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EOR - Internal Med > Internal Med - Uro/Renal > Flashcards

Internal Med - Uro/Renal Flashcards

1
Q

1 cause of renal vascular disease

A

1 → Diabetic kidney disease

Hypertension, smoking, renal artery stenosis, glomerular disease, renal cysts, genetics

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2
Q

Stage 1 - Stage 5 Kidney failure classification

A

Stage 1 - Normal GF >90

Stage 5 - Kidney Failure GFR <15 → Dialysis pts

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3
Q

Acute kidney injury occurs when

A

Abrupt decline in renal fitration

Elevated Creatinine and decreased GFR; Azotemia → Rise in blood urea nitrogen (BUN) concentration

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4
Q

Causes of prerenal kidney injury

A

Kidney working fine, but perfusion issue → Volume loss, heart failure, loss of peripheral vascular resistance (Sepsis or anesthesia)

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5
Q

MCC of prerenal kidney injury

A

Hypovolemia → MC

NSAIDs, IV contrast, ACE/ARBS (renal artery stenosis)

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6
Q

Tx of prerenal kidney injury

A

Fluids, cardiac support, tx shock

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7
Q

Intrinsic kidney injury MCC

A

Direct damage to kidneys

MC → Nephrotoxic drugs (aminoglycosides like Gentamicin) or Cyclopsporine

Other causes → Tumor lysis syndrome, vasculitis, crystals from gout, myoglobin from rhabdo

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8
Q

Celluar cast is the hallmark of which type of kidney dz (pre, intrinsic or postrenal)

A

Intrinsic renal disease

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9
Q

Muddy casts signify

A

ATN

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10
Q

Tx of intrinsic renal dz

A

IV fluids remove drugs + Lasix can help kidneys get moving

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11
Q

Postrenal kidney injury causes

A

Some type of obstruction in the ureteres → Usually low or no urine output

BPH + Tumors → Common

Congenital or structual abnormalities

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12
Q

Acute tubular necrosis causes

A

Damaged tubules → Cant concentrate urine = high FENa

UA → Muddy casts

MCC = Prerenal failure

Drugs (Amp B, aminoglycosides, NSAIDs, ACE)

Ischemic causes → Dehydration, shock, sepsis

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13
Q

Chronic kidney dz definition

A

Progression of ongoing loss of kidney function (GFR less than 60) or presence of kidney damage (proteinuria, glomerulonephritis or structual damage from polycystic kidney dz)

Lasting longer than 3 months

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14
Q

PE findings of CKD

A

Broad waxy casts; fatigue, pruritis, Kussmaul respirations, asterixis (flapping tremor), muscle wasting

Pruritis d/t immune system dysfunction and elevated proinflammatory cytokines involved

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15
Q

Lab findings in a pt with CKD

A

Hypocalcemia (low Ca), hyperphosphotemia (high PO24), metabolic acidosis

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16
Q

5 Ps as the MCC of acute insterstitial nephritis

A

Pee- Diuretics, especially sulfa ones

Pain-free - NSAIDs

PCN and cephalosporins

Proton Pump Inhibitors

rifamPin

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17
Q

UA of acute interstitial nephritis

A

WBC casts and eosinophils

Immune mediated response to things like drugs, infections like strep, SLE, Sjorgens, Sarcoid etc

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18
Q

BPH sx

A

Decreased force of urinary stream, hesitancy (stop/start), straining, postvoid dribbling, incomplete emptying, frequency, nocturia, urgency, recurrent UTis

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19
Q

Dx of BPH

A

DRE → Enlarged rubbery prostate

Labs → PSA often elevated >4

US → Evaluate bladder size, prostate size, degree of hydronephrosis

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20
Q

Tx of BPH

A

alpha a1 receptor blockers - Zosins - Terazosin, tamsulosin

5-alpha reductase inhibitors → Finasteride

PDE-5 enzyme inhibitors → Tadalafil/Sidelenfil

*TURP = Surgery of prostate, resection; used if refractory to meds

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21
Q

Painless gross hematuria in a pt with smoking hx

A

Bladder cancer; Transitional cell carcinoma = MC type

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22
Q

Dx of bladder cancer

A

Cystoscopy with biopsy is gold standard

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23
Q

Tx of bladder cancer

A

Surgery; biological therapy; chemotherapy

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24
Q

Epididymitits in men <35 MCC

A

Chlamydia and gonorrhea

In men >35 → E.Coli

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25
Sx of epididymitis
Dysuria, unilateral dull aching scrotal pain that can radiate to ipsilateral flank Swollen epidymis; tender +/- fever/chills
26
+ phrens sign in epididymitis
Relief with elevation is classic sign
27
Dx of epididymitis
UA → Pyuria and bacteruria
28
Tx of epididymitis
Over 35 → Tx E.Coli - Levofloxacin 500mg x 10 days or Trimeth/Sulfa (Bactrim) BID x 10 days Under 35→ Tx gonorrhea or chlamydia = Ceftriazone 500mg IM plus doxy 100mg BID x 10 days
29
Glomerulonephritis, MC in kids, what is the MCC
Strep infection; Check antistrep O titer
30
Damage to renal glomeruli by deposition of inflammatory proteins in glomerular membranes as a result of immunologic response
Glomerulonephritis
31
Dx of glomerulonephritis
Hematurea; RBC casts, proteinuria, HTN, decreased GFR
32
Tx of glomerulonephritis
Steroids + Immunesupressive drugs to control inflammatory response
33
Fluid-filled sac around testicle often first noticed as swelling of scrotum
Hydrocele
34
Hydrocele are MC in what populations
Newborns and usually dissapear w/o tx within first year; Older men can develop these d/t inflammation or injury
35
Dx of hydrocele
Transillumination on PE; US may needed
36
Tx of hydrocele
Watchful waiting; rare = surgery
37
Hydronephrosis MCC
Blockage in ureter → Kidney stone, enlarged prostate, blood clot, tumor
38
Sx of hydronephrosis
Difficulty urinating and pain in the side, abd or groin
39
Tx of hydronephrosis
Abx if infection; In severe cases urine drained from bladder/kidney
40
Difference between nephritic and nephrotic syndrome
Nephrotic → Loss of a lot of protein Nephritic → Loss of a lot of blood
41
Inflammation that damages glomerular basement membrane leading to hematuria and RBC casts in urine
Nephritic syndrome
42
MCC of nephritic syndrome
Infections, immune system disorders, inflammation of blood vessels
43
Dx of nephritic syndrome
High BUN and Cr and hematuria, proteinuria and RBC casts in urine
44
Tx of nephritic syndrome
\*Depends on cause Steroids and immunosupressive drugs can be used to control inflammatory response Dialysis if symptomaic azotemia
45
Inflammation of kidneys that may involve glomeruli, tubules, or interstitial tissue surrounding glomeruli and tubules
Nephritis
46
Types of nephritis
Glomerulonephritis → Inflammation of glomeruli Interstitial nephritis → Inflammation of the spaces between renal tubules
47
MCC of nephritis
Autoimmune dz that affect kidneys Pyelonephritis from UTI Lupus Nephritis → SLE Athletic Nephritis → Strenous exercise
48
tx of nephritis
Tx based on what provoked inflammation of kidneys Lupus → Hydroxychlorquine can be used
49
Autosomal kidney disease causing a mutation of PKD1/PKD2
Polycystic kidney disease → Growth of numerous cysts on kidneys can lead to → Kidney failure/ESD
50
Sx of Polycystic kidney dz
Painful enlargements of the kidneys d/t cysts; Flank pain; Htn MC in young patients \>30yo
51
Polycystic kidney dz cardiovascular abnormalities
Mitral valve prolapse, LVH 10% have brain aneurysms
52
Dx of Polcystic kidney dz
US will show many fluid-filled cysts CT shows large renal size and multiple thin walled cysts
53
Tx of polycystic kidney disease
No cure; supportive, BP control ACE/ARBs → Renoprotective
54
Difficulty with urination or no symptoms at all, dx?
Prostate cancer MC area → Peripheral zone
55
MC area of prostate cancer to occur
Peripheralzone
56
PE findings of prostate cancer
DRE → hard, irregular, nodular
57
PSA for prostate cnacer
PSA \>4 → BPH, prostate cancer, prostatitis
58
When should prostate screenings occur
White male @ 50 yrs Black male, positive family hx, or +BRCA gene @ 40yrs
59
If PSA is 4.1 - 10 and DRE is negative
Biopsy is recommended
60
If PSA is \<4.0 and DRE is negative
Annual follow up recommended
61
PSA \>10
Transrectal US with biopsy is indicated; regardless of DRE findings
62
If DRE is abnormal
Transrectal US with biopsy is indicated, regardless of PSA level
63
Ascending infection of gram-negative rods into prostatic ducts
Prostatitis
64
Sx of prostatitis
Acute → Sudden onset of fever, chills, low back pain combined with urinary frequency, urgency, and dysuria Chronic → Variable- asymptomatic → Acute splenomegaly \*All forms present with irrative bladder symptoms (frequency, urgency, dysuria) and some obstruction
65
PE findings in Prostatitis
Tender, enlarged prostate on DRE
66
Dx of prostatits
UA → Pyuria and hematuria Prostatic fluid → Leukocytosis, culture → E.coli positive ; Chronic will show enterococcus \*If prostatitis is suspected, DO NOT massage prostate, can lead to sepsis
67
Tx of prostatitis
Men under 35 → Chlamydia,gonorrhea - Ceftriazxone and doxy Over 35 → E. coli and pseudomonas - fluroquinolones or Bactrim 4-6 wks Chronic prostatitis → Fluroquinolones or bactrim 6-12 weeks NSAIDs - Analgesia
68
Irrititative voiding, fever, flank pain, N/V, CVA tenderness
Pyelonephritis
69
MC bug in pyelonephritis
E.coli UA → Bacteria + WBC casts
70
Tx of pyelonephritis
Outpatient → FQ like Cipro or Levaquin/Bactrim for 1-2 weeks Inpatient → IV FQ, 3rd or 4th gen cephalosporins, PCN, Gentamicin \*Failure to respond to tx → US
71
Flank pain radiating into scrotum, gross hematuria, right sided hydronephrosis and normal abd xray
Renal calculi
72
Sx of renal calculi or renal stones
Colicky flank pain radiating to groin, hematuria, CVA tenderness, N/V
73
Dx of renal calculi
CT Scan (Spiral CT) without contrast of abd and pelvis → Gold std UA → Microscopic hematuria BUN & Cr levels elevated
74
MC type of renal calculi
Calcium oxalate → MC 80% ; Avoid grapefruit juice makes stones worse Struvite → Associated with chronic UTI Uric acid → Excess meat/alcohol; gout Cystine → Rare, genetic, radiolucent
75
Tx of renal calculi
Analgesia → IV morphine, NSAIDs Hydration Abx if UTI is present Alpha blocker→ Flomax helps passage of stones
76
What size renal calculi can be passed on their own?
\<5mm will spontaneous pass \>5-10 may need lithotripsy \>10mm need stend or nephrostomy
77
Triad → Hematuria, flank pain, abdominal mass
Renal cell carcinoma
78
MC type of renal carcinoma
Renal clear cell; Second → Transitional Cell \*\*\*RF = SMOKING
79
Dx and tx of renal carcinoma
Dx → US or CT then biopsy Tx → Surgery radical nephrectomy = curative
80
Nephritic vs Nephrotic which one affects protein?
Nephrotic -PRO→ Protein losing Nephritic -Blood loss
81
Disorders that can cause nephritic syndrome
* **Those caused by type III hypersensitivity** * poststreptococcal glomerulonephritis * IgA nephropathy (Berger's disease) * diffuse proliferative glomerulonephritis (often caused by SLE) * **Those with multiple potential causes** * membranoproliferative glomerulonephritis (MPGN) * rapidly progressive glomerulonephritis (RPGN) * **Alport syndrome** which affects collagen synthesis
82
MC type of testicular cancer
Germ cell tumor; Nonseminomatous germ cell tumor

EOR - Internal Med (9 decks)

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