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NP School > Genitourinary > Flashcards

Genitourinary Flashcards

1
Q

An upper urinary tract infection involves what structures?

A

kidney and/or ureters

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2
Q

A lower urinary tract infection involves what structures?

A

bladder and/or urethra

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3
Q

What is the most common pathogen that causes a UTI?

A

Escherichia Coli (E. Coli)

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4
Q

S/S of Lower Urinary Tract Infection
(cystitis, urethritis, prostatitis)

A

-NO FLANK OR CVA TENDERNESS
- dysuria
- frequency/urgency
- suprapubic pain
- hematuria w/ bacteruria
- fever
- chills

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5
Q

S/S of Upper Urinary Tract Infection
(Pyelonephritis, abscess)

A
  • FLANK PAIN and/or CVA Tenderness
  • fever
  • hematuria
  • N/V
  • malaise
  • rigors
  • tachypnea
  • tachycardia
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6
Q

What is the diagnostic gold standard test to diagnose a UTI?

A

Positive Urine Culture - detection of bacteria in the culture

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7
Q

How long does it take for urine culture results to be available after collection?

A

24 hrs

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8
Q

What is the term for the presence of
> 10 leukocytes/ml in urine?

A

pyuria

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9
Q

Bacteriuria is when there is > __?__ bacteria/ml of urine?

A

> 100,000
- indicates active infection

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10
Q

Leukocytosis with a shift to the left is indicative of what urinary tract disorder?

A

Pyelonephritis
- shift to the left means increased number of immature WBCs, usually band cells which are immature precursors

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11
Q

What tests are done to r/o obstruction, calculi or urinary retention?

A
  • post void residuals
  • CT abd/pelvis w/ and w/o contrast
  • Pelvic Ultrasound
  • MRI pelvis w/ and/or without contrast
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12
Q

What should be suspected in a patient with a UTI related fever lasting longer than 3 days?

A

obstruction or abscess
- abd imaging (CT, US, MRI)
- urology consult

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13
Q

What labs should be done if a UTI is suspected?

A
  • Clean catch midstream Urinalysis
  • Urine dipstick test
  • CBC (leukocytosis w/ shift to left)
  • blood culture (pyelonephritis, sepsis)
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14
Q

What are the 4 first line ABX used to treat acute cystitis?

A
  • Fosfomycin
  • Macrobid
  • Sulfonamides
    • TMP-SMX aka Bactrim DS
    • Trimethoprim
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15
Q

What is the generic name for Nitrofurantoin monohydrate/macrocrystal?

A

Macrobid

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16
Q

When should Fluoroquinolones be used in the treatment of acute cystitis?

A

As a second line therapy and should only be used when there is no other option due to the severity of adverse effects
- end in -oxacin
- cause tendonitis, tendon rupture, disorientation

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17
Q

What is the treatment for an uncomplicated upper UTI (pyelonephritis)?

A

Treated as an outpatient
- Fluoroquinolones (ciprofloxacin)
- Sulfonamides (TMP-SMX aka Bactrim DS)
- Oral B-lactams (amoxicillin-clavulanate)

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18
Q

Sulfonamides should be used with caution in patients with _______ when treating an UTI?

A

impaired renal function
- sulfonamides are nephrotoxic

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19
Q

Levofloxacin is used to treat what kind of UTI?

A

Cystitis -complicated lower UTI

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20
Q

What are the fluoroquinolone ABX?

A
  • ciprofloxacin
  • levofloxacin
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21
Q

Ciprofloxacin and levofloxacin are what classification of ABX?

A

Fluoroquinolones

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22
Q

What is the treatment for a complicated lower UTI (cystitis)?

A
  • Levofloxacin
  • ceftriaxone
  • piperacillin/tazobactam (zosyn)
  • aminoglycoside with ampicillin
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23
Q

What is the treatment for a complicated upper UTI (pyelonephritis)

A
  • Fluoroquinolones (ciprofloxacin)
  • Sulfonamides (TMP-SMX aka Bactrim DS)
  • Oral B-lactams (amoxicillin-clavulanate)
  • piperacillin/tazobactam (zosyn)
  • aminoglycosides (not use as monotherapy)
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24
Q

What are common s/s of a UTI in the elderly?

A
  • altered LOC
  • lethargy
  • delirium
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25
Q

Cause(s) of pre-renal AKI?

A

Decreased renal perfusion d/t:
(1) Volume depletion:
- hemorrhage
- GI loss (diarrhea, vomit, pancreatitis)
- increased UO (diabetes insipidus, diuretics)
- edema or 3rd spacing (burns, wounds)
(2) Vasodilation decreases blood flow
- sepsis
- anaphylaxis
- pancreatitis (increase cytokine release = increase premeability)
- drugs (ACEI, NSAIDs, diuretics)
(3) decreased CO decreases renal perfusion
- severe systolic HF
- MI
- cardiogenic shock
(4) Vasoconstriction or arterial occlusion

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26
Q

Lab findings indicative of a Pre-renal AKI?

A
  • oliguria (little to no UO)
  • urine sodium < 20 mEq/L (low)
  • urine osmolality > 500 mOsm/L (high)
  • urine specific gravity > 1.020 (high)
  • BUN/creatinine ration > 20:1 (high)
  • hyperuricemia
  • increased ADH secretion
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27
Q

Will Urinary sodium be high, low, or normal in a patient with a Pre-renal AKI?

A

low (< 20 mEq/L)

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28
Q

Will Urinary osmolality be high, low, or normal in a patient with a Pre-renal AKI?

A

high (> 500 mOsm/L)

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29
Q

Will Urinary specific gravity be high, low, or normal in a patient with a Pre-renal AKI?

A

high (> 1.020)

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30
Q

What are the 3 types of Intrinsic or Intra-renal AKIs?

A
  • acute glomerulonephritis
  • acute tubular necrosis
  • vascular
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31
Q

What are the causes of acute glomeruloneprhitis?

A
  • autoimmune
  • SLE
  • Sjogrens syndrome
  • sarcoidosis
  • idiopathic
32
Q

What are the causes of acute tubular necrosis (ATN)?

A
  • conditions that cause decreased renal perfusion and eventual ischemia and necrosis
  • sepsis
  • infection
  • low CO
33
Q

What is the term for the build up of nitrogenous products in the blood r/t to renal insufficiency?

A

Azotemia
- increased BUN/creatinine

34
Q

Furosemide is what type of diuretic?

A

Loop

35
Q

Bumetidine is what type of diuretic?

A

Loop

36
Q

Torsemide is what type of diuretic?

A

Loop

37
Q

What is the drug of choice to treat volume overload in a patient with an AKI?

A

Furosemide (lasix)
- 20-200mg q6hrs
- double dose after 1hr if response is not adequate

38
Q

Which drug is given to temporarily reverse the neuromuscular effects r/t to hyperkalemia?

A

IV Calcium, is cardioprotective

39
Q

Why is IV Calcium given to hyperkalemic patients?

A

to temporarily reverse the neuromuscular effects r/t to hyperkalemia

40
Q

What are the drugs that treat hyperkalemia by pushing K+ into the cells?

A
  • 10 Units of IV Regular insulin
    • give 25gm of dextrose if BG < 250
  • Inhaled Beta-2 agonist (onset w/in 30min)
41
Q

Which drug binds K+ in the GI tract preventing absorption?

A

Sodium Polystyrene Sulfonate (SPS)
- aka Kayexalate
- 15-30gm orally
- adds 1mEq Na for q 1mEq K+ removed

42
Q

What are methods for treating hyperkalemia?

A
  • Insulin
  • hInhaled Beta-2 agonist
    -Sodium Polystyrene Sulfonate (SPS) aka Kayexalate
  • Lasix (takes longer)
  • dialysis
43
Q

What is the definition of CKD?

A
  • GFR < 60mL/min with or w/out renal damage
  • Kidney dysfunction w/ one or more of:
    • albumineria
    • urine sediment abnormalities
    • elyte abnormalities r/t tubular disorders
44
Q

What are the causes of CKD?

A
  • Diabetes
  • glomerular disease
  • polycystic kidney disease
  • HTN
  • renal artery stenosis
  • recurrent kidney infections
45
Q

What is the normal GFR value?

A

80-120 mL/min

46
Q

Renal replacement therapy is started when the GFR is?

A

5-10mL/min

47
Q

Management of CKD?

A
  • tx fluid overload
  • tx HTN (ACE-I or ARBs are 1st choice)
48
Q

What is the 1st line drug for treatment of HTN in a patient with CKD?

A

ACE-I or ARB if cannot tolerated ACE-I

49
Q

What are common issues r/t to CKD?

A
  • fluid overload
  • HTN
  • hyperkalemia
  • hyperphosphatemia
  • hypocalcemia
  • hypermagnesemia (reduced excretion)
  • anemia (decreased erythropoietin)
50
Q

S/S of BPH?

A
  • frequency/urgency
  • dysuria
  • nocturia
  • incontinence
  • hesitancy
  • straining
  • dribbling
  • retention
    sensation of incomplete emptying
51
Q

What are the tests/diagnostic/lab tests if BPH is suspected?

A
  • UA
  • Urine culture to r/o infection
  • BUN/creatine to r/o renal insuffiency
  • Prostate-specific antigen (PSA)
  • Transrectal US for elevated PSA or palpable nodule
52
Q

Management of BPH?

A
  • wait and watch (may recover on own)
  • avoid nightly fluid intake
  • surgery (TURP)
    Meds
  • alpha 1 blockers (preferred for mild-mod) (terazosin, tamsulosin)
  • 5-alpha reductase inhibitors (finasteride, dutasteride)
  • muscarinic receptor antagonist
    -phosphodiesterase 5 (PDE5) inhibitors (sildenafil, end in afil)
53
Q

Terazosin (Hytrin) is what class of medication and is used to treat what condition?

A

alpha-1 blocker used to treat BPH
- relaxes muscle fibers in the prostate gland and i n the internal urethral sphincter

54
Q

Prazosin (Minipress) is what class of medication and is used to treat what condition?

A

alpha-1 blocker used to treat BPH
- relaxes muscle fibers in the prostate gland and i n the internal urethral sphincter

55
Q

What are the most common side effects r/t to alpha-1 blockers?

A

hypotension and dizziness

56
Q

Tamsulosin is what class of medication and is used to treat what condition?

A

alpha-1 blocker used to treat BPH
- relaxes muscle fibers in the prostate gland and i n the internal urethral sphincter

57
Q

Tadalafil (Cialis) is what class of medication and is used to treat what condition?

A

phosphodiesterase 5 (PDE5) inhibitor used to tx:
- BPH
- erectile dysfunction
- lower urinary tract symptoms (LUTS) that are not responsive to alpha-adrenergic antagonists

58
Q

What is the medical term for kidney stone?

A

nephrolithiasis

59
Q

What are the most common types of kidney stones?

A

calcium oxalate and calcium phosphate

60
Q

What are the different types of kidneys stones?

A
  • calcium oxalate
  • calcium phosphate
  • uric acid
  • struvite
  • cystine
61
Q

What is the main risk factor for calcium oxalate and calcium phosphate stone development?

A

high urine pH

62
Q

What is the difference between nephritic and nephrotic syndromes?

A
  • Nephritic - damage to glomerular basement membrane
    • proteinuria < 3.5 g/day
    • hematuria
  • Nephrotic - damage to podocytes
    • proteinuria > 3.5 g/day
    • lipidurea (fat oval bodies)
63
Q

What are causes of uric acid stone formation?

A
  • dehydration and low urine pH
64
Q

What are causes of calcium phosphate and struvite kidney stone formation?

A

high urine pH

65
Q

What are causes of calcium oxalate kidney stone formation?

A
  • decreased urinary citrate
  • increased urine calcium
  • increased uric acid
66
Q

What are causes of cystine kidney stone formation?

A
  • low urine pH
  • increased urine calcium
  • increased uric acid
67
Q

S/S of kidney stones

A
  • flank pain, can radiate to the groin
  • renal colic
    hematuria
  • CVA tenderness
  • hydronephrosis
68
Q

What are complications of having kidney stones?

A

Urine backs up = decreased bacteria out
- hydronephrosis
- pyelonephritis
- urosepsis (if gets into blood)

69
Q

What is the relationship between calcium and oxalate and how does it relate to a kidney stone formation?

A
  • oxalate binds to calcium in the GIT for excretion in stool
  • low calcium in diet leads to higher levels of free oxalate that are absorbed into the blood via the GIT
  • increased blood oxalate means higher level in urine to bind to urine calcium = stone formation
70
Q

Low urine pH is conducive to the formation of which type(s) of kidney stones?

A
  • Uric acid
  • cystine
  • calcium oxalate
71
Q

High urine pH is conducive to the formation of which type(s) of kidney stones?

A
  • calcium phoshate
  • struvite
72
Q

Which stone is aka a staghorn?

A

struvite

73
Q

What does urease do?

A
  • converts urea into ammonia
  • produced by bacteria such as
    ) helicobacter pylori
    ) proteus sp
    ) klebsiela sp
  • high ammonia levels can cause changes in LOC, tremors, coma
74
Q

What are the diagnostic tests if a kidney stone is suspected?

A
  • CT Abd and pelvis (gold standard)
  • renal us
  • kidney ureter bladder xr (KUB)
  • UA w/ microscopy
  • 24hr UA for recurrent stones
75
Q

Which stones will be radiopaque (can be seen) on a KUB XR?

A
  • Calcium oxalate
  • calciumphosphate
  • struvite (staghorn)
76
Q

Which stones will be radiolucent (can not be seen) on a KUB XR?

A
  • uric acid
  • cystine
77
Q

What is the treatment for a struvite kidney stone)

A

Abx

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