GU/RENAL Flashcards
(589 cards)
1
Q
Water and fluid is about what percentage of our body weight?
A
60%
2
Q
What are the two different types of fluid included in our water body weight?
A
Intracellular fluid (40%)
- Cations: potassium and magnesium
- Anions: molecules with negative charge (Proteins and phosphates)
Extracellular fluid (20%)
- Cation: sodium
- Anion: chloride and bicarb
2
Q
The body keeps a balance between what to types of ions?
A
Positive cations equal the negative anions
3
Q
The body keeps the osmolarity The same between extracellular and intracellular fluid meaning what?
A
Serum Osmolarity can be calculated (Normal about 275 to 290)
4
Q
What is the serum or plasma osmolality?
A
It is the measure of the different saw in the plasma
5
Q
Where is the extracellular fluid?
A
Blood and interstitium (The space between cells)
6
Q
What is the equation for serum osmolality?
A
7
Q
Which ion is the biggest factor in the serum osmolality equation?
A
Sodium
8
Q
Sodium moves easily between intracellular and extracellular compartments. The normal plasma sodium concentration is what?
A
135 to 145, all the intracellular fluid concentration is approximately 10 to 12. Water follows sodium
9
Q
What does sodium do?
A
It helps with water and blood pressure regulation. It generates the resting membrane potential, the sodium potassium pump
10
Q
What are crystalloid solutions?
A
These are the most commonly used IV fluids and contain small molecules that can freely pass through cell membranes. They are generally used to restore water and electrolyte balance.
11
Q
Crystalloids Are classified into three main types, what are they?
A
Isotonic fluid fluids, hypotonic fluid fluids, hypertonic fluids
12
Q
What are isotonic fluids?
A
These fluids have the same osmolarity as blood plasma. They are used for volume resuscitation and to treat dehydration
13
Q
What are three examples of isotonic fluids?
A
Normal saline, lactated ringers, Plasmalyte
14
Q
What is normal saline?
A
(0.9% NaCl) Used for general fluid replacement to expand extracellular fluid volume
15
Q
What are lactated ringers?
A
LR contains sodium, chloride, potassium, calcium, and lactate. It is often used in trauma and surgical patients
16
Q
What is plasmalyte?
A
Similar to LR, but without lactate; it’s used in inpatients who may have liver dysfunction (Lactate is metabolized in the liver).
17
Q
What are hypotonic fluids?
A
These fluids have a lower osmolarity than blood plasma, causing water to move into cells. They are used for conditions like dehydration where the cells are dry I need to absorb water
18
Q
What is an example of hypotonic fluids?
A
Half normal saline
19
Q
What is half normal saline?
A
(0.45% NaCl) Used for hydration and patient with mild dehydration, as it moves water into the cells.
20
Q
What are hypertonic fluids?
A
These fluids had a higher osmolarity than blood plasma and draw water out of the cells into the extracellular space. They are used for cerebral edema, hyponatremia, or when you need to expand extracellular fluid volume quickly
21
Q
What are some examples of hypertonic fluids?
A
3% sodium chloride or hypertonic saline
D5NS or 5% dextrose in normal sailing
22
Q
What is hypertonic saline?
A
3% sodium chloride.Used in case cases of severe hyponatremia to raise sodium levels
23
Q
What is 5% dextrose in normal saline?
A
D5NS. Used for both fluid resuscitation and providing some caloric support
24
What are colloid solutions?
These fluids contain larger molecules like proteins or starches that don't cross cell membranes as easily as crystalloids. They are often used to expand blood volume, especially in case cases of hypothalamic shock
25
What are some examples of colloid solutions?
Albumin and Dextran
26
What is albumin?
A naturally occurring protein used to increase the osmotic pressure in the blood vessels, helping to pull fluid into the vascular space.
27
What is dextran?
A synthetic solution that acts like albumin, used for volume expansion in certain shock states
28
Water and fluid is about what percentage of our body weight?
60%
29
What are the two different types of fluid included in our water body weight?
Intracellular fluid (40%) and Extracellular fluid (20%)
30
What cations are found in intracellular fluid?
Potassium and magnesium
31
What anions are found in intracellular fluid?
Proteins and phosphates
32
What cation is found in extracellular fluid?
Sodium
33
What anions are found in extracellular fluid?
Chloride and bicarb
34
The body keeps a balance between what two types of ions?
Positive cations equal the negative anions
35
What does it mean that the body keeps the osmolarity the same between extracellular and intracellular fluid?
Serum Osmolarity can be calculated (Normal about 275 to 290)
36
What is the serum or plasma osmolality?
It is the measure of the different solutes in the plasma
37
Where is the extracellular fluid located?
Blood and interstitium (The space between cells)
38
What is the equation for serum osmolality?
Not provided in the text.
39
Which ion is the biggest factor in the serum osmolality equation?
Sodium
40
What is the normal plasma sodium concentration?
135 to 145
41
What does sodium do?
It helps with water and blood pressure regulation, and generates the resting membrane potential.
42
What are crystalloid solutions?
These are the most commonly used IV fluids and contain small molecules that can freely pass through cell membranes.
43
What are the three main types of crystalloid solutions?
Isotonic fluids, hypotonic fluids, hypertonic fluids
44
What are isotonic fluids?
These fluids have the same osmolarity as blood plasma.
45
What are three examples of isotonic fluids?
Normal saline, lactated ringers, Plasmalyte
46
What is normal saline?
(0.9% NaCl) Used for general fluid replacement to expand extracellular fluid volume.
47
What are lactated ringers?
LR contains sodium, chloride, potassium, calcium, and lactate. It is often used in trauma and surgical patients.
48
What is plasmalyte?
Similar to LR, but without lactate; it's used in inpatients who may have liver dysfunction.
49
What are hypotonic fluids?
These fluids have a lower osmolarity than blood plasma, causing water to move into cells.
50
What is an example of hypotonic fluids?
Half normal saline
51
What is half normal saline?
(0.45% NaCl) Used for hydration and patients with mild dehydration.
52
What are hypertonic fluids?
These fluids have a higher osmolarity than blood plasma and draw water out of the cells.
53
What are some examples of hypertonic fluids?
3% sodium chloride or hypertonic saline, D5NS or 5% dextrose in normal saline
54
What is hypertonic saline?
3% sodium chloride. Used in cases of severe hyponatremia to raise sodium levels.
55
What is 5% dextrose in normal saline?
D5NS. Used for both fluid resuscitation and providing some caloric support.
56
What are colloid solutions?
These fluids contain larger molecules like proteins or starches that don't cross cell membranes as easily as crystalloids.
57
What are some examples of colloid solutions?
Albumin and Dextran
58
What is albumin?
A naturally occurring protein used to increase the osmotic pressure in the blood vessels.
59
What is dextran?
A synthetic solution that acts like albumin, used for volume expansion in certain shock states.
60
What is incontinence?
The involuntary loss of urine that is so severe as to have social or hygienic consequences.
61
What are common causes of incontinence?
Abnormalities within the urinary tract and non-urinary tract abnormalities.
62
Who is most affected by incontinence?
Occurs most often in older women (about 75%).
63
What are risk factors for men regarding incontinence?
Major depression, age, hypertension, and BPH.
64
What are risk factors for women regarding incontinence?
Parity, vaginal delivery, increased BMI, DM, family hx, hormone replacement, depression, anxiety, post-menopausal.
65
What medications can contribute to incontinence?
Antihypertensive meds: diuretics, alpha-adrenergic blockers, ACE inhibitors, CCBs, pain relievers (opioids, COX-2 inhibitors), muscle relaxants, psych meds (antidepressants, antipsychotics, sedatives, hypnotics, antiparkinson agents, antihistamines, anticholinergics, alcohol).
66
What does the acronym DIAPPERS stand for in relation to causes of urinary incontinence?
D: delirium/confusional state, I: infection, A: atrophic urethritis/vaginitis, P: Pharmaceuticals, P: Psychiatric causes, E: excessive urinary output, R: restricted mobility, S: stool impaction.
67
What are the two muscles controlling urine exit?
The male or female external urethral sphincter and the internal urethral sphincter.
68
What is the role of the detrusor muscle?
Remains relaxed to allow the bladder to store urine and contracts during urination to release urine.
69
What characterizes urge incontinence?
Strong, often immediate, urge to void followed by involuntary loss of urine, suggesting detrusor overactivity.
70
What characterizes stress incontinence?
Involuntary loss of urine during physical exertion, effort, coughing, or sneezing due to elevated intra-abdominal pressure.
71
What characterizes overflow incontinence?
Loss of urine associated with overdistension of the bladder, resulting from detrusor hypoactivity.
72
What is functional incontinence?
Physical or cognitive impairments that interfere with continence even in patients with normal urinary tracts.
73
What should be assessed in the physical examination for incontinence?
Focus on the CV, abdominal, genital, and rectal areas.
74
What lab evaluations are important for diagnosing incontinence?
Urinalysis, renal function (BUN/creatinine), hyperglycemia.
75
What are some treatment options for incontinence?
Treat reversible causes, life measures, schedule voiding, pelvic floor exercises, pharmacotherapy, surgery.
76
What are the drugs of choice for urge incontinence?
Anticholinergic/antimuscarinic medications like oxybutynin and tolterodine.
77
What is desmopressin used for?
Nocturia.
78
What can vaginal estrogen be used for?
Post-menopausal women with vaginal atrophy.
79
What is the purpose of surgical interventions for incontinence?
Surgical decompression of the urethra for obstruction, bladder/urethral slings, artificial sphincters.
80
What is Overactive Bladder?
Describes the urge to urinate more often than usual, but may not have the leakage associated with urge incontinence.
## Footnote
Term used interchangeably with urge incontinence.
81
What is Bladder Prolapse?
Several types of pelvic organ prolapse that occur in women, specifically cystocele, which is a prolapse of the bladder into the anterior vaginal wall.
## Footnote
More common in postmenopausal women aged 70-79 years, with an uncertain prevalence of around 12% lifetime risk.
82
What are the risks for Bladder Prolapse?
Previous vaginal delivery, advancing age, menopause, increasing parity, and obesity.
83
What is Cystocele?
Occurs when the supportive tissue between a woman’s bladder and vaginal wall weakens and stretches, allowing the bladder to bulge into the vagina.
84
What are the symptoms of Bladder Prolapse?
Symptoms worsen when standing and can vary based on activity and bladder fullness.
## Footnote
Vaginal symptoms include sensation of or visible bulge, pelvic pressure, feeling of something 'falling out', and urinary dysfunction.
85
How is Bladder Prolapse diagnosed?
Diagnosis is made based on exam; no testing needed.
86
What is the treatment for Bladder Prolapse?
Watchful waiting if asymptomatic, pelvic floor muscle exercises, pessary, and surgical reconstruction.
87
What is Interstitial Cystitis?
A chronic pain disorder characterized by irritation with bladder filling and relief with emptying.
88
What are the risk factors for Interstitial Cystitis?
Female (5:1 female to male ratio), white, age around forty, depression, other chronic pain syndromes, recent UTI, history of sexual abuse.
89
What are the abnormal presentations noted in bladder tissue for Interstitial Cystitis?
Reduced urothelial layer, impaired storage capacity, atypical smooth muscle cell pattern, high microvascular density, high density of mast cells and nerve fibers.
90
What happens to the bladder urothelium in Interstitial Cystitis?
Increased urothelial permeability allows irritants to leak from urine into bladder tissue, resulting in symptoms such as pelvic pain and irritative voiding symptoms.
91
What are the common symptoms of Interstitial Cystitis?
Pain, pressure, or discomfort with bladder filling that relieves with urination; urgency, frequency, and nocturia.
92
What types of pain can be associated with Interstitial Cystitis?
Suprapubic pain related to bladder filling, pelvic pain (in urethra, vulva, vagina, and rectum), and extragenital pain (such as lower abdomen and back).
93
What are the common physical exam findings at the time of diagnosis for Interstitial Cystitis?
Bladder neck tenderness, dysphoric mood, suprapubic tenderness, cervical motion tenderness, posterior vaginal wall tenderness, rectal tenderness, costovertebral angle tenderness, atrophic vaginitis, vulvodynia.
94
What is the diagnostic approach for Interstitial Cystitis?
Diagnosis is a diagnosis of exclusion; labs are meant to rule out other causes of symptoms: UA, urine culture, +/- cystoscopy, pregnancy test.
95
What is the treatment approach for Interstitial Cystitis?
No universally effective treatment; most options target symptom control. Common treatments include amitriptyline, CCBs, Elmiron, and intravesical treatments.
96
What is Elmiron used for in Interstitial Cystitis?
Elmiron (Pentosan polysulfate) is instilled into the bladder to reduce permeability and coat the inside of the bladder.
97
What are some intravesical treatments for Interstitial Cystitis?
Intravesical treatment with lidocaine, dimethyl sulfoxide, or heparin may help repair damage to the mucus lining of the bladder.
98
What is uncomplicated acute cystitis?
Uncomplicated acute cystitis is an infection of the bladder occurring in healthy premenopausal, nonpregnant women without underlying urinary tract abnormalities.
99
Who is considered to have a complicated UTI?
Anyone other than healthy premenopausal, nonpregnant women without underlying urinary tract abnormalities is considered to have a complicated UTI.
100
What is the most common demographic affected by uncomplicated acute cystitis?
It occurs most often in adult women aged 17-39 years.
101
What are the risk factors for uncomplicated acute cystitis?
Risk factors include sexual intercourse, spermicide use, new sex partner within the past year, and previous UTI.
102
What is the most common causative organism of uncomplicated UTI?
E. coli causes 75-95% of uncomplicated UTI.
103
What are other organisms that can cause uncomplicated UTI?
Other organisms include Klebsiella, Enterococcus, Proteus, Staphylococcus, and Streptococcus.
104
What are common symptoms of uncomplicated acute cystitis?
Common symptoms include dysuria, frequency, urgency, suprapubic pain, and less commonly gross hematuria.
105
What should be assessed in a patient with suspected uncomplicated acute cystitis?
Be sure to ask about fever, new back or flank pain, nausea/vomiting, vaginal discharge, pregnancy risk, structural abnormalities, and instrumentation of urethra or bladder.
106
What are the physical exam findings in uncomplicated acute cystitis?
Physical exam may show suprapubic tenderness and absence of abnormal vaginal findings; there should NOT be CVA tenderness.
107
What is the primary diagnostic test for uncomplicated acute cystitis?
Urinalysis (clean catch, using chlorhexidine wipe) is the primary diagnostic test.
108
What findings on urinalysis indicate cystitis?
Presence of WBCs, bacteria, leukocyte esterase, nitrites, maybe RBCs, and <5 epithelial cells would indicate cystitis.
109
What is the first choice treatment for uncomplicated acute cystitis?
First choice is Macrobid or Bactrim (if local resistance < 20%).
110
What are alternative treatments if first choice is not appropriate?
If first choice is not appropriate, can use Cipro or Levo. Augmentin or Cephalexin are also acceptable.
111
What medication can be used for symptom relief in uncomplicated acute cystitis?
Phenazopyridine (AZO) can be used for symptom relief but should not be taken for longer than 3 days.
112
When is acute cystitis considered 'complicated'?
In pregnant women, sexually active men (usually an STD), if a catheter is present or has recently been present (48 hours), if the patient has a fever or other signs of more severe infection, or in a patient with structural abnormalities (prostatic hypertrophy, kidney stones).
113
What is the treatment for complicated UTIs in pregnant women?
Depends on the trimester.
114
What is the outpatient treatment for other complicated UTIs?
FQ; if known resistance, give one dose parenteral agent then FQ. If unable to take FQ, give one dose parenteral agent, then Bactrim, Augmentin, or Cefdinir.
115
What is the inpatient treatment for complicated UTIs?
Ceftriaxone or Zosyn.
116
What is the most common malignancy involving the urinary system?
Bladder cancer.
117
What percentage of urinary cancers are urothelial tumors?
90%.
118
What are the risk factors for bladder cancer?
Smoking, certain chemical exposures, HPV/gonorrhea, previous pelvic radiation (especially in men with previous prostate cancer).
119
What is the presenting symptom of bladder cancer?
Painless hematuria.
120
What are some irritative voiding symptoms of bladder cancer?
Decreased force of stream, intermittent stream, straining, feeling of incomplete emptying of the bladder.
121
What does the physical exam usually show in bladder cancer?
Usually unremarkable; may have lower extremity edema in advanced disease.
122
What does a step 1 UA show in bladder cancer diagnosis?
Microscopic blood.
123
What is done in step 2 for bladder cancer diagnosis?
Refer patient to nephrology for urine cytology and cystoscopy.
124
What imaging is done for bladder cancer evaluation?
US, CT, PET, MRI to show masses within the bladder.
125
What is the treatment for non-muscle invasive bladder cancer?
Transurethral resection of bladder tumor and IV chemo inside the bladder given within 24 hours.
126
What is the treatment for muscle invasive bladder cancer?
Partial cystectomy, complete cystectomy, chemo, immunotherapy.
127
What is the 5-year survival rate for localized bladder cancer?
70%.
128
When is acute cystitis considered 'complicated'?
In pregnant women, sexually active men (usually an STD), if a catheter is present or has recently been present (48 hours), if the patient has a fever or other signs of more severe infection, or in a patient with structural abnormalities (prostatic hypertrophy, kidney stones).
129
What is the treatment for complicated UTIs in pregnant women?
Depends on the trimester.
130
What is the outpatient treatment for other complicated UTIs?
FQ; if known resistance, give one dose parenteral agent then FQ. If unable to take FQ, give one dose parenteral agent, then Bactrim, Augmentin, or Cefdinir.
131
What is the inpatient treatment for complicated UTIs?
Ceftriaxone or Zosyn.
132
What is the most common malignancy involving the urinary system?
Bladder cancer.
133
What percentage of urinary cancers are urothelial tumors?
90%.
134
What are the risk factors for bladder cancer?
Smoking, certain chemical exposures, HPV/gonorrhea, previous pelvic radiation (especially in men with previous prostate cancer).
135
What is the presenting symptom of bladder cancer?
Painless hematuria.
136
What are some irritative voiding symptoms of bladder cancer?
Decreased force of stream, intermittent stream, straining, feeling of incomplete emptying of the bladder.
137
What does the physical exam usually show in bladder cancer?
Usually unremarkable; may have lower extremity edema in advanced disease.
138
What does a step 1 UA show in bladder cancer diagnosis?
Microscopic blood.
139
What is done in step 2 for bladder cancer diagnosis?
Refer patient to nephrology for urine cytology and cystoscopy.
140
What imaging is done for bladder cancer evaluation?
US, CT, PET, MRI to show masses within the bladder.
141
What is the treatment for non-muscle invasive bladder cancer?
Transurethral resection of bladder tumor and IV chemo inside the bladder given within 24 hours.
142
What is the treatment for muscle invasive bladder cancer?
Partial cystectomy, complete cystectomy, chemo, immunotherapy.
143
What is the 5-year survival rate for localized bladder cancer?
70%.
144
What is urethral prolapse?
A rare condition presenting as a protrusion of the distal urethra through the distal meatus.
145
In which populations does urethral prolapse commonly occur?
Occurs in prepubertal girls and postmenopausal women, especially after a UTI.
146
What are potential causes of urethral prolapse?
May be due to straining, poor hygiene, or decrease in estrogen.
147
What is the treatment for urethral prolapse?
Topical estrogen and sitz baths to get it to go back in. Surgery if above is unsuccessful.
148
What is urethral stricture?
Area of scarring or fibrosis that causes concentric narrowing of the urethra, impeding the flow of urine as it drains from the bladder.
149
Who is more commonly affected by urethral stricture?
More common in men.
150
What are the causes of urethral stricture disease?
Iatrogenic causes, inflammatory causes, and idiopathic causes.
151
What are the symptoms of urethral stricture disease?
Symptoms include incomplete emptying, weak urinary stream, urinary urgency/frequency, and pain.
152
What are the diagnostic methods for urethral stricture?
Cystourethroscopy, retrograde urethrogram, and voiding cystourethrogram.
153
What is urethritis?
Inflammation of the urethra.
154
What are the most common causes of urethritis?
Most often caused by STD: Neisseria gonorrhea, Chlamydia trachomatis, trichomonas vaginalis.
155
Who can get urethritis?
Women and men can get urethritis.
156
What additional conditions can urethritis cause in women?
These infections can also cause cervicitis and PID.
157
What was the incidence of gonorrhea in the US in 2018?
Overall incidence of gonorrhea was 179.1 cases per 100,000 persons.
158
How many cases of C. trachomatis were reported to the CDC in 2016?
Nearly 1.6 million cases of C. trachomatis were reported.
159
What patient factors are associated with a high risk for gonorrhea infection?
New sex partner, multiple sex partners, partner with concurrent partners, partner with an STI, inconsistent condom use, exchanging sex for money or drugs.
160
Which populations are at increased prevalence for gonorrhea infection?
Men who have sex with men, incarcerated populations, military recruits, Black and Hispanic persons.
161
What cells does C. trachomatis primarily infect?
C. trachomatis primarily infects columnar and transitional epithelial cells.
162
How is gonorrhea transmitted?
The bacterium is transmitted through direct contact with infected tissue, including vaginal, anal or oral sex.
163
What are common symptoms of gonorrhea/chlamydia urethritis in men?
Mucopurulent urethral discharge, dysuria, erythema of urethral meatus.
164
When do symptoms typically start after exposure?
Symptoms start within 2-8 days after exposure.
165
What physical exam findings may be present in men with urethritis?
Urethral discharge, testicular pain, tenderness, epididymal tenderness, meatal erythema.
166
What complications should be assessed for in urethritis?
Assess for complications including prostatitis and epididymitis.
167
What is the recommended test for diagnosing urethritis?
NAAT is the recommended test for screening asymptomatic at-risk men and testing symptomatic men.
168
What specimen is better for testing gonorrhea?
Urine is a better specimen than urethral swab and does not hurt.
169
What should be done if tests for gonorrhea and chlamydia are negative?
Consider culture if symptoms persist despite adequate treatment.
170
What is the treatment for chlamydia?
Doxycycline BID for 7 days or azithromycin if doxycycline cannot be taken.
171
What is the treatment for gonorrhea?
Ceftriaxone 500 mg IM or gentamicin if allergic to PCN.
172
What should patients be advised regarding sexual activity after treatment?
Advise patients to refrain from sexual activity until asymptomatic (7 days minimum, maybe 10 just to be safe).
173
What is vesicoureteral reflux?
A common ureteral abnormality in children causing retrograde flow of urine from the bladder into the upper urinary tract.
174
What complications can arise from vesicoureteral reflux?
Complications include recurrent UTIs, pyelonephritis, renal scarring, hypertension, and renal failure.
175
What is the prevalence of vesicoureteral reflux?
Reported prevalence is unknown, but it is more common in girls.
176
What causes vesicoureteral reflux?
Reflux of urine from the bladder to the ureter and renal pelvis due to incompetence of the valvular mechanism at the ureter-bladder junction.
177
What symptoms should be asked about regarding vesicoureteral reflux?
Ask about recurrent UTI, urologic abnormalities, family history of VUR.
178
What are the symptoms of uncomplicated UTI and acute pyelonephritis?
Uncomplicated UTI: dysuria, frequency, urgency, suprapubic pain, hematuria. Acute pyelonephritis: fever, chills, flank pain, N/V.
179
What imaging studies are used for diagnosing vesicoureteral reflux?
Voiding cystourethrogram, renal ultrasound may help to show direction of flow.
180
What laboratory tests are important for vesicoureteral reflux?
UA and establishing baseline GFR.
181
What is the typical course of vesicoureteral reflux in children?
May resolve on its own, typically around age 4.
182
What treatment may be indicated for recurrent UTI or pyelonephritis in vesicoureteral reflux?
Surgery may be indicated, involving ureteral reimplantations or injecting bulking agents.
183
What is hydronephrosis?
Hydronephrosis refers to the distension of the renal calyces and pelvis of one or both kidneys by urine.
184
Is hydronephrosis a disease?
No, hydronephrosis is not a disease but a physical result of urinary blockage.
185
Where can urinary blockage occur that leads to hydronephrosis?
Urinary blockage may occur at the level of the kidneys, ureters, bladder, or urethra.
186
Can hydronephrosis be physiologic?
Yes, hydronephrosis may be physiologic, such as occurring in up to 80% of pregnant women.
187
How is hydronephrosis usually discovered?
It is usually found during investigation for urinary symptoms or flank pain.
188
What causes unilateral hydronephrosis?
Unilateral hydronephrosis can be caused by an obstruction in/around the ureter, such as pressure from a gravid uterus, ovarian tumors, colon cancer, stricture, or stone.
189
What causes bilateral hydronephrosis?
Bilateral hydronephrosis can be caused by an obstruction in/around the urethra, such as BPH, carcinoma of the prostate, bladder cancer, stricture, or carcinoma of the cervix or uterus.
190
What are the consequences of urinary tract obstruction?
Consequences include reduced glomerular filtration (GFR), reduced renal blood flow, and potential renal insufficiency or failure.
191
What happens to the kidneys after about 3 weeks of obstruction?
After about 3 weeks, there can be irreversible damage to the kidneys.
192
How is hydronephrosis diagnosed?
Hydronephrosis is seen on CT scan or ultrasound.
193
What is nephrolithiasis commonly known as?
Kidney stones
194
What are the risk factors for nephrolithiasis?
High humidity and elevated temperatures, sedentary lifestyle, obesity, HTN, insulin resistance and poor glycemic control, carotid calcification, CV disease
195
Which gender is more commonly affected by nephrolithiasis?
More common in men
196
What are the five major types of urinary stones?
Calcium oxalate/phosphate, Struvite, Uric acid, Cystine
197
What percentage of stones are calcium oxalate/phosphate?
Makes up 85% of stones
198
What conditions are calcium oxalate/phosphate stones associated with?
Parathyroid gland hyperplasia and sarcoidosis
199
What are struvite stones composed of?
Magnesium ammonium phosphate
200
What conditions are struvite stones associated with?
Gout, leukemia, and lymphoma
201
What are uric acid stones associated with?
Xanthogranulomatous pyelonephritis
202
What is the pathophysiology of stone formation?
Crystals precipitate out of supersaturated urine, aggregate in the nephron, and act as nidus for stone development
203
What type of stones are noninfectious?
Calcium and uric acid stones
204
What symptoms are associated with moving kidney stones?
Flank pain that may radiate to lower abdomen or groin, described as colicky and intermittent
205
What additional symptoms may occur with ureteral calculi?
Dysuria, urgency, frequency, possible fever and chills, scrotal, labial, penile, or pelvic pain
206
What is a common sign of acute renal colic?
Patient unable to find a position of comfort
207
What does CVA tenderness indicate?
Costovertebral angle tenderness elicited by tapping on the CVA
208
What may urine analysis show in nephrolithiasis?
Microscopic or gross hematuria, acidic urine, alkaline urine with struvite calculi, pyuria, bacteriuria, crystals
209
What is a concerning sign when a kidney stone is present?
A kidney stone with an infection is BAD NEWS FOR THE PT.
210
What blood tests are important in diagnosing nephrolithiasis?
Electrolytes, calcium, BUN and creatinine, uric acid, CBC, PTH level if primary hyperparathyroidism suspected
211
What is the best imaging modality for nephrolithiasis?
Non-contrast CT has the best sensitivity and specificity
212
What is the first-line treatment for acute pain management in nephrolithiasis?
Ketorolac (Toradol) plus or minus an opiate such as morphine or hydromorphone
213
What is the management for small stones less than 5 mm?
Observation with symptomatic care like zofran, pain meds, and urine strainer
214
What is indicated for stones over 10 mm?
Stone removal if hydronephrosis or infection or does not pass, plus pain management
215
What is the average recurrent rate of nephrolithiasis at 10 years?
30%
216
What percentage of stones up to 4 mm pass spontaneously within 40 days?
95%
217
What lifestyle change is recommended for all patients with nephrolithiasis?
Increase fluid intake
218
What is acute pyelonephritis?
An infectious and inflammatory disease involving the kidney parenchyma and renal pelvis.
219
What are the risk factors for acute pyelonephritis?
Sexually active females, elderly individuals, and pregnancy.
220
What is the most common bacteria causing acute pyelonephritis?
E. coli.
221
What are the symptoms of acute pyelonephritis?
Fever, chills, flank pain, nausea/vomiting.
## Footnote
Symptoms may not be typical in children or the elderly.
222
What are the physical exam findings in acute pyelonephritis?
Fever, signs of systemic inflammatory response syndrome or systemic toxicity, flank pain, costovertebral angle tenderness, suprapubic tenderness, and pelvic pain.
223
What are the diagnostic tests for acute pyelonephritis?
Urinalysis, CBC, renal function tests (BUN and creatinine), urine cultures, plus or minus blood cultures, plus or minus imaging (CT or US) to check for hydronephrosis or stones.
224
What is the treatment for acute pyelonephritis?
IV antibiotics.
## Footnote
Hospitalized patients: amp, ceftriaxone, cipro; Non-hospitalized patients: Initial IV dose of abx (ceftriaxone, cipro, gent), followed by an oral regimen (cipro, levo, bactrim).
225
What is renal cell carcinoma?
Makes up 85% of all primary renal cancers and originates in the renal cortex.
226
What are the common demographics for renal cell carcinoma?
Most common in ages 60 to 70 and in men.
227
What are the risk factors for renal cell carcinoma?
Smoking, hypertension, obesity, and genetic factors.
228
What mutation is associated with renal cell carcinoma?
A mutation on chromosome three that inhibits tumor suppressor genes, resulting in overgrowth of epithelial cells.
229
What are the symptoms of renal cell carcinoma?
Gross or microscopic painless hematuria, flank pain, or an abdominal mass.
## Footnote
The triad of flank pain, hematuria, and mass is found in only 10% of patients, often a sign of advanced disease.
230
What are the physical exam findings in renal cell carcinoma?
Hypertension, weight loss, and a palpable abdominal mass.
231
What are the diagnostic tests for renal cell carcinoma?
Urinalysis (may have hematuria), renal function tests, CT, or MRI.
232
What is the treatment for renal cell carcinoma?
Depending on tumor size and kidney function: partial nephrectomy, total nephrectomy, thermal ablation, chemotherapy.
## Footnote
Earlier diagnosis leads to a higher survival rate.
233
What is Wilms tumor?
Also known as nephroblastoma, it occurs in children younger than 15 years old, most commonly between 2 to 5 years old.
234
What are the symptoms of Wilms tumor?
Increasing size of the abdomen or asymptomatic abdominal mass.
235
What are the diagnostic tests for Wilms tumor?
Ultrasound and MRI.
236
What is the treatment for Wilms tumor?
Surgery and chemotherapy.
## Footnote
Good prognosis.
237
What is Acute Kidney Injury (AKI)?
Acute Kidney Injury is a condition characterized by a rapid onset of kidney dysfunction over hours to days. It reflects various entities causing kidney injury.
238
What are the criteria for diagnosing AKI?
An increase in serum creatinine by 0.3 mg/dL or more within 48 hours, or an increase of 1.5 times baseline within 7 days.
239
What is the prevalence of AKI in hospitalizations?
AKI occurs in 5% of hospitalizations and 30% of ICU admissions.
240
What are the common symptoms of prerenal AKI?
Symptoms include vomiting, diarrhea, and use of diuretics.
241
What should be suspected with post renal AKI?
History of prostatic disease, nephrolithiasis, or pelvic malignancy.
242
What indicates intrinsic AKI?
History of autoimmune disease or nephrotoxic drug administration.
243
What is the initial urine output in AKI?
Urine output will be normal at first, but oliguria may develop with severe AKI.
244
What tests are used for diagnosing AKI?
Urinalysis for proteinuria, hematuria, and casts; 24-hour urine collection for protein; renal function tests; electrolytes; and imaging if post renal obstruction is suspected.
245
What is the significance of fractional excretion of sodium (FeNa)?
FeNa is calculated using urine and plasma electrolytes to help determine the cause of AKI.
246
What is the staging of AKI?
AKI is staged in 3 stages.
247
What is the treatment for AKI?
Treatment depends on the cause; some patients may require urgent dialysis.
248
What are common causes of pre renal kidney injury?
Hypovolemia, decreased blood flow through glomeruli, and azotemia.
249
What are the symptoms of pre renal kidney injury?
Orthostatic hypotension, tachycardia, decreased skin turgor, and dry mucous membranes.
250
What is the BUN:creatinine ratio in pre renal injury?
The BUN:creatinine ratio often exceeds 20 to 1.
251
What is the urine sodium level in pre renal injury?
Urine sodium is less than 20 mEq/L.
252
What are the characteristics of urine in pre renal injury?
Urine is more concentrated, with increased osmolality and specific gravity.
253
What activates the RAAS system in pre renal injury?
Low perfusion activates the RAAS system, leading to increased reabsorption of Na/H2O.
254
What is Post Renal Kidney Injury?
Less common but is due to obstruction in both kidneys or of a single functioning kidney leading to increased pressure, which damages the kidney.
255
What are some causes of Post Renal Kidney Injury?
Urethral obstruction, bladder dysfunction or obstruction, BPH, anticholinergic drugs, stones, foley catheter.
256
What are the symptoms of Post Renal Kidney Injury?
Colicky flank pain, urinary frequency or hesitancy, suprapubic pain/tenderness.
257
What happens to urine in Post Renal Kidney Injury?
Back up of urine into the kidney leads to higher pressure, which means the kidneys will not function well. Increased pressure leads to increased sodium reabsorption, increased urine sodium, and increased H2O. This results in decreased specific gravity and decreased osmolality.
258
What is the diagnostic BUN to creatinine ratio for Post Renal Kidney Injury?
BUN to creatinine ratio is greater than 15 to 1.
259
What urine sodium level indicates Post Renal Kidney Injury?
Urine sodium is greater than 40 mEq/L.
260
What are the characteristics of urine in Post Renal Kidney Injury?
Urine is less concentrated, with decreased urine osmolality and decreased urine specific gravity.
261
What is the treatment for Post Renal Kidney Injury?
Remove the obstruction.
262
What are the three types of Intrinsic Kidney Injury?
1. Acute tubular necrosis
2. Glomerulonephritis
3. Acute interstitial nephritis
263
When is intrinsic kidney dysfunction considered?
After prerenal and post renal causes have been excluded.
264
What are the systemic features associated with Intrinsic Kidney Injury?
Hypersensitivity, rashes, and arthritis with autoimmune disease.
265
What causes Acute Tubular Necrosis (ATN)?
Tubular damage due to necrosis of epithelial cells, which can be caused by hyper perfusion or nephrotoxins.
266
What are some exogenous nephrotoxins that can cause ATN?
Aminoglycosides, amphotericin B, radiographic contrast media, some herbal medicines, vancomycin, and heavy metals like lead.
267
What are some endogenous nephrotoxins that can cause ATN?
Myoglobin (from rhabdomyolysis), hemoglobin (from hemolytic anemia), and hyperuricemia (from cell turnover/tumor lysis syndrome).
268
What can lead to necrosis in the kidneys?
Lack of oxygen due to hypoperfusion, which can occur with prerenal acute kidney injury.
269
What is a characteristic finding in the urine for ATN?
Brown granular casts formed by clumped tubular cells.
270
How can ATN be differentiated from prerenal azotemia?
In prerenal azotemia, renal perfusion is decreased but not enough to cause ischemic damage to tubular cells.
271
What happens to sodium reabsorption in ATN?
There is a decrease in sodium reabsorption, leading to increased sodium and water in urine, resulting in decreased specific gravity and osmolality.
272
What is the treatment for Acute Tubular Necrosis?
Stop the offending agent.
273
What is Glomerulonephritis?
Glomerulonephritis is damage to the glomeruli and can be categorized as nephritic or nephrotic.
274
What are the types of Glomerulonephritis?
The five types are: Acute Post Streptococcal Glomerulonephritis, IgA Nephropathy, Good Pasture Syndrome, Diabetes Mellitus, and Minimal Change Disease.
275
What characterizes nephritic Glomerulonephritis?
Nephritic Glomerulonephritis involves inflammation of the glomeruli, causing renal dysfunction and hematuria.
276
What characterizes nephrotic Glomerulonephritis?
Nephrotic Glomerulonephritis involves inflammation of the glomeruli, causing renal dysfunction and mostly proteinuria.
277
What causes Glomerulonephritis?
It is usually caused by deposition of antibody and antigen complexes, activating the complement system.
278
What happens when the glomeruli are damaged?
Damage increases membrane permeability, allowing large molecules like proteins and red blood cells to filter into urine, causing proteinuria and hematuria.
279
What is the effect of decreased GFR in Glomerulonephritis?
Decreased GFR leads to less fluid filtered, prompting the RAAS system to increase Na reabsorption, resulting in decreased sodium and water in urine.
280
What is Acute Post Streptococcal Glomerulonephritis?
It occurs when immune complexes deposit in the basement membrane of the glomeruli, with an abrupt onset of nephritic syndrome.
281
When does Acute Post Streptococcal Glomerulonephritis typically occur?
It typically occurs six weeks after impetigo or one to two weeks after pharyngitis.
282
What are the symptoms of Acute Post Streptococcal Glomerulonephritis?
Symptoms include rising ASO titers, oliguria, cola-colored urine, and peripheral edema.
283
What is the treatment for Acute Post Streptococcal Glomerulonephritis?
It usually resolves spontaneously but can lead to renal failure.
284
What is IgA Nephropathy?
IgA Nephropathy, also known as Berger disease, is a nephritic syndrome where deformed IgA antibodies deposit in the glomeruli.
285
When does IgA Nephropathy typically occur?
It usually occurs in young adults during a mucosal infection.
286
What are the symptoms of IgA Nephropathy?
Symptoms include red urine one to two days after infection onset and may include hypertension.
287
How is IgA Nephropathy diagnosed?
There is no neurologic test; it can be shown on biopsy.
288
What is the treatment for IgA Nephropathy?
Treatment is primarily supportive, focusing on blood pressure control, and it may progress to chronic renal failure.
289
What is Good Pasture Syndrome?
A rare autoimmune disease where antibodies attack the basement membrane in the lungs and kidneys, leading to bleeding from the lungs and kidney failure.
290
What is another name for Good Pasture Syndrome?
Anti-glomerular basement membrane disease.
291
What are the common symptoms of Good Pasture Syndrome?
Usually lung symptoms first, then hematuria.
292
What are the common associations with Good Pasture Syndrome?
Pulmonary infection, tobacco use, and exposure to hydrocarbon solvents.
293
How is Good Pasture Syndrome diagnosed?
Kidney biopsy and high anti-GBM antibody titers.
294
What is the treatment for Good Pasture Syndrome?
Steroids and immunosuppressive drugs.
295
What can Good Pasture Syndrome progress to?
Chronic renal failure.
296
What is the most common cause of nephrotic syndrome in adults?
Diabetes Mellitus.
297
How does diabetes mellitus affect the kidneys?
Excess glucose damages the basement membrane of the glomerulus, leading to decreased glomerular filtration rate.
298
What is the eventual outcome of untreated diabetes mellitus related to the kidneys?
Chronic renal failure.
299
What is the treatment for diabetes mellitus to prevent kidney damage?
Well controlled diabetes.
300
What is Minimal Change Syndrome?
The most common cause of nephrotic syndrome in children (80%), though can occur in adults (20%).
301
What are the associations of Minimal Change Syndrome?
Related to allergic reactions (especially NSAID use and insect stings) and viral infections.
302
How is Minimal Change Syndrome diagnosed?
No changes on light microscopy, only on electron microscopy.
303
What is the treatment for Minimal Change Syndrome?
Steroids.
304
What is Acute Interstitial Nephritis?
An inflammatory condition characterized by infiltrate in the kidney interstitium.
305
What causes Acute Interstitial Nephritis?
Caused by drugs (NSAIDs, Diuretics, penicillin), infections, and systemic diseases (sarcoidosis, lupus).
306
What happens to the tubules in Acute Interstitial Nephritis?
The tubules become inflamed and do not reabsorb sodium, leading to increased sodium and water excretion in urine.
307
What is the treatment for Acute Interstitial Nephritis?
Remove the offending agent; may require dialysis, with mild cases observed. Steroids may be used.
308
What is Chronic Kidney Disease (CKD)?
A.k.a. chronic kidney failure; kidney dysfunction lasting more than 3 months.
309
What are some causes of Chronic Kidney Disease?
Diabetes, hypertension, glomerulonephritis, and autosomal dominant polycystic kidney disease.
310
What is the significance of a GFR under 60?
It indicates irreversible kidney damage.
311
What percentage of the US adult population has CKD at stages 1 and 2?
6% of the adult population.
312
What percentage of the US population has stages 3 and 4 CKD?
4.5% of the population.
313
What are common ideologies of Chronic Kidney Disease?
Lupus, rheumatoid arthritis, and toxins like tobacco smoke.
314
What are risk factors for Chronic Kidney Disease?
Age, family history, obesity, smoking, and recurrent kidney infections.
315
What are the functions of healthy kidneys?
Potassium exclusion, activation of vitamin D, and production of erythropoietin.
316
What happens to kidneys with hypertension?
Renal artery thickens, narrowing lumen, leading to ischemic injury to glomeruli.
317
What happens to kidneys with diabetes?
Excess glucose damages the glomerular basement membrane, leading to decreased GFR.
318
What are common symptoms of Chronic Kidney Disease?
Usually asymptomatic early; later stages may include shortness of breath, peripheral edema, and urine changes.
319
What are the physical exam findings in early stages of CKD?
Fatigue, peripheral edema, and less urine output.
320
What are the physical exam findings in later stages of CKD?
Hypertension, pallor, uremic frost, peripheral neuropathy, cognitive changes, seizures, or coma.
321
What are the diagnostic criteria for CKD?
Abnormal GFR persisting longer than three months, electrolyte abnormalities, and persistent proteinuria.
322
What is the treatment focus for Chronic Kidney Disease?
Slowing disease progression and controlling diabetes and hypertension.
323
What dietary restrictions are recommended for CKD patients?
Salt and water restriction, potassium restriction, and phosphorus restriction.
324
What is hemodialysis?
A process where blood is filtered through a machine and returned to the body, typically done three times a week.
325
What is peritoneal dialysis?
A home-based dialysis method that can be done while sleeping, but has higher infection risks.
326
What is the role of a nephrologist in CKD?
Referral at late stage 3 CKD improves mortality.
327
What is Polycystic Kidney Disease?
An inherited disorder in which clusters of cysts develop within your kidneys, causing your kidneys to enlarge and lose function over time.
328
What is the inheritance pattern of Polycystic Kidney Disease?
Autosomal dominant.
329
What percentage of patients develop End-Stage Renal Disease (ESRD) by age 60?
50%.
330
What are common symptoms of Polycystic Kidney Disease?
Family history present in 75% of cases, HTN in 50%, abdominal or flank pain, microscopic or gross hematuria, kidneys may be palpable.
331
What is the diagnostic method for Polycystic Kidney Disease?
Renal ultrasound (US) is diagnostic.
332
What are the treatment options for Polycystic Kidney Disease?
Management of HTN (ACE or ARB), dietary sodium restriction, Tolvaptan, dialysis, renal transplant.
## Footnote
Tolvaptan is a vasopressin receptor antagonist that can help to reduce cyst formation but is very expensive.
333
What is Horseshoe Kidney?
A congenital abnormality where two distinct functioning kidneys are joined at the lower pole.
334
What causes Horseshoe Kidney?
Hypothesized that the kidneys do not undergo their normal rotation in utero.
335
What complications can arise from Horseshoe Kidney?
Tend to get ureteral obstructions; otherwise asymptomatic. Can lead to hydronephrosis and AKI if unmonitored.
336
How is Horseshoe Kidney diagnosed?
Can be seen on ultrasound (US) or CT.
337
What is the treatment for Horseshoe Kidney?
Usually no treatment needed; occasionally may require some level of reconstruction if chronic obstructions/infections.
338
What is Renal Artery Stenosis?
Narrowing of one or both renal arteries, commonly causing secondary hypertension.
339
What are the main causes of Renal Artery Stenosis?
90% is caused by atherosclerotic disease and 10% by fibromuscular dysplasia.
340
What is Fibromuscular Dysplasia (FMD)?
A non-atherosclerotic, non-inflammatory disease of blood vessels causing abnormal growth within artery walls.
341
What percentage of the general population has Renal Artery Stenosis greater than 60%?
5-10% of the general population.
342
What are the risk factors for Atherosclerotic disease related to Renal Artery Stenosis?
Men, smokers, patients over 65 years old, and those with cardiovascular disease risk factors.
343
What are the risk factors for Fibromuscular Dysplasia?
Female gender, particularly premenopausal women ages 15-50, smoking history, and hypertension.
344
What symptoms may indicate Renal Artery Stenosis?
Refractory hypertension, acute kidney injury, and new onset hypertension in older patients.
345
What initial tests are used for diagnosing Renal Artery Stenosis?
Doppler ultrasonography, CT angiography, and MRA.
346
What is the gold standard for diagnosing Renal Artery Stenosis?
Renal angiography performed after abnormal initial imaging test results.
347
What is the characteristic appearance of Fibromuscular Dysplasia on imaging?
A 'beads-on-a-string' appearance.
348
What are the treatment goals for Renal Artery Stenosis?
Blood pressure control, improvement or stabilization of renal function, treatment of heart failure/pulmonary edema, prevention of cardiovascular and renal events, and reduction in cardiovascular mortality.
349
When is revascularization indicated for Renal Artery Stenosis?
In cases of resistant hypertension, malignant hypertension, progressive chronic kidney disease, or stenosis greater than 70%.
350
What are the methods of revascularization for Renal Artery Stenosis?
Percutaneous angioplasty/stent placement and vascular surgery reconstruction (renal artery bypass surgery).
351
What is Peyronie Disease?
Peyronie Disease is characterized by plaques forming under the skin of the penis, causing it to bend or become indented during erection.
352
What are the symptoms of Peyronie Disease?
Symptoms include penile pain, soft nodules, changes in penile shape (curvature, hinging, hourglass, narrowing, shortening), and hard palpable plaques in the chronic phase.
353
What are the risk factors for Peyronie Disease?
Risk factors include penile trauma, genetic predisposition, smoking, excessive alcohol consumption, and pelvic surgery.
354
How is Peyronie Disease diagnosed?
Diagnosis is based on patient history and clinical exam, including findings of palpable penile plaque, pain on erection, and penile deformity.
355
What is the first-line treatment for Peyronie Disease?
The first-line treatment is potassium para-aminobenzoate, an FDA approved medication.
356
What is Erectile Dysfunction (ED)?
Erectile Dysfunction is the persistent inability to attain or maintain an erection satisfactory for sexual performance.
357
What are the common risk factors for Erectile Dysfunction?
Common risk factors include age, obesity, diabetes, dyslipidemia, metabolic syndrome, lack of exercise, and smoking.
358
What should be included in the patient history for ED?
Patient history should include sexual orientation, previous and current relationships, emotional status, self-assessment of sexual performance, and knowledge about sex.
359
What physical examination is performed for ED?
Physical examination includes evaluating the penis for size, scars, fibrosis, and curvature, as well as assessing testicular size and consistency.
360
How is ED diagnosed?
Diagnosis includes testing for underlying diseases and conducting a nocturnal penile tumescence and rigidity test.
361
What is the first-line therapy for Erectile Dysfunction?
Oral PDE5 inhibitors are the first-line therapy for Erectile Dysfunction in men.
362
What is the second-line treatment for Erectile Dysfunction?
Intracavernosal injection therapy is the second-line treatment for Erectile Dysfunction.
363
What is hypospadias?
A relatively common congenital anomaly of the male urogenital tract where the urethra opens on the ventral surface of the penis, scrotum, or perineum instead of at the tip of the glans.
## Footnote
Risk factors include family history, maternal exposure to DES, and advanced maternal age.
364
What is epispadias?
A relatively rare congenital anomaly of the male genital tract where the urethral meatus opens at the dorsal surface of the penis.
## Footnote
No known risk factors, but may be due to malformation of the pubic bone and can occur with bladder exstrophy.
365
What is Diethylstilbestrol (DES)?
A synthetic form of the female hormone estrogen prescribed to pregnant women between 1940 and 1971 to prevent miscarriage, which caused significant birth defects.
366
How is hypospadias typically diagnosed?
Typically diagnosed at birth by examining the infant for any other dysmorphic features and asking about maternal intake during early pregnancy.
367
What are the diagnostic tests for hypospadias?
Hormone testing including testosterone, thyroid function, glucose, cortisol, hCG, estradiol, progesterone, and pelvic and renal ultrasound to look for other structural anomalies.
368
What is the treatment for hypospadias?
Surgical repair by a pediatric urologist.
369
What is phimosis?
A condition in which the prepuce cannot be retracted back over the glans penis, occurring more in childhood and adolescence.
370
What is paraphimosis?
A condition where the foreskin that has been retracted cannot be advanced back over the glans, more common in adulthood.
371
What is physiologic (primary) phimosis?
A normal developmental variant common in boys three years old and younger, usually resolving with time.
372
What is pathologic (secondary) phimosis?
Phimosis caused by inflammatory or traumatic injury to the prepuce resulting in an acquired inelastic scar that prevents retraction.
373
What are the symptoms of phimosis?
Inability to retract the prepuce over the glans, with possible pain and scarring in pathologic cases.
374
What are the symptoms of paraphimosis?
Penile pain and swelling, inability to reduce foreskin over the glans, and possible urinary obstruction symptoms.
375
What is the treatment for phimosis in children under two?
No treatment is needed as most cases resolve spontaneously.
376
What is the first-line treatment for physiologic phimosis?
Conservative treatment with steroid ointment or cream applied twice daily for 20 to 30 days.
377
What is the treatment for pathologic phimosis?
Consult a pediatric urologist; circumcision is indicated in cases of lichen sclerosis or scarred fibrosis.
378
What is balanitis/balanoposthitis?
Inflammation of both the glans penis (balanitis) and the prepuce or foreskin (posthitis).
## Footnote
Risk factors include uncircumcised status, phimosis, and poor hygiene.
379
What is the most common cause of balanitis?
Candida albicans accounts for up to 20% of cases, with Streptococcus species being the most common cause.
380
What are the symptoms of balanitis?
Mild burning during urination, dysuria, itching, tenderness, swelling, erythema patches, and discharge.
381
What is the treatment for balanitis?
Proper genital hygiene, regular foreskin retraction, and specific treatments based on etiology, such as clotrimazole or miconazole for Candida.
382
What type of carcinoma accounts for 98% of penile cancers?
Sequacious cell carcinoma
383
What are the risk factors for penile cancer?
* HPV (found in almost 50% of penile cancer patients)
* Lack of neonatal circumcision
* Smoking
* HIV
* Balanitis
384
What are common symptoms of penile cancer?
* Palpable lesion
* Modular, ulcerative, or fungating lesion on the penis or foreskin
* Penile pain
* Discharge
* Bleeding
* Foul odor
* Fatigue or weight loss in advanced disease
385
What key aspects should be evaluated during a physical exam for penile cancer?
* Morphology
* Color
* Borders of lesions
* Number of lesions
* Location on penis
* Relationship and extent of invasion into other penile structures
* Associated lymphadenopathy
386
How is the diagnosis of penile cancer confirmed?
Histopathologic evaluation of the primary lesion after punch biopsy, excisional biopsy, or incisional biopsy
387
What is the treatment for early stages of penile cancer?
Excision of tumor or penis amputation
388
What treatment options are available for later stages of penile cancer?
* Chemotherapy
* Radiation
389
What percentage of full-term births is affected by cryptorchidism?
2 to 4%
390
When is treatment considered for undescended testes?
If they have not descended by six months of age
391
What hormone tests are used to assess if testes are functioning in cryptorchidism?
* FSH
* LH
* Testosterone
392
What is the surgical treatment for cryptorchidism?
Orchidopexy
393
What is a hydrocele?
A normal, painless accumulation of fluid between the parietal and visceral layers of the tunica vaginalis and/or along the spermatic cord, leading to swelling in the scrotum or groin.
394
What is the prevalence of hydrocele in men?
Occurs in about 1% of men and 3.2% of infertile men.
395
What is the prevalence of congenital hydrocele in male infants?
Present in 0.7 to 4.7% of male infants.
396
What causes hydrocele in infants?
It is a result of an abnormal communication between the peritoneum and the scrotum.
397
What are the types of hydrocele in adults?
Can be communicating (like in pediatrics) or non-communicating, which is due to an imbalance between secretion and reabsorption of fluid.
398
What are the symptoms of hydrocele?
Swelling in the groin or scrotum, usually painless, with a feeling of heaviness. Size may increase throughout the day if communicating.
399
How is hydrocele diagnosed?
Clinical diagnosis based on palpation of painless, fluid-filled swelling that easily transilluminates. Ultrasound may be used if inconclusive.
400
What is the treatment for hydrocele in infants?
Watchful waiting for 12 months; surgery if it does not resolve or if there is a hernia.
401
What is the treatment for hydrocele in adults?
Period of watchful waiting before surgery if small and asymptomatic; further examination if persistent over one year or symptomatic.
402
What is a varicocele?
A vascular lesion characterized by the dilation of gonadal veins in the scrotum.
403
What is the prevalence of varicocele?
15% overall, 10% in adolescents, and 40% of men seeking treatment for infertility.
404
What causes varicocele?
Valves in the testicular vein malfunction, causing blood backup and elevated temperature, which affects spermatogenesis.
405
What are the symptoms of varicocele in adults?
Most are asymptomatic; chief complaints include painless scrotal swelling, scrotal pain, or infertility.
406
How is varicocele diagnosed?
Clinical diagnosis with palpation and visual exam; ultrasound may be used.
407
What is the treatment for varicocele?
Increase fertility; treatment if very painful or trying to conceive. Surgery may be considered in kids if painful or significant testicular atrophy.
408
What is a spermatocele?
A cyst at the head of the epididymis that contains sperm. Very common and does not require treatment unless symptomatic.
409
What are the physical exam findings for spermatocele?
On exam, it will feel soft, smooth, and transilluminate superior to the testicle on the lateral side.
410
What is testicular torsion?
An emergency caused by twisting of the spermatic cord resulting in obstruction of testicular venous return, which may lead to compromised arterial flow and testicular ischemia.
411
What is the most common age for testicular torsion presentation?
The most common age at presentation is 12 to 18 years, with a peak between ages 13 and 16.
412
What are the symptoms of testicular torsion?
Sudden onset of unilateral scrotal pain that is excruciating, very tender, with changes in the position or size of the testicle.
413
What are the physical exam findings for testicular torsion?
Unilateral testicular tenderness, absent cremaster reflex, negative Phren's sign, high riding testicle, and may have a 'Blue dot' sign.
414
How is testicular torsion diagnosed?
Primarily a clinical diagnosis; US with Doppler is the GOLD STANDARD to assess blood flow to the testicle.
415
What is the treatment for testicular torsion?
Consult ASAP, can attempt manual detorsion, orchidopexy where the testicle is sutured to the scrotum, and urgent surgical exploration is required.
416
What is orchitis?
Inflammation of the testicle, occurring due to systemic infections like mumps or ascending UTI, most commonly with epididymitis.
417
What should be considered in the differential diagnosis for orchitis?
Differential includes cancer, abscess, and torsion.
418
How is orchitis treated?
Treated like epididymitis.
419
What is Acute Epididymitis?
Refers to inflammation of the epididymis of under six weeks duration.
420
What often causes Acute Epididymitis?
Often arises due to the retrograde ascent of a sexually transmitted or a urinary tract pathogen.
421
Is Acute Epididymitis usually unilateral or bilateral?
Usually unilateral.
422
What age group has 43% of Acute Epididymitis cases?
Ages 20 to 30.
423
What are the causes of Acute Epididymitis in men under 35?
Sexually transmitted infections.
424
What are the causes of Acute Epididymitis in men over 35?
Urinary tract pathogens.
425
What is the etiology of Acute Epididymitis in males?
Etiology is unclear, and illness is usually self-limited (probably E. coli).
426
What are some risk factors for Acute Epididymitis?
Congenital abnormalities of the urinary tract, increased sexual activity or new partner or multiple partners, anal intercourse, urinary tract obstruction.
427
What is the pathophysiology of Epididymitis?
UTI→ vas deferens/lymphatics of the spermatic cord→ epididymitis.
428
What are common symptoms of Epididymitis?
Positive Phren sign, testicular pain and swelling, gradual onset over one to two days, unilateral swelling, pain located posterior to testes.
429
What additional symptoms may be present with Epididymitis?
Symptoms associated with urethritis or urinary tract infection may include frequency, hematuria, dysuria.
430
What does the physical examination reveal in Epididymitis?
Epididymis typically swollen and tender, scrotal erythema may be present, testes typically in normal anatomic position.
431
What is the Phren sign?
Pain may be relieved with testicular elevation.
432
What imaging may be used to rule out torsion in Epididymitis?
Ultrasound (US) if needed.
433
What is the empirical treatment for Epididymitis?
Do not delay treatment for lab results; treat empirically.
434
What is the recommended treatment for sexually transmitted Epididymitis?
Ceftriaxone IM PLUS doxycycline for 10 days.
435
What is the treatment if caused by other organisms?
Levo PO for 10 days OR Ofloxacin PO for 10 days.
436
What are the two types of testicular cancer?
Germ cell tumors (90 to 95%) and Non-germ cell tumors (Stromal tumors).
437
Where do germ cell tumors arise from?
They arise from the terminal epithelium of the seminiferous tubules.
438
What is the lifetime risk of testicular cancer?
Lifetime risk is low but typically occurs in Caucasian men between 15 and 34 years old.
439
What are the risk factors for testicular cancer?
Family history, genetic factors (like Down syndrome or Klinefelter syndrome), cryptorchidism, and cannabis use.
440
What is the most common presentation of testicular cancer?
Painless testicular mass.
441
What are some other potential presentations of testicular cancer?
Testicular discomfort, swelling, back pain, chronic cough, hemoptysis, headache, and gynecomastia.
442
What is the initial testing for a testicular mass?
Testicular ultrasound, blood tests (CBC, electrolytes, creatinine, liver function tests, serum tumor markers), chest x-ray.
443
What is the role of orchiectomy in testicular cancer?
Orchiectomy is both diagnostic and therapeutic.
444
What is the survival rate if testicular cancer is detected in stage 1?
95% survival rate.
445
What is Benign Prostatic Hyperplasia (BPH)?
A benign enlargement of the prostate gland due to stromal and epithelial cell hyperplasia.
446
What are the risk factors for BPH?
Genetic factors, age, obesity, testosterone supplementation, diabetes, cardiovascular issues, and low physical activity.
447
What happens to the prostate as men age?
There is less cell turnover, causing compression and narrowing of the urethra, leading to an increase in prostate size.
448
What are the lower urinary tract symptoms of BPH?
Weak or intermittent urinary stream, straining, hesitancy, incomplete emptying, urinary incontinence, nocturia, and post-micturition dribbling.
449
What is the International Prostate Symptoms Score?
A score that assesses the severity of urinary symptoms.
450
What is the diagnostic test for prostate cancer?
PSA (Prostate Specific Antigen) test.
451
What is the first line medication for BPH?
Alpha blockers and 5-alpha reductase inhibitors.
452
What surgical options are available if medication fails for BPH?
Transurethral resection of the prostate (TURP), laser procedures, and open prostatectomy.
453
What is Acute Bacterial Prostatitis?
A bacterial infection of the prostate gland typically causing pelvic pain and urinary tract symptoms.
454
What is the lifetime prevalence of Acute Bacterial Prostatitis?
14.2% with peak incidence at ages 20 to 40 years and again after 70.
455
What are the risk factors for Acute Bacterial Prostatitis?
High risk sexual behavior, history of STI, urinary tract instrumentation, urethral structure, or BPH.
456
What are the common causative organisms of Acute Bacterial Prostatitis?
Usually caused by gram-negative rods like E. coli or pseudomonas; less frequently by gonorrhea and chlamydia.
457
What are the likely routes of infection for Acute Bacterial Prostatitis?
Up the urethra and reflux of infected urine into the prostatic ducts.
458
What are the common symptoms of Acute Bacterial Prostatitis?
Fever, localized pain in the perineum or lower abdomen, urinary tract symptoms, and systemic infection symptoms.
459
What are irritative urinary tract symptoms associated with Acute Bacterial Prostatitis?
Dysuria, frequency, urgency.
460
What are obstructive urinary tract symptoms associated with Acute Bacterial Prostatitis?
Straining, hesitancy, weak stream, and incomplete voiding.
461
What are other symptoms that may occur with Acute Bacterial Prostatitis?
Painful erections, hematospermia, painful defecation.
462
What findings are expected on physical examination for Acute Bacterial Prostatitis?
Fever, tender and enlarged prostate on digital rectal exam, and CVA tenderness.
463
What are the diagnostic tests for Acute Bacterial Prostatitis?
UA, urine culture, STD testing if indicated, and CBC may show leukocytosis.
464
What complications can arise from Acute Bacterial Prostatitis?
It can progress to prostatic abscess; pelvic CT or transrectal ultrasound is indicated if no response to antibiotics.
465
What is the first-line treatment for Acute Bacterial Prostatitis?
Cipro or Levo or Bactrim for 4-6 weeks.
466
What are the indications for admission in Acute Bacterial Prostatitis?
Risk factors for antibacterial resistance, inability to tolerate oral medication, systemic symptoms suggestive of septicemia, urinary retention.
467
What is the inpatient treatment for Acute Bacterial Prostatitis?
IV antibiotics, can switch to PO once stabilized for the remainder of treatment.
468
What is Chronic Prostatitis?
Chronic Prostatitis can be non-bacterial (90%) or bacterial (10%). Non-bacterial prostatitis involves persistent or recurrent episodic pain in the pelvic area of men for three or more occurrences in the previous six months, with possible urinary or sexual dysfunction, attributed to the prostate but without evident pathology such as localized infection.
469
What are the symptoms of Chronic Prostatitis?
Symptoms include pelvic pain and perineal pain.
470
What is the treatment approach for Chronic Prostatitis?
Multidisciplinary treatment is recommended, interrelated to inflammatory, immunologic, endocrine, muscular, neuropathic, and psychological mechanisms.
471
How is bacterial Chronic Prostatitis treated?
Treatment is based on culture and sensitivity and should be administered for a minimum of six weeks.
472
What is the most common type of prostate cancer?
Adenocarcinoma accounts for 76% of prostate cancer.
473
What is the lifetime risk of developing prostate cancer in the United States?
The lifetime risk is 15.3% and increases with age, significantly rising after the age of 50.
474
What are the risk factors for prostate cancer?
Risk factors include age, diets high in red meat and low in fruits and vegetables, black ancestry, and having a first-degree relative with prostate cancer.
475
What is a characteristic of prostate cancer growth?
Prostate cancer is very slow growing, with tumors usually starting in the periphery of the gland.
476
What are the symptoms of advanced prostate cancer?
Often asymptomatic until later stages, then may present with obstructive urinary symptoms, back pain, and urinary retention due to spinal cord metastasis.
477
How is prostate cancer detected?
Prostate cancer is detected by suspicious DRE results in about 18% of patients, and may also show lower extremity lymphedema, neurologic defects if spinal cord metastasis is present, and bone pain.
478
What diagnostic tests are used for prostate cancer?
+/- PSA, biopsy required for diagnosis, transrectal ultrasound used to guide biopsy, and CT or PET to detect metastasis.
479
What are the treatment options for prostate cancer?
Treatment depends on cancer staging and may include radical prostatectomy, chemotherapy, and radiation.
480
What is infertility?
Infertility is defined as the inability to conceive after 1 year of unprotected sexual intercourse.
481
What percentage of infertile couples have male factors as the sole cause?
The cause of infertility involves male factors alone in 30% of infertile couples.
482
What is the most common risk factor for male factor infertility?
The most common risk factor for male factor infertility is a history of cryptorchidism.
483
What are other risk factors for male factor infertility?
Other risk factors include endocrine pathology, exogenous administration of androgenic steroids, genetic conditions, genital tract obstruction, infections, gonadotoxins, and obesity.
484
What defines primary male infertility?
Primary infertility is when the man has never fathered a child.
485
What defines secondary male infertility?
Secondary infertility is when the male has previously fathered a child but is now unable to do so.
486
How does obesity affect male fertility?
Obesity, defined as a BMI above 30, can impact sperm quality due to fat deposits influencing androgen metabolism.
487
What effect do smoking and addictive substances have on male fertility?
Inhaled addictive substances have a significant, negative effect on sperm.
488
How does radiation exposure affect male fertility?
Radiation exposure in cancer treatment can impact fertility; sperm freezing is part of the fertility preservation protocol.
489
What infections can cause male infertility?
STIs such as gonorrhea, chlamydia, and ureoplasma can cause male infertility by affecting sperm quality and causing obstruction.
490
What is varicocele?
Varicocele is the enlargement of veins in the scrotal sack, raising testicular temperature and influencing sperm production and quality.
491
How do supplements and steroids affect male fertility?
Testosterone injections and anabolic steroids can severely harm sperm production.
492
How does high testicular temperature affect sperm quality?
Raising testicular temperature by even 2 or 3 degrees can compromise sperm quality and functionality.
493
What is the procedure for semen analysis?
Semen analysis should be performed after 3 to 5 days of ejaculatory abstinence and analyzed within one hour after collection.
494
What is considered a normal sperm count?
Normal sperm count is 15 million per 1 mL.
495
What are common issues with sperm?
Common issues include abnormal motility and abnormal morphology.
496
What can cause specific sperm abnormalities?
Specific sperm abnormalities can be caused by specific endocrine issues.
497
What are some treatment options for male infertility?
Treatment options include lifestyle changes, stopping smoking, decreasing alcohol use, avoiding excessive heat exposure, medications, and corrective surgeries.
498
Who tends to get hyponatremic?
Little old ladies with a tea and toast diet.
499
What is 'true' hyponatremia?
It has a low serum osmolality (hypotonic hyponatremia).
500
What are the categories of hyponatremia based on volemia?
Hypovolemic, Euvolemic, Hypervolemic.
501
What sodium level indicates hyponatremia?
Sodium < 135.
502
What are the classifications of hyponatremia severity?
Mild: 130-134, Moderate: 120-129, Severe: < 120.
503
What is the most common electrolyte abnormality in hospitalized patients?
Hyponatremia.
504
What causes hypervolemic hyponatremia?
Gaining more water than sodium, leading to dilution of sodium.
505
What conditions are associated with hypervolemic hyponatremia?
Heart failure, liver disease, nephrotic syndrome, advanced kidney disease, end stage renal disease.
506
What is hypovolemic hyponatremia?
Too little water, with a larger decrease of sodium than water.
507
What causes hypovolemic hyponatremia?
Extrarenal salt loss (diarrhea, vomiting, burns) and renal salt loss (medications, cerebral salt wasting).
508
What is euvolemic hyponatremia?
Increased total water with normal sodium.
509
What are the causes of euvolemic hyponatremia?
Dilute urine: adrenal insufficiency, polydipsia; Concentrated urine: SIADH, hypothyroidism.
510
What are the symptoms of hyponatremia?
Nausea, vomiting, muscle cramps, headache, lethargy, AMS, respiratory arrest, coma, seizures, cerebral edema.
511
What are the symptoms of mild hyponatremia?
Patients may be asymptomatic.
512
What are the symptoms of hypervolemic hyponatremia?
Crackles, edema.
513
What are the symptoms of hypovolemic hyponatremia?
Dry mucous membranes, tachycardia, decreased skin turgor, pulmonary and extremity edema.
514
What tests are used to diagnose hyponatremia?
Serum electrolytes, serum osmolality, urine sodium, urine osmolality.
515
What is the treatment for acute hyponatremia?
Managed inpatient; if no symptoms, monitor serum sodium hourly.
516
What should be done if symptomatic hyponatremia is present?
Give 100 mL bolus of hypertonic saline.
517
What is the treatment for chronic hyponatremia with sodium < 120?
Managed inpatient, give hypertonic saline 15 to 30 mL per hour.
518
What is the sodium correction rate?
Sodium should be corrected 4 to 6 mEq every 24 hours.
519
When should hypertonic saline be stopped?
When sodium reaches 125; rapid correction can lead to brain herniation and irreversible neurologic damage.
520
What is Osmotic Demyelination Syndrome also known as?
Central pontine myelosis.
521
Where does Osmotic Demyelination Syndrome primarily occur?
First primarily in the brain stem but can occur anywhere.
522
What are the risk factors for Osmotic Demyelination Syndrome?
Alcohol use, liver disease, malnutrition, radiation treatment of the brain, severe nausea and vomiting during pregnancy.
523
What happens if sodium is corrected too quickly in Osmotic Demyelination Syndrome?
It causes disruption of the blood-brain barrier and inflames the nervous tissue.
524
What is Hypernatremia?
Sodium >145.
525
What can cause Hypernatremia?
Losing more water than sodium or gaining more sodium than water.
526
What happens to cells in Hypernatremia?
Water is drawn out of cells.
527
What are the symptoms associated with hypovolemic hypernatremia?
Sweating, burns, fever, diarrhea, vomiting, uncontrolled diabetes mellitus, mannitol (diuretic).
528
What diseases are associated with hyponatremia?
Diabetes insipidus, diabetes mellitus, hypothalamic lesions affecting thirst and osmoreceptors, iatrogenic sodium overload, salt poisoning.
529
What are the mild symptoms of Hypernatremia?
Thirsty, restlessness, dry mucous membranes.
530
What are the severe symptoms of Hypernatremia?
Orthostatic hypertension, irritability, muscle twitching, decreased urine output, lethargy, weakness, seizures, swelling of the brain, delirium, coma (>160).
531
How is Hypernatremia diagnosed?
Serum electrolytes (sodium >145), urine and serum osmolality.
532
What is the treatment for acute Hypernatremia?
Calculate free water deficit, water by mouth if possible, IV fluid should be hypotonic, replaced in 24 hours, monitor sodium every 1 to 3 hours.
533
What is the treatment for chronic Hypernatremia?
Lower sodium by 10 milliequivalents in 24 hours, IVD5W at 1.5 mL per kilogram per hour.
534
What is Hypokalemia?
Normal serum potassium is 3.6-5.5 meq/L; <3.5 meq/L is life-threatening (<2.5).
535
Where is potassium primarily found in the body?
98% in the intracellular compartment, 2% in the plasma.
536
What causes Hypokalemia?
Decreased potassium intake, increased potassium excretion, potassium moves into cells.
537
What can severe hypokalemia cause?
Cardiac arrhythmias.
538
What can increase potassium excretion?
Diuretic use, increased aldosterone activity, diarrhea, excessive sweating.
539
What can cause increased entry of potassium into cells?
Increased insulin, increased beta adrenergic activity, hypothermia.
540
What are the symptoms of severe Hypokalemia?
Muscle weakness, cardiac arrhythmias, constipation or ileus, rhabdomyolysis with acute kidney injury (<2.5 mEq/L).
541
How is Hypokalemia diagnosed?
Serum electrolytes, serum magnesium, EKG (flattened T waves, ST segment depression, prolonged QT).
542
What is the treatment for Hypokalemia?
Oral potassium if possible (20-40 meq), IV if severe (<3) or unable to tolerate oral, but must be given very slowly.
543
What are the guidelines for IV potassium administration?
May be given through a peripheral IV line at rates up to 10-15 meq/h diluted in 0.5% or 0.9% normal saline; higher rates (up to 20 meq/h) require central access.
544
What should be monitored during IV potassium infusion?
ECG continuously and serum potassium level every 3-6 hours; correct magnesium as well.
545
What is hyperkalemia?
Serum potassium > 5.0 Meq/L (>5.0 mmol/L)
## Footnote
Mild: 5.5-5.9, Moderate: 6-6.4, Severe: > 6.5
546
What causes hyperkalemia?
Excessive intake of potassium, increased potassium release from cells, decreased potassium excretion by kidneys.
547
What can severe hyperkalemia induce?
Arrhythmias.
548
What are the symptoms of hyperkalemia?
Usually asymptomatic, weakness, paresthesia, if serious - cardiac arrest, more a bradycardia, heart block picture.
549
What are the causes of increased potassium release from cells?
Rhabdomyolysis, trauma, hemolysis, tumors, diabetes mellitus, DKA, beta blockers, digoxin toxicity.
550
What conditions can lead to decreased potassium excretion?
AKI, CKD, MI, CHF, sickle cell, Addison's disease, dialysis.
551
What is the diagnostic approach for hyperkalemia?
Serum electrolytes, serum potassium (>5), EKG (peaked T waves), any test to assess underlying issues.
552
What is the treatment for hyperkalemia if EKG changes or muscle weakness are present?
Calcium chloride or calcium gluconate to treat and prevent cardiac arrhythmias, 5 to 10 units of insulin with glucose (IV dextrose).
553
What is the normal serum calcium level?
4.6 to 5.3 mg/dL.
554
How is calcium homeostasis maintained?
By PTH and vitamin D.
555
What are the three forms of calcium in the blood?
Ionized, bound to albumin, bound to other substances.
556
What are the common causes of hypercalcemia?
Hyperthyroidism (usually mild and asymptomatic), malignancy (usually severe and symptomatic).
557
What are the symptoms of hypercalcemia?
Stones, bones, abdominal moans, and psychic groans.
558
What is the diagnostic approach for hypercalcemia?
Serum electrolytes, ionized calcium, look for underlying issues with PTH, malignancy, vitamin D.
559
What is the treatment for hypercalcemia?
Treat underlying issue, treat if symptomatic or severe, biphosphonate for long-term management, calcitonin for rapid reduction.
560
What is hypercalcemia?
A condition where total calcium is < 8.4 mg/dl and ionized calcium is < 4.65 mg/dl. It can range from asymptomatic to life-threatening.
561
What are common causes of hypercalcemia?
Vitamin D deficiency, medications, hypothyroidism, and chronic kidney disease (CKD).
562
What decreases calcium intake or reabsorption?
Vitamin D deficiency and malabsorption syndrome.
563
What increases calcium loss?
Chronic kidney disease (CKD) and diuretics.
564
What are parathyroid disorders associated with hypercalcemia?
Specifically hypothyroidism.
565
What are other causes of hypercalcemia?
Acute pancreatitis or blood transfusions.
566
What are the severe symptoms of hypercalcemia?
Tetany.
567
What are mild to moderate symptoms of hypercalcemia?
Fatigue, anxiety, and depression.
568
What are classic signs of hypercalcemia?
Chvostek’s sign and Trousseau’s sign.
569
What are cardiovascular effects of hypercalcemia?
Prolonged QT interval, hypertension, and bradycardia.
570
What cognitive symptoms can occur with hypercalcemia?
Anxiety, irritability, and confusion.
571
What skin and hair changes occur with hypercalcemia?
Dry skin and brittle nails.
572
How is hypercalcemia diagnosed?
Serum electrolytes and ionized calcium. Look for underlying issues like PTH, vitamin D deficiency, serum phosphate, and magnesium.
573
What is the treatment for severe symptomatic hypercalcemia?
IV calcium gluconate.
574
What is the treatment for asymptomatic hypercalcemia?
Oral calcium (Calcium carbonate) taken with Vitamin D and a diet higher in calcium.
575
What is hypomagnesemia?
A condition where serum magnesium is less than 1.8 mg/dL.
576
What is the normal range for serum magnesium?
1.7 to 2.1 mg/dL.
577
What roles does magnesium play in the body?
Energy production, maintaining electrolyte balance, neuromuscular function, calcium and potassium transport.
578
What is closely related to a deficit in magnesium?
A deficit in potassium.
579
What are the symptoms of hypomagnesemia?
Neurologic symptoms and arrhythmias.
580
What are common causes of hypomagnesemia?
Chronic diarrhea, PPI use, alcohol use disorder, diuretics, and hyperthyroidism.
581
What foods are high in magnesium?
Leafy greens, nuts, and seeds.
582
What is the treatment for acute symptomatic hypomagnesemia?
IV magnesium sulfate.
583
What is the treatment for chronic hypomagnesemia?
Magnesium oxide orally.
584
What is hypermagnesemia?
A condition associated with advanced CKD and intake of magnesium-containing drugs.
585
What are the symptoms of hypermagnesemia?
Muscle weakness, decreased tendon reflexes, and cardiac arrest.
586
How is hypermagnesemia diagnosed?
Elevated magnesium, often elevated potassium, and low calcium.
587
What is the treatment for asymptomatic hypermagnesemia?
Calcium chloride or calcium gluconate. Discontinue magnesium-containing drugs.
588
What should be avoided in CKD regarding magnesium?
Magnesium-containing drugs.
