Test 28 - IM Gi/GU

Question 1

What are the 3 possibilities when presents with symptoms consistent with renal colic but nothing is seen on KUB?

Answer 1

1. Radiolucent stones (uric acid, xanthine stones)
2. Calcium stones too small to be seen (less than 1-3 mm in diameter)
3. Non-stone ureteral obstruction (blood clot, tumor)

Question 2

What type of patients do you usually find uric acid stones in and what is the treatment?

Answer 2

Usually found in patients with unusually low urine pH (in the 4s, when normal is 5-6). Treated by alkanilization of the urine with potassium citrate and a low purine diet.

Question 3

How do you treat recurrent hypercalciuric renal stones?

Answer 3

HCTZ

Question 4

What are the signs of Post-Strep Glomerularnephritis

Answer 4

PERIORBITAL SWELLING, hematuria, oliguria

Question 5

What is the treatment for first time anal fissure? What is the treatment for recurrent anal fissure?

Answer 5

First time: High fiber, lots of fluids, stool softener, local anesthetic
Recurrent: Lateral sphincterotomy to provide a wider aperture for stool

Question 6

What is the underlying pathology of membranoproliferative glomerular nephritis?

Answer 6

IgG antibodies against C3 convertase cause activation of the complement pathway. Thus on immunofluorescence, the biopsy stains positive for C3 in glomerular membrane.

Question 7

Antibodies found against the glomerular basement membrane?

Answer 7

Goodpasture’s

Question 8

Signs of Alport syndrome?

Answer 8

recurrent gross hematuria and proteinuria
alternating areas of thickened and thinned capillary loops
splitting of the GBM
presents in childhood

Question 9

Signs of microscopic polyangiitis?

Answer 9

Kidney inflammation (~ 80% of patients).
    Weight loss (> 70%).
    Skin lesions (> 60%).
    Nerve damage (60%).
    Fevers (55%).

Question 10

microscopic polyangiitis typical patient?

Answer 10

In the United States, the typical MPA patient is a middle-aged white male or female, but many exceptions to this exist.

Question 11

What is Wegner’s granulomatosis?

Answer 11

Wegener’s granulomatosis, which is also called granulomatosis with polyangiitis (GPA), often affects your kidneys, lungs and upper respiratory tract. The restricted blood flow to these organs can damage them. Wegener’s can affect other organs, but this isn’t as common, and generally isn’t as serious.

Wegener’s granulomatosis also produces a type of inflammatory tissue known as a granuloma that’s found around the blood vessels. Granulomas can destroy normal tissue. There is no known cause for Wegener’s granulomatosis.

Question 12

What is IgA nephropathy?

Answer 12

IgA nephropathy (nuh-FROP-uh-thee), also known as Berger's disease, is a kidney disease that occurs when an antibody called immunoglobulin A (IgA) lodges in your kidneys. This results in local inflammation that, over time, may hamper your kidneys' ability to filter waste, 
Causes hematuria.

Question 13

Nagging epigastric pain that is worse with food, at night, has weight loss an a non-tender enlarged gall bladder, scleral icterus

Answer 13

Biliary tract obstruction - probably at the ampulla

Check for pancreatic cancer, with tumor pressing on the pancreatic duct and common bile duct

Question 14

What is the double duct sign?

Answer 14

Intrahepatic biliary dilation (dilation of the common bile duct)
Extrahepatic biliary duct dilation (dilation of pancreatic duct)
Sign to check for pancreatic cancer

Question 15

Treatment for uncomplicated cystitis (UTI) in otherwise healthy 25 year old female?

Answer 15

1. Nitrofurantoin, TMP/SMX or Fosfomycin

2. Do not culture urine unless fail initial trt