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Unit 3 Clin Med II > L21: Cases > Flashcards

L21: Cases Flashcards

1
Q

Nephrolithiasis is due to

A

supersaturation of urine leading to crystal formation

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2
Q

Crystals can be

A

Calcium oxalate
Calcium phosphate
Struvite
Uric acid
Crystine

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3
Q

Struvite means

A

Magnesium ammonium phosphate

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4
Q

Uric acid crystals are

A

radiolucent

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5
Q

Risk factors for nephrolithiasis

A 
History/family history
Decreased fluid intake
Malabsorption causing increased urinary oxalate excretion
Hyperparathyroidism
DM
Gout
Obesity
Marathon running
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6
Q

How often do stone recur?

A

1/3 recur within 4 years

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7
Q

What might cause malabsorption, causing increased urinary oxalate excretion?

A

Bariatric surgery

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8
Q

Imaging of choice for nephrolithiasis

A

Non-contrast CT abdomen/pelvic

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9
Q

Why isn’t contrast used for nephrolithiasis diagnosis?

A

Decreases sensitivity for small stones

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10
Q

Perinephritis stranding on CT

A

a sign of inflammation/obstruction

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11
Q

Ultrasound+nephrolithiasis

A

less sensitive. may need follow up CT

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12
Q

Is IV pyelogram recommended for detection of stones?

A

NO

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13
Q

Treatment of kidney stones: symptomatic

A

NSAIDS
Opiates
Hydration
Strain urine to catch ya stone

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14
Q

If a stone is strained from urine or surgically removed….

A

send it off for composition analysis

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15
Q

Stones <5 mm….

A

Usually pass spontaneously

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16
Q

Stones >20 mm….

A

refer to urology

17
Q

Stones tx to relax smooth muscle around urinary tract

A

Tamsulosin .4 mg qd

alpha 1 blocker

18
Q

If your patient has a uric acid stone

A

Gout tx: allopurinol

19
Q

Optional tx for stones

A

HCTZ diuretic increases Ca++ absorption, can prevent future stones

20
Q

Prevention of stones

A

Increase hydration

Decrease sodium

21
Q

You patient fails to pass the stone

A

refer to urology

22
Q

How many stones need surgery?

A

10-20%

23
Q

Your patient has a urologic infection+stone

A

URGENT refer to urology

24
Q

Your patient has AKI+stone

A

URGENT refer to urology

25
Q

Your patient has significant obstruction

A

refer to urology: to avoid damage/scarring

26
Q

First choice for surgical intervention for stones

A

shock wave lithotripsy

27
Q

Other options for surgical intervention for stones

A

Ureteroscopy

Percutaneous nephrolithotomy

28
Q

Your patient has a stone+anuria

A

URGENT refer to urology

29
Q

Your patient has unyielding pain, N/V

A

URGENT refer to urology

30
Q

Risk factors for renal cell carcinoma

A

Smoker
Males
6th-8th decade

31
Q

renal cell carcinoma triad

A

Hematuria
Flank pain
Palpable abdominal mass

32
Q

How many patients actually have the renal cell carcinoma triad

A

9%

33
Q

Diagnosis of renal cell carcinoma

A

CT abdomen pelvis
Histology
+/-US

34
Q

Localized renal cell carcinoma tx

A

Nephrectomy

35
Q

Disseminated renal cell carcinoma tx

A

“various treatment options”

Unit 3 Clin Med II (8 decks)

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