Quiz 5 - Urogenital

Question 1

which enzyme is responsible for regulating blood pressure in the kidney?

Answer 1

renin

Question 2

which kidney is lower?

Answer 2

right

Question 3

which PMHx are common in the renal patient?

Answer 3

lupus
DM
hypertension

Question 4

what are associated ROS for renal dz?

Answer 4

general: fever, wt loss, fatigue
CV - dypnes, chest pain, edema
GI - anorexia, NV cramps
GU - polyuria, dysuria, hematuria
Skin - rash, puritis

Question 5

what does deep breathing suggest

Answer 5

metabolic acidosis

Question 6

what are red flag symptoms of urinary frequency

Answer 6

fever
back pain
lower extremity weakness

Question 7

what are red flag symptoms of dysuria?

Answer 7

fever
flank pain
recent instrumentation
immunocompromised
recurrence

Question 8

what is involuntary bed wetting after age 5

Answer 8

nocturnal enuresis

Question 9

what are the three types of urinary incontinence

Answer 9

inability to hold urine due to:

overflow
stress
urge

Question 10

what are the red flags of polyuria?

Answer 10

abrupt onset
night sweats
cough
weight loss
psychiatric disorder

Question 11

what is oliguria?

Answer 11

decreased urine output

Question 12

anuria is?

Answer 12

urine output

Question 13

microscopic hematuria should be investigated when

Answer 13

then presence of any RBCs >1

Question 14

when painless urination is seen - what should be considered?

Answer 14

tumors of bladder, kidney, prostate - until proven otherwise

Question 15

what are red flags in regards to hematuria?

Answer 15

gross hematuria
persistant microscopic in elderly
hypertension
edema

Question 16

what is the most common cause of renal colic and what are red flag symptoms?

Answer 16

most often caused by passage of renal calculi

red flags:
fever
oliguria
anuria

Question 17

what is commonly used for STI testing

Answer 17

NAAT PCR

Question 18

which bacterial UTI is common in kiddos?

Answer 18

kelbsiella enterobacter

Question 19

what host defenses reside in the uroepithelium and renal tubules?

Answer 19

tamm-horsfall glycoproteins

• IgA local antibodies also exist in the uroepithelium

Question 20

in regards to urethritis, which organisms are responsible?

Answer 20

Gonococcal urethritis - 50% cases, yellow green d/c

NGU - non gonococcal urethritis - most are Chlamydia, whitish-mucoid d/c

• urgency, frequency, tingling with urination

Question 21

what is a good ddx for recurrent UTI

Answer 21

bladder cancer
DM
prostate obstruction

Question 22

what is unique to cystitis?

Answer 22

NO FEVER

• usually asx in kiddos and elderly
• run a UA

Question 23

patient ptc with history of LUT infection, quickly have acquired chills, fever and tachycardia.. what condition is this and what is expected on lab work?

Answer 23

Acute Pyelonephritis

CBC - elevated WBC w left shift

UA - WBCs, pos LE, nitrites

** if protein is present on UA sign of nephron destruction

Question 24

what are glitter cells and what do they represent?

Answer 24

PMNs with cytoplasmic granules in state of Brownian motion

seen in acute pyelonephritis

Question 25

what is a common complication of acute pyelonephritis

Answer 25

renal abscess

Question 26

what is key in regards to chronic pyelonephritis

Answer 26

can take over 20 years to develop
usually asymptomatic

Decreased SG is seen sometimes on UA

Image with KUB (kidney ureter bladder X-ray)

Question 27

how is a definitive dx for glomerular disorder discovered?

Answer 27

renal biopsy

Question 28

what is the classic presentation of nephritic syndromes?

Answer 28

PHAROH
proteinuria
hematuria
azotemia
RBC casts
oliguria
HTN

Question 29

what is the most common cause of post-infectious glomerulonephritis?

Answer 29

group A beta hemolytic strep

• coca cola colored urine.

if untreated could lead to nephrotic syndrome, acute kidney injury, htn encephalopathy

Question 30

what are the 3 rapidly progressive glomerulonephritis conditions and what concomitant symptoms distinguish them?

Answer 30

goodpasture’s syndrome - pulmonary hemorrhage

henoch-schonlein purpura - skin lesions

wegener’s granulomatosis (ANCA -assocaited)

Question 31

what is the most common cause of glomerulonephritis worldwide?

Answer 31

BERGER’S DZ

- IgA nephropathy,

Question 32

nephrotic syndromes present with?

Answer 32

severe proteinuria
- foamy urine

DDX with other illnesses that present with edema
CHF, liver failure, PN, malignant HTN

Question 33

what is the most common cause of nephrotic syndrome and ESRD (end stage renal disease) in the US? what is commonly seen on lab work?

Answer 33

diabetic nephropathy

microalbuminuria 30-300 mg/d which progresses to proteinuria

Question 34

what is a common sequelae of acute tubular necrosis (ATN)

Answer 34

acute renal failure

UA - proteinuria, hematuria, RTE and RTE casts

Question 35

what’s important about acute tubointerstitial nephritis

Answer 35

acute onset of dec renal function

UA reveals NO bacteria, eosinophiluria often present

Question 36

what are the 4 common causes of chronic tubulointerstitial nephritis

Answer 36

obstructive uropathy
reflux nephropathy
analgesic nephropathy (sloughed papillae in urine)
lead nephropathy

Question 37

fanconi syndrome presents with ___ in adults or ____ in kiddos

Answer 37

osteomalacia in adults

hypophosphatemic rickets in kiddos

polyuria and polydipsia make you think DM

Question 38

what is the classic triad of renal cell carcinoma?

Answer 38

gross hematuria
flank pain
palpable abd mass

Question 39

what should be suspected in patients presenting with unexplained hematuria?

Answer 39

BLADDER CANCER