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Stanford PCAP 2010
Genitourinary
| Question | Answer |
|---|---|
| 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
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