GU 2

Question 1

positive result is highly indicative of a UTI

Answer 1

nitrites

Question 2

how to nitrites end up in urine

Answer 2

breakdown of urea into nitrite by bacteria

Question 3

casts are

Answer 3

shaped like cylinders because they are formed in the renal tubules

Question 4

cast that is nonspecific

Answer 4

hyaline casts

Question 5

WBC casts may be seen with

Answer 5

infections (pyelonephritis) or inflammation (interstitial nephritis)

Question 6

RBC casts are caused by

Answer 6

microscopic bleeding in the glomeruli

Question 7

suspect glomerulonephritis is you find what cast in urine

Answer 7

RBC cast

Question 8

UA - positive culture is what number

Answer 8

10 or more colony-forming units of one dominant bacteria

Question 9

UA - if multiple bacteria are present, think

Answer 9

may be contaminated sample

Question 10

WBC casts with proteinuria and hematuria are associated with

Answer 10

pyelonephritis

Question 11

AKI lasts how long

Answer 11

7-21 days

Question 12

AKI is defined as
2

Answer 12

• increase in serum creatinine by 0.3 or more within 48 hours
• increase in serum creatinine by 1.5 or more from baseline

Question 13

AKI - urine volume of less than what

Answer 13

< 0.5 ml/kg/hr for 6 hours

Question 14

most common cause of intrinsic AKI

Answer 14

acute tubular necrosis ATN, 90% of cases and is often a reversible injury

Question 15

meds that cause prerenal AKI
3

Answer 15

limit the GFR - ACE I, ARB, NSAID

Question 16

AKI - postrenal causes
3

Answer 16

bladder obstruction
uretheral/renal obstruction
neurogenic bladder

Question 17

acute pyelonephritis is an acute bacterial infection of the kidney(s) that is most commonly caused by
3

Answer 17

gram negative Enterobacteriaceae such as E. coli (75-95%), Proteus, and Klebsiella

Question 18

adult pt presents with acute onset of high fever, chills, anorexia, NV, and one sided flank pain

Answer 18

acute pyelonephritis

Question 19

acute pyelonephritis physical exam
2

Answer 19

1. temperature 100.4 or greater
2. CVB angle tenderness

Question 20

acute pyelonephritis dx tests
4 (UA, cases, C&S, CBC)

Answer 20

1. UA - presence of leukocytes, hematuria, nitrites, mild proteinuria
2. urinary cases - WBC casts
3. urine C&S - presence of 10 mL of one organism
4. CBC - leukocytosis, neutrophilia >80% with a shift to the left

Question 21

neutrophils with a shift to the left means

Answer 21

presence of bands, which are immature neutrophils, suggests an infection

Question 22

OP tx for acute pyelonephritis abx

Answer 22

oral fluoroquinolone (e.g. levofloxacin, ciprofloxacin) 5-7 days

Question 23

asymptomatic bacteriuria ASB is defined as

Answer 23

the presence of one or more species of bacteria growing in the urine (10 or more CFU/mL) in the absence of UTI symptoms

Question 24

the presence of one or more species of bacteria growing in the urine (10 or more CFU/mL) in the absence of UTI symptoms

Answer 24

asymptomatic bacteriuria ASB

Question 25

asymptomatic bacteriuria ASB - indications for screening and abx therapy include 3

Answer 25

pregnancy undergoing urologic intervention renal transplant recipients

Question 26

asymptomatic bacteriuria ASB - not recommended to screen or treat in who 4

Answer 26

1. older adults 2. pts with DM 3. pts with indwelling bladder catheters 4. pts undergoing non-urologic surgery

Question 27

CKD is more common in what gender

Answer 27

females

Question 28

CKD - calcemia

Answer 28

hypocalcemia

Question 29

CKD - parathyroid hormone

Answer 29

often elevated parathyroid hormone

Question 30

CKD - order what imaging 2

Answer 30

kidney US - to assess for abnormalities in the kidney which may warrant further evaluation vascular duplex US - to evaluate for renal artery stenosis

Question 31

hematuria - if infection is suspected the UA will often indicate

Answer 31

WBCs with or without nitrites

Question 32

hematuria - if infection is suspected do what

Answer 32

order UA with urine C&S; the infection should be treated, and the UA should be repeated about 6 weeks after completion of abx therapy to ensure resolution of hematuria

Question 33

poststreptococcal glomerulonephritis is suspected if pt presents with 6

Answer 33

dark reddish brown urine edema proteinuria fatigue decreased urine output recent strep throat

Question 34

hematuria in female with history of recent sexual activity or exercise

Answer 34

stop exercise and repeat UA in 4-6 weeks

Question 35

most kidney stones are made up of 2

Answer 35

calcium oxalate 70-80% calcium phosphate 15%

Question 36

calcium stones risk factors - diet

Answer 36

high dietary intake of: calcium vitamin C oxalate foods sodium protein lower fluid intake intake of foods high in sucrose and fructose

Question 37

majority of patients will pass a stone within how many hours

Answer 37

48 hours

Question 38

acute onset of severe colickly flank pain

Answer 38

kidney stone - nephrolithiasis

Question 39

nephrolithiasis - UA will often show what in majority of patients

Answer 39

hematuria

Question 40

preferred imaging method to dx nephrolithiasis

Answer 40

CT of abd and pelvis w/o contrast - if CT not available or pt is pregnant, then alt test is US of the kidneys and bladder

Question 41

nephrolithiasis - tx stone <5 mm

Answer 41

will pass on its own, strain urine, bring stone in for analysis by lab

Question 42

nephrolithiasis - tx for stones 5-10 mm

Answer 42

tamsulosin (alpha blocker) for up to 4 weeks to help relex ureter smooth muscle; can use another alpha blocker or CCB to facilitate passage of stone

Question 43

nephrolithiasis - for larger stones, methods used to break the stone and remove it include

Answer 43

extracorporeal shock wave lithotripsy ESWL

Question 44

nephrolithiasis - diet tx

Answer 44

increase fluid intake to 2-3 L/day

Question 45

nephrolithiasis - avoid foods high in oxalate such as 8

Answer 45

rhubarb spinach okra nuts beets chocolate tea meats