STEP 2 renal/GU

Question 1

Causes of nephritic syndrome? (5)

Answer 1

PSGN
IgA
GPA (Wegener's)
Alport
Goodpasture's
(MPGN (I & II))

Question 2

PSGN - pathophys, clinical features, labs/histology, TX

Answer 2

• subendothelial and subepithelial deposits of IgG and complement lead to glomerular injury (type III)
• hematuria, edema, HTN - resolves in 6-8 wks - skin or throat infections with GAS 2-6 wks prior
• granular IF staining, low C3 levels, ASO+, anti-DNAseB+
• TX - supportive w/ diuretics - most recover

Question 3

IgA nephropathy - pathophys, clinical features, labs/histology, TX

Answer 3

• mesangial deposits of IgA and complement (type III)
• asymptomatic RPGN picture, h/o viral URI or GI infx 48-72 hrs previously, +- HSP
• nl C3, granular IF pattern
• steroids for some pts; ACEI for proteinuria; 20% progress to ESRD

Question 4

GPA nephritis (Wegener’s) - pathophys, clinical features, labs/histology, TX

Answer 4

• pauci-immune GN cell-mediated damage (type IV)
• fever, weight loss, hearing, sinus, +hemoptysis - northern euro male 35-55
• c-ANCA+, nl C3, scant IF staining
• corticosteroids, cytotoxins, relapsing course

Question 5

Goodpasture syndrome - pathophys, clinical features, labs/histology, TX

Answer 5

• anti-GBM vs type IV collagen (type II rxn)
• RPGN with pulm hemorrhage, males in mid 20’s
• linear IF
• PLEX, pulse steroids, -> ?ESRD

Question 6

Alport syndrome - pathophys, clinical features, labs/histology, TX

Answer 6

• collagen IV mutations - X-linked
• hematuria, hearing loss, +- eye problems
• GBM splitting on EM
• -> ESRD, may recur after transplant

Question 7

Causes of nephrotic syndrome? (7)

Answer 7

MCD
FSGS
Membranous nephropathy
SLE
DM
Amyloidosis
(MPN)

Question 8

MP(G)N - pathophys, clinical features, labs/histology, TX

Answer 8

• type I - subendothelial and mesangial immune complexes - HCV, cryo, SLE, SBE
• type II - dense deposit disease, C3 nephritic factor
• children/young adults, idiopathic
• low C3, tram-track GBM
• steroids & cytotoxics, -> ESRD

Question 9

ADPKD associations? RCC risk?

tx?

Answer 9

berry aneurysm -> subarachnoid hem, MVP/AR
hepatic/pancreatic cyst
hernias
diverticulosis
HTN, CKD, proteinuria
no increased RCC risk
tx: ACE/ARB

Question 10

urine test for cystinosis?

Answer 10

cyanide nitroprusside, hexagonal crystals

Question 11

Children 2 yrs and under with febrile UTI workup?

Answer 11

U/S -> VCUG if scarring, hydronephrosis, high grade VUR

Question 12

Does orchiopexy decrease risk of testicular cancer?

Answer 12

No. So if cryptoorchidism discovered post 12mo, ectomy.

Question 13

Painless scrotal swelling workup

Answer 13

transluminate (varicocele opaque vs hydrocele)

U/S, CXR, CTAP, betaHCG, AFP for testicular ca w/up

Question 14

Painful scrotal swelling workup

Answer 14

Prehn’s sign (relief upon nutsack elevation), surgery if high suspicion for torsion, vascular U/S

Question 15

Urge incontinence: defn and tx?

Answer 15

Defn: sudden urge w/o incr IAP
Tx: Kegels, bladder training, oxybutinin

Question 16

Overflow incontinence: defn and tx?

Answer 16

involuntary continuous leakage (impaired bladder emptying)

alpha-blockers (doxazosin eg) and bethanechol

Question 17

hypercalcemia tx?

Answer 17

severe (>14 or symptomatic): hydration, calcitonin, loop D if vol overloaded
long term: bisphosphonates

Question 18

hyperkalemia associated meds?

Answer 18

beta-blockers: shift out
dig: NaK atpase inhibition
succinylcholine: leak
ACEI/ARB/antialdos/anti-ENAC
heparin: blocks aldo production
cyclosporine: blocks aldo
TMP: blocks ENAc
NSAIDs: decreases renal perfusion

Question 19

nephrotic syndrome and sudden flank pain, fever, gross hematuria = ?
tx?

Answer 19

renal vein thrombosis, due to loss of ATIII in nephrotic syndrome
tx: heparin -> warfarin. no data for thrombolysis.

Question 20

hypocalcemia - check which serum levels?

Answer 20

albumin - 0.8 factor
Mg - esp in alcoholics
finally, PTH

Question 21

ADPKD vs amyloidosis?

Answer 21

ADPKD: flank pain, hematuria, HTN, big kidneys
Amyloidosis: edema, proteinuria, HTN, big kidneys, inflammatory condition (for AA)

Question 22

hematuria - beginning of urination, end of urination, whole cycle? from where? clots?

Answer 22

beginning of urination: suggests urethra (urethritis)
end of urination: suggests bladder or prostate origin (cancer)
whole cycle: suggests kidney or ureters - clots not seen

Question 23

hypomagnesemia - effects on calcium and K?

Answer 23

causes PTH resistance and decreased PTH secretion resulting in low Ca (and low-nl Phos levels)
interferes with kidney retention of K+

Question 24

associations for:
MCD
Membranous Nephropathy
FSGS
MPGN
IgA Nephropathy

Answer 24

MCD - lymphoma (hodgkins!), NSAIDs
Membranous Nephropathy - hep B, adenocarcinoma, SLE
MPGN - hep B, hep C, cryoglobulinemia
FSGS - african american, HIV, heroin
IgA - URI

Question 25

AV block with wheezing - what toxicity?

tx?

Answer 25

beta blocker
1st line - IVF and atropine
refractory hypotension - glucagon

Question 26

what is trihexyphenidyl?

Answer 26

anticholinergic parkinson’s drug (like benztropine)

Question 27

congenital hypothyroidism etiology?

Answer 27

thyroid dysgenesis

Question 28

toxicities of: cyclosporine, tacrolimus, mycophenolate, azathioprine?

Answer 28

cyclosporine: renal failure, hyperkalemia, hypertension, gum hyperplasia, hirsutism
tacrolimus: renal failure, hypertension, neurotoxicity, glucose intolerance, diarrhea
mycophenolate: bone marrow suppression
azathioprine: diarrhea, leukopenia, hepatotoxicity, pancreatitis