D\'s GU Step 2

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Author:
JCremer
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29312
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D\'s GU Step 2
Updated:
2010-08-08 13:52:40
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USMLE Step
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Genitourinary
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  1. CA inhibitors used for
    • Glaucoma
    • Epilepsy
    • Alt. Sickness
    • Metabolic Alkalosis
  2. Site of axn for CA i's
    Proximal convoluted Tubule
  3. SE of CA i's
    • Mild metabolic acidosis
    •  K
    • Nephrolithiasis
  4. Use for osmotic agents (mannitol)
    • ICP
    • ARF
    • Acute Glaucoma
  5. SE osmotic agents
    • Pulmonary edema
    • Relative NA
  6. Site of axn of osmotic agents
    • PCT
    • LoH
    • Collecting tubule
  7. Loop diuretic's use:
    • CHF
    • Pulmonary edema
    • Hypercalcemia
    • Cirrhosis
    • Rapid onset-good for emergency situations
  8. SE Loop Diuretics
    • Ototoxicity
    • Uricemia (gout)
    • K
    • Ca
  9. Thiazides use:
    • HTN
    • CHF
    • Hypercalciuria w norm serum Ca
    • Nephrogenic DI
  10. SE thiazides
    • K
    • uricemia
    • Ca
  11. K sparer's use:
    • 2 hyperaldosteronism
    • CHF
    • K preserving diuresis
    • PCOS (aldactone)
    • Acne (aldactone)
  12. SE of K sparer's:
    • Gynecomastia (aldactone)
    • Menstrual irregularity
    • K
  13. Name 4 K sparer's
    • Spironolactone
    • Eplernone
    • Triamenterne
    • Amiloride
  14. Name a diuretic that can be used in ppl with sulfa allergy
    Ethacrynic acid
  15. Treating pyleonephritis
    • Fluoroqunilones
    • Aminoglycosides
    • Cephalosporins

    • (1-2 days IV then outpt oral)
    • If severe or complicated 14-21 IV antibiotics
  16. Treating pyleonephritis in pregnant women.
    Amp/gent or ceftriaxone
  17. How do you see a Uric H stone
    IVP
  18. Expectant management of kidney stone:
    • Strain urine with strainer
    • Drink 3L h2o
    • Tamsulosin-relaxes mm
    • NSAID
    • Repeat CT
  19. Require sx for kidney stone if:
    • Unable to pass after 4-6wks
    • Complete urinary obstruction
    • Persistent infxn
    • Impaired renal fxn
  20. Stones  what size likely to pass?
    •  8 mm or in
    • UVJ
  21. 5 types of kidney stones
    • Calcium oxalate
    • Struvite
    • Calcium phosphate
    • Uric acid
    • Cystine
  22. Only stone that can not be seen on CT/Xray.
    Uric acid

    (radiolucent)
  23. Staghorn calculi
    • Struvite
    • (mg-nh4-po4)
    • Cystine-rarely
  24. Cause of calcium oxalate stone
    • Idiopathic hypercalciuria
    • Also SB dz
  25. Cause of struvite stone
    UTI-proteus, klebsiella
  26. Cause of calcium phosphate stone
    Hyperparathyroidism
  27. Treat uric acid stone by..
    Alkalinizing urine
  28. Large palpable kidneys, HTN, hematuria, flank pain. Dx?
    Polycystic kidney dz (PKD)
  29. Which PKD more common?
    Autosomal dominant-adult onset
  30. Treat PKD?
    • Vasopressin R antagonist
    • Amiloride
    • Drain large cysts
    • Dialysis
    • Transplant
  31. Complications in PKD
    • Incranial aneurysms
    • SAH
    • MVP
    • ESRD
    • Hepatic cysts
  32. #1 risk factor for RCC
    Smoking 
  33. Scrotal variocele, flank pain, HTN, hematuria. Dx?
    RCC
  34. Why do you usually move directly to surgical resection of RCC & bypass the biopsy?
    Biopsy can SEED cancer! 
  35. 4 cancers causing  EPO
    • RCC
    • HCC
    • Pheochromocytoma
    • Hemangioblastoma
  36. Paraneoplastic syndromes with RCC
    • Anemia
    • Erythrocytosis
    • Hepatic dysfxn
    •  Ca
    • Cachexia
    • Thrombocytosis
    • Polymyalgia Rheumatica
  37. Med that cause interstitial nephropathy ("allergic")
    • Aminoglycosides
    • B lactam antibiotics
    • Sulfonamides
    • NSAIDs
    • Allopurinol
    • PPI's
    • Diuretics
  38. Toxic causes of interstitial nephropathy
    • Cadmium
    • Lead
    • Cu
    • Mercury
    • Poison mushrooms
  39. Rash, fever,  Cr, eosinophilia, granular or epithelial casts. Dx? Tx?
    Interstitial "allergic/drug induced" nephropathy

    • Stop offending agent!
    • Steriods!
  40. Complication of Interstitial "allergic/drug induced" nephropathy
    • ATN
    • ARF or CRF
    • Renal papillary necrosis
    • ESRD
  41. Causes of nephritic glomerulonephritis:
    (PIG WAIL)
    • P: Post-infxn glomerulonephritis
    • I: IgA nephropathy
    • G: Goodpasture's
    • W: Wegener's
    • A: Alport's
    • I: Idio. crescentic glomerulonephritis
    • L: Lupus nephritis
  42. Recent infxn, oliguria, brown urine, HTN, kid. Dx? Tx?
    Post-streptococcal (infectious) glomerulopnephritis

    Self limited & supportive tx
  43. Post-streptococcal (infectious) glomerulopnephritis EM? Other labs?
    Bumpy depositis of IgG and C3 on renal BM.

    • UA- hematuri, proteinuria
    •  ASO titer
  44. Hematuria, flank pain, low grade fever, mesangial cell proliferation on EM. Dx? Tx?
    IgA nephropathy (Berger's)

    • Self limited
    • ACE i
    • Statin
    • Steriod
  45. Increased serum IgA & mesangial cell proliferation
    IgA nephropathy
  46. IgG antiglomerular BM antibodies. Dyspnea, hemoptysis, hematuria, myalgia. Dx?
    Goodpasture's
  47. Goodpasture's fluorescence
    Linear pattern of IgG antibody deposition
  48. Treatment Goodpasture's
    • Plasmapheresis
    • Steriods
    • Immunosuppressants
  49. Hematuria, RF, high frequency hearing loss, cataracts. Dx?
    Alports

    Defect in collagen IV in BM
  50. Alport's EM
    Glomerular basement membrane inconsistency

    Split GBM
  51. Rapidly progressive RF
    Idiopathic crescentic glomerulonephritis

    + ANCA
  52. Idiopathic crescentic glomerulonephritis (2 causes)
    • Wegener: cANCA
    • Pauci immune: pANCA

    Crescents on EM
  53. Renal dz + ANA, anti-DNA antibodies
    Lupus nephritis
  54. Respiratory symptoms, hematuria, granulomatous inflammation. cANCA dx? Tx?
    Wegener's

    • Cyclophosphamide
    • Corticosteriods
  55. Young kid with HTN, increased freq of infxn, flattening of podocytes on EM
    Minimal change dz
  56. MC kidney syndrome in HIV
    Focal segmental glomerular sclerosis
  57. Hyperlipidemia,  albumin, hematuria, drug use, proteinuria dx
    Focal segmental glomerular sclerosis
  58. MC kidney syndrome in black person
    Focal segmental glomerular sclerosis
  59. Spike & dome BM thickening
    Membranous glomerulonephritis
  60. Train track, double layer EM
    Membranoproliferative glomerulopnephritis
  61. Hep B or C association
    Membranoproliferative glomerulonephritis
  62. Metabolic alkalosis causes
    • Vomiting (ctrxn alkalosis)
    • Diuretucs
    • Cushings
    • Hyperaldoseronism
    • Adrenal hyperplasia
  63. Respiratory alkalosis
    • Hypervent
    • High altitude
    • Asthma
    • ASA toxicity
    • PE
  64. Respiratory acidosis
    • COPD
    • Respiratory depression
    • Neuromuscular dz
  65.  AG metabolic acidosis
    • Methanol
    • Uremia
    • DKA
    • Paraldehyde
    • INH
    • LA
    • Ethanol
    • Salicylates
  66. Normal AG metabolic acidosis
    • Diarrhea
    • RTA
    • TPN
  67. Normal AG
    8-12
  68. 6 D's of hypernatriemia
    • Diuretics
    • Dehydration
    • DI
    • Docs-iatrogenic
    • Diarrhea
    • Disease of kidney-hyperaldosteronism
  69. Too rapid correction of hypernatriema can cause
    Cerebral Edema
  70. Treatment of hypernatriema
    Gradual hydration of NS if dehydrated until stable then 1/2 NS
  71.  Na (serum),  urine osmolality, large urine volume. Cause?
    Diabetes Insipidous
  72. Treat CDI
    DDAVP
  73. Treat NDI
    • Salt restrict
    • h2o
    • Thiazide
    • Indomethacin
  74. If lithium induced NDI tx?
    • Thiazide
    • &
    • Amiloride!
  75. Water deprivation test and response in CDI vs NDI
    CDI: respond,  urine osmolality

    NDI: no change
  76. Na (serum),  urine osmolality, ( uNa >20)
    SIADH
  77. Treatment of SIADH
    • Fluid restrict
    • Loop diuretic
    • Hypertonic saline
    • Demeclocycline
  78. Correction of hyponatremia too quickly leads to
    CPM

    Correct by 12 in 24hrs!
  79. Causes of hypercalcemia
    • C: Calcium supplementation
    • H: Hyperparathyroidism
    • I: Immobility/iatrogenic
    • M: Milk alkali
    • P: Paget
    • A: Addisons/Acromegaly
    • N: Neoplasm
    • Z: ZE
    • E: Excess vit A
    • E: Excess vit D
    • S: Sarcoidosis
  80. Differentiate b/t familial hypocalciuric hypercalcemia and other causes of hypercalcemia by
    • +FH
    • Low urine Ca
    • Absence of osteopenia, nephrolithiasis & AMS
  81. UTI treatment
    • Amoxicillin
    • TMP SMX
    • Fluoroquinolones
  82. UTI treatment in pregnancy
    • Amoxicillin
    • Cephalexin
    • Nitrofurantoin
  83. MC bladder Ca
    Transitiona cell
  84. Treatment urethritis
    Ceftriaxone with doxy or azithromycin
  85. Treatment in prostatitis under 35
    Ceftriaxone with doxy or azithromycin
  86. Treatment in prostatitis over 35 or anal intercourse
    TMP SMX or fluoroquinolone
  87. Treatment of BPH
    • Alpha 1 blocker: terazosin
    • 5alphareductase i: finasteride
    • TURP
    • Transurethral needle ablation
  88. Treatment of prostate cancer
    • Prostatectomy
    • Radiation therapy
    • PSA follow up
    • Antiandrogen (fludimide, leuprolide)
    • Chemo
  89. Epididymitis treatment under 35
    Ceftriaxone & doxycycline/fluroquinolone
  90. Treatment of testicular torsion
    • Emergent surgical reduction
    • Orchiopexy
  91. Transilluminates
    • Hydrocele
    • Variocele
  92. Beat treatment for enuresis
    Alarms!
  93. Causes of persistent hematuria
    • Adult PKD
    • BPH
    • Neoplasm-bladder, kidney, prostate
    • Glomerular dz
  94. Do not biopsy what 2 cancers due to potential of seeding
    • RCC
    • Testicular cancer
  95. Testicular cancer with  Beta-hCG,  AFP
    Germ cell tumors

    • -Seminomatous
    • -Nonseminomatous
  96. Testicular cancer with  estrogen
    • Stromal cell tumor
    • -Leydig
    • -Serotoli
    • -granulosa

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