Urology/Renal from PANCE Pearls Flashcards
(104 cards)
1
Q
What is Incontinence
A
Involuntary loss of urine
2
Q
What is Stress Incontinence
A
Increased intraabdominal pressure leads to urinary leakage
3
Q
How does Stress Incontinence occur
A
Increased intrabdominal pressure is greater than the urethral resistance to blood flow
Laxity of pelvic floor muscles caused by childbirth, obesity, estorgen
4
Q
Sx of Stress Incontinence
A
Sneezing, Coughing, Laughing all lead to increased intrabdominal pressure which leads to leakage
5
Q
Tx of Stress Incontinence
A
Pelvic Floor Exercises: Kegel, Biofeedback
Alpha Agonists: Midodrine, Pseudoephedrine (increase urethral sphincter tone)
Surgery: Increase urethral outlet resistance
6
Q
What is Urge Incontinence
A
Urine leakage accompanied by or preceding urge
7
Q
What causes Urge Incontinence
A
Detrusor muscle overactivity
Remember, detrusor muscle is stimulated by muscarinic Ach receptors
Contraction of detrusor causes release of urine
8
Q
Sx of Urge Incontinence
A
Urgency, frequency, small volume voids, nocturia
9
Q
Tx of Urge Incontinence
A
Bladder training (timed, frequent voids)
Anticholinergics are 1st line (Tolterodine, Propantheine, Oxybutynin)
TCA’s (Imipramine)
10
Q
What is Overflow Incontinence
A
Urinary Retention
Incomplete bladder emptying
11
Q
What leads to Overflow Incontinence
A
Decreased Detrusor Muscle activity
“Underactive bladder”
Bladder outlet obstruction: BPH
12
Q
Sx of Overflow Incontinence
A
Small volume voids, frequency, dribbling
Increased Post void residual >200mL
13
Q
Tx of Overflow Incontinence
A
Intermittent or indweling catheter 1st line
Cholinergics (Bethanacol)
BPH: Alpha-1 Blockers (Tamsulosin)
14
Q
What is Chronic Kidney Disease
A
Chronic Kidney damage for > 3 months evidence by: Proteinuria Abnormal Urine Sediment Abnormal Serum/Urine Chemistries Abnormal Imaging Studies Inability to buffer pH Inability to make urine Inability to excrete nitrogenous waste Decreased Synthesis of Vitamin D/Erythropoietin
15
Q
What are the different stages of Chronic Kidney Disease
A
Stage 0: At risk patients (DM, HTN, Chronic NSAID) State 1: Normal GFR with kidney damage Stage 2: GFR 60-89 Stage 3: GFR 30-59 Stage 4: 15-29 Stage 5: GRF
16
Q
What interventions occurs with end stage renal disease
A
Uremia requiring dialysis and/or transplant
17
Q
What is a normal GFR
A
120-130
18
Q
What is common causes of end stage renal disease
A
DM #1
HTN
Glomerulonephritis
19
Q
Dx of Chronic Kidney Disease
A
Proteinuria: Can test with spot Microalbumin/Microcreatine Ratio or 24 hour urine collection Urinalysis: See broad waxy casts GFR BUN/Cr ratio Renal Ultrasound: Small Kidney
20
Q
What are dietary modifications for Chronic Kidney Disease
A
Protein Restriction
Water Restriction
Potassium and phosphate restriction
21
Q
What are the two most important modifications to prevent Chronic Kidney Disease
A
Reduce blood pressure to
22
Q
What is the gold standard for Dialysis access
A
AV fistula which connects an artery to a vein
23
Q
What is the primary regulator of water secretion and what does it do
A
ADH
It conserves water by concentrating urine
24
Q
What are 4 ways to regulate water
A
ADH
Thirst
Aldosterone
Sympathetics
25
What happens in the environment of high ADH
The kidney excretes small volumes of concentrated urine
| ADH makes aquaporins to preserve water
26
What stimulates ADH
Hyperosmolarity
| Decreased Arterial Volume (Hypovolemia) which reduces blood pressure
27
What happens in the environment of low ADH
Kidney generates large volumes of dilute urine
28
What inhibits ADH
Hypoosmlarity, which increases free water
Note that hypovolemia always takes precedence over hypoosmalarity (so ADH will be stimulated)
29
What stimulates thirst
Dehydration = Decreased free water
| Hyerosmolarity which increases serum osmolarity
30
What does Aldosterone do
Causes sodium to be reabsorbed which in turn, water follows
31
What role does the sympathetic nervous system have in water regulation
Alpha-1 activation causes arteriole constriction
| Afferent Arteriole constriction decreases renal perfusion (decreases GFR) which leads to less urine formation
32
How is sodium regulated in the body
Aldosterone
33
How is Aldosterone stimulated
Hypovolemia = low blood pressure = decreased intravascular volume (sodium + water)
Hyperkalemia
34
Water homeostasis is determined by ____
| Sodium homeostasis is determined by ___
```
Water = ADH
Sodium = Aldosterone
```
35
What is Hyponatremia
Increased free water = Decreased serum sodium
36
What is Hypernatremia
Decreased free water = Increased serum sodium
37
What makes up extracellular volume
Sodium and Water
38
What is hypovolemia
Hypervolemia
Euvolemia
Total body sodium is decreased
Total body sodium is increased
Normal total body sodium
39
Sx of Hypervolemia
Peripheral edema
Pulmonary edema
Jugular venous distension
HTN
40
Sx of Hypovolemia
```
Poor skin turgor
Dry mucous membranes
Flat neck veins
Hypotension
Increased BUN:Cr ratio
```
41
What is True Hyponatremia
Kidney unable to excrete free water to match oral free water intake
Associated with increased free water
42
What is Hypovolemic Hyponatremia
```
Decreased volume (water and sodium) AND increased free water
Usually due to impaired free water excretion, leads to increased ADH
```
43
Sx of Hyponatremia
CNS dysfunction due to cerebral edema
44
Tx of Hyponatremia
Isovolemic: Water restriction
Hypervolmeic: Sodium and water restriction
Hypovolemic: Normal saline
45
What is Hypernatremia
Due to net water loss
| Sustained hypernatremia is seen when appropriate water intake is not possible
46
Sx of Hypernatremia
CNS dysfunction due to shrinkage of brain cells
| Confusion, lethargy, coma, muscle weakness, seizures
47
Tx of Hypernatremia
Hypotonic fluids to replace water deficit
Oral route is best (pure water)
D5W, 0.45%NS, o.2% saline
48
What is Magnesium essential for
DNA and protein synthesis
Parathyroid hormone production
Cardiovascular and neurologic function
49
What is Hypomagnesemia and what causes it
GI Loss: Malabsorption, Alcoholics, Celiac
| Renal Loss: Diuretics, PPI, DM
50
Sx of Hypomagnesemia
Neurovascular: AMS, lethargy, weakness, Increased DTR
Hypocalcemia: Increasd DTR, Trousseau's and Chvostek's sign
Cardiovascular: Arrhythmias, Palpitations
51
What do you see on EKG with Hypomagnesemia
Prolonged PR and QT intervals
52
Tx of Hypomagnesemia
IV Magnesium Sulfate if Torsades de pointes or severe
| Oral Magnesium
53
What causes Hypermagnesemia
Renal insufficiency or Increased Mg intake
54
Sx of Hypermagnesemia
N/V
Skin flushing
Weakness
Decreased DTR, Muscle Weakness
55
What do you see on EKG with Hypermagnesemia
Bradyarrhythmias, Prolonged PR or QT intervals
56
Tx of Hypermagnesemia
Mild to Moderate: IV fluids + Furosemide
| Severe: Calcium Gluconate (antagonizes toxic effects and stabilizes cardiac membranes)
57
What is Hypokalemia
Increased urinary/GI losses usually due to vomiting, diarrhea, diuretic therapy
58
Sx of Hypokalemia
Neuromuscular: Severe muscle weakness, Rhabdomyolysis
Cardiovascular: Palpitations, Arrhythmias
59
What do you see on EKG with Hypokalemia
T wave flattening, prominent U waves
60
Tx of Hypokalemia
Potassium replacement
| Potassium sparing diuretics
61
What leads to Hyperkalemia
Decreased renal excretion usually due to acute or chronic renal failure
Potassium supplements, Potassium sparking Diuretics
Cell Lysis: Rhabdomyolysis, burns, hypovolemia
62
Sx of Hyperkalemia
Neuromuscular: Weakness, fatigue, parasthesias
Cardiovascular: Palpitations, Cardiac Arrhythmias
GI: Abdominal distention, diarrhea
63
What do you see on EKG with Hyperkalemia
Tall Peaked T waves with eventual QR interval shortening, Wide QRS
64
Tx of Hyperkalemia
IV Calcium Gluconate
Insulin with glucose
Beta-2 Agonist
Kayexalte (enhances GI potassium excretion, lowers total body potassium)
65
What is Metabolic Alkalosis and what causes it
```
Increased pH
Increased Bicarbonate
Loss of protons from GI/Kidneys: Vomiting/N Tube
Exogenous: Diuresis
Post Hypercapnia: Mechanical Ventilation
```
66
What is Respiratory Acidosis and what causes it
Decreased pH
Increased CO2
Anything that decreases respiration
CNS Depression: Opiates, Sedatives, Trauma
Chronic Diseases: COPD, Obesity, Neuromuscular Disorders
67
What is Respiratory Alkalosis and what causes it
Increased pH
Decreased CO2
Due to Hyperventiation
68
What is Testicular Cancer
Most common solid tumor in young men 15-40yrs
69
What are risk factors for Testicular Cancer
Cryptochidism, usually right sided
70
What are the different forms of Testicular Cancer
Germinal Cell Tumor (most common)
Nongerminal Cell Tumors
Germinal Cell
- Seminoma: Most common type
- Nonseminoma: Embryonal cell, tratoma, choriocarcinoma (bad prognosis)
Non-Germinal
-Leydig, Sertoli, Gonadoblastoma
71
Sx of Testicular Cancer
Painless testicular nodule, solid mass or enlargement
Hydrocele is sometimes present
Gynecomastia
72
Dx of Testicular Cancer
Scrotal Ultarsound and Serum Studies (alpha-fetoprotein, HCG, LDH)
Seminomas are radiosensitive and lack tumor markers
Nonseminomas are radioresistant and tumor markers are noted (increased apha-fetoprotein and HCG)
73
Tx of Testicular Cancer
Low rade Nonseminoma: Orchiectomy with retroperitoneal lymph nodes
Low grade seminoma: Orchiectomy followed by radiation
High Grade Seminoma: Debulking chemo followed by orchiectomy and radiation
74
What are the pathogens involved in Cystitis and Pyelonephritis
E.Coli is most common in complicated and uncomplicated
Staph. Saprophyticus in sexually active women
Enterococci with indwelling catheter
75
Sx of Acute Cystitis
Dysuria, Frequency, Urgency, hematuria, Suprapubic Discomfort
76
Sx of Pyelonephritis
Fever, Tachycardia, Back/Flank Pain, CVA tenderness, N/V
77
Dx of Acute Cystitis
| What is the definitive dx
Urinalysis: Pyuria and Leukocyte Esterase, Nitrites, Hematuria
Dipstick: Leukocyte Esterase, Nitrites, Hematuria, WBC
Cultures: Definitive
78
Dx of Pyelonephritis
| What is the definitive dx
Urinalysis: Pyuria, Leukocyte Esterase, WBC Casts, Nitrites, Hematuria
Dipstick: Leukocyte Esterase, Nitrites, Hematuria, WBC
Cultures: Definitive
79
Tx of Uncomplicated Cystitis
Increased fluid itake
Fluoroquinolones are tx of choice (Cipro)
Nitrofurantoin (Macrobid)
TMP-SMX (Bactrim)
80
Tx of Complicated Cystitis
| Pregnancy
Fluoroquinolone
Aminoglycoside
Pregnancy: Amoxicillin, Nitrofurantoin
81
Tx for Pyelonephritis
Fluoroquinolones
82
What is Bladder Cancer
Most are Transitional Cell or Uroepithelial Cell
| Most present early and respond to treatment
83
What are risk factors for Bladder Cancer
Smoking
| Occupational Exposures such as dyes, rubber, leather, white males
84
Sx of Bladder Cancer
Painless microscopic or gross hematuria
| Dysuria, Urgency, frequency, Hesitancy if locally advanced
85
Dx of Bladder Cancer
Cytoscopy with Biopsy
86
Tx of Bladder Cancer
If Localized or Superficial: Transurethral Resection with cautery
If Invasive (involves muscular layer): Cystectomy, Chemi
Recurrent: BCG Immune Therapy
87
What is Renal Cell Carcinoma
Tumors originating in the kidney
Tumor of proximal convoluted renal tubule cells
Usually no warning signs
88
Risk factors for Renal Cell Carcinoma
Smoking, Dialysis, HTN, Obesity, Men
89
Sx of Renal Cell Carcinoma
Hematuria
Flank/Abdominal Pain
Palpable Mass
Malaise, Weight Loss, Left sided varicocele, HTN and Hypercalcemia
90
Dx of Renal Cell Carcinoma
CT scan
91
Tx of Renal Cell Carcinoma
Localized: Radical Nephrectomy
| Bilateral Involvement or patient with solitary kidney: Partial Nephrectomy
92
What is Wilms Tumor
Nephroblastoma
See in kids within first 5 yrs of life
Usually associated with other GU abnormality (cryptochidism, hypospadias)
93
Sx of Wilms Tumor
Painless, Palpable abdominl mass
| Hematuria, HTN, Anemia
94
Tx of Wilms Tumor
Nephrectomy followed by Chemo
| If beyond Renal Capsule, Pulmonary METS or large tumor, radiation post surgery
95
What is the most common site for METS for Wilms Tumor
Lungs
96
What is Renovascular Hypertension
HTN due to renal artery stenosis
| Due to increased RAAS activation
97
What can cause Renovascular HTN
Atherosclerosis in eldery
| Fibromuscular dysplasia in women less than 50
98
Sx of Renovascular HTN
Severe/Refractory HTN
| Adominal Bruit
99
Dx of Renovascular HTN
| What is the gold standard
Renal Angiogram: Gold Standard
| Renogram (best non-invasive): Captopril Test
100
Tx of Renovascular HTN
Angioplasty with stent is definitive
Ace-I, however contraindicated in patients with bilateral stenosis or solitary kidney because Ace-I reduces renal blood flow and GFR in these patients
101
What is Nephrolithiasis and what is their composition
```
Stones
Calcium is most common
Uric Acid (high protein foods)
Struvite Stones (Mg Ammonium Phosphate)
Cystine
```
102
Sx of Nephrolithiasis
Renal Colic: Sudden onset of constant upper/lateral back pain over CVA, radiating to groin
+ CVA tenderness
103
Dx of Nephrolithiasis
What is most common 1st line
What is gold standard
Urinalysis: Microscopic hematuria
pH7.2=Struvite stones
Noncontrast CT: Only will see Calcium and Struvite stones (most common 1st line)
IV Pyelography is gold standard
104
Tx of Nephrolithiasis
If 7mm: Shock wave lithotripsy, Uretoscopy with stent, Percutaneous Nephrolithotomy (used for large stones or struvite)
