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68 Cards in this Set
- Front
- Back
2 disease accounting for majority of ARF
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reduced renal perfusion, acute tubular necrosis (ATN)
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general symptoms of ARF
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nausea, vomiting, diarrhea, pruritus, drowsiness, dizziness, hiccups, SOB, anorexia, hematochezia
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symptoms suggesting ARF is from a postrenal cause
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distended bladder, CVA tenderness, enlarged prostate
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signs suggesting prerenal cause of ARF
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tachycardia, hypotension
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urinalysis findings if intrinsic renal cause of ARF
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granular casts, WBCs & casts, RBCs & casts, proteinuria, epithelial cells
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decreased urine sodium, urine osmolality >500, elevated BUN:creatinine ratio suggests
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prerenal cause of ARF
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high urine sodium, urine osmolality of 250-300, decreased BUN:creatinine ratio suggests
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intrinsic renal cause
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indications for dialysis in ARF
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unresponsive acidosis, electrolyte disorders, fluid overload, uremic complications
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definition of CKD
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decreased kidney function for >3 months (GFR <60)
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most common causes of CKD
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diabetes, hypertension, glomerulonephritis, polysystic kidney disease
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dietary management in pt with CKD
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restrict protein, adequate calories, calcium + D, limit water sodium potassium & phosphorus
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damage of the renal glomeruli by deposition of inflammatory proteins in the glomerular membranes as result of an immunologic response
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glomerulonephritis
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age of most cases of glomerulonephritis
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age 2-12 is 60% of cases; prognosis excellent in children, worse in adults
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clinical features of glomerulonephritis
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hematuria, tea colored urine, oliguria, anuria; edema of face and eyes in morning, ankles in evening;
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labs in glomerulonephritis
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decreased C3, RBCs & WBCs in urine, proteinuria
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treatment of glomerulonephritis
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steroids, immunosuppressive drugs, ACEI are renoprotective in GN
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3.5 grams of protein in urine indicates
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nephrotic syndrome
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malaise, abdominal distenstion, anorexia, facial edema, oliguria, scrotal swelling, dyspnea, weight gain, ascites, edema, hypertension, orthostatic hypotension, retinal sheen, skin striae
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nephrotic syndrome
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treatment of nephrotic syndrome
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ACEI early in disease, judicious use of diuretics, some pts respond to steroids, avoid excessive sunlight, blood thinners as needed for clots
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disorder characterized by growth of numerous cysts in kidneys, cysts replace mass of kidneys, reducing function & leading to failure
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polycystic kidney disease
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most common symptoms of PKD (polycystic kidney disease)
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back & flank pain, headaches
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cause of nephrolithiasis
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increased saturation of urine with stone-forming salts
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4 types of kidney stones
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calcium (75-85%), Uric acid (5-8%), cystine (<1%), Struvite (10-15%, formed by combo of calcium, ammonium magnesium, formation increased by UTIs, 2x more common in women than men)
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treatment of kidney stones
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<5 mm usually pass spontaneously. drink fluids, analgesics, 5-10 mm consider elective lithotripsy or ureteroscopy with stone extraction; >10 mm admit, hydrate, antibiotics, ureteral stent or percutaneous nephrostomy, ESWL (extracorporeal shock wave lithotripsy)
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signs & symptoms of hypernatremia
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thirst, restlessness, irritability disorientation, delirium, convulsions, coma
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diabetes insipidous
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low urine sodium, polyuria, hypernatremia
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SIADH is defined as....
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hypotonic hyponatremia, urine osmolality >100
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this is a disorder of water conservation
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diabetes insipidus
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neurologic symptoms of hyperkalemia
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numbness, tingling, weakness, and flaccid paralysis
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ECG findings with hyperkalemia
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>6.5=peaking of T wave; >7.0=flattening of p wave, prolonged PR, widenin of QRS; >8-10=sine-wave pattern with cardiac arrest
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treatment of hyperkalemia
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IV calcium gluconate should be given to antagonize effects on heart; sodium bicar, glucose, insulin drives potassium back intracellular-rapid onset but short duration of action; kayexalate (sodium polystyrene sulfonate
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signs & symptoms of hypokalemia
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malaise, skeletal muscle weakness, cramps, smooth muscle involvement leading to ileus & constipation, polyuria, nocturia, hyperglycemia
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ECG findings in hypokalemia
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flattened or inverted T waves, increased prominence of U waves, depression of ST segment, ventricular ectopy
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increase in PTH levels do what to calicum and phosphorus
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increase calcium, decrease phosphorus
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most common causes of disorders of calcium and phosphorus
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parathyroid disorders, CKD, malignancy
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causes of high calcium levels
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cancer, vit D intoxication, hyperparathyroidism, sarcoidosis
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electrolyte imbalance presenting with anorexia, nausea, constipation, pollyuria, polydispsia, dehydration, change in LOC
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hypercalcemia
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calcium levels must be corrected for _______ levels
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albumin; corrected calcium= measured total calcium + 0.8 x (4-albumin)
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high calcium + high phosphorus suggests
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vitamin D intoxication
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high calcium + low phosphorus suggests
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primary hyperparathyroidism
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electrolyte disorder suggested with dry skin, brittle nails, pruritus, muscle cramping, dyspnea, numbness/tingling, psoriasis, dry skin, perioral numbness, irritability, confusion, dementia, seizures
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hypocalcemia
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a respiratory acid-base disorder is characterized by alterations in.....
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carbon dioxide
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a metabolic acid-base disorder is characterized by alterations in.....
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serum bicarbonate
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what is respiratory acidosis
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decreased pH, increase in Pco2; causes include pulmonary disease, neuromuscular disease, CNS dysfucntion (brainstem injury), drug-induced hypoventilation
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treatment of severe respiratory acidosis
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Pco2>60 may need ventilator
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what is respiratoy alkalosis
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increased pH, decreased Pco2; results from excessive elimination of CO2 from lungs; anxiey is most common cause
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this is an infectious inflammatory process involving the kidney parenchyma and renal pelvis
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acute pyelonephritis
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treatment of acute pyelonephritis
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quinolones or bactrim for 1-2 weeks
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what type of follow up treatment should you do in someone who had acute pyelonephritits
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urine cultures 1-2 weeks after treatment
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treatment of acute prostatitis
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<35 yo: ofloxacin x 10 days or ceftriaxone 250mg IM + 10 days of doxycycline; >35 yo fluoroquinolone or bactrim x 10-14 days
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testicular swelling & tenderness, fever, tachycardia, pyuria, bacteriuria suggests
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orchitis
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common causes of orchitis
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25% of postpubertal males who have mumps infection get it; bacterial causes
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presents with heaviness & dull, aching discomfort in the affected hemiscrotum, which can radiate up the ipsilateral flank; epididymis is swollen, tender, becoming a warm, erythematous enlarged scrotal mass
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epididymitis
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most common causes of epididymitis
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<35 yo: chlamydia & gonococci (treat with rocephin + doxycycline); >35 yo: E. coli (treat with cipro)
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symptoms of prostatic obstruction (bph)
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decreased force of stream, hesitancy, postvoid dribbling, incomplete emptying, frequency, nocturia, urgency; PSA is typically a little elevated
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the principal symptom of this type of incontinence is a strong desire to void, followed by loss of urine
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urge incontinence
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the principal symptom of this type of incontinence is leakage of urine and increased intra-abdominal pressure, such as with sneezingk coughing, or laughing
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stress incontinence
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classic triad of renal cell carcinoma
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hematuria, flank pain, palpable mass
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most common tumor of childhood
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wilms' tumor (aka nephroblastoma)
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signs & symptoms of Wilms' tumor
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most common is asymptomatic abdominal mass; anorexia, nausea, vomiting, fever, abdominal pain, hematuria
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treatment of Wilms' tumor
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radical nephrectomy if resection if possible; preop chemo if not resectable followed by biopsy; radiation for stage 3 & 4
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most common cancer of young men; average age at diagnosis is 32
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testicular cancer
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more than 90% of patients with this testicular disorder present with a painless, solid, testicular swelling
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testicular cancer
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this is a mass of fluid-filled congenital remnants of the tunica vaginalis, usually resulting from a patent processus vaginalis
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hydrocele
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this presents as a soft, nontender fullness of the hemiscrotum that transilluminates, the mass may wax & wane in size
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hydrocele
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the testis is abnormally twisted on its spermatic cord, compromising arterial supply
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testicular torsion
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this is the formation of a venous varicosity in the spermatic vein
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varicocele
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chronic nontender mass that does not thansilluminate, lesion has consistency of a "bag of worms"
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varicocele
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