APEA 3P EXAM PREP3 –NEPHROLOGY WITH RATIONALE

APEA 3P EXAM PREP3 –NEPHROLOGY WITH RATIONALE A hea l thy 32-year-o l d female has le f t f l ank pa in and nausea. What is the most l i ke ly d iagnos is? Ur inary t rac t in fec t i on Rena l s tone Cholecys t i t i s Pye lonephr i t i s The most common presenta t ion o f acu te uncompl ica ted pye lonephr i t i s inc ludes fever , f lank pa in , and nausea and vomi t i ng. Somet imes pat ient s p resent w i th symptoms o f pe lv ic i nf lammatory d isease (PID) . In th is p resenta t ion , abdomina l pa in is common too . Fever is so s t rong ly cor re la ted wi th acute pye lonephr i t i s tha t i t i s unusua l not to have fever . Rena l s tone pa t ien ts may have th is presenta t ion , bu t fever is usua l ly NOT present . I t i s un l ikel y tha t cho lecys t i t i s wou ld present w i th le f t -s i ded f lank pa in . The ga l l b ladder is on the r igh t s ide o f the body. The inc idence o f pyel onephr i t i s i s : l eas t common in young adu l ts . l ess common than ur i nary t rac t in fec t ions . a lways assoc ia ted wi th u r inary t rac t in f ect ions . more l i ke ly in e lderl y ma les . The inc idence o f pyel onephr i t i s in the US is much less common than ur inary t rac t in fec t ions (UTI s ) . I t i s less l i kel y in males , bu t i s most common in females aged 15-29 years ; and even more common dur ing pregnancy. Fac tors assoc ia ted wi th pye l onephr i t i s a re f requent sexua l in te rcourse, UTI w i th in the l as t year , p resence of d iabetes , and presence o f s t ress incont inence wi th in the prev ious 30 days . A 79-year-o ld female pa t ien t w i th u r inary f requency is found to have a UTI . What med ica t ion cou l d produce ar rhy thmias in her? Doxycyc l ine Amoxic i l l in Cipro f loxac in Macrodant in Cipro f loxac in is a qu ino lone ant ib io t ic . A l l qu ino lones have the po ten t ia l to produce pro longat ion o f the QT in te rva l . I t shou ld be prescri bed wi th caut ion i n o lder adu l ts . Mrs. Jackson compla i ns o f u r inary inconti nence when she laughs or sneezes. What shou ld be used f i rs t l ine to t rea t her symptoms? Kege l exerc ises Prescr ibe oxybutyn in Avo id ca f fe ine and al coho l Min imize f lu ids a t nigh t t ime This pa t ien t has s t r ess incont inence. The f i rs t - l ine approach wi th these pat ien ts is to a t tempt to s t reng then the pe lv ic f loor musc les . Appropr ia te per formance o f Kege l exerc ises is key . Prescr ib ing an an t icho l inerg ic might worsen incont inence because i t w i l l cause ur inary re ten t ion . Avo id ing ca f fe ine and a lcoho l i s especi a l l y he lp fu l fo r peop le wi th u rge incont inence, bu t cou ld have a min imal benefi t fo r th is pa t ien t . However , th is does not address the under ly ing prob lem, weak pe lv ic musc les . Min imiz ing f lu ids at n igh t t ime wi l l he lp i f noc tur ia is a prob lem. A 76-year-o ld male presents w i th u re thral i r r i ta t i on a f te r vo id ing . I f sexua l ly t ransmi t ted d iseases and ur inary t rac t i nfec t ion are ru led out , what is another et io logy? Acute bac ter ia l p rosta t i t i s Chron ic p ros ta t i t i s Epid idymi t is Asymptomat ic bac ter i ur ia Chron ic p ros ta t i t i s can produce these symptoms. Somet imes thi s i s accompanied by per inea l pa in , but the pa t ien t may have a normal p ros ta te exam. Acute bacter ia l p ros ta t i t i s pa t ien ts w i l l p resent w i th fever , ch i l l s . Examinat ion o f the pros ta te g land r evea ls a tender , boggy pros ta te g land. Ep id idymi t is can produce scro ta l pa in, no t dysur ia o r i r r i ta t ion wi th vo id ing. Asymptomat ic bacter iu r ia is asymptomat ic . These pa t ients don ’ t know they have th is because they have no symptoms . A 25-year-o ld male pat ien t w i th subacute bac ter ia l ep id idymit i s shou ld be t rea ted in i t ia l l y w i th an ora l qu ino lone doxycyc l ine . NSAIDs on ly . i ce and scro ta l suppor t . In a 25-year-o ld male wi th subacute bac t er ia l ep id idymi t is , the most l i ke ly organ ism is Ch lamyd ia. There fore , un t i l cu l tu res are back , he shou ld be t reated empi r ica l l y w i th doxycyc l ine 100 mg BID fo r 10 days . Qu ino lones shou ld spec i f i ca l l y be avo i ded i f the suspec ted agent is gonor rhea because o f r i s ing res is tance. NSAIDs, i ce , and scro ta l suppor t w i l l he lp the pat ien t ’s symptoms but no t t rea t the under ly ing cause. A 73-year-o ld male pat ien t repor ts tha t he is exper ienc ing a weakened ur inary s t ream, u r inary f requency, and urgency. He is wak ing up once o r tw ice n igh t ly to u r ina te . How shoul d the nurse prac t i t i oner p roceed? Dig i ta l rec ta l exam (DRE) on ly DRE, ur ina lys is , PSA PSA on ly PSA, DRE, BUN, Cr Many tes ts can be used to eva lua te an o l der pa t ien t w i th suspected ben ign pros ta t ic hyper t rophy (BPH) . The va lue of d ig i ta l rec ta l exam (DRE) is to eva lua te the s ize , cons is tency and assess fo r ma l ignancy o f the pros ta te g land. Ur ina lys is is done t o de tec t b lood or infec t ion , bu t hematuri a i s common in pat ien ts w i th BPH. The pros ta te spec i f i c an t igen (PSA) is done as a screen ing tes t fo r p ros ta te cancer in symptomat ic men. Th is pa t ien t has mul t ip le symptoms which cou ld ind ica te pa tho logy in the prosta te g land as the et io logy o f h is symptoms (weakened ur inary s t ream, ur inary f requency and urgency, and noctur ia ) . A serum crea t in ine can be part o f the in i t ia l sc r een ing . Th is wou ld he lp iden t i f y b ladder ou t le t obs t ruc t ion, rena l , o r p re - renal d isease. A b lood urea n i t rogen (BUN) i s no t necessary to eva lua te th is pa t ient ' s symptoms. Cipro f loxac in g iven to t rea t a u r inary t rac t in fec t ion wou ld be cont ra ind ica ted i n a : pregnant pa t ien t . 19-year-o ld female . pat ien t w i th hyper tens ion . pat ien t w i th pye lonephr i t i s . Cipro f loxac in is a qu ino lone ant ib io t ic and is cont ra ind ica t ed in pa t ien ts who are pregnant o r younger than 18 years o l d because o f po ten t i a l p rob lems wi th bone and car t i lage f ormat ion . There is no cont ra ind ica t ion i n a pa t ien t w i th hyper tens ion . A qu ino lone might be a good cho ice in a pa t ient w i th pye lonephr i t i s and wou ld no t be cont ra ind ica ted . An example o f a d rug tha t ta rgets the ren in -ang io tens in -a ldos terone sys tem is a(n) : ACE inh ib i to r . beta b locker . ca lc ium channe l b locker . d iure t ic . Examples o f d rugs that ta rget the ren in - ang io tens in -a ldos terone sys tem are ang io tens in -conver t i ng enzyme (ACE) inh i b i to rs and ang io tensi n receptor b lockers (ARBs) . These drugs are par t icul a r l y benef ic ia l to pat ien ts w i th d iabet ic nephropathy because they may prevent and t rea t d iabet ic nephropathy . Addi t iona l ly , these agents lower b lood pressure , wh ich has been shown to be renopro tec t ive . Management o f g lucose leve ls and hyper tens ion is espec ia l l y impor tan t in p reventi ng d iabet ic nephropathy , bu t so is aggress ive management of hyper l ip idemia . Test icu la r to rs ion can produce: pen i le e ry thema. scro ta l edema. scro ta l e ry thema. pen i le edema. Test icu la r to rs ion i s an emergency because the tes t ic le is depr ived o f normal b lood supp ly . I f b lood supp ly is no t rees tab l ished wi th in 12 hours , i r revers ib le damage i s cer ta in to occur . Idea l ly , i schemia i s reso lved wi th in 4-6 hours . The pen is i s no t a f fec ted duri ng tes t icu la r to rs i on. Bes ides tes t icu la r to rs ion , ep id idymi t is , t rauma, and an ingu ina l hern ia a re o ther common causes o f sc r ota l pa in . How long shou ld a female pa t ien t w i th an uncompl ica ted UTI be t rea ted wi th an ora l an t ib io t ic? 3days 5 days 7 days Three days o f t rea tment w i th an appropr i ate an t ib io t ic is as e f f i cac ious as 7 - 10 days o f t rea tment. Three-day t rea tment i s assoc ia ted wi th fewer s ide ef fec ts , be t te r adherence, and fewer adverse reac t ions . A pat ien t has a u r inary t rac t in fec t ion . What f ind ings on uri ne d ips t ick bes t descr ibe a typ ica l ur inary t rac t in f ec t i on? Pos i t i ve leukocytes Pos i t i ve n i t ra tes Pos i t i ve leukocytes , pos i t i ve n i t r i tes Pos i t i ve n i t ra tes and hematur ia Class ic f ind ings in a ur inary t rac t in fec t ion (UTI ) a re pos i t i ve leukocytes and n i t r i tes . Leukocytes ind ica te the presence o f wh i te ce l ls in the u r ine . Ni t ra tes are a normal f ind ing in a u r ine spec imen. N i t r i tes are no t normal in the ur ine . Pos i t i ve n i t r i tes ind ica te that an organ ism in the ur ine is consuming n i t ra tes f or nu t r i t ion . Hematur ia ind ica tes the presence o f red b lood ce l ls in the ur ine . This is common in the presence o f a UTI . Which med ica t ion shou ld be avo ided in a pat ien t w i th a su l fa a l le rgy? Sul fony lu rea Sul famethoxazo le Naproxen Cefazo l in Sul famethoxazo le is the su l fa component i n Bac t r im DS. I t i s con t ra ind ica ted in pat ien ts w i th a su l f a a l le rgy . There is no a l le rg ic po ten t ial w i th the ant ihyperg lycemic agents known as the sul f ony lu reas . Naproxen and cefazo l in have no cont ra ind icat ions i f a pa t ien t has a su l fa a l le rgy . Some HIV pro tease i nh ib i to rs have the su l fony l a ry lamine chemica l g roup tha t i s respons ib le fo r the a l le rg ic reac t ion. A female pa t ien t who i s 45 years o ld s tates tha t she is hav i ng ur inary f requency. She descri bes ep isodes o f “ h av ing to go r igh t now ” and no t be ing ab le to wa i t . Her u r i na lys is resu l ts a re p rov ided. What is par t o f the d i f fe ren t ia l? Diabetes Lupus Stress incont inence Asymptomat ic bac ter i ur ia Pat ien ts w i th d iabetes can present w i th po lyur ia . An assessment o f the pat ien t ’s r i sk fac tors shou ld be done wi th s t rong cons idera t i on g iven to check ing g lucose leve ls . I f th is is norma l , o ther d iagnoses to cons ider a re urge incont inence and vag in i t i s . The pat i en t ’s med ica t ions shou ld be reviewed fo r med ica t ions produc ing urgency, l i ke d iure t ics or herba l supp lements .