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Stanford PCAP 2010


Struvite Stones 15% "staghorn formation" "infection"stone pt.w/chronic infec. pH>7 may be visible w/x-ray if it complexs w/CAPO4 if (+) suggestive of gram (-)bact.
Uric acid stones 5% urine pH<5 KUB misses these stones "radiolucent" diets rich in purines (organ meats, gravies) present in gout 25%
Calcium oxalate stones 75% most common X-ray visible 85% idiopathic can result from any disorder that raises serum Ca+, dumps more in urine
Cystine stones 2% Rare due to metabolic defect renal tubule does not reabsorb cystine Tx adjustment in diet KUB "ground glass"can be seen
Acute Pyelonephritis "uncomplicated" THE 2's ER regimen 2L fluid IV or PO 2 Tylenol #3 2g Ceftriaxone IV or IM(can go home if fever drops and Abx orally) 2 degrees and can tolerate 2 glasses of water 2 TMP/SMX DS 2x/day for 2wks f/u in 2 days
Nitrofurantoin i.e. Macrodantin Give w/food or milk Bacteriostatic and bacterialcidal and is very effective for UTI's!! contraindicated w/renal insufficiency s/e anorexia, nausea, and vomiting. adverse effects NEUROPATHIES AND Hemolytic anemia in G6PD deficiency
Non-gonococcal urethritis Most common chlamydia trachomatis Others- Uresplasma urealyticum, haemophilus vaginalis and mycoplasma genitalium S/S burning, dysuria, frequency, white/cloudy discharge for both men and women. PID for women if progressed Tx- Doxycycline
Abx for Acute Cystitis for ALL stages of Pregnancy MACRODANTIN, Ampicillin, Amoxicillin, 1st gen Ceph. ok i.e. Cephalexin(Keflex), Cefazolin(Ancef)
Causes of Acute Epidymitis Most common chlamydia trachomatis, e. coli, n gonorrhoeae Tx if sexually transmitted- Ceftriazone PLUS Doxycycline if not sexually transmitted - Ampicillin IV or Cipro PO, TMP/SMX PO
Treatment for Barretts Esophagus Proton pump inhibitors
Shigella Diarrhea T or F Definitive DX can be made by stool Culture TRUE
Acute Viral Hepatitis lab values Increase in Bilirubin, ALT(alanine aminotransferase), AST(aspartate aminotransferase) and Alkaline Phosphatase
What labs will you find if jaundice is present in severe alcoholism The serum AST level will be doubled than that of serum ALT
Primary diarrheal disorder assoc. with lactose intolerance is caused by.... undigested lactose creating an increased osmotic load.
4 organisms that cause diarrheal illness through primarily through release of endotoxin are; C dificile Vibreo Cholorae S. Aureus E Coli 0157: H7
Common physical finding for early intestinal obstruction high pitched bowel sounds, hyperactive
Acute pancreatitis LAB VALUES Serum Amylase and lipase elevated Leukocytosis (10,000-30,0000) Proteinuria Granular casts AND Glycosuria
Acute pancreatitis S/S Abrupt onset of deep epigastric pain with radiation to back most often! Pain DECREASES when leaning forward N/V sweating and weakness Abdominal tenderness, distention,fever (+) Murphy's sign
Diverticulitis S/S Acute abdominal pain and fever Left lower abdominal tenderness and mass. Constipation or loose stools (+/-) Leuckocytosis- mild to moderate
Diverticulitis Outpatient Tx Clear liquid diet and Abx w/anaerobic activity. Amoxicillin w/Clavulanate OR Metronidazole w/Cipro OR w/TMP/SMX
BEST indicator of renal function? creatinine clearance
COMMON side effect (>25%) of the Rubella vaccine if given to a pregnant woman? fetal infection
Stenosis of renal artery will have WHICH of the following effect? a. decreased renin b. decreased glomerular blood flow c. decreased aldosterone b. decreased glomerular blood flow
Adverse effects of the MMR vaccine? parotitis, thrombocytopenia, autism, encephalopathy
Prostate gland functions as the site of? production of ejaculate fluid
Bowman's capsule MAIN function? site of action of aldosterone
Endometriosis Definition and Treatment Presence of endometrial tissue outside the endometrium. Tx- Oral contraceptive i.e. danazol(inhibitor LH/FSH) and/or GnRH agonist
Treponema Pallidum Primary Stage Lesion "chancre"painless ulcer (+) (genitalia, perianal, rectum, pharynx, tongue, lip) Non-tender regional lymph enlargement Serologic testing- 75-85% positive RPR/VDRL Tx- Benzathine penicillin G 2.4million units IM 1 time.
Alternative Tx for primary/secondary/early latent stage syphilis Primary DOXYCYCLINE 14D, TETRACYCLINE 28D, CEFTRIAXONE 8-10D
Treponema pallidum Secondary Stage Macopapular skin rash(palms and soles 80%), condylomas lata in moist areas Generalized nontender lymphadenopathy Fever, SYSTEMIC signs Serologic tests positive almost always at this stage Tx- Benzathine penicillin G 2.4million units IM
Treponema Pallidum Late tertiary stage treatment Benzathine penicillan G 2.4million units IM weekly for 3 wks Altern. DOXYCYCLINE 28D, TETRACYCLINE 28D
Achalasia Incomplete relaxation, incomplete contractility Excessive contractility of distal esophagus "loss of peristalysis" S/S diff swallowing w/liquids and solids. More diff w/cold drinks than hot. Significant regurgitation, chest pain, weight loss
T or F Does NSAID induce gastric ulcers? Yes! NSAIDs inhibit prostaglandin release. Prostaglandins are a potent mucus secretagogues 'are gastric barriers' by controlling blood flow. By stopping this secretion the gastric mucosa is at risk for injury and ulceration
Acute Gastritis S/S N/V, epigastric abdominal pain, mild tenderness to palpation, poss coffee ground hematemesis and postitive guaiac stool. Causes- alcohol, NSAIDs, cocaine, H.Pylori infection
What antacid is used with(safe) renal failure? Al(OH)3 can treat hyperphosphatemia in renal failure. This is a weaker antacid than CaCO3 Liquid form is best
Which antacid causes diarrhea? Mg(OH)2 Milk of Magnesia If you combine Aluminum with Mg this will off set the diarrhea (Riopan)
What are TUMS? CaCO3 antacid that acts as a buffer can cause constipation! can cause urine stones!! Can lead to LIVER FAILURE
Who should NOT get PPI's for GERD Tx? Pregnant women, infants and elders(in HIGH doses)
Metoclopromide (Reglan) Dopamine antagonist Used for motility dysfunction i.e. GERD Fx- Promotes gastric emptying and increases pressure to prevent back slosh. Adverse effects is extrapyramidal reactions i.e. dystonia, motor restlessness...
Nephrolithiasis is a common cause of _____ in the U.S. morbidity
The peak incidence of nephrolithiasis is in the age group of ___ - ___. 20-45
____stones are most common accoutn for 75% of all stones Calcium
MOST calcium stones are: calcium oxylate
_____ _____ require an alkaline pH and are therefore less common. calcium phosphate
Patients with nephrolithiasis usually have (symptoms): FLANK pain radiating to the groin ont he same side
Initial screening for kidney stones should include: elecrolytes, creatinin, serum calcium, phosphate and uric acid
Management of nephrolithiasis requires identifying the specific type of stone
Conditions that may lead to calcium phosphate stone formation? RTA, primary hyperparathyroidism, milk-alkali syndrome
After 20 yrs of follow up < ___% of patietns remain stone free 10
All patients with nephrolithiasis should be advised to consume approximately ____ L of fluid per day 3
The two dietary restrictions that have been beneficial in reducing recurrence of stones restricting intake of animal protein and sodium
___% of renal stones are passed spontaneously 90
Stones that are wider than ___mm are unlikely to pass. 8
Extracroporeal shock wave lithotripsy treatment is more beneficial in patients with renal pelvic, or upper ureteral stones
Ureteroscopy with basket retrieval or ultrasonic lithotripsy may be more successful in patients with lower ureteral stones
Calcium stones ___mm have a 50% chance of passing spontaneously 4-7
Surgical intervention is indicated if a stone is unlikely to pass on its own or when serial studies show a LOSS of renal function or increasing HYDRONEPHROSIS, when infection is present, and when pain is intractable
The main risk factors for uric acid stones dehydration, persistently acidic urine, increased secretion associated with RTA
The mainstay of uric acid stone treatment is to increase volume & alkalinize the urine in an effort to reduce precipitation of uric acid.
Alkalinization can be achieved during the day with: oral sodium bicarbonate.
To achieve alkalinzation at night when urine is most acidic acetazolamide may be used.
The majority of ___ stones dissolve within a few weeks with proper therapy. uric acid
Patients with ____ stones usually have a history of several UTI's treated with multiple courses of antibiotics. Struvite (magnesium ammonium phosphate)
Percutaneous nephrolithotomy is currently the primary surgical intervention of choice for ____ stones. Struvite (magnesium ammonium phosphate)
Cystine stones can be dissolved by maintaining high urine output as well as by alkalinizing the urine.
Foods that are high in oxylate? nuts, spinach, black tea, sweet potatoes
Three most common places for a stone to get stuck? ureteropelvic junction, crossing of iliac artery, ureterovesical junction
The ureter contracting against a stone, causing flank pain that may radiate toward the groin and genitals? renal colic
A stone that fills out the kidney pelvis and 2/3 of the calyces? STAGHORN stone
An IVP is good for viewing? filling defects in the urinary system, radiolucent stones
Urinalysis: normal color, odor and appearance? amber yellow, aromatic, clear
Urinalysis: Normal pH? 4.6-8.0 (avg 6.0)
Urinalysis: Normal protein? (mg/dL) 0-8
Urinalysis: ____ infection may cause green urine Pseudomonas
Patients with ____ may have the strong sweet smell of acetone diabetic ketoacidosis
Urinalysis: Bacteria, UTI, or a diet high in citrus fruits or vegetable may cause increased urine pH
Urinalysis: Proteinuria in pregnant women can indicate? preeclampsia
Urinalysis: Probably the most important indicator of kidney disease proteinuria
Urinalysis:The combination of proteinuria adn edema is known as nephrotic syndrome
Urinalysis: High specific gravity indicates? concentrated urine
Urinalysis: Starvation, dehydration, or a diet high in meat products or cranberries may cause decreased urine pH
Urinalysis: Positive results indicate UTI leukocyte esterase
Urinalysis: Obstruction of a bile duct by a gallstone will lead to elevated urine bilirubin
Urinalysis: Product of fat breakdown? ketones
Urinalysis: Main cause of glycosuria? diabetes
Urinalysis: Product of hemoglobin breakdown? bilirubin
Urinalysis: RBC casts indicates? actue glomerulonephritis
Urinalysis: WBC casts indicates? acute pyelonephritis
Urinalysis: Epithelial casts indicates? tubular necrosis
Urinalysis: Granular casts indicates? nephrotic syndrome, pyelonephritis
Urinalysis: waxy casts indicates? tubular atrophy, renal failure
Urinalysis: bacterial casts indicates? pyelnephritis
Urinalysis: fatty casts indicate? proteinuria, nephrotic syndrome
____ can be estimated by blood level creatnine? GFR
Urinalysis: For ___ to form the pH must be acidic and the urine concentrated casts
Urinalysis: Clumps of materials or cells that form in the renal distal and collection tubules, where material is maximally concentrated? casts
Urinalysis: Conglomerations of protein & are indicative of proteinuria, a few may be present after strenuous exercise? hyaline casts
Created by: rcdanks