Renal/GU + Neuro Flashcards
Acute prostatitis (Dx and labs)
- DRE
- UA + Urine culture positive in acute; neg in chronic
- Avoid prostatic massage in acute prostitis
- Transrectal US = may be useful if suspected prostate abscess
Acute Tubular necrosis (FMLD)
Epithelial cell casts and muddy brown casts; waxy/granular casts (formed in damaged tubules
Low specific gravity (unable to concentrate urine)
Hyperkalemia, hyperphosphatemia
Anemia of chronic disease (scientific concepts)
Damaged kidneys produce less EPO = less RBC production = ANEMIA
AKA question was where is EPO produced = Kidneys
Anemia, pernicious (health maint + prevention)
B12 injections IM once a month
Monitor B12 levels and adjust dosage as needed
Azotemia prerenal (scientific concepts)
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)
Bladder cancer (scientific concepts)
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
Bladder cancer (clinical intervention)
- Localized or superficial = transurethral resection and follow up every 3 months
- Invasive = radial cystectomy, chemo, radiation
- Recurrent = BCG vaccine intravascular if electrocautery is unsuccessful; Do not use if immunesupressed or if gross hematuria is present
Bladder injury (dx and labs)
Ureteral contrast study with pelvic fracuture
Look for blood in the meatus; high riding prostate or scrotal hematoma
Bladder outlet obstruction (pharm tx)
If due to BPH = alpha 1-blocker like Tamsulosin
If decreased detrusor muscle (atony)= use cholinergic like bethanechol
Testicular cancer (dx and labs)
Scrotal US = best INITIAL test
Tumor markers = Increased alpha-fetoprotein and beta-HcG
CT chest/abd for staging
CKD (dx and labs)
- Proteinuria = single BEST predictor of disease progression (spot urine or urine/creatinine ratio/24hr urine)
- UA = Broad waxy casts seen in ESRD
- Estimated GFR
- Increased BUN/creatinine, serum electrolytes, lipid profile, renal biopsy
- Renal US = Small kidneys is classic sign
Chronic renal insufficiency (pharm tx)
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
Contrast-induced nephropathy (pharm tx)
Volume expansion with isotonic saline (0.9% NaCl) or hypotonic saline (0.45% of NaCl)
Cryptochordism (FMLD)
Empty small scrotum +/- inguinal fullness
Diabetic nephropathy (Dx and Labs)
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
Adverse drug reaction (diuretics) Pharm tx
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
Glomerulonephritis (scientific concepts)
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
Glomerulonephritis (dx and labs)
UA = Hematuria (RBC casts), dysmorphic RBC, proteinuria
High specific gravity, increased BUN & Cr
Renal biopsy = Gold standard but not needed if post strep
Goodpasture’s disease (FMLD)
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
Goodpasture’s disease (pharm tx)
High dose steroids + cyclophosphamide + plasmaphoresis (removes antibodies)
Hemochromatosis (clinical intervention)
Phlebotomy
Iron chelation (desferrioxamine)
Hemolytic uremic syndrome (FMLD)
Triad
1.Thrombocytopenia
2.Microangiopathic hemolytic anemia
3. Kidney failure
Suspect HUS in child w/ renal failure w/ diarrhea prodrome
Hereditary spherocytosis (pharm tx)
Splenectomy is definitive
Long term folic acid supplement before and after splenectomy
Hydronephrosis (scientific concepts)
Distention of renal calyces and pelvis w/ urine as a result of obstruction of flow of urine distal to renal pelvis
Hypercalcemia (pharm tx)
Mild = No treatment
Severe/Symptomatic = IV saline, furosemide (avoid HCTZ, calcitonin, bisphosphonate if severe)
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
BPH (pharm tx)
Alpha 1 adrenergic antagonist (-zosin) = immediate sx relief
5-alpha reductase inhibitors (finasteride) = longterm prostate growth inhibition
Hypovolemia (scientific concepts)
Low volume = wide pulse pressure
Increased HR and decreased BP with standing
Immobilization (Health maint + prevention)
Beware of pressure ulcers, infection from repeated urinary catheters, skin infections if patient is not getting frequent baths
Impotence, organic origin (clinical intervention)
- Do dx and PE (BP, DRE)
- Check testosterone, LH, Prolactin, TSH, HbA1c,
- Direct injection of PGE1 into corpora cavernosa to create erection in 5 min if blood vessels are able to dilate
- Nocturnal penile turnescence to evaluate sleep erections
- Duplex US to evaluate penile blood flow
Impotence, organic origin (Pharm tx)
- PDE5 inhibitor = sildenafil,. tadalafil
- PGE1 injection
- Vacuum pump, penile revascularization, penile prosthetics
- Testosterone if low
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
Interstitial nephritis (FMLD)
Acute kidney injury with increased eosinophils
Fever, maculopapular rash, arthalgias
WBC = pathognomonic = Urine eosinophils
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
Minimal change Dz (scientific concepts)
80% of nephrotic syndrome in kids
Etiologies = Idiopathic +/-associated with viral infections, allergies (insect stings, NSAID)
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
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
Nephrotic syndrome (dx and labs)
- 24hr urine protein collection = GOLD std
- UA = Proteinuria on dipstick + MALTESE cross shaped oval fat bodies
- Hypoalbuminemia
- Renal biopsy = May differentiate types; not usually needed if minimal change is suspected
Peyronie (clinical intervention)
Vitamin E and potassium (PABA)
Colchicine injection
Surgery
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
Premature ejactuation (Pharm tx)
- Topicals = lidocaine, benzocaine
- SSRI
- PDE-5 = Sildenafil
- Pindolol, timolol
Priapism (scientific concepts)
Ischemic = Low-flow
MC = Decreased venous outflow
Nonischemic = High flow - due to penile trauma
Priapism (FMLD)
Prolonged, painful erection
Penis is erect for hours
Absence of stimulation
Pyelonephritis (clinical intervention)
FQ (IV or PO) Aminoglycosides (gent), TMP/SMX, Cephalosporin
Admit for IV fluids + IV abx for severe or complicated
Renal artery stenosis (Labs and Dx)
Renal arteriography = Gold Standard (not initial choice since invasive)
CT with angiography = MC initial choice
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
Sex dysfunction, premature ejacuation (pharm tx)
SSRI
Undescended testicle (clinical intervention_
Orchipexy recommended at 4-6 mo
Must be done before 2yo
If less than 4 mo watch and wait
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
Urinary incontinence, detrusor overactivity (clinical intervention)
Bladder training (timed frequent voids, decrease fluid intake)
Surgical injection of botox, bladder augmentation
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
Wilms tumor (nephroblastoma) clinical intervention
Nephrectomy followed by chemo
Post surgery radiation therapy if extends past renal capsule, pulmonary METS or large tumor
Wilms tumor (nephroblastoma) Dx and Labs
Abdominal ultrasound = best INITIAL test
CT with contrast/MRI = More accurate
Acute infective polyneuritis (clinical intervention)
Acute infective polyneuritis (clinical intervention)
AKA guillain barre syndrome
monitor closely and mechanical ventilation at first sign of decreased FVC on PFTs
Akathisia (pharm tx)
Antihistamine
Stop enticing medicine; maybe beta blocker
Movement disorder makes it hard to sit still
Alzheimers disease (pharm tx)
Acetylcholinesterase inhibitors (donepezil, tacrine, rivastigmine, galantamine) + NMDA antagonist (memantine)
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
C5 nerve root (scientific concepts)
C5 controls biceps and deltoids
C5 dermatome covers the outer part of the arm down to the elbow
CN III Disorder (Hx and PE)
Oculomotor nerve = inferior rectus, ciliary body
Abnormalities = oculomotor, dilated pupil
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
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)
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
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
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
Fracture, skull, basilar (Hx and PE)
MCC = TBI
MC involvement = Temporal bone
PE = Periorbital ecchymosis, mastoid ecchymosis, hemotympanum, rhinorrea
Guillain-barre syndrome (clinical intervention)
- Plasmapharesis
2.IVIG - Mechanical ventilation if resp failure
*Prednisone is contraindicated
HA (Dx and labs)
CT = First line
If negative due an LP looking for blood or xanthochromia
4-vessel angio = after confirmed SAH
Cluster HA (Health maint + prevention)
Prophy = Verapamil
Steroids, ergotomines, valproic acid, lithium
HA postdural puncture (clinical intervention)
Bed rest, hydration, caffeine, epidural blood patch if conservative management fails
Huntington disease (scientific concepts)
Autosomal dominant neurodegenerative disorder
Mutation of chromosome 4
Decreased GABA and substance P
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
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
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
Brain lesion, basal ganglia (FMLD)
Problems with speech, movement, posture
“Parkinsonism”
Brain lesion, cerebellum (scientific concepts)
Causes dyssynergia, dysmetria, dysarthria, ataxia of stance and gait
ON same side of body as lesion (ipsilateral)
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
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
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
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
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
Myasthenia Gravis (pharm tx)
- Acetylcholinesterase inhibitors = pyridostigmine or neostigmine
- Immunesupression: Plasmapheresis or IVIG
- Thymectomy if due to thymoma
*Avoid FQ or aminoglycosides
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)
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
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
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
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
Spinal accessory injury (clinical intervention)
Non surgery = Transcutaneous nerve stimulation
Surgery = Neurolysis primary nerve anastamosis
Trigeminal neuralgia (Health maint + prevention)
Carbamazepine = 1st line
Depression is common in these pts- monitor and tx with TCA and valproic acid
Normal nerve function (hx and pe)
Thorough CN evaluation of each cranial nerve for motor and sensory
Restless leg syndrome (pharm tx)
- Dopamine agonist = Prampiexole, ropinirole
- Alpha-2-delta calcium ligands (gabapentin, pregab)
- Benzo = adjunct
- Opioids in resistant case
- Iron supp if low ferritin
Stroke (dx and labs)
Non-contrasted CT head = best initial to determine hemorrhagic vs ischemic
MRI = MOST ACCURATE
SAH (pharm tx)
Nimodipine, nicardipine, labetolol to lower BP
Supportive - Best rest, stool softeners
Decrease ICP = mannitol, hyperventilation, head elevation
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
Tardive dyskinesia (pharm tx)
Clonazepam, valbenazine
Clozapine requires antipsychotic tx (ex for schizophrenia)
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
Tumor lysis syndrome (pharm tx)
Allopurinol, IV fluids
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
