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Internal Medicine > Renal/Urinary > Flashcards

Renal/Urinary Flashcards

1
Q

Benign Prostatic Hyperplasia cause

A

age, cancer

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2
Q

Benign Prostatic Hyperplasia s/s

A

urinary hesitancy, weak stream, stream intermittency, post-void dribbling, nocturia

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3
Q

Benign Prostatic Hyperplasia dx

A

rectal exam; PSA, UA

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4
Q

Benign Prostatic Hyperplasia tx

A

lifestyle modifications; phytotherapy, a-blockers (tamsulosin), 5-a-reductase inhibitors (finasteride), PDE5-inhibitors (tadalafil)

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5
Q

Erectile Dysfunction cause

A

hypertension, diabetes mellitus, hyperlipidemia, cardiovascular disease; obstructed arterial inflow, inadequate venous constriction; poor hormones; psych disorder; medications (b-blockers); drugs

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6
Q

Erectile Dysfunction s/s

A

unable to have/sustain an erection; need info on timing/frequency of sexual relations, partners, morning erections, ejaculation, ability to masturbate; look for deformities (peyronie disease, testicular atrophy, etc)

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7
Q

Erectile Dysfunction dx

A

CBC, UA, lipid profile, TSH, testosterone, glucose, prolactin, FSH/LH; nocturnal penile tumescence testing (organic vs psychogenic); direct injection of vasoactive substance

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8
Q

Erectile Dysfunction tx

A

therapy (psych); testosterone replacement (hypogonadism); Phosphodiesterase-5 inhibitors (Sildenafil, tadalafil); vacuum constriction, injected/inserted vasoactive substances, penile prosthesis

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9
Q

Incontinence cause

A

uncontrolled bladder contractions (urge); dysfunction of urethral sphincter (stress); urinary retention leading to bladder distention and overflow (overflow); untimely urination by physical/cognitive disability (functional); neurologic disease (parkinson, stroke, dementia); metabolic (hypoxemia, diabetic neuropathy); pelvic disorders (uterine prolapse)

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10
Q

Incontinence s/s

A

strong desire to void, loss of urine (urge); frequency, urgency, nocturia (overactive); leakage of urine w/ abdominal pressure (stress); hydronephrosis, obstructive nephropathy

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11
Q

Incontinence dx

A

postvoid residual urine volume; UA (UTI vs glucosuria); cystometry, stress test, US, cystoscopy

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12
Q

Incontinence tx

A

pelvic floor muscle training (Kegel exercises); electrical stimulation, biofeedback, bladder straining; pessaries/implants; anticholinergics (oxybutynin, tolterodine); catheterization

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13
Q

Nephrolithiasis cause

A

elevated calcium, uric acid, bacteria; diet w/ salt and protein

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14
Q

Nephrolithiasis s/s

A

sudden onset of severe CVA tenderness; N/V; lower abdominal pain radiating to groin; pt cannot sit still

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15
Q

Nephrolithiasis dx

A

CT abd/pel WO contrast; CBC, BMP (BUN/Cr, UA (blood)

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16
Q

Nephrolithiasis tx

A

IV ketorolac/IV morphine; IV hydration, antiemetics; surgery >7mm (lithotripsy, stent, etc)

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17
Q

Cystitis cause

A

infection of the bladder (E. coli, enterococci)

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18
Q

Cystitis s/s

A

frequency, urgency, dysuria, suprapubic discomfort

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19
Q

Cystitis dx

A

UA (pyuria, bacteriuria, hematuria); positive urine culture; imaging for pyelo

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20
Q

Cystitis tx

A

Nitrofurantoin 100 mg BID x 5 days, TMP-SMX BID x 3 days, Cipro 500 mg BID x 3 days; nitrofurantoin/augmentin for pregnancy; phenazopyridine (symptom relief)

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21
Q

Epididymitis cause

A

Behcet’s disease, amiodarone excess, tumor, bacterial infection (gonorrhea <35yo, e.coli >35yo)

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22
Q

Epididymitis s/s

A

gradual onset; testicular pain, urethral discharge, urethral sx if STD; edematous tender testicle, epididymis, and spermatic cord

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23
Q

Epididymitis dx

A

clinical; scrotal doppler US (r/o torsion); urine culture

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24
Q

Epididymitis tx

A

scrotal support; analgesia, antibiotics (cef, doxy, levoflox for no STD)

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25
Q

Orchitis cause

A

ascending bacterial infection from urinary tract

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26
Q

Orchitis s/s

A

unilateral swelling and tenderness; fever, tachycardia

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27
Q

Orchitis dx

A

US; UA, culture

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28
Q

Orchitis tx

A

antibiotics (cef, azithromycin, doxy)

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29
Q

Prostatitis cause

A

bacterial (E. coli, pseudomonas, proteus; chlamydia/gonorrhea in younger men); chronic pelvic pain syndrome; nonbacterial, granulomatous

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30
Q

Prostatitis s/s

A

perineal/prostate pain; dysuria, obstructive uropathy symptoms; low back/abdominal pain; fever, chills, myalgias

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31
Q

Prostatitis dx

A

tender, nodular, boggy prostate; CBC, BMP, blood cultures, UA

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32
Q

Prostatitis tx

A

fluoroquinolones vs TMP-SMX; admission if bad

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33
Q

Pyelonephritis cause

A

infection of the kidney and renal pelvis by bacteria (E. coli)

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34
Q

Pyelonephritis s/s

A

fever, flank pain, shaking chills (rigors), irritative voiding symptoms

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35
Q

Pyelonephritis dx

A

CVA tenderness, fever, tachycardia; CBC (leukocytosis w/ left shift); UA (pyuria, bacteriuria, hematuria); urine culture; US abd

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36
Q

Pyelonephritis tx

A

Fluoroquinolone or TMP-SMX x 1-2 weeks (outpatient); IV fluoroquinolones or gentamicin x 1-2 days, then 2 weeks oral therapy (inpatient); ampicillin (pregnancy)

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37
Q

Urethritis cause

A

noninfectious (trauma, retiers, stones); infectious (gonococcal, nongonoccocal

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38
Q

Urethritis s/s

A

dysuria, urethral discharge, urethral pruritus

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39
Q

Urethritis dx

A

voiding UA (leukocyte esterase, >10 WBC/hpf); gram stain of urethral discharge (>5 WBC/oil immersion field)

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40
Q

Urethritis tx

A

Ceftriaxone 250mg IM x 1 dose (gonorrhea), Azithromycin 1g PO x 1 dose OR Doxycycline 100mg PO BID x7d (chlamydia)

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41
Q

Acute Renal Failure cause

A

prerenal, intrinsic, postrenal
■ Prerenal: hypovolemia, hypotension, CHF, cirrhosis, nephrotic syndrome, early sepsis, aortic aneurysm, renal artery stenosis, renal artery embolus
■ Intrinsic: acute tubular necrosis, NSAIDs, aminoglycosides, radiologic contrast, acute interstitial nephritis, SLE, infection, glomerulonephritis, vascular disease
■ Postrenal: tubular obstruction, urolithiasis, BPH, bladder outlet obstruction

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42
Q

Acute Renal Failure s/s

A

: N/V/D, pruritus, drowsiness, dizziness, hiccups, SOB, anorexia, hematochezia; tachycardia, hypotension (prerenal); distended bladder, CVA tenderness, enlarged prostate (postrenal); anuria/oliguria, weight change, AMS, edema, weakness, dehydration, rashes, JVD, urine odor, ecchymosis

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43
Q

Acute Renal Failure dx

A

GFR <90% (injury <50%); BUN/Cr ratio (20:1 [pre], <15:1 [intrinsic]); UA (hyaline casts [pre/post]; granular casts, WBC w/ casts, RBC w/ cast, protein, tubular epithelial cells [intrinsic]); US/CT

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44
Q

Acute Renal Failure tx

A

IV fluids, improve cardiac output (prerenal); adjustments/avoidance of meds (intrinsic); ureteral stents, urethral catheter, etc (postrenal); short term dialysis Cr >5-10

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45
Q

Chronic Renal Failure cause

A

GFR <60 w kidney damage (proteinuria, glomerulonephritis, structural damage) >3 months; DM, HTN, glomerulonephritis, polycystic kidney disease

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46
Q

Chronic Renal Failure s/s

A

fatigue, malaise, anorexia, N/V, metallic taste, hiccups, SOB, orthopnea, impaired mentation, insomnia, irritability, muscle cramps, restless legs, weakness, pruritus, easy bruising; cachexia, weight loss, muscle wasting, pallor, HTN, ecchymosis, sensory deficits, asterixis, Kussmaul breathing

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47
Q

Chronic Renal Failure dx

A

GFR (<60); proteinuria, microalbuminemia, BUN/Cr (elevated); H&H, electrolytes, UA (abnormal); cystatin C (elevated)

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48
Q

Chronic Renal Failure tx

A

ACE/ARBs; manage comorbid condition, tobacco cessation, control sugars, weight loss; limit water, Na, K, Ph; hemodialysis, peritoneal dialysis, kidney transplant

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49
Q

Glomerulonephritis cause

A

HSP, postinfectious GN, IgA nephropathy, hereditary (focal); postinfectious GN, membranoproliferative GN (diffuse) [children]; IgA nephropathy, hereditary, SLE (focal); SLE, membranoproliferative GN, rapidly progressive GN, postinfectious, vasculitis (diffuse) [adult]

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50
Q

Glomerulonephritis s/s

A

hematuria (tea/cola colored); oliguria/anuria, edema of face/eyes and feet/ankles; HTN

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51
Q

Glomerulonephritis dx

A

Antistreptolysin-O titer (r/o postinfectious); UA (hematuria >3 RBC, proteinuria, RBC casts); serum complement C3 decreased; renal biopsy

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52
Q

Glomerulonephritis tx

A

steroids, immunosuppressive drugs; decrease salt and fluid intake; dialysis (azotemia); ACE inhibitors

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53
Q

Nephrotic Syndrome cause

A

GN, glomerulosclerosis, IgA nephropathy, membranoproliferative GN, minimal change disease, congenital, drugs, cancer, SLE, postinfectious

54
Q

Nephrotic Syndrome s/s

A

malaise, abdominal distention, anorexia, facial edema/puffy eyelids, oliguria, scrotal swelling, SOB, weight gain; ascites, edema, HTN, orthostatic hypotension, retinal sheen, skin striae

55
Q

Nephrotic Syndrome dx

A

> 3.5 g protein in 24 hrs; UA (proteinuria, lipiduria, glycosuria, hematuria, foamy, RBC casts, granular casts, hyaline casts, fatty casts); CMP (hypoalbuminemia, azotemia, hyperlipidemia)

56
Q

Nephrotic Syndrome tx

A

ACE inhibitors and diuretics; monitor salt, water, protein, and potassium intake; anticoagulants

57
Q

Polycystic Kidney Disease cause

A

autosomal dominant and recessive PKD; acquired PKD from ESRD

58
Q

Polycystic Kidney Disease s/s

A

back/flank pain, headaches, nocturia; hematuria, HTN, recurrent UTIs, weight loss, renal colic, N/V; palpable nodular/tender kidney

59
Q

Polycystic Kidney Disease dx

A

US (fluid free cysts); UA (proteinuria, hematuria, pyuria, bacteriuria); CBC (anemia); CT

60
Q

Polycystic Kidney Disease tx

A

pain control, HTN control, high intake of fluids, low protein; infectious w/ abx (bactrim, cipro, vancomycin); dialysis and transplant

61
Q

Renal Artery Stenosis cause

A

HTN, DM, renal insufficiency, atherosclerosis, smoking

62
Q

Renal Artery Stenosis s/s

A

HTN, swelling, azotemia (prerenal ARF)

63
Q

Renal Artery Stenosis dx

A

angiogram; UA, CMP

64
Q

Renal Artery Stenosis tx

A

bypass/revascularization depending on degree of stenosis; ACEs/ARBs to control HTN/provide renal support, control cholesterol

65
Q

Bladder Neoplasm cause

A

tobacco, occupational carcinogens, schistosomiasis, cyclophosphamide, chronic infections

66
Q

Bladder Neoplasm s/s

A

painless hematuria; bladder irritability and infection

67
Q

Bladder Neoplasm dx

A

cystoscopy w/ biopsy (definitive); CBC/CMP (r/o infection and renal function); IV urogram, CT abd/pel, bone scan, retrograde pyelography (staging)

68
Q

Bladder Neoplasm tx

A

endoscopic resection/fulguration, repeat cystoscopy q3mos (superficial); intravesical instillation of thiotepa, mitomycin C, bacillus calmette-guerin (recurrent, multiple lesions); radical cystectomy (recurrent, diffuse TCC, invaded muscle); chemo/radiation

69
Q

Prostate Neoplasm cause

A

unknown; genetic, hormonal, diet, environmental, infectious

70
Q

Prostate Neoplasm s/s

A

urinary obstruction, irritative voiding; enlarged, nodular, asymmetric prostate; bone pain from mets, spinal cord impingement (advanced)

71
Q

Prostate Neoplasm dx

A

PSA (elevated); biopsy (diagnostic); transrectal US (hypoechoic lesions); CT/MRI (staging)

72
Q

Prostate Neoplasm tx

A

radical retropubic prostatectomy, brachytherapy, external beam radiation (stage A/B/C); hormonal manipulation w/ orchiectomy, antiandrogens, LH agonists, estrogens (stage D)

73
Q

Renal Cell Carcinoma cause

A

smoking, hereditary (Hippel-Lindau, hereditary papillary renal carcinoma)

74
Q

Renal Cell Carcinoma s/s

A

gross/microscopic hematuria, flank pain, palpable mass (classic triad); paraneoplastic syndrome (erythrocytosis, hypercalcemia, HTN, hepatic dysfunction)

75
Q

Renal Cell Carcinoma dx

A

CT with and without contrast; US/MRI w/ contrast and arteriography

76
Q

Renal Cell Carcinoma tx

A

radical nephrectomy; radiation, medications (interferon-a and interleukin)

77
Q

Wilms Tumor (nephroblastoma) cause

A

unknown, common childhood tumor

78
Q

Wilms Tumor (nephroblastoma) s/s

A

asymptomatic abdominal mass; anorexia, N/V, fever, abdominal pain, hematuria, HTN

79
Q

Wilms Tumor (nephroblastoma) dx

A

US (initial); CT/MRI (to access extension); UA (hematuria, anemia)

80
Q

Wilms Tumor (nephroblastoma) tx

A

radical nephrectomy w/ lymph node sampling, chemo (dactinomycin, vincristine, doxorubicin), radiation (resectable); biopsy and chemo (unresectable)

81
Q

Testicular Neoplasm cause

A

cryptorchidism, previous testicular cancer

82
Q

Testicular Neoplasm s/s

A

painless, solid testicular swelling; heaviness in testicle (can be painful), para-aortic LAD, abdominal complaints

83
Q

Testicular Neoplasm dx

A

scrotal US; CT (staging); elevated a-fetoprotein, b-HCG (nonseminomatous

84
Q

Testicular Neoplasm tx

A

orchiectomy; surveillance (S1), surgery/chemo (S2), surgery and chemo (S3) [nonseminomatous]; radiation (S1), increased radiation (S2), chemo (S3) [seminomatous]

85
Q

Metabolic Acidosis cause

A

MUDPILES; lactic acidosis, ketoacidosis, ethylene glycol, methanol, salicylate intoxication, renal tubular acidosis, renal insufficiency, adrenal insufficiency, diarrhea, pancreatic drainage, ureteral diversion

86
Q

Metabolic Acidosis s/s

A

hyperventilation, ventricular arrhythmia, neurologic symptoms (lethargy, coma); N/V/D; kussmaul breathing

87
Q

Metabolic Acidosis dx

A

ABG (pH <7.38, bicarb <22, PO2 dec (compensation))

88
Q

Metabolic Acidosis tx

A

remove primary cause; insulin therapy, volume repletion; bicarbonate therapy

89
Q

Metabolic Alkalosis cause

A

hypovolemia, vomiting, hyperalimentation therapy, diarrhea, NG tube suctioning, villous adenoma, diuretics, hypercalcemia, milk-alkali syndrome, mineralocorticoid excessive steroids causing Cl/K depletion

90
Q

Metabolic Alkalosis s/s

A

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

91
Q

Metabolic Alkalosis dx

A

ABG (pH >7.42, bicarb >26, PO2 inc (compensation))

92
Q

Metabolic Alkalosis tx

A

sodium chloride solutions; interventions to increase excretion of bicarb; remove adenoma or add spironolactone (aldosterone antagonist)

93
Q

Respiratory Acidosis cause

A

COPD, neuromuscular disease (myasthenia gravis), CNS dysfunction (brain stem injury), drug induced hypoventilation; high carbs/parenteral nutrition

94
Q

Respiratory Acidosis s/s

A

hypercapnic encephalopathy, headache, drowsiness; stupor, coma

95
Q

Respiratory Acidosis dx

A

ABG (pH <7.38, PCO2 >45)

96
Q

Respiratory Acidosis tx

A

ventilation, treat underlying disorder

97
Q

Respiratory Alkalosis cause

A

anxiety hyperventilation, salicylate intoxication, hypoxia, intrathoracic disorders, CNS dysfunction, gram-negative septicemia, liver insufficiency, pregnancy

98
Q

Respiratory Alkalosis s/s

A

hyperventilation (frequent, deep, sighing respirations and obvious rapid, deep breathing); tetany-like syndrome (paresthesia of extremities, chest discomfort, lightheadedness, confusion)

99
Q

Respiratory Alkalosis dx

A

ABG (pH >7.42, PCO2 <35)

100
Q

Respiratory Alkalosis tx

A

correct underlying disorder; breathing into paper bag, light sedation vs antianxiety; ventilation (severe >7.6

101
Q

Hyperkalemia cause

A

potassium retention, impaired excretion, increased tissue breakdown, hemolysis, thrombocytosis

102
Q

Hyperkalemia s/s

A

dysrhythmias, cardiac arrest; numbness, tingling, weakness, flaccid paralysis

103
Q

Hyperkalemia dx

A

CMP (K >5.0); EKG (peaked T waves >6.5, flat p wave w/ prolonged PR, wide QRS >7.0, cardiac arrest 8.0-10.0)

104
Q

Hyperkalemia tx

A

sodium gluconate IV (severe); sodium bicarb, glucose D50, and insulin; low potassium diet; remove potassium sparing drugs; sodium polystyrene sulfonate

105
Q

Hypokalemia cause

A

diuretics, renal tubular acidosis, GI losses (V/D)

106
Q

Hypokalemia s/s

A

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

107
Q

Hypokalemia dx

A

CMP (K <3.5); EKG (flattened/inverted T waves, increased U waves, ST depression, ventricular ectopy)

108
Q

Hypokalemia tx

A

oral potassium (potassium chloride, 100meq per 1 point); IV potassium (severe <2.5 or arrhythmias)

109
Q

Hypercalcemia cause

A

vitamin D intoxication, hyperparathyroidism, sarcoidosis, hospitalized pts w/ malignancy

110
Q

Hypercalcemia s/s

A

anorexia, nausea, constipation, polyuria, polydipsia, dehydration, lethargy, stupor, coma, volume depletion, orthostatic hypotension, tachycardia

111
Q

Hypercalcemia dx

A

Ca > 10.5 (Ca + [0.8 x (4-albumin)]; 24hr urine (elevated Ca malignancy, paraneoplastic, hyperparathyroidism; decreased Ca hyperparathyroidism) CXR (mass), UA (hematuria, RCC), ESR

112
Q

Hypercalcemia tx

A

isotonic saline, loop diuretics, bisphosphonates, manage underlying cause

113
Q

Hypocalcemia cause

A

CKD, hypoparathyroidism, cardiovascular collapse, chronically ill, low albumin (correct)

114
Q

Hypocalcemia s/s

A

dry skin, brittle nails, pruritus, muscle cramping, SOB, numbness, syncope, angina; wheezing, bradycardia, crackles; Trousseau sign (carpal tunnel spasm after BP), Chvostek sign (spasm of facial muscle), irritability, confusion, dementia, seizures

115
Q

Hypocalcemia dx

A

Ca <8.5; ionized calcium, magnesium, phosphate, albumin, LFTs, BUN/Cr

116
Q

Hypocalcemia tx

A

treat emergent cardiovascular states; IV calcium gluconate, calcium chloride; oral calcium or vitamin D supplements

117
Q

Hyperphosphatemia cause

A

CKD, phosphate containing laxatives/enemas

118
Q

Hyperphosphatemia s/s

A

fatigue, SOB, anorexia, N/V, sleep disturbance, Trousseau’s sign, Chvostek’s sign, hyperreflexia, seizure

119
Q

Hyperphosphatemia dx

A

Phosphate >4.5, hypocalcemia

120
Q

Hyperphosphatemia tx

A

dietary phosphorous restriction, oral phosphate binders; Calcium carbonate tablets

121
Q

Hypophosphatemia cause

A

diminished supply/absorption, increased urinary losses, redistribution; vitamin D deficiency, respiratory alkalosis, burns, hyperparathyroidism

122
Q

Hypophosphatemia s/s

A

asymptomatic; disorientation, muscle pain, seizures; rhabdomyolysis, paresthesia, encephalopathy

123
Q

Hypophosphatemia dx

A

Phosphate <2.5, hypercalcemia

124
Q

Hypophosphatemia tx

A

oral phosphate repletion

125
Q

Hypermagnesemia cause

A

renal failure, excessive intake, lithium therapy, hypothyroidism, addison disease, familial, milk-alkali syndrome, depression

126
Q

Hypermagnesemia s/s

A

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

127
Q

Hypermagnesemia dx

A

Mg > 2.2; EKG (wide QRS, prolonged PR, prolonged QT); bleeding/clotting times increased

128
Q

Hypermagnesemia tx

A

10-20mL IV calcium gluconate over 10 min; saline diuresis and IV furosemide; dialysis (severe)

129
Q

Hypomagnesemia cause

A

chronic alcoholism, diarrhea, hypoparathyroidism, hyperaldosteronism, diuretic therapy, osmotic diuresis, nutritional deficiencies (malnutrition, parenteral feeding)

130
Q

Hypomagnesemia s/s

A

lethargy, anorexia, N/V, weakness, tetany, seizures

131
Q

Hypomagnesemia dx

A

Mg <1.8; hypokalemia, hypocalcemia, hypocalciuria; EKG (prolonged PR/QT, wide QRS)

132
Q

Hypomagnesemia tx

A

oral magnesium oxide; magnesium sulfate solution (severe) w/ IV infusion w/ fluids

Internal Medicine (9 decks)

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