AMH

Question 1

Definition of AMH:

Answer 1

no symptoms, greater than 3 RBCs per high power field on microscopy. (Urine dipstick positive for heme not adequate)

Question 2

What is the sample collection for male and female?

Answer 2

both are clean catch midstream. with men, you wipe the meatus or retract the foreskin. with women you spread the labia and wipe. (some require catheterized specimen–> obese, elderly, mentally unstable)

Question 3

How many positive micro UA is sufficient for a work up?

Answer 3

just one.

Question 4

What are the risk factors for urologic malignancy?

Answer 4

smoking, males, age>35, occupational exposures, history of : gross hematuria, pelvic radiation, chronic UTI, alkylating chemo, chronic indwelling.

Question 5

What are the top 3 benign causes of AMH?

Answer 5

BPH, UTI, and Stones (other causes include obstructions, renal disease, benign tumors–> bhp, renal cysts, polyps)

Question 6

What are some obvious causes of a positive micro UA?

Answer 6

uti, strenuous exercise, sex, trauma, periods

Question 7

Should you send for a culture in the case of AMH?

Answer 7

yes!

Question 8

What two things to bladder cancer and UTIs have in common?

Answer 8

positive leukocytes, positive blood

Question 9

Can a blood thinner cause AMH?

Answer 9

yes

Question 10

If there is a negative culture, what else should be included in your workup?

Answer 10

creatinine. it will help r/o a renal cause of the disease. If renal disease is noted then nephrology and urology eval is needed.

Question 11

What further eval may be needed?

Answer 11

imaging (always), cystoscopy (almost always), cytology (not initially)

Question 12

What is the gold standard for imaging of AMH?

Answer 12

CT with and without contrast

Question 13

What is good of evaluation of stones?

Answer 13

IVP

Question 14

What is good for the evaluation of masses?

Answer 14

U/S

Question 15

What can the non-contrast CT tell you?

Answer 15

stones, hydronephrosis, fat containing lesions

Question 16

What does the arterial phase tell you?

Answer 16

tumors, inflammatory lesions

Question 17

What does the venous stage tell you?

Answer 17

scarring

Question 18

What does the excretory phase tell you?

Answer 18

pyelogram, ureters, bladder

Question 19

Who can’t have CT with contrast?

Answer 19

pregnant, contrast allergy (give them some benadryl), renal insufficiency (could put them into renal failure)

Question 20

What is retrograde pyelography?

Answer 20

A scope is put into the bladder, and you inject contrast. It goes up into the upper collecting systems. Safe even with renal insufficiency or contrast allergy.

Question 21

What is the best way to R/O bladder cancer?

Answer 21

Cystoscopy. Imagine may miss many bladder tumors depending on how full the bladder is.

Question 22

Who is recommended to have a cystoscopy?

Answer 22

all patients older than 35 years old, or those who have a risk factor and hx for risk of malignancy.

Question 23

What are the AUA guidelines for AMH

Answer 23

3 negative microscopic Uas need to be done on every patient with one positive dipstick for a rule out. After a negative AMh eval, then follow up with UAs yearly. After two negative UAs, then no further are needed for AMH. If persistent, then follow up after 3-5 years.