RENAL/URO/STI Flashcards
Which of the following is not an indicator of prerenal failure
Urine Na > 40 (this is postrenal)
Know all your values from this chart in Barkley pg128
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?
Strain the urine immediately (she may pass it on her own)
Your 33F patient tells you she does not use protection during sexual intercourse. Cervical motion tenderness in addition to what other finding indicates PID?
adnexal tenderness
53 yo M c/o dribbling and nocturia. You suspect BPH. PSA is 3.2. What confirms the dx?
Transrectal ultrasound
A male patient you have placed on an alpha blocker for BPH comes in complaining of increased urinary frequency. What do you do?
Leave it alone, the med is working
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:
ciprofloxacin
Pt w/hx AFib has maintained NSR w/ sotalol (Betapace), is hospitalized for acute pyelonephritis. The appropriate antibiotic regimen for this patient is
IV ceftriaxone (Rocephin
A young female pt in ED w/ a vaginal d/c. After a pelvic exam, the NP documents which finding?
Cervical motion tenderness
Your female pt presents with mucopurulent cervical drainage, fever >102 F, adnexal tenderness, & distended, rigid abdomen. What is the appropriate measure?
Call surgery and arrange for an exploratory laparotomy & pelvic abscess drainage (key is rigid abdomen)
Lower UTI Tx
Bactrim, Cipro, Augmentin, for 3 days course
Male pt w/UTI on 3 day regimen of abx, comes in requesting stronger abx:
Levaquin (another version is narrow the spectrum
UTI pt allergic to PCN
TMP/SMX (Bactrim)
UTI during pregnancy
Amoxicillin, Macrobid, Keflex, for 7 days
Most common UTI etiology in women
E.Coli (Men = Proteus
Difference between upper UTI and lower UTI:
Flank pain
First test to order with a male presenting with BPH?
U/A
5 alpha-reductase inhibitors
shrink prostate
finasteride (Proscar) and dutasteride (Avodart)
At what age is the PSA screening indicated in a non-African American male with no family hx?
50
ATN causes
ischemia (prerenal/perfusion related), sepsis, and nephrotoxins (IV contrast)
What is the leading cause of intrinsic acute renal failures?
Nephrotoxic drugs
Renal disease gives what metabolic abnormality?
Metabolic acidosis, IVF with NS and possible sodium bicarb needed
What is the cause of anemia in renal failure
Decrease in erythropoietin
What is azotemia
BUN >100, tx is dialysis
What should the dietary protein requirement be with chronic renal insufficiency
<40g/day
Chronic renal insuff results in what calcium imbalance
Hypercalcemia (d/t 2nd hyperparathyroidism, renal osteodystrophy)
Gold standard for dx nephrolithiasis?
CT scan
Most common types of stones
Calcium 80%, Gout = uric acid, women = struvite
45 yo M s/p ABD Sx has now developed ARF: BUN 100/Cr 4.5, indications for dialysis
↑K, metabolic acidosis, & encephalopathy
Treatment for chlamydia
Azithromycin
25 yo F presents w/ green vaginal discharge, what is dx:
Gonorrhea (Females s/s dysuria, urinary frequency, abd pain, fever, n/v
males with gonorrhea
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)
Pt sexually active with gonorrhea who is not practicing safe sex:
Educate
Minor with STI:
have parent step out of room
What is the confirmatory test for diagnosing syphilis
Fluorescent treponemal antibody absorption (FTA-ABS)
When treating a pt diagnosed with syphilis, what drug allergy is most important to consider before initiating Tx?
?PCN allergy, syphilis is treated with PCN G
