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Precision > Renal/GU + Neuro > Flashcards

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
Q

Hypercalcemia (pharm tx)

A

Mild = No treatment

Severe/Symptomatic = IV saline, furosemide (avoid HCTZ, calcitonin, bisphosphonate if severe)

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26
Q

Hyperkalemia (scientific concepts)

A

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

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27
Q

BPH (pharm tx)

A

Alpha 1 adrenergic antagonist (-zosin) = immediate sx relief

5-alpha reductase inhibitors (finasteride) = longterm prostate growth inhibition

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28
Q

Hypovolemia (scientific concepts)

A

Low volume = wide pulse pressure

Increased HR and decreased BP with standing

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29
Q

Immobilization (Health maint + prevention)

A

Beware of pressure ulcers, infection from repeated urinary catheters, skin infections if patient is not getting frequent baths

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30
Q

Impotence, organic origin (clinical intervention)

A
  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
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31
Q

Impotence, organic origin (Pharm tx)

A
  1. PDE5 inhibitor = sildenafil,. tadalafil
  2. PGE1 injection
  3. Vacuum pump, penile revascularization, penile prosthetics
  4. Testosterone if low
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32
Q

Interstitial cystitis (Dx and Labs)

A

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

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33
Q

Interstitial nephritis (FMLD)

A

Acute kidney injury with increased eosinophils

Fever, maculopapular rash, arthalgias

WBC = pathognomonic = Urine eosinophils

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34
Q

Medullary sponge kidney (FMLD)

A

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

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35
Q

Minimal change Dz (scientific concepts)

A

80% of nephrotic syndrome in kids

Etiologies = Idiopathic +/-associated with viral infections, allergies (insect stings, NSAID)

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36
Q

Minimal change dx (Dx and labs)

A

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

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37
Q

Interstitial nephritis (Pharm tx)

A

MCC = Drug induced

D/c offending agent

Steroids if renal impairment is severe

Dialysis if extremely severe and no response after stopping offending agent

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38
Q

Nephrotic syndrome (dx and labs)

A
  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
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39
Q

Peyronie (clinical intervention)

A

Vitamin E and potassium (PABA)

Colchicine injection

Surgery

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40
Q

Polycystic kidney dz (hx and pe)

A

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
Q

Premature ejactuation (Pharm tx)

A
  1. Topicals = lidocaine, benzocaine
  2. SSRI
  3. PDE-5 = Sildenafil
  4. Pindolol, timolol
42
Q

Priapism (scientific concepts)

A

Ischemic = Low-flow

MC = Decreased venous outflow

Nonischemic = High flow - due to penile trauma

43
Q

Priapism (FMLD)

A

Prolonged, painful erection

Penis is erect for hours

Absence of stimulation

44
Q

Pyelonephritis (clinical intervention)

A

FQ (IV or PO) Aminoglycosides (gent), TMP/SMX, Cephalosporin

Admit for IV fluids + IV abx for severe or complicated

45
Q

Renal artery stenosis (Labs and Dx)

A

Renal arteriography = Gold Standard (not initial choice since invasive)

CT with angiography = MC initial choice

46
Q

Renal cell carcinoma (clinical intervention)

A

Stage 1-3 = Radial nephrectomy, immune therapy, renal cell is resistant to chemo/radiation

Bilateral involvement or patient with solitary kidney = Partial nephrectomy

47
Q

Sex dysfunction, premature ejacuation (pharm tx)

A

SSRI

48
Q

Undescended testicle (clinical intervention_

A

Orchipexy recommended at 4-6 mo

Must be done before 2yo

If less than 4 mo watch and wait

49
Q

Undescended testicle (hx and PE_

A

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
Q

Urinary incontinence, detrusor overactivity (clinical intervention)

A

Bladder training (timed frequent voids, decrease fluid intake)

Surgical injection of botox, bladder augmentation

51
Q

Vesicoureteral Reflux (VUR) FMLD

A

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
Q

Wilms tumor (nephroblastoma) clinical intervention

A

Nephrectomy followed by chemo

Post surgery radiation therapy if extends past renal capsule, pulmonary METS or large tumor

53
Q

Wilms tumor (nephroblastoma) Dx and Labs

A

Abdominal ultrasound = best INITIAL test

CT with contrast/MRI = More accurate

54
Q

Acute infective polyneuritis (clinical intervention)

A
55
Q

Acute infective polyneuritis (clinical intervention)

A

AKA guillain barre syndrome

monitor closely and mechanical ventilation at first sign of decreased FVC on PFTs

56
Q

Akathisia (pharm tx)

A

Antihistamine

Stop enticing medicine; maybe beta blocker

Movement disorder makes it hard to sit still

57
Q

Alzheimers disease (pharm tx)

A

Acetylcholinesterase inhibitors (donepezil, tacrine, rivastigmine, galantamine) + NMDA antagonist (memantine)

58
Q

Amyotrophic lateral sclerosis (ALS) FMLD

A

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
Q

C5 nerve root (scientific concepts)

A

C5 controls biceps and deltoids

C5 dermatome covers the outer part of the arm down to the elbow

60
Q

CN III Disorder (Hx and PE)

A

Oculomotor nerve = inferior rectus, ciliary body

Abnormalities = oculomotor, dilated pupil

61
Q

Coma (pharm tx)

A

Depends on underlying cuase

Status epilepticus = First line tx = Lorazepam; 2nd line + Phenytoin

Hypoglycemia = Glucose +/- thiamine

Opioid toxicity = Nalaxone

Benzo toxicity = Flumazenil

62
Q

CN III Palsy (FMLD)

A

Damage results in patient unable to move their eye normally

Levator palpebrae superioris and muscles responsible for pupil constriction (sphincter papillae)

63
Q

Duchenne Muscular Dystrophy (health maint + prevention)

A

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
Q

Encephalopathy, Bovine spongiform (scientific concepts)

A

Mad cow disease

Spread via consumption of infected meat

Rapid mental deterioration within months leading to coma

Variant is Creutzfeldt-Jakob disease

65
Q

Epilepsy, simple partial (FMLD)

A

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
Q

Fracture, skull, basilar (Hx and PE)

A

MCC = TBI

MC involvement = Temporal bone

PE = Periorbital ecchymosis, mastoid ecchymosis, hemotympanum, rhinorrea

67
Q

Guillain-barre syndrome (clinical intervention)

A
  1. Plasmapharesis
    2.IVIG
  2. Mechanical ventilation if resp failure

*Prednisone is contraindicated

68
Q

HA (Dx and labs)

A

CT = First line

If negative due an LP looking for blood or xanthochromia

4-vessel angio = after confirmed SAH

69
Q

Cluster HA (Health maint + prevention)

A

Prophy = Verapamil

Steroids, ergotomines, valproic acid, lithium

70
Q

HA postdural puncture (clinical intervention)

A

Bed rest, hydration, caffeine, epidural blood patch if conservative management fails

71
Q

Huntington disease (scientific concepts)

A

Autosomal dominant neurodegenerative disorder

Mutation of chromosome 4

Decreased GABA and substance P

72
Q

Huntington disease (dx and labs)

A

CT scan = cerebral and caudate nucleus atrophy

MRI = similar findings

Genetic testing

Pet scan = Decreased glucose metabolism in caudate nucleus and putamen

73
Q

Intracranial abscess (hx and pe)

A

MC sx = HA usually on side of abscess that is unrelieved by analgesics, neck stiffness, AMS, vomiting

PE = Fever, focal neuro deficits, +/- seizure

74
Q

Lateral medullary (wallenberg) syndrome (Dx and Labs)

A

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
Q

Brain lesion, basal ganglia (FMLD)

A

Problems with speech, movement, posture

“Parkinsonism”

75
Q

Brain lesion, cerebellum (scientific concepts)

A

Causes dyssynergia, dysmetria, dysarthria, ataxia of stance and gait

ON same side of body as lesion (ipsilateral)

76
Q

Lesion, CN III (scientific concepts)

A

Causes ptosis, down and out pupil, mydriasis, absent light reflex, failure to accomodate,

2ndary to uncal herniaiton due to ipsilateral cerebral injury

77
Q

Long thoracic nerve injury (clinical intervention)

A

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
Q

Meningitis, bacterial, acute (pharm tx)

A

<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
Q

Motor neuron deficit (Hx and PE)

A

AKA ALS

Both upper and lower motor neuron necrosis = progressive motor degeneration

Asymmetric limb weakness is the MC presenting sx

80
Q

Multiple sclerosis (scientific concepts)

A

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
Q

Myasthenia Gravis (pharm tx)

A
  1. Acetylcholinesterase inhibitors = pyridostigmine or neostigmine
  2. Immunesupression: Plasmapheresis or IVIG
  3. Thymectomy if due to thymoma

*Avoid FQ or aminoglycosides

82
Q

Myasthenia Gravis (scientific concepts)

A

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
Q

CN 6 (Scientific concepts)

A

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
Q

CN 6 (Hx and PE)

A

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
Q

CN 11 (hx and PE)

A

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
Q

Peroneal nerve injury (Hx and PE)

A

Provides sensation to lateral leg

Innervated by peroneous longus, peroneus brevis and
short head of biceps femoris

Injury= FOOT DROP

87
Q

Spinal accessory injury (clinical intervention)

A

Non surgery = Transcutaneous nerve stimulation

Surgery = Neurolysis primary nerve anastamosis

88
Q

Trigeminal neuralgia (Health maint + prevention)

A

Carbamazepine = 1st line

Depression is common in these pts- monitor and tx with TCA and valproic acid

89
Q

Normal nerve function (hx and pe)

A

Thorough CN evaluation of each cranial nerve for motor and sensory

90
Q

Restless leg syndrome (pharm tx)

A
  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
Q

Stroke (dx and labs)

A

Non-contrasted CT head = best initial to determine hemorrhagic vs ischemic

MRI = MOST ACCURATE

92
Q

SAH (pharm tx)

A

Nimodipine, nicardipine, labetolol to lower BP

Supportive - Best rest, stool softeners

Decrease ICP = mannitol, hyperventilation, head elevation

93
Q

Suprascapular nerve entrapment (FMLD)

A

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
Q

Tardive dyskinesia (pharm tx)

A

Clonazepam, valbenazine

Clozapine requires antipsychotic tx (ex for schizophrenia)

95
Q

Transient Ischemic attack (TIA) (scientific concepts)

A

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
Q

Tumor lysis syndrome (pharm tx)

A

Allopurinol, IV fluids

97
Q

Tumor lysis syndrome (FMLD)

A

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

Precision (5 decks)

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