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ctjghjkbgf > Renal (nephro and urology) > Flashcards

Renal (nephro and urology) Flashcards

1
Q

DDx of urinary frequency (list 6)

A

UTI, cystitis, urethritis, (pinworms), appendicitis/pelvic abscess, ovarian torsion, PUV, neurogenic bladder, constipation, pregnancy, unstable bladder, behavioural, ectopic ureter, osmotic diuresis, intrinsic renal parenchymal disease, sickle cell anemia/trait, hypercalciuria, urinary calculi, CAH, hypercalcemia (and hypercalciuria), DI, head injury, drugs, psychogenic

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2
Q

How to diagnose / tx pinworms

A

Diagnose with piece of tape, eggs stick to tape. Tx with albendazole or mebendazole x 1 dose, repeat in 2 weeks.

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3
Q

Findings on microscopy with glomerular causes of hematuria

A

RBC casts, tea or brown colour, protein +2, dysmorphic RBC’s

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4
Q

Glomerular causes of hematuria

A

acute post strep GN, other post infectious GN, IgA nephropathy, Alport syndrome, exercise, familial benign hematuria

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5
Q

Microscopic hematuria: 5 signs suggesting need for more GU investigations.

A

Fever, Edema, Hypertension, Flank Pain, Bruising, Petechiae, Oliguria
Headache, hx of trauma, concern for tumor

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6
Q

2 renal injuries that don’t have hematuria.

A

1) vascular pedicle injury

2) penetrating trauma

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7
Q

Causes of hypoalbuminemia

A
  • Decreased production: liver disease, malnutrition
  • Increased losses: renal (ie. Nephrotic syndrome), GI, skin conditions
  • Cardiac/ increased hydrostatic pressure: CHF, venous obstruction
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8
Q

What is Hoagland sign?

A

bilateral eyelid edema as an early sign of EBV

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9
Q

Causes of rhabdomyolysis

A

o Traumatic: crush injuries, vascular occlusions and lower extremity compartment syndrome
o Non-traumatic causes: extreme exertion, prolonged seizure, malignant hyperthermia, DKA, hypokalemia, hypophosphatemia, metabolic myopathies, NMS, postarrest, infectious, meds (cocaine, ecstacy, amphetamines, statins, colchicine)

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10
Q

Urinalysis findings in rhabdomyolysis

A

UA will show red/brown urine, positive for blood (but no RBC’s – myoglobin instead)

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11
Q

4 Causes of urinary retention In a Girl

A 
●	UTI
●	Constipation
●	Pelvic Tumour
●	Abdominal mass - rhabdomyosarcoma
●	Behavioural/Voluntary
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12
Q

Management of urinary retention?

A 
●	Bladder Scan to confirm
●	Catheterization to decompress urine
●	Massage and warm bath to help her void
●	Treat UTI (abx)
●	Treat Constipation (enema, stool softeners)
●	Urology consult
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13
Q

15 yo male with back pain that is not responsive to analgesics at home. Now coming in because has not peed in 20 hours. 4 DDx

A 
●	Abdominal mass
●	Severe constipation
●	Transverse myelitis
●	Spinal cord injury
●	Discitis/ osteomyelitis of spinal process
●	Kidney stones
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14
Q

Important items on physical exam for HTN

A

Ht, Wt, BMI, vital signs + UL and LL BP, evaluate for end organ damage, CV (femoral pulses for CoA), neuro, fundi, underlying cause

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15
Q

Investigations to do in severe HTN

A
  1. Laboratory studies:
    a. Serum: CBC, electrolytes, glucose, urea, creatinine
    b. Urine: Urinalysis, toxicology screen if indicated
  2. Imaging studies: ECG (LVH), CXR, +/-echocardiogram if cardiac pathology suspected, CT head for severe neurologic dysfunction, Renal US with doppler for suspected renal artery stenosis
  3. Additional studies: Consider plasma renin (before initiating therapy), urinary catecholamines, TSH, T4 as indicated
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16
Q

HTN emergency - what 3 tests to do?

A

A) Labs (Renal function tests (BUN + creatinine), Electrolyte panel (R/O hyperkalemia, ?hyponatremia), CBC/diff
B) Urines: Urine analysis dip + microscopy (for proteinuria +/- hematuria), urine culture,
C) CXR/ECG +/- echo

+/- CT head

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17
Q

HTN emergency - What 2 medications would you use for management?

A

Labetalol/Nicardipine/Nitroprusside as IV medication that you can titrate

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18
Q

Def of HTN emergency

A

Significantly elevated BP with evidence of severe symptoms or secondary organ injury (most commonly brain, eyes, heart, kidneys);

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19
Q

What are 6 common causes of secondary hypertension in a child < 1year

A
  • Renovascular disease
  • Congenital renal anomalies
  • Coarctation of the aorta
  • Renal vein thrombosis
  • CAH
  • BPD
  • Renal parenchymal d/o
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20
Q

2 Drugs to treat hypertensive emergency: Name them and 1 adverse effect or contraindication

A

IV labetalol – CI: asthma, BPD, heart failure
IV nicardipine – can cause reflex tachycardia
IV nitroprusside - methemoglobinemia, cyanide toxicity

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21
Q

What are 6 clinical findings of hypertensive emergency, not including labs

A
  • BP at stage 2 or >180/120 in adolescent
  • Neurologic symptoms: lethargy, coma, seizure
  • Eyes: papilledema, retinal hemorrhages
  • Cardiac: heart failure, peripheral edema
  • Renal: oliguria, anuria
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22
Q

DDx of painful scrotal swelling

A
  • testicular torsion
  • torsion of appendix testis
  • inguinal hernia (incarcerated, strangulated)
  • epidydimitis
  • orchitis
  • lymphadenitis
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23
Q

Complications of undescended testicle if not treated surgically

A

testicular underdevelopment, infertility, malignancy, hernia, torsion, increased risk of traumatic injury

Need Orchidopexy by 1 year of age

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24
Q

DDx of painless scrotal swelling

A
  • hydrocele
  • varicocele
  • hernia
  • spermatocele
  • tumor
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25
Q

Red flags in pediatric varicocele

A

right varicocele, pre-pubertal

If occurs on the right (connects directly to IVC) –> worry about abdominal mass and IVC obstruction, renal vein thrombosis (get abdo US)

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26
Q

Risk factors for UTI in infants

A
  • Female < 12 mo, male < 6 months
  • uncircumcised
  • non-black
  • fever > 39, > 2 days, no alternate source
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27
Q

When to start empiric tx for UTI (choosing wisely)?

A

dipstick + nitrite OR LE 2/3+; standard UA >5 WBC/hpf AND bacteria

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28
Q

When to treat UTI with IV antibiotics

A

< 6 mo, mod/severe dehydration, inability to tolerate PO

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29
Q

Physical exam findings in dehydration

A

weight loss, HR, pulse quality, mental status, mucous membranes, skin turgor, urine output

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30
Q

Categories of dehydration (by %) and their characteristics

A

Mild (3-5% volume loss): minimal or absent signs/symptoms

Moderate (6-9%): tachycardia, orthostatic hypotension, dry mucous membranes, prolonged cap refill

Severe (10%+): shock (hypotension, weak pulses, mottling)

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31
Q

Work-up of new suspected glomerulonephritis?

A

o Urine analysis and microscopy to confirm RBCs, casts
o Urine culture
o Urine protein, calcium, creatinine
o Bloodwork: CBC, lytes, BUN, creatinine, Ca, albumin, protein, ASOT/antiDNAseB, ANA, C3, C4
o Renal ultrasound

32
Q

Criteria for diagnosis of nephrotic syndrome?

A

PALE:
o Persistent heavy proteinuria (mainly albuminuria) > 50 mg/kg/day
o Hypoproteinemia (serum albumin <25-30)
o Hypercholesterolemia (lipids)(>250 mg/dL): hypoproteinemia stimulates hepatic lipoprotein synthesis and decreases metabolism of lipoproteins
o Edema

33
Q

Complications of nephrotic syndrome?

A

serious bacterial infection (SBP, encapsulated organisms), thrombosis (esp. renal vein thrombosis), complications of steroids

34
Q

Atypical/concerning features in nephrotic syndrome?

A

age <12m or >12y, sustained serum creatinine elevation, HTN, gross hematuria, low C3/C4, evidence of specific infection (HBV, HCV, HIV), unresponsive to steroids x 4 weeks

35
Q

List 3 nephrotoxic meds

A

NSAIDs, ACE inhibitors, tacrolimus, cisplatin, ifosfamide

36
Q

Dialysis indications

A 
(AEIOU):
▪	Acidosis
▪	Electrolyte imbalance
▪	Ingestion
▪	Overload (volume)
▪	Uremia
37
Q

What is the 4-point dehydration scale?

A

1) cap refill > 2 sec; 2) dry mucous membranes; 3) no tears; 4) ill appearance (4 features = severe dehydration)

38
Q

When are Oral rehydration solutions contraindicated?

A

ORS contraindicated for severe dehydration, vomiting, altered mental status (risk of aspiration), ileus, short gut/ malabsorption

39
Q

When is zofran recommended? What dose?

A

Single dose of ondansetron in children > 6 months with vomiting (8-15 kg: 2 mg; 15-30 kg: 4 mg: > 30 kg: 8 mg)

40
Q

Symptoms of hyponatremia?

A

generally if Na<125: neurologic (cerebral edema) – nausea, malaise, headache, altered mental status, lethargy, ataxia, seizures, coma, respiratory depression

41
Q

What are 5 laboratory tests to determine the cause of hyponatremia?

A 
●	Serum electrolytes
●	Osmolality
●	Cr/BUN
●	Urine osmolality
●	Urine sodium (and calculate FENa)
●	Urine analysis
42
Q

EKG changes seen with hyperkalemia?

A

initial ECG changes narrow/peaked T waves, shortened QTc then prolongation of PR interval and widening of QRS, then loss of P wave amplitude and eventual “sine wave” pattern where QRS merges with T wave then V fib

43
Q

Medications associated with hyperkalemia?

A

NSAIDS, ACEI, angiotensin receptor II blocker, spironolactone, tacrolimus, cyclosporine, propranolol (beta blocker), digitalis

44
Q

Tx of hyperkalemia?

A
  1. Stabilize cardiac membranes (calcium)
  2. Shift K into intracellular space (insulin/glucose, Ventolin, bicarb if acidemic)
  3. Elimination (kyaxelate, Lasix, dialysis)
45
Q

Symptoms of hypocalcemia

A

o Acute: neuromuscular instability or tetany
o Mild: paresthesias perioral/ hands and feet, muscle cramps
o Severe: seizure, laryngospasm, bronchospasm

46
Q

What are Chvostek and Trousseau signs?

A

o Trousseau’s sign: carpopedal spasm with inflation of a BP cuff for >3 minutes
o Chvostek’s sign: contraction of the ipsilateral facial muscle induced by tapping of the facial nerve in front of the ear (present in 10% of normal people)

47
Q

What ECG change is seen with hypocalcemia?

A

Prolonged QTc

48
Q

Name 4 indications for IV calcium

A 
●	Hyperkalemia with ECG changes
●	Calcium channel blocker overdose
●	Beta blocker overdose – really?
●	Hypocalcemia with seizures or tetany or prolonged QTc
●	Hypermagnesemia
49
Q

Symptoms of hypercalcemia/ hyperPTH?

A

bones, stones, groans, psychiatric overtones:

o Moderate: anorexia, irritability, abdominal pain, constipation and weakness
o Severe: progressive weakness, confusion, seizures and coma
o Polyuria can be present

50
Q

How to calculate anion gap?

A

Na – (Cl + HCO3)

Normal AG (8-12)= diarrhea, RTA

High AG (> 14-16) = MUDPILES

51
Q

How to calculate osmolar gap?

A

Serum osmolarity = 2 x Na + (glucose + BUN +/- ETOH)

Osmolar gap = Osm (measured) – Osm (calc)

52
Q

Kid with chronic renal failure and epigastric pain/vomiting - 8 clinical/labs/investigations that you want to perform in the ED

A 
Clinical
●	Blood Pressure
●	HR
●	Weight 
●	Volume status 
Tests:
●	CBC and diff
●	Electrolytes (Na, K, Cl)
●	Renal function (Cr, BUN) – GFR by Schwartz formula
●	Extended electrolytes (Ca, Mg, PO4)
●	Urine analysis 
●	Renal ultrasound
53
Q

HUS triad?

A

Coombs negative hemolytic anemia (MAHA) + thrombocytopenia + AKI

54
Q

Lab findings in HUS?

A

fragmented erythrocytes, schistocytes, helmet cells, inc. retic count, inc LDH, dec haptoglobin, normal INR/PTT, DAT negative (in typical HUS)

55
Q

TTP (Thrombotic Thrombocytopenic Purpura): 5 Features

A
  1. Thrombocytopenia
  2. Microangiopathic hemolytic anemia (MAHA)
  3. Neurologic symptoms
  4. Kidney failure
  5. Fever
56
Q

How to diagnose HSP?

A

Diagnosis is clinical
o Obtain UA on first presentation
o If normal – no need for renal function or labs

57
Q

Initial work-up for kidney stones

A
  • urinalysis
  • urine cx
  • labs: creat, urea, extended electrolytes
  • consider imaging: RUB US, KUB xray, CT 2nd line
58
Q

Tx of renal stone

A

o Analgesia: NSAIDs and opioids
o Hydration: IV fluids
o IV antibiotics: cefotaxime (if infected stone)
o Alpha adrenergic blockers: e.g. tamsulosin facilitate stone passage
o Urology consult for admission/stone removal

59
Q

2 complications of stones

A

o Acute kidney injury - obstructive
o Hydronephrosis
o Sepsis

60
Q

2 alternate diagnoses for kidney stones

A

o Pyelonephritis
o Trauma
o Renal / perinephric abscess
o Renal mass

61
Q

Management of symptomatic phimosis

A

betamethasone 0.05% BID x6 weeks, instruct the foreskin as far back as it will go and then apply a small amount

62
Q

Complications of balanitis?

A

true phimosis (from scarring) –> urinary obstruction

63
Q

What are 2 causes of balanitis

A

Poor hygiene
Local trauma
Bacterial infection

64
Q

Management of balanitis?

A
  • Antibiotics

- Other mgmt: po abx, warm soaks → if phimosis or recurrent infx then circumcision

65
Q

2 yo male presenting with balanoposthitis.

What 2 features that would make you refer to urology?

A

acute urinary obstruction, prolonged/refractory single course, recurrent +/- phimosis

66
Q

3 causes of priapism in a 6-year-old?

A 
●	Trauma
●	Leukemic infiltration
●	Sickle cell disease
●	ingestion sildenafil
●	spinal shock
67
Q

Treatment of priapism

A

● Treatment: urgency based on time since onset + symptoms (pain = indication)
● Irrigation of the corporal bodies with saline in combination with vasoactive substances (e.g. phenylephrine)
● Urology consultation
o If SCD: add hydration + O2 + analgesia

68
Q

Causes of epidydimitis

A

o If sexually active: chlamydia, Neisseria gonorrhea, e coli, mycobacterium, viruses
o If HIV infected: mycobacterium, CMV, cryptococcus *TB!
o Pre-pubertal: viral, chemical irritant, or idiopathic most common (rare – r/o structural abnormalities of the urinary tract)

69
Q

What is Prehn sign?

A

Elevation of the testicle may relieve pain in epididymitis

70
Q

When does ischemia begin in testicular torsion?

A

ischemia after 6 hours (50% by 12 hours, 10% salvage rate by 24 hours)

71
Q

Name 3 symptoms of testicular torsion

A

■ Acute onset testicular pain (often waking up from sleep)
■ Presence of nausea/vomiting
■ Severe pain not improved by any position
■ Sudden enlargement + redness of the hemiscrotum (newborn)

72
Q

Name 4 physical exam findings of testicular torsion

A 
Enlarged + swollen hemiscrotum
Significant tenderness
Loss of cremasteric reflex
Horizontal lie of the affected testis
Hard testicle, high riding testicle
73
Q

Tx of urethral prolapse

A

Tx: estrogen cream, sitz baths, excision of prolapsed mucosa if recurrent

74
Q

Tx of labial adhesions

A

observation if asymptomatic as resolve by puberty. Topical estrogen cream (Premarin 0.1% BUD for 4-6 weeks) and petroleum jelly

75
Q

What are three complications of not surgically correcting a testicular trauma?

A
  • Ischemic necrosis
  • Secondary infections
  • Disruption of testicular function
  • torsion
76
Q

4 ways to manage zipper injury of foreskin

A
  • If fastener is not involved then just cut the cloth of the zipper
  • Apply mineral oil for 10-15 minutes followed by traction
  • Cut the median bar of fastener with wire cutters, bone cutters or a mini hacksaw
  • Place the thin blade of a flathead screwdriver between the faceplates on the side in which the tissue is not entrapped
  • Local anesthesia and thin unzip over the entrapped area
77
Q

2 positions for genital examination

A

frog-leg or knee to chest position

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