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99 Cards in this Set

  • Front
  • Back
If you found sediment in a UA would might you be suspicious of?
chronic kidney disease, pre/post renal disorders
If you found hematuria with RBC casts, and proteinuria, what might you be suspicious of?
If you found heavy proteinuria and lipiduria, what might you be suspicious of?
nephrotic syndrome
What can cause inadequate excretion of urea which leads to a rise in BUN?
renal disease, high protein diets, dehydration.
What is creatinine?
by-product of skeletal muscle contraction and is generally constant. Excreted exclusively by kidney, so impaired renal fx will cause elevation.
Explain GFR
index of overall renal fx. measures amount of plasma filtered across glomerular capillaries. Correlates ability of kidney to filter fluids & certain substances.
What are advantages of ultrasound of the urinary tract?
dertermine: thickness of renal cortex, medulla, pyramids,kidney size, hydronephrosis and obstruction, masses, lesion, screen for polycystic disease, etc.
What are advantages / contraindications of intravenous pyelogram (IVP) of the urinary tract?
assesses kidneys, ureter and bladder, gives detailed view of pelvicaliceal system, size, shape, etc. Uses contrast so contraindicated in some.
When is CT, MRI useful for imaging urinary tract?
CT for further eval of abnormalities found by US, IVP.
When is MRI useful for imaging urinary tract?
shows loss of corticomedullary fx, renal cysts, CA staging, renal artery stenosis
What are indications for renal biopsy
unexplained acute renal failure or chronic kidney disease, acute nephritic syn, unexplained proteinuria, hematuria; previously ID'd & tx'd lesions, systemic disease associated with kidney dysfx, suspected transplant rejection,
What are contraindications for renal biopsy
solitary or ectopic diney, horseshoe kidney, oncorrected bleeding disorder, severe uncontrolled HTN, renal infection, renal neoplasm, hydronephrosis, congneital, multiple cysts
What are some complications for renal biopsy
hematuria (nearly all pt's) sig bleeding which require transfusion, nephrectomy and mortality
Define acute urethral syndrome
frequency and dysuria without demonstrable infection. Etiiology unkown, Tx behavioral, diety, rx
Define asymptomatic bacteriuria
bacteria in urine without sx of UTI or pyelonephritis. Common in elderly women, indwelling caths.
Identify predisposing factors for UTI
female, incomplete bladder emptying, diminished renal blood flow, intrinsic renal disease
Identify common uropathogens
e.coi, proteus, klebsiella, enterobacter, pseudomonas, less common s. aureus
Identify 3 routes of infection for UTI
ascending infection (most common), hematogenous spread, lymphogenous, direct extension from other organs
Describe classic signs and symptoms of lower UTI
frequency, urgency, dysuria, suprapubic discomfort, gross hematuria
Describe classic signs and symptoms of upper UTI
fever, flank px, chills, urgency, frequency, dysuria, NV, diarrhea, tachycardia, CVA tenderness
Describe the use of urinatry nitrates in diagnosing outpatient UTI
indicates bacteria in urine
Describe the use of urinary leukocyte esterase in diagnosing outpatient UTI
enzyme produced by WBC's suggestive for UTI
Describe the use of pyuria and bacteriuria in diagnosing outpatient UTI
>5 WBC significant. Indicative of injury possibly from infection. Bacteria implies infection
Describe the use of a urine culture in diagnosing outpatient UTI
used to ID pathogen responsible for infection
Identify pt's who should have urologic evaluation following UTI
women with >3 bladder infections in 1 year, persistent bacteriuria, reinfection
Identify other causes of dysuria that should be considered in the differential dx of UTI
obstruction, acute urinary retention, prostate problems, STD's
Describe the approach to tx for low-risk uncomplicated UTI
short-term abx; fluoroquinolones and nitrofurantioin
Distinguish between relapse and reinfection in recurrent UTI
relapse: unresolved or persistent bacteriuria. Reinfection: new pathogens occur following tx
Describe the role of prophylactic abx in recurrent UTI
3+ cystitis per year after urologic eval to exclude anatomic abnorm
Describe an approach to evaluation and management of acute urethral syndrome
PE. labs: UA, PAP, preg, KOH. Image: IVP, cystogram, MRI, prostate / pelvic US. Mgt: meds, behavioral, diet, referral
Describe the differing approach to asymptomatic bacteriuria evaluation and managemet in elderly vs. pregnant women
Tx pregnant women due to complications to fetus, ederly don't need tx.
Identify which pt's with acute pylenophritis should be hospitalized vs. outpatient tx
Evaluate age and stability of pt's, DM, co-existing renal disease or those not likely to comply should be hospitalized. Common for elderly to get urosepsis
Describe outpatient tx for acute uncomplicated pyelonephritis
quinolones or nitrofurantoin. Follow up urine cultures over several weeks post tx.
Describe the classic clinical syndromes associated with kidney stones, particularly renal colic
high humidty & temp, diet and fluid intake, cystinuria
Describe the symptoms associated with nephrolithiasis (kidney stones)
flank px, NV, constantly moving, may be episodical, may radiate anteriorly and refer into ipsilateral testis or labium
Describe the gernal approach to diagnosis and management of a pt with acute stone episode
UA shows hematuria, Ct first line to dx. Encourage fluids, px mgt, strain urine, suergery.
What is are common complications of kidney stones
infection and obstruction
What can a pt do to prevent future or recurring stones?
modify diet, increase fluids (at meals, 2 hr after eating, prior to sleep & during night). Change sleep posture; typically pt's sleep stone side down
Identify common causes of metabolic acidosis
decreased HCO3. DM ketoacidosis, renal insufficiency, starvation, diarrhea
Identify common causes of metabolic alkalosis
high HCO3, saline responsive and saline unresponsive
Define saline responsive in context of metabolic alkalosis
diuretics vomiting, antacids
Define saline unresponsive in context of metabolic alkalosis
Bartter's syndrome, aldosteronism, licorice
Identify common causes of hyperkalemia
Vit. D or A excess, hyperparathyroidism, acromegaly, adrenal insuff, tumors, mult myeloma, lymphoma, thiazide diuretic, lithium intake
Identify common causes of hypokalemia
malabsorption, short bowel, vit D deficit, alcoholism, chronic renal insuf, diuretic therapy, hypoarathyroidism, sepsis
Identify common causes of hypernatremia
most commonly occurs when water intake is inadequate as in pt's with altered mental status
Identify common causes of hyponatremia
Hypovolemic: diarrhea, vomiting. euvolemic: endocrine disorders, endurance exercise. Hypervolemic: CHF, liver disease, nephritic syndrome
What is the most common electrolyte abnormality observed in general hospitalized population
What is the most common reason for hyponatremia
result from water imbalance not sodium imbalance.
Describe signs and symptoms of hypokalemia including EKG changes
muscle spasms, convulsions, prolonged QT interval, Chvostek sign: contraction of facial muscle, Trousseaus sign: carpal spasms post brachial artery occlusion
Describe signs and symptoms of hyperkalemia including EKG changes
GI, renal, neurologic, constipation, polyuria, NV, anorexia, fatigue, weak, stupor, coma, ventricular extra systoles & idioventricular rhythm
Identify labs that might be obtained to evaluate renal disease
UA: sediment - chronic kidney disease, pre/post renal. Hematuria, proteinuria - glomerulonephritis
Define oliguria and identify it's association with renal failure
scanty urine production results in ineffeicient excretion of products of metabolism
Define azotemia and identify its association with renal failure
(Syn of uremia) Excess of urea and other nitrogenous waste in the blood
Define Uremia
excess of urea and other nitrogenous waste in blood. Complex of sx due to severe persisting renal failure - relieved by dialysis
Define prerenal causes of acute renal failure
Most common cause of acute renal failure. Poor vascular resistance or low cardiac output. hemorrhage, GI losses, dehydration, burns, trauma, peritonitis
Define postrenal causes of acute renal failure
obstruction of urinary tract or flow from kidneys. bladder ureter renal pelvises obstruction, BPH in men, anticholinergic drugs, CA, clots, stones or strictures
Define intrinsic causes of acute renal failure
account for 50% of renal failure. Considered after pre/post-renal excluded. Site of injury: tubules, interstitium, vasculature, glomeruli.
Discuss the 3 types of intrinsic causes of acute renal failure
1.acute tubular necrosis: ischemia, nephrotoxins 2.Acute glomerularnephritis: post-strep, callagen vascular disease 3.Acute interstitial nephritis: allergic rxn, drug rxn
Identify important systemic diseases associated with renal insufficiency
DM, amyloidosis, HIV, collagen-vascular diseas, sickle cell, drug hypersensitivity, heavy metals, polycystic kidney, renal artery stenosis
Identify general principles of treatment of acute tubular necrosis in acute renal failure
goal is to hasten recovery, avoid complications. prevent fluid overload & hyperkalemia.
Identify general principles of treatment of interstitial nephritis in acute renal failure
acute dialytic therapy, supportive measures and removal of inciting agent
Identify general principles of treatment of glomerulonephritis in acute renal failure
depending on severity; high dose steroids and cytotoxic agents. Plasma exchange in Goodpasture's disease
Identify general principles of management of chronic renal failure
Diet: protein, salt, water, potassium, phosphorus and magnesium restrictions, dialysis and transplant
What is the criteria for initiation of dialysis
GFR > 10ml/ min or serum creatinine 8mg/dL. DM pt's start FGR 15mL/ min or creatinine 6mg/dL.
What might be other indications for dialysis other than chronic renal failure
uremice symptoms such as pericarditis, encephalopathy, coagulopathy, fluid overload, unresponsive to diuresis, refractory hyperkalemia, severe metabolic acidosis and neurologic sx's such as seizure or neuropathy
Define nephritic syndrome
inflammatory process causing renal dysfunction over days to wks. Sx: acute glomerul. hematuria, HTN and renal failure
Define nephrotic syndrome
1/3 pt have renal disease. peripheral edema-hallmark, albuminuria, increased lipids. Can result from DM glomer., SLE, amyloidosis, renal vein thrombosis, toxic agents
What is an important sign of renal disease, urinary tract disease or hematologic disorder
What are common causes of hematuria
renal & bladder CA: extraglomerular: cysts, calculi, interstitial nephrities, renal neoplasms. Glomerular: IgA nephropathy, thin GBM, systemic nephritic syndromes
Describe an approach to working up a pt with hematuria
ask about meds, hx stones diseases or malignancy. pt's on anticoagulation get complete eval
Define proteinuria: Know that it is associated with virtually all kidney diseases as well as certain functional disorders
Protein in urine. Associated with virtually all kidney diseases, acute illness, exercise, orthostatic DM, bence jones proteins associated with multiple myeloma
Describe the findings of isolated proteinuria and its apparent relation to postural factors
generally <30 y/o resulting ion excretion abnormal amounts of urinary proteins. Confirmed by measuring 8h overnight supine urinary proteine excretion
Describe an approach to working up a pt with proteinuria discovered during a randome urine examination
Usually glomerular; elevated BUN & creatinine, abnormal urinary sediment. After dipstick, 24h urine, renal biopsy as indicated
Describe the routine hx, pe and labs of pt's with BPH
hx: obstructive, irritative voiding PE: obstructive or irritative Labs: UA, serum creatinine, PSA optional
Define obstructive symptoms in context of BPH
hesitancy, decreased force and caliber of stream, sensation of incomplete bladder empyting, double voiding, (twice in 2hr) straining to urinate and postvoid dribbling - of urine not b-ball
Define irritative symptoms in context of BPH
urgency, frequency and nocturia
Describe the medical option of a-blockers for treating BPH
give prostate and bladder neck contractile response to agonists
Describe the medical option of 5a-reductase inhibitors for treating BPH
block conversion of testorterone to dihydrotestosterone impacting epithelial component of prostate resulting in reduction in size and improvement in sx's
Describe the medical option of phytotherapy for treating BPH
use of plants or plant extracts suc has saw palmetto verry. MOI unknown.
Describe the surgical options for treatment of BPH
Many surgical options including prostatectomy or less invasive ones like stents, balloon dilation, hyperthermia, etc.
Describe the typical clinical presentation, diagnostic tests and general principals of tx of prostate cancer
PE: vague Dx: abnornal PSA, biopsy, US, MRI. Tx: stage 1st., prostatectomy, radiation, surveillance, cryosurgery
Describe the different types of prostatitis
acute bacterial prostatitis, chronic bacterial, nonbacterial, that really big irritating one...:)
Describe Sx, Dx, and tx if any, for testicular torsion
sx: 10-20 y/o, acute px swelling within testis, lack of voiding. Dx: examine "high lie" in relation to other testis
Describe Sx, Dx, and tx if any, for epididymitis
Sx: fever, irritative voiding, px of scrotal contents. Dx: leukocytosis and L. shift, gram stain for STD, US. Tx: elevate scrotum, ID bugs - STD: abx 10-21 days, non-STD: abx 21-28 days
Describe Sx, Dx, and tx if any, for varicocele
Sx: mostly L.side. sudden onset should think retroperitoneal malignancy. Tx: diminishes in size or disappears when pt is supine
Define epididymitis
acute infection of epididymis
Define hydrocele
collection of fluid between 2 layers of tunica vaginalis
Define varicocele
engorgement of the internal spermatic veins above the testis
Define spermatocele
cyst of the epididymis containing sperm
Describe age and clinical presentation of pt's with testicular tumors. Know that cryptorchidism is a risk factor!
late teens early 20's, painless enlargement of testis, mass, gynecomastia, 50% have cryptorchism
What different cell types are involved with testicular cancer
95% are germ cell tumors: seminoma and nonseminoma. Rest are nongerminal neoplasms: leydig cell, sertoli cell or gonadoblastoma.
What am I? This is a surgical emergency: seen in teens / young adults, acute px, dx with US, irreversible damage with eschemia >6 hrs.
testicular torsion
What can cause scrotal swelling?
hydrocele, inguinal hernia, varicocele, spermatocele, epididymitis, testicular CA, torsion or trauma
Name that incontinence! more common in elderly, usually reversible and not caused by urinary tract problems:
Name that incontinence! most common in elderly, leakage delayed seconds after stress, can result from bladder stones or tumor
Detrusor overactivity AKA urge incontinence. Tx: behavioral, void every 1-2 hrs, antispasmodics or TCA's
Name that incontinence! 2nd most common cause in older women. instantaneous leakage of urine with increaed intra-abd stress: cough, normal post-void residual
stress. Tx: kegal exercises, estrogen, surgery, a-agonist if not contraindicated
Name that incontinence! 2nd most common in men, rare in women. caused by prostatic enlargement, stricture. post-void dribbling, urge, etc.
urethral obstruction. Tx: alpha blocker, surgery, 5a-reductase inhibitor
Name that incontinence! least common, idiopathic or sacral nerve dysfunction. Frequency, nocturia, small volume.
Detrusor underactivity. Tx: mechanical - double voiding, suprapubic pressure, intermittent or indwelling caths, cholinergic agents