Treatment - Renal & GU

Question 1

minimal change disease (nephrotic syndrome)

Answer 1

prednisone/corticosteroids

+/- diuretics for edema and ACE/ARB to reduce pressure on kidneys

Question 2

acute glomerulonephritis (nephritic syndrome)

Answer 2

corticosteroids +/- ACE

+ cyclophosphamide if rapidly progressing

Question 3

acute tubular necrosis (ATN)

Answer 3

remove offending agents, IV fluids (restore BP), +/- furosemide if euvolemic and not urinating

Question 4

adult polycystic kidney disease

Answer 4

-increased fluid intake (to decrease vasopressin/ADH)
-control HTN
+/- dialysis or transplant

Question 5

chronic kidney disease

Answer 5

prevent progression; HTN, low protein diet, DM control

Question 6

SIADH

Answer 6

tx underlying, H2O restriction (<800/d)

-demeclocycline in severe cases (inhibits ADH)

Question 7

diabetes insipidus

Answer 7

• central: desmopressin/DDAVP (synthetic ADH) +/- carbamazepine (inc ADH)
• nephrogenic: Na/protein restrict, hydroclorothiazide (causes mild hypovolemia to promote retention), indomethacin (potentiates effect of ADH)

Question 8

hyponatremia and hypernatremia fluid rate

Answer 8

correct <0.5 mEq/L/h to prevent demyelination (hypo) or cerebral edema (hyper)

Question 9

hypovolemic hyponatremia

Answer 9

normal saline (correct volume)

Question 10

critical hyponatremia

Answer 10

hypertonic saline + loop diuretic (furosemide)

-with neurologic symptoms require treatment with hypertonic (3%) saline.

Question 11

euvolemic hyponatremia

Answer 11

water restriction (<1500mL/d)

Question 12

hypervolemic hyponatremia

Answer 12

water and salt restriction

Question 13

hypomagnesemia

Answer 13

oral magnesium oxide

severe - IV mag sulfate (also w/ TORSADES de POINTES)

Question 14

hypokalemia

Answer 14

KCl oral (IV if severe) *use non-dextrose IV bc dextrose induced insulin release will shift K into cells)

• replace Mg
• hypoK associated w/ increased risk of digoxin toxicity

Question 15

hyperkalemia

Answer 15

-repeat blood draw to verify not from venipuncture error

• IV calcium gluconate - stabilizes cardiac membrane if significant lab (>6.5) and ECG findings
• insulin w/ glucose to shift K intracellularly
• kayexalate (sodium polystyrene sulfonate) to enhance GI excretion
• beta-2 agonists (albuterol helps move K intracellular)
• lasix to rid extra through kidneys
• sodium bicarb

Question 16

corrected serum sodium (high glucose) calculation

Answer 16

1.6 mEq/L to the sodium value for every 100 mg/dL of glucose above 100 mg/dL

Question 17

corrected serum potassium in acidosis

Answer 17

subtracting 0.6 mEq/L from the initial potassium value for every 0.1 decrease in pH from 7.4.

Question 18

chlamydia

Answer 18

doxy 100mg x 10d

alt: azithro

Question 19

gonorrhea

Answer 19

ceftriaxone (250 mg IM)

Question 20

chronic epididymitis (enteric cause)

Answer 20

fluoroquinolones

children - cephalexin or amoxicillin

Question 21

testicular torsion

Answer 21

detorsion + orchiopexy (testicle fixation in scrotum)

-orchiectomy if testicle not salvageable

Question 22

cryptorchidism

Answer 22

orchiopexy (ideal btw 6 mo and 1 yr)

-observation if <6 mo - most descend by 3 mo

Question 23

testicular cancer

Answer 23

low-grade nonseminoma –> orchiectomy w/ retroperitoneal lymph node dissection
low-grade seminoma –> orchiectomy –> radiation
high-grade seminoma –> debulking chemo –> orchiectomy + radiation

Question 24

hydrocele

Answer 24

infants: no tx needed, most resolve by 1 yo
adults: sx if communicating (elective) or complications

Question 25

uncomplicated cystitis

Answer 25

nitrofurantoin (macrobid) - not if pyelo suspected fluoroquinolones bactrim double strength

Question 26

complicated cystitis or pyelo

Answer 26

fluoroquinolones, aminoglycosides

Question 27

pregnant + cystitis

Answer 27

AMOXICILLIN, augmentin, cephalexin | nitrofurantoin

Question 28

acute prostatitis

Answer 28

>35 yo - fluoroquinolones or bactrim 4-6 weeks | <35 yo - ceftriaxone plus doxy (or azithro)

Question 29

chronic prostatitis

Answer 29

fluoroquinolones or bactrim 6-12 wks or TURP if refractory (transurethral resection)

Question 30

BPH

Answer 30

5-a-reductase inhibitors (suppress growth, reduce obstx) a-1-blockers (sx relief but not course of BPH) TURP

Question 31

prostate cancer

Answer 31

local - radical prostatectomy | advanced - external beam radiation, androgen deprivation (orchiectomy + GnRH agonists)

Question 32

bladder cancer

Answer 32

local/superficial: transurethral resection (elecrocautery) invasive: radical cystecomty, +/- chemo, radiation recurrent: Bacillus Calmette-Guerin vaccine intravesicular (immune rx stim cross-rx w/ tumor antigens) dont use if immunosuppressed

Question 33

renal cell carcinoma

Answer 33

stage 1-3 --> radical nephrectomy, immune therapy | usually resistant to chemo and radiation

Question 34

wilms tumor / nephroblastoma

Answer 34

nephrectomy followed by chemo (80-90% cure rate) | -radiation if extends beyond renal capsule or lung mets

Question 35

ischemic priapism

Answer 35

phenylephrine (intracavernous injection) alpha-agonist C/I --> cardiac or cerebrovascular hx (non ischemic - observation)

Question 36

renal artery stenosis

Answer 36

angioplasty w/ stent (if Cr >4 or >80% stenosis) | +ACE/ARB (unless bilateral or one kidney)

Question 37

enuresis

Answer 37

bedwetting - behavioral: motivational tx, education and reassurance, bladder training (most resolve spontaneously) - alarm: if fail bx tx, sensor - DESMOPRESSIN - better for short-term use (synthetic ADH) - TCAs (stim ADH secretion, detrusor muscle relax) i.e. imipramine

Question 38

stress incontinence

Answer 38

laugh, sneeze - pelvic floor exercises - alpha agonists: midodrine, pseudoephedrine (increase urethral sphincter tone) - surgery, anti-incontinent devices, estrogen

Question 39

urge incontinence

Answer 39

overactive bladder - bladder training (time void, dec fluid intake) - ANTICHOLINERGICS: oxybutynin/ditropan, tolterodine - TCAs - Mirabergon - avoid spicy foods, citrus fruit, chocolate, caffiene

Question 40

overflow incontinence

Answer 40

intermittent or indwelling catheter 1st line -cholinergics (bethanacol) BPH --> a-1-blockers tamsulosin

Question 41

Haemophilus ducreyi (painful ulcers + enlarged lymph nodes in groin)

Answer 41

ceftriaxone 250 mg or one gram of oral azithromycin