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neph Flashcards

1
Q

Upper UTI x2

A

Pyelonephritis

Renal Abscess

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2
Q

Lower UTI x2

A

Cystitis

Urethritis

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3
Q

UTI

A

inflammation and infection: kidneys ureters bladder and/or urethra

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4
Q

Most common etiology UTI women

A

E. coli

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5
Q

Most common etiology UTI men

A

Proteus

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6
Q

Lower UTI s/s

A

DYSURIA *
Frequency, Urgency
Hematuria - 40-60%
Nocturia

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7
Q

Your patient is displaying symptoms suggestive of BPH. What is the first test you should order?

A

UA

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8
Q

Key symptom of lower UTI

A

Dysuria

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9
Q

Lower UTI: general mgmt x3 choices + what duration? *

A

trimethoprim-sulfamethoxazole (Bactrim)
ciprofloxacin (Cipro)
amoxicillin/clavulanate (Augmentin)

3 day course: max benefits, min drawbacks (ex: SE, less costly)

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10
Q

Lower UTI: mgmt during pregnancy x3 choices + what duration? *

A

amoxicillin
nitrofurantoin (Macrobid)
cephalexin (Keflex)

7 - 10 day course

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11
Q

Upper UTI s/s x5

A

flank, abd, lower back pain
fever, chills
AMS in elderly

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12
Q

AMS causes in elderly

A

TIA
UTI
drugs (interactions)
pulm infections

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13
Q

Upper UTI treatment x5 choices + what duration? *

A

2 vs. 6 wk course

heeeey, same as lower UTI +2:
trimethoprim-sulfamethoxazole (Bactrim)
ciprofloxacin (Cipro)
amoxicillin/clavulanate (Augmentin)

fluoroquinolone
aminoglycoside

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14
Q

Hospitalization is indicated for a patient with what kind of UTI?

A

Upper UTI: pyelonephritis with nausea and vomiting

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15
Q

what is renal insufficiency?

A

↓ renal fxn = ↓ GFR + ↓ clearance of solutes

can be acute or chronic

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16
Q

renal insufficiency: causes x5

A 
hypertensive (major) nephrosclerosis
Glomerulonephritis
DM nephropathy
interstitial nephritis
polycystic kidney disease
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17
Q

comorbs associated with renal insufficiency

A

HTN

DM

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18
Q

what is acute renal insufficiency?

A

SUDDEN impairment, REVERSIBLE w tx
BUN: out of proportion to creatinine
causes: obstruction, acute tubular necrosis, contrast media

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19
Q

Is ATN reversible?

A

Yes. ATN reversible r/t acute renal insufficiency

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20
Q

what is chronic renal insufficiency?

A

PROGRESSIVE: mo - yrs, irreversible
STEADY ↑ BUN and creatinine
d/t intrinsic damage - progression can be slowed

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21
Q

what causes chronic renal insufficiency?

A

Intrinsic kidney damage

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22
Q

what is diminished renal reserve? *

A

first stage of renal failure
50% nephron loss
Creat x2

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23
Q

what is the second stage of renal failure and 2 characteristics?

A

renal insufficiency
75% nephron loss
mild azotemia

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24
Q

what is End-Stage Renal Disease?

A

90% nephron damage
azotemia
metabolic alterations

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25
Q

percentage of nephron function in ESRD

A

10% nephron function

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26
Q

dialysis criteria mnemonic

A

AEIOU

A cidosis - metabolic; azotemia
E lectrolyte abn: Ca, K
I ntoxication: AMS
O liguria: lt 400 mL/24 hrs
U remia
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27
Q

Acute Renal Insufficiency: mgmt

A

determine & reverse underlying cause (pre, intra, post)

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28
Q

Chronic Renal Insufficiency: mgmt

A

slow the progression of failure!
control HTN + DM
Δ rx doses
↓ dietary protein under 40 g/day

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29
Q

dietary protein requirement for chronic renal insufficiency?

A

less than 40 g/day

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30
Q

what is a classic electrolyte imbalance seen in chronic renal failure?

A

hypercalcemia

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31
Q

expected acid/base imbalance in chronic renal insufficiency + tx?

A

metabolic acidosis

IV: NS + sodium bicarb

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32
Q

major complication of peritoneal dialysis

A

peritonitis

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33
Q

acute renal failure: pre-renal causes x6

A

OUTSIDE kidney

↓ kidney perfusion: shock, dehydration, cardiac failure, burns, diarrhea, sepsis

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34
Q

what is pre-renal acute renal failure?

A

acute renal failure caused by conditions impairing renal perfusion; no damage to renal tubules

acute only if reversible with correction of underlying cause

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35
Q

What kind of damage do renal tubules sustain from pre-renal causes of acute renal failure?

A

Psych! NONE!

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36
Q

acute renal failure: intrarenal causes x4

A

renal or intrinsic causes that directly affect renal cortex/medulla:

  • nephrotoxic drugs (most common)
  • hypersensitivity reaction (ex: to contrast media)
  • embolism/thrombosis of renal vessels
  • mismatched blood transfusions (RBCs hemolyze then block nephrons)

RESULTS IN NEPHRON DAMAGE - acute tubular necrosis is the most common cause

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37
Q

what is the most common cause of damage to the nephron tubules in acute renal failure?

A

acute tubular necrosis in intrarenal acute renal failure

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38
Q

what does intrarenal acute renal failure result in?

A

nephron damage to tubules

ATN = most common cause

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39
Q

most common nephrotoxic drug

A

aminoglycosides - gentamicin

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40
Q

what is post-renal acute renal failure?

A

urine flow obstruction; mechanical or functional

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41
Q

acute renal failure: mechanical post-renal causes x4

A

BPH
tumor
renal calculi
urethra strictures

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42
Q

acute renal failure: functional post-renal causes x2

A

DM nephropathy

neurogenic bladder

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43
Q

pre-renal ARF BUN/Cr ratio

A

greater than 10:1

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44
Q

pre-renal ARF urine Na

A

less than 20 mEq/L

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45
Q

pre-renal ARF specific gravity

A

1.015+

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46
Q

pre-renal ARF fractional excretion of sodium (FENa)

A

under 1%

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47
Q

intrarenal ARF vs Postrenal ARF key diagnostic difference

A

urinary sediment

intra: granular white casts
post: normal

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48
Q

pre-renal ARF: mgmt

A

expand intravascular volume

dopamine

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49
Q

intrarenal ARF: mgmt

A

maintain renal perfusion
STOP nephrotoxic drugs
RRT

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50
Q

post-renal ARF: mgmt

A

remove obstruction
check foley
CT
renal US

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51
Q

most common type of renal calculi

A

calcium stones - 80%

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52
Q

renal calculi associated with gout

A

uric acid stones

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53
Q

most common type of renal calculi in women

A

struvite stone
r/t urease-producing bacteria UTIs
ARF infection: staghorn stones EMERGENCY

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54
Q

renal calculi: s/s x6

A

passage = pain + bleeding
colic-like FLANK pain, INCREASING intensity
groin/testicular pain
frequency, urgency, dysuria

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55
Q

gold standard for diagnosis of renal calculi

A

non-contrast CT scan

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56
Q

standard intravenous trio for renal calculi

A

morphine or hydromorphone (Dilaudid)
toradol (Ketorolac)
metoclopramide (Reglan)

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57
Q

** top 2 priorities in management of renal calculi

A

ANALGESIA

HYDRATION

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58
Q

what is benign prostatic hypertrophy?

A

enlargement of the prostate, doy
common in 50+ males

50% of men by 50
80% + of men 80+

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59
Q

benign prostatic hypertrophy: s/s

A 
dysuria
frequency, urgency
nocturia, incontinence
hesitancy
start/stop flow, dribbling
retention
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60
Q

benign prostatic hypertrophy: diagnostics x4

A

UA: r/o infection
PSA
transrectal US: if palpable nodule or elevated PSA

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61
Q

normal PSA for 60 - 69

A

less than 4.5 ng/mL

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62
Q

normal PSA for 70-79

A

less than 6.5 ng/mL

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63
Q

abnormal PSA value + note

A

4+ ng/mL

40% w prostate cancer present with normal PSA values

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64
Q

BPH: mgmt - standard of care meds

A

ALPHA BLOCKERS! relaxes bladder/prostate muscles

terazocin (Hytrin)
prazocin (Minipress)
tamsulosin (Flomax)

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65
Q

alpha blockers MOA

A

relax muscles of the bladder and prostate

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66
Q

BPH: overall mgmt

A

** alpha blockers: terazocin (Hytrin), prazocin (Minipress), tamsulosin (Flomax)

5-alpha-reductase inhibitors: finasteride (Proscar), dutaseride (Avodart) - shrink prostates

surgery, TURP, urology referral

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67
Q

MOA 5-alpha-reductase inhibitors

A

shrink the prostate

68
Q

What meds worsen BPH s/s? x4

A

OTC antihistamines, decongestants

  • Benadryl, Sudafed, Afrin
  • SSRIs
  • Diuretics
69
Q

green discharge is most commonly associated with what STD?

A

Gonorrhea

Green = Gonorrhea

70
Q

gonorrhea hallmark s/s women

A

ASYMPTOMATIC 80%
mucopurulent GREEN vaginal discharge
dysuria

71
Q

gonorrhea hallmark s/s men

A

ASYMPTOMATIC (often)
yellow-GREEN/white penile discharge
dysuria

72
Q

gonorrhea: diagnostics x2

A

gram stain: discharge = gram neg diplococci + WBC

cervical culture

73
Q

gonorrhea: treatment **

A

ceftriaxone (Rocephin) 250 mg IM one

PLUS

azithromycin (Zithromax) 1 g PO once (cover chlamydia)

then report to health department

74
Q

syphilis: causative agent

A

Treponema pallidum, a spirochete

75
Q

primary syphilis: description x2

A

PAINLESS chancre @ site of exposure

indurated ulcer

76
Q

secondary syphilis: s/s + description *

A
    • flu-like sx

* * highly variable skin rash: palmar/plantar surfaces + mucous patches

77
Q

latent syphilis: presentation

A

seropositive but asymptomatic

78
Q

tertiary syphilis: complications x6

A 
leukoplakia
cardiac insufficiency
aortic aneurysm
meningitis
hemiparesis/hemiplegia
79
Q

which diagnostic is confirmatory for syphilis?

A

fluorescent treponemal antibody absorption (FTA-ABS)

+ 85-95% primary, 100% secondary

80
Q

which lab do you order to rule out syphilis that is NOT diagnostic?

A

VDRL/RPR

non-treponeal serological test for syphilis

81
Q

primary, secondary, or early syphilis + duration under 1 year: treatment

A

pencillin G 2.4 million units IM

82
Q

late, latent, indeterminate length and tertiary syphilis: treatment

A

pencillin 2.4 million units IM weekly x 3 weeks

83
Q

What drug allergy do you care about when treating a syphilis patient, and how do you treat syphilis patients with that allergy?

A

pencillin

doxycycline 100 mg PO BID
OR
erythromycin 500 mg PO QID

84
Q

most common bacterial STD in United States

A

Chlamydia

85
Q

chlamydia

A

PARASITIC STD
Chlamydia trachomatis

produces serious reproductive tract complications in men and women

86
Q

chlamydia: s/s women

A

ASYMPTOMATIC (often)
dyspareunia
dysuria
postcoital bleeding

87
Q

chlamydia: s/s men

A

ASYMPTOMATIC (often)
dysuria
thick cloudy penile discharge

88
Q

STDs that present often asymptomatic

A

gonorrhea

chlamydia

89
Q

top causes of dyspareunia

A

trichomonas
PID
menopause
chlamydia

90
Q

most definitive test for chlamydia

A

culture

… it takes 3 - 9 days

91
Q

chlamydia: diagnostics

A

culture
enzyme immunoassay (EIA)
- low cost + takes 30 to 120 mins

92
Q

chlamydia: treatments top 2 + 3x more

A

** azithromycin (Zithromax) 1 g PO once
OR
** doxycycline 100mg PO BID x7 days

alts: erythromycin, ofloxacin, levofloxacin (Levaquin)

+ report to health department

93
Q

what is vulvovaginitis?

A

inflammation or infection of VULVA & VAGINA

  • most commonly bacterial, fungal, protozoan
    • top 3: trichomonas, bacteria, and candida

only trichomonas is considered sexually transmitted

94
Q

trichomonas: presentation x6

A 
malodorous frothy yellow-greenish discharge
pruritis
strawberry patches on cervix/vagina
vaginal erythema
dyspareunia, dysuria
95
Q

You observe strawberry patches on your patient’s cervix. Yiiikes she has…

A

trichomonas

96
Q

Bacterial Vaginosis: presentation x2

A

fishy, watery, gray discharge

vaginal spotting

97
Q

trichomonas: diagnostic test

A

microscopic wet prep: NS mixture shows motile TRICHOMONADS

98
Q

candidiasis: diagnostic test

A

microscopic wet prep: KOH mixture show PSEUDOHYPHAE

99
Q

bacterial vaginosis: diagnostic test

A

microscopic wet prep: NS mixture shows CLUE CELLS

100
Q

Trichomonas: treatment

A

metronidazole (Flagyl) 2 g PO once

then 500 mg PO BID x 7 days

101
Q

bacterial vaginosis: treatment

A

metronidazole (Flagyl) 2 g PO once
then 500 mg PO BID x 7 days +
gel 0.75%, intravag BID x 5 days

clindamycin (Cleocin) vaginal cream 2%, 5g qHS +
300 mg PO BID x 7 days

102
Q

candidiasis: treatment

A

miconazole (Mono-stat) OR clotrimazole
- 5 g intravag qHS x 7 days

terconazole 80mg supp, qHS x3 days

butaconazole: 3 applications

103
Q

chancroid: s/s in men + women

A

women: asymptomatic

men: painful ulcer(s) surrounded by erythematous halo
- can be necrotic or erosive, yuck

104
Q

How do you diagnose chancroid? Definitive diagnosis?

A

DIAGNOSIS OF EXCLUSION

  • definitive dx: morphologically (sens 80+%)
  • genitalia +/or unilateral bubo
  • painful genital ulcers + tender inguinal lymphadenopathy that aren’t syphilis or HSV
105
Q

Wat ur pt haz quail egg lymph node in groin da fuuuuu

A

unilateral bubo - swollen inguinal lymph node associated with chancroid

106
Q

Chancroid management

A

same as gonorrhea and chlamydia

107
Q

herpes

A

recurrent VIRAL STD
no cure
painful genital lesions

HERPES = HURTS

108
Q

herpes: transmission

A

direct contact with ACTIVE lesions
OR
virus-containing fluids (saliva HSV1; cervical secretions HSV2)

109
Q

herpes: initial s/s

A

painful/pruritic ulcers x ~12 days

dysuria, fever, malaise

110
Q

herpes: recurrent s/s

A

less painful/pruritic ulcers x 5 days

111
Q

Most definitive test for Herpes

A

viral culture

112
Q

herpes: diagnostics x3

A

Pap
Tzanck stain
Viral culture

113
Q

herpes: mgmt x4

A

no cure
acyclovir (Zovirax): topical, oral, IV use
valacyclovir: useful for asx viral shedding HSV2
famciclovir
symptomatic (drying/antipruritic)

114
Q

30 yo. F presents with 6 month history of three UTIs associated with hematuria. What should be your plan of care?

A

Refer to a urologist

115
Q

What is the most common potential complication associated with a TURP?

A

Impotence

116
Q

Treatment of choice of uncomplicated cystitis in women?

A

Bactrim

117
Q

most common cause of metabolic acidosis in patients s/p surgery

A

circulatory dysfunction with lactic acidosis

118
Q

differential diagnosis for significant proteinuria

A

nephrotic syndrome
CHF
DM

119
Q

50 yo. M diagnosed with uric acid renal calculi. Treatment?

A

allopurinol

120
Q

antihypertensive of choice for patients with marked proteinuria

A

ACE Inhibitors

121
Q

treatment of hyperphosphatemia in ESRD

A

calcium citrate

122
Q

45 yo. M s/p abdominal surgery has now developed ARF with BUN 100 mg/dL and Cr 4.5 mg/dL. Indications for dialysis include

A

hyperkalemia
metabolic acidosis
encephalopathy

123
Q

nephrotic syndrome: mgmt

A

ACE Inhibitors
Protein restriction
NSAIDS

124
Q

most common complication associated with hemodialysis

A

hypotension

125
Q

sensitivity/specificity of a urine dipstick?

A

+ nitrate: very SPECIFIC, but not sensitive
+ esterase: very SENSITIVE, but not specific
… for bacteruria

126
Q

Your 29 yo F patient complains that she feels the urge to pee frequently and that it burns when she voids, and that it looks like there is blood in her urine. What are 2 diagnostics you want to order?

A

UA

dipstick

127
Q

pyuria on UA

A

10+ WBC/mL

128
Q

“it hurts when I pee” song

A

UTI or STD (G or C)

129
Q

expected UA finding with upper UTI

A

WBC casts

130
Q

UA in lower vs upper UTI

A

lower: pyuria
upper: WBC casts

131
Q

You suspect your patient has pyelonephritis, and they have been nauseated and vomited a few times. What is your priority intervention?

A

admit

132
Q

renal function in renal insufficiency

A

less than 20 - 25% of normal

133
Q

top 2 causes of renal obstruction

A

kidney stones

enlarged prostate

134
Q

what are 3 causes of acute renal insufficiency?

A

obstruction
acute tubular necrosis
contrast media

135
Q

what type of diet is indicated for ESRD HD patient?

A

low potassium

136
Q

anuria

A

UOP less than 100 mL/24 hrs

137
Q

oliguria

A

UOP less than 400 mL/24 hrs

138
Q

renal insufficiency: 5 complications and their treatments

A 
volume overload: diuretics
metabolic acidosis: NS + Na bicarb 
hypercalcemia (calcitonin, dialysis)
anemia
azotemia: RRT (dialysis)
139
Q

azotemia

A

BUN 100+ mg/dL

140
Q

renal replacement therapy

A

is dialysis!!!!!

141
Q

what is the most common cause of intrarenal acute renal failure?

A

nephrotoxic agents: ex - aminoglycosides

142
Q

how do mismatched blood transfusions cause intrarenal renal failure?

A

the RBCs hemolyze then clog up the nephrons

143
Q

acute renal failure: diagnostics x5 + key

A 
serum BUN/Cr
urine Na
specific gravity
urinary sediment
FENa

intra and post renal are the same and prerenal is different

144
Q

The only amino acid that becomes insoluble in urine, and why that is important.

A

cystine - can result in cystine calculi that are difficult to manage

145
Q

renal calculi: mgmt

A

1 analgesia (trio) & hydration !!!

depends on stone type, location, extent, etc

diuretics (controversial)
remove obstruction (if preventing outflow or infected)
lithotripsy
cystoscopy

146
Q

You are ordering the standard IV trio for your poor little patient who is having the worst renal calculi of his life. What is an important consideration about metoclopramide (Reglan)?

A

metoclopramide is associated with an increased incidence of extra-pyramidal symptoms (ex: tardive dyskinesia)

147
Q

gonorrhea

A

BACTERIAL STD: Neisseria gonorrhoeae (gram neg diplococci)

found in GU, oropharynx, anorectum

148
Q

causative agent of gonorrhea + gram and shape

A

Neisseria gonorrhoeae (gram neg diplococci)

149
Q

syphilis diagnostics x3

A

FTA-ABS (fluorescent treponemal antibody absorption)

non-treponemal:
VDRL/RPR
microhemagglutination assay for antibody to T- pallidum

150
Q

gonorrhea green vs trichomonas green discharge

A

gonorrhea: mucopurolent
trichomonas: frothy, malodorous

151
Q

candidiasis presentation x2

A

thick white curd-like discharge

vulvovaginal erythema + pruritis

152
Q

which GU infection has clue cells on wet prep?

A

bacterial vaginosis

153
Q

which GU infection has pseudohyphae on wet prep?

A

candiasis

154
Q

chancroid

A

STD caused by Hemophilus ducreyi
(gram neg bacillus)
- well-established co-factor for HIV transmission
- up to 10% also infected with syphilis and HSV

155
Q

Your patient DEFFO has chancroid. Hoo doggy. What three other infectious diseases pop into your head and what is so significant about them?

A

HIV: chancroid is a co-factor for transmission

syphilis + HSV: frequent co-infections

156
Q

HSV1 vs HSV2

A

1: lips, face, mucosa
2: genitalia

157
Q

differentials for genital ulcers

A

herpes, primary syphilis, chancroid

158
Q

older adults: changes in renal blood flow

A

diminished up to 10% per decade after 30-40

159
Q

older adults: kidney changes

A

↓ size, nephron #/size, # glomeruli 30-40%

160
Q

older adults: GFR changes

A

↓ ~10% per decade after 30

161
Q

most common clinical illness for adults over 65

A

UTI

162
Q

top 2 gram neg UTI

A

E Coli

Pseudomonas

163
Q

top 4 gram + UTI

A

Enterococci
Staph (coagulase neg)
Strep agalactiae
Staph aureus

164
Q

fungal UTI is common especially in what population?

A

patients with indwelling catheters

165
Q

old folks + incontinence + confusion = ?

A

think UTI

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