Genitourinary System

Question 1

Renal failure/injury is asymptomatic until ___ % of the nephron is lost

Answer 1

60

Question 2

Oliguric = \_\_\_\_ ml/day
Non-oliguric = \_\_\_ml/day

Answer 2

<400; >400

Question 3

Prerenal (60%-70%)

Answer 3

⬇️ renal blood flow (hypoxia)
Hypovolumia
⬇️ CO (CHF)
Sepsis
Burns
Renal artery stenosis

Question 4

Renal (intrinsic) injury

Answer 4

Damage to renal parenchyma
Acute tubular necrosis (MCC)
Nephrotoxic drugs (aminoglycosides, antifreeze, contrast)
Myoglobinuria (crush injury)

Question 5

Postrenal injury

Answer 5

Uriniary tract obstuction (BPH, stone, neoplasm)

Question 6

FEFNa (fractional excretion of filtered sodium):
___ suggests renal etiology (ATN:filter is broken)
___ suggests prerenal etiology (hypoperfusion)

Answer 6

> 1%; <1%

Question 7

Muscle relaxants of choice for acute renal failure. Which is contraindicated?

Answer 7

Atracurium, vecuronium, mivacurium;

Sux bc it causes hyperkalemia

Question 8

What is the most serious problem of uremia? MCC of death?

Answer 8

It inhibits immunity. Sepsis

Question 9

MC type of stone with nephrolithiasis

Answer 9

Calcium oxalalate

Question 10

Acute onset, colicky severe flank pain, N/V

Answer 10

Nephrolithiasis

Question 11

Tx of nephrolithiasis

Answer 11

Hydration, analgesia, lithotripsy, nephrolithotomy, Thiazide diuretics (⬇️ Ca conc in urine)

Question 12

What is the best test for renal function?

Answer 12

Creatinine clearance. Approximately equals GFR

Question 13

What test distinguishes prerenal from renal failure?

Answer 13

Fractional excretion of filtered sodium (FEFNa)

⬇️ prerenal, ⬆️ renal

Question 14

What organism causes glomerulonephritis?

Answer 14

Beta-streptococcal infection (cross reaction of antibodies)

Question 15

Immune complex mediated
Hematuria, proetinuria, HTN, & edema
Increase Cr
Red cell cast

Answer 15

Glomerulonephritis

Question 16

Tx for glomerulonephritis

Answer 16

Steroid + immunosuppressant

Question 17

Proteniuria > 3.5 g/day
Edema
Na retention
HTN
Hyperlipoproteinemia
Thromboembolic phenomenon & infections

Answer 17

Nephrotic syndrome

Question 18

Causes of nephrotic syndrome

Answer 18

DM, neoplasia, HIV, preeclampsia

Question 19

Hemoptysis & hematuria
Cross-reaction of antibodies
Progress to RF

Answer 19

Goodpasture syndrome

Question 20

Proteinuria
Decrease concentration ability
HTN
Reversible

Answer 20

Interstitial presentation

Question 21

Have deafness & ocular problems
HTN
RF
Tx ACE inhibitor for some protection

Answer 21

Hereditary nephritis (alport’s syndrome)

Question 22

Autosomal dominant

Accompanying Berry’s aneurysm -> subarachnoid hemorrhage

Answer 22

Polycystic renal disease

Question 23

Defects in PCT functions that lead to:
Polyuria
Metabolic acidosis d/t loss fo HCO3
Skeletal muscle weakness d/t loss of K
Dwarfism & osteomalcia d/t loss of phosphorous
Vit-D resistant rickets

Answer 23

Fanconi syndrome

Question 24

Detrusor Muscle

Answer 24

Filling of bladder: Relaxed B2

Emptying of bladder: Contracted M

Question 25

Internal sphincter

Answer 25

Filling of bladder: contracted (a1)

Emptying of bladder: relaxed (M)

Question 26

External sphincter

Answer 26

Filling of bladder: contracted (voluntary)

Emptying of bladder: relaxed (voluntary)

Question 27

Causes of transient urinary incontinence (DIAPPERS)

Answer 27

Delerium/confusion
Infection, urinary
Atropic urethritis/vaginitis
Pharmaceuticals
Psychological esp depression
Excessive urine output (CHF, hyperglycemia)
Restricted mobility
Stool impaction

Question 28

Overacitve bladder -> urgency

A/w UTI

Answer 28

Detrusor over-activity

Question 29

Tx for detrusor over-activity

Answer 29

Anticholinergic (M3 blocker tolterodine/detrol)

Bladder training

Question 30

Leak with ⬆️ intraabdominal pressure (sneezing, coughing)

Answer 30

Stress incontinence “outlet incompetence”

Question 31

Tx for stress incontenince

Answer 31

Kegel’s exercise, pessary, alpha agonist (phenylpropanolamine)

Question 32

Seen in BPH

Answer 32

Outlet obstruction

Question 33

Tx for outlet obstruction

Answer 33

Alpha blocker (prazosin), 5a-reductase inhibitor (finasteride)

Question 34

Incomplete emptying -> leak with overfilling

Answer 34

Detrusor underactivity “overflow incontinence”

Question 35

Tx for detrusor underactivity

Answer 35

Intermittent catheterization, bethanechol (cholingergic)

Question 36

What test differentiates detrusor overactivity from underactivity?

Answer 36

Bladder scan (cystogram)

Question 37

Treponema pallidum

Answer 37

Syphyllis

Question 38

Small ulcer at site of inoculation

Persists for 4-6 weeks (heals even w/o tx)

Answer 38

Primary syphilis

Question 39

Systemic infeciton with skin rash and enlarged lymphnodes.

Begins several months after chancre has healed.

Answer 39

Secondary syphilis

Question 40

Late destructive lesions in internal organs
Can manifest 20-30 yrs after initial infection
Heart valve dz, dementia, personality changes

Answer 40

Tertiary syphilis

Question 41

Major complicaitons of \_\_\_\_\_\_:
Joint inflammaiton (arthritis)
Pharyngitis
Sepsis
Tx?

Answer 41

Gonorrhea; PCN

Question 42

What local mediators are released in response to hypoxia/ischemia in the kidneys?

Answer 42

PGE2 and bradykinin

Question 43

List 3 factors regulating release of renin

Answer 43

Decreased renal perfusion (hypovolumia)
SNS stimulation (B1 receptor)
Hyponatremia

Question 44

What is the most important determinant of ADH release?

Answer 44

Serum osmolarity