Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
218 Cards in this Set
- Front
- Back
|
Anion Gap Calculation
|
Na+ - (Cl- + HCO3-)
|
|
|
Normal Anion Gap
|
8-12 mEq/L
|
|
|
6 Causes of Non-gap Metabolic Acidosis
|
1) Diarrhea
2) Renal Tublar Acidosis (RTA) 3) Spironolactone 4) Total Perenteral Nutrition (TPN) 5) Glue Sniffing 6) Hyperchloremia |
|
|
9 Causes of Anion Gap Metabolic Acidosis
|
"MUD PILERS"
1) Methanol 2) Uremia 3) Diabetic Ketoacidosis (DKA) 4) Paraldehyde 5) INH or Iron Tablet Overdose 6) Lactic Acidosis 7) Ethylene Glycol or Ethanol 8) Rhabdomyolysis (massive) 9) Salicylate Toxicity |
|
|
Most Common Mechanism of Respiratory Acidosis
|
Hypoventilation
- Lung Obstruction (Acute/Chronic Lung Disease) - Neuromuscular Disorders (Sedatives, Weakening of Respiratory Muscles) |
|
|
4 Causes of Respiratory Alkalosis
|
1) Hyperventilation 2/2 Hypoxia
2) Early ASA Ingestion 3) Pregnancy 4) Cirrhosis |
|
|
4 Causes of Chloride-Responsive (Dry) Metabolic Alkalosis
|
1) Excessive Vomiting
2) Villous Adenoma 3) Diuretics 4) Contraction Alkalosis |
|
|
3 Diseases causing Chloride-Unresponsive (Wet) Metabolic Alkalosis
|
1) Cushing Syndrome
2) Conn Syndrome 3) Bartter Syndrome |
|
|
Ingestion of what substance can cause both a Metabolic Acidosis & Respiratory Alkalosis?
|
ASA (Salicylates)
|
|
|
Primary Acid/Base Disturbance & Compensatory Response:
pH >7.4 PCO2 >40 mm Hg |
Metabolic Alkalosis
--> Hypoventilation |
|
|
Primary Acid/Base Disturbance & Compensatory Response:
pH 7.4 PCO2 >40 mm Hg |
Respiratory Acidosis
--> Renal HCO3- Reabsorption |
|
|
Primary Acid/Base Disturbance & Compensatory Response:
pH >7.4 PCO2 40 mm Hg |
Respiratory Alkalosis
--> Renal HCO3- Secretion |
|
|
Primary Acid/Base Disturbance & Compensatory Response:
pH 7.4 PCO2 40 mm Hg |
Metabolic Acidosis
--> Hyperventilation |
|
|
Electrolyte Imbalance:
- Diabetes Insipidus (DI) - Dehydration - Osmotic Diuresis |
Hypernatremia
|
|
|
Electrolyte Imbalance:
- ARF - Adrenal Insufficiency - Spironolactone - Rhabdomyolysis - Acidosis - Insulin Deficiency - Digitalis Poisoning |
Hyperkalemia
|
|
|
Electrolyte Imbalance:
- SIADH - Volume Depletion - Water Intoxication - Cirrhosis - Heart Failure - Hyperglycemia |
Hyponatremia
|
|
|
Electrolyte Imbalance:
- Diarrhea - Alkalosis - Hypomagnesemia - Laxative Abuse - RTA - Vomiting - Bartter Syndrome |
Hypokalemia
|
|
|
Electrolyte Imbalance:
- Acute Pancreatitis - Hypomagnesemia - Post-Parathyroidectomy (MCC) |
Hypocalcemia
|
|
|
Electrolyte Imbalance:
- Hyperparathyroidism - Malignancy: Multiple Myeloma, Breast Cancer, Squamous Cell Cancers |
Hypercalcemia
|
|
|
Electrolyte Imbalance:
- Malnutrition - Alcoholism - DKA - Pregnancy |
Hypomagnesemia
|
|
|
ECG Changes:
Hyperkalemia |
In Order:
1) Peaked T Waves 2) Increased PR Interval 3) Loss of P Wave 4) Widened QRS Complex 5) Sine Wave |
|
|
ECG Changes:
Hypokalemia |
1) T Wave Flattening
2) U Waves 3) ST Depression 4) AV Block |
|
|
ECG Changes:
Hypocalcemia |
Increased QT Interval
|
|
|
ECG Changes:
Hypomagnesemia |
Torsade de pointes
|
|
|
Causes of Hypercalcemia
|
"CHIMPANZEES"
1) Calcium Supplementation 2) Hyperparathyroidism (MC) 3) Iatrogenic, Immobility 4) Milk-Alkali Syndrome 5) Paget Disease 6) Acromegaly, Addison's Disease 7) Neoplasm (very common) 8) Zollinger-Ellison (ZE) Syndrome (MEN Type I) 9) Excess Vitamin A 10) Excess Vitamin D 11) Sarcoidosis (or other Granulomatous Disease |
|
|
Electrolyte Disturbance Treatment:
Hypernatremia |
Isotonic NS or LR
(correct over a 48-72 hour period) |
|
|
Electrolyte Disturbance Treatment:
Hyponatremia |
If Na+ 120: hypertonic NS
If Hypovolemic: Isotonic NS If Euvolemic or Hypervolemic: salt and water restriction Rapid increase in plasma sodium leads to central pontine myelinolyis |
|
|
Electrolyte Disturbance Treatment:
Hyperkalemia |
"C BIG Kay Di"
1) Calcium Gluconate: stabilizes cardiac membrane 2) Bicarbonate 3) Insulin & Glucose 4) Kayexalate 5) Diuretics (loop) & Dialysis |
|
|
Electrolyte Disturbance Treatment:
Hypercalcemia |
1) IV Hydration
2) Loop Diuretics: "loops lose calcium" 3) Bisphosphonates: especially when caused by malignancy Avoid thiazide diuretics |
|
|
Electrolyte Disturbance Treatment:
Hypokalemia |
1) Oral Potassium Chloride
2) IV Infusion of 10 mEq/h 3) Potassium-Sparing Diuretics - Amiloride, Triamterene, Spironolactone, Eplerenone |
|
|
What electrolyte imbalance can result in hypokalemia refractory to supplementation?
|
Hypomagnesemia
|
|
|
What lab abnormality may cause serum calcium to be falsely low?
|
Hypoalbuminemia
|
|
|
2 Classic Physical Exam Findings a/w Hypocalcemia
|
1) Chvostek's Sign: facial spasm elicited from tapping the facial nerve
2) Trousseau's Sign: carpal spasm after arterial occlusion with BP cuff |
|
|
Type of RTA:
Decreased bicarbonate reabsorption |
Type II (Proximal)
|
|
|
Type of RTA:
Aldosterone deficiency or resistance |
Type IV
|
|
|
Type of RTA:
Decreased H+ excretion Nephrocalcinosis |
Type I (Distal)
|
|
|
Type of RTA:
Hyperkalemia |
Type IV
|
|
|
Type of RTA:
Most common RTA |
Type IV
|
|
|
Type of RTA:
Fanconi Syndrome |
Type II (Proximal)
|
|
|
Type of RTA:
Hyporeninemic Hypoaldosteronism |
Type IV
|
|
|
Type of RTA:
Commonly seen in diabetes mellitus |
Type IV
|
|
|
3 Etiologies of ARF
|
1) Prerenal (Hypoperfusion)
2) Intrinsic (Renal) 3) Postrenal (Obstructive): can evaluate cause with renal US |
|
|
5 Causes of Prerenal ARF
|
1) Hypovolemia
2) Congestive Heart Failure 3) Sepsis 4) Burns 5) Decreased Renal Blood Flow (RBF) - Renal Artery Stenosis |
|
|
5 Causes of Intrinsic ARF
|
1) Acute Tubular Necrosis (ATN)
- most common cause 2) Acute Interstitial Nephritis (AIN) 3) Glomerulonephritis (GN) 4) Autoimmune Vasculitis 5) Renal Ischemia: eg, thromboembolism |
|
|
4 Causes of Postrenal ARF
|
1) Prostate Disease (BPH)
2) Nephrolithiasis 3) Pelvic Tumors - bladder, cervical, or prostate cancer 4) Recent Pelvic Surgery |
|
|
Fractional Excretion of Sodium (FENa) Calculation
|
(Urine Na+ / Plasma Na+)
/ (Urine Cr / Plasma Cr) |
|
|
Type of ARF:
FENa 1% |
Prerenal
|
|
|
Type of ARF:
FENa >4% |
Postrenal
|
|
|
Type of ARF:
Hyaline urine casts |
Prerenal
|
|
|
Type of ARF:
Muddy brown/granular casts |
Intrinsic (ATN)
|
|
|
Type of ARF:
BUN:Cr >20 |
Prerenal
|
|
|
Type of ARF:
Red cell casts |
Intrinsic (GN)
|
|
|
Type of ARF:
White cell cast +/- eosinophils |
Intrinsic (Allergic Nephritis)
|
|
|
Type of ARF:
Enlarged prostate |
Postrenal
|
|
|
Type of ARF:
+ANCA |
Intrinsic (Vasculitis)
|
|
|
Type of ARF:
Urine osmolality >500 |
Prerenal
|
|
|
Type of ARF:
White cells, white cell casts |
Postrenal (Pyelonephritis)
|
|
|
3 Types of Insults to the Proximal Tubules resulting in ATN
|
1) Ischemia
2) Direct Toxins: - contrast dye - amphotericin B - aminoglycosides 3) Myoglobulinuria/Hemoglobinuria |
|
|
2 Most Common Classes of Drugs Causing Interstitial Nephritis
|
1) Penicillins
2) Nonsteroidal Anti-Inflammatory Drugs (NSAIDS) |
|
|
Unique UA Finding a/w Drug-Induced Interstitial Nephritis
|
Eosinophilia
|
|
|
Lab Value used to diagnose & follow Renal Failure
|
Creatinine
|
|
|
Effects of Uremia:
Nervous System |
1) Asterixis
2) Confusion 3) Seizures 4) Coma |
|
|
Effects of Uremia:
Cardiovascular System |
Fibrinous Pericarditis
|
|
|
Effects of Uremia:
Hematologic System |
1) Anemia
2) Immunosupression Coagulopathy |
|
|
Effects of Uremia:
Dermatologic System |
1) Pruritis
2) Uremic Frost - urea crystals on skin - in severe uremia |
|
|
6 Non-Uremic Complications of ARF
|
1) Metabolic Acidosis
2) Hyperkalemia: --> arrhythmias 3) Na+ & H2O Excess --> pulmonary edema & CHF 4) Hypocalcemia --> osteodystrophy from failure to secrete active vitamin D 5) Anemia: decreased erythropoietin (EPO) secretion 6) HTN: from renin hypersecretion |
|
|
Indications of Dialysis Treatment
|
"AEIOUY"
1) Acidosis (unresponsive) 2) Electrolyte Abnormality: hyperkalemia 3) Ingestion of Toxins: salicylates, barbiturates, lithium, ethylene glycol 4) Overload: fluid 5) Uremic Symptoms: pericarditis, encephalopathy 6) Y-not? |
|
|
What type of infection presents with flank pain, costovertebral angle (CVA) tenderness, fever, dysuria, pyuria, and bacteriuria?
|
Acute Pyelonephritis
|
|
|
2 Major Causes of Pyelonephritis
|
1) Ascending Infection
2) Hematogenous Seeding |
|
|
Most Common Organisms Responsible for Acute Pyelonephritis
|
E. coli
> Proteus > Enterobacter Same as UTIs |
|
|
Greatest Risk Factor for Pyelonephritis
|
Vesicoureteric Reflux or Incompetency
|
|
|
All children 7 yo presenting with their first UTI should undergo what radiologic test to screen for reflux?
|
Voiding Cystourethrogram
|
|
|
3 Possible Sequelae of Acute Pyelonephritis
|
1) Abscess
2) Renal Papillary Necrosis 3) Renal Scars |
|
|
What condition is characterized by broad renal scarring, loss of renal parenchyma over time, and thyroidization of kidneys?
|
Chronic Pyelonephritis
|
|
|
Which renal disease presents with multiple 3-4 cm cysts in bilaterally enlarged kidneys resulting in chronic renal failure in adults?
|
Autosomal Dominant (Adult) Polycystic Kidney Disease (ADPKD)
50% have end-stage renal disease (ESRD) by age 60 |
|
|
2 Most Common Presenting Symptoms of ADPKD
|
1) Pain
2) Hematuria |
|
|
What may the abdominal examination reveal in ADPKD?
|
Large palpable kidney
|
|
|
7 Findings a/w ADPKD
|
1) Pain
2) Hematuria 3) Cerebrovascular Aneurysm (Berry Aneurysm) 4) HTN 5) Nephrolithiasis 6) Mitral Valve Prolapse 7) Hepatic Cysts |
|
|
What is the prognosis for Autosomal Recessive PKD?
|
Death in the first few years of life
|
|
|
What syndrome is characterized by hematuria, ARF, HTN, and mild proteinuria?
|
Nephritic Syndrome
|
|
|
What syndrome is characterized by massive proteinuria (>3.5 g/d), generalized edema, hyperlipidemia, and hypoalbuminemia?
|
Nephrotic Syndrome
|
|
|
Nephrotic or Nephritic Syndrome:
Increased risk of infections |
Nephrotic Syndrome
|
|
|
Nephrotic or Nephritic Syndrome:
Gross hematuria, oliguria |
Nephritic Syndrome
|
|
|
Nephrotic or Nephritic Syndrome:
Anticoagulation therapy is indicated to reduce risk of DVT and renal vein thrombosis |
Nephrotic Syndrome
|
|
|
Nephrotic or Nephritic Syndrome:
"Foamy Urine" |
Nephrotic Syndrome
|
|
|
Nephrotic or Nephritic Syndrome:
Transient oliguria usually followed by spontaneous diuresis |
Nephritic Syndrome
|
|
|
Nephrotic or Nephritic Syndrome:
Hyperlipidemia, Lipiduria |
Nephrotic Syndrome
|
|
|
Nephrotic or Nephritic Syndrome:
Dyspnea & Ascites |
Nephrotic Syndrome
- severe edema |
|
|
Nephrotic or Nephritic Syndrome:
1/3 of cases a/w systemic diseases (lupus, diabetes, or amyloidosis) |
Nephrotic Syndrome
|
|
|
Nephrotic or Nephritic Syndrome:
Smoky brown urine with RBC casts |
Nephritic Syndrome
|
|
|
Glomerulopathy:
Apple-green birefringence under polarized light |
Renal Amyloidosis
|
|
|
Glomerulopathy:
GN with lens dislocation, nerve deafness, and posterior cataracts |
Alport Syndrome
|
|
|
Glomerulopathy:
Nodular glomerulosclerosis, glomerular capillary basement membrane thickening |
Diabetic Glomerulosclerosis
(Kimmelstiel-Wilson Disease) |
|
|
Glomerulopathy:
Young African American males |
Focal Segmental Glomerulonephritis (FSGN)
|
|
|
Glomerulopathy:
c-ANCA |
Wegener's Granulomatosis
|
|
|
Glomerulopathy:
Most common cause of nephrotic syndrome in children |
Minimal Change Disease
(Lipoid Nephrosis) |
|
|
Glomerulopathy:
Most common cause of ESRD in the U.S. |
Diabetic Glomerulosclerosis
|
|
|
Glomerulopathy:
Commonly a/w HIV infection, heroin addiction, sickle cell disease, & obesity |
Focal Segmental Glomerulonephritis (FSGN)
|
|
|
Glomerulopathy:
Mesangial widening and recurrent hematuria and proteinuria |
IgA Nephropathy
(Berger Disease) |
|
|
Glomerulopathy:
A/w Hepatitis C |
Membranoproliferative Glomerulonephritis (MPGN)
|
|
|
Glomerulopathy:
Responds well to steroids |
Minimal Change Disease
(Steroid Responsive Nephropathy) |
|
|
Glomerulopathy:
Responds to plasma exchange and pulsed steroids |
Goodpasture Syndrome
|
|
|
Glomerulopathy:
Type IV (COLA4A5) |
Alport Syndrome
|
|
|
Glomerulopathy:
Asymptomatic familial hematuria |
Thin Membrane Disease
- glomerular basement membrane (GBM) is only 50-60% of normal thickness |
|
|
Glomerulopathy:
"Wire Loop Lesions" |
SLE Lupus Nephropathy
- diffuse proliferative pattern |
|
|
Glomerulopathy:
Upper-Respiratory granulomatous inflammation --> to hemoptysis Kidney with necrotizing vasculitis |
Wegener's Granulomatosis
|
|
|
Glomerulopathy:
Increased ASO titer |
Postinfectious GN
|
|
|
Glomerulopathy:
Most common glomerulopathy worldwide |
IgA Nephropathy
(Berger Disease) |
|
|
Glomerulopathy:
Pulmonary hemorrhage & hemosiderin-filled macrophages in sputum |
Goodpasture Syndrome
|
|
|
Glomerulopathy:
A/w URI or GI infections Increased in kids |
IgA Nephropathy
(Berger Disease) |
|
|
Glomerulopathy:
A/w Hepatitis B infection |
Membranous GN
|
|
|
Glomerulopathy:
Antiglomerular basement membrane antibodies |
Goodpasture Syndrome
|
|
|
Glomerulopathy:
Antinuclear antibody (ANA) positive |
SLE
|
|
|
Glomerulopathy:
Immunofluorescence: "lumpy bumpy" granular IgG or C3 deposits |
Postinfectious GN
|
|
|
Glomerulopathy:
Immunofluorescence: smooth, linear IgG deposits |
Goodpasture Disease
(Crescentic GN) |
|
|
Glomerulopathy:
Immunofluorescence: "spike & dome" |
Membranous GN
|
|
|
Glomerulopathy:
Immunofluorescence: "tram track", double-layered basement membrane |
Membranoproliferative Nephropathy
|
|
|
Glomerulopathy:
GN a/w decreased complement levels (3) |
1) SLE
2) MPGN 3) Postinfectious GN |
|
|
Glomerulopathy:
A/w multiple myeloma or chronic inflammatory disease |
Renal Amyloidosis
|
|
|
Glomerulopathy:
Light microscopy appears normal Electron microscopy shows fusion of epithelial foot processes |
Minimal Change Disease
|
|
|
Glomerulopathy Treatment:
FSGN |
1) Supportive: protein and salt restriction, diuretic therapy, antihyperlipidemics
2) Prednisone |
|
|
Glomerulopathy Treatment:
Postinfectious GN |
Supportive
- prognosis is very good |
|
|
Glomerulopathy Treatment:
Wegener Granulomatosis |
1) High-dose Steroids
2) Cytotoxic Agents |
|
|
Glomerulopathy Treatment:
IgA Nephropathy |
Steroids for flares
20% progress to ESRD |
|
|
Glomerulopathy Treatment:
SLE |
1) Steroids
2) Cyclophosphamide (for advanced types) |
|
|
Renal Calculus:
Primary Hyperparathyroidism |
Calcium Phosphate
|
|
|
Renal Calculus:
Idiopathic Hypercalciuria |
Calcium Oxalate
|
|
|
Renal Calculus:
Radiolucent Stones |
Uric Acid
|
|
|
Renal Calculus:
Staghorn Calculi |
Struvite
(MgNH4PO4) |
|
|
Renal Calculus:
Hexagonal Crystals |
Cystine
|
|
|
Renal Calculus:
A/w Proteus, Pseudomonas, Providencia, & Klebsiella UTIs |
Struvite
(MgNH4PO4) |
|
|
Renal Calculus:
Forms in acidic urine (pH 5.5) |
Uric Acid
|
|
|
Renal Calculus:
Amino Acid Transport Defect |
Cystine
|
|
|
Renal Calculus:
Gout, myeloproliferative disease, or chemotherapy |
Uric Acid
|
|
|
Renal Calculus:
Crohn Disease |
Calcium Oxalate
|
|
|
Renal Calculus:
Xanthine Oxidase Deficiency |
Uric Acid
|
|
|
Renal Calculus:
~80% of Renal Stones |
Calcium Oxalate/Calcium Phosphate
|
|
|
8 Risk Factors for Nephrolithiasis
|
1) Decreased Fluid Intake
2) Hypercalcemia 3) Gout 4) Enzyme Deficiency 5) RTA 6) Medications: Allopurinol, Chemotherapy, Loop Diuretics 7) Inflammatory Bowel Disease (IBD) 8) Family History |
|
|
What is the typical presentation of nephrolithiasis?
|
Acute onset of severe, colicky flank pain radiating to the groin with N/V and hematuria
|
|
|
3 Tests to Evaluate for Nephrolithiasis
|
1) UA: hematuria, pH, crystals under microscope
2) Abnormal X-Ray: 90% of stones are radiopaque 3) Helical CT Scan w/o Contrast: now the test of choice |
|
|
What is the initial treatment for calculi?
|
1) Hydration
2) Analgesia |
|
|
What antihypertensive decreases calcium in urine?
|
Thiazide Diuretics
|
|
|
Stones up to what size can pass spontaneously?
|
Typically 5 mm
|
|
|
What is the treatment for stones >5mm but <3cm?
|
Extracorporeal Shock Wave Lithotripsy (ESWL)
|
|
|
Differential Diagnosis:
Hematuria |
"S2I3T3"
Stricture, Stones Infection, Inflammation, Infarction Tumor, Trauma, TB |
|
|
What is the most common malignant tumor of the urinary tract?
|
Bladder (Transitional Cell) Cancer
- especially in males >60 yo |
|
|
What is the strongest risk factor for urinary tract malignancies?
|
Smoking
Also: - Chronic Infections - Aniline Dye - Calculi |
|
|
What is the most common presenting symptom of bladder cancer?
|
Painless, gross hematuria
|
|
|
What is the diagnostic test of choice for evaluation of bladder cancer?
|
Cystoscopy with Biopsy
|
|
|
What is the etiology of squamous cell bladder cancer?
|
Schistosoma haematobium
|
|
|
4 Treatment Options for Bladder Cancer
|
1) Intravesical Chemotherapy
2) Transurethral Resection 3) Surgery +/- Radiation 4) Chemotherapy Alone |
|
|
Classic Triad of Renal Cell Carcinoma
|
1) Hematuria
2) Flank Pain 3) Palpable Mass |
|
|
5 Risk Factors for Renal Cell Carcinoma
|
1) Male Gender
2) Smoking 3) Obesity 4) Acquired Cystic Kidney Disease in ESRD 5) von Hippel-Lindau Disease |
|
|
Most Common Cause of Cancer in Men
|
Prostate Cancer
Lung Cancer is the leading causes of cancer death in men, followed by Prostate Cancer |
|
|
What digital rectal examination (DRE) finding suggests prostate cancer?
|
Firm Nodules
|
|
|
Histologic Type of 95% of Prostate Cancers
|
Adenocarcinoma
|
|
|
What percentage of patients with prostate cancer present with metastatic disease?
|
40%
Most are initially asymptomatic |
|
|
Most Common Site of Metastasis for Prostate Cancer
|
Bone (Vertebrae)
Must rule out in any elderly male with back pain |
|
|
Why do obstructive symptoms occur less frequently than in BPH?
|
Cancer usually begins in the peripheral zone, while BPH occurs in the central zone.
|
|
|
Serum Marker:
Detect & Follow Prostate Cancer |
Prostate-Specific Antigen (PSA) >4ng/mL
|
|
|
4 Causes of Elevated PSA other than Carcinoma
|
1) BPH
2) Prostatitis 3) UTI 4) Prostatic Trauma |
|
|
How is Prostate Cancer definitely diagnosed?
|
Transrectal Biopsy of Suspicious Lesions
|
|
|
Alternative to Prostatectomy for Treatment of Localized Prostate Cancer
|
Radiation Therapy
|
|
|
2 Most Common Complications of Prostatectomy
|
1) Impotence
2) Incontinence |
|
|
3 Treatment Options:
Metastatic Prostate Cancer |
Androgen Ablation:
1) Luteinizing Hormone-Releasing Hormone (LHRH) Agonist: Leuprolide 2) Anti-Androgens: Flutamide 3) Orchiectomy |
|
|
Screening Recommendations:
Prostate Cancer |
DRE & PSA every year for patients >50 yo
>40 yo if African American or with family history |
|
|
2 Types of Symptoms of BPH
|
1) Obstructive: hesitancy, weak stream, incomplete emptying, urinary retention
2) Irritative: nocturia, increased frequency, urge incontinence, opening hematuria |
|
|
What may be found on PE in a patient with BPH?
|
Diffusely enlarged prostate with a rubbery texture
|
|
|
Is PSA helpful in monitoring BPH?
|
No
Useful in post-treatment cancer patients |
|
|
4 Complications of BPH
|
1) Bladder Outlet Obstruction
2) Urinary Stasis: leading to infections & calculi 3) Chronic Urinary Retention & Overflow 4) Renal Failure |
|
|
What lab value can help detect Obstructive Uropathy?
|
Creatinine Level
- elevated if obstructive lesion |
|
|
Medical Options for BPH (2)
|
5-Alpha-Reductase Inhibitors: Finasteride
Alpha-Receptor Blockers: Terazosin |
|
|
Indications for Surgery in BPH
|
Symptomatic Obstruction:
1) Post-Void Residual Volume >100mL 2) Multiple Bouts of Gross Hematuria 3) Recurrent UTIs |
|
|
Most Common Surgical Procedure for BPH
|
Transurethral Resection of the Prostate (TURP)
|
|
|
2 Categories of Erectile Dysfunction (ED)
|
1) Primary: never been able to have sustained erections
2) Secondary: Acquired |
|
|
3 Causes of Primary Erectile Dysfunction
|
1) Psychologic
2) Gonadal: decreased testosterone 3) Endocrine: thyroid, Cushing, etc |
|
|
3 Causes of Secondary Erectile Dysfunction
|
1) Drug-Induced: TCAs, diuretics, antipsychotics
2) Vascular Disease: veno-occlusive dysfunction 3) Neurologic Disease |
|
|
4 Treatment Options for ED
|
1) PDE5 Inhibitors: Sildenafil
2) Intracavernosal Prostaglandins 3) Vacuum-Constriction Device 4) Penile Prosthesis |
|
|
What drug is an absolute contraindication for patients taking Sildenafil?
|
Nitrates
- combined effects of lowering BP --> myocardial ischemia |
|
|
Testicular Disorder:
Failure of descent of testicle before 1 yo Risk of cancer |
Cryptorchidism
|
|
|
Testicular Disorder:
Malignant testicular tumor that is highly radiosensitive |
Seminomas
'Sem'inomas = 'Sen'itive to radiation |
|
|
Testicular Disorder:
Worst prognosis of all testicular tumors Highly invasive Elevated Beta-hCG levels |
Choriocarcinoma
|
|
|
Testicular Disorder:
Slow growing tumor usually discovered & removed before metastasis Most common type of testicular cancer |
Seminomas
- type of germ cell tumor |
|
|
Testicular Disorder:
A/w an abnormally high attachment of the tunica vaginalis around the distal end of the spermatic cord (Bell Clapper Deformity) |
Testicular Torsion
- usually bilateral |
|
|
Testicular Disorder:
Usually presents as a firm, painless mass |
All testicular tumors
|
|
|
Testicular Disorder:
Rapid onset of testicular pain, swelling, & absence of flow on Doppler ultrasound |
Testicular Torsion
- testicle unsalvageable after 6 hours |
|
|
Testicular Disorder:
Bag of worms on testicular examination |
Varicocele
|
|
|
Testicular Disorder:
Alpha-Fetoprotein (AFP) is often elevated in this form of testicular cancer |
Endodermal Sinus Tumor
|
|
|
Treatment of Cryptorchidism
|
Orchiopexy after age 1, but before age 5 to preserve fertility
Orchiectomy later in life to avoid risk of testicular cancer |
|
|
25 yo Asian male presents with N/V, and colicky right flank pain
PE: acute distress & CVA tenderness W/U: hematuria & discrete radiopacities on abdominal X-Ray |
Renal Stones
|
|
|
45 you with documented h/o aortic atheromatous plaques presents with recent onset of severe left flank pain and hematuria
Abdominal CT: wedge-shaped lesion in the left kidney |
Renal Infarct
|
|
|
55 yo with long h/o DM presents with increasing fatigue & edema
PE: increased BP, retinopathy, & pitting edema W/U: severe proteinuria & glycosuria |
Diabetic Nephropathy
- Glomerulosclerosis |
|
|
21 yo sexually active female presents with frequency & dysuria
PE: afebrile, suprapubic tenderness, no CVA tenderness W/U: E. coli positive urine cultures |
UTI
|
|
|
25 yo male presents with hemoptysis, dark urine, & fatigue
PE: bilateral crackles at lung bases W/U: oliguria, hematuria, & anti-GBM Abs |
Goodpasture Syndrome
|
|
|
7 yo presents in stupor after ingesting antifreeze
PE: Kussmaul respirations & mental status changes W/U: anion gap of 21 mEq/L |
Metabolic Acidosis
Ethylene Glycol Toxicity |
|
|
6 yo boy presents with hematuria & worsening vision
PE: corneal abnormalities, retinopathy, sensorineural hearing loss W/U: hematuria with dysmorphic red cells |
Alport Syndrome
|
|
|
3 yo boy with h/o recent URI presents with facial edema
PE: ascitic fluid in abdomen & pedal edema W/U: 4+ proteinuria & decreased serum albumin |
Minimal Change Disease
|
|
|
70 yo male recently started on an ACE inhibitor presents with weakness, N/V, & palpitations
PE: areflexia ECG: tall, peaked T waves & wide QRS complex |
Hyperkalemia
|
|
|
65 yo patient with h/o small cell lung cancer presents with lethargy, confusion, and seizures
W/U: serum Na+ 135 mEq/L, urinary Na+ >20 mEq/L, & urine osmolality >100 mOsm/kg |
SIADH
Hyponatremia |
|
|
A patient s/p parathyroidectomy presents with muscle cramps, dyspnea, & tetanic contractions
PE: facial spasm with tapping over facial nerve, carpal spasm with arterial occlusion by BP cuff ECG: increased QT interval |
Hypocalcemia
|
|
|
A patient on a loop diuretic for CHF presents with muscle weakness, fatigue, & ileus
PE: hyporeflexia, bradycardia ECG: T-wave flattening, ST depression, & U waves |
Hypokalemia
|
|
|
A patient hospitalized for CHF recently started on an aminoglycoside for a UTI develops oliguria, N/V, & malaise
PE: increased BP & asterixis W/U: increased Cr, K+ UA: "muddy brown" casts, FENa >3% |
ARF
Drug-Induced ATN |
|
|
70 yo black male with h/o lifelong DM presents with peripheral edema, SOB, & oliguria
PE: auscultatory rales, pitting edema, myoclonus, & uremic frost Serum Electrolytes: increased Cr, hyperkalemia, hypocalcemia, hyperphosphatemia |
Chronic Renal Failure
|
|
|
A female presents with fever, chills, & flank pain
PE: CVA tenderness UA: leukocyte esterase positive, 30 WBC/HPF |
Pyelonephritis
|
|
|
32 yo male presents with pain & hematuria
PE: increased BP, palpable kidney, & midsystolic ejection click ABD US: multiple cysts of renal parenchyma Cerebral Angiogram: unruptured berry aneurysm |
Polycystic Kidney Disease
|
|
|
12 yo male with h/o sore throat 2 weeks ago presents with low urine output & dark urine
PE: periorbital edema W/U: hematuria, increased BUN & Cr, increased ASO titer |
Poststreptococcal GN
(Postinfectious GN) |
|
|
45 yo Asian male with h/o hepatitis B presents with malaise, edema, & foamy urine
PE: anasarca W/U: proteinuria (>3.4 g/d), hyperlipidemia, & hypoalbuminemia |
Membranous GN
|
|
|
80 yo male presents with urinary hesitancy, nocturia, & weak urinary stream
PE: diffusely enlarged, rubbery prostate W/U: increased Cr, PSA UA: wnl |
Benign Prostatic Hyperplasia (BPH)
|
|
|
68 yo male smoker presents with flank pain & hematuria
PE: fever, palpable kidney mass W/U: hypercalcemia, polycythemia |
Renal Cell Carcinoma
|
|
|
20 yo male presents with acute onset of left testicular pain & N/V
PE: swollen, tender testicle in transverse position, absent cremasteric reflex on left side Doppler: no flow detected in left testicle |
Testicular Torsion
|
|
|
85 yo male presents with back pain, weight loss, & weak urinary stream
PE: palpable firm nodule on DRE W/U: increased PSA (5 ng/mL) |
Prostate Cancer
|
|
|
65 yo male smoker presents with painless gross hematuria & frequency
PE: obese UA: hematuria, dysplastic cells Intravenous Pyelogram (IVP): bladder filling defect |
Bladder Cancer
Transitional Cell Carcinoma |
|
|
41 yo male with h/o HTN recently started on Beta-Blocker presents with impotence that started 2 months ago. Reports no early-morning erections
PE: normal size testes & normal lower extremity sensation W/U: testosterone/prolactin wnl |
Drug-Induced Erectile Dysfunction
|
|
|
22 yo male with h/o of cryptorchidism presents with painless enlargement of left testis
PE: left scrotal swelling & a palpable mass W/U: increased AFP |
Testicular Cancer
Endodermal Sinus Tumor |
|
|
16 yo male with recent h/o gastroenteritis 2 days ago presents with episodic brown urine
PE: unremarkable W/U: hematuria, mild proteinuria, normal C3 |
IgA Nephropathy
|
|
|
33 yo male presents with fever, hemoptysis, & hematuria
PE: weight loss & bilateral crackles at lung bases W/U: hematuria, + c-ANCA CXR: bilateral cavitary lesions |
Wegener Granulomatosis
|
|
|
A patient is hospitalized & started on methicillin develops fever, arthralgias, & a pruritic rash
PE: increased BP, edema & diffuse erythematous rash W/U: oliguria, increased Cr UA: eosinophils, WBCs |
Allergic Interstitial Nephritis (AIN)
|
|
|
65 yo male with multiple myeloma presents with lethargy & bone pain
PE: altered mental status ECG: decreased QT interval |
Hypercalcemia
|
