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NP Prep > Urology > Flashcards

Urology Flashcards

1
Q

What is the normal Gfr range?

A

Less than 90

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2
Q

Patient presents with acute onset of high fevers, chills, dysuria, frequency, and unilateral flank pain. The flank pain is described as a deep ache. May complain of nausea with vomiting. And they have recent history of urinary tract infection.

A

Acute pyelonephritis

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3
Q

Infection of the upper urinary tract and renal parenchyma

A

Acute pyelonephritis

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4
Q

Untreated for undertreated UTI, urinary tract abnormalities, elderly, fecal incontinence, and pregnancy are all risk factors for

A

Acute pyelonephritis

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5
Q

CVA tenderness, fever, pyuria, white cells in urine, and casts are all findings associated with

A

Pyelonephritis

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6
Q

What are the diagnostic studies for pyelonephritis

A

Urine analysis which shows pyuria, possibly hematuria, and mild protein urea. Urine culture with sensitivity. CBC will show leukocytosis, CVA tenderness, fever, sed rate i.e. ESR

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7
Q

How is pyelonephritis treated

A

Culture before starting antibiotic. Quinolones are the only anti-microbial’s recommended for outpatient treatment. If Unable to take quinolone start Ceftriaxone 1 g. Plus Augmentin times 14 days i.e. Rocephin. Hospitalize if patient appears toxic

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8
Q

What is the antibiotic of choice for pyelonephritis

A

Quinolones

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9
Q

Infection of the upper urinary tract and renal parenchyma

A

Acute pyelonephritis

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10
Q

What might be the significance of white cell casts

A

Pyelonephritis

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11
Q

White blood cells in urine signifies

A

Inflammation which signifies pyelonephritis

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12
Q

If white blood cells are found in the urine is this consistent with a UTI

A

No

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13
Q

Patient presents with the abrupt onset of oliguria, edema, and weight gain i.e. fluid retention. Complains of lethargy, nausea, and loss of appetite. Rapid decrease in renal function. Elevated urinary and serum creatinine.

A

Acute renal failure

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14
Q

What is located in the retro peritoneal area

A

Kidneys

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15
Q

Why is the right kidney lower than the left

A

Displacement by the liver

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16
Q

What are the functional units of the kidney

A

Nephrons which contain the glomeruli

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17
Q

What is the body’s regulator of electrolytes and fluids

A

Kidneys

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18
Q

Urinary output that is less than 400 mL per day in adults

A

Oliguria

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19
Q

What part of the body excretes erythropoietin for red blood cell production, Renin and Bradykinin for blood pressure, prostaglandins for renal perfusion, and Calcitrol and vitamin D3 for the bones

A

Kidneys

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20
Q

What is related to muscle Mass in the kidneys

A

Creatinine production

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21
Q

What level decreases with age and loss of muscle mass by the age of 30

A

Creatinine

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22
Q

If a patient has high muscle mass that the creatinine maybe

A

Lad

Falsely normal but actually it’s low

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23
Q

What lab level is a better measure of kidney function

A

Creatinine clearance

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24
Q

When renal function decreases, the creatinine level well

A

Increase

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25
Q

Serum creatinine maybe falsely decreased in people with

A

Low muscle volume i.e. the elderly

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26
Q

Elevated values in creatinine are seen with

A

Renal damage or failure, nephrotoxic drugs.

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27
Q

What are some factors that affect the serum creatinine in people

A

Males as they have a higher level, race as African-Americans have more muscle mass, and muscle mass

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28
Q

What test is ordered to evaluate patients with protein urea, Albuminuria, and microalbumin urea.

A

Creatinine clearance 24 hour urine

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29
Q

When renal function decreases the creatinine clearance

A

Also decreases

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30
Q

Normal GFR rate is

A

Greater than 60 mL

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31
Q

What drugs can affect the GFR rate

A

Allopurinol, many antibiotics, digoxin, lithium, gabapentin, H2 blocker’s, anti-arrhythmic’s

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32
Q

What GFR level would mean renal failure

A

Less than 15 mL

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33
Q

Before getting a GFR what is it important for the patient to not eat

A

Patient should not eat me 12 hours before the blood test

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34
Q

If a patient has an abnormal BUN level what must be checked

A

GFR

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35
Q

Is the BUN as sensitive as the serum creatinine or the GFR

A

No

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36
Q

The BUN to creatinine ratio oh is used to classify

A

The type of renal failure such as Renal, infrarenal, or post renal

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37
Q

When do you do a urine culture

A

For recurrent infections, if refractory to treatment, and in children, women, and the elderly

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38
Q

What does it mean if if there is nitrates in the urine

A

Bacteria is present

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39
Q

What does it mean if they are nitrates in the urine

A

Nitrates are normal. Think A as is A-ok!! Normally found in urine

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40
Q

Nitrites equals

A

Infection. Think I as in infection. Abnormal never normal usually gram-negative bacteria such as E. coli.

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41
Q

Pyuria is

A

White blood cells in the urine which equals infection. Most reliable indicator of infection. 95% sensitive. Usually indicates UTI

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42
Q

What does leukocyte esterase test for

A

Test for enzyme present and white blood cell. Usually indicates UTI.

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43
Q

A large amount of epithelial cells in the urine sample indicates

A

Contamination as a few epithelial cells are considered normal

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44
Q

How many white blood cells in the urine is considered normal

A

Less than or equal to 10 white blood cells per milliliter

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45
Q

Presence of leukocytes in the urine or pyuria is

A

Always abnormal in males and means infection

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46
Q

In a urine culture greater than or equal to how many milliliters of bacteria is indicative of a UTI

A

10 to the fifth power CFU/ML of bacteria

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47
Q

How many red blood cells are considered normal in a urinalysis

A

Less than five cells

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48
Q

What conditions cause hematuria

A

Kidney stones, Pyelonephritis , and sometimes in cystitis

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49
Q

Protein in the urine indicates

A

Kidney damage i.e. chronic kidney disease

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50
Q

What may be present in the urine with acute pyelonephritis

A

Protein urea

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51
Q

Nitrates are indicative of

A

Infection with E. coli

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52
Q

Are hyaline casts normal in concentrated urine

A

Yes

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53
Q

With UTI and Pyelonephritis are white blood cell casts seen

A

Yes

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54
Q

Red blood cell casts and proteinuria are diagnostic for

A

Glomerulonephritis

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55
Q

Infection and inflammation of the bladder with presence of bacteria in the urine. E. coli is the most common bacteria

A

UTI

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56
Q

Back pain can also mean

A

Kidney infection

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57
Q

What is the first choice of treatment for uncomplicated UTI

A

Nitrofurantoin or Macrobid which is pregnancy category B

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58
Q

How long do you treat women with UTIs

A

Three day therapy if uncomplicated

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59
Q

How long do you treat a male for UTI

A

7 to 10 days

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60
Q

If it is a Complicated UTI or comorbidities how long to treat

A

Consider 7 to 10 days

61
Q

What conditions make a UTI complicated

A

Pregnancy, fever, diabetes

62
Q

What comfort measures can be taken for UTI

A

Anti-spasmodic for dysuria such as Phenazopyridine (Pyridium), Flavoxate (Urispas)

63
Q

What medication can discolor urine orange

A

Anti-spasmodic

64
Q

What are health promotion measures for UTI

A

Prompt treatment, hydration especially for elders, avoid bladder irritants such as caffeine, alcohol, carbonation and artificial sweeteners. Void after sexual intercourse extra lubrication and patient needs to follow up if blood is present on diagnosis

65
Q

Other than E. coli what other bacteria can cause a UTI or cystitis

A

Staphylococcus saprophyticus, proteus mirabilis, and klebsiella pneumoniae

66
Q

In what population is a UTI more likely to progress to pyelonephritis

A

Children younger than age 3 and pregnant women

67
Q

In infancy are UTIs more common in boys or girls

A

Boys usually due to anatomic abnormality

68
Q

Are males or females adolescent to adults at a higher risk for UTIs

A

Females of reproductive age

69
Q

What are some risk factors for UTI

A

Female gender with Pregnancy, history of recurrent UTI or history of recurrent infections, diabetes mellitus or immunocompromise, failure to void after sex or increased sexual intercourse, spermicidal use within the past year, infected renal calculi, low fluid intake, poor hygiene, catheterization

70
Q

A sexually active female complains of new onset of dysuria, frequency, frequent urge to urinate, and nocturia. May also complain of suprapubic discomfort. Not associated with fever. Urine dipstick will show moderate to large amount of leukocytes and will be positive for nitrates. May show a few red blood cells due to inflammation, negative for ketones and protein

A

Urinary tract infection or Cystitis

71
Q

Symptomatic bacteriurua with leukocytosis, fever, chills, malaise is treated as

A

UTI

72
Q

pyridium (phenazopyridine) Should be avoided for patients with

A

Liver or renal disease, G6PD anemia

73
Q

If clinical symptoms persist for 48 to 72 hours after initiating antibiotics for her UTI

A

Order urine culture and sensitivity and urine analysis. Rule out pyelonephritis. Switch to another antibiotic drug class such as a quinolone and treat for 7 to 10 days

74
Q

How long should complicated UTIs be treated

A

7 to 10 days

75
Q

What patients would be considered a complicated UTI

A

Males, diabetics, pregnant women, children or elderly, immunocompromised, recurrent UTIs or reinfections, anatomic abnormality’s of the kidneys or ureters including kidney stones

76
Q

What are the labs for complicated UTI’s

A

Urinalysis and urine culture and sensitivity before and after treatment to document resolution

77
Q

Are UTIs ever normal in males

A

No. rule out ureteral stricture, infected kidney stones, anatomic abnormality, acute prostatitis, STI’s. Must be evaluated further. Refer to urologist

78
Q

Three or more UTIs in one year or two infections within six months

A

Re-current UTI never normal in males

79
Q

With recurrent UTIs what must be ruled out

A

Infected stones, reflux, fistulas, ureteral stenosis, urologic abnormalities

80
Q

Long-term use of nitrofurantoin is associated with

A

Lung problems, chronic hepatitis, and neuropathy.

81
Q

Nitrofurantoin is contra indicated with

A

Renal insufficiency

82
Q

Acute bacterial infection of the kidneys most commonly due to gram-negative bacteria such as E. coli, Proteus Mirabilis, and klebsiella pneumonia. Outpatient treatment is only from milder cases that are uncomplicated i.e. immunocompetent adult female with normal urinary/renal system without comorbidities and compliant patients

A

Acute pyelonephritis

83
Q

Adult patient presents with acute onset of high fever, chills, nausea/vomiting, and one sided flank pain. Some patients may have symptoms of cystitis such as dysuria, frequency, and urgency.

A

acute pyelonephritis

84
Q

Physical exam shows fever equal or greater than 100°F, CVA tenderness on one kidney, urine dipstick with large amounts of leukocytes, hematuria, WBC casts, and protein urea. Urine culture and sensitivity shows presence of 10 to the fifth power ML of one organism. CBC shows leukocytosis, neutrophilia with shift to the left. Presence of bands noted.

A

Acute pyelonephritis

85
Q

In order for a UTI to be diagnosed how many organisms need to be noted in a urine sample

A

Greater than 10,000 ML of one organism

86
Q

White blood cell casts With protein urea is associated with

A

Pyelonephritis

87
Q

What is a better measure of renal function compared with BUN or BUN and creatinine ratio.

A

Serum creatinine

88
Q

Which kidney sits lower because of displacement of the liver

A

Right kidney

89
Q

Large numbers of epithelial cells in the urine mean

A

Contamination

90
Q

What is a normal white blood cell count and neutrophil or seg count

A

Normal white blood cell count is 10.5 and neutrophil/seg is greater than 80%

91
Q

Neutrophils make up how much percent of all of the white blood cells in a sample

A

50 to 75%

92
Q

If band forms are seen it is indicative of

A

A serious bacterial infection

93
Q

Immature white blood cells

A

Neutrophil or band forms or secs

94
Q

What two serum studies are preferred to BUN when checking renal function

A

Serum creatinine and GFR

95
Q

Long term use of nitrofurantoin is associated with

A

Lung problems, chronic hepatitis, and neuropathy

96
Q

The majority of kidney stones is made up of

A

Calcium oxalate

97
Q

What are two risk factors for kidney stones or nephrolithiasis

A

Family history of stones, low fluid intake, gout, bariatric surgery

98
Q

Adult with acute onset of severe colicky flank pain on one side that comes in waves. The pain builds up in intensity, then lessons and disappears. For some, the pain can be extreme and associate with nausea and vomiting. Majority have hematuria. Urine in maybe pink from blood.

A

Nephrolithiasis (kidney stones)

99
Q

What labs are needed for kidney stone or nephrolithiasis diagnosis

A

Instruct patient to strain urine for several days and to bring a kidney stone to office if past for analysis by laboratory. Order renal ultrasound to determine location and stone size. Urinalysis until the episode resolves. Refer to urology if large stone and inability to pass it or acute renal failure. Refer to ED with high fever extreme pain and acute renal failure

100
Q

What dietary measures should be taken with nephrolithiasis/kidney stones

A

Increase fluid and take up to 2 L per day. Avoid high oxalate foods such as rhubarb, spinach, beats, chocolate, tea, and meats

101
Q

Involuntary loss of urine from the urethra

A

Urinary incontinence

102
Q

What type of urinary incontinence is due to an unstable bladder

A

Urge incontinence

103
Q

What type of urinary incontinence is due to laughing, coughing or jumping

A

Stress incontinence

104
Q

What type of urinary incontinence has components of both urge and stress incontinence

A

Mixed incontinence which is most common

105
Q

What should be avoided in urinary incontinence

A

Alcohol, carbonation, coffee or tea, citrus juices

106
Q

What is the treatment for Urge, stress, and mixed urinary incontinence -behavioral therapy

A

Weight loss especially for stress incontinence, regular voiding but not frequent, pelvic floor muscles i.e. Kegel exercises at three sets of 10 to 12 contractions for five seconds each daily for three months, minimize fluids after dinner, take diuretics in the afternoon not at night

107
Q

What pharmacologic measures can be taken for urinary incontinence

A

Anti-cholinergics for urge and stress urinary incontinence. Side effects include dry mouth, Eyes, & G.I. I.e. Vesicare RX. Estrogen for post-menopausal over active bad bladder, biofeedback, pelvic physical therapy, and Surgery for stress incontinence

108
Q

What medication is best for urinary incontinence due to fewer side effects over the anti-cholinergics

A

Mirabegron Rx.

109
Q

A patient with a history of kidney stones presents to your office. He has intermittent pain that is rated Four out of 10 but now has become nine out of 10. What describes his demeanor in the exam room

A

He is lying on the table and rolling from side to side

110
Q

How do you treat kidney stone

A

Toradol injection if not contraindicated, Then refer to ER. Referral for hospitalization if infection is present, stone is greater than 6 mm in diameter, and excessive nausea and vomiting is present. Urological consult if obstruction suspected or symptoms persist greater than 3 to 4 days. Consider an alpha blocker such as Flomax for a calcium channel blocker such as Nifedipine as these medications are off label use

111
Q

85% of bladder cancer presents with

A

Hematuria

112
Q

What can cause hematuria in adults

A

Malignant neoplasm’s of the renal and bladder, infection, renal calculi, kidney stones, coagulopathy, glomerular disease, hydronephrosis, polycystic kidneys, trauma, medications, BPH, exercise-induced which results in 72 hours

113
Q

What are risk factors for malignancy of the renal system and bladder

A

Age greater than 40, smoking history, occupational exposure, chronic cystitis, history of pelvic irradiation, history of analgesic abuse

114
Q

Red blood cells are found in the urine what must be considered

A

Always pathological, consider glomerulonephritis, urinary tract injury

115
Q

If a male presents with symptoms of burning with urination what part of the body would you not examine

A

Abdominal area

116
Q

A symptom of scrotal heaviness in men is consistent with

A

Inguinal hernia

117
Q

If a 76-year-old male patient presents with urethral irritation after voiding and STDs are ruled out what can be another etiology

A

Chronic prostatitis

118
Q

If a 24-year-old female patient presents and is diagnosed with uncomplicated UTI which assessment is least important at this time

A

Vaginal exam

119
Q

If a female patient is diagnosed with UTI and a bacteria count was collected midstream clean catch how many bacteria would be found in the sample

A

Greater than 100,000 bacteria

120
Q

If a patient presents with flank pain that waxes and wanes what finding on urine analysis should direct the next action

A

Blood

121
Q

A 72-year-old male patient has early renal insufficiency he. What laboratory test best assesses his kidney function

A

Glomerular filtration rate

122
Q

What causes an insignificant increase in prostate specific antigen

A

Digital rectal exam

123
Q

A patient with urolithiasis is most likely to

A

Be of male gender

124
Q

A patient with dysuria has a urine specimen that reveals less than 10,000 bacteria and numerous trichomonads how should this patient be managed

A

Flagyl for seven days

125
Q

Classical findings in a urinary tract infection in a urine sample are

A

Positive leukocytes and positive nitrates

126
Q

If a patient takes her saw palmetto he is using it because he thinks it

A

Improves urine flow

127
Q

A 25-year-old male patient with subacute bacterial epididymitis should be treated initially with

A

Doxycycline

128
Q

Hey sexually active male patient presents with epididymitis What finding is likely

A

Recent history of heavy physical exercise

129
Q

An example of a drug that targets the Renin– angiotensin – aldosterone system is

A

Ace inhibitor

130
Q

What are symptoms of proctitis

A

Rectal pain, bleeding, and a continuous sensation to defecate (tenesmus)

131
Q

Inflammation of the lining of the rectum leading to rectal pain etc.

A

Proctitis

132
Q

A whitish sebaceous secretion that collects between the glans penis and foreskin or in the vulva is known as

A

Smegma

133
Q

And then painful urination without frequency urgency suggests

A

Urethritis

134
Q

What symptoms indicate a cute glomerulonephritis

A

Hematuria, protein urea, hypertension

135
Q

At what point in a males life does BPH begin

A

Third decade of life

136
Q

What condition usually coexists with epididymitis

A

Chlamydia infection

137
Q

A 50-year-old male describes difficulty emptying his bladder. On exam a distended bladder is noted. this finding may be associated with

A

Functional incontinence

138
Q

In a newborn what is the renal adaptation

A

The kidneys have an inability to concentrate urine and adapt to fluid and electrolyte stress

139
Q

When examining the scrotum and a young male child, test the ceemasteric reflex by

A

Scratching the medial aspect of the thigh

140
Q

Stress urinary incontinence is

A

Maybe aggravated by caffeine or alcohol

141
Q

A 72-year-old man has chronic prostatitis. What is the initial drug treatment of choice for this patient

A

Ciprofloxacin or Bactrim

142
Q

Is the prostate gland boggy with BPH

A

No it is rubbery

143
Q

A patient post op TURP procedure should be monitoring

A

For bladder spasms

144
Q

Will a U/A show protein in acute pyelonephritis

A

No. But it will show nitrates, white blood cells, and red blood cells

145
Q

Micro albumin urea is a measure of

A

Protein lost in the urine

146
Q

A nurse practitioner palpates a nodule during a prostate exam. What other clues may indicate prostate cancer?

A

Elevated PSA and hematuria

147
Q

What is the most common early sign of colchicine toxicity

A

Diarrhea

148
Q

When is asymptomatic protein urea seen in patients

A

It is often seen in patients who participate in strenuous exercise programs or who do physical labor.

NP Prep (20 decks)

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