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Gen. Med > Test #4 Slide Questions > Flashcards

Test #4 Slide Questions Flashcards

1
Q

What is the function of the kidneys?

A

They filter the blood to remove waste products and maintain normal hydration status

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2
Q

What are the main organs of the urinary system?

A

Kidneys, ureters, bladder, and urethra

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3
Q

What physiological part of the kidney has high blood pressure?

A

Glomerus

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4
Q

What physiological part of the kidney makes urine either concentrated or diluted?

A

The collecting tubule

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5
Q

What are some of the main symptoms of urinary tract diseases? (x5)

A
  • dysuria
  • frequency
  • urgency
  • hematuria
  • pain
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6
Q

What two things might you find on an examination of a pt with a urinary tract diesease?

A

CVA tenderness and suprapubic tenderness

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7
Q

What urinary tract disease is very common in athletes? How common?

A

Proteinuria (62%)

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8
Q

What causes proteinuria?

A

With exercise there is increased blood flow to the kidneys, which leads to more small proteins to be filtered through, and then all of the extra protein that was filtered cannot be absorbed

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9
Q

True or false:

In most cases of proteinuria, the extra protein in the urine is not indicative of disease.

A

True

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10
Q

What is the MOI for a kidney contusion/laceration?

A

Blow to the flank

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11
Q

What are the S/S of a kidney contusion/laceration? (x4) How should you deal with a suspected case of this?

A

Severe pain in the flank, hematuria, possible nausea and vomiting, and symptoms of shock; refer to the ED immediately (if they are hemodynamically stable they will stay overnight for observation, but if not stable then surgery will be required)

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12
Q

With traumatic hematuria, will the patient exhibit flank pain?

A

No they will have minimal to no flank pain

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13
Q

What does it indicate if urine is tea or cola colored?

A

That there is a lower concentration of blood in the urine than if it was redder

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14
Q

How would you deal with a traumatic hematuria?

A

Their exam will be normal (no CVA tenderness or peritoneal signs) but the urine dipstick will be positive for blood. They should cease all activity and be referred to the physician. Push fluids and repeat dipsticks daily until its clear…they allow non-contact activity and if they urine continues to be clear then allow contact activity

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15
Q

How can traumatic hematuria be prevented?

A

Empty bladder before contact sports

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16
Q

What is atraumatic hematuria? What is it caused by? Who does it affect the most?

A

Mild gross or microscopic hematuria that is very common in athletes (especially with long runs or intense exercise–20% of marathoners). It is caused by the bladder walls slapping against one another

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17
Q

What are two possible causes of false hematuria? Are they positive or negative on the dipstick analysis for blood in the urine? What about a microscope?

A

1) V8 juice or beets (- dipstick)

2) myoglobinuria (+ dipstick but - microscope)

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18
Q

What are six causes of true hematuria?

A
  • Kidney stones
  • Bladder infection
  • Glomerulonephritis
  • NSAIDs
  • Kidney or bladder tumor
  • Sickle cell trait
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19
Q

True or false:

Most traumatic hematurias will resolve with time.

A

True

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20
Q

What are some common causes of UTIs? (x3)

A
  • Urethritis (stds)
  • Cystitis
  • Pyelonephritis
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21
Q

True or false:

UTIs are not very common.

A

False

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22
Q

What are the risk factors for a UTI? (x5)

A
  • Female
  • Age
  • Urinary tract instrumentation/catheterization
  • Urinary statis (not emptying the bladder…allows things to grow…?)
  • Sexual activity
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23
Q

What are the two main sources of a UTI? What species of bacteria are usually the cause?

A
  • bacteria from stool
  • blood or lymphatic borne
  • *E. coli, proteus, klebsiella, and enterobacter
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24
Q

What is cystitis? Describe the pathogenesis of this and pyelonephritits.

A

Infection of the bladder…if left untreated then theres virulent bactera–>obstruction leading to reflux of the bladder–> the infection travels up the ureters and to the kidneys

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25
Q

What are the S/S of cystitis? (x6)

A 
Dysuria
Urgency
Frequency
Fever
Suprapubic (mostly) or flank pain
Tenderness over the suprapubic area
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26
Q

If a patient is suffering from pyelonephritis, how will they present as compared to cystitis?

A

They will have the same symptoms as cystitis but will be more ill, have more flank pain or back pain, a higher fever, chills, nausea and vomiting, and CVA tenderness

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27
Q

True or false:

If someone has an uncomplicated UTI, the typical treatment includes an i.v. of medicine.

A

False…this is for a complicated UTI

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28
Q

True or false:

The old wives’ tale of cranberry juice being helpful for an UTI is correct.

A

True because there is bacteria static in the juice that can help

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29
Q

True or false:

Carbonated beverages cause UTIs.

A

False…but the extra acidity can mimic UTI problems??

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30
Q

What is incidence of new cases of the following STDs each year?
Chlamydia, gonorrhea, syphilis, herpes, HPV, and tricomonas?

A 
Chlamydia= 3 million
Gonorrhea= 650,000
Syphilis= 70,000
Herpes= 1 million
HPV- 5.5 million
Tricomonas= 5 million
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31
Q

How are STDs spread? (x3)

A

Genital, oral, and rectal

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32
Q

When does urethritis (std) develop symptoms? What are the S/S? (x3)

A

4 days to 2 weeks after contact with an infected partner. S/S= urethral discharge, dysuria, and urethral itching between urinations.

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33
Q

What percentage of men are asymptomatic with urethritis> Women?

A

Males- 25%

Females- 75%

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34
Q

When does vaginitis(std) develop symptoms? What are the S/S? (x3)

A

4 days to 2 weeks after contact with an infected partner. S/S- vaginal discharge, itching, and odor.

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35
Q

What is another common cause of vaginitis besides as an STD?

A

Yeast (candida)…this is common after antibiotics

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36
Q

How is a yeast infection treated?

A

Topical or oral antifungal

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37
Q

What are the S/S of herpes? (x3)

A

Parasthesias, painful blisters on an erythmeatous base, and recurrences

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38
Q

What is the treatment for herpes?

A

Antiviral medications, decrease the length of the treatment, or suppressive treatment (taking antiviral all the time so as to help the outbreaks happen less often)

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39
Q

What causes genital warts?

A

Human papillomavirus (HPV)

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40
Q

Does HPV increase or decrease a pt’s risk for cervical cancer?

A

Increase

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41
Q

What is the medical term for a kidney stone?

A

Nephrolithiasis

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42
Q

What percentage of kidney stones occur in men? Women?

A

Men- 15%

Women- 7%

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43
Q

What is the most common type of kidney stone? What are the other three types?

A

Most common- calcium oxalate…others= calcium phosphate, uric acid, and struvite

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44
Q

A combination of three factors makes up the pathogenesis of kidney stones. What are these three factors?

A

1) increased concentration of calculi components
2) lack of components that inhibit stone formation
3) organic material (dead cells that line the tubules) that serves as a matrix

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45
Q

What are the risk factors for kidney stone development? (x8)

A

Male, increasing age, low urine volume, SE US/Mediterranean/Middle East, increase dietary uptake (of protein, salt, or oxalate–tea), decreased dietary calcium, hyperparathyroidism, and acidosis

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46
Q

What are the three most common locations for a kidney stone?

A

1) Kidney (at the isthmus)
2) Iliac vessels (where they cross over the ureter)
3) Bladder (where the ureters insert)

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47
Q

What are the S/S of a kidney stone? (x5)

A

Renal colic (cramping pain)–excruciating flank and abdominal pain that may radiate to the scrotum or labia, nausea/vomitting, diaphoresis (sweating), urgency, and frequency

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48
Q

True or false:
As a primary method of treatment for kidney stones, it is common for the doctors to want the patient to try to “catch” the stone when they pass it so it can be analyzed.

A

True

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49
Q

If primary methods of treatment for a kidney stone don’t work, what would the possible three next steps be?

A

Lithotripsy, cystoscopy, and surgery

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50
Q

How can you help prevent the reoccurance of a kidney stone?

A

Increase fluid intake, decrease dietary protein, decrease dietary oxalate (chocolate, nuts, dark green leafy veggies), and alkalinizing the urine.

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51
Q

What are the three etiologies of acute renal failure?

A
  • Prerenal (before the kidney)
  • Renal (in the kidney)
  • Postrenal (in the urinary tract after the kidney)
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52
Q

What prerenal causes lead to acute renal failure?

A

Not enough blood flow to the kidneys (such as during shock, dehydration, hypertension, and vascular obstruction such as a blood clot in the renal artery)

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53
Q

What renal causes lead to acute renal failure?

A

1) Nephrotic syndrome (polyuria or massive edema)

2) Nephritic syndrome (hematuria, oliguria, or hypertension)

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54
Q

What causes nephrotic syndrome?

A

Damage to the basement menbrane of the glomerus (or the filter of the kidneys). This increase the permeability to the proteins, leading to a large loss of protein in the urine. This large loss of protein in the urine leads to polyuria to try and dilute the urine, and hypoalbuminemia because of the change in osmotic pressure leading to massive edema

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55
Q

What causes nephritis syndrome?

A

Damage to the capillaries in the glomerus…this allows actual blood cells to be filtered in the urine (aka hematuria). Because the glomerular filtration rate is being decreased, less blood is being filtered resulting in decreased urine output and an increase in blood volume (leading to hypertension)

56
Q

What are the postrenal causes of acute renal failure?

A

Obtructions of the urinary tract (kidney stones, enlarged prostate, or medications)

57
Q

What is the breakdown of muscle cells due to overexertion releasing muscle cell contents into the blood stream that can lead to renal failure?

A

Exertional rhabdomyolosis

58
Q

What are the causes of rhabdomyolysis (not necessarily exertional rhabdo)?

A

Alcohol poisioning, antifreeze overdoes, spider and snake bites, and street drugs

59
Q

What are the risk factors for exertional rhabdo?

A

Fitness level, intensity and duration of a workout, the type of exercise (worse if eccentric), viral illness, and sickle cell trait

60
Q

What would the urine of someone with exertional rhabdo look like?

A

Brown (myoglobin)

61
Q

What is the physiology behind stress incontinence?

A

Malfunction of the urethral sphincter…so urine leaks when the intra-abdominal pressure increases (as with coughing, sneezing, lifting, and exercising). This is due to weakness of the pelvic floor muscles

62
Q

What are some renal abnormalities? (x

A

Solitary kidney, pelvic kidney, horseshoe kidney, and kidney transplant

63
Q

What is the recommendation for contact sport if a patient has a pelvic kidney? Horseshoe kidney? Transplanted kidney? Solitary kidney?

A

Pelvic- not recommended
Horseshoe- not recommended
Transplanted- not recommended
Solitary- depends on location…if can then extra portection

64
Q

What is twisting of the testicle resulting in a blockage of the testicular vessels?

A

Testicular torsion

65
Q

What are the S/S of testicular torsion? (4)

A

Sudden onset of testicular pain, swelling, no injury, & tender/swollen testicles

66
Q

True or false:
If surgery isn’t done within a couple of hours to reverse a testicular torsion, then the testicle could die from ischemia.

A

True

67
Q

What is a collection of peritoneal fluid between the parietal and visceral layers of the tunica vaginalis surrounding the testicle?

A

Hydrocele

68
Q

What testicular issue involves painless scrotal swelling that worsens throughout the day, and feels like one testicle feels more “bulky” and heavier than the other?

A

Hydrocele

69
Q

What is an abnormal tortuosity and dialation of the venous plexus around the scrotal area?

A

Varicocele (varicose vein shit around the testicles)–“bag of worms”

70
Q

What is the most common surgically correctable cause of male infertility?

A

Varicocele

71
Q

True of false:

Testicular cancer is 4-5x more common in Caucasians than African Americans.

A

True

72
Q

What is the most common cause of a tumor in males aged 15-34?

A

Testicular cancer

73
Q

How does testicular cancer present?

A

Painless lump in the testicle

74
Q

What is an orchiectomy?

A

Removal of a testicle

75
Q

What should a player doing contact or collision sports with only one testicle do?

A

Wear a cup (duhhh)

76
Q

What are the cardiovascular changes during pregnancy?

A
  • increased cardiac output
  • increased heart rate
  • increase blood volume
  • increase in venous capicitance (lower BP)
  • physiological anemia of pregnancy
77
Q

What pulmonary changes occur during pregnancy?

A

Elevated diaphragm (due to enlarged uterus) and increase of 20% of the resting O2 consumption

78
Q

What are the musculoskeletal changes that occur during pregnancy?

A

Shift of COG, increased lumbar lordosis, back pain, and increase laxity of ligaments

79
Q

What are nine issues to be concerned about when thinking about exercise and pregnancy?

A 
Placental blood flow
Hydration
Hyperthermia
Coordination
Trauma
Body position
Back/pelvic pain
Labor
Infant birthweight (lower in women who exercise)
80
Q

What does “adnexal” mean?

A

Ovaries and fallopian tubes

81
Q

What is endometriosis? How common is it in premenopausal women?

A

When endometrial tissue is found outside the uterus; 10-15%

82
Q

True or false:

Endometriosis is not a common cause of infertility.

A

False

83
Q

What are the Sx of endometriosis?

A

(Depends on the location of the implants)

  • The implants swell immediately before and during menstruation
  • cyclic (monthly) pelvic pain
  • dyspareunia (pain with intercourse)
  • adhesions
  • pain with defication, urination, etc.
84
Q

What is the classic triad for a endometriosis diagnosis?

A

Dysmenorrhea, dyspareunia, infertility

85
Q

How could endometriosis affect us as ATs?

A

It could mimic musculoskeletal pain (in the psoas, pelvic floor muscles, SI ligaments, and abdominal wall)

86
Q

What are three main causes of primary dysmenorrhea? For secondary dysmenorrhea?

A 
Primary= elevated production of prostaglandins, NSAIDS, and birth control pills
Secondary= endometriosis, PID, fibroids
87
Q

What is defined as any pregnancy that doesn’t occur in the normal place?

A

Ectopic pregnancy

88
Q

What are the risk factors for an ectopic pregnancy?

A

PID, endometriosis, previous ectopic pregnancy, previous pelvic surgery, and contential abnormalities

89
Q

What is PID?

A

Pelvic inflammatory disease…any STD that spreads up into the fallopian tubes and causes probs

90
Q

What are the Sx of PID?

A

lower quadrant pain, fever, vaginal discharge, and sexually active

91
Q

What is skin irritation due to friction from a shirt or bra?

A

Runner’s nipple

92
Q

What is fibrocystic breast disease?

A

(fibrocystic change)…response of the breast tissue to changes in hormone levels during menstrual cycle

93
Q

True or false:

Your breasts tend to enlarge before your period.

A

True…aka the whole fibrocystic breast change.

94
Q

What is the most common malignancy in women and the 2nd most common cause of this type of death in women?

A

Breast cancer (2nd most common cause of cancer death in women)

95
Q

What are the risk factors for breast cancer? (x5)

A

Female, age 40-60, white, FHx of breast cancer, and prolonged uninterrupted menstrual cycles

96
Q

Describe the pathophysiology of breast cancer.

A

A palpable mass arises from the glandular epithelium (adenocarcinoma)..then it will spread to the axillary lymph nodes…eventually may metatasize to the brain, lung, liver, or other lymph nodes

97
Q

What is gynecomastia?

A

Breast bud development in males

98
Q

What is the etiology of gynecomastia?

A

Small amounts of testerone convert to estradiol in all males…if you have more testosterone then more is produced…then the more of estradiol results in breast tissue development. Also steroids can have this occur as well

99
Q

What percentage of males will develop gynecomastia in mid-to-late puberty?

A

40-60%

100
Q

What 3 things are involved in the female athlete triad?

A

1) disordered eating
2) amenorrhea
3) osteoporosis

101
Q

What is oligomenorrhea?

A

Fewer than 9 periods a year

102
Q

What are some causes of secondary amenorrhea?

A

Pregnancy, hypothalamic, PCOS, and hypothyroidism

103
Q

For the female athlete triad, what is the energy drain hypothesis?

A

Inadequate caloric intake for needs –> starvation mode –> decreased estrogen –> amenorrhea & decreased bone density (**the body shuts down estrogen when its in starvation mode)

104
Q

What are some common characteristics of female athlete triad (x5)

A
  • High risk sports (judging sports)
  • Elite or highly competitive athlete
  • Individual vs team sports
  • Perfectionalistic
  • High expectations
105
Q

What types of sports might female athlete triad be most likely seen?

A

Gymnastics, ballet, cheerleading, track, cross country, female wrestling, figure skating, diving, and swimming

106
Q

What is a common conversion when doing a physical exam and looking at an athlete that may be at risk for female athlete triad? (when comparing height and weight)

A

5 feet = 100 lbs (and for every inch over 5 feet add 5-10 lbs)

107
Q

How might an athlete with the female athlete triad present? (x9)

A

Fatigue, stress fx, cold intolerance, lightheadedness, abdominal pain/bloating, sleep disturbance, dry skin, constipation/diarrhea, and poor performance

108
Q

What are some physical signs of female athlete triad?

A

Anemia, cold/discolored hands and feet, swollen parotic glands, callused knuckles, erosin of dental enamel, face and extremity edema, bradycardia, fat/muscle wasting, lanugo, orthostatic hypotension, cardenemia (orange appearance), and decreased body temperature

109
Q

For a female, how much calcium should she be getting a day?

A

1500mg

110
Q

For a female, how much vitamin D should she be getting per day?

A

400-800 IU

111
Q

What is defined as decreased bone mineral density?

A

Osteopenia

112
Q

What is defined as more severely decreased bone mineral density resulting in brittle bones and increased fx risk?

A

Osteoporosis

113
Q

What is primary osteoporosis?

A

Osteoporosis that occurs after menopause and senile people

114
Q

What is secondary osteoporosis>

A

Osteoporosis that occurs from other causes than a hormone change (like menopause). Often this is caused by prolonged corticosteroid or anticonvulsant use, alcoholism, thyroid/parathryoid disorders, or female athlete triad

115
Q

How many people are affected by osteoporosis? What percentage of this number is women?

A

10 million (80% women)

116
Q

How many people are affected by osteopenia?

A

18 million

117
Q

True or false:

Osteoporosis affects men later in their life than women.

A

True..usually when they’re over 70 years old

118
Q

Who has a higher morbidity and mortality associated with osteoporosis, men or women?

A

Men (they are twice as likely to die within 1 year after a hip fracture)

119
Q

What hormone is essential for absorption of calcium into a bone?

A

Estrogen (hence the problem for so many women after menopause)

120
Q

What type of bone is more affected by osteoporosis?

A

Trabecular (spongy) bone because there is more osteoblast and osteoclast activity happening there

121
Q

What physiological part of trabecular bone is really important for bone strength but is affected highly by osteoporosis?

A

The horizontal cross-links…they help properly accept loads and stresses applied to the bones)

122
Q

What ethnicities are more affected by osteoporosis?

A

Caucasian and Asian

123
Q

What are some risk factors for osteoporosis?

A

Female, age, caucasion/asian, post-menopause, FHx, inactivity, low body weight, smoking, alcohol, caffeine, low dietary calcium, and vitamin D deficiency

124
Q

What is estrogen’s function in relation to bone strength?

A
  • increases intestinal calcium absorption
  • decrease bone calcium resorption
  • increased osteoblastic activity
125
Q

What percentage of bone is lost per year after peak bone mass has been reached? What about after the first 5 years of menopause?

A

1% per year…up to 10% per year in the first five years after menopause

126
Q

What three types of medications can be possible risk factors for osteoporosis?

A

Corticosteroids
Anticoagulants
Anticonvulsants

127
Q

What are some medical disorders that serve as risk factors for osteoporosis?

A

Hyperthyroidism, hyperparathyroidism, type II diabetes chronic renal failure, hypogonadism, and malabsorption syndromes

128
Q

What are the 4 clinical manifestations of osteoporosis?

A

Fractures (vertebral bodies, femoral neck, or radius)
Loss of height
Postural changes (Dowagers hump)
Back pain

129
Q

When examining a younger patient for the possibility of osteoporosis (such as someone with female athlete triad), is it better to use a T-score or Z-score?

A

Z-score

130
Q

What two components of exercise are good for patients suffering from osteoporosis?

A

1) weight bearing (strength bones)

2) muscle strengthening (reducing fall risk in elderly)

131
Q

What two hormones may need to be increased in a patient with osteoporosis?

A

Calcium and vitamin D…but then there’s also hormone replacement therapy

132
Q

What is hormone replacement therapy used for?

A

It’s used to try and combat osteoporosis because of menopause or hysterectomy…often it used conjugated equine estrogen (Premarin). It is used less frequently however because of risk for CAD, CVA, and breast cancer. So its mainly a preventative treatment

133
Q

What is the function of bisphosphonates?

A

Stop osteoclast activity and decrease calcium reabsorption

134
Q

What do patients taking bisophosphonates need to after immediately after taking them?

A

Remain upright for 30 minutes to prevent gravity from keeping the med in the esophagus because it can cause esophageal irritation or an ulcer

135
Q

What could serve as a secondary treatment to bisphosphanates?

A

Calcitonin (Miacalcin)

136
Q

What is the only true bone building medication that stimulates osteoblasts? Why don’t we use it more often?

A

Parathyroid hormone…its like $10,000 per year

Gen. Med (13 decks)

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