Nephrology 3

Question 1

Presentation of PD-associated peritonitis

Answer 1

abdominal pain + nausea

*often don’t have a fever or white count

Question 2

PD-associated peritonitis diagnosis

Answer 2

Peritoneal fluid with over 100 WBCs or 50% PMNs

Question 3

Treatment of PD-associated peritonitis

Answer 3

• Intraperitoneal vancomycin and cefepime

treat empirically for both gram-positive and gram-negative organisms

Question 4

Why recurrent urolithiasis occurs in gastric bypass patients

Answer 4

• hyperoxaluria and hypocitraturia (malabsorption causes more intenstinal fatty acid binding to calcium, which increases colonic oxalate absorption and renal oxalate excretion)
• applies to all malabsorption

Question 5

Management of recurrent calcium oxalate stones in patients with malabsorption (Crohn’s)

Answer 5

• low oxalate diet + exogenous citrate supplementation

Question 6

significance of blood clots with hematuria

Answer 6

• non-glomerular source of urinary tract bleeding (glomerular bleeding presents with dysmorphic RBCs-casts)

Question 7

Significance of hematuria in a patient with previous cyclophosphamide exposure

Answer 7

• high risk for bladder cancer, patient needs cyclophosphamide

Question 8

Key feature of rhabdo

Answer 8

blood on dipstick (3-4+) but no RBCs on microscopic urinalysis

Question 9

cystinuria clinical features

Answer 9

• hexagonal (benzene ring) crystals in a *young patient with multiple stones

Question 10

Treatment of nephrogenic DI

Answer 10

• stop lithium
  IF patient can’t stop lithium – salt restriction + trial of diuretics (amiloride blocks sodium channels in collecting ducts to prevent lithiums entry, thiazides promote hypovolemia which increases proximal sodium and water reabsorption)

Question 11

What is amiloride?

Answer 11

a diuretic

Question 12

Management of Simple renal cyst

Answer 12

observation, no need for imaging unless symptomatic

Question 13

Lab features of surreptitious diuretic use

Answer 13

• intermittent hypokalemia
• metabolic alkalosis
• variable urinary chloride (diuretics cause a high urine chloride but urine chloride returns to low levels once effect wears office, thus level is variable)

Question 14

Lab features of surreptitious vomiting

Answer 14

• metabolic alkalosis + low urinary chloride

Question 15

Management of hypercalcemic patient with nephrolithiasis

Answer 15

Repeat BMP + obtain PTH (rule out primary hyperparathyroidism)

Question 16

Clinical features of anti phospholipid antibody syndrome

Answer 16

• CVA or VTE in a young patient

- recurrent miscarriage and or fetal loss

Question 17

lab features of anti phospholipid antibody syndrome

Answer 17

• thrombocytopenia (more than 25% of patients)
• prolonged PTT
• lupus anticoagulant
• anticardiolipin antibody
• anti-beta-2 glycoprotein antibody

Question 18

First step before anticoagulation patient with anti phospholipid antibody syndrome

Answer 18

• MRI brain (risk stratification)

Question 19

other presentation of TTP

Answer 19

Fever

Question 20

Major side effect of hydroxychloroquine

Answer 20

retinopathy

Question 21

pathogen that is the cause of anal pruritus

Answer 21

• enterobius vermicularis (pinworm)

Question 22

First line treatment of listeriosis

Answer 22

ampicillin

Question 23

Presentation of listeriosis in immunocompromised or elderly patient

Answer 23

• invasive disease (bacteremia, sepsis, meningitis)

Question 24

diabetic nephropathy features vs. GN

Answer 24

DN = albuminuria + bland UA (but can occasionally see RBC casts and hematuria) +
*slowly progressive (takes years to develop)
GN = active sediment (hematuria, RBC casts) + HTN + *rapidly progressive

Question 25

management of patient with features of diabetic nephropathy but also GN features

Answer 25

biopsy

Question 26

When to call urology for nephrolithiasis

Answer 26

• stone greater than 10 mm
• no passage within 4-6 weeks
• complicated nephrolithiasis (AKI, sepsis, complete obstruction, uncontrolled pain)

Question 27

initial workup of suspected nephrolithiasis

Answer 27

• noncon CT scan

Question 28

Management of fulminant cdiff

Answer 28

add IV flagyl

Question 29

treatment of first recurrence of cdiff

Answer 29

• prolonged course of oral vanc pulse dosed (QID for 10-14 days) and then slowly tapered over 2-8 weeks
• can also use fidaxomicin

Question 30

Management of cholecystitis in patient with high surgical risk (elderly with multiple comorbidities)

Answer 30

• percutaneous cholecytostomy

Question 31

Dietary modifications for reducing calcium-containing kidney stone formation in patients with hypercalciuria

Answer 31

• low sodium (increased proximal tubule calcium and sodium reabsorption and reduced calcium excretion)
• low animal protein diet (decreases acid load and urinary calcium excretion)
• increase calcium intake
• increase citrate intake
• increase fluids, fruits, and vegetables

Question 32

Management of bilateral urinary obstruction complicated by post-obstructive diuresis

Answer 32

• Volume repletion at significantly *lower rate than urine volume loss (matching volume repletion with UOP can worsen diuresis)

Question 33

bilateral urinary obstruction with post-obstructive diuresis physiology

Answer 33

• patient has underlying bilateral obstruction (typically due to intrabdominal disease, mets), which when relieved leads to post obstructive diuresis (kidneys attempt to excrete retained fluid)

Question 34

Initial steps in suspected hepatorenal syndrome

Answer 34

• albumin + *48 hour trial of diuretic cessation

Question 35

hepatorenal syndrome management

Answer 35

• midodrine, octreotide, albumin
• levophed in ICU
• transplant (best definitive treatment)

Question 36

Renovascular HTN due to renal artery stenosis clinical features

Answer 36

• recurrent flash pulmonary edema + severe HTN + AKI + underlying atherosclerosis