8. GU Flashcards
Anion gap formula
Na - (Bicarb + Cl) = 12 (normal)
- PH range
- Lab orders
- RAcid disease
- RAlka disease
- MAcid disease
- (Non anion gap) MAcid disease
- MAlka disease
- MAlka Tx
- Acid > 7.35-7.45 < Alka
- Lab Order - Serum electrolytes, ABG, and serum albumin
- 2 COPD, PNA - hypercapnia (unable to remove CO2)
- Sepsis, Anxiety, Salicylate toxicity, CNS disorder, Pregnancy - Hyperventilation (increase breathing drive obtain O2)
- MUDPILE (Methanol, uremia, DKA, Propylene glycol, Iron (INH), Lactic acidosis, Ethylene glycol, salicylats)
- Diarrhea (most loss HCO3) - Anion gap within limit but dump too much HCO3 which result Cl is high (hyperchloremic)
- Vomitting (loss Cl, H+) with nasogastric suctions, Diarrhea (may loss Cl), diuresis, ingesting large amount of calcium and absorbable alkali
- Tx for MAlka - give NaCl
Pre-renal failure
MC type/Tx
Pre renal most common type is Shock / Tx replace fluid
hx of strep infection + difficult urination + BP high + Edema + RBC cast
Name/Patho/Hx/Dx/Tx
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
AKI Explain 3 types and sub types
- Prerenal
- Postrenal
- Instrinsic
- ATN
- AIN
- AGN
- Vascular
Hypovolemia + difficulty urination
Name/Patho/Medication cause/MC type of/Tx/Complication
Name: Prerenal AKI
Patho: reduced renal perfusion
Medication cause: NSAID
MC type of AKI
Tx: Volume repletion
Complication: develop ATN if not corrected
Obstruction + dribbling urination
Name/Tx
Name: Postrenal aki
Tx: Removal of the obstruction
Epithelial cell cast & mud brown casts
Name/Patho/Etio/Hx/Dx/Tx
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
WBC cast + hx of NSAID, Sulfa + Maculopapular rash
Name/Dx/Tx
Name: AIN (Acute tubulointerstitial nephritis)
Dx: UA
Tx: removal offending agent
Waxy cast (sharp edges)
Name
Name: Chronic ATN or end stage renal disease
Prerenal vs ATN (4 category)
- 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
Proteinuria + hypoalbumin + hyperlipid + edema
Name/Patho/Type/PE/Dx/Tx
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
hx of muscle injuries + increase CK
Name/Etio/Patho/Dx/Complication/Tx
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
Dialysis indicated cases
- Severe metabolic acidosis
- Severe Na+ acidosis
- Refractory hyperkalemia
- Refractory colume overload
- Sx uremia
Palpable flank mass with Pain + HTN + hx of MVP
Name/Patho/Dx/Tx
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
hx of DM + Broad waxy cast + proteinuria + low GFR
Name/Stage/Etio/Dx/Tx
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
hx of CKD + Normochromic, Normocytic heme result
Name/Tx
Qucik check of ferritin, TIBC, Serum Fe, Transferrin function and pathway
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
PO4 high + Low Calcium + x-ray on Salt and Pepper
Name/Tx
Name: Renal osteodystrophy
Tx: Vit D + Calcium acetate
No signs of Edema + Na 135> + Serum Osm <280
Name/Etio/Dx/Tx
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
Polyuria (20 liters per day) + polydipsia + Nocturia
Name/Etio/Drug induce/Dx(differenciate)/Tx
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
Hyponatremia Etio/category/Dx/Tx/Other PE(special)
- 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
- low Serum Osm Na <135 (1st step)
- 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)
- Isovolumic
- 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
Hypernatremia Etio/Dx/Tx
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
Hypo vs Hyper Mg
Etio/PE/Lab serum/ECG hypo/Tx
- 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
Hypo vs Hyper K
- Etio
- Hypo - diuretic, dialysis
- Hyper - Adrenal insufficiency, K sparing diuretic
- Dx
- ECG
- Hypo - flat T wave
- Hyper - tall T wave
- ECG
- Tx
- Hypo - oral KCl (potassium), if digoxin toxic - IV
- Hyper - Calcium gluconate or chloride (1st), Insulin + albuterol + Sodium bicarb (2nd)
Scrotal pain with swelling + fever + Positive Prehn + Positive Cremasteric reflex
Name/Etio/Dx/Tx
Name: Epididymitis & Orchitis
Etio
- Men <35y - Chlamydia
- Men >35y - Enteric organism
- Orchitis - Mump Virus
Dx: US
Tx
- <35 - doxy + ceftx
- 35< - FQ
- Children - amox
Prehn vs Cremasteric
- Prehn - actively lift ball no pain
- Cremasteric - touch affected side of groin and elevation of ball
Negative Prehn and Cremasteric reflex + sudden scorotal pain with N/V
Name/Etio/Risk/PE/Dx/Tx
Name: Testicular torsion
Etio: Spermatic cord twist
Risk: Teenage
PE: blue bot
Dx: US
Tx: Orchiopexy within 6 hours, if unable to save, Orchiectomy
Empty, small scrotum in newborn
Name/Etio/Risk/Complication/Tx
Name: Cryptorchidism
Etio: Undescended testicle
Risk: Premature infants
Complication: Testicular cancer
Tx: Orchiopexy at 6 month, Observe if less than 6 month
loss of weight + painless testicular mass, nodule, solid mass or enlargement
Name/Risk/Type/Dx/Tx
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
-
Seminoma - MC form
- Nongerminal
Dx: US (1st), AFP, Radical inguinal orchiectomy(definitive)
Tx: Nonsemi - Orchiectomy, Semi - Radiation + Orchiectomy
Painless scrotal swelling + transillumination
Name/Risk/Tx
Name: Hydrocele
Etio: cystic testicular fluid collection, MC painless scrotal swelling
Dx: US
Tx: No tx (most resolve by first birthday)
Bag of Worms + Painless
Name/Etio/Dx/Tx
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
Cystic mass in the head of the epididymis + freely movable and transilluminates easily
Name/Dx/Tx
Name: Spermatocele
Dx: US
Tx: None
Dysuria + frequency or urgency
Name/Etio/Dx/Tx
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
Fever + tachycardia + flank pain back
Name/Etio/PE/Dx/Tx
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
Paraphimosis vs phimosis
Define/Tx
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
Acute Prostatitis vs Chronic prostatitis
Etio/PE/Dx/Tx
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
BPH vs Prostate Cancer - Trouble urination both case
Etio/Dx/Tx
Prostate cancer only special clinical presentaion
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
hx of smoking + 45y white male + painless gross hematuria
Name/Risk/Dx/Tx
Name: Bladder Cancer
Risk: Smoking, 40<, White male
Dx: Cystoscopy with biopsy
Tx
- Local - transrethral resection
- Invasive - Radical cystectomy
Hematuria + flank pain + palpable mass + weight loss + hx of smoking
Name/Risk/Originated/Dx/Tx
Name: Renal cell carcinoma
Risk: Smoking
Originated: epithelial cells of the proximal convoluted tubule
Dx: CT scan
Tx: Radical Nephrectomy
Children less than 5 yo + palpable abdominal mass
Name/Dx/Tx
Name: Wilms Tumor
Dx: US (1st), CT w/ constrast (more accurate)
Tx: Nephrectomy + chemotherapy
Constant upper lateral back/flank pain + CVA tenderness
Name/Risk/types/Dx/Tx/Emergenct case
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
Erectile dysfunction Tx/CI/Duration
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
Complain of prolong erection
Name/Risk/Dx/Tx
Name: Priapism
Risk: idiopathic
Dx: hx intake
Tx: Phenylephrine
sexual active + dyruria + mucopurulent discharge
Name/Pathogen/Neonate category and Tx/Dx/Tx
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
Hematuria work up and risk
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)
HTN + abdominal bruit
Name/Risk/Dx/Tx
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)
Children 5 yr old keep weting bed
Name/Tx
Name: Enuresis
Tx: behavioral (1st) -> Enuresis alarm
- Meds - DDVP,TCA
Stress vs Urge vs Overflow incontinence
Risk/sx/Etio/Tx
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
Hx of DM + itch and pain + thick foul smell exudate discharge around penis
Name/Risk/Pathogen/Tx
Name: Blanitis
Risk: DM
Pathogen: Candida albican
Tx: Antifungal
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
Name: Hemolytic uremic syndrome
Risk: usually 5 year or less
Pathogen: E coli
Dx: BUN or Creatine lab check
Tx: Supportive
