Renal & Urologic

Question 1

What is the most common etiology of acute renal failure in surgical patients? what is it? what causes it?

Answer 1

acute tubular necrosis; death of epithelial tubule cells; typical causes are HoTN and nephrotoxic drugs

Question 2

What is the best tool for measuring kidney function? how does it work?

Answer 2

creatinine clearance test; measures Cr lvls in both blood and urine over a 24hr period (2hr can be done as well)

Question 3

What’s the limitation of serum BUN and Cr in measuring renal function? what about perioperatively?

Answer 3

influenced by non-renal variables; perioperatively is a late sign of renal dysfunction

Question 4

A stress response is characterized by a shift of blood flow to the ______ of the kidney.

Answer 4

medulla

Question 5

Normal GFR is ____; GFR can be reduced to about ____ before a patient needs dialysis.

Answer 5

125cc/min; 10cc/min

Question 6

Oliguria is defined as less than ___.

Answer 6

0.5cc/kg/hr

Question 7

What is prerenal azotemia? what causes it?

Answer 7

high levels of nitrogenous waste in the blood (urea, nitrogen, Cr etc.) caused by insufficient filtering of the kidneys; due to renal hypoperfusion or ischemia

Question 8

What is post-renal failure?

Answer 8

acute renal failure caused by obstruction of the outflow of urine

Question 9

What is GFR at the 5 stages of chronic renal failure?

Answer 9

Stage 1 - 90cc/min, 2 - 60-89cc/min, 3 - 30-59cc/min, 4 - 15-29cc/min, 5 - <15cc/min

Question 10

What is an option for an ESRD patient who no longer has any graft/fistula sites for dialysis?

Answer 10

peritoneal dialysis

Question 11

Why does ESRD result in anemia?

Answer 11

inadequate production of erythropoetin in the kidneys to signal RBC production in the bone marrow

Question 12

What is the most common bleeding problem associated w/ ESRD?

Answer 12

prolonged bleeding time

Question 13

In what types of ABX would you want to make dosing adjustments for ESRD?

Answer 13

aminoglycosides and vancomycin

Question 14

What drug can cause direct renal tubular epithelial damage?

Answer 14

iodine contrast dye

Question 15

What drugs have active metabolites? what are the names of the metabolites?

Answer 15

demerol (normeperidine) and morphine (morphine-6-glucuronide)

Question 16

What is ESWL?

Answer 16

extracorporeal shock wave lithotripsy - breaking up kidney stones w/ sound waves

Question 17

What percent of people experience renal calculus in their lifetime? what percent require open surgical intervention?

Answer 17

12%; 5%

Question 18

What is urethral stricture? What’s the most common cause?

Answer 18

narrowing of urethra, UTI

Question 19

What level spinal would be appropriate for a cystoscopy that is longer in duration?

Answer 19

T10

Question 20

What is VLAP?

Answer 20

visual laser ablation of the prostate

Question 21

What is water intoxication? what is it seen in?

Answer 21

dilutional hyponatremia; seen in TURP syndrome (excessive uptake of irrigation fluid)

Question 22

What is the typical TURP irrigation fluid?

Answer 22

glycine

Question 23

What GU procedure involves the implantation of radioactive seeds?

Answer 23

brachytherapy

Question 24

Radical nephrectomy has a pain score of __.

Answer 24

10

Question 25

Why is the urethra more prone to taking up irrigation fluid than the bladder?

Answer 25

It is more vascular

Question 26

What are the CNS effects of TURP syndrome and how does it occur? What Na level indicates severe TURP syndrome?

Answer 26

Hypotonic blood shifts fluid intracellularly, causing swelling of the brain; 120mmol/L