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DOOS 2 > renal questions (1) > Flashcards

renal questions (1) Flashcards

1
Q

presents with: symptoms: nausea, vomiting, diarrhea, pruritus, drowsiness, dizziness, hiccups, SOB, anorecia, hematochezia and o Signs: tachycardia and hypotension indicate prerenal. Distended bladder, CVA tenderness, enlarged prostate indicate postrenal. Other signs: anuria, change in volume status, change in mental status, edema, weakness, dehydration, rashes, JVD, uriniferous odor, ecchymosis

A

acute renal failure

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2
Q

lab that is key parameter to measure renal function

A

GFR

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3
Q

tx of acute renal failure

A

correcting underlying problem
**IV fluids for prerenal states.

Avoidance of medications and nephrogenic agents in intrarenal states.
Relief of urinary tract obstruction in postrenal states.
Short term dialysis if serum creatinine exceeds 5-10 mg/dL

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4
Q

presents with: symptoms: fatigue, malaise, anorexia, nausea, vomiting, metallic taste, hiccups, dyspnea, orthopnea, impaired mentation, insomnia, irritability, muscle cramps, restless legs, weakness, pruritus, easy bruising, altered consciousness and cachexia, weight loss, muscle wasting, pallor, hypertension, ecchymosis, sensory deficits, asterixis, Kussmal respirations

A

Chronic kidney disease

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5
Q

labs for CKD

A

Measure GFR gold standard.

Proteinuria is marker of kidney damage. 
BUN and creatinine are elevated. 
Hemoglobin and hematocrit, 
serum electrolytes,
urinalysis are abnormal
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6
Q

tx for CKD

A

ACEI and ARBs

tight glycemic control in diabetic pts,
cholesterol-lowering therapy,
tobacco cessation,
weight control.

Erythropoieten, iron supplements, antiplatelet therapy

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7
Q

presents with: hematuria, urine is tea or cola colored, oliguria, edema of the face and eyes is present in the morning, and edema of the feet and ankles occurs in the afternoon and evening, hypertension

A

glomerulonephritis

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8
Q

glomerulonephritis labs

A

antistreptolysin O titer increased. Urinalysis reveal hematuria, RBC cases and proteinuria. Serum complement (C3) is decreased

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9
Q

glomerulonephritis tx

A

steroids and immunosuppressive drugs, salt and fluid intake should be decreased, dialysis, ACEI

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10
Q

presents with: symptoms: malaise, abd distention, anorexia, facial edema/puffy eyelids, oliguria, scrotal swelling, SOB, weight gain and o Signs: ascites, edema, hypertension, orthostatic hypotension, retinal sheen, skin striae

A

nephrotic syndrome

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11
Q

nephrotic syndrome labs

A

Urinalysis shows proteinuria, lipiduria, glycosuria, hematuria, foamy urine. Microscopic exam shows RBC casts, granular casts, hyaline casts, fatty casts, key finding is oval fat body . blood chemistry shows hypoalbuminemia, azotemia, hyperlipidemia. C3 levels low or normal

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12
Q

nephrotic syndrome tx

A

ACEI, diuretics, sodium and fluid restriction. Dietary protein and potassium normal

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13
Q

presents with: back and flank pain, headaches, hematuria, hypertension, recurrent UTI, weight loss, renal colic, N/V, one or both kidneys palpable and feel nodular or tender

A

polycystic kidney disease

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14
Q

PKD labs

A

anemia on CBC, Urinalysis shows proteinuria, hematuria, pyuria and bacteriuria. o Imaging: US shows fluid filled cysts- imaging of choice

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15
Q

PKD tx

A

no cure, supportive. ACEI or ARB for HTN, high fluids, low protein. ABX(Bactrim, fluoroquinolones, chloramphenicol, vanco), Dialysis

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16
Q

presents with: asymptomatic until inflame or ureteral obstruction, unilateral back pain and renal colic that waxes and wanes.

Symptoms: hematuria, dysuria, urine frequency, fever, chills, N/V
Stone in upper ureter: pain radiate to anterior abdomen
Stone in lower ureter: pain radiate to ipsilateral groin, testicle or labia
Stone in UVJ: pain in pelvis and urinary frequency and urgency

Signs: diaphoresis, tachycardia, tachypnea, restlessness, CVA tenderness, abd distention because of ileus

A

nephrolithiasis

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17
Q

main stone type

A

calcium

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18
Q

nephrolithiasis labs

A

microscopic or gross hematuria on urinalysis. o Imaging of choice helical CT, plain film radiograph

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19
Q

nephrolithiasis tx

A

stone less than 5 mm: pass spontaneously, drink plenty of fluids, strain urine to capture stone, alpha blocker or CCB to facilitate passage. Most stones pass 2-4 weeks. o Stone 5-10mm: pass spontaneously, increased fluid and analgesics, elective lithotripsy or ureteroscopy.o Stone >10 mm: not likely to pass spontaneously, vigorous hydration, ureteral stent or percutaneous nephrostomy(gold standard), extracorporeal shock wave lithotripsy, analgesics

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20
Q

presents with: alterations in brain water content, thirst, restlessness, irritability, disorientation, lethargy, delirium, convulsions, coma, dry mouth, dry mucous membranes, lack of tears, flushed skin, tachycardia, hypotension, fever, oliguria, anuria, hyperventilation, lethargy, hyperreflexia

A

hypernatremia

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21
Q

hypernatremia tx

A

IV D5W, dialysis if Na > 200. Rapid correction of hypernatremia can cause pulmonary or cerebral edema

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22
Q

presents with: symptoms: lethargy, disorientation, muscle cramps, anorexia, hiccups, N/V, sz and o Signs: weakness, agitation, hyporeflexia, orthostatic hypotension, Cheyne-Stokes respirations, delirium, coma, stupor

A

hyponatremia

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23
Q

hyponatremia tx

A

consultation with nephrology, fluid restriction, monitor volume status, hypertonic saline used if Na <120. Overly rapid correction can cause central pontine myelinolysis, resulting in neurologic damage

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24
Q

presents with: polyuria, nocturia, polydipsia.

A

diabetes insipidus

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25
Q

DI lab

A

water deprivation and desmopression testing. Urine osmolality <250.

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26
Q

DI tx

A

parenteral or intranasal desmopressin, diuretics, chlorpropamide

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27
Q

presents with: thirsty, urinary output decreases, increased heart rate, fatigue, muscle cramps, dizziness, hypotension when standing, signs of ischemia and shock, lethargy, confusion, decreased skin turgor and dry mucous membranes

A

volume depletion

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28
Q

volume depletion labs

A

hematocrit and serum albumin increased, urinary sodium decreased, urea increases

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29
Q

volume depletion tx

A

mild by increasing salt and water intake. Severe with fluids containing electrolytes, glucose, amino acids

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30
Q

presents with: dysrhythmia, cardiac arrest, numbness, tingling, weakness, flaccid paralysis

A

hyperkalemia

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31
Q

hyperkalemia lab

A

potassium level >5. EKG Peaking T waves

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32
Q

hyperkalemia tx

A

IV calcium gluconate with cardiac probs. Sodium bicarb and insulin administered to drive potassium into intracellular compartment. Sodium polystyrene sulfonate to remove potassium from the body

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33
Q

presents with: ventricular arrhythmias, hypotension, cardiac arrest, malaise, skeletal muscle weakness, cramps, smooth muscle involvement, ileus, constipation, polyuria, nocturia, hyperglycemia, rhabdomyolysis

A

hypokalemia

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34
Q

hypokalemia lab

A

potassium <3.5. ECG show flattened or inverted T waves, increased prominence of U waves, depression of ST segment, ventricular ectopy

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35
Q

hypokalemia tx

A

IV potassium replacement

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36
Q

presents with: symptoms: anorexia, N, constipation, polyuria, polydipsia, dehydration, lethargy, stupor, coma. o Signs: orthostatic hypotension and tachycardia

A

hypercalcemia

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37
Q

hypercalcemia labs

A

serum calcium high, protein electrophoresis of serum, 24 hr urine collection

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38
Q

hypercalcemia tx

A

isotonic saline for volume repletion

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39
Q

presents with: : symptoms: dry skin, brittle nails, pruritis, muscle cramping, SOB, numbness and tingling, syncope and angina. Signs: psoriasis, dry skin, perioral numbness, wheezing, bradycardia, crackles, third heart sound. Neuro: trousseau sign, chvostek sign, irritability, confusion, dementia, sz

A

hypocalcemia

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40
Q

hypocalcemia lab

A

calcium <8.5. BUN and creatinine for renal function

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41
Q

hypocalcemia tx

A

IV calcium gluconate

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42
Q

Secondary to CKD. Severe may lead to rhabdomyolysis, paresthesis and encephalopathy

A

Hyperphosphatemia and hypophosphatemia

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43
Q

Hyperphosphatemia and hypophosphatemia tx

A

dietary phosphorus restriction and oral phosphate binders and Calcium carbonate for hyper. Oral phosphate for hypo

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44
Q

presents with: deep tendon reflexes reduced, muscle weakness, hypotension, respiratory depression, cardiac arrest, N/V, flushing

A

hypermagnesemia

45
Q

hypermagnesemia lab

A

ECG shows widened QRS complex, prolonged PR interval, prolonged Q-T interval. Bleeding and clotting time increased

46
Q

hypermagnesemia tx

A

IV calcium gluconate, saline diuresis, IV furosemide, dialysis

47
Q

presents with: lethargy, anorexia, N/V, weakness, tetany, sz

A

hypomagnesemia

48
Q

hypomagnesemia lab

A

EKG show prolonged PR and QT interval and widening of QRS

49
Q

hypomagnesemia tx

A

oral magnesium or IV if severe

50
Q

presents with: metabolic encephalopathy, headache and drowsiness, stupor and coma

A

respiratory acidosis

51
Q

presents with: hyperventilation, frequent, deep, sighing respirations, tetany like syndrome, paresthesis, chest discomfort, light-headedness, confusion

A

respiratory alkalosis

52
Q

respiratory alkalosis tx

A

rebreathing technique

53
Q

presents with: hyperventilation, ventricular arrhythmia, lethargy and coma

A

metabolic acidosis

54
Q

metabolic acidosis tx

A

insulin therapy, volume repletion, bicarb therapy

55
Q

presents with: paresthesias, carpopedal spasm, light-headedness, confusion, stupor, coma, weakness, muscle cramps, postural dizziness, polyuria, polydipsia, muscle weakness

A

metabolic alkalosis

56
Q

metabolic alkalosis tx

A

Increase renal excretion of bicarb

57
Q

presents with: frequency, urgency, dysuria, suprapubic discomfort, gross hematuria

A

cystitis

58
Q

cystitis lab

A

urinalysis show pyuria, bacteriuria, hematuria. Culture positive. Imaging for pyelonephritis

59
Q

cystitis tx

A

fluroquinolone. Resistant E coli treat with Bactrim. Fluids encouraged.

60
Q

presents with: fever, flank pain, shaking, chills, irritative voiding, N, V, diarrhea, abd discomfort, tachycardia, CVA tenderness

A

pyelonephritis

61
Q

pyelonephritis lab

A

CBC shows leukocytosis and left shift. Urinalysis shows pyuria, bacteriuria, hematuria, WBC casts. Urine culture shows growth

62
Q

pyelonephritis tx

A

quinolones, Bactrim

63
Q

presents with: acute: sudden onset of high fever, chills, low back and perineal pain. Frequency, urgency, dysuria, obstruction, prostate is swollen and tender

A

prostatitis

64
Q

prostatitis lab

A

urinalysis reveals pyuria. Prostatic fluic culture shows E.Coli

65
Q

prostatitis tx

A

35y/o fluoroquinolone or Bactrim

66
Q

presents with: testicular swelling and tenderness, unilateral. Fever, tachycardia

A

orchitis

67
Q

orchitis lab

A

urinalysis reveals pyuria and bacteriuria with bacterial infection. Cultures are positive, US for abscess or tumor

68
Q

orchitis tx

A

symptomatic relief with ice and analgesia. o Abx: 35 y/o cipro.

69
Q

presents with: heaviness and dull, aching discomfort in the affected hemiscrotum, epididymis swollen and tender, warm, erythematous, enlarged scrotal mass, fever and chills, Phrehn_s sign

A

epididymitis

70
Q

epididymitis lab

A

Urinalysis reveals pyuria and bacteriuria. Culture shows positive

71
Q

epididymitis tx

A

Abx: 35 y/o cipro bed rest, scrotal elevation, analgesics

72
Q

presents with: decreased force of urinary stream, hesitancy, straining, postvoid dribbling, sensation of incomplete emptying, frequency, nocturia, urgency, recurrent UTI, large prostrate

A

benign prostatic hyperplasia

73
Q

BPH lab

A

PSA elevated

74
Q

BPH tx

A

alpha adrenergic agonists and 5 alpha reductase inhibitors. Surgical

75
Q

types of incontinence

A

Urge incontinence results from bladder contractions that cannot be controlled by the brain= strong desire to void, followed by loss of urine;

Stress incontinence caused by dysfunction of the urethral sphincter= leakage of urine with increased intra-abd pressure such as sneezing, coughing, laughing;

Overflow incontinence is when urinary retention leads to bladder distention and overflow of urine= hydronephrosis and obstructive nephropathy;

Functional incontinence is caused by physical or cognitive disability;

Mixed incontinence is combo of stress and urge incontinence

76
Q

incontinence lab

A

urinalysis shows diabetes related glycosuria or acute UTI, postvoid residual urine volume measured, cystometry, stress test, US

77
Q

incontinence tx

A

Kegel exercises, electrical muscle stimulation, biofeedback, bladder training, Oxybutynin or tolterodine(anticholinergic meds), surgical as lest resort for stress incontinence

78
Q

presents with: symptoms of urinary obstruction or irritative voiding, bone pain from metastases, prostate enlarged, nodular, asymmetric

A

prostate cancer

79
Q

prostate cancer lab

A

PSA elevated. Biopsy to confirm

80
Q

prostate cancer tx

A

tumor confined to prostate use radical retropubic prostatectomy, brachytherapy, external beam radiation therapy. Tumor with local invasion use radical retropubic prostatectomy, brachytherapy, external beam radiation therapy. Distant metastases use hormonal manipulation, orchiectomy, antiandrogens, estrogens

81
Q

presents with: painless hematuria, bladder irritability and infection

A

bladder cancer

82
Q

bladder cancer lab

A

cystoscopy definitive. Biopsy confirms

83
Q

bladder cancer tx

A

superficial lesions treat with endoscopic resection and fulguration. Radial cystectomy for recurrent cancer

84
Q

presents with: gross or microscopic hematuria, pain or abd mass, erythrocytosis, hypercalcemia, hypertension, hepatic dysfunction

A

renal cell carcinoma

85
Q

renal cell carcinoma lab

A

normochromic anemia, elevated erythrocyte sedimentation. CT scan diagnostic

86
Q

renal cell carcinoma tx

A

Radiation nephrectomy, radiation therapy, hormonal therapy, chemotherapy, alpha interferon and interleukins

87
Q

presents with: asymptomatic abd mass, anorexia, N/V, fever, abd pain, hematuria, HTN

A

wilms tumor

88
Q

wilms tumor lab

A

urinalysis shows hematuria, anemia. US study of choice

89
Q

wilms tumor tx

A

surgery, chemotherapy and radiation. Radiacal nephrectomy. Responds to dactinomycin, vincristine, doxorubicin

90
Q

presents with: painless, solid, testicular swelling, ureteral obstruction, abd complaints

A

testicular cancer

91
Q

testicular cancer lab

A

scrotal US

92
Q

testicular cancer tx

A

orchiectomy. Nonseminomatous tumors use surgery or chemo. Seminomatous tumors use radiation

93
Q

presents with: erythema with tenderness and possible purulent drainage, inability to retract foreskin, obstructed urinary stream, hematuria, pain of prepuce

A

phimosis

94
Q

phimosis tx

A

refer for circumcision, ABX, steroidal creams or nonsteroidal ointment

95
Q

presents with: pain, edema, tenderness, erythema of glans and foreskin

A

paraphimosis

96
Q

paraphimosis tx

A

Emergent manual reduction, surgical technique, refer for circumcision

97
Q

erectile dysfunction tx

A

behaviorally oriented sex therapy. Phosphodiesterase inhibitor(Sildenafil, vardenafil, tadalafil)

98
Q

presents with: soft, nontender fullness of the hemiscrotum that transilluminates, mass may wax and wane in size

A

hydrocele

99
Q

hydrocele tx:

A

elective repair

100
Q

presents with: palpable, round, firm cystic mass with distinct borders, free floating above testicle, which transilluminates. Mass is tender

A

spermatocele

101
Q

spermatocele lab

A

scrotal US

102
Q

spermatocele tx

A

surgical removed or sclerosed

103
Q

presents with: sudden onset of severe unilateral pain and scrotal swellin are present. Testis painful to palpation, testicle and scrotum are edematous. No relief with elevation of the testicle

A

testicular torsion

104
Q

testicular torsion lab

A

clinical diagnosis, doppler US

105
Q

testicular torsion tx

A

mild analgesics, surgical emergency

106
Q

presents with: chronic, nontender mass that does not transilluminate, bag of worms appearance that increases with Valsalva

A

variocele

107
Q

variocele lab

A

doppler sonography

108
Q

variocele tx

A

surgical repair

DOOS 2 (6 decks)

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