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Renal/GU > General > Flashcards

General Flashcards

1
Q

Urinalysis finding in:
Glomerulonephritis
Nephrotic syndrome
Interstitial nephritis

A

GN: RBC casts, proteinuria, hematuria
Nephrotic syndrome: fatty casts, oval bodies, proteinuria
Interstitial nephritis: WBC casts without bacteria, proteinuria

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2
Q

Components of nephrotic syndrome

A

Proteinuria, hypoalbuminemia, edema, hyperlipidemia, hypercoagulability
Will also see oval fat bodies in urine

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3
Q

Treatment of nephrotic syndrome

A

Fluid restriction, iv diuresis,ACEi

Steroids

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4
Q

Patient with nephrotic syndrome presents with hematuria, flank Pain and worsening renal function .. what complication should be considered

A

Renal vein thrombosis

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5
Q

Causes of pseudohematuria

A

Foods (beers, berries, rhubarb), meds (rifampin, phenazopyridine, nitofurantoin), porphyrias

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6
Q 
Match clinical feature with disease. Gross hematuria with:
A) dysuria, frequency
B) hemoptysis
C) recent URTI
D) RBC casts, proteinuria
E) petechiae/purpura, schistocytes
F) nephrotic syndrome, flank pain
G) developing countries
A 
A) uti
B) goodpastures, Wegener
C) glomerulonephritis
D) glomerulonephritis
E) HUS / TTP
F) renal vein thrombosis
G) schistosomiasis
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7
Q

What should you consider if a dipstick is positive for heme but no RBCs are seen on microscopy

A

Rhabdomyolysis

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8
Q

Who should get imaging in hematuria

A

Gross hematuria and risk factors for serious etiology (>35, abdo pain , excessive analgesic use)

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9
Q

Where along GU tract should you suggest pathology for hematuria:
At beginning of stream
Throughout stream
At end of stream

A

Urethral
Proximal to urethra
Bladder neck or prosthatic urethra

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10
Q

Two possible treatments to relieve bladder spasms in patients with bladder cancer and hematuria

A

Belladonna and opium suppositories

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11
Q

4 renal causes of AKI

A

Glomerulonephritis
AIN
ATN
vascular

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12
Q

What should be considered as a cause of AKI in a patient who just started an ACEi

A

Bilateral renal artery stenosis

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13
Q

4 causes of pre renal AKI

A

Hypovolemia
Volume redistribution (third spacing, sepsis, hypoalbuminemic states eg cirrhosis)
Decreased effective cardiac output (MI, cardiomyopathy, valvular disease)
Meds limiting perfusion (ACEi, NSAIDs)

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14
Q

What happens to the urine sodium and the fractional excretion of sodium in pre renal AKI

A

Low urine sodium and low fractional excretion of sodium

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15
Q

Treatment of pre renal AKI

A

Correct hypovolemia, augment cardiac output
Discontinue ACEi, NSAIDs
Correct electrolyte imbalance

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16
Q

Causes of glomerulonephritis

A

Primary eg Post streptococcal

Secondary to systemic disease eg SLE, Goodpasture, vasculitis

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17
Q

Management of glomerulonephritis

A

Supportive care, control BP

Steroids and immunesuppressants for underlying systemic illness (not for post strep GN)

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18
Q

Lab and UA findings in AIN
meds that can cause AIN
Treatment of AIN

A

Elevated Cr
WBC, WBC casts, eosinophils on UA
Meds: penicillin, anticoagulants, NSAIDs, diuretics
Treatment is supportive, stop offending agent, steroids if no improvement in 3-7d

19
Q

3 causes of acute tubular necrosis

A 
Renal ischemia (surgery, sepsis, trauma)
Nephrotoxic agents (contrasts, aminoglycosides)
Pigments (myoglobin in rhabdo, hemoglobin in hemolysis)
20
Q

Diagnostic criteria for ATN

A

Loss of urine concentrating ability
UA shows granular muddy brown casts, renal tubular casts. Consider rhabdo if UA positive for heme but never for RBCs
Urine osmolality = serum osmolality

21
Q

Macro and micro vascular causes of renal AKI

A

Macro: renal artery occlusion, AAA
micro: HUS, TTP, embolus, malignant hypertension

22
Q

6 causes of bladder outlet obstruction

A 
BPH
stones
Tumor
Clot
Neurogenic bladder
Posterior urethral valve
Urethral stricture
Phimosis
23
Q

How does uremic frost present

A

Deposition of urea from evaporated sweat, fine white powder on skin

24
Q

10 manifestations of CKD

A

Uremia
Volume overload, pulmonary edema
Hypertension
Pericarditis (look for tamponade in sick ESRD pt)
Anemia (decreased EPO)
Bleeding
Encephalopathy (altered mental status, hiccups, asterixis)
Peripheral neuropathy
Immunesuppression
Hyperkalemia
Systemic calcification (consider calciphylaxis in violaceous skin lesions with ESRD)

25
Q

Management of CKD

A

If not in ESRD look for AKI on CKD
Manage HTN, hyperk and pulm edema
Dialysis
Renal transplant

26
Q

Management of actively bleeding ESRD patient

A

DDAVP is first line (releases vWF)
Cryo (factors I, II, VIII, XIII, VWF)
Transfuse for symptomatic under 70
Conjugated estrogens

27
Q

By what mechanism may furosemide still be helpful in cardiogenic edema in Anuric patients

A

Vasodilation

28
Q

5 indications for emergent dialysis

A

Acid base disturbance (severe metabolic acidosis)
Electrolyte disturbance (hyperkalemia, hypercalcemia)
Ingestions (salicylates, alcohols, lithium, barbiturates)
Overload (severe HTN, pulmonary edema)
Uremia symptomatic (pericarditis, encephalopathy, nausea/vomiting, twitching)

29
Q

5 renal colic mimics

A 
AAA
pyelonephritis
Testicular torsion
Ovarian torsion 
Acute papillary necrosis
30
Q

5 sites where renal calculi cause obstruction

A

calyx, ureteropelvic junction, uretovesicular junction, vesical orifice, pelvic brim

31
Q

This type of renal stone is caused by urea splitting bacteria (pseudomonas, klebsiella, staph, proteus) and can cause stag horn calculi

A

Struvite

32
Q

When should imaging be performed in suspected renal colic

A

Patient looks sick, diagnosis in question, first episode flank pain, suspect high grade obstruction

33
Q

What percentage of stones >8 mm will pass

A

20% only, often need lithotripsy or surgical intervention

34
Q

Criteria for admission for renal colic

A

Solitary kidney
Acute renal insufficiency
Obstructing stone with infection
Intractable pain or vomiting

35
Q

11 factors making UTI Complicated

A 
Men
Elderly (>65)
Pregnant 
Pyelo
Indwelling catheter
Recent instrumentation
Structural urinary tract abnormalities
Treatment failure
Immunesuppressed
Recent hospitalization
36
Q

Most likely cause of dysuria and Pyuria

A

Urethritis or prostatitis (not UTI)

37
Q

What type of bacteria do nitrites on UA

A

Gram-negative UA

38
Q

Duration of therapy for:
A)Uncomplicated cystitis
B)Uncomplicated cystitis with comorbidities
C)Uncomplicated pyelo
D)Complicated UTI
E)Pregnancy (including asymptomatic bacteriuria)
F)Pregnant pyelo

A 
A) 3-5
B) 7
C) 14
D) 14
E) 7
F) 14
39
Q

Admission criteria for uti

A 
Extremes of age
Systemic toxicity
Renal failure
Obstruction
Complicated uti have lower threshold
Intractable vomiting or pain
40
Q

Treatment of acute bacterial prostatitis

A

<35 treat at STI: ceftriaxone 250 mg IM and doxy x 10d
>35 : GN predominates. Fluoroquinolone

In chronic bacterial: fluoroquinolone x 4 weeks or septa x 1-3 months

41
Q

Two types of painful penile ulcers and their treatment

A

Hsv : acyclovir

Chancroid: azithro or cipro or ceftriaxone

42
Q

Presentation of lymphogranuloma venereum and treatment

A

Chlamydia. Transient, painless ulcer followed by tender unilateral inguinal adenopathy
Doxy

43
Q

Differential for presenting with both oral and penile ulcers

A

Behcets, Stevens Johnson syndrome, pemphigus vulgaris, Reiter syndrome

Renal/GU (3 decks)

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