Renal (Exam #3) Flashcards
(278 cards)
1
Q
GENERALLY for kidney disease, what two values should be low and which one should be high?
A
- LOW: GFR, UO
- HIGH: Cr
2
Q
What is a measure of number of functional nephrons? Can this be measured directly?
A
GFR
- NOPE, need MDRD or Cockcroft-Gault formulas
3
Q
What lab value is used to screen or monitor disease with tx for prostate CA?
A
Prostate-Specific Antigen (PSA)
4
Q
PSA is seen in all males but high if… (4)?
A
- Prostate CA
- BPH
- Prostatitis
- AFTER prostate manipulation
5
Q
What diagnostic test should be used to detect prostate CA in patients with a HIGH PSA?
A
Prostate US/Biopsy transrectally (TRUS)
6
Q
High ANA is indicative of what?
A
SLE
7
Q
High C-ANCA/P-ANCA is indicative of what?
A
Granulomatosis with Polyangiitis (GPA)
8
Q
High Anti-GBM is indicative of what?
A
Goodpasture Syndrome
9
Q
What UA finding is earliest clinical sign of diabetic nephropathy?
A
Microalbumin
10
Q
What UA finding is never normal; seen with acute interstitial nephritis?
A
Urine Eosinophils
11
Q
Bence Jones proteins seen on what diagnostic test is indicative of MM?
A
UPEP
12
Q
What is the first line radiographic test ordered if renal failure of UO or “abdominal/flank pain”?
A
Renal US
13
Q
What radiographic test can distinguish renal mass vs. cyst?
A
CT Scan
14
Q
What is the gold standard test for nephrolithiasis?
A
CT WITHOUT contrast
15
Q
What is the concern with using Iodine contrast, and what can this lead to?
A
Can be nephrotoxic
- Can cause Contrast-Induced Nephropathy = CNI
16
Q
What medication should be held for 48 hours prior to performing a CT WITH contrast, and WHY?
A
Metformin
- Avoid lactic acidosis
17
Q
What is the gold standard test for renal vein thrombosis?
A
MRI
18
Q
What might Gadolinium contrast may increase risk for?
A
Nephrogenic systemic fibrosis
19
Q
What radiographic test can show “string of pearls”, and what is this indicative of?
A
Renal Angiography
- Indicates Fibromuscular Dysplasia
20
Q
What test is x-ray w/ contrast; almost never ordered because other tests available (dye concern)?
A
Intravenous Pyelogram (IVP)
21
Q
What test is preferred to IVP for bladder-specific conditions?
A
Cystourethrogram
22
Q
With what test is post-procedural hematuria expected and should clear within 3 voids?
A
Cystoscopy
- Commonly used by urology
- Cystoscope inserted into urethra → bladder
23
Q
If ordering a Testicular US, what other test should always be obtained, and why?
A
Obtain Doppler to evaluate blood flow
- R/O testicular torsion
24
Q
What involves diseases that present in nephritic spectrum; inflammatory process → renal dysfunction?
A
Glomerulonephritis (GN)
25
What condition involves hematuria (smoky/cola-colored)?
Glomerulonephritis (GN)
26
What condition involves RBC casts?
Glomerulonephritis (GN)
27
What condition involves dysmorphic RBCs?
Glomerulonephritis (GN)
28
What condition involves proteinuria (<3 g/day)?
Glomerulonephritis (GN)
29
With what condition will you not see clots in hematuria, but may have proteinuria?
Glomerulonephritis (GN)
30
What is the general treatment for Glomerulonephritis (GN)? What medication may be considered?
Depends on underlying cause SO JUST nephrology referral
| - Consider ACE-I/ARB for renoprotection
31
With what two conditions should IMMEDIATE hospitalization be considered with Glomerulonephritis (GN)?
- Acute Nephritic Syndrome
| - Rapidly Progressive Glomerulonephritis (RPGN)/Crescentic Glomerulonephritis
32
What condition is due to progressive loss of renal function over short period of time?
Rapidly Progressive Glomerulonephritis (RPGN)
| - AKA Crescentic Glomerulonephritis
33
What condition involves crescent formation of glomerular cells?
Rapidly Progressive Glomerulonephritis (RPGN)
| - AKA Crescentic Glomerulonephritis
34
What is the most common cause of primary Glomerulonephritis (GN)?
IgA Nephropathy
35
What condition peaks 2nd and 3rd decades of life, often male?
IgA Nephropathy
36
What condition involves gross hematuria 1-2 DAYS after URI?
IgA Nephropathy
37
With IgA Nephropathy, if there is persistent proteinuria >1 g/dL, high Cr/low GFR or HTN, what medication should be considered?
ACE-I/ARB +/- steroids
38
What condition is due to group A beta-hemolytic strep; more common in male children?
Poststreptococcal Glomerulonephritis (PSGN)
39
What condition occurs 1-3 WEEKS after pharyngitis or skin infection (impetigo)?
Poststreptococcal Glomerulonephritis (PSGN)
40
What diagnostic finding is indicative of Poststreptococcal Glomerulonephritis (PSGN)?
Recent GAS infection with high ASO or +throat/skin culture
41
What is the recommended treatment for Poststreptococcal Glomerulonephritis (PSGN)?
SUPPORTIVE
42
Is recurrence of Poststreptococcal Glomerulonephritis (PSGN) common or rare?
RARE
43
What condition involves tetrad of palpable purpura (rash), arthralgias, abdominal pain, renal disease after URI?
IgA Vasculitis (IgAV) = Henoch-Schönlein Purpura (HSP)
44
What tetrad of symptoms is seen with IgA Vasculitis (IgAV) = Henoch-Schönlein Purpura (HSP)?
- Palpable purpura
- Arthralgias
- Abdominal pain
- Renal disease
45
What is the recommended treatment for IgA Vasculitis (IgAV) = Henoch-Schönlein Purpura (HSP)?
SUPPORTIVE
46
What age group has higher risk of progressive renal disease a few days-1 month after onset of systemic sxs with IgA Vasculitis (IgAV) = Henoch-Schönlein Purpura (HSP)?
ADULTS
47
What two age groups are most affected by Anti-GBM Antibody Disease (Goodpasture Syndrome)?
- Male in 3rd decade (more severe)
| - Female in 6th/7th decade
48
What two conditions/findings are consistent with Anti-GBM Antibody Disease (Goodpasture Syndrome)?
- RPGN
| - Alveolar hemorrhage (pulmonary)
49
What condition involves anti-GBM antibodies in serum or biopsy? What other test may be positive?
Anti-GBM Antibody Disease (Goodpasture Syndrome)
| +/- positive ANCA
50
What two medications are recommended for treatment of Anti-GBM Antibody Disease (Goodpasture Syndrome)?
- Prednisone
| - Cyclophosphamide
51
What condition presents with +Anti-ds DNA antibodies?
Lupus Nephritis (LN) aka Systemic Lupus Erythematosus Nephritis
52
What condition is ANCA-associated, where ANCA antibodies produce tissue and vascular damage?
Pauci-Immune Glomerulonephritis
53
What are the three possible causes of Pauci-Immune Glomerulonephritis? How do you treat ALL THREE?
- Granulomatosis with Polyangiitis (GPA)
- Microscopic Polyangiitis (MPA)
- Eosinophilic Granulomatosis with Polyangiitis (EGPA)
Tx: referral +/- immunosuppressants
54
What condition involves necrotizing granulomas, and what is it a possible cause of?
Granulomatosis with Polyangiitis (GPA)
| - Possible cause of Pauci-Immune Glomerulonephritis
55
What triad is consistent with Granulomatosis with Polyangiitis (GPA)?
- Upper respiratory sxs
- Lower respiratory sxs
- GN
56
What condition involves nasal/oral inflammation, saddle nose deformity; RPGN common?
Granulomatosis with Polyangiitis (GPA)
57
How can you differentiate Granulomatosis with Polyangiitis (GPA) from Microscopic Polyangiitis (MPA) and Eosinophilic Granulomatosis with Polyangiitis (EGPA)?
GPA = C-ANCA
| - MPA and EGPA = P-ANCA
58
What condition involves ONLY lower respiratory sxs and GN? How does this differ from Granulomatosis with Polyangiitis (GPA)?
Microscopic Polyangiitis (MPA)
- NO granulomas
- NO upper resp. sxs
59
What two findings/symptoms are associated with Eosinophilic Granulomatosis with Polyangiitis (EGPA)?
- Asthma
| - Eosinophilia
60
What condition involves prodromal (Atopic Triad) → Eosinophilic → Vasculitis (systemic renal sxs)?
Eosinophilic Granulomatosis with Polyangiitis (EGPA)
61
What condition is common; often asymptomatic and found incidentally on US?
Simple Renal Cyst
62
What condition is benign = NO enhancement with contrast, round, sharply demarcated, smooth walls?
Simple Renal Cyst
63
What condition is an inherited disease that causes irreversible decline in kidney function? What are the two types, and what symptom/finding is seen with BOTH?
Polycystic Kidney Disease (PKD)
- Autosomal Dominant PKD (ADPKD)
- Autosomal Recessive PKD (ARPKD)
BOTH have bilateral marked kidney enlargement
64
In Autosomal Dominant PKD (ADPKD), which gene is mutated? In Autosomal Recessive PKD (ARPKD), which gene is mutated?
- ADPKD: PKD1 OR PKD2
| - ARPKD: PKD1 only
65
How does the presentation of Autosomal Recessive PKD (ARPKD) differ from ADPKD? What can this lead to (2)?
Kidneys AND Liver
- Bilateral marked kidney enlargement AND congenital hepatic fibrosis
Can lead to HTN and portal HTN
66
What two non-renal conditions are often associated with Autosomal Dominant PKD (ADPKD)?
- HTN
| - Liver cysts
67
What two non-pharmacologic treatments are recommended for Autosomal Dominant PKD (ADPKD)?
- Strict BP control/low-salt diet
| - Pain control
68
What medication can also be prescribed to treat Autosomal Dominant PKD (ADPKD)?
Tolvaptan
69
What condition involves abrupt loss of kidney function resulting in urea retention, dysregulation of volume status and electrolytes?
Acute Kidney Injury (AKI)
70
What are the three aspects of KDIGO Diagnostic Criteria (need 1 of 3)?
- Increase in serum Cr by >0.3 mg/dL within 48 hours
- Increase in serum Cr to >1.5 times baseline
- Urine volume <0.5 mL/kg/hour for 6 hours
71
What renal condition is often common in hospitalized patients, and what are two likely causes?
Acute Kidney Injury (AKI)
- Prerenal disease
- ATN
72
What does prerenal etiology of Acute Kidney Injury (AKI) mean?
Decreased renal BF
73
What does intrinsic etiology of Acute Kidney Injury (AKI) mean?
Acute tubular necrosis (ATN)
| - Pathology of vessels, glomeruli, tubules
74
What does post renal etiology of Acute Kidney Injury (AKI) mean?
Obstruction
75
What is the most common renal etiology of Acute Kidney Injury (AKI)? What is second most common?
MOST common = ATN (intrinsic)
| - 2nd most common: prerenal
76
What are five possible causes of prerenal Acute Kidney Injury (AKI)?
- Volume depletion
- Hypotension
- Edema
- Selective renal ischemia
- Drugs affecting GFR
77
What two drug groups can cause prerenal Acute Kidney Injury (AKI)?
- NSAIDs
| - ACE-I
78
What are three possible causes of intrinsic Acute Kidney Injury (AKI)?
- Renal ischemia
- Sepsis
- Nephrotoxins (IV contrast)
79
What are three risk factors for IV contrast toxicity in intrinsic Acute Kidney Injury (AKI)?
- Pre-existing renal disease
- Volume depletion
- Repeated doses of contrast
80
What can cause renal tubular epithelial cell toxicity, renal medullary ischemia?
IV contrast toxicity
81
A reduction in GFR WITHOUT hx of prerenal requires what for posterenal Acute Kidney Injury (AKI)?
BILATERAL obstruction
82
What are two of the most common reasons for posterenal Acute Kidney Injury (AKI)?
- Prostatic disease (BPH, CA)
| - Metastatic CA
83
What condition involves "muddy brown casts"?
ATN
84
What does FENa measure? What does an FENa <1% indicate? What does an FENa >2% indicate?
FENa = measures % of Na+ excreted in urine
- FENa <1% = prerenal
- FENa >2% = ATN
85
What test can be used to assess for obstruction, and what can obstruction predispose you for?
Renal US
| - Obstruction can predispose for UTI → urosepsis → kidney failure
86
SEVERE Acute Kidney Injury (AKI) can present with what symptom?
AMS
87
What are six possible complications of Acute Kidney Injury (AKI)? What is often the treatment if any of these complications are present?
- Volume imbalance
- Metabolic acidosis
- Hyperkalemia
- Hypocalcemia
- Hyperphosphatemia
- Uremia
If complications present, often requires hemodialysis to treat
88
If volume depleted due to Acute Kidney Injury (AKI), what is the recommended treatment? If the patient does not respond, what is the likely etiology of AKI?
1-3 L of IV fluids (isotonic crystalloids)
| - Likely ATN or intrinsic AKI (not prerenal)
89
If volume overloaded due to Acute Kidney Injury (AKI), what is the recommended treatment? What should be considered with this treatment decision?
Diuretics temporarily
| - STOP diuretics if UO does not increase with diuretic use (NOT for long-term use)
90
If mild case of metabolic acidosis due to Acute Kidney Injury (AKI), what is the recommended treatment? What symptom especially calls for this treatment?
Give bicarbonate
- Especially if diarrhea
- If overloaded, no bicarb because → increase Na+ load
91
If overloaded or severe case of metabolic acidosis due to Acute Kidney Injury (AKI), what is the recommended treatment? Why can't bicarbonate be used to treat overload AKI?
Dialysis
| - If overloaded, no bicarb because → increase Na+ load
92
What can hyperkalemia due to Acute Kidney Injury (AKI) cause symptomatically (2)? How do you treat this (2)?
NM issues and/or arrhythmias
| - Treat with medicine and dialysis (drive K+ from ECF → ICF and remove excess K+)
93
What often causes Hypocalcemia due to Acute Kidney Injury (AKI)?
Hypocalcemia often occurs because of hyperphosphatemia
94
If symptomatic hypocalcemia due to Acute Kidney Injury (AKI), what is the recommended treatment? What three symptoms might present as hypocalcemia?
Give IV Calcium
- Trousseau’s sign
- Chvostek’s sign
- QT prolongation
95
If asymptomatic hyperphosphatemia of >5.5 mg/dL present with Acute Kidney Injury (AKI), what is the recommended treatment?
Phosphate binders
96
For hyperphosphatemia + LOW serum Ca2+ with Acute Kidney Injury (AKI), what is the recommended treatment (2)?
- Calcium acetate
| - Calcium carbonate
97
For hyperphosphatemia + HIGH serum Ca2+ with Acute Kidney Injury (AKI), what is the recommended treatment (2)?
- Aluminum hydroxide
| - Lanthanum carbonate
98
What stage is uremia (“urine in blood) more common with, and what is the recommended treatment if severe?
More common in CKD
| - If severe (neuropathy, pericarditis), start dialysis
99
What involves diffusion of small molecules down their concentration gradient? What types of molecules CAN diffuse?
Dialysis
| - Small molecules = waste (urea, Cr, K+ and excess fluid) can cross
100
What is the general prognosis for Acute Kidney Injury (AKI)?
MOST recover renal function with normalized Cr and UO
| - BUT MANY have residual renal dysfunction
101
What two issues are those with an Acute Kidney Injury (AKI) at increased risk for?
- Another AKI
| - Develop CKD
102
What constitutes Chronic Kidney Disease (CKD)?
- Decreased kidney function (GFR <60)
OR
- Kidney damage (albuminuria with ACR of 30+)
FOR 3+ MONTHS = chronic
103
What constitutes Stage 1 kidney disease?
Kidney damage with normal GFR (90+)
104
What constitutes Stage 2 kidney disease?
Kidney damage with mildly low GFR (60-89)
105
What constitutes Stage 3a kidney disease?
Mild/moderate GFR of 45-59
106
What constitutes Stage 3b kidney disease?
Moderate/severe GFR of 30-44
107
What constitutes Stage 4 kidney disease?
Severely low GFR (15-29)
108
What constitutes Stage 5 kidney disease?
FAILURE (GFR <15)
109
What constitutes Stage 1 kidney disease (ACR specifically)?
Normal/mild increase of ACR (<30)
110
What constitutes Stage 2 kidney disease (ACR specifically)?
Moderately increased ACR (30-300)
111
What constitutes Stage 3 kidney disease (ACR specifically)?
Severely increased ACR (>300)
112
What is the hallmark of progressive kidney disease?
Declining GFR
113
What condition involves nephron destruction leads to compensatory hypertrophy with supranormal GFR of remaining nephrons → overwork injury of remaining nephrons... What does this lead to?
Chronic Kidney Disease (CKD)
| - Leads to dlomerular sclerosis and interstitial fibrosis
114
What two hormones are LOW in Chronic Kidney Disease (CKD)?
- Erythropoietin
| - Calcitriol (active Vitamin D3)
115
What two conditions are often the cause of Chronic Kidney Disease (CKD)? What is another possible cause we discussed?
What are three other risk factors for CKD?
- DM
- HTN
Also, chronic tubulointerstitial disease
RF other than DM, HTN: 65+ years, hx of AKI, CVD
116
What condition should be considered with CKD that involves accumulation of metabolic waste or uremic toxins?
Uremic Syndrome
117
What condition involves fatigue, malaise, pericarditis, encephalopathy?
Uremic Syndrome
| - Associated with CKD
118
What four symptoms are associated with Uremic Syndrome?
- Fatigue
- Malaise
- Pericarditis
- Encephalopathy
119
CKD alone is risk factor for developing what disease?
CVD
120
What group of diseases involves low GFR → secondary hyperparathyroidism?
CKD-Mineral/Bone Disorders (CKD-MBD)
121
CKD-Mineral/Bone Disorders (CKD-MBD) can lead to what condition? What four lab findings are often seen with CKD/MBD?
Secondary hyperparathyroidism
- Hyperkalemia
- Hyperphosphatemia
- Hypocalcemia
- High PTH
122
What medication can be used to treat proteinuric CKD by decreasing albuminuria?
ACE-I/ARBs
123
ACE-I/ARBs are considered _____, but CAN be harmful if used with what two conditions?
ACE-I/ARBs are renoprotective but CAN be harmful if...
- AKI
- Bilateral renal artery stenosis
124
What is the target BP control for CKD WITH proteinuria? What is the target BP control for CKD without proteinuria?
- WITH proteinuria: <130/80
| - Without proteinuria: <140/90
125
What are the two types of dialysis, and what is a complication for each?
- Hemodialysis: hypotension
| - Peritoneal dialysis: peritonitis
126
What treatment is often used for ESRD? BUT what is the TREATMENT OF CHOICE?
Dialysis often used
| - Treatment of choice of ESRD is kidney transplant
127
What two improvements are seen with kidney transplant?
- Improve quality of life
| - Reduce mortality risk
128
What are the three types of Chronic Tubulointerstitial Disease, and what is this a possible cause of?
Chronic Tubulointerstitial Disease can lead to CKD
- Obstructive Uropathy
- Reflux Nephropathy
- Analgesic Nephropathy
129
Which group of diseases involves tubules and interstitium (NOT glomeruli)?
Chronic Tubulointerstitial Disease
130
What two findings characterize Chronic Tubulointerstitial Disease?
- Interstitial scarring
| - Tubular atrophy
131
What two general symptoms/findings are seen with Chronic Tubulointerstitial Disease?
- Polyuria
| - Hyperkalemia
132
What condition involves prolonged/recurrent obstruction of urinary tract → chronic reduction of GFR, and what can this cause/eventually lead to?
Obstructive Uropathy
| - Causes Chronic Tubulointerstitial Disease → CKD
133
What two tests are used to diagnose Obstructive Uropathy, and what is seen with each?
- UA shows sterile pyuria
| - Renal US shows hydronephrosis
134
What condition is a consequence of vesicoureteral reflux (VUR), and what can this cause/eventually lead to?
Reflux Nephropathy
| - Causes Chronic Tubulointerstitial Disease → CKD
135
In what population is Reflux Nephropathy often diagnosed in?
Young children with history of recurrent UTIs +/- HTN
136
What two tests are used to diagnose Reflux Nephropathy?
- Renal US
| - Voiding cystourethrogram (VCUG)
137
What condition involves long-term consumption of analgesics, and what can this cause/eventually lead to?
Analgesic Nephropathy
| - Causes Chronic Tubulointerstitial Disease → CKD
138
How is Analgesic Nephropathy often diagnosed?
Incidental finding of high serum Cr
139
What condition involves NON-inflammatory damage to glomerular capillary wall?
Nephrotic Syndrome
140
Compare proteinuria of Nephritic Syndrome and Nephrotic Syndrome.
- Nephritic: proteinuria <3 g/dL
| - Nephrotic: proteinuria >3.5 g/dL
141
What are the three PRIMARY causes of Nephrotic Syndrome?
- Minimal Change Disease (MCD)
- Membranous Nephropathy (MN)
- Focal Segmental Glomerulosclerosis (FSGS)
142
What is the most common cause of nephrotic syndrome in children?
Minimal Change Disease (MCD)
143
What condition involves sudden onset edema over days/weeks, and what is this a possible cause of?
Minimal Change Disease (MCD)
| - Can cause Nephrotic Syndrome
144
What condition is seen post-URI; NO changes on light microscopy, primarily effects podocytes? What is this a possible cause of?
Minimal Change Disease (MCD)
| - Can cause Nephrotic Syndrome
145
What is one of most common causes of nephrotic syndrome in adults?
Membranous Nephropathy (MN)
146
What condition involves white males age 40+ years; primary = immune-mediated vs. secondary = HBV, autoimmune diseases? What is this a possible cause of?
```
Membranous Nephropathy (MN)
- Can cause Nephrotic Syndrome
```
147
What are you at higher risk of with Membranous Nephropathy (MN)?
Hypercoagulation
148
What is one of most common causes of primary nephrotic syndrome in adults?
Focal Segmental Glomerulosclerosis (FSGS)
149
What condition is often seen in middle-aged AA male, and what is this a possible cause of?
Focal Segmental Glomerulosclerosis (FSGS)
| - Can cause Nephrotic Syndrome
150
What condition involves histologic pattern of kidney injury; sclerosis in parts of 1+ glomerulus (focal)? What is this a possible cause of?
Focal Segmental Glomerulosclerosis (FSGS)
| - Can cause Nephrotic Syndrome
151
What are the two SECONDARY causes of Nephrotic Syndrome?
- Diabetic Nephropathy
| - Amyloidosis
152
What is the most common cause of ESRD in U.S.?
Diabetic Nephropathy
153
What two labs findings are often seen with Diabetic Nephropathy?
- Hyperglycemia
| - Albuminuria >300 mg/d
154
What other condition is commonly associated with Diabetic Nephropathy?
Retinopathy
155
What diagnostic test should be used to diagnose Amyloidosis (causes Nephrotic Syndrome)?
SPEP/UPEP
156
What two symptoms are associated with Nephrotic Syndrome?
- "Foamy urine"
| - Edema
157
What condition involves "foamy urine"?
Nephrotic Syndrome
158
What are two possible complications of Nephrotic Syndrome?
- Hypercoagulability
| - Infection
159
What diagnostic finding is associated with Nephrotic Syndrome?
Oval fat bodies
160
What two things can cause false negative nitrite for UTI?
- Non-nitrate producing organism
| - Frequent urination
161
What two things can cause false positive LE for UTI?
- Vaginal contamination
| - Trichomonas infection
162
What is the most common pathogen of UTI?
Escherichia coli
163
What condition is an infection confined to bladder, and what types of symptoms are seen?
Acute Simple Cystitis
| - No systemic sxs or sxs suggestive of upper UTI ("classic sxs" = dysuria, urinary frequency, urgency)
164
What condition is an infection that extends beyond bladder, and what types of symptoms are seen?
Acute Complicated UTI
| - More systemic sxs like fever, chills, flank pain, CVA tenderness
165
What are the four special populations for UTI?
- Pregnant
- Males
- IC
- Comorbidities
166
What three symptoms are suggestive of Acute Simple Cystitis?
- Dysuria
- Frequency
- Urgency
167
What population may present with atypical sxs with Acute Simple Cystitis, and what are two example symptoms?
Elderly
| - Can present with AMS/confusion, nocturne
168
What four labs are often positive for Acute Simple Cystitis?
- +LE
- +Nitrites
- Pyuria
- Bacteriuria
169
What symptomatic care (medication) can be prescribed to treat Acute Simple Cystitis?
Pyridium
170
How long should Pyridium be prescribed, and why (2)?
Pyridium for 2 days ONLY
| - Can mask sxs, decrease GFR
171
If normal patient (not special population), what three antibiotics can be used to treat Acute Simple Cystitis?
- Nitrofurantoin/Macrobid
- Bactrim
- Fosfomycin/Monurol
172
If pregnant, what three antibiotics can be used to treat Acute Simple Cystitis?
- Augmentin
- Cefpodoxime
- Fosfomycin/Monurol
173
What antibiotic should be avoided if pregnant?
Fluoroquinolones
174
If male (but normal), how does treatment to treat Acute Simple Cystitis change? What three antibiotics are used?
Duration is longer (7 days)
- Nitrofurantoin/Macrobid
- Bactrim
- Fosfomycin/Monurol
175
If IC or comorbidites, how does treatment to treat Acute Simple Cystitis change? What three antibiotics are used?
Duration is much longer (7-14 days)
- Nitrofurantoin/Macrobid
- Bactrim
- Fosfomycin/Monurol
176
Under what condition should a follow up culture be ordered for Acute Simple Cystitis (2)?
ONLY needed if pregnant or symptoms persist post-abx
177
What is an infection of LOWER urinary tract?
Acute Simple Cystitis
178
What is an infection of UPPER urinary tract (ascent of bacteria up ureters from bladder)?
Acute Pyelonephritis
179
What five additional symptoms are seen with Acute Pyelonephritis (not with Acute Simple Cystitis)?
- Fever
- Chills
- Abdominal/flank pain
- N
- V
180
What two physical exam findings are seen with Acute Pyelonephritis?
- Fever
| - CVA tenderness
181
How can you differentiate Acute Simple Cystitis from Acute Pyelonephritis diagnostically?
WBC Casts
182
Is follow up required for Acute Pyelonephritis?
MUST FOLLOW UP IN 48-72 HOURS REGARDLESS OF OP TX
183
If mild/moderate Acute Pyelonephritis, what antibiotics can be used?
Fluoroquinolones (Ciprofloxacin, Levofloxacin)
184
If severe Acute Pyelonephritis, what antibiotics can be used (4)?
IV antibiotics
- Fluoroquinolone
- Extended spectrum Cephalosporin
- Extended spectrum Penicillin
- Carbapenem
185
What four complications are possible with Acute Pyelonephritis?
- Sepsis with shock
- Renal failure
- Scarring/chronic pyelonephritis
- Renal abscess
186
What condition involves LOWER UTI sxs for 6+ weeks, no obvious infection?
Interstitial Cystitis (IC)/Bladder Pain Syndrome (BPS)
187
What condition often coexists with other chronic pain conditions; more common in women?
Interstitial Cystitis (IC)/Bladder Pain Syndrome (BPS)
188
What is the primary symptoms associated with Interstitial Cystitis (IC)/Bladder Pain Syndrome (BPS), and what makes it better AND worse?
Chronic, debilitating pain
- Worse with bladder filling
- Better with voiding
189
What condition involves chronic, debilitating bladder pain worse with bladder filling, relieved with voiding?
Interstitial Cystitis (IC)/Bladder Pain Syndrome (BPS)
190
What condition involves altered urothelium?
Interstitial Cystitis (IC)/Bladder Pain Syndrome (BPS)
191
What condition involves disruption of GAG layer, mast cell activation, neural hypersensitivity?
Interstitial Cystitis (IC)/Bladder Pain Syndrome (BPS)
192
What renal condition is a diagnosis of exclusion?
Interstitial Cystitis (IC)/Bladder Pain Syndrome (BPS)
193
What diagnostic test should be ordered if smoker/smoking history?
Urine cytology
194
What test can be used to support the diagnosis of Interstitial Cystitis (IC)/Bladder Pain Syndrome (BPS)?
Cystoscopy
195
What is the FIRST line treatment for Interstitial Cystitis (IC)/Bladder Pain Syndrome (BPS)?
LIFESTYLE
| - Diet modifications, bladder retraining, exercise, psychotherapy, Pyridium
196
What three medications can be considered as SECOND line treatment for Interstitial Cystitis (IC)/Bladder Pain Syndrome (BPS)?
- Tricyclic Antidepressants (Amitriptyline)
- Pentosan Polysulfate (Elmiron)
- Antihistamines (Hydroxyzine)
197
What condition involves risk factors of 65+, women, obese, parity, prolapse, DM, neuro disease?
Overactive Bladder (OAB)
198
What causes Overactive Bladder (OAB)?
Overactivity of Detrusor muscle
199
What three symptoms are consistent with Overactive Bladder (OAB)?
- Urgency
- Incontinence
- Frequency of small
200
What is the first line treatment for Overactive Bladder (OAB) (3)?
- Kegel exercises
- Lifestyle modifications
- Bladder training
201
What two medications can be considered as SECOND line treatment for Overactive Bladder (OAB)?
- Antimuscarinics
| - Beta3 Agonists
202
What is the most common type of crystal seen with Nephrolithiasis/Ureterolithiasis? What other crystal type is common?
- Calcium oxalate = MOST common
| - Calcium phosphate
203
How can you differentiate uric acid crystals vs. calcium crystals for Nephrolithiasis/Ureterolithiasis?
Uric acid crystals are usually radiolucent (NOT seen on x-ray)
204
What condition involves pain/“renal colic” (flank radiating to groin); hematuria?
Nephrolithiasis/Ureterolithiasis
205
What is the gold standard test for Nephrolithiasis/Ureterolithiasis?
LDCT WITHOUT contrast
206
What two medications are recommended for treatment of Nephrolithiasis/Ureterolithiasis?
- NSAIDs (unless surgery)
| - Alpha-Blocker (Tamsulosin)
207
What size stone should pass spontaneously with Nephrolithiasis/Ureterolithiasis?
Less than or equal to 5 mm
208
Under what five conditions should you refer to urology for Nephrolithiasis/Ureterolithiasis, and which two conditions are URGENT referral?
- >10 mm
- Fail to pass
- Significant obstruction
- Infection = URGENT
- Renal involvement = URGENT
209
What two medications can be considered for prophylaxis treatment of Nephrolithiasis/Ureterolithiasis?
- Allopurinol
| - HCTZ
210
What is the most common benign tumor in men 40-80 years?
Benign Prostatic Hyperplasia (BPH)
211
What condition involves proliferation of tissue in transitional zone?
Benign Prostatic Hyperplasia (BPH)
212
What are four risk factors for Benign Prostatic Hyperplasia (BPH)?
- Type II DM (nocturia)
- Age 60+ years
- Black
- History of 3+ months of bothersome urinary sxs
213
What is the FIRST line treatment for Benign Prostatic Hyperplasia (BPH)?
Behavior modifications
- Avoid caffeine/alcohol/meds
- Fluid restrict before bed or going out
- Double void
214
What is the SECOND line treatment for Benign Prostatic Hyperplasia (BPH)? Give an example.
Alpha-Blockers
- Tamsulosin
- Doxazosin
- Terazosin
215
What is the THIRD line treatment for Benign Prostatic Hyperplasia (BPH)? Give an example.
5-Alpha Reductase Inhibitors
| - Finasteride
216
What is the most common general etiology of Acute Bacterial Prostatitis? What is the alternative?
Often urinary pathogens (i.e. E. coli)
| - Can be STI (gonorrhea, chlamydia)
217
What condition presents with DRE = tender, edema (unlike UTI); leukocytosis, elevated PSA and ESR?
Acute Bacterial Prostatitis
218
What is the recommended treatment for a stable/reliable patient with Acute Bacterial Prostatitis (2)?
- Fluoroquinolone for 6 weeks
OR
- Bactrim for 6 weeks
219
What is the most common cause of Chronic Bacterial Prostatitis?
Recurrent UTI
| - Especially following acute BP
220
How is Chronic Bacterial Prostatitis often diagnosed? What is the gold standard test?
```
Often clinical (DRE and labs often normal)
- Prostatic fluid analysis = gold standard
```
221
What is the recommended treatment for a stable/reliable patient with Chronic Bacterial Prostatitis (2)?
- Fluoroquinolone for at least 6 weeks
OR
- Bactrim for at least 6 weeks
222
What condition involves chronic pelvic pain, voiding difficulties, hematospermia for 3+ months?
Chronic Prostatitis/Chronic Pelvic Pain Syndrome
223
What urinary condition is a diagnosis of exclusion?
Chronic Prostatitis/Chronic Pelvic Pain Syndrome
224
What three medications are considered in treatment of Chronic Prostatitis/Chronic Pelvic Pain Syndrome?
- Alpha-Blockers
- Abx
- 5-Alpha Reductase Inhibitors
225
What is the most common CA in men 60-80 years?
Prostate Cancer
226
What is the 2nd leading cause of CA death in men (death still rare)?
Prostate Cancer
227
What condition involves slow growing malignant neoplasm of adenomatous cells?
Prostate Cancer
228
What scoring system can be used to stage Prostate CA?
Gleason score = based on architectural structure of prostate
| - Also, TMN
229
What is the recommended follow up for a patient with Prostate CA?
Total PSA every 6-12 months for 5 years, then annually
230
What condition involves common in early 40s, increasing with age (worse if meds or comorbidities)?
Erectile Dysfunction (ED)
231
What is the FIRST line treatment for Erectile Dysfunction (ED)? Give an example.
Phosphodiesterase-5 Inhibitors
- Sildenafil
- Vardenafil
232
What are the two types of Urethritis?
- Gonococcal
| - Non-gonococcal (Chlamydia, etc.)
233
What condition involves dysuria and urethral discharge; inflamed meatus?
Urethritis
234
How can you differentiate gonococcal from non-gonococcal Urethritis?
Gonococcal will show polymorphonuclear cells and G- diplococci
- Non-gonococcal does not have the "little balls"
235
What two findings are seen with Gonococcal Urethritis?
- Polymorphonuclear cells
| - G- diplococci
236
What is the recommended treatment for Gonococcal Urethritis (__ + __)?
Ceftriaxone 250 mg IM + Azithromycin 1000 mg x1 dose
237
What is the recommended treatment for Non-gonococcal Urethritis (2)?
- Azithromycin 1 gram orally
OR
- Doxycycline 100mg PO BID x7 days
238
What is often the general etiology of Epididymitis in the young vs. old?
- Young = STI
| - Older = urinary pathogens
239
What condition involves acute, unilateral dull-severe scrotal pain radiating to flank?
Epididymitis
240
What condition does a +Prehn's sign indicate?
Epididymitis
241
What is the recommended treatment for Epididymitis caused by STI (__ + __)?
Ceftriaxone 250mg IM x1 + Doxycycline 100mg BID x10 days
242
What is the recommended treatment for Epididymitis caused by urinary pathogens (2)?
- Levofloxacin 500 mg QID x10 days
OR
- Ofloxacin 300mg BID x10 days
243
What condition involves similar to Epididymitis + involvement of testicle (retrograde infection)?
Epididymoorchitis
244
What is a common etiology of Epididymoorchitis?
MUMPS
245
If Varicocele is seen on the right side, what should be considered?
Pelvic/abdominal malignancy
246
What condition involves “bag of worms”?
Varicocele
247
What condition involves a increase in size with Valsalva, decrease in size with supine/elevated scrotum?
Varicocele
248
What condition has peaks of neonates and post-pubertal boys?
Testicular Torsion
249
What condition involves acute onset scrotal pain (severe/worsening); unilateral, hemi-scrotal swelling?
Testicular Torsion
250
What condition involves Bell-Clapper deformity?
Testicular Torsion
251
What condition involves absent Cremasteric reflex; -Prehn’s sign?
Testicular Torsion
252
What type of urinary CA is most common in males 15-35 years?
Testicular Cancer
253
What is the most common tumor type seen with Testicular Cancer, and what are the two subtypes?
Germ cell tumors
- Non-seminoma
- Seminoma
254
What is a major risk factor associated with Testicular Cancer?
Personal history of testicular CA
| - Also, cryptorchidism
255
What condition involves painless, solid nodule with swelling, inguinal LAD?
Testicular Cancer
256
If a patient has advanced Testicular Cancer, what other two systems may be affected?
- Pulmonary
| - Neuro
257
What condition involves firm/hard/fixed testicle; check for supraclavicular LAD?
Testicular Cancer
258
What three tumor markers may be positive with Testicular Cancer?
- Beta-hCG
- LDH
- AFP
259
What is the recommended treatment for Non-seminoma Testicular Cancer? What about for Seminoma Testicular Cancer?
- Non-seminoma: chemotherapy (NOT sensitive to radiation)
| - Seminoma: radiation
260
What are the three types of groin hernias?
- Inguinal (direct)
- Inguinal (indirect)
- Femoral
261
What type of hernia involves Hesselbach’s triangle?
Direct Inguinal Hernia
262
What type of hernia involves int. inguinal ring → inguinal canal → INTO scrotum?
Indirect Inguinal Hernia
263
What is the most common type of groin hernia?
Indirect Inguinal Hernia
264
What type of groin hernia is most often seen in females?
Femoral Hernia
265
What is the definitive treatment for all three types of groin hernias?
SURGERY
266
What is the second most common urologic malignancy?
Bladder Cancer
267
What is the most common type of Bladder Cancer?
Transitional Cell Carcinoma
268
What risk factor is associated with Bladder Cancer?
Smoking
| - More common in men
269
What condition involves painless hematuria (gross or microscopic)?
Bladder Cancer
270
What is the gold standard test for Bladder Cancer?
Cystourethroscopy
271
What are the four types of Incontinence?
- Urge
- Stress
- Mixed (Urge + Stress)
- Incomplete Emptying Incontinence (Overflow)
272
What condition involves loss of urine proceeded by strong, unexpected urge to void?
Urge Incontinence
273
What condition involves leakage with exertion or Valsalva?
Stress Incontinence
274
What condition involves urgency and exertional leakage?
Mixed Incontinence
275
What condition involves impaired detrusor contractility +/- obstruction; nocturia?
Incomplete Emptying Incontinence (Overflow)
276
What two medications are recommended for treatment of Urge Incontinence? Give an example of each.
Antimuscarinics
- Tolterodine
Alpha-Blockers
- Tamsulosin
277
What medication is recommended for treatment of Incomplete Emptying Incontinence (Overflow)? Give an example.
Alpha-Blockers
| - Tamsulosin
278
What condition might present with glomerulations or Hunner ulcer on cystoscopy?
Interstitial Cystitis (IC)/Bladder Pain Syndrome (BPS)
