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1
Q

testicular cancer

A
  • common in 15- 35 men
  • RF: undescended testicles

seminonam and nonseminoams

presentation: painless testicular mass
- mets signs ( brain mets, retroperitoneal mets)

labs;
nonseminomas- very high bHCG, AFP, LDH

seminomas: slight high bHCG, non-elevated, elevated LDH

imaging: scrotal sonogram
surveillance for mets and brain

tx: radical orchiectomy for every one
seminona- rad tx with chemo

nonseminona- no rad tx
chemo tx

px: excellent

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2
Q

prostate cancer

A

adenocarcinoma , AA,
fix

s/s: 2/3 asymptomatic when diagnosed
- rectal exam: hard and nodule
advanced dz: specific to mets ( does, nodes, rectum, and bladder)

labs: PSA> 4.0 good for monitoring and following pt with cancer
changed recs; over dx of cancer and tx

PSA can be high with other cancers
transrectal us/ guided bx
- do for anyone with positive DRE

Gleason score: evaluate tissue sample

tumor surveillance: CT abdomen/ pelvis, bone scan, MRI

tx: active surveillance
radical prostatectomy
rt and androgen therapy( luron, orchiectomy, anti-androgen)
cryotherapy

screening: Lots of disagreement
- need to screen in AA and fix

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3
Q

bladder cancer

A

linked to manufacture (leather, rubber, cig smoking, dyes)

transitional cells
- s/s: painless hematuria

labs: UA

studies; bx

tx: how much penetrattion of bladder wall

Transurethral resection with fulguration with chemo IP - Ta/ T1

invasive bladder: radical cystectomy with pelvic lymphadectomy chemo/t x

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4
Q

renal cell carcinoma

A
  • occlusive thrombi in renal veina
  • associated with paraneoplastic syndrome
  • diagnosed on incidental scan

s/s: flank pain with hematuria

dx: CT scan and met work up
labs: check LFTs, CBC, CMP

tx: radial partial nephrectomy 
with met ( lung, bones, and brain --> poor px
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5
Q

wilms tumor

A

2-3 y/o
tumors in the kidneys
palpable ab mass, and pain, and hematuria

cannot bx- spill tumor cell and increase stage

tx; surgical resection, nephrectomy, chemotherapy, rad tx

px: depends on histology

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6
Q

acute renal failure

A
  • sudden rise in BUN/Cr
  • build up of nitrogenous waste

s/s: uremic ( nausea/ itching)

labs: BUN/Cr
causes: pre renal azotemia, intrinsic renal ( failure, post renal azoetmia

major cause: pre-renal azotemia

  • volume deplete
  • septic
  • no blood flow to kidneys

tx: tx the cause
monitor K

post renal azotemia-
bilat obstruciotn

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7
Q

acute tubular necrosis

A
  • damage of renal of tubules
  • muddy sediment, granular case
    cause: MI, sepsis,nephrotoxic, IV constrast

tx: tx the cause, low protein diets, dialysis
- can repair itself

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8
Q

interstitial nephritis

A

inflame of renal tubules

causes:
drugs

s/s : fever, rash, arthalgias

labs: WBC casts and eosinophils

tx: remove cause
steroids
dialysis
-pts get better

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9
Q

glomerulonephritis

A

inflame of glomerulus from immune complex deposition

Immune complex- strep in kids

  • tea colored urine
  • puffy on eyes and scrotum
  • positive ASO titer

IGA nephropathy- starts with URI or H. flu and have hematuria

lupus nephritis- auto ab production
+ ANA and ANCA

Good Pasteur syndrome: assoc with pulmonary hemorrhage
tx: plasmapheritis

Vasculitis: effects small and medium sized vessels
- assoc with granuloma formation airway, lung skin,
Rhinitis

Vascular: hemolytic uremic syndrome
-uremia, low plts, hemolytic anemia

s/s: hematuria, HTN, edema, tea colored urine with RBC casts

dx: renal bx
tx: steroids except for post strep pt

Good pasteur- plasmapheresis

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10
Q

chronic renal failure

A

destruction of nephrons least to progressive decline

causes: HTN and DM

dx: HTN, high BUN/ Cr, SOB
UA: proteinuria, U/s shows small echogenic kidneys

tx: renal diet, dialysis
and or transplant

ACE or ARB to delay progression

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11
Q

nephrotic syndrome

A 
increased permeability of glomeulr capillary walls ) glomeulr becomes a sieve)
proteinuria, hypoalbuimnaea and edema 
causes: primary
minimal change dz
membranous nephropathy

dx: proteinuria > 3 gm
oval fat body( Maltese cross)

management: low ptn diet, restrict salt, tx of hyperlipidemia, anemia
diuretics and ACE inhibitors

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12
Q

polycystic kidney disease

A

hereditary dz ( 30s and 40s)

clinical features: cross hematuria, abd flank pain,

complications: cysts rupture, stones, HTN, Cerebral aneurysms, aspirate cyst

tx: agressive HTN tx,
renal transplant

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13
Q

rental artery stenosis

A

HTN 50
abd exam: renal bruit
if you give ACE–> creatine goes up

dx: renal arteriography
tx: renal artery angioplasty with stunting

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14
Q

renal vein thrombosis

A

causes: children - severe dehydration
adults: infection, ascending thrombus of v. cava

sxs: flank pain and palpable kindness
dx: renal us, renal venography
tx: eliminate cause, anticoagulant or thrombolytic

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15
Q

hypnatremia

A

-affect CNS
- low sodium
- total body watery and total body sodium
-

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16
Q

SIADH

A
  • brain produces ADH despite normal plasma volume
  • causes: trauma, strok, small cell lung ca
    labs: Urine:
    tx: fluid restrict, and tx the cause
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17
Q

hypernatremia

A

Na> 145 mEq/L
Causes: impaired thirst, lack of access to water, lactulose and mannitol

s/s: dehydraiton, hyperthermia, delirium

tx: volume replacement and dehydration

Decrease serum sodium by no more than 1 meQ/:

too fast–> neuro edema

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18
Q

diabetes insipidus

A

problem wth ADH
central DI: head injury
nephrogentic- kindney not listening to ADH

dx: water deprivation test (

tx: volume replacement for everyone
central: desmopression
nephrogenic ID: treat underlying cause

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19
Q

hypokalemia

A

-sxs in mm

-

20
Q

hyperkalemia

A

K > 5, > 6.5 severe

when severe
V.fib–> death

causes: renal disease, hypoaldosterism, drugs ( NSAiDs, ACE, and ARBs), burns, rehab,
s/s: mm weakness, hyperreflexia, flaccid paralysis

ekg: peaked T waves

tx; confirm that lab result i real
-treat cause

  1. stabilize heart- calcium gluconat
  2. dive K back into cells

insulin+ glucose
albuterol
sodium bicarb

excrete- kayelate

21
Q

hypocalcemia

22
Q

hypercalcemia

A

> 10.5
less sensitive to stimulation

cause: hyperparthathyrid, renal cell carcinoma, MM
s/s: anorexia, diagnostic, polyuria

EKG: shortened QT interval

tx: IV fluids and loop diuretics

23
Q

hypomagnemia

24
Q

Acid -base basics

A

body wants a ph of 7.4

CO2 and bicarb maintain this

if bicarb drops- ph goes how

if ph high -high bicarb or low CO2

when ph is too low=acidosis
pCo2 is high and HC03 is low

When ph is too high = alkalosis
HCo3 is high and Pco2 is low

respiratory: alteration in pc02
metabolic - alteration in Hc bicarb ( kidneys)

when on system fails–> other system kick in

25
metabolic acidosis
ph is low, bicarb issue too much H ion then positive ion gap ``` - MUDPILES- rise in H ion methanol uremia DKA glycol Isoniazid lactic acidosis ethanol salicylates ``` compensation: increased ventilation ( kassuma) tx: fix underlying cause
26
metabolic alkalosis
high bicarb and high ph causes: due to loss of H or too much bicarb vomiting , aggressive suction of gastric content compensation; dec ventilation to increase pC02 s/sx; associated with low CA and low K tx: fix underlying cause and associated metabolic problems IV fluids
27
respiratory acidosis
low ph, high Co2 - causes: COPD, narcotic overdose compensation: reabsorption of bicarb by kidneys tx; fix underlying cause naloxone
28
resp alkalosis
low co2 and high ph cause: hysterical hyperventilaion, salicylate intoxication, PE sx: rapid breathing, lightheadedness, perioral paresthia compensation; incr eliminate of bicarb by kidney tx: tx underling cause
29
kidney stones
calcium 85% , struviet ( infection) uric acid, cystine s/s: M >F inc calcium, diets in oxalate ( chocolate, tea, coffee), diets high in purine sever pain- radiation got the flank or labia dx; spiral CT scan and do KUB UA/ culture tx: meds, pain control- tordal , flomax if stone 10 mm
30
hydronephrosis
-distension of renal calices ``` causes by urinary blockage - kidney stone -pregnancy - s/s: pain ``` dx; UA, check BUN/ Cr tx: tx causes catheter, anticholingerica infeciotn- needing emergent stunting or nephrostomy
31
incontinence
requires evluaiotn women> men stress: incr ab press tx: kegel, estrogen, surgery urge: overative bladder ( irritable bladder) - oxcybutin and petrol LA bowel training overflow: outlet obstruction ( big BPH) functional- unable to urinate on own
32
bening prostatic hyperplasia
enlargement of prostate due to inc. number of cells - s/s; obstructive sxs; hesistany, slow, weak, dribbling irritative sxs; frequency on DRE: smooth, firm, elastic enlargement in move over 50 y/o dx: UA, check PSA, cr , cystoscopy, flow rates tx; depends on symptoms alpha blockers: tamsulosin, doxaxoin- relaxes smooth muscle - finasterid, dutasterid- blocks formation of DHT surgery; TURP, TUIP, TNA prostatectomy
33
erectile dysfunction
not able to attain or maintain a rigid penile erection - check UA, tesosteroi, FSH, thyroid panel, psychogenic: check for erections at night management: treat underlying cause viagra- careful who have CAD or h/o MI don't give with Nitro vacuums erection device, penile prosthesis priapism: erection > 4 hours medical causes: SC, leukemia, illicit drugs meds: terbutaline Peyronies dz- penis becomes curved tx: intraplaque injection of verapamil or interferon cause: repetive trauma
34
balanitis
swollen foreskin d/t hygiene tx: children: no tx Adults: abx cream, steroid cream, anti fungal
35
phimosis
foreskin is unable to br retracted tx; betamethazoe stretch the fore skin circumcision paraphiosis- emergency -edema- compromised blood ---> surgery
36
congenital abn
hypospaids- urethera meatus is ventral and proximal to normal positive - repat before kid is 18 month old chord- ventral penile curvature - surgery veisicoureteral reflux: urine passess retrograde from bladder to kidneys lead to: reflux nephropathy: renal scarring assoc with infrarenal reflux child with recurrent UTi test: IVD, renal us, tx: Tx HTN, Ace, abx
37
cryptorchidism
testes don't descent from abdomen - s/s: empty hemiscrotitum on right tx; hCG 1500 X 3 days if not,must tx surgically incr risk for testicual cancer and infertility
38
scrotal masses
hydrocele: fluid in membranes around the testicle - transillumination - no tx required varicocele: varicose veins in scrotum - may feel achy - rarely treated unless indicted by infertility sprematocel- retention cuts of the head of the epididmysis no tx
39
testicular torsion
testicel rotate on spermatic cord causing occlusion s/s: sudden, severe tesitcular pain, n/v - Preh's sign- no relief with elevation of testicle - cremaster reflex - no retraction of ipsilateral testis when medial thigh is stocked imaging u/s tx: surgical emergency ( 4-6 hours) - need to detorse it ( in to out)
40
epididmyitis
most common cause of adults scrotal pain - caused by STI or E. col s/s: gradual sever, scrotal pain dx; must do doppler u/s labs; UA, GC/ chlamydia CBC tx: abx if infection, bed rest, scrotal election/ tight fitting briefs, NSAIDs if STI- ceftriaxome
41
orchitis
seen with mumps -s/s: develop 1 week after parrots marked pain and swelling in one or both testicles n/v, fever, urinary sxs, tx; bed rest, scrotal support, ice abx d/t epidimytis complication: testicular
42
urethritis
STI, s/s: d/c labs; check urine tx: cefrixone and doxycycline treat partner
43
cystitis
common in women, enterococcus s/s: dysruai, flank pain labs; UA and culture tx; abx X 3-7 days, longer if elderly, DM, pregnant, men Bactrim, microbic, quinones
44
pyelonephritis
fever/ chills, sepsis, vomiting, flank pain labs: WBC casta urine culture blood cultures imaging; u/s r/o hydronephrosis Ct scan tx; admit ampicillin and aminoglycoides
45
prostatitis
``` acute bacterial- gram neg rods, sick perineal, lower back pain no DRE dx: CBC, UA, tranrectal uS ``` tx: bacterium or quinolone analgesis, fluids, rest if septic--> admit chronic: recurrent infection of prostate - gram neg rods s/s: vary, milder h/o UTI or sexual dysfunction dx; UA : norma, expressed prostatic secretions ( manage prostate and milk out pus) two glass test tx: bacterium, quinolone X 6-12 weeks, alpha blocker chronic nonbacterial prostates - no bacteria same sxs - no bacterial on prostate secretions tx; alph blocker, NSAiDS try bacterium 4- 6 weeks asymptomatic- WBC on prostate fluids feel fine no tx

PANRE (27 decks)

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