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Internal Medicine > GU > Flashcards

GU Flashcards

1
Q

Defintion of nephritic syndrome (5)

A

Glomerulonephritis
Intrinsic form of AKI

HTN+ RBC casts in urine + Incr Creatinine + edema + dysmorphic RBCs

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2
Q

What two bacteria cause nephritic syndrome commonly

A

Staph
Strep viridans [ think kids; post strep GN]

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3
Q

Immune causes of GN

A

SLE
IgA Nephropathy

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4
Q

Management with GN patients?

A

Salt and water restriction
Diuretics
ACE/ARBS

TXT if infection

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5
Q

What part of the kidney is effected in good pastures syndrome

A

Glomerular basement membrane

Anti-GBM Abs +

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6
Q

TXM Good Pastures Syndrome

A

Tx
1. Admit
2. Plasmapheresis (plasma exchange to remove circulating anti-GBM antibodies)
3. Prednisone
4. Cyclophosphamide

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7
Q

What is present in nephrotic syndrome

A

a. S/Sx: proteinuria, hypoalbuminemia, edema, hyperlipidemia, frothy urine

i. Edema predominant feature (d/t loss of proteins and albumin; fluid leaves blood)

b. Urinalysis: proteinuria > 3.5 g/day, urine dipstick protein 3+ or 4+, fatty casts, oval fat bodies

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8
Q

3 important characteristics of minimal change disease

A

Loss of podocytes on electron microscopy
Effects children 2-7 yrs
+ Hypercoagable = DVTs and PEs

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9
Q

Defintion of AKI

A

Defined as ↑ SCr by ≥ 0.3 mg/dL w/in 48 hrs or ↑ SCr ≥ 1.5x baseline or urine output < 0.5 mL/kg/hr for 6 hr

S/Sx: dark cola-colored urine, flank pain, low urine volume; uremia → N/V, malaise, anorexia, fatigue, pruritus,
AMS

Abrupt reduction in GFR

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10
Q

Azotemia refers to

A

Abnormal levels of urea and creatinine

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11
Q

Pre Renal Azotemia :

A

Prerenal azotemia: impaired renal perfusion w/ resultant ↓ in glomerular capillary filtration pressure

i. MC cause of AKI

ii. BUN:Cr ratio often > 20:1

iii. Labs: ↑ SCr, ↑ BUN, metabolic acidosis, hyperkalemia, hyperphosphatemia, anemia, platelet dysfxn, ↓
GFR

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12
Q

Causes of pre renal Azotemia (3)

A
  1. Hypovolemia
  2. NSAIDs + ACE-I
  3. Iodinated radiocontrast agents (↑ risk for pts w/ renal impairment, DM, HF)
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13
Q

Intrinsic Azotemia represents ___ and Causes

A

i. Hallmark = structure injury to kidney

ii. Causes
1. Acute tubular necrosis (ATN): MC cause of AKI d/t intrinsic renal dz; can be ischemic or
nephrotoxic
a. Ischemic is common in ICU pts w/ hypotension

b. Nephrotoxic: hemoglobin, myoglobin (rhabdomyolysis), medications, or ingested
poisons (ethylene glycol)

c. Muddy brown casts-granular-ATN

  1. Acute glomerulonephritis (AGN): characterized by inflammatory glomerular lesions
  2. Acute interstitial nephritis (AIN): drug rxn

iii. ↑ FeNa
= increase in fractional excretion of sodium. Due to DIRECT INJURY

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14
Q

Triad of {physical exam findings} Intrinsic Azotemia

A

a. Triad: fever, transient maculopapular rash, arthralgias

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15
Q

Think what causes for post renal Azotemia and labs?

A

Causes
1. BPH

  1. Urethral obstruction: clot, kidney stones, tumor, etc.

iii. Labs: ↑ osmolality, ↓ urine sodium (FeNa), ↑ BUN:Cr

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16
Q

Indications for acute dialysis in patients with renal impairment?

A

Indications for acute dialysis

  1. Acidosis and refractory to HCO3
  2. Hyperkalemia > 6.5 mmol/L or w/ ECG changes (↑ t waves)
  3. Ingestion of lithium or ethylene glycol
  4. Uremia (may present w/ pericarditis or ↓ in mental status)

a. S/Sx: anorexia, nausea, vomiting, metallic taste
b. PE: asterixis, pericardial rub

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17
Q

Alarming sxs in renal impairment

A

a. S/Sx: anorexia, nausea, vomiting, metallic taste
b. PE: asterixis, pericardial rub

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18
Q

2 common complications of post renal Azotemia

A

Hyperkalemia
Pulmonary edema

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19
Q

Chronic kidney disease requires decreased GFR for how long

A

Greater 3 months

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20
Q

Markers of kidney damage (3)

A

Markers of kidney damage:

proteinuria,

structural abnormalities on imaging,

abnml urinary sediment or
chemistries

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21
Q

Decreased EPO assoc with CKD can lead to what?

A

Metabolic acidosis with anemia

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22
Q

What is a kidney related reason to add ezetimibe if dyslipedmic and over the age of 50

A

GFR less 60

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23
Q

Indications for dialysis in ESRD (7)

A

i. GFR < 10

ii. Fluid overload unresponsive to diuresis

iii. Refractory hyperkalemia

iv. Uremic sxs

v. Severe metabolic acidosis

vi. Neuro sxs

vii. BUN > 100

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24
Q

Indications for dialysis in ESRD (7)

A

i. GFR < 10

ii. Fluid overload unresponsive to diuresis

iii. Refractory hyperkalemia iv. Uremic sxs

v. Severe metabolic acidosis

vi. Neuro sxs

vii. BUN > 100

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25
Q

What is Prehns sign in epididymitis

A

Raising the scrotal ; relieves pain

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26
Q

Management of epididymitis

A

viii. Labs: UA, culture, STI panel, +/- US to r/o torsion

ix. Tx

  1. STI: Ceftriaxone + Doxycycline
  2. Non-STI: Ofloxacin or Levofloxacin
  3. Viral or non-infxn: sx care → NSAIDs, ice packs, bed rest, scrotal elevation
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27
Q

Acute bacterial prostatitis is usually what 2?

A

E Coli
Psuedomonas

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28
Q

TXM for prostatitis includes? Inpatient vs Outpatient

A

Labs: UA, pyuria, bacteriuria, hematuria, CBC, culture

Transrectal US may be needed to ID a prostatic abscess if no response to abx w/in 24-48 hrs
. Tx
a. Outpt
i. Empiric: FQ, double-strength TMP-SMX
ii. Consider tx for STI for men < 35 y/o

b. Inpt: pts who cannot tolerate PO or have major comorbidities
i. IV FQ +/- aminoglycoside ii. IV beta-lactam w/ enteric coverage +/- aminoglycosides

c. If urinary retention → catheter

d. F/u w/ urine and prostatic secretion cultures → ensure eradication

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29
Q

Sxs of chronic bacterial prostatitis ; get what?

A

S/Sx: afebrile, irritative voiding sxs, urethral pain, and obstructive urinary sxs; low back and
perineal pain; hx of UTIs

Get a UA with Culture

30
Q

Bacterial prostatitis with systemic signs [ADMITTED] treatment?

A

Inpt: pts w/ systemic signs
i. IV therapy w/ broad-spectrum abx → Ampicillin + Gentamicin, 3rd gen
Cephalosporin, or FQ

31
Q

Labs: ↑ leukocytes in prostatic secretions, negative cultures ; think?

A

Non bacterial Prostatitis

32
Q

TXM for prostate cancer

A

Tx
1. Localized: acute surveillance for older pts w/ low-risk cancer; pts w/ life expectancy > 10 yrs
should be considered for with urology. [Gold Plates for Radiation/Chemo]

33
Q

mean age for bladder cancer in males?

A

73 y/o

34
Q

Over 40 with painless hematuria you’re thinking ; smoker

A

Bladder cancer

35
Q

Painless hematuria smoker over 40 yrs old male;

A

Bladder cancer
Confirmed by ; Cystoscopy and Bx

36
Q

Painless hematuria smoker over 40 yrs old male;

A

Bladder cancer
Confirmed by ; Cystoscopy and Bx

37
Q

Triad of renal cell carcinoma + SMOKER

A

Hematuria
Flank pain
ABD/Renal Mass

38
Q

3 common characteristics of testicular cancer

A

i. MC neoplasm in men 15-35 y/o (young man’s cancer)

ii. Typical presentation: painless mass

iii. RF: cryptorchidism, testicular trauma/torsion, infxn-related testicular atrophy, chemical exposure/pollutants

39
Q

Treatment for testicular cancer

A

Radicle orchiectomy

40
Q

Labs that are high in testicular cancer

A

HcG
AFP
LDH

41
Q

RF and Protective Factors for Ovarian Cancer

A

RF = Advancing Age ; Early menarche ; Late menopause ; Nulliparity ; Fam Hx

Protective = Contraceptive Use; Tubal Ligation; Hysterectomy

42
Q

Young patients with HTN / CVDz / Flank Pain / ABD mass ; may result in ESRD ; think

A

Polycystic kidney disease

43
Q

Reasons for renal artery stenosis @ (60-70yrs) and (20-30yrs)

A

60-70 yrs old = atherosclerosis

20-30 yrs old = fibromuscular dysplasia

44
Q

If someone develops an AKI after starting an ACE think?

A

renal artery stenosis

45
Q

Initial and Gold Standard test for Renal Artery Stenosis

A

Initial = Renal U/S

Gold = CT renal A

46
Q

MC pathogens in acute cystitis

A

E Coli
Staph
Saprophyticus

47
Q

Workup for male cystitis (3)

A

ABD U/S
Post void residual testing
Cystoscope

48
Q

TXM for acute cystitis ; first line ; pain ; and pregnant

A

Tx
1. Nitrofurantoin or TMP/SMX, Norfloxacin, Ciprofloxacin, Levofloxacin

  1. Phenazopyridine (Pyridium): 200 mg TID
  2. Pregnant: Amoxicillin, Cephalexin, Nitrofurantoin
49
Q

Recurrent acute cystitis is defined as ; and treated with

A

Greater 3 episodes in a year:

TMP / SMX

Nitrofurantoin

Cephalexin

50
Q

Characteristics of interstitial cystitis

A

Pain with bladder filling; relieved by emptying

51
Q

Chracteristics of interstitial cystitis

A

Painful bladder filling; relieved by emptying

Negative UA/Culture

Cystoscopy = Glommerulations / Hunters Lesion

52
Q

TXM of interstitial cystitis

A

Tx: no cure → tx aimed at sx relief
1. 1st line: general relaxation / stress management, diet, pt education, behavioral modification, pain
management

  1. 2nd line: medications – Amitriptyline, Hydroxyzine, Cimetidine, Intravesical dimethyl sulfoxide
  2. 3rd line: Hydrodistention; intradetrusor botox
53
Q

TXM of Pyelo

A
  1. FQ or TMP-SMX
  2. If inpt or pregnant: ampicillin/gentamicin or 3rd gen cephalosporin
54
Q

Discuss the 4 common types of stones in kidney disease

A

i. MC caused by calcium oxalate

ii. Struvite: staghorn calculi, urease-producing bacteria

iii. Uric acid: radiolucent on XR, gout

iv. Cystine: children w/ metabolic dz

55
Q

Discuss txm based on kidney stone size

A
  1. < 5 mm: likely to pass spontaneously
  2. > 8 mm: unlikely to pass; lithotripsy
56
Q

What are the obstructive vs irritative sxs in BPH

A

Obstructive sx: hesitancy, ↓ force and caliber of stream, sensation of incomplete bladder emptying, double voiding, straining to urinate, post-void dribbling

Irritate sxs: frequency, urgency, nocturia, dysuria

57
Q

Physical exam findings BPH vs Prostate Cancer/Prostatitis

A

f. PE: smooth, symmetric, firm yet elastic enlargement is c/w BPH

g. If indurated or asymmetrical → further w/u to r/o cancer (TRUS) /prostatitis

58
Q

Meds and definitive management of BPH

A
  1. Alpha blockers (-osin) - ALLOW DILATION OF URETER TO IMPROVE FLOW
  2. 5-alpha-reductase inhibitors (Finasteride/Dutasteride) -SHRINK THE PROSTATE 2 WEEKS ISH
  3. Tadalafil: FDA approved for BPH and/or urinary tract sxs in pts w/ ED-IF ALSO HAVE ED

ABSOLUTE = TURP ; may need a repeat TURP

59
Q

5 CAUSES OF ED

A

i. Vascular: CV dz, HTN, DM, hyperlipidemia, smoking, major surgery, radiotherapy

ii. Neurologic: spinal cord/brain injuries, Parkinson dz, Alzheimers dz, MS, stroke, major surgery,
radiotherapy of prostate

iii. Local penile factors: Peyronie’s dz, cavernous fibrosis, penile fX

iv. Hormonal: hypogonadism, hyperprolactinemia, hyper/hypo hypothyroidism, hyper/hypocortisolism

v. Drug Induced : anti-HTN; anti-psychs ; anti-depressives anti androgens; alcohol

60
Q

Management of ED

A

Tx
1. Lifestyle changes: smoking cessation, wgt loss, gastric bypass, CPAP for sleep apnea

  1. Phosphodiesterase-5 inhibitors: Sildenafil, Vardenafil, Tadalafil, Avanafil
  2. 2nd line: vacuum-assisted erection devices, penile self-injection, intraurethral alprostadil
  3. Surgery
61
Q

Urge inconvenience think ; TXM

A

Overactive bladder -Detrusor Increased activity!

W/ Nocturia

TXM = anti Cholinergics

62
Q

Stress incontinence ; description and treatment

A

i. MC caused by muscle weakness

ii. S/Sx: small amount of urine loss when coughing, laughing, or sneezing

iii. Tx
1. Kegel exercises (PFT) 2. Estrogen replacement 3. Surgery

63
Q

Acididemia; Bicarbonate and CO2 levels

A

pH less than 7.35

Bicarbonate -less 24 = +

CO2- greater 40 = +

64
Q

Alkalemia Bicarbonate and CO2 levels

A

pH greater than 7.45

Bicarbonate - greater than 24 = +

CO2 - less than 40 = +

65
Q

MUDDY Brown Granular casts represent what?

A

Degenerating RBCs

Acute Tubular Necrosis

66
Q

Waxy casts represent what?

A

Severe urine stasis ;

chronic renal f.

67
Q

Waxy casts represent what?

A

Severe urine stasis ‘

Chronic renal f.

68
Q

Broad casts represent what?

A

Dilated or atrophic renal tubules 2nd to parenychmal damage ;

ESRD

69
Q

Associated state with fatty casts

A

Nephrotic syndrome

70
Q

White cell casts are more common in ___ than ___

A

Pyelonephritis ; than lower bladder tract infection

71
Q

What it’s the hallmark kind of cast in glomerulonephritis

A

Red Cell Cast

72
Q

2 types of casts found in acute tubular necrosis

A

1) Renal tubular epithelial cell cast

2) Granular Muddy Brown Cast

Internal Medicine (6 decks)

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