Nephrology/Urology

Question 1

Hx of Hodgkins, undergoing chemotx and AG
Oliguria, inc urinary sodium, azotemia
Enlarged kidneys, hydropic degeneration

Answer 1

ATN
Tx: Stop offending agent
IVF and electrolyte correction

Question 2

Hx of recurrent UTI
“Worst headache of my life”
Palpable nontender bilateral flank masses

Answer 2

ADPKD
Usually with berry aneurysms, HPN, MVP
Tx: Dialysis, renal transplant

Question 3

Hematuria, proteinuria
Poor visual acuity, bilateral cataracts
Sensorineural hearing loss

Answer 3

Alport’s
Type IV collagen defect
Tx: ACEI, transplant

Question 4

Fatigue, SOB, palpitations, wt loss
Macroglossia, LE edema, ascites
Restrictive cardiomyopathy
Apple green birefringence with congo red

Answer 4

Amyloidosis
with nephrotic or MM - bence jones
Tx: supportive

Question 5

Urinary frequency, nocturia, terminal dribbling
Smooth enlarged prostate (middle lobe)
Increased PSA

Answer 5

BPH
Tx: Finasteride, TURP
TMPSMX for UTI

Question 6

Painless hematuria
Hx: smoking
Cauliflowerlike lesion of bladder wall

Answer 6

Bladder Cancer
Transitional cell Ca
Tx: surgery, chemorad

Question 7

Frequency, urgency, hesitancy
Feeling of incomplete evacuation
Bilateral hydroureter and nephrosis

Answer 7

Obstructive uropathy

Tx: transurethral resection of prostate (TURP)

Question 8

Hx of T1DM
Generalized pitting edema, HPN
Proteinuria, fatty casts
Kimmelstiel wilson nodules

Answer 8

DM Glomerulosclerosis
Tx: Control blood glucose
ACEI for HPN

Question 9

Fatigue, malaise, hematemesis
Oliguric, dark orange urine
Hx: smoking

Answer 9

Goodpasture’s
Hemorrhagic alveolitis with nephritis and IDA
AntiGBM (type II)
Tx: plasmapharesis, steroids

Question 10

Hx of URTI and recurrent bloody urine
RBC casts, inc serum IgA
Mesangial proliferation with segmental necrosis

Answer 10

IgA nephropathy
crescentic glomerulonephritis, FPGS
Tx: supportive, kidney transplant

Question 11

Recurrent oral ulceration, photosensitive skin rash
Arthritis, butterfly malar rash
ANA (+), wire-loop GN

Answer 11

Lupus nephritis
Tx: Steroids, cyclophosphamide, azathioprine
Dialysis, transplant

Question 12

Headache, palpitations, tinnitus, generalized edema
Hematuria, hypocomplementemia
Tramtrack appearance, (+) fatty casts

Answer 12

MPGN

Tx: steroids, transplant

Question 13

Bilateral pitting edema, periorbital edema, ascites
Proteinuria>3.5, Cholesterol>250, Albumin<3g
Spike and dome pattern

Answer 13

Nephrotic

MGN

Question 14

Child with hx of URTI
Abdominal distention, generalized edema
Hypoalb, hypercholes, proteinuria
Normal renal biopsy

Answer 14

MCD

Tx: corticosteroids, salt restriction

Question 15

Dysuria, frequency, back pain
Hx of high fat diet
Rockhard irregular peripheral lobe of prostate
Inc PSA and acid phosphatase

Answer 15

Prostate carcinoma
Mets to bone and nerves
Tx: prostatectomy
leuprolide, flutamide

Question 16

60/M, flank pain, hematuria, wt loss
Hx: heavy smoking, moderate HPN
Polygonal clear cells with atypia

Answer 16

Renal cell carcinoma (VHL, ADPKD)
Invades renal vein, IVC, mets to lung and bone
Tx: nephrectomy

Question 17

Progressive painless enlargement of left testicle
(-) transillumination
Normal AFP, normal LDH

Answer 17

Seminoma (MC GCT)
Good prognosis
Tx: orchiectomy with LN dissection
Chemotx: cisplatin

Question 18

Painless nodular swelling of testicle
Increase in growth of breast tissue
Elevated BHCG

Answer 18

Testicular choriocarcinoma
Most malignant, mets to LN and liver
Tx: chemotx cisplatin etoposide bleomycin, orchiectomy LN dissection

Question 19

Hard painless palpable mass in testis 2 mos
Gynecomastia
Increased AFP and BHCG

Answer 19

Testicular cancer (males 20-35)
vs Yolk sac (elevated AFP normal BHCG)
Tx: radical inguinla orchiectomy

Question 20

Sudden onset severe pain in lower abd, scrotum
Swollen tender testicle, inc pain with elevation
negative transillumination, no hernia

Answer 20

Testicular torsion

Tx: IMMEDIATE surgery within 4 hours

Question 21

child, abdominal mass
crytorchidism, aniridia, hematuria
Displaced pelvocaliceal system

Answer 21

Wilm’s tumor
Chr 11p WT-1gene
WAGR Wilm’s, aniridia, GU, MR
Tx: surgery