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comp 3 - nephro/uro
Nova Orlando
156
Health Care
Graduate
05/06/2011

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Cards

Term
collection of fluid between the two layers of the tunica vaginalis
Definition
hydrocele
Term
when is a hydrocele MC?
Definition
first year of life
Term
what scrotal masses transilluminate?
Definition
hydrocele, spermatocele
Term
tx of hydrocele
Definition
watchful waiting, can refer for surgery if symptomatic.
Term
what should never be done to a hydrocele?
Definition
aspiration
Term
what diagnostic test should you do if you unsure about the state of a testicle?
Definition
ultrasound
Term
engorgement of the internal spermatic veins above the testis, results from incompetence of the venous valves of the internal spermatic venous system
Definition
varicocele
Term
MC site of a varicocele
Definition
left side
if soley on the right side consider retroperitoneal or renal mass.
Term
bag of worms
Definition
varicocele
Term
where do the L and R spermatic veins empty?
Definition
L = L renal vein
R = inferior vena cava
Term
what happens to a varicocele when the pt is supine?
Definition
it should diminish or disappear
Term
can a unilateral varicocele affect both testes?
Definition
yes
Term
complication of varicocele
Definition
can lead to infertility
Term
tx of varicocele
Definition
reassurance esp if asx, left sided, and has had for a long time.
watchful waiting.
surgery if associated with infertility or pain.
Term
cryptorchidism
Definition
undescended testicle
Term
increased risk of what with cryptorchidism?
Definition
infertility and testicular malignancy (seminoma)
Term
tx of cryptorchidism
Definition
surgery by 1 yo,
according to urology notes most will descend by 3 months.
Term
most cases of epididymitis are?
Definition
infectious
Term
MCC of epididymitis in pts < 40? > 40?
Definition
< 40 = STD due to chlamydia or gonorrhea
> 40 = non STD, gram negative rod/UTI
Term
urethritis (pain and discharge), cysitis (frequency, urgency, dysuria), fever, scrotal swelling
Definition
epididymitis
Term
tx of epididymitis
Definition
supportive: bed rest, scrotal eval
abx: STD = ceftriaxone, doxy x 10-21d
non STD = bactrim, erythro, flouroquinalone x 21-28d
Term
inflammation of the prostate gland
Definition
prostatitis
Term
difference between acute and chronic prostatitis
Definition
acute = bacterial infection
chronic = presents as intermittent UTI's
Term
causes of orchitis (3)
Definition
coxsackie B, mumps, trauma
Term
MC complications after mumps in adolescents and adults
Definition
orchitis
Term
typically follows parotitis infx within 8 days, abrupt onset fever, chills, nausea, abd pain, testicle becomes swollen and tender
Definition
orchitis
Term
tx of orchitis
Definition
supportive with pain control, 1/3 of affected testicles will atrophy, infertility is rare
Term
hernia within the scrotum is usually a
Definition
indirect inguinal hernia
Term
always document what about hernias?
Definition
if they are reducible or not
Term
tx of inguinal hernia
Definition
surgery, support belt
refer to GU/general surgery
educate the pt
Term
twisting of the testis and spermatic cord resulting in ischemia
Definition
testicular torsion
Term
peak ages for testicular torsion
Definition
14 yo
neonates
Term
difference between intravaginal and extravaginal testicular torsion
Definition
intravaginal = within tunica vaginalis
extravaginal = involves twisting testis, cord, and processes vaginalis (often in newborns)
Term
diagnostic test for testicular torsion
Definition
doppler US
Term
diagnostic test for UTI
Definition
urine culture
Term
diagnostic indicator of acute cystitis
Definition
UA = pyuria, bacteriuria, varying degrees of hematuria
Term
pt loses urine at all times and in all positions
Definition
total incontinence
Term
tx of total incontinence
Definition
surgery
Term
loss of urine associated with activites that result in an increase in intra-abdominal pressure
Definition
stress incontinence
Term
does a pt with stress incontinence leak urine when supine?
Definition
no
Term
what type of incontinence is most common in multiparous women or status post pelvic surgery
Definition
stress
Term
what is the position of the bladder on lateral stress cystogram for a pt with stress incontinence?
Definition
bladder neck will descend below the midportion of the pubic symphysis
Term
tx of stress incontinence
Definition
surgery "sling" (highest cure rate)
kegal exercises
post menopausal = estrogen cream
Term
overactive bladder is also known as
Definition
urge incontinence
Term
uncontrolled loss of urine that is preceded by a strong, unexpected urge to void
Definition
urge incontinence
Term
is urge incontinence related to position or activity
Definition
no
Term
what conditions are commonly associated with urge incontinence (2)
Definition
inflammatory conditions, neurogenic bladder
Term
tx of urge incontinence
Definition
anticholinergic meds (oxytuinin, tolterodine, darifenacin, trospoum chloride, festerodine fumarate, solifenacin succinate)
tricyclic antidepressants (imipramine)
botulism toxin
toilet re-training
Term
results from chronic urinary retention
Definition
overflow incontinence
Term
causes of urinary retention (4)
Definition
BPH
urethral strictures
neurogenic bladder
meds (psychotropics)
Term
tx of overflow incontinence
Definition
placement of urethral catheter (dx and therapeutic), further tx directed at underlying disease
Term
oligospermia
Definition
< 20 million sperm/ml of ejactulate
Term
azoospermia
Definition
absence of sperm
Term
how long should you wait between semen analysis?
Definition
60 days
Term
how long does spermatogenesis take?
Definition
74 days
Term
consistent inability to maintain an erect penis with sufficient rigidity to allow sexual intercourse
Definition
erectile dysfunction
Term
wha tis the MCC of ED?
Definition
organic
Term
if the pt wakes up with an erection what is the cause of his ED?
Definition
psychogenic
Term
orgnanic causes of ED (3)
Definition
smoking, alcohol, diabetes
Term
endocrine causes of ED (3)
Definition
hypogonadism, hyperthyroidism, elevated prolactin
Term
neurological causes of ED (3)
Definition
spinal cord lesions, MS, autonomic neuropathy
Term
pelvic surgery causes of ED (2)
Definition
bladder neck, prostate
Term
radiotherapy causes of ED (5)
Definition
PVD
renal/hepatic fialure
BPH
penile abnormalities (post priapism)
Peyronie's disease
Term
causes of drug induced ED (8)
Definition
antihypertensives (BB, diuretics)
digoxin
major tranquilizers
alcohol
estrogen
antidepressants
cimetidine
steroids
Term
risk factors for ED (15)
Definition
males over age 40, DM, dyslipidemia, HTN
psychological conditions
neurologic disease
renal failure
previous prostate cancer tx
previous groin trauma
hormonal d/o (thyroid, adrenal, pituitary)
drug use, smokers, alcoholics
obesity, sedentary lifestyle
Term
meds associated with ED (9)
Definition
BB
thiazide diuretics, spirinolactone
clonidine
doxazosin, terazosin
antidepressants
cimetidine
ketoconazole
Term
normal testicular size
Definition
2.5 x 4.5 cm
Term
what test is done to differentiate between organic and psychologic ED?
Definition
nocturnal tumescence testing = injection of alprostadil
Term
tx of psychogenic ED
Definition
behaviorally oriented sex therapy
Term
tx for ED pts with venous disorder of the penis who fail to achieve erection with vasoactive substance injection
Definition
vacuum constriction device
Term
how long should PDE-5 inhibitors be taken before sex?
Definition
1 hour
Term
contraindications to PDE-5 inhibitors
Definition
nitrates, alpha blockers
Term
oral ED meds
Definition
sildenafil, vardenafil, tadalafil, yohimbine
Term
what BPH and ED meds can be taken together?
Definition
tamsulosin (flomax) and tadalafil (cialis)
Term
SE of PDE-5 inhibitors (5)
Definition
hypotension
temporary color vision disturbances
mild HA
facial flushing
priapism
Term
what are the basics of ED tx (5)
Definition
regular exercise
healthy diet
smoking cessation
decrease alcohol intake
limit long distance cycling or change seat
Term
what is often the first indication of renal disease?
Definition
proteinuria
Term
what leads to increased urinary levels of urobilinogen and billirubin
Definition
hemolytic processes, or hepatic disease
Term
if urine is positive for glucose what do you do next?
Definition
screen for diabetes
Term
what can cause false positive urine test for ketones?
Definition
fasting, post exercise, pregnancy
Term
what do nitrites in the urine mean?
Definition
bacteruria
many gram negative bacteria can reduce nitrates to nitrites
Term
most reliable urine for sample to test for nitrites
Definition
first morning urine
Term
what do leukocytes in the urine indicate?
Definition
bacteria
Term
what can cause a false postive urine leukocyte esterase test?
Definition
contaminatino
Term
what should you do if urine is positive for blood?
Definition
confirm with microscopy
Term
MOA of ADH
Definition
released by the posterior pituitary in response to several stimuli, acts on the collecting tubules to promote resorption of free water
Term
what stimulates release of ADH?
Definition
increased plasma oncotic pressure
left atrial distention
exercise
certain emotional states
Term
ADH insufficiency
Definition
diabetes insipidus = kidney can't concentrate urine.
sxs = polyuria, polydipsia
Term
two types of DI
Definition
central (lack of ADH)
neprhogenic (periphreal resistance to ADH)
Term
ADH excess
Definition
SIADH
Term
pathophys of SIADH
Definition
resportion of excessive amounts of free water with resultant hyponatremia.
Term
sxs of SIADH
Definition
hyponatremia, cerebral edema, and resultant neurologic dysfunction
Term
normal electrolyte values: sodium, potassium, chloride, bicarb, anion gap
Definition
sodium: 135-145
potassium: 3.5-5.0
chloride: 95-110
bicarb: 20-32
anion gap: 8-14
Term
sxs of hyponatremia(4)
Definition
nausea, generalized weakness, mental confusion, seizures
Term
causes of hypovolemic hyponatremia (4)
Definition
loss of fluid with hypotonic replacement
thiazide diuretics
K depletion in cells
aldosterone deficiency
Term
causes of euvolemic hyponatremia (5)
Definition
SIADH
severe hyperglycemia
polydipsia
diuretics
hypothyroidism
Term
causes of hypervolemic hyponatremia (5)
Definition
CHF
hepatic cirrhosis
overhydration
nephrotic syndrome
renal failure
Term
major defense agaisnt hypernatremia
Definition
thirst
Term
sxs of hypernatremia (5)
Definition
tremors
irritability
ataxia
confusion
coma
Term
MCC of hypernatremia
Definition
hypovolemic hypernatremia
Term
causes of hypovolemic hypernatremia (3)
Definition
dehydration
profuse sweating
vomiting or diarrhea
Term
causes of hypovolemic hypernatremia (2)
Definition
skin/lung losses
polyuria
Term
what electrolye disturbances are caused by DI? DM?
Definition
DI = hypernatremia
DM = hyponatremia
Term
causes of hypervolemic hypernatremia (3)
Definition
hypertonic saline/sodium bicarb tx
hyperaldosteronism
Curhsing's syndrome
Term
causes of hypokalemia (6)
Definition
decreased dietary intake
diuretics
insulin
alkalosis
hypomagnesemia
hyperaldosteronism
Term
MCC of hypokalemia
Definition
diuretics
Term
causes of hyperkalemia (7)
Definition
excess intake
acidosis
insulin deficiency
drugs (heparin, digoxin, cyclosporin)
ACEI
K sparing diuretics
decreased excretion (renal failure, hypoaldosteronism)
Term
sxs of hyperkalemia (2)
Definition
muscle weakness
cardiac arrhythmias/arrest
often fatal if not corrected
Term
ECG abnormality associated with hyperkalemia
Definition
peaked T-waves
Term
hyperchloremia parallels what?
Definition
hypernatremia
Term
causes of hyperchloremia (3)
Definition
dehydration
hyperventilation
excess loss of bicarb (via GI loss, renal tubular acidosis)
Term
causes of hypochloremia (3)
Definition
prolonged vomiting
metabloic alkalosis
pyelonephritis
Term
know acid/base disorders, simple/mixed, and compensation appropriateness
Definition
Term
anion gap formula
Definition
AG = Na - (Cl + HCO3)
normal = 12
Term
causes of high anion gap acidosis
Definition
Methanol
Uremia
DKA/AKA
Paraldehyde
INH
Lactic acidosis
Ethylene Glycol
Salicylate (starvation)
Term
MC conditions of the urinary tract (3)
Definition
1 = pathologic conditions of the prostate
2 = UTI
3 = urinary calculi
Term
when do kidney stones usually present? men or women more?
Definition
3rd - 4th decade
MC in men
Term
5 major types of kidney stones
Definition
calcium oxylate, calcium phosphate
cystine
struvite
uric acid
Term
only kidney stone that is radiolucent
Definition
uric acid
Term
MC type of kidney stone
Definition
calcium
Term
who is at increased risk of kidney stones?
Definition
pts in hot, humid environments esp. during the summer months
decreased fluid intake
gastric bypass
HTN, obesity, DM
excessive PT
meds that crystalize the urine (indinavir, acyclovir, triamterene)
Term
gold standard for dx of kidney stones
Definition
helical CT
Term
what size stones usually pass spontaneously?
Definition
< 5mm
Term
tx of kidney stones
Definition
most can be tx conservatively with hydration, analgesics, and anti-emetics
Term
when is lithotripsy recommended for kidney stones?
Definition
smaller radiolucent stones < 1cm
Term
when is percutaneous nephrolithotomy recommended for stones?
Definition
larger renal stones > 2 cm
proximal ureteral stones > 1cm
Term
urology referral indications for kidney stones (7)
Definition
intractable pain
obstruction
stone > 5mm
infection
pt with a single kidney
pregnant pt
PMH of severe renal disease
Term
compliations of kidney stones (6)
Definition
renal failure
ureteral stricture
infection, sepsis
urine extravasation
perinephric abscess
xanthogranulomatosus pyelonephritis
Term
what type of stone most commonly causes staghorn calculi?
Definition
struvite
Term
essentials of dx for acute glomerulonephritis (3)
Definition
edema, HTN, hematuria
Term
prevention of kidney stones (6)
Definition
hydrate, hydrate, hydrate
watch diet (decrease salt/animal protein)
don't skip meals
be aware of your climate
preventative meds
stay active
Term
pt c/o dark "cola colored" urine, decreased urine volume, edema (periorbital, scrotal), HTN
Definition
nephritic
Term
tx of acute glomerulonephritis
Definition
goal = reduce inflammation
most cases = admit pt
aggressive reduction of HTN and fluid overload (salt & water restriction, diuretic therapy, possible dialysis).
may require corticosteroids, cytotoxic agents
Term
who has a better prognosis with acute glomerulonephritis
Definition
chlidren
Term
heavy proteinuria, hypoalbuminemia, edema, hypercholesterolemia
Definition
nephrotic syndrome
Term
essentials of dx for nephrotic syndrome
Definition
urine protein > 3.5g/24 hrs
hypoalbuminemia < 3g/dL
peripheral edema = hallmark!
Term
1/3 of adult pts with nephrotic syndrome also have
Definition
systemic renal disease (DM, amyloidosis, SLE)
Term
4 MCC of nephrotic syndrome
Definition
minimal change disease (kids)
membranous nephropathy
focal glomerular sclerosis
membranoproliferative GN
Term
tx of nephrotic syndrome
Definition
monitor protein loss and intake (tx proteinuria with an ACEI or ARB)
tx edema (salt restriction, diuretics = thiazide or loop)
tx hyperlipidemia (diet, exercise, statin)
consider anticoagulation
Term
what can lead to hypercoagulability with nephrotic syndrome
Definition
serum albumin < 2g/dL --> prone to renal vein thrombosis, DVT, etc
Term
MCC of renal failure
Definition
pre-renal
Term
causes of pre-renal failure (3)
Definition
decreased perfusion from:
decreased intravascular volume
change in vascular resistance
low cardiac output
Term
causes of volume depletion in pre-renal failure
Definition
hemorrhage, GI loss, dehydration, excessive diuresis, pancreatitis, burns, trauma, peritonitis
Term
least common cause of ARF
Definition
post-renal
Term
cause of post-renal failure
Definition
urinary flow from both kidneys or a single functioning kidney is obstructed (usually a urologic problem)
Term
MCC of post-renal failure
Definition
BPH
Term
what kind of drug puts you at risk for post renal failure?
Definition
anticholinergics
Term
causes of post renal failure (6)
Definition
urethral obstruction
bladder dysfunction/obstruction
obstruction of both ureters/renal pelvisies
bladder/prostate/cervical cancer
retroperitoneal processes
neurogenic bladder
Term
sites of injury in intrinsic renal failure
Definition
tubules, interstitium, vasculature, glomeruli
Term
causes of intrinsic renal failure (3)
Definition
acute tubular necrosis
acute interstitial nephritis
acute glomerulonephritis
Term
hyaline casts
Definition
seen in concentrated urine, febrile disease, following strenuous exercise, during the course of diuretic therapy.
not specific for renal disease
Term
red blood cell casts
Definition
intraparenchymal bleeding, hallmark of GN
Term
white cell casts
Definition
pyelonephritis, interstital nephritis
Term
tubular cell casts
Definition
ATN
Term
granular casts
Definition
ATN, GN, tubulointerstitial disease
Term
broad/waxy casts
Definition
form in tubules that have become dilated and atrophic due to chronic parenchymal disease. Frequently seen in CRF
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