Nephrology

Question 1

Acute renal failure - renal causes (4), most common (bolded)

glomerulonephritis, and most common pathophysiology
most common cause, others

Answer 1

–Vascular - Dissection, Thrombosis, Emboli

–Glomerular - Glomerulonephritis (GN)

–Interstitial - Acute Interstitial Nephritis (AIN)

–Tubular (most common) - Acute Tubular Necrosis (ATN)

pathophysiology-immune complexes/antibodies in glomeruli

–Autoimmune / Vasculitities

• Post-streptococcal GN
• Wegeners, Goodpastures Hepatitis B/C
• SLE, PAN, HSP, HUS, TTP, HELLP

–Malignant Hypertension

Question 2

Glomerulonephritis - key urine finding

tx

acute interstitial nephritis (AIN) cause categories (2)

key urine finding (2)

Answer 2

urine finding - RBC casts
steroids, immunosuppressive agents

AIN: drugs and infections

key urine finding: eosinophiluria, WBC casts

–Drugs

• Penicillin, Sulpha
• Diuretics
• NSAIDs

–Infections

Question 3

ATN, cause categories (2), review subcategories

Answer 3

Ischemic and toxic

•Ischemic

–Usually oliguric (<500 mL/day)

–Leading causes: trauma and sepsis

–

•Toxic

–Usually not oliguric

–Causes: Contrast media

Myoglobin(rhabdomyolysis)

Hemoglobin (hemolysis)

Aminoglycosides

Multiple myeloma

Ethylene glycol

Question 4

hem+ urine dip, no RBCs = (2)

treatment for this condition (3)

medications to reduce risk of contrast -induced nephropathy (form of ATN) - (4)

Answer 4

= Rhabdomyolysis; note: can also be hemoglobinuria from intravascular hemolysis (MAHA etc)

hydration, treat hyperkalemia/hypocalcemia, alkalinization of the urine with bicarb

meds: HCO3, NAC, hypertonic saline, volume expansion

Question 5

Answer 5

Question 6

Answer 6

Question 7

Nephrotic syndrome features (5)

most common cause, other causes (review)

Answer 7

–Massive proteinuria (>3g / 24h)

–Hypoalbuminemia

–Edema

–Hyperlipidemia

–Thrombotic diathesis

•DVT/PE

most common cause: idiopathic

Secondary

–Diabetes mellitus

–Henoch-Schonlein purpura (HSP)

–SLE / Syphilis / Hepatitis B/C

–HIV

–Cancer

–Drugs (gold, mercury. heroin)

Question 8

Polycystic kidney disease
inheritance pattern
primary symptom and association

ESRD: indications for dialysis (5)

Answer 8

Autosomal dominant
progressive renal failure and cerebral aneurysms/SAH

refractory acidosis, electrolyte disturbance (Na, K), volume overload, symptomatic uremia, toxins

Question 9

ESRD

hematologic complications (3)

stealth cardiac + treatment

neurologic (2)

calcium and magnesium tend to be

Answer 9

Heme: depression of all cell lines, RBCs, malfunctioning WBCs, platelets

cardiac: uremic pericarditis treated with dialysis
neuro: SDH more common, uremic encephalopathy

tend to be low

Question 10

Dialysis complications related to acces + treatment

Bleeding

clotting
infection - cause, tx

cardiac - type

Answer 10

Bleeding - DDAVP, protamine for uremic platelet dysfunction

clotting - inject thrombolytic into site versus surgical; thrill gone
infection - cause: staph, vanc/gent

cardiac - type: high-output failure

Question 11

AMS after dialysis (5)

diagnostic criteria for peritoneal dialysis peritonitis, most common cause, tx

Answer 11

Hypotension, hypoglycemia, hypercalcemia, subdural, disequilibrium syndrome (elevated ICP due to osmotic shifts during dialysis often accompanied by headache, nausea, generally resolve spontaneously)

dx: > 100 WBC/mL; staph epi #1, also aureus and strep
tx: intraperitoneal antibiotics and lavage, consider systemic antibiotics

Question 12

Sterile pyuria: most common and classic

scrotal/rectal/peritoneal pain out of proportion to clinical findings =

etiology

tx

Answer 12

Sterile pyuria: chlamydia, TB

= Fournier’s gangrene

polymicrobial
surgical and antibiotics

Question 13

Balanitis vs posthitis

Balanoposthitis tx

Answer 13

Balanitis (glans) vs posthitis (foreskin)

tx: soap and water hygiene, bacitracin and paren peds), clotrimazole (adults)

Question 14

Answer 14

Question 15

Answer 15

Question 16

Priapism types (2) + tx;

subcategories of first type (4) and most common

Answer 16

•Low-flow priapism (ischemic): terbutaline/phenylephrine injected to corpora; transfusion for sickle cell associated, copora aspiration/irrigation

–Sickle cell or other hematologic diseases

–Intracavernosal injections - most common

–Drugs (phenothiazines, SSRIs, Viagra et al., neuroleptics)

–Spinal cord injuries

–

•High-flow priapism (arterial injury) - embolization or surgery

–Trauma (straddle mechanism)

Question 17

Pictured entity

Fever, chills, headache, myalgia, rash onset 2-6 hours after tx, lasts a few hours =

Answer 17

Secondary syphilis

Jarisch-Herxheimer – Antibiotic treatment causes organism death and the release of endotoxins

–Occurs in 50% of cases of primary syphilis (90% of secondary cases)

–Treat with acetaminophen two hours before and after antibiotic treatment

Question 18

Pictured entity, cause

other rash sx

tx

Answer 18

Lymphogranuloma venereum (LGV)

Chlamydia trachomatis

painless herpes like genital ulcers

doxycycline three weeks

Question 20

Pictured entity, painful
cause

dx

tx

Granuloma Inguinale - what, salient difference, tx

Answer 20

Chancroid

Haemophilus ducreyi

culture
azithromycin or ceftriaxone

Granuloma Inguinale - progressive, mutilating painless ulcer without lymphadenopathy

doxycycline three weeks

Question 21

Testicular torsion, peak incidence

associated with this congenital deformity

cremesteric reflex and Prehn’s sign

direction of first attempt detorsion maneuver

Answer 21

Puberty
Bill Klapper deformity that allows free rotation of testis
reflex absent, Prehn’s sign absent (relief of pain with scrotal elevation)

medial to lateral-open book

Question 22

Acute prostatitis treatment procedures (2), contraindicated procedure, long term

non-traumatic hematuria, see chart

Answer 22

Prostate massage, consider suprapubic drain, no Foley!; Antibiotics long-term

Question 23

Answer 23

Question 24

Kidney stone, most common site of impaction

hematuria absent ?%

Fluid boluses indicated?

Passage rate 5 mm and greater than 6 mm

Answer 24

UVJ

absent 15%

bolus relatively contraindicated per board review

passage: 50% versus 10%