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Clinical Medicine II > Exam 2: GU/Renal > Flashcards

Exam 2: GU/Renal Flashcards

1
Q

Methods to treat hemorrhoids include

A
  • Increasing fiber (20-30 G per day) and water (1 1/2-2 L per day)
  • Sitz baths
  • Stool softeners (docusate sodium)
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2
Q

Internal hemorrhoids can be treated with

A

Office banding or sclerotherapy

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3
Q

Diverticulitis can be Dx with

A

Contrast CT scan

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4
Q

Outpatient tx of Diverticulitis includes

A

Liquid diet x 2-3 days then advance to soft foods

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5
Q

what Antibiotics do we discharge a diverticulitis pt with?

A

Either ciprofloxacin plus metronidazole or augmentin (10-14 day course)

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6
Q

Inpatient tx of Diverticulitis includes

A
  • Liquids / bowel rest
  • IV antibiotics: Metronidazole + 3rd gen cephalosporin
  • Pain control (Acetaminophen or morphine)
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7
Q

International prostate sx score (IPSS) / American urological association sx index can be used to diagnose

A

BPH (benign prostatic hyperplasia)

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8
Q

Other helpful tools to confirm dx of BPH (benign prostatic hyperplasia) includes

A
  • Urinalysis to rule out UTI
  • Post-void residual volume (can see how much urine gets trapped)
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9
Q

What post void residual volume would be considered abnormal?

A

Abnormal is >250 mL

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10
Q

Medication tx for BPH (benign prostatic hyperplasia) can include

A

Alpha-1-receptor blockade: Tamsulosin (Flomax) 0.4 mg po daily

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11
Q

One contra-indication of Tamsulosin for BPH tx is

A

**Cataract surgery! can cause intra-op floppy iris syndrome

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12
Q

A common surgical tx of BPH (benign prostatic hyperplasia) includes

A

Transurethral resection of the prostate (TURP)

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13
Q

Pts with BPH (benign prostatic hyperplasia) should have what done annually?

A

DRE and PSA annually

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14
Q

What is a complication of BPH?

A

Bladder outlet obstruction

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15
Q

An undescended or maldescended testis that does not ascend by 4 months of age is known as

A

Cryptorchidism

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16
Q

Treatment / surgical exploration of cryptorchidism us

A

orchidopexy/orchidectomy

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17
Q

Those with cryptorchidism have a risk for

A

testicular tumor development

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18
Q

Dx of a unilateral undescended testis WITHOUT hypospadias is done via

A

Surgical exploration

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19
Q

Unilateral or bilateral undescended testis WITH hypospadias or bilateral non-palpable testis should under go

A
  • Karyotype for sex determination and some other tests
  • Plus surgical exploration
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20
Q

Bilateral cryptorchidism have decreased

A

fertility

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21
Q

NPT (nocturnal penile tumescence testing) testing can be used for

A

Erectile dysfunction

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22
Q

First line medication therapy for erectile dysfunction is

A
  • PDE5 inhibitors 1st- sildenafil (viagra)
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23
Q

Varicoele is more common in

A

left testicle

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24
Q

Unilateral varicoceles can sometimes be associated with

A

malignancy

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25
Q

Dx method of choice for a varicocele

A

High-resolution color-flow doppler ultrasonography

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26
Q

Primary treatment for a varicocele is

A

Surgery

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27
Q

Transillumination is POSITIVE in a

A

Hydrocele (NOT diagnostic)

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28
Q

Diagnosis of a hydrocele is

A

Ultrasound

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29
Q

what is THE BEST TEST for bladder contractility and the extent of bladder outlet obstruction? Confirms stress incontinence.

A

Voiding Cystometrogram

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30
Q

The most sensitive clinical imaging modality for calcifications / suspected nephrolithiasis / urolithiasis is

A

Helical CT scanning without contrast material

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31
Q

The definitive therapy for paraphimosis is

A

Circumcision

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32
Q

The definitive therapy for phimosis is

A

Circumcision

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33
Q

Breakdown the grading score of Phimosis

A

Grade I = Fully retractable prepuce w/ stenotic ring in the shaft
Grade II = Partial retractibility with partial exposure of the glans
Grade III = Partial retractibility with exposure of the meatus only
Grade IV = No retractability

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34
Q

Testicular salvage in a pt with testicular torsion most likely occurs if the duration of torsion is LESS than

A

6-8 hrs

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35
Q

The cremasteric reflex is ABSENT in patients with

A

testicular torsion

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36
Q

Definitive diagnosis of testicular torsion is

A

scrotal color doppler sonogram

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37
Q

Treatment of choice for testicular torsion is

A

(manual detorsion) or surgical exploration; correction or orchiectomy if needed

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38
Q

if a patient presents with sudden onset of severe testicular pain and the testicle is high-riding and horizontal you should suspect

A

Testicular torsion

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39
Q

The most sensitive clinical imaging modality for calcifications is

A

Helical CT scanning with contrast

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40
Q

The most common metabolic abnormality related to nephrolithiasis and urolithiasis is

A

hypercalciuria

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41
Q

surgical treatment of kidney stones includes

A

Extracorpeal shock wave lithotripsy

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42
Q

Indications for surgery for a pt with kidney stones is

A

Pain, infection, and obstruction; Stone > 4weeks

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43
Q

Hypospadias is when

A

the meatus on ventral side (underside) of the penis

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44
Q

Diagnosis of hypospadias is

A

via examination!
- refer to urology

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45
Q

Tx of hypospadias includes

A
  • avoiding circumcision in neonates
  • surgery is done btw 6 mo - 1 yr
  • can require multiple surgeries
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46
Q

Epispadias is when the

A

urethral meatus located on the dorsum of the penus

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47
Q

Dx tool of choice for peyronie’s dz is

A

Ultrasound

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48
Q

Tx of peyronie’s dz if LESS than < 30 degree curvature and normal function is

A

observation

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49
Q

Tx of peyronie’s dz if greater than >30

A

NSAIDs and Pentoxifylline x 3 months 1st

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50
Q

Dx test of a spermatocele is

A

Ultrasound

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51
Q

Most common cause of acute urinary retention is

A

Outflow obstruction

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52
Q

Dx of acute urinary retention is

A

Ultrasound of the bladder >300 cc (may be MUCH more)

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53
Q

Dx of Chronic urinary retention is

A

Ultrasound of the bladder >300 cc (may be MUCH more)

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54
Q

Acute treatment of chronic urinary retention is

A

Bladder decompression via catheterization
EITHER - urethral OR suprapubic

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55
Q

Most common cause of UTIs is

A

E. coli **

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56
Q

Dx of UTIs is

A

Urinalysis (UA)

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57
Q

Leukocyte esterase and nitrites on UA are suggestive of

A

UTI

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58
Q

First line antibiotics for a simple UTI is

A

Nitrofurantoin (Macrobid) 100mg PO q12 x 5 days

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59
Q

First line antibiotics for a complicated UTI is

A

Ciprofloxacin (Cipro) PO or IV (500 mg po BID x 5-10 days)

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60
Q

When to obtain a culture with suspected UTI?

A
  • Males w/ sx of UTI
  • Females that have had >2 UTIs within 6 mo
  • Pts that don’t resolve in 2-4 wks
  • pregnant women
  • anyone w/ fever
  • anyone w/ signs of pyelonephritis
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61
Q

Dx of pyelonephritis is

A

Urinalysis (UA)

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62
Q
  • White cell casts on UA
  • Leukocytosis w/ left shift on CBC
    both are indicative of
A

Pyelonephritis

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63
Q

Tx of pyelonephritis includes

A

Ciprofloxacin (cipro) PO or IV* better as initial therapy* for 14 days

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64
Q

Organism likely to cause acute prostatits in pts <35 yo

A

STDs are more likely

65
Q

Organism likely to cause acute prostatitis in pts > 50 yo

A

E. coli

66
Q

First line treatment of acute prostatitis is

A

Any will work
- Trimethoprim - sulfamethoxazole (Bacterim)**
- Ciprofloxacin (Cipro)
- Levofloxacin (levaquin)

67
Q

Pts < 35 yo with acute prostatitis - what should be added into their treatment plan?

A

Add tx to cover STD: Ceftriaxone

68
Q

What is Prehn’s sign

A

lifting testicle relieves pain in epididymitis NOT pain caused by testicular torsion

69
Q

epididymitis in sexually active men is likely

A

Chlamydia trachomatis

70
Q

epididymitis in less sexually active men is likely

A

E. coli and pseudomonas species

71
Q

If E.coli is the suspected cause of epididymitis tx with

A

Levofloxacin 500 mg orally once daily for 10 days

72
Q

If an STI is the suspected cause of epididymitits tx with

A

Ceftriaxone (gonorrhea) PLUS Doxycycline (chlamydia)

73
Q

Orchitis is mostly associated with

A

viral mumps infection

74
Q

Interstital cystitis is a diagnosis of

A

exclusion*

75
Q

Cystoscopy may help in the dx of

A

interstitial cystitis

76
Q

Hunner lesions are seen in

A

interstitial cystitis

77
Q

Lesions affecting all layers of the bladder wall; brownish-red patches on the mucosa are known as

A

Hunner lesions

78
Q

Tx of interstitial cystitis includes

A

No cure - reassurance and education
- Amitriptyline (TCA)*
- Anti-inflammatory meds
- Antihistamines

79
Q

what are two tests/ that can directly observe urine loss?

A
  • Cough stress test
  • Marshall test (aka. Marshall-Bonney test)
80
Q

what does the cough stress test evaluate?

A

Evaluates for cough leak pressure point

81
Q

What does the Marshall test, test for?

A

Placing an index finger and the second finger on either side of the bladder neck, advise pt to Valsalva and observe for leakage

82
Q

most common urologic emergency is

A

Acute urinary retention

83
Q

IgA nephropathy aka “Berger Disease” is dx via

A

Positive IgA staining on renal biopsy

84
Q

dx of Goodpasture syndrome

A
  • Anti GBM antibodies in 90%
  • Renal biopsy shows cresent formation
85
Q

Kimmelstiel-Wilson nodules is pathognomic for

A

Diabetic Nephropathy

86
Q

Minimal change disease is tx with

A

prednisone

87
Q

Most common cause of proteinic renal dz in children in the world is

A

Minimal change disease

88
Q

Malignancy of plasma cells is

A

Multiple myeloma

89
Q

Presence of light chain Ig (Bence Jones proteins) in the urine is dx of

A

Multiple myeloma

90
Q

Dx gold standard for tuberculosis is

A

Sterile urine culture

91
Q

Best initial dx test for a Wilms tumor is

A

Ultrasound

92
Q

Definitive dx of Wilms tumor is

A

Histology/biospy

93
Q

MC type of hernia is

A

Indirect hernia

94
Q

A hernia through the internal ring of the inguinal ring and that touches the TIP of your finger on exam is likely a

A

Indirect hernia

95
Q

A hernia that passes through the external inguinal ring at Hesselbach’s triangle is

A

Direct hernia

96
Q

Femoral hernias are more common in

A

Females

97
Q

A hernia that appears at birth, goes away by age 13 and protrudes when the pt coughs or bears down is

A

Umbilical hernia

98
Q

Biggest risk factors for bladder cancer are

A

Environmental exposures and SMOKING

99
Q

90-95% of bladder cancers are

A

urothelial or transitional cell carcinomas

100
Q

painless gross hematuria is suspicious of

A

Bladder cancer (until proven otherwise)

101
Q

Gold standard for initial dx and staging of bladder cancer is

A

Cystoscopy with biopsy

102
Q

Surgery to remove bladder cancer is

A

Transurethral resection of the bladder tumor (TURBT)

103
Q

Follow up care/studies for bladder cancer includes

A

Cystoscopy and bladder wash cytology every
- 3mo for 2 yrs
- 6mo for 2 yrs
- At LEAST yearly

104
Q

Most prostate cancers are what and in which zone

A
  • Adenocarcinoma
  • 70% in the peripheral zone
105
Q

Risk factors for Prostate cancer

A
  • increasing age
  • African American
    • FHx
106
Q

Hematospermia is suspicious of

A

Prostate cancer

107
Q

DRE findings of nodular, asymmetric prostate is suspicious of

A

Prostate cancer

108
Q

What PSA level is normal

A

Less than 4

109
Q

Risk of a PSA 4-10 ng/mL

A

20-30% risk

110
Q

Risk of a PSA 10-20 ng/mL

A

50-75% risk

111
Q

Risk of a PSA above 20 ng/mL

A

90% risk

112
Q

A PSA rate/rise of what in a year is concerning

A

0.4-0.8

113
Q

When do you do a TRUS in a pt suspected of prostate cancer

A

If PSA is elevated with abnormal DRE

114
Q

Dx and staging of prostate cancer

A

Transrectal ultrasound and biopsy (TRUS)

115
Q

what is the Gleason score used for

A

Tells differentiated vs anapestic cells of prostate cancer

116
Q

A classic triad of Hematuria, a palpable abdominal mass, and flank pain is suspicious of

A

Renal cell carcinoma

117
Q

Dx of renal cell carcinoma is

A

CT and ultrasonography

118
Q

Testicular cancer presents in what age group

A

males 15-35yrs

119
Q

Cryptorchidism is a risk factor of

A

Testicular cancer

120
Q

Serum tumor markers for testicular cancer include

A
  • HCG
  • AFP
  • LDH
121
Q

Surgery for testicular cancer is

A

Orchiectomy

122
Q

Penile cancer is usually

A

squamous cell carcinoma

123
Q

The most likely cause of Thromboembolic disease is

A

90% originate in the Heart; commonly happen from atrial fibrillation

124
Q

Best test dx for Thromboembolic disease

A

CTA

125
Q

Tx of Thromboembolic disease includes

A

1) Anticoagulation w heparin
2) Thrombolytic therapy
3) Best option = Percutaneous transluminal renal angioplasty (PTRA)

126
Q

Polyarteritis nodosa is treated with

A

Prednisone / Glucorticoids

127
Q

Polyarteritis nodosa is dx with

A

Biopsy

128
Q

Atheroembolic disease is dx with

A

CTA

129
Q

Definitive dx of atheroembolic dz is

A

Biopsy (BUT NOT DONE)

130
Q

If a pt has refractory HTN and on multiple meds / good lifestyle changes but nothing is working, you should consider what condition?

A

Renal artery stenosis (RAS)

131
Q

Renal artery stenosis (RAS) is dx with

A

Duplex US

132
Q

TTP (Thrombotic thrombocytopenia purpura) pentad is

A
  1. hemolytic anemia
  2. thrombocytopenia
  3. fever
  4. Renal sx
  5. CNS sx
133
Q

TTP can be treated with

A

TPE - therapeutic plasma exchange

134
Q

Triad of hemolytic anemia, thrombocytopenia, and acute renal failure indicates

A

HUS - Hemolytic uremic syndrome

135
Q

HUS - Hemolytic uremic syndrome tx is

A

Supportive!!! AVOID antibiotics

136
Q

Elevated levels of both BUN and Creatinine is

A

Azotemia / Renal failure

137
Q

Urine MUSST be examined within how many hours of collection?

A

1 HOUR

138
Q

what is most commonly used for the assessment of GFR?

A

Creatinine

139
Q

An elevated BUN WITH elevated creatinine likely indicates a

A

Kidney issue

140
Q

If the BUN to creatinine ratio raises TOGETHER maintaining the ratio it suggests

A

Renal Parenchymal disease

141
Q

If there is excess urea production increasing the BUN to creatinine ratio it us likely due to

A

GI bleeding, catabolic drugs, or decreased urine flow

142
Q

A decrease in the BUN/creatine ratio may indicate

A

Extremely low protein ingestion

143
Q

GFR can be measured indirectly by calculating

A

the renal clearance of plasma substances

144
Q

Hematuria with dysmorphic RBC and RBC casts on UA indicate

A

Glomerulonephritis

145
Q

Proteins and lipids on UA indicate

A

Nephrotic syndrome

146
Q

WBC and WBC casts on UA indicate

A

Interstitial nephritis or pyelonenephritis

147
Q

Proteinuria in an adult is

A

> 150-160 mg/24 hrs

148
Q

Nephrotic syndrome is

A

3.5 g/24 hrs

149
Q

what are two meds that can help lower the intraglomerular pressure

A
  • ACE inhibitors and ARBs
150
Q

Hematuria is

A

> 3-5 RBS / high power field of UA

151
Q

Dx imaging for kidneys is

A

Ultrasound

152
Q

Contrast injection is contraindicated in those

A

increased risk for acute renal failure (DM, Creatinine >2mg/dl, or dehydration)

153
Q

Muddy brown casts indicates

A

Acute tubular necrosis

154
Q

Fatty casts indicate

A

Nephrotic syndrome

155
Q

RBC and Granular casts indicate

A

Nephritic syndrome

156
Q

Waxy and pigmented granular casts indicates

A

Chronic renal failure

157
Q

Muddy brown casts indicates

A

Acute tubular necrosis

158
Q

Hyaline casts are

A

Normal

Clinical Medicine II (4 decks)

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