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68 Cards in this Set

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