GU exam 1 clinical correlations

Ciprofloxacin

A 26 year-old sexually active woman has a 3-day history of dysuria, frequency, and urgency. She has a fever of 102 degrees F orally with shaking chills and right-sided costovertebral angle tenderness. Urinalysis reveals 10-20 RBCs/HPF, 30 WBCs in clumps/HPF, 3-4 WBC casts and 3+ bacteria. Which of the following is the treatment of choice for outpatient management? A Ciprofloxacin B Erythromycin C Doxycycline D Amoxicillin

Glomerulonephritis

BE is a 26-year-old man who presents with hematuria, periorbital edema, and jaundice. He has a medical history of opioid use disorder with prior hospitalizations for a heroin overdose. He is on methadone but is non-adherent. His blood pressure is 155/102 mmHg. Physical examination is significant for scleral icterus, hepatomegaly, and palpable purpura. Serology shows decreased C3 and C4 levels and elevated anti-hepatitis C antibodies. Urinalysis demonstrates dysmorphic red blood cells and red blood cell casts. What is the clinical dx?

Viral hepatitis

Membranoproliferative glomerulonephritis - due to SLE, ______ ______

Crescent

Rapidly progressive glomerulonephritis - _________ formation on biopsy due to fibrin and plasma protein deposition Goodpasture's syndrome: (+) anti-GBM antibodies, dx linear IgG deposits, treat with high dose steroids, plasmapheresis + cyclophosphamide Vasculitis - lack of immune deposits (+) ANCA antibodies Microscopic polyangiitis (+) P-ANCA Granulomatosis with polyangiitis (Wegener's) (+) C-ANCA

Prostatitis

SM is a a 63-year-old man with a history of benign prostatic hyperplasia reports 3-days of fever, chills, and pain with urination. He was recently catheterized during admission to the hospital. Physical exam reveals a tender and enlarged prostate on digital rectal exam. Urinalysis reveals pyuria and hematuria. What is the likely diagnosis?

Pyelonephritis

What is an infection of the renal pelvis and interstitium?

PKD

What is an inherited kidney disease that produces fluid-filled cysts in the kidneys that produce chronic renal failure over many years?

juxtaglomerular apparatus

What is composed of 2 types of cells which control renal blood flow, glomerular filtration and renin secretion?

Cystitis

What is inflammation of the bladder?

Recent strep infection

What is the most common cause of nephritic syndrome in a 4-year-old? A Trauma B Recent strep infection C Dehydration D Nonsteroidal anti-inflammatory drugs (NSAIDs) E Varicella infection

Internal urethral sphincter

What is the ring of smooth muscle at the junction of the urethra and the bladder?

Nephrosis

What is the term for degeneration of the renal tubular epithelium?

First sign of nephrotic syndrome

Which of the following statements is accurate regarding the presentation of nephrotic syndrome? A Hematuria is among the most common presenting symptoms in adults with nephrotic syndrome B The first sign of nephrotic syndrome in children is usually swelling of the face C The presence of deep venous thrombosis or pulmonary embolism suggests a diagnosis other than nephrotic syndrome D Weight loss and hypotension are frequently present in adults with nephrotic syndrome

Afferent

______ arteriole: transports blood into a structure (e.g. glomerulus)

IV ceftriaxone

A 35 year-old pregnant patient presents with fever, chills, and left-sided flank pain. On physical examination left-sided CVA tenderness is noted. Urinalysis reveals numerous white blood cells and white blood cell casts. Which of the following is the most appropriate treatment? A Oral ciprofloxacin (Cipro) B Oral trimethoprim-sulfamethoxazole (Bactrim) C IV gentamicin (Garamycin) D IV ceftriaxone (Rocephin)

Renal biopsy

A 54 year-old woman with history of lupus comes to the office with increasing significant peripheral edema over the past four days. Laboratory findings include marked proteinuria, hypoalbuminemia and hyperlipidemia. Which of the following diagnostic studies is the best for determining the cause of the proteinuria? A Renal ultrasound B Renal biopsy C Cystoscopy D Computed tomography scan

GFR

WHat is the the filtration of the plasma per unit time and is directly related to the perfusion pressure in the glomerular capillaries.?

proximal convuluted tubule (PCT)

Which of the following is the portion of the nephron responsible for the absorption of 90% of the ultrafiltrate? A Proximal convoluted tubule B Loop of Henle C Distal convoluted tubule D Collecting duct

respiratory alkalosis

A patient with the following ABG has what type of acid-base disorder? ph 7.52, PCO2 25, Bicarb 22 PH (7.35-7.45 normal) CO2 (35-45 normal) HCO3 (20-26 normal) A Respiratory acidosis B Respiratory alkalosis C Metabolic acidosis D Metabolic alkalosis

Hematuria, hearing, lenticonus

Alports Syndrome Presents as isolated persistent ________ A genetic condition that occurs in children resulting in renal failure and ________ loss Ophthalmologic exam reveals anterior __________ - anterior part of the lens has a conical shape DX - C3 and C4 Levels

Phimosis, paraphimosis

Patient will present with → foreskin in normal position that cannot be retracted. What am I? Patient will present with → entrapment of the foreskin in the retracted position. What am I?

Renal arteries

What arise as the fifth branches of the abdominal aorta and supply blood to the kidneys?

Nephrotic syndrome

What syndrome is when there is excretion of large amounts of protein in the urine per day. This is characteristic of glomerular injury.?

CKD

__________ is at least 3 months of either: structural or functional abnormalities of the kidney that can lead to kidney failure; or GFR < 60 mL/min/1.73 m2

ASO

A 15 year old boy comes to your clinic after having a sore throat, he wasn't treated. He now has hematuria, pretibial edema and hypertension. What antibody do expect on lab findings? ANCA ASO ANA Anti GBM

Nephrotic

EM is a 6-year-old boy who is brought to the emergency department by his mother due to swelling around his eyes and legs. The mother reports that the patient recently recovered from an upper respiratory tract infection. Physical exam is significant for periorbital and lower extremity edema. Laboratory testing is significant for hypoalbuminemia and normal complement levels. Urinalysis demonstrates 4+ protein and fatty casts with "maltese cross" sign. He presents with _______ syndrome.

Glomerulonephritis, hematuria, flank

IgA Nephropathy (Berger disease) - most common cause of acute ____________ worldwide Gross ________and __________pain in a person with acute URI Often affects young males within days (24-48 hours) after URI or GI infection Caused by IgA immune complexes which are the first line of defense in respiratory and GI secretions so infections cause an overproduction which then damages the kidneys Diagnosed by (+) IgA deposits in mesangium and with immunostaining

Prerenal azotemia

Lab results for a post-operative oliguric patient reveals an increased BUN to creatinine ratio. The patient has a low fractional excretion of sodium (less than 1%). Which of the following is the most likely diagnosis? A prerenal azotemia B acute tubular necrosis C acute glomerulonephritis D obstructive uropathy

Amyloidosis

Of the following, which is more commonly recognized as a secondary cause of nephrotic syndrome? A Sjögren syndrome B Cushing disease C Hemolytic anemia D Amyloidosis

extracorporeal shock wave lithotripsy (ESWL)

What are Ultrasound waves are used to break up stones in the kidney, ureter and bladder into smaller pieces which can eliminated from the body in the urine?

Glomerulus

What is the tuft of capillaries that loop into a circular capsule, called the Bowman Capsule?

Excessive diuresis

Which of the following is a cause of acute kidney failure due to prerenal azotemia? A Excessive diuresis B Urinary tract obstruction C Radiologic contrast media D Aminoglycosides

Acute Glomerulonephritis (AGN)

A 15 year-old male patient presents with oliguria, hematuria, proteinuria, and fatigue following streptococcal pharyngitis 2 weeks ago. Which of the following is the most likely diagnosis? A Acute pyelonephritis B Acute glomerulonephritis C Systemic lupus erythematosus D Initial onset of type 1 diabetes mellitus

Glomerulonephritis

A 22-year-old woman comes to the office because her urine is cola-colored and she has not urinated since yesterday morning. Her past medical history is significant for pharyngitis two weeks ago. Her mother and grandmother have type 2 diabetes. Her blood pressure is 146/92 mmHG. On physical examination, she has edema of her face and hands. Which of the following is the most likely diagnosis? A Glomerulonephritis B Acute tubular necrosis C Nephrolithiasis D Diabetic nephropathy

White cell casts

A 28-year-old female comes to the office with fever, flank pain, and dysuria for the past two days. Which of the following urinalysis results are suggestive of acute pyelonephritis? Hyaline casts Red cell casts White cell casts Granular casts

IgA nephropathy

A 9 year-old boy who has had cold-like symptoms for the past few days is brought to the clinic by his mother who states that her son had gross hematuria this morning. Prior to the cold-like symptoms the boy has been in excellent health. He is up-to-date on all of his immunizations. The patient does not have any edema, hypertension or purpura. Urinalysis reveals the urine to be cola-colored with a 2+ positive protein and 2+ hemoglobin. Microscopic analysis reveals 50-100 RBCs/HPF, no WBCs, bacteria, casts or crystals. What is the most likely diagnosis A Post streptococcal glomerulonephritis (PSGN) B IgA nephropathy C Minimal change disease (MCD) D Membranous nephropathy

Nephrotic syndrome

A patient presents with edema, which is most noticeable in the hands and face. Laboratory findings include proteinuria, hypoalbuminemia, and hyperlipidemia. The most likely diagnosis is A congestive heart failure B end-stage liver disease C nephrotic syndrome D malnutrition

Pyelonephritis

BE is a 32-year-old female who presents with fever, chills, nausea and flank pain for 24 hours. She developed dysuria and urinary frequency 3 days prior and states that both have worsened. On physical exam you note suprapubic abdominal pain and CVA tenderness. The urinalysis reveals white blood cell casts. What is the clinical DX?

Acute renal failure

BE is a 52-year-old male with a past medical history of diabetes mellitus presents with fever and acute onset left lower quadrant abdominal pain. CT scan with contrast shows acute diverticulitis. He is started on broad-spectrum antibiotics. The next day, labs reveal a rise in creatinine from 0.7 mg/dL to 2.0 mg/dL. Urinalysis is obtained and a significant amount of muddy brown casts is found. What is the clinical DX?

Stress incontinence

BE is a 68-year-old woman who presents to your office with leakage of urine when she sneezes, laughs, or coughs. She reports that these symptoms strictly occur during the day and never at night. She denies any subjective fever, dysuria, or hematuria. Pelvic examination is notable for a protrusion from the anterior vagina. What am i?

White blood cell casts

What casts in urine are PATHOGNOMONIC for pyelonephritis?

Chronic glomerulonephritis

What encompasses several glomerular diseases with a progressive course leading to chronic renal failure?

Detrusor muscle

What is a basket weave of smooth muscle fibres that form the urinary bladder?

PCr (plasma creatine)

What is a blood test which is directly related to GFR.?

Metabolic acidosis

A patient with the following ABG has what type of acid-base disorder? ph 7.30, PCO2 40, Bicarb 16 PH (7.35-7.45 normal) CO2 (35-45 normal) HCO3 (20-26 normal) A Respiratory acidosis B Respiratory alkalosis C Metabolic acidosis D Metabolic alkalosis

Hydronephrosis

What is the accumulation of urine in the renal collecting system?

Analgesic nephropathy

What is the kidney disease that is caused from high consumption of analgesic (pain-relieving) medications?

ATN (acute tubular necrosis)

What is the most common cause of ARF? (It can be caused by ischaemia (blood vessel obstruction) post surgery, sepsis, obstetric complications or severe burns)

Acute pyelonephritis

A 25 year-old female presents with right lower quadrant pain, right flank pain, nausea, and vomiting. Her temperature is 39.6 degrees C. There is right CVA tenderness and RLQ tenderness. Pelvic exam is unremarkable. Urinalysis reveals pH 7.0, trace protein, negative glucose, negative ketones, positive blood, and positive nitrates. Specific gravity is 1.022. Microscopic shows 102 RBCs/HPF, 50-75 WBCs/HPF, rare epithelial cells, and WBC casts. The most likely diagnosis is A acute salpingitis B nephrolithiasis C acute pyelonephritis D appendicitis

IV sodium bicarbonate

A 27 year-old patient presents with crush injuries to both lower extremities after being involved in an automobile accident. Within six hours of the accident, urine output has decreased to less than 10 cc per hour. Within 24 hours the serum creatinine increased from 0.9 mg/dl to 2.9 mg/dl and serum CPK is now 12,000 U/L. In addition to a fluid challenge with normal saline, which of the following is the most appropriate treatment as this time? A IV calcium chloride B Oral captopril (Capoten) C IV sodium bicarbonate D Oral sevelamer (Renagel)

Enuresis

A mother and her 6-year-old son come to the office with a concern that he continues to have nighttime wetting several times a week. He is the second child of three. He is in the first grade and struggling with his performance. He has had no medical problems. There is no history of developmental delay, and he was the product of a normal uncomplicated pregnancy and delivery. Since the birth of the third child, his behavior has been problematic. The examination of other body systems is normal. He does not have laboratory evidence of a urinary tract infection. What is the likely diagnosis?

Respiratory acidosis

A patient with the following ABG has what type of acid-base disorder? ph 7.30, PCO2 60, Bicarb 22 PH (7.35-7.45 normal) CO2 (35-45 normal) HCO3 (20-26 normal) A Respiratory acidosis B Respiratory alkalosis C Metabolic acidosis D Metabolic alkalosis

Metabolic alkalosis

A patient with the following ABG has what type of acid-base disorder? ph 7.52, PCO2 40, Bicarb 38 PH (7.35-7.45 normal) CO2 (35-45 normal) HCO3 (20-26 normal) A Respiratory acidosis B Respiratory alkalosis C Metabolic acidosis D Metabolic alkalosis

Do nothing

A urinalysis performed during a routine physical examination on a 43 year-old male reveals 1-2 hyaline casts/HPF. The remainder of the UA is normal. Based upon these results, the physician assistant should A collect a urine for culture and sensitivity B do nothing, since these casts are considered normal C refer the patient to a nephrologist D schedule the patient for a CT scan

Rhabdo

An elderly appearing adult male patient is transported to the emergency room with unconsciousness for an underdetermined amount of time. There is no family and the only history is provided by the paramedics. The patient arouses to verbal and painful stimuli. VS: T-97.0 degrees F rectally, P-52 bpm, R-10, BP-95/60 mmHg. Physical examination is unremarkable except for ecchymosis across his extremities. A Foley catheter is inserted draining a small amount of dark brown urine. Urine dipstick reveals 4+ positive hemoglobin and protein. Microscopic urinalysis reveals no RBCs but many renal tubular epithelial cells and renal tubular casts. Drug screen is negative, blood alcohol is 2.5 mg/dL, and creatinine is 4.9 mg/dL. What is the most likely diagnosis? A Rhabdomyolysis causing acute renal failure B Obstructive uropathy causing acute renal failure C Ethanol ingestion causing acute renal failure D Methanol ingestion causing acute renal failure

Vitamin D

What is a fat-soluble chemical that is activated naturally in the body on exposure to sunlight?

CCPD (Continuous Cycle Peritoneal Dialysis)

What is a form of continuous dialysis in which the peritoneal cavity is continuously filled with dialysis fluid by a machine?

Continuous ambulatory peritoneal dialysis (CAPD)

What is a form of continuous peritoneal dialysis in which dialysis fluid is exchanged at regular intervals throughout the day?

Loop of henle

What is a hollow, hairline loop of the nephron, composed of thick and thin portions. Solutes are actively transported across the thick section of the loop resulting in urine concentration?

Reflux nephropathy

What is a kidney disease caused by the backflow of urine from the bladder up the ureters into the kidney tissue?

renin-angiotensin system

What is a major hormonal regulator of renal blood flow, which can increase systemic arterial pressure and thus change renal blood flow?

Interstial cystitis

What is a persistent and chronic form of 'non-bacterial' cystitis occurring primarily in women?

Dialysis

What is a treatment for kidney failure which removes wastes and water from the blood; a process by which small molecules pass from one fluid where they are in high concentration to another fluid where the concentration is lower, through a porous membrane?

URS

What is a visual inspection of the interior of the ureter and kidney by means of a fiberoptic endoscope?

Urea

What is a waste product from the breakdown of protein and the major constituent of urine along with water?

Creatinine

What is a waste product of muscle activity that is removed from the body by the kidneys, and excreted in the urine; high levels of creatinine represent reduced kidney function?

AKI

What is an abrupt reduction in kidney function with elevation of blood urea nitrogen (BUN) and plasma creatinine?

Renal cortex

What is an area of the kidney that contains all the glomeruli and portions of the tubules?

Dyselectrolytemia

What is an imbalance of certain ionized salts (i.e., bicarbonate, calcium, chloride, magnesium, phosphate, potassium, and sodium) in the blood?

glomerulonephritis

What is the condition in which the glomeruli, the tiny filters in the kidneys are damaged; often referred to as nephritis?

Intermittent peritoneal dialysis (IPD)

What is the form of peritoneal dialysis in which exchanges are done hourly for two or three days each week?

Axolemia

What is the term for increased serum urea levels and frequently increased creatinine levels as well?

Nephron

What is the the structural and functional units of the kidney, numbering over a million in each kidney, which are capable of forming urine?

peritoneal dialysis (PD)

What is the treatment for kidney failure in which dialysis fluid is introduced into the peritoneal cavity to remove wastes and water from the blood?

Gentamicin

Which of the following medications is most likely to cause acute tubular necrosis? A Trimethoprim-sulfamethoxazole (Bactrim) B Acetaminophen C Cephalothin (Kefzol) D Gentamicin

Podocytes

__________: are specialized cells located in the glomerular epithelium. These foot-like cells interlock and form a network of intracellular clefts called filtration slits which filter the glomerular filtrate, forming the primary urine