Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Exam 1 PNP > Genitourinary > Flashcards

Genitourinary Flashcards

1
Q

signs of renal disease in utero

A
  • oligohyramnios
  • polyhydramnios
  • intrauterine growth retardation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

oligohydramnios

A

reduced urine production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

polyhydramnios

A

reduced swallowing of amniotic fluid /w

increased urine production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

signs of renal disease in children

A
  • abnormal growth (small stature)
  • hypertension
  • dehydration
  • edema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

physical features w/ potential

underlying renal defects

A
  • fetal alcohol syndrome
  • down syndrome
  • pre-auricular skin tags or pits
  • external ear deformities
  • eye abnormalities (cataracts, coloboma, aniridia)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

name the condition

A

coloboma

(“leaking pupil”)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

name the condition

A

aniridia

(absence of iris)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

control of kidney filtration

A

glomeruar filtration

  • rate of blood flow through glomerulus controlled by arteriolar tone
  • renin
    • hormone prod. in juxtaglomerlar apparatus
    • responds to glomerular flow and perfusion
    • sensitive to low blood flow and low serum sodium
  • renin-angiotensin-aldosterone axis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

products absorbed and produced

by proximal tube

A
  • reabsorbs
    • 2/3 of filtered volume
    • Na+ and Cl-
    • glucose
    • amino acids, K+, PO4 almost completely reabsorbed
    • NaHCO3 reabsorption set by bicarb threshold
  • produces
    • calcitriol (Vit D analog)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Role of Loop of Henle

A

determines urine concentration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

components absorbed by distal tubule and collecting ducts

A
  • impermeable to water except if ADH present
  • active reabsorption of NaCl into bloodstream
  • collecting ducts are primary site of ADH production and aldosterone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

urinary anion gap

causes of low and elevated gap

A

measured gap between serum anions and cations

  • low
    • increased renal acid secretion
    • increased NH4 production
  • elevated
    • caused by metabolic acidosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

causes of increased anion-gap

metabolic acidosis

A

MUDPILES

  • Methanol
  • Uremia
  • Diabetic ketoacidosis
  • Iron, Inhalents (CO, cyanide, toluene), Isoniazid, Ibuprofen
  • Lactic acidosis
  • Ethylene glycol, ethanol ketoacidosis
  • Salicylates, starvation ketoacidosis, sympathomimetics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

maturation of renal function

(urine concentration, GFR, tubular reabsorption)

A
  • max. urine concentration - infants cannot concentrate urine (produce same amount even if dehydrated)
  • GFR - reaches adult levels by 1-2 years old
  • tubular reabsorption - adult levels by 1-2 y-o
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

urinalysis

what dipstick checks for

A

pH, protein, glucose, ketones, blood leukocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

urinalysis

what microscope checks for

A

pyuria, hematuria, casts, crystals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

urinalysis

what spot calcium/creatinine checks for

A

renal stones, hematuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

renal imaging

what US used for

A

most utilized in peds

kidney size, dilation, assess cortex vs. medulla

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

used to evaluate bladder filling/function

position of ureters/urethra

reflux into kidneys/ureters

A

voiding cystourethrogram (VCUG)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is nephrotic syndrome

A

heavy and persistent proteinuria

with protein losses (albumin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

signs of nephrotic syndrome

A
  • pitting edema and/or ascites
  • anorexia, malaise, abdominal pain
  • increased BP (25%)
  • shock d/t sudden albumin decline and fluid loss
  • NO gross hematuria or renal insufficiency
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

2 sources of proteinuria

A
  • tubular
  • glomerular
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

tubular proteinuria

types of proteins seen

A

low molecular weight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

tubular proteinuria

conditions

A
  • acute tubular necrosis
  • pyelonephritis
  • polycystic kidney
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

tubular proteinuria

causes

A

tubular toxins:

antibiotics

chemotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

glomerular proteinuria

type of protein seen

A

large and small

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

glomerular proteinuria

evidence of disease

A
  • hematuria
  • casts
  • HTN
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

MC but least severe nephrotic syndrome

A

minimal change disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

least common but most severe nephrotic syndrome

A

IgA nephropathy

30
Q

primary nephrotic syndrome

minimal change disease characteristics

A
  • MCC nephrotic syndrome in children (80% in children < age 7)
  • MC in males
  • most respond to steroids within 4 weeks
  • treat with oral steroids x12 weeks
31
Q

primary nephrotic syndrome

focal segment glomerulosclerosis characteristics

A
  • 10-20% of kids w/ NS
  • no specific tx - less steroid responsive
  • may need nephrectomy, dialysis, transplant
32
Q

primary nephrotic syndrome

membranoproliferative glomerulonephritis characteristics

A
  • 5-10% of kids w/ NS
  • caused by hypocomplementemia (immune complex deposits)
  • tx is to stop deposition of immune complexes
33
Q

what is secondary nephrotic syndrome

A

protein losses from kidney occur secondary to other diseases

  • vasculitis
  • chronic infections (hepatitis, malaria, HIV)
  • diabetes
  • renal vein thrombosis
  • amyloidosis
  • heart disease
  • malignancies
  • drug reactions
34
Q

when/what to check for proteinuria

A
  • first morning urine - r/o orthostatic or transient proteinuria which are not significant
  • presence of 1+ or higher protein on dipstick 2 or more times
35
Q

nephrotic syndrome treatment

A
  • steroids
  • loop diuretics for edema
  • B-blockers or Ca+ channel blockers for HTN
36
Q

complications of nephrotic syndrome

A
  • peritonitis and bacteremia
  • side effects of high dose steroids
  • hypovolemia from diuretics or diahhrea
  • loss of coagulation factors -
    • hypercoagulable state
    • DVT
37
Q

general presentation of glomerulonephritis

A

gross hematuria

38
Q

acute vs. chronic glomerlonephritis

A
  • acute
    • post streptococcal (PSGN) MC
  • chronic
    • IgA neuropathy MC
39
Q

presentation of acute glomerulonephritis

A
  • ages 2-12
  • MC in boys
  • HTN most serious problem
  • 10 days after strep infection (PSGN)
  • OR-
  • 4-6 weeks after impetigo (undiagnosed)
40
Q

S/s of glomerulonephritis

A
  • variable presentation
    • asymptomatic microscopic hematuria
    • or more acute
    • often assoc. w/ concurrent URI
  • rapidly progressing
    • can quickly progress to renal disease
    • observe emergently until no blood
  • glomerular blood brownish
    • casts and dymorphic RBCs
41
Q

x-lined disorder of collagen defect in glomerular basement membrane

(name, s/s)

A

Alport syndrome

  • hearing and vision problems

(can’t see, can’t hear)

  • renal failure in males
42
Q

non-glomerular causes of hematuria

A
  • painless gross hematuria
    • sickle cell
    • Wilms tumor
    • strenuous exercise
  • kidney trauma
  • urolithaisis
  • hypercalcemia
43
Q

Tx of gomerulonephritis

A
  • sick or not sick
    • observation if not sick
    • recheck urine and BP weekly
    • refer to nephrology if becoming chronic or BP elevated
  • Na+ restrictions, diuretics, antihypertensives for BP
  • treat underlying cause
  • ACE inhibitors reduce glomerular HTN
  • post-step usually self limited and benign
  • others w/ higher risk of chronic disease
44
Q

hemolytic uremic syndrome (HUS)

triad/cause

A
  • microangiopathic hemolythic anemia
  • thrombocytopenia
  • renal injury secondary to syndrome
  • assoc. w/ shigatoxin and diarrheal illnesses
    • E. coli - verotoxin (VT)
  • important cuase of kidney injury in children
  • typically < 5 y/o
  • non-diarrheal more severe
    • HIV, complement defects, medications, malignancy, pregnancy
45
Q

hemolytic uremic syndrome (HUS)

S/s

A
  • verotoxin causes hemorrhagic enterocolitis
  • bloody stools
  • 7-10 days after stools - lethargy, oliguria
  • irratability, pallor, petechiae
  • HTN from volume overload and renal injury
  • seizures (25%)
  • rare: pancreatitis, dysfunction, colonic perf.
46
Q

HUS

laboratory findings

A
  • CBC- anemia, thrombocytopenia
  • peripheral smear- schistocytes, burr cells, helmet cells
  • elevated LDH, AST, reticulocytes, bilirubin
  • decreased haptoglobin

“chewed up” RBCs

47
Q

HUS treatment

A
  • supportive care
  • volume repletion
  • RBC transfusion
  • HTN management
  • dialysis
48
Q

categories of renal failure

A
  • pre-renal
  • renal
  • post-renal
49
Q

cause/sign of pre-renal failure

A
  • glomerular hypoperfusion
  • MC dehydration
  • others:
    • cardiac failure
    • hemorrhage
    • cirrhosis
    • shock
  • sign: very concentrated urine
50
Q

causes/sign of renal failure

A
  • usually tubular injury
  • hypoxic ischemic tubular injury
  • infection (sepsis)
  • nephrotoxic agents
    • (myoglobin, meds, contrast medium)
  • inflammation
    • Interstitial nephritis
  • sign: mild hematuria/proteinuria, SG < 1.015
51
Q

causes/sign of post-renal failure

A
  • urinary tract obstructions
  • sign: reduced urine volume
52
Q

MCC chronic kidney disease

greater than/less than 10 y/o

A
  • < 10 y/o
    • congenital anomalies:

agenesis, duplication, polycystic, ureteral implantation, kidney parenchyma

  • > 10 y/o
    • focal glomerulosclerosis
53
Q

signs of kidney failure / CKD

A
  • growth failure
  • fractures and bone deformities
  • delayed puberty
  • HTN
  • renal osteodystrophy
  • hormonal abnormalities
  • uremia
54
Q

Tx of CKD

A
  • nutritional supplements / tube feeding
  • treat acidosis - NaHCO3, Na+ citrate
  • dialysis
  • address salt needs based on Na+ excretion
  • anemia - supplement erythropoietin and iron
  • renal ostedystrophy - PO4 restriction, Vit D
  • renal transplant
55
Q

2 types of pediatric HTN

A
  • essential
    • leading cause in children and adults - obesity
  • secondary
    • typically renal
56
Q

at what age do you begin

routine measurements of BP

A

3 y/o

57
Q

correct cuff size

A

“2 fingers under the cuff”

58
Q

effect of too large/small cuff on BP measurement

A

too large - low BP

too small - high BP

59
Q

diagnosis of HTN in children

A

3 measurements over 95 %tile

  • UA, electrolytes, Ca+, BUN, Cr tests
  • renal US
  • cardiac evaluation
60
Q

Tx of HTN in children

A
  • address underlying cause (esp. renal)
  • anti-hypertensives (like adults)
    • Ca+ blockers
    • ACE inhibitors
    • B-blockers
  • diet and exercise
61
Q

backward flow of urine from bladder up ureter

A

vesicoureteral reflux

62
Q

causes/risks of vesicoureteral reflux

A
  • junction of ureter and bladder congenitally malformed - can be familial
  • incomplete emptying leading to kidney infections and scarring (reflux nephropathy)
  • increased pressure of urine in renal pelvis -> decreased renal function and failure
  • neurologic bladder in 50% w/ VUR
  • significant incontinence and bladder training difficulties
63
Q

Dx of VUR

A
  • ususally unnoted until UTI
  • voiding cystourethrogram (VCUG)
    • bladder filled w/ contrast - allows grading
  • radionucleotide cystogram
  • renal US to ID abnormalities
64
Q

vesicoureteral reflux Tx

A
  • antibiotics to prevent recurrent UTI
  • teach good bladder/bowel habits to minimize urinary retention
  • deflux procedure - produce a valve at entry of ureter in to bladder
  • surgical reimplantation of ureters into bladder
65
Q

congenital kidney abnormalities

renal agenesis assoc. w/ this

A

diabetes during pregnancy

66
Q

congenital kidney abnormalities

renal hypoplasia/dysplasia assoc. w/ this outcome

A

eventual kidney failure

67
Q

congenital kidney abnormalities

polycystic kidney disease assoc. w/ this

A

genetic defect in structure - possible kidney failure

68
Q

congenital kidney abnormalities

posterior uretheral valves MC patient

A

1 DDx when 3 mo male w/ UTI

69
Q

when childhood urinary incontinence unacceptable

A

after age 5

70
Q

potty training characteristics

A
  • age varies by child and parent
  • daytime dryness preceeds nighttime
71
Q

issues preventing daytime dryness

A
  • poor habits
  • UTI undiagnosed
  • structural problem
72
Q

issues preventing nighttime dryness

A
  • age
  • bladder size
  • ADH production (DDAVP)
  • behavioral

Exam 1 PNP (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions