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ACNP Certification > GU/Renal/STD's > Flashcards

GU/Renal/STD's Flashcards

1
Q

This symptom occurs in 40-60% of Lower UTI patients

A
  • Hematuria
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2
Q

Define pyuria

A

WBC in urine (>10 WBC/mL + for UTI)

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3
Q

UTI tx in pregnancy

A
  • Amoxicillin
  • Nitrofurantoin (Macrobid)
  • Cephalexin (Keflex)
  • 7-10 days for complete course
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4
Q

What signs often present and indicate upper UTI?

A

Fever and chills

(Flank, low back, or abd pain may be present)

Mental status changes in elderly

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5
Q

What diagnostic test may be elevated in pyelonephritis?

A

ESR

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6
Q

Upper UTI Management

A
  • Trimethoprim/Sulfa (Bactrim)
  • Cipro
  • Quinolones
  • Aminoglycoside (gent)
  • 14 days to 6 months
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7
Q

List 4 causes of Renal Insufficiency

A
  • HTN
  • Glomerulonephritis
  • Diabetes
  • Nepthritis
  • Polycystic kidney dz
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8
Q

At what percentage of remaining renal function are systemic changes evident?

A

20-25%

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9
Q

Diminished Renal Reserve

A

50% nephron loss, creatinine doubles

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10
Q

Renal Insufficiency Definition

A

75% nephron loss, mild azotemia

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11
Q

ESRD definition

A

90% neprhon damage, azotemia, metabolic alterations

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12
Q

Dialysis Criteria

A

A acidosis/Azotemia

E Electrolyte imbalance

Intoxication

Oliguria/ Overload

Uremia

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13
Q

3 startegies for Chronic Renal failure Management

A
  • Control HTN and DM
  • Reducing dietary protein to 40g/day
  • Modify drug dosing
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14
Q

Causes pre-renal failure

A
  • Shock
  • Dehydration
  • Burns
  • Sepsis
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15
Q

Most common cause of Intra-renal failure

A

Nephrotoxic agents

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16
Q

Three causes of intra-renal failure

A
  • Hypersenstivity reactions
  • Obstruction of vessels
  • Mismatched blood products
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17
Q

Location of acute tubular necrosis

A

Tubular portion of the nephron

Most common cause of intrarenal failure

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18
Q

Examples of mechanical post-renal failure

A

Calculi

Tumors

Urethral stricture

BPH

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19
Q

Causes of Functional Postrenal Failure

A

Neurogenic bladder

Diabetic neuropathy

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20
Q

Specific gravity for intra-renal and post-renal disease

A

<1.015

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21
Q

Urine sodium in intra and post renal disease

A

>40

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22
Q

Sediment in intra-renal disease

A

Granular/casts

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23
Q

FENa in intra and post renal disease

A

>3

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24
Q

Serum BUN/Creat ratio in Pre-renal dz

A

>10:1

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25
Q

Pre-renal Managment

A

Expand volume

Consider dopamine

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26
Q

Intra-renal

A
  • Maintain renal perfusion
  • D/c nephrotoxic drugs
  • HD as needed
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27
Q

Post-renal managment

A
  • Remove source of obstruction
  • Check foley
  • CT
  • Renal US
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28
Q

Name percentage of population that will develop renal cacluli

A

10%

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29
Q

Name four types of stones

A

Calium

Uric acid

Struvite

Cystine

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30
Q

Which stones result from UTI’s with urease producing bacteria?

A

Struvite

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31
Q

What does radiation of pain to the groin indicate in renal calculi?

A

Passage of stone to the lower 1/3 of ureter

Testicular pain is possible

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32
Q

Diagnostics for renal calculi

A

Abd XR- majority of stones are radiopaque

CT is indicated

Crystals in urinary sediment is suggestive of calculi

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33
Q

Indications for surgical removal of calculi

A

Obstruction of outflow

Accompanied by infection

Cystoscopy can be used for larger fragments

34
Q

Tx for renal calculi

A

Analgesia with:

Morphine, dilaudid, toradol, reglan

Hydration

35
Q

What is the theorized cause of BPH?

A

Response of the prostate to androgen hormones over time

36
Q

Abnormal PSA values

A

>4

Age specific:

40-49 <2.5

50-59 <3.5

60-69 <4.5

70-79 <6.5

37
Q

What percentage of prostate cancer patients present with normal PSA values?

38
Q

What is the least expensive method for enlarged prostate detection?

39
Q

If elevated PSA or palpable nodule is found, what diagnostic is recommended?

A

Transrectal US

40
Q

First line tx for BPH?

A

Alpha blockers

Terazosin (HYtrin), prazosin (Minipress), Tamulosin (flomax)

-relaxes muscles of the bladder and prostate

41
Q

Second line tx for BPH?

A

5-alpha-reductase inhibitors

Finasteride (proscar), dutasteride (Flomax)

Shrinks the prostate

42
Q

What herbal is used for BPH?

A

no decreased risk of prostate CA but may decrease PSA values

43
Q

Meds to avoid in BPH?

A
  • anti-histamine
  • decongestatns
  • antidepresants (SSRI)
  • diuretics
  • narcotic pain relievers
44
Q

Causative agent for Gonorrhea

A

Neisseria gonorrhoeae - gm neg diplococci

45
Q

Transmission rate after exposure Gonorrhea

A

Often asymptomatic, 80-90% for male to female exposure

Leading cause of infertility

1-2% general population

46
Q

Color of discharge in Gonorrhea

A

Men- white-yellow/green

Women-green

47
Q

Tx for Gonorrhea

A

Ceftriaxone (Rocephin) 250mg x 1 IM

PLUS

Azithromycin 1 gm oral x1 to treat chlamydia

G+C go together!!!!!

48
Q

Reportable diseases to the health department

A

Gonorrhea

Chlamydia

Syphyllis

HIV

TB

49
Q

Causative agent for Syphilis

A

Treponema pallidum (spirochete)

3rd most common infectious disease in the US

50
Q

4 stages of Syphilis

A
  • Primary- painless chancre
  • Secondary- flu-like illness with rash to palms and soles
  • Latent- asymptomatic but sero-positive
  • Tertiary- systemic symptoms, cardiac, neuro symptoms
51
Q

What testing is confirmatory in Syphilis?

A
  • Treponemal- FTA-antibody 85-90% primary and 100% secondary cases
  • MHA-TP to test for the anti-body to T pallidum
52
Q

What is the non-treponemal test for syphilis?

53
Q

Tx for primary syphilis of <1 yr duration

A

Pen-G 2.4 million units IM

54
Q

Tx for late, latent, or indeterminate Syphilis

A

Pen-G 2.4 million units IM weekly x 3 weeks

55
Q

Syphilis tx in PCN allergic patients

A

Doxycycline 100mg oral BID

Erythromycin 500mg oral QID

56
Q

Chlamydia causative agent

A

Chlamydia trachomatis-paracyte

57
Q

Most common bacterial STD in US

58
Q

Top 4 causes of dysparunia

A
  • CMPT
  • Chlamydia
  • Menopause
  • PID
  • Trichamonas
59
Q

What is the preferred test for chlamydia?

A

Enzyme immunoassay (EIA) is low cost 30-120 min for results

Culture is most definitive -days for results

60
Q

Tx for chlamYdia

A
  • AzithromYcin 1 gm oral x 1

OR

  • Doxycycline 100 mg oral BID
61
Q

Name 3 types of vulvovagintits

A
  • Trichomonas: frothy discharge, strawberry patches
  • Bacterial vaginosis (BV): fishy odor, watery gray discharge
  • Candiasis: white curdy discharge
62
Q

Diagnostic test trichomonas

A

NS wet prep with motile trichomonads

63
Q

Diagnostic test BV

A

NS wet prep with clue cells (squamous cells with undefined border)

64
Q

Diagnostic test Candidiasis

A

KOH mixture with psuedo-hyphae

65
Q

Tx trichomonas

A

Metronidazole (flagyl) 2gm oral x 1, 500 mg bid x 7 days

66
Q

Tx BV

A

Metronidazole (flagyl) 2 gm oral x1, 500mg bid x 7 days

or intravaginal gel BID x 5 days

Clindamycin

67
Q

Tx candidiasis

A

Miconazole (mono-stat), clotrimazole (gyne-lotrimin)

Butazonazole x 3

68
Q

Chancroid causative agent

A

Hemophilus ducreyi (gm neg bacilli)

69
Q

Co-infections common with chancroid

A

HIV

10% may be infected with syphilis and HSV

70
Q

Two physical signs of chancroid

A

Painful genital ulcer

Bubo-unilateral inguinal lymph node swelling

71
Q

Painful STD’s

A

Herpes

Chancroid

72
Q

All STD’s are bacterial except

A

HIV

Herpes

73
Q

STD’s causing genital ulcers

A

Herpes

Chancroid

Syphillis

74
Q

Chancroid tx

A

Aztihromycin 1 gm PO x 1

OR

Caftriaxone )rocephin) 250mg x 1 IM

OR

Cipro 500mg BID x 3 days

75
Q

Herpes lesions

A

Type 1: face, oral, lips

Type 2: gential

Painful!

76
Q

Duration for initial and recurrent Herpes lesions

A

Intial: 12 days

Recurrent: < 5 days

77
Q

Definitive test Herpes

78
Q

Treatment for asymptomatic viral shedding

A

Valacyclovir

Acyclovir: topical/oral/IV use

80
Q

Which test is confirmatory for syphilis?

A

FTA-ABS (treponemal antibody absorption) is confirmatory

VDRL/RPR test for disease but is not confrimatory

ACNP Certification (17 decks)

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