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Emergency EOR > Urology/Renal > Flashcards

Urology/Renal Flashcards

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1
Q

DDX for dysuria

A 
PID
Trichomoniasis
Chlamydia / gonorrhea
UTI
Epididymitis and orchitis
Pyelonephritis
Prostatitis
Urethritis
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2
Q

DDX for hematuria

A 
Acute glomerulonephritis
Polycystic kidney disease
Cystitis
Pyelonephritis
BPH
Bladder CA
Renal cell CA
Wilms Tumor
Nephrolithiasis
Urethritis
Chlamydia
Gonorrhea
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3
Q

DDX for suprapubic/flank pain

A 
Glomerulonephritis
Nephrolithiasis
Pyelonephritis
Polycystic kidney disease
Cystitis
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4
Q

DDX for incontinence

A

Hydrocephalus
Spinal cord injury
Cauda equina
Tertiary syphilis

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5
Q

Most common types of stones in nephrolithiasis

A
  1. Calcium oxalate
  2. Calcium phosphate
    Other types: uric acid, struvite stones, cystine stones
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6
Q

Characteristics of struvite stones in nephrolithiasis

A

Staghorn appearance

Caused by urea splitting bacteria (proteus)

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7
Q

Risk factors for nephrolithiasis

A

Decreased fluid intake
Medications (loop diuretics, chemo drugs)
Gout

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8
Q

Signs/symptoms of nephrolithiasis

A

Renal colic - acute flank pain that radiates to groin
Pain over CVA
N/V
unable to find comfortable position

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9
Q

Diagnosis of nephrolithiasis

A
  1. Urinalysis - will show hematuria in 80%
  2. Non-contrast helical CT scan - test of choice
  3. KUB - will only visualize calcium stones
  4. Intravenous pyelography - gold standard
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10
Q

Treatment of nephrolithiasis < 5 mm in diameter

A

80% chance of spontaneous passage

  1. IV fluids, analgesics, antiemetics
  2. Tamsulosin - may facilitate passage
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11
Q

Treatment of nephrolithiasis > 7 mm in diameter

A

Extracorporeal shock wave lithotripsy
Ureteroscopy +/- stent
Percutaneous nephrolithotomy - used for stones > 10 mm

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12
Q

Prevention of future nephrolithiasis

A
  1. Adequate hydration
  2. Decrease animal protein intake
  3. Thiazide diuretics are used for recurrent calcium stones
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13
Q

Spermatic cord twists and cuts off testicular blood supply due to congenital malformation which allows the testicle to be free floating in the tunica vaginalis causing it to twist on itself

A

Testicular torsion

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14
Q

If nausea/vomiting if present in the setting of abrupt onset of scrotal or inguinal pain, suspect

A

Torsion

Usually absent in epididymitis

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15
Q

Physical exam signs for testicular torsion

A

Negative Prehn’s sign
Negative cremasteric reflex
Blue dot sign at upper pole
Bell clapper deformity

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16
Q

Pain relief of scrotal elevation

A

Prehn’s sign

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17
Q

Diagnosis of testicular torsion

A
  1. Testicular doppler ultrasound - best initial
  2. Emergency surgical exploration required if US unable to exclude
  3. Radionuclide scan (not used frequently)
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18
Q

Management of testicular torsion

A
  1. Detorsion and orchiopexy within 6 hours and in obvious cases (testicle fixation in the scrotum)
  2. Orchiectomy if testicle not salvageable
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19
Q

Risk factors for cystitis (women)

A

Sexual intercourse
Spermicidal use
Pregnancy
Postmenopausal

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20
Q

Risk factors for cystitis (men0

A

Rare - should have workup
> 50 y/o
BPH
Prostate CA

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21
Q

Most common etiology for cystitis

A

E. coli
Staph, saprophyticus (sexually active women)
Enterococci for indwelling catheters

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22
Q

Dysuria (burning), increased frequency, urgency, hematuria, suprapubic discomfort

A

Acute cystitis

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23
Q

Fever and tachycardia, back/flank pain, + CVAT, n/v

A

Pyelonephritis

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24
Q

Diagnosis of cystitis/pyelonephritis

A
  1. Urinalysis
  2. Dipstick
  3. Urine culture
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25
If urinalysis shows WBC casts
Pyelonephritis
26
Indications for urine culture with cystitis/pyelonephritis
``` Complicated UTI Infants/children Elderly Males Urologic abnormalities Refractory to tx Catheterized pts ```
27
Conservative treatment for cystitis
Increase fluid intake, void after intercourse
28
Management of cystitis
1. Phenazopyridine (Pyridium) turns urine orange 2. Nitrofurantoin, ciprofloxacin, bactrim, fosfomycin 3. Pregnant: amoxicillin, augmentin
29
Management of pyelonephritis
Fluoroquinolones IV or PO aminoglycosides
30
Epididymal pain and swelling thought to be secondary to retrograde infection or reflux of urine
Epididymitis
31
Epididymitis is usually __________, while orchitis is usually ___________
Bacterial | Viral
32
Most common causes of orchitis and epididymitis in men < 35 y/o
Chlamydia, gonorrhea
33
Most common causes of orchitis and epididymitis in men > 35 y/o and children
Enteric organisms most common | E. coli, Klebsiella
34
1/3 of postpubertal men with __________ whave concomitant orchitis
Mumps
35
Gradual onset of scrotal pain, erythema and swelling. Most commonly unilateral. +/- groin or abdominal pain. Fever, chills, irritative symptoms
Epididymitis and orchitis
36
Relief of pain with elevation of the affected scrotum
Positive Prehn's sign | Epididymitis and orchitis
37
Elevation of the testicle after stroking the inner thigh
Positive cremasteric reflex | Epididymitis and orchitis
38
Diagnosis of epididymitis / orchitis
1. Scrotal ultrasound - increased testicular blood flow, enlarge epididymitis 2. UA: pyuria (WBC), bacteriuria 3. CBC: leukocytosis 4. Urine culture 5. STD testing
39
Symptomatic treatment for orchitis
Bed rest, scrotal elevation, cool compresses and analgesics (NSAIDs)
40
Management of acute epididymitis
Gonorrhea and chlamydia: doxycycline plus ceftriaxone IM Enteric organisms: fluoroquinolones Children: cephalexin or amoxicillin
41
Management of chronic epididymitis
4-6 week trial of abx
42
Prostate gland inflammation secondary to an ascending infection
Prostatitis
43
Most common causes of prostatitis when > 35 y/o
E. coli (MC) Pseudomonas Klebsiella Proteus
44
Most common causes of prostatitis when < 35 y/o
Chlamydia and gonorrhea MC
45
Most common cause of chronic prostatitis
E. coli Enterococci Trichomonas
46
Fever/chills, malaise, arthralgias, irritative and obstructive urinary symptoms, lower back/abdominal pain, perineal pain
Prostatitis
47
Chronic prostatitis usually presents as:
Recurrent UTIs | Intermittent dysfunction
48
Physical exam for acute prostatitis
Exquisitely TENDER, normal or hot, boggy prostate
49
Physical exam for chronic prostatitis
Usually non tender boggy prostate
50
Diagnosis of prostatitis
1. Urinalysis and urine culture 2. Avoid prostate massage in acute prostatitis 3. Transrectal ultrasound
51
Management of acute prostatitis > 35 y/o
Fluoroquinolones or TMP-SMZ | If hospitalized, IV fluoro
52
Management of acute prostatitis < 35 y/o
Tx for gonorrhea and chlamydia | Ceftriaxone plus Doxy/Azithro
53
Management of chronic prostatitis
Fluoroquinolones, TMP-SMZ | Transurethral resection of the prostate for refractory chronic prostatitis
54
Most common cause of urethritis in men < 30 y/o
Gonorrhea
55
Anal, vaginal, penile or pharyngeal discharge, may cause septic arthritis
Urethritis and cervicitis - gonorrhea
56
Culture shows gram negative diplococci in polymorphonuclear leukocytes
gonorrhea
57
Management of gonorrhea
Ceftriaxone IM plus doxy or azithromycin
58
Purulent or mucopurulent discharge, pruritus, dysuria, dyspareunia, hematuria
Urethritis - chlamydia
59
Most common causes of urethritis
Chlamydia | Gonococcal (2nd most common)
60
Urethritis with abrupt onset of symptoms (especially within 3-4 days). Opaque, yellow, white, or clear thick discharge, pruritus
Gonococcal urethritis
61
Urethritis of 5-8 days with purulent or mucopurulent discharge, pruritus. Hematuria, pain with intercourse
Chlamydia urethritis
62
Complications of men with urethritis
Epididymitis, prostatitis, infertility, reactive arthritis
63
Complications of women with urethritis
Pelvic inflammatory disease, infertility, ectopic pregnancy, premature delivery, septic arthritis
64
Diagnosis of urethritis
Nucleic acid amplification
65
Acute renal failure is described as: (2)
1. Increased serum creatinine > 50% OR | 2. Increased BUN (azotemia)
66
Phases of AKI
1. Oliguric phase (decreased urine output, hyperkalemia, azotemia, metabolic acidosis) 2. Diuretic phase (increased urine output, hypotension, hypokalemia) 3. Recovery
67
3 types of acute renal failure
1. Prerenal (rapidly reversible) 2. Postrenal (rapidly reversible) 3. Intrarenal
68
Causes of prerenal acute renal failure
Reduced renal perfusion | Hypovolemia
69
Management of prerenal acute renal failure
Volume repletion to restore volume and renal perfusion (rapidly responds to tx)
70
Causes of postrenal acute renal failure
Obstruction of the passage of urine (stones, BPH)
71
Management of postrenal acute renal failure
Removal of obstruction
72
Cause of intrinsic acute renal failure
Direct kidney damage - nephrotoxic, cytotoxic, prolonged ischemic, inflammatory insults to the kidney Structural/functional nephron damage (cellular cast formation) - hallmark
73
Most common type of intrinsic acute renal failure
Acute Tubular Necrosis
74
Overall cause of intrinsic acute renal failure
NSAIDs, contrast, aminoglycosides, infections, penicillins, sulfa drugs, ciprofloxacin, allopurinol, etc.
75
Management of intrinsic acute renal failure
Remove offending agents IV fluids Furosemide if p euvolemic and not urinating If glomerulonephritis - give corticosteroids
76
Immunologic inflammation of the glomeruli causing protein and RBC leakage into the urine
Glomerulonephritis
77
HTN, hematuria (RBC casts), dependent edema (proteinuria), and azotemia (nitrogen in blood) are hallmarks
Glomerulonephritis
78
Types of glomerulonephritis
1. IgA Nephropathy (Berger's Dz) 2. Post infectious 3. Membranoproliferative / Mesangiocapillary 4. Rapidly progressive 5. Goodpasture's dz 6. Vasculitis
79
Most common cause of acute glomerulonephritis in adults worldwide
IgA nephropathy (Berger's dz)
80
Glomerulonephritis that often affects young males within days (24-48 hours) after URI or GI infection
IgA nephropathy
81
Diagnosis of IgA nephropathy
IgA mesangial deposits on immunostaining
82
Management of IgA nephropathy
ACEI +/- corticosteroids
83
Glomerulonephritis that is most common after GABHS
Post infectious
84
Glomerulonephritis that classically presents as a 2-14 yo boy with facial edema up to 3 weeks after Strep with scanty, cola-colored dark urine (hematuria and olguria)
post infectious glomerulonephritis
85
Diagnosis of post infectioius glomerulonephritis
``` Increased antistreptolysin (ASO) titers, low serum complement Biopsy: hypercellularity, increased monocytes/lymphocytes, immune humps ```
86
Management of post infectious glomerulonephritis
Supportive, +/- antibiotics
87
Glomerulonephritis due to SLE, viral hepatitis (HCV, HBV), hypocomplementemia, cryoglobulinemia
Membranoproliferative / mesangiocapillary glomerulonephritis
88
Glomerulonephritis associated with poor prognosis (progresses to end stage renal failure within weeks/months)
Rapidly progressive glomerulonephritis (RPGN)
89
Crescent formation on biopsy
Rapidly progressive glomerulonephritis | Due to collapse of crescent shape of Bowman's capsule
90
Management of rapidly progressive glomerulonephritis
Corticosteroids + cyclophosphamide
91
Two types of glomerulonephritis that only present with RPGN:
Goodpasture's disease | Vasculitis
92
Glomerulonephritis with + anti-GBM antibodies
Goodpasture's disease
93
Diagnosis of goodpasture's disease
Linear IgG deposits
94
Management of goodpasture's disease
High dose corticosteroids + cyclophosphamide + plasmapheresis
95
Glomerulonephritis that is characterized by lack of immune deposits and + ANCA antibodies
Vasculitis | Can either have p-ANCA or C-ANCA
96
The presence of ______________ in nephritis distinguishes nephritic from nephrotic
Gross hematuria
97
Signs/Symptoms of glomerulonephritis
``` Hematuria Edema HtN Fever, abdominal pain, flank pain Oliguria ```
98
Diagnosis of glomerulonephritis
1. Urinalysis 2. Increased BUN, creatinine 3. Renal biopsy gold standard
99
Proteinuria, hypoalbuminemia, edema, hyperlipidemia
Nephrotic syndrome
100
Edema is the predominant feature in:
Nephrotic syndrome
101
Diagnosis of nephrotic syndrome
1. Urinalysis - protein > 3.5 | 2. Biopsy - hypocellular
102
Complications of nephrotic syndrome
Transudative pleural effusion DVTs Frothy urine
103
Disorder that may cause hypernatremia
Diabetes insipidus
104
In surgical patients, hypernatremia may result from
Loop diuretics | Also from gastrointestinal losses
105
In the acute setting, rapid hypernatremia can cause
Intracerebral hemorrhage
106
Causes of hypervolemic hyponatremia - patient will usually have edema
Renal failure CHF COPD Severe liver disease
107
Causes of normovolemic hyponatremia
SIADH
108
Causes of hypovolemic hyponatremia
``` Renal losses of sodium Diuretic use Aldosterone deficiency Renal failure Subarachnoid hemorrhage ```
109
Treatment of hypervolemic hyponatremia
Volume restriction and loop diuretic
110
Treatment of normovolemic hyponatremia
SIADH - fluid restriction
111
How do you correct hypernatremia?
D5W
112
Treatment of hypovolemia hyponatremia
Salt and water replacement
113
Should not increased serum sodium concentration faster than _________ mEq/L/hr
0.5
114
Hyperkalemia can result from
Renal or adrenal insufficiency Metabolic acidosis Iatrogenic causes
115
Most important results of severe hyperkalemia
Myocardial effects Peaked T wave is first sign Finally: complete heart block, ventricular tachycardia, cardiac standstill can occur
116
Treatment of hyperkalemia
10-20 mL of 10% calcium gluconate Can give Kayexalate (takes longer) Most effect method: hemodialysis
117
Hypokalemia is common in surgical pts due to :
GI losses - vomiting, diarrhea, fistula | Use of diuretics
118
Treatment for hypokalemia
1. Oral potassium unless severe or pt is symptomati
119
Treatment for hypercalcemia (when not due to parathyroidism)
Saline diuresis Furosemide Calcitonin - reduces bone resorption
120
Signs of hypocalcemia
Trousseau's | Chvostek Sign
121
Trousseau's Sign
Seen in hypocalcemia | BP cuff inflated - spasm in muscles of hand/forearm
122
Chvostek Sign
Seen in hypocalcemia | Tap facial nerve - twitch on same side of face
123
Treatment of hypocalcemia if symptomatic/severe
IV calcium therapy
124
Diseases that cause hypermagnesemia
Renal failure | Addison's disease
125
Treatment for hypermagnesemia
Calcium infusion followed by immediate dialysis
126
In surgical pts, hypomagnesemia is a result of
GI losses | Reduced absorption
127
Treatment for hypomagnesemia
Magnesium infusion | If treatment not urgent, give oral supplements
128
Most common causes of hyperphosphatemia
Renal insufficiency
129
Treatment of hyperphosphatemia
Treat underlying renal failure | Phosphate-binding antacids
130
Treatment of hypophosphatemia
Oral or parental phosphate
131
Metabolic acidosis formula
Decreased pH Decreased bicarb Decreased CO2
132
Metabolic alkalosis formula
Increased pH Increased bicarb Increased CO2
133
Respiratory acidosis formula
Decreased pH Increased bicarb Increased CO2
134
Respiratory alkalosis formula
Increased pH Decreased bicarb Decreased CO2
135
An anion gap over _____ is considered an elevated anion gap
12
136
MUDPILERS
``` Methanol Uremia Diabetic/alcoholic ketoacidosis Paraldehyde/propylene glycol Isoniazid / iron Lactic acidosis Ethylene glycol Rhabdomyolysis Salicylates ```
137
When can you treat an acidotic pt with sodium bicarb?
If pH < 7.2 Life-threatening ventricular arrhythmia Inadequate compensatory response
138
Risks fo sodium bicarbonate therapy
Hypernatremia Hyperosmolarity Volume overload

Emergency EOR (12 decks)

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