RENAL/URO/STI

Question 1

Which of the following is not an indicator of prerenal failure

Answer 1

Urine Na > 40 (this is postrenal)

Know all your values from this chart in Barkley pg128

Question 2

A 34 year old female presents to the ED w/severe flank pain, nausea, and vomiting. The pt states she had trouble urinating before the onset of her other s/s. A CT scan reveals a 2.5 mm stone in the L kidney just above the upper ureter. Which course of action is most appropriate?

Answer 2

Strain the urine immediately (she may pass it on her own)

Question 3

Your 33F patient tells you she does not use protection during sexual intercourse. Cervical motion tenderness in addition to what other finding indicates PID?

Answer 3

adnexal tenderness

Question 4

53 yo M c/o dribbling and nocturia. You suspect BPH. PSA is 3.2. What confirms the dx?

Answer 4

Transrectal ultrasound

Question 5

A male patient you have placed on an alpha blocker for BPH comes in complaining of increased urinary frequency. What do you do?

Answer 5

Leave it alone, the med is working

Question 6

A 78-year-old male pt w/CHF develops a bacterial UTI 2° to an indwelling f/c. Pt has a known allergy to PCN and sulfonamides. The appropriate choice for antimicrobial therapy is:

Answer 6

ciprofloxacin

Question 7

Pt w/hx AFib has maintained NSR w/ sotalol (Betapace), is hospitalized for acute pyelonephritis. The appropriate antibiotic regimen for this patient is

Answer 7

IV ceftriaxone (Rocephin

Question 8

A young female pt in ED w/ a vaginal d/c. After a pelvic exam, the NP documents which finding?

Answer 8

Cervical motion tenderness

Question 9

Your female pt presents with mucopurulent cervical drainage, fever >102 F, adnexal tenderness, & distended, rigid abdomen. What is the appropriate measure?

Answer 9

Call surgery and arrange for an exploratory laparotomy & pelvic abscess drainage (key is rigid abdomen)

Question 10

Lower UTI Tx

Answer 10

Bactrim, Cipro, Augmentin, for 3 days course

Question 11

Male pt w/UTI on 3 day regimen of abx, comes in requesting stronger abx:

Answer 11

Levaquin (another version is narrow the spectrum

Question 12

UTI pt allergic to PCN

Answer 12

TMP/SMX (Bactrim)

Question 13

UTI during pregnancy

Answer 13

Amoxicillin, Macrobid, Keflex, for 7 days

Question 14

Most common UTI etiology in women

Answer 14

E.Coli (Men = Proteus

Question 15

Difference between upper UTI and lower UTI:

Answer 15

Flank pain

Question 16

First test to order with a male presenting with BPH?

Answer 16

U/A

Question 17

5 alpha-reductase inhibitors

Answer 17

shrink prostate

finasteride (Proscar) and dutasteride (Avodart)

Question 18

At what age is the PSA screening indicated in a non-African American male with no family hx?

Answer 18

50

Question 19

ATN causes

Answer 19

ischemia (prerenal/perfusion related), sepsis, and nephrotoxins (IV contrast)

Question 20

What is the leading cause of intrinsic acute renal failures?

Answer 20

Nephrotoxic drugs

Question 21

Renal disease gives what metabolic abnormality?

Answer 21

Metabolic acidosis, IVF with NS and possible sodium bicarb needed

Question 22

What is the cause of anemia in renal failure

Answer 22

Decrease in erythropoietin

Question 23

What is azotemia

Answer 23

BUN >100, tx is dialysis

Question 24

What should the dietary protein requirement be with chronic renal insufficiency

Answer 24

<40g/day

Question 25

Chronic renal insuff results in what calcium imbalance

Answer 25

Hypercalcemia (d/t 2nd hyperparathyroidism, renal osteodystrophy)

Question 26

Gold standard for dx nephrolithiasis?

Answer 26

CT scan

Question 27

Most common types of stones

Answer 27

Calcium 80%, Gout = uric acid, women = struvite

Question 28

45 yo M s/p ABD Sx has now developed ARF: BUN 100/Cr 4.5, indications for dialysis

Answer 28

↑K, metabolic acidosis, & encephalopathy

Question 29

Treatment for chlamydia

Answer 29

Azithromycin

Question 30

25 yo F presents w/ green vaginal discharge, what is dx:

Answer 30

Gonorrhea (Females s/s dysuria, urinary frequency, abd pain, fever, n/v

Question 31

males with gonorrhea

Answer 31

asymptomatic white/yellow-green discharge. Tx: Ceftriaxone 125mg IM X1, cervical culture with Thayer Martin media, gram – diplococci, Tx Cephtriaxone IM x 1, Zithromax 1 gm PO x 1, report to health department)

Question 32

Pt sexually active with gonorrhea who is not practicing safe sex:

Answer 32

Educate

Question 33

Minor with STI:

Answer 33

have parent step out of room

Question 34

What is the confirmatory test for diagnosing syphilis

Answer 34

Fluorescent treponemal antibody absorption (FTA-ABS)

Question 35

When treating a pt diagnosed with syphilis, what drug allergy is most important to consider before initiating Tx?

Answer 35

?PCN allergy, syphilis is treated with PCN G