GU Flashcards
EKG changes: Name the electrolyte disorder which causes prolonged PR interval widened QRS.
Hypermagnesemia
EKG changes: Name the electrolyte disorder which causes long QT.
Hypocalcemia
EKG changes: Name the electrolyte disorder which causes flattened T waves U waves.
Hypokalemia
EKG changes: Name the electrolyte disorder which causes short QT.
Hypercalcemia
EKG changes: Name the electrolyte disorder which causes tall T waves.
Hypomagnesemia
EKG changes: Name the electrolyte disorder which causes peaked T waves
Hyperkalemia
Which electrolyte abnormality do spironolactone and ACE inhibitors predispose a patient to?
Hyperkalemia
What does the “S” in MUDPILES (causes of metabolic acidosis) stand for?
S : salicylates
What does the “E” in MUDPILES (causes of metabolic acidosis) stand for?
E : ethylene glycol
What does the “L” in MUDPILES (causes of metabolic acidosis) stand for?
L: lactic acidosis
What does the “I” in MUDPILES (causes of metabolic acidosis) stand for?
I : idiopathic
What does the “P” in MUDPILES (causes of metabolic acidosis) stand for?
P : paraldehyde
What does the “D” in MUDPILES (causes of metabolic acidosis) stand for?
D : diabetes
What does the “U” in MUDPILES (causes of metabolic acidosis) stand for?
U : uremia
What does the “M” in MUDPILES (causes of metabolic acidosis) stand for?
M : methanol
MUDPILES is used to describe the causes of which acid base disorder?
Causes of metabolic acidosis
What electrolyte disorder may occur after a large blood transfusion?
Hypocalcemia
Osteitis fibrosa cystica or Brown tumors occur with which electrolyte disorder?
Hypercalcemia
How will high glucose levels change sodium levels on lab values?
Serum sodium is decreased with high serum glucose
Which disorder has oval fat bodies in the urine?
Nephrotic syndrome
Is the FENa (fractional excretion of sodium) low normal or high in acute tubular necrosis?
High
Is the FENa (fractional excretion of sodium) low normal or high in pre renal failure?
Normal
What are the CT findings expected with pyelonephritis?
Perinephric stranding
What procedures can assist in confirming the diagnosis of interstitial cystitis?
Urodynamics - Cystoscopy with hydrodistention of bladder
What is a blue dot sign associated with?
Torsion of the appendix testis (paratesticular nodule superior aspect of testicle)
How are pain and cremasteric reflex different in testicular torsion vs. torsion of the appendix testis?
Torsion has diffuse pain and absent cremasteric - Appendix testis has superior testicle pain and + cremasteric
When would you use an open book procedure?
Testicular torsion (Refers to manually turning and lowering the testicle to relieve the torsion)
What modality should be used to diagnose testicular torsion?
Ultrasound with Doppler
What is a + transillumination of the scrotum associated with?
Hydrocele
What disorder is likely with severe testicular pain and a negative Phren’s sign?
Testicular torsion (Elevation of the testicle does not change the pain)
Describe a positive Phren’s sign.
Elevation of the testicle relieves the pain
What disorder is Phren’s sign associated with?
Epididymitis
What GU disorder is LeRiche syndrome associated with?
Erectile dysfunction
What other electrolyte must be corrected in the treatment of hypokalemia?
Magnesium
What is the most common electrolyte abnormality with furosemide or bumetanide?
Hypokalemia
What electrolyte abnormality potentiates the cardiac toxicity of digoxin?
Hypokalemia
List dietary modifications for chronic kidney disease
Restrict protein sodium potassium and fluid intake
What urinalysis findings are consistent with acute tubular necrosis?
Muddy casts and renal tubular cells
What is the most likely cause of acute tubular necrosis in a patient who has recently used cocaine?
Rhabdomyolysis
Which type of acute renal injury is most likely following injection of radio contrast dye?
Acute Tubular Necrosis (ATN)
What is the most common cause of prerenal failure?
Dehydration
What is the most likely underlying disorder in a patient who develops acute renal failure after initiation of an ACE inhibitor?
Renal artery stenosis
What are the two most common long term complications of polycystic kidney disease?
Hypertension and renal failure
What renal disorder is linked to cerebral aneurysm?
Polycystic kidney disease
What type of tumor is the most common renal cancer found in children?
Wilms Tumor
What are flank pain hematuria and a palpable abdominal/renal mass hallmark signs of?
Renal cell carcinoma
What is the most common causative factor for bladder cancer?
Smoking
What non-infectious disorder causes cystitis in response to specific foods?
Interstitial cystitis
What is the most common type of incontinence?
Mixed (both stress and urge)
What type of incontinence results from an over active detrusor muscle?
Urge incontinence
What type of incontinence results from activity such as laughing or coughing?
Stress incontinence
Sudden onset of severe testicular pain which does not alleviate with elevation of the testicle?
Testicular torsion
Name two disorders which may cause orchitis in children?
Mumps and brucellosis infections
What hematological disorder may cause priapism?
Sickle cell crisis
What medication classes can not be taken with PDE5 inhibitors?
Nitrates or alpha blockers (May result in hypotension)
What are the most common causative agents for prostatitis in an 15-30 year old male?
Chlamydia and/or gonorrhea
What is the most common causative agent for prostatitis in an elderly male?
What is the most common causative agent for prostatitis in an elderly male?
What surgical procedure is most commonly used in patients with BPH who fail pharmacological treatment?
Transurethral Resection of the Prostate (TURP)
What counseling must be given to a patient who is started on doxazosin terazosin or prazosin?
Take while sitting on bed prior to sleep to avoid orthostatic hypotension
What is the most common type of renal calculus in children?
Cystine
Which type of renal calculus is highly associated with chronic infection?
Struvite
What are the 3 electrolyte abnormalities which occur with tumor lysis syndrome?q
Hyperkalemia -Hyperuricemia - Hyperphosphatemia
What nephropathy is associated with lupus?
Membranous nephropathy
Most common histology of bladder cancer?
Transitional cell carcinoma
What is the Dx? Hematuria flank pain and a palpable flank mass.
Renal cell carcinoma
What is the Dx? Eosinophils in the urine sediment.
Allergic interstitial nephritis
What are the 2 most common types of nephrotic syndrome?
Focal Segmental Glomerulosclerosis (FSGS) - Membranous glomerulonephritis
What is the most common type of nephrolithiasis?
Calcium oxalate
Ventricular septal defect -Atrial septal defect -Patent ductus arteriosus
Malignancy and hyperparathyroidism
What is the Dx? Hypernatremia and azotemia.
Most likely dehydration
“Doughy skin” with skin tenting may represent which electrolyte abnormality?
Hypernatremia
The recommended age to start annual prostate screening?
White male average risk: 50 years old - Black male, + FMHX or + BRCA mutations: 40 years old
Inability to retract the foreskin from the penis?
Phimosis
What is the Dx? Gram stain of penile discharge reveals gram-negative intracellular diplococci.
Gonorrhea
Where is the most likely initial distant site for prostate cancer to metastasize?
Bone
Inability to replace the foreskin back over the glans in an uncircumcised male?
Paraphimosis
Describe a + Chvostek’s sign. What does it indicate?
The facial muscle contracts in response to tapping of the facial nerve. Sign of hypocalcemia
What is the treatment for asymptomatic hyponatremia?
Fluid restriction
Enlarged prostate with a firm nontender discrete mass?
Prostatic carcinoma
What is the Dx? Nausea vomiting rash hematuria and eosinophilia in a patient taking allopurinol.
Acute interstitial nephritis
Peaked T waves on EKG?
Hyperkalemia
Bag of worms in scrotum?
Varicocele
Most common presentation for bladder carcinoma?
Painless hematuria
Most likely organisms causing acute epididymitis in young males?
Chlamydia and Neisseria gonorrhoeae
Definitive treatment for a 3 year old with an undescended testicle?
Orchiopexy
Most likely organisms causing epididymitis in an older male?
E. Coli - Klebsiella - Pseudomonas
What is the Dx? Male patient presents with fever chills dysuria perineal pain and decreased stream.
Acute prostatitis (Do not massage the prostate = bacteremia)
What factors are associated with increased risk of infertility in males?
Cryptorchidism - Hypogonadism - Orchitis Hx - Testicular torsion
Most common cause of dysuria in an adult male?
Urethritis
What is the Dx? UA shows pyuria white blood cell casts and hematuria.
Pyelonephritis
What may correcting a patients hyponatremia too quickly cause?
Pontine crenation which may lead to central pontine myelinolysis
Organism most likely to cause urethritis in males under 30?
Neisseria gonorrhoeae (Note: 30% have concurrent Chlamydia infection)
Risk factors for stress incontinence?
Age - Obesity - Vaginal deliveries
Drug of choice for treatment of BPH?
1st line: alpha-1-blockers - 2nd line: 5-alpha-reductase inhibitors
What are the hallmark manifestations of acute hypernatremia?
Lethargy - Weakness - Muscle twitching
What are the three hemodynamic factors that influence renal perfusion?
Cardiac output - Blood pressure - Systemic vascular resistance
Hemolysis of red blood cells may cause increased serum levels of what electrolyte?
Potassium
What drug may slow the progression of diabetic nephropathy?
ACE inhibitors and angiotension II receptor blockers (ARBs)
What is the Dx? Proteinuria and fatty casts in urine.
Nephrotic syndrome
What is the Dx? RBC casts in the urine.
Glomerulonephritis
What is the most common form of nephrotic syndrome?
Membranous
What is the serologic marker for Wegener’s granulomatosis?
Antineutrophilic cytoplasmic autoantibodies (ANCA)
What are the hallmark signs of nephrotic syndrome?
Upper and lower extremity edema with normal jugular venous pressure
What is the most common type of renal cell carcinoma?
Clear cell
Acid-base disorder associated with renal failure?
Metabolic acidosis with increased anion gap
Diagnostic tests for renal artery stenosis?
Initial: Renal artery Doppler US - CT or MRI angiography to confirm
What is the Dx? Proteinuria hypoalbuminemia hyperlipidemia lipiduria and edema.
Nephrotic syndrome
What is the Dx? Hematuria hypertension oliguria with worsening azotemia.
Nephritic syndrome
Most common cause of acute renal failure?
Prerenal
What two diagnoses should be considered with hematuria and red blood cell casts after URI?
IgA nephropathy (<5 days) - Post-streptococcal glomerulonephritis (10-21 days)
What is the Dx? Paresthesia muscle cramping and agitation in a patient who has received multiple transfusions.
Hypocalcemia (Citrate in the transfused blood chelates calcium)
What must be ruled out in a patient with polycystic kidney disease and the worst headache of their life?
Cerebral aneurysm rupture
Common extrarenal manifestation of polycystic Kidney disease?
Cerebral aneurysm - Hepatic and pancreatic cysts
List the symptoms of interstitial nephritis.
Arthralgias - Rash - Renal failure - Fever - Eosinophilia - Eosinophiluria
Hyperkalemia in a patient receiving chemotherapy is indicative of what syndrome?
Tumor lysis syndrome
What type of nephropathy is associated with Hodgkins lymphoma?
Minimal change nephropathy
What type of nephropathy is associated with carcinomas?
Membranous nephropathy
Most common type of kidney damage associated with HIV?
Focal Segmental Glomerulosclerosis (FSGS) presenting as nephrotic syndrome
What is the treatment for acute, symptomatic hyperphosphatemia?
Phosphate binders - Acetazolamide - Dialysis
What is treatment for hypophosphatemia?
Oral phosphate replacement
Bones, stones, groans and psychiatric overtones is the mnemonic for what electrolyte disorder?
Hypercalcemia
Trousseau and Chvostek sign are associated with what abnormality?
Hypocalcemia
A patient with preeclampsia is given magnesium IV. She develops hypotension, bradycardia. What is the recommended treatment?
She is hypermagnesemic, treatments are: Calcium gluconate - Insulin& glucose - Furosemide - Dialysis if these are unsuccessful
What electrolyte will not correct with supplementation until hypomagnesemia is corrected?
Hypokalemia
Digoxin and what potassium abnormality leads to increased digoxin toxicity and ventricular arrhythmia?
Hypokalemia
What is the endocrine disease that leads to hypernatremia?
Diabetes insipidus
Correction of hyponatremia too quickly with 3% saline IV fluid will lead to what brain abnormality?
Pontine crenation
Nephrotic syndrome is associated with protein loss in excess of how many grams per day?
3.5 g of protein or more
A fraction of excreted sodium that is greater than 2% is associated with what renal condition?
Acute tubular necrosis
Red blood cell casts on urinalysis are associated with what kidney condition?
Nephritic
What is the treatment for anemia due to chronic renal failure?
Erythropoietin analogs (epoetin alfa, darbepoetin alfa)
What is the most common cause of nephrotic syndrome in non-diabetic adults?
Membranous
A 18 year old male presents with hematuria, hypertension and pedal edema after a recent viral infection. What antibody will be noted on lab work?
IgA (IgA nephropathy)
What are the four main causes of acute tubular necrosis?
Prerenal (#1 cause) - Contrast dye - Drugs - Rhabdomyolysis
What are the three components of prerenal failure?
Volume loss: bleed, dehydration - Weak cardiac pump: heart attack, CHF - Loss of SVR: sepsis, neuro injury, anaphylaxis
A 65 year old male presents with suprapubic pain, anuria and a palpable bladder. What is the first step in the evaluation?
Foley catheterization
A 65 year old female presents with painless hematuria. She has a 50 year smoking history. What underlying condition do you suspect?
Bladder cancer
What is the treatment of choice for renal cell carcinoma without metastasis?
Radical nephrectomy
A patient with polycystic kidney disease suddenly develops the worst headache of his life. What do you suspect?
Subarachnoid hemorrhage due to a ruptured cerebral aneurysm
What is the gold standard for evaluating a patient with renal artery stenosis?
Angiography of the renal arteries
A 30 year old female presents with persistant hypertension. She has an abdominal bruit on exam. What do you suspect is the underlying cause of her hypertension?
Renal artery stenosis
A 17 year old male presents with hypertension and azotemia. What is his most likely diagnosis?
Polycystic kidney disease
What is the most common renal cancer in children, presenting with a unilateral abdominal mass?
Wilms tumor
Flank pain hematuria and palpable right abdominal renal mass is associated with what condition?
Advanced renal cell cancer
What is the most common type of bladder cancer?
Transitional cell
An untreated urinary tract infection leads to a high fever, chills, flank pain, nausea and vomiting. What condition do you suspect?
Pyelonephritis
What class of medication can often help patients with interstitial nephritis?
Tricyclics such as amitriptyline
What is the most common cause of urinary tract infection?
E. Coli
Bilateral hydronephrosis leads to what type of renal failure?
Post renal failure due to obstruction
Untreated pyelonephritis can lead to what kidney condition?
Hydronephrosis
White blood cell casts on urinalysis are associated with what condition?
Pyelonephritis
ear old male has recurrent dysuria and urinary frequency which has not improved with antibiotics. What underlying condition do you suspect?
Interstitial cystitis
Urinary incontinence associated with activity is called what type of incontinence?`
Stress
What antibiotics are indicated for the treatment of chlamydia and gonorrhea?
Ceftriaxone and doxycycline or ceftriaxone and azithromycin
Elevation of the testicles will not relieve the pain in which condition?
Testicular torsion
By what age should a males testicles be descended into the scrotum?
Six months (If they have not descended by six months surgery is indicated)
A 20 year old male presents with an enlarged, firm, non-tender testicular mass. What underlying condition do you suspect?
Testicular cancer
What reflex is absent in a patient with testicular torsion?
Cremasteric reflex
A 24 year old male on examination of the testicles is found to have a “bag of worms” on the right side. What is the underlying condition?
Varicocele
A painless unilateral swelling of the testicle that transilluminates is what disease condition?
Hydrocele
What viral condition can cause orchitis in a young male child?
Mumps
What is the suspected etiology of a tender, swollen, warm mass located above the testicle in a 24 year old male?
Chlamydia and-or gonorrhea
What class of medication treats the prostate by shrinking it?
Five alpha reductase inhibitors (finasteride and dutasteride)
What is the initial screening for a patient with BPH?
Digital rectal exam and PSA test
A 55 year old male is found to have prostate cancer with metastasis. In addition to radical prostatectomy, what other treatment will he require?
Surgical castration or androgen deprivation medications such as leuprolide
At what time should you instruct your patients with BPH to take their alpha blocker medications?
At bedtime to prevent postural hypotension
What condition needs to be ruled out first in erectile dysfunction?
“Psychogenic conditions like performance anxiety
Prostatitis in a 24 year old male is most commonly caused by what organism?
Chlamydia or gonorrhea
Prostatitis in a 55 year old male is most commonly caused by what organism?
E. Coli
What condition is defined as the inability to return retracted foreskin to its normal position?
Paraphimosis
What condition is defined as the inability to retract the foreskin in an uncircumcised male?
Phimosis
What type of kidney stones is a patient with a diet high in purines most likely to suffer from?
Uric acid stones
What medications are used to treat patients with calcium oxalate stones but makes patients with uric acid stones worse?
Chlorthalidone and hydrochlorothiazide
Which type of kidney stone requires chronic antibiotics?
Struvite stones
What type of kidney stone does a female with a chronic urinary tract infection most likely have?
Struvite
What type of kidney stone is most commonly seen in a young boy?
Cystine stone
Before sending a patient home with kidney stones, in addition to pain medications, what should you give the patient?
A strainer so they can catch the stone and bring it in for analysis
What test is the gold standard for diagnosing kidney stones?
CT scan
