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Renal/GU + Neuro Flashcards

1
Q

Acute prostatitis (Dx and labs)

A
  1. DRE
  2. UA + Urine culture positive in acute; neg in chronic
  3. Avoid prostatic massage in acute prostitis
  4. Transrectal US = may be useful if suspected prostate abscess
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2
Q

Acute Tubular necrosis (FMLD)

A

Epithelial cell casts and muddy brown casts; waxy/granular casts (formed in damaged tubules

Low specific gravity (unable to concentrate urine)

Hyperkalemia, hyperphosphatemia

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3
Q

Anemia of chronic disease (scientific concepts)

A

Damaged kidneys produce less EPO = less RBC production = ANEMIA

AKA question was where is EPO produced = Kidneys

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4
Q

Anemia, pernicious (health maint + prevention)

A

B12 injections IM once a month

Monitor B12 levels and adjust dosage as needed

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5
Q

Azotemia prerenal (scientific concepts)

A

Usually dehydration leading to poor renal perfusion

MC form of kidney failure in hospitalized patients

Decreased perfusion of the kidney (burn patients, vomiting, diarrhea, bleeding)

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6
Q

Bladder cancer (scientific concepts)

A

MC = Transitional cell

Biggest RF - smoking, white males in 40s ; occupational exposures (dyes, rubber, leather)

Most present early and respond well to treatment but has the highest rate of reoccurence of all cancer

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7
Q

Bladder cancer (clinical intervention)

A
  1. Localized or superficial = transurethral resection and follow up every 3 months
  2. Invasive = radial cystectomy, chemo, radiation
  3. Recurrent = BCG vaccine intravascular if electrocautery is unsuccessful; Do not use if immunesupressed or if gross hematuria is present
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8
Q

Bladder injury (dx and labs)

A

Ureteral contrast study with pelvic fracuture

Look for blood in the meatus; high riding prostate or scrotal hematoma

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9
Q

Bladder outlet obstruction (pharm tx)

A

If due to BPH = alpha 1-blocker like Tamsulosin

If decreased detrusor muscle (atony)= use cholinergic like bethanechol

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10
Q

Testicular cancer (dx and labs)

A

Scrotal US = best INITIAL test

Tumor markers = Increased alpha-fetoprotein and beta-HcG

CT chest/abd for staging

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11
Q

CKD (dx and labs)

A
  1. Proteinuria = single BEST predictor of disease progression (spot urine or urine/creatinine ratio/24hr urine)
  2. UA = Broad waxy casts seen in ESRD
  3. Estimated GFR
  4. Increased BUN/creatinine, serum electrolytes, lipid profile, renal biopsy
  5. Renal US = Small kidneys is classic sign
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12
Q

Chronic renal insufficiency (pharm tx)

A

Control HTN (BP) with ACE and diuretics

Proteinuria = ACE/ARB tx

DM control = Metformin/Insulin

Lipid control - Statin (LDL), fibrates (decreased TC)

Anemia = oral iron, EPO if anemia persists after normal iron stores

Coagulopathy = Desmopressin prior to surgical procedures

Renal osteodystrophy = Vitamin D

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13
Q

Contrast-induced nephropathy (pharm tx)

A

Volume expansion with isotonic saline (0.9% NaCl) or hypotonic saline (0.45% of NaCl)

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14
Q

Cryptochordism (FMLD)

A

Empty small scrotum +/- inguinal fullness

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15
Q

Diabetic nephropathy (Dx and Labs)

A

Persistent albuminuria (>300mg) confirmed on 2 separate occasions 3-6 months apart

Relentless decline in GFR

Elevated arterial BP

Anemia, acidosis

Kidney biopsy = Kimmelstiel-Wilson

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16
Q

Adverse drug reaction (diuretics) Pharm tx

A

Mannitol SE = Pulmonary edema

Actazolamide SE = Hyperchloremic met acidosis, sulfa allergies, kidney stones

Loop diuretics = Hypokalemia, hypocalcemia, hypomagnesia, ototoxic, sulfa *NSAIDs decrease efficacy

Thiazides = Hyponatremia, hypokalemia, hypercalcemia, hyperlipidemia, sulfa allergies, met alkalosis

K+ sparing = Hyperkalemia, met acidosis, gynecomastia

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17
Q

Glomerulonephritis (scientific concepts)

A

Immunologic inflammation of glomeruli causing protein and RBC leakage into urine

HTN, hematuria, azotemia = HALLMARK

Causes = IgA nephropathy, post infectious (after GABHS), goodpasture’s disease, vasculitis

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18
Q

Glomerulonephritis (dx and labs)

A

UA = Hematuria (RBC casts), dysmorphic RBC, proteinuria

High specific gravity, increased BUN & Cr

Renal biopsy = Gold standard but not needed if post strep

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19
Q

Goodpasture’s disease (FMLD)

A

Cause of acute glomerulonephritis

Presents with rapid progressive glomerulonephritis = CRESCENT formation on biopsy

Anti-GBM antibodies in kidney and lung alveoli

**Often occurs post-URI

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20
Q

Goodpasture’s disease (pharm tx)

A

High dose steroids + cyclophosphamide + plasmaphoresis (removes antibodies)

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21
Q

Hemochromatosis (clinical intervention)

A

Phlebotomy

Iron chelation (desferrioxamine)

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22
Q

Hemolytic uremic syndrome (FMLD)

A

Triad

1.Thrombocytopenia
2.Microangiopathic hemolytic anemia
3. Kidney failure

Suspect HUS in child w/ renal failure w/ diarrhea prodrome

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23
Q

Hereditary spherocytosis (pharm tx)

A

Splenectomy is definitive

Long term folic acid supplement before and after splenectomy

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24
Q

Hydronephrosis (scientific concepts)

A

Distention of renal calyces and pelvis w/ urine as a result of obstruction of flow of urine distal to renal pelvis

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25
Hypercalcemia (pharm tx)
Mild = No treatment Severe/Symptomatic = IV saline, furosemide (avoid HCTZ, calcitonin, bisphosphonate if severe)
26
Hyperkalemia (scientific concepts)
Causes = Acute or chronic renal failure, eating a lot of bananans, hyperaldosteronism, adrenal insufficiency, pot. sparing diuretics, NSAID, rhabdo, burns, hypovolemia, met acidosis (DKA) LAB EROR
27
BPH (pharm tx)
Alpha 1 adrenergic antagonist (-zosin) = immediate sx relief 5-alpha reductase inhibitors (finasteride) = longterm prostate growth inhibition
28
Hypovolemia (scientific concepts)
Low volume = wide pulse pressure Increased HR and decreased BP with standing
29
Immobilization (Health maint + prevention)
Beware of pressure ulcers, infection from repeated urinary catheters, skin infections if patient is not getting frequent baths
30
Impotence, organic origin (clinical intervention)
1. Do dx and PE (BP, DRE) 2. Check testosterone, LH, Prolactin, TSH, HbA1c, 3. Direct injection of PGE1 into corpora cavernosa to create erection in 5 min if blood vessels are able to dilate 4. Nocturnal penile turnescence to evaluate sleep erections 5. Duplex US to evaluate penile blood flow
31
Impotence, organic origin (Pharm tx)
1. PDE5 inhibitor = sildenafil,. tadalafil 2. PGE1 injection 3. Vacuum pump, penile revascularization, penile prosthetics 4. Testosterone if low
32
Interstitial cystitis (Dx and Labs)
Sx = Long standing urinary frequency, urgency, pelvic pain in the absence of underlying etiology UA + Urine culture Voiding diary = establish baseline Cystophgraphy, Voiding cystourethrography MRI/CT pelvis = evaluate for pelvic mass
33
Interstitial nephritis (FMLD)
Acute kidney injury with increased eosinophils Fever, maculopapular rash, arthalgias WBC = pathognomonic = Urine eosinophils
34
Medullary sponge kidney (FMLD)
Patients may be asx +/- recurrent nephrolithiasis or recurrent UTI, sterile pyuria, renal colic often from hematuria AKA Cacchi-Ricci disease, is a birth defect where changes occur in the tubules, or tiny tubes, inside a fetus' kidneys. In a normal kidney, urine flows through these tubules as the kidney is being formed during a fetus' growth
35
Minimal change Dz (scientific concepts)
80% of nephrotic syndrome in kids Etiologies = Idiopathic +/-associated with viral infections, allergies (insect stings, NSAID)
36
Minimal change dx (Dx and labs)
No visible cellular change seen on simple light microscopy Podocyte damage + diffuse effacement of foot processes and loss of negative charge of glomerular basement membrane
37
Interstitial nephritis (Pharm tx)
MCC = Drug induced D/c offending agent Steroids if renal impairment is severe Dialysis if extremely severe and no response after stopping offending agent
38
Nephrotic syndrome (dx and labs)
1. 24hr urine protein collection = GOLD std 2. UA = Proteinuria on dipstick + MALTESE cross shaped oval fat bodies 3. Hypoalbuminemia 4. Renal biopsy = May differentiate types; not usually needed if minimal change is suspected
39
Peyronie (clinical intervention)
Vitamin E and potassium (PABA) Colchicine injection Surgery
40
Polycystic kidney dz (hx and pe)
Autosomal dominant disorder Formation of kidney cysts and cysts in other organs (liver, spleen, pancreas) HTN, flank pain, PALPABLE abd mass, UTI, nephrolithiasis, CVA
41
Premature ejactuation (Pharm tx)
1. Topicals = lidocaine, benzocaine 2. SSRI 3. PDE-5 = Sildenafil 4. Pindolol, timolol
42
Priapism (scientific concepts)
Ischemic = Low-flow MC = Decreased venous outflow Nonischemic = High flow - due to penile trauma
43
Priapism (FMLD)
Prolonged, painful erection Penis is erect for hours Absence of stimulation
44
Pyelonephritis (clinical intervention)
FQ (IV or PO) Aminoglycosides (gent), TMP/SMX, Cephalosporin Admit for IV fluids + IV abx for severe or complicated
45
Renal artery stenosis (Labs and Dx)
Renal arteriography = Gold Standard (not initial choice since invasive) CT with angiography = MC initial choice
46
Renal cell carcinoma (clinical intervention)
Stage 1-3 = Radial nephrectomy, immune therapy, renal cell is resistant to chemo/radiation Bilateral involvement or patient with solitary kidney = Partial nephrectomy
47
Sex dysfunction, premature ejacuation (pharm tx)
SSRI
48
Undescended testicle (clinical intervention_
Orchipexy recommended at 4-6 mo Must be done before 2yo If less than 4 mo watch and wait
49
Undescended testicle (hx and PE_
Born premature, low birth weight, any difficulties with subfertility or history of testicular torsion or inguinal hernia PE = Look at scrotum check for inguinal hernia or testicular torsion
50
Urinary incontinence, detrusor overactivity (clinical intervention)
Bladder training (timed frequent voids, decrease fluid intake) Surgical injection of botox, bladder augmentation
51
Vesicoureteral Reflux (VUR) FMLD
Retrograde regurge of urine from bladder up ureter and into collecting system of kidneys Causes = UTI or fever and kidney infection HIGH suspicion in children or neonate with a UTI or fever with unknown orgin
52
Wilms tumor (nephroblastoma) clinical intervention
Nephrectomy followed by chemo Post surgery radiation therapy if extends past renal capsule, pulmonary METS or large tumor
53
Wilms tumor (nephroblastoma) Dx and Labs
Abdominal ultrasound = best INITIAL test CT with contrast/MRI = More accurate
54
Acute infective polyneuritis (clinical intervention)
55
Acute infective polyneuritis (clinical intervention)
AKA guillain barre syndrome monitor closely and mechanical ventilation at first sign of decreased FVC on PFTs
56
Akathisia (pharm tx)
Antihistamine Stop enticing medicine; maybe beta blocker Movement disorder makes it hard to sit still
57
Alzheimers disease (pharm tx)
Acetylcholinesterase inhibitors (donepezil, tacrine, rivastigmine, galantamine) + NMDA antagonist (memantine)
58
Amyotrophic lateral sclerosis (ALS) FMLD
Off balance, instability, weakness in upper extremities +/- atrophy Sensation, urinary sphincter, and voluntary eye movements are spared Loss of ability to initiate/control motor movements Mixed upper and lower motor neuron signs
59
C5 nerve root (scientific concepts)
C5 controls biceps and deltoids C5 dermatome covers the outer part of the arm down to the elbow
60
CN III Disorder (Hx and PE)
Oculomotor nerve = inferior rectus, ciliary body Abnormalities = oculomotor, dilated pupil
61
Coma (pharm tx)
Depends on underlying cuase Status epilepticus = First line tx = Lorazepam; 2nd line + Phenytoin Hypoglycemia = Glucose +/- thiamine Opioid toxicity = Nalaxone Benzo toxicity = Flumazenil
62
CN III Palsy (FMLD)
Damage results in patient unable to move their eye normally Levator palpebrae superioris and muscles responsible for pupil constriction (sphincter papillae)
63
Duchenne Muscular Dystrophy (health maint + prevention)
Nutrition = Chronic steroids which puts patients at high risk of malnutrition; vitamin D & calcium Closely monitor height and nostanding growth measure every 6 mo Adrenal crisis awareness Fracture + Fall prevention
64
Encephalopathy, Bovine spongiform (scientific concepts)
Mad cow disease Spread via consumption of infected meat Rapid mental deterioration within months leading to coma Variant is Creutzfeldt-Jakob disease
65
Epilepsy, simple partial (FMLD)
Consciousness fully maintained EEG shows focal discharge at onset of seizure May be followed by transient neurologic deficit (todds paralysis) lasting up to 24hrs
66
Fracture, skull, basilar (Hx and PE)
MCC = TBI MC involvement = Temporal bone PE = Periorbital ecchymosis, mastoid ecchymosis, hemotympanum, rhinorrea
67
Guillain-barre syndrome (clinical intervention)
1. Plasmapharesis 2.IVIG 3. Mechanical ventilation if resp failure *Prednisone is contraindicated
68
HA (Dx and labs)
CT = First line If negative due an LP looking for blood or xanthochromia 4-vessel angio = after confirmed SAH
69
Cluster HA (Health maint + prevention)
Prophy = Verapamil Steroids, ergotomines, valproic acid, lithium
70
HA postdural puncture (clinical intervention)
Bed rest, hydration, caffeine, epidural blood patch if conservative management fails
71
Huntington disease (scientific concepts)
Autosomal dominant neurodegenerative disorder Mutation of chromosome 4 Decreased GABA and substance P
72
Huntington disease (dx and labs)
CT scan = cerebral and caudate nucleus atrophy MRI = similar findings Genetic testing Pet scan = Decreased glucose metabolism in caudate nucleus and putamen
73
Intracranial abscess (hx and pe)
MC sx = HA usually on side of abscess that is unrelieved by analgesics, neck stiffness, AMS, vomiting PE = Fever, focal neuro deficits, +/- seizure
74
Lateral medullary (wallenberg) syndrome (Dx and Labs)
Head impulsive, nystagmus, test of skew (HINTS) exam of oculomotor function CT or MRI to assists in stroke detection WS is typically due to ischemia from a vertebral artery or posterior inferior cerebellar artery infarction
75
Brain lesion, basal ganglia (FMLD)
Problems with speech, movement, posture "Parkinsonism"
75
Brain lesion, cerebellum (scientific concepts)
Causes dyssynergia, dysmetria, dysarthria, ataxia of stance and gait ON same side of body as lesion (ipsilateral)
76
Lesion, CN III (scientific concepts)
Causes ptosis, down and out pupil, mydriasis, absent light reflex, failure to accomodate, 2ndary to uncal herniaiton due to ipsilateral cerebral injury
77
Long thoracic nerve injury (clinical intervention)
Physical therapy, occupational therapy, surgery of scapulothoracic fusion a shoulder condition characterized by pain and loss of shoulder movement owing to damage or injury of the long thoracic nerve. This nerve evolves from the roots of neck vertebrae (C5-C7) and supplies to serratus anterior muscle that retains the scapula bone to the chest wall
78
Meningitis, bacterial, acute (pharm tx)
<1 month = Amp + Cefotacimine or aminoglycoside 1month = 50yo = Ceftriaxone + Vanco >50yo = Amp + Ceftriaxone +/- Vanco Dexamethasone if known or suspected strep pneumo Post exposure prophy = Cipro or Rifampin
79
Motor neuron deficit (Hx and PE)
AKA ALS Both upper and lower motor neuron necrosis = progressive motor degeneration Asymmetric limb weakness is the MC presenting sx
80
Multiple sclerosis (scientific concepts)
Autoimmune, inflammatory demyelinating disease of CNS Axon degeneration of white matter of the brain, optic nerve, spinal cord 3 types: Relapsing/remitting = MC Progressive Secondary progressive
81
Myasthenia Gravis (pharm tx)
1. Acetylcholinesterase inhibitors = pyridostigmine or neostigmine 2. Immunesupression: Plasmapheresis or IVIG 3. Thymectomy if due to thymoma *Avoid FQ or aminoglycosides
82
Myasthenia Gravis (scientific concepts)
Strogest in the morning - weakest in the evening Autoimmune disorder of peripheral nerves Inefficient skeletal muscle transmission due to autoimmune antibodies against acteylcholine (decreased Ach receptors) 75% have thymic abnormality (hyperplasia or thymoma)
83
CN 6 (Scientific concepts)
Abducens = INABILITY tp abduct eye and horizontal diplopia MC affected ocular motor nerve in adults 2nd MC in children Occurs at any point from pons to lateral rectus muscle Sx depend on site of lesion along path
84
CN 6 (Hx and PE)
Sudden onset = Vascular cause Slow progression = Compression Subactue = Demyelination PE = Visual acuity, motility evaluation, stabisumus measurements, esotropia of affected eye due to unopposed action of medial rectus muscle
85
CN 11 (hx and PE)
Accessory nerve Tested with head rotation and shoulder elevation against resistance PE = Inability to turn head from lateral to neutral against resistance and inability to raise shoulders
86
Peroneal nerve injury (Hx and PE)
Provides sensation to lateral leg Innervated by peroneous longus, peroneus brevis and short head of biceps femoris Injury= FOOT DROP
87
Spinal accessory injury (clinical intervention)
Non surgery = Transcutaneous nerve stimulation Surgery = Neurolysis primary nerve anastamosis
88
Trigeminal neuralgia (Health maint + prevention)
Carbamazepine = 1st line Depression is common in these pts- monitor and tx with TCA and valproic acid
89
Normal nerve function (hx and pe)
Thorough CN evaluation of each cranial nerve for motor and sensory
90
Restless leg syndrome (pharm tx)
1. Dopamine agonist = Prampiexole, ropinirole 2. Alpha-2-delta calcium ligands (gabapentin, pregab) 3. Benzo = adjunct 4. Opioids in resistant case 5. Iron supp if low ferritin
91
Stroke (dx and labs)
Non-contrasted CT head = best initial to determine hemorrhagic vs ischemic MRI = MOST ACCURATE
92
SAH (pharm tx)
Nimodipine, nicardipine, labetolol to lower BP Supportive - Best rest, stool softeners Decrease ICP = mannitol, hyperventilation, head elevation
93
Suprascapular nerve entrapment (FMLD)
Mixed motor/sensory nerve supplies supraspinatous and infraspinatous (part of rotator cuff) Compression can be caused by tumors or ganglion cysts, injury etc Shoulder/arm weakness or heaviness, radiating burning pain to neck/back/arm
94
Tardive dyskinesia (pharm tx)
Clonazepam, valbenazine Clozapine requires antipsychotic tx (ex for schizophrenia)
95
Transient Ischemic attack (TIA) (scientific concepts)
Transient episode of neuro deficits caused by focal brain, spinal cord, or retinal ischemia without acute infarction Often lasting <24hrs; most resolve in 30-60 min MC = Due to embolus (Heart, carotid, vertebrobasilar) or transient hypotension
96
Tumor lysis syndrome (pharm tx)
Allopurinol, IV fluids
97
Tumor lysis syndrome (FMLD)
Complication of induction of tx with chemo in AML patients Happens 48-72hrs after induction of treatment Large # of cells are being destroyed; Hyperkalemia, hyperphosphatemia; acute renal failure

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