GU 2 (Step up son) Flashcards
A patient comes in with symptoms of acidosis. She has had multiple kidney stones and is found to have a urine pH >5.3 (nml 4.5-8). What is the likely problem? What is seen on labs? What can be done?
Distal (type 1) renal tubular acidosis…impaired H+ secretion
Low K+
Variable bicarb
Oral bicarb, K+, thiazide
A patient comes in with symptoms of acidosis and bone pain. She is found to have bone lesions. UA shows a urine pH less than 5.3. What could be going on? What would be seen on labs? What can be done? What other syndromes/diseases could this person have?
Proximal (type 2) renal tubular acidosis…impaired bicarb reabsorption
Low K+
Low bicarb
Oral bicarb, K+, thiazide or loop
Multiple myeloma, Fanconi syndrome, Wilson disease, amyloidosis, Vitamin D deficiency, autoimmune diseases
A diabetic patient comes in with symptoms of acidosis and is found to have a urine pH less than 5.3 and a high K+ and Cl-. What could be the cause? What should the treatment be?
Low Renin/Aldosterone (type 4) renal tubular acidosis…primary or secondary hypoaldosteronism
Treat with fludrocortisone
K+ restriction
The ol’ delta-delta is used to determine if there is only an anion gap acidosis or if there are multiple things going on. How is the delta-delta determined? What are the indications?
Corrected HCO3 = measured gap - normal gap…12 + measured HCO3
if the corrected HCO3 is:
Within normal range –> only an anion gap acidosis
Above normal range –> mixed w/ metabolic alkalosis
Below normal range –> mixed w/ non-gap acidosis
There can be mixed metabolic/respiratory conditions. How can an additional respiratory condition be determined with a metabolic acidosis?
Expected pCO2 = 1.5(HCO3) + 8 +/-2
Actual less than expected –> additional resp alk
Actual greater than expected –> additional resp acid
There can be mixed metabolic/respiratory conditions. How can an additional respiratory condition be determined with a metabolic alkalosis?
pCO2 greater than 50 –> additional resp acid
pCO2 less than 40 –> additional resp alk
What are the common causes of a UTI?
E. coli Staph sapro Proteus Klebsiella Enterobacter Pseudomonas Enterococcus
How is a UTI treated?
Amox, bactrim, or a fluoro for 3 days…14 days if relapse
How is urge incontinence treated?
Bladder training
Antimuscarinics (oxybutynin, tolterodine, solifenacin)
How is stress incontinence treated?
Therapy…weight loss, Kegel exercises
Midurethral sling
Who gets overflow obstruction?
Often men…BPH, urethral strictures
Patient comes in with hematuria. Has a hx of treated bladder cancer. What is an option?
Recurrence of bladder cancer…happens frequently
Growth on Thayer-Martin culture indicates what?
N. gonorrhea
Which STD can be confirmed with nucleic acid amplification?
Chlamydia
How is GC treated?
Single dose ceftriaxone with doxy or azithromycin
What is the most common cause of prostatitis? How is it treated?
Nonbacterial is more common
Still treat with bactrim for 4-6 weeks…also treat for STD if sexually active
What is the most common non-derm cancer in men? Which cancer causes the most deaths?
Prostate cancer is more common than lung
Lung kills more than prostate…but prostate is second
How can epididymitis be differentiated from testicular torsion?
Support the sack…pain goes away = epididymitis
How is epididymitis treated?
Ceftriaxone and doxy or fluoroquinolone
NAIDs and sack support if non-infectious cause
Where does a Wilms tumor originate? Who gets a Wilms tumor? What is often seen with a Wilms tumor?
Renal origin
Children less than 4yo
WAGR
W- Wilms tumor
A- Aniridia
G- GU abnormalities
R- Retardation
Boy is born with hypospadias. Should the urethra be corrected before or after circumcision?
Before
What is enuresis?
Nocturnal bed wetting…usually resolves by 4yo
