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GU
PANCE review
102
Health Care
Graduate
08/08/2011

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Term
rapidly deteriorating glomerular filtration rate with the accumulation nitrogenous wastes (urea and creatinine) referred to as azotemia
Definition
acute renal failure
Term
hypotension is indicative of what kind of ARF?
Definition
pre-renal
Term
S&S of post renal failure
Definition
distended bladder, CVA tenderness, enlarged prostate
Term
kidney smaller than what indicates chronic problems?
Definition
10cm
Term
decreased BUN/Cr (< 15:1) indicates what?
Definition
intrinsic renal failure
Term
pre renal causes of renal failure (5)
Definition
hypovolemia
hypotension
ineffective circulating volume
aortic aneurysm
renal artery stenosis or embolic disease
Term
intrinsic causes of renal failure (5)
Definition
acute tubular necrosis
nephrotoxins (NSAID, aminoglycosides, radiologic contrast)
interstitial diseases (acute interstitial nephritis, SLE, infection)
glomerulonephritis
vascular diseases (polyarteritis nodosa, vasculitis)
Term
causes of post renal failure (2)
Definition
tubular obstruction
obstructive uropathy (urolithiasis, BPH, bladder outlet obstruction)
Term
when should short term dialysis be initiated in ARF?
Definition
serum creatinine > 5-10 mg/dL
other indications include:
unresponsive acidosis
electrolyte disorders
fluid overload
uremic complications
Term
how is chronic kidney disease classified?
Definition
5 stages based on estimated GFR
Term
what are the 5 stages of kidney disease?
Definition
1 = kidney damage with normal GFR (>90)
2 = kidney damage with minor decrease in GFR (60-89)
3 = moderate decrease in GFR (30-59)
4 = severe decrease (15-29)
5 = kidney failure GFR < 15
Term
MCCs of chronic renal failure (4)
Definition
DM
HTN
glomerulonephritis (GN)
polycystic kidney disease (PKD)
Term
gold standard for dx of CKD?
Definition
measurement of GFR
Term
what is the marker for kidney disease?
Definition
proteinuria
Term
what medications help to slow the progression of renal dysfunction, particularly in proteinuric patients
Definition
ACEI/ARB
Term
tea or cola colored urine, edema of the face and eyes present in the morning
Definition
GN
Term
common cause of GN
Definition
poststreptococcal GN
Term
exretion of > 3.5g of protein in 24 hrs.
S&S = hypoalbuminemia, lipiduria, hypercholesterolemia, and edema
Definition
nephrotic syndrome
Term
nephrotic syndrome can predispose the pt to
Definition
thrombosis due to loss of proteins S and C and antithrombin III
Term
ascites, edema, HTN, othrostatic hypotension, retinal sheen, skin striae, proteinuria, lipiduria, glycosuria, hematuria, foamy urine
Definition
nephrotic syndrome
Term
microscopic UA reveals oval fat body
Definition
nephrotic syndrome
Term
tx of nephrotic syndrome
Definition
ACEI
judicious use of diuretics
decrease sodium and fluid intake
Term
more aggressive form of PKD
Definition
recessive
Term
other than the kidneys where can cysts be found in PKD?
Definition
liver, pancreas, and other locations
Term
diagnostic method of choice for PKD?
Definition
ultrasound
Term
most common form of PKD?
Definition
autosomal dominant
Term
what renal stone is radiopaque?
Definition
CCS
calcium, cystine, struvite
Term
imaging modality of choice for nephrolithiasis
Definition
helical CT
Term
stones what size pass spontaneously?
Definition
5mm
Term
tx for stones measuring 5-10mm
Definition
less likely to pass on their own, increased fluids and analgesics are necessary.
elective lithotripsy can be performed
Term
tx for stones measuring > 10mm
Definition
tx inpatient if the pt is unable to maintain adequate oral intake.
if renal function is jeopordized, gold standard = percutaneous nephrostomy
Term
lithotripsy should be used for stones of what size?
Definition
renal stones < 2cm
ureteral stones < 1cm
Term
percutaneous nephrolithotomy can be used when?
Definition
stones > 2cm
Term
peaked T waves
Definition
hyperkalemia
Term
review electrolyte disorders
Definition
Term
review acid base disorders
Definition
Term
decreased pH, increased PCO2, increased HCO3
Definition
respiratory acidosis
Term
increased pH, decrased PCO2, decreased HCO3
Definition
respiratory alkalosis
Term
decreased pH, decreased CO2, decreased HCO3
Definition
metabolic acidosis
Term
increased pH, increased CO2, increased HCO3
Definition
metabolic alkalosis
Term
AG formula
Definition
Na - (HCO3 + Cl)
normal = 8 -12
Term
pneumonic for elevated anion gap acidosis
Definition
MUDPILES
Term
Winter's Formula
Definition
PCO2 = (1.5 x HCO3) + 8 +/-2
Term
MCC of UTI
Definition
E-coli
Term
pyuria, bacteriuria, and varying degree of hematuria
Definition
cystitis
Term
tx of cystitis
Definition
flouroquinalone or bactrim
Term
fever, flank pain, shaking chills, and irritative voiding sxs
Definition
pyelonephritis
Term
tx of pyelonephritis
Definition
outpt = quinalone or bactrim
inpt = IV quinalone or ampicillin + gentamycin
Term
T/F
follow up urine cultures are mandatory with pyelonephritis
Definition
True
Term
MC prostatitis
Definition
chronic nonbacterial
Term
sudden onset high fever, chills, and low back and perineal pain, irritative bladder symptoms
Definition
acute prostatitis
Term
what are irritative bladder sxs?
Definition
frequency, urgency, dysuria
Term
difference in tx of acute and chronic protatitis?
Definition
chronic is treated for up to 3 months
Term
testicular swelling and tenderness, usually unilateral, fever, and tachycardia. U/A = pyruia and bacteriuria
Definition
orchitis
Term
tx of orchitis
Definition
if caused by bacteria tx like epididymitis
Term
viral cause of orchitis
Definition
mumps
Term
MCC of epididymitis < 35 or > 35
Definition
< 35 = chlamydia and gonorrhea
> 35 = E. Coli
Term
heaviness and dull aching, discomfort in the affected hemiscrotum which can radiate up the ipsilateral flank
Definition
epididymitis
Term
relief of pain with scrotal elevation
Definition
Prehn's sign
classic sign of epididymitis
Term
what system is used to asses BPH?
Definition
American Urological Association (AUA)
Term
what are the scores on the AUA associated with sx wise?
Definition
0-7 = mild
8-19 = moderate
20-35 = severe
Term
tx of BPH
Definition
mild - moderate = watch and wait
medical therapy = alpha adrenergic agonists and 5a-reductase inhibitors
Term
results from bladder contractions that cannot be controlled by the brain
Definition
urge incontinence
Term
caused by dysfunction of the urethral sphincter, allowing urine to leak wih increased intra-abdominal presssure
Definition
stress incontinence
Term
occurs when urinary retention leads to bladder distention and overflow of urine through the urethra
Definition
overflow incontinence
Term
untimely urination caused by physical or cognitive disability, preventing a person from reaching a toilet
Definition
functional incontinence
Term
combination of elements from both stress and urge incontinence
Definition
mixed incontinence
Term
principle sx of urge incontinence
Definition
strong desire to void followed by loss of urine
Term
principle sx of stress incontinence
Definition
leakage of urine with increased intra-abomdinal pressure (coughing, laughing, sneezing)
Term
untreated overflow incontinence can lead to
Definition
hydronephrosis and obstructive nephropahty
Term
what is used to measure urinary retention?
Definition
post void residual
Term
tx of overactive bladder
Definition
tolterodine and oxybutynin
Term
tx of overflow incontinence
Definition
self cath
Term
most effective tx for stress incontinence
Definition
surgery
Term
tx for urge incontinence
Definition
anticholinergic meds such as oxybutynin
Term
histologic grading of prostate cancer is via
Definition
Gleason scale with a higher score indicating worse prognosis
Term
tx of stage A and B prostate cancer
Definition
radical retropubic prostatectomy, brachytherapy, or external beam radiation
Term
tx of stage D prostate cancer
Definition
tx with hormonal maniupulation and palliative therapy
Term
MC presenting sx of bladder cancer
Definition
painless hematuria
Term
MC type of renal malignancy
Definition
renal cell carcinoma
Term
often called the "internists tumor"
Definition
renal cell carcinoma
Term
RCC is associated with paraneoplastic syndromes including (4)
Definition
erythrocytosis
hypercalcemia
hypertension
hepatic dysfunction in the absence of hepatic mets
Term
grading scale for renal cell carcinoma
Definition
Furman scale and TNM
Term
MC solid renal tumor in childhood
Definition
Wilm's tumor (nephroblastoma)
Term
asx abdominal mass found by a family member or during a physical in a child.
Anorexia, N/V, fever, abdominal pain, hematuria, HTN
Definition
Wilm's tumor
Term
initial study of choice for nephroblastoma
Definition
Ultrasonography
Term
MC malignancy in young men
Definition
testicular cancer
Term
painless, solid testicular swelling with a heaviness.
Definition
testicular cancer
Term
inabilty to retract foreskin over the glans penis
Definition
phimosis
Term
entrapment of the foreskin behind the glans penis
Definition
paraphimosis
Term
tx of paraphimosis
Definition
manual reduction
inability to reduce = emergeny urology consult
pt should be circumcised to prevent recurrence
Term
consistant inability to maintain an erect penis wiht sufficient rigidity to allow sexual intercourse.
Definition
erectile dysfunction
Term
normal erections require intact
Definition
parasympathetic and somatic nerve supply, unobstructed arterial flow, adequate venous constriction, hormonal stimulation, psychological desire
Term
what can be used to differentiate between organic and psychogenic impotence?
Definition
nocturnal tumescence testing
Term
tx of psychogenic ED
Definition
behviorally oriented sex therapy
Term
PDE-5 inhibitors are contraindicated with what?
Definition
nitrates
Term
mass of the fluid filled remnants of the tunica vaginalis usually resutling from a patent processus vaginalis
Definition
hydrocele
Term
which testicular masses transilluminate?
Definition
hydrocele, spermatocele
Term
should you needle aspirate a hydrocele?
Definition
NO!
Term
testis is abnormally twisted on it's spermatic cord thus compromising arterial supply and venous drainage of the testis leading to testicular ischemia. Loss of cremesteric reflex
Definition
testicular torsion
Term
formation of venous varicosity within the spermatic vein (pampiniform plexus)
Definition
varicocele
increases in size with valsalva
decreases in size with elevation of the scrotum or supine position
Term
bag of worms
Definition
varicocele
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