Renal/GU

Question 1

Nephrotic syndrome: pathophys?

dx?

Answer 1

loss of negative charge on GBM → proteinuria → edema, hypoalbuminemia, hyperlipidemia

UA shows fatty casts

Question 2

Nephritic syndrome: pathophys?

dx?

Answer 2

inflammation of glomeruli → hematuria, oliguria, HTN, azotemia

Dx UA shows RBC casts

Question 3

MCC of death associated with minimal change disease?

tx?

Answer 3

spontaneous bacterial peritonitis

steroids, salt-restriction + diuretics during flares

Question 4

WAGR syndrome?

Answer 4

∆WT1 on chromosome 11 → Wilms tumor (kidney), Aniridia, GU anomalies, mental Retardation, hemihypertrophy

Question 5

Neuroblastoma = ?

dx?

Answer 5

N-myc amplification →
proliferation of neural crest cells in adrenal gland →
1. abdominal mass/pain
2. opsoclonus-myoclonus syndrome (muscle + eyelid jerks)
3. ± bone mets (pancytopenia)

Dx urinary ↑HVA/↑VMA

Question 6

Fanconi syndrome: cause?

s/s?

Answer 6

proximal tubule dysfunction → defective resorption of amino acids, bicarb, glucose, phosphate

polydipsia, polyuria, glucosuria, aminoaciduria, type 2 RTA, hypophosphatemic rickets, etc.

Question 7

Type 1 RTA: cause?

s/s?

Answer 7

“distal RTA”, collecting duct can’t excrete H+ → metabolic acidosis + urinary alkalosis, hypo-K

Question 8

Type 2 RTA: cause?

s/s?

Answer 8

“proximal RTA”, proximal tubule can’t resorb bicarb → metabolic acidosis + urinary alkalosis, hypo-K

Question 9

Type 4 RTA: cause?

s/s?

Answer 9

“hyperkalemic RTA”, ↓aldosterone or ∆aldosterone-R → metabolic acidosis + urinary acidosis, hyper-K

Question 10

Low implantation of ureter:
boys vs girls?
dx?

Answer 10

• asx in boys
• “wet w/ urine all the time” in girls b/c ureter drips into vagina instead of bladder

Dx IV pyelo
(Tx surgical correction)

Question 11

Posterior urethral valve:
presentation?
dx?
tx?

Answer 11

presents w/ oliguria + lower abdominal mass (distended bladder) in a neonate

first catheterize to empty bladder, then Dx VCUG

Tx resection

Question 12

Idiopathic hypercalciuria:

Answer 12

persistent excretion of calcium irritates urinary tract → dysuria, ↑risk of kidney stones, microscopic hematuria w/
recurrent episodes of gross hematuria

Question 13

Dialysis indications:

Answer 13

AEIOU – Acidosis (severe metabolic acidosis), Electrolytes (severe hyperkalemia), Intoxication, Overload (severe hypervolemia), Uremia (BUN >150, pericarditis)

Question 14

tx of upper UTI? lower UTI?

Answer 14

upper = ceftriaxone

lower = bactrim > cipro

Question 15

VCUG indications?

Answer 15

r/o VUR in all males w/ UTIs, girls 5 w/ 2+ UTIs

Question 16

Vesicoureteral reflux (VUR):
dx?
tx?

Answer 16

ureters implanted into wrong site on bladder → no mechanism for preventing retrograde urine reflux →
recurrent UTIs at young age

Dx VCUG

Tx long-term abx until kid grows out of it (low grade), surgical reimplantation of ureter (high grade)

Question 17

Inconspicuous penis vs Micropenis

Answer 17

Inconspicuous: normal in fat boys, retract foreskin and measure → refer to urology if <2.5 std dev

Micropenis: GH deficiency

Question 18

When should you consult urology for phimosis?

Answer 18

> 3 yo

Question 19

Paraphimosis:

Answer 19

inability to relocate foreskin after retraction; Tx urology consult

Question 20

Labial adhesions:

Answer 20

benign fusion of labia minora; Tx estrogen cream

Question 21

Labial adhesions + electrolyte imbalances:

Answer 21

congenital adrenal hyperplasia

Question 22

Polycystic ovarian syndrome (PCOS): hormone abn?

Answer 22

↑LH, ↓FSH, ↑E/T

Question 23

PID + pelvic mass:
dx?
tx?

Answer 23

tubo-ovarian abscess
Dx transvaginal U/S
Tx I+D

Question 24

Omphalocele:

management?

Answer 24

intestines protrude into umbilical cord w/ peritoneal covering, ↑risk of associated cardiac defects

first sterile wrapping, then Dx echo to r/o cardiac defects, then Tx closure if small, silo if large

Question 25

Gastroschisis:

management?

Answer 25

intestines tear through abdominal wall w/o peritoneal covering

first sterile wrapping, then Tx closure if small, silo if large

Question 26

Patent urachus:

Vitelline fistula:

Answer 26

PU: failure of urachus to obliterate → urination from umbilical cord

VF: failure of vitelline duct to obliterate → meconium from umbilical cord