Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clin Med III > kidney stones, bladder ca, RCC > Flashcards

kidney stones, bladder ca, RCC Flashcards

1
Q

types of kidney stones

A
  • calcium stone- most common
  • struvite stones- aka staghorn calculi
  • uric acid stones
  • cystine stones- often recurrent
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

risk factors for calcium stones

A
  • hx of prior stones
  • family hx
  • diet
  • medications
  • hyperparathyroidism
  • hypercalcemia of malignancy
  • sarcoidosis
  • medullary sponge kidney
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

dietary risk factors for calcium stones

A
  • dehydration*
  • short gut -> increased enteric absorption of oxalate
  • large consumption of grapefruit juice, tomato juice, apple juice, soda
  • high Na or protein intake
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

medications at risk for causing calcium stones

A
  • diuretics- esp thiazides
  • antacids in high volumes
  • vit D and C
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

risk factors for uric acid stones

A
  • gout
  • hyperuricosuria
  • chronic diarrhea
  • HTN, DM, obesity*
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

other drugs that may cause stones

A
  • indinavir
  • acyclovir
  • triamterene
  • sulfadiazine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

clinical presentation of kidney stones

A
  • sudden onset renal colic
  • severe unilateral flank pain, may radiate to groin
  • pacing, rocking, writing, constant movement
  • n/v, diaphroesis
  • tachycardia, HTN
  • normal abd exam
  • testicles non-tender and non-swollen
  • hematuria, dysuria, frequency, urgency
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

describe the colicky pain of kidney stones

A
  • SUDDEN onset severe pain
  • pain waxes and wanes
  • severe pain usually lasts 20-60 min
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

where do kidney stones usually get stuck?

A
  • UPJ
  • pelvic brim
  • UVJ
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

pain from a stone stuck in the kidney

A
  • flank pain

- hematuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

pain from a stone stuck in the proximal ureter

A
  • renal colic and flank pain

- upper abd pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

pain from a stone stuck in middle ureter

A
  • renal colic

- anterior abdominal/groin pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

pain from a stone stuck in distal ureter

A
  • renal colic
  • dysuria/ urgency/ frequency/ hesitancy
  • anterior abd pain
  • groin pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what should you look for on UA for kidney stone work up

A
  • microhematuria- common but not always present
  • pH, crystals, bacteria
  • signs of infection
  • limited pyuria is common from irritation due to stone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

US for kidney stone dx

A
  • look for indirect signs of obstruction
  • hydroureter, no ureteric jet
  • procedure of choice in pregnancy, kids, hx of prev stone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

KUB for kidney stone dx

A
  • stone frequently gets obscured by stool, bowel gas, bones
  • does not show all stone types
  • cant see uric acid stones, pure cystine stones, indinavir stones
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

IV pyelograms for kidney stone dx

A
  • poor visualization of non-GU structures

- need good kidney function- get SCr prior to test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

non-contrast CT scan for kidney stone dx

A
  • gold std
  • IDs all stone types in all locations
  • fast and accurate
  • c/i in kids and pregnancy
  • can also see ureteral/ collecting dilation, perinephric/ periureteric stranding, nephromegaly, rim sign
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what is the rim sign

A
  • ureter swollen around kidney stone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

management for kidney stones

A
  • IV hydration
  • NSAIDs (ketorolac)
  • +/- antiemetics- usu emesis due to pain
  • +/- tamulosin
  • d/c to home if able to take PO meds and fluids
  • strain urine
  • send stone for analysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

when is hospitalization required for kidney stones

A
  • cannot take PO due to intractable vomiting
  • refractory/ severe pain
  • pregnant
  • elderly/ comorbidities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what are emergent situations in the setting of kidney stones

A
  • sepsis + obstruction
  • ARF
  • anuria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what are the procedures used for kidney stones

A
  • extracorporeal shock wave lithotripsy (ESWL)
  • ureteroscopy
  • percutaneous nephrolithostomy (PCNL)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

extracorporeal shock wave lithotripsy

A
  • usu for proximal stones < 2 CM renally or < 1 cm ureterally
  • stone broken up into pieces
  • fragments passed
  • consider stent
  • less effective if morbidly obese or very hard/ cystine stones
25
Q

when is extracorporeal shock wave lithotripsy c/i

A
  • pregnancy
  • tightly impacted stones
  • bleeding disorders
26
Q

ureteroscopy

A
  • used for mid- distal ureteral stones
  • endoscope through bladder
  • if stone < 5 mm retrieve it with basket
  • larger stones get broken up with lithotripsy
  • usu requires stent
27
Q

percutaneous nephrolithostomy

A
  • stones > 2 cm and proximal collecting system
  • percutaneous insertion of needle into kidney through CVA
  • usu done if failed other modalities or large/ complex renal stone
28
Q

staghorn calculi

A
  • upper urinary tract stones
  • involve renal pelvis and at least two calyces
  • usu struvite stones
  • assoc with recurrent UTIs- proteus* or klebsiella
  • rarely colicy pain
  • tx of choice= percutaneous nephrolithotomy
29
Q

who requires metabolic work ups for kidney stones

A
  • recurrent stones
  • strong family hx
  • usu uric acid or cystine stones
30
Q

what is included in a metabolic work up for kidney stones

A
  • serum PTH and Ca
  • 24 hour urinalysis**- urine volume, Ca, oxalate, phosphate, citrate, uric acid, pH, Na
  • BMP
31
Q

treatment for recurrent stones

A
  • depends on 24 hour urine findings
  • thiazides for hypercalciuria
  • tx hyperparathyroidism
  • dietary restriction of purines, give allopurinol or oxalate
  • k citrate for citrate in urine
32
Q

treatment for uric acid stones

A
  • k citrate- alkalinize urine
  • allopurinol as prevention
  • restrict dietary purines
33
Q

treatment for cystine stones

A
  • high fluid intake- 3-4 L of urine output per day
34
Q

treatment for struvite stones

A
  • PNL

- prophylactic abx

35
Q

what type of cancer are most bladder cancers?

A
  • transitional cell carcinoma

- can arise anywhere in GU tract

36
Q

risk factors for bladder cancer

A
  • age > 55
  • men > women
  • cigarette smoking**
  • occupational exposure
  • chronic urinary inflammation
  • family hx
  • previous pelvic xrt
37
Q

si/sx of bladder cancer

A
  • painless hematuria**
  • urinary voiding sx less common
  • advanced disease: LE swelling, bone/ pelvic/ flank pain, palpable mass
38
Q

work up for bladder cancer

A
  • UA- get microscopy and culture, cytology*
  • cystoscopy*- gold std
  • CT with contrast or MRI
  • bone scan and CXR for mets
39
Q

staging of bladder cancer

A
  • T1- superficial tumor
  • T2- tumor in muscle
  • T3- tumor in adipose
  • T4- tumor beyond adipose and into nearby organs/ structures
40
Q

prognosis of bladder cancer

A
  • 70% 10 year survival

- best prognosis if caught early

41
Q

treatment for bladder cancer

A
  • tumor depth determines treatment
  • endoscopic TURBT for T1 tumors
  • T2 or larger get neoadjuvant chemo then radical cystectomy
42
Q

what is the chemo used for bladder cancer

A
  • BCG intravesicular for 6-12 weeks
43
Q

renal cell carcinoma (RCC)

A
  • majority of all renal cancer
  • most commonly in proximal renal tubular epithelium
  • sporadic or hereditary
44
Q

risk factors for RCC

A
  • males> female
  • smoking*
  • obesity
  • HTN
  • s/p renal transplant/ dialysis if dev cystic renal disease
45
Q

si/sx of RCC

A
  • painless hematuria*
  • weight loss, night sweats, malaise
  • L sided varicocele
  • classic triad: flank pain, hematuria, flank mass (only seen in 10%)
  • frequently occur with paraneoplastic syndromes
46
Q

paraneoplastic syndromes assoc with RCC

A
  • hyperCa
  • non-metastatic liver dysfunction
  • malignant HTN
  • erythrocytosis
47
Q

advanced sx of RCC

A
  • spreads to lungs, soft tissue, bones, liver, cuteanous sites, CNS
  • cough, SOB
  • HA, seizure
  • bone pain
48
Q

diagnosis of RCC

A
  • often incidental finding
  • cytology not as helpful
  • CT gold std
  • US good for simple cysts
  • MRI to det IVC involvement
  • bone scan and pet scan for mets
49
Q

stage I RCC

A
  • confined to kidneys
  • IA < 4 cm
  • IB 4-7 cm
50
Q

stage II RCC

A
  • confined to kidneys (gerota’s fascia)

- > 7 cm

51
Q

stage III RCC

A
  • vascular or regional LN involvement

- IVC or renal v

52
Q

stage IV RCC

A
  • adjacent organ involvement and/or distant mets
53
Q

RCC treatment if localized to kidney

A
  • TIA- partial nephrectomy
  • TIB- T2- radical nephrectomy
  • low rate of recurrence
  • good prognosis
54
Q

treatment for locally advanced RCC

A
  • radical nephrectomy

- LN dissection and IVC thrombectomy

55
Q

venous tumor thrombus

A
  • RCC tumor grows into venous circulation

- does not invade wall

56
Q

venous tumor thrombus sx

A
  • LE edema
  • isolated R varicocele or one that does not reduce
  • dilated superficial abd veins
  • PE
  • RA mass
  • nonfunction of involved kidney
57
Q

treatment for locally invasive RCC

A
  • en block resection of adjacent organs
58
Q

treatment for disseminated RCC

A
  • palliative radical nephrectomy to help relieve sx
  • nephrectomy and metastatic excision
  • IL 2 drugs in minima tumor burden, lung or nodal mets only
  • interferon- alpha
  • multikinase inhibitors and VEGF prevent tumor growth
  • radioresistant and chemoresistant

Clin Med III (26 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions