Nephrology

Question 1

Most common benign tumor in men

Answer 1

BPH

Question 2

Describe the pathophysiology of BPH

Answer 2

Characterized by proliferation of the prostate. DHT is the major hormone responsible for proliferation. BPH produces nodules that compress prostatic urethra

Question 3

What scores correlate w/ mild, moderate, severe in the American Urological Association Symptoms Index

Answer 3

Mild 1-7

Moderate 8-19

Severe 20-35

Question 4

When would it be indicated to perform a CT or renal U/S in a patient w/ BPH?

Answer 4

If there is presence of UTI or complications of BPH (hematuria, UTI, CKD, hx of stone disease)

Question 5

A pt who scores a 5 on the American Urological Association Symptoms Index for BPH gets what treatment?

Answer 5

Watchful waiting (Scores 0-7)

Question 6

3 mechanisms behind erectile dysfunction

Answer 6

1. Failure to initiate
2. Failure to fill
3. Failure to store adequate blood volume within the lacunar network

Question 7

Risk factors for erectile dysfunction

Answer 7

DM
Obesity
BPH
HTN
Low HDL levels
CV Disease
Smoking
Spinal Cord Injury
Hx of radiation or surgery of prostate
Medications
Psychosocial

Question 8

When are oral phosphodiesterase type 5 inhibitors (PDE-5) contraindicated?

Answer 8

Nitrate treatment

CHF

Cardiomyopathies

Question 9

The endocrinologic causes of erectile dysfunction

Answer 9

1. Hypogonadism (low testosterone)

2. Hyperprolactinemia (leads to low testosterone)

Question 10

Most common organic cause of ED and most common cause of ED

Answer 10

MC organic cause = vasculogenic (atherosclerosis, traumatic arterial dz, structural alterations)

MC cause = Psychogenic (anxiety, depression, relationship conflict)

Question 11

The medications associated w/ medication-induced erectile dysfunction

Answer 11

Thiazides
BBs
CCB
Digoxin
SSRI
TCA
MAO-I
Phenothiazines
H2 Agonists
Hormone therapy
MTX
Anticholinergics
ETOH
Cocaine
Marijuana

Question 12

Storage issues = _______ issues and they include…

Answer 12

Storage issues = Bladder issues

Urgency
Frequency
Nocturia
Urge incontinence
Stress incontinence
Mixed incontinence
Overflow incontinence

Question 13

Voiding issues = ______ issues and they include…

Answer 13

Voiding issues = Prostate issue

Hesitancy
Poor flow/weak stream
Intermittency
Straining to void
Terminal dribbling
Prolonged urination
Urinary retention

Question 14

A weak flow –> ? problem

Answer 14

Prostate problem

Question 15

Voiding small amounts –> ? problem

Answer 15

Bladder problem

Question 16

Good flow and nml volume –> ? problem

Answer 16

Consider other medical conditions

Question 17

3 main treatment approaches for overactive bladder syndrome

Answer 17

1. Anticholinergic/Antimuscarinic
2. Behavioral Therapy
3. Surgical

Question 18

How would you treat acute bacterial prostatitis in an uncomplicated case of a 34 year old?

Answer 18

Cefixime PO once and doxy 100mg BID for 10 days

Question 19

How would you treat acute bacterial prostatitis in an uncomplicated case of a 36 year old?

Answer 19

Fluroquinolone (Cipro or Levo for 14 days or Bactrim for 14 days)

Question 20

Anion gap equation?

Answer 20

AG = Na - (Cl + HCO3)

Question 21

Information obtained from an ABG

Answer 21

1. Acid/Base status
2. Oxygenation: dissolved O2 (pO2), saturation of Hgb
3. CO2 elimination (ventilation)
4. Levels of carboxyhemoglobin and methemoglobin

Question 22

Contraindications to doing an ABG

Answer 22

1. Bleeding diathesis
2. AV fistula
3. Severe peripheral vascualr dz
4. Absence of an arterial pulse
5. Infection over site

Question 23

4 causes of Anion Gap acidosis

Answer 23

1. Ketoacidosis
2. Lactic Acidosis
3. Renal Failure
4. Toxins (salicylate)

Question 24

2 causes of hyperchloremic or nongap acidosis

Answer 24

1. Bicarbonate loss from GI tract

2. Renal tubular acidosis