Urology

Question 1

nepthritic syndrome mneumonic

Answer 1

PHAROAH = Proteinuria, Hematuria, Azotemia, RBC casts, Oliguria, Anti-strep titres (if post-strep), and Hypertension

Question 2

nephrotic syndrome

Answer 2

1. Massive proteinuria (>3.5g/24hr)
2. Hypoalbuminemia
3. Edema
4. Hyperlipidemia/hyperlipiduria

Question 3

Vesicoureteral reflux Grades

Answer 3

I/II not urgent. Observation, abx prophylaxis, cultures q3months. IV/V: suspect kidney damage, surgery.

Question 4

Metabolic consequences of the nephrotic syndrome include the following:

Answer 4

Infection
Hyperlipidemia and atherosclerosis
Hypocalcemia and bone abnormalities
Hypercoagulability
Hypovolemia

Question 5

Selective vs nonselective proteinuria criteria

Answer 5

> 85% albumin = selective (probably only affects glomerular charge).

Question 6

Tx categories of nephrotic syndrome

Answer 6

steroid sensitive, steroid resistant, steroid dependent, frequently relapsing.

Question 7

Causes of nephrotic syndrome

Answer 7

primary: MCD, focal glomerulosclerosis, membranous, hereditary.
Secondary: diabetes, SLE, amyloidosis, infection like HCV, HBV, HIV, drugs.

Question 8

Posterior urethral valve

Answer 8

Congenital in males. Causes bilateral hydronephrosis. Dx: ultrasound is ok, best is voiding cystourethrogram or cystoscopy.

Question 9

Testicular torsion

Answer 9

Clinical diagnosis. Adolescents and neonates mosty. Severe unilateral scrotal pain and swelling, abdominal cramps, nausea and vomiting. Absent cremasteric reflex. Surgical detorsion/exploration immediately. 90% are saved if within 6 hours.

Question 10

A 7-year-old boy has crampy abdominal pain and a rash mainly on the back of his legs and buttocks as well as on the extensor surfaces of his forearms. Laboratory analysis reveals proteinuria and microhematuria. He is most likely to be affected by:

Answer 10

HSP. IgA small vessel vasculitis. Extensor surface of extremities rash (rarely trunk and face); colicky abdo pain, hematuria, arthritis, edema, GI bleed, renal failure. Supportive care. Recovery in several weeks.

Question 11

A 2-year-old patient has microscopic and occasionally gross hematuria. His father has hearing loss and end-stage renal disease. The most
likely cause of this child’s hematuria is:

Answer 11

Alport Syndrome: xlinked. Hereditary nephritis/hearing loss. Leads eventually to ESRD.

Question 12

Bartter Syndrome

Answer 12

aka juxtaglomerular hyperplasia - salt waste disorder. Autosomal recessive.

Maternal polyhydraminos. Polyuria, polydipsia. Hypokalemia, hypocalcemia, hyperaldosteronism, hyperreninism, alkalosis.

Question 13

Encopresis stats and therapy

Answer 13

Common: 20% at age 5 with 15% spontaneously resolving per year. ddAVP can help but not a cure usually. Fm Hx common.

Question 14

Varicocoele

Answer 14

Seen usually after age 10. 15% incidence. “bag of worms” and painless. Incompetence of pampiniform plexus.