Clinical Medcine
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| edema, ascites, HTN, ortho hypoTN, skin striae, retinal sheen = | nephrotic syndrome
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| renal stones lodge at: | UPJ (kidney stones), ureterovesicular jtn/UVJ (bladder stones), or ureter at level of iliac vessels
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| types of stones | Ca ox (75-85%); uric acid (8%); cystine; struvite (10%)(in pt w/freq urease-prod infxn)
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| renal stone in upper ureter sx: | radiate to ant abdomen
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| renal stone in lower ureter sx: | rad to ipsilateral groin, testes/ labia
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| renal stone in UVJ sx: | urgency, frequency, pelvic pain
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| Total body water (TBW): compartments | 60% ICF, 40% ECF (32% ISV, 8% IVV)
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| hyponatremia = | Na <135 (sxs at Na <125)
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| hyponatremia w/hypervolemia causes | CHF, nephrotic syndrome, AKI, hepatic cirrhosis
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| hyponatremia w/euvolemia causes | hypothyroid, glucocorticoid xs, SIADH
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| hyponatremia w/hypovolemia causes | Na loss (renal or extrarenal)
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| hyperkalemia (K >5) causes | AKI, metab acidosis, cell death, hyporeninemic hypoaldosteronism
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| hypokalemia (K <3.5) causes | diuretics, renal tubular acidosis, GI losses
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| hypercalcemia causes | hosp pts w/malig (lung, head/neck, MM, NHL, cervical, RCC); vit D intox; hyperPTH; sarcoid
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| Dry skin, brittle nails, mx cramps/tetany, paresthesias, perioral numbness, SOB, crackles, S3, poss syncope & angina = | hypocalcemia (Ca <8.5); usu 2/2 CKD or hypoPTH
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| hyperphosphatemia most common cause | CKD
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| Hyperphosphatemia (1.0-2.5); severe (<1.0) can lead to: | rhabdo, paresthesia, encephalopathy
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| hypermagnesemia (2.5 mEq/L) s/s | 1st: reduced DTRs; mx weak, hypoTN, resp depression, cardiac arrest; N/V, flushing; high bleeding time/coag
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| prostatitis bugs | GN (E coli) or enterococcus; poss NG/CT
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| BPH etiology | Poss: androgen, estrogen, stromal GF dysregulation, decreased cell death, inc stem cells, genetics
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| BPH obstructive sxs: | dec force of urinary stream, hesitancy, postvoid dribbling, incomplete voiding
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| BPH irritative sxs: | freq, urgency, nocturia
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| prostate ca prevalence by site: | peripheral zone > transition zone (periurethral area) > central zone (urethra + ejac ducts)
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| testicular ca s/s | painless solid testic swelling; poss heaviness; para-aortic LN involvement resembles ureteral obstruction
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| testicular ca prevalence by type | seminoma (35%); nonseminoma (65%): mixed > embryonal > teratoma > choriocarcinoma
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| entrapment of foreskin behind glans penis = | paraphimosis; poss 2/2 frequent caths
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| Predictors of ED: | HTN, DM, HLD, CVD
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| Hydrocele is usu 2/2: | fluid filled congenital remnants of tunica vaginalis (2/2 patent processus vaginalis)
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| spermatocele = | painless cystic mass containing sperm; usu <1 cm; superior & posterior to testes
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| Varicocele = | venous varicocity within spermatic vein (pampiniform plexus); L vein > R vein (bc longer)
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| Varicocele s/s | chronic nontender mass, does not transilluminate; bag of worms, enlarges w/Valsalva, diminishes w/elevation
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| Male infertility: most common etiologies | varicocele (37%); idiopathic (25%)
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| Male factors contribute what percent to infertility cases? | 40%
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| BPH vs prostate ca: findings | BPH: firm smooth enlarged prostate, normal PSA; cancer: firm, irregular, nodular non-tender prostate, elevated PSA
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| Normal range: pH: | 7.40 (7.35-7.45)
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| Normal range: pO2: | 80-100 mmHg
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| Normal range: pCO2: | 35-45 mmHg
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| Normal range: HCO3: | 22-26 mmol/L
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| Anion gap = | cations (Na+) - anions (Cl- + HCO3-); Normal AG = 7-13 mmol/L
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| Resp compensation for metabolic acidosis | pCO2 should fall 1.2 for every 1.0 drop in HCO3
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| Irritative voiding symptoms, Fever, chills, CVA tenderness | Pyelonephritis
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| Crush injury, alcoholic on ground, elevated CPK, AKI | Rhabdomyolysis
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| Painless hematuria, flank pain or mass | Renal cell Carcinoma
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| Oliguria, hematuria, proteinuria following streptococcal infection; AM facial edema & PM LE edema: | Acute glomeruloneprhitis
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| Hematuria, purpuric rash following streptococcal infection | Glomerulonephritis, HSP
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| Inability to retract foreskin; erythema, TTP, poss purulence | Phimosis
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| <40 yo male with high fever/chills, perineal pain, dysuria, freq/urgency, prostate swollen/TTP | Acute prostatitis
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| >50 yo obstructive voiding sx, nocturia. Firm smooth enlarged prostate; Normal PSA | BPH. (Cancer would have firm, irregular, nodular non-tender prostate, elevated PSA)
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| Incontinence with straining | Stress, 2/2 inc intra-abd pressure
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| Hearing loss or tinnitus w/ metabolic acidosis | Aspirin OD
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| Prostate ca RFs | AA, age, FH, testost; high Gleason: high mets risk (usu to bone); not always high PSA
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| testicular torsion | most emergent scrotal pain prob, absent cremasteric sx, comp: necrosis; dx US; surgery
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| blue dot sign | Testicular appendiceal torsion
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| Nephrotic syndrome complications: | Pneumococcal pna / cellulitis; Spontaneous bacterial peritonitis; PE; NOT cardiac arrhythmias
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| Nephrotic syndrome causes | kids: MCD; adults membranous nephropathy (AA: FSGN)
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| infrarenal cause of AKI in a hospitalized patient | ATN
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| BPH Pathophysiology | Proliferation of fibrostromal tissue => urethral compression; dev in periurethral or transitional zone; BPH req older age and functioning Leydig cells
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| BPH Sx/Sx | AUA sx score (0-35, severe >20), IPSS; LUTS (irritative & obstructive sxs). DRE: firm smoothly enlarged, non-nodular
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| BPH DDx | overactive bladder, interstitial cystitis, prostatitis, prostate or bladder ca, UTI, neurogenic bladder, urethral stricture
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| AKI Pathophysiology | multiple: pre, infra (vascular, glom, interstitial, tubular [ischemic, nephrotoxic, sepsis), postrenal
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| AKI Etio | contrast, aminoglycoside, NSAIDs, COX-2, cisplatin
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| AKI Sx/Sx | N/V/D, anorexia; poss edema, rash, purpura; ATN: wt loss
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| AKI DDx | CKD (anemia more likely); ATN: high U-Na, FeNa; lowU-Cr, UrOsmo; Prerenal Azo: low U-Na, FeNa; high U-Cr, UrOsmo
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| CKD etiology | DM (40%), HTN (33%)
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| Glomerulonephritis Etio | PSGS, Hep, Wegener, Goodpasture, Churg Strauss
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| Nephritic syndrome | AKI, HTN, urinary sediment (RBC, RBC casts)
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| Nephritic syndrome DDx | PSG, SLE, SBE, IgA nephropathy, HSP, Wegener
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| Nephrotic syndrome Etiology | DM2, multi myeloma, amyloid, SLE, MCD, PSGN, malig; Hep C (membranoproliferative); HIV (FSGS)
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| Respiratory acidosis Etio | impairment in rate of alveolar ventilation; acute medullary resp ctr depression (narcotic OD), resp mx paralysis, airway obstruction; chronic: emphysema, pickwickian
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| Resp acidosis Sx/Sx | metab encephalopathy: somnolence, confusion, narcosis, asterixis; fundi: dilated, tortuous vessels, possible papilledema
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| Resp acidosis DDx/causes | COPD, airway obstruction, CNS depression (opioids, brainstem inj), neuromx (GBS, MG, botulism), myxedema
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| Resp alkalosis (hypocapnia) Patho/etio | hyperventilation reduces PCO2, inc pH; No. 1 is hyperventilation syndrome (including anxiety); also GNR septicemia/fever, cirrhosis, PE, CHF, ILD, pna, pulmo edema, HAPE, CVA, anemia, PG (2/2 progesterone stim of resp ctr), acute salicylism
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| Resp alkalosis Sx/Sx | lightheadedness, anxiety, perioral numbness, acroparesthesias (pain hands & feet)
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| Resp alkalosis DDx | PE, pulmo edema, PTX, ARDS, pulmo art HTN, asthma, interstitial pulmo fibrosis
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| NAGMA possible causes = | FUSEDCARS (Fistula, Uretero-enterostomy, Saline admin, Endocrine (hypErPTH), *Diarrhea*, Carbonic anhydrase inhibitors, Ammonium Chloride, *Renal tubular acidosis*, Spironolactone
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| AGMA: GOLDMARK | Glycol, Oxoproline, Lactate, D-lactate, Methanol, Aspirin, Renal failure, Ketoacidosis
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| Metab acidosis Sx/Sx | CP, palpitations, HA, AMS (anxiety), decreased visual acuity, n/v/abd pain, wt loss, mx weakness, bone pain; Kussmaul (profound DKA), lethargy, stupor, coma, seizures; V-tach, hypotension
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| Metabolic alkalosis: chloride-responsive (low urine Cl): due to: | diuretic tx (contraction alkalosis) or loss of gastric secretions (2/2 vomiting or NG tube)
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| Metabolic alkalosis: chloride-resistant (high urine Cl): etio | Bartter or Gitelman syndrome; hyperaldosteronism; bicarb intake in CKD
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| CKD most common causes | DM, HTN, glomerulonephritis, PKD
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| CKD s/s | cachexia, pallor, HTN, ecchymosis, sensory deficits, asterixis, kussmaul
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| causes of glomerulonephritis | HSP, post-infxs GN, IgA nephropathy, membranoproliferative GN
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| glomerulonephritis: focal vs diffuse | focal involves <50% of all glomeruli
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