General surgery: Urology and Renal Flashcards
Patient will present as → a 60-year-old male with painless hematuria. He first noticed the color of his urine darkening several weeks ago, and it has recently worsened. He denies any pain. Vital signs are stable. Physical examination is within normal limits. Past medical history is significant for a 25 pack/year history of smoking. He has no costovertebral angle tenderness. Urinalysis is positive for heme with with >100 RBC/HPF and urine culture is negative. Urine cytology reveals malignant cells.
bladder carcinoma
What is the m/c type of bladder cancer?
transitional cell carcinoma
gold standard for dx of bladder carcinoma?
cystoscopy with biopsy
What is the classic sign of urinary retention in an elderly patient?
confusion
Dysuria + fever + flank Pain + nausea and vomiting + CVA tenderness
pyelonephritis
how do you dx urethritis?
nucleic acid amplification test (NAAT)
characterized by dysuria, unilateral scrotal pain, and swelling
epididymitis
what is most likely to cause epididymitis in a male < 35 yo?
chlamydia and gonorrhea
what is most likely to cause epididymitis in a male > 35 yo?
e. coli
whats the abx for epididymitis caused by e coli?
levofloxacin
whats the abx for epididimitis caused by gono or chlam
doxycycline 100mg PO BID for 10 days PLUS ceftriaxone 250 mg IM × 1
Sudden onset of fever, chills, and low back pain combined with urinary frequency, urgency, and dysuria
prostatitis
Patient will present as → a 45-year-old woman who presents to the ED with sharp, severe, colicky right flank pain radiating to the groin that she reports started suddenly several hours ago. She also reports discolored urine when she last voided, along with nausea and vomiting. Vital signs are within normal limits. On exam, the patient is visibly in pain and shifts positions every few minutes. Costovertebral tenderness is elicited on percussion. Past medical history is significant for type II diabetes mellitus, fibromyalgia, gout, and depression.
nephrolithiasis
most common type of nephrolithiasis?
calcium oxylate stones
most common type of infected kidney stones?
struvite stones
When is lithotripsy indicated?
stones >6 mm in size or intractable pain
whats the gold standard for dxing nephrolithiasis?
CT scan (spiral ct) w/o contrast
Patient will present as → a 65-year-old man who noticed blood in his urine earlier this morning. This has never happened before and he denies any new medications or prior infection. He also reports having flank pain for the past few weeks. Medical history is significant for hypertension. He has a 40 pack-year smoking history. On physical examination, there is a firm, nontender, and homogeneous mass in the right flank. Computerized tomography (CT) scan of the abdomen is shown
renal cell carcinoma
flank pain, hematuria, palpable abd/renal mass
renal cell carcinoma
most common type of kidney cancer
renal cell carcinoma
second most common type of renal cancer
TCC
What type of antihypertensive med is contraindicated in pts with renal artery stenosis?
ACE inhibitors and K+ sparring diuretics
If patient is placed on an ACE inhibitor and all of a sudden develops acute renal failure or sharp rise in BUN/CR you should think what?
renal artery stenosis
whats usually the initial imagining in those <60 yo with suspected renal artery stenosiss?
Ultrasound
