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Renal GU and STDs Flashcards

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1
Q

Name two lower UTI differentials

A

urethritis

cystitis

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2
Q

two Upper UTI differentials

A

pylonephritis

renal abscess

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3
Q

What is the most common UTI causing organism in women?

A

e. coli

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4
Q

What is the most common UTI organism in men?

A

proteus species

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5
Q

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

A

UA because UTI has some of the same sypmtoms at BPH

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6
Q

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

A

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

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7
Q

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

A

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

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8
Q

What are two commonly used agents for treatment of UTI?

A

bactrim or cipro

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9
Q

What agent is used for UTI in pregnancy?

A

Amoxicillin and nitrofurantoin

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10
Q

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

A

a full 10 day course

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11
Q

What are symptoms of pylonephritis?

A

flank pain

fever

back pain

N/V

chills

*mental status changes in the elderly

(plus UTI symptoms)

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12
Q

What are common agents to treat upper UTI infection?

A

bactrim

cipro

fluoroquinolones

short course of gentamicin

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13
Q

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

A

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

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14
Q

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

A

acute renal failure

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15
Q

Is acute renal failure reversible?

A

Yes

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16
Q

Name three causes of acute renal failure

A

obstruction

contrast media

obstruction

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17
Q

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

A

chronic renal failure

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18
Q

What is the normal BUN/cr ratio?

A

10:1

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19
Q

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

A

ESRD

end stage renal disease

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20
Q

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

A

renal insufficiency

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21
Q

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

A
  1. serum cr 2-3 times their baseline OR GFR decrease >50%
  2. UOP <0.5ml/kg/hr for >12 hours
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22
Q

What are the AEIOU indications for dialysis?

A

A: acidosis/azotemia

E: electrolyte disturbances

I: intoxication

O: overload (fluid overload)/oliguria

U: uremia (urine in the blood)

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23
Q

How do we treat acute renal failure?

A

determine and Treat the underlying cause

treat symptoms

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24
Q

How do we treat chronic renal failure?

A

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

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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

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