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Flashcards in GU 2 (Step up son) Deck (22):
1

A patient comes in with symptoms of acidosis. She has had multiple kidney stones and is found to have a urine pH >5.3 (nml 4.5-8). What is the likely problem? What is seen on labs? What can be done?

Distal (type 1) renal tubular acidosis...impaired H+ secretion

Low K+
Variable bicarb

Oral bicarb, K+, thiazide

2

A patient comes in with symptoms of acidosis and bone pain. She is found to have bone lesions. UA shows a urine pH less than 5.3. What could be going on? What would be seen on labs? What can be done? What other syndromes/diseases could this person have?

Proximal (type 2) renal tubular acidosis...impaired bicarb reabsorption

Low K+
Low bicarb

Oral bicarb, K+, thiazide or loop

Multiple myeloma, Fanconi syndrome, Wilson disease, amyloidosis, Vitamin D deficiency, autoimmune diseases

3

A diabetic patient comes in with symptoms of acidosis and is found to have a urine pH less than 5.3 and a high K+ and Cl-. What could be the cause? What should the treatment be?

Low Renin/Aldosterone (type 4) renal tubular acidosis...primary or secondary hypoaldosteronism

Treat with fludrocortisone
K+ restriction

4

The ol' delta-delta is used to determine if there is only an anion gap acidosis or if there are multiple things going on. How is the delta-delta determined? What are the indications?

Corrected HCO3 = measured gap - normal gap...12 + measured HCO3

if the corrected HCO3 is:
Within normal range --> only an anion gap acidosis
Above normal range --> mixed w/ metabolic alkalosis
Below normal range --> mixed w/ non-gap acidosis

5

There can be mixed metabolic/respiratory conditions. How can an additional respiratory condition be determined with a metabolic acidosis?

Expected pCO2 = 1.5(HCO3) + 8 +/-2
Actual less than expected --> additional resp alk
Actual greater than expected --> additional resp acid

6

There can be mixed metabolic/respiratory conditions. How can an additional respiratory condition be determined with a metabolic alkalosis?

pCO2 greater than 50 --> additional resp acid
pCO2 less than 40 --> additional resp alk

7

What are the common causes of a UTI?

E. coli
Staph sapro
Proteus
Klebsiella
Enterobacter
Pseudomonas
Enterococcus

8

How is a UTI treated?

Amox, bactrim, or a fluoro for 3 days...14 days if relapse

9

How is urge incontinence treated?

Bladder training
Antimuscarinics (oxybutynin, tolterodine, solifenacin)

10

How is stress incontinence treated?

Therapy...weight loss, Kegel exercises
Midurethral sling

11

Who gets overflow obstruction?

Often men...BPH, urethral strictures

12

Patient comes in with hematuria. Has a hx of treated bladder cancer. What is an option?

Recurrence of bladder cancer...happens frequently

13

Growth on Thayer-Martin culture indicates what?

N. gonorrhea

14

Which STD can be confirmed with nucleic acid amplification?

Chlamydia

15

How is GC treated?

Single dose ceftriaxone with doxy or azithromycin

16

What is the most common cause of prostatitis? How is it treated?

Nonbacterial is more common

Still treat with bactrim for 4-6 weeks...also treat for STD if sexually active

17

What is the most common non-derm cancer in men? Which cancer causes the most deaths?

Prostate cancer is more common than lung

Lung kills more than prostate...but prostate is second

18

How can epididymitis be differentiated from testicular torsion?

Support the sack...pain goes away = epididymitis

19

How is epididymitis treated?

Ceftriaxone and doxy or fluoroquinolone
NAIDs and sack support if non-infectious cause

20

Where does a Wilms tumor originate? Who gets a Wilms tumor? What is often seen with a Wilms tumor?

Renal origin

Children less than 4yo

WAGR
W- Wilms tumor
A- Aniridia
G- GU abnormalities
R- Retardation

21

Boy is born with hypospadias. Should the urethra be corrected before or after circumcision?

Before

22

What is enuresis?

Nocturnal bed wetting...usually resolves by 4yo