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Renal GU and STDs Flashcards

1
Q

Name two lower UTI differentials

A

urethritis

cystitis

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2
Q

two Upper UTI differentials

A

pylonephritis

renal abscess

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3
Q

What is the most common UTI causing organism in women?

A

e. coli

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4
Q

What is the most common UTI organism in men?

A

proteus species

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5
Q

What is the first test you would order in a man who had BPH symptom complaints?

A

UA because UTI has some of the same sypmtoms at BPH

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6
Q

The presence of nitrates by dipstick is a very specific but not very sensitive test for bacteruria.

A

So it shows better that they don’t have it than if they do have it.

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7
Q

Esterase detection is very sensitive for UTI, that means if it is positive________.

A

If it is very sensitive it means if it is positive, most likely they do have a UTI.

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8
Q

What are two commonly used agents for treatment of UTI?

A

bactrim or cipro

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9
Q

What agent is used for UTI in pregnancy?

A

Amoxicillin and nitrofurantoin

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10
Q

How many days of abx therapy does a pregnant woman get for UTI?

A

a full 10 day course

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11
Q

What are symptoms of pylonephritis?

A

flank pain

fever

back pain

N/V

chills

*mental status changes in the elderly

(plus UTI symptoms)

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12
Q

What are common agents to treat upper UTI infection?

A

bactrim

cipro

fluoroquinolones

short course of gentamicin

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13
Q

When using bactrim or cipro to treat pylonephritis, how does the medication regimen change?

A

the duration changes, it is long, 14 days to 6 weeks

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14
Q

Sudden change, BUN out of proportion to creatinine, often due to obsruction, acute tubular necrosis, or contrast media.

A

acute renal failure

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15
Q

Is acute renal failure reversible?

A

Yes

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16
Q

Name three causes of acute renal failure

A

obstruction

contrast media

obstruction

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17
Q

Steady increase in BUN/creatinine, progressive over time from months to years, intrinsic kidney damage, not reversable but we can slow the progression

A

chronic renal failure

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18
Q

What is the normal BUN/cr ratio?

A

10:1

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19
Q

How would you categorize a patient with 10% or less of functioning nephrons, with complete loss of kidney function >3 months, who requires dialysis?

A

ESRD

end stage renal disease

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20
Q

If you had a patient with 75% nephron loss and a double in the baseline creatinine, how would you classify their renal function?

A

renal insufficiency

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21
Q

According to the RIFLE criteria, to classify a patient with acute kidney injury (AKI) they must have:

A
  1. serum cr 2-3 times their baseline OR GFR decrease >50%
  2. UOP <0.5ml/kg/hr for >12 hours
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22
Q

What are the AEIOU indications for dialysis?

A

A: acidosis/azotemia

E: electrolyte disturbances

I: intoxication

O: overload (fluid overload)/oliguria

U: uremia (urine in the blood)

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23
Q

How do we treat acute renal failure?

A

determine and Treat the underlying cause

treat symptoms

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24
Q

How do we treat chronic renal failure?

A

slow progression of the chronic renal failure by:

treating HTN and DM if applicable

low protein diet

modify medications that maybe contributing to renal failure

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25
Q

How do you treat azotemia?

A

with renal replacement therapy (dialysis)

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26
Q

What type of HTN medication would you consider for a patient with chronic renal failure?

A

ACE inhibitor

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27
Q

Three catagories of causes of acute renal failure

A

pre-renal

intrarenal

post-renal

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28
Q

According to Barkley, what catagory of cause of acute renal failure is reversible by treating the underlying cause?

A

prerenal

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29
Q

Name three causes of prerenal failure?

A

burns

dehydration

hemorrhage

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30
Q

What are two causes of intrarenal (or intrinsic) renal failure?

A

The use of nephrotoxic drugs (i.e. gentamicin)

mismatched blood transfusions

allergic reactions (contrast media)

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31
Q

What are causes of post-renal failure?

A

mechanical and functiononal causes

renal stone

obstructed foley

32
Q

If a patient has BUN/Cr ratio >10:1, what type of renal failure would you consider?

A

prerenal

33
Q

If a patient has BUN/cr ratio 10:1, what two types of renal failure would you consider?

A

intrarenal (intrinsic)

or

post-renal

34
Q

Would the urine specific gravity of a patient in prerenal failure be high or low?

A

high

>1.015

35
Q

In prerenal failure what is the FENA (fractional excretion of sodium)?

A

<1

36
Q

In intra and post renal failure what is the FENA (fractional excretion of sodium)?

A

>3

37
Q

How do we treat prerenal failure?

A

volume, increase BP if necessary

38
Q

How do we treat intrarenal failure?

A

decrease use of nephrotoxic drugs

renal replacement therapy if needed (dialysis)

39
Q

How do we treat post-renal failure?

A

remove the obstruction

40
Q

What is the most common type of kidney stone?

A

calcium stones

41
Q

What are the four types of kidney stone?

A

calcium

uric acid (more common in men)

struvite (more common in women)

cysteine (difficult to treat)

42
Q

What is Prehn’s test and what is it used to do distinguish?

A

Prehn’s test is done by elevating the scrotum

to distinguish epidydimitis from testicular torsion

According to Prehn’s sign, the physical lifting of the testicles relieves the pain of epididymitis but not pain caused by testicular torsion

43
Q

Negative Prehn’s sign indicates no pain relief with lifting the affected testicle, which points towards the diagnosis of ____________ which is a surgical emergency and must be relieved within 6 hours.

A

testicular torsion

44
Q

What are three causes of an abnormal PSA?

A

prostatitis

BPH

prostate cancer

45
Q

What is an abnormal PSA level?

A

They are based on age

but

>4 is abnormal

46
Q

Management of BPH includes avoiding medications that make symptoms worse including:

A

OTC for common cold and allergies

antihistamines

decongestants

antidepressants

antipsychotics

47
Q

The medication class that is the standard of care for BPH:

A

alpha blockers

-osins

tamulosin (flomax)

48
Q

PSA for prostate cancer is not a very sensitive test,

this means:

A

40% of men who actually have prostate CA may have a normal PSA

49
Q

The 5 alpha reductase inhibitors treat BPH by:

A

actually shrinking the prostate

example: finasteride (proscar)

50
Q

If a patient has BPH symptoms refractory to the -osins and 5 alpha reductase inhibitors they may consider:

A

TURP/TUNA

51
Q

If a woman comes in with green vaginal discharge consider:

A

gonerhhea

52
Q

Gonerrhea is a bacterial infection that can be asymptomatic or associated with discharge/dysurea and can be treated with

A

ceftriaxone/rocephin 250mg IM

53
Q

Name 5 conditions that have to be reported to the health department in most states:

A

Gonorrhea

Chlamydia

Syphillis

HIV

TB

54
Q

What type of bacterial STD presents with a painless indurated chancre 4 weeks after exposure?

A

syphilis

55
Q

Stages of syphilis

A
  1. painless chancre
  2. flulike prodrome with macropapular rash on palms hands and soles feet
  3. tertiary syphilis: cardiac or CNS involement (neurosyphilis)

*latent syphilis = asymptomatic

56
Q

What is the treatment for syphilis?

A

PCN G

57
Q

What is treatment for syphilis in a patient who is allergic to PCN?

A

doxycycline

58
Q

What bacterial STD can be asymptomatic or cause dysurea and dyspareunia in women, dull testicular pain, is the most common in the US?

A

chlamydia

59
Q

Name 4 differentials for dyspareunia:

A

chlamydia

PID

menopause

trichomaniasis

60
Q

What is the medication for treatment of chlamydia?

A

azithromycin 1g PO x1

61
Q

What viral recurrent STD hurts, has a painful prodrome, has no treatment to cure?

A

genital herpes

62
Q

What drug is used to suppress herpes outbreaks and is used to decrease asymptomatic transmission of herpes?

A

valacyclovir (valtrex)

63
Q

About 10% of people with this incurable virus is shed intermittantly all the time and therefore can be spread even when the patient is asymptomatic

A

herpes

64
Q

Malodorous frothy vaginal discharge, dyspareunia, STD, strawberry patches on the cervix and vagina

A

trichomoniasis

65
Q

strong vaginal odor, Fish like odor, watery grey discharge, vaginal spotting (not an STD)

A

BV

bacterial vaginosis

66
Q

thick white curd like discharge, vulvovaginal erythema and pruritis, not an STD

A

candida

67
Q

Clue cells are found in:

A

bacterial vaginosis (BV)

68
Q

Both trich and BV can be treated with:

A

METROnidazole (antibiotic)

69
Q

Pharmacologic treatment of vaginal candida

A

MICONazole (antifungal)

70
Q

Name three normal physiologic renal changes as people age

A

diminished renal blood flow (up to 10% per decade after age 30-40)

kidneys decrease in size

GFR decreases 10% per decade after 30

impaired ability to retain sodium which leads to dehydration

bladder tone/elasticity decreased

increased nocturia

decreased drug clearance—> increased risk for adverse drug reaction/increase drug clearance

71
Q

Incontinence is never normal at any age, in an older patient with new incontinence consider:

A

UTI

72
Q

Serum cr is the best indicator of renal function in all patients, but in elderly consider

A

creatinine clearance, as it takes into consideration age

73
Q

The most common clinical illness of adults over the age 65 is:

A

UTI

74
Q

In the elderly who present with weakness, lethary, confusion, urinary urgency, frequency, incontinence, consider this diagnosis

A

UTI

75
Q
A

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