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Emergency EOR > Urology/Renal > Flashcards

Urology/Renal Flashcards

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1
Q

DDX for dysuria

A 
PID
Trichomoniasis
Chlamydia / gonorrhea
UTI
Epididymitis and orchitis
Pyelonephritis
Prostatitis
Urethritis
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2
Q

DDX for hematuria

A 
Acute glomerulonephritis
Polycystic kidney disease
Cystitis
Pyelonephritis
BPH
Bladder CA
Renal cell CA
Wilms Tumor
Nephrolithiasis
Urethritis
Chlamydia
Gonorrhea
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3
Q

DDX for suprapubic/flank pain

A 
Glomerulonephritis
Nephrolithiasis
Pyelonephritis
Polycystic kidney disease
Cystitis
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4
Q

DDX for incontinence

A

Hydrocephalus
Spinal cord injury
Cauda equina
Tertiary syphilis

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5
Q

Most common types of stones in nephrolithiasis

A
  1. Calcium oxalate
  2. Calcium phosphate
    Other types: uric acid, struvite stones, cystine stones
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6
Q

Characteristics of struvite stones in nephrolithiasis

A

Staghorn appearance

Caused by urea splitting bacteria (proteus)

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7
Q

Risk factors for nephrolithiasis

A

Decreased fluid intake
Medications (loop diuretics, chemo drugs)
Gout

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8
Q

Signs/symptoms of nephrolithiasis

A

Renal colic - acute flank pain that radiates to groin
Pain over CVA
N/V
unable to find comfortable position

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9
Q

Diagnosis of nephrolithiasis

A
  1. Urinalysis - will show hematuria in 80%
  2. Non-contrast helical CT scan - test of choice
  3. KUB - will only visualize calcium stones
  4. Intravenous pyelography - gold standard
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10
Q

Treatment of nephrolithiasis < 5 mm in diameter

A

80% chance of spontaneous passage

  1. IV fluids, analgesics, antiemetics
  2. Tamsulosin - may facilitate passage
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11
Q

Treatment of nephrolithiasis > 7 mm in diameter

A

Extracorporeal shock wave lithotripsy
Ureteroscopy +/- stent
Percutaneous nephrolithotomy - used for stones > 10 mm

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12
Q

Prevention of future nephrolithiasis

A
  1. Adequate hydration
  2. Decrease animal protein intake
  3. Thiazide diuretics are used for recurrent calcium stones
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13
Q

Spermatic cord twists and cuts off testicular blood supply due to congenital malformation which allows the testicle to be free floating in the tunica vaginalis causing it to twist on itself

A

Testicular torsion

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14
Q

If nausea/vomiting if present in the setting of abrupt onset of scrotal or inguinal pain, suspect

A

Torsion

Usually absent in epididymitis

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15
Q

Physical exam signs for testicular torsion

A

Negative Prehn’s sign
Negative cremasteric reflex
Blue dot sign at upper pole
Bell clapper deformity

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16
Q

Pain relief of scrotal elevation

A

Prehn’s sign

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17
Q

Diagnosis of testicular torsion

A
  1. Testicular doppler ultrasound - best initial
  2. Emergency surgical exploration required if US unable to exclude
  3. Radionuclide scan (not used frequently)
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18
Q

Management of testicular torsion

A
  1. Detorsion and orchiopexy within 6 hours and in obvious cases (testicle fixation in the scrotum)
  2. Orchiectomy if testicle not salvageable
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19
Q

Risk factors for cystitis (women)

A

Sexual intercourse
Spermicidal use
Pregnancy
Postmenopausal

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20
Q

Risk factors for cystitis (men0

A

Rare - should have workup
> 50 y/o
BPH
Prostate CA

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21
Q

Most common etiology for cystitis

A

E. coli
Staph, saprophyticus (sexually active women)
Enterococci for indwelling catheters

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22
Q

Dysuria (burning), increased frequency, urgency, hematuria, suprapubic discomfort

A

Acute cystitis

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23
Q

Fever and tachycardia, back/flank pain, + CVAT, n/v

A

Pyelonephritis

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24
Q

Diagnosis of cystitis/pyelonephritis

A
  1. Urinalysis
  2. Dipstick
  3. Urine culture
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25
Q

If urinalysis shows WBC casts

A

Pyelonephritis

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26
Q

Indications for urine culture with cystitis/pyelonephritis

A 
Complicated UTI
Infants/children
Elderly
Males
Urologic abnormalities
Refractory to tx
Catheterized pts
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27
Q

Conservative treatment for cystitis

A

Increase fluid intake, void after intercourse

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28
Q

Management of cystitis

A
  1. Phenazopyridine (Pyridium) turns urine orange
  2. Nitrofurantoin, ciprofloxacin, bactrim, fosfomycin
  3. Pregnant: amoxicillin, augmentin
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29
Q

Management of pyelonephritis

A

Fluoroquinolones IV or PO aminoglycosides

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30
Q

Epididymal pain and swelling thought to be secondary to retrograde infection or reflux of urine

A

Epididymitis

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31
Q

Epididymitis is usually __________, while orchitis is usually ___________

A

Bacterial

Viral

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32
Q

Most common causes of orchitis and epididymitis in men < 35 y/o

A

Chlamydia, gonorrhea

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33
Q

Most common causes of orchitis and epididymitis in men > 35 y/o and children

A

Enteric organisms most common

E. coli, Klebsiella

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34
Q

1/3 of postpubertal men with __________ whave concomitant orchitis

A

Mumps

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35
Q

Gradual onset of scrotal pain, erythema and swelling. Most commonly unilateral. +/- groin or abdominal pain. Fever, chills, irritative symptoms

A

Epididymitis and orchitis

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36
Q

Relief of pain with elevation of the affected scrotum

A

Positive Prehn’s sign

Epididymitis and orchitis

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37
Q

Elevation of the testicle after stroking the inner thigh

A

Positive cremasteric reflex

Epididymitis and orchitis

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38
Q

Diagnosis of epididymitis / orchitis

A
  1. Scrotal ultrasound - increased testicular blood flow, enlarge epididymitis
  2. UA: pyuria (WBC), bacteriuria
  3. CBC: leukocytosis
  4. Urine culture
  5. STD testing
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39
Q

Symptomatic treatment for orchitis

A

Bed rest, scrotal elevation, cool compresses and analgesics (NSAIDs)

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40
Q

Management of acute epididymitis

A

Gonorrhea and chlamydia: doxycycline plus ceftriaxone IM
Enteric organisms: fluoroquinolones
Children: cephalexin or amoxicillin

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41
Q

Management of chronic epididymitis

A

4-6 week trial of abx

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42
Q

Prostate gland inflammation secondary to an ascending infection

A

Prostatitis

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43
Q

Most common causes of prostatitis when > 35 y/o

A

E. coli (MC)
Pseudomonas
Klebsiella
Proteus

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44
Q

Most common causes of prostatitis when < 35 y/o

A

Chlamydia and gonorrhea MC

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45
Q

Most common cause of chronic prostatitis

A

E. coli
Enterococci
Trichomonas

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46
Q

Fever/chills, malaise, arthralgias, irritative and obstructive urinary symptoms, lower back/abdominal pain, perineal pain

A

Prostatitis

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47
Q

Chronic prostatitis usually presents as:

A

Recurrent UTIs

Intermittent dysfunction

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48
Q

Physical exam for acute prostatitis

A

Exquisitely TENDER, normal or hot, boggy prostate

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49
Q

Physical exam for chronic prostatitis

A

Usually non tender boggy prostate

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50
Q

Diagnosis of prostatitis

A
  1. Urinalysis and urine culture
  2. Avoid prostate massage in acute prostatitis
  3. Transrectal ultrasound
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51
Q

Management of acute prostatitis > 35 y/o

A

Fluoroquinolones or TMP-SMZ

If hospitalized, IV fluoro

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52
Q

Management of acute prostatitis < 35 y/o

A

Tx for gonorrhea and chlamydia

Ceftriaxone plus Doxy/Azithro

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53
Q

Management of chronic prostatitis

A

Fluoroquinolones, TMP-SMZ

Transurethral resection of the prostate for refractory chronic prostatitis

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54
Q

Most common cause of urethritis in men < 30 y/o

A

Gonorrhea

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55
Q

Anal, vaginal, penile or pharyngeal discharge, may cause septic arthritis

A

Urethritis and cervicitis - gonorrhea

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56
Q

Culture shows gram negative diplococci in polymorphonuclear leukocytes

A

gonorrhea

57
Q

Management of gonorrhea

A

Ceftriaxone IM plus doxy or azithromycin

58
Q

Purulent or mucopurulent discharge, pruritus, dysuria, dyspareunia, hematuria

A

Urethritis - chlamydia

59
Q

Most common causes of urethritis

A

Chlamydia

Gonococcal (2nd most common)

60
Q

Urethritis with abrupt onset of symptoms (especially within 3-4 days). Opaque, yellow, white, or clear thick discharge, pruritus

A

Gonococcal urethritis

61
Q

Urethritis of 5-8 days with purulent or mucopurulent discharge, pruritus. Hematuria, pain with intercourse

A

Chlamydia urethritis

62
Q

Complications of men with urethritis

A

Epididymitis, prostatitis, infertility, reactive arthritis

63
Q

Complications of women with urethritis

A

Pelvic inflammatory disease, infertility, ectopic pregnancy, premature delivery, septic arthritis

64
Q

Diagnosis of urethritis

A

Nucleic acid amplification

65
Q

Acute renal failure is described as: (2)

A
  1. Increased serum creatinine > 50% OR

2. Increased BUN (azotemia)

66
Q

Phases of AKI

A
  1. Oliguric phase (decreased urine output, hyperkalemia, azotemia, metabolic acidosis)
  2. Diuretic phase (increased urine output, hypotension, hypokalemia)
  3. Recovery
67
Q

3 types of acute renal failure

A
  1. Prerenal (rapidly reversible)
  2. Postrenal (rapidly reversible)
  3. Intrarenal
68
Q

Causes of prerenal acute renal failure

A

Reduced renal perfusion

Hypovolemia

69
Q

Management of prerenal acute renal failure

A

Volume repletion to restore volume and renal perfusion (rapidly responds to tx)

70
Q

Causes of postrenal acute renal failure

A

Obstruction of the passage of urine (stones, BPH)

71
Q

Management of postrenal acute renal failure

A

Removal of obstruction

72
Q

Cause of intrinsic acute renal failure

A

Direct kidney damage - nephrotoxic, cytotoxic, prolonged ischemic, inflammatory insults to the kidney
Structural/functional nephron damage (cellular cast formation) - hallmark

73
Q

Most common type of intrinsic acute renal failure

A

Acute Tubular Necrosis

74
Q

Overall cause of intrinsic acute renal failure

A

NSAIDs, contrast, aminoglycosides, infections, penicillins, sulfa drugs, ciprofloxacin, allopurinol, etc.

75
Q

Management of intrinsic acute renal failure

A

Remove offending agents
IV fluids
Furosemide if p euvolemic and not urinating
If glomerulonephritis - give corticosteroids

76
Q

Immunologic inflammation of the glomeruli causing protein and RBC leakage into the urine

A

Glomerulonephritis

77
Q

HTN, hematuria (RBC casts), dependent edema (proteinuria), and azotemia (nitrogen in blood) are hallmarks

A

Glomerulonephritis

78
Q

Types of glomerulonephritis

A
  1. IgA Nephropathy (Berger’s Dz)
  2. Post infectious
  3. Membranoproliferative / Mesangiocapillary
  4. Rapidly progressive
  5. Goodpasture’s dz
  6. Vasculitis
79
Q

Most common cause of acute glomerulonephritis in adults worldwide

A

IgA nephropathy (Berger’s dz)

80
Q

Glomerulonephritis that often affects young males within days (24-48 hours) after URI or GI infection

A

IgA nephropathy

81
Q

Diagnosis of IgA nephropathy

A

IgA mesangial deposits on immunostaining

82
Q

Management of IgA nephropathy

A

ACEI +/- corticosteroids

83
Q

Glomerulonephritis that is most common after GABHS

A

Post infectious

84
Q

Glomerulonephritis that classically presents as a 2-14 yo boy with facial edema up to 3 weeks after Strep with scanty, cola-colored dark urine (hematuria and olguria)

A

post infectious glomerulonephritis

85
Q

Diagnosis of post infectioius glomerulonephritis

A 
Increased antistreptolysin (ASO) titers, low serum complement
Biopsy: hypercellularity, increased monocytes/lymphocytes, immune humps
86
Q

Management of post infectious glomerulonephritis

A

Supportive, +/- antibiotics

87
Q

Glomerulonephritis due to SLE, viral hepatitis (HCV, HBV), hypocomplementemia, cryoglobulinemia

A

Membranoproliferative / mesangiocapillary glomerulonephritis

88
Q

Glomerulonephritis associated with poor prognosis (progresses to end stage renal failure within weeks/months)

A

Rapidly progressive glomerulonephritis (RPGN)

89
Q

Crescent formation on biopsy

A

Rapidly progressive glomerulonephritis

Due to collapse of crescent shape of Bowman’s capsule

90
Q

Management of rapidly progressive glomerulonephritis

A

Corticosteroids + cyclophosphamide

91
Q

Two types of glomerulonephritis that only present with RPGN:

A

Goodpasture’s disease

Vasculitis

92
Q

Glomerulonephritis with + anti-GBM antibodies

A

Goodpasture’s disease

93
Q

Diagnosis of goodpasture’s disease

A

Linear IgG deposits

94
Q

Management of goodpasture’s disease

A

High dose corticosteroids + cyclophosphamide + plasmapheresis

95
Q

Glomerulonephritis that is characterized by lack of immune deposits and + ANCA antibodies

A

Vasculitis

Can either have p-ANCA or C-ANCA

96
Q

The presence of ______________ in nephritis distinguishes nephritic from nephrotic

A

Gross hematuria

97
Q

Signs/Symptoms of glomerulonephritis

A 
Hematuria
Edema
HtN
Fever, abdominal pain, flank pain 
Oliguria
98
Q

Diagnosis of glomerulonephritis

A
  1. Urinalysis
  2. Increased BUN, creatinine
  3. Renal biopsy gold standard
99
Q

Proteinuria, hypoalbuminemia, edema, hyperlipidemia

A

Nephrotic syndrome

100
Q

Edema is the predominant feature in:

A

Nephrotic syndrome

101
Q

Diagnosis of nephrotic syndrome

A
  1. Urinalysis - protein > 3.5

2. Biopsy - hypocellular

102
Q

Complications of nephrotic syndrome

A

Transudative pleural effusion
DVTs
Frothy urine

103
Q

Disorder that may cause hypernatremia

A

Diabetes insipidus

104
Q

In surgical patients, hypernatremia may result from

A

Loop diuretics

Also from gastrointestinal losses

105
Q

In the acute setting, rapid hypernatremia can cause

A

Intracerebral hemorrhage

106
Q

Causes of hypervolemic hyponatremia - patient will usually have edema

A

Renal failure
CHF
COPD
Severe liver disease

107
Q

Causes of normovolemic hyponatremia

A

SIADH

108
Q

Causes of hypovolemic hyponatremia

A 
Renal losses of sodium
Diuretic use
Aldosterone deficiency
Renal failure
Subarachnoid hemorrhage
109
Q

Treatment of hypervolemic hyponatremia

A

Volume restriction and loop diuretic

110
Q

Treatment of normovolemic hyponatremia

A

SIADH - fluid restriction

111
Q

How do you correct hypernatremia?

A

D5W

112
Q

Treatment of hypovolemia hyponatremia

A

Salt and water replacement

113
Q

Should not increased serum sodium concentration faster than _________ mEq/L/hr

A

0.5

114
Q

Hyperkalemia can result from

A

Renal or adrenal insufficiency
Metabolic acidosis
Iatrogenic causes

115
Q

Most important results of severe hyperkalemia

A

Myocardial effects
Peaked T wave is first sign
Finally: complete heart block, ventricular tachycardia, cardiac standstill can occur

116
Q

Treatment of hyperkalemia

A

10-20 mL of 10% calcium gluconate
Can give Kayexalate (takes longer)
Most effect method: hemodialysis

117
Q

Hypokalemia is common in surgical pts due to :

A

GI losses - vomiting, diarrhea, fistula

Use of diuretics

118
Q

Treatment for hypokalemia

A
  1. Oral potassium unless severe or pt is symptomati
119
Q

Treatment for hypercalcemia (when not due to parathyroidism)

A

Saline diuresis
Furosemide
Calcitonin - reduces bone resorption

120
Q

Signs of hypocalcemia

A

Trousseau’s

Chvostek Sign

121
Q

Trousseau’s Sign

A

Seen in hypocalcemia

BP cuff inflated - spasm in muscles of hand/forearm

122
Q

Chvostek Sign

A

Seen in hypocalcemia

Tap facial nerve - twitch on same side of face

123
Q

Treatment of hypocalcemia if symptomatic/severe

A

IV calcium therapy

124
Q

Diseases that cause hypermagnesemia

A

Renal failure

Addison’s disease

125
Q

Treatment for hypermagnesemia

A

Calcium infusion followed by immediate dialysis

126
Q

In surgical pts, hypomagnesemia is a result of

A

GI losses

Reduced absorption

127
Q

Treatment for hypomagnesemia

A

Magnesium infusion

If treatment not urgent, give oral supplements

128
Q

Most common causes of hyperphosphatemia

A

Renal insufficiency

129
Q

Treatment of hyperphosphatemia

A

Treat underlying renal failure

Phosphate-binding antacids

130
Q

Treatment of hypophosphatemia

A

Oral or parental phosphate

131
Q

Metabolic acidosis formula

A

Decreased pH
Decreased bicarb
Decreased CO2

132
Q

Metabolic alkalosis formula

A

Increased pH
Increased bicarb
Increased CO2

133
Q

Respiratory acidosis formula

A

Decreased pH
Increased bicarb
Increased CO2

134
Q

Respiratory alkalosis formula

A

Increased pH
Decreased bicarb
Decreased CO2

135
Q

An anion gap over _____ is considered an elevated anion gap

A

12

136
Q

MUDPILERS

A 
Methanol
Uremia
Diabetic/alcoholic ketoacidosis
Paraldehyde/propylene glycol
Isoniazid / iron
Lactic acidosis
Ethylene glycol
Rhabdomyolysis
Salicylates
137
Q

When can you treat an acidotic pt with sodium bicarb?

A

If pH < 7.2
Life-threatening ventricular arrhythmia
Inadequate compensatory response

138
Q

Risks fo sodium bicarbonate therapy

A

Hypernatremia
Hyperosmolarity
Volume overload

Emergency EOR (12 decks)

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