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502 Flashcards

1
Q

normal characteristics of urine

A

pH 5-9
specific gravity 1.001 - 1.035
protein < 20 mg/dL
urobilinogen up to 1 mg/dL

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2
Q

newborn renal fxn

A

produces dilute urine
2 mL/kg/hr
unable to reabsorb
glomerular filtration matures around 1-2 yrs

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3
Q

children renal fxn

A

shorter urethras
prone to UIT
complete bladder control at 4-5 yrs
ability to regain full renal fxn after ARF

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4
Q

aging renal fxn

A

(+)muscle thickness/(-)capacity/(+)frequency
(-)contractility and tone/(+)retention
(-)sphincter control (x2 for women)
(-)urethral length (affected by w/d of estrogen)
(+)prostate enlargement/(+)retention

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5
Q

hypospadias

A

opening on dorsal side (top)
more common
surgical correction 6-12 mos
should not be circumcised

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6
Q

epispadias

A

opening on ventral side (bottom)

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7
Q

VUR

A

vesicoureteral reflux

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8
Q

bladder extrophy

A

extrusion of bladder through defect in lower abdominal wall
may be associated with genital anomalies or anus defects
risk for kidney damage due to VUR s/p corrective surgery

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9
Q

MSRE

A

modern staged repair of extrophy

  1. bladder closure
  2. epispadias repair
  3. BNR (bladder neck reconstruction at 5 yrs
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10
Q

CPRE

A

complete primary repair of extrophy

bladder closure, epispadias repair, and BNR done simultaneously

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11
Q

primary VUR vs secondary VUR

A

congenital abnormality vs. acquired condition (UTI or obstruction)
graded I - V by how distended ureter is/how deep into nephrons

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12
Q

VUR management (stage I-II)

A

80% probability of spontaneous resolution

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13
Q

VUR management (less severe)

A

inject bulking agent (Deflux)

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14
Q

VUR management (stage IV-V)

A

surgical correction
ureter reimplantation
renal US to R/O obstruction

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15
Q

UTI

A 
-bacteria ascending through urethra:
E. coli (most common)
streptococci
S. saprophyticus
occasionally fungal or parasitic
-obstruction or void dysfunction
-reflux
-should be R/O in any presenting child with malaise or changed urinary habits
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16
Q

UTI (upper) involves:

A

renal parenchyma, pelvis, and ureters
>pyelonephritis
VUR
glomerulonephritis

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17
Q

UTI (lower) involves:

A

urinary tract
absent clinical manifestations
cystitis
urethritis

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18
Q

febrile UTI indicates:

A

pyelonephritis

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19
Q

kidney scarring from childhood UTIs cause concern regarding:

A

renal HTN and impaired fxn in adulthood

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20
Q

glomerulonephritis manifestations:

A 
hematuria, proteinuria
acute edema of eyelids/ankles (worse in AM)
pulmonary edema
proteinuria
HTN
renal insufficiency
fever fatigue
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21
Q

nephrotic syndrome (kinds)

A

primary (MCNS): minimal change
secondary: systemic disease (SLE, poisoning)
congenital

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22
Q

process of nephrotic syndrome:

A

glomerular membrane becomes permeable to albumin > hyperalbuminuria > hypoalbuminemia > fluid shift from plasma to interstitial spaces > hypovolemia/ascites

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23
Q

nephrotic syndrome s/s:

A 
proteinuria (frothy)
hypoalbuminemia/hyperalbuminuria
dependent edema (worsens through day)
hypovolemia/normotensive
pallor/fatigue
\++cholesterol/triglycerides
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24
Q

management of nephrotic syndrome:

A

reduce relapse:
high-dose prednisone, cytoxan, cyclosporine
manage fluid balance:
diuretics, albumin infusion
infection prevention:
PCN prophylaxis, pneumococcal vax, no live virus

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25
Q

enuresis

A

inability to control voiding:
most master by 5 yrs
females often before males
controlled by CNS; can be r/t delayed maturation

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26
Q

enuresis medications:

A

antidiuretics
anticholinergics
antidepressants/temporal therapy

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27
Q

osgood-schlatter disease:

A

most frequent cause of knee pain in kids
usu ages 9-16
overuse associated w/running, twisting, jumping
irritation of patellar ligament at its attachment to the tibial tuberosity

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28
Q

RICE interventions:

A

Rest
Ice
Compression
Elevation

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29
Q

traction

A

pull/force exerted on one part of body in presence of counterforce

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30
Q

focus of traction on:

A

spine
pelvis
long bones of UE/LE

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31
Q

purpose of traction:

A

provide rest/immobilize
prevent/improve contractures
correct deformity
treat dislocation

32
Q

casts: plaster v. fiberglass

A

plaster: inexpensive, molds easy, but heavy, long drying time, and can’t get wet
fiberglass: quick-drying and water resistant, but more costly and not ideal for young children or sever breaks (don’t mold easy)

33
Q

treatment of compartment syndrome:

A

don’t elevate above the heart (slows arterial perfusion, increases venous pressure)
no ice (causes vasoconstriction)
bivalve cast, loosen under layer
loosen surgical dressings
fasciotomy (surgical): removal of fascia decreases pressure and allows perfusion

34
Q

compartment syndrome s/s:

A

myoglobinuria (protein from damaged muscle)
precipitates like gel/blocks renal tubules
dark reddish brown urine

35
Q

types of traction:

A

manual (applied to body part by hand, usu during cast application)
skin (applied to surface, indirectly to skeletal structures, like dunlop/humeral or buck/hip)
skeletal (directly to skeletal via pin, wire, tongs)

36
Q

scoliosis is:

A

lateral curvature of spine with vertebral rotation

37
Q

types of scoliosis

A

adolescent idiopathic (occurs during growth spurt)
congenital
infantile/juvenile
neuromuscular

38
Q

scoliosis s/s:

A

prominent scapula/hip
uneven shoulders/scapulae
spinous process misaligned
uneven fit/hem of clothing

39
Q

osteomyelitis is:

A

bacterial infection of bone that involves cortex or marrow cavity

40
Q

etiology/epidemiology of osteomyelitis:

A 
S. aureus most common organism
exogenous (from penetrating wound) or
hematogenous (preexisting infection)
boys/girls 2:1
commonly at 5-14 yrs
41
Q

osteomyelitis s/s:

A 
hx of trauma at affected area
leukocytosis
\++ESR
irritability
elevated temp
local tenderness/swelling/pain
\+bone culture
42
Q

osteomyelitis treatment:

A

immobilization (prevents spread of infection)
antibiotics (3-4 weeks usu, up to 6)
surgical intervention if necessary

43
Q

juvenile arthritis is:

A 
autoimmune disease, cause unknown
peak ages of onset 1-3 yrs and 8-10 yrs
occurs before age 16
girls/boys 2:1
30% of children suffer long term limitations
44
Q

types of juvenile arthritis:

A

50% pauciarticular (onset of fewer joints)
40% polyarticular (onset of 5+ joints)
10% systemic (variable arthritis/systemic)

45
Q

juvenile arthritis s/s:

A

swelling/stiff/loss of fxn in affected joint
warm/erythematous
leukocytosis during flares
synovial thickening
systemic: maculopapular rash, fever, hepatosplenomegaly, pericarditis, lymphadenopathy

46
Q

pharmacological management of JA:

A

corticosteroids
NSAIDS
cytotoxic drugs

47
Q 
DM1:
age at onset:
inheritance:
nutritional status:
insulin:
sulfonylurea therapy:
symptoms:
onset:
A 
insulin-dependent DM
any age, usu before 30 yrs
recessive
usually nonobese
dependent 
none
polyuria/polydipsia/polyphagia, weight loss, fatigue and irritability
abrupt
48
Q 
DM2:
age at onset:
inheritance:
nutritional status:
insulin:
sulfonylurea therapy:
symptoms:
onset:
A 
non insulin-dependent DM
usu starts in 40s/peaks in 50s, but increasing incidence in childhood and adolescences
dominant 
60-80% patients obese
insulin required in 20-30% of cases
sulfonylurea therapy effective
none, OR DM1 similar (thirst/fatigue), OR vascular/neural/visual complications, frequent infections (esp skin, gums, bladder), slow healing cuts/bruises, tingling/numbness in hands or feet
gradual onset
49
Q

gestational diabetes:

A

develops during pregnancy
detected at weeks 24-28
Bg usually returns to normal 6 weeks postpartum
increased risk for C-section, prenatal complications
increased risk for development of DM2
treatment: nutrition, insulin

50
Q

secondary diabetes:

A 
*resulting from: 
cushing syndrome
hyperthyroidism
pancreatitis
parenteral nutrition
cystic fibrosis
hemochromatosis
*results from treatment with:
corticosteroids
thiazides
phenytoin
atypical antipsychotics like clozapine
*usu resolved w/resolution of above
51
Q

DM methods of diagnosis:

A

HbA1c > 6.5%
Fasting Bg > 126
random Bg > 200 + s/s
2hr OGTT > 200 w/glucose load of 75g

52
Q

rapid-acting insulin (aspart)

A

onset: 15 min
peak: 60-90 min
duration: 3-4 hr

53
Q

short-acting insulin (regular, ending in -R)

A

onset: 30-60min
peak: 2-3 hr
duration: 3-6 hr

54
Q

intermediate-acting insulin (NPH, ending in -N)

A

onset: 2-4 hr
peak: 4-10 hr
duration: 10-16 hr

55
Q

long-acting insulin (glargine)

A

onset: 1-2 hr
NO PEAK
duration: 24+ hr

56
Q

somogyi effect

A

overabundance of insulin overnight > hypoglycemia > rebound hyperglycemia

57
Q

dawn phenomenon

A 
waning insulin (+growth hormone surge?) > hyperglycemia 
not rebound, unlike somogyi
58
Q

sick day rules:

A 
call PCP
Bg Q4h
test for ketonuria when Bg >240
drink 8-12 sugar free fluids Qh when awake
observe for changes in n/v or fever
59
Q

hypoglycemia:

A

mild: 40-70
moderate: 20-40
s/s: diaphoresis, tremor, tachycardia, palpitations, moves to tachypnea, cold/clammy skin, pallor, change in mood
tx with CHO, fruit juice/soft drink/hard candy/skim milk/saltines/graham crackers

60
Q

pelvic floor exercises

A

kegels (10 reps 3-5xday 4-8 weeks)

vaginal weights/cones

61
Q

urge control technique

A

be still, squeeze x5, distract, walk, then bathroom

62
Q

most common cause of incontinence in women:

A

fecal impaction

63
Q

most common cause of incontinence in men:

A

prostate enlargement

64
Q

PVR is:

A

post void residual
tested 10 min post void
50-100cc normal
>200cc abnormal

65
Q

surgical interventions for urinary retention:

A

BPH reduction
TURP
bladder sling/suspension

66
Q

BPH is:

A

noncancerous enlargement of prostate
50% of men will have BPH by age 50
90% of men will have BPH by age 80
AA men develop at a younger age

67
Q

BPH s/s:

A 
void hesitancy
unsteady stream
nocturia
frequency
vesical tenesmus
intermittent starting and stopping
68
Q

TURP is:

A

transurethral resection of prostate
correction of BPH
removal of prostate tissue using resectoscope inserted through urethra

69
Q 
AKI:
onset:
nephrons involved:
duration:
reversible?
mortality:
urine status:
most common cause:
A 
acute kidney injury
sudden
50% 
2-4 weeks, < 3 mos
yes
high
oliguria to polyuria
ATN
70
Q 
CKD:
onset:
nephrons involved:
duration:
reversible?
mortality:
urine status:
most common cause:
A 
chronic kidney disease
gradual
80-90% 
permanent
no
poor diagnosis w/o HD/transplant
polyuria to oliguria
diabetic nephropathy
71
Q

common abnormalities cause by renal failure:

A

fluid disturbances
electrolyte imbalance
accumulation of nitrogenous waste/toxin
neurologic disorders

72
Q

prerenal AKI:

A 
55-60% of cases
results from decreased perfusion
pathology doesn't reach parenchyma
caused by hypovolemia, heart failure, hypotension, shock, hepato-renal syndrome, cyclosporin/tacrolimus
resolved with resolution of cause
73
Q

intrarenal AKI:

A

35-40% of cases
results from damage to glomeruli, interstitium, or tubules
pathology reaches parenchyma
caused by ischemia, immune complexes (lupus), RBC waste (sickle cell), nephrotoxins (aminoglycosides, contrast dye)

74
Q

postrenal AKI:

A 
<5% of cases
results from obstruction to urine flow
can move backward into parenchyma
cased by obstruction: calculi, stone, tumor, fibrosis, clot, prostate
resolved with resolution of cause
75
Q

clinical manifestations of AKI:

A
  • oliguria ( HF, pulm edema, effusions
  • metabolic acidosis (buildup of H+)
  • decreased sodium excretion, hyponatremia
  • decreased potassium secretion, hyperkalemia
76
Q

prerenal AKI urine:

A

SG > 1.015
Na+ < 10-20
Os > 500

77
Q

intrarenal AKI urine:

A

SG < 1.010
Na+ > 40
Os < 350
RBC/WBC, casts

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