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Clinical Medicine II > GU/Renal > Flashcards

GU/Renal Flashcards

1
Q

Nephrolithiasis/Urolithiasis

A

worst pain ever
cannot find comfortable position
NEW onset colicky abdomen; flank/low back pain; hematuria

Ibuprophen 200-400mg q4-6h
IV Onadansetron (Zofran) 2-4m
Promethazine (Phenergan) 25mg IM or PO

Tamulosin (alpha-adernergic blocker- dilation)
Nifedipine XL (CCB- ureteral m. spasm)
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2
Q

Obstructive Uropathy

A

decreased GFR
DECREASED URINE OUTPUT (oliguria- <400ml/d)
hydroureter
hypertension (RAA)

pain control
free urine: ureteral stent; percutaneous nephrostomy tube
antibiotics to prevent UTI

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3
Q

Renal Artery Stenosis (RAS)

A

“RESISTANT HTN
Renal bruits
Atherosclerotic disease MCC
Fibromuscular dysplasia (arterial webs)

ACE/ARB (add thiazide; b-blocker; CCB as needed)”

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4
Q

Renal Thromboembolic Disease

A 
"atrial fibrillation MCC
lactic dehydrogenase (ischemia)

heparin/LMWH and warfarin 3-6m
daily aspirin”

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5
Q

Acute Interstitial Nephritis

A

“WHITE CELL CASTS
TINU syndrome: uveitis
drug induced rash and eosinophilia
meds MCC

stop offending agent
check for infection or autoimmune
Prednisone 1mg/kg/d max 40-60mg/d”

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6
Q

Chronic Interstitial Nephritis

A

“signs of renal impairment:
metabolic acidosis
HTN
anemia of chronic disease

treat like acute but with 3 addional:
ACE/ARB for HTN
sodium bicarb 600mg PO for acidosis
erythropoiesis stimulating agent for anemia”

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7
Q

Nephrotic Syndrome

A 
"O NO I SPILLED MY PROTEIN
albuminuria (3+ g in 24h urine)
edema
hyperlipidemia
hypercoagulation
Minimal Change Disease MCC
renal biopsy

Nephrology referral
ACE/ARB to slow progression”

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8
Q

Nephritic Syndrome

A

“agent causes immune complexes to form in glomerulus
structural changes and RBCs spill out
Coca-Cola colored urine
RBC casts

Post Strep; endocarditis; Berger’s disease

Nephrology referral
abx; sodium restriction; loop diuretics”

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9
Q

Polycystic Kidney Disease

A

“ADPKD:
intracranial aneurysms
gross hematuia
can present: UTI; managing HTN; managing pain
cyst infection (localized) vs. pyelo (diffuse)
cyst- neg. urine culture
pyelo- white cell casts

Ciprofloxacin or Levofloxacin 4-6w for UTI
strict BP control for disease

ARPKD:
significantly enlarged kidneys
Potter syndrome
respiratory distress

manage co-morbidities and transplant”

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10
Q

Acute Kidney Injury

A

“serum creatinine increase >0.3 in 48h
or increase 150% off baseline in 7d
AZOTEMIA- BUN and creatinine increase

prerenal: poor flow to kidney
intrarenal: meds; contrast; sepsis; crush; venom
postrenal: obstruction”

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11
Q

Prerenal Azotemia

A

“hypoprofusion; decreased flow
NO damage to glomerulus or tubules
BUN/Creatinine >20:1”

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12
Q

Acute Tubular Necrosis (ATN)

A

“prolonge severe ischemia leads to this intrarenal process
renal tube injury
MUDDY BROWN CASTS”

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13
Q

Intrarenal Azotemia

A

“injury within the kidney
causes: renovascular; glomerular; tubulointerstitial; toxins
BUN/Creatinine <10:1”

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14
Q

Postrenal Azotemia

A

“damage to kidneys due to process after renal structure
causes: BPH; CA; obstruction
BUN/Creatinine >20:1 early then <10:1 later”

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15
Q

Chronic Kidney Disease (CKD)

A

“kidney damage 3+ mo or GFR <60 3+ mo
anemia of chronic disease
RBCs and proteinuria
serum creatinine and hyperkalemia

Nephrologist referral:
ACE/ARB to slow progression
dialysis if GFR <10
transplant discussion when GFR <30”

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16
Q

CKD Staging

A 
"GFR:
>90 and damage - stage 1
60-89 and damage - stage 2
30-59 - stage 3
15-29 - stage 4
<15 or dialysis - stage 5 (failure)"
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17
Q

Overactive Bladder (OAB)

A 
"muscarinic receptors overstimulated
triad:
urinary frequency (immediate urge)
frequency (every 1-2h)
nocturia (waking 2-3 times per night)

atrophic vaginitis (Primarin or Estrace)

behavior therapy; bladder diary; training; fixed schedule toileting; prompted; PFE w/ biofeedback
antimuscarinics
augmentation cystoplasty (bowel increases bladder)”

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18
Q

Stress Incontinence

A

“involuntary low volume leakage w/ sneezing, coughing, etc.
bladder stress test

pessaries
NO FDA APPROVED Rx
estrogen
alpha-agonists (stim. urethral closure): pseudoephedrine (Midodrine)
SNRI: Duloxetine (Cymbalta)
midurethral sling; bladder neck sling"
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19
Q

Urge Incontinence

A

“OAB with incontinence (frequent, high volume)
immediate urge then rapid incontinence
overactive detrusor muscle

lifestyle
antimuscarinics: Oxybutynin (Ditropan; Oxytrol)
beta3 agonist (relax detrusor): Mirabegron (Mybetriq) 25-50qd
acupuncture; botox; augmentation cystoplasty”

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20
Q

Mixed Incontinence

A

“stress and urge
lifestyle modifications
PFE
Tx based on more predominant symptoms”

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21
Q

Overflow Incontinence

A

“continuous dribbling with no warning or urgency
incomplete emptying- urine spills over when changing positions
weakened detrusor
BOO- bladder outlet obstruction

post void residual (PVR) measurement
tx depends on etiology”

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22
Q

Transient Incontinence

A 
"DIAPERS:
delerium
infection of bladder or urethra
atrophic vaginosis
pharmaceuticals; alcohol; caffeine; artificial sweeteners
excess excretion
restricted mobility
stool impaction"
23
Q

Incontinence in Men

A

“GU and DRE exams
PVR test if symptoms severe
cystoscopy if indicated

lifestyle and diet modifications
Urgency:
antimuscinics
alpha-blockers esp. if prostate disease
augmentation cystoscopy; botox; electrical stim.
Stress:
NO FDA meds- Duloxetine in EU
collagen injections; perineal sling; artificial urinary sphincter"
24
Q

Acute Cystitis

A

“infection of lower urinary tract confined to bladder
NO vaginal discharge
culture >100,000 significant (low if symptomatic)

Uncomplicated:
Nitrofurantoin (Macrobid) 100mg bid 5d
TMP-SMX (Bactrim DS) 160/800 tab bid 3d
Ciprofloxacin 500mg bid 3d if allergy or intolerable
if multiple allergies:
Beta-lactams (Cefpodoxime; Defdinir; Cefaclor) 7d”

25
Complicated UTIs
``` "ABX GIVEN MIN of 7 DAYS structural abnormalities recurrent/frequent UTIs past multi-drug resistance immunocompromised male" ```
26
Urinary Analgesics
"Phenazopyridine (AZO; Uristat OTC 190mg tid) Pyridium Rx 200mg tid NO MORE than 2 days to unmask symptoms"
27
Acute Pyelonephritis
"systemic symptoms CVA TENDERNESS ``` CT of abdomen w/out contrast then w/ contrast wedge lesions- ischemia outpatient: Ciprofloxacin 500mg PO bid 7 days reevaluate in 48 hours inpatient: IV abx immediately IV fluids PO abx when tolerable" ```
28
Healthcare Assoc. UTIs
"bacteria in recent cath with UTI s/s nonspecific symptoms if cath in place risk 3-8% per day cathed Significant UA: clean catch- 1,000 symptomatic; 100,000 asymptomatic (1-2x) cath spec.- 1,000 symptomatic; 10,000 asymptomatic Ciprofloxacin 500mg PO bid 7-14d or Ceftriaxone IV 1g qd 7-14d Fluconazole (Diflucan) 200-400mg PO qd 2w for fungus"
29
Interstitial Cystitis
``` "painful bladder syndrome urination every 5-10 min pain w/ bladder filling; relief w/ voiding gradual onset and >6w duration normal UA and culture ``` Urology referal Amitriptyline 25-150mg qd at bedtime std. tx"
30
Acute Cystitis in Men
"watch for fever/chills; CVA tenderness; perneal pain; toxic all get UA and culture (1,000 significant) Nitrofurantoin (Macrobid) or TMP-SMX (Bactrim DS) 7 days Ciprofloxacin 5 days"
31
Prostatitis
"acute fever/chills; NAV dribbling; hesitancy prostate exam TMP-SMX (Bactrim DS) q12h 6 WEEKS Ciprofloxacin q12h 6 WEEKS 6w tx to avoid chronic prostate/pelvic pain syndrome"
32
Urethritis
"STI MCC- gonorrhoeae: urethral discharge NGU: clear HSV: ulcers chlamydia: dysuria no discharge Ceftriaxone 250mg IM + Azithromycin 1gm (G&C) (Gemifloxin + Doxycycline bid 7d if allergic) Metronidazole 500mg bid 7d (trichomonas) no sex for 7d after tx started"
33
Epididymitis
"MCC scrotal pain posterior scrotal swelling <35 chlamydia MCC; >35 E coli MCC Ceftriaxone + Azithromycin (G&C) MSM: Cefriaxone 250mg IM + Levofloxacin 500mg (coliform) No infection: elevation; NSAIDs; ice; avoid lifting"
34
Orchitis
"pain and swelling in the testicle red/edematous skin fever; NAV MUMPS viral- elevation; NSAIDs+ bacterial- based on organism"
35
Balanitis
"swelling of the glans diabetes Candida MCC Clortrimazole; Miconazole; Fluconazole hyrocortisone for irritation improve hygiene; Bacitracin if mild; Abx if severe; remove contact irritants; d/c meds and give steroids"
36
Congenital Cryptorchidism
orchiopexy
37
Testicular Torsion
"higher on one side bell clapper deformity no cremasteric reflex movement from midline provides relief surgical detorsion and fixation"
38
Parephimosis/Phimosis
"retracted foreskin / cannot retract | reduction / topical steroid for inflammation"
39
Peyronie's Disease
"abnormal curvature d/t fibrotic tissue in tunica albuginea observation Penoxifylline 400mg tid up to 2y (blocks TGF1) Verpamil (CCB) intralesional injection surgery"
40
Fourneir's Gangrene
"rapid onset cellulitis open wound culture debridement broad spectrum abx: Cipro + Clindamycin orciectomy"
41
Spermatocele
"benign accumulation of sperm along epididymis head soft, cystic lesion with smooth border <1cm can be transilluminated no tx unless uncomfortable"
42
Hydrocele
"bag of water; pain transilluminate surgical incision"
43
Varicocele
"dilated and tortuous veins of pampiniform plexus more common in left scrotum RT SIDE CAN BE IVC OBSTRUCTION- CT rest; NSAIDs; elevation Urology if need fertility; have atrophy or pain"
44
Hypospadias
"urethral opening fails to close- opens more proximal and ventral Pediatric urologist for surgery"
45
Renal Dysplasia/Aplasia
"hypoplasia- decreased size d/t decreased nephrons dysplasia- malformation of shape/size (horseshoe) agenesis- absence of kidney"
46
Renal Agenesis
"annual US; control BP; monitor serum creatinine | Pediatric nephrologist referral- AVOID TOXIC DRUGS"
47
Renal Dysplasia
"horseshoe kidney refer to pediatric nephrologist monitor function"
48
Erectile Dysfunction
"failure to initiate: <35; psychological; endo; neuro failure to fill: heart disease; diabetes failure to store: venoocclusive disease meds: SSRIs; spironolactone; HTN; cimetidine; alcohol check PE and GU education; psychotherapy; lifestyle change; tx underlying disease remove offending med 1st: PDE5 inhibitors (Sildenafil/Viagra; Tadalafil/Cialis; Vardenafil/Levitra) 2nd: Intraurethral/cavernosal (Alprostadil/Muse/Caverject) 3rd: prosthesis"
49
Priapism
"erection >4h unrelated to sex sickle cell; trauma; infection; neuro; meds ischemic: pain control; Phenylephedrine (Sudafed) inject; surg. non-ischemic: observation; surg. If no resolution stuttering: pt. phenylephedrine inj; check testosterone levels"
50
BPH
"prostate volume >30cc increased urination; small volumes; urge incontinence check hx; meds; PE; CT if stone suspected; Urology may do PVR (>100-200 significant) no tx if asymptomatic lifestyle alpha-1 blockers (""sins"")- do not reduce progression 2nd gen A1b (""zosins"") 3rd gen A1a- Tamsulosin (Flomax) 5-alpha reductase inhibitors (""asterides"")- reduce progression 6mo to work Finasteride (Proscar; Propecia) Other: Tadalafil (Cialis) if others fail or ED Surgical: TURP; TUNA; microwave; TUIP"
51
Testosterone Replacement
"Buccal: Staint 30mg q12h Implant: Testopal 150-450mg SQ q 3-6mo IM: Dep-testosterone (Cypionate) 50-400mg q 2-4w; Aveed (Undecanoate) 750mg 1x/4w late/then q 10w Nasal gel: Natesto 1 spray ea nostril tid Transdermal: Androderm 4mg patch every night Transdermal creams; gels; ointments; solutions"
52
Bladder Outlet Syndrome (BOO) and Acute Urinary Retention (AUR)
"SEVERE DISTRESS SUDDEN ONSET OF PAIN bladder distention and straining men: BPH; women: pelvic mass cath to free urine (unless recent injury)- Coude bent tip tx underlying condition once bladder decompressed"
53
Prostate CA
"asymptomatic; elevated PSA; DRE mass; hematuria biopsy w/ transurethral US (TRUS); MRI; CT lymph spread Urology referral when elevated PSA; PSA velocity >.75/y; abnormal DRE; symptoms of metastases watchful waiting; radiation; brachytherapy (beads); androgen deprivation therapy; LHRH antagonists; prostatectomy"

Clinical Medicine II (5 decks)

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