Nephrology and Urology

Question 1

What is the most likely diagnosis of pt presenting with dehydration, pallor, hemolytic anemia (helmet shaped schistocytes and burr cells on smear), thrombocytopenia, and elevated creatinine after GI illness?

Answer 1

Hemolytic uremic syndrome (HUS)

due to E.Coli O157:H7

Question 2

When should surgical repair of a varicocele (collection of dilated and tortuous veins that surrounds the spermatic cord, feels like bag of worms) occur?

Answer 2

when there is evidence of atrophy or growth retardation of the affected testicle

Question 3

What is the possible complication associated with undescended testicles?

Answer 3

increased risk of cancer (seminoma)

Question 4

What is the silk glovesign and what does it indicate?

Answer 4

thickened processus vaginalis; inguinal hernia

Question 5

What is the most likely diagnosis for pt with hearing loss, hematuria, extrusion of central portion of lens into anterior chamber, macular flecks, corneal erosions and family history of kidney failure?

Answer 5

Alport syndrome

abnormal basement membrane

Question 6

What is the most likely diagnosis for pt presenting with absent/ hypoplastic/ dystrophic nails, proteinuria and orthopedic anomalies (hypoplastic patella)?

Answer 6

Nail-patella syndrome

15% can result in end stage renal disease

Question 7

What is the most likely diagnosis for pt presenting with testicular pain, horizontal lying testes that is high riding, absence of cremasteric reflex, pain continues with elevation of testis, and nausea/ vomting?

Answer 7

Testicular torsion

dx: ultrasound
(tx: surgery)

Question 8

What are 3 causes of pseudohyperkalemia (spurious hyperkalemia)?

Answer 8

1. hemolyzed specimen
2. thrombocytosis
3. Leukocytosis

Question 9

What are the 2 lab findings diagnostic of post-streptococcal glomerulonephritis?

Answer 9

1. Antistreptolysin O (after strep pharyngitis)

2. DNase B antibody (after cutaneous strep)

Question 10

What is the treatment used for microalbuminuria in diabetics and what is the possible side effects?

Answer 10

ACE inhibitors (lisinopril); chronic cough and angioedema

Question 11

What is the most likely diagnosis for pt presenting with dark urine, hypertension, red blood cell casts in urine, and erythematous weeping lesions associated with yellowish crusting under/ around the nose?

Answer 11

Post-streptococcal Glomerulonephritis

can also occur after strep throat

Question 12

What is the next best step in management for pt presenting with hydrocele after 1 year old?

Answer 12

surgical referral

possible inguinal hernia

Question 13

What is the most likely diagnosis for pt with proteinuria in the evening but not in the morning without other symptoms?

Answer 13

Orthostatic proteinuria

dx: urine protein to creatinine ratio on 1st morning void followed by an upright specimen

Question 14

What is the most likely diagnosis for pt presenting with recurrent painless hematuria after URIs with IgA within mesangial deposits of the glomerulus and normal C3 complement?

Answer 14

Berger disease (IgA nephropathy)

Question 15

What is the difference between diabetes insipidus and pschogenic polydipsia?

Answer 15

DI: low urine osm, high serum osm
PP: low urine osm, low serum osm

Question 16

What is the most likely diagnosis for a pt presenting with asymptomatic microscopic hematuria with a calcium to creatinine ratio less than 0.2?

Answer 16

Familial hematuria

check parents urine

Question 17

What is the electrolyte derangement associated with ethylene glycol intoxication?

Answer 17

high anion gap metabolic acidosis with acute renal failure

high Na, high K, low Cl, low bicarb, high creatinine, high osm, low pH

Question 18

…is when a tight prepuce is retracted over the glans of the level of the distal corona and can lead to ischemia of the distal shaft and glans of the penis

Answer 18

Paraphimosis

Question 19

What is the most likely diagnosis of pt presenting with lower extremity and generalized edema, normal blood pressure, diffuse abdominal pain, elevated Tg/ cholesterol, proteinuria, hypoalbuminemia, but normal creatinine?

Answer 19

Idiopathic nephrotic syndrome

Question 20

what is the most likely diagnosis for newborn presenting with deficient abdominal musculature, cryptorchidism, urinary tract anomalies (hydronephrosis, VUR), pulmonary hypoplasia (respiratory distress) and prenatal oligohydramnios?

Answer 20

Prune belly syndrome

Eagle- Barrett syndrome

Question 21

What is the most likely diagnosis for pt presenting with painless fluid filled cyst liek nodule above the upper pole of the testicle?

Answer 21

Spermatocele

filled with nonviable sperm

Question 22

What is the most likely diagnosis for pt presenting with scrotal pain localized to palpable mass at superior pole with bluish discoloration and positive cremasteric reflex?

Answer 22

Torsion of the testicular appendix

tx: supportive

Question 23

What are the major reasons for delay in renal transplantation?

Answer 23

1. active or recurrent UTIs
2. uncontrolled malignancy
3. ABO incompatibility

Question 24

What is the most likely diagnosis for pt presenting with shortened QT interval, nausea, confusion, constipation, anorexia in the setting of prolonged immobilization or sarcoidosis?

Answer 24

Hypercalcemia

Question 25

What renal disorder is fanconi syndrome associated with?

Answer 25

Type 2 renal tubular acidosis

fanconi syndrome: bicarb, phos, glu, and amino acid loss

Question 26

What is the most likely diagnosis for pt presenting with dysuria, urinary frequency, difficulty voiding and friable, erythematou, edematous, fleshy donut shaped mass extruding from near the vaginal introitus?

Answer 26

Urethral prolapse

tx: topical estrogen cream BID for 2 weeks

Question 27

What is the most likely diagnosis for pt presenting with cough, recurrent sinusitis, mucosal ulceration, hemoptysis, exercise intolerance, conjunctival injection, glomerulonephritis, and saddle nose deformity?

Answer 27

Granulomatosis with polyangitis
(aka Wegener granulomatosis)

(due to ANCA)

Question 28

What GI manifestation is assocaited with autosomal recessive polycystic kidney disease?

Answer 28

congenital hepatic fibrosis

Question 29

What is the change of body distribution of water from infancy to 10 years old?

Answer 29

total body weight decreases
extracellular water decreases
intracellular water increases

Question 30

What dietary change can result in decreased renal stones?

Answer 30

decreased vitamin C intake

Question 31

What disorder is most often associated with idiopathic nephrotic syndrome?

Answer 31

renal vein thrombosis

Question 32

What is the most likely diagnosis for pt presenting with hypertension, headaches, bruit heard lateral to umbilicus?

Answer 32

renal artery stenosis (due to fibromuscular dysplasia)

Question 33

What is the recommendations for urine microalbumin screening for type 1 versus type 2 diabetics?

Answer 33

Type 1: start 5 years after diagnosis

Type 2: start at diagnosis

Question 34

what is the best long-term treatment for nocturnal enuresis?

Answer 34

enuresis alarms (older than 7 year old)

Question 35

What is the most likely diagnosis for pt presenting with gross/ microscopic hematuria, pain with urination, normal blood pressure, no proteinuria, normal C3/C4/C50?

Answer 35

Idiopathic hypercalciuria

dx: 24hr urine for total calcium excretion or spot urine calcium to creatinine ratio

Question 36

What is the next best step in management for patient with coma/ seizure due to hyponatremia?

Answer 36

immediately raise Na level by 2-3 meq using 3% NS

then raise by 0.5 meq/hr to normal using NS