Test 4 Flashcards
1
Q
anaphylaxis pathophysiology
A
bronchoconstriction, coronary vasoconstriction, peripheral vasodilation
2
Q
First diagnostics for anaphylactic reaction
A
pulse ox and EKG
3
Q
epinephrine works on
A
alpha and beta adrenergic agonist receptors
4
Q
epinephrine dosing for adults
A
0.2-0.5 mg IM, repeat every 5-15 min with max dose of 1 mg
5
Q
epinephrine dosing for children
A
0.01 mg/kg IM repeat every 20 min- 4 hours with max dose of 0.5 mg
6
Q
preferred injection site for epinephrine
A
vastus lateralis
7
Q
other medications that can be used for anaphylaxis
A
diphenhydramine, beta2 agonists
8
Q
delayed reaction to insect bites can occur
A
10-14 days after bite with fever, malaise, rash, lymphadenopathy
9
Q
Local wound care for insect bites
A
removal of stinger, ice packs, anithistamines, topical steroids, NSAIDs, atbx if needed
10
Q
There people should be given a medical warning tag, epi pen, and referral for venom immunotherapy
A
anaphylactic reaction to bees or wasps
11
Q
common types of spider bites
A
brown recluse or black widow
12
Q
Commonly found in the central Midwest south to the Gulf of Mexico. They travel in boxes and packages. They are also found in warm, dry areas such as abandoned buildings, woodpiles, and cellars
A
brown recluse spider
13
Q
bite is usually painless with a mild erythematous lesion that may either heal spontaneously or become necrotic
A
brown recluse
14
Q
healing time for brown recluse bites
A
6 weeks to 4 months
15
Q
systemic symptoms that may occur within 24-48 hours of brown recluse spider bite
A
fever, chills, N/V, myalgias
16
Q
treatment for brown recluse spider bite
A
no medication or antivenom;
tetanus prophylaxis
analgesics
17
Q
Most venomous spider bite
A
female black widow
18
Q
It is most common in the South and West. They tend to live in basements, gardens, woodpiles, and garages.
A
black widow spider
19
Q
The bite is mildly to moderately painful with erythema, swelling, and muscle cramps beginning within 30 minutes to 12 hours.
A
black widow spider
20
Q
bite from black widow can mimic
A
acute abdomen/peritonitis
21
Q
complication of black widow bite
A
hypertension
22
Q
black widow bite is fatal in
A
children and elderly
23
Q
treatment for black widow bite
A
wound care,
tetanus prophylaxis,
analgesics,
antivenom is only indicated for severe bite b/c of risk of anaphylaxis
24
Q
antivenom is only available for this kind of spider bite
A
black widow
25
venomous snakes includ
pit vipers and coral snakes
26
most snake bites occur between
april and october
27
venomous rattlesnakes and coral snakes have
fangs
28
the presentation of no envenomation from snake is
minimal pain and swelling
29
Minimum envenomation from snake presents with
local swelling less than 6 in with no systemic symptoms
30
Moderate envenomation from snake presents with
local swelling of 6-12 in with systemic s/s
31
Coral snake bites resemble
scratch marks and are painful
32
presenting s/s of coral snake bites
neurologic: tremor, dysarthia, dysphagia, diplopia
33
physical exam for all spider bites
```
ABCs,
vitas,
examination of bite and extent to envenomation,
tissue damage,
neuro exam
```
34
diagnostics for snake bite
CBC, CMP, coags, UA, ECG
35
Management for snake bites
Go to ER for antivenom,
immobilize and elevate extremity ,
observe respiratory status
36
management for scorpion bites
supportive care
37
teaching to avoid snake bites
walk with stick tapping ahead;
wear loose, long pants with thick boots,
shine a flashlight
38
atbx is recommended for these kinds of bites
hand and cat bites. Treat with Augementin
39
treatment for human or dog bites
Augmentin or clindamycin can be given prophylactically, must be given within 12 hours of bite
40
common carriers of rabies virus
raccoons, bats, skunks, foxes
41
most common bacteria from human bites
staph aureus
42
a bite history includes
time of bite, rabies vaccination of animal, current immunization status, hx of splenectomy or liver disease
43
assess for this with any bite
compartment syndrome: paresthesias, pain, pallor, paralysis
44
Management for any kind of bite
irrigate with at least 150 mL of normal saline,
| debride tissue, clots, foreign bodies
45
Wounds involving the hand or foot should be
elevated for 1-3 days
46
treatment for infected bites
Augmentin 500 mg tid x 5-7 days;
clindamycin + doxycycline;
TMP/SMZ;
ciprofloxacin
47
can assist in the diagnosis of corneal abrasion
fluorescein dye; abrasion appears as a bright green area
48
treatment for corneal abrasion
erythromycin or Polysporin ointment, oral analgesics
49
when to refer for corneal abrasion
if foreign body cannot be easily removed by a cotton tip applicator
50
most common symptom of corneal abrasion
sever eye pain
51
risk factors for epistaxis
nasal trauma, rhinitis, drying of mucosa from low humidity, deviation of septum, alcohol, anticoagulant meds
52
Most nosebleeds occur from the
anterior plexus (Kiesselbach's plexus)
53
initial management of epistaxis
sit straight up, tilt head forward, apply firm pressure to anterior aspect of nose for 15 min
54
medication for epistaxis
phenylephrine 0.125% 1-2 sprays that acts as a vasoconstrictor, silver nitrate
55
When to refer for epistaxis
bleeding does not resolve in 15 min
56
teaching for epistaxis
avoid ASA, vigorous exercise, hot/spicy foods for a week
57
GCS variables
eye opening, motor response, verbal response
58
immediate ER referral for head trauma with
```
AMS;
paralysis or paresthesia;
Raccoon's sign;
Battle's sign;
blood in external auditory canal
```
59
in elderly, the first sign of head trauma is
confusion, change in behavior
60
The neuro exam for head injury should include
pupillary response, EOM, Romberg test, gait, finger-to-nose test, memory, and concentration.
61
diagnostic for head injury
cervical x-ray, head CT,
| CBC, CMP, UA, ABG, coags
62
immediate treatment for head injury
ABCs,
cervical spine stabilization,
assess GCS
63
high risk patients for heat-related mortalities
those less than 10 and older than 50, those with underlying heart/lung disease or diabetes
64
quick method to determine TBSA
back of the hand is 1% TBSA
65
Only involves the epidermis
first-degree
66
involves the epidermis and portions of the dermis
second-degree (partial thickness)
67
may look like first degree burns initially, but may show blistering 12-24 hours later. May present as dull or glossy with pink, red, or white pigmentation. Heal spontaneously in less than 3 weeks.
superficial partial-thickness burn
68
extend into the lower layers of the dermis and can cause scar formation. They usually heal in 3-9 weeks. However, they can cause hypertropic scarring and impaired joint function. These burns are best treated by excision and grafting.
Deep partial thickness
69
Involve all layers of the dermis and often underlying adipose tissue
third-degree (full-thickness)
70
Area appears matte with eschar
third-degree
71
Treatment for mild burns
irrigate with cool tap water, apply thin layer or antimicrobial (sulfadiazine), cover with nonadherant
72
Management of intact blisters in burns
Do not rupture as they maintain protection
73
treatment for moderate burns
irrigate with NS, chlorhexidine, debrided, cover with antimircobial, cover with nonadherant.
74
these kinds of dressings are preferred because they promote re-epithelialization
moist
75
burns that should be referred
partial-thickness burns greater than 10% TBSA;
Burns on face, hands, feet, genitalia, or major joints;
electrical/chemical burns
76
immediate referral to a plastic surgeon for
hand and face wounds
77
wounds involve the epidermis and dermis and may extend through the subcutaneous tissue into muscle and bone
full thickness wounds
78
diagnostics for lacerations
x-ray to identify bone/tendon involvement;
MRI to r/o osteomyelitis;
CBC
79
assess this with all lacerations
vascular, neurologic, and musculoskeletal function
80
wounds with smooth edges that is not grossly contaminated can be
approximated with steri-strips
81
These kinds of wounds should NOT be closed
crush injuries, bites to hand and feet, cat/human bites, puncture wounds, wounds more than 12 hours old (24 for face)
82
Should be administered if Tdap status is unknown or if patients has not completed 3 injections
Td and tetanus immune globulin
83
Td can be given if Tdap has been given within
5 years
84
these wounds do not need tetanus shot
less than 6 hours old
85
suggested suture size for scalp, trunk, arms, and legs is size
4-5
86
suggested suture removal for scalp
7-14 days
87
suggested suture removal for trunk and upper extremities
7 days
88
wounds that require atbx therapy
wounds more than 8 hours old;
crushing injuries;
wounds in patients with diabetes
89
infected wounds can be treated with
TMP/SMZ DS 160/800 bid or clindamycin 300-450 mg tid
90
acromegaly results from excessive secretion of
growth hormone and insulin-like growth factor (IGF-1)
91
most common cause of acromegaly is
adenoma of the anterior pituitary
92
feedback of GH hormone
GHRH and somatostatin secreted from hypothalamus --> GHRH stimulates GH secretion; somatostatin inhibits GH secretion
93
factors that affect GH secretion
sleep, stress, meals, aging
94
Manifested as excessive bone and soft tissue growth
acromegaly
95
common s/s of acromegaly
facial puffiness, enlarged jaw, swelling of hands and feet, hirsuitism
96
onset of acromegaly is
slow, about 12 years
97
diagnostics of acromegaly
IGF-1 is a direct indicator of GH levels, oral glucose tolerance test, MRI of pituitary gland
98
oral glucose tolerance test in those with acromegaly
oral glucose does not suppress GH secretion as it normally should.
99
complications of acromegaly
diabetes, HTN, sleep apnea, colon cancer
100
This disease has a high risk of colon cancer
acromegaly
101
feedback of adrenal glands
hypothalamus secretes CRH--> pituitary gland secretes ACTH --> adrenal glands secrete cortisol, aldosterone, and androgens
102
most common manifestation of adrenal crisis is
hypotension
103
primary adrenal insufficiency most commonly presents with
shock, abd tenderness, fever
104
in primary adrenal insufficiency this is NOT common
hypoglycemia
105
when adrenal glands produce too little cortisol (adrenal cortical hypofunction)
Addison's disease
106
s/s of addison's disease
chronic malaise, weight loss, abd pain, muscle cramps, hyperpigmentation, salt craving
107
Addison's disease is characterized as
low glucocorticoids, mineralcorticoids, and androgens
108
Complication of Addison's disease
adrenal crisis d/t low mineralcorticoids
109
Diagnostics of Addison's disease
low levels of cortisol; high ACTH
110
when adrenal glands produce too much cortisol (adrenal cortical hyperfunction)
Cushing's disease
111
common cause of Cushing's
long-term use of steroids suppress ACTH suppression from anterior pituitary
112
when steroids can caused HPA suppression and Cushing's
more than 15 mg/day for more than 3 weeks
113
s/s of cushing's
weight gain, loss of menses, HTN, glucose intolerance, insomnia, "moon face", "buffalo hump", muscle wasting, hirsuitism, striae
114
diagnostic for Cushing's
elevated cortisol in 24-hour urine collection
115
treatment for Cushing's
daily ketoconazole; it competes with steroids
116
A catecholamine-secreting tumor of chromaffin cells, mostly found in the adrenal medulla.
pheochromocytoma
117
pheochromocytoma causes an abnormal production of
epinephrine and norepinephrine
118
symptoms of pheochromocytoma are
headache, sweating, tachycardia, HTN
119
episodes of pheochromocytoma
episodic, last 15-30 minutes, precipitated by position change, Valsalvia, exercise, anxiety
120
risk factor for pheochromocytoma
family hx
121
diagnosis of pheochromocytoma
high levels of metanephrines and catecholamines in 24-hour urine collection
122
most tumors in pheochromocytoma are found in
abdomen or pelvis
123
most common symptom of primary hyperparathyroidism is
hypercalcemia
124
the kidney's role in calcium and phosphorus balance
PTH hormone causes kidneys to reabsorb calcium and excrete phosphorous
125
primary hyperparathyroidism is the inappropriate secretion of PTH in the setting of
hypercalcemia
126
primary hyperparathyroidism is mostly caused by
parathyroid adenoma
127
Excess PTH effect on the bone
increases release of calcium and phosphorus from the bone, causing weak bones
128
Excess PTH effect on the kidney
increase calcium resorption and phosphorus excretion; eventually causing nephrolithiasis
129
s/s of primary hyperparathyroidism
weakness, fatigue, anxiety, HTN, CAD, short QT interval, kidney stones, hyporeflexia
130
band keratopathy, a white cloudiness at the nasal and temporal borders of the cornea is seen in
primary hyperparathyroidism
131
diagnostics for primary hyperparathyroidism
PTH, serum calcium, albumin, and vitamin D, fasting phosphorus;
Bone mineral density of distal radius;
renal US;
24-hour urine collection for calcium and creatinine
132
complications of primary hyperparathyroidism
osteoporosis, nephrolithiasis, CVD
133
criteria for parathyroidectomy
age less than 50;
serum calcium greater than normal;
GFR less than 60;
Tscore less than -2.5
134
management of primary hyperparathyroidism
monitor calcium and creatinine annually; bone density every 1-2 years; keep vitamin D > 20 ng/mL;
weight bearing activities;
adequate fluid intake
135
hypercalcemia is serum calcium greater than
5.3 mg/dL
136
PTH dependent hypercalcemia is d/t
primary hyperparathyroidism, the parathyroid is nonsuppressed.
137
hypocalcemia is serum calcium less than
4.4 mg/dL
138
hypocalcemia can result from
increased calcium loss in circulation, decreased entry of calcium, or inadequate PTH produciton
139
s/s of hypocalcemia
muscle weakness, seizures, AMS, hyperreflexia, coarse/dry hair and nails
140
carpal spasm occurring after occlusion of the brachial artery with a BP cuff for 3 minutes
Trousseau's sign with hypocalcemia
141
contraction of the facial muscle in response to tapping of the facial nerve against the bone anterior to the ear
Chvostek's sign in hypocalcemia
142
Diagnostics in hypocalcemia
high phosphate, low calcium, low vitamin D
143
treatment for hypocalcemia
vitamin D
144
hypernatremia is sodium greater than
145 mEq/L
145
secretion of ADH
water loss, high osmolality --> stimulate thirst receptors, ADH secreted from posterior pituitary --> stimulates renal absorption of sodium and water
146
s/s of hypernatremia
neuro signs are intially seen: agitation, irritability, confusion;
muscle tremor, hyperreflexia, dehydration
147
treatment for hypernatremia
hypotonic saline (0.45% NaCl or D5W)
148
those at high risk for hypernatremia
elderly, those on diuretics/laxatives
149
hyponatremia is serum sodium less than
135 mEq/L
150
response of ADH to hyponatremia
usually ADH is suppressed to allow diuresis
151
chronic hyponatremia causes
fluid to seep into the cells leading to swelling.
152
meds that can caused hyponatremia
ACEI, thiazide diuretics, NSAIDs, SSRIs
153
excess production of ADH leading to hyponatremia and increased urine osmolality
SIADH
154
s/s of hyponatremia
headache, blurred vision, lethargy, weakness
155
Refer to ER is serum sodium is less than
125 mEq/L
156
If asymptomatic with serum sodium greater than 125 mEq/L, management consists of
fluid restriction (1000-1500 mL/day), dietary sodium restriction, and loop diuretics.
157
hyponatremia is common in
elderly, endurance runners
158
feedback of thyroid hormones
hypothalamus secretes TRH --> anterior pituitary secretes TSH ---> thyroid secretes T3 and T4.
159
The synthesis of T3 and T4 requires
iodine intake
160
Most T3 and T4 is
bound to proteins; but free T4 is always maintained at a constant level.
161
Hyperthyroidism is characterized by TSH less than
0.3
162
Graves disease is most common in
women 20-40
163
When thyroid stimulating antibodies or immunoglobulins compete with TSH for TSH receptors on the thyroid and increase the production of thyroid hormones.
Grave's disease
164
Subacute thyroiditis is caused by
postviral illness
165
majority of causes of subclinical hyperthyroidism is caused by
nodules or multinodular goiters
166
Diagnostics for hyperthyroidism
thyroid peroxidase (TPO), thyroid US, radioactive iodine reuptake scan
167
Normal or high radioactive uptake during the scan indicates
Grave's disease or toxic multinodular goiter
168
Decreased or zero radioactive uptake during the scan indicates
thyroiditis
169
symptomatic treatment of hyperthyroidism is treated with
beta blockers
170
major side effect of antithyroid drugs
agranulocytosis, liver failure
171
instructions about radioactive iodine
no kissing or sharing food for 5 days;
wash dishes in dishwasher;
no close contacts with kids less than 8 for five days;
flush toilets twice
172
complications of hyperthyroidism
afib, angina, osteoporosis
173
s/s of thyroid storm
fever, profuse sweating, tachycardia, confusion
174
causes of goiter
Grave's, iodine deficiency/excess, thyroiditis
175
Nontoxic goiter is mostly caused by
autoimmune thyroiditis
176
meant when thyroid nodules are "hot"
concentrate iodine
177
meant when thyroid nodules are "cold"
don't concentrate iodine
178
in goiter, lab studies may show
high or normal TSH
179
when the thyroid gland enlarges in response to increased TRH and TSH production
nontoxic goiter
180
treatment is only necessary when goiter
is symptomatic
181
treatment for goiter
levothyroxine (T4) can suppress TSH, although controversial
182
hypothyroidism is characterized as TSH of
greater than 4
183
most common cause of hypothyroidism
chronic autoimmune thyroiditis where autoantibodies destroy thyroid tissue
184
drugs that can cause hypothyroidism
amiodarone, lithium, IV contrast
185
tender thyroid gland is suggestive of _____; whereas a nontender thyroid gland is suggestive of _______
subacute thyroiditis; chronic autoimmune thyroiditis
186
treatment for hypothyroidism
synthetic T4 (levothyroxine)
187
average T4 replacement for hypothyroidism
1.6 mcg/kg/body weight per day (about 50 mcg/day)
188
those who should be started on a lower dose of levothyroxine
heart disease or afib
189
dosing instructions for levothyroxine
taken on an empty stomach
190
steady state of TSH when taking levothyroxine is not seen for
at least 6 weeks
191
Dessicated thyroid (Armour) is
combination of T3 and T4
192
dessicated thyroid (Armour) has a black box warning not recommending it for
weight reduction
193
subclinical hypothyroidism is
elevated TSH with normal T4.
194
treated for subclinical hypothyroidism is indicated when
TSH greater than 10
195
complication of congenital hypothyroidism (Cretinism)
mental retardation
196
risk factors for thyroid cancer
hx of head or neck radiation, family hx, age younger than 20 or older than 60, male
197
____ has been associated with an increased risk of malignant transformation of a thyroid nodule
elevated TSH
198
characteristics of a malignant thyroid nodule on ultrasound
increased vascular flow to nodule, hypoechoic, irregular margins
199
gynecomastia is caused by an increase in the ratio of
estrogen to androgen
200
gynecomastia is diagnosed as a palpable mass of tissue at least _____ in diameter
0.5 cm
201
Gynecomastia differs from female breast development in that there is no
progesterone
202
drugs that can cause gynecomastia
spironolactone, cimetidine, ketoconazole, 5-alpha-reductase inhibitors
203
characteristics of gynecomastia
bilateral, centrally located to nipple area, symmetrical, tender
204
breast development
thelarche
205
Tanner stages
thelarche, pubarche, menarche
206
first sign of puberty in males
testicular enlargement at 11 years average
207
Precocious puberty is defined as the onset of secondary sexual development before the age of ___ in girls and ___ in boys.
8; 9
208
Gonadotropin-dependent precocious puberty (central precocious puberty) is
caused by early maturation of the HPA axis
209
Gonadotropin-independent precocious puberty is
caused by excess secretion of sex hormones by tumor
210
In Gonadotropin-dependent precocious puberty, the LH levels are
elevated
211
In Gonadotropin-independent precocious puberty, the LH levels are
normal or low
212
If secondary sexual findings is noted, then next step is
radiographic assessment of bone age; abnormal if bone age is more than 20% older than age
213
Delayed puberty is the absence of sex characteristics by the upper 95th percentile age for boys which is ___ and girls which is ____
14; 12
214
delayed puberty is usually caused by
defective gonadotropin secretion from anterior pituitary
215
feedback of GnRH secretion
hypothalamus secretes GnRH --> anterior pituitary secretes LH and FSH --> stimulate testosterone, estrogen, and progesterone release
216
primary hypogonadism shows FSH and LH levels that are
high
217
secondary hypogonadism shows FSH and LH levels that are
low or normal
218
causes of secondary hypogonadism
constitutional delay, congenital GnRH deficiency, hypothyroidism, hyperprolactinemia.
219
the physical exam for delayed pubtery
height, weight, arm span, secondary sex characteristic staging
220
Patients with constitutional delay of puberty typically have bone ages of
12 to 13.5 years but rarely progress beyond this age.
221
therapy for delayed puberty should be restricted to
boys older than 14 and girls older than 12
222
those with hirsuitism needs this to be ruled out
ovarian or adrenal tumors
223
An indicator of severe hirsuitism (hyperandrogenism)
virilization: deepening voice, balding, increased muscle mass, clitoromegaly
224
diagnostics for hirsuitism
serum total testosterone
225
oral contraceptive role in hirsuitism
inhibit LH secretion, this reducing testosterone
226
Vitamin D of less than 20 ng/mL can be a cause of
secondary hyperparathyroidism
227
vitamin D insufficiency is levels less than ___; vitamin D deficiency is levels less than ____
30 ng/mL; 20 ng/mL
228
dosages of vitamin D
50,000 IU of vitamin D3 three times a week for 4 weeks
229
Obstructive symptoms of BPH
urinary hesitancy, dribbling, decreased force of stream
230
irritative symptoms of BPH
frequency, urgency, nocturia
231
drugs that can cause symptoms of BPH
anticholinergics and sympathomimetics
232
physical exam with BPH
enlarged, nontender, smooth prostate
233
diagnostics for BPH
bladder ultrasound to determine post-void residual
234
BPH is not a risk factors for
prostate cancer
235
Progression of BPH and risk of prostate cancer can be decreased by
finasteride
236
Work by lowering bladder neck and ureteral resistance in BPH
alpha adrenergic antagonist therapy
237
direct alpha adrenergic antagonist
tamsulosin;
| only act on smooth muscle of the prostate
238
indirect alpha adrenergic antagonist
doxazosin;
| act on all smooth muscle causing vasodilation
239
shrink prostate gland by decreasing DHT levels
5alpha-reductase inhibitors: finasteride
240
these two meds showed a higher risk reduction in BPH symptoms than when used alone
doxazosin and finasteride
241
causes of acute and chronic prostatitis
gram negative: E. coli, Proteus, Klebsiella
242
s/s of acute prostatitis
fever, chills, malaise, arthralgias, urinary sympoms
243
s/s of chronic prostatitis
may be asymptomatic; may have recurrent UTI or urogenital symptoms
244
physical exam with acute prostatitis
prostate is enlarged and tender. Avoid massaging to minimize risk of bacteremia.
245
physical exam with chronic prostatitis
may have normal prostate; may feel tender.
246
this should not be checked as it may appear elevated with prostatitis
PSA level
247
diagnostic for prostatitis
acute: UA will show pyuria; Urine culture
chronic: prostatic specimen through urologist
248
treatment for acute prostatitis
TMP/SMZ or fluoroquinolone for 2-6 weeks
249
treatment for chronic prostatitis
TMP/SMZ or fluoroquinolone for at least 6 weeks
250
teaching for prostatitis
sitz baths; avoid coffee, tea, alcohol; stool softeners; use condoms during therapy
251
risk factors for prostate cx
men older than 65, Black, family history
252
most common type of prostate cancer
adenocarcinoma
253
difference between symptoms of BPH and prostate cancer
symptoms increase in intensity in 1-2 month intervals with prostate cancer whereas in BPH it is slow progression
254
physical exam with prostate cancer
firm, indurated, asymmetric nodule on prostate
255
screening for prostate cancer
recommended in all men starting at 50; 45 for black men; 40 for men with family hx
256
PSA levels with prostate cancer
If less than 2.5 normal;
greater than 4 is abnormal- refer for biopsy;
greater than 10 indicative of cancer
257
risk factors for renal cell carcinoma
```
tobacco use;
black;
leather tanning and shoe-making;
exposure to asbestos, gas, petroleum;
family hx
```
258
risk factors for bladder cancer
white male;
smoking;
ingestion of red meat
259
symptoms of renal tumor
flank pain, hematuria, renal mass; however most are not diagnosed until it has metastasized
260
occurs in those ages 3-4 and is usually unilateral
Wilms tumor
261
s/s of bladder cancer
painless hematuria that continues throughout urination
262
trx for bladder cancer
transurethral resection of bladder tumor
263
diagnostic for bladder/renal cancer
UA, urine cytology, CBC, diagnostic ultrasound, cystoscopy, spiral CT
264
loss of urine associated with activities that increased intra-abdominal pressure such as coughing, sneezing.
stress incontinence
265
involuntary loss of urine usually preceded by a strong, unexpected urge to void.
urge incontinence
266
an involuntary loss of urine associated with incomplete emptying
overflow incontinence
267
DIAPPERS for incontinence
```
Delirium;
Infection;
Atropic vaginitis;
Pharmaceuticals;
Psychological;
Excess urinary output;
Restricted mobility;
Stool impaction
```
268
Diagnostics for urinary incontinence
UA, C&S, BUN/creatinine, postvoid residual, cystoscopy
269
a PVR greater than ____ is considered abnormal
100 mL
270
treatment for incontinence
time void every 2 hours, smoking cessation, pelvic muscle exercises, pessary placement;
271
meds for stress incontinence
alpha adrenergic agonist (Sudafed), estrogen, tricyclic antidepressant
272
meds for urge incontinencne
anitcholinergic/antimuscarinic agents: Detrol & Oxybutynin
273
Meds for overflow incontinence
alpha adrenergic blockers (doxazosin or tamsulosin); alpha5 reductase inhibitors (finasteride)
274
BPH can cause this type of incontinence
overflow
275
risk factors for stone formation
```
family history;
insulin-resistance;
HTN;
gout;
primary hyperparathyroidism (high calcium);
obesity;
dehydration
```
276
Foods that can cause uric acid stones
seafood, meats
277
foods that can cause oxalate stones
cola, chocolate
278
Meds that can cause stone formation
HCTZ, antacids
279
Most common type of urinary calculi in women
calcium oxalate stone
280
Most common type of urinary calculi in men
uric acid stones
281
s/s of nephrolithiasis
N/V, hematuria, dysuria, renal colic
282
s/s of urolithiasis
dysuria, frequency, urgency, hematuria
283
diagnostics for urolithiasis
UA, urine C&S, serum calcium, intact PTH
284
urine pH less than 6.5 indicates what type of stone
calcium oxalate
285
with urolithiasis, urine pH greater than 6.5 indicates
infection and f/u culture is necessary
286
diagnostic for nephrolithiasis
renal ultrasound, KUB, noncontrast CT
287
differential diagnosis for urolithiasis
gastroenteritis, appendicitis, abd aneurysm, ectopic pregnancy, peptic ulder
288
Urinary stones less than ___ pass spontaneously, whereas urinary stones greater than ____ need surgical intervention
4 mm; 6-8 mm
289
treatment for calcium oxalate stones
thiazide diuretic;
| low calcium, protein, and sodium diet
290
treatment for uric acid stones
allopurinol;
decrease purine intake;
increasing fluids
291
In post-streptococcal glomerular nephritis, it is usually preceded by a hx of
GABHS skin or throat infection 1-3 weeks prior
292
post-streptococcal glomerular nephritis is most common in
children 5-12 years old; those older than 60
293
symptoms of post-streptococcal glomerular nephritis
edema, gross hematuria & proteinuria, HTN
294
diagnostic for post-streptococcal glomerular nephritis
UA;
| streptozyme test that measure 5 different streptococcal antibodies
295
treatment for post-streptococcal glomerular nephritis
control HTN;
sodium and water restriction;
Loop diuretics
296
Proteinuria is defined as urinary protein excretion of more than
150 mg/day
297
Drugs that can cause proteinuria
lithium, cyclosporine, NSAIDs
298
Diagnostic for proteinuria
1+ protein on urine dipstick x 2;
CBC, CMP, lipid panel;
24-hour protein and creatinine urine collection
299
those with proteinuria should be tested for
Bence Jones proteins to r/o multiple myeloma
300
Those with proteinuria need to be started on
ACEI or ARB, low sodium diet
301
these people have high rates of hematuria
long distance runners
302
Oliguria is defined as urine output of less than
400 mL in 24 hours
303
Anuria is defined as urine output of less than
200 mL in 24 hours
304
Prerenal ARF is caused by
dehydration and hypotension
305
Intrarenal ARF is caused by
nephrotoxins (IV contrast, aminoglycosides
306
postrenal ARF is caused by
BPH, bladder dysfunction or strictures, nephrolithiasis
307
All patients with acute renal failure should be
hospitalized
308
ESRD is a GFR of less than
15%
309
Most common indicator of CKD is
proteinuria
310
Best measure of kidney function
GFR
311
Stage II kidney disease is GFR
60-89 mL/min
312
Stage III kidney disease is GFR
30-59 mL/min
313
Diet education for those with CKD
protein and phosphorus restriction; avoid salt substitutes as they contain high amount of potassium;
glycemic control;
increase calcium
314
Vitamin D deficiency with CKD
give 50,000 IU of vitamin D2 monthly for 6 months
315
testicular torsion is most commonly seen in
the left testicle
316
s/s of testicular torsion
extremely painful, N/V, abdominal pain
317
physical exam with testicular torsion
swollen and red scrotum, tender spermatic cord, absent cremasteric reflex
318
Diagnostic for testicular torsion
Doppler US shows diminished blood flow
319
Treatment for testicular torsion
must be sent to ER and treated within 6 hours
320
testicular cancer is common in men ages
20-39 years old
321
risk factors for testicular cancer
Caucasian;
cryptorchidism;
family hx;
scrotal trauma
322
S/S of testicular cancer
testicular mass; swelling; sensation of fullness
323
common causes of epididymitis in young men
Chalmydia and gonorrhea
324
common causes of epididymitis in men older than 35
gram negative organisms;
| TURP
325
S/S of epididymitis
fever, chills, penile discharge, lower abd pain
326
Physical exam with epididymitis
scrotum is red, enlarged, and tender.
327
When pain is relieved with scrotal elevation (Prehn's sign)
epididymitis
328
Doppler US with epididymitis shows
normal blood flow
329
medication for orhcitis and epididymitis
ceftriaxone, doxycycline, or levofloxacin
330
education for epididymitis
scrotal elevation
331
complication of epididymitis and orchitis
infertility
332
Systemic, blood-borne infection that results in an acute inflammation of one or both testicles.
orchitis
333
orchitis has similar signs and symptoms as
epididymitis
334
causes of orchitis
may coexist with prostatitis or epididymitis; STDs
335
The major classes of drugs that can affect erectile function are
antihypertensives, antidepressants, alcohol
336
medications used to facilitate erection
PDE5 inhibitors:
sildenafil (Viagra),
vardenafil (Levitra),
tadalafil (Cialis)
337
PDE5 inhibitors are contraindicated in those taking
nitrates
338
Education for sildenafil (Viagra) and vardenafil (Levitra)
have a short duration of action; take on empty stomach; avoid taking with high fat meal
339
Education for tadalafil (Cialis)
longer half-life for 24-36 hours. No dietary restrictions
340
Patients taking SSRIs who have side effects of sexual dysfunction
take with buproprion
341
most common organisms in UTI
gram negative : E. coli, Klebsiella, Enterobacter
342
Any UTI in a male less than 50 years old is
considered complicated`
343
common causes of urethritis
chlamydia and gonorrhea
344
s/s of urethritis in males
dysuria, burning on urination
345
Discharge with gonococcal urethritis is most often ___, whereas that with NGU tends to be ____.
purulent; clear or mucoid
346
complicated UTIs occur in those
with urologic abnormalities, underlying disease (DM, renal failure), pregnancy, catheter, advanced age
347
Four variables predict the presence of UTI
cloudy urine, malodorous urine, dysuria, nocturia
348
UA in UTIs show
pyuria, high nitrates, hematuria
349
avoid this medication pyelonephritis is suspected
nitrofurantoin
350
Medication for UTI
nitrofurantoin x 5 days, TMP/SMZ DS x 3 days, fluoroquinolones x 3 days
351
Recommended treatment duration for those with UTI who have DM.
10-14 days
352
medication for UTI in children
third generation cephalosporins (cefexime, cefdinir); aminoglycosides
353
Not recommended for trx of UTI in children d/t high resistance
amoxicillin and ampicillin
354
s/s of pyelonephritis
UTI symptoms with fever, chills, flank pain, CVA tenderness, N/V
355
Diagnostic for pyelonephritis
UA and Urine culture
356
treatment for pyelonephritis
fluoroquinolones or TMP/SMZ for 7 days
357
asymptomatic bacteruria refers to a colony count of at least ___ in the absence of symptoms
100,000/mL
358
diagnosis of asymptomatic bacteruria in women
two clean catch urine specimens with more than 100,000 of bacteria
359
risk factors for asymptomatic bacteruria
```
advanced age;
nursing home;
incontinence;
women with diabetes;
pregnancy
```
360
screening and treatment is indicated in these people with asymptomatic bacteruria
pregnant women and those undergoing urologic surgery
361
avoid these eye drops with corneal abrasions
steroids
362
where to avoid giving lidocaine and epi
fingers, toes, penis, nose
363
treatment for most typical spider bites
supportive
364
important to differentiate spider bites from
MRSA
365
home remedy for bee/wasp stings
meat tenderizer paste
366
s/s of UTI in elderly
confusion, AMS
367
foods to avoid with incontinence
alcohol, caffeine, carbonated, spicy foods
368
avoid these drugs with renal failure
NSAIDs, amnioglycosides, IV contrast
369
blood under the finger or toe
subungual hematoma
370
suggested suture removal for lower extremities
8-10 days
371
suggested suture removal for face
5 days
