Download MBBS (Bachelor of Medicine, Bachelor of Surgery) Nephrology and Urology 1st Year Handwritten Notes, 2nd Year Handwritten Notes, 3rd Year Handwritten Notes & Final Year Handwritten Notes (Lecture Notes)
1
Acute Renal Failure (1)
PRERENAL
RENAL
POSTRENAL
2
Acute Renal Failure (2)
PRERENAL
= Shock ( Perfusion)
? Causes
?Hypovolemic (most common)
?Cardiogenic
?Distributive
? Treatment
?Restore circulating volume
?Fluids
?Pressors
3
Acute Renal Failure (3)
RENAL
= Intrinsic Disease
? Causes
?Vascular
Dissection, Thrombosis, Emboli
?Glomerular
Glomerulonephritis (GN)
?Interstitial
Acute Interstitial Nephritis (AIN)
?Tubular (most common)
Acute Tubular Necrosis (ATN)
4
Acute Renal Failure (4)
Vascular Causes
? Catastrophes along the aorta
?Dissection
?Thrombosis
? Emboli
? Suspect when more than one
organ along aorta is involved
5
Acute Renal Failure (5)
Rapidly Progressive Glomerulonephritis
(Acute Nephritic Syndrome)
? Pathology
?Immune complexes/antibodies
in glomeruli
? Causes
?Autoimmune / Vasculitities
?Post-streptococcal GN
?Wegeners, Goodpastures
Hepatitis B/C
?SLE, PAN, HSP, HUS,
TTP, HELLP
?Malignant Hypertension
6
Acute Renal Failure (6)
Rapidly Progressive Glomerulonephritis
(Acute Nephritic Syndrome)
? Clinical Features
?Oliguria, edema, hypertension
? Urine
?Hematuria, pyuria, RBC casts,
mild/moderate proteinuria
? Treatment
?Steroids, immunosuppressive
agents
7
Acute Renal Failure (7)
Acute Interstitial Nephritis (AIN)
? Pathology
?Immune mediated
? Causes
?Drugs
?Penicil in, Sulpha
?Diuretics
?NSAIDs
?Infections
8
Acute Renal Failure (8)
Acute Interstitial Nephritis (AIN)
? Clinical Features
?Fever, rash, eosinophilia
? Urine
?Pyuria, WBC casts,
eosinophiluria
? Treatment
?Treat underlying infection
?Remove offending agent(s)
9
Acute Renal Failure (9)
Acute Tubular Necrosis (ATN)
Leading cause of renal failure
? Ischemic
?Usual y oliguric (<500 mL/day)
?Leading causes: trauma and sepsis
? Toxic
?Usual y not oliguric
?Causes: Contrast media
Myoglobin(rhabdomyolysis)
Hemoglobin (hemolysis)
Aminoglycosides
Multiple myeloma
Ethylene glycol
10
Acute Renal Failure (10)
Rhabdomyolysis (ATN)
? Pathology
?Skeletal muscle injury
?Myoglobin clogs tubules
?Myoglobin causes
positive dip for heme, but
no RBCs seen on micro
? Causes
?Trauma, Crush
?Burns, Electrical injury,
TASER
?Heat stroke, "Found
down"
?EtOH, other drugs
11
Acute Renal Failure (11)
Rhabdomyolysis (ATN)
? Diagnosis
?CK > 5 times normal for
diagnosis (more sensitive
marker than myoglobin
itself)
?Dramatic acute increase in
creatinine (Cr)
? Treatment
?IV hydration
?Treat hyperkalemia and
hypocalcemia
?Alkalinization of urine with
bicarbonate
12
Acute Renal Failure (12)
Contrast Induced Nephropathy (ATN)
? Who is at high risk? ? Mitigating the risk
?Pre-existing renal disease
?Choose a non-contrast
?Recent contrast study
study
(within 72 hours)
?Volume expansion
?
?
Hypotension
Low osmolar contrast
agents
?Dehydration
?Bicarbonate infusions
?Diabetes
?Hypertonic saline
?Multiple myeloma
?N-acetylcysteine
?Age > 70
?Hypertension
?Hyperuricemia
?Diuretics
13
Acute Renal Failure (13)
POSTRENAL
= Obstruction
? Causes
?Bilateral kidney
crystals in tubules, stones in calyces
?Bilateral ureteric
multiple stones, surgical y cut
retroperitoneal blood, pus or scar,
papillary necrosis
?Urethral
prostatic hypertrophy (most common)
neurogenic bladder
phimosis, meatal stenosis
14
Acute Renal Failure (14)
MEASURE
PRE-RENAL
RENAL (ATN)
Fractional
Excretion of Na+
< 1%
> 1%
(FENa)
%
Urine Na+
LOW (< 20)
HIGH (> 40)
mEq/L
BUN / Creatinine
Ratio
HIGH (> 20)
LOW (< 20)
15
Acute Renal Failure (15) ? U/A
FORMED ELEMENT
LOCATION OF
SPECIFIC ENTITIES
PATHOLOGY
RBC Casts
Glomerular Disease Nephritic
(or dysmorphic RBCs)
Syndrome
(Rapidly progressive GN)
WBC Casts
Interstitium
Pyelonephritis
AIN
Eosinophils
Interstitium
Acute Interstitial
Nephritis (AIN)
Granular Casts
Tubule
Acute Tubular
(Cell debris)
Necrosis (ATN)
Hyaline Casts
Pre- or post-renal
Pre- or post-renal
(Acellular)
acute renal failure
16
Acute Renal Failure (16) ? U/A
RBC Cast
17
Acute Renal Failure (17) - Summary
PRERENAL?
Yes
No
Restore circulating
volume
POSTRENAL?
Yes
No
Relieve obstruction
RENAL
Vascular ?
No
Rapidly Progressive GN ?
Acute Interstitial Nephritis (AIN) ?
Acute Tubular Necrosis (ATN)
18
Pink Urine
RBCs ? Hematuria
?Kidney stone
?Cancer
?Nephritic syndrome
? Myoglobinuria
NO RBCs = Rhabdomyolysis
VS
Microscopy
?
Hemoglobinuria
= Intravascular hemolysis
?MAHA (DIC, TTP, HUS)
?Mechanical valve
emergency
19
Chronic Renal Failure
The Nephrotic Syndrome = Nephrosis
? Clinical Features
?Massive proteinuria (>3g/24h)
?Hypoalbuminemia
?Edema
?Hyperlipidemia
?Thrombotic diathesis
?DVT/PE
20
Chronic Renal Failure
The Nephrotic Syndrome = Nephrosis
? Causes
Primary
?Idiopathic entities involving
kidneys alone
?Most commonly focal, segmental
Secondary
?Diabetes mel itus
?Henoch-Schonlein purpura (HSP)
?SLE / Syphilis / Hepatitis B/C
?HIV
?Cancer
?Drugs (gold, mercury. heroin)
21
Chronic Renal Failure
Polycystic Kidney Disease
U/S
CT
? Autosomal Dominant
? Flank Pain and Hematuria
? Progressive Renal Failure
? Association with cerebral aneurysms and SAH
22
Indications for Emergent Dialysis
? Refractive volume overload
? Refractive hyperkalemia
? Metabolic acidosis
? Severe Na+ imbalance
? Symptomatic uremia
- Encephalopathy
- Pericarditis
- Bleeding
- Nausea/vomiting
? Toxins
23
End Stage Renal Disease (1)
Complications
? Cardiac
?Coronary Artery Disease
?Severe Refractory Hypertension
?Uremic Pericarditis
?Tamponade (Beck's triad is rare)
?Pulmonary Edema (furosemide ok if any U/O)
?Uremic Cardiomyopathy (Dx of exclusion)
Consider tamponade in any critically
ill ESRD patient
24
End Stage Renal Disease (2)
Complications
? Hematologic
?All cel lines are affected
?RBCs ? Anemia
?WBCs ? Infection
?Platelets ? Bleeding
? Neurologic
?Subdural hematoma
?Subarachnoid hemorrhage (with polycystic kidneys)
?Uremic encephalopathy
?Dialysis dementia (Dx of exclusion)
Consider subdural hematoma in any
altered ESRD patient
25
End Stage Renal Disease (3)
Complications
? Electrolyte
?Hyperkalemia (K+)
?Bradyasystolic arrest in uremic patients
?Stabilize: Calcium gluconate (for life-threatening
rhythms)
?Shift: HCO3, Insulin/D50, Albuterol (for ECG changes
or levels)
?Eliminate: Binding resin (sodium polystyrene)
?Hypokalemia (K+)
?Ventricular fibril ation in dialysed patients
?PVC's
?Hypocalcemia (Ca2+)
?Hypomagnesemia (Mg2+)
26
End Stage Renal Disease (4)
The Many Faces of Hyperkalemia
The Good
The Bad
27
End Stage Renal Disease (5)
The Many Faces of Hyperkalemia
The Ugly!
28
Hemodialysis Complications (1)
? Hypotension (most common)
? Access complications
?Bleeding
?Direct pressure or tourniquet if necessary
?Correct coagulopathy (protamine sulfate, DDAVP)
?Clotting
?"The thril is gone"
?Can inject thrombolytic, surgical removal within 24hr
?Infection
?Cel ulitis, abscess, "occult" presentation
?S. aureus and gram negatives (Rx with vanco +/-
gentamicin)
?High Output Failure
29
Dialysis Access Complications
30
Hemodialysis Complications (2)
? Altered Mental Status
?Hypotension
?Hypoglycemia
?Hypercalcemia
?Subdural hematoma
?Dysequilibrium syndrome
?Increased ICP from osmotic shifts during dialysis
?Headache, nausea, confusion
?Diagnosis of exclusion
?Resolves spontaneously. Symptomatic Rx.
? GI Issues
?GI bleeding, constipation and bowel obstruction are
common
31
Peritoneal Dialysis
? Requires no heparin and occurs slowly (fewer acute
complications)
? Peritoneal infection is the most serious problem
Symptoms: Abdominal discomfort , Fever
Pain during inflow
Diagnosis: Peritoneal fluid analysis
>100 WBCs/mm3, >50% PMNs
S. epidermidis (#1)
S. aureus, Strep. and gram negatives
Treatment: Intraperitoneal antibiotics and lavage
IV antibiotics if systemical y il
32
Urinary Tract Infection (1)
? Definition
?Symptoms plus as few as 100 CFUs (colony
forming units) of a single pathogen
? Relapse
?Same organism and serotype
?Less than one month since the initial infection
? Reinfection
?Different organism or serotype
?One to six months after initial infection
33
Urinary Tract Infection (2)
UNCOMPLICATED
COMPLICATED
Host
Young, healthy non-
Everyone else
pregnant female
Pathogen
Klebsiella Group D Strep
Proteus
Pseudomonas
E.coli
Enterobacter Staph spp
Work-Up
Culture
Do not culture
+/- Follow-up studies
Treatment
3 days
10 days
Empiric coverage to cover
pseudomonas in high-risk patient
34
Urinalysis in UTIs
Nitrite test:
Specific but insensitive.
Based on bacterial metabolism of
nitrate to nitrite
Leukocyte esterase:
Specific but insensitive.
Based on the presence of WBCs
Bacteriuria:
Any bacterium (uncentrifuged)
>15/HPF
(centrifuged)
Pyuria:
>2-5 WBCs
(centrifuged, female)
>1-2 WBCs
(male)
35
UTI Miscellaneous
? Asymptomatic bacteruria
?Treat only in pregnancy to prevent pyelonephritis
? Sterile pyuria
?Genitourinary TB (classic sterile pyuria)
?Chlamydia (most common)
? Acute urethral syndrome
?Sterile or low bacterial count with dysuria
?Differential: Chlamydia, GC, HSV, vaginitis
?Treatment: Empiric Rx of STDs
Pyelonephritis incidence is increased in the third trimester
(may precipitate preeclampsia, sepsis and miscarriage)
36
Surgical Complications of UTI
? Perinephric abscess
?Complication of UTI, from contiguous spread
?Contrast with renal abscess or carbuncle, which
is from hematogenous spread
? Emphysematous
pyelonephritis
?Occurs in diabetics
?High mortality without
drainage
Consider surgical complications in sick patients with
pyelonephritis ? especially in diabetics
37
Fournier's Scrotal Gangrene
? Surgical emergency
? Polymicrobial
? More common in the immunocompromised
?Alcoholic liver disease / cirrhosis
?Diabetes
?IV drug use
? Begins as benign infection (cel ulitis, abscess)
Consider Fournier's in any patient with scrotal, rectal
or genital pain out of proportion to clinical findings
38
Fournier's Scrotal Gangrene
39
The Many Faces of Fournier's
40
The Many Faces of Fournier's
41
Necrotizing Soft Tissue Infections
Not Missing the Diagnosis
? Pain Out of Proportion (POOP) or indifference
? Vital sign derangements (esp. tachycardia)
? WBC count
? Low serum Na+
? Blisters
? Odor
? Rapid change
? Skin appearance variable
? Subcutaneous air (crepitus)
42
Balanoposthitis
? Balanitis: glans penis
? Posthitis: foreskin
? Rule out diabetes
? Treatment
?Local measures (soap
and water, keep dry)
?Topical bacitracin (peds)
?Topical clotrimazole
(adults)
Balanoposthitis
43
Candidal balanitis
44
Logical images Inc.
Candidal balanitis
45
Logical images Inc.
Phimosis / Paraphimosis
PHIMOSIS
PARAPHIMOSIS
Rarely
Emergency
emergent
Unable to
Retracted
Definition retract foreskin
foreskin
Urinary
Complication
Necrosis of glans
retention (Rare)
Dilation of
Compression &
Treatment preputial ostium
dorsal incision
(if retention only)
46
Paraphimosis and Its Treatment
Penile Block
Attempt at Manual
Reduction
47
Penile Hair Tourniquet
? Constricting hair band
? In DDx of persistently crying boy (2-5 y.o)
? Hair may be buried in coronal ridge due to
edema
48
Fractured Penis
? During intercourse
? Rupture of tunica albuginea
? Hematoma formation, may involve urethra
? Surgical management
49
Priapism (1)
Pathologic erection
? Involves both corpora cavernosa
but not
glans or corpus spongiosum
Complications
? Urinary retention
? Impotence
50
Med-Chal enger ? EM
Priapism (2)
Two Forms / Causes
? Low-flow priapism (ischemic)
?Sickle cel or other hematologic diseases
?Intracavernosal injections
?Drugs (phenothiazines, SSRIs, Viagra et al.,
neuroleptics)
?Spinal cord injuries
? High-flow priapism (arterial injury)
?Trauma (straddle mechanism)
51
Priapism (3)
Treatment
? Low flow
Basic treatment is the same for all causes
?Terbutaline subcutaneously or local y
?Corporal aspiration and irrigation
?Phenylephrine injection into corpora
?Specific hematologic Rx (e.g. transfusion for
sickle cel disease)
?Surgery (placement of shunt)
? High flow
Embolization or surgery
52
Penile Lesions ? Syphilis (1)
? Treponema pal idum
? Primary infection
?Painless chancre (arrives 21 days after contact and lasts
4-6 weeks)
?Indurated borders
?No constitutional symptoms
?Minimal adenopathy
?Dx: dark field microscopy, RPR, FTA-ABS
?Serology usual y negative first 4-6 weeks
? Treatment
?2.4 mil ion units benzathine penicil in G IM
?Anticipate Jarisch-Herxheimer reaction (slide 56)
53
Chancre (primary syphilis)
54
Med-Chal enger ? EM
Penile Lesions ? Syphilis (2)
? Secondary Syphillis
?6-8 weeks after primary
infection
?Most infectious phase of
syphil is
?Rash on palms, soles,
trunk
?Lesions contain
spirochetes
?In moist areas the
lesions are flat =
condyloma lata
55
Secondary Syphilis
56
Med-Chal enger ? EM
Penile Lesions ? Syphilis (3)
? Jarisch-Herxheimer reaction
?Antibiotic treatment causes organism death and
the release of endotoxins
?Fever, chil s, headache, myalgia, rash
?Comes on 2-6 hours after the onset of
treatment
?Lasts a few hours
?Occurs in 50% of cases of primary syphyllis
(90% of secondary cases)
?Treat with acetaminophen two hours before and
after antibiotic treatment
57
Penile Lesions - Herpes
? Herpes simplex virus (HSV-1 or HSV-2)
? Primary Infection
? Constitutional symptoms
?Headache, fever, myalgias
? Painful blisters, pustules or ulcers
? Lymphadenopathy
? Complications
?Urinary retention
?Aseptic meningitis (HSV-2)
? Treatment: acyclovir 200 mg 5x/day for 10 days
58
Penile Lesions - Herpes
59
Logical images Inc.
Penile Lesions - LGV
? Lymphogranuloma venereum (LGV)
? Chlamydia trachomatis
? Urban outbreaks in the U.S.
? Primary infection
? Primary lesion: painless herpes-like ulcer
? Inguinal "buboes" (enlarged nodes), groove
sign
? Treatment: doxycycline x 3 weeks
60
Lymphogranuloma venereum (LGV)
61
LGV
Groove sign
Ulcerated Bubo
62
Penile Lesions - Chancroid
? Haemophilus ducreyi
? Rare in U.S.
? Primary infection
?Tender papule fol owed by painful ulcer
(multiple lesions may be present and coalesce)
?Painful inguinal adenopathy (buboes)
? Culture!
? Treatment: azithromycin or ceftriaxone (single
dose treatment with either agent)
63
Chancroid
64
Penile Lesions ? Granuloma Inguinale
? Calymmatobacteruim granulomatis
(Donovaniasis)
? Rare in U.S.
? Presentation
?Chronic painless progressive ulcers and
vascular granulomata
?Multilating
?No inguinal adenopathy
? Biopsy! (Donovan bodies)
? Treatment: doxycycline x 3 weeks
65
Granuloma Inguinale
66
Testicular Torsion (1)
? Peak incidence in puberty
? Bel clapper deformity - bilateral: testis is free
to swing and rotate inside the tunica vaginalis
? Presentation
?Sudden onset of testicular pain
?Testicle is elevated; horizontal lie
?Cremasteric reflex usual y absent
?Prehn's sign usual y absent (relief of pain by
scrotal elevation ? a sign of epididymitis)
Consider torsion in any young male with
abdominal pain
67
Testicular Torsion (2)
? Treatment
Manual detorsion
?Detorse medial-to-lateral (like opening a book
when viewed from the feet)
?Relief of pain, normal lie indicates success
?If unsuccessful, try opposite direction
?High salvage rate if detorsed within 6 hours, high
loss rate after 8 hours
Emergency Surgery
?Bilateral y orchidopexy
CALL THE UROLOGIST STAT ? then do the U/S
or nuclear scan!
68
Testicular Appendage Torsion
? Twisting of appendix testis or
other "non-essential" structures
? More common in prepubertal boys
? Blue dot sign: Necrotic
appendages visualized through
scrotum
? Surgery is not necessary
if diagnosis is unequivocal
(normal color Doppler of testis)
69
Epididymitis (1)
? Causes
?Infection (age-related etiology)
?Inflammation (e.g. urine reflux)
? Presentation
?Can mimic torsion but usual y gradual onset of pain
?Cremasteric reflex usual y present (stroking the inner
thigh causes retraction of the scrotum and testicle)
?Prehn's sign usual y present (relief of pain on lifting the
testicle) (Ischemic pain of torsion not relieved by lifting)
? Age-related factors
?Young boys: Consider structural abnormality / E. coli
?Sexual y active: Usual y STD-related (Chlamydia/GC)
?Older patients: Think obstruction, prostatism / E.coli 70
Epididymitis (2)
? Diagnosis
?Urine frequently
positive for bacteria,
WBCs, nitrites
?Increased flow on color
Doppler (U/S)
? Treatment
?Antibiotics to cover age-specific causes
?NSAIDs
?Intermittent ice packs, scrotal support
71
Acute Prostatitis
? Causes
?Same etiologies as epididymitis
?Similar age-related considerations
? Presentation
?Perineal pain, dyschezia, frequency, dysuria, fever,
chil s, urinary retention
?Boggy, enlarged, tender prostate
? Treatment
?Acute: Prostate massage, Foley contraindicated
Suprapubic drain PRN
IV Antibiotics
?Chronic: Long term outpatient antibiotics
72
Urethritis
? Gonococcal
?White discharge
?Gram negative intracel ular diplococci
?Treatment: ceftriaxone 250mg IM
?Treat for Chlamydia as wel
? Non-Gonococcal
?Watery or no discharge
?Few findings on smear
?Chlamydia, HSV, Trichomonas,
Ureaplasma,
?Treatment: azithromycin (1g x single dose)
doxycycline (100 mg BID x 10 days)
Consider HIV/syphilis and treat partners
73
Urinary Retention
? Causes
?Mechanical
? Prostatic hyperplasia (most common), meatal stenosis,
urethral stricture
?Neurologic
? Spinal cord injury, MS, diabetes
? Drugs are a key precipitant/exacerbating factor
? OTC sympathomimetics (e.g. cold remedies)
? TCAs, anticholinergics, antihypertensives
? Opioids
? Treatment
?Coud? catheter if BPH suspected
?DO NOT attempt filiform and fol owers
?Suprapubic drainage if cannot pass
catheter and no urologist available
?Discharge with catheter in place
Coud? catheter
74
Non-traumatic Hematuria (1)
? Definition: >5 RBC's/hpf
When during
On Initiation
Bladder/Urethra
urination?
At end
Prostate
Throughout
Renal
Cyclic
Endometriosis
Color?
Brown
Renal
Consistency?
Clots
Post-renal
Associated Hx
Recent Infection
Renal
Multisystem
(Renovascular, GN,
disease
AIN)
Drugs
75
Non-traumatic Hematuria (2)
AGE
Common CAUSES
<20 years
Glomerulonephritis
UTI
20-40 years
Stone
UTI
Carcinoma
>40 years
Carcinoma
Stone
UTI
>60 years (male)
Prostatism
Carcinoma
76
Kidney Stones (1)
STONE TYPE
CAUSES
NOTES
(INCIDENCE)
Calcium oxalate
Most related to diet Male predominance
(75%)
IBD (UC and Crohn's)
Warm & dry climates
Hyperparathyroidism
Struvite (Mg-NH4-PO4) Chronic Infection
Staghorn formation
(15%)
(Proteus, pseudomonas)
High pH (>7)
Uric acid
Gout
Radiolucent
(10%)
Congenital
Low pH (<6)
Cysteine
In-born error
Staghorn formation
(1%)
Renal failure
Indinivir
Indinivir therapy
HIV or post-exposure
(protease inhibitor) prophylaxis patients
(<1%)
77
Kidney Stones (2)
Common areas of impaction
1
1 Renal calyx
2
2 Ureteropelvic junction (UPJ)
3
3 Pelvic Brim
4
4 Ureterovesical junction (UVJ)
UVJ is the most common site of impaction
78
Kidney Stones Diagnosis
Hematuria may be absent in 10-20%
Diagnostic Mimics
? Critical DDx includes: AAA
Testicular torsion
Ectopic pregnancy
Appendicitis
Incarcerated hernia
Biliary colic
Renal colic is the most common misdiagnosis in
cases of abdominal aortic aneurysm
79
Kidney Stones Treatment
? NSAIDs
?Avoid in congenital stones, any history of renal failure,
bilateral stones
? Opioid Narcotics
? Hydration
?Fluid boluses increase pain, not helpful
? ECSWL (lithotripsy)
? Percutaneous lithotomy, retrograde lithotomy
? Open Surgery
80
Stone Admission Indications
? Concurrent infection
? Concomitant renal insufficiency
? Solitary kidney with complete obstruction
? Uncontrol ed pain or intractable vomiting
? Ruptured renal capsule
Stone Passage
? 5 mm pass 50% of time
? >6 mm pass 10% of the time
? 1 cm stones do not pass)
81
Stone Imaging
Plain films-KUB Ultrasound
Non-contrast CT
New Gold Standard
Not sensitive
Not sensitive
Sensitive
Not specific
More specific
Most specific
For - pregnant
No info on function
- repeat imaging
(need IVP or CT urogram)
82
Staghorn Calculus on Plain Film (KUB)
83
Renal U/S:
Hydronephrosis
84
Renal U/S:
Ruptured Renal Capsule
85
Renal US:
Large Stone in Renal Pelvis
86
CT:
Hydronephrosis
87
CT:
Ruptured Abdominal Aortic Aneurysm
88
Renal Transplant Tidbits
? Most common solid organ transplant
? Transplant location: retroperitoneal in pelvis
? Hepatitis C is very common
? Patients receive azathioprine, cyclosporine
and prednisone
? Cyclosporine is nephrotoxic
Infection and Rejection
Can be subtle clinical y
Any rise in creatinine is cause for alarm
Consult transplant team
89
NEPHROLOGY QUESTIONS
90
Which of the following is a pre-renal cause
of renal failure?
A. CHF
B. Acute tubular necrosis
C. Renal papil ary necrosis
D. Glomerulonephritis
E. Nephrolithiasis
NEP 1
A 25 y/o presents with a 3 week history of
lower extremity edema and fatigue. U/A:
Massive proteinuria. Which of the
following is the most likely diagnosis?
A. Familial hyperlipidemia
B. Hereditary angioedema
C. Thrombotic diathesis
D. Nephrotic syndrome
E. Guil ain Barre syndrome
NEP 2
Which is true regarding diabetes
insipidus?
A. The least common drug-related cause is lithium
B. In nephrogenic DI, the kidney responds to
exogenous infusion of ADH
C. The urine is typical y very dilute
D. Head trauma is not a common cause
E. Results from increased secretion or response to
ADH
NEP 3
A 30 y/o dialysis patient presents with a
decreased blood pressure, distended neck
veins, distant heart sounds and equal lung
sounds. A low-grade fever is present.
What is the most likely cause?
A. Congestive heart failure
B. Tension pneumothorax
C. Pulmonary embolism
D. Pericardial effusion
E. Dressler's syndrome
NEP 4
A dialysis patient who missed her last
treatment has a bradyasystolic cardiac
arrest. Which of the following would be
most beneficial during her resuscitation?
A. Potassium
B. Magnesium
C. Phosphorus
D. Calcium
E. NaHCO3
NEP 5
Which of the following penile lesions is
classically described as painless?
A. Herpes simplex
B. Chancroid
C. Herpes zoster
D. Chancre
E. Inguinal bubo
NEP 6
Which of the following is
consistent with renal transplants?
A. The least common solid organ
transplanted
B. Hepatitis C is uncommon
C. Cyclosporine is contraindicated
D. Corticosteroids are contraindicated
E. Cyclosporine is nephrotoxic
NEP 7
A dialysis patient is brought to the ED with
a sudden, severe headache with vomiting.
What is the likely cause of the patient's
chronic renal failure and subarachnoid
hemorrhage?
A. Acute tubular necrosis
B. Diabetes
C. Polycystic kidney disease
D. Aminoglycoside toxicity
E. Hypertension
NEP 8
A 30 y/o patient is suspected of having
epididymitis. The usual etiology is:
A. Chlamydia trachomatis
B. Urethritis from non-oxyl-9
C. E. coli
D. Klebsiel a
E. Bacteroides fragilis
NEP 9
Which of the following is a true
statement regarding imaging studies
for ureteral stones?
A. The IVP demonstrates function and anatomy
B. Contrast reactions and nephrotoxicity are
more likely to occur with non-ionic vs. ionic
contrast
C. Patients who are dehydrated, hyperglycemic,
over the age of 70 and with pre-existing
renal disease are good candidates for IVPs
D. Total obstructions induced by ureteral stones
>6mm are poorly visualized on
ultrasonography
E. Ultrasound is the gold standard in renal stone
imaging
NEP 10
Which of the following statements is
true regarding ureteral stones?
A. They are more common in females than males
B. Most uric acid stones are radiopaque
C. Ureteral stones are less common in warmer
climates
D. Few stones > 6 mm wil spontaneously pass
E. The UPJ is the most common location of
obstruction
NEP 11
Regarding dialysis-associated
problems, which of the following is true?
A. First-use syndrome is manifested by hypertension
from an anaphylactoid reaction to a new dialyzer
B. Dialysis-related dysequilibrium is treated with
corticosteroids
C. Hypokalemia is the most common cause of dialysis-
related bradyasystolic cardiac arrest
D. Hyperkalemia in dialysis patients can be initial y
treated with IV calcium gluconate.
E. "Dialysis dementia" responds to increasing the
frequency of treatments
NEP 12
Which of the following is the most
common cause of painless, gross
hematuria in patients over 40 years of
age?
A. Vigorous exercise
B. Kidney / bladder stones
C. GU tumors
D. Bleeding disorders / coagulopathies
E. Foley catheter insertion
NEP 13
Which of the following statements is
true regarding acute epididymitis?
A. A positive Prehn's sign is relief of scrotal
pain with rotation of the testes
B. Pain relief on elevation of the testes is
considered suggestive of epididymitis rather
than testicular torsion
C. Epididymitis is most common in young
prepubertal males
D. The etiologic agent is unrelated to the
patient's age
E. Is always caused by infection
NEP 14
A 14 y/o presents with an acute onset of scrotal
pain. He is diagnosed with testicular torsion.
Which of the following is accurate, regarding
this patient's diagnosis?
A. There is an 80-100% salvage rate if detorsed
within 24 hours
B. Manual detorsion general y involves rotating
the testes from medial to lateral
C. Peak incidence is 6 years
D. A testicle in torsion usual y lies vertical y
E. Abdominal pain is rare
NEP 15
Which of the following is true
regarding priapism?
A. This is a pathologic erection involving the
glans and corpora spongiosum
B. SQ epinephrine is used to treat most
reversible causes
C. Exchange transfusions may be necessary for
those caused by sildenafil (Viagra)
D. Most etiologies are veno-occlusive, as
opposed to arterial
E. The basic treatment varies, dependant on the
cause
NEP 16
Which of the following
statements, regarding general
urology, is true?
A. Balanitis is an inflammation of the foreskin
B. Posthitis is an inflammation of the glans
penis
C. Phimosis is a common cause of urinary
retention
D. Paraphimosis can be a true urologic
emergency
E. The typical age for a penile hair tourniquet is
3-7 years
NEP 17
Which of the following statements is
true regarding Fournier's gangrene?
A. Penicil in is general y adequate treatment
B. It typical y begins as a benign abscess and
slowly develops into a more serious infection
C. It should be considered in any patient with
scrotal, rectal or genital pain out of proportion
to their clinical findings
D. I&D in the ED is usual y adequate therapy
E. Antimicrobials are unnecessary after surgical
debridement
NEP 18
Which of the following drugs will not
worsen contrast induced nephropathy ?
A. Ibuprofen
B. Furosemide
C. Enalapril
D. N-acetylcysteine
E. Naproxen
NEP 19
Which of the following is a cause of
rapidly progressive
glomerulonephritis?
A. Chronic, control ed hypertension
B. Pyelonephritis
C. Lupus
D. Toxic alcohol overdose
E. Diabetic neuropathy
NEP 20
Nephrology Answer Key
1. A
11. D
2. D
12. D
3. C
13. C
4. D
14. E
5. D
15. B
6. D
16. D
7. E
17. D
8. C
18. C
9. A
19. D
10. A
20. C
This post was last modified on 24 July 2021