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EOR - Emergency Medicine > Urology/Renal > Flashcards

Urology/Renal Flashcards

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1
Q

average values of HCO3, pH, and CO2

A

HCO3: 24
pH: 7.40
CO2: 40

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2
Q

3 step acid-base approach

A
  1. normal pH range: 7.35-7.45 -> acidosis vs alkalosis
  2. CO2 (respiratory): normal range: 35-45
  3. HCO3 (metabolic): normal range: 20-26

ex.
elevated CO2, low pH: respiratory acidosis
low CO2, high pH: respiratory alkalosis

low HCO3, low pH: metabolic acidosis
elevated HCO3, elevated pH: metabolic alkalosis

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3
Q

6 types of urinary incontinence

A

urge
stress
overflow
functional
mixed
nocturnal

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4
Q

urinary incontinence due to detrusor overactivity

sudden urge to urinate, loss of large volumes, small post void residual

A

urge incontinence

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5
Q

tx for urge incontinence

A

pelvic muscle exercises
anticholinergics/TCAs

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6
Q

urinary incontinence due to weak pelvic floor muscles

involuntary urine loss in spurts during activities that increase abdominal pressure, small post void volume

A

stress incontinence

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7
Q

tx for stress incontinence

A

kevels
topical estrogens
mid-urethral sling

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8
Q

urinary incontinence caused by impaired detrusor contractility

inability to empty bladder -> high void post volume, nocturnal wetting

A

overflow incontinence

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9
Q

6 causes of overflow incontinence

A

diabetes
neuro d.o
anticholinergics/alpha agonists
BPH/prostate ca
urethral stricture
constipation/fecal impaction

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10
Q

tx for overflow incontinence

A

gs: self catheterization
cholinergics (bethanecol)
alpha blockers (tamsulosin)

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11
Q

urinary incontinence that involves normal voiding systems but difficulty reaching toilet 2/2 mental/physical disability

A

functional incontinence

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12
Q

tx for functional incontinence

A

scheduled voiding times

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13
Q

mixed urinary incontinence is a combo of

A

stess/urge

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14
Q

mc type of urinary incontinence

A

mixed

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15
Q

involuntary urination during sleep w.o urologic or neurologic causes after 5 yo

A

nocturnal enuresis

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16
Q

management of nocturnal enuresis (4)

A

UA
postvoid residual volume
urodynamic studies
US/cystoscopy

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17
Q

stages of acute renal failure based on GFR

A

stage 1 (normal): GFR > 90
stage 2 (early): GFR 60-89
stage 3 (moderate): GFR 30-59
stage 4 (severe): GFR 15-29
stage 5 (kidney failure): GFR < 15

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18
Q

top 2 causes of renal vascular dz

A

1. DM
2. HTN

other:
smoking
renal a stenosis
glomerular dz
renal cysts
genetics

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19
Q

_ is caused by a rise in BUN concentration

A

azotemia

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20
Q

AKI is marked by elevated serum _ and decreased _

A

Cr
GFR

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21
Q

3 types of AKI

A

prerenal
intrinsic
postrenal

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22
Q

AKI caused by decrease bloodflow to the kidneys

nephrons intact

A

prerenal

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23
Q

AKI in the kidneys

A

intrinsic

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24
Q

AKI downstream of the kidneys

A

postrenal

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25
Q

3 causes of prerenal AKI

A

hypovolemia - mc
NSAIDs, IV contrast, ACE/ARB
renal artery stenosis

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26
Q

tx for prerenal AKI

A

IVF
underlying cause

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27
Q

causes of intrinsic AKI

A

direct damage to the kidneys:
nephrotoxic drugs: ex aminoglycosides
cyclosporines
tumor lysis syndrome
vasculitis (SLE/Sjorgens)
gout
rhabdo

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28
Q

hallmark finding of intrinsic AKI

A

RBC casts

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29
Q

tx for intracellular AKI

A

IVF
Lasix

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30
Q

causes of postrenal AKI

A

obstruction:
nephrolithiasis
BPH/tumors
congenital/structural abnl’s

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31
Q

retention of nitrogenous waste

A

azotemia

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32
Q

symptomatic azotemia w. n/v/lethargy

A

uremia

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33
Q

oliguria is defined as

A

urine output < 400 ml/day

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34
Q

causes of prerenal failure

A

-volume loss
-HF
-loss of peripheral vascular resistance (sepsis/anesthesia)

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35
Q

sx of prerenal AKI (5)

A

weak
dizzy/orthostatic
decreased urine
sunkey eyes
tachy

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36
Q

labs findings of prerenal AKI

A

FENa nl
SpGr >1.030
Bun/Cr > 20
urine osm > 500

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37
Q

tx for prerenal AKI

A

fluids
cardiac support
treat shock

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38
Q

3 types of intarenal AKI

A

glomerular
tubular
intersitial

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39
Q

RBC casts

A

glomerulonephritis

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40
Q

WBC casts

A

pyelonephritis

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41
Q

muddy casts

A

ATN

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42
Q

hyaline casts

A

normal

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43
Q

waxy casts

A

CKD

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44
Q

lab findings of intrarenal AKI

A

SpGr < 1.010
Bun/Cr < 10
urine osm < 300

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45
Q

post renal failure is mc due to

A

prostate pathology

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46
Q

mc cause of post renal failure

A

low/no urine output

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47
Q

management of post renal AKI

A

catheter
US - find blockage/hydronephrosis

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48
Q

muddy, pigmented/brown granular casts

A

ATN

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49
Q

2 causes of ATN

A

renal ischemia (dehydration/shock/sepsis)
toxins

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50
Q

mc cause of ATN

A

prerenal failure

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51
Q

5 drugs associated w. ATN

A

amp B
cisplatin
aminoglycosides
NSAIDs
ACE

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52
Q

lab finding of ATN

A

FENa > 2%
urine osm: high

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53
Q

immune mediated AKI

A

interstitial nephritis

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54
Q

4 drugs assocaited w. interstitial nephritis

A

PCN
sulfa
NSAIDs
phenytoin

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55
Q

3 UA findings of interstitial nephritis

A

WBC casts
eosinophilia
hematuria

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56
Q

dx for interstitial nephritis

A

renal bx

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57
Q

management of interstitial nephritis (4)

A

identify offending drugs
steroids
self limiting
+/- dialysis

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58
Q

IgA nephropathy, postinfectious, membranoproliferative

A

glomerulonephritis

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59
Q

UA findings of glomerulonephritis

A

oliguria
hematuria
RBC casts

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60
Q

4 common causes of glomerulonephritis

A

GAB hemolytic strep
IgA
anti-GBM
ANCA

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61
Q

mc cause of acute glomerulonephritis

A

post streptococcal:
skin (impetigo) vs pharyngitis

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62
Q

triad for glomerulonephritis

A

hematuria
HTN
periorbital edema

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63
Q

dx for glomerulonephritis

A

UA: RBC, proteinuria

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64
Q

4 types of kidney stone mc -> least

A
  1. calcium oxalate
  2. uric acid
  3. struvite
  4. cystine
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65
Q

colicky, unilateral back/flank pain radiating to the groin, CVA tenderness, n/v

A

nephrolithiasis

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66
Q

labs will prob be normal for nephrolithiasis, but what abnl might you see

A

leukocytosis

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67
Q

gs dx for nephrolithiasis

A

CT w.o contrast (spiral CT)

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68
Q

CT can detect stones as small as

A

1 mm

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69
Q

tx for nephrolithiasis based on size

A

< 5 mm: likely to pass on their own, supportive
5-10: not likely to pass spontaneously, supportive, lithotripsy/uteroscopy w. extraction
> 10 mm: high likelihood of complication, inpt, stent/nephrostomy, opioids, lithotripsy

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70
Q

gs tx for kidney stones > 10 mm

A

ureteral stent/percutaneous nephrostomy

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71
Q

bacteria mc associated w. cystitis

A

e.coli

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72
Q

2 urine dipstick findings of cystitis

A

nitrite
leukocyte esterase

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73
Q

UA findings of cystitis

A

pyuria
bacteruria
+/- hematuria

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74
Q

tx for uncomplicated UTI

A

bactrim
nitro
x 3-5 days

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75
Q

tx for post coital UTIs

A

single dose bactrim OR cephalexin may reduce frequency

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76
Q

tx for UTI in pregnant pt

A

nitro
OR
cephalexin

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77
Q

31 yo M w. unilateral scrotal swelling/pain radiating to ipsilateral groin - PE shows tender, swollen testicle, scrotal edema, erythema w. shiny overlying skin

A

orchitis

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78
Q

common cause of orchitis in postpubertal males

A

mumps

79
Q

orchitis is rarely seen w.o

A

epididymitis

80
Q

what do you think when you see orchitis w.o epididymitis

A

mumps

81
Q

UA findings of bacterial orchitis

A

pyuria
baceriuria

82
Q

tx for orchitis

A

< 35 yo OR sexually active (over for GC/CT): ceftriaxone PLUS doxy

> 35 yo (STI not suspected): levofloxacin

83
Q

5 causes of dysuria

A

cystitis
pyelonephritis
urethritis
epididymitis
prostatitis

84
Q

gs dx for cystitis

A

urine cx

85
Q

tx for pyelonephritis

A

fluroquinolones

86
Q

definition for recurrent UTIs

A

2 uncomplicated x 6 mo
3+ complicated x 1 year

87
Q

definition for UTI relapse

A

UTI w.in 2 weeks of tx

88
Q

mc cause and dx for urethritis

A

mc: GC/CT
dx: NAAT

89
Q

dysuria, unilateral scrotal pain

A

epididymitis

90
Q

what sign is associated w. epididymitis

A

prehn’s: relief w. testicle elevation

91
Q

pathogens associated w. epididymitis:
treatment for epididymitis:

A

< 35 yo: GC/CT
> 35 yo: e.coli

tx: fluoroquinolone OR doxy
PLUS
ceftriaxone

92
Q

sudden onset f/c, lbp, increased frequency/urgency/dysuria

A

prostatitis

93
Q

mc cause of prostatitis

A

< 35 yo: GC/CT
> 35 yo: e.coli

94
Q

never _ a pt. w. prostatitis

A

prostate massage

95
Q

all pt’s w. prostatitis present w. (2)

A

irritative bladder sx
obstruction

96
Q

dx for prostatitis

A

-UA: pyuria and hematuria
-prostatic fluid: leukocytosis, culture

97
Q

pathogens associated w. acute vs chronic prostatitis

A

acute: GC/CT vs. e.coli vs pseudo
chronic: enterococcus

98
Q

tx for acute prostatitis

A

< 35 yo: ceftriaxone PLUS doxy
> 35 yo: fluoroquinolones vs bactrim x 4-6 weeks

+/- inpatient

99
Q

tx for chronic prostatitis

A

fluoroquinolones
OR
bactrim
x6-12 weeks

100
Q

when should sexual partners of epididymitis pt be treated

A

if contact w.in 60 days of sx onset

101
Q

tx for epididymitis in pt’s wh practice insertive anal sex

A

ceftriaxone
PLUS
fluoroquinolone

102
Q

organism mc associated w. pyelonephritis

A

e.coli

103
Q

lab findings of pyelonephritis

A

leukocytosis w. left shift

104
Q

US findings suggestive of complicated pyelonephritis

A

hydronephrosis 2/2 obstruction

105
Q

tx for pyelo

A

outpt: cipro vs levo vs bactrim x 1-2 weeks
inpt: IV fluoroquinolones/cephalosporins/gentamycin

106
Q

2 mc cause of hyperphosphatemia

A

1. renal failure
2. hypoparathyroidism

other:
DKA
crush injuries
rhabdo
infxn
tumor lysis
metabolic vs respiratory alkalosis

107
Q

sx of severe hyperphosphatemia

A

diplopia
low CO
dysphagia
respiratory dpn
AMS
coma

108
Q

tx for hyperphophatemia

A

IVF
acetazolamide
phosphate binders

109
Q

lab to order if suspicious of phos or ca imbalance

A

PTH

110
Q

causes of hypophosphatemia

A

hyperparathyroidism
etoh
burns
starvation
CKD
diuretics

111
Q

sx of hypophosphatemia

A

anorexia
muscle weaknes
sz/coma
osteomalacia

112
Q

causes of hypocalcemia

A

1. hypoparathyroidism

other: thyroid surgery, renal dz

113
Q

2 PE findings of hypocalcemia

A

trousseau’s sign
chvostek’s sign

114
Q

EKG finding of hypocalcemia

A

prolonged QT

115
Q

what is this showing

A

trosseau’s sign -> hypocalcemia

116
Q

what is this showing

A

chvostek sign -> hypocalcemia

117
Q

tx for hypocalcemia

A

IV calcium gluconate

118
Q

what is more indicative of serious electrolyte imbalance over serum levels

A

EKG findings

119
Q

causes of hypercalcemia

A

1. hyperparathyroidism

other:
sarcoidosis
TB
paget dz
metastases to bone
MM

120
Q

sx of hypercalcemia

A

stones
bones
groans
psychiatric moans

121
Q

ekg finding of hypercalcemia

A

shortened QT

122
Q

sx of hypercalcemia

A

polyuria
constipation
anorexia
nephrolithiasis
muscle weakness
confusion

123
Q

tx for hypercalcemia

A

IVF
furosemide

124
Q

hypercalcemia in elderly is _ until proven otherwise

in young adults, think _

A

elderliy: cancer
young: hyperparathyroidism

125
Q

2 pt pops at high risk for hyponatremia

A

etoh
malnourished

126
Q

3 sx of severe hyponatremia

A

coma
brainstem herniation
sz

127
Q

t/f: chronic hyponatremia is not as emergent as acute

A

t!

128
Q

sx of chronic hyponatremia

A

problems w. motor/gait -> falls

129
Q

correcting chronic hyponatremia too rapidly can lead to

A

osmotic demyelination syndrome

130
Q

tx for acute vs chronic hyponatremia

A

acute: 50 mL bolus of 3% saline
chronic: IV NS

131
Q

hypernatremia is mc caused by

A

dehydration (limited access to water)
impaired thirst mechanism

other: diabetes insipidus

132
Q

sx of severe hypernatremia

A

confusion
neuromuscular excitability
hyperreflexia
sz/coma

133
Q

tx for hypernatremia

A

IV D5W
vs
D5W 1/2 NS

134
Q

rapid correction of chronic hypernatremia can cause

A

cerebral edema
pontine herniation

135
Q

4 causes of hyperkalemia

A

late CKD
spironolactone
ACEI
AKI

136
Q

EKG finding of hyperkalemia

A

peaked T waves

137
Q

tx for hyperkalemia (5)

A

IV insulin
glucose
albuterol
Ca gluconate
lasix

138
Q

indication for imergent tx w. hyperkalemia

A

EKG changes

139
Q

EKG progression for hyperkalemia

A

peaked T waves
sine waves
wide QRS: v tach/vfib

140
Q

2 mc causes of hypokalemia

A

diuretics
cushing’s

141
Q

ekg finding of hypokalemia

A

u waves

142
Q

sx of hypokalemia (3)

A

muscle cramps
constipation
prolonged QT

143
Q

tx for hypokalemia

A

IV potassium PLUS oral potassium
replace Mg

144
Q

what type of fluid is most similar to the body’s plasma/serum concentration

A

LR

145
Q

when would you use NS 0.9% (3)

A

hydration due to vomiting/diarrhea
hemorrhage
shock

146
Q

when would you use LR

A

burn victims
hypovolemia due to fluid shifts

147
Q

D5W is _ tonic

A

hypotonic

148
Q

indication for D5W

A

DM
NPO prior to surgery

149
Q

3 contraindications for D5W

A

renal failure
cardiac compromise
increased intracranial pressure

150
Q

1/2 NS (aka 45% NS) is _ tonic

A

hypo

151
Q

indications for 1/2 NS

A

cellular dehydration:
hypernatremia
DKA

152
Q

avoid 1/2 NS in what pt pops

A

burns
trauma
depleted intravascular fluid levels

153
Q

5 causes of severe diarrhea

A

cholera
rotavirus
norovirus
DKA
burns

154
Q

dehydration causes metabolic _

A

acidosis

155
Q

tx for dehydration

A

NS 0.9%

156
Q

diabetes insipidus is caused by

A

decreased ADH:
head trauma
brain tumor
autoimmune

hyperparathyroidism

157
Q

2 drugs associated w. diabetes insipidus

A

lithium
demecloclycine

158
Q

dx for diabetes insipidus

A

fluid deprivation test

159
Q

effect of diabetes insipidus on urine osmolarity

A

low

160
Q

tx for diabetes insipidus

A

desmopressin (DDAVP)
D5W 1/2 NS

161
Q

increased ADH from pituitary gland -> inability to dilute serum through kidney excretion -> too much water in the serum

A

SIADH

162
Q

ectopic cause of SIADH

A

SCLC

163
Q

lab finding of SIADH

A

hyponatremia

164
Q

4 meds associated w. hyponatremia

A

carbamazepine
HCTZ
NSAIDs
TCAs

165
Q

tx for SIADH

A

restrict fluids
vasopressin-2 receptor agonists (tolvapatan)
demeclocycline

166
Q

what test is always required w. suprapubic/flank pain

A

UA
pregnancy test for females

167
Q

suprapubic tenderness in males always points to _ pathology (3)

A

bladder
colon
prostate

168
Q

rapid swelling of the kidney -> severe pain

A

hydronephrosis

169
Q

renal/utereal colic

A

nephrolithiasis

170
Q

do not miss for flank pain

A

aortic aneurysm

171
Q

damage to glomeruli by deposition of inflammatory proteins in as a result of immunologic response

A

glomerulonephritis

172
Q

t/f: glomerulonephritis has a good prognosis in kids and bad prognosis in adults

A

t!

173
Q

4 causes of glomerulonephritis

A

henoch-schonlein purpura
postinfectious
IgA nephropathy
hereditary

174
Q

5 sx of glomerulonephritis

A

hematuria -> cola/tea colored urine
oliguria/anuria
AM edema of face/eyes
PM edema of feet/ankles
HTN

175
Q

what lab is increased in 60-80% of post streptococcal GN

A

antistreptolysin-O

176
Q

lab value decreased with post strep GN

A

complement

177
Q

tx for GN

A

steroids
immunosuppression
limit Na/fluid
dialysis if azotemia
ACEI if chronic

178
Q

15 yo M, severe, sharp lower abd pain that radiates to left thigh, n/v - hx cryptochordism - normal vitals - scrotal exam shows diffusely tender testis, lifting of testicle does not relieve pain - loss of cremasteric reflex

A

testicular torsion

179
Q

what is this showing

A

absent blood flow -> testicular torsion

180
Q

what is this showing

A

bilateral nonattachment of testicles to gubernaculum to the scrotum -> bell clapper deformity -> increased risk for testicular torsion

181
Q

timeline for testicular torsion detorsion

A

< 6 hr: > 90% salvage rate
after 24 hr: < 10% salvage rate

182
Q

what is this showing

A

tender nodule 2-3 mm in diameter on upper pole of testicle -> blue dot deformity

183
Q

hx clue for testicular torsion

A

cryptochordism

184
Q

mc vs gs imaging for testicular torsion

A

mc: testicular doppler
gs: radionuclide scan

185
Q

tx for testicular torsion

A
  1. emergent surgery
  2. elective surgery on contralateral side (increased risk for torsion)
186
Q

ddx for hematuria

A

bladder ca
renal cell carcinoma
nephrolithiasis
acute GN
coagulation d.o
polycystic kidney dz
nephrolithiasis
UTI
pyelonephritis

187
Q

mc causes of urethritis

A

HSV - mc
CT
GC
trichomonas

188
Q

2 sx of urethritis

A

dysuria
urethral d.c

189
Q

t/f: sexually active pt w. sx of urethritis is treated presumptively for STIs

A

t!

190
Q

tx for urethritis

A

ceftriaxone 500 mg IM x 1
PLUS
doxy 100 mg po bid x 7 days (azithromycin if pregnant)

191
Q

types of hernias (7)

A

umbilical
diaphragmatic/hiatal
incisional
cystocele
rectocele
inguinal
ventral

192
Q

what type of hernia is espically associated w. obesity

A

incisional

193
Q

ventral hernias can be either _ or _

A

incisional
umbilical

194
Q

imaging for hernia

A

US

esp in male kiddo w. other scrotal masses

EOR - Emergency Medicine (13 decks)

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