Medical Quiz: Urolithiasis and Related Conditions

Urolithiasis/Nephrolithiasis

• Causes and Risk Factors: Supersaturation of urine (calcium, oxalate, uric acid, calcium phosphate), infection (UTI), urine stasis, immobility, hypercalcemia, structural defects.
• Assessment: Colicky pain (especially in ureter stones), hematuria, pyuria, nausea, vomiting, diarrhea, urinary retention/obstruction.
• Diagnosis: CT scan, intravenous pyelography (IVP), blood chemistry, 24-hour urine analysis, diet/medication/family history, stone analysis.
• Management: Pain relief (opioids, NSAIDs), heat/hot baths, increased fluid intake, ambulation, dietary changes (low calcium, low purine, low protein, low oxalate). Procedures include ureteroscopy, extracorporeal shock wave lithotripsy (ESWL), nephrostomy.

Urinary Bladder Cancer

• Risk Factors: Age, male gender, race, tobacco use, chronic UTIs, high cholesterol, high urine pH, bladder stones.
• Assessment: Painless hematuria, changes in voiding patterns.
• Diagnosis: Cystoscopy, CT scan, ultrasound, biopsy, bimanual examination.
• Treatment: Transurethral resection or fulguration, BCG vaccine, radiation therapy, chemotherapy, cystectomy with urinary diversion, bladder transplant.

Benign Prostatic Hyperplasia (BPH)

• Mechanism: Obstructs urine flow, causing incomplete bladder emptying and urinary retention. Can block ureter and kidney flow.
• Consequences: Gradual dilation of ureters and kidneys, UTIs from urinary stasis.
• Assessment: Frequency, nocturia, urgency, hesitancy, decreased urinary stream volume and force, difficulty initiating urination.
• Diagnosis: Digital rectal exam (DRE), prostate-specific antigen (PSA), transrectal ultrasound (TRUS).
• Education: Aging is a cause, frequent ejaculation is beneficial, avoid large water intake at once, avoid caffeine and alcohol.
• Management: Medications like tamsulosin (Flomax) to relax bladder outlet, and finasteride (Proscar) to decrease testosterone production.

Prostate Cancer

• Risk Factors: African American ethnicity, aging, diet high in red meat and high-fat dairy.
• Clinical Manifestations: Initially asymptomatic, urinary obstruction symptoms, blood in urine or semen, painful ejaculation.

Surgical Interventions for BPH/Prostate Cancer

• Various procedures (TURP, suprapubic/retropubic prostatectomy, perineal prostatectomy, Da Vinci prostatectomy, brachytherapy) are used.

Continuous Bladder Irrigation (CBI)

• Use: Always used after TURP.
• Assessment: Monitor drainage color and amount, look for obstructions.
• Complications: Hemorrhage, infection, deep vein thrombosis (DVT), catheter blockage.
• Post-Op Expectations: Pain relief, fluid balance, ambulation, catheter care, avoid straining/heavy lifting, stable vitals, wound healing, normal urination.

Hysterectomy

• Purpose: Surgical removal of the uterus (laparoscopic or robotic).
• Pre-Op Test: Pregnancy test.
• Indications: Uterine cancer, fibroids, endometriosis, prolapse (uterine), hypermenorrhea.
• Post-Op Considerations: Monitor vaginal bleeding, Foley catheter for 24 hours, monitor vital signs, breath/bowel sounds, I&O, assess incision, watch for thromboembolism, monitor labs, watch for infection/shock.

CVA/Stroke

• Risk Factors: Cardiovascular risk factors.
• Types: Ischemic (thrombosis/embolism from atherosclerosis, atrial fibrillation, endocarditis), hemorrhagic (aneurysm), transient ischemic attack (TIA), reversible ischemic neurologic deficit, stroke in evolution, complete stroke.
• Assessment: Facial symmetry, swallowing, LOC, eye assessment, DTRs, communication loss, progression of symptoms, time of onset, increased intracranial pressure (ICP).
• Early ICP symptoms: Altered LOC, headache, nausea, projectile vomiting.
• Late ICP symptoms: Bradycardia, bradypnea, hypertension.
• Other Symptoms: Paralysis/weakness, communication loss (expressive, receptive, global), perceptual disturbances, sensory loss (visual changes), agnosia, alexia, agraphia.
• Diagnosis: CT scan, MRI, PET scan, cerebral angiography (allergy/kidney function checks, post-procedure: leg flat, head slightly elevated if ICP present).
• Management: Airway management (oxygen, intubation, suction), reduce ICP (HOB 30-45, neutral neck position, bed rest, avoid fluid overload/coughing/straining), ICP medications (Mannitol, dexamethasone, 3% NaCl), control blood pressure (max 180/100), maintain cardiac output, oral care, eye care, prevent immobility complications.
• Hemorrhagic Stroke Management: NO thrombolytics, prevent vasospasm (hydration, nimodipine), control hypertension (beta-blockers, vasodilators), surgery (craniotomy, aneurysm coiling/clipping).

Seizure Disorders

• Seizures: Abnormal motor, sensory, autonomic, or psychic activity from sudden neuronal discharge.
• Epilepsy: Two or more recurring seizure episodes.
• Causes: Idiopathic, acquired (e.g., hypoxemia, head trauma, hypertension, CNS infection, metabolic/toxic conditions).

Stroke Core Measures

• Thrombolytics: Administered within 3-4.5 hours (ischemic stroke only).
• Antithrombotic therapy: Initiated by hospital day 2 (ischemic stroke only).
• VTE prophylaxis: Implemented by hospital day 2.
• Anticoagulation: For atrial fibrillation/flutter at discharge.

Parkinson's Disease

• Cause: Decreased dopamine due to degeneration of nigrostriatal neurons.
• Symptoms: Tremors, rigidity, bradykinesia/akinesia, postural instability, muscle weakness, dysphagia.
• Diagnosis: History, physical assessment, response to levodopa.
• Management: Levodopa-carbidopa (before meals), deep brain stimulation (DBS).

Open-Angle Glaucoma

• Mechanism: Increased aqueous humor, decreased outflow.
• Assessment: Headache, mild eye pain, peripheral vision loss, increased intraocular pressure (IOP).
• Management: Miotics (pilocarpine), beta-blockers (timolol), carbonic anhydrase inhibitors (acetazolamide). Do NOT use atropine.
• Education: Avoid activities increasing IOP, do not lie on surgical side.

Angle-Closure Glaucoma

• Mechanism: Sudden angle closure obstructing outflow.
• Assessment: Rapid IOP increase, vision changes (blurred, halos).
• Management: Same as open-angle glaucoma.
• Education: Avoid activities increasing IOP, do not lie on surgical side.

Cataracts

• Mechanism: Lens cloudiness impairing vision.
• Assessment: Decreased visual acuity/blurring, double vision.
• Surgical Management: Mydriatics (atropine sulfate), antibiotics, and corticosteroids postoperatively.
• Post-Op Management: Monitor for bleeding and infection.
• Education: Wear sunglasses and other protective eyewear.

General Assessment (Skeletal Disorders)

• Components: Past medical/social/family history, exercise habits, diet (Calcium/Vitamin D), concurrent conditions, familial/genetic abnormalities.
• Symptoms: Pain, tenderness, tightness, swelling, paresthesias, muscle spasms.

Common Orthopedic Diagnostics

• Imaging: X-ray, CT, MRI, arthrography, bone densitometry (DXA), bone scan.
• Procedures: Arthroscopy, arthrocentesis.
• Testing: Electromyography (EMG), nerve conduction studies, labs (calcium, vitamin D, phosphorus, alkaline phosphatase (increased with bone damage), PTH/calcitonin).

Osteoporosis

• Characteristics: Metabolic bone disorder, often causing compression fractures.
• Symptoms: May be asymptomatic, spine typically affected (compression = pain); common in post-menopausal women and older adults.
• Risk Factors: Genetics, age, gender, small frame, postmenopause, low calcium/vitamin D, high phosphate intake, caffeine/alcohol/smoking, sedentary lifestyle, lack of weight-bearing exercise, medications (steroids), comorbidities.
• Diagnosis: Bone densitometry, labs, detectable x-ray loss occurs after bone demineralization 25-40%.
• Home Care: Identify calcium-rich foods, vitamin D, weight-bearing exercises, modify lifestyle choices (discontinue corticosteroids if necessary).

Rheumatoid Arthritis

• Cause: Autoimmune disorder, possibly triggered by a previous infection.
• Assessment: Primarily in small bones (hands), "morning stiffness."
• Diagnosis: Elevated erythrocyte sedimentation rate (ESR).
• Medical Management: NSAIDs, steroids, disease-modifying antirheumatic drugs (DMARDs) like methotrexate, antimalarials, gold compounds. Use cold compresses during flare-ups.

Osteoarthritis

• Cause: Degenerative disease, "wear and tear" due to aging.
• Assessment: Inflammation, crepitus.
• Diagnosis: X-ray, elevated ESR.
• Medical Management: Acetaminophen, NSAIDs, steroids, weight management, rest.

Fractures

• Types: Closed/simple, open/compound, complete/incomplete, simple, displaced, stress, compression, comminuted, greenstick.
• Causes: Trauma, severe muscle contractions, pathological conditions.
• Assessment: Pain, muscle spasms, edema, ecchymosis, deformity, shortening, crepitus, loss of function.
• Effects: Soft tissue damage, hemorrhage (joints/organs), joint dislocation, tendon/blood vessel/nerve damage.
• Fracture Healing: Factors promoting healing (immobilization, blood supply, Calcium/Vitamin D, isometric exercise, hormones) vs. inhibiting healing (trauma, improper immobilization, infection, irradiated bone, age, steroids).
• Complications: Early: shock, DVT, fat embolism, compartment syndrome; Late: delayed union, malunion, nonunion, avascular necrosis.
• Management: RICE (Rest, Ice, Compression, Elevation) – elevate limb above heart (except for compartment syndrome), neurovascular checks, prevent infection (open fractures) surgery (reduction), immobilization (casts, splints, traction).
• Cast Care: Explain treatment, maintain neuromuscular function, elevate extremity initial 24-48 hours.

Traction Management

• Types: Straight/running, balanced suspension, Buck's traction, skeletal traction.
• Purpose: Minimize spasms, reduce/align/immobilize fractures, reduce deformity.
• Maintenance: Continuous pull, good body alignment, no friction/weight must hang freely..
• Complications: Skin breakdown, nerve pressure, circulatory impairment (Buck's traction). Monitor device/complications.

Orthopedic Surgeries

• Types: Open reduction/internal fixation (ORIF), joint arthroplasty/replacement, meniscectomy, amputation, bone graft, fasciotomy, arthroscopy.
• Hip Arthroplasty: Replace damaged hip with artificial joint (acetabular cup, femoral head, stem). Indications include degenerative joint diseases, osteoarthritis, rheumatoid arthritis. Post-op: Prevent dislocation, positioning, pain management, bleeding, infection, DVT. Precautions: Abduction pillow, no crossing legs/bending at waist/crossing legs.
• Knee Arthroplasty: Replace damaged knee with metal and acrylic prostheses. Post-op: Pain management, continuous passive motion (CPM) machine. Precautions - no kneeling/deep knee bends.

Spinal

• Degenerative Disc Disease (DDD): Cause of most back problems; natural aging, trauma. Assessment: Muscle weakness/atrophy, loss of sensory/motor control, localized or sciatica pain, Surgery types: Microdiscectomy, Laminectomy, Partial Laminectomy, Discectomy fusion, Foraminotomy

Digestive Disorders

• Assessment: History (dietary habits, pain patterns, bowel/stool changes), physical exam (quadrant method, inspection/auscultation/percussion/palpation).
• Diagnostics: Imaging (endoscopy for EGD, Colonoscopy), Ultrasound (gallstones), CT/MRI.

Gastroesophageal Reflux Disease (GERD)

• Mechanism: Backflow of stomach contents due to incompetent lower esophageal sphincter (LES).
• Assessment: Pyrosis, dyspepsia, dysphagia, odynophagia, epigastric pain.
• Complications: Inflammation, erosion, esophageal cancer.
• Diagnosis: Esophageal pH monitoring, endoscopy, barium swallow.
• Management: Lifestyle (low-fat diet, avoid irritants, HOB elevation, meal timings, normal body weight), medications (antacids, H2 blockers, PPIs, prokinetics), surgery (Nissen fundoplication).

Gastritis

• Types: Acute/chronic, erosive/non-erosive.
• Causes: H. pylori, NSAIDs, alcohol, smoking, caffeine, autoimmune, age, comorbidities.
• Assessment: Abdominal pain, burning epigastric pain, anorexia, vomiting, heartburn, hematemesis, melena (dark, tarry stools).
• Complications: Pernicious anemia, GI wall perforation.
• Diagnosis: Endoscopy, biopsy, acid analysis.
• Management: Antacids, H2 blockers, PPIs, antibiotics (if H. pylori), antidiarrheals, prostaglandin analogs. Surgery (gastric resection, gastrojejunostomy/duodenostomy).

Peptic Ulcer Disease (PUD)

• Causes: H. pylori, NSAIDs, increased stomach acid (duodenal ulcers).
• Assessment: Dull, gnawing epigastric pain (indigestion, N/V, melena).
• Complications: Perforation, peritonitis, hemorrhage, pernicious anemia.
• Types: Gastric Ulcers (in stomach) and Duodenal Ulcers (in duodenum).
• Characteristics: Gastric ulcers: LUQ/mid-line pain, pain after eating. Duodenal ulcers: Right sided/mid-line pain, pain relieved by eating, pain more common 2 hours after eating.

Inflammatory Bowel Disease (IBD)

• Types: Crohn's disease (small intestine to ileum, all GI layers affected), ulcerative colitis (large intestine to rectum, mucosal inflammation).
• Assessment: RLQ pain (Crohn's, less severe diarrhea, scattered inflammation); LLQ/LUQ pain (Ulcerative Colitis, severe diarrhea, severe GI bleeding).
• Diagnosis: Barium studies (Crohn's), colonoscopy.
• Management: Antibiotics, steroids, immunomodulators (e.g., azathioprine, methotrexate), anticholinergics (propantheline bromide), analgesics, vitamin B12 injections (if pernicious anemia).
• Surgical Management: Strictureplasty, intestinal transplant, colon resection/hemi-colectomy, total colectomy/ileostomy/colostomy.

Diverticulitis/Diverticulosis

• Symptoms: LLQ pain, fever, inflammation of diverticula (sigmoid colon common), often in sedentary clients, N/V, abdomen distension.
• Complications: Peritonitis, abscess/fistula, bleeding, fluid/electrolyte imbalance.
• Diagnosis: CT scan with contrast (most common), barium enema, colonoscopy.
• Management: Analgesics (opioids), antispasmodics, antibiotics, bulk-forming laxatives, stool softeners. Dietary modifications during exacerbations (NPO, clear liquids, gradually introduce low-fiber foods).

Cholecystitis/Cholelithiasis

• Symptoms: RUQ pain radiating to shoulder, nausea, jaundice.
• Risk Factors: 4 F's (Forty, Female, Fertile, Fat), rapid weight loss, infection.
• Assessment: Fatty food intolerance, nausea/vomiting, RUQ sharp colicky pain radiating to right shoulder/midsternum, epigastric distress.
• Diagnostics: Ultrasound (most common), cholecystography, ERCP, abdominal x-ray.
• Labs: Elevated alkaline phosphatase, GGT/GGTP, LDH, bilirubin, cholesterol.
• Medical Management: Opioids for pain, antispasmodics, stone lysis (UDCA, Actigall), vitamin supplements, lithotripsy (ESWL).
• Surgical Management: Laparoscopic cholecystectomy, cholecystostomy, T-tube placement.
• Nursing Management: Low-fat, high-protein/carb diet, regular exercise, weight reduction.

Intestinal Obstruction

• Types: Mechanical (adhesions, tumors), non-mechanical (paralytic ileus).
• Mechanism: Blockage preventing normal stool passage.
• Small Bowel: Severe fluid/electrolyte imbalance, metabolic alkalosis, visible peristaltic waves, projectile vomiting, dehydration
• Large Bowel: Mild fluid/electrolyte imbalance, abdominal distention, intermittent cramping, diarrhea/ribbon-like stools, leakage.
• Management: Decompression (NGT/rectally), NPO/IV fluids, monitor bowel sounds/fluid/electrolytes, medications (prokinetics for increased peristalsis), antibiotics.

Enteral/TPN Feeding

• Enteral: Via NGT or PEG tube, monitor complications (aspiration, diarrhea, hyperglycemia), flush tubes, HOB 30-45 degrees, check residuals, monitor tolerance/labs.
• TPN: Central line, monitor for complications (hyperglycemia, infection, sepsis, fluid overload).

Test your knowledge on urolithiasis, nephrolithiasis, and related medical conditions in this comprehensive quiz. Covering causes, symptoms, diagnostic procedures, and treatment options, this quiz is ideal for medical students and professionals alike. Enhance your understanding of essential medical concepts in nephrology and urology.