Urology and Renal Flashcards
What pH is considered acidodic
< 7.35
what pH is considered alkalotic
> 7.45
if there is a elevated CO2 levels and decreased pH level what type of acid/based disorder is this?
respiratory acidosis
if there is a decreased CO2 levels and increased pH level what type of acid/based disorder is this?
respiratory alkalosis
if there is a decreased HCO3 and pH level, what type of acid/based disorder is this?
metabolic alkalosis
if a patient has an elevated HCO3 and pH level, what type of acid/based disorder is this?
metabolic alkalosis
a 78-year-old woman, G5P5, who presents to establish care. She is healthy and denies any additional problems. However, when specifically asked, she admits to having urinary incontinence for several years and reports that symptoms have recently worsened. The patient experiences the need to void almost hourly and she now uses four to five adult incontinence pads per day to manage the urine she leaks. She has had occasional accidents while asleep at night as well. She denies leaking urine with coughing or sneezing.
what is the likely diagnosis?
urge incontinence
what are the diagnostic tests for urge incontinence
urodynamic testing
what is the treatment of urge incontinence
Bladder-training exercises
can due anticholinergics (oxybutynin) and TCAs (imipramine)
what is stress incontience
weakness of pelvic floor - urine leakage due to abrupt increases in intra-abdominal pressure (ex. with coughing, sneezing, laughing, bending or lifting)
a 68-year-old woman who presents to your office with leakage of urine when she sneezes, laughs, or coughs. She reports that these symptoms strictly occur during the day and never at night. She denies any subjective fever, dysuria, or hematuria. Pelvic examination is notable for a protrusion from the anterior vagina.
what is the likely diagnosis?
Stress incontinence
what is the treatment of stress incontinence
kegel exercises to strengthen pelvic floor musculature
vaginal estrogens
pessary
surgery is an option for mid-urethral sling
what is overflow incontience
impaired detrusor contractility - occurs when urinary retention leads to bladder distrention and overflow of urine through urethra
a 67-year-old man comes to the clinic because of urinary incontinence with the frequent loss of small amounts of urine for the past 2 weeks. He describes having difficulty initiating urination or telling when or if his bladder is full or empty. He denies frequency, urgency, or bowel dysfunction. Past medical history is significant for stroke 1 year ago in addition to hypertension and coronary artery disease. Past surgical history is significant for lower back surgery one month ago after a car accident. Physical examination shows decreased sphincter tone and 110 ml of post-void residual urine. Diagnostic tests show normal bladder capacity, no sign of infection, normal prostate-specific antigen levels, and normal creatinine.
what is the likely diagnosis?
overflow incontinence
how is overflow incontience diagnosed?
urodynamic testing
elevated postvoid residual volume
what is the best management of overflow incontinence
intermittent self-catheterization
what are other medical management options for stress incontinence
cholinergic agents (bethanechol) to increase bladder contractions
alpha blockers (terazosin, doxazosin) to decrease sphincter resistance
a 38-year-old military veteran who served three tours in Afghanistan presents to your clinic complaining of urinary incontinence. He was injured during his last tour of duty when he stepped on an improvised explosive device and lost the bottom of both of his legs. He ambulates much of the time in a wheelchair. He lives alone with little assistance. He reports a history of hypertension and was recently prescribed lisinopril + hydrochlorothiazide. He denies tobacco and alcohol use but drinks about 4-5 cups of coffee per day. He has a normal exam with a normal urinalysis and normal prostate-specific antigen.
What is the likely diagnosis?
functional incontinence
what is the treatment for functional incontinence
scheduled voiding times and removal of precipitating factors
what is the number one cause of renal vascular disease
diabetic kidney disease
other causes: HTN, Smoking, Vascular disease aka rental artery stenosis, glomerular disease, renal cyst, genetics
what is Azotemia
elevated BUN concentration
what are causes of prerenal injury
due to decreased blood flow to the kidneys
- Hypovolemia
- NSAIDs, IV contrast, ACEi and ARBs
-
what is the treatment of prerenal injury
IV fluids will help improve creatine
what are causes of intrinsic kidney injury
Nephrotoxic drugs = aminoglycosides (gentamicin)
cyclosporine
Tumor lysis syndrome
Vasculitis (SLE, sarcoidosis)
crystsals from gout
Myoglobin from rhabdomyolysis
what is the hallmark sign of intrinsic kidney injury
WBC casts
what is the treatment of intrinsic kidney injury
IV fluids remove drugs if present and somteimes lasix to get the kidneys moving
what are causes of postrenal kidney injury
kidney stones
BPH, tumors
congential/structural abnormalities
what are RC casts indicative of
glomerulonephritis
what are WBC casts indicative of
pyelonephritis
what are Muddy casts indicative of
ATN
what are hyaline casts indicative of
normal kidneys
what are waxy casts indicative of
chronic renal disease
what is interstitial nephritis
immune mediated response
can be causes by PCN, Sulfa, NSAIDs and phenytoin
a 31-year-old man with right flank pain radiating into the scrotum, gross hematuria, right-sided hydronephrosis, and normal abdominal x-ray
what is the likely diagnosis?
nephrolithiasis
a 34-year-old woman with a 3-day history of hematuria, dysuria, increased urinary frequency, and nocturia. She has had no fever, chills, or back pain. On examination, she does not look ill. Her temperature is 37.5 ° C. Her abdomen is nontender. There is no CVA tenderness.
what is the most likely diagnosis?
Cystitis
what is the most common pathogen associated with cystitis
E/coli
what is the treatment of uncomplicated cystitis
short term abx: Bactrim or nitrofurantoin 3-5 days
a 31-year-old male complaining of unilateral scrotal swelling with pain radiating to the ipsilateral groin. Examination reveals a tender swollen testicle, scrotal edema with erythema and shininess of the overlying skin.
what is the most likely diagnosis?
Orchitis
what is the treatment of orchitis
if mumps is the cause, treat mumps (+ ice/analgesia)
if bacteria: treat like epididymitis
what is the presentation of cystitis
dysuria, urgency, frequency, hematuria with no fever, chills, flank pian
what is the gold standard diagnostic test for cystitis
urine culture
what is the presentation of pyelonephritis
dysuria + fever + flank pain + nausea and vomiting + CVA tenderness + white casts on UA
what is Prehn’s sign
relief of scrotal pain with elevation
classic sign of epididymitis
what is the treatment of epididymitis
FQ/Doxycyline + ceftriaxone
what is the presentation of prostatitis
sudden onset fever, chills and low back pain combined with urinary frequency, urgency and dysuria
a 63-year-old man with a history of benign prostatic hyperplasia reports 3-days of fever, chills, and pain with urination. He was recently catheterized during admission to the hospital. Physical exam reveals a tender and enlarged prostate on digital rectal exam. Urinalysis reveals pyuria and hematuria.
what is the most likely diagnosis?
prostatitis
a 25-year-old male with a dull, achy scrotal pain that has been gradually increasing over the last several days. He also reports pain with urination. Physical exam reveals a swollen right testicle with substantial induration. Urinalysis reveals positive leukocyte esterase and 20 WBC/HPF.
What is the most likely diagnosis
epididymitis
a 32-year-old female presents with fever, chills, nausea and flank pain for 24 hours. She developed dysuria and urinary frequency 3 days prior and states that both have worsened. On physical exam, you note suprapubic abdominal pain and CVA tenderness. The urinalysis reveals white blood cell casts.
What is the most likely diagnosis?
pyelonephritis
what is the most common pathogen associated with pyelonephritis
e. coli
what is the outpatient treatment for pyelonephritis
FQ (cipro/levaquin)/ bactrim for 1-2 weeks
what is the most common cause of renal failure
hyperphosphatemia
what is the treatment of hyperphosphetemia
IV hydration and acetazolamide
what are causes of hypophosphatemia
hyperparathyroidism
alcoholism
burns
starvation
CKD
diuretics
what is the presentation of hypophosphatemia
anorexia and muscle weakness
Heart failure
seizure and coma
osteomalacia
what is the most common cause of hypocalcemia
hypoparathyroidism
what is Trousseau’s sign
flexion of wrist, thumbs and metacarpophalyngeal joints and exntesion of tingers with BP
what is chvostek’s sign
abdomral twitching of muscles that are activated by the facial nerve - facial nerve is tapped in front of ear and fasical muslce on the same side will contract
what is the presentation of hypercalcemia
“stones, bones, abdominal groans, psychiatric moans
what is the presentation of hyperkalemia on EKG
peaked T-waves
what is the diagnostic test for diabetes insipidus
fluid deprivation test
what is the treatment for diabetes insipidus
desmopressin (DDAVP) can treat central - non kidney related
what is SIADH
increased antidiretic hormone (ADH) from the pituitary gland that makes the kidneys retain water
what is glomerulonephritis
damage of renal glomeruli by deposition of inflammatory proteins in glomerular membranes as a result of immunologic response
what is the treatment of glomerulonephritis
steroids and immunosuppressive drugs to control inflammatory response
dietary management (satl and fluid intake decreased)
disalysis if symptomatic azotemia present
a 15-year-old boy with severe lower abdominal pain that awoke him from sleep about 3 hours ago. The pain is sharp and radiates to the right thigh. While in the emergency room, the patient experiences one episode of vomiting. He denies any fever, dysuria, or chills. The mom reports a childhood history of cryptorchidism. Physical examination reveals normal vitals with a blood pressure of 100/60 and a temperature of 98.6F. Abdominal examination is relatively benign. Scrotal examination reveals an elevated right testis that is diffusely tender. Lifting of the right testicle DOES NOT relieve pain, and there is a loss of a cremasteric reflex. The transillumination test is negative.
what is the most likely diagnosis
testicular torsions
what is the gold standard diagnostic test for testicular torsion
radionuclide study
a 22-year-old heterosexual male who recently started having unprotected intercourse with his new girlfriend. He now reports a painful itching and burning sensation with urination and discomfort in the urethra. He says that sometimes in the morning it appears that the walls of the meatus are stuck together with evidence of dried secretions. On exam, there is no purulent discharge. The meatus does appear red. His girlfriend does not have any symptoms.
what is the likely diagnosis
urethritis
how is urethritis diagnosed?
first-void or first-catch urine and somteimes urine culture
a 20-year-old male presents with a swelling in his right groin that has been increasing in size over the past six months. He notes that the bulge is more noticeable when standing and disappears when lying down. It is not painful but causes discomfort during physical activities. On examination, a soft mass is palpable in the right inguinal canal and extends into the scrotum
what is the likely diagnosis
indirect inguinal hernia
