General surgery: Urology and Renal

Question 1

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.

Answer 1

bladder carcinoma

Question 2

What is the m/c type of bladder cancer?

Answer 2

transitional cell carcinoma

Question 3

gold standard for dx of bladder carcinoma?

Answer 3

cystoscopy with biopsy

Question 4

What is the classic sign of urinary retention in an elderly patient?

Answer 4

confusion

Question 5

Dysuria + fever + flank Pain + nausea and vomiting + CVA tenderness

Answer 5

pyelonephritis

Question 6

how do you dx urethritis?

Answer 6

nucleic acid amplification test (NAAT)

Question 7

characterized by dysuria, unilateral scrotal pain, and swelling

Answer 7

epididymitis

Question 8

what is most likely to cause epididymitis in a male < 35 yo?

Answer 8

chlamydia and gonorrhea

Question 9

what is most likely to cause epididymitis in a male > 35 yo?

Answer 9

e. coli

Question 10

whats the abx for epididymitis caused by e coli?

Answer 10

levofloxacin

Question 11

whats the abx for epididimitis caused by gono or chlam

Answer 11

doxycycline 100mg PO BID for 10 days PLUS ceftriaxone 250 mg IM × 1

Question 12

Sudden onset of fever, chills, and low back pain combined with urinary frequency, urgency, and dysuria

Answer 12

prostatitis

Question 13

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.

Answer 13

nephrolithiasis

Question 14

most common type of nephrolithiasis?

Answer 14

calcium oxylate stones

Question 15

most common type of infected kidney stones?

Answer 15

struvite stones

Question 16

When is lithotripsy indicated?

Answer 16

stones >6 mm in size or intractable pain

Question 17

whats the gold standard for dxing nephrolithiasis?

Answer 17

CT scan (spiral ct) w/o contrast

Question 18

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

Answer 18

renal cell carcinoma

Question 19

flank pain, hematuria, palpable abd/renal mass

Answer 19

renal cell carcinoma

Question 20

most common type of kidney cancer

Answer 20

renal cell carcinoma

Question 21

second most common type of renal cancer

Answer 21

TCC

Question 22

What type of antihypertensive med is contraindicated in pts with renal artery stenosis?

Answer 22

ACE inhibitors and K+ sparring diuretics

Question 23

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?

Answer 23

renal artery stenosis

Question 24

whats usually the initial imagining in those <60 yo with suspected renal artery stenosiss?

Answer 24

Ultrasound

Question 25

what is the gold standard imagining to dx renal artery stenosis?

Answer 25

renal arteriography

Question 26

how do you treat real artery stenosis?

Answer 26

stenting. perc transluminal angioplasty plus stent placement

Question 27

what are risk factors for testicular cancer?

Answer 27

cryptorchidism, Leydig cell hyperplasis, orchitis

Question 28

what are the rumor markers for testicular tumors?

Answer 28

Beta-human chorionic gonadotropin (βHCG)
Alpha-fetoprotein (α-fetoprotein )

Question 29

Most common solid tumor in young men ages 15-40 (average age 32 years old)

Answer 29

testicular carcinoma

Question 30

most common type of testicular cancer

Answer 30

seminoma (60%)

Question 31

What is the most common solid renal tumor of childhood?

Answer 31

Wilms tumor