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Flashcards in Renal GU and STDs Deck (75):
1

Name two lower UTI differentials

urethritis

cystitis

2

two Upper UTI differentials

pylonephritis

renal abscess

3

What is the most common UTI causing organism in women?

e. coli

4

What is the most common UTI organism in men?

proteus species

5

What is the first test you would order in a man who had BPH symptom complaints?

UA because UTI has some of the same sypmtoms at BPH

6

The presence of nitrates by dipstick is a very specific but not very sensitive test for bacteruria.   

So it shows better that they don't have it than if they do have it.

7

Esterase detection is very sensitive for UTI, that means if it is positive________.

If it is very sensitive it means if it is positive, most likely they do have a UTI.

8

What are two commonly used agents for treatment of UTI?

bactrim or cipro

 

9

What agent is used for UTI in pregnancy?

Amoxicillin and nitrofurantoin

10

How many days of abx therapy does a pregnant woman get for UTI?

a full 10 day course

11

What are symptoms of pylonephritis?

flank pain

fever

back pain

N/V

chills

*mental status changes in the elderly

(plus UTI symptoms)

12

What are common agents to treat upper UTI infection?

bactrim

cipro

fluoroquinolones

short course of gentamicin

13

When using bactrim or cipro to treat pylonephritis, how does the medication regimen change?

the duration changes, it is long, 14 days to 6 weeks

14

Sudden change, BUN out of proportion to creatinine, often due to obsruction, acute tubular necrosis, or contrast media.

acute renal failure

15

Is acute renal failure reversible?

Yes

16

Name three causes of acute renal failure

obstruction

contrast media

obstruction

17

Steady increase in BUN/creatinine, progressive over time from months to years, intrinsic kidney damage, not reversable but we can slow the progression

chronic renal failure

18

What is the normal BUN/cr ratio?

10:1

19

How would you categorize a patient with 10% or less of functioning nephrons, with complete loss of kidney function >3 months, who requires dialysis?

ESRD 

end stage renal disease

20

If you had a patient with 75% nephron loss and a double in the baseline creatinine, how would you classify their renal function?

renal insufficiency

21

According to the RIFLE criteria, to classify a patient with acute kidney injury (AKI) they must have:

1. serum cr 2-3 times their baseline OR GFR decrease >50%

2. UOP <0.5ml/kg/hr for >12 hours

22

What are the AEIOU indications for dialysis?

A: acidosis/azotemia

E: electrolyte disturbances

I: intoxication

O: overload (fluid overload)/oliguria

U: uremia (urine in the blood)

23

How do we treat acute renal failure?

determine and Treat the underlying cause

treat symptoms

24

How do we treat chronic renal failure?

slow progression of the chronic renal failure by:

treating HTN and DM if applicable

low protein diet

modify medications that maybe contributing to renal failure

25

How do you treat azotemia?

with renal replacement therapy (dialysis)

26

What type of HTN medication would you consider for a patient with chronic renal failure?

ACE inhibitor

27

Three catagories of causes of acute renal failure

pre-renal

intrarenal

post-renal

28

According to Barkley, what catagory of cause of acute renal failure is reversible by treating the underlying cause?

prerenal

29

Name three causes of prerenal failure?

burns

dehydration

hemorrhage

30

What are two causes of intrarenal (or intrinsic) renal failure?

The use of nephrotoxic drugs (i.e. gentamicin)

mismatched blood transfusions

allergic reactions (contrast media)

 

31

What are causes of post-renal failure?

mechanical and functiononal causes

renal stone

obstructed foley

32

If a patient has BUN/Cr ratio >10:1, what type of renal failure would you consider?

prerenal

33

If a patient has BUN/cr ratio 10:1, what two types of renal failure would you consider?

intrarenal (intrinsic)

or 

post-renal

34

Would the urine specific gravity of a patient in prerenal failure be high or low?

high

>1.015

35

In prerenal failure what is the FENA (fractional excretion of sodium)?

<1

36

In intra and post renal failure what is the FENA (fractional excretion of sodium)?

>3

37

How do we treat prerenal failure?

volume, increase BP if necessary

38

How do we treat intrarenal failure?

decrease use of nephrotoxic drugs

renal replacement therapy if needed (dialysis)

39

How do we treat post-renal failure?

remove the obstruction

40

What is the most common type of kidney stone?

calcium stones

41

What are the four types of kidney stone?

calcium

uric acid (more common in men)

struvite (more common in women)

cysteine (difficult to treat)

 

42

What is Prehn's test and what is it used to do distinguish?

Prehn's test is done by elevating the scrotum

to distinguish epidydimitis from testicular torsion

According to Prehn's sign, the physical lifting of the testicles relieves the pain of epididymitis but not pain caused by testicular torsion

43

Negative Prehn's sign indicates no pain relief with lifting the affected testicle, which points towards the diagnosis of ____________ which is a surgical emergency and must be relieved within 6 hours.

testicular torsion

44

What are three causes of an abnormal PSA?

prostatitis

BPH

prostate cancer

45

What is an abnormal PSA level?

They are based on age

but

>4 is abnormal

46

Management of BPH includes avoiding medications that make symptoms worse including:

OTC for common cold and allergies

antihistamines

decongestants

antidepressants

antipsychotics

 

47

The medication class that is the standard of care for BPH:

alpha blockers

-osins

tamulosin (flomax)

48

PSA for prostate cancer is not a very sensitive test,

this means:

40% of men who actually have prostate CA may have a normal PSA 

49

The 5 alpha reductase inhibitors treat BPH by:

actually shrinking the prostate

example: finasteride (proscar)

50

If a patient has BPH symptoms refractory to the -osins and 5 alpha reductase inhibitors they may consider:

TURP/TUNA

51

If a woman comes in with green vaginal discharge consider:

gonerhhea

52

Gonerrhea is a bacterial infection that can be asymptomatic or associated with discharge/dysurea and can be treated with

ceftriaxone/rocephin 250mg IM

53

Name 5 conditions that have to be reported to the health department in most states:

Gonorrhea

Chlamydia

Syphillis

 

HIV

TB

54

What type of bacterial STD presents with a painless indurated chancre 4 weeks after exposure?

syphilis

55

Stages of syphilis

1. painless chancre

2. flulike prodrome with macropapular rash on palms hands and soles feet

3. tertiary syphilis: cardiac or CNS involement (neurosyphilis)

*latent syphilis = asymptomatic

 

56

What is the treatment for syphilis?

PCN G

57

What is treatment for syphilis in a patient who is allergic to PCN?

doxycycline

58

What bacterial STD can be asymptomatic or cause dysurea and dyspareunia in women, dull testicular pain, is the most common in the US? 

chlamydia

59

Name 4 differentials for dyspareunia:

chlamydia

PID

menopause

trichomaniasis

60

What is the medication for treatment of chlamydia?

azithromycin 1g PO x1

61

What viral recurrent STD hurts, has a painful prodrome, has no treatment to cure?

genital herpes

62

What drug is used to suppress herpes outbreaks and is used to decrease asymptomatic transmission of herpes?

valacyclovir (valtrex)

63

About 10% of people with this incurable virus is shed intermittantly all the time and therefore can be spread even when the patient is asymptomatic

herpes

64

Malodorous frothy vaginal discharge, dyspareunia, STD, strawberry patches on the cervix and vagina  

trichomoniasis

65

strong vaginal odor, Fish like odor, watery grey discharge, vaginal spotting (not an STD)

BV

bacterial vaginosis

66

thick white curd like discharge, vulvovaginal erythema and pruritis, not an STD 

candida

67

Clue cells are found in:

bacterial vaginosis (BV)

68

Both trich and BV can be treated with:

METROnidazole (antibiotic)

69

Pharmacologic treatment of vaginal candida

MICONazole (antifungal)

70

Name three normal physiologic renal changes as people age

diminished renal blood flow (up to 10% per decade after age 30-40)

 

kidneys decrease in size

GFR decreases 10% per decade after 30

impaired ability to retain sodium which leads to dehydration

bladder tone/elasticity decreased

increased nocturia

decreased drug clearance---> increased risk for adverse drug reaction/increase drug clearance

 

 

71

Incontinence is never normal at any age, in an older patient with new incontinence consider:

UTI

72

Serum cr is the best indicator of renal function in all patients, but in elderly consider

creatinine clearance, as it takes into consideration age

73

The most common clinical illness of adults over the age 65 is:

UTI

74

In the elderly who present with weakness, lethary, confusion, urinary urgency, frequency, incontinence, consider this diagnosis

UTI

75