Renal

Question 1

Hyponatremia mx, risk of faster correction

Answer 1

3% saline. should be 0.5mEq/L/hr due to osmotic demyelination. LOW TO HIGH PONS WILL DIE

Question 2

Risk of correcting hypernatremia quickly

Answer 2

Cerebral edema. HIGH TO LOW BRAIN WLL BLOW

Question 3

Vomiting for 4 days. electrolytes? Rx?

Answer 3

hypokalemic hypochloremic metabolic alkalosis, urine Na decreased due to compensatory reabsorption, urine Cl decreased. RX- NS

Question 4

Renal failure in AML

Answer 4

Tumor lysis synd- hyperphos, hypocalc, hyperK, hyperuricemia. Calcium phosphate, uric acid stones- AKI- tubular obstruction

Question 5

Mx of tumor lysis syndrome

Answer 5

Aggressive hydration, rasburicase, allopurinol, rx electrolyte abn

Question 6

Dull left flank pain, non radiating, hematuria. Swelling of left testis, dil and tortous veins. H/o MN.

Answer 6

Renal vein thrombosis due to hypercoag - nephrotic synd

Question 7

RF for renal vein thrombosis

Answer 7

Nephrotic syndrome, trauma, renal malig

Question 8

24F dysuria, hematuria, lower abd tenderness, bladder tender on palpation of ant vaginal wall. UA- RBC+

Answer 8

Endometriosis

Question 9

Wilms. NBS

Answer 9

Abd USG. For extent- CECT, MRI, CT chest for mets

Question 10

BPH causing LUTS, Cr elevated evaluation

Answer 10

UA, PSA, CR. AKI- do renal USG, place catheter

Question 11

SCZ-confused. Na low, S.osm- low, u.osm-low

Answer 11

Primary polydipsia

Question 12

22M urti 3 days ago, hematuria, RBC casts, CR high

Answer 12

IgA nephropathy

Question 13

SIADH Rx

Answer 13

Hypertonic saline, fluid restriction +salt tablets

Question 14

Posterior urethral injury mx

Answer 14

Retrograde urethrography, urethrography and urethroscopy before sx, suprapubic catheter followed by delayed repair

Question 15

Primary VUR in children diag and rx

Answer 15

Renal USG, voiding cystourethrography. Rx- mild- observation+ppx antibiotics, severe- ppx antibiotics+sx

Question 16

ESRD pt has painful skin lesions. Biopsy shows arteriolar calcification, occlusion, subintimal fibrosis. Diag, rx?

Answer 16

Calcific uremic arteriolopathy- calciphylaxis. Analgesics, wound care,treat RF, optimize dialysis

Question 17

Conditions causing enuresis

Answer 17

constipation, bladder dysfunction, CKD, UTI, DM, DI, OSA

Question 18

5M enuresis, recurrent UTI, tired, HTN, proteinuria. NBS

Answer 18

serum Cr- CKD suspect of PUV. can check renal usg, vsug

Question 19

Blood in urine, 1-2 RBC in urine causes

Answer 19

hemoglobinuria, myoglobinuria

Question 20

Hypertonic saline given for hyponatremic pt NBS to find cause

Answer 20

Urine osmolality

Question 21

72M on TCA, lower abd tenderness

Answer 21

Urinary retention- catheterize, stop TCA

Question 22

4M right varicocele, mass doesnt decrease in supine, HTN

Answer 22

Do USG abd

Question 23

Elevated Cr, small kidneys, bland sediment, mild proteinuria

Answer 23

chronic HTN

Question 24

RA with proteinuria

Answer 24

Nephrotic syndr- amyloidosis AA. Take renal biopsy

Question 25

PSGN + vol overload status. NBS

Answer 25

Loop diuretic

Question 26

HTN in PSGN

Answer 26

CCB- DOC, Dont use ACEi for AKI

Question 27

Liver cirrhosis on furosemide, spironolactone, hypotension, low Na, High K, High BUN/Cr, Urine Na low

Answer 27

Prerenal AKI- renal hypoperfusion Hepatorenal syndrome. Rx- albumin+splanchnic vasoconstrictors- terlipressin, NE, midrodrine, octreotide, liver transplant

Question 28

Nephrotic syndrome, HIV+

Answer 28

FSGS. 2/2 HIV continue ART

Question 29

Struvite stone formation mechanism

Answer 29

Urease producing organisms- increased urine ammonia production

Question 30

Decompensated HF with increased BUN/Cr

Answer 30

Prerenal azotemia due to elevated CVP

Question 31

Rx for asymptomatic bacteriuria

Answer 31

cefpodoxime, fosfomycin, augmentin, nitrofurantoin only in T2

Question 32

Transplanted kindey x 5 months, elevated Cr, biopsy shows heavy lymphocyte infiltrate + vascular intimal swelling

Answer 32

Acute rejection, increase dose of suppressants

Question 33

Afferent and efferent vasoconstriction- prerenal AKI, HTN, BUN/Cr >20, transplanted kidney pt

Answer 33

Tacrolimus toxicity

Question 34

Ischemic stroke, cvs, rs- normal, EPO-elevated, smokes

Answer 34

RCC- secondary polycythemia. Do CT abdomen

Question 35

NBS after ABG shows metabolic alkalosis

Answer 35

Urine chloride to diff saline responsive or not

Question 36

Metabolic alkalosis, high urine Cl in hypovolemic pt

Answer 36

Bartter, gitelman synd

Question 37

Alkalosis, high urine Cl in hypervolemic pt

Answer 37

Primary hyperaldosteronism, cushing, ectopic ACTH production

Question 38

Mx of magnesium toxicity

Answer 38

Stop the drug, IVF + loop diuretics, IV calcium, hemodialysis

Question 39

1st line mx for any incontinence

Answer 39

bladder training, kegel