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Diagnosis & Management 2 > EXAM 2 > Flashcards

EXAM 2 Flashcards

1
Q

first line tx for persons without cognitive impairments who present with urge incontinence:

A

pelvic floor muscle exercises

bladder retraining

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2
Q

Pharmacological therapy with _______ is an option for tx urge incontinence if behavioral therapy is unsuccessful; b/c of adverse effects, these agents are not recommended in _____
______

A

anticholingergics

older adults

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3
Q

most common types of urge incontinence in women:

A

urge, stress and mixed

less common: overflow and functional

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4
Q

overflow incontinence is often caused by adverse effects of ________ drugs or by _____ ______ innervation from neurologic dx

A

anticholinergic

impaired detrusor

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5
Q

what kind of UI?
s/s: loss of urine accompanied or preceded by strong desire to void; may be accompanied by frequency and nocturia
- most common is older adults with a strong association with stroke

A

urge incontinence

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6
Q

what kind of UI?
s/s: loss of urine with physical exertion or increases in intr- abdominal pressure ( sneezing, coughing, laughing)
- most common in younger women, second more common type in older adults

A

stress incontinence

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7
Q

conservative mgmt of urge incontinence:

A

weight loss; fluid reduction; constipation management; bladder training; pelvic floor muscle exercises; electrical stimulation of the posterior tibial nerve

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8
Q

pharmacological mgmt of urge incontinence:

A

anticholinergic drugs
beta adrenergic agonists
botox
intravaginal estrogen

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9
Q

surgical mgmt of urge incontinence:

A

neuromodulation ( implanted sacral nerve stimulation)

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10
Q

conservative mgmt of stress incontinence:

A

weight loss, smoking cessation, fluid reduction, constipation mgmt, pelvic floor muscle exercises, extracorporeal magnetic innervation, electrical stimulation, mechanical devices ( pessary, urethral plugs)

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11
Q

pharmacologic stress incon. mgmt:

A

alpha adrenergic agonists

cymbalta

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12
Q

surgical mgmt of stress incontinence:

A

sling procedures
(suburethral sling with tension free vaginal tape, pubovaginal sling, midurethral sling)
urethropexy
periurthral injections of bulking agents

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13
Q

natural menopause occurs around ___ years old

A

52

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14
Q

premature menopause describes menopause before age ___

A

40

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15
Q

metorrhagia

A

irregular cycles with heavy, prolonged flow

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16
Q

oligomenorrhea

A

long cycles with scant flow

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17
Q

polymenorrhea

A

short cycles with regular flow

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18
Q

diff dx for dysfunctional uterine bleeding in non - pregnant women

A

trauma: blunt force, penetrating force, foreign bodies
infectious: vaginitis, cervicitis, endometritis

DUB: ovulatory, anovulatory, andenomyosis

benign growths:
uterine leiomyomas, cervical polyps

malignancy: vulvar, cervical, uterine, ovarian,

systemic dx: weight loss, stress, excessive exercise, hypothyroid, hyperthyroid, hyperprolactinemia, liver failure, renal failure

medications: anticoags, antipsychotics, corticosteroids, tamoxifen, SSRI’s, metformin
contraceptives

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19
Q

adenomyosis

A

endometrial tissue, which normally lines the uterus, exists within and grows into the muscular wall of the uterus. The displaced endometrial tissue continues to act as it normally would — thickening, breaking down and bleeding — during each menstrual cycle. An enlarged uterus and painful, heavy periods can result.

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20
Q

Dysfunctional uterine bleeding diagnostics, start with:

A

pregnancy test & CBC

inspect perineum, speculum exam including pap smear and cervical cultures,
bimanual exam
rectal exam

if H&P don’t point toward medical or infectious cause, source of bleeding not identified:
US and gyn consult

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21
Q

structural causes of AUB:

A

polyp
adenomyosis
leiomyomas
malignancy and hyperplasia

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22
Q

non structural causes of AUB:

A

coagulopathy
ovulation dysfunction
endometrial
iatrogenic

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23
Q

types of fibroids

A

submucosal: under the lining of the womb, can grow on stalk ( pedunculated)
intramural: within the wall of the womb, most common type, may distort the uterine cavity or cause irregular external uterine contour
subserosal: on the outer wall of the uterus and usually causes no s/s till it grows large enough to cause interference to adjacent organs, sometimes they have stalk.

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24
Q

failure to menstruate by age 14 w/out sex characteristics or 16 with sex characteristics is:

A

amenorrhea

secondary amenorrhea: pregnancy is #1 reason
lack of menstrual cycles for 3 or more months in a female who has achieved menarche

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25
Q

evaluation of amenorrhea:

A

Urine HCG - #1
CMP, TSH, FSH, LH, prolactin
testosterone, DHES for androgen excess ( look for associated physical changes)
progesterone challenge to eval for outflow integrity and pituitary gonadal function( if bleeding occurs, consider an ovulation as cause, if no bleeding, consider low estrogen)

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26
Q

amenorrhea tx:

A

if progesterone challenge neg: oral estrogen /progesterone

if challenge pos: adequate estrogen - administer progesterone for 10 days each month to prompt cycle

consult with GYN/endocrinology

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27
Q

eval for menorrhagia:

A 
CBC including platelets
coags ( PT/INR, PTT and LFTS)
TSH
transvaginal ultrasound for fibroids
endometrial biopsy especially is > 35 or risk for hyperplasia, PCOS, endometriosis, adenomyosis
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28
Q

UA results: heavy proteinuria and lipiduria indicate?

A

nephrotic syndrome

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29
Q

UA results: hematuria with dysmorphic RBC’s, RBC casts and proteinuria is indicative of?

A

glomerulonephritis

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30
Q

UA: pigemented granular casts ( muddy brown casts) and renal tubular epithelial cells alone or in casts suggest?

A

acute tubular necrosis

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31
Q

UA with WBC’s ( including neutrophils and eosinophils) ,WBC casts, RBC’s and small amounts of protein suggest?

A

interstitial nephritis and pyelonephritis.

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32
Q

proteinuria is excessive protein in excretion in the urine, greater than _______ mg/24h in adults

A

150-160

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33
Q

proteinuria of more than 1g/day=

less than 1g/day=

A

glomerular in origin

multiple causes along nephron segment

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34
Q

functional proteinuria: benign process stemming from stressors such as:

A

acute illness, exercise, “orthostatic proteinuria”

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35
Q

overload proteinuria causes:

A

results from overproduction of circulating, filtrable plasma proteins or myoglobinuria in rhabdomyolysis OR hemoglobinuria in hemolysis

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36
Q

glomerular proteinuria is seen in:

A

diabetic nephropathy

increased permeability of albumin across a damaged GBM

results from effacement of epithelial cell foot processes and altered glomerular permeability with an increased filtration fraction of normal plasma proteins

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37
Q

tubular proteinuria causes:

A

acute tubular necrosis, toxic injury, drug induced interstitial nephritis, hereditary metabolic disorders

results from faulty reabsorption of normally filtered proteins in the proximal tubule

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38
Q

hematuria is significant if:

A

there are more than three red cells pre high power field on at least two occasions

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39
Q

most common extraglomerular sources of hematuria:

A

cysts, calculi, interstitial nephritis and renal neoplasia

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40
Q

glomerular causes of hematuria:

A

IgA nephropathy, thin GBM dx, membranoproliferative glomerulonephritis, systemic nephritic syndromes, hereditary glomerular dx

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41
Q

The GFR measures the ____________ ultra filtered across the glomerular capillaries and correlates with the ability of the kidneys to ________

A

amount of plasma

filter fluids and various substances

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42
Q

GFR in normal individuals is usually:

A

100-120

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43
Q

unexplained acute kidney injury or CKD, acute nephritic syndromes, unexplained proteinuria and hematruria, previously identified and treated lesions, SLE and other systemic dx associated with kidney dysfunction, suspected transplant rejection all indicate need for:

A

percutaneous needle biopsy

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44
Q

essential of dx of acute kidney injury:

A

rapid increase in serum creatinine
oliguria can be associated
s/s depend on cause: pre renal, intrarenal, post renal

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45
Q

pts with acute kidney injury of any type are at a _______ for all cause mortality, whether or not there is _______

A

higher risk

substantial renal recovery

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46
Q

essential of dx of acute tubular necrosis

A

acute kidney injury
ischemic or toxic insult with underlying sepsis

urine sediment with pigmented granular casts and renal tubular epithelial cells is pathognomic but not essential

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47
Q

prerenal causes are the most common of acute kidney injury, and due to:

A

renal hypoperfusion

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48
Q

decreased renal perfusion can be caused by:

A

a decrease in intravascular volume, a change in vascular resistance, low cardiac output

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49
Q

causes of volume depletion leading to decreased renal perfusion:

A

hemorrhage, GI losses, dehydration, excessive diuresis, extravascular space sequestration, pancreatitis, burns, trauma, peritonitis

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50
Q

changes in vascular resistance leading to decreased renal perfusion:

A

sepsis, anaphylaxis, anesthesia, after load reducing drugs, renal artery stenosis

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51
Q

low cardiac output is a state of ______ renal arterial blood flow. this occurs in states of:

A

low effective

cardiogenic shock
heart failure,
pulmonary embolism, pericardial tamponade, arrhythmias, valvular disorders

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52
Q

BPH is the _______ of the prostate ( not associate with or a precursor to cancer) that can lead to ________, likely as the result of an enlargement in _______ and an increase in the number of __________

A

enlargement

bladder outlet obstruction

prostatic connective tissue

epithelial and smooth muscle cells

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53
Q

In BPH, bladder detrusor ____ occurs as a result of difficulty emptying bladder with increased bladder outflow obstruction

A

hypertrophy

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54
Q

chronic incomplete bladder emptying causes _____ and predisposes to _______ and _____ with secondary inflammatory changes including ______

A

stasis

calculus formation and infection

prostatitis and UTI

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55
Q

DX of BPH:

A

digital rectal exam : prostate is enlarged, rubbery and has lost median sulcus

UA to rule out infection/other dx

postvoid residual test, transracial ultrasound, prostate biopsy

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56
Q

a systematic eval for ________ must be done on any man who has an abnormal prostate exam with or without urinary s/s

A

prostate cancer

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57
Q

BPH s/s:

A

increased frequency of urination, decreased force of stream, nocturia, sensation of incomplete emptying, urinary urgency, hesitancy, a need to strain or push to initiate or maintain urination to more fully empty the bladder

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58
Q

drugs with _______effect can cause acute urinary retention in men with BPH, as can _____ and _____

A

anticholinergic ( tricyclic antidepressants, antihistamines)

opioid use and inactivity

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59
Q

caffeine, alcohol and artificial sweeteners are all ______ that can worsen _________

A

bladder irritants

urinary frequency

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60
Q

BPH tx:

A

tamsulosin ( Flomax), alpha 1 receptor antagonists

5 alpha reductase inhibitors: finasterid (proscar) dutasterid ( avodart)

Cialis - phosphodiesterase inhibitor ( this cannot be taken with alpha blockers or nitrates)

61
Q

surgical intervention for BPH:

A

transurethral resection of the prostate

open prostatectomy

minimally invasive thermal and laser interventions

62
Q

herbal/nutritional NPH therapy:

A

saw palmetto, rye, pumpkin

63
Q

fibrocystic condition of breast is a _____ breast disorders with the following characteristics:

A

benign

painful, often multiple, usually bilateral masses in the breast

rapid fluctuation in the size of the masses in common

frequently, pain occurs or worsens and size increases during premenstrual phase of cycle

most common age is 30 -50 yrs, rare in postmenopausal women not receiving hormonal replacement.

64
Q

diagnostics for mass in pt with fibrocystic condition:

A

mammography and ultrasonography

ultrasonography alone can be used in pts under 30

suspicious lesions should be biopsied with fine needle aspiration cytology. if mass nonmalignant on cytology doesn’t resolve over several months, excise or biopsy with core needle

65
Q

fibrocystic mass tx:

A

pt with previous dx of fibrocystic or classic presentation: aspiration of cyst to alleviate pain and confirm diagnosis.

wear supportive bra

66
Q

if on aspiration of fibrocystic mass no fluid is obtained, fluid is bloody, mass persists or recurrs after aspiration, then:

A

biopsy should be performed

67
Q

a typical fibroadenoma of the breast is:

A

round or ovoid, rubbery, discrete, relatively movable, nontender mass 1-5 cm in diameter.

it is a common benign neoplasm occurring most frequently in younger women, usually within 20 yrs of puberty

68
Q

dx of fibroadenoma:

A

needle biopsy or cytologic exam

69
Q

in non pregnant, non lactating women serous nipple discharge often means:

A

most likely benign FCC ( fibrotic cyst changes) such as duct ectasia

70
Q

in non pregnant, non lactating women bloody nipple discharge often means:

A

more likely to be neoplastic, papilloma, carcinoma

71
Q

in non pregnant, non lactating women unilateral nipple discharge often means:

A

either neoplastic or non neoplastic

72
Q

in non pregnant, non lactating women nipple discharge and an associated mass often means:

A

more likely neoplastic

73
Q

in non pregnant, non lactating women milky nipple discharge often means:

A

endocrine disorders, medications

74
Q

in non pregnant, non lactating women nipple discharge related to menses, premenopausal and/or taking hormones often means:

A

Fibrocystic breast

75
Q

post renal causes of acute kidney injury occur when obstruction leads to _______, causing kidney parenchymal damage, with marked effects on ________ and _______ and a decrease in _____

A

elevated intraluminal pressure

renal blood flow and tubular function

GFR

76
Q

post renal causes of acute kidney injury:

A

urethral obstruction, bladder dysfunction or obstruction, obstruction of both ureters or renal pelvises.
in men, BPH is most common cause.
can also be caused by cancer, retroperitoneal fibrosis, neurogenic bladder.

77
Q

post renal acute kidney injury s/s:

A

pts may be anuric or polyuric, may complain of lower abdominal pain.
on exam, pt may have enlarged prostate, distended bladder, or detectable mass

labs may show high urine osmolality, low urine sodium, high BUN: creatinine ratio.

78
Q

intrinsic acute kidney injury sites:

A

tubules, interstitial, vasculature and glomeruli

79
Q

most common type of intrinsic acute kidney injury:

A

acute tubular necrosis

80
Q

most likely cause of acute tubular necrosis:

A 
ischemic  insult ( prolonged hypotension, hypoxemia, volume depletion, shock, sepsis) 
toxic insult ( aminoglycosides: streptomycin is least nephrotoxic, gentamicin and tobramycin equally nephrotoxic; amphotericin B after a dose of 2-3 g; vancomycin, IV acyclovir, cephalosporins; contrast dye; cyclosporine

underlying sepsis

81
Q

characteristics of interstitial nephritis:

A

fever, transient maculopapular rash; acute/chronic kidney injury; pyuria, WBC casts, hematuria

82
Q

characteristics of glomerulonephritis:

A

hematuria, dysmorphic red cells, red cells casts, mild proteinuria

dependent edema and HTN

acute kidney injury

83
Q

Uremia, the build up of metabolic waste products, can result in uremic syndrome, the s/s of which are:

A

fatigue and weakness; anorexia, N/V, metallic taste in mouth, irritability, memory impairment, twitching, insomnia, restless legs, paresthesias, decreased libido and menstrual irregularities

84
Q

s/s of uremia warrant ________ and _________for initiation of dialysis

A

immediate hospital admission

nephrology consult

85
Q

metabolic bone dx of CKD is seen as early as stage three and usually has the following pattern:

A

hyperphosphatemia, hypocalcemia, hypovitaminosis D, resulting in secondary hyperparathyroidism. This can lead to vascular calcification, increasing risk for CVD.

86
Q

in men younger than 35 yrs, epididymitis is usually caused by:

A

C. trachomatis

or N. gonorrhoeae

87
Q

in men older than 35 yrs, epididymitis is usually caused by:

A

secondary to prostatitis and due to gram neg organism

88
Q

s/s of epididymitis:

A

irritative voiding symptoms; fever; acutely painful, enlarged epididymus; urethritis, scrotal swelling and penile discharge. pain often radiates up the spermatic cord to the ipsilateral lower and.

89
Q

Prehn sign:

A

a reduction in pain when the scrotum is elevated above the symphysis pubis

noted in pts with acute epididymitis

90
Q

Gonorrhea, one of the most common STIs, has a incubation period of:

A

1 to 5 days

91
Q

s/s of gonorrhea infection in men:

A

dysuria with a milky, occasionally blood tinged penile discharge.

however, men are often asymptomatic

92
Q

tx for uncomplicated gonorrhea infection

A

single dose ceftriaxone 250 mg IM plus either single dose azithromycin 1g PO or doxycycline 100 mg PO bid x 7 days

93
Q

most common cause of bacterial prostatitis in older men:

A

E. Coli and pseudomonas

94
Q

most common cause of bacterial prostatitis in younger men or men at risk for STIs:

A

gonorhea, chlamydia or both

95
Q

white, pigmented or thickened vulvar or vaginal lesions should be ______ to obtain an accurate diagnosis and rule out_______

A

biopsied

pre/malignant condition

96
Q

skin changes associated with menopause include:

A

decreased skin thickness and elasticity, loss of collagen, increased laxity and wrinkling

97
Q

combined HT started after age ___ increase the risk of dementia

A

65

98
Q

while working up a non pregnant patient with secondary amenorrhea, the prolactin serum assay results show a level of 29 ng/ml. appropriate mgmt would include:

A

referring to an endocrinologist

levels higher than 20 ng/ml indicate need to refer

All of these women should be screened for thyroid disease because hypothyroidism can sometimes cause hyperprolactinemia

99
Q

Initial laboratory testing for women with amenorrhea without hyperandrogenism should include:

A

serum prolactin (PRL), follicle-stimulating hormone (FSH), and thyroid-stimulating hormone (TSH) to test for hyperprolactinemia, ovarian failure, and thyroid disease, respectively.

100
Q

In cases of secondary amenorrhea, If there is clinical evidence of hyperandrogenism (hirsutism, acne, scalp hair loss [alopecia]), ________should be measured in addition to the initial laboratory tests.

A

serum total testosterone

101
Q

In cases of secondary amenorrhea,women with normal serum PRL and TSH, a low or normal serum FSH concentration, and no history of uterine instrumentation are likely to have:

A

a hypothalamic-pituitary disorder or PCOS.

102
Q

Hypothalamic amenorrhea can also be seen with systemic illness such as:

A

as celiac disease and type 1 diabetes mellitus

103
Q

A high serum follicle-stimulating hormone (FSH) concentration indicates:

A

POI, formerly referred to as premature ovarian failure.

104
Q

The overall goals of management in women with secondary amenorrhea include:

A

Correcting the underlying pathology, if possible
●Helping the woman to achieve fertility, if desired
●Preventing complications of the disease process (eg, estrogen replacement to prevent osteoporosis)

105
Q

Women with primary ovarian insufficiency (POI) should receive:

A

estrogen therapy for prevention of bone loss.

This can be either an oral contraceptive (if the patient is having intermittent ovarian function and does not wish to become pregnant) or replacement doses of estrogen and progestin.

106
Q

31 y/o F with hx of long distance running has 9% body fat, which of the following findings would an NP expect?

A)Regular menses and a basal body temperature that indicates lack of ovulation

B)Regular menses and a basal body temperature that indicates ovulation

C) Irregular menses and basal body temperature that indicates ovulation

D)Irregular menses and a basal body temperature that indicates lack of ovulation

A

D)Irregular menses and a basal body temperature that indicates lack of ovulation

14% body fat is considered adequate for reg menses and ovulation. A woman with less than 10% body fat will ovulate and menstruate very irregularly or not at all.

107
Q

A 19 y/o female patient is requesting to start on Depo-Provera injections as her method of birth control. She informs you that she has had four sexual partners in the past year. Her last menstrual period was 12 days ago and she had unprotected intercourse 3 days ago. The most appropriate management for this patient would be to:

A) Advise her to use another method of birth control for now and to return to the clinic at the start of her next menses to start the Depo-Proveram provide counseling on sexually transmitted diseases.

B)Perform a qualitative pregnancy test, with negative results administer Depo-Provera 150mg IM, provide sexually transmitted disease education.

C)Administer Depo-Provera 75mg IM and educate the patient on the use of condoms.

D)Administer Depo-Provera 150mg IM and counsel the patient on sexual transmitted diseases.

A

Advise her to use another method of birth control for now and to return to the clinic at the start of her next menses to start the Depo-Proveram provide counseling on sexually transmitted diseases.

Correct answer as Depo must be administered within 5 -7 days of the onset of menses, it can be given after the 7th day but this patient had unprotected intercourse and pregnancy could have occurred which disallows it being given at this time.

108
Q

A 20 y/o patient is seeing the nurse practitioner for their wellness physical and informs you that she is newly married and does not want to become pregnant. She is using the basal body temperature method of birth control and asks you to confirm when she should avoid unprotected intercourse. The most appropriate response by the nurse practitioner would be:

A)Whenever her BBT is elevated

B)From the end of her menstrual cycle until the BBT has been low for 5 days

C)Whenever the BBT is elevated then lowers

D)From the beginning of the menstrual cycle until the BBT has been slighlty increased for 1-3 days

A

From the beginning of the menstrual cycle until the BBT has been slighlty increased for 1-3 days

109
Q

The nurse practitioner is seeing a 18 year female for their wellness physical and first pap smear. During the encounter the patient asks the NP what can HPV (Human papillomaviris) cause?

The nurse practitioners best response is:

A)If a person would contract this and it is not treated it can lead to infertility

B)If a person would contract this and it is not treated it can lead to the development of Herpes Simplex II

C)If a person would contract this and it is not treated it can cause cervical dysplasia

D)If a person would contract this and it is not treated it can cause molluscum contagiosum.

A

If a person would contract this and it is not treated it can cause cervical dysplasia

HPV can lead to the development of of genital wars which can cause cervical dysplasia and cervical cancer

110
Q

A 70-year-old female patient visits the adult nurse practitioner for a yearly evaluation. Which physical examination finding receives the highest priority for immediate treatment?

A)Atrophy of vaginal rugae

B)Pessary in place

C)Cystocele present

D)Palpable ovary

A

Palpable ovary

Ovaries at this age should not be palpable, A palpable ovary at this age is worrisome for ovary cancer

111
Q

Mary, age 50, desires hormone replacement therapy (HRT) for her hot flashes, which she can’t stand. You’ve discussed the pros and cons and given her some alternative suggestions. Her mother had a history of osteoporosis. You have decided to initiate therapy for 1 year. She asks you if she also needs to take calcium or vitamin D for prevention of osteoporosis. How do you respond?

A) “If you are getting sufficient exercise, you don’t need to take calcium and vitamin D.”

B)“Research has shown that HRT alone is sufficient to protect against osteoporosis.”

C)“Yes, calcium intake should be increased to 1,200 mg/day along with 600 mg of vitamin D to decrease bone turnover and increase intestinal absorption.”

D)“If you decide to take calcium and vitamin D, you can stop the HRT.”

A

“Yes, calcium intake should be increased to 1,200 mg/day along with 600 mg of vitamin D to decrease bone turnover and increase intestinal absorption.”

Prevention includes the HRT along with Ca+ and Vit D supplement ( as listed in this answer) and exercise

112
Q

The nurse practitioner is seeing a 21 y/o female who is taking an oral contraceptive (OC). She complains of having acne breakouts on her current pill forumuation. How should you adjust the estrogen in the OC?

A

Increase the estrogen content.

It is most appropriate to increase the estrogen amount the the OC to counteract the progestin effects

113
Q

The patient that you are seeing for their yearly health visit inquires about why she needs progesterone in addition to her estrogen for hormone replacement?

The nurse practitioner responds that “women who have an intact uterus need to add progesterone to their prescribed estrogen because progestin:

A

reduces the incidence of endometrial hyperplasia and cancer

114
Q

The majority of breast carcinomas are found in which anatomical site in the breast?

A

in the upper outer quadrant

60% are found in the outer quadrant

115
Q

Chronic kidney dx is defined as:

A

GFR < 60 for 3 months with/without kidney damage

OR

kidney damage for 3 months, with/without decreased GFR, manifested by either

116
Q

a case finding approach to screening for CKD is suggested. This means:
and who should be tested?

A

testing for CKD only in people at increased risk

hx of DM, HTN, CVD, HIV, Hep C, virus infection, malignancy, autoimmune dx, nephrolithiasis, recurrent UTIs

aboriginal

fam hx of CKD

sickle cell trait

chronic tx with potentially nephrotoxic drugs ( lithium, PPIs, NSAIDs).

117
Q

tests to screen for CKD:

A

urine test for albumin
blood test for creatinine

renal ultrasonography for select individuals such as those with a family hx of polycystic kidney dx

118
Q

a rapid increase in creatinine from 0.8 to 1.2 within 8 hrs represents:

A

AKI

119
Q

a change in creatinine from 0.9 to 1.4 is about _____ loss of kidney function

A

50%

120
Q

patients that require assessment for complications of decreased GFR include:

A

moderately ( stage 3) or severely ( stage 4) decreased GFR

risk factors for faster decline in GFR

CVD

proteinuria

hematuria

consultation and or co mgmt with kidney dx care team during stage 3 is recommended, as is referral to nephrologist at stage 4.

121
Q

info to send with referral to nephrologist for CKD pt:

A

medication hx

exam

urine dipstick result for hematuria and quantization of proteinuria

blood tests: CBC, urea, electrolytes, HbA1c if diabetic; if available, Calcium, albumin, phosphate, cholesterol

previous tests of renal function with dates

imaging: renal ultrasound

122
Q

commonly prescribed drugs that should be renal dosed in CKD:

A

DM meds

HTN meds

Cholesterol meds

Abx

antidepressants

analgesics

123
Q

JNC recommendation for tx of HTN in pts with CKD:

A

ACE1 and ARB

124
Q

if a pt decides he wants to be screened for prostate cancer, PSA tests should be done at intervals ranging from every __ to __ yrs

A

2 -4

125
Q

if a pt decides he wants to be screened for prostate cancer,
stop screening after age __ or earlier when comorbities limit life expectancy to less than __ yrs or the pt decides they want to stop screening

A

69

10

126
Q

long term calcium supplementation is recommended in postmenopausal women as its use reduces the risk of fracture by about:

A

50 %

127
Q

the typical HT regimen contains_____ or less of the estrogen dose of COC

A

1/4

128
Q

phytoestrogens are:

A

chemical substances similar to estrogen, in particular estrodiol, that are found in more than 300 plants including apples, carrots, coffee, potatoes, yams, soy products, flaxseed, ginseng, bean sprouts, red clover sprouts, sunflower seeds, rye, wheat, sesame seed, linseed, black cohosh and bourbon

129
Q

which body area has the greatest concentration of estrogen receptors?

A

vulva

130
Q

average age of onset of perimenopause:

A

40 -45 yrs

131
Q

during asymptomatic HSV2 infections, genital shedding of virus occurs approximately ____ % of days

A

10%

132
Q

which agent is most effective against C. Trichomatis?

A

azithromycin

133
Q

tx of vulvovaginitis caused by candida albicans includes:

A

clotrimazole cream

134
Q

annual screening for C. Trachomatis infection is recommended for

A

sexually active women 25 yrs of age and younger

135
Q

guidelines recommend considering initiating tx with an ESA for pts with CKD and hg of :

A

less than 10 mg/dL

136
Q

creatinine is best described as:

A

a product related to skeletal muscle metabolism

137
Q

creatinine clearance usually ________ GFR

A

approximates

138
Q

ACEI can limit the progression of some forms of renal dx by:

A

reducing efferent arteriolar resistance

139
Q

what is azotemia?

A

elevation of BUN and creatinine levels

140
Q

renal failure associated electrolyte imbalances

A

hyperkalemia
hyperphosphatemia
hypocalcemia
bicarbonate deficiency(metabolic acidosis)

141
Q

the use of which medications can precipitate acute renal failure in a pt with bilateral renal artery stenosis?

A

ACEI

ARBs

142
Q

if Urine sodium is low, urine osmolality is high, elevated BUN, normal serum creatinine, dx is:

A

pre renal azotemia

143
Q

if urine sodium is low, urine osmolality is high, BUN and Cr are WNL, dx is:

A

post- renal azotemia

144
Q

urine sodium high, urine osmolality is low, BUN: Cr is low, dx:

A

intrarenal injury

145
Q

dx confirmation of glomerulonephritis confirmation requires a ______

A

kidney biopsy

146
Q

in children and the elderly, ________ can contribute to bladder instability and increase the risk of a UTI

A

constipation

147
Q

hemorrhagic cystitis is characterized by ______ voiding symptoms

A

irritative

148
Q

the most likely causative organism in community acquired UTI in women of child bearing years is:

A

E. Coli

149
Q

most common form of incontinence in elders, caused by detrusor overactivity causing uninhibited bladder contractions

A

urge incontinence

Diagnosis & Management 2 (4 decks)

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