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ITE > Renal and Urogenital > Flashcards

Renal and Urogenital Flashcards

1
Q

What defines acute renal failure?

A

50% increase from baseline Cr OR 50% decrease in Cr clearance

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2
Q

How do you diagnose a prerenal
cause of acute renal failure?

A

MCC acute of AKI in the community. ↓ Renal perfusion = MCC (ACEI NSAIDs); ↓ Intravascular volume (hypovolemia, sepsis, blood loss, etc). Labs: BUN:Cr ratio >20 and FENa < 1%, urine Na <20, relatively normal UA

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3
Q

How do you diagnose an intrinsic
cause of acute renal failure
(AKI)?

A

2/2 pathology within the kidney; acute tubular necrosis = MCC (90%).
Labs: BUN:Cr ratio < 20, FENa > 2% (damaged kidney is unable to retain Na), low urine osmolality (injured kidney is unable to concentrate causing dilute urine), granular casts on UA

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4
Q

How do you diagnose a
postrenal cause of acute renal
failure?

A

2/2 obstruction of urine outflow (bladder CA, ureteral stone, urethral stricture, BPH = MCC). Labs: relatively normal UA; Dx: ultrasound; postvoid residual (>100cc is abnormal)

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5
Q

What is the most likely cause of a code before and after HD in a
patient with ESRD?

A

Before: hyperkalemia.
After: hypokalemia or blood loss.

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6
Q

What are indations for emergent
HD?

A

“AEIOU”:
Acidosis,
Electrolytes (hyperK refractory to medical management),
Intoxication (toxins e.g. ethylene glycol, methanol, Li,
etc.),
Overload (volume, any pulmonary edema),
Uremia with symptoms (e.g.pericarditis, AMS, BUN 100 or Cr 10)

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7
Q

What is the initial treatment for
bleeding AV fistula?

A

Apply pressure to the arterial supply proximal to the AV fistula. Give local and IV DDAVP (desmopressin).

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8
Q

What are symptoms of uremia?

A

Pericardial effusion/tamponade, pulmonary edema, encephalitis, n/v, anemia/bleeding (2/2 platelet dysfunction)

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9
Q

What percentage of kidney
stones <5mm will pass
spontaneously?

A

90%

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10
Q

What life threat should always be
considered on the differential of
a patient with potential kidney
stone?

A

AAA

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11
Q

What is the most common site of
impaction for kidney stones?

A

Ureterovesical junction (UVJ)

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12
Q

What is the composition of most
kidney stones and what patients
are at increased for these
stones?

A

Calcium oxylate; pts with hypercalcemia (2/2 sarcoid, multiple myeloma, hyperthryoid and hyperparathyroid, cancer), Crohn’s disease (2/2 increased oxalate absorption)

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13
Q

Dx and Tx: Struvite kidney
stones?

A

Magnesium-ammonium-phosphate stones. MCC of staghorn calculi.
Increased risk with chronic UTIs, caused by urease-splitting bacteria (e.g. Proteus). ± staghorn calculi, ± pneumoturia.
Rx: surgical removal, abx

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14
Q

Dx and Tx: Uric acid kidney
Stones?

A

Increased risk with gout, leukemia, myeloproliferative disorders, tumor lysis syndrome.
XR: radiolUcent (don’t show up)
Rx: IVF, bicarb to alkalinize urine, surgical removal PRN.

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15
Q

How often is there hematuria on
UA with + kidney stone?

A

75-80%

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16
Q

What are absolute indications for
admission for kidney stones?

A

Obstruction + infection, obstruction + solitary kidney, intractable pain or vomiting, urinary extravasation, hypercalcemic crisis

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17
Q

What is the most common cause
of glomerulonephritis?

A

Post-streptococcal GN

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18
Q

What are signs and symptoms of
glomerulonephritis and nepritic
syndrome?

A

Proteinuria, hematuria, edema, HTN, renal failure (AKI/intrinsic); UA may show red cell casts.
Tx: largely supportive, find and treat cause.

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19
Q

What is an important secondary
risk for patients with nephrotic
syndrome?

A

Thromboembolism 2/2 loss of anticoagulant proteins in urine

20
Q

What are the signs and
symptoms of nephrotic
syndrome?

A

“NAPHROTIC”:
Na decrease (hypoNa),
Albumin decrease (hypoalbuminemia),
Proteinuria (>3.5g/day),
Hyperipidemia,
Renal vein thrombosis,
Orbital edema,
Thromboembolism,
Infection (lose Ig’s in urine),
Coagulabiity (lose ATIII in urine).

Rx: IVF, Na restriction, steroids, ACE-I (dilates efferent arterioles, reduces glomerular pressure, and decreases protein loss), VTE prevention

21
Q

What are the most common
causes of nephrotic syndrome in
kids and adults?

A

Kids: Minimal change disease.
Adults: Focal segmental glomerulosclerosis

22
Q

Painless hematuria?

A

In old men: Bladder cancer followed by renal cancer.
In children: glomerulonephritis.
Young adults and older women: UTI.

23
Q

Dx: UTI + fever

A

Pyelonephritis; cystitis rarely presents with fever.

24
Q

Dx: UA with WBC but no bacteria

A

Think of STIs and non-urinary causes (appy, diverticulitis, etc.)

25
Q

Interpretation of +nitrites on UA

A

Specific for nitrite reducing bacteria - Gram negative infection (esp. E. coli), not sensitive

26
Q

What distinguishes direct from
indirect inguinal hernias?

A

Indirect: through inguinal canal into scrotum (lateral to inferior epigastric arteries).
Direct: through muscle of abdominal wall.

27
Q

What are potential complications
of hernias?

A

Bowel obstruction, incarceration (hernia gets stuck out), strangulation (no blood flow, dead tissue)

28
Q

What is the usual cause of
balanitis/balanoposthitis?

A

Inflammation of glans 2/2 fungal infection, less commonly bacterial; seen in uncircumcised men, diabetics, obese.

29
Q

Cause of bilateral orchitis

A

Mumps virus

30
Q

Most common cause (and
treatment) of epididymitis/orchitis
in young vs. old men?

A

Young (<35yr): STIs; Rx: CTX + azithro x1 OR doxycycline x10 days.
Old (>35 yr): E. coli; Rx: fluoroquinolone x10 days.

31
Q

What is Phren’s sign?

A

Relief of pain with scrotal elevation in patients with epididymitis/orchitis

32
Q

Dx and Tx: Prostatitis

A

SSx: dysuria, urinary frequency, pain with defecation, tender prostate.
Avoid Foley as this will increase inflammation.
If <35yr cover for STDs, otherwise give cipro.

33
Q

What are the key differences
between low-flow and high-flow
priapism?

A

Low-flow: most common form; ischemic & painful. Causes: sickle cell (MCC), meds (antipsychotics, penile injections).

High-flow: usually painless, arterial. Cause: trauma = MCC.

34
Q

ABG anaylsis of ischemic
priapism

A

Acidemic (pH < 7.25), hypoxic (pO2<30), hypercapnic (pCO2 >60)

35
Q

What is appropriate treatment for
priapism?

A

Pain control (opiates, dorsal penile v ring nerve block); Intracavernosal aspiration (first line Rx); Intracavernosal phenylephrine (Rx after irrigation has failed), consider terbutaline, and consult urology.
In sickle cell patients consider exchange transfusion (but low threshold to drain).

36
Q

Dx and Tx: Testicular torsion

A

SSx: Acute severe unilateral testicular pain, n/v/abd pain, scrotal
swelling and tenderness, absent cremasteric reflex.
Dx: US with Doppler (although this may be normal - trust your exam).
Rx: emergent urologic consultation for orchiopexy, can try manual detorsion via external rotation. Consider this dx in young male child with nonstop crying or abdominal pain.

37
Q

What is the appropriate technique for manual detorsion
of testicular torsion?

A

Medial to lateral rotation, “open the book”

38
Q

What is the most sensitive sign
for RULING OUT testicular
torsion?

A

A normal cremasteric reflex

39
Q

What clinical finding is characteristic of torsion of the
appendix testis?

A

“Blue dot sign” (tender bluish nodule on the upper pole of the testis on physical exam - present in 25%); Dx: US. Rx; scrotal support, NSAIDs

40
Q

What is the most common
misdiagnosis in patients with
testicular cancer?

A

Epididymitis; testicular ca is the most common cancer in men aged 15-35; exam will show a painless, firm, fixed nodule or mass.

41
Q

What is the characteristic finding
on CXR with metastatic testicular
cancer?

A

“Cannonball” lesions in lungs

42
Q

What are extrarenal problems
commonly associated with
polycystic kidney disease?

A

Liver cysts, cerebral aneurysm

43
Q

What is the most common sign of
bladder injury?

A

Gross hematuria

44
Q

What medication can cause
epididymitis?

A

Amiodarone

45
Q

Dx and Tx: Peritonitis in a patient
on peritoneal dialysis

A

Dx: cloudy effluent, UA: 100 WBC, > 50% neutrophils or + Gram stain.
Rx: Stable: intraperitoneal antibiotics and continued use of catheter.
Unstable: admission + IV abx. All ABx should cover skin flora (Strep and Staph).

ITE (18 decks)

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