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RRPA Clinical Med II > Ross About the flow (Exam 4) > Flashcards

Ross About the flow (Exam 4) Flashcards

1
Q

A 25 year old male pt presents to your clinic with some mild (at the point) back pain. You ask him about the pain and he says it comes and goes. You notice he has a history of crohns disease. What is at the top of you Dx?

A

Nephrolithiasis- Due to the malabsorption with crohns pts are at a higher risk of elevated oxalate which is a primary ingredient in kidney stones

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2
Q

You have a 51 year old Pt who presents pale and diaphoretic, in pain and cant stand still, no visible in blood in urine and creatine level is normal. He states the pain started in his back and now radiates to the front. He has a history of recurrent gout. Which is the best imaging study for this pt?

A. X-ray
B. Abdominal ultrasound
C. non-contrast ct
D. no imaging necessary you know its a stone

A

C. Non-contrast CT

Stoned formed from gout show up radiotranslucent onX-rays

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3
Q

Which of the following put you at risk of developing a calcium oxalate or calcium phosphate stone?

A. Hyperparathyroidism 
B. Prolonged immobilization 
C. Absorptive problems of kidneys 
D. Low urine volume 
E. All of the above
A

E. All of the above

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4
Q

You have a Pt presenting with urosepsis. They recently were diagnosed with having kidney stones. Which type of stone is most likely to cause this?

A. Calcium phosphate
B. Uric acid stone
C. Calcium oxalate
D. Stag horn calculi

A

Stag horn calculi

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5
Q

You saw a patient about 1.5 weeks ago who you performed a non-contrast CT on because it was their first stone. You noticed the stone was about 2mm so you told them itll pass on its own. Well they are back cause it still hurts…of course it does. What imaging is best for following known stones?

A. Another non-contrast CT
B. Ultrasound
C. KUB xray
D. No imaging needed

A

C. KUB xrays are good for following stones

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6
Q

If you suspected a Kidney stone and you order an ultrasound what is it you’re looking for?

A. Dilated drainage system
B. The stone
C. Size of kidney
D. casted shadow

A

A. Dilated drainage system-if seen would indicate need for non-contrast CT

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7
Q

You are seeing a 15 year old female who presents with pain that radiates from the back to the front. You suspect a kidney stone. The Pt does not have a fever, hydronephrosis and has normal CR. What is your next step?

A. KUB
B. Tx with pain meds and d/c
C. Non-contrast CT
D. Ultrasound

A

B. Tx with Pain meds and send home

This is a young uncomplicated case of kidney stone in which they are able to go home and no imaging is needed

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8
Q

Rank from most common to least common area to find a kidney stone

A. Ureterovesicular junction, crossing of iliac artery, ureteropelvic junction
B. Ureteropelvic junction, ureterovesicular junction, crossing of iliac artery
C. Ureterovesicular junction, ureteropelvic junction, crossing of iliac artery
D. crossing of iliac artery, ureterovesicular junction, ureteropelvic junction

A

C.

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9
Q

What three things make a kidney stone complicated?

A
  1. Infection
  2. Intractable pain
  3. Obstruction as in it wont pass because of size
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10
Q

What radiologic sign indicates infection in the kidney?

A

Perinephric stranding

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11
Q

You are seeing a 28 year old pregnant female who not able to stand still, looks pale/diaphoretic and said she notices some blood in her urine. She is having back/flank pain. What is your next step?

A. Non-contrast CT
B. US looking for hydronephrosis
C. MRI
D. KUB xray

A

B. US looking for Hydronephrosis

If this is present you would consult urology and see what they want to do

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12
Q

True or false: pts with UTI and a Stone who show systemic signs (fever, abnormal vitals) needs admission to hospital

A

True

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13
Q

If you get a CBC on a Pt with a UTI and kidney stone and it comes back elevated but they are not showing any systemic signs do you admit to hospital?

A

No, but you treat them with cipro 500mg for 14 days anyway

WBC can be elevated because of the inflammation in the ureter caused by the stone

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14
Q

Which antibiotics can you use for infected kindey stones?

A

2nd gen cephalosporins (cefuroxime) and floroquinalone

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15
Q

What are some labs that will be helpful with determining how complicated or not a pt is with in regards to kidney stone?

A

UA: looking for presence of WBC

BMP: looking at Cr level

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16
Q

Out of the following pain management options which is preferred for kidney stones?

A. NSAIDS
B. IV lidocaine
C. IV narcotics

A

A. NSAIDs- they have a direct action on ureter by inhibiting prostaglandin synthesis

NSAIDS not to be given to pregnant Pts

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17
Q

If you diagnose a pt as having a 4mm sized stone and they do not have any systemic effects or co-morbidities how should you treat them?

A. Calcium channel blocker
B. Alpha blocker
C. manage pain (NSAID)
D. surgery

A

C. NSAIDs

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18
Q

If you diagnose a Pt as having a 7mm stone they have no systemic effects or co-morbidities how can you treat them?

A. Nifedipine
B. Tamsulosin
C. Tenolol
D. A and B

A

D. A and B

Nifedipine (CCB)- allows dilation of ureter to pass large stones

Tamsulosin (alpha blocker)- is considered superior though

Not helpful for stones less than 6mm

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19
Q

What 5 symptoms would make you admit a pt with a kidney stone to the hospital?

A
  1. Intractable pain
  2. urosepsis
  3. one or transplanted kidney with obstructive stone
  4. acute renal failure
  5. multiple co morbidities
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20
Q

An elderly pt appears to you with confusion, pain in their back, decreased urine output and extreme fatigue. You draw labs and they have an elevated WBC count and a lactate level of 3.5. You were thinking UTI but now what are you thinking?

A. Pyelonephritis w/bacteremia (urosepsis)
B. nephrolithiasis
C. Cystitis
D. Pyelonephritis

A

A. Pyelonephritis w/bacteremia (urosepsis)

What differentiates pyelonephritis from urosepsis is the presence of bacteremia with a lactate level greater than 2.5

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21
Q

What is the difference between pyelonephritis and a UTI

A

pyelonephritis is an infection of the upper tract where as a UTI is an infection of the lower tract

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22
Q

A pt presents with a Temp of 101.4 and flank pain. They have a fever so you’re not really thinking kidney stone per say. What test can you do which will allow you clinically diagnose?

A. UA
B. Ultrasounds
C. CVA tenderness
D. blood urine test

A

A. UA- if this comes back positive, according to ross all you need to clinically diagnose pyelonephritis is Fever, Flank pain, and Positive UA

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23
Q

Three complications of an UTI are?

A
  1. Acute bacterial nephritis
  2. Renal abscess
  3. emphysematous
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24
Q

A 45 year old female pt presents to you in the ED with dysuria, polyuria, and burning sensation when she pees. You remember from Dr. Ross lecture that you should check a UA on this pt. What can you expect to see?

A. Nitrites
B. Pyuria (WBC in urine)
C. Leukocyte esterase
D. All of the above

A

D. All of the above

  • Having nitrites in the urine is a high positive predictive value as bacteria convert nitrates to nitrites when present. Most likely E.Coli
  • Leukocytes are there to act on bacteria
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25
Q

What does epithelial cells in a UA mean?

A

Contamination

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26
Q

How would you treat someone with cystitis (UTI) who is pregnant? someone who isnt pregnant?

A
  1. Make sure no upper tract infection
  2. 3 days of Macrobid
  3. Quiniolone
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27
Q

You have a pregnant pt who you determine to have pyelonephritis. They are unable to tolerate fluids PO or manage pain. Can you send them home?

A

No, for a couple reasons.

  1. pregnant pts not allowed home
  2. unable to tolerate fluids PO or manage pain

a third not in this would be the elderly

28
Q

You are making rounds in the hospital and your supervisor is pimping you hard and ask whats the Rule of 2 for Pyelo. You quick turn and tell them “childs play, the rule of 2 for Pyelo is……..”

A

2L NS

2g ceftriaxone

2mg of morphine

29
Q

True or false: Pyelonephritis is a UTI with a Fever

A

true

30
Q

What are some reasons as to why youd admit a patient to the hospital if they present with pyelonephritis?

A
  1. unable to tolerate fluids PO or manage pain
  2. Unreliable
  3. Elderly
  4. Diabetics- very very high chance of admittance
  5. Failed outpatient tx
31
Q

Match the following:

  1. uncomplicated UTI
  2. Pyelonephritis
  3. asymptomatic bacteriuria in pregnancy

A. antibiotics for 3-5 days
B. antibiotics for 14 days
C. Treat same as UTI

A

1 and A

2 and B

3 and C

32
Q

Which ones have pain or not

  1. Torsion
  2. Epididymitis
  3. Varicocele
  4. Hydrocele
  5. testicular tumor
A

1,2 def have pain

3,5 no pain

4 is a possibility of pain

33
Q

A male pt present to you with enlarged testicles. You take your pen light out and press it to the sack. It glows like a lantern on halloween. Why do they possibly have? and what type of imaging could you consider?

A

Hydrocele and consider an U.S to look for malignancy

34
Q

A 25 year old male presents with dysuria, urgency and frequency to pee along with some urethral discharge. He is having pain in his pelvic area all the way to his testicles and his temp is 101.3 a CBC shows leukocytosis. What is your next diagnostic move?

A. US
B. Blood smear
C. non-contrast CT
D. UA

A

A. an US
Torsion is also painful so keep in your mind and consider US

Also can get a UA to look for pyuria

35
Q

A 25 year old male presents with dysuria, urgency and frequency to pee along with some urethral discharge. He is having pain in his pelvic area all the way to his testicles and his temp is 101.3 a CBC shows leukocytosis. He says he had intercourse a few weeks ago. What does this Pt have?

A

Epididymitis

36
Q

How can you diagnose epididymitis?

A

PCR swab for GC and C. trachomatis

37
Q

What would you use to treat a 25 year old sexually active male with if they had epididymitis?

A. Ceftriaxone 250mg IM then Doxy for 10 days
B. ofloxacin 250 mg bid
C. Levofloxacin 500mg qd for 10 days
D. Amoxicillin 250mg bid

A

A. Ceftriaxone 250mg IM then Doxy for 10 days

38
Q

How would you treat the partner of someone with epididymitis caused by Gonorrhea?

A

single shot ceftriaxone 250mg IM

39
Q

How would you treat the partner of someone who had epididymitis not caused by gonorrhea?

A

Treat as though it was caused by C. trachomatis with azithromycin or doxycycline

40
Q

Isolated inflammation of the testicle is known as what?

A

Orchitis

41
Q

What ways can you get orchitis?

A

After having Mumps you can get mumps orchitis

After a viral infection like EBV, Varicella or echovirus

42
Q

Whats is orchitis almost always associated with?

A

Epididymitis so treat as an epididymitis

43
Q

A 65 year old male presents to the office with perineal, suprapubic and genital tenderness. Also complains of frequency, dysuria and urgency with his peeing. Also noted is that he has an inwelling catheter. You do a DRE and feel a boggy and tender prostate. What is the most likely diagnoses?

A. Urethritis
B. Prostate cancer
C. Acute Prostatitis
D. Cystitis

A

C. Acute prostatitis

Other risk factors are

  1. Lower tract obstruction
  2. Receptive intercourse
44
Q

What lab would you draw for a Pt with acute prostatitis?

A

A lactate to assess for systemic inflammatory response

45
Q

How do you treat Acute prostatitis?

A

Floroquinalone for 2-4 weeks

46
Q

A 25 year old male comes into the clinic with dysuria,, frequency with urination and sometimes a discharge with urination. Pt states he is sexually active. Little pink dots are noted on the PMN. What is the most likely diagnoses?

A. Urethritis
B. Orchitis
C. Balantitis
D. Acute prostatitis

A

A. Urethritis- penile discharge helps to think about this

47
Q

An infection at the tip of the penis usually caused by candidiasis is what?

A

Balantitis

48
Q

What do you want to check as balantitis can be a presenting symptom for another medical issue?

A

A glucose level because it can be a presenting symptom for diabetes

49
Q

What are the 5 GU emergencies?

A
  1. Testicular torsion
  2. Scrotal infection( Fourniers)
  3. Paraphimosis
  4. Priapism
  5. GU trauma
50
Q

A painful inguinal mass with an empty scrotum equal what?

A

Torsion

51
Q

You are seeing a Pt in acute pain located in the scrotum. Pt also states episode of nausea and vomiting. Upon physical exam you see a swollen, tender, firm hemiscrotum thats high riding and transverse? What do you do next?

A. US
B. Get GU
C. Ice
D. A then B

A

B. Get GU- do not wait for US results before getting GU involved

Time is Testicle as this is testicular torsion

52
Q

What is the hallmark finding for Testicular appendix?

A

A blue dot sign

53
Q

What imaging must you still get even if you see a blue dot sign and know its testicular appendix?

A

An US

54
Q

Tx for Testicular appendix?

A

Supportive- its self limiting

55
Q

What are the three penile entrapment injuries?

A

Paraphimosis

Phimosis

Foreign body

56
Q

How can you reduce the edema in penile entrapment injuries?

A
  1. Tightly wrap the glands with elastic bandage for 5 mins

2. Or Lido with epi on the constriction and then cut

57
Q

True or false: repetitive priapism can cause impotence?

A

True

58
Q

True or False: Priapism is usually caused by medications?

A

True

59
Q

What meds can cause priapism?

A

Hydralazine, CCB, Trazadone, Citalopram, erectile meds

60
Q

True or False: sickle cell can cause priapism?

A

True so if pt isnt on any of the meds that can cause it might want to ask about PMH

61
Q

What is the noninvasive tx for priapism?

A

Terbutaline or pseudoephedrine

62
Q

Invasive therapy for priapism?

A
  1. Penile block with 1% lidocaine then aspiration of blood

2. Injection of epinephrine, phenylephrine into corpus cavernous

63
Q

For sickle cell pts with priapism how would you treat?

A

Hydrate them then aspirate the blood

64
Q

When hearing vaginal or urethral burning what 2 DD go through your mind (according to ross)

A
  1. Urethritis

2. Vaginitis

65
Q

When hearing/seeing Hematuria what should you think of?

A
  1. Infection
  2. Stone
  3. GN
  4. Trauma
  5. Cancer
66
Q

People who cant pee should make you think what three things?

A
  1. Infection
  2. BPH
  3. Neuropathic
67
Q

When people say they need to pee all the time what 2 things should you think of?

A
  1. Stone

2. Infection

RRPA Clinical Med II (45 decks)

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