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164 Cards in this Set

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Most common cause of acute renal failure.
Prerenal azotemia
Disease state resulting from renal hypoperfusion that can be reversed by restoring blood flow.
Prerenal azotemia
Hallmark symptom of hypernatremia
Polydipsia (excessive thirst).
Most common site of breast tumors (what quadrant?)
Upper outer quadrant that extends into the axilla. Often missed on breast self exam.
Pain or pressure in the vaginal area, associated with dyspareunia, most likely indicates...
Uterovaginal prolapse
Most common etiology of priapism.
Idiopathic. However, may be associated with sickle cell disease, leukemia, self-injection with erectile-aiding agents, and trauma.
Drug of choice to treat Trichomonas vaginalis
Metronidazole (Flagyl)
Initial management of a breast cancer patient with hypercalcemia
IV fluids and IV furosemide. Malignancy is associated with hypercalcemia. Calcium causes dehydration which interferes with the kidney's response to ADH. Furosemide facilitates calcium excretion by the kidneys and prevents volume overload.
The most definitive diagnostic test for a patient suspected of having renal artery stenosis
Renal arteriography. However the best noninvasive test is radionuclide renogram so you can have a point if you said that too.
75 year old man complains of a 3 month history of leaking urine, nocturia, and reduced stream. He has a postvoid residual of >200mL. Likely diagnosis?
Overflow incontinence caused by urinary retention
Drug of choice for treatment of BPH
alpha-1-blockers (prazosin) or 5-alpha-reductase inhibitors (finasteride)
The most common acid-base disorder associated with chronic renal failure
Metabolic acidosis (due to the inability of the kidneys to excrete the acid generated by the metabolism of dietary proteins. Protein restriction is recommended.)
Risk factors for stress incontinence
Age, obesity, vaginal deliveries
What anticholesterol drug class may prevent the absorption of fat-soluble vitamins (ADEK)?
Bile acid sequestrants (such as cholestyramine)
What is the serum osmolality in hyperosmolar states?
>290mOsm/kg
What is the most common presenting symptom of primary vaginal carcinoma?
Painless bloody discharge
Where do lesions typically occur in vaginal cancer?
The upper third of the vaginal canal
What is the most common cause of urethritis in males under 30?
Neisseria gonorrhoeae
Most common cause of bloody nipple discharge
Intraductal papilloma
What are the risk factors for ovarian cancer?
Caucasian, >50, Jewish descent, history of breast cancer, immediate family history of ovarian cancer, nulliparity, hormone replacement therapy, high fat diet, use of infertility drugs
Etiologic agent of syphilis
Treponema pallidum
Etiologic agent of chancroid
H. ducreyi
A young woman c/o pain in the vulvar region. Exam reveals unilateral tenderness and swelling over the distal labia minora. Likely diagnosis?
Bartholin gland abscess
Correcting a patient's hyponatremia too quickly results in...
Central pontine myelinolysis (cerebral edema). It is a severe, irreversible complication.
Outpatient treatment for pelvic inflammatory disease
Doxycycline 100mg po BID for 14 days plus ceftriaxone 250mg IM single dose
79 year old diabetic nursing home patient presents with a 24 hour history of flank pain, dysuria, and tachycardia. UA shows pyuria and hematuria. Likely diagnosis?
Pyelonephritis
In peptic ulcer disease, what type of ulcer is more prominent in younger patients?
Duodenal ulcers. (Gastric ulcers are more common in the elderly and have a high association with gastric cancer.)
What diagnostic study can quantify proteinuria?
24 hour urine collection
Most common cause of dysuria in an adult male
Urethritis
What are the risk factors for fibrodysplasia in the breasts?
Irregular menses, underweight, early menarche, late menopause, and small breast size
Menstrual pain caused by pelvic pathology such as endometriosis
Secondary dysmenorrhea
Menstrual pain associated with early onset and symptoms that worsen over time
Primary dysmenorrhea
What factors are associated with increased risk of infertility in males?
Cryptorchidism, hypogonadism, history of orchitis, testicular torsion, infection
Male patient presents with fever, chills, dysuria, perineal pain, and decreased stream. Rectal exam reveals boggy prostate. Likely diagnosis?
Acute prostatitis. Do not massage the prostate in this scenario as it may cause bacteremia.
What is the definitive treatment for a 2 year old patient with an undescended testicle?
Orchiopexy. (HCG injections may be attempted by orchiopexy is the definitive treatment.) It is unlikely the testicle will descend on its own after 1 year of age.
Most common causative organisms of acute epididymitis in an older male.
E.coli and Klebsiella
Most common causative organisms of acute epididymitis in young males
Chlamydia trachomatis, Neisseria gonorrhoeae, and Ureaplasma urealyticum
What are the causes of hypovolemic hyponatremia?
Pancreatitis, vomiting, diarrhea, peritonitis, and burns. (cause extrarenal loss of sodium)
What bacterium is responsible for maintaining the normal pH of the vagina?
Lactobacillus acidophilus
What lab tests are indicated for evaluation of impotence?
CBC, U/A, lipid profile, and determination of serum testosterone, glucose, and prolactin
Enlarged, irregularly shaped uterus on bimanual exam is likely...
Uterine fibroids, the most common cause of change in uterine contour
ABG findings common to respiratory alkalosis and metabolic acidosis
Decreased plasma bicarb concentration
What vitamin is required for adequate intestinal absorption of calcium?
Vitamin D
Most common presentation for bladder carcinoma
Painless hematuria
Most common type of hernia in males
Direct inguinal
Hallmark sign of nephrotic syndrome
Peripheral edema
What is anasarca?
Widespread swelling of the skin due to effusion of fluid into the extracellular space. A sign of CHF, liver failure, and renal failure.
Mnemonic: Anasarca is like a parka, all over.
What is the recommended management for acute hepatitis A?
Hydration, rest, restricted physical activity, well-balanced diet, avoid fatty foods and alcohol, and avoidance of hepatotoxic drugs such as Tylenol.
ECG change associated with hypokalemia
U waves
Physical exam finding of a "bag of worms" is characteristic of what?
Varicocele
Partially retracted, tender, firm testicle
Testicular torsion
Firm, tender mass along the testes
Epididymitis
What electrolyte abnormality may cause peaked T waves on ECG?
hyperkalemia
Infertility is defined as inability to get pregnant with unprotected intercourse after what period of time?
1 year
Narcotic overdose in a patient with no underlying lung disease is most commonly associated with what acid/base abnormality?
Respiratory acidosis
A patient presents with a transient rash, gross hematuria, and flank pain. He had been taking allopurinol for a gout attack. Likely diagnosis?
Acute tubulointerstitial nephritis
True or false: the kidney may take up to 3 days to form a compensatory response to a primary respiratory acid/base disturbances
True.
Enlarged prostate with a firm nontender discrete mass is likely what?
Prostatic carcinoma
A 14 year old boy has pubic hair that is coarse, curly, and spreading sparsely over the pubic symphysis. This is consistent with what Tanner stage of sexual maturity?
Stage 3
A 13 year old boy has scanty, long, slightly pigmented pubic hair primarily at the base of the penis. This is consistent with what Tanner stage of sexual maturity?
Stage 2
The breast and papilla are elevated as a small mound, and the diameter of the areola has increased. This is consistent with what Tanner stage of sexual maturity?
Stage 2
The breast and areola are enlarged with no separation of their contours. This is consistent with what Tanner stage of sexual maturity?
Stage 3
The areola and papilla are projected to form a secondary mound above the level of the breast. This is consistent with what Tanner stage of sexual maturity?
Stage 4
How many Tanner stages of sexual maturity are there?
5
Tanner stage 1 of sexual maturity indicates what?
Preadolescence
A patient presents with euvolemia, but serum sodium of 126 mEq/L. This most likely indicates what?
SIADH
What is the treatment for asymptomatic hyponatremia?
Water restricted to 0.5 to 1 L/day. Gradual increase in sodium will occur over a few days.
Metabolic acidosis with a pH less than 7.20 in a patient with chronic renal failure is indication for what treatment?
Dialysis
Excessive bicarb excretion with decreased bicarb absorption in the GI tract, with a decreased pH, indicates what acid/base disturbance?
Metabolic acidosis
Microangiopathic hemolytic syndrome, thrombocytopenia, and renal failure are characteristic of what disease state?
Hemolytic-uremia syndrome. The prodromal phase is characterized by abdominal pain, vomiting, and diarrhea.
Decreased partial pressure of carbon dioxide, decreased pH, and decreased bicarb are indicative of what acid/base disturbance?
Metabolic acidosis
The facial nerve contracts in response to tapping of the facial nerve anterior to the ear. What sign is this, and what does it indicate?
Chvostek's sign. Indicates hypocalcemia.
A small palpable lump is found on the superior pole of a patient's testicle or epididymis that may appear blue when the skin is pulled over it, "blue dot sign". This is indicative of what?
Testicular appendix torsion
Most common cause of chronic tubulointerstitial nephritis
Prolonged urinary tract obstruction
2 most common causes of chronic tubulointerstitial nephritis
Prolonged urinary tract obstruction and reflux nephropathy
The most important approach to reducing recurrence of renal calculi
Increasing fluid intake
True or false: Treatment for orchitis include 4-6 weeks of antibiotics to cover causative organisms
False. Orchitis is usually caused by a virus.
Scrotal pain occurs 3-10 days after acute mumps parotitis. What is the likely diagnosis?
Acute orchitis
What is the gold standard diagnostic test to diagnose testicular torsion?
Radionucleotide scan of the testes. (Ultrasound may also be used.)
COPD is associated with what acid/base abnormality?
Chronic respiratory acidosis
Hernias associated with necrotic tissue outside the abdominal cavity that cannot be reduced
Incarcerated
What age group is most likely to develop orchitis?
Adults. 25% of postpubertal males who have mumps develop orchitis
Peripheral blood eosinophilia, white blood cell casts, proteinuria, and hematuria are commonly associated with what renal disease?
acute tubulointerstitial nephritis
What is the most common cause of hematuria?
UTI
What finding on U/A is most often seen in uncomplicated cystitis?
WBCs
A young woman complains of vulvar lesions that started with a tingling of the skin followed by painful clear blisters that oozed and crusted. Likely diagnosis?
genital herpes simplex
The presence of red blood cell casts in a urine sample indicates...
glomerulonephritis or vasculitis
The most likely diagnosis for an obese woman with hirsutism and infertility is...
polycystic ovarian syndrome
The most common physical exam finding of testicular carcinoma?
Nontender testicular mass
When is emergent treatment for hyperkalemia indicated?
When cardiac toxicity or muscle paralysis is present
What is the most common cause of chronic hyperkalemia?
type IV renal tubular acidosis, aka hyporenin-hypoaldosteronism
"gold standard" test for asymptomatic osteoporosis
DEXA scan
Most likely causative organism in chronic bacterial prostatitis
E.coli
What are the clinical features of hypercalcemia?
Malaise, tremor, fatigue, hypotonia, confusion, polydipsia, renal calculi
Most common groin hernias in females
Indirect and femoral
Most common cause of renal vascular hypertension in females under age 50
fibromuscular dysplasia
Budding pseudohyphae on a KOH wet prep indicates...
Candida albicans infection
Most common cause of hypercalcemia
Hyperparathyroidism
Uterine bleeding that occurs at irregular intervals with varying amounts and duration is known as...
menometrorrhagia
What BPH medication prevents the conversion of testosterone to dihydrotestosterone to decrease the size of the prostate?
Finasteride (Proscar) or dutasteride (Avodart)
Inability to replace the foreskin back over the glans in an uncircumcised male.
Paraphimosis
Where is the most likely first site for prostate cancer to metastasize?
Bone
A 2 month old comes in for a well baby check up. You note a white reflex on fundoscopic exam. Most likely diagnosis?
Retinoblastoma
A dendritic ulcer on the cornea is most consistent with what diagnosis?
viral keratitis (usually herpes simplex)
Gram stain of penile discharge reveals gram-negative intracellular diplococci. Most likely STD?
Gonorrhea urethritis
Anatomical region of the prostate that becomes hyperplastic in BPH
Transition zone
Inability to retract the foreskin from the penis due to inflammation or infection.
Phimosis
What cranial nerve is involved with hearing?
VIII
Patients with Meniere's disease should limit their intake of...
salt
The recommended age for men to start annual prostate screening
50
Which type of renal tubular acidosis (RTA) is associated with abnormal H+ secretion and nephrolithiasis?
RTA type I (distal)
What type of renal tubular acidosis (RTA) is associated with abnormal bicarb and rickets?
Type II RTA (Proximal)
What type of renal tubular acidosis (RTA) is associated with aldosterone defect?
Type IV (distal) RTA
"Doughy skin" is associated with what electrolyte abnormality?
Hypernatremia
Positive Trousseau's sign indicates...
hypocalcemia
What is Trousseau's sign?
Compression of the brachial artery (as with a BP cuff) causes carpal spasm
Most common causes of hypercalcemia
Malignancy and hyperparathyroidism
What is the most common type of nephrolithiasis?
Calcium oxalate
What brain anomaly is associated with polycystic kidney disease (PCKD)
Cerebral berry aneurysms
Hematuria, hypertension, oliguria
Nephritic syndrome
Proteinuria, hypoalbuminemia, hyperlipidemia, hyperlipiduria, edema
Nephrotic syndrome
What is the most common form of nephritic syndrome
Membranous glomerulonephritis
What is the most common form of glomerulonephritis?
IgA nephropathy (Berger's disease)
The presence of RBC casts in the urine sediment indicates...
Glomerulonephritis/nephritic syndrome
Eosinophils in the urine sediment indicates...
Allergic interstitial nephritis
Waxy casts in the urine sediment and lipiduria indicate..
Nephrotic syndrome
Drowsiness, asterixis, nausea, and pericardial friction rub indicates...
Uremic syndrome in patients with renal failure
Low urine specific gravity in the presence of high serum osmolality indicates...
diabetes insipidus
What is the treatment for SIADH?
Fluid restriction, demeclocycline (a tetracycline antibiotic)
Hematuria, flank pain, and a palpable flank mass. Diagnosis?
Renal cell carcinoma
What type of testicular cancer is associated with beta-HCG and alpha-fetoprotein?
Choriocarcinoma
Most common histology of bladder cancer
Transitional cell carcinoma
Salicylate overdose leads to what acid-base disorder?
anion gap acidosis and primary respiratory alkalosis due to central respiratory stimulation
What acid-base disturbance is most commonly seen in pregnant women?
Respiratory alkalosis
What 3 systemic diseases can lead to nephrotic syndrome?
DM, SLE, amyloidosis
A 55 year old man presents with irritative and obstructive urinary symptoms. Likely diagnosis?
BPH
What is the treatment for sexually-transmitted epididymitis?
Ceftriaxone and/or doxycycline for 10 to 21 days
What is the treatment for non-sexually-transmitted epididymitis?
Trimethoprim-sulfamethoxazole, erythromycin, or fluoroquinolones for 21 to 28 days
A young adult male presents with a dull aching left testicle. On exam, a mass is noted over the spermatic cord which becomes more prominent with standing. Diagnosis?
Varicocele
What is the most common type of prostate cancer?
Adenocarcinoma
What are the risk factors for prostate cancer?
Advancing age, positive family history, and African-American heritage
What is the most common type of renal cell carcinoma?
Clear cell
What are the risk factors for renal cell carcinoma?
Obesity, hypertension, and smoking
What are the classic triad of symptoms for renal cell carcinoma?
Flank pain, abdominal mass, and hematuria
White blood cell casts in the urine may indicate...
Pyelonephritis
What drug may slow the progression of renal failure?
ACEIs. However, monitor the potassium level when starting ACEIs.
What renal disease is an uncommon cause of acute renal failure, results from immune complex deposits in the kidney, and may be caused by Berger's disease (IgA nephropathy) or lupus?
Glomerulonephritis
How is the diagnosis of glomerulonephritis confirmed?
Biopsy
What is the serologic marker for Wegener's granulomatosis?
Antineutrophilic cytoplasmic autoantibodies (ANCA)
If serum magnesium is low, what other electrolyte will likely be decreased?
Potassium
Hemolysis of red blood cells may cause what electrolyte to increase?
Potassium
What drugs may be associated with hyperkalemia?
heparin, spironolactone, ACEIs, NSAIDs
What is Trousseau sign and what does it indicate?
Carpopedal spasm when upper arm is compressed. Indicates hypocalcemia.
What electrolyte imbalance may cause a prolonged QT interval?
Hypocalcemia
What electrolyte abnormality may cause a shortened QT interval?
Hypercalcemia
pH 7.30, PCO2 60, Bicarb 22. Diagnosis?
Respiratory acidosis
pH 7.52, PCO2 25, Bicarb 22. Diagnosis?
Respiratory alkalosis
pH 7.30, PCO2 40, Bicarb 16. Diagnosis?
Metabolic acidosis
pH 7.52, PCO2 40, Bicarb 35. Diagnosis?
Metabolic alkalosis
How is anion gap calculated?
Anion gap = Na - (Cl + HCO3)
What could cause elevated anion gap metabolic acidosis?
DKA, lactic acidosis, uremia, ethylene glycol intoxication, methanol ingestion, salicylate intoxication
How are the etiologies of metabolic alkalosis separated?
Low urine chloride (vomiting, past diuretic use) vs. normal or high urine chloride (Cushing's syndrome, Conn's syndrome, steroid use, current diuretic use)
What acid/base disturbance is caused by CNS depression?
Respiratory acidosis
What type of acid/base disturbance is caused by hyperventilation?
Respiratory alkalosis