Hy Renal And Genitourinary

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Prostate CA

Back 1

prostate antigen test (PSA) should be done annually, usually over 50 years old

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MC tumor in men

Back 2

prostate ca

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pelvic exam (ages)

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20-40 yo should be every 3 yrs, >40 should be annually

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pelvic inflammatory disease (PID)

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MC preventable cause of infertility

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polycystic ovarian syndrome

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MCC of dysfunctional uterine bleeding, associated with obesity, hirsutism and inc risk of endometrial CA secondary to unopposed estrogen

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Kidney stones

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Calcium (mc), ammonium (2nd mc and is caused by urease positive organism such as proteus and staphylococcus) are both radiopaque

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MCC of hydronephrosis

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stones

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cryptorchidism

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major risk factor for testicular CA and infertility, requires surgical treatment

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Testicular CA associated with beta-HCG and alpha-feto protein

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Choriocarcinoma

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MCC of testicular tumor

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Seminoma (germ cell tumor)

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MCC of bladder CA

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transitional cell carcinoma

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MCC of epididymitis in less than 40 yrs old

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gonorrhea and chlamydia

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MCC of epididymitis in more than 40 yrs old

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E. coli and pseudomonas

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Malignant renal tumor in children

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Wilm's tumor (Chromosome 11, aniridia and hypertension

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Benign prostatic hypertrophy (BPH)

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can cause renal failure secondary to obstruction, patients usually present with distended bladder and hydronephrosis (dilation of pelvis and calices) on US

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MCC of male urinary tract obstruction

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BPH

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Treatment of BPH

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terazosin (a1-blocker), finasteride (5-a-reductase inhibitor) or perform transurethral resection of the prostate (TURP)

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Photograph of a mass in vulva

Back 18

Bartholin gland abscess and it is associated with gonorrhea

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Diuretics- MCC of metabolic problems - Thiazide

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Inc Ca, hyperglycemia, hyperuricemia, hyperlipidemia, hyponatremia, hypokalemic metabolic alkalosis, hypovolemia. This is a sulfa drug so watch out for allergic reactions.

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Diuretics- MCC of metabolic problems - Loop

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hypokalemic metabolic alkalosis, hypovolemia (more than thiazide), decreased Ca and ototoxicity. Furosemide is a sulfa drug so watch for allergies. (Ethacrynic acid is not a sulfa drug)

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Diuretics- MCC of metabolic problems - Acetazolamide (carbonic anhydrase inhibitor)

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metabolic acidosis

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Diuretics- MCC of metabolic problems - Spironolactone (potassium sparing)

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Hyperkalemia

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Alkalosis

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can lead to hypokalemia and hypocalcemia

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Acidosis

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can lead to hyperkalemia and hypercalcemia

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"Normal" anion gap metabolic acidosis

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Bicarb is lost and it is replaced by Cl; RTA I, RTA II, diarrhea (loss of Na, K, and HCO3)

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"Increased" anion gap metabolic acidosis

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MUDPILES
Methanol, Uremia, DKA, Paraldehyde, Infection, Lactate, Ethanol, Salicylate

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Hypomagnesemia

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can lead to hypokalemia, and hypocalcemia that can not be corrected by replacement of K or Ca

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Hypervolumic hyponatremic

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Cirrhosis, CHF, Nephritic syndrome

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Tx for SIADH

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fluid restriction

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Trousseau's sign

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carpopedal spasm while using blood pressure cuff, a sign of tetany due to hypocalcemia

Front 31

Chevostek's sign

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tetany secondary to tapping the facial nerve, a sign of hypocalcemia

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ambiguous genitalia + hypotention

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21-hydroxylase deficiency in girls

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nephritic syndrome+nerve deafness

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alport's syndrome

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nephritic syndrome + hemptysis

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wegener's granulomatosis and good pasture's syndrome (hemptysis 1st)

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Flank pain +hematuria

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nephrolithiasis

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flank pain + hematuria + flank mass

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renal cell carcinoma (inc EPO, inc HCT but normal O2 sat)

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Flank mass + hematuria

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adult polycystic kidney disease (associated with berry aneurysm)

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HTN +oliguria +hematuria

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nephritic syndrome

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proteinuria

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nephrotic syndrome (leads to hypoalbuminemia, hyperlipidemia, edema)

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systemic causes of nephrotic syndrome

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SLE, DM, and amyloidosis

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hyperrenunemia

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Bartter's syndrome

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IgA nephropathy

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Berger's disease

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MCC of nephritic syndrome

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IgA nephropathy

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proximal tubular absorption defect

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fanconi's syndrome

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kimmelstiel-wilson nodules

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diabetic nephropathy

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anti-glomerular basement membrane

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goodpasture's

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what slows down diabetic nephropathy?

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ACE inhibitor

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lumpy bumpy appearance of glomeruli on immunofluorescence

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poststreptococcal glomerulonephritis

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subepithelial humps on electrom microscope

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poststreptococcal glomerulonephritis

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spike and dome on electrom microscope

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membranous glomerulonephritis

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MCC of nephrotic syndrome

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membranous glomerulonephritis

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MCC of nephrotic syndrome in children

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minimal change disease

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MCC of nephrotic syndrome in AIDS patients

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focal segmental glomerulosclerosis

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nephrotoxic acute tubular necrosis

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aminoglycoside and contrast dye

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analgesic abuse (acetamenophen and ASA)

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renal papillary necerosis

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Tram-track appearance on light microscope

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membranoproliferative glomerulonephritis

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red urine in the morning

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paroxysmal nocturnal hemoglobinuria (PND)

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RBC casts

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nephritic syndrome or nephrotic syndrome

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WBC casts

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pyelonephritis

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waxy casts

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chronic renal failure

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fatty casts with maltese crossing

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nephrotic syndrome

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urethritis + conjunctivitis + arthritis + male

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reiter's syndrome

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renal epithelial cast in urine

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acute toxic or viral nephropathy

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MCC of 2ndary hyperparathyroidism

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hypocalcemia due to chronic renal failure

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as one kidney fails...the other kidney....

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hypertrophies

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Type I renal tubular acidosis

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distal tubule, decrease H+ secretion and nephrolithiasis

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Type II renal tubular acidosis

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proximal tubule, decrease HCO3- re-absorption

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type IV renal tubular acidosis

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distal tubule, low level and reponse to aldosterone

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prerenal acute renal failure

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FEna<1%

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Chronic remal failure causes hypocalcemia secondary to....

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Vit D def (lack of second hydroxylation)

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low urine specific gravity +high serum osmolality

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diabetes insipidus

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DES exposure

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clear cell adenocarcinoma of vagina

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oligohydramnios

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renal agenesis

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bluish-black testicles

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testicular torsion

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tx of syphilis

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penicillin

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Tx of gonorrhea

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ceftriaxone

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tx of chlamydia

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doxycycline

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tx of bacterial vaginosis (not the partner) and trichominiasis (and the partner)

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metronidazole (used to treat anaerobes)

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sterile pyuria (WBC) with negative culture

Back 79

renal TB or Chlamydia