 Which of the following group is most prone to developing nephrolithiasis -White men

 who is at higher risk for developing nephrolithiasis? Bill who runs everyday and takes
excessive amounts of vitamin C
 patient is seen in clinic for flank pain . The clinician should assess this patient for which
risk factors for kidney stones? -Hypertension
 which diagnostic findings may lead to a diagnosis of nephrolithiasis? urinary calcium
output of greater than 300mg/24 hrs
 The most common metabolic condition that predisposes to the formation of kidney stones
is -idiopathic hypercalciuria
 calcium oxalate or calcium phosphate stones are found -in men
 Most calcium phosphate kidney stones are caused by -Primary Hyperparathyroidism
 Which type of kidney stone is the most common? Calcium oxalate
 Struvite stones are found predominantly in -Women
 struvite stones occur when urine is- Alkaline and a urea-splitting organism is present
 Cystine stones are caused by a rare autosomal recessive disorder called -Cystinuria
 An acid urine favors precipitation of which type of kidney stone? -Cystine stone
 stone formation is facilitated by extremes in -urine PH
 calcium stones -light in color resemble RBC's in shape and size
 Struvite stones Flat and consist of hexagon- shaped crystals
 Staghorn stones are more likely to be  -Struvite stones
 Red-Orange & radiolucent or tear drop,flat and square shaped is -Uric acid
 Cystine stones are -lemon yellow and hexagonal shape and sparkle under light
microscopy
 meds that promote Crustalluria and predispose renal stones are:
Topiramate,Triameterene, Sulfadiazine, Crixivan (tx for HIV)
 nephrolithasis clinical presentation -renal colic pain, nausea, vomiting,frequency,
diaphoresis, dysuria, hematuria, weakness, hx of recent or chronic UTI
 The clinical presentation of urolithiasis would include -pain starting in the flank and
localizing in the costovertebral angle
 The preferred method to identify the location of small renal stones is: NO contrast CT,
abdominal US
 The most common cause of Urinary tract obstruction is -Ureterolithiasis
 The first step in treating a uric acid kidney stone is: Encouraging hydration
 Thiazide diuretics are used for the treatment of which type of renal calculi  -Calcium
phosphates and oxalate stones
 pain meds for nephrolithiasis -NSAIDS 600-800mg tid (relaxes smooth muscle)oral
narcotics are often necessary
 tx for nephrolithiasis -warn compress,focused breathing,imagery,diversional activity's
 non -invasive or invasive surgical procedures -ESWL- Extracorporeal shock wave
lipotripsy
 ESWL is not recommended for which type of stone? -Struvite stones
 which of the following instructions should be given to the patient with nephrolithiasis?
take ibuprofen 600mg every 8 hours
 for nephrolithasis which OTC meds should be avoided -meds that contain phosphorus or
calcium and Vitamin D3
 What dereases oxaluria by facilitating oxalate metabolism -Vitamin B6 and Magnesium
 what foods high in oxalate should you avoid? Asparagus,beer,beets,cabbage,celery,
chocolate and cocoa, fruits, green beans, nuts, tea and colas, and tomatoes
 general recommendations for prevention of kidney stones regardless of the type of stone-
reducing protein in the diet
 renal cell carcinoma 85% originate where -in the renal cortex
 5-8% of transitional cell carcinoma affect -the bladder
 which of the following is associated with an elevated risk of renal cell carcinoma (RCC)?
High levels of lead exposure
 60% of renal tumors present with  -gross hematuria as the only symptom
 renal tumor presents like -gross hematuria,dull, achy flank pain, or papable abd mass,
Weight loss and fatigue, Nephralgia
 Clinical manifestations including microscopic or gross hematuria, a palpable abdominal
mass , fever and flank pain may indicate-a Renal tumor
 Renal mass diagnosed with -Ureteroscopy or ultrasonography with IVP
 which of the following renal exams identifies the size of the kidneys or obstruction in the
kidneys or in the lower urinary tract and may detect tumors or cysts? -Ultrasonography
(US)
 Which of the following radio-logical studies provides direct imaging in several planes
conductive to detecting renal cystic disease , inflammatory process, and renal cell
carcinoma? MRI- magnetic resonance imaging
 a renal mass was accidentally found on George a 70 yr old man during hospitalization for
an episode of diverticulitis. Which of the following statement is true? The malignancy
risk is related to the size of the lesion
 which is the least expensive method for evaluating renal mass size? ultrasound imaging
 Renal tumor stage I -confined within the kidney capsule,treated by nephrectomy
 Stage II-Renal Tumor invasion of renal capsule confined within Georta's fascia treated by
nephrectomy
 Stage III- Renal tumor involvement of regional lymph nodes ipsilateral, renal vein, or
vena cava
 Stage IV- Renal tumor distant metastasis 5-year survival less than 5%
 most common mets are bone, lung,regional nodes,brain,and adjacent organs
 which of the following conditions does not cause flank pain? Renal cysts
 is polycystic kidney disease hereditary ? It is hereditary and unfortunately incurable but
there are many measures we use to deal with it 
 what is a Koch pouch? It is a continent internal ileal reservoir in which the nipple valves
are formed on the skin. The filling pressure closes the values preventing leakage and
reflux
 Total Nephrectomy Complete removal of the KIDNEY!!!

CT done 3-6 months

Renal Us- every 6 months for 3 yrs annually

CXR - quarterly for one year

 Stage one renal cancer the patient is referred to a nephrologist for a nephrectomy
 After a renal biopsy the client is instructed to -avoid strenuous activities for at least 2
weeks
 Bladder tumors are -the most common CA in urinary systems
 which of the patients is at risk for developing urinary tract cancer? 45 yr old woman who
is 100 lbs over weight, 78 yr old man smokes 3 pks a day,84 yr old ma who works in
asestos mines,all the above
 which of the following accounts for 1/2 of the bladder tumors among men and 1/3 in
women? Cigerette smoke both active and passive
 86 yr old woman seen in clinic for hematuria. provider suspect bladder ca which of the
patients hx would be considered a risk factor?- 65 yr smoking history
 which of the following diagnostic tests would be ordered to check for bladder ca?
Cystoscopy with biospy
 bladder tumor staging -0: confined to the mucosa, A: invade the lamina propria, B:
invade the muscular layer, C: extend to the peripelvic fat or renal parenchyma, D.
indicates metastic disease
 78 yr old man is diagnosed with stage D bladder ca and asks the provider what that
means. Which is the best answer? Your cancer has spread to other organs
 what is the incidence of impotence after a total cystectomy-This surgery requires removal
of the prostate and seminal vessels which results in impotence. lets talk about it!
 acute kidney injury (AKI) -sudden or rapid loss of renal function (occurring over hours or
days to weeks and often completely reversible)get decreased GFR, increased BUN,
increased serum creatinine, oliguria
 which condition may result from pt taking NSAID's on a long-term basis-
Hemodynamically induced acute renal failure
 Which class of anti hypertensive drug is contraindicated in clients with renal artery
stenosis -ACE inhibitors
 Drug not associated with acute renal failure? Erythromycin
 pt is diagnosed with acute renal failure which of the following info obtained from the hx
should alert the provider that this is a case of prerenal azotemia? Recent heat stroke
 Which statement is true regarding ATN Acute tubular necrosis -The removal of the
offending agent may allow renal function to return gradually to normal
 The patient is diagnosed with acute renal failure (ARF). Which of the following
conditions is the most common cause? Acute tubular necrosis
 Which type of lung cancer is most prevalent in women, young adults, and non-smokers?
Adenocarcinoma 
 medication that can cause cough -Captopril -ACE I dry ,hacky cough ("Prils")
 headache, cough, fever, rash on arms and legs, myalgia and dysuria?Coccidioidomycosis
 Treatment Regimine for TB-(INH may cause peripheral neuropathy what would you
consider using ?Pyridoxine
 pts on long term corticoidsteroids have a decrease response to -tuberculin skin test
 chronic cough lasts longer than -3 weeks
 After discussing management of upper respiratory infection (URI) with a patient who
 What is the treatment for bacterial URI? Beta-lactam, Macrolide, Lincomycin, NO
Flouroquinolones!!!!!
 URI Treatment
 antibiotics- oseltamivir, Zanamivir

cough supressant, rest, fluids, antipyretic

Characteristics of asthma -wheezing, chest tightness,dyspnea, cough

 Status Asthmaticus -Prolonged asthma; does not respond to drug therapy, can last several
mins-hours, medical emergency.
 Asthma -A chronic obstructive pulmonary disease characterized by diffuse inflammation
and superimposed bronchospasm that occurs due to various stimuli
 What are the 4 cardinal symptoms of asthma? Cough ,Weezing,Tachypnea ,Prolonged
expiration
 Pattern of symptoms in asthma? Perennial, seasonal or both?; Continual, episodic, or
both?; Diurnal variations?
 asthma vs COPD -pattern -as: seasonal s/s, worse at night/morning, COPD: slow
progression
 population overlooked for asthma diagnosis -ELDERLY
 3 principle triggers for asthma include _or _ factors, bacterial or viral _ and _ factors,
environmental, allergen factors, infections, psychological factors
 Prednisone-acute asthma flair up with URI
 Baylor's rule of two- more than 2 uses of quick-relief inhaler/week, more than two night
time awakenings for the month, more than 2 quick relief MDI canisters per year

 status asthmaticus can be fatal if- progresses or fails to reverse

 likely to see on x-ray of person having severe attack - Hyperinflation
 Severe asthma attack involves -inaudible breath sounds
 Asthmatics may have all the following symptoms during an exacerbation except -Chronic
Coughing
 1st sign of asthma excerbation -wheezing
 obtain peak and flow measures when - before and after nebs and compare to baseline if
available
 Spirometry- initial diagnosis or to confirm diagnosis
 pulmonary function test-Measures lung capacities
-breath into spirometer to measure
-bronchodilators are usually held for 4-6 hr before
-avoid smkg/caffine
-shows lung volume
-amt of air in lung after expiration
 peak flow-peak flow meters measure maximum ability to expel air from lungs
 PEF is based on –HAG ( height,age,gender )