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CCFP EM > GU/renal > Flashcards

GU/renal Flashcards

1
Q

pathophys of rhabdo

A

from destruction of skeletal muscle due to injury of myocytes

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2
Q

common causes of rhabdo

A

drugs of abuse (cocaine, meth), alcohol (direct toxic effect and coma induced muscle breakdown aka passing otu no muscle), medications (antipsychotics, statins, SSRI, huge list), muscle diseases, trauma, NMS, seizures, immobility, infection, strenous physical activity, heat-illness.

** more than 1/2 the time there are multiple causes present

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3
Q

rhabdo symptoms

A

weakness, myalgias, malaise, dark brown urine (tea colored urine)

if severe can lead to n/v, abdo pain or even urea induced encephalopathy

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4
Q

rhabdo cutoffs for dx, IVF and trend, vs admit

A

> 1000 is dx
5000 probable admit

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5
Q

dialysis indications in rhabdo?

A

same as any other pt… AEIOU

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6
Q

treatment of rhabdo

A

aggressive IV fluid (Ns or RL), for 24 to 72 hours. target OU of 200 mL per hour or 3 mL/kg/hr.

basically, boluses then 250-500 mL per hour based on pt factors (age, EF etc)

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7
Q

4 general complications of rhabdo

A

AKI, DIC, electrolyte abn (K, P, Ca), mechanical complications (compartment syndrome, peripheral neuropathy)

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8
Q

uremic symptoms

A

n/v, drowsiness, fatigue, confusion, if untreated coma

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9
Q

fastest screening test for hyperK?

A

ECG
detects 50% of levels over 6.5

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10
Q

creatinine changes required for AKI

A

Cr increase of 26, over less then 48 hrs

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11
Q

ACE inhibitor effects on kindeys

A

decrease GFR, but also decrease glomerular pressure

preferentially vasodilate efferent arteriole

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12
Q

NSAIDs effect on kidney arterioles

A

vasoconstrict afferent

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13
Q

general treatment principles in AKI

A

target euvolemia, hold insulting meds, relieve/rule out obstruction (u/s and foley)

look for hyper K, metabolic acidosis (WAGMA), proteinuria etc.

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14
Q

indications for acute dialysis

A

A: refractory/life threatening acidosis
E: refractory hyper K (>6.5 and not improving)
I: life-threatening ingestion of dialyzable drug (common methanol/ethylene glycol, salicylates, lithium)
O: refractory overload (causing hypoxia)
U: symptomatic uremia (pericarditis, encephalopathy, bleeding)

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15
Q

hyperkalemic ECG

A

peaked T waves, prolonged PR, wide QRS and then sinusoidal pattern

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16
Q

broad definition of cardiorenal syndrome

A

acute or chronic dysfunction of one organ causes acute or chronic dysfunction of the other

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17
Q

metformin and contrast CT

A

if gfr >30 and on metformin go for it, otherwise hold metformin for 48 hrs before and after (if possible)

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18
Q

define uremia

A

a (poorly named) clinical syndrome, involves accumulation of urea AND OTHER metabolites in the blood which cause sequalae that are not solely resolved by dialyzing them out, it is the end-point of CKD/ESRD…. interestingly BUN is inaccurate marker of uremia severity

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19
Q

uremic neurologic complications (3):

A

uremic encephalopathy, dialysis dementia, peripheral neuropathy

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20
Q

cardiovascular complications of uremia

A

elevated troponins, HTN, HF, uremic cardiomyopathy, pulm edema, tamponade, pericarditis, CAD

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21
Q

unique feature of uremic pericarditis?

A

aseptic and inflammatory cells dont enter myocardium, so you dont get the ECG changes!

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22
Q

hematologic complications of uremia? 3

A

anemia, coagulopathy, immune disorders

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23
Q

do you remove dialysis line if infected?

A

generally trial IV abx for 2-3 days first.

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24
Q

what is Branham sign?

A

indicates high out put HF/AV fistula steal syndrome, you occlude fistula and look for drop in HR.

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25
Q

complications during dialysis (4)

A

hypotension (often due to volume loss), dialysis dysequilibrium (due to osmolar changes, s/s are n/v and HTN, can be life threatneing), air embolism, electrolyte abn

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26
Q

most common organisms in PD peritonitis?

A

staph and strep, gram neg can occur too

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27
Q

signs/symptoms of PD peritonitis

A

fever, abdo pain, guarding, peritonitic signs

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28
Q

size of catheter in acute urinary retention

A

14-16F

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29
Q

what is coude tip catherter?

A

has angled and firm tip, which should be angled anterioirly to follow the anatomy

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30
Q

Causes of acute urinary retention

A
31
Q

normal bladder scan and PVR

A

scan should be less then 400 mL, PVR should be less than 150 mL

32
Q

contraindications for urethral catheterization?

A

recent urological surgery

33
Q

what is post obstructive diuresis? what to do about it?

A

after initial drainage of bladder, observe for 2-4 hours, looking for >200 cc/hr of output.
if this happens, consult medicine for admission and start volume replacement that is equal to their losses

34
Q

TOV in urinary retention

A

should be done in 3 days, remove catheter, aggressive po rehydration, and measure PVR at 4-6 hours. should be less than 150-200 mL.

35
Q

who is at risk for post obstructive diuresis?

A

long standing obstruction, poor renal function, HF, AMS and underlying comorbidity.

36
Q

Management of urinary retention with clots or gross hematuria

A

Insertion 20-24 F triple lumen catheter and irrigate with saline until clots are cleared. If clots persist consult uro

37
Q

Algo for urinary retention

A
38
Q

definition of asymptomatic bacturia

A

2 clean catch cutlures in women
1 clean catch culture in men
without symptoms, only treat if pregnant or about to have invasive GU procedure

39
Q

which UTI bugs dont produce nitrites?

A

pseudomonas, enterococcus,

40
Q

Abx for pregnant cystitis

A

Macrobid, cefixime, keflex

41
Q

Ddx for dysuria

A
42
Q

pathophys of fournier’s gangrene, RF for it?

A

starts as benign infection or simple abcess, then turns into necrotizing infection, can occur in women too (20% of cases).
RF: DM, immuno comp etc

43
Q

abx for fourniers?

A

pip-taz, vanco + surgical debridement

44
Q

balanoposthitis:
what is it?
s/s
tx

A

inflammation of glans and foreskin
treatment: antifungals or abx or steroid cream

45
Q

phimosis
what is it?
s/s
tx

A

cannot retract foreskin
normal until adolsecne, but only 10% remain unretractable by age 3
tx is steroid cream or circumcision

46
Q

paraphimosis
what is it?
s/s
tx

A

fore skin stuck retracted (true emergency)
-can lead to ischemia of glans
-tx: reduction – >apply EMLA –> wrap glans for 5 mins with plastic (?coban)–> manual reduction with fingers/thumbs –> doesn’t work dorsal block and make a slit.

47
Q

penile fracture
what is it?
s/s
tx

A
48
Q

what breaks in penile fracture?

A

tunica albuginea

49
Q

2 main causes of priapism

A

sickle cell, medications

50
Q

ischemic vs non ischemic priapism

A

ischemic –> veno occlusive, low flow
non ischemic –> arterial, high flow –> PAINLESS

can use blood gas from penis or Doppler to help differentiate too

51
Q

treatment of priapism

A

corporal aspiration, irrigation and injection with phenylephrine

52
Q

torsion ddx

A

torsion, appendigeal torsion, epididymitis, orchitis, hernia, trauma

53
Q

time frame to target detorsion

A

<6 hrs = excellent results

54
Q

most sensitive finding in to r/o torsion?

A

cremasteric reflex present bilat = 75-96% sens

55
Q

exam findings in torsion

A

swollen, firm, high-riding, transverse lie, absent cremasteric reflex.

56
Q

how to manually detort?

A

2/3 of bases –> opening a book,
1/3 of cases = opposite of that, if pain worsens with book opening try the other way

57
Q

blue dot sign is pathognomonic for?

A

appendageal torsion

58
Q

treatment of epididymitis by organisms and age

A

> 35 treat for e coli and klebiella = levo or cipro
< 35 treat for G+C = ctx and doxy

59
Q

%age of normal u/a in epididymitis?

A

50%

60
Q

symptoms of prostatitis

A

LUTS, back pain, pelvic pain, fever, chills, dyschezia, painful ejaculation

61
Q

most common organisms for prostatitis? empiric tx for prostatitis?

A

e colie, then other uropathogens
fluoroquinolone for 2 weeks

62
Q

Does decreasing calcium diet help with stones?

A

No, does opposite. Causes more calcium release from bones

63
Q

Composition of kidney stones

A

80%: calcium phosphate or oxalste
10%: struvite
10%: Utica acid

64
Q

3 common stone locations

A

UPJ
Pelvic brim
UVJ

65
Q

What %age of pts with renal colic have hematuria?

A

85%

66
Q

Most common miss with renal colic

A

AAA.. remember that it is rare for first time presentation of renal colic in pt > 60

67
Q

Ddx if renal colic

A
68
Q

%age of passage based on stone size

A

<5 mm, 98% at 4 week

5-7 60% at 4 weeks

Should talked to uro about stones >5 and defs >7

69
Q

mgmt of UTI and kidney stones

A

if obstruction, AKI, fever, other systemic signs = admission, IV ABX and uro consult for septic stone

if UTI and stone, but no other symptoms = oral abx and r/a in 48-72 hrs

70
Q

% age of kidney stones seen on xray

A

85% b/c the calcium ones have same density as bone roughly.

71
Q

general sensitivities and specificity of CT, US and xray for kidney stones

A
72
Q

medical expulsion therapy in stones

A

Tamsulosin is recommended, most impact in stones > 5 mm

73
Q

reasons for admission with kidney stone?

A

refractory pain/vomiting, septic stone, single kidney/renal transplant, severe comorbidity, hypercalcemic crisis

74
Q

avergae time to stone passage

A

varies, on size and location ,but 7-30 days (lol)

CCFP EM (20 decks)

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