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FA17 Nephrology > Howell App > Flashcards

Howell App Flashcards

1
Q

risk factors of prostate cancer

A

Age
Race
Family History
High fat diet

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2
Q

shared decision making

A

working with patient to determine outcome

PSA, DRE

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3
Q

PSA

A

glycoprotein produced only by prostate

prostate specific antigen

tumor marker - increases in levels due to increase in size of prostate

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4
Q

Screening PSA

(sensitive/specific) + when to start

A

SENSITIVE not specific (bc it doesn’t eliminate other possible causes)

Begin checking PSA at 40, or 10 years prior to first degree relative diagnosis

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5
Q

PSA Velocity

A

used as a screening risk

check PSA range over time

Rise of >0.35 ng/mL indicates “rapid” increase

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6
Q

reasons why PSA could be elevated (5)

A 
malignancy
UTI
prostatitis
prostatic trauma
BPH
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7
Q

abnormal findings on DRE

A

induration or nodularity

prostate should be considered suspicious for prostate cancer

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8
Q

limitations of DRE

A

Finger length

body habitus of patient

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9
Q

Prostate Cancer metastasis

A

bone meds to lower back

evaluate with bone scan + Xray

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10
Q

Histologic type of prostate cancer

A

Adenocarcinoma

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11
Q

Diagnostic analysis of prostate cancer

A
  1. Prostate biopsy via TRUS
  2. MRI
  3. Conventional radionucletide bone scan
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12
Q

Prostate Biopsy via Transrectal Ultrasound

A

Tumors are hypoechoic on TRUS

TRUS IS NOT first line alone

Expensive, invasive, LOW specificity

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13
Q

Standard method of detecting/proving prostate CA

A

Prostate biopsy via TRUS

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14
Q

MRI prostate cancer benefits

A

Evaluation of prostate as well as regional lymph nodes

Better at staging than TRUS

Non-invasive, non-radiation

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15
Q

scale used in staging of prostate cancers

A

Gleason scale

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16
Q

stage 1

A

No symptoms, confined to prostate

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17
Q

stage 2

A

Hard nodule on rectal exam, confined within prostate

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18
Q

stage 3

A

Spread out of prostate capsule, urinary symptoms appear

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19
Q

stage 4

A

Spread beyond prostate to lymph nodes and bones (urine, bone pain, weight loss, fatigue)

20
Q

tx options of prostate cancer

A

active surveillance
radical prostatectomy
radiation therapy
androgen manipulation

21
Q

active surveillance

A

avoid tx in men who will not have disease progression

accurately discuss risks/benefits

(low Gleason score, age and health)

22
Q

radical prostatectomy removes what

A

Removal of entire system (prostate, vas deferens, seminal vesicle)

23
Q

Tx with most proven ability for long term cure for prostate cancer

A

prostatectomy

24
Q

PSA and prostatectomy

A

PSA should drop following surgery

if PSA rises later( >0.2 ng/mL) indicates metastasis or recurrence

PSA is sensitive AND specific here

25
Q

Radical prostatectomy

3 treatment approaches:

A

Transperineal
Open retropubic
Laporoscopic

26
Q

Radical prostatectomy in patients with what stage?

A

Used in patients with LOW stage

adjunctive stages 3,4

27
Q

Primary alternative for localized prostate cancer

A

external beam radiation

risk for damage to bladder or rectum

28
Q

Transperineal implantation of radioisotopes

+ PSA

A

Seeds

Monotherapy or combined

PSA can rise for up to 20 months after initiation bc radiation cases inflammation and necrosis

29
Q

Androgen Manipulation and prostate CA

what does it do?

A

Most are hormone dependent

Decrease prostate size, improvement in disease symptoms, decline in serum PSA

“rapid regression”

30
Q

Androgen Manipulation

Long Term Side effects: (7)

A

Hot flashes

loss of libido

impotence

osteoporosis

decreased facial hair

loss of muscle mass

weight gain

31
Q

BPH V prostate cancer

A

Prostate CA is most commonly asx and found “incidentally”

PC: Elevated Alkaline and Phosphate

32
Q

risk factors of bladder CA

A

Cigarette smoking

Exposure to industrial solvents

Dyes

MC in men

33
Q

MC presentation of bladder CA

A

gross or microscopic hematuria (typically painless)

34
Q

tools used to diagnose and stage bladder CA

A

Cystoscopy

Transurethral resection

35
Q

grading of bladder CA

A

size
pleomorphism
mitotic rate
hyperchromatism

36
Q

categories (depth) of bladder CA

A

Superficial
Invasive
Metastatic

37
Q

types of bladder CA

A

Urothelial (90%)
Squamous
Adenocarcinoma

38
Q

bulky tumor, hope to reduce size before cystectomy:

A

neo-adjuvant systemic therapy

39
Q

benefit of immunotherapeutic agents delivered DIRECTLY to bladder

A

Reduces likelihood of recurrence in those who have undergone complete transurethral resection of dysplastic/CA cells

40
Q

most effective form of intravesical chemo

A

BCG

reduces likelihood of recurrence in those who have undergone complete resection of dysplastic CA cells

41
Q

BCG

A

basically giving a patient TB

still have similar symptoms to other tx mechanisms BUT

also TB symptoms

42
Q

types of bladder diversion

A

Ileal conduit (older, sicker)

Continent catheterizable reservoir

Orthotopic neobladder (younger patients)

43
Q

extent of bladder CA

LE edema and pelvic pressure

A

CA extends beyond bladder

symptoms can be explained by compression of local structures

44
Q

staging of bladder CA based on (2)

A

extent (depth) into bladder wall

presence of regional or distance mets

45
Q

T3 bladder CA tx

A

radical cystectomy and irradiation or combo of chemo and sx/radiation

HIGH risk of progression compared to lower stage

FA17 Nephrology (13 decks)

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