GU Overview Flashcards
(133 cards)
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
2
Q
Pyelonephritis
A
Irritative voiding symptoms - urine casts
Fever, chills
CVA tenderness
Tx - Ciprofloxacin, IV Ceftriaxone
3
Q
Pre-renal Failure
A
(Azotemia)
- High BUN:Cr ( > 20:1)
- Low fractional excretion of sodium (GFR)
4
Q
Renal Cell Carcinoma
A
Painless hematuria
Flank pain - constant
Abdominal mass
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
6
Q
Goodpasteures Disease
A
Kidney & lung bleeding (hematuria, nephritis, hemoptysis)
7
Q
< 40 yo male with fever, perineal pain, dysuria
A
Acute prostatitis caused by Chlamydia & N. gonorrhea
8
Q
Benign Prostatic Hypertrophic
A
> 50 yo male Obstructive voiding sxs Nocturia Firm smooth enlarged prostate Slowly rising PSA
9
Q
Hyperkalemia
A
Peaked T-waves
10
Q
Hypokalemia
A
Depressed T-waves
U-waves
11
Q
Stones due to gram negative bacteria
- PROTEUS
- Klebsiella
- Pseudomonas
A
Struvite (magnesium ammonium phosphate stones)
12
Q
Urogram: paint-brush appearance of the papillae
A
Medullary cysts
13
Q
Nephrotic Syndrome: associated risks
A
Hypercoaguability - d/t loss of anticoagulant proteins
-DVT, PE
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
15
Q
Cystitis: UA diagnostics
A
- Hematuria
- Nitrates
- Pyuria
16
Q
Damaged glomeruli results in inability to absorb which electrolyte
A
Sodium
17
Q
Size of passable stones
A
Smaller than 5 mm - NSAIDs for pain control
18
Q
Broad, waxy casts
A
Chronic kidney disease
19
Q
Dysmorphic RBCs & RBC casts
A
Glomerulonephritis
20
Q
WBC casts
A
Infection or inflammation (e.g. pyelonephritis)
21
Q
brown urine + granular casts
A
Acute tubular necrosis
22
Q
Risk factors for bladder cancer
A
- Rubber/dye industries
- Chronic inflammation
- Cystoxin (chemotherapy)
- SMOKING
- Lynch-syndrome
23
Q
Sinusitis, pulmonary infiltrates, nephritis
A
Wegner granulomatosis
24
Q
Slow correction of hyponatremia prevents…
A
central pontine myelinolysis
25
MC reason for hypomagnemia
alcoholism
26
MC reason for hypermagemia
chronic renal failure
27
Diagnostic marker for acute renal failure
Serum creatinine
- Prerenal-BUN:Cr > 20:1
- Intrinsic-BUN:Cr < 20:1 (10:1)
28
Causes of prerenal failure
1. Low IV volume - hemorrhage, burns, diuresis
2. Low BP - sepsis, ACEI/ARBs, NSAIDs
3. Low cardiac output - shock, CHF
29
urine specific gravity >1.030 - osmolality > 500
BUN/Cr >20
FENA <1
prerenal acute renal failure
30
urine specific gravity 1
Intrinsic - acute renal failure
31
Causes of intrinsic ARF
Acute tubular necrosis (MCC)
Interstitial nephritis
Glomerulonephritis
Nephrotoxic drugs
32
Nephrotoxic Drugs
Streptomycin, penicillin, and amphotericin Contrast dyes
ACEI
NSAIDS
33
Causes of nephritic syndrome
```
"PIG ARM"
Poststreptococcal glomerulonephrosis
IgA nephropathy
Goodpasture's syndrome
Alport's syndrome
Rapidly progressive GN (RPGN)
Membranoproliferative GN
```
34
Causes of nephrotic syndrome
```
Membranous GN - immune mediated
Focal segmental glomerulosclerosis
Minimal change glomerulonephritis
Membranoproliferative GN
Diabetic nephropathy (MCC)
```
35
fever, rash, peripheral blood eosinophilia
Interstitial nephritis
| -Commonly due to drugs (penicillin, cephalosporins, sulfa-drugs, NSAIDs, rifampin, phenytoin, allopurinol)
36
RBC casts, dark urine, acute periorbital edema, + strep titers
post-streptococcal glomerulonephritis
37
IgA nephropathy - renal failure after infxn
| Young (20-30 y.o.), Asian male
Berger Disease
| -the MCC of glomerulonephritis
38
MC kidney stone composition
calcium oxalate
39
meatus located on the ventral (posterior) surface
hypospadias
40
meatus located on the dorsal aspect
epispadias
41
acute inflammatory disease of the penis associated with penile curvature
peyronie's disease
42
"bag of worms" feeling along spermatic cord
varicocele
| -varicosities of the pampiniform plexus
43
epididymitis, > 40 y.o.
E. coli
| Treatment = ofloxacin or levofloxacin (no quinolones <18 y/o)
44
epididymitis, < 40 y.o.
N. Gonorrhea
| Treatment= cefriaxone or doxycycline
45
fever, scrotal pain, swelling and tenderness of posterior or superior testicle, NORMAL cremasteric reflex
epididymitis; prehn's sign +
46
abnormal testicular suspension, "bell clapper deformity"
testicular torsion
47
MC testicular cancer
seminoma (marker HCG); other type is nonseminoma (marker AFP) & stromal (marker LDH)
48
Painless testicular mass, palpable, firm, irregular nodule - 33 y.o. white male
Testicular cancer - 15-30 y.o. white males
Serum makers AFP, HCG, LDH
Diagnose with US
Treat with orchiectomy, chemo/radiation
49
DRE: symmetrically large rubbery prostate
benign prostatic hypertrophy
| -MC benign tumor in males
50
fever, chills, perineal pain, irritative voiding symptoms, malaise
acute bacterial prostatitis
| tx - PO TMP/SMX x 4-6 weeks
51
contraindications to bacterial prostatitis
prostatic massage, instrumentation
52
pelvic and perineal pain with irritative voiding symptoms > 3 months
chronic prostatitis
53
Risk factors for prostate cancer
```
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
```
54
MC prostate cancer
adenocarcinoma
55
absence of sperm
azoospermia
56
tx of uncomplicated cystitis
TMP/SMX
Nitrofurantoin (pregnancy)
Ciprofloxacin
+/- Phenazopyridine
57
tx of complicated cystitis
Levofloxacin
| Ciprofloxacin
58
pelvic pain relieved with voiding, recurs with bladder filling, constant urgency, suprapubic pain, dyspaeunia
interstitial cystitis
59
tx of stress incontinence
pseudoephedrine
| bladder sling or suspension
60
tx of urge incontinence
- (anticholinergics) - oxybutynin, tolerodine
- neuromodulation
- onabotulinumtoxin A
61
risk factors for renal cell carcinoma
```
HTN
Dialysis
Von Hippel-Lindau syndrome
Smoking
Obesity
Hereditary papillary renal cell carcinoma
```
62
painless hematuria, flank pain, palpable mass
renal cell carcinoma
dx w/ CT
no reliable blood markers
63
MCC of cystitis
E. coli
64
Complicated Cystitis
```
Male
Pregnant
Foley catheter
Recurrent UTIs
Abnormal bladder anatomy
Recent bladder procedures
Failed antibiotic course
Hx of resistant bacteria
DM
Immunocompromised
```
65
Cystitis - "Red Flags"
```
Fever
Pain
N/V
Frank blood
Onset following antibiotic use
```
66
MCC of bladder cancer
transitional cells - d/t chronic inflammation
67
medications inducing incontinence
diuretics
antihistamines
antidepressants
calcium channel blockers
68
MCC of chronic renal failure
DIABETES MELLITUS - 2nd MC is HTN
- low GFR
- elevated BUN & creatinine
- small kidneys on US
- associated w/ anemia
69
acute flank/lower abdominal pain w/ radiation into testicle or labia, CVA tenderness, irritative voiding symptoms
hydronephrosis
70
MC lethal condition inherited as a dominant trait
autosomal dominant polycystic kidney disease
| -sxs (MC, pain) present in 3rd-4th decade
71
flank/abdominal/back pain, intermittent-self limited hematuria (recurrent UTIs), diastolic HTN
polycystic kidney disease
72
risk factors for PKD progression
```
PKD dominant genotype
Large kidneys
Episodes of gross hematuria
Severe & frequent kidney infections
HTN
Multiple pregnancies
Black ethnicity
Male sex
```
73
Complications of AD PKD
ESRD
Polycystic liver disease
Cerebral/aortic aneurysms, heart valve defects
Nephrolithiasis
74
purpura/mottling of toes & feet, renal failure, weight loss, fever, myalgias
atheroembolic renal disease
- d/t surgery, catheter insertion, anticoagulation
- tx w/ stent, angioplasty, bypass
75
acute, colicky flank pain w/ radiation into groin, N/V, irritative voiding sxs, marked distress (writhing, pacing)
Nephrolithiasis - kidney stone
76
Kidney Stone - diagnostic test
NON-CONTRAST CT SCAN
77
Medical Expulsive Therapy - kidney stone
NSAID - ketorolac
Opioid - morphine
Alpha-adrenergic blocker - Tamsulosin
Given 10-14 days while stone passes
78
MCC of urinary tract obstruction
Benign prostatic hypertrophy - men
79
paresthesias, tetany, +/- torsades de pointes
hypocalcemia
| -due to thyroid conditions, chronic renal disease, vitamin D deficiency
80
lethargy, hyperreflexia, paresthesias
hypomagnesmia
| -due to alcoholism, GI losses, re-feeding syndrome
81
Brodel's Line
pale, avascular line along the lateral border of the kidney - used in surgeries to minimize bleeding
82
proximal convoluted tubule
- cuboidal cells
- dense microvilli
- large mitochondris
- function: reabsorption & secretion
83
Loop of Henle
- thin, descending limb
* simple squamous
* permeable to water
- thick, ascending limb
* cuboidal & columnar
* permeable to electrolytes
84
distal convoluted tubule
- cuboidal cells
- few microvilli
- function: secretion > reabsorption
85
collecting duct cells
1. intercalated - acid/base balance
| 2. principle - water/salt balance
86
juxtaglomerular apparatus
- 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
Male Urethra
- Carries semen & urine
- 3 portions:
* prostatic - in prostate
* membranous - in urogenital diaphragm
* spongy - penis to external oriface
88
Causes of PSA Elevation
1. prostate cancer
2. BPH
3. prostate infection/inflammation
4. perineal trauma
*leads to over-diagnosis, w/ associated complications* - pair w/ DRE
89
Serum Creatinine
- Breakdown product of creatine phosphate in muscles
- Influential factors:
* race
* muscle mass
* diet
90
BUN elevation
renal dysfunction
increased protein intake
dehydration
poor circulation
91
BUN:SCr ratio
> 20:1 - prerenal
10-20:1 - postrenal or normal
< 10:1 - intrarenal
92
KUB
- kidneys, ureter, bladder (though, not usually visualized)
| - detects CALCIFIED kidney stones, constipation, SBO
93
Intravenous Pyelogram
- Interval abdominal XR's w/ IV contrast
- Kidneys, ureter, bladder
- Kidney/bladder abnormalities
- Risks: worsening renal failure, allergy
- Largely replaced by CT
94
CT Scan
- With or w/o contrast
- Higher level of detail
- #1 test for renal stones (+ tumors, congenital abnormalities)
95
Renal US
- No radiation; good in kids/pregnancy
- Assess size/shape of kidneys/bladder
- Stone not visualized; dx by hydronephrosis
96
Testicular US
- Evaluate epididymis, testicles, scrotum
| - Cancer, torsion, infection, hydrocele
97
Prostate US
- Transrectal approach
- Evaluates for hypertrophy, nodule, mass
- Indications: nodule, elevated PSA, urinary difficulty, needle biopsy
98
Renal Urethrogram
- Assess urethra
- MC after trauma, look for strictures/rupture
- XR w/ dye
99
Cystogram
- Contrast into bladder via Foley
- XR image; less radiation
- Assess for mass, vesiculoureteral reflux (radionuclide cystogram), bladder rupture
100
Voiding Cystourethrogram
- Vesiculoureteral reflux, bladder rupture, urethral abnormalities
- Catheter inserts dye & fluoroscopy
- Voiding increases intraluminal bladder pressure
101
Retrograde Pyelogram
- 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
Cystoscopy
- 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
Radioisotope Renography
- Nuclear medicine scan
- Concentrates in kidneys & excreted through ureters
- Evaluates renal blood flow, function of kidneys, & obstruction
- Indications: renal failure before transplant
104
Captopril Radioisotope Renography
- Screens for renal artery stenosis
- Non-invasive
- ACE inhibitor - vasodilate efferent arteriole & decrease GFR -> contrast accumulation in abnormal kidneys (not normal)
105
Renal Angiogram
- Selective catheterization of renal arteries
- Contrast & XR scans
- Evaluates for renal artery stenosis, vascular tumors, & aneurysms
- Can undergo angioplasty/stenting
106
Urodynamic Testing
- 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
edema, proteinuria, hypoalbuminemia, hyperlipidemia
nephrotic syndrome
108
normal pH
7. 4 (7.38-7.42)
- Higher = alkalosis
- Lower = acidosis
109
normal pCO2
40 (38-42)
110
normal HCO3
24 (22-26)
111
normal Na+
140 (135-145)
112
normal K+
4.5 (3.5-5)
113
normal serum creatinine
1.0 (0.6-1.1)
114
normal BUN
10 (6-21)
115
>100,000 CFU/mL + pyuria
positive urine culture
116
normal BUN:Cr ratio
10-20:1
117
normal GFR
125 (mL/min)
118
peritonitis secondary to peritoneal dialysis - organism
staph
119
low GFR, high BUN and Cr, hyperkalemia, anemia
chronic renal failure
120
Typical maintenance IV fluid
D51/2NS+20K
121
Daily weights, electrolytes, ins/outs, BP
IV fluid orders
122
Severe dehydration IV fluid order
1-2L NS bolus
123
Replacement of blood loss IV fluid order
normal saline
124
Replacement for hypernatremia IV fluid order
hypotonic
125
Replacement for hyponatremia IV fluid order
isotonic (or hypertonic)
126
Requirement before adding K+ to IV fluid
urine production
127
Maintenance for IV Calculation
4/2/1
128
low pH, high pCO2 and HCO3
respiratory acidosis
129
low pH, low pCO2 and HCO3
metabolic acidosis
130
high pH, high pCO2 and HCO3
metabolic alkalosis
131
high pH, low pCO2 and HCO3
respiratory alkalosis
132
fever, chills, flank pain, nausea, vomiting
pyelonephritis
133
orchitis in young boy
mumps - paroditis
