Term
| What type of kidney stone is likely to form in acid urine? What medication can be used to prevent the formation? |
|
Definition
-calcium oxalate
-K citrate |
|
|
Term
| What type of kidney stone should HCTZ be used to treat and why? |
|
Definition
| Calcium stones should be tx by hydrochlorothiazide bc it blocks the sodium-chloride transport in the distal convoluted tubules of the nephrons, impairing the secondary passive calcium transport and decreasing urinary calcium. |
|
|
Term
| In utero, what maternal hormone causes the testes to descend |
|
Definition
|
|
Term
| At what age should a child with cryptorchidism be evaluated by a specialist, bc after this point spontaneous descent is unlikely |
|
Definition
|
|
Term
| What are 5 predisposing factors to cryptorchidism ? |
|
Definition
-prematurity
-low birth weight
-small size for gestational age
-twinning
-maternal exposure to estrogen during 1st trimester |
|
|
Term
| What s/sx in cryptorchidism signal a possibly life threatening condition and require urgent consult with a peds endocrinologist or geneticist |
|
Definition
| BL nonpalpable testes with hypospadias or ambiguous genitalia |
|
|
Term
| How is anorchia evaluated in BL nonpalpable gonads? |
|
Definition
Measure testosterone levels before and after stimulation with hCH along with basal LH and FSH
-anorchia suspected with elevated basal androgen levels and negative testosterone response to hCG |
|
|
Term
| What is the efficacy rate of hormonal tx in cryptorchidism? |
|
Definition
< 20%
Surgery yields more efficacious results |
|
|
Term
| What are the two types of hydroceles |
|
Definition
-communicating- due to latency of the processus vaginalis which allows peritoneal fluid to fellow into the scrotum--> particularly during valsalva
-non communicating- balance between fluid production within the tunica and fluid absorption is altered. Better in the AM and worsens as the day progresses |
|
|
Term
| What is the MCC of hydroceles worldwide |
|
Definition
Wuchereria bancrofti (filarial)
Almost non existent in the US |
|
|
Term
| What are the results of transillumination in a patient with a hydrocele |
|
Definition
| Scrotum will light up! 10% of testicular teratomas will as well, so order labs (AFP and hCG) If there is any suspicion |
|
|
Term
| What's the best rad for evaluation of a varicocele and a hydrocele |
|
Definition
|
|
Term
|
Definition
| Dilatation if the pampiniform venous plexus and internal soermatic vein |
|
|
Term
| What is the MCC of poor sperm production and decreased sperm quality |
|
Definition
|
|
Term
| If surgery is indicated in a patient with a varicocele how long after the procedure should sperm analysis be conducted |
|
Definition
| 3-4 months because spermatogenesis takes 72 days |
|
|
Term
| What is the difference between paraphimosis and phimosis ? |
|
Definition
Para: entrapment of the foreskin BEHIND the glans penis
Phimosis: inability to retract the foreskin over the glans |
|
|
Term
| At about what age does congenital phimosis recede |
|
Definition
| About three years of age. Trying to retract the foreskin before this can cause injury |
|
|
Term
| Paraphimosis is a urologic emergency, what can be done to tx |
|
Definition
-manual reduction
-ice packs, penile wraps, sugar in a condom (hypertonic gradient effect)
-lidocaine withOUT Eli
-1 mL hyaluronidase injected into prepuce (breaks down hyaluronic acid in CT and enhances fluid diffusion between tissue planes, decreasing swelling) |
|
|
Term
| Describe the difference between a neonate and an adolescent/adult with testicular torsion |
|
Definition
Neonate: extravaginal
Older: infra signal |
|
|
Term
| What happens with the cremaster reflex in testicular torsion |
|
Definition
| It is absent, most sensitive finding |
|
|
Term
| Is there relief in testicular torsion with elevation of the testicle? What is the name if this sign? |
|
Definition
|
|
Term
| What type of deformity, present in12% of males, predisposes to testicular torsion |
|
Definition
|
|
Term
| What is the tx for testicular torsion? |
|
Definition
SURGICAL EMERGENCY
Analgesics and antiemetics and anti anxiety meds can help with sx |
|
|
Term
| What is the time frame for detonation of a testicular torsion that shows 90-100% salvage rate |
|
Definition
| If its done within 6 hours of onset of pain |
|
|
Term
| What is the most common solid renal tumor of childhood |
|
Definition
| Wilms tumor AKA nephronlastoma |
|
|
Term
| Give some general sx that may be present when a pt presents with a wilms tumor |
|
Definition
| Anorexia, nausea, vomiting, fever, abdominal pain, hematuria |
|
|
Term
| Do patients with wilms rumors sometimes resent with HTN or hypotension? |
|
Definition
| HTN due to increased renin levels |
|
|
Term
| Describe the obstructive and irritative sx of BPH |
|
Definition
-obstructive: hesitancy, feeling of incomplete void, decr force of stream, straining, post void dribbling
-irritative: dysuria, nocturia, urgency, frequency |
|
|
Term
| What are the two classes of medication used to tx BPH. Give an ex and the MOA for each. |
|
Definition
-Alpha adrenergic antagnosits, Terazosin (Hytrin), make urination easier by relaxing smooth muscle tissue in prostate and outlet of bladder
-5 alpha reductase inhibitors, Finasteride (Propecia) shrink the prostate by hormone suppression |
|
|
Term
| What specific hormones are manipulated in the MOA of 5 alpha reductase inhibitors |
|
Definition
| BLOCKS The enzymatic conversion of testosterone to DHT |
|
|
Term
| what is the class of medications used to tx ED? Examples? MOA? Do no take these with what other med? |
|
Definition
-Phosphodiesterase type 5 Inhibitors
-Sildenafil (Viagra), Vardenafil (levitra), Tadalafil (Cialis)
-Relax smooth muscle in the penis to allow for more blood flow to get and maintain an erection
-Do not take if they are taking nitrates |
|
|
Term
| what amount of urine classifies as polyuria? |
|
Definition
|
|
Term
| Describe the causes of stress, urge, and overflow incontinence |
|
Definition
-Stress: dysfunction of the sphincter (loss of pelvic support) causes urine loss with increases in intra-abdominal pressure
-Urge: Overactive bladder sends signals of contraction to the brain that the brain cannot overcome
-Overflow: bladder distention leads to overflow of urine in the urethra |
|
|
Term
| what post void residual value would signal that a pt has overflow incontinence |
|
Definition
|
|
Term
| what is the DDX for transient, acute incontinence (think of the mnemonic) |
|
Definition
-DIAPPERS
-Delerium
-Infection
-Atrophic urethritis or vaginitis
-Pharmaceuticals
-Psych causes
-Excessive urine output
-Restricted mobility
-Stool impaction |
|
|
Term
| What are some drugs implicated in the tx of urge incontinence |
|
Definition
antimuscarinincs that help decr. the overactive spasms of the bladder
-Oxybutynin
-Tolterodine |
|
|
Term
| what is the gold standard for dx a kidney stone |
|
Definition
| helical CT of the abdomen without contrast |
|
|
Term
| What size of stone will be most likely to pass spontaneously, what size will most likely not and should undergo surgical intervention |
|
Definition
|
|
Term
| What is the most common type of kidney stone? |
|
Definition
|
|
Term
| what drug can be given to tx uric acid stone? |
|
Definition
|
|
Term
| What are the two signs on PE that would lead you to believe that testicular torsion was the dx |
|
Definition
-Cremaster reflex absent: Stroking the side of the testes does not illicit elevation of the testicle
-Negative phren's sign: no relief with elevation of the testes |
|
|
Term
| What type of anatomic deformity is associated with 90% of cases of testicular torsion? |
|
Definition
|
|
Term
| What is the tx for a testicular torsion? |
|
Definition
SURG emergency
experienced clinician can left the testes outward and laterally
consult Urology for emergency surg |
|
|
Term
| what type of organism may be associated with a rancid or ammonia smell in a pt with a UTI |
|
Definition
| a urea splitting organism such as proteus |
|
|
Term
| What does positive leukocyte esterase mean on a urine dipstick |
|
Definition
| it measures the enzyme, when its positive it means that there is neutrophils >4 wbc/hpf and this is a sign of infection |
|
|
Term
| When are nitrites positive? |
|
Definition
| in the presence of a gram negative organism (proteus or e coli) |
|
|
Term
| what is the avg ph of urine? what if the urine is alkaline in a pt with UTI sx, what does this mean? |
|
Definition
avg is 5-6
alkaline means that there is a urea splitting organism present (proteus) that is splitting urea into ammonia and CO2 which will cause an increase in pH |
|
|
Term
| what is the only drug on the market specific for the tx of interstitial cystitis |
|
Definition
|
|
Term
| what is the MC organism assoc with epididymitis in men <35, men >35? |
|
Definition
<35 chlamydia and gonorrhea
>35 e coli |
|
|
Term
| what are the signs and sx of epididymitis? |
|
Definition
| heaviness and dull aching discomfort in the affected hemiscrotum that can radiate up the ipsilateral flank. The epididymis is markedly swollen and tender to touch, may eventually become warm, erythematous, scrotal mass |
|
|
Term
| What occurrence in a pt's history may be elicited in a pt with epididymitis? |
|
Definition
| hx of heavy lifting, trauma, or sexual activity |
|
|
Term
| What is the PE sign that is often positive in a pt with epididmytis? |
|
Definition
| positive phren's sign, relief with elevation of the testes. this test is negative in a testicular torsion |
|
|
Term
|
Definition
UA positive for pyuria and bacteriura
cx grow organism |
|
|
Term
| What is the tx for epididymitis based on the MC organisms for age group? |
|
Definition
<35: ceftriaxone 250 mg IM one time + doxycycline 100 mg BID x 10 days
>35: ciprofloxacin 500 mg BID x 10-14 days |
|
|
Term
| what is the MC viral C of orchitis |
|
Definition
|
|
Term
| what is the most common type of prostatitis |
|
Definition
|
|
Term
| what are the sx of prostatitis? |
|
Definition
-Irritative bladder sx (should help differentiate dx) frequency, urgency, dysuria
-fever, chills, low back pain
-perineal pain
-dyspareunia |
|
|
Term
| what are the most common organisms implicated in acute bacterial prostatisis |
|
Definition
| ascending infection of gram negative rods ( E coli or Klebsiella) |
|
|
Term
| What is a test to figure out the nidus of infection in a man with sx of prostatitis, UTI, etc |
|
Definition
| the glass test (either 4 or 2 glass test) |
|
|
Term
| What is the tx for prostatitis? |
|
Definition
| While waiting for cx, tx with parenteral abx then pick appropriate drug when cx come back |
|
|
Term
| what are the most common causative agents in pyelonephritis? iN DM? |
|
Definition
-gram negative bacteria (e coli, proteus, klebsiella, enterobacter, and pseudomonas)
-Klebsiella is the MC in DM |
|
|
Term
| what will be seen on a UA that will distinguish pyelo from any other UTI? |
|
Definition
|
|
Term
| What is the PO abx treatment for gram negative bacteria in pyelo? gram positive? |
|
Definition
quinolones or bactrim
amoxicillin |
|
|
Term
| what are the guidelines in terms of rx pyridium |
|
Definition
warn the patient that it will turn the bodily fluids orange
do not give for longer than 3 days, bc after 3 days there should be improvement in sx if the abx choice was correct and we want the pt to be able to see improvement
-200 mg TID is the dosage |
|
|
Term
| what is the MC RF for bladder cancer |
|
Definition
tobacco use
it is also 3x more common in men |
|
|
Term
| what is the most common type of bladder cancer? |
|
Definition
| transitional cell carcinoma |
|
|
Term
| what is the MC presenting sx in bladder cancer |
|
Definition
|
|
Term
| what is the definitive diagnostic procedure for dx of bladder cancer? |
|
Definition
|
|
Term
| what is a non GU symptom that could be the first presenting sx for a pt with prostate cancer |
|
Definition
| back pain d/t spinal cord mets |
|
|
Term
| what is the mc area of the prostate for a tumor to arise from? |
|
Definition
|
|
Term
| what non renal sx may renal cell carcinoma present as? |
|
Definition
| PNA in the lung from mets to the lung |
|
|
Term
| what is a major rf of renal cell carcinoma? |
|
Definition
|
|
Term
| what is the best tx for renal cell carcinoma |
|
Definition
| surg, chemo and rad do not work well |
|
|
Term
| what is the MC malignancy in young men |
|
Definition
|
|
Term
| what two labs will be elevated in a nonseminomatous germ cell tumor of the testicle |
|
Definition
| increased AFP and increased hCG |
|
|
Term
| what are the two major types of testicular cancer and which is MC |
|
Definition
-seminomatous (35)
-nonseminomatous (^%) |
|
|
Term
| what is a major RF for testicular cancer? |
|
Definition
|
|
Term
| what is the MC presentation of testicular cancer |
|
Definition
| painless solid testicular swelling |
|
|
Term
| what are some major differences between post streptococcal glomerulonephritis and IgA nephropathy (Berger Disease) |
|
Definition
-PSGN: 1-4 weeks after strep infection of throat or skin, sub epithelial immune complexes "humps" seen on bx, "sore throat, face bloat, pee coke"
-Bergers: occurs 1-2 days after URI, hematuria |
|
|
Term
| What is a total s/o to nephritic syndrome on UA? |
|
Definition
|
|
Term
| Which has more protein in the urine, nephritic or nephrotic? |
|
Definition
-Nephrotic! >3.5g/24 hrs is the magic number
-nephritic has proteinuria but it is <3.5 g/24 hr |
|
|
Term
| What is different about the PRO lost in nephrotic vs nephritic besides the amount? |
|
Definition
-nephrotic: you're losing actual PRO
-nephritic: you're losing cells which are made of PRO so you get an incr in PRO on UA |
|
|
Term
| which will always cause HTN, nephrotic or nephritic? |
|
Definition
|
|
Term
| What lab must be ordered to R/O wegeners in a pt with nephritic syndrome |
|
Definition
| ANCA (antineutrophiliccytoplasmic AB) |
|
|
Term
| Which has FOAMY urine, nephrotic or nephritic? |
|
Definition
| nephrotic due to the have proteinuria |
|
|
Term
| Which has changes in lipids, nephrotic or nephritic? |
|
Definition
| -Nephrotic has lipiduria and hyperlipidemia. This is bc you lose a lot of PRO and albumin in blood is low, the liver goes into overdrive to replace the albumin in the blood but at the same time starts making a ton of lipids. You're not "losing" the lipids, so you have an inadvertent hyperlipidemia with spillage into the urine |
|
|
Term
| What are the two terms that are used that are pathognomonic one for nephritic and one for nephrotic |
|
Definition
-Membranous: nephrotic
-Proliferative: nephritic
ONE EXCEPTION: membranoproliferative has features of both |
|
|
Term
| What can happen to a pt with nephrotic syndrome in terms of coagulability? |
|
Definition
| THey can become HYPERcoagulable bc they lose ANTI-clotting PRO (like C and S) |
|
|
Term
| What will be seen on microscopic exam of the urine in a pt with nephrotic syndrome? |
|
Definition
| oval fat bodies and maltese cross formations |
|
|
Term
| What is the MCC of nephrotic syndrome in kids? in adults? |
|
Definition
-Kids: minimal change disease
-Adults: Focal and segmental glomerulosclerosis (FSGC) |
|
|
Term
| What is the rad of choice for dx PCKD |
|
Definition
|
|
Term
| What is formula for anion gap? What is a normal anion gap? |
|
Definition
Na - (Cl + HCO3)
normal is 12-16 |
|
|
Term
| what acid base DO is seen in renal failure? |
|
Definition
| Metabolic acidosis with an incr. anion gap |
|
|
Term
| What is formula for anion gap? What is a normal anion gap? |
|
Definition
Na - (Cl + HCO3)
normal is 12-16 |
|
|
Term
| what acid base DO is seen in renal failure? |
|
Definition
| Metabolic acidosis with an incr. anion gap |
|
|
