neph Flashcards Preview

0 BOARDS > neph > Flashcards

Flashcards in neph Deck (165):
1

Upper UTI x2

Pyelonephritis
Renal Abscess

2

Lower UTI x2

Cystitis
Urethritis

3

UTI

inflammation and infection: kidneys ureters bladder and/or urethra

4

Most common etiology UTI women

E. coli

5

Most common etiology UTI men

Proteus

6

Lower UTI s/s

DYSURIA *
Frequency, Urgency
Hematuria - 40-60%
Nocturia

7

Your patient is displaying symptoms suggestive of BPH. What is the first test you should order?

UA

8

Key symptom of lower UTI

Dysuria

9

Lower UTI: general mgmt x3 choices + what duration? *

trimethoprim-sulfamethoxazole (Bactrim)
ciprofloxacin (Cipro)
amoxicillin/clavulanate (Augmentin)

3 day course: max benefits, min drawbacks (ex: SE, less costly)

10

Lower UTI: mgmt during pregnancy x3 choices + what duration? *

amoxicillin
nitrofurantoin (Macrobid)
cephalexin (Keflex)

7 - 10 day course

11

Upper UTI s/s x5

flank, abd, lower back pain
fever, chills
AMS in elderly

12

AMS causes in elderly

TIA
UTI
drugs (interactions)
pulm infections

13

Upper UTI treatment x5 choices + what duration? *

2 vs. 6 wk course

heeeey, same as lower UTI +2:
trimethoprim-sulfamethoxazole (Bactrim)
ciprofloxacin (Cipro)
amoxicillin/clavulanate (Augmentin)

fluoroquinolone
aminoglycoside

14

Hospitalization is indicated for a patient with what kind of UTI?

Upper UTI: pyelonephritis with nausea and vomiting

15

what is renal insufficiency?

↓ renal fxn = ↓ GFR + ↓ clearance of solutes

can be acute or chronic

16

renal insufficiency: causes x5

hypertensive (major) nephrosclerosis
Glomerulonephritis
DM nephropathy
interstitial nephritis
polycystic kidney disease

17

comorbs associated with renal insufficiency

HTN
DM

18

what is acute renal insufficiency?

SUDDEN impairment, REVERSIBLE w tx
BUN: out of proportion to creatinine
causes: obstruction, acute tubular necrosis, contrast media

19

Is ATN reversible?

Yes. ATN reversible r/t acute renal insufficiency

20

what is chronic renal insufficiency?

PROGRESSIVE: mo - yrs, irreversible
STEADY ↑ BUN and creatinine
d/t intrinsic damage - progression can be slowed

21

what causes chronic renal insufficiency?

Intrinsic kidney damage

22

what is diminished renal reserve? *

first stage of renal failure
50% nephron loss
Creat x2

23

what is the second stage of renal failure and 2 characteristics?

renal insufficiency
75% nephron loss
mild azotemia

24

what is End-Stage Renal Disease?

90% nephron damage
azotemia
metabolic alterations

25

percentage of nephron function in ESRD

10% nephron function

26

dialysis criteria mnemonic

AEIOU

A cidosis - metabolic; azotemia
E lectrolyte abn: Ca, K
I ntoxication: AMS
O liguria: lt 400 mL/24 hrs
U remia

27

Acute Renal Insufficiency: mgmt

determine & reverse underlying cause (pre, intra, post)

28

Chronic Renal Insufficiency: mgmt

slow the progression of failure!
control HTN + DM
Δ rx doses
↓ dietary protein under 40 g/day

29

dietary protein requirement for chronic renal insufficiency?

less than 40 g/day

30

what is a classic electrolyte imbalance seen in chronic renal failure?

hypercalcemia

31

expected acid/base imbalance in chronic renal insufficiency + tx?

metabolic acidosis
IV: NS + sodium bicarb

32

major complication of peritoneal dialysis

peritonitis

33

acute renal failure: pre-renal causes x6

OUTSIDE kidney

↓ kidney perfusion: shock, dehydration, cardiac failure, burns, diarrhea, sepsis

34

what is pre-renal acute renal failure?

acute renal failure caused by conditions impairing renal perfusion; no damage to renal tubules

acute only if reversible with correction of underlying cause

35

What kind of damage do renal tubules sustain from pre-renal causes of acute renal failure?

Psych! NONE!

36

acute renal failure: intrarenal causes x4

renal or intrinsic causes that directly affect renal cortex/medulla:

- nephrotoxic drugs (most common)
- hypersensitivity reaction (ex: to contrast media)
- embolism/thrombosis of renal vessels
- mismatched blood transfusions (RBCs hemolyze then block nephrons)

RESULTS IN NEPHRON DAMAGE - acute tubular necrosis is the most common cause

37

what is the most common cause of damage to the nephron tubules in acute renal failure?

acute tubular necrosis in intrarenal acute renal failure

38

what does intrarenal acute renal failure result in?

nephron damage to tubules
ATN = most common cause

39

most common nephrotoxic drug

aminoglycosides - gentamicin

40

what is post-renal acute renal failure?

urine flow obstruction; mechanical or functional

41

acute renal failure: mechanical post-renal causes x4

BPH
tumor
renal calculi
urethra strictures

42

acute renal failure: functional post-renal causes x2

DM nephropathy
neurogenic bladder

43

pre-renal ARF BUN/Cr ratio

greater than 10:1

44

pre-renal ARF urine Na

less than 20 mEq/L

45

pre-renal ARF specific gravity

1.015+

46

pre-renal ARF fractional excretion of sodium (FENa)

under 1%

47

intrarenal ARF vs Postrenal ARF key diagnostic difference

urinary sediment

intra: granular white casts
post: normal

48

pre-renal ARF: mgmt

expand intravascular volume
dopamine

49

intrarenal ARF: mgmt

maintain renal perfusion
STOP nephrotoxic drugs
RRT

50

post-renal ARF: mgmt

remove obstruction
check foley
CT
renal US

51

most common type of renal calculi

calcium stones - 80%

52

renal calculi associated with gout

uric acid stones

53

most common type of renal calculi in women

struvite stone
r/t urease-producing bacteria UTIs
ARF infection: staghorn stones EMERGENCY

54

renal calculi: s/s x6

passage = pain + bleeding
colic-like FLANK pain, INCREASING intensity
groin/testicular pain
frequency, urgency, dysuria

55

gold standard for diagnosis of renal calculi

non-contrast CT scan

56

standard intravenous trio for renal calculi

morphine or hydromorphone (Dilaudid)
toradol (Ketorolac)
metoclopramide (Reglan)

57

** top 2 priorities in management of renal calculi

ANALGESIA
HYDRATION

58

what is benign prostatic hypertrophy?

enlargement of the prostate, doy
common in 50+ males

50% of men by 50
80% + of men 80+

59

benign prostatic hypertrophy: s/s

dysuria
frequency, urgency
nocturia, incontinence
hesitancy
start/stop flow, dribbling
retention

60

benign prostatic hypertrophy: diagnostics x4

UA: r/o infection
PSA
transrectal US: if palpable nodule or elevated PSA

61

normal PSA for 60 - 69

less than 4.5 ng/mL

62

normal PSA for 70-79

less than 6.5 ng/mL

63

abnormal PSA value + note

4+ ng/mL

40% w prostate cancer present with normal PSA values

64

BPH: mgmt - standard of care meds

ALPHA BLOCKERS! relaxes bladder/prostate muscles

terazocin (Hytrin)
prazocin (Minipress)
tamsulosin (Flomax)

65

alpha blockers MOA

relax muscles of the bladder and prostate

66

BPH: overall mgmt

** alpha blockers: terazocin (Hytrin), prazocin (Minipress), tamsulosin (Flomax)

5-alpha-reductase inhibitors: finasteride (Proscar), dutaseride (Avodart) - shrink prostates

surgery, TURP, urology referral

67

MOA 5-alpha-reductase inhibitors

shrink the prostate

68

What meds worsen BPH s/s? x4

OTC antihistamines, decongestants
- Benadryl, Sudafed, Afrin
- SSRIs
- Diuretics

69

green discharge is most commonly associated with what STD?

Gonorrhea

Green = Gonorrhea

70

gonorrhea hallmark s/s women

ASYMPTOMATIC 80%
mucopurulent GREEN vaginal discharge
dysuria

71

gonorrhea hallmark s/s men

ASYMPTOMATIC (often)
yellow-GREEN/white penile discharge
dysuria

72

gonorrhea: diagnostics x2

gram stain: discharge = gram neg diplococci + WBC
cervical culture

73

gonorrhea: treatment **

ceftriaxone (Rocephin) 250 mg IM one

PLUS

azithromycin (Zithromax) 1 g PO once (cover chlamydia)

then report to health department

74

syphilis: causative agent

Treponema pallidum, a spirochete

75

primary syphilis: description x2

PAINLESS chancre @ site of exposure
indurated ulcer

76

secondary syphilis: s/s + description *

** flu-like sx
** highly variable skin rash: palmar/plantar surfaces + mucous patches

77

latent syphilis: presentation

seropositive but asymptomatic

78

tertiary syphilis: complications x6

leukoplakia
cardiac insufficiency
aortic aneurysm
meningitis
hemiparesis/hemiplegia

79

which diagnostic is confirmatory for syphilis?

fluorescent treponemal antibody absorption (FTA-ABS)

+ 85-95% primary, 100% secondary

80

which lab do you order to rule out syphilis that is NOT diagnostic?

VDRL/RPR
(non-treponeal serological test for syphilis)

81

primary, secondary, or early syphilis + duration under 1 year: treatment

pencillin G 2.4 million units IM

82

late, latent, indeterminate length and tertiary syphilis: treatment

pencillin 2.4 million units IM weekly x 3 weeks

83

What drug allergy do you care about when treating a syphilis patient, and how do you treat syphilis patients with that allergy?

pencillin

doxycycline 100 mg PO BID
OR
erythromycin 500 mg PO QID

84

most common bacterial STD in United States

Chlamydia

85

chlamydia

PARASITIC STD
Chlamydia trachomatis

produces serious reproductive tract complications in men and women

86

chlamydia: s/s women

ASYMPTOMATIC (often)
dyspareunia
dysuria
postcoital bleeding

87

chlamydia: s/s men

ASYMPTOMATIC (often)
dysuria
thick cloudy penile discharge

88

STDs that present often asymptomatic

gonorrhea
chlamydia

89

top causes of dyspareunia

trichomonas
PID
menopause
chlamydia

90

most definitive test for chlamydia

culture
... it takes 3 - 9 days

91

chlamydia: diagnostics

culture
enzyme immunoassay (EIA)
- low cost + takes 30 to 120 mins

92

chlamydia: treatments top 2 + 3x more

** azithromycin (Zithromax) 1 g PO once
OR
** doxycycline 100mg PO BID x7 days

alts: erythromycin, ofloxacin, levofloxacin (Levaquin)

+ report to health department

93

what is vulvovaginitis?

inflammation or infection of VULVA & VAGINA
- most commonly bacterial, fungal, protozoan
-- top 3: trichomonas, bacteria, and candida

only trichomonas is considered sexually transmitted

94

trichomonas: presentation x6

malodorous frothy yellow-greenish discharge
pruritis
strawberry patches on cervix/vagina
vaginal erythema
dyspareunia, dysuria

95

You observe strawberry patches on your patient's cervix. Yiiikes she has...

trichomonas

96

Bacterial Vaginosis: presentation x2

fishy, watery, gray discharge
vaginal spotting

97

trichomonas: diagnostic test

microscopic wet prep: NS mixture shows motile TRICHOMONADS

98

candidiasis: diagnostic test

microscopic wet prep: KOH mixture show PSEUDOHYPHAE

99

bacterial vaginosis: diagnostic test

microscopic wet prep: NS mixture shows CLUE CELLS

100

Trichomonas: treatment

metronidazole (Flagyl) 2 g PO once
then 500 mg PO BID x 7 days

101

bacterial vaginosis: treatment

metronidazole (Flagyl) 2 g PO once
then 500 mg PO BID x 7 days +
gel 0.75%, intravag BID x 5 days

clindamycin (Cleocin) vaginal cream 2%, 5g qHS +
300 mg PO BID x 7 days

102

candidiasis: treatment

miconazole (Mono-stat) OR clotrimazole
- 5 g intravag qHS x 7 days

terconazole 80mg supp, qHS x3 days

butaconazole: 3 applications

103

chancroid: s/s in men + women

women: asymptomatic

men: painful ulcer(s) surrounded by erythematous halo
- can be necrotic or erosive, yuck

104

How do you diagnose chancroid? Definitive diagnosis?

DIAGNOSIS OF EXCLUSION
- definitive dx: morphologically (sens 80+%)
- genitalia +/or unilateral bubo
- painful genital ulcers + tender inguinal lymphadenopathy that aren't syphilis or HSV

105

Wat ur pt haz quail egg lymph node in groin da fuuuuu

unilateral bubo - swollen inguinal lymph node associated with chancroid

106

Chancroid management

same as gonorrhea and chlamydia

107

herpes

recurrent VIRAL STD
no cure
painful genital lesions

HERPES = HURTS

108

herpes: transmission

direct contact with ACTIVE lesions
OR
virus-containing fluids (saliva HSV1; cervical secretions HSV2)

109

herpes: initial s/s

painful/pruritic ulcers x ~12 days
dysuria, fever, malaise

110

herpes: recurrent s/s

less painful/pruritic ulcers x 5 days

111

Most definitive test for Herpes

viral culture

112

herpes: diagnostics x3

Pap
Tzanck stain
Viral culture

113

herpes: mgmt x4

no cure
acyclovir (Zovirax): topical, oral, IV use
valacyclovir: useful for asx viral shedding HSV2
famciclovir
symptomatic (drying/antipruritic)

114

30 yo. F presents with 6 month history of three UTIs associated with hematuria. What should be your plan of care?

Refer to a urologist

115

What is the most common potential complication associated with a TURP?

Impotence

116

Treatment of choice of uncomplicated cystitis in women?

Bactrim

117

most common cause of metabolic acidosis in patients s/p surgery

circulatory dysfunction with lactic acidosis

118

differential diagnosis for significant proteinuria

nephrotic syndrome
CHF
DM

119

50 yo. M diagnosed with uric acid renal calculi. Treatment?

allopurinol

120

antihypertensive of choice for patients with marked proteinuria

ACE Inhibitors

121

treatment of hyperphosphatemia in ESRD

calcium citrate

122

45 yo. M s/p abdominal surgery has now developed ARF with BUN 100 mg/dL and Cr 4.5 mg/dL. Indications for dialysis include

hyperkalemia
metabolic acidosis
encephalopathy

123

nephrotic syndrome: mgmt

ACE Inhibitors
Protein restriction
NSAIDS

124

most common complication associated with hemodialysis

hypotension

125

sensitivity/specificity of a urine dipstick?

+ nitrate: very SPECIFIC, but not sensitive
+ esterase: very SENSITIVE, but not specific
... for bacteruria

126

Your 29 yo F patient complains that she feels the urge to pee frequently and that it burns when she voids, and that it looks like there is blood in her urine. What are 2 diagnostics you want to order?

UA
dipstick

127

pyuria on UA

10+ WBC/mL

128

"it hurts when I pee" song

UTI or STD (G or C)

129

expected UA finding with upper UTI

WBC casts

130

UA in lower vs upper UTI

lower: pyuria
upper: WBC casts

131

You suspect your patient has pyelonephritis, and they have been nauseated and vomited a few times. What is your priority intervention?

admit

132

renal function in renal insufficiency

less than 20 - 25% of normal

133

top 2 causes of renal obstruction

kidney stones
enlarged prostate

134

what are 3 causes of acute renal insufficiency?

obstruction
acute tubular necrosis
contrast media

135

what type of diet is indicated for ESRD HD patient?

low potassium

136

anuria

UOP less than 100 mL/24 hrs

137

oliguria

UOP less than 400 mL/24 hrs

138

renal insufficiency: 5 complications and their treatments

volume overload: diuretics
metabolic acidosis: NS + Na bicarb
hypercalcemia (calcitonin, dialysis)
anemia
azotemia: RRT (dialysis)

139

azotemia

BUN 100+ mg/dL

140

renal replacement therapy

is dialysis!!!!!

141

what is the most common cause of intrarenal acute renal failure?

nephrotoxic agents: ex - aminoglycosides

142

how do mismatched blood transfusions cause intrarenal renal failure?

the RBCs hemolyze then clog up the nephrons

143

acute renal failure: diagnostics x5 + key

serum BUN/Cr
urine Na
specific gravity
urinary sediment
FENa

intra and post renal are the same and prerenal is different

144

The only amino acid that becomes insoluble in urine, and why that is important.

cystine - can result in cystine calculi that are difficult to manage

145

renal calculi: mgmt

depends on stone type, location, extent, etc

#1 analgesia (trio) & hydration !!!

diuretics (controversial)
remove obstruction (if preventing outflow or infected)
lithotripsy
cystoscopy

146

You are ordering the standard IV trio for your poor little patient who is having the worst renal calculi of his life. What is an important consideration about metoclopramide (Reglan)?

metoclopramide is associated with an increased incidence of extra-pyramidal symptoms (ex: tardive dyskinesia)

147

gonorrhea

BACTERIAL STD: Neisseria gonorrhoeae (gram neg diplococci)

found in GU, oropharynx, anorectum

148

causative agent of gonorrhea + gram and shape

Neisseria gonorrhoeae (gram neg diplococci)

149

syphilis diagnostics x3

FTA-ABS (fluorescent treponemal antibody absorption)

non-treponemal:
VDRL/RPR
microhemagglutination assay for antibody to T- pallidum

150

gonorrhea green vs trichomonas green discharge

gonorrhea: mucopurolent
trichomonas: frothy, malodorous

151

candidiasis presentation x2

thick white curd-like discharge
vulvovaginal erythema + pruritis

152

which GU infection has clue cells on wet prep?

bacterial vaginosis

153

which GU infection has pseudohyphae on wet prep?

candiasis

154

chancroid

STD caused by Hemophilus ducreyi
(gram neg bacillus)
- well-established co-factor for HIV transmission
- up to 10% also infected with syphilis and HSV

155

Your patient DEFFO has chancroid. Hoo doggy. What three other infectious diseases pop into your head and what is so significant about them?

HIV: chancroid is a co-factor for transmission
syphilis + HSV: frequent co-infections

156

HSV1 vs HSV2

1: lips, face, mucosa
2: genitalia

157

differentials for genital ulcers

herpes, primary syphilis, chancroid

158

older adults: changes in renal blood flow

diminished up to 10% per decade after 30-40

159

older adults: kidney changes

↓ size, nephron #/size, # glomeruli 30-40%

160

older adults: GFR changes

↓ ~10% per decade after 30

161

most common clinical illness for adults over 65

UTI

162

top 2 gram neg UTI

E Coli
Pseudomonas

163

top 4 gram + UTI

Enterococci
Staph (coagulase neg)
Strep agalactiae
Staph aureus

164

fungal UTI is common especially in what population?

patients with indwelling catheters

165

old folks + incontinence + confusion = ?

think UTI