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Clinical: Emergency Medicine > Urology and Renal > Flashcards

Urology and Renal Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

What pH is considered acidodic

A

< 7.35

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2
Q

what pH is considered alkalotic

A

> 7.45

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3
Q

if there is a elevated CO2 levels and decreased pH level what type of acid/based disorder is this?

A

respiratory acidosis

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4
Q

if there is a decreased CO2 levels and increased pH level what type of acid/based disorder is this?

A

respiratory alkalosis

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5
Q

if there is a decreased HCO3 and pH level, what type of acid/based disorder is this?

A

metabolic alkalosis

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6
Q

if a patient has an elevated HCO3 and pH level, what type of acid/based disorder is this?

A

metabolic alkalosis

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7
Q

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?

A

urge incontinence

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8
Q

what are the diagnostic tests for urge incontinence

A

urodynamic testing

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9
Q

what is the treatment of urge incontinence

A

Bladder-training exercises
can due anticholinergics (oxybutynin) and TCAs (imipramine)

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10
Q

what is stress incontience

A

weakness of pelvic floor - urine leakage due to abrupt increases in intra-abdominal pressure (ex. with coughing, sneezing, laughing, bending or lifting)

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11
Q

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?

A

Stress incontinence

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12
Q

what is the treatment of stress incontinence

A

kegel exercises to strengthen pelvic floor musculature
vaginal estrogens
pessary
surgery is an option for mid-urethral sling

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13
Q

what is overflow incontience

A

impaired detrusor contractility - occurs when urinary retention leads to bladder distrention and overflow of urine through urethra

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14
Q

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?

A

overflow incontinence

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15
Q

how is overflow incontience diagnosed?

A

urodynamic testing
elevated postvoid residual volume

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16
Q

what is the best management of overflow incontinence

A

intermittent self-catheterization

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17
Q

what are other medical management options for stress incontinence

A

cholinergic agents (bethanechol) to increase bladder contractions
alpha blockers (terazosin, doxazosin) to decrease sphincter resistance

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18
Q

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?

A

functional incontinence

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19
Q

what is the treatment for functional incontinence

A

scheduled voiding times and removal of precipitating factors

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20
Q

what is the number one cause of renal vascular disease

A

diabetic kidney disease

other causes: HTN, Smoking, Vascular disease aka rental artery stenosis, glomerular disease, renal cyst, genetics

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21
Q

what is Azotemia

A

elevated BUN concentration

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22
Q

what are causes of prerenal injury

A

due to decreased blood flow to the kidneys
- Hypovolemia
- NSAIDs, IV contrast, ACEi and ARBs
-

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23
Q

what is the treatment of prerenal injury

A

IV fluids will help improve creatine

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24
Q

what are causes of intrinsic kidney injury

A

Nephrotoxic drugs = aminoglycosides (gentamicin)
cyclosporine
Tumor lysis syndrome
Vasculitis (SLE, sarcoidosis)
crystsals from gout
Myoglobin from rhabdomyolysis

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25
Q

what is the hallmark sign of intrinsic kidney injury

A

WBC casts

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26
Q

what is the treatment of intrinsic kidney injury

A

IV fluids remove drugs if present and somteimes lasix to get the kidneys moving

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27
Q

what are causes of postrenal kidney injury

A

kidney stones
BPH, tumors
congential/structural abnormalities

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28
Q

what are RC casts indicative of

A

glomerulonephritis

29
Q

what are WBC casts indicative of

A

pyelonephritis

30
Q

what are Muddy casts indicative of

A

ATN

31
Q

what are hyaline casts indicative of

A

normal kidneys

32
Q

what are waxy casts indicative of

A

chronic renal disease

33
Q

what is interstitial nephritis

A

immune mediated response
can be causes by PCN, Sulfa, NSAIDs and phenytoin

34
Q

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?

A

nephrolithiasis

35
Q

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?

A

Cystitis

36
Q

what is the most common pathogen associated with cystitis

A

E/coli

37
Q

what is the treatment of uncomplicated cystitis

A

short term abx: Bactrim or nitrofurantoin 3-5 days

38
Q

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?

A

Orchitis

39
Q

what is the treatment of orchitis

A

if mumps is the cause, treat mumps (+ ice/analgesia)
if bacteria: treat like epididymitis

40
Q

what is the presentation of cystitis

A

dysuria, urgency, frequency, hematuria with no fever, chills, flank pian

41
Q

what is the gold standard diagnostic test for cystitis

A

urine culture

42
Q

what is the presentation of pyelonephritis

A

dysuria + fever + flank pain + nausea and vomiting + CVA tenderness + white casts on UA

43
Q

what is Prehn’s sign

A

relief of scrotal pain with elevation
classic sign of epididymitis

44
Q

what is the treatment of epididymitis

A

FQ/Doxycyline + ceftriaxone

45
Q

what is the presentation of prostatitis

A

sudden onset fever, chills and low back pain combined with urinary frequency, urgency and dysuria

46
Q

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?

A

prostatitis

47
Q

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

A

epididymitis

48
Q

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?

A

pyelonephritis

49
Q

what is the most common pathogen associated with pyelonephritis

A

e. coli

50
Q

what is the outpatient treatment for pyelonephritis

A

FQ (cipro/levaquin)/ bactrim for 1-2 weeks

51
Q

what is the most common cause of renal failure

A

hyperphosphatemia

52
Q

what is the treatment of hyperphosphetemia

A

IV hydration and acetazolamide

53
Q

what are causes of hypophosphatemia

A

hyperparathyroidism
alcoholism
burns
starvation
CKD
diuretics

54
Q

what is the presentation of hypophosphatemia

A

anorexia and muscle weakness
Heart failure
seizure and coma
osteomalacia

55
Q

what is the most common cause of hypocalcemia

A

hypoparathyroidism

56
Q

what is Trousseau’s sign

A

flexion of wrist, thumbs and metacarpophalyngeal joints and exntesion of tingers with BP

57
Q

what is chvostek’s sign

A

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

58
Q

what is the presentation of hypercalcemia

A

“stones, bones, abdominal groans, psychiatric moans

59
Q

what is the presentation of hyperkalemia on EKG

A

peaked T-waves

60
Q

what is the diagnostic test for diabetes insipidus

A

fluid deprivation test

61
Q

what is the treatment for diabetes insipidus

A

desmopressin (DDAVP) can treat central - non kidney related

62
Q

what is SIADH

A

increased antidiretic hormone (ADH) from the pituitary gland that makes the kidneys retain water

63
Q

what is glomerulonephritis

A

damage of renal glomeruli by deposition of inflammatory proteins in glomerular membranes as a result of immunologic response

64
Q

what is the treatment of glomerulonephritis

A

steroids and immunosuppressive drugs to control inflammatory response
dietary management (satl and fluid intake decreased)
disalysis if symptomatic azotemia present

65
Q

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

A

testicular torsions

66
Q

what is the gold standard diagnostic test for testicular torsion

A

radionuclide study

67
Q

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

A

urethritis

68
Q

how is urethritis diagnosed?

A

first-void or first-catch urine and somteimes urine culture

69
Q

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

A

indirect inguinal hernia

Clinical: Emergency Medicine (13 decks)

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