GU/Renal/STD's Flashcards
1
Q
This symptom occurs in 40-60% of Lower UTI patients
A
- Hematuria
2
Q
Define pyuria
A
WBC in urine (>10 WBC/mL + for UTI)
3
Q
UTI tx in pregnancy
A
- Amoxicillin
- Nitrofurantoin (Macrobid)
- Cephalexin (Keflex)
- 7-10 days for complete course
4
Q
What signs often present and indicate upper UTI?
A
Fever and chills
(Flank, low back, or abd pain may be present)
Mental status changes in elderly
5
Q
What diagnostic test may be elevated in pyelonephritis?
A
ESR
6
Q
Upper UTI Management
A
- Trimethoprim/Sulfa (Bactrim)
- Cipro
- Quinolones
- Aminoglycoside (gent)
- 14 days to 6 months
7
Q
List 4 causes of Renal Insufficiency
A
- HTN
- Glomerulonephritis
- Diabetes
- Nepthritis
- Polycystic kidney dz
8
Q
At what percentage of remaining renal function are systemic changes evident?
A
20-25%
9
Q
Diminished Renal Reserve
A
50% nephron loss, creatinine doubles
10
Q
Renal Insufficiency Definition
A
75% nephron loss, mild azotemia
11
Q
ESRD definition
A
90% neprhon damage, azotemia, metabolic alterations
12
Q
Dialysis Criteria
A
A acidosis/Azotemia
E Electrolyte imbalance
Intoxication
Oliguria/ Overload
Uremia
13
Q
3 startegies for Chronic Renal failure Management
A
- Control HTN and DM
- Reducing dietary protein to 40g/day
- Modify drug dosing
14
Q
Causes pre-renal failure
A
- Shock
- Dehydration
- Burns
- Sepsis
15
Q
Most common cause of Intra-renal failure
A
Nephrotoxic agents
16
Q
Three causes of intra-renal failure
A
- Hypersenstivity reactions
- Obstruction of vessels
- Mismatched blood products
17
Q
Location of acute tubular necrosis
A
Tubular portion of the nephron
Most common cause of intrarenal failure
18
Q
Examples of mechanical post-renal failure
A
Calculi
Tumors
Urethral stricture
BPH
19
Q
Causes of Functional Postrenal Failure
A
Neurogenic bladder
Diabetic neuropathy
20
Q
Specific gravity for intra-renal and post-renal disease
A
<1.015
21
Q
Urine sodium in intra and post renal disease
A
>40
22
Q
Sediment in intra-renal disease
A
Granular/casts
23
Q
FENa in intra and post renal disease
A
>3
24
Q
Serum BUN/Creat ratio in Pre-renal dz
A
>10:1
25
Pre-renal Managment
Expand volume
Consider dopamine
26
Intra-renal
* Maintain renal perfusion
* D/c nephrotoxic drugs
* HD as needed
27
Post-renal managment
* Remove source of obstruction
* Check foley
* CT
* Renal US
28
Name percentage of population that will develop renal cacluli
10%
29
Name four types of stones
Calium
Uric acid
Struvite
Cystine
30
Which stones result from UTI's with urease producing bacteria?
Struvite
31
What does radiation of pain to the groin indicate in renal calculi?
Passage of stone to the lower 1/3 of ureter
Testicular pain is possible
32
Diagnostics for renal calculi
Abd XR- majority of stones are radiopaque
CT is indicated
Crystals in urinary sediment is suggestive of calculi
33
Indications for surgical removal of calculi
Obstruction of outflow
Accompanied by infection
Cystoscopy can be used for larger fragments
34
Tx for renal calculi
Analgesia with:
Morphine, dilaudid, toradol, reglan
Hydration
35
What is the theorized cause of BPH?
Response of the prostate to androgen hormones over time
36
Abnormal PSA values
\>4
Age specific:
40-49 \<2.5
50-59 \<3.5
60-69 \<4.5
70-79 \<6.5
37
What percentage of prostate cancer patients present with normal PSA values?
40%
38
What is the least expensive method for enlarged prostate detection?
DRE
39
If elevated PSA or palpable nodule is found, what diagnostic is recommended?
Transrectal US
40
First line tx for BPH?
Alpha blockers
Terazosin (HYtrin), prazosin (Minipress), Tamulosin (flomax)
-relaxes muscles of the bladder and prostate
41
Second line tx for BPH?
5-alpha-reductase inhibitors
Finasteride (proscar), dutasteride (Flomax)
Shrinks the prostate
42
What herbal is used for BPH?
no decreased risk of prostate CA but may decrease PSA values
43
Meds to avoid in BPH?
* anti-histamine
* decongestatns
* antidepresants (SSRI)
* diuretics
* narcotic pain relievers
44
Causative agent for Gonorrhea
Neisseria gonorrhoeae - gm neg diplococci
45
Transmission rate after exposure Gonorrhea
Often asymptomatic, 80-90% for male to female exposure
Leading cause of infertility
1-2% general population
46
Color of discharge in Gonorrhea
Men- white-yellow/green
Women-green
47
Tx for Gonorrhea
Ceftriaxone (Rocephin) 250mg x 1 IM
PLUS
Azithromycin 1 gm oral x1 to treat chlamydia
G+C go together!!!!!
48
Reportable diseases to the health department
Gonorrhea
Chlamydia
Syphyllis
HIV
TB
49
Causative agent for Syphilis
Treponema pallidum (spirochete)
3rd most common infectious disease in the US
50
4 stages of Syphilis
* Primary- painless chancre
* Secondary- flu-like illness with rash to palms and soles
* Latent- asymptomatic but sero-positive
* Tertiary- systemic symptoms, cardiac, neuro symptoms
51
What testing is confirmatory in Syphilis?
* Treponemal- FTA-antibody 85-90% primary and 100% secondary cases
* MHA-TP to test for the anti-body to T pallidum
52
What is the non-treponemal test for syphilis?
VDRL-RPR
53
Tx for primary syphilis of \<1 yr duration
Pen-G 2.4 million units IM
54
Tx for late, latent, or indeterminate Syphilis
Pen-G 2.4 million units IM weekly x 3 weeks
55
Syphilis tx in PCN allergic patients
Doxycycline 100mg oral BID
Erythromycin 500mg oral QID
56
Chlamydia causative agent
Chlamydia trachomatis-paracyte
57
Most common bacterial STD in US
Chlamydia
58
Top 4 causes of dysparunia
* CMPT
* Chlamydia
* Menopause
* PID
* Trichamonas
59
What is the preferred test for chlamydia?
Enzyme immunoassay (EIA) is low cost 30-120 min for results
Culture is most definitive -days for results
60
Tx for chlamYdia
* AzithromYcin 1 gm oral x 1
OR
* Doxycycline 100 mg oral BID
61
Name 3 types of vulvovagintits
* Trichomonas: frothy discharge, strawberry patches
* Bacterial vaginosis (BV): fishy odor, watery gray discharge
* Candiasis: white curdy discharge
62
Diagnostic test trichomonas
NS wet prep with motile trichomonads
63
Diagnostic test BV
NS wet prep with clue cells (squamous cells with undefined border)
64
Diagnostic test Candidiasis
KOH mixture with psuedo-hyphae
65
Tx trichomonas
Metronidazole (flagyl) 2gm oral x 1, 500 mg bid x 7 days
66
Tx BV
Metronidazole (flagyl) 2 gm oral x1, 500mg bid x 7 days
or intravaginal gel BID x 5 days
Clindamycin
67
Tx candidiasis
Miconazole (mono-stat), clotrimazole (gyne-lotrimin)
Butazonazole x 3
68
Chancroid causative agent
Hemophilus ducreyi (gm neg bacilli)
69
Co-infections common with chancroid
HIV
10% may be infected with syphilis and HSV
70
Two physical signs of chancroid
Painful genital ulcer
Bubo-unilateral inguinal lymph node swelling
71
Painful STD's
Herpes
Chancroid
72
All STD's are bacterial except
HIV
Herpes
73
STD's causing genital ulcers
Herpes
Chancroid
Syphillis
74
Chancroid tx
Aztihromycin 1 gm PO x 1
OR
Caftriaxone )rocephin) 250mg x 1 IM
OR
Cipro 500mg BID x 3 days
75
Herpes lesions
Type 1: face, oral, lips
Type 2: gential
Painful!
76
Duration for initial and recurrent Herpes lesions
Intial: 12 days
Recurrent: \< 5 days
77
Definitive test Herpes
Viral cx
78
Treatment for asymptomatic viral shedding
Valacyclovir
Acyclovir: topical/oral/IV use
79
80
Which test is confirmatory for syphilis?
FTA-ABS (treponemal antibody absorption) is confirmatory
VDRL/RPR test for disease but is not confrimatory
