Flashcards in Test #4 Slide Questions Deck (136):
What is the function of the kidneys?
They filter the blood to remove waste products and maintain normal hydration status
What are the main organs of the urinary system?
Kidneys, ureters, bladder, and urethra
What physiological part of the kidney has high blood pressure?
What physiological part of the kidney makes urine either concentrated or diluted?
The collecting tubule
What are some of the main symptoms of urinary tract diseases? (x5)
What two things might you find on an examination of a pt with a urinary tract diesease?
CVA tenderness and suprapubic tenderness
What urinary tract disease is very common in athletes? How common?
What causes proteinuria?
With exercise there is increased blood flow to the kidneys, which leads to more small proteins to be filtered through, and then all of the extra protein that was filtered cannot be absorbed
True or false:
In most cases of proteinuria, the extra protein in the urine is not indicative of disease.
What is the MOI for a kidney contusion/laceration?
Blow to the flank
What are the S/S of a kidney contusion/laceration? (x4) How should you deal with a suspected case of this?
Severe pain in the flank, hematuria, possible nausea and vomiting, and symptoms of shock; refer to the ED immediately (if they are hemodynamically stable they will stay overnight for observation, but if not stable then surgery will be required)
With traumatic hematuria, will the patient exhibit flank pain?
No they will have minimal to no flank pain
What does it indicate if urine is tea or cola colored?
That there is a lower concentration of blood in the urine than if it was redder
How would you deal with a traumatic hematuria?
Their exam will be normal (no CVA tenderness or peritoneal signs) but the urine dipstick will be positive for blood. They should cease all activity and be referred to the physician. Push fluids and repeat dipsticks daily until its clear...they allow non-contact activity and if they urine continues to be clear then allow contact activity
How can traumatic hematuria be prevented?
Empty bladder before contact sports
What is atraumatic hematuria? What is it caused by? Who does it affect the most?
Mild gross or microscopic hematuria that is very common in athletes (especially with long runs or intense exercise--20% of marathoners). It is caused by the bladder walls slapping against one another
What are two possible causes of false hematuria? Are they positive or negative on the dipstick analysis for blood in the urine? What about a microscope?
1) V8 juice or beets (- dipstick)
2) myoglobinuria (+ dipstick but - microscope)
What are six causes of true hematuria?
-Kidney or bladder tumor
-Sickle cell trait
True or false:
Most traumatic hematurias will resolve with time.
What are some common causes of UTIs? (x3)
True or false:
UTIs are not very common.
What are the risk factors for a UTI? (x5)
-Urinary tract instrumentation/catheterization
-Urinary statis (not emptying the bladder...allows things to grow...?)
What are the two main sources of a UTI? What species of bacteria are usually the cause?
-bacteria from stool
-blood or lymphatic borne
**E. coli, proteus, klebsiella, and enterobacter
What is cystitis? Describe the pathogenesis of this and pyelonephritits.
Infection of the bladder...if left untreated then theres virulent bactera-->obstruction leading to reflux of the bladder--> the infection travels up the ureters and to the kidneys
What are the S/S of cystitis? (x6)
Suprapubic (mostly) or flank pain
Tenderness over the suprapubic area
If a patient is suffering from pyelonephritis, how will they present as compared to cystitis?
They will have the same symptoms as cystitis but will be more ill, have more flank pain or back pain, a higher fever, chills, nausea and vomiting, and CVA tenderness
True or false:
If someone has an uncomplicated UTI, the typical treatment includes an i.v. of medicine.
False...this is for a complicated UTI
True or false:
The old wives' tale of cranberry juice being helpful for an UTI is correct.
True because there is bacteria static in the juice that can help
True or false:
Carbonated beverages cause UTIs.
False...but the extra acidity can mimic UTI problems??
What is incidence of new cases of the following STDs each year?
Chlamydia, gonorrhea, syphilis, herpes, HPV, and tricomonas?
Chlamydia= 3 million
Herpes= 1 million
HPV- 5.5 million
Tricomonas= 5 million
How are STDs spread? (x3)
Genital, oral, and rectal
When does urethritis (std) develop symptoms? What are the S/S? (x3)
4 days to 2 weeks after contact with an infected partner. S/S= urethral discharge, dysuria, and urethral itching between urinations.
What percentage of men are asymptomatic with urethritis> Women?
When does vaginitis(std) develop symptoms? What are the S/S? (x3)
4 days to 2 weeks after contact with an infected partner. S/S- vaginal discharge, itching, and odor.
What is another common cause of vaginitis besides as an STD?
Yeast (candida)...this is common after antibiotics
How is a yeast infection treated?
Topical or oral antifungal
What are the S/S of herpes? (x3)
Parasthesias, painful blisters on an erythmeatous base, and recurrences
What is the treatment for herpes?
Antiviral medications, decrease the length of the treatment, or suppressive treatment (taking antiviral all the time so as to help the outbreaks happen less often)
What causes genital warts?
Human papillomavirus (HPV)
Does HPV increase or decrease a pt's risk for cervical cancer?
What is the medical term for a kidney stone?
What percentage of kidney stones occur in men? Women?
What is the most common type of kidney stone? What are the other three types?
Most common- calcium oxalate...others= calcium phosphate, uric acid, and struvite
A combination of three factors makes up the pathogenesis of kidney stones. What are these three factors?
1) increased concentration of calculi components
2) lack of components that inhibit stone formation
3) organic material (dead cells that line the tubules) that serves as a matrix
What are the risk factors for kidney stone development? (x8)
Male, increasing age, low urine volume, SE US/Mediterranean/Middle East, increase dietary uptake (of protein, salt, or oxalate--tea), decreased dietary calcium, hyperparathyroidism, and acidosis
What are the three most common locations for a kidney stone?
1) Kidney (at the isthmus)
2) Iliac vessels (where they cross over the ureter)
3) Bladder (where the ureters insert)
What are the S/S of a kidney stone? (x5)
Renal colic (cramping pain)--excruciating flank and abdominal pain that may radiate to the scrotum or labia, nausea/vomitting, diaphoresis (sweating), urgency, and frequency
True or false:
As a primary method of treatment for kidney stones, it is common for the doctors to want the patient to try to "catch" the stone when they pass it so it can be analyzed.
If primary methods of treatment for a kidney stone don't work, what would the possible three next steps be?
Lithotripsy, cystoscopy, and surgery
How can you help prevent the reoccurance of a kidney stone?
Increase fluid intake, decrease dietary protein, decrease dietary oxalate (chocolate, nuts, dark green leafy veggies), and alkalinizing the urine.
What are the three etiologies of acute renal failure?
-Prerenal (before the kidney)
-Renal (in the kidney)
-Postrenal (in the urinary tract after the kidney)
What prerenal causes lead to acute renal failure?
Not enough blood flow to the kidneys (such as during shock, dehydration, hypertension, and vascular obstruction such as a blood clot in the renal artery)
What renal causes lead to acute renal failure?
1) Nephrotic syndrome (polyuria or massive edema)
2) Nephritic syndrome (hematuria, oliguria, or hypertension)
What causes nephrotic syndrome?
Damage to the basement menbrane of the glomerus (or the filter of the kidneys). This increase the permeability to the proteins, leading to a large loss of protein in the urine. This large loss of protein in the urine leads to polyuria to try and dilute the urine, and hypoalbuminemia because of the change in osmotic pressure leading to massive edema
What causes nephritis syndrome?
Damage to the capillaries in the glomerus...this allows actual blood cells to be filtered in the urine (aka hematuria). Because the glomerular filtration rate is being decreased, less blood is being filtered resulting in decreased urine output and an increase in blood volume (leading to hypertension)
What are the postrenal causes of acute renal failure?
Obtructions of the urinary tract (kidney stones, enlarged prostate, or medications)
What is the breakdown of muscle cells due to overexertion releasing muscle cell contents into the blood stream that can lead to renal failure?
What are the causes of rhabdomyolysis (not necessarily exertional rhabdo)?
Alcohol poisioning, antifreeze overdoes, spider and snake bites, and street drugs
What are the risk factors for exertional rhabdo?
Fitness level, intensity and duration of a workout, the type of exercise (worse if eccentric), viral illness, and sickle cell trait
What would the urine of someone with exertional rhabdo look like?
What is the physiology behind stress incontinence?
Malfunction of the urethral sphincter...so urine leaks when the intra-abdominal pressure increases (as with coughing, sneezing, lifting, and exercising). This is due to weakness of the pelvic floor muscles
What are some renal abnormalities? (x
Solitary kidney, pelvic kidney, horseshoe kidney, and kidney transplant
What is the recommendation for contact sport if a patient has a pelvic kidney? Horseshoe kidney? Transplanted kidney? Solitary kidney?
Pelvic- not recommended
Horseshoe- not recommended
Transplanted- not recommended
Solitary- depends on location...if can then extra portection
What is twisting of the testicle resulting in a blockage of the testicular vessels?
What are the S/S of testicular torsion? (4)
Sudden onset of testicular pain, swelling, no injury, & tender/swollen testicles
True or false:
If surgery isn't done within a couple of hours to reverse a testicular torsion, then the testicle could die from ischemia.
What is a collection of peritoneal fluid between the parietal and visceral layers of the tunica vaginalis surrounding the testicle?
What testicular issue involves painless scrotal swelling that worsens throughout the day, and feels like one testicle feels more "bulky" and heavier than the other?
What is an abnormal tortuosity and dialation of the venous plexus around the scrotal area?
Varicocele (varicose vein shit around the testicles)--"bag of worms"
What is the most common surgically correctable cause of male infertility?
True of false:
Testicular cancer is 4-5x more common in Caucasians than African Americans.
What is the most common cause of a tumor in males aged 15-34?
How does testicular cancer present?
Painless lump in the testicle
What is an orchiectomy?
Removal of a testicle
What should a player doing contact or collision sports with only one testicle do?
Wear a cup (duhhh)
What are the cardiovascular changes during pregnancy?
-increased cardiac output
-increased heart rate
-increase blood volume
-increase in venous capicitance (lower BP)
-physiological anemia of pregnancy
What pulmonary changes occur during pregnancy?
Elevated diaphragm (due to enlarged uterus) and increase of 20% of the resting O2 consumption
What are the musculoskeletal changes that occur during pregnancy?
Shift of COG, increased lumbar lordosis, back pain, and increase laxity of ligaments
What are nine issues to be concerned about when thinking about exercise and pregnancy?
Placental blood flow
Infant birthweight (lower in women who exercise)
What does "adnexal" mean?
Ovaries and fallopian tubes
What is endometriosis? How common is it in premenopausal women?
When endometrial tissue is found outside the uterus; 10-15%
True or false:
Endometriosis is not a common cause of infertility.
What are the Sx of endometriosis?
(Depends on the location of the implants)
-The implants swell immediately before and during menstruation
-cyclic (monthly) pelvic pain
-dyspareunia (pain with intercourse)
-pain with defication, urination, etc.
What is the classic triad for a endometriosis diagnosis?
Dysmenorrhea, dyspareunia, infertility
How could endometriosis affect us as ATs?
It could mimic musculoskeletal pain (in the psoas, pelvic floor muscles, SI ligaments, and abdominal wall)
What are three main causes of primary dysmenorrhea? For secondary dysmenorrhea?
Primary= elevated production of prostaglandins, NSAIDS, and birth control pills
Secondary= endometriosis, PID, fibroids
What is defined as any pregnancy that doesn't occur in the normal place?
What are the risk factors for an ectopic pregnancy?
PID, endometriosis, previous ectopic pregnancy, previous pelvic surgery, and contential abnormalities
What is PID?
Pelvic inflammatory disease...any STD that spreads up into the fallopian tubes and causes probs
What are the Sx of PID?
lower quadrant pain, fever, vaginal discharge, and sexually active
What is skin irritation due to friction from a shirt or bra?
What is fibrocystic breast disease?
(fibrocystic change)...response of the breast tissue to changes in hormone levels during menstrual cycle
True or false:
Your breasts tend to enlarge before your period.
True...aka the whole fibrocystic breast change.
What is the most common malignancy in women and the 2nd most common cause of this type of death in women?
Breast cancer (2nd most common cause of cancer death in women)
What are the risk factors for breast cancer? (x5)
Female, age 40-60, white, FHx of breast cancer, and prolonged uninterrupted menstrual cycles
Describe the pathophysiology of breast cancer.
A palpable mass arises from the glandular epithelium (adenocarcinoma)..then it will spread to the axillary lymph nodes...eventually may metatasize to the brain, lung, liver, or other lymph nodes
What is gynecomastia?
Breast bud development in males
What is the etiology of gynecomastia?
Small amounts of testerone convert to estradiol in all males...if you have more testosterone then more is produced...then the more of estradiol results in breast tissue development. Also steroids can have this occur as well
What percentage of males will develop gynecomastia in mid-to-late puberty?
What 3 things are involved in the female athlete triad?
1) disordered eating
What is oligomenorrhea?
Fewer than 9 periods a year
What are some causes of secondary amenorrhea?
Pregnancy, hypothalamic, PCOS, and hypothyroidism
For the female athlete triad, what is the energy drain hypothesis?
Inadequate caloric intake for needs --> starvation mode --> decreased estrogen --> amenorrhea & decreased bone density (**the body shuts down estrogen when its in starvation mode)
What are some common characteristics of female athlete triad (x5)
-High risk sports (judging sports)
-Elite or highly competitive athlete
-Individual vs team sports
What types of sports might female athlete triad be most likely seen?
Gymnastics, ballet, cheerleading, track, cross country, female wrestling, figure skating, diving, and swimming
What is a common conversion when doing a physical exam and looking at an athlete that may be at risk for female athlete triad? (when comparing height and weight)
5 feet = 100 lbs (and for every inch over 5 feet add 5-10 lbs)
How might an athlete with the female athlete triad present? (x9)
Fatigue, stress fx, cold intolerance, lightheadedness, abdominal pain/bloating, sleep disturbance, dry skin, constipation/diarrhea, and poor performance
What are some physical signs of female athlete triad?
Anemia, cold/discolored hands and feet, swollen parotic glands, callused knuckles, erosin of dental enamel, face and extremity edema, bradycardia, fat/muscle wasting, lanugo, orthostatic hypotension, cardenemia (orange appearance), and decreased body temperature
For a female, how much calcium should she be getting a day?
For a female, how much vitamin D should she be getting per day?
What is defined as decreased bone mineral density?
What is defined as more severely decreased bone mineral density resulting in brittle bones and increased fx risk?
What is primary osteoporosis?
Osteoporosis that occurs after menopause and senile people
What is secondary osteoporosis>
Osteoporosis that occurs from other causes than a hormone change (like menopause). Often this is caused by prolonged corticosteroid or anticonvulsant use, alcoholism, thyroid/parathryoid disorders, or female athlete triad
How many people are affected by osteoporosis? What percentage of this number is women?
10 million (80% women)
How many people are affected by osteopenia?
True or false:
Osteoporosis affects men later in their life than women.
True..usually when they're over 70 years old
Who has a higher morbidity and mortality associated with osteoporosis, men or women?
Men (they are twice as likely to die within 1 year after a hip fracture)
What hormone is essential for absorption of calcium into a bone?
Estrogen (hence the problem for so many women after menopause)
What type of bone is more affected by osteoporosis?
Trabecular (spongy) bone because there is more osteoblast and osteoclast activity happening there
What physiological part of trabecular bone is really important for bone strength but is affected highly by osteoporosis?
The horizontal cross-links...they help properly accept loads and stresses applied to the bones)
What ethnicities are more affected by osteoporosis?
Caucasian and Asian
What are some risk factors for osteoporosis?
Female, age, caucasion/asian, post-menopause, FHx, inactivity, low body weight, smoking, alcohol, caffeine, low dietary calcium, and vitamin D deficiency
What is estrogen's function in relation to bone strength?
-increases intestinal calcium absorption
-decrease bone calcium resorption
-increased osteoblastic activity
What percentage of bone is lost per year after peak bone mass has been reached? What about after the first 5 years of menopause?
1% per year...up to 10% per year in the first five years after menopause
What three types of medications can be possible risk factors for osteoporosis?
What are some medical disorders that serve as risk factors for osteoporosis?
Hyperthyroidism, hyperparathyroidism, type II diabetes chronic renal failure, hypogonadism, and malabsorption syndromes
What are the 4 clinical manifestations of osteoporosis?
Fractures (vertebral bodies, femoral neck, or radius)
Loss of height
Postural changes (Dowagers hump)
When examining a younger patient for the possibility of osteoporosis (such as someone with female athlete triad), is it better to use a T-score or Z-score?
What two components of exercise are good for patients suffering from osteoporosis?
1) weight bearing (strength bones)
2) muscle strengthening (reducing fall risk in elderly)
What two hormones may need to be increased in a patient with osteoporosis?
Calcium and vitamin D...but then there's also hormone replacement therapy
What is hormone replacement therapy used for?
It's used to try and combat osteoporosis because of menopause or hysterectomy...often it used conjugated equine estrogen (Premarin). It is used less frequently however because of risk for CAD, CVA, and breast cancer. So its mainly a preventative treatment
What is the function of bisphosphonates?
Stop osteoclast activity and decrease calcium reabsorption
What do patients taking bisophosphonates need to after immediately after taking them?
Remain upright for 30 minutes to prevent gravity from keeping the med in the esophagus because it can cause esophageal irritation or an ulcer
What could serve as a secondary treatment to bisphosphanates?