Urology/Renal Flashcards
(178 cards)
1
Q
average acid base values
A
“24/7 40/40”
HCO3: 24
pH: 7.40
CO2: 40
2
Q
7 causes of renal vascular dz
A
DM - mc
htn
smoking
renal a stenosis
glomerular dz
renal cysts
AI/SLE/PCKD/alport’s
3
Q
presentation of ARF/AKI (3)
A
rapid decline in renal fxn:
elevated SCr
decreased GFR
elevated BUN (azotemia)
4
Q
3 types of ARF/AKI
A
prerenal
intrinsic
postrenal
5
Q
causes of prerenal ARF/AKI
A
decreased kidney perfusion -> loss of peripheral vascular resistance:
hypovolemia - mc
nsaids
IV contrast
ACEI
ARBs
6
Q
t/f: w. prerenal failure, the nephrons remain intact
A
t!
7
Q
6 sx of prerenal AKI
A
weak
decreased urine output
dizzy
sunken eyes
tachy
orthostatic
8
Q
lab findings associated w. prerenal AKI
A
FEN: normal
urine SpGr: > 1.030
BUN/Cr: > 20
Urine Osm: > 500
9
Q
tx for prerenal AKI
A
fluids
BP support
10
Q
5 causes of intrinsic renal failure
A
drugs
tumor lysis syndrome
vasculitis (SLE/sarcoidosis)
gout
rhabdo
11
Q
2 nephrotoxic drugs
A
aminoglycosides
cyclosporine
12
Q
hallmark finding of intrinsic AKI
A
RBC casts
13
Q
types of cast and associated condition
A
RBC: glomerulonephritis
WBC: pyelonephritis
muddy/brown: ATN
waxy: CKD
hyaline: normal
14
Q
lab findings of intrinsic ARF/AKI
A
urine SpGr: < 1.010
Bun/Cr: < 10
Urine Osm: < 300
15
Q
tx for intrinsic AKI
A
IVF
+/- diuretics
16
Q
mcc of obstructive/postrenal AKI
A
BPH
17
Q
4 all causes of postrenal AKI
A
BPH
stones
tumors
congenital abnl
18
Q
tx for postrenal AKI
A
catheter
US
remove obstruction vs fix abnl
19
Q
US finding of postrenal AKI
A
hydronephrosis
20
Q
3 types of intrinsic AKI
A
ATN
interstitial nephritis
glomerulonephritis
21
Q
causes of ATN
A
ischemia
toxins
22
Q
why is FENa elevated with ATN
A
damaged tubules can concentrate urine
23
Q
what is FENa
A
fractional excretion of sodium
24
Q
FENa < 1% suggests _
FENa > 1% suggests _
A
< 1%: prerenal
> 2%: ATN
25
lab findings associated w. ATN
FENa: >2%
urinary sodium: >40
BUN/Cr: <20
Urine osmo: <350
26
mcc of ATN
prerenal failure
27
5 drugs associated w. ATN
amp B
cisplatin
aminoglycosides
nsaids
ACEI
28
ATN triad
FENa > 2%
muddy brown casts
low urine Osm
29
interstitial nephritis triad
wbc casts
eosinophilia
hematuria
30
interstitial nephritis is caused by a _ reponse
immune mediated
31
5 drugs associated w. interstitial nephritis
**5 p's:**
pee (diuretics)
pain free (nsaids)
pcn's/cephalosporins
ppi's
rifamPin
32
dx for interstitial nephritis
renal bx
33
management of interstitial nephritis
usually self limited
steroids
+/- dialysis
34
3 types of GN
IgA nephropathy
postinfectious
membranoproliferative
35
GN triad
hematuria
htn
periorbital edema
also: oliguria, hematuria, RBC casts
36
4 causes of GN
GAS
IgA
anti-GBM
ANCA
37
mcc of acuteGN
post streptococcal: skin vs pharyngitis
38
ckd is defined as ongoing loss of kidney fxn w. GFR < _ for _ months
60
3 months
39
gs dx for ckd
cockroft gault
40
3 causes of ckd
DM
HTN
GN
41
5 sx of CKD
fatigue
pruritis
kussmaul respirations
asterixis
muscle wasting
42
what stage ckd indicates need for dialysis
4
43
bp goal for ckd pt
130/80
44
all ckd pt's should be on what med for bp control
ACEI or ARB
45
lab findings for ckd (3)
hypocalcemia
hyperphosphatemia
metabolic acidosis
46
62 yo M w. sudden onset fever and rash - recently started omeprazole - labs: SCr 3.5, eosonophilia, WBC casts
acute interstitial nephritis
47
2 drugs to avoid in pt's w. BPH
anticholinergics
antihistamines
48
t/f: BPH is a precursor to prostate ca
f!
49
PE finding of BPH
enlarged rubbery prostate
50
PSA < _ is associated w. BPH
4
51
lifestyle management of bph (2)
decrease nighttime fluids
avoid caffeine/etoh
52
3 classes of bph meds
-alpha adrenergic receptor blockers: terazosin, tamsulosin
-5 alpha reductase inhibitors: finasteride
-phosphodiesterase-5 enzyme inhibitors: tadalafil
53
which prostate med decreases DHT synthesis and actually reduces prostate gland size
5 alpha reductase inhibitors: finasteride
54
what is DHT
dihydrotestosterone
55
moa for terazosin/tamsulosin
decrease prostate/bladder/urethral muscle tone
56
moa for tadalafil
induce smooth m relaxation
57
what surgery is used for bph
TURP (transurethral resection of the prostate)
58
2 s.e of TURP
sexual dysfxn
urinary incontinence
59
smoker w. gross hematuria
bladder ca
60
mc type of bladder ca
transitional cell carcinoma
61
gs dx for bladder ca
cystoscopy w. bx
62
tx for bladder ca
surgery
biologics
chemo
63
25 yo M w. a few days of gradually worsening dull, achy scrotal pain, dysuria, and a swollen right testicle - UA positive for leuks
epididymitis
64
unilateral swollen testicle w. induration
epididymitis
65
epididymitis is acquired by
retrograde spread of organisms through the vas deferens
66
mcc of epididymitis based on age
men < 35: CT/GC
men > 35: e. coli
67
epididymitis pain radiates to the
ipsilateral flank
68
what PE sign is associated w. epididymitis
prehn sign: pain w. relief of scrotal elevation
69
tx for epididymitis (3)
bed rest
scrotal elevation
analgesics
abx
70
abx for epididymitis based on age
< 35: ceftriaxone + doxy
> 35: levofloxacin vs bactrim
71
6 causes of ED
psychological
HTN
DM
hormonal dysfxn
meds
nocturnal penile tumescence
72
tx for ED
wt loss
smoking/etoh cessation
hormone replacement
vacuum erection devices
surgery
73
what ed med should you never use with nitrates due to risk of life threatening hypotn
pde 5's: tadalafil, vardenafil, sildenafil
74
damage of renal glomeruli by deposition of inflammatory proteins in glomerular membranes as a result of immunologic response
glomerulonephritis
75
what lab is elevated in a majority of PSGN cases
antistreptolysin-O titer
76
is serum complement increased or decreased w. GN
decreased
77
tx for GN
steroids
immunosuppressants
decrease salt/fluids
+/- dialysis
78
fluid filled sac around a testicle
hydrocele
79
hydrocele is mc in what 2 pt pops
newborns
older men
80
PE finding of a hydrocele
mass transilluminates
81
tx for hydrocele
obs
usually self resolves
82
4 causes of hydronephrosis
**blockage in the ureter:**
stone
bph
blood clot
tumor
83
6 causes of hypervolemia
iatrogenic
CHF
nephrotic syndrome
cirrhosis
ESR
hypoalbuminemia
84
5 PE findings associated w. hypervolemia
weight gain
peripheral edema
ascites
JVD
pulmonary rales
85
gs dx for fluid status
pulmonary a catheter (swan-ganz) to measure CVP
86
causes of hypovolemia
decreased thirst
GI/urinary fluid loss
burns
diuretics
osmotic diuresis
hyperglycemia
sodium excess
diabetes insipidus
87
PE findings associated w. hypovolemia
weakness/fatigue/apathetic
tachycardia
postural hypotn
dry mm
decreased skin turgor
hypothermia
pale extremities
oliguria
88
2 types of diabetes insipidus
neurogenic (central)
nephrogenic
89
neurogenic diabetes insipidus is caused by
deficient vasopressin/ADH secretion from post pit
90
nephrogenic diabetes insipidus is caused by
unresponsive kidneys to normal ADH levels
91
3 causes of nephrogenic diabetes insipidus
inherited x linked
lithium
renal dz
92
hallmark finding of diabetes insipidus
urine osmo < 250 in setting of hypernatremia
93
management of diabetes insipidus
isotonic fluid bolus (NS vs LR)
replace blood loss w. crystalloid
maintenance D5/NS + KCl
94
goal urine output for diabetes insipidus
0.5-1.0 mL/kg/hr
95
consequence of rapid fluid replacement w. diabetes insipidus
pulmonary edema
96
basic difference between nephrotic vs nephritic syndrome
nephrotic: protein loss
nephritic: blood loss
97
nephritic syndrome is caused by
inflammation that damages the glomerular basement membrane
98
hallmark finding of nephritic syndrome
hematuria
RBC casts
99
3 sx of nephritic syndrome
low urine output
sodium retention -> htn
peripheral/periorbital edema
100
4 lab findings of nephritic syndrome
elevated BUN/Cr
hematuria
proteinuria
RBC casts
101
dx for nephritic syndrome (2)
24 hr urine protein collection: < 3.5 g/day
renal bx
102
3 different classes of nephritic syndrome causes
type III hypersensitivity
multifactorial
alport syndrome
103
3 type III hypersensitivity causes of nephritic syndrome
PSGN
diffuse proliferative GN (SLE)
IgA (berger's dz)
104
2 multifactorial causes of nephritic syndrome
menbranoproliferative GN (MPGN)
rapidly progressive GN (RPGN)
105
what cause of nephritic syndrome is associated w. collagen synthesis
alport syndrome
106
management of nephritic syndrome
salt/fluid restriction
ACEI/ARB
IgA: steroids
RPGN: immunosupressants
PSGN: ccs instead of ACE/ARB
107
inflammation of the kidneys that may involve glomeruli, tubules, or interstitial tissue surrounding glomeruli and tubules
nephritis
108
mcc of nephritis
AI
109
nephritis caused by inflammation from a UTI that reaches the renal pelvis
pyelonephritis
110
otherwise healthy 45 yo M w. painless hematuria x 3 days - no PMH stones or UTIs - fam hx of htn at a young age - PE positive for bilat non tender flank masses
ADPCKD (autosomal dominant polycystic kidney dz)
111
ADPCKD is caused by a mutation of what gene
PKD1/PKD2
112
ADPCKD involves numerous cysts in the kidneys made of
epithelial cells from renal tubules
113
sequale of ADPCDK
kidney failure/ESRD
114
classic presentation of ADPCKD
young
back/flank pain
htn
115
3 cardiac complications associated w. ADPCKD
**brain aneurysms**
MVP
LVH
116
what is this showing
multiple fluid filled cysts -> ADPCKD
117
management of ADPCKD
no cure -> supportive
ACEI/ARB
dialysis/transplant
118
mc location for prostate ca
peripheral zone
119
PE finding of prostate ca
DRE: hard, irregular, nodular prostate
120
PSA > 4 makes you think of (3)
bph
prostate ca
prostatitis
121
prostate ca screening recs
55-69 yo: +/- annual PSA
>70: USPSTF recommends against screening
122
2 indications for TRUS (transrectal US)
PSA > 10, regardless of DRE findings
abnormal DRE, regardless of PSA
123
management of PSA <4.0-10.0
<4.0: PSA annually based on pt preference
4.1-10.0: bx
124
ascending infxn of gram negative rods into prostatic ducts
prostatitis
125
presentation of acute prostatitis
sudden onset:
f/c
lbp
frequency/urgency/dysuria/obstruction
126
presentation of chronic prostatitis
irritative bladder symptoms/obstruction
+/- other symptoms
127
all forms
128
prostatic fluid findings associated w. prostatitis
leukocytosis
acute: e.coli
chronic: enterococcus
129
what PE exam is contraindicated if you suspect prostatitis
DRE -> can lead to sepsis!
130
pathogen associated w. prostatitis: < 35 vs > 35
< 35: CT/GC
> 35: e.coli, pseudomonas
131
tx for prostatitis: < 35 vs > 35 vs chronic
< 35: ceftriaxone PLUS doxy
> 35: fluoroquinolones vs bactrim, test of cure
chronic: fluoroquinolones vs bactrim x **6-12 weeks**
132
what should you do if fever w. prostatitis hasn't resolved w.in 36 hr
suspect abscess -> consult urology
133
organism mc associated w. pyelonephritis
e.coli
134
tx for pyelo: outpt vs inpt
outpt: FQ vs bactrim x 1-2 weeks
inpt: IV FQ vs 3rd/4th gen cephalosporins vs gentamicin
135
colicky flank pain radiating to the groin, hematuria, n/v
nephrolithiasis
136
gs dx for nephrolithiasis
abd/pelvis spiral CT w.o contrast
137
4 types of kidney stones
**calcium oxalate - mc**
struvite
uric acid
cystine
138
what condition do calcium oxalate stones make you think of
hyperparathyroidism
139
what beverage should pt's w. calcium oxalate stones avoid
grapefruit juice
140
what type of kidney stone is associated w. chronic UTI
struvite
141
what 2 pathogens do struvite stones make you think of
klebsiella
proteus
142
young boy with kidney stones probs has what type of stone
cystine
143
general management of kidney stones
outpt for most
analgesia
hydration
abx if UTI
alpha blockers (tamsulosin)
+/- lithotripsy
144
3 indications for hospitalization w. kidney stones
refractory pain despite meds
anuria
UTI and/or fever
145
you should consider lithotripsy for stones > _ mm
5
146
gs management of kidney stones > 10 mm
nephrostomy
*can also consider stent*
147
renal cell carcinoma triad
hematuria
flankl pain
palpable abd mass
148
2 mc types of renal cell carcinoma
**1. clear cell**
2. transitional cell
149
rf to know for renal cell carcinoma
smoking
150
dx for renal cell carcinoma
1. US vs CT
2. bx
151
tx for renal cell carcinoma
nephrectomy
152
narrowing of one or both renal arteries mc caused by atherosclerosis or fibromuscular dysplasia
renal artery stenosis
153
presentation of renal a stenosis
<30 yo
HTN + CAD/PVD
HTN resistant to 3+ drugs
154
pt placed on ACEI who develops acute renal failure or a sharp rise in BUN/Cr
renal a stenosis
155
dx for renal a stenosis: initial vs gs
initial: US
gs: renal arteriography
156
tx for renal a stenosis
percutaneous transluminal angioplasty (PTA) PLUS stent vs bypass
157
15 yo M w. severe/sharp lower abd pain radiating to left thigh - associated vomiting - no f/c or dysuria - single elevated left testis that is diffusely tender
testicular torsion
158
what is the bell clapper deformity
bilat nonattachment of the testicles by the gubernaculum to the scrotum
159
how much time do you have to detorse a testicle
**ideally: <6 hr**
>24 hr = < 10% chance of salvaging testicle
160
how would you differentiate btw torsion and epididymitis on PE
epididymitis: (+) prehn sign
torsion: absent cremaster reflex
161
what is this showing
**blue dot sign** -> tender nodule on upper pole -> **torsion**
162
PMH clue for torsion
cryptochordism
163
management of testicular torsion
emergency surgery
elective surgery for contralateral teste
164
UTI is infection of
kidneys, bladder, or urethra
165
mc pathogen associated w. UTI
e.coli
166
gs dx for UTI
urine culture
167
tx for UTI
uncomplicated: **nitro,** bactrim, fosfomycin
complicated: cipro
postcoital: bactrim vs keflex, single dose
pregnant: nitro vs keflex
168
hunner's ulcer on cystoscopy
intersitial cystitis
169
UTI symptoms that are relieved w. voiding
interstitial cystitis
170
enlargement of the veins w.in the scrotum
varicocele
171
what is this showing
varicocele
172
varicocele involves dilation of the _ plexus
pampiniform
173
2 causes of varicocele
poorly functioning valves
vein compression
174
if a varicocle is symptomatic, how may it present
low sperm production/quality -> infertility
175
how does a varicocele look on PE
bag of worms
176
varicocele is worse when the pt is _ and relieved when the pt is _
worse: upright
relieved: supine
177
varicocele is mc on what side
left
178
tx for varicocele
surgery if symptomatic
