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NEPHR/URO/STI/MENSHEALTH

Terms in this set (112)

Stones on ultrasound will appear

A. Anechoic
B. Echogenic
Echogenic aka bright
Cysts appear on ultrasound

A. Anechoic
B. Echogenic
A. Anechoic, dark
A UVJ stone is located at what junction?

A. Renal pelvis
B. Bladder
C. Ureteral crossing of iliac vessels
At the bladder
We found hydronephrosis on ultrasound (the renal pelvis was ballooned out) what study would we order next and why?
CT Urogram

to investigate underlying cause

if we had high suspicious for nephrolith then we would do a more straightforward path and do ct without contrast to measure stone and call it a day
Why would we order a nuclear med study on a patient with long standing hydronephrosis?
Function study, eval how long the tracer stays in the kidney compared to normal values

Nuc med - think functional study or eval extent of metastasis
We eval renal mass vs cyst with what best initial imaging modality
Ultrasound

will show uniformity of cyst/mass
The ultrasound revealed septations, internal echoes with vascularity on doppler, we would want to further investigate with:
CT best for cysts

MRI is best for masses
What imaging study do you order for renal artery stenosis?
Renal arteriogram - eval renal supply
Your patient with low GFR needed to have a CT scan with contrast, what must the patient do after the exam?
HYDRATE
What is azotemia and what lab measures this?
Uremia, BUN
What are some symptoms of uremia?
Pruritius, asterixis, malnutrition
2 days after starting your patient on cyclosporine, your patient's BUN:Cr ratio was found to be 17:1, what kind of AKI do they have?

Pre
Intrarenal
Post
Intrarenal from nephrotoxic drug
Your patient has not been making urine lately, you get a renal panel and it reveals a BUN:Cr ratio of 8:1, what kind of AKI do they have?

Pre
Intrarenal
Post
Post
What lab do we use for drug dosing and what calculation is used for it?

A. Cr
B. Crcl
C. GFR
D. BUN
E. UA
B. CrCl

Cockcroft-Gault
What lab do we use to stage kidney disease?

A. Cr
B. Crcl
C. GFR
D. BUN
E. UA
GFR
We start to dose adjust for our renal patients whose GFR is < _______
60
Hematuria detected on UA is associated with all of the following except?

Glomerulonephritis
Pyelonephritis
Cystitis
Renal infarction
Tumors
Beets
Stones
Coagulopathies
Exertion
Trauma
Fever
Menses
Beets

(sorry)

Per Gambini's clin skills lab lecture
Pyelonephritis, glomerulonephritis, interstitial nephritis is associated with what type of casts?

A. Red cell cast
B. White cell cast
C. Tubular epithelial cell cast
D. Hyaline casts
B. White cell
Glomerular nephritis, cross fit people likely to have what type of casts?

A. Red cell cast
B. White cell cast
C. Tubular epithelial cell cast
D. Hyaline casts
A. Red cell cast

Specifically nephritic conditions, rhabdo
Range for specific gravity is 1.016-1.022, if pt's value is 1.030, what does that mean?

A. Fluid overload
B. Dehydration
Concentrated urine, dehydration
<1% FENa indicates what kind of renal cause?

Pre
Intrarenal
Post
Pre
A patient with CKD will likely have these elevated electrolytes except:

A. Na
B. K
C. Ca
D. Ph
E. Mg
C. Calcium

Dysfunctional kidneys can't convert calcidiol to calcitriol so we can't absorb Ca from diet
A patient with long term CKD may present with increased or decreased fracture risk?
Increased fracture risk,

bone demineralization can occur from lack of serum Ca
You determine your patient has an AKI and has been taking Bactrim, which electrolyte abnormality are you worried about and what do you want to order to check?

Na, K, Ca, Mg, P
Potassium

EKG
A patient with kidney damage and metabolic acidosis has issues with (2)

A. H+ production
B. H+ excretion
C. HCO3- resorption
D. HCO3- excretion
B and C
A patient has low bp, decreased skin turgor, dry mucus membranes, their hematocrit is likely:

Decreased
Increased
Increased
Over the last few days, your patient has had low bp, decreased skin turgor, dry mucus membranes, their fractional excretion of sodium is likely:

<1%
>3%
<1%
When would we consider a staph saprophyticus > e.coli UTI?
Uncomplicated female with recurrent UTI
What is the difference in treating cystitis vs pyelonephritis with Bactrim?
longer duration, 3 days vs 7-14 days
What patient education do we need to give about phenazopyridine for UTI?

(AZO/otc, Pyridine/Rx)
2 day max while on abx medication, we need to know if abx is working. AZO may mask symptoms
A 25 year old female with diabetes presents with dysuria, frequency, malodorous urine and is tender upon palpation of suprapubic region.

What is on the top of your differential?
Acute cystitis
A 25 year old female presents with dysuria, frequency, malodorous urine with frothy green discharge.

What is on the top of your differential?
Trichomoniasis
A 25 year old female presents with dysuria and is tender upon palpation of lower abdomen.

What else could you consider on differential?
Chlamydia/Gonorrhea

baby girl has adnexal tenderness

or baby girl has baby
A 28 year old abstinent and healthy female presents with dysuria and frequency, whose UA demonstrates pos nitrites and pos LE. What is your preferred abx?
Nitrofurantoin 100 mg 5 days

uncomplicated female
You decide to give this nice young lady nitrofurantoin. What drug interaction does it have?
PPI

can decrease effectiveness of Macrobid
Your 64 year old male has had voiding symptoms, fevers, CVA tenderness and nausea,

What might you see on UA?
White cell casts, LE, nitrites

pyelonephritis, older male, prostatic obstruction
Your 40 year old male patient with has had CVA tenderness, nausea, and stabbing pain,

What do you expect to see on bmp?
Possible bump in creatinine/BUN

kidney stone, younger males
Your 40 year old male patient with has had dysuria, CVA tenderness, nausea, and stabbing pain,

what imaging do you want to order?

A. Retrograde urethrogram
B. CT Urogram
C. CT angiography
D. CT no contrast
D. No contrast CT
You measure on CT the size of the stone, it is 3 mm, what is your plan?
Medical expulsion therapy: Flomax, strainer, anti-emetic
Your uncomplicated female with recurrent UTIs came back again and is now complaining of CVA tenderness and stabbing pain. You decide to get a CT and you find a staghorn struvite stone that is 3 cm, what is your plan?

A. Blast it
B. Pee it out
C. Surgical removal
D. Roller coaster ride
Surgical: percutaneous nephrolithotomy
Your 67 year old male has had urinary frequency and urgency and nocturia, no pain with urination.

CVA neg, what PE do you want to do next?
Prostate exam

overactive bladder due to obstruction
What imaging do you order for overactive bladders?

A. Post void residuals on ultrasound
B. Voiding cystourethrogram
C. CT Urogram
A. Post void residuals on ultrasound
25 year old diabetic female presents with vaginal itching and curd like discharge, what do you expect to see on wet mount?

A. Giant multi nucleated cells
B. Flagellated protozoa
C. Clue cells
D. Hyphae and budding
D. Hyphae
Say you have herpes. You need to notify all partners in the last:

A. 48 hours
B. 3 weeks
C. 3 months
D. 10 years
C. 3 months
35 year old female presents with vaginal discharge that was cultured and found gardnerella vaginalis, what is our treatment?
BV:
Metronidazole
Amsel's criteria is associated with which STI?
Bacterial vaginosis 3/4 to diagnose

1. d/c thin and grey
2. whiff test fish
3. ph >4.5
4. clue cells on wet mount
PID is most commonly caused by?
Chlamydia and gonorrhea

but can also be caused by bv and trich
Your female patient presents with positive chandelier's sign, adnexal tenderness, fever and has been vomiting, how do we treat PID as inpatient?
Abx,

cefotetan and doxy for 2 weeks. Start with cefotetan and then continue doxy oral
Your female patient presents with positive chandelier's sign, adnexal tenderness, but she's not in distress, how do we treat PID as outpatient?
Doxy, Rocephin, metronidazole
How do we treat chlamydia?
Gonorrhea?
Chlamydia: Doxy

Gonorrhea: Rocephin (ceftriaxone)
A patient presents with painful vesicles and you decide to do a Tzanck smear and you see the giant nucleated cells. How do you want to treat?
Herpes: Valacyclovir

We can do acyclovir, but valacyclovir has a less dosing/higher compliance
Which of these STI treatments can cause crystalize and cause nephrolithiasis? (1)

A. Doxy
B. Rocephin
C. Metronidazole
D. Fluconazole
E. Acyclovir
F. Cefotetan
G. Benzathine PCN
H. Permethrin cream
E. Acyclovir
How do we diagnose chlamydia, gonorrhea, and herpes?
NAAT / genprobe
Neisseria gonorrhoeae can cause meningitis, endocarditis, arthralgias

how would we change treatment?
Up dose, longer duration

Standard gonorrhea with cervicitis/abdominal pain we do 1 time IM injection

meningitis we treat for 2 weeks
A Gram-negative diplococci should make you think of what STI diagnosis?
Gonorrhea
Treponema pallidum is a spirochete associated with which STI?

A. Gonorrhea
B. Herpes
C. Syphilis
D. Trichomoniasis
C. Syphilis

SS
So then what do we use to diagnose syphilis?
Rapid Plasma Reagin (RPR) test.
Your patient presents with a painless chancre on his penis and asks you how to get rid of it. What do you do?
Order RPR test and admin penicillin

follow up with RPR titers to confirm success of tx and prevent advancement
Which of these STI's may present with a maculopapular rash but also possibly other vague rashes?

A. Gonorrhea
B. Chlamydia
C. Herpes
D. Syphilis
Syphilis's painless chancre will disappear and advance to rash.

Syphilis is our "great imitator" for rashes
Ok your next patient comes in with a painful chancre on his penis, what does he have?
Chancroid,

caused by H. Ducreyi and treat with azithromycin
Jarisch Herxheimer reaction is associated with abx treatment of which STI?

A. Gonorrhea
B. Chlamydia
C. Herpes
D. Syphilis
Spirochete lysis- fevers, chills, nausea, vomiting, tachycardia, hyperventilation
Your male patient has urethritis and you find buboes along his groin. What do you suspect and how would you treat differently?
lymphogranuloma venereum

evil sister to chlamydia, still doxy but longer treatment
Condyloma Acuminata are genital warts that are associated with what STI?
HPV
High majority of HPV infections are asymptomatic/resolve, but why do we worry about it?
Certain strains of HPV can cause cervical/oral cancers
What can we do for HPV
Prevention/vaccinate with Guardasil9

Younger than 15, 2 doses, older than 15, 3 doses

indicated for men/women up to 45
Your 67 year old male patient comes in complaining of urinary frequency, no pain. What can you prescribe?
Tamsulosin "Flomax"

BPH, older males
11 year old male patient comes in for dysuria, frequency and urgency. He had a recent excretory urogram study that indicated that he has a horseshoe kidney. What do you suspect?
hydronephrosis, stones, obstruction
How does one get hydronephrosis?
Any kind of obstruction. BPH, cancer, neurogenic bladder, UTI, stone, tumor, fibrosis
30 year old female has cutaneous leiomyomas and uterine fibroids, which predisposes her for renal cell cancer. What is this condition called?
Reed syndrome

rare, very aggressive
You're tickling your 3 year old niece and you find a mass on her belly. She says it doesn't hurt. You just learned renal and you're scared it might be:
Wilm's tumor
50 year old male works in plastics and has been having gross hematuria. You hear a bruit over the renal artery. You're thinking it could be _______
Renal cell carcinoma
Your patient has a varicocele on the right testicle and that's weird because the right testicle shouldn't have any venous congestion since it connects directly to IVC, you're thinking it could be ______
Renal cell carcinoma
Gross hematuria and occupational exposure is also associated with?
Transitional cell tumors of bladder
Which is associated with >3 g/day proteinuria and hypoalbuminemia?

Nephritic vs nephrotic
Nephrotic
How does hypoalbuminemia cause hypocalcemia?
Calcium binds to albumin
How does a nephrotic state lead to increased risk of DVT/PE events?
You're losing all of that protein, you're also losing the anti-thrombin factors.
Focal segmental glomerulosclerosis is autoimmune, treated with cyclosporine and is more common in

A. African Americans
B. White males
African Americans, diagnosed in childhood
Membranous nephropathy is autoimmune, treated with prednisone and is more common in:

A. African Americans
B. White males
White males
Your patient was recently had an upper respiratory infection and is now having hematuria. What kind of renal issue does the patient have?
Glomerulonephritis- nephritic
You identify that your patient is having proteinuria. They don't have diabetes and they haven't been sick lately. What could you do to definitivelyfcond diagnose your patient?
Biopsy
If a patient just started a medication and they came back in a week for follow up and their creatine increased by 50% What would you do?
Increase time between dosing to allow kidneys more time to clear

or discontinue completely
Kidney dz tx - must identify underlying cause and modifying risk factors.

-Control HTN
-Control DM
-Control dyslipidemia
-Drug monitoring
Treatment of CKD also involves treating the complications such as hyperkalemia, volume overload, bone disease, hyperparathyroidism, anemia, malnutrition, uremia.
When would we start renal replacement therapy?
GFR < ____
GFR <10-15
Which of these is preferred long term?

A. AV fistula
B. AV graft
C. Tunneled cath
D. Temporary cath
E. Peritoneal dialysis
AV fistula
A patient complains of having pain with erection, crooked shape, but no trauma, what is this called and what would you do?
Peyroinies disease

Referral, he's got penis fibrosis
Which is a medical emergency?

Phimosis
Paraphimosis
Paraphimosis

cutting off circulation
How would we prevent paraphimosis?
Put the foreskin back if you retracted it

Can't get hood on
You stroke the inside of a man's thigh and the scrotum rises. This is a positive sign and it is called:

A. Phren
B. Cremasteric
Cremasteric

Phren: lifting a testicle and it relieves pain, not a great test
Why in the world would we want to stroke a mans thigh?
To rule out testicular torsion
A 66 year old male patient comes in for frequent urination. While you're doing your male GU exam you discover his left testicle feels like a bag of worms. What do you suspect?
Varicocele- painless
A 66 year old male patient comes in for frequent urination. While you're doing your male GU exam you discover his right testicle feels like a bag of worms. Your Gambini senses are tingling, what's on your mind?
Renal cell carcinoma
A 14 year old male patient comes in and complains of a painful scrotum. He has a negative cremaster reflex. What is your suspicion and what imaging study do you order next?
Torsion

Ultrasound- look at blood flow
How long do you have to save that testicle?
6 hours max
Your 32 year old patient comes in for urethral discharge and dysuria. During your male GU exam you discover the left posterior lateral aspect of his scrotum is tender. Cremasteric positive, Phren positive. What do you suspect and how would you treat?
Epididymitis

cause is likely STI, Abx = Doxy/rocephin
Your 54 year old patient comes in with pain on one side of his scrotum. Both cremasteric, phren's reflex positive. What do you suspect and how would you treat?
Also epididymitis

cause is likely E.Coli/pseudomonas, tx levoflox
A 30-year-old male patient complains of general scrotal pain, he says he works as a primary school teacher and reveals he and his wife plan on having children soon. What is on the top of your differential and what is your plan?
Orchitis- caused by viral mumps/coxsackie

send straight to urology for sterility testing
You just learned how to do male GU exam and decide to practice on significant other. You palpate a bump on one testis. It's anterior and midline and he says it doesn't hurt. First thought is:

A. That's just the epididymis
B. Maybe it's a spermatocele
C. Bumps are normal
D. Testicular cancer
D. Testicular cancer- single firm painless unilateral mass
Are hydroceles painful? What do they indicate?
No, hydroceles can be secondary to epididymitis, orchitis, torsion, tumor
A new varicocele should lead to you think?
Cancer
How are most testicular conditions diagnosed?

Torsion, testicular cancer, hydroceles, varicoceles,
Ultrasound
Your patient is flipping tables because his scrotum is hurting quite a bit. He just so happens to have diabetes. You calm him down, take a look and find a black patch on his scrotum.

Who you gonna call?
Surgery bc it's emergent, our friend has Fournier's gangrene
If you find a scrotal mass, lesion, abscess and it doesn't hurt.. what should you do?
MUST BIOPSY FOR CANCER
70 year old patient with BPH has had recurrent hematuria and refractory urinary retention. What surgical options are available for him?
TURP/TUIP -- transurethral resection/incision of prostate

or

Laser/ablation
Epididymitis and proctitis in older males you think of what bacteria?
E.Coli/pseudomonas

cover with levoflox
Epididymitis and proctitis in young males makes you think of what bacteria?
Chlamydia/gonorrhea

doxy/rocephin
69 year old male presents with a fever, dysuria, and pain at the tip of his penis. He recently had a prostatic biopsy.
Acute Proctitis
Fin

Disclaimer- I did not focus much on CKD treatment, men's health treatment or infertility because I don't have time to make questions anymore

the rest of the deck is nonsense
: |
Prazosin, terazosin, doxazosin
Selective Alpha 1 blocker used for hypertension, BPH, may cause first dose orthostatic hypotension
Tamsulosin
alpha 1 blocker
5-alpha reductase inhibitors
Finasteride (Proscar)
Dutasteride (Avodart)
acute vs chronic prostitis
idk, treat chronic longer
prostate cancer gold standard diagnosis
transrectal US guided biopsy
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