
  3. Partial obstruction of solitary kidney
  4. Stone >5mm
  5. Stone that fails to pass after 2wk trial of conservative therapy
  6. Renal insufficiency

C.

  1. Increase daily fluid intake 2-2.5L in teen
  2. Low salt + prot diet
  3. Normal Ca
  4. Lemonade to increase citrate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q
  1. Child with hemolytic uremic syndrome (you are told it is HUS)
    a. What are the 3 characteristic laboratory features of HUS?
    b. What one clinical feature would make you think you had to follow this child’s renal function over the long term?
A

A. Labs

  1. Anemia - Coombs negative, high bili, high LDH, low haptoglobin, high retic
  2. Thrombocytopenia
  3. High Cr + BUN

B. Proteinuria

Patients with HTN, any level of renal insufficiency, or residual urinary abnormalities persistent 1 year after an episode of diarrhea positive HUS (particularly significant proteinuria) require careful long-term follow-up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q
  1. 14-year-old boy with primary hypertension wants to participate in hockey. BP 140/90 (> 99th percentile for age and height).

A. List 3 investigations you will do to screen for the effect of hypertension on the organs, and state what you are looking for on each test (3)

B. What finding on the screening tests will make you advise him to avoid contact sports?

A

A.

  1. Ophthalmology referral to assess for retinopathy
  2. ECHO for LVH
  3. First morning Albumin:Cr to assess for kidney damage
  4. Fasting glucose + serum lipids to assess for CVS risk

B. ?LVH

  • Athletes diagnosed with Stage 1 or Stage 2 hypertension without signs of end organ damage have no restrictions on their participation in sport.
  • Athletes diagnosed with Stage 1 or Stage 2 hypertension accompanied by signs of end organ damage may not participate in sport until their BP is well-controlled
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q
  1. A 15 year old boy has a non painful enlargement in his Left Scrotum. Please give FIVE possible reasons for this presentation
A
  1. Testicular tumour
  2. Hydrocele
  3. Inguinal hernia
  4. Varicocele
  5. Spermatocele
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q
  1. Child with hematuria. What are four tests on urinalysis that you would check to see if it is of a glomerular origin?
A
  1. Microscopy to look for RBC casts (pathognomonic of glomerulonephritis)
  2. RBC morphology (dysmorphic or acanthocytes suggest glomerular)
  3. Proteinuria >100mg/dL
  4. No clots (more vesicular/bladder disease)

Hematuria from tubular system: WBC casts or renal tubular casts

Lower urinary tract sources: gross hematuria, blood clots, normal RBC morphology, minimal proteinuria on dipstick

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q
  1. Kid with nephrotic syndrome.

A. How much protein loss is the cut off?

B. What are the other 3 criteria?

A

A. 3+ or 40mg/m2/hr

B.

  1. Hypoalbuminemia
  2. Edema
  3. Hyperlipidemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q
  1. Kid with kidney stone, stone found to be calcium phosphate crystals
    a. What 3 things do you tell the kid to prevent from getting stones later
    b. What 4 urine tests would you do to help with your management
A

A.

  1. Increase fluid intake
  2. Decrease salt and protein
  3. Normal Ca
  4. Drink lemonade

B.

  1. Urine Ca:Cr
  2. Urinalysis for blood + protein
  3. Urine culture to r/o UTI
  4. 24H collection for Cr clearance, Ca, phos, citrate, oxalate, uric acid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q
  1. 6yo boy presents with gross hematuria. He had a sore throat 1-2 weeks prior. His dip is 3+ positive blood, 2+ positive protein, there were red cell casts. His serum Cr and albumin are normal. You suspect Post strep GN, name two test results that would support this diagnosis.
A
  1. Low C3, normal C4
  2. High ASOT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q
  1. DDx intermittent scrotal pain
A
  1. Epididymitis
  2. Inguinal hernia (incarcerated)
  3. Torsion of appendix testis
  4. Testicular torsion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q
  1. Moderate antenatal hydronephrosis and a normal postnatal U/S – management?
A

No further work up

17
Q
  1. Secondary enuresis, previous history of constipation and UTI
    a. dx (1)
    b. therapy (2)
A

A. Overactive bladder

  • most common cause of daytime incontinence
  • Functionally small bladder, normal anatomy. Strong uninhibited contractions
  • Urinary frequency, urgency, Vincent’s curtsy
  • Recurrent UTIs
  • VCUG in girls “spinning top deformity” => dilated urethra with narrowed bladder neck + bladder wall hypertrophy

B.

  1. Timed voiding Q1.5-2H
  2. Treat constipation with PEG for cleanout + maintenance
  3. Treat UTI if present
  4. Kegel/pelvic floor exercises to reduce bladder contractions
  5. Anticholinergic Tx to reduce bladder overactivity
  6. Alpha-adrenergic blocker (terazosin) to promote bladder neck relaxation to help empty bladder
  7. Sacral nerve stimulation for refractory cases
18
Q
  1. Long term complications of Fanconi syndrome
A
  1. Rickets from hypophosphatemia
  2. Growth failure due to chronic acidosis + bone demineralization
  3. Muscle weakness from hypoK
  4. Constipation from hypo K
19
Q

Long term complications of Fanconi anemia

A
  1. Q1Y BMA + Bx Q for leukemia + MDS surveillance
  2. Q1Y for Solid tumour surveillance
    • SCC of H+N, upper eso
    • Liver tumours
  3. Screen gyne cancers starting at menarche
  4. Q1Y screen glucose intolerance + hyperinsulinism
  5. Risks of infections due to pancytopenia
20
Q
  1. 6 yo has nephrotic syndrome and responded well to steroids. He has been off steroids when you see him today. He is grossly edematous with distended abdomen and he has proteinuria again. Please state your therapy options – be specific (list 3)
A
  1. Prednisone daily
  2. Salt restriction
  3. Lasix +/- albumin
    • If underfilled, urine low Na + urine high K b/c high aldo -> give lasix + albumin
    • If overfilled or normovolemia -> give lasix only
  4. Cyclophosphamide prolongs the duration of remission + reduces number of relapses in children with frequently relapsing + seroid-dependent nephrotic syndrome
  5. Calcineurin inhibitors (cyclosporine or tacrolimus) are recommended for initial therapy for children wtih steroid-resistant nephrotic syndrome
21
Q
  1. A 6 year old boy received 3 months of steroid treatment for minimal change nephrotic syndrome. He was weaned off his steroid about a month ago but is admitted to hospital today with generalized edema and an albumin of 12. List 3 treatments you would offer.
A
  1. Restart steroids
  2. Lasix + albumin (albumin if severe symptomatic edema (large pleural effusions, ascites, severe genital edema) and evidence of IV depletion)
  3. Cyclophosphamide
  4. Fluid + salt restriction
22
Q
  1. An 8 year old boy presents with hematuria and hypertension. His ASOT is positive. List one test that you could do that would support your diagnosis of post infectious glomerulonephritis.
A

Low C3

23
Q
  1. List 3 symptoms of hypernatremia.
A
  1. Irritable
  2. Lethargic
  3. Thirsty
  4. Weak
  5. Dehydrated
  6. Central pontine myelinolysis
  7. Brain hemorrhage (most severe consequence of untreated hypernatremia; shrinking brain cells -> decreased brain volume + earing of intracerebral veins)
24
Q
  1. What are symptoms of hyponatremia? (list 3)
A
  1. Lethargic
  2. H/A
  3. Sz
  4. N/V
  5. Anorexia
  6. Brainstem herniation (if acute + severe)
25
Q
  1. List 4 reasons for a normocytic anemia in children with chronic renal failure
A
  1. Low erythropoietin
  2. Anemic of chronic disease
  3. Nutritional deficiencies (iron, folate, B12)
  4. Hematuria
  5. Dilutional due to fluid overload

DDx for normocytic anemia

  1. anemia of Chronic disease
  2. Renal failure - EPO deficiency
  3. Aplastic anemia (usu bi or pancytopenia)
  4. Malignancy
  5. TEC
  6. Infection
  7. Meds
  8. Endocrinopathy
26
Q
  1. 10 year old with history of gross hematuria several times post URTI. Father had renal transplant. What’s the diagnosis?
A

Alport syndrome if girl (b/c most likely X linked), IgA nephropathy if boy (b/c most common)

  1. Hematuria. Usually microscopic + asymptomatic. 50% have recurrent gross hematuria 1-2d after URTI.
  2. Progressive proteinuria
  3. Bilateral SNHL
  4. Anterior lenticonus

Tx

  • ACEI can slow rate of progression
  • ESRD: dialysis + kidney transplant
27
Q
  1. A 9 month old boy is referred to your office for unilateral cryptorchidism. What is the latest you would send him to get repaired?
A
  • No later than 12mo
  • If doesn’t descend by 4mo, unlikely to descend on own
28
Q
  1. A 3 day old boy with prune belly syndrome has a Na of 122 and a K of 5.0. His BUN and Creatinine are normal. He has been receiving 90cc/kg/day of IV fluid and he is NPO. He only put out 10cc of urine yesterday.

A. What are his fluid requirements (cc/kg/day)?

B. How should his glucose requirements be provided

A

A. TFI 120mL/kg/d on DOL3 + replacement of urine output

  • (desired sodium - serum sodium) x TBW = required sodium
  • TBW = 0.6xwt

B. D10W

29
Q
  1. A patient has a Na 135 K 4.0 Cl 114 HCO3 14.

A. Calculate the anion gap.

B. What are two causes of a normal anion gap metabolic acidosis?

C. What are two causes of an elevated anion gap metabolic gap acidosis?

A

A. AG = 7

B. 1) RTA, 2) iatrogenic from NS, 3) diarrhea

C. 1. Lactic acidosis , 2. DKA

30
Q
  1. You are present at the delivery of 30 week premature baby. The medical student asks you how much sodium to put into the IV solution.

A. What would you tell her?

B. What are two reasons for your choice?

A

A. D10W to start b/c baby has not had initiatl diuresis yet (due to increase ANP). Typically born with normal serum Na and have not had urinary losses -> don’t require supplmentation at birth.

Once diuresis occurs ~DOL 2-3, add Na to IVF (2-3mmol/kg/d) = D10 .2NS

B.

  1. Immature tubular function, cannot excrete Na
  2. Immature RAS cannot be maximally inhibited -> risk of sodium overload
31
Q
  1. Patient 5 yo nocturnal enuresis. What one thing not to do?
A
  • Do not punish or same the child
32
Q

31.

A. What is the most common cause of proteinuria in an otherwise well teen?

B. How would you test for this?

C. Two causes of false + proteinuria on dipstick.

A

A. Orthostatic proteinuria

B. First AM albumin:Cr for 3 mornings in a row. Should be negative.

C.

FP!

  1. Gross hematuria
  2. Highly concentrated urine
  3. Urne pH >7.0
  4. Contamination with antiseptic agents (chlorhexidine)

FN

  1. Dilute urine
  2. Disease states where predominate urinary protein lost is not albumin (LMW protein, Ig)
33
Q
  1. Infant boy presents with Na 125 K 8.0. Name the two most likely causes.
A
  1. CAH
  2. RTA type 4
34
Q

33.

A. By what age should you refer an infant for orchidopexy?

B. Give 2 reasons for doing orchidopexy.

A

A. Refer by 6mo if still undescended. Should get repair by 12mo

B.

  1. Increases fertility
  2. Decreases testicular malignancy
35
Q
  1. 4 year old with primary enuresis. What is one important piece of advice that you should give to the parents?
A
  • Reassure that this is normal
36
Q
  1. Teenager presents with acute scrotal pain.

A) List two important features on physical exam.

B) List 4 differential diagnoses.

C) What two things would you do for management?

A

A.

  1. Cremasteric reflex
  2. Blue dot sign

B.

  1. Testicular torsion
  2. Torsion of the appendix testis
  3. Epidydimitis
  4. Trauma

C.

  1. Testicular U/S with dopplers
  2. Call urology
  3. Pain management

Josh's RC Questions (39 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions