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GIR Test 4 > B5-082 CBCL Hematuria > Flashcards

B5-082 CBCL Hematuria Flashcards

1
Q

cubiform clot is likely from the

A

bladder

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2
Q

vermiform clot is likely from the

A

upper urinary tract

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3
Q

hematuria at the start of urination may indicate

A

urethral/prostate issue

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4
Q

hematuria at termination of urination may indicate

A

bladder neck issue

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5
Q

oxidation of the indicator strip can be caused by

3

A

hematuria
myoglobin
providone-iodine antiseptics

confirm on centrifuged mid stream urine

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6
Q

definition of microscopic hematuria

A

greater than 3 RBC/hpf

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7
Q

standard work up of gross hematuria

A
  • cystoscopy
  • CT urogram or MR urography
  • cytology
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8
Q

standard workup of microscopic hematuria depends heavily on

2

A

H&P
risk stratification

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9
Q

if a patient with microscopic hematuria is determined to be low risk

A

repeat urinalysis in 6 months
or cystography/US

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10
Q

if a patient with microscopic hematuria is determined to be intermediate risk

A

cystoscopy and renal US

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11
Q

if a patient with microscopic hematuria is determined to be high risk

A

cystoscopy and CT urogram

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12
Q

factors that differentiate low risk vs high risk microscopic hematuria

4

A
  • age
  • smoking status
  • number of RBC/hpf
  • relevant history
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13
Q

abnormal urinalysis after strenous exercise

A

exercise induced hematuria

non glomerular medical

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14
Q
  • gross hematuria, CT shows filling defect
  • flank pain, AA, analgesic abuse, diabetes
A

papillary necrosis

non glomerular medical

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15
Q
  • renal stones on CT, IVP showing pathopneumonic brush stroke papilla
  • flank pain, recurrent UTIs, urolithiasis
A

medullary sponge kidney

non glomerular medical

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16
Q

family history of renal cystic disease

A

PKD

non glomerular medical

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17
Q
  • renal artery embolus, vein thrombus, AV fistula
  • a fib, dehydration, bruit
A

renovascular disease

non glomerular medical

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18
Q
  • urine dipstick + for nitrates, positive urine culture, leukocytosis
  • dysuria, fever
A

UTI

non glomerular surgical

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19
Q
  • CT scan demonstrating stone, hydronephrosis
  • flank/groin pain, nausea/vomiting, fever
A

urolithiasis

non glomerular surgical

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20
Q
  • demonstrated on CT, cystoscopy, ureteroscopy
  • constitutional symptoms, blood clots, pain
A

urologic malignancy

non glomerular surgical

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21
Q
  • enlarged prostate on DRE
  • obstructive urinary symptoms
A

BPH

non glomerular surgical

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22
Q
  • friable tissue on cystoscopy
  • history of pelvic radiation
A

radiation cystitis

non glomerular surgical

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23
Q
  • demonstrated on retrograde urethrogram
  • obsructive urinary
A

urethal stricture

non glomerular surgical

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24
Q

does anticoagulation therapy cause denovo hematuria?

A

no

however, can worsen it

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25
Q

if a dipstick is positive, must be confirmed with

A

microscopic analyisis of urine

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26
Q

chemotherapy that can cause hematuria

2

A
  • mitotane
  • cyclophosphamide
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27
Q

common risk factors for urinary tract malignancy in patients with microscopic hematuria

A
  • over 35 years old
  • analgesic abuse
  • exposure to benzenes or aromatic amines
  • male
  • smoking
  • history of irritation to GU tract
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28
Q

upper tract imaging of choice

A

CT urogram

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29
Q

lower urinary tract test of choice

A

cystoscopy

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30
Q

patients that catheterize themselves or elderly women may have

A

asymptomatic bacteriuria

colonization

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31
Q

infection associated with anatomical/functional abnormality of the urinary tract, immunocompromised host, or MDR bacteria

A

complicated UTI

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32
Q

type P fimbriae is most commonly associated with

A

pyelonephritis

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33
Q

pathogen commonly causing UTIs in women of childbearing age

A

staph. sapro

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34
Q

best way to assure your getting urine from the bladder for urinalysis

A

catheterization

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35
Q

greater than 10 WBC/hpf is most sensitive for

pyuria

A

UTI

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36
Q

management of uncomplicated UTI

A

nitrofurantoin x 5 days OR
TMP/SMX x 3 days

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37
Q

nitrofurantoin should not be used to treat

A

complicated UTI

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38
Q

how long should complicated UTI be treated for?

A

2 weeks

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39
Q

most common type of stone

A

calcium oxalate

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40
Q

precipitates with hypocitraturia

A

calcium oxalate

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41
Q

stone shaped like envelope or dumbbell

A

calcium oxalate

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42
Q

what stones can results from ethylene glycol, vitamin C over use, hypocitriuria, or malabsoprtion

A

calcium oxalate

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43
Q

treatment for calcium oxalate stones

A
  • increase fluids
  • decrease urinary calcium
  • increase citrate
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44
Q

what stones form in acidic urine at a pH less than 6?

A

uric acid

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45
Q

rhomoid or rosette stones

A

uric acid

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46
Q

what stones are associated with a high protein diet, hyperuricemia (gout) hyperuricosuria, insulin resistance, leukemia

A

uric acid

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47
Q

treatment for uric acid stones

A

alkalization of urine

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48
Q

what type of stones are caused by urease-producing organisms

A

struvite

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49
Q

proteus causes

A

struvite stones

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50
Q

staghorn calculi

A

struvite stones

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51
Q

treatment of struvite stones

A

surgical removal and agressive treatment of infection

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52
Q

does E. coli produce urease?

A

no

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53
Q
  • form in alkaline urine
  • usually associated with metabolic disorders
A

calcium phosphate

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54
Q

treatment of calcium phosphate stones

A

manage underlying disorder

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55
Q

caused by AR disease cystinuria

A

cystine stones

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56
Q

in cystinuria, what 4 amino acids are unable to be transported normally?

A
  • Cystine
  • Ornithine
  • Lysine
  • Arginine

COLA (all dibasic)

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57
Q

cystine stones appear in patients that are […] for the recessive gene

A

homozygous

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58
Q

hexagonal cystals

A

cystine

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59
Q

wedge-shaped prism stone

A

calcium phosphate

60
Q

treatment for cystine stones

A
  • alkalization of urine
  • Thiola (breaks disulfide bonds)
61
Q

symptoms of urolithiasis

A
  • colicky flank pain
  • nausea, vomiting
  • CVA tenderness
  • hematuria
62
Q

gold standard imaging for urolithiasis

A

non contrast CT scan

63
Q

expectant management of urolithiasis

A
  • pain control with NSAIDs
  • tamsulosin (alpha blocker)
  • observe for 2-4 weeks
64
Q

2 options for urgent surgical intervention of urolithiasis

A
  • stent
  • percutaneous nephrostomy tube
65
Q

why is treatment of the stone contraindicated in infection?

A

breaking the stone can release bacterial endotoxins

66
Q

oral dissolution therapy works for which type of stones?

A

uric acid

67
Q

any patients with recurrent stones warrants

A

metabolic workup

68
Q

high serum calcium in a patient with recurrent stone can indicate

A

hyper PTH

69
Q

increase in number of prostatic stromal and epithelial cells in the transition zone

A

BPH

70
Q

what zone of the prostate surrounds the urethra?

A

transition zone

71
Q

storage symptoms of BPH

A
  • Frequency
  • Urgency
  • Nocturia

FUN

72
Q

empyting symptoms of BPH

A
  • Weak stream
  • Intermittent flow
  • Straining to urinate
  • incomplete Emptying

WISE

73
Q

mainstain drug therapy for BPH

A

alpha blocker

-osins

74
Q

gold standard for surgical treatment of BPH

A

TURP

75
Q

cancers arising from parenchymal cells of urinary tract

A

RCC

76
Q

risk factors for RCC

A

smoking
obesity
HTN

77
Q

“enhancing renal mass” on CT

A

RCC

78
Q

VHL gene

A

von-Hippel Lindau disease

familial RCC

79
Q

c-MET protooncogene

A

hereditary papillary RCC

familial RCC

80
Q

most common type of RCC

A

clear cell

81
Q

cell of origin- PCT

2

A
  • clear cell RCC
  • papillary RCC
82
Q

clear cell RCC is associated with […] syndrome

A

von Hippel Lindau

83
Q

most likely RCC to be multifocal

A

papillary

84
Q

syndromes associated with papillary RCC

2

A

hereditary papillary RCC
familial leiomyomatosis

85
Q

cell of origin- distal tubule/collecting duct

A

chromophobe RCC

less aggressive

86
Q

associated syndrome with chromophobe RCC

A

Birt-Hogg Dube

87
Q

folliculin

A

chromophobe RCC

88
Q
  • oncocytomas
  • fibrofolliculomas
  • pulmonary cysts
  • spontaneous pneumothoraces
A

chromophobe RCC

89
Q
  • retinal angiomas
  • hemangioblastomas
  • pheochromocytoma
  • renal cysts
A

clear cell RCC

90
Q

fumerate hydratase

A

familial leiomyomatosis

91
Q
  • Type II RCC
  • cutaneous leiomyomas
  • uterine fibroids
A

familial leiomyomatosis

92
Q

what stage of RCC

tumor within capsule

A

stage 1

93
Q

what stage of RCC

tumor invasion of perinephric fat

A

stage 2

94
Q

what stage of RCC

tumor involvement of regional lymph nodes and/or renal vena cava

A

stage III

95
Q

what stage of RCC

tumor involvement of adjacent organs or distant metastases

A

stage IV

96
Q

what treatment is indicated for this stage RCC

T1: small and localized

A

surveillance vs ablation vs partial nephrectomy

97
Q

what treatment is indicated for this stage RCC

T1a/T2: larger and localized

A

partial vs radial nephrectomy

98
Q

what treatment is indicated for this stage RCC

T3: locally advanced

A

radical nephrectomy

99
Q

what treatment is indicated for this stage RCC

T4M1

A

systemic therapy

100
Q

cell of origin- renal papillae

A

renal medullary carcinoma

101
Q

associated syndrome with renal medullary carcinoma

A

sickle trait

102
Q

major risk factor for urothelial carcinoma

A

smoking
solvent exposure

103
Q

most common site of urothelial carcinoma

A

bladder

104
Q

diagnosis of bladder urothelial carcinoma

A

cystoscopy and resection

105
Q

treatment of non-invasive low grade bladder urothelial carcinoma

A

resection/observation

T1/T2

106
Q

treatment of non-invasive high grade bladder urothelial carcinoma

A

intravesical therapy
BCG

T1/T2

107
Q

treatment of invasive or locally advance bladder urothelial carcinoma

T2/T3

A

chemotherapy
radical cystectomy

108
Q

treatment of T4 bladder urothelial carcinoma

A

chemotherapy

109
Q

associated with Lynch syndrome (MLH1 MSH2)

A

upper tract UC

colon cancer

110
Q

management of low grade upper tract UC

A

endoscopic resection

111
Q

management of high grade distal ureter UC

A

distal ureterectomy with reimplant to bladder VS
radical nephrourectomy

112
Q

management of high grade upper ureter or renal pelvis upper tract UC

A

radical nephroureterectomy

113
Q

renal masses are […] until proven otherwise

A

RCC

114
Q

most malignant causes of hematuria have

symptoms

A

no other symptoms

115
Q

[..] % of microscopic hematuria and
[…] % of gross hematuria are due
to a malignant cause

A

5% micro
25% gross

116
Q

a UTI is considered complicated in what patient populations?

A
  • immunocompromised
  • males
  • pregnancy
  • diabetes
  • sepsis
117
Q

which patient population should be treated for asymptomatic bacturia?

A

pregnancy

118
Q

are males or females at an increased risk of urologic malignancy?

A

males

119
Q

risk factors of urologic malignancy in asymptomatic microscopic hematuria

4

A
  • advancing age (>35)
  • chronic inflammation (UTIs)
  • prior radiation
  • smoking
120
Q

risk factors for RCC

A
  • genetic mutations
  • hypertension
  • obesity
  • smoking

NOT age

121
Q

the risk of malignancy with a solid enhancing renal mass is

A

80%

122
Q

cell of origin for renal medullary carcinoma

A

papillae

123
Q

cell of origin for chromophobe RCC

A

DCT

124
Q

cell of origin for clear cell and papillary RCC

A

PCT

125
Q

Lynch syndrome is associated with

A

upper tract UC

126
Q

which type of cancer often causes obstruction, flank pain, and hematuria?

A

upper tract UC

127
Q

which mutations are associated with Lynch syndrome?

A

MSH2
MLH1

upper tract UC

128
Q

sickle cell trait is associated with which cancer type?

A

renal medullary carcinoma

129
Q

folliculin

A

Birt-Hogg Dube

chromophobe RCC

130
Q

c-Met

A

hereditary papillary RCC

papillary RCC

131
Q

TSC1

A

angiomyoplipomas

benign renal tumors

132
Q

VHL

A

clear cell RCC

133
Q

43-68% of all microscopic hematuria cases are found to be caused by

A

idiopathic

134
Q

before preceeding with upper tract imaging, what lab value should be obtained?

A

serum Cr

assess renal function

135
Q

type 1 RTA is associated with what kind of stones?

A

calcium phosphate

136
Q

indications for urgent stone management

3

A
  • fever
  • UTI
  • obstruction
137
Q

cysteine is more soluble in […] urine

A

alkaline

138
Q

cysteine stones are caused by an […] disorder

mode of inheritance

A

autosomal recessive

139
Q

perfect hexagon crystal

A

cysteine

140
Q

the only clinical manifestation of cysteinuria is

A

urolithiasis

141
Q

treatment of recurrent UTI in postmenopausal women with vaginal atrophy

A

estrogen

142
Q

next best step in management for a patient with urinary retention due to BPH

A

catheterization

143
Q

a […] is required for work-up of suspected BPH

A

urinalysis

144
Q

most common place to find prostate cancer

A

peripheral zone

145
Q

[…] zone hyperplasia leads to increased resistance and outlet obstruction

A

transition

146
Q

indications for treatment of BPH

4

A
  • recurrent UTIs
  • gross hematuria
  • bladder stones
  • acute urinary retention

GIR Test 4 (18 decks)

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