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PANCE > 8. GU > Flashcards

8. GU Flashcards

1
Q

Anion gap formula

A

Na - (Bicarb + Cl) = 12 (normal)

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2
Q
  1. PH range
  2. Lab orders
  3. RAcid disease
  4. RAlka disease
  5. MAcid disease
  6. (Non anion gap) MAcid disease
  7. MAlka disease
  8. MAlka Tx
A
  1. Acid > 7.35-7.45 < Alka
  2. Lab Order - Serum electrolytes, ABG, and serum albumin
  3. 2 COPD, PNA - hypercapnia (unable to remove CO2)
  4. Sepsis, Anxiety, Salicylate toxicity, CNS disorder, Pregnancy - Hyperventilation (increase breathing drive obtain O2)
  5. MUDPILE (Methanol, uremia, DKA, Propylene glycol, Iron (INH), Lactic acidosis, Ethylene glycol, salicylats)
  6. Diarrhea (most loss HCO3) - Anion gap within limit but dump too much HCO3 which result Cl is high (hyperchloremic)
  7. Vomitting (loss Cl, H+) with nasogastric suctions, Diarrhea (may loss Cl), diuresis, ingesting large amount of calcium and absorbable alkali
  8. Tx for MAlka - give NaCl
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3
Q

Pre-renal failure

MC type/Tx

A

Pre renal most common type is Shock / Tx replace fluid

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4
Q

hx of strep infection + difficult urination + BP high + Edema + RBC cast

Name/Patho/Hx/Dx/Tx

A

Name: Glomerulonephritis

Patho: inflammed glomerulo -> plugged up -> unable to pee out

Hx: hx of URI or GI infection, MC after GABHS

  • IgA - after URI or GI infection
  • Post strep infection

Dx: UA - RBC cast (dark cola urine)

Tx

  • IgA nephropathy - high dose corticosteriod + ACEI
  • Post strep infection (GAB) - Supportive
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5
Q

AKI Explain 3 types and sub types

A
  • Prerenal
  • Postrenal
  • Instrinsic
    • ATN
    • AIN
    • AGN
    • Vascular
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6
Q

Hypovolemia + difficulty urination

Name/Patho/Medication cause/MC type of/Tx/Complication

A

Name: Prerenal AKI

Patho: reduced renal perfusion

Medication cause: NSAID

MC type of AKI

Tx: Volume repletion

Complication: develop ATN if not corrected

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7
Q

Obstruction + dribbling urination

Name/Tx

A

Name: Postrenal aki

Tx: Removal of the obstruction

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8
Q

Epithelial cell cast & mud brown casts

Name/Patho/Etio/Hx/Dx/Tx

A

Name: Acute tubular necrosis (ATN)

Patho: destruction of renal tubules

Etio: Ichemic vs toxic

Hx

  • Ichemic - prolonged prerenal, hypotension, hypovolemia or post-op
  • Toxic - Constrast (aminoglycosides)

Dx: UA (hyperK)

Tx: IV fluids, remove offending agent

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9
Q

WBC cast + hx of NSAID, Sulfa + Maculopapular rash

Name/Dx/Tx

A

Name: AIN (Acute tubulointerstitial nephritis)

Dx: UA

Tx: removal offending agent

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10
Q

Waxy cast (sharp edges)

Name

A

Name: Chronic ATN or end stage renal disease

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11
Q

Prerenal vs ATN (4 category)

A
  • Prerenal - Urine NA less than 20, FeNa less than 1%, UOsm high, BUN:Cr >20:1
  • ATN - Urine NA more than 40, FeNa more than 2%, UOsm low, BUN:Cr =10-15:1
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12
Q

Proteinuria + hypoalbumin + hyperlipid + edema

Name/Patho/Type/PE/Dx/Tx

A

Name: Nephrotic syndrome

Patho: immune inflammation

Type

  • Minimal change - 80% Nephrotic syndrome in children
  • FSGs (focal segmental) - HTN (AA)
  • Membranous nephropathy - thickened membrane (caucasian with 40<)

PE: Edema (extremity, eyes swellen in the morning)

Dx

  • Collecting urine 24 hours to check protein (3.5 < Positive)
  • UA - proteinuria, mircoscopy - Oval fat bodies
  • Hypoalbumin - less than 3.4

Tx

  • Corticosteriod
  • Diruretic - edema reduction
  • Proteinuria - ACEI
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13
Q

hx of muscle injuries + increase CK

Name/Etio/Patho/Dx/Complication/Tx

A

Name: Rhabdomyolysis

Etio: Crush injury, Overdoese

Patho: muscle damage cause release myoglobin -> myoglobin plugs tubules

Dx: CK serum high

  • Dark Urine - urine dip stick thinks RBC but it is not, it is myoglobin

Complication: kidney failure

Tx: IV fluid

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14
Q

Dialysis indicated cases

A
  • Severe metabolic acidosis
  • Severe Na+ acidosis
  • Refractory hyperkalemia
  • Refractory colume overload
  • Sx uremia
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15
Q

Palpable flank mass with Pain + HTN + hx of MVP

Name/Patho/Dx/Tx

A

Name: Polycystic kidney disease

Patho: Autosomal dominant

Dx: US

Tx

  • simple cyst: observe
  • multiple cyst: fluid intake
  • BP control: ACE and ARB

Complication: Cerebral aneurysm

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16
Q

hx of DM + Broad waxy cast + proteinuria + low GFR

Name/Stage/Etio/Dx/Tx

A

Name: CKD

Stage

  • 1 - 90<
  • 2 - 89-60
  • 3 - 59-30
  • 4 - 29-15
  • 5 - 15> ERSD

Etio: DM(1st), HTN(2nd)

Dx: Spot ACR (1st), 24 hrs collection (2nd)

Tx: Underlying cause

  • HTN: ACEI
  • Proteinuria: protein restriction
  • DM control
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17
Q

hx of CKD + Normochromic, Normocytic heme result

Name/Tx

Qucik check of ferritin, TIBC, Serum Fe, Transferrin function and pathway

A

Name: Anemia of chronic

Tx: EPO or DPO

  • Serum Fe: pure iron -> helps to make hemoglobin
  • TIBC: Capacity of Iron
  • Transferrin: Transporter from Deuodenum to Liver
  • Ferritin: bound with Iron in liver (why? Iron alone will take sing electron and become free radical -> damage cells)
  • Pathway Fe
    • Deuodenum absorb Fe -> Transferrin escort Fe to Liver -> Ferrin bound with Transported Fe
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18
Q

PO4 high + Low Calcium + x-ray on Salt and Pepper

Name/Tx

A

Name: Renal osteodystrophy

Tx: Vit D + Calcium acetate

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19
Q

No signs of Edema + Na 135> + Serum Osm <280

Name/Etio/Dx/Tx

A

Name: SIADH

Etio: MC stroke, Small cell lung cancer, Head trauma

Patho: ADH increase by pituitary or ectopic source -> increase free water -> hyponaturemia

Dx: Blood serum (Serum Osm low <280), Urine Concentrate (300<)

Tx

  • H2O restriction
  • Severe case: IV hypertonic saline + demeclocycline
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20
Q

Polyuria (20 liters per day) + polydipsia + Nocturia

Name/Etio/Drug induce/Dx(differenciate)/Tx

A

Name: Diabetes inspidus

Etio: Central (decrease produce ADH) vs nephrogenic (insensitivity)

Drug induce: Lithium

Dx: UA (Dilute Urine <200 Urin Osm)

  • differenciate - Desmopressin (ADH) stimulation test
    • reponsive - Uosm increase means -> Central
    • Nonresponsive - Uosm not change ->Nephrogenic

Tx

  • Central: Desmopressin/DDAVP
  • Nephrogenic: Na/H2O restriction -> HCTZ
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21
Q

Hyponatremia Etio/category/Dx/Tx/Other PE(special)

A
  • Etio: Hypotonic in blood which lead water gets into cell -> swelling brain cell (cerebral edema)
  • Hypotonic Hyponatremia
    • Hypovolumic - Diuretics(thiazide), bleeding, vomitting
    • Euvolumic - SIADH, Adrenal insufficiency, hypothyrodism, Ecstasy
    • Hypervolumic - CHF, nerphrotic syndrome, cirrhosis
  • Dx
    1. low Serum Osm Na <135 (1st step)
    2. Check volume
      • Isovolumic
        • Normal lab
      • Hypervolumic
        • Urine Na <20 - CHF, Cirrhosis, nephrotic
        • Urine Na >20 - Renal failure
      • Hypovolumic
        • Urine Na >20 - renal loss (diuretic)
        • Urine Na 10-15, FeNa less than 1% (extra renal loss - bleeding, diarrhea, vomitting)
  • Tx
    • Isocolumic - water stop
    • hypervolumic - water and sodium stop
    • hypovolumic - NS <0.5 Meq slowly to prevent demyelination
    • Severe case - hypertonic with furosemide
  • HICCUP is another PE shown in hyponatremia
22
Q

Hypernatremia Etio/Dx/Tx

A

Etio: Hypertonic in blood which lead water gets out of cell -> shrinkage brain cell

Dx: Serum Na 145<

Tx: Preferred Oral pure water or hypotonic fluid

23
Q

Hypo vs Hyper Mg

Etio/PE/Lab serum/ECG hypo/Tx

A
  • Etio
    • Hypo - GI loss(N/V/D), malabsorption, ETOH
    • Hyper - renal insufficiency, large intake Mg
  • Clinical
    • Hypo - DTR high
    • Hyper - DTR low
  • Lab
    • Hypo - low K, Mg, Ca (KCM)
    • Hyper - high K, Mg, Ca
  • ECG
    • Hypo - Torsade point
  • Tx
    • Hypo - Oral Mg, IV if severe
    • Hyper - Fluid + Furosemide, Calcium gluconate if severe
24
Q

Hypo vs Hyper K

A
  • Etio
    • Hypo - diuretic, dialysis
    • Hyper - Adrenal insufficiency, K sparing diuretic
  • Dx
    • ECG
      • Hypo - flat T wave
      • Hyper - tall T wave
  • Tx
    • Hypo - oral KCl (potassium), if digoxin toxic - IV
    • Hyper - Calcium gluconate or chloride (1st), Insulin + albuterol + Sodium bicarb (2nd)
25
Q

Scrotal pain with swelling + fever + Positive Prehn + Positive Cremasteric reflex

Name/Etio/Dx/Tx

A

Name: Epididymitis & Orchitis

Etio

  • Men <35y - Chlamydia
  • Men >35y - Enteric organism
  • Orchitis - Mump Virus

Dx: US

Tx

  • <35 - doxy + ceftx
  • 35< - FQ
  • Children - amox
26
Q

Prehn vs Cremasteric

A
  • Prehn - actively lift ball no pain
  • Cremasteric - touch affected side of groin and elevation of ball
27
Q

Negative Prehn and Cremasteric reflex + sudden scorotal pain with N/V

Name/Etio/Risk/PE/Dx/Tx

A

Name: Testicular torsion

Etio: Spermatic cord twist

Risk: Teenage

PE: blue bot

Dx: US

Tx: Orchiopexy within 6 hours, if unable to save, Orchiectomy

28
Q

Empty, small scrotum in newborn

Name/Etio/Risk/Complication/Tx

A

Name: Cryptorchidism

Etio: Undescended testicle

Risk: Premature infants

Complication: Testicular cancer

Tx: Orchiopexy at 6 month, Observe if less than 6 month

29
Q

loss of weight + painless testicular mass, nodule, solid mass or enlargement

Name/Risk/Type/Dx/Tx

A

Name: Testicular Cancer

Risk: 15-40 yr, hx of cryptorchidism (MC right side), white, klinefelter’s syndrome

Type

  • Germinal cell (malignant) MC form
    • Seminoma - MC form
      • Simple (tumor marker - Normal - Beta HCG, Alpha feto)
      • Sensitive(to radioactive)
      • Slower growing
      • Stepwise spread
    • NonSeminoma - Radioresistance, high tumor marker
  • Nongerminal

Dx: US (1st), AFP, Radical inguinal orchiectomy(definitive)

Tx: Nonsemi - Orchiectomy, Semi - Radiation + Orchiectomy

30
Q

Painless scrotal swelling + transillumination

Name/Risk/Tx

A

Name: Hydrocele

Etio: cystic testicular fluid collection, MC painless scrotal swelling

Dx: US

Tx: No tx (most resolve by first birthday)

31
Q

Bag of Worms + Painless

Name/Etio/Dx/Tx

A

Name: Varicocele

Etio: Cystic testicular of varicose veins

Dx: US

Tx: Observation

  • Surgical correctable cause of male infertility

Complication

  • L-side old man - Renal cell carcinoma
  • R-side children - retroperitoneal malignancy
32
Q

Cystic mass in the head of the epididymis + freely movable and transilluminates easily

Name/Dx/Tx

A

Name: Spermatocele

Dx: US

Tx: None

33
Q

Dysuria + frequency or urgency

Name/Etio/Dx/Tx

A

Name: Cystitis

Etio: infection in urinary tract, MC Ecoli

  • if sexually active women - staph. sap

Dx: UA (1st) - Leukocyte esterase, Urine Culture (definitive)

Tx

  • Uncomlicated - Nitrofurantoin (1st), Cipro (2nd)
  • Complicated - Cipro
  • Pregnancy - Amox
34
Q

Fever + tachycardia + flank pain back

Name/Etio/PE/Dx/Tx

A

Name: Pyelonephritis

Etio: MC Ecoli, Staph Sap - sexually active

PE: CVA tenderness

Dx: UA - WBC CAST (1st), Urine Culture (definitive)

Tx: FQ x 14 days

35
Q

Paraphimosis vs phimosis

Define/Tx

A

Define

  • Paraphimosis - trapped behind glan (tight band cause stangulation) - EMERGENCY
  • Phimosis - unable to retract over glan - NOT EMERGENCY

Tx

  • Paraphimosis - Manual reduction by cooling compress or pressure dressing
  • Phimosis - Circumcision
36
Q

Acute Prostatitis vs Chronic prostatitis

Etio/PE/Dx/Tx

A

Etio

  • Acute
    • 35< - E coli infection
    • 35> - Chlamydia & Gonorrhea
  • Chronic
    • E coli

PE

  • Acute - Tender, swelling prostate
  • Chronic - NONtender, swelling prostate

Dx: UA & Urine culture (Positive - ACUTE, Negative - Chronic)

Tx

  • Acute
    • 35< - FQ or Bactrim
    • 35> - Ceftx + doxy
  • Chronic
    • Bactrim (TMX-SMX)
    • TURP(transurethral resection of the prostate) for refractory chronic prostatitis
37
Q

BPH vs Prostate Cancer - Trouble urination both case

Etio/Dx/Tx

Prostate cancer only special clinical presentaion

A

Etio

  • BPH - Normal aging process (dihydrotestosterone increased) hyperplasia cause baldder outlet obstruction
  • Prostate cancer - slow growing tumor

Risk

  • BPH - Age
  • Prostate cancer - high fat food intake

Special clinical present - back or bone pain may presents of METs

Dx

  • BPH - DRE - UNIFORM Enlarge FIRM, rubbery prostate
  • Cancer - DRE - IRREGULAR Enlarge HARD, prostate + PSA >10ng
    • Biposy to confirm may need bone scan to rule out METs

Tx

  • BPH
    • Meds: Observe if mild, Fina/Dutasteride or Alpha blocker - Zosin meds
    • TURP
  • Cancer
    • Local - radical prostatectomy
    • Advanced - radiation therapy
38
Q

hx of smoking + 45y white male + painless gross hematuria

Name/Risk/Dx/Tx

A

Name: Bladder Cancer

Risk: Smoking, 40<, White male

Dx: Cystoscopy with biopsy

Tx

  • Local - transrethral resection
  • Invasive - Radical cystectomy
39
Q

Hematuria + flank pain + palpable mass + weight loss + hx of smoking

Name/Risk/Originated/Dx/Tx

A

Name: Renal cell carcinoma

Risk: Smoking

Originated: epithelial cells of the proximal convoluted tubule

Dx: CT scan

Tx: Radical Nephrectomy

40
Q

Children less than 5 yo + palpable abdominal mass

Name/Dx/Tx

A

Name: Wilms Tumor

Dx: US (1st), CT w/ constrast (more accurate)

Tx: Nephrectomy + chemotherapy

41
Q

Constant upper lateral back/flank pain + CVA tenderness

Name/Risk/types/Dx/Tx/Emergenct case

A

Name: Nephrolithiasis

Risk: low fluid intake

Type

  • Calcium oxalate MC (protein & salt intake high)
  • Uric acid (high protein intake)
  • Struvite stone (klebsiella)

Dx

  • Noncontrast CT (1st)
  • UA may helpful identify stone
    • 5.5-6.8 ph - calcium
    • acidic ph - uric acid
    • Alkaline - struvite

Tx

  • 5mm or less in diameter - Fluid intake or IV, analgesic
  • 7mm or more in diameter - shock wave lithotripsy, percutaneous nephrolithotomy

Emergent case: solitary kidney, complete obstruction, and sepsis often require emergent decompression

42
Q

Erectile dysfunction Tx/CI/Duration

A

Tx: sildenafil, tadalafil, vardenafil

CI: Do not use with nitrate or any CVD hx

Long duration 24-72 hrs - Tadalafil

Short duration 3 hrs - sildenafil, vardenafil

43
Q

Complain of prolong erection

Name/Risk/Dx/Tx

A

Name: Priapism

Risk: idiopathic

Dx: hx intake

Tx: Phenylephrine

44
Q

sexual active + dyruria + mucopurulent discharge

Name/Pathogen/Neonate category and Tx/Dx/Tx

A

Name: Urethritis

Pathogen

  • Chlamydia (5-8 days shows discharge)
  • gonococcal urethritis (3-4days shows discharge Y or W color)

Neonate - eye infection occur during birth canal passage

  • 2-5 days gonoccocal (Tx: erythoromycin Eye oint)
  • 5 days later chlamydia (Tx erythromycin Oral drop)

Dx: NAAT

Tx

  • Gonococcal - ceftx 250mg x IM
  • Nongonococcal - aza 1 g orally
45
Q

Hematuria work up and risk

A

Risk

  • 40y younger - GU infection MC, Nephrolithiasis
  • 40y older - Urinary tract cancer, prostatic disease

Dx

  • UA/Urine culture is initial test
  • Cystoscopy best for bladder or urethral cancer
  • IV pyelogram - checking kidney ureter but use dye (Kidney function check)
46
Q

HTN + abdominal bruit

Name/Risk/Dx/Tx

A

Name: Renovascular hypertension

Risk - MC secondary HTN

  • atherosclerosis (1st)
  • MC cause in women <50y - fibromuscular dysplasia

Dx: Renal angio (definitive)

Tx

  • Surgical - angioplasty with stent
  • ACEI/ARB (but if both stenosis contraindicated - why? low blood flow & GFR -> lead to AKI)
47
Q

Children 5 yr old keep weting bed

Name/Tx

A

Name: Enuresis

Tx: behavioral (1st) -> Enuresis alarm

  • Meds - DDVP,TCA
48
Q

Stress vs Urge vs Overflow incontinence

Risk/sx/Etio/Tx

A

Stress

  • Risk: Young women
  • Sx: Sneezing, coughing, laughing cause leak
  • Etio: Weak pelvic floor muscle
  • Tx: Kegel exercises, Pseudoephedrine

Urge

  • Risk: Older women
  • Sx: Frequency, Urgency
  • Etio: Overactive bladder
  • Tx: Bladder training, Oxybutin (anticholinergic)

Overflow

  • Sx: Post Void residual >200ml
  • Etio: Underactive bladder - unable to empty
  • Tx: Bladder atony - catheterization
49
Q

Hx of DM + itch and pain + thick foul smell exudate discharge around penis

Name/Risk/Pathogen/Tx

A

Name: Blanitis

Risk: DM

Pathogen: Candida albican

Tx: Antifungal

50
Q

A complaint of bloody diarrhea and abdominal cramping. Recently, she ate a rare hamburger at a birthday party for her 4-year-old son.

Name/Risk/PathogenDx/Tx

A

Name: Hemolytic uremic syndrome

Risk: usually 5 year or less

Pathogen: E coli

Dx: BUN or Creatine lab check

Tx: Supportive

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