Ch 4 Male MDT Flashcards
1
Q
Hematuria visible to the naked eye
A
Gross Hematuria
2
Q
Hematuria only detectible by examination of the urine sediment by microscopy, or urinalysis
A
Microscopic
3
Q
Both gross and microscopic hematuria require:
A
Evaluation
4
Q
An upper urinary tract source (kidneys and ureters) can be identified in __% of patients with gross or microscopic hematuria
A
10%
5
Q
Hematuria
Stone disease accounts for __%
A
40%
6
Q
Hematuria
__% caused by kidney disease
A
20%
7
Q
Hematuria
__% from renal cell carcinoma
A
10%
8
Q
Hematuria
__% caused by urothelial cell carcinoma of the ureter or renal pelvis
A
5%
9
Q
The lower tract source of gross hematuria is most commonly from:
A
Urothelial carcinoma of the bladder
10
Q
Microscopic hematuria in the male is most commonly from:
A
Benign prostatic hyperplasia
11
Q
Gross hematuria
What may help localize the disease?
A
Description of timing
12
Q
The presence of blood at the beginning of the urinary stream that clears during the stream, implies an anterior penile urethral source
A
Initial hematuria
13
Q
The presence of the blood at the end of the urinary stream, implies a bladder neck or prostatic urethral source
A
Terminal hematuria
14
Q
The presence of blood through the urinary stream, implies a bladder or upper tract source
A
Total hematuria
15
Q
Hematuria associated with renal colic suggests:
A
Ureteral stone
16
Q
Irritative voiding symptoms in a young woman may suggest:
A
Acute bacterial infection and associated cystitis
17
Q
In the absence of other symptoms, gross hematuria may be more indicated of:
A
Tumor
18
Q
Labs:
Hematuria
A
UA
Urine Culture
BUN and Creatinine
19
Q
Imaging:
Hematuria
A
CT scan of the upper tract w/o contrast
Cystoscopy
20
Q
Indicated in patients with gross hematuria or those over 35 years with asymptomatic hematuria
A
Cystoscopy
21
Q
Treatment for hematuria
A
Depends on the underlying disease process
22
Q
Hematuria UA
Proteinuria and casts suggest:
A
Renal Origin
23
Q
What kind of bacteria are responsible for most of the UTIs?
A
Coliform bacteria (E. Coli)
24
Q
Most common route for UTI
A
Ascending infection from the urethra
25
Infection of the bladder
Cystitis
26
Cystitis is most commonly caused by:
Coliform bacteria
-E. Coli
Gram-positive bacteria
-Enterococci
27
Uncomplicated cystitis in men is rare and suggests:
Infection from stones
Prostatitis
Chronic urinary retention
28
Signs and symptoms:
- Irritative voiding symptoms
- Suprapubic discomfort
- Women have hematuria after sex
- Usually afebrile
- Exam may elicit suprapubic tenderness with palpation
Cystitis
29
Noninfectious cystitis can be caused by:
Pelvic irradiation
Chemotherapy
Bladder carcinoma
Interstitial cystitis
Voiding dysfunction disorders
Psychosomatic disorders
30
Cystitis UA may reveal
Pyuria
Bacteriuria
Various degrees of hematuria
31
Treatment for cystitis
Antimicrobial therapy
- Ciprofloxacin
- Nitrofurantoin
- Trimethoprim/sulfamethoxazole (Bactrim)
Urinary analgesics
-Phenazopyridine
32
Women who have more than __ episodes of cystitis per year are considered candidates for prophylactic antibiotic therapy
3
33
The three most commonly used oral agents for Cystitis prophylaxis
Trimethoprim-sulfamethoxazole (40/200mg) daily
Nitrofurantoin (100mg) daily
Cephalexin (250mg) daily
34
Infectious inflammatory disease involving the kidney parenchyma and renal pelvis
Pyelonephritis
35
Most common causative agents that cause pyelonephritis
Gram-negative bacteria:
- Klebsiella
- Proteus
- E Coli
- Enterobacter
- Pseudomonas
36
Bacteria commonly seen in pyelonephritis
Gram-positive
- Enterococcus faecalis
- Staphylococcus
37
What bacteria causes Pyelonephritis from a hematogenous route?
Staph Aureus
38
Signs and symptoms
- Fever
- Flank pain
- Irritative voiding symptoms (urgency, frequency, dysuria)
- Shaking chills
- Associated nausea & vomiting
- Diarrhea
- Tachycardia
- Costovertebral angle tenderness is usually pronounced
Pyelonephritis
39
Pyelonephritis lab findings
CBC: Leukocytosis & Left Shift
UA: Pyuria, bacteriuria, hematuria, white cell casts
Urine Culture: Heavy growth of offending organism
Blood culture may be positive
40
Imaging for pyelonephritis
Renal Ultrasound
| -May show hydronephrosis (stone/obstruction)
41
Treatment for pyelonephritis
Antibiotic therapy (2-week therapy)
- Ampicillin & Gentamicin IV
- Ciprofloxacin PO
- Levofloxacin PO
- Trimethoprim-sulfamethoxazole PO
Urinary Analgesics
-Phenazopyridine
42
Pyelonephritis
IV antibiotics are continued for __ hours after the fever resolves and oral antibiotics are then given to complete the 14 day course of therapy
24 hours
43
Pyelonephritis
Fevers may persist for up to __ hours even with appropriate antibiotics
72
44
Inflammation and infection of the prostate gland
Acute Prostatitis
45
Prostatitis is usually caused by:
Gram negative
- E Coli
- Pseudomonas Species
46
Prostatitis is less commonly caused by:
Gram-positive
| -Enterococci
47
Most likely routes for infection of prostatitis
Ascent up the urethra
Reflux of infected urine into the prostatic ducts
(Lymphatic and hematogenous routes are rare)
48
Signs and symptoms
- Perineal, sacral, or suprapubic pain
- High fever
- Irritative voiding symptoms
- Obstructive symptoms, urinary retention
- Warm and often exquisitely tender prostate (gentle exam)
Prostatitis
49
Laboratory findings in prostatitis
CBC: Leukocytosis and left shift
UA: Pyuria, bacteriuria, hematuria
50
Treatment for prostatitis
Antibiotics (4-6 weeks)
- Ampicillin & Gentamicin IV
- Ciprofloxacin PO
- Levofloxacin PO
- Trimethoprim-sulfamethoxazole PO
Tylenol
NSAIDs
Stool softeners
51
Prostatitis
IV Antibiotics are continued for ___ hours after the fever resolves and oral antibiotics are given to complete the ___ week course therapy
24-48 hours
4-6 weeks
52
May evolve from acute bacterial prostatitis
Many men have no history of acute infection
Chronic bacterial prostatitis
53
What organism is associated with chronic bacterial prostatitis infection?
Gram Neg Rods (MOST COMMON)
Enterococcus (Gram Positive)
54
Prostate may be:
Normal
Boggy
Indurate
55
Chronic bacterial prostatitis
Pelvic radiographs or transrectal U/S may show:
Prostatitis calculi
56
Treatment for Chronic bacterial prostatitis
Antimicrobials (6-12 weeks Therapy)
- Trimethoprim-sulfamethoxazole PO
- Ciprofloxacin PO
- Levofloxacin PO
NSAIDs
Sitz Baths
57
Chronic bacterial prostatitis optimal duration of antibiotic therapy length
6-12 weeks
58
Inflammation and/or infection of the epididymis
Epididymitis
59
Sexually transmitted forms of epididymitis usually occur in men under:
40
60
Sexually transmitted epididymitis is caused by:
Chlamydia trachomatis
Neisseria gonorrhoeae
61
Non-sexually transmitted forms of epididymitis occur in:
Older men
Associated with UTI and Prostatitis
62
Non-sexually transmitted epididymitis is typically caused by:
Gram-negative rods
- E coli
- Klebsiella
63
Signs and symptoms
- May follow acute physical strain, trauma, or sex
- Associated Sx: Urethritis, Cystitis
- Pain in the scrotum, may radiate to flank
- Fever
- Scrotal swelling
Epididymitis
64
Physical findings
Early course of epididymitis:
The epididymis may be distinguishable from the testes
65
Later course of epididymitis
The teste and epididymis appear as one enlarged tender mass
66
Elevation of the scrotum above the pubic symphysis improves pain from epididymitis
Prehn sign
67
Epididymitis
Testing for suspected chlamydia and gonorrhoeae
NAAT (Nucleic acid amplification testing)
68
Imaging for epididymitis
Ultrasound
69
Treatment for sexually transmitted epididymitis
Ceftriaxone IM & Doxycycline PO
70
Treatment for non-sexually transmitted epididymitis
Trimethoprim/sulfamethoxazole
Ciprofloxacin
Levofloxacin
71
Complications of epididymitis that is delayed or inadequate treatment may result in:
Epididymo-orchitis (Testicle Inflammation)
Decreased fertility
Abscess formation
72
Epididymitis
Refer to urology when:
Persistent symptoms and infection despite antibiotic therapy
Signs of sepsis or abscess formation
73
Renal calculi is also known as:
Urolithiasis
74
Men are more effected by urolithiasis than women by:
2.5:1
75
How many major types of urinary stones are there?
5
76
Most common type of urinary stone
Calcium (85%)
77
Weather
Contributing factors of renal calculi
High humidity & elevated temperatures
78
Higher incidence rates of renal calculi are associated with what disease processes?
Sedentary lifestyle
Hypertension
Carotid calcification
Cardiovascular disease
79
Diet that is associated with renal calculi
High protein and salt intake
Inadequate hydration
80
Signs and symptoms:
- Pain often occurs suddenly in the flank
- Nausea and vomiting
- Constantly moving to find a comfortable position
- May be episodic
Renal calculi
81
Urinalysis findings in renal calculi
Hematuria (90%)
Urinary pH
82
Imaging for Renal Calculi
Plain abdominal radiograph (Kidney, Ureter and Bladder)
Renal U/S
Spiral CT in prone position
83
Renal calculi
KUB with renal U/S can diagnose up to __% of stones
80%
84
Renal calculi
What has increased sensitivity and specificity over other tests?
Spiral CT
85
Stones smaller than ____mm in diameter on a plain abdominal radiograph usually pass spontaneously
5-6 mm
86
Renal Calculi
Medications that can increase the rate on spontaneous stone passage
Alpha-blockers (Tamsulosin)
NSAIDs
-With or without a low dose oral corticosteroid
87
Stones that require surgical removal include those that are showing signs of:
Obstruction or infection
88
Procedures for stone removal include:
Ureteroscopy stone extraction
Extracorporeal shock wave lithotripsy
89
The greatest importance in reducing stone recurrence
Increased fluid intake
90
Renal calculi
Increasing fluid intake to ensure a voided volume of:
2.5 L/day
91
Stones
Patients are encouraged to ingest fluids during meals, __ hours after each meals, and prior to sleep
2 hours
92
Renal calculi
Sodium intake should be restricted to:
150 mEq/day
93
Renal calculi
Protein intake should be:
Spread out through the day
Limited to 1g/kg/day
94
Disposition
Obstructing stone with associated infection is a:
MEDEVAC
95
Renal calculi
Signs/symptoms of infection:
Fever
Tachycardia
Elevated WBC
96
Referral to urology is warranted if the stone fails to pass within:
4 weeks
97
Two types of erectile tissue
Corpus cavernosa
Corpus spongiosum
98
Normal male erection is a neurovascular event relying on:
Intact autonomic and somatic nerve supply
Arterial blood flow
Smooth and striated musculature of the corpora cavernosa and pelvic floor
99
Erection is caused and maintained by:
Increase in arterial flow
Relaxation of the smooth muscle
Increase in venous resistance
100
The key transmitter that initiates and sustains erections
Nitric oxide
101
The consistent inability to attain or maintain a sufficiently rigid penile erection for sexual performance
Erectile dysfunction (ED)
102
ED has what kind of etiologies?
Organic and psychogenic
103
Organic erectile dysfunction may be an early sign of:
Cardiovascular disease
104
Loss of libido may indicate:
Androgen deficiency
105
Loss of erections may result from:
Arterial
Venous
Neurogenic
Hormonal
Psychogenic
106
The most common cause of erectile dysfunction is:
Decrease in arterial flow resultant from progressive vascular disease
107
The ability to attain but not maintain an erection may be the first sign of:
Endothelial dysfunction and further Cardiovascular risk
108
What medications are associated with erectile dysfunction?
Antihypertensive
Antidepressant
Opioids
109
Fibrotic disorder of the tunica albuginea of the penis resulting in varying degrees of penile pain, curvature, or deformity
Peyronie disease
110
The loss of seminal emission
Anejaculation
111
Anejaculation may result from
Androgen deficiency
Sympathetic denervation as a result of spinal cord injury
112
Labs for erectile dysfunction:
Lipid profile (dyslipidemia)
Glucose (diabetes)
Testosterone
113
Free testosterone must be drawn at what hours?
8-10 am
114
Treatment for ED:
Lifestyle modification (smoking, alcohol, diet, exercise)
Hormonal replacement
Oral agents (phosophodiesterase-5 inhibitors)
115
ED
Men with psychogenic component benefit from:
Sexual health therapy or counseling
116
Occurrence of penile erection lasting longer than 4 hours
Priapism
117
Ischemic injury of the corpora cavernosa from venous congestion and cessation of arterial inflow
Priapism
118
Initial treatment for priapism
Aspiration of blood from the penis and injection of sympathomimetic drugs (epinephrine/phenylephrine)
119
Benign prostatic hyperplasia (BPH) is a hyperplastic process, meaning:
There is an increased number of cells
120
Most common benign tumor in men and its incidence is age related
BPH
121
At age 55, __% of men report obstructive voiding symptoms
25%
122
At age __, 50% of men report decrease in the force and caliber of the urinary stream
75
123
BPH symptoms can be related to what two things?
1) OBSTRUCTIVE component of the prostate
| 2) IRRITATIVE, secondary response of the bladder to the outlet resistance
124
Hesitancy
Decreased force and caliber of stream
Sensation of incomplete bladder empyting
Double voiding (urinating 2 times within 2 hours)
Straining to urinate
Postvoid dribbling
Obstructive BPH symptoms
125
Urgency
Frequency
Nocturia
Irritative BPH Symptoms
126
Most important tool used in the evaluation of patients with BPH
American Urological Association (AUA) symptom index
127
AUA symptom index
Number of questions & scale
7 questions
Severity of 0-5
128
BPH DRE exam normal findings
Smooth firm elastic enlargement of the prostate
129
DRE findings that should alert you for possible prostate cancer
Induration
130
Labs for BPH
UA: to exclude infection/hematuria
Prostate specific antigen test (PSA)
131
BPH
Only recommended to assist in determining the surgical approach
Cystoscopy
132
BPH
CT or renal Ultrasound is recommended only:
Concomitant urinary tract disease or complications
133
Treatment for BPH patients with mild symptoms
Watchful waiting
134
Medical therapy for BPH
Alpha-blockers
5-alpha-reductase-inhibitors
Phsophdiesterase-5 inhibitors
135
Act against bladder outlet obstruction by relaxing smooth muscle in the bladder neck, prostate capsule, and prostatic urethra
Alpha-blockers
136
Act by reducing the size of the prostate gland and in turn improves symptoms
5-alpha-reductase inhibitors
137
Used in patients with erectile dysfunction with mild or moderate symptoms
Phosphdiesterase-5 inhibitors
138
BPH
Absolute surgical indications:
Refractory urinary retention (failing one catheter removal)
Large bladder diverticula
Sequelae of benign prostatic hyperplasia
139
Conventional surgeries for BPH
Transurethral resection of the prostate (TURP)
Transurethral incision of the prostate (TUIP)
Open simple prostatectomy
140
Minimally invasive surgeries for BPH
Laser therapy
Transurethral needle ablation of the prostate (TUNA)
Transurethral elect vaporization of the prostate
Hyperthermia
Implant, to open prostatic urethra
141
Refer to urology with an AUA score of:
>7
142
Most common non-cutaneous cancer in American men and second leading cause of cancer related death in men
Prostate Cancer
143
A 50 year old American man has a lifetime risk of:
__% latent cancer
__% clinically apparent cancer
__% death due to prostatic cancer
40%
16%
2.9%
144
Risk factors of prostate cancer
African American race
Family history
History of high dietary fat intake
145
Most prostate cancers are detected because of:
Elevations in serum PSA
146
Obstructive symptoms of the prostate is most often due to:
BPH
147
Prostate cancer
Metastases commonly occurs in:
Lower extremity lymphedema
Axial skeleton (Most Common)
148
__% if men with intermediate elevation between 4.1-10 ng/mL will have prostate cancer
__% of men with elevations greater than 10 ng/mL will have prostate cancer
8-30%
50-70%
149
Labs for prostate cancer
PSA
BUN & Creatinine
Alkaline phosphatase and calcium
CBC
150
Standard method for detection and confirmation of prostate cancer
Prostate biopsy
151
Imaging for prostate cancer
Transrectal U/S
MRI
Bone Scan
152
PSA testing baseline testing is offered at what age with no risk factors?
50
153
PSA testing for 40-45 year old's with risk factors that include:
African American men
Family history of prostate cancer
BRCA1 or BRCA2 mutations
154
Prostate cancer possible therapies
Active surveillance
Radical prostatectomy
Radiation therapy
Cryosurgery
Androgen deprivation therapy for advanced disease
155
All patients with a focal nodule or induration on DRE or elevated PSA MUST be:
Referred to Urology
156
What is responsible for the infrequent rate of injury to the testis?
Mobility of the testicle
Cremasteric muscle
Tough capsule of the testes
157
What is a part of the spermatic cord?
Vas deferens
Cremasteric muscle
Artery
Vein
Nerves
158
Scrotal laceration/avulsion should be:
Explored and debrided
Managed by housing the testicle in the remaining scrotal skin
159
Blunt testicular injury usually occurs secondary to a direct blow to the testes impinging against the:
Pubic symphysis (Bicycle injury)
160
Sac fills with blood and appears as a large blue tender scrotal mass
Blunt testicular injury
161
Labs for testicular trauma
CBC
UA
162
Imaging for scrotal trauma
Scrotal and testicular US
163
What studies can help delineate the extent of testicular involvement and evaluate for testicular rupture?
Colored Doppler
164
Blunt and penetrating testicular injuries require:
MEDEVAC to Urology
165
Treatment for lacerations or avulsions just involving the skin of the scrotum
Closed primarily by independent provider
166
Necrotizing fasciitis of the subcutaneous tissues of the perineum often involving the scrotum
Fournier's Gangrene
167
Typically begins as a benign infection or simple abscess that quickly leading to widespread necrosis of otherwise previously healthy tissue
Fournier's Gangrene
168
You must maintain a high suspicion of what, if the patient presents with scrotal, rectal or any genitalia pain out of proportion to their physical exam findings
Fournier's Gangrene
169
Signs and symptoms:
- Tense edema of scrotum and other involved skin
- Blisters/bullae
- Crepitus
- Fever
- Pain out of proportion to physical exam
- Tachycardia
- Hypotension
Fournier's Gangrene
170
Imaging for Fournier's Gangrene
CT
MRI
171
Treatment for Fournier's Gangrene
Aggressive surgical exploration and debridement
Broad spectrum antibiotics
-Ertapenem
Fluids
MEDEVAC
172
Complications from Fournier's gangrene.
| Patients may ultimately need:
Cystostomy
Colostomy
Orchiectomy
173
Malignancy is often:
Painless
174
Dilation of the pampiniform plexus of spermatic veins and is generally left sided
Varicocele
175
Symptoms:
- Asymptomatic mass, may have mild pain
- Mass is separate from testes
- Feels like a "bag of worms", especially upright
- Size increased with Valsalva
Varicocele
176
Right sided varicocele should raise suspicion of:
Inferior vena cava and intraabdominal pathology
177
Sudden left sided varicocele should raise suspicion for:
Left renal vein obstruction
Renal tumor
178
Collection of peritoneal fluid between the parietal and visceral layers around the testes and spermatic cord
Hydrocele
179
Gradually enlarging painless cystic mass that transilluminates
May indicate tumor
Hydrocele
180
Fluid filled cyst at the head of the epididymis that may contain nonviable sperm
Spermatocele
181
Painless
Palpated as distinct from the testes
Typically transilluminates as cystic in nature
Spermatocele
182
Diagnostic imaging of choice for scrotal and testicular abnormalities
Ultrasound
183
Most common neoplasm in men aged 20-35
Testicular cancer
184
Testicular cancer
What is necessary for diagnosis?
Orchiectomy
185
Testicular cancer
___ cases per 100,00 males each year
5-6
186
__% of testicular cancer develop in patients with a history of cryptorchism
5%
187
Symptoms:
- Painless enlargement of the testis
- Sensation of heaviness
Testicular cancer
188
Testicular cancer
__% Asymptomatic
__% Metastatic disease symptoms
__% Gynecomastia
10%
10%
5%
189
An incorrect diagnosis is made at the initial examination in up to __% of patients with testicular tumors
25%
190
If this test is positive, you should have a high suspicion of testicular cancer
HCG
191
Imaging for testicular cancer
Scrotal US
-Determine intra/exta-testicular
Chest, abd, and pelvic CT after diagnosis is made
192
__% of testicular cancer diagnosis is made by inguinal orchiectomy
75%
193
Testicular cancer
5-year disease free survival for patients with stage I-III are ___%
90-100%
194
Testicular Cancer
Patients with disseminated disease have a 5-year disease free survival rate at __%
55-80%
195
Testicular torsion may occur after:
Trauma
Spontaneously
196
Urgency to diagnose and treat testicular torsion with __ hours to prevent loss of the testis
6 hours
197
Testicular torsion tends to occur in:
Young men
198
Which testicle is more prone to torsion?
Left
199
Testicular torsions usually rotate:
Medially
200
Symptoms:
- Acute scrotal pain (several hours after activity)
- Profound tenderness and swelling
- Nausea and vomiting
- Negative cremasteric reflex
Testicular torsion
201
High riding testis oriented transversely
Bell clapper deformity
202
Imaging for testicular torsion
Scrotal US with color flow Doppler
203
Manual Detorsion
Grasping the testicle and rotating it within the scrotum outward (Lateral to Medial) one to two full 360 degree turns
204
If there is no improvement from testicle detorsion you should:
Rotate it in the opposite direction (lateral to medial)
205
_____ of torsed testicles may have lateral rotation
One-third
206
Disposition for testicle torsion
MEDEVAC
Needs surgical exploration and detorsion regardless of result of manual detorsion
207
Testicle salvage
___% at 6-8 hours
___% at 12 hours
80-100%
0%
208
___% of patients sustaining injury to the external genitalia require RBC transfusion due to blood loss from genital injury alone
25%
209
Blunt trauma to the erect penis may cause rupture of the:
Corpus cavernosum
210
- Immediate pain
- Deforming hematoma (eggplant)
- "Cracking sound"
- Immediate detumescence
- May cause urethral injury
Penile rupture or fracture
211
Can occur secondary to clothing being trapped by heavy machinery
Amputation
212
Treatment zipper injuries
Local anesthetic is injected and then unzip after mineral oil lubrication
213
Treatment for penile contusions
Analgesics/NSAIDs
Cold packs
Rest
Elevation
214
Imaging for penile trauma
Retrograde urethrogram
Scrotal/Penile US
215
Treatment for penile trauma
MEDEVAC
Immediate urological consultation for surgical repair
216
Urethral injury is suspected if:
Blood in the urethra meatus
Perineal hematoma
High riding prostate on DRE
217
Fibrous constriction of the foreskin preventing retraction
Phimosis
218
Inflammation of the glans penis
Balanitis
219
Inflammation of the glans penis and the prepuce
Balanoposthitis
220
If Foley catheter cannot be inserted, what is indicated?
Suprapubic catheterization
221
Most common infectious cause of underlying balanoposthitis
Candidal infection
222
Treatment for Phimosis
Good hygiene and topical antifungal
223
Phimosis
Urologist can perform this procedure to temporarily fix the problem
Dorsal slit circumcision
224
Two conditions that can be the result from phimosis
Balanitis
Balanoposthitis
225
A true urologic emergency
Retracted foreskin develops a fixed constriction proximal to the glans
Paraphismosis
226
Treatment for paraphimosis
Manual reduction
-Compress glans firmly for 5-10 minutes to reduce its size
-Icing
Move the prepuce distally while the glans is pushed proximally
227
Treatment
Manual reduction fails for paraphimosis
Dorsal slit of the foreskin
228
Disposition
Paraphismosis
Referral to urology for circumcision to reduce recurrence
229
Results in a sudden decrease in kidney function
Acute Kidney Injury (AKI)
230
Labs
AKI is characterized as:
Increase in serum creatinine
231
The inability to maintain acid-base, fluid, and electrolyte balance and to excrete nitrogenous wastes
AKI
232
Three categories of AKI
Prerenal
Intrinsic
Post renal
233
Most common etiology of AKI
Prerenal (40-80%)
234
Prerenal AKI
Continuous hypoperfusion can lead to:
A secondary intrinsic kidney injury
235
Decreased renal perfusion occurs by:
Decrease in intravascular volume
Change in vascular resistance
Low cardiac output
236
Least common cause (5-10%) of AKI
Postrenal
237
Postrenal AKI
Important to detect because etiologies are:
Reversible
238
Postrenal causes
Urethral obstruction
Bladder dysfunction or obstruction
Obstruction of both ureters/renal pelvises
BPH
Cancer (Bladder, prostate, and cervical)
239
Most common cause of postrenal AKI in males
BPH
240
Up to 50% of AKI
Intrinsic
241
Consider intrinsic AKI after:
Prerenal and postrenal causes are ruled out
242
Sites of intrinsic AKI injury
Tubules
Interstitium
Vasculature
Glomeruli
243
Symptoms:
- Buildup of waste products (nausea, vomiting, altered sensorium, pericarditis, malaise)
- Pericardial effusion leading to tamponade and friction rub
- Arrythmias
- Rales in hypervolemia
- Diffuse abdominal pain and ileus
Acute Kidney Injury
244
Labs for AKI
Blood Urea Nitrogen (BUN)
Creatinine
UA
245
AKI
Can help determine prerenal, postrenal or intrinsic
Creatinine (Cr)
246
Imaging for AKI
Renal US
247
Treatment for prerenal AKI
Achieving euvolemia
Restoring renal perfusion
248
Treatment for postrenal AKI
Bladder catheterization
Relieve underlying cause
249
Treatment for AKI
Usually self-limited
Managed by nephrology
250
Complications of AKI
Dialysis
Arrhythmias secondary to electrolyte abnormalities
Bleeding/clotting disorders
Encephalopathy
Cardiac Tamponade
251
Disposition for AKI
MEDEVAC
Prerenal: ER, Cardiology, Internal Medicine
Postrenal: Urology referral to relieve obstruction
Intrinsic: Nephrologist
252
Hyponatremia is defined as:
Less than 135 mEq/L
253
Most common electrolyte abnormality in hospitalized patients often caused by hypotonic fluids
Hyponatremia
254
Hyponatremia is usually caused by:
Excess water-retention
255
Mismanagement of hyponatremia can result in:
Neurologic catastrophes from cerebral osmotic demyelination
256
Evaluation for hyponatremia
New medications
Changes in fluid intake
Fluid output
257
Mild hyponatremia
130-135 mEq/L
Nausea
Malaise
258
Moderate hyponatremia symptoms
Headache
Lethargy
Disorientation
259
Severe symptoms of hyponatremia
Respiratory arrest
Seizure
Coma
Permanent brain damage
Brainstem herniation
Death
260
Treatment for hyponatremia
Restriction of free water and hypotonic fluid
Less than 1-1.5 L/day
261
Hyponatremia
What may be necessary in patients with negative free water clearance?
Hypertonic saline
262
Most serious complication of hyponatremia is iatrogenic cerebral osmotic demyelination from:
Overly rapid sodium correction
263
Symptomatic and severe hyponatremia generally require:
Hospitalization for
- Monitoring of fluid balance and weights
- Treatment
- Frequent sodium checks
264
Hypernatremia is classified as:
Sodium concentration greater than 145 mEq/L
265
Hypernatremia is typically due to:
Free water loss
266
Primary defense against hypernatremia
Intact thirst mechanism and access to water
267
Signs and symptoms:
- Dehydration (hypotension, oliguria)
- Lethargy
- Irritability
- Weakness
Hypernatremia
268
Severe signs of Hypernatremia (>158)
Hyperthermia
Delirium
Seizures
Coma
269
Treatment for hypernatremia
Correcting the cause of fluid loss
Replacing water
Replacing electrolytes
270
Hypernatremia
Fluids should be administered over a _____ period
48-hour
271
Hypernatremia
Aiming for serum sodium correction of approximately
1 mEq/L/h
272
Rapid correction of hypernatremia may cause:
Cerebral edema
Severe neurologic impairment
273
Hypokalemia is classified as:
<3.5 mEq/L
274
Severe hypokalemia may induce:
Arrhythmias and rhabdomyolysis
275
Hypokalemia can result from:
Insufficient dietary potassium intake
Intracellular shifting
276
The most common cause of hypokalemia is:
GI loss from infectious diarrhea
277
The potassium concentration in intestinal-secretion is __ times higher than in gastric secretions
10 times
278
Symptoms
Mild to moderate hypokalemia
Muscular weakness
Fatigue
Muscle cramps
279
Severe hypokalemia
<2.5mEq/L
280
Signs and symptoms of severe hypokalemia
Flaccid paralysis
Hyporeflexia
Hypercapnia
Tetany
Rhabdomyolysis
281
Imaging for hypokalemia
ECG
- Decreased and broadening of T waves
- PVCs
- Depressed ST segments
282
Treatment for hypokalemia
Oral potassium supplementation
| -40-100 mEq/day for days to weeks
283
Complications of hypokalemia
Cardiac arrhythmias
Rhabdomyolysis
284
Hyperkalemia
>5.0 mEq/L
285
Hyperkalemia may develop in patients taking:
ACE inhibitors
Angiotensin-receptor blockers
Potassium-sparing diuretics
286
Hyperkalemia usually occurs in patients with:
Advanced kidney disease
287
Hyperkalemia
_____ causes intracellular potassium to shift extracellularly
Acidosis
288
Hyperkalemia impairs neuromuscular transmission, causing:
Muscle weakness
Flaccid paralysis
Ileus
289
Can causing a raise in potassium concentration by 1-2 mEq/L by causing acidosis and potassium shift from cells
Fist clenching during venipuncture
290
ECG changes in hyperkalemia include
Bradycardia
PR interval prolongation
Peaked T waves
QRS widening
Conduction disturbances (bundle branch block, AV block)
V-Fib and cardiac arrest
291
Treatment for hyperkalemia
Withholding exogenous potassium
292
Hyperkalemia
Emergent treatment is indicated when:
Cardiac toxicity
Muscle paralysis
Severe hyperkalemia (>6.5)
293
Shifts potassium intracellularly within minutes of administration
Insulin (give with glucose)
Bicarbonate
Beta-agonists
294
Intravenous _____ may be given to antagonize the cell membrane effects of potassium
Calcium
295
Medications for hyperkalemia
Loop diuretics
- Furosemide
- Bumetanide
296
Complications of hyperkalemia
V-fib
Cardiac arrest
297
Epididymitis
Inflammation of the epididymis
