Chapter 20, Renal and Urologic Emergencies Video Solutions, Emergency Medicine Examination & Board Review

Problem 1

Which of the following findings are consistent with acute prerenal failure?
(A) BUN to creatinine ratio of $<10$, fractional excretion of sodium (FeNa) $<1$, red cells in urine sediment.
(B) BUN to creatinine ratio of $>20$, FeNa $>1$, normal urinalysis.
(C) Urine osmolality $<350$, moderate proteinuria, granular casts.
(D) Urine osmolality $>500$, red cell casts, proteinuria, FeNa <1.

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Problem 2

Which of the following is NOT a cause of postrenal failure?
(A) Bladder tumor.
(B) Phimosis.
(C) Neurogenic bladder.
(D) Urethral prolapse.

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01:39

Problem 3

Which of the following is NOT a cause of acute renal failure?
(A) Rhabdomyolysis.
(B) Nonsteroidal anti-inflammatory drugs (NSAIDs).
(C) Iron.
(D) Penicillin.

Qudsiya Anis

Numerade Educator

01:52

Problem 4

A chronic renal dialysis patient is brought to the ED in cardiac arrest. Which of the following is the MOST likely cause?
(A) Pericardial effusion.
(B) Hyperkalemia.
(C) Malignant hypertension.
(D) Postdialysis hypotension.

Qudsiya Anis

Numerade Educator

02:56

Problem 5

Which of the following statements regarding infection in patients with continuous ambulatory peritoneal dialysis (CAPD) is TRUE?
(A) Gram-negative bacteria are responsible for most cases of CAPD peritonitis.
(B) Cell count in cases of peritonitis is $>250$ leukocytes.
(C) Infection is the most frequent complication of CAPD.
(D) The peritoneal catheter should be changed at the first sign of peritonitis.

Qudsiya Anis

Numerade Educator

Problem 6

Which of the following is TRUE regarding vascular access in a chronic renal failure patient on hemodialysis?
(A) Vascular graft thrombosis requires immediate surgical thrombectomy.
(B) A nonfunctioning or infected Hickman catheter should be pulled in the ED.
(C) Vascular graft infection often presents with signs of systemic sepsis and few classic signs of local infection.
(D) "Steal syndrome," resulting in shunting of arterial blood away from the extremity distal to the vascular access, is common in patients with AV fistulas.

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00:51

Problem 7

Which of the following is NOT a risk factor for urinary tract infection (UTI) in women?
(A) New sexual partner.
(B) Uterine prolapse.
(C) Use of diaphragm and spermicide.
(D) Oral contraceptive use.

Hast Aggarwal

Numerade Educator

01:22

Problem 8

What is the MOST common causative organism for uncomplicated UTI?
(A) Chlamydia trachomatis.
(B) Proteus species.
(C) Escherichia coli.
(D) Staphylococcus saprophyticus.

Emily Terlap

Numerade Educator

03:18

Problem 9

Which of the following structures needs to be repaired in a fractured penis?
(A) Tunica albuginea.
(B) Corpus spongiosum.
(C) Corpora cavernosum.
(D) Urethra.

Rashmi Gondi

Numerade Educator

Problem 10

Which of the following is NOT an appropriate treatment for priapism?
(A) Terbutaline $0.25 \mathrm{mg}$ administered subcutaneously in the deltoid.
(B) Sedation.
(C) Neosynephrine instillation into the corpora cavernosa.
(D) Exchange transfusion.

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Problem 11

A 19-year-old man complains of acute onset of scrotal pain. Which of the following procedures is LEAST indicated?
(A) Treat with ceftriaxone and doxycycline, then discharge.
(B) Obtain a radionuclide scan of the testes.
(C) Attempt manual detorsion.
(D) Obtain a Doppler ultrasound study.

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Problem 12

What is the MOST appropriate test for diagnosing kidney stones?
(A) Ultrasound.
(B) Urine dipstick.
(C) Plain abdominal radiograph.
(D) Noncontrast computed tomography.

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Problem 13

Which of the following patients with nephrolithiasis can be safely discharged home?
(A) A 50-year-old diabetic man with associated urinary tract infection and signs of obstruction.
(B) A 30-year-old man with a single kidney and signs of obstruction.
(C) A 40-year-old man with a 4-mm stone in the distal ureter.
(D) A 25-year-old woman with uncontrolled pain and persistent vomiting.

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01:39

Problem 14

Which of the following is NOT a common cause of hematuria?
(A) Rifampin.
(B) Glomerulonephritis.
(C) Cancer.
(D) Schistosomiasis.

Qudsiya Anis

Numerade Educator

Problem 15

A patient with a history of ureteral stricture presents to the ED 3 days after placement of a ureteral stent. The patient reports urgency, frequency, and dysuria for the last 24 hours. The patient denies flank pain, gross hematuria, fever, nausea, or vomiting. A urinalysis in the ED confirms the presence of microscopic hematuria but is otherwise unremarkable. Which of the following diagnoses is MOST likely in this patient?
(A) Bladder irritation secondary to stent placement.
(B) Stent migration.
(C) Pyelonephritis.
(D) Urinary obstruction.

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00:39

Problem 16

What is the MOST common site of infection in a renal transplant patient during the first year posttransplant?
(A) Urinary tract.
(B) Mucocutaneous tissue.
(C) Respiratory tract.
(D) Cerebrospinal fluid.

Emily Terlap

Numerade Educator

00:53

Problem 17

Which of the following commonly used immunosuppressive agents can cause nephrotoxicity in a renal transplant patient?
(A) Prednisone.
(B) Mycophenolate mofetil.
(C) Azathioprine.
(D) Cyclosporine.

Hast Aggarwal

Numerade Educator

Problem 18

Which of the following imaging modalities used in evaluating renal colic is the MOST sensitive and specific for identifying renal calculi or hydronephrosis?
(A) Ultrasonography.
(B) Kidneys, ureters, and bladder (KUB) plain radiograph.
(C) Helical CT without intravenous contrast.
(D) Intravenous pyelography (IVP).

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Problem 19

During the initial trauma evaluation of a 24-year-old male involved in a motor vehicle accident, blood is discovered at the urethral meatus, and there is concern for a pelvic fracture. Which of the following diagnostic modalities should be used to evaluate a possible urethral injury?
(A) Helical abdominal CT scan with intravenous and oral contrast.
(B) Retrograde urethrogram.
(C) Focused assessment with sonography in trauma (FAST) scan.
(D) IVP.

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