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EOR - Internal Med > Urology/Renal > Flashcards

Urology/Renal Flashcards

1
Q

average acid base values

A

“24/7 40/40”

HCO3: 24
pH: 7.40
CO2: 40

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2
Q

7 causes of renal vascular dz

A

DM - mc
htn
smoking
renal a stenosis
glomerular dz
renal cysts
AI/SLE/PCKD/alport’s

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3
Q

presentation of ARF/AKI (3)

A

rapid decline in renal fxn:

elevated SCr
decreased GFR
elevated BUN (azotemia)

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4
Q

3 types of ARF/AKI

A

prerenal
intrinsic
postrenal

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5
Q

causes of prerenal ARF/AKI

A

decreased kidney perfusion -> loss of peripheral vascular resistance:

hypovolemia - mc
nsaids
IV contrast
ACEI
ARBs

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6
Q

t/f: w. prerenal failure, the nephrons remain intact

A

t!

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7
Q

6 sx of prerenal AKI

A

weak
decreased urine output
dizzy
sunken eyes
tachy
orthostatic

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8
Q

lab findings associated w. prerenal AKI

A

FEN: normal
urine SpGr: > 1.030
BUN/Cr: > 20
Urine Osm: > 500

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9
Q

tx for prerenal AKI

A

fluids
BP support

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10
Q

5 causes of intrinsic renal failure

A

drugs
tumor lysis syndrome
vasculitis (SLE/sarcoidosis)
gout
rhabdo

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11
Q

2 nephrotoxic drugs

A

aminoglycosides
cyclosporine

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12
Q

hallmark finding of intrinsic AKI

A

RBC casts

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13
Q

types of cast and associated condition

A

RBC: glomerulonephritis
WBC: pyelonephritis
muddy/brown: ATN
waxy: CKD
hyaline: normal

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14
Q

lab findings of intrinsic ARF/AKI

A

urine SpGr: < 1.010
Bun/Cr: < 10
Urine Osm: < 300

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15
Q

tx for intrinsic AKI

A

IVF
+/- diuretics

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16
Q

mcc of obstructive/postrenal AKI

A

BPH

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17
Q

4 all causes of postrenal AKI

A

BPH
stones
tumors
congenital abnl

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18
Q

tx for postrenal AKI

A

catheter
US
remove obstruction vs fix abnl

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19
Q

US finding of postrenal AKI

A

hydronephrosis

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20
Q

3 types of intrinsic AKI

A

ATN
interstitial nephritis
glomerulonephritis

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21
Q

causes of ATN

A

ischemia
toxins

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22
Q

why is FENa elevated with ATN

A

damaged tubules can concentrate urine

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23
Q

what is FENa

A

fractional excretion of sodium

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24
Q

FENa < 1% suggests _
FENa > 1% suggests _

A

< 1%: prerenal
> 2%: ATN

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25
Q

lab findings associated w. ATN

A

FENa: >2%
urinary sodium: >40
BUN/Cr: <20
Urine osmo: <350

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26
Q

mcc of ATN

A

prerenal failure

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27
Q

5 drugs associated w. ATN

A

amp B
cisplatin
aminoglycosides
nsaids
ACEI

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28
Q

ATN triad

A

FENa > 2%
muddy brown casts
low urine Osm

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29
Q

interstitial nephritis triad

A

wbc casts
eosinophilia
hematuria

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30
Q

interstitial nephritis is caused by a _ reponse

A

immune mediated

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31
Q

5 drugs associated w. interstitial nephritis

A

5 p’s:
pee (diuretics)
pain free (nsaids)
pcn’s/cephalosporins
ppi’s
rifamPin

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32
Q

dx for interstitial nephritis

A

renal bx

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33
Q

management of interstitial nephritis

A

usually self limited
steroids
+/- dialysis

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34
Q

3 types of GN

A

IgA nephropathy
postinfectious
membranoproliferative

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35
Q

GN triad

A

hematuria
htn
periorbital edema

also: oliguria, hematuria, RBC casts

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36
Q

4 causes of GN

A

GAS
IgA
anti-GBM
ANCA

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37
Q

mcc of acuteGN

A

post streptococcal: skin vs pharyngitis

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38
Q

ckd is defined as ongoing loss of kidney fxn w. GFR < _ for _ months

A

60
3 months

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39
Q

gs dx for ckd

A

cockroft gault

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40
Q

3 causes of ckd

A

DM
HTN
GN

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41
Q

5 sx of CKD

A

fatigue
pruritis
kussmaul respirations
asterixis
muscle wasting

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42
Q

what stage ckd indicates need for dialysis

A

4

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43
Q

bp goal for ckd pt

A

130/80

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44
Q

all ckd pt’s should be on what med for bp control

A

ACEI or ARB

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45
Q

lab findings for ckd (3)

A

hypocalcemia
hyperphosphatemia
metabolic acidosis

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46
Q

62 yo M w. sudden onset fever and rash - recently started omeprazole - labs: SCr 3.5, eosonophilia, WBC casts

A

acute interstitial nephritis

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47
Q

2 drugs to avoid in pt’s w. BPH

A

anticholinergics
antihistamines

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48
Q

t/f: BPH is a precursor to prostate ca

A

f!

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49
Q

PE finding of BPH

A

enlarged rubbery prostate

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50
Q

PSA < _ is associated w. BPH

A

4

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51
Q

lifestyle management of bph (2)

A

decrease nighttime fluids
avoid caffeine/etoh

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52
Q

3 classes of bph meds

A

-alpha adrenergic receptor blockers: terazosin, tamsulosin
-5 alpha reductase inhibitors: finasteride
-phosphodiesterase-5 enzyme inhibitors: tadalafil

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53
Q

which prostate med decreases DHT synthesis and actually reduces prostate gland size

A

5 alpha reductase inhibitors: finasteride

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54
Q

what is DHT

A

dihydrotestosterone

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55
Q

moa for terazosin/tamsulosin

A

decrease prostate/bladder/urethral muscle tone

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56
Q

moa for tadalafil

A

induce smooth m relaxation

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57
Q

what surgery is used for bph

A

TURP (transurethral resection of the prostate)

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58
Q

2 s.e of TURP

A

sexual dysfxn
urinary incontinence

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59
Q

smoker w. gross hematuria

A

bladder ca

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60
Q

mc type of bladder ca

A

transitional cell carcinoma

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61
Q

gs dx for bladder ca

A

cystoscopy w. bx

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62
Q

tx for bladder ca

A

surgery
biologics
chemo

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63
Q

25 yo M w. a few days of gradually worsening dull, achy scrotal pain, dysuria, and a swollen right testicle - UA positive for leuks

A

epididymitis

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64
Q

unilateral swollen testicle w. induration

A

epididymitis

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65
Q

epididymitis is acquired by

A

retrograde spread of organisms through the vas deferens

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66
Q

mcc of epididymitis based on age

A

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

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67
Q

epididymitis pain radiates to the

A

ipsilateral flank

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68
Q

what PE sign is associated w. epididymitis

A

prehn sign: pain w. relief of scrotal elevation

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69
Q

tx for epididymitis (3)

A

bed rest
scrotal elevation
analgesics
abx

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70
Q

abx for epididymitis based on age

A

< 35: ceftriaxone + doxy
> 35: levofloxacin vs bactrim

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71
Q

6 causes of ED

A

psychological
HTN
DM
hormonal dysfxn
meds
nocturnal penile tumescence

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72
Q

tx for ED

A

wt loss
smoking/etoh cessation
hormone replacement
vacuum erection devices
surgery

73
Q

what ed med should you never use with nitrates due to risk of life threatening hypotn

A

pde 5’s: tadalafil, vardenafil, sildenafil

74
Q

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

A

glomerulonephritis

75
Q

what lab is elevated in a majority of PSGN cases

A

antistreptolysin-O titer

76
Q

is serum complement increased or decreased w. GN

A

decreased

77
Q

tx for GN

A

steroids
immunosuppressants
decrease salt/fluids
+/- dialysis

78
Q

fluid filled sac around a testicle

A

hydrocele

79
Q

hydrocele is mc in what 2 pt pops

A

newborns
older men

80
Q

PE finding of a hydrocele

A

mass transilluminates

81
Q

tx for hydrocele

A

obs
usually self resolves

82
Q

4 causes of hydronephrosis

A

blockage in the ureter:
stone
bph
blood clot
tumor

83
Q

6 causes of hypervolemia

A

iatrogenic
CHF
nephrotic syndrome
cirrhosis
ESR
hypoalbuminemia

84
Q

5 PE findings associated w. hypervolemia

A

weight gain
peripheral edema
ascites
JVD
pulmonary rales

85
Q

gs dx for fluid status

A

pulmonary a catheter (swan-ganz) to measure CVP

86
Q

causes of hypovolemia

A

decreased thirst
GI/urinary fluid loss
burns
diuretics
osmotic diuresis
hyperglycemia
sodium excess
diabetes insipidus

87
Q

PE findings associated w. hypovolemia

A

weakness/fatigue/apathetic
tachycardia
postural hypotn
dry mm
decreased skin turgor
hypothermia
pale extremities
oliguria

88
Q

2 types of diabetes insipidus

A

neurogenic (central)
nephrogenic

89
Q

neurogenic diabetes insipidus is caused by

A

deficient vasopressin/ADH secretion from post pit

90
Q

nephrogenic diabetes insipidus is caused by

A

unresponsive kidneys to normal ADH levels

91
Q

3 causes of nephrogenic diabetes insipidus

A

inherited x linked
lithium
renal dz

92
Q

hallmark finding of diabetes insipidus

A

urine osmo < 250 in setting of hypernatremia

93
Q

management of diabetes insipidus

A

isotonic fluid bolus (NS vs LR)
replace blood loss w. crystalloid
maintenance D5/NS + KCl

94
Q

goal urine output for diabetes insipidus

A

0.5-1.0 mL/kg/hr

95
Q

consequence of rapid fluid replacement w. diabetes insipidus

A

pulmonary edema

96
Q

basic difference between nephrotic vs nephritic syndrome

A

nephrotic: protein loss
nephritic: blood loss

97
Q

nephritic syndrome is caused by

A

inflammation that damages the glomerular basement membrane

98
Q

hallmark finding of nephritic syndrome

A

hematuria
RBC casts

99
Q

3 sx of nephritic syndrome

A

low urine output
sodium retention -> htn
peripheral/periorbital edema

100
Q

4 lab findings of nephritic syndrome

A

elevated BUN/Cr
hematuria
proteinuria
RBC casts

101
Q

dx for nephritic syndrome (2)

A

24 hr urine protein collection: < 3.5 g/day
renal bx

102
Q

3 different classes of nephritic syndrome causes

A

type III hypersensitivity
multifactorial
alport syndrome

103
Q

3 type III hypersensitivity causes of nephritic syndrome

A

PSGN
diffuse proliferative GN (SLE)
IgA (berger’s dz)

104
Q

2 multifactorial causes of nephritic syndrome

A

menbranoproliferative GN (MPGN)
rapidly progressive GN (RPGN)

105
Q

what cause of nephritic syndrome is associated w. collagen synthesis

A

alport syndrome

106
Q

management of nephritic syndrome

A

salt/fluid restriction
ACEI/ARB
IgA: steroids
RPGN: immunosupressants
PSGN: ccs instead of ACE/ARB

107
Q

inflammation of the kidneys that may involve glomeruli, tubules, or interstitial tissue surrounding glomeruli and tubules

A

nephritis

108
Q

mcc of nephritis

A

AI

109
Q

nephritis caused by inflammation from a UTI that reaches the renal pelvis

A

pyelonephritis

110
Q

otherwise healthy 45 yo M w. painless hematuria x 3 days - no PMH stones or UTIs - fam hx of htn at a young age - PE positive for bilat non tender flank masses

A

ADPCKD (autosomal dominant polycystic kidney dz)

111
Q

ADPCKD is caused by a mutation of what gene

A

PKD1/PKD2

112
Q

ADPCKD involves numerous cysts in the kidneys made of

A

epithelial cells from renal tubules

113
Q

sequale of ADPCDK

A

kidney failure/ESRD

114
Q

classic presentation of ADPCKD

A

young
back/flank pain
htn

115
Q

3 cardiac complications associated w. ADPCKD

A

brain aneurysms
MVP
LVH

116
Q

what is this showing

A

multiple fluid filled cysts -> ADPCKD

117
Q

management of ADPCKD

A

no cure -> supportive
ACEI/ARB
dialysis/transplant

118
Q

mc location for prostate ca

A

peripheral zone

119
Q

PE finding of prostate ca

A

DRE: hard, irregular, nodular prostate

120
Q

PSA > 4 makes you think of (3)

A

bph
prostate ca
prostatitis

121
Q

prostate ca screening recs

A

55-69 yo: +/- annual PSA
>70: USPSTF recommends against screening

122
Q

2 indications for TRUS (transrectal US)

A

PSA > 10, regardless of DRE findings
abnormal DRE, regardless of PSA

123
Q

management of PSA <4.0-10.0

A

<4.0: PSA annually based on pt preference
4.1-10.0: bx

124
Q

ascending infxn of gram negative rods into prostatic ducts

A

prostatitis

125
Q

presentation of acute prostatitis

A

sudden onset:
f/c
lbp
frequency/urgency/dysuria/obstruction

126
Q

presentation of chronic prostatitis

A

irritative bladder symptoms/obstruction
+/- other symptoms

127
Q

all forms

A
128
Q

prostatic fluid findings associated w. prostatitis

A

leukocytosis
acute: e.coli
chronic: enterococcus

129
Q

what PE exam is contraindicated if you suspect prostatitis

A

DRE -> can lead to sepsis!

130
Q

pathogen associated w. prostatitis: < 35 vs > 35

A

< 35: CT/GC
> 35: e.coli, pseudomonas

131
Q

tx for prostatitis: < 35 vs > 35 vs chronic

A

< 35: ceftriaxone PLUS doxy
> 35: fluoroquinolones vs bactrim, test of cure
chronic: fluoroquinolones vs bactrim x 6-12 weeks

132
Q

what should you do if fever w. prostatitis hasn’t resolved w.in 36 hr

A

suspect abscess -> consult urology

133
Q

organism mc associated w. pyelonephritis

A

e.coli

134
Q

tx for pyelo: outpt vs inpt

A

outpt: FQ vs bactrim x 1-2 weeks
inpt: IV FQ vs 3rd/4th gen cephalosporins vs gentamicin

135
Q

colicky flank pain radiating to the groin, hematuria, n/v

A

nephrolithiasis

136
Q

gs dx for nephrolithiasis

A

abd/pelvis spiral CT w.o contrast

137
Q

4 types of kidney stones

A

calcium oxalate - mc
struvite
uric acid
cystine

138
Q

what condition do calcium oxalate stones make you think of

A

hyperparathyroidism

139
Q

what beverage should pt’s w. calcium oxalate stones avoid

A

grapefruit juice

140
Q

what type of kidney stone is associated w. chronic UTI

A

struvite

141
Q

what 2 pathogens do struvite stones make you think of

A

klebsiella
proteus

142
Q

young boy with kidney stones probs has what type of stone

A

cystine

143
Q

general management of kidney stones

A

outpt for most
analgesia
hydration
abx if UTI
alpha blockers (tamsulosin)
+/- lithotripsy

144
Q

3 indications for hospitalization w. kidney stones

A

refractory pain despite meds
anuria
UTI and/or fever

145
Q

you should consider lithotripsy for stones > _ mm

A

5

146
Q

gs management of kidney stones > 10 mm

A

nephrostomy

can also consider stent

147
Q

renal cell carcinoma triad

A

hematuria
flankl pain
palpable abd mass

148
Q

2 mc types of renal cell carcinoma

A

1. clear cell
2. transitional cell

149
Q

rf to know for renal cell carcinoma

A

smoking

150
Q

dx for renal cell carcinoma

A
  1. US vs CT
  2. bx
151
Q

tx for renal cell carcinoma

A

nephrectomy

152
Q

narrowing of one or both renal arteries mc caused by atherosclerosis or fibromuscular dysplasia

A

renal artery stenosis

153
Q

presentation of renal a stenosis

A

<30 yo
HTN + CAD/PVD
HTN resistant to 3+ drugs

154
Q

pt placed on ACEI who develops acute renal failure or a sharp rise in BUN/Cr

A

renal a stenosis

155
Q

dx for renal a stenosis: initial vs gs

A

initial: US
gs: renal arteriography

156
Q

tx for renal a stenosis

A

percutaneous transluminal angioplasty (PTA) PLUS stent vs bypass

157
Q

15 yo M w. severe/sharp lower abd pain radiating to left thigh - associated vomiting - no f/c or dysuria - single elevated left testis that is diffusely tender

A

testicular torsion

158
Q

what is the bell clapper deformity

A

bilat nonattachment of the testicles by the gubernaculum to the scrotum

159
Q

how much time do you have to detorse a testicle

A

ideally: <6 hr
>24 hr = < 10% chance of salvaging testicle

160
Q

how would you differentiate btw torsion and epididymitis on PE

A

epididymitis: (+) prehn sign
torsion: absent cremaster reflex

161
Q

what is this showing

A

blue dot sign -> tender nodule on upper pole -> torsion

162
Q

PMH clue for torsion

A

cryptochordism

163
Q

management of testicular torsion

A

emergency surgery
elective surgery for contralateral teste

164
Q

UTI is infection of

A

kidneys, bladder, or urethra

165
Q

mc pathogen associated w. UTI

A

e.coli

166
Q

gs dx for UTI

A

urine culture

167
Q

tx for UTI

A

uncomplicated: nitro, bactrim, fosfomycin
complicated: cipro
postcoital: bactrim vs keflex, single dose
pregnant: nitro vs keflex

168
Q

hunner’s ulcer on cystoscopy

A

intersitial cystitis

169
Q

UTI symptoms that are relieved w. voiding

A

interstitial cystitis

170
Q

enlargement of the veins w.in the scrotum

A

varicocele

171
Q

what is this showing

A

varicocele

172
Q

varicocele involves dilation of the _ plexus

A

pampiniform

173
Q

2 causes of varicocele

A

poorly functioning valves
vein compression

174
Q

if a varicocle is symptomatic, how may it present

A

low sperm production/quality -> infertility

175
Q

how does a varicocele look on PE

A

bag of worms

176
Q

varicocele is worse when the pt is _ and relieved when the pt is _

A

worse: upright
relieved: supine

177
Q

varicocele is mc on what side

A

left

178
Q

tx for varicocele

A

surgery if symptomatic

EOR - Internal Med (13 decks)

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