RCC, Wilms Tumor, Dehydration, Hypervolemia

Question 1

what is the classic triad of S&S of renal cell carcinoma?

Answer 1

CAB

CVA tenderness (flank pain)
Abdominal mass
Bloody urine

Question 1

a patient with renal cell carcinoma has blockage of left renal vein or inferior vena cava. what 3 symptoms would be present?

Answer 1

LLE edema
left varicocele
ascites

Question 2

what is the 1st line to diagnose renal cell carcinoma? (2)

Answer 2

CT or US

Question 3

2nd line diagnostic for renal cell carcinoma?

Answer 3

MRI

Question 4

what diagnostics can be used to assess for mets of renal cell carcinoma? (3)

Answer 4

Chest xray
Chest CT
bone scan

Question 5

stage this RCC: diameter < 7cm
localized
tumor only within kidney

Answer 5

stage 1

Question 6

stage this RCC: diameter > 7cm
localized
tumor only within kidney

Answer 6

stage 2

Question 7

stage this RCC: any size
regional
tumor within kidney parenchyma or blood vessels and in surrounding lymph nodes or fatty tissue

Answer 7

stage 3

Question 8

stage this RCC: any size
metastatic
tumor spread beyond kidney to the adrenal glands or other organs

Answer 8

stage 4

Question 9

treatment for small RCC < 4cm, advanced disease or not good surgical candidate?

Answer 9

active surveillance

Question 10

treatment for small RCC 4-7 cm in affected kidney and healthy contralateral kidney, persons with single kidney, or bilateral RCC?

Answer 10

partial nephrectomy

Question 11

treatment for RCC > 7cm or if partial nephrectomy not feasible?

Answer 11

radical nephrectomy

Question 12

what does RCC respond to?

Answer 12

immunotherapy (interleukin-2 and interferon-alpha 2b)

Question 13

what are 2 complications of RCC?

Answer 13

renal vein thrombosis
mets to adrenals, brain, bones, lungs…

Question 14

what is the most common renal malignancy in children?

Answer 14

wilms tumor / nephroblastoma

Question 15

what is wilms tumor associated with?

Answer 15

WT1 or WT2 gene deletions

Question 16

what is the most common presentation of wilms tumor?

Answer 16

painless abdominal mass

Question 17

patient presents with painless abdominal mass, hypertension, hematuria, fever, N/V, weight loss, and lethargy. Dx?

Answer 17

wilms tumor

Question 18

what will a patient with wilms tumor show on CBC?

Answer 18

polycythemia

Question 19

how to diagnose wilms tumor?

Answer 19

renal US

Question 20

what diagnostic should be ordered for wilms tumor to characterize it, see lung and pulmonary mets, assess for renal extension into inferior vena cava, and staging?

Answer 20

CT chest, abdomen, pelvis

Question 21

what is a favorable finding in wilms tumor?

Answer 21

triphasic pattern of blastema, epithelial or stromal tissues (differentiated)

Question 22

what is a unfavorable finding in wilms tumor?

Answer 22

focal/diffuse anaplasia (undifferentiated)

loss of the structural and functional differentiation

Question 23

treatment for wilms tumor?

Answer 23

nephrectomy

Question 24

what is the treatment for high stage wilms tumor with mets? (3)

Answer 24

chemo radiation renal replacement therapy

Question 25

what are 3 ways we intake water?

Answer 25

food (800) oral water (500) oxidation (300)

Question 26

what are 4 ways we output water?

Answer 26

urine (500) skin (500) respirations (400) feces (200)

Question 27

patient presents with thirst and mild discomfort. severity of dehydration?

Answer 27

mild

Question 28

patient presents with lethargy, postural dizziness, fatigue, thirst, and muscle cramps. severity of dehydration?

Answer 28

moderate

Question 29

patient presents with confusion, chest/abdominal pain, tachypnea, seizures, and coma. severity of dehydration?

Answer 29

severe

Question 30

what can extreme dehydration lead to?

Answer 30

death

Question 31

what suggests volume depletion in dehydration?

Answer 31

low urine Na / Cl

Question 32

treatment for mild-moderate dehydration?

Answer 32

oral rehydration with free water

Question 33

what should we do if weight/fluid loss is unknown in dehydration?

Answer 33

administer 1-2 liters of isotonic fluids

Question 34

what is the maintenance therapy for dehydration?

Answer 34

1-2 liters / day of 1/2 isotonic saline in 5% dextrose + 20 mEq KCl per liter

Question 35

what should be considered if dehydration lasts over 1-2 weeks without eating?

Answer 35

total parenteral nutrition (TPN)

Question 36

IVFs that contain water, electrolytes, +/- glucose

Answer 36

crystalloids

Question 37

IVFs that are mainly albumin and blood products

Answer 37

colloids

Question 38

crystalloid solution that is used to raise ECF quantity

Answer 38

isotonic

Question 39

crystalloid solution that is used when the cells are dehydrated in a hypertonic environment and fluid needs to be returned into the cells

Answer 39

hypotonic

Question 40

crystalloid solution that is used in a hypotonic environment and prevents cell edema

Answer 40

hypertonic

Question 41

colloids are usually ______ solutions that contain albumin and fresh frozen plasma. which patients are they given to?

Answer 41

hypertonic burn patients

Question 42

what are the 2 most used crystalloids?

Answer 42

normal saline lactated ringers

Question 43

4 advantages of crystalloids?

Answer 43

inexpensive non-allergenic half life = 30-60 mins veggie/vegan

Question 44

what can large volumes of crystalloids increase the risk of?

Answer 44

hyperchloremic acidosis

Question 45

what do lactated ringers increase the risk for?

Answer 45

hyperglycemia

Question 46

what should not be done concurrently with IV fluids?

Answer 46

blood transfusion

Question 47

what patients are colloids reserved for?

Answer 47

severely hypovolemic patients

Question 48

3 advantages of colloids?

Answer 48

replaces fluid volume molecules too large to cross walls half life = hours to days

Question 49

4 disadvantages of colloids?

Answer 49

anaphylaxis risk expensive bleeding not veggie/vegan

Question 50

what can excessive use of colloids lead to?

Answer 50

cardiac or renal failure

Question 51

what is the most common cause of fluid overload?

Answer 51

CHF

Question 52

patient presents with weight gain, increased HR, hypertension, crackles, polyuria, edematous skin, and jugular venous distention. Dx?

Answer 52

hypervolemia

Question 53

how will urinalysis present in hypervolemia?

Answer 53

diluted

Question 54

2 imaging studies used to diagnose hypervolemia?

Answer 54

CXR echo

Question 55

management for hypervolemia? (4) treatment medication?

Answer 55

treat cause monitor weight + I&O restrict fluid restrict sodium furosemide

Question 56

what position would help manage hypervolemia?

Answer 56

high-semi Fowler's position (elevate head of bed)