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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
Q

Complicated UTIs

A 
"ABX GIVEN MIN of 7 DAYS
structural abnormalities
recurrent/frequent UTIs
past multi-drug resistance
immunocompromised
male"
26
Q

Urinary Analgesics

A

“Phenazopyridine (AZO; Uristat OTC 190mg tid)
Pyridium Rx 200mg tid
NO MORE than 2 days to unmask symptoms”

27
Q

Acute Pyelonephritis

A

“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
Q

Healthcare Assoc. UTIs

A

“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
Q

Interstitial Cystitis

A 
"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
Q

Acute Cystitis in Men

A

“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
Q

Prostatitis

A

“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
Q

Urethritis

A

“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
Q

Epididymitis

A

“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
Q

Orchitis

A

“pain and swelling in the testicle
red/edematous skin
fever; NAV

MUMPS
viral- elevation; NSAIDs+
bacterial- based on organism”

35
Q

Balanitis

A

“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
Q

Congenital Cryptorchidism

A

orchiopexy

37
Q

Testicular Torsion

A

“higher on one side
bell clapper deformity
no cremasteric reflex
movement from midline provides relief

surgical detorsion and fixation”

38
Q

Parephimosis/Phimosis

A

“retracted foreskin / cannot retract

reduction / topical steroid for inflammation”

39
Q

Peyronie’s Disease

A

“abnormal curvature d/t fibrotic tissue in tunica albuginea

observation
Penoxifylline 400mg tid up to 2y (blocks TGF1)
Verpamil (CCB) intralesional injection
surgery”

40
Q

Fourneir’s Gangrene

A

“rapid onset cellulitis
open wound culture

debridement
broad spectrum abx: Cipro + Clindamycin
orciectomy”

41
Q

Spermatocele

A

“benign accumulation of sperm along epididymis head
soft, cystic lesion with smooth border <1cm
can be transilluminated
no tx unless uncomfortable”

42
Q

Hydrocele

A

“bag of water; pain
transilluminate
surgical incision”

43
Q

Varicocele

A

“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
Q

Hypospadias

A

“urethral opening fails to close- opens more proximal and ventral
Pediatric urologist for surgery”

45
Q

Renal Dysplasia/Aplasia

A

“hypoplasia- decreased size d/t decreased nephrons
dysplasia- malformation of shape/size (horseshoe)
agenesis- absence of kidney”

46
Q

Renal Agenesis

A

“annual US; control BP; monitor serum creatinine

Pediatric nephrologist referral- AVOID TOXIC DRUGS”

47
Q

Renal Dysplasia

A

“horseshoe kidney
refer to pediatric nephrologist
monitor function”

48
Q

Erectile Dysfunction

A

“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
Q

Priapism

A

“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
Q

BPH

A

“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
Q

Testosterone Replacement

A

“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
Q

Bladder Outlet Syndrome (BOO) and Acute Urinary Retention (AUR)

A

“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
Q

Prostate CA

A

“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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