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GIR Test 4 > B5.082 Prework 1: Hematuria: Benign Causes > Flashcards

B5.082 Prework 1: Hematuria: Benign Causes Flashcards

1
Q

process of microscopic urinalysis

A

10 mL of midstream clean catch specimen is centrifuged for 10 min at 2000 rpm
3 or more rbc per hpf

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2
Q

does excessive anticoagulation lead to hematuria?

A

no

but may make degree and duration worse

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3
Q

overview of the steps taken when evaluating microscopic hematuria

A
  1. dipstick
  2. microscopic urinalysis
  3. assess for UTI or benign causes
  4. renal function testing
  5. CT urography
  6. cystoscopy
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4
Q

categories of evaluation

A 
medical history
physical exam
lab workup
upper tract imaging
lower tract imaging
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5
Q

risk factors for urinary tract malignancy

A 
> 35 years
analgesic abuse
chemicals/dyes
male sex
smoking
history of: indwelling foreign body, chronic UTI, known carcinogens, gross hematuria, irritative voiding, pelvic irradiation, urologic disorder/disease
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6
Q

important components of physical in analysis of hematuria

A 
BP
edema
cardiac arrhythmia
CVA tenderness
DRE
pelvic exam
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7
Q

components of a urinalysis

A

RBCs
WBCs
presence of bacteria
nitrites

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8
Q

what do you do if infection is suspected?

A

urine culture must be sent to confirm infection

UA must be repeated after treatment

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9
Q

components of a lab workup for microscopic hematuria

A

UA
culture?
renal function studies
PSA

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10
Q

alternatives to CT urography for imaging

A

MRI
US
non-contrast CT
retrograde pyelography

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11
Q

mechanism for evaluation of lower urinary tract

A

cystoscopy

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12
Q

most common benign etiologies of microscopic hematuria

A

idiopathic : 43-68%
UTI: 4-22%
urolithiasis: 4-5%
BPH: 10-13%

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13
Q

uncomplicated UTI

A

infection in a healthy patient with functionally normal urinary tract

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14
Q

complicated UTI

A

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

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15
Q

risk factors for UTI

A

reduced urine flow
colonization
facilitation of ascent (catheter, incontinence)

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16
Q

host factors that can predispose to UTI

A 
changes in estrogen, low vaginal pH
high urine glucose
obstruction
vesicoureteral reflux
immunocompromised
pregnancy
SCI
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17
Q

which bacterial factor is associated with pyelonephritis?

A

type P pili/fimbrae

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18
Q

use of UA in suspected URI

A

catheterized urine is best
dipstick urinalysis rules infection out not in
nitrite positivity is very specific
pyuria (>10 WBC/hpf) is most sensitive for UTI

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19
Q

quantitative urine culture in UTI

A

100,000 CFU is diagnostic

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20
Q

indications for imaging in UTI evaluation

A 
persistence after treatment
sepsis from urinary source
history of urolithiasis
neurogenic bladder
poor response to therapy
infections with urea-splitting bacteria
recurrence with same or unusual strain
21
Q

DOC for uncomplicated UTI

A

nitrofurantoin 100 mg BID x 5 days

TMP/SMX BID x 3 days

22
Q

outpatient management of complicated UTI

A

Cipro BID x 7 days
Levaquin x 5 days
TMP/SMX BID x 14 days
one time IV then 14 day oral ttx

23
Q

inpatient management of complicated UTI

A 
IV fluoro
aminoglycoside + ampicillin
3rd gen ceph
extended spectrum pen
carbapenem
switch from parenteral to oral in 48 hours if clinical improvement, treat for 14 days
24
Q

pathophys of urolithiasis

A

soluble urine metabolites occur in amounts too high to stay dissolved in urine
supersaturation allows precipitation and aggregation to form crystalline concentrations
obstruction from a stone can cause pain via ureteral dilation

25
Q

common types of stones

A 
calcium oxalate
uric acid
struvite
calcium phosphate
cystine
26
Q

calcium oxalate stones

A

most common
urinary citrate is an inhibitor
risk factors: dehydration, hypercalciuria, hyperoxaluria, hypernatriuria, hyperuricosuria
treatment: fluids, decreased Ca in urine, increasing citrate

27
Q

uric acid stones

A

for in ACIDIC urine, 100 times more soluble at pH > 6
risk factors: persistently acidic urine from diet high in protein, hyperuricemia, hyperuricosuria, treatment of lymphoma/leukemia
treatment: alkalization of urine

28
Q

urine alkalization agents

A

K+ citrate
Na+ citrate
Na+ bicarb

29
Q

struvite stones

A

magnesium ammonium phosphate stones
caused by infections with urease producing organisms (proteus)
form staghorn calculi
treatment: surgical removal and aggressive treatment of infection

30
Q

calcium phosphate stones

A

form in ALKALINE unrine
usually associated with metabolic disorders such as type 1 RTA (distal), primary hyperparathyroidism, or medullary sponge kidney
treatment: managing the underlying disorder

31
Q

cystine stones

A

autosomal recessive disorder known as cystinuria
microscopic hexagonal crystals
cystine more soluble in alkaline urine
treatment: alkalization of urine, treat with drug Thiola to break down sulfide bond

32
Q

clinical signs of urolithiasis

A

colicky flank pain radiating to groin or scrotum
nausea and vomiting
CVA tenderness
hematuria

33
Q

imaging for urolithiasis

A

non-contrast CT

34
Q

lab workup for urolithiasis

A

UA + culture
serum creatinine and electrolytes
WBC count

35
Q

indications for urgent intervention for urolithiasis

A

concomitant UTI, fever, or signs of sepsis
renal azotemia (high serum Cr)
solitary kidney (impending renal damage)
intractable pain, nausea, or vomiting despite treatment
patient preference

36
Q

expectant management for urolithiasis

A

pain control with NSAIDs
medical expulsive therapy with a blocker
observation of 2-4 weeks

37
Q

options for urgent surgical intervention of urolithiasis

A

placement of ureteral stent
placement of percutaneous nephrostomy tube
don’t break the stone in case of releasing bacterial endotoxins causing sepsis

38
Q

how to treat a kidney stone itself

A

oral dissolution therapy
extracorporal shock wave lithotripsy
ureteroscopy with intracorporal lithotripsy
percutaneous nephrolithotomy

39
Q

what workup is necessary when someone has recurrent stones?

A

metabolic work up

40
Q

general dietary modifications to prevent kidney stones

A

increase fluid
decrease dietary salt
moderate animal protein
increase dietary citrate

41
Q

what is BPH

A

histologic diagnosis

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

42
Q

lower urinary tract symptoms associated with BPH

A

phenotypic diagnosis

urinary frequency, urgency, slow stream, straining

43
Q

pathophys of BPH

A

transition zone hyperplasia leads to increased resistance via:

  • bladder outlet obstruction from tissue (static)
  • increased smooth tone and resistance within the gland (dynamic)
44
Q

storage symptoms

A

frequency
urgency
nocturia

45
Q

emptying symptoms

A

weak stream
intermittent flow
straining to urinate
incomplete emptying

46
Q

indications for surgical management of BPH

A 
gross hematuria
UTI
bladder stones
urinary retention
bladder diverticula
47
Q

drug therapy options for BPH

A

alpha blocker: relax prostatic smooth muscle by blocking a1 adrenergic receptors
5 alpha reductase inhibitor: block conversion of testosterone to DHT and decrease prostate volume by 30%

48
Q

surgical options in BPH

A

TURP (gold standard)
open simple prostatectomy
transurethral laser surgery
minimally invasive therapy

GIR Test 4 (20 decks)

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