Urology/Renal Flashcards
(194 cards)
1
Q
average values of HCO3, pH, and CO2
A
HCO3: 24
pH: 7.40
CO2: 40
2
Q
3 step acid-base approach
A
- normal pH range: 7.35-7.45 -> acidosis vs alkalosis
- CO2 (respiratory): normal range: 35-45
- HCO3 (metabolic): normal range: 20-26
ex.
elevated CO2, low pH: respiratory acidosis
low CO2, high pH: respiratory alkalosis
low HCO3, low pH: metabolic acidosis
elevated HCO3, elevated pH: metabolic alkalosis
3
Q
6 types of urinary incontinence
A
urge
stress
overflow
functional
mixed
nocturnal
4
Q
urinary incontinence due to detrusor overactivity
sudden urge to urinate, loss of large volumes, small post void residual
A
urge incontinence
5
Q
tx for urge incontinence
A
pelvic muscle exercises
anticholinergics/TCAs
6
Q
urinary incontinence due to weak pelvic floor muscles
involuntary urine loss in spurts during activities that increase abdominal pressure, small post void volume
A
stress incontinence
7
Q
tx for stress incontinence
A
kevels
topical estrogens
mid-urethral sling
8
Q
urinary incontinence caused by impaired detrusor contractility
inability to empty bladder -> high void post volume, nocturnal wetting
A
overflow incontinence
9
Q
6 causes of overflow incontinence
A
diabetes
neuro d.o
anticholinergics/alpha agonists
BPH/prostate ca
urethral stricture
constipation/fecal impaction
10
Q
tx for overflow incontinence
A
gs: self catheterization
cholinergics (bethanecol)
alpha blockers (tamsulosin)
11
Q
urinary incontinence that involves normal voiding systems but difficulty reaching toilet 2/2 mental/physical disability
A
functional incontinence
12
Q
tx for functional incontinence
A
scheduled voiding times
13
Q
mixed urinary incontinence is a combo of
A
stess/urge
14
Q
mc type of urinary incontinence
A
mixed
15
Q
involuntary urination during sleep w.o urologic or neurologic causes after 5 yo
A
nocturnal enuresis
16
Q
management of nocturnal enuresis (4)
A
UA
postvoid residual volume
urodynamic studies
US/cystoscopy
17
Q
stages of acute renal failure based on GFR
A
stage 1 (normal): GFR > 90
stage 2 (early): GFR 60-89
stage 3 (moderate): GFR 30-59
stage 4 (severe): GFR 15-29
stage 5 (kidney failure): GFR < 15
18
Q
top 2 causes of renal vascular dz
A
1. DM
2. HTN
other:
smoking
renal a stenosis
glomerular dz
renal cysts
genetics
19
Q
_ is caused by a rise in BUN concentration
A
azotemia
20
Q
AKI is marked by elevated serum _ and decreased _
A
Cr
GFR
21
Q
3 types of AKI
A
prerenal
intrinsic
postrenal
22
Q
AKI caused by decrease bloodflow to the kidneys
nephrons intact
A
prerenal
23
Q
AKI in the kidneys
A
intrinsic
24
Q
AKI downstream of the kidneys
A
postrenal
25
3 causes of prerenal AKI
hypovolemia - mc
NSAIDs, IV contrast, ACE/ARB
renal artery stenosis
26
tx for prerenal AKI
IVF
underlying cause
27
causes of intrinsic AKI
direct damage to the kidneys:
nephrotoxic drugs: ex aminoglycosides
cyclosporines
tumor lysis syndrome
vasculitis (SLE/Sjorgens)
gout
rhabdo
28
hallmark finding of intrinsic AKI
RBC casts
29
tx for intracellular AKI
IVF
Lasix
30
causes of postrenal AKI
obstruction:
nephrolithiasis
BPH/tumors
congenital/structural abnl's
31
retention of nitrogenous waste
azotemia
32
symptomatic azotemia w. n/v/lethargy
uremia
33
oliguria is defined as
urine output < 400 ml/day
34
causes of prerenal failure
-volume loss
-HF
-loss of peripheral vascular resistance (sepsis/anesthesia)
35
sx of prerenal AKI (5)
weak
dizzy/orthostatic
decreased urine
sunkey eyes
tachy
36
labs findings of prerenal AKI
FENa nl
SpGr >1.030
Bun/Cr > 20
urine osm > 500
37
tx for prerenal AKI
fluids
cardiac support
treat shock
38
3 types of intarenal AKI
glomerular
tubular
intersitial
39
RBC casts
glomerulonephritis
40
WBC casts
pyelonephritis
41
muddy casts
ATN
42
hyaline casts
normal
43
waxy casts
CKD
44
lab findings of intrarenal AKI
SpGr < 1.010
Bun/Cr < 10
urine osm < 300
45
post renal failure is mc due to
prostate pathology
46
mc cause of post renal failure
low/no urine output
47
management of post renal AKI
catheter
US - find blockage/hydronephrosis
48
muddy, pigmented/brown granular casts
ATN
49
2 causes of ATN
renal ischemia (dehydration/shock/sepsis)
toxins
50
mc cause of ATN
prerenal failure
51
5 drugs associated w. ATN
amp B
cisplatin
aminoglycosides
NSAIDs
ACE
52
lab finding of ATN
FENa > 2%
urine osm: high
53
immune mediated AKI
interstitial nephritis
54
4 drugs assocaited w. interstitial nephritis
PCN
sulfa
NSAIDs
phenytoin
55
3 UA findings of interstitial nephritis
WBC casts
eosinophilia
hematuria
56
dx for interstitial nephritis
renal bx
57
management of interstitial nephritis (4)
identify offending drugs
steroids
self limiting
+/- dialysis
58
IgA nephropathy, postinfectious, membranoproliferative
glomerulonephritis
59
UA findings of glomerulonephritis
oliguria
hematuria
RBC casts
60
4 common causes of glomerulonephritis
GAB hemolytic strep
IgA
anti-GBM
ANCA
61
mc cause of acute glomerulonephritis
post streptococcal:
skin (impetigo) vs pharyngitis
62
triad for glomerulonephritis
hematuria
HTN
periorbital edema
63
dx for glomerulonephritis
UA: RBC, proteinuria
64
4 types of kidney stone mc -> least
1. calcium oxalate
2. uric acid
3. struvite
4. cystine
65
colicky, unilateral back/flank pain radiating to the groin, CVA tenderness, n/v
nephrolithiasis
66
labs will prob be normal for nephrolithiasis, but what abnl might you see
leukocytosis
67
gs dx for nephrolithiasis
CT w.o contrast (spiral CT)
68
CT can detect stones as small as
1 mm
69
tx for nephrolithiasis based on size
**< 5 mm:** likely to pass on their own, supportive
**5-10:** not likely to pass spontaneously, supportive, lithotripsy/uteroscopy w. extraction
**> 10 mm:** high likelihood of complication, inpt, stent/nephrostomy, opioids, lithotripsy
70
gs tx for kidney stones > 10 mm
ureteral stent/percutaneous nephrostomy
71
bacteria mc associated w. cystitis
e.coli
72
2 urine dipstick findings of cystitis
nitrite
leukocyte esterase
73
UA findings of cystitis
pyuria
bacteruria
+/- hematuria
74
tx for uncomplicated UTI
bactrim
nitro
x 3-5 days
75
tx for post coital UTIs
single dose bactrim OR cephalexin may reduce frequency
76
tx for UTI in pregnant pt
nitro
OR
cephalexin
77
31 yo M w. unilateral scrotal swelling/pain radiating to ipsilateral groin - PE shows tender, swollen testicle, scrotal edema, erythema w. shiny overlying skin
orchitis
78
common cause of orchitis in postpubertal males
mumps
79
orchitis is rarely seen w.o
epididymitis
80
what do you think when you see orchitis w.o epididymitis
mumps
81
UA findings of bacterial orchitis
pyuria
baceriuria
82
tx for orchitis
< 35 yo OR sexually active (over for GC/CT): ceftriaxone PLUS doxy
> 35 yo (STI not suspected): levofloxacin
83
5 causes of dysuria
cystitis
pyelonephritis
urethritis
epididymitis
prostatitis
84
gs dx for cystitis
urine cx
85
tx for pyelonephritis
fluroquinolones
86
definition for recurrent UTIs
2 uncomplicated x 6 mo
3+ complicated x 1 year
87
definition for UTI relapse
UTI w.in 2 weeks of tx
88
mc cause and dx for urethritis
mc: GC/CT
dx: NAAT
89
dysuria, unilateral scrotal pain
epididymitis
90
what sign is associated w. epididymitis
prehn's: relief w. testicle elevation
91
pathogens associated w. epididymitis:
treatment for epididymitis:
< 35 yo: GC/CT
> 35 yo: e.coli
tx: fluoroquinolone OR doxy
PLUS
ceftriaxone
92
sudden onset f/c, lbp, increased frequency/urgency/dysuria
prostatitis
93
mc cause of prostatitis
< 35 yo: GC/CT
> 35 yo: e.coli
94
never _ a pt. w. prostatitis
prostate massage
95
all pt's w. prostatitis present w. (2)
irritative bladder sx
obstruction
96
dx for prostatitis
-UA: pyuria and hematuria
-prostatic fluid: leukocytosis, culture
97
pathogens associated w. acute vs chronic prostatitis
acute: GC/CT vs. e.coli vs pseudo
chronic: enterococcus
98
tx for acute prostatitis
< 35 yo: ceftriaxone PLUS doxy
> 35 yo: fluoroquinolones vs bactrim x 4-6 weeks
+/- inpatient
99
tx for chronic prostatitis
fluoroquinolones
OR
bactrim
x6-12 weeks
100
when should sexual partners of epididymitis pt be treated
if contact w.in 60 days of sx onset
101
tx for epididymitis in pt's wh practice insertive anal sex
ceftriaxone
PLUS
fluoroquinolone
102
organism mc associated w. pyelonephritis
e.coli
103
lab findings of pyelonephritis
leukocytosis w. left shift
104
US findings suggestive of complicated pyelonephritis
hydronephrosis 2/2 obstruction
105
tx for pyelo
outpt: cipro vs levo vs bactrim x 1-2 weeks
inpt: IV fluoroquinolones/cephalosporins/gentamycin
106
2 mc cause of hyperphosphatemia
**1. renal failure**
**2. hypoparathyroidism**
other:
DKA
crush injuries
rhabdo
infxn
tumor lysis
metabolic vs respiratory alkalosis
107
sx of severe hyperphosphatemia
diplopia
low CO
dysphagia
respiratory dpn
AMS
coma
108
tx for hyperphophatemia
IVF
acetazolamide
phosphate binders
109
lab to order if suspicious of phos or ca imbalance
PTH
110
causes of hypophosphatemia
hyperparathyroidism
etoh
burns
starvation
CKD
diuretics
111
sx of hypophosphatemia
anorexia
muscle weaknes
sz/coma
osteomalacia
112
causes of hypocalcemia
**1. hypoparathyroidism**
other: thyroid surgery, renal dz
113
2 PE findings of hypocalcemia
trousseau's sign
chvostek's sign
114
EKG finding of hypocalcemia
prolonged QT
115
what is this showing
trosseau's sign -> hypocalcemia
116
what is this showing
chvostek sign -> hypocalcemia
117
tx for hypocalcemia
IV calcium gluconate
118
what is more indicative of serious electrolyte imbalance over serum levels
EKG findings
119
causes of hypercalcemia
**1. hyperparathyroidism**
other:
sarcoidosis
TB
paget dz
metastases to bone
MM
120
sx of hypercalcemia
stones
bones
groans
psychiatric moans
121
ekg finding of hypercalcemia
shortened QT
122
sx of hypercalcemia
polyuria
constipation
anorexia
nephrolithiasis
muscle weakness
confusion
123
tx for hypercalcemia
IVF
furosemide
124
hypercalcemia in elderly is _ until proven otherwise
in young adults, think _
elderliy: cancer
young: hyperparathyroidism
125
2 pt pops at high risk for hyponatremia
etoh
malnourished
126
3 sx of severe hyponatremia
coma
brainstem herniation
sz
127
t/f: chronic hyponatremia is not as emergent as acute
t!
128
sx of chronic hyponatremia
problems w. motor/gait -> falls
129
correcting chronic hyponatremia too rapidly can lead to
osmotic demyelination syndrome
130
tx for acute vs chronic hyponatremia
acute: 50 mL bolus of 3% saline
chronic: IV NS
131
hypernatremia is mc caused by
dehydration (limited access to water)
impaired thirst mechanism
other: diabetes insipidus
132
sx of severe hypernatremia
confusion
neuromuscular excitability
hyperreflexia
sz/coma
133
tx for hypernatremia
IV D5W
vs
D5W 1/2 NS
134
rapid correction of chronic hypernatremia can cause
cerebral edema
pontine herniation
135
4 causes of hyperkalemia
late CKD
spironolactone
ACEI
AKI
136
EKG finding of hyperkalemia
peaked T waves
137
tx for hyperkalemia (5)
IV insulin
glucose
albuterol
Ca gluconate
lasix
138
indication for imergent tx w. hyperkalemia
EKG changes
139
EKG progression for hyperkalemia
peaked T waves
sine waves
wide QRS: v tach/vfib
140
2 mc causes of hypokalemia
diuretics
cushing's
141
ekg finding of hypokalemia
u waves
142
sx of hypokalemia (3)
muscle cramps
constipation
prolonged QT
143
tx for hypokalemia
IV potassium PLUS oral potassium
replace Mg
144
what type of fluid is most similar to the body's plasma/serum concentration
LR
145
when would you use NS 0.9% (3)
hydration due to vomiting/diarrhea
hemorrhage
shock
146
when would you use LR
burn victims
hypovolemia due to fluid shifts
147
D5W is _ tonic
hypotonic
148
indication for D5W
DM
NPO prior to surgery
149
3 contraindications for D5W
renal failure
cardiac compromise
increased intracranial pressure
150
1/2 NS (aka 45% NS) is _ tonic
hypo
151
indications for 1/2 NS
cellular dehydration:
hypernatremia
DKA
152
avoid 1/2 NS in what pt pops
burns
trauma
depleted intravascular fluid levels
153
5 causes of severe diarrhea
cholera
rotavirus
norovirus
DKA
burns
154
dehydration causes metabolic _
acidosis
155
tx for dehydration
NS 0.9%
156
diabetes insipidus is caused by
decreased ADH:
head trauma
brain tumor
autoimmune
hyperparathyroidism
157
2 drugs associated w. diabetes insipidus
lithium
demecloclycine
158
dx for diabetes insipidus
fluid deprivation test
159
effect of diabetes insipidus on urine osmolarity
low
160
tx for diabetes insipidus
desmopressin (DDAVP)
D5W 1/2 NS
161
increased ADH from pituitary gland -> inability to dilute serum through kidney excretion -> too much water in the serum
SIADH
162
ectopic cause of SIADH
SCLC
163
lab finding of SIADH
hyponatremia
164
4 meds associated w. hyponatremia
carbamazepine
HCTZ
NSAIDs
TCAs
165
tx for SIADH
restrict fluids
vasopressin-2 receptor agonists (tolvapatan)
demeclocycline
166
what test is always required w. suprapubic/flank pain
UA
pregnancy test for females
167
suprapubic tenderness in males always points to _ pathology (3)
bladder
colon
prostate
168
rapid swelling of the kidney -> severe pain
hydronephrosis
169
renal/utereal colic
nephrolithiasis
170
do not miss for flank pain
aortic aneurysm
171
damage to glomeruli by deposition of inflammatory proteins in as a result of immunologic response
glomerulonephritis
172
t/f: glomerulonephritis has a good prognosis in kids and bad prognosis in adults
t!
173
4 causes of glomerulonephritis
henoch-schonlein purpura
postinfectious
IgA nephropathy
hereditary
174
5 sx of glomerulonephritis
hematuria -> cola/tea colored urine
oliguria/anuria
AM edema of face/eyes
PM edema of feet/ankles
HTN
175
what lab is increased in 60-80% of post streptococcal GN
antistreptolysin-O
176
lab value decreased with post strep GN
complement
177
tx for GN
steroids
immunosuppression
limit Na/fluid
dialysis if azotemia
ACEI if chronic
178
15 yo M, severe, sharp lower abd pain that radiates to left thigh, n/v - hx cryptochordism - normal vitals - scrotal exam shows diffusely tender testis, lifting of testicle does not relieve pain - loss of cremasteric reflex
testicular torsion
179
what is this showing
absent blood flow -> testicular torsion
180
what is this showing
bilateral nonattachment of testicles to gubernaculum to the scrotum -> **bell clapper deformity** -> increased risk for testicular torsion
181
timeline for testicular torsion detorsion
< 6 hr: > 90% salvage rate
after 24 hr: < 10% salvage rate
182
what is this showing
tender nodule 2-3 mm in diameter on upper pole of testicle -> blue dot deformity
183
hx clue for testicular torsion
cryptochordism
184
mc vs gs imaging for testicular torsion
mc: testicular doppler
gs: radionuclide scan
185
tx for testicular torsion
1. emergent surgery
2. elective surgery on contralateral side (increased risk for torsion)
186
ddx for hematuria
bladder ca
renal cell carcinoma
nephrolithiasis
acute GN
coagulation d.o
polycystic kidney dz
nephrolithiasis
UTI
pyelonephritis
187
mc causes of urethritis
**HSV - mc**
CT
GC
trichomonas
188
2 sx of urethritis
dysuria
urethral d.c
189
t/f: sexually active pt w. sx of urethritis is treated presumptively for STIs
t!
190
tx for urethritis
ceftriaxone 500 mg IM x 1
PLUS
doxy 100 mg po bid x 7 days (azithromycin if pregnant)
191
types of hernias (7)
umbilical
diaphragmatic/hiatal
incisional
cystocele
rectocele
inguinal
ventral
192
what type of hernia is espically associated w. obesity
incisional
193
ventral hernias can be either _ or _
incisional
umbilical
194
imaging for hernia
US
*esp in male kiddo w. other scrotal masses*
