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Renal-Genitourinary > RCC, Wilms Tumor, Dehydration, Hypervolemia > Flashcards

RCC, Wilms Tumor, Dehydration, Hypervolemia Flashcards

1
Q

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

A

CAB

CVA tenderness (flank pain)
Abdominal mass
Bloody urine

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1
Q

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

A

LLE edema
left varicocele
ascites

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2
Q

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

A

CT or US

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3
Q

2nd line diagnostic for renal cell carcinoma?

A

MRI

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4
Q

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

A

Chest xray
Chest CT
bone scan

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5
Q

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

A

stage 1

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6
Q

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

A

stage 2

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7
Q

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

A

stage 3

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8
Q

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

A

stage 4

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9
Q

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

A

active surveillance

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10
Q

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

A

partial nephrectomy

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11
Q

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

A

radical nephrectomy

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12
Q

what does RCC respond to?

A

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

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13
Q

what are 2 complications of RCC?

A

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

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14
Q

what is the most common renal malignancy in children?

A

wilms tumor / nephroblastoma

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15
Q

what is wilms tumor associated with?

A

WT1 or WT2 gene deletions

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16
Q

what is the most common presentation of wilms tumor?

A

painless abdominal mass

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17
Q

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

A

wilms tumor

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18
Q

what will a patient with wilms tumor show on CBC?

A

polycythemia

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19
Q

how to diagnose wilms tumor?

A

renal US

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20
Q

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?

A

CT chest, abdomen, pelvis

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21
Q

what is a favorable finding in wilms tumor?

A

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

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22
Q

what is a unfavorable finding in wilms tumor?

A

focal/diffuse anaplasia (undifferentiated)

loss of the structural and functional differentiation

23
Q

treatment for wilms tumor?

A

nephrectomy

24
Q

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

A

chemo
radiation
renal replacement therapy

25
Q

what are 3 ways we intake water?

A

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

26
Q

what are 4 ways we output water?

A

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

27
Q

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

A

mild

28
Q

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

A

moderate

29
Q

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

A

severe

30
Q

what can extreme dehydration lead to?

A

death

31
Q

what suggests volume depletion in dehydration?

A

low urine Na / Cl

32
Q

treatment for mild-moderate dehydration?

A

oral rehydration with free water

33
Q

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

A

administer 1-2 liters of isotonic fluids

34
Q

what is the maintenance therapy for dehydration?

A

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

35
Q

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

A

total parenteral nutrition (TPN)

36
Q

IVFs that contain water, electrolytes, +/- glucose

A

crystalloids

37
Q

IVFs that are mainly albumin and blood products

A

colloids

38
Q

crystalloid solution that is used to raise ECF quantity

A

isotonic

39
Q

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

A

hypotonic

40
Q

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

A

hypertonic

41
Q

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

A

hypertonic

burn patients

42
Q

what are the 2 most used crystalloids?

A

normal saline
lactated ringers

43
Q

4 advantages of crystalloids?

A

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

44
Q

what can large volumes of crystalloids increase the risk of?

A

hyperchloremic acidosis

45
Q

what do lactated ringers increase the risk for?

A

hyperglycemia

46
Q

what should not be done concurrently with IV fluids?

A

blood transfusion

47
Q

what patients are colloids reserved for?

A

severely hypovolemic patients

48
Q

3 advantages of colloids?

A

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

49
Q

4 disadvantages of colloids?

A

anaphylaxis risk
expensive
bleeding
not veggie/vegan

50
Q

what can excessive use of colloids lead to?

A

cardiac or renal failure

51
Q

what is the most common cause of fluid overload?

A

CHF

52
Q

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

A

hypervolemia

53
Q

how will urinalysis present in hypervolemia?

A

diluted

54
Q

2 imaging studies used to diagnose hypervolemia?

A

CXR
echo

55
Q

management for hypervolemia? (4)
treatment medication?

A

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

furosemide

56
Q

what position would help manage hypervolemia?

A

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

Renal-Genitourinary (7 decks)

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