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INTERNAL MED IP/OP > GU > Flashcards

GU Flashcards

1
Q

A 55y/o male presents with increased urinary frequency, nocturia, hesitancy, and a weak stream – dx? How do you confirm?

A

BPH

Confirm with PSA and UA

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2
Q

If a male has BPH symptoms and HTN how would you treat?

A

Alpha Blockers

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3
Q

How do we treat BPH?

A

Tamulosin

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4
Q

What are the most common causes of erectile dysfunction?

A

Vascular, diabetes, SSRI’s, and psychogenics

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5
Q

What should we always remember about phosphodiesterace inhibitors?

A

They are contraindicated in pts taking nitrates!

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6
Q

How do we treat urge incontinence?

A

Oxybutynin

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7
Q

How do we treat stress incontinence?

A

Vaginal estrogen

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8
Q

What are the 3 MC types of stones that cause nephrolithiasis?

A

Calcium Oxylate
Cystine – autosomal disorder, can’t absorb amino acid cysteine.
Struvite – urea splitting bacteria

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9
Q

What’s the gold standard diagnostic for nephrolithiasis?

A

UA shows hematuria

*Non-contrast helical CT

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10
Q

How do we treat kidney stones?

A 
Hydrate, NSAIDs
 
Stones less than 10mm – Tamulosin
 
Stones greater than 10mm – lithotripsy
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11
Q

What types of foods should someone with chronic kidney stones avoid?

A

Oxalate rich foods (nuts, bran, spinach, and vit C)

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12
Q

If a pt has painless intermittent hematuria – what should you always think of? Dx? And Tx?

A 
Bladder CA
 
Dx – Cystoscopy and CT
 
Tx – TURBT
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13
Q

How do we handle prostate cancer?

A

Risk stratify patients with PSA

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14
Q

What is the MC malignancy in young males? How do we dx and tx?

A 
Testicular CA
 
Dx – U/S DO NOT BIOPSY and CT
 
Tx – Radical inguinal orchiectomy
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15
Q

What are the MC causes of cystitis?

A

E. coli, staph, proteus, and klebsiella

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16
Q

What would make a complicated UTI?

A

Preggo, male, foley cath, DM, immunocompromised, or structural abnormality

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17
Q

What finding in a UA is most specific to an infection?

A

Nitrites

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18
Q

How do we treat an uncomplicated vs complicated UTI?

A

Uncomplicated: Nitrofurantoin, TMP-SMX
Complicated: TMP-SMX, Cipro or levo
*If a man, does NOT improve after 7 days, think prostatitis

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19
Q

What is prostatitis? What would you see on PE?

A

Inflammation of the prostate (from e. coli)

The prostate feels tender, warm, and edematous

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20
Q

How do you treat prostatitis?

A

Floro or trimethoprim-sulfameth.

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21
Q

What would you see on PE with pyelonephritis?

A

Cystitis PLUS fever, chills, flank pain, and CVA tenderness

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22
Q

What would you see on UA with pyelonephritis?

A

Same as cystitis PLUS WBC’s and casts

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23
Q

How do we treat pyelo?

A

Floroquinolones – ciprofloxacin

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24
Q

If we see testicular pain, erythema, and swelling – what is it called? What does it usually occur with? If it occurs alone, what should we think of?

A 
Known as – Orchitis
 
Occurs with epididymitis
 
Occurs alone think MUMPS
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25
Q

How do we diagnose epididymitis? Tx?

A

NAAT + U/A and culture

If over 35 tx with fluoroquinolone

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26
Q

If a male has dysuria and penile discharge, the gram-stain is positive for gonorrhea – dx? Confirm? Tx?

A 
Urethritis
 
Dx – NAAT for gonorrhea
 
Tx – Ceftriaxone + azith or doxy *Must treat all partners regardless of sxs
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27
Q

How do we treat for chlamydia?

A

Azithromycin 1g (single dose) or Doxy x 10 days

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28
Q

What type of herpes causes oral components vs genital?

A

HSV1 = oral

HSV2 = genital

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29
Q

How do we diagnose and treat herpes?

A

Dx – PCR

Tx – Acyclovir or valavivlovir (within 72 hours)

30
Q

How do we diagnose and treat Gonorrhea?

A

Dx – NAAT

Tx – Ceftriaxone

31
Q

How do we diagnose and treat Chlamydia?

A

Dx – NAAT

Tx – Doxy or Azith

32
Q

How do we diagnose and treat Trichomonas?

A

Dx – Naat

x – Metronidazole

33
Q

IF we see an increased Cr by .3 or by 50% within 48 hours – what do you think of? What are the different types?

A

Acute Kidney Injury

  1. Pre-renal
  2. Intrinsic
  3. Post-Renal
34
Q

Are there any sxs associated with acute kidney injury?

A

Either Asymptomatic or edema, HTN, fatigue

35
Q

What are the MC causes of pre-renal AKI?

A

decreased renal perfusion = dehydration, vomiting, diarrhea, CHF

Also, NSAIDs, contrast, and ACE

36
Q

How do you Dx pre-renal AKI?

A

UA = normal
BUN/Cr >20:1
Urine Na <20
Urine Osmol = increased

37
Q

How do treat pre-renal AKI?

A

Increase renal perfusion via GIVE FLUIDS!

38
Q

If you see muddy brown casts, tubular cell casts, and dysmorphic RBC’s on UA – Dx?

A

Intrinsic renal disease

39
Q

What is the MC cause of Intrinsic AKI?

A

ATN (caused by ischemia secondary to prolonged decreased renal perfusion)

*thrombus, scleroderma, malignant HTN or aminoglycosides and sulfonamides

40
Q

How do you dx intrinsic AKI?

A

UA = granular muddy brown casts, tubular cell casts, dysmorphic RBC’s, hematuria, and/or proteinuria
BUN/Cr 10:1
Urine Na >40
Urine Osmol = decreased

41
Q

How do we treat intrinsic AKI?

A

Treat underlying cause (fluids DO NOT improve ATN)

42
Q

What causes post-renal AKI? Tx?

A

Due to outflow obstruction

Tx – Cath or remove obstruction

43
Q

What are some life threatening issues associated with AKI?

A

Hyperkalemia (dialysis for peaked T waves), uremia, and metabolic acidosis

44
Q

What will cause a false-positive for blood in the urine?

A

Rhabdo from Hyperkalemia

45
Q

If a pts GFR has been decreased over the past 3 months – dx? What is a decrease in GFR?

A

Chronic renal failure

Less than 60 = decreased GFR

46
Q

What other ways can we see kidney damage?

A

Protein uria, casts, small echogenic kidneys on U/S

47
Q

So a GFR of 45-59 is known as what?

A

3A

48
Q

So a GFR of 30-44 is known as what?

A

3B

49
Q

So a GFR of 15-29 is known as what?

A

4

50
Q

So a GFR of less than 15 is known as what?

A

5

51
Q

How do we treat chronic renal failure?

A

start with protein and sodium restriction

52
Q

If someone has CKD and HTN how do we treat them?

A

ACE/ARB and loop diuretic

*be careful of hyperkalemia!!

53
Q

When we start an ACE what lab finding do we often see?

A

Transient drop in GFR

*Why you need a baseline Cr and K, followed by a re-check, if Cr increases by over 30% stop ACE

54
Q

CKD is viewed as an equivalent to what?

A

Coronary artery disease

55
Q

What are some indications for dialysis?

A

Uremia, significant bleeding, refractory metabolic acidosis, hyperkalemia, pericarditis, and malnutrition, and GFR of 5!

56
Q

What is the normal range for a pH?

A

7.35-7.45

57
Q

What is normal PCO2?

A

35-45

58
Q

What’s a normal bicarb?

A

24-30

59
Q

If the pH is down – what state are you in?

A

Acidosis

60
Q

If the pH is up – what state are you in?

A

Alkalosis

61
Q

If both the pH and bicarb are down – what state are you in? Cause? Tx?

A 
Metabolic Acidosis (both go down = metabolic)
 
MUDPILES
 
Tx underlying cause
62
Q

What does MUDPILES stand for?

A

Methanol, uremia, DKA, propylene glycol, infection/isonized, lactic acidosis, ethylene glycol/ethanol, and salicylates (ASA)

63
Q

If the pH is low but the bicarb is high – what state are you in? What can cause it? Tx?

A 
Respiratory acidosis
 
Caused by svere COPD or drug OD
 
Tx = ventilator support or narcan
64
Q

If the pH is up but the bicarb is down – what state? Cause? Tx?

A 
Respiratory alkalosis
 
Caused by hyperventilation
 
Tx = breath into a bag
65
Q

If the pH is up and the bicarb is up – state? Cause? Tx?

A 
Metabolic Alkalosis
 
Severe vomiting with hypokalemia
 
Isotonic fluids and electrolytes
66
Q

If your pt has kussmal breathing, tinnitus, and anxiety/delirium – what are you worried about?

A

Aspirin OD

67
Q

How do we treat aspirin OD?

A

Bicarb and dialysis

68
Q

If a pt have RUQ for 48 hours and they are jaundiced – what do you think?

A

Acetaminophen OD

69
Q

What will we see on labs with acetaminophen OD?

A

Re-draw labs every 4 hours because it can take a long time to see results (AST/ALT, BUN/Cr, Lactate, ABG’s)

70
Q

How do we treat an acetaminophen OD?

A

Oxygen, cardiac monitor, N-acetylcystine within 8 hours

INTERNAL MED IP/OP (9 decks)

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