Renal and GU

Question 1

How do you diagnose PreRenal failure? - 2

Answer 1

1. Urina Na+ < 10
2. FeNa < 1%

Question 2

What is the most common cause of PostRenal failure?

Answer 2

BPH

Question 3

Intrinsic renal failure can be caused by Glomerulonephritis or Acute Tubular Necrosis

What are the major causes of Acute Tubular Necrosis? - 6

Answer 3

1. IV Contrast
2. Myoglobinuria from rhabdomyolysis
3. Acute ischemia
4. Aminoglycosides
5. ACE inhibitors
6. NSAIDs

Acute Tubular Necrosis is associated with Granular cast

Question 4

What are the most common electrolyte abnormalities missed Dialysis pts encounter? - 3

Answer 4

1. HYPERKalemia (in and of itself can be indication FOR HD)
2. HYPERMagnesemia
3. hypOCalcemia

Note: Na+ derangements –> HTN in these pts

Question 5

List the indications for HemoDialysis (5)

Answer 5

AEIOU

Acidosis (HCO3 <10)

Electrolytes (⇪K+ / Mg / P) or (⬇︎ Ca+)

Intoxication (from Drug OD)

Overloaded BADLY with Fluid

Uremia (⇪ NH3-BUN)

Question 6

what do Granular cast indicate

Answer 6

Acute Tubular Necrosis

Question 7

what do WBC cast indicate - 2

Answer 7

1. pyelonephritris
2. interstitial nephritis

Question 8

what do RBC cast indicate - 2

Answer 8

1. Malignant HTN emergency
2. Glomerulonephritis

Question 9

DDx for Hematuria - 11

Answer 9

1. V: AAA
2. V: renal vesel thrombosis
3. I: pseudohematuria 2/2 Phenazopyridine or beets
4. N: Bladder CA/prostate CA/RCC
5. I: STI
6. I: UTI
7. I: Schistosoma haemotobium
8. C: Sickle cell disease
9. Auto/inflamm: Glomerulonephritis
10. Auto/inflamm: BPH
11. Trauma

Question 10

Timing of hematuria can help diagnose

Hematuria at the end of stream indicates what? - 2

Answer 10

1. Bladder neck
2. Prostate

Question 11

Timing of hematuria can help diagnose

Hematuria at the start of stream indicates what?

Answer 11

urethra

Question 12

Timing of hematuria can help diagnose

Hematuria continuously throughout urination indicates what? - 3

Answer 12

source is

1. Renal
2. Ureter
3. Bladder

Question 13

A kidney stone is surgicially problematic if it’s > ___ mm

Where do renal stonest typically cause most pain? - 5

Answer 13

8

1. Ureterovesicular junction
2. Urteropelvic junction
3. Pelvic brim
4. Renal calyx
5. Vesicular orifice

Don’t confuse kidney stone with AAA

Question 14

CP for Prostatitis - 4

Answer 14

1. Lower Back pain
2. Perineal pain
3. fever/chills
4. recurrent UTIs despite tx

Tx = usual UTI abx if acute and 1 month abx if chronic

Question 15

pts with NephrOtic syndrome lose more than ____ grams of protein/day

Answer 15

3.5 ;

Question 16

What are 3 physical exam findings specific to Testicular Torsion? - 3

Answer 16

1. Blue dot sign to upper pole w/TTP = APPENDAGE torsion-image
2. Loss of Cremasteric Reflex
3. • Prehn sign (Lifting testicles relieves pain which means NOT torsion but possibly epididymitis)

APPENDAGE testicular torsion doesn’t need detorsion. It degenerates on its own

Question 18

Tx of Testicular Torsion - 2

Answer 18

1. Manual DeTorsion…STILL followed by [option 2 vs 3]
2. Orchiopexy of affected testicle WITHIN 6 HOURS –> Px Orchiopexy of UnAffected testicle

Orchiopexy = (surgical repair of testes)

Question 19

Orchitis is inflammation of the _____

What causes this? - 2

Answer 19

testicles bilaterally (self-limited to 3 days)

1. Mumps
2. Syphilis (give abx)

Question 20

MOD for hydrocele ; causes?-5

Answer 20

Fluid accumulates in a persistent tunica vaginalis due to obstruction of testicular lymphatic drainage

1. Congenital
2. Trauma
3. CA
4. CHF
5. Elephantiasis infection

Question 21

Describe Varicoceles.

Etiology?

Answer 21

Tortuous Dilation of Pampiniform Venous Plexus surrounding spermatic cord & testis within scrotum

L renal vein compression (from Aorta and SMA or thrombosis) –>L side scrotal bag of worms worst with standing/valsalva and better when supine

Question 22

What is Fournier’s Gangrene? ; tx?-3

Answer 22

polymicrobial subQ infection in DM/immunocompromised that causes extensive scrotal and medial thigh necrosis with end-artery thrombosis

Broad Spec IV abx, Surgical debridement, Hyperbaric O2 therapy

Question 23

What is the MOD for Penile fracture? ; tx?

Answer 23

Tearing of tunica albuginea ; Surgery to evacuate hematoma and repair tunica albuginea

Question 24

What is the difference between Phimosis and Paraphimosis? ; Which one is an Emergency and why?

Answer 24

Phimosis = inability to retract foreskin over glans

PARAPHIMOSIS =edema of glans –> venous engorgement –> [Compressive swelling that inhibits reduction of foreskin over glans –> ⬇︎arterial flow –

> eventually gangrene] = EMERGENCY!

Question 25

Tx for Paraphimosis - 3

Answer 25

1. Manual reduction wrap glans with elastic banding for several minutes and/or
2. Manual reduction - apply several small punctures to edematous area with 27G to express fluid
3. Dorsal Slit

Question 26

What are the main causes of Priapism? - 4

Answer 26

priapism = corpuscavernosum with stagnant blood while spongiosum and glans are usually soft 1. Drugs (Trazodone, Sildenafil, Phentolamine) 2. Sickle Cell (sickling in corpus cavernosum) 3. Spinal cord injury 4. Idiopathic

Question 27

Priapism tx - 4

Answer 27

1. Terbutaline IM 2. Aspirate blood from Corpus cavernosum 3. Hydration and hyperbaric oxygen for Sickle cell 4. Urology consult

Question 28

CP for Benign Prostatic Hyperplasia (BPH) - 4

Answer 28

1. urinary dribbling 2. urinary hesitancy 3. incomplete bladder emptying 4. ⬇︎ urinary stream ## Footnote *exacerbating factors: caffeine, pseudophedrine, EtOH*

Question 29

Urinary retention is defined as inability to urinate for \> ___ hours What are the causes? - 5

Answer 29

7 1. BPH 2. Drugs **(anticholinergics, antihistamines, antispasmodics, alpha R agonist, antipsychotics, TCAs)** 3. Mechanical (uretral meatus stenosis, bladder neck contracture) 4. Neurogenic bladder 5. CA (bladder vs prostate)

Question 30

Pts with chronic urinary retention can develop ______ when relived by Foley Why is this an issue? - 2

Answer 30

Post Obstructive diuresis massive urine output --\> **hypOtension** and **electrolyte derangements**

Question 31

What are the features of a ChancROID?-3 ; Is it painful? ; What organism causes this?

Answer 31

1. Multiple deep ulcers 2. Exudative Grayish yellow Base 3. **PAINFUL** inguinal coalesced buboes nodes ## Footnote Organisms clump in long strands like a "school of fish" **PAINFUL** *Haemophilus Ducreyi*

Question 32

What are the features of a Lymphogranuloma Venereum?-2 ; Is it painful? ; What organism causes this?

Answer 32

1. Multiple shallow ulcers (similar to herpes) 2. Large **PAINFUL** coalesced inguinal lymph nodes = *Buboes* Intracytoplasmic chlamydial inclusion bodies \*\* Initial lesion is NOT painful but Buboes are \*\* *Chlamydia Trachomatis*

Question 33

Tx for Condyloma Acuminata - 5

Answer 33

HPV 6 & 11 1. **Trichloroacetic acid** 2. Cryotherapy c liquid nitrogen or cryoprobe 3. Podophyllin resin 4. Podofilox 0.5% gel - pt application 5. Imiquimod 5% cream - pt application