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GI/GU > GU Overview > Flashcards

GU Overview Flashcards

1
Q

Hyaline Casts

A

-Normal (may be present after febrile illness, strenuous exercise)

  • Factors favoring formation:
    • low flow rate
    • high salt concentration
    • low pH
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2
Q

Pyelonephritis

A

Irritative voiding symptoms - urine casts
Fever, chills
CVA tenderness
Tx - Ciprofloxacin, IV Ceftriaxone

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3
Q

Pre-renal Failure

A

(Azotemia)

  • High BUN:Cr ( > 20:1)
  • Low fractional excretion of sodium (GFR)
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4
Q

Renal Cell Carcinoma

A

Painless hematuria
Flank pain - constant
Abdominal mass

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5
Q

Acute Glomerulonephritis

A 
Oliguria
Hematuria - "tea-, cola-colored urine"
Protienuria
Dysmorphic RBC casts
Edema (periorbital -> pedal) + HTN
MC 1-3 weeks post-infection
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6
Q

Goodpasteures Disease

A

Kidney & lung bleeding (hematuria, nephritis, hemoptysis)

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7
Q

< 40 yo male with fever, perineal pain, dysuria

A

Acute prostatitis caused by Chlamydia & N. gonorrhea

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8
Q

Benign Prostatic Hypertrophic

A 
> 50 yo male
Obstructive voiding sxs
Nocturia
Firm smooth enlarged prostate
Slowly rising PSA
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9
Q

Hyperkalemia

A

Peaked T-waves

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10
Q

Hypokalemia

A

Depressed T-waves

U-waves

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11
Q

Stones due to gram negative bacteria

  • PROTEUS
  • Klebsiella
  • Pseudomonas
A

Struvite (magnesium ammonium phosphate stones)

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12
Q

Urogram: paint-brush appearance of the papillae

A

Medullary cysts

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13
Q

Nephrotic Syndrome: associated risks

A

Hypercoaguability - d/t loss of anticoagulant proteins

-DVT, PE

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14
Q

Nephrotic Syndrome: definition

A
  • proteinuria > 3.5 g/24 hr (foamy urine)–>
  • hypoalbuminemia < 3.0 g/dL
  • hyperlipidemia
  • edema - d/t low albumin
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15
Q

Cystitis: UA diagnostics

A
  • Hematuria
  • Nitrates
  • Pyuria
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16
Q

Damaged glomeruli results in inability to absorb which electrolyte

A

Sodium

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17
Q

Size of passable stones

A

Smaller than 5 mm - NSAIDs for pain control

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18
Q

Broad, waxy casts

A

Chronic kidney disease

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19
Q

Dysmorphic RBCs & RBC casts

A

Glomerulonephritis

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20
Q

WBC casts

A

Infection or inflammation (e.g. pyelonephritis)

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21
Q

brown urine + granular casts

A

Acute tubular necrosis

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22
Q

Risk factors for bladder cancer

A
  • Rubber/dye industries
  • Chronic inflammation
  • Cystoxin (chemotherapy)
  • SMOKING
  • Lynch-syndrome
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23
Q

Sinusitis, pulmonary infiltrates, nephritis

A

Wegner granulomatosis

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24
Q

Slow correction of hyponatremia prevents…

A

central pontine myelinolysis

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25
Q

MC reason for hypomagnemia

A

alcoholism

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26
Q

MC reason for hypermagemia

A

chronic renal failure

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27
Q

Diagnostic marker for acute renal failure

A

Serum creatinine

  • Prerenal-BUN:Cr > 20:1
  • Intrinsic-BUN:Cr < 20:1 (10:1)
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28
Q

Causes of prerenal failure

A
  1. Low IV volume - hemorrhage, burns, diuresis
  2. Low BP - sepsis, ACEI/ARBs, NSAIDs
  3. Low cardiac output - shock, CHF
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29
Q

urine specific gravity >1.030 - osmolality > 500
BUN/Cr >20
FENA <1

A

prerenal acute renal failure

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30
Q

urine specific gravity 1

A

Intrinsic - acute renal failure

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31
Q

Causes of intrinsic ARF

A

Acute tubular necrosis (MCC)
Interstitial nephritis
Glomerulonephritis
Nephrotoxic drugs

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32
Q

Nephrotoxic Drugs

A

Streptomycin, penicillin, and amphotericin Contrast dyes
ACEI
NSAIDS

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33
Q

Causes of nephritic syndrome

A 
"PIG ARM"
Poststreptococcal glomerulonephrosis
IgA nephropathy
Goodpasture's syndrome
Alport's syndrome
Rapidly progressive GN (RPGN)
Membranoproliferative GN
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34
Q

Causes of nephrotic syndrome

A 
Membranous GN - immune mediated
Focal segmental glomerulosclerosis
Minimal change glomerulonephritis
Membranoproliferative GN
Diabetic nephropathy (MCC)
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35
Q

fever, rash, peripheral blood eosinophilia

A

Interstitial nephritis

-Commonly due to drugs (penicillin, cephalosporins, sulfa-drugs, NSAIDs, rifampin, phenytoin, allopurinol)

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36
Q

RBC casts, dark urine, acute periorbital edema, + strep titers

A

post-streptococcal glomerulonephritis

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37
Q

IgA nephropathy - renal failure after infxn

Young (20-30 y.o.), Asian male

A

Berger Disease

-the MCC of glomerulonephritis

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38
Q

MC kidney stone composition

A

calcium oxalate

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39
Q

meatus located on the ventral (posterior) surface

A

hypospadias

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40
Q

meatus located on the dorsal aspect

A

epispadias

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41
Q

acute inflammatory disease of the penis associated with penile curvature

A

peyronie’s disease

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42
Q

“bag of worms” feeling along spermatic cord

A

varicocele

-varicosities of the pampiniform plexus

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43
Q

epididymitis, > 40 y.o.

A

E. coli

Treatment = ofloxacin or levofloxacin (no quinolones <18 y/o)

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44
Q

epididymitis, < 40 y.o.

A

N. Gonorrhea

Treatment= cefriaxone or doxycycline

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45
Q

fever, scrotal pain, swelling and tenderness of posterior or superior testicle, NORMAL cremasteric reflex

A

epididymitis; prehn’s sign +

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46
Q

abnormal testicular suspension, “bell clapper deformity”

A

testicular torsion

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47
Q

MC testicular cancer

A

seminoma (marker HCG); other type is nonseminoma (marker AFP) & stromal (marker LDH)

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48
Q

Painless testicular mass, palpable, firm, irregular nodule - 33 y.o. white male

A

Testicular cancer - 15-30 y.o. white males
Serum makers AFP, HCG, LDH
Diagnose with US
Treat with orchiectomy, chemo/radiation

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49
Q

DRE: symmetrically large rubbery prostate

A

benign prostatic hypertrophy

-MC benign tumor in males

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50
Q

fever, chills, perineal pain, irritative voiding symptoms, malaise

A

acute bacterial prostatitis

tx - PO TMP/SMX x 4-6 weeks

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51
Q

contraindications to bacterial prostatitis

A

prostatic massage, instrumentation

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52
Q

pelvic and perineal pain with irritative voiding symptoms > 3 months

A

chronic prostatitis

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53
Q

Risk factors for prostate cancer

A 
Age - MCC of death in men > 75 y.o.
Black ethnicity
Family hx
Alcoholism
High fat diet
Exposures - agent orange, cadmium, farmers, tire plant workers
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54
Q

MC prostate cancer

A

adenocarcinoma

55
Q

absence of sperm

A

azoospermia

56
Q

tx of uncomplicated cystitis

A

TMP/SMX
Nitrofurantoin (pregnancy)
Ciprofloxacin
+/- Phenazopyridine

57
Q

tx of complicated cystitis

A

Levofloxacin

Ciprofloxacin

58
Q

pelvic pain relieved with voiding, recurs with bladder filling, constant urgency, suprapubic pain, dyspaeunia

A

interstitial cystitis

59
Q

tx of stress incontinence

A

pseudoephedrine

bladder sling or suspension

60
Q

tx of urge incontinence

A
  • (anticholinergics) - oxybutynin, tolerodine
  • neuromodulation
  • onabotulinumtoxin A
61
Q

risk factors for renal cell carcinoma

A 
HTN
Dialysis
Von Hippel-Lindau syndrome
Smoking
Obesity
Hereditary papillary renal cell carcinoma
62
Q

painless hematuria, flank pain, palpable mass

A

renal cell carcinoma
dx w/ CT
no reliable blood markers

63
Q

MCC of cystitis

A

E. coli

64
Q

Complicated Cystitis

A 
Male
Pregnant
Foley catheter
Recurrent UTIs
Abnormal bladder anatomy
Recent bladder procedures
Failed antibiotic course
Hx of resistant bacteria
DM
Immunocompromised
65
Q

Cystitis - “Red Flags”

A 
Fever
Pain
N/V
Frank blood
Onset following antibiotic use
66
Q

MCC of bladder cancer

A

transitional cells - d/t chronic inflammation

67
Q

medications inducing incontinence

A

diuretics
antihistamines
antidepressants
calcium channel blockers

68
Q

MCC of chronic renal failure

A

DIABETES MELLITUS - 2nd MC is HTN

  • low GFR
  • elevated BUN & creatinine
  • small kidneys on US
  • associated w/ anemia
69
Q

acute flank/lower abdominal pain w/ radiation into testicle or labia, CVA tenderness, irritative voiding symptoms

A

hydronephrosis

70
Q

MC lethal condition inherited as a dominant trait

A

autosomal dominant polycystic kidney disease

-sxs (MC, pain) present in 3rd-4th decade

71
Q

flank/abdominal/back pain, intermittent-self limited hematuria (recurrent UTIs), diastolic HTN

A

polycystic kidney disease

72
Q

risk factors for PKD progression

A 
PKD dominant genotype
Large kidneys
Episodes of gross hematuria
Severe & frequent kidney infections
HTN
Multiple pregnancies
Black ethnicity
Male sex
73
Q

Complications of AD PKD

A

ESRD
Polycystic liver disease
Cerebral/aortic aneurysms, heart valve defects
Nephrolithiasis

74
Q

purpura/mottling of toes & feet, renal failure, weight loss, fever, myalgias

A

atheroembolic renal disease

  • d/t surgery, catheter insertion, anticoagulation
  • tx w/ stent, angioplasty, bypass
75
Q

acute, colicky flank pain w/ radiation into groin, N/V, irritative voiding sxs, marked distress (writhing, pacing)

A

Nephrolithiasis - kidney stone

76
Q

Kidney Stone - diagnostic test

A

NON-CONTRAST CT SCAN

77
Q

Medical Expulsive Therapy - kidney stone

A

NSAID - ketorolac
Opioid - morphine
Alpha-adrenergic blocker - Tamsulosin

Given 10-14 days while stone passes

78
Q

MCC of urinary tract obstruction

A

Benign prostatic hypertrophy - men

79
Q

paresthesias, tetany, +/- torsades de pointes

A

hypocalcemia

-due to thyroid conditions, chronic renal disease, vitamin D deficiency

80
Q

lethargy, hyperreflexia, paresthesias

A

hypomagnesmia

-due to alcoholism, GI losses, re-feeding syndrome

81
Q

Brodel’s Line

A

pale, avascular line along the lateral border of the kidney - used in surgeries to minimize bleeding

82
Q

proximal convoluted tubule

A
  • cuboidal cells
  • dense microvilli
  • large mitochondris
  • function: reabsorption & secretion
83
Q

Loop of Henle

A
  • thin, descending limb
    • simple squamous
    • permeable to water
  • thick, ascending limb
    • cuboidal & columnar
    • permeable to electrolytes
84
Q

distal convoluted tubule

A
  • cuboidal cells
  • few microvilli
  • function: secretion > reabsorption
85
Q

collecting duct cells

A
  1. intercalated - acid/base balance

2. principle - water/salt balance

86
Q

juxtaglomerular apparatus

A
  • JG cells:
    • smooth muscle of afferent arteriole
    • contain renin
    • mechanoreceptors - sense BP
  • Macula densa:
    • cells of distal convoluted tubule
    • chemoreceptors - sense NaCl
  • Lacis cells (extraglomerular mesangial):
    • b/t both - pass signals
87
Q

Male Urethra

A
  • Carries semen & urine
  • 3 portions:
    • prostatic - in prostate
    • membranous - in urogenital diaphragm
    • spongy - penis to external oriface
88
Q

Causes of PSA Elevation

A
  1. prostate cancer
  2. BPH
  3. prostate infection/inflammation
  4. perineal trauma

leads to over-diagnosis, w/ associated complications - pair w/ DRE

89
Q

Serum Creatinine

A
  • Breakdown product of creatine phosphate in muscles
  • Influential factors:
    • race
    • muscle mass
    • diet
90
Q

BUN elevation

A

renal dysfunction
increased protein intake
dehydration
poor circulation

91
Q

BUN:SCr ratio

A

> 20:1 - prerenal
10-20:1 - postrenal or normal
< 10:1 - intrarenal

92
Q

KUB

A
  • kidneys, ureter, bladder (though, not usually visualized)

- detects CALCIFIED kidney stones, constipation, SBO

93
Q

Intravenous Pyelogram

A
  • Interval abdominal XR’s w/ IV contrast
  • Kidneys, ureter, bladder
  • Kidney/bladder abnormalities
  • Risks: worsening renal failure, allergy
  • Largely replaced by CT
94
Q

CT Scan

A
  • With or w/o contrast
  • Higher level of detail
  • # 1 test for renal stones (+ tumors, congenital abnormalities)
95
Q

Renal US

A
  • No radiation; good in kids/pregnancy
  • Assess size/shape of kidneys/bladder
  • Stone not visualized; dx by hydronephrosis
96
Q

Testicular US

A
  • Evaluate epididymis, testicles, scrotum

- Cancer, torsion, infection, hydrocele

97
Q

Prostate US

A
  • Transrectal approach
  • Evaluates for hypertrophy, nodule, mass
  • Indications: nodule, elevated PSA, urinary difficulty, needle biopsy
98
Q

Renal Urethrogram

A
  • Assess urethra
  • MC after trauma, look for strictures/rupture
  • XR w/ dye
99
Q

Cystogram

A
  • Contrast into bladder via Foley
  • XR image; less radiation
  • Assess for mass, vesiculoureteral reflux (radionuclide cystogram), bladder rupture
100
Q

Voiding Cystourethrogram

A
  • Vesiculoureteral reflux, bladder rupture, urethral abnormalities
  • Catheter inserts dye & fluoroscopy
  • Voiding increases intraluminal bladder pressure
101
Q

Retrograde Pyelogram

A
  • Contrast into ureter via cystoscopy
  • Used when IV contrast cannot be given for IVP or CT due to renal failure or allergy
  • Identifies filling defects from stones, tumors - shows anatomy
102
Q

Cystoscopy

A
  • Endoscopy of the bladder via urethra
  • Sterile water inserted to distend bladder
  • May take biopsy
  • May enter urethra via urethroscope to retrieve a stone
103
Q

Radioisotope Renography

A
  • Nuclear medicine scan
  • Concentrates in kidneys & excreted through ureters
  • Evaluates renal blood flow, function of kidneys, & obstruction
  • Indications: renal failure before transplant
104
Q

Captopril Radioisotope Renography

A
  • Screens for renal artery stenosis
  • Non-invasive
  • ACE inhibitor - vasodilate efferent arteriole & decrease GFR -> contrast accumulation in abnormal kidneys (not normal)
105
Q

Renal Angiogram

A
  • Selective catheterization of renal arteries
  • Contrast & XR scans
  • Evaluates for renal artery stenosis, vascular tumors, & aneurysms
  • Can undergo angioplasty/stenting
106
Q

Urodynamic Testing

A
  • Bladder/urethral function
  • Indications: incontinence, urgency/frequency, difficulty w/ initiation, frequent UTIs
  • Uroflometry: bladder pressure & reate of emptying
  • Post-void: > 100cc’s is high, US or catheter drainage
  • Cystometry: bladder pressure w/ increasing volume
  • Urethral pressure profilometry: strength of urethral sphincter contraction
107
Q

edema, proteinuria, hypoalbuminemia, hyperlipidemia

A

nephrotic syndrome

108
Q

normal pH

A
  1. 4 (7.38-7.42)
    - Higher = alkalosis
    - Lower = acidosis
109
Q

normal pCO2

A

40 (38-42)

110
Q

normal HCO3

A

24 (22-26)

111
Q

normal Na+

A

140 (135-145)

112
Q

normal K+

A

4.5 (3.5-5)

113
Q

normal serum creatinine

A

1.0 (0.6-1.1)

114
Q

normal BUN

A

10 (6-21)

115
Q

> 100,000 CFU/mL + pyuria

A

positive urine culture

116
Q

normal BUN:Cr ratio

A

10-20:1

117
Q

normal GFR

A

125 (mL/min)

118
Q

peritonitis secondary to peritoneal dialysis - organism

A

staph

119
Q

low GFR, high BUN and Cr, hyperkalemia, anemia

A

chronic renal failure

120
Q

Typical maintenance IV fluid

A

D51/2NS+20K

121
Q

Daily weights, electrolytes, ins/outs, BP

A

IV fluid orders

122
Q

Severe dehydration IV fluid order

A

1-2L NS bolus

123
Q

Replacement of blood loss IV fluid order

A

normal saline

124
Q

Replacement for hypernatremia IV fluid order

A

hypotonic

125
Q

Replacement for hyponatremia IV fluid order

A

isotonic (or hypertonic)

126
Q

Requirement before adding K+ to IV fluid

A

urine production

127
Q

Maintenance for IV Calculation

A

4/2/1

128
Q

low pH, high pCO2 and HCO3

A

respiratory acidosis

129
Q

low pH, low pCO2 and HCO3

A

metabolic acidosis

130
Q

high pH, high pCO2 and HCO3

A

metabolic alkalosis

131
Q

high pH, low pCO2 and HCO3

A

respiratory alkalosis

132
Q

fever, chills, flank pain, nausea, vomiting

A

pyelonephritis

133
Q

orchitis in young boy

A

mumps - paroditis

GI/GU (5 decks)

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