Renal / Genitourinary Flashcards
1
Q
Hypernatremia (etiologies, PE)
A
Na >145
Esp free water loss (not Na+ gain)
6 D’s: Diuresis, Dehydr, Db insip, Docs (iatrog), Diarrh, Disease (kidn, SCD)
Thirst, neuro sympt (alt mental stat, weak, focal def, hyporefl, seiz)
2
Q
Hypernatremia (dg)
A
Urin osmol <100 central DI 100-300 nephro DI 300-600 osmotic diuresis >600 extrarenal loss (vomit, diarr, ... with Na+ur <25) or Na+ gain (hypertonic saline w/ Na+ur >100)
3
Q
Hypernatremia (ttt)
A
ttt: hypoVol + unstable vitals give isotonic 0.9% NaCl
If Nl vitals + asympt give D5W
Determine water deficit: replace w/ D5W, 0.45% NaCl or enteral water
!!! rate of replacement (48-72h if chronic hyperNa)
EuVol and hyperVol hyperNa: diuretics + D5W
4
Q
Hyponatremia (PE, dg)
A
Na <135
Esp ↑ADH
Asympt or confus, lethargy, M cramps, hyporefl, nausea
Seiz, coma, brainstem herniat
Dg: calculate serum osmol (#1 is hypotonic hypoNa) then check volume (usually for hypotonic; hypoVol isoVol hyperVol) then measure urine Na and urine osmol
5
Q
Hyponatremia (ttt)
A
Underl cause HyperVol + euVol: water restrict* +/- diuretics HypoVol: Nl saline Sev hypoNa (Na <120): hypertonic saline Chron hypoNa (>72h): correct slowly
6
Q
Hyperkalemia (etiologies)
A
K >5
- Spurious: hemolysis, delay in analysis, extreme ↑WBCs or ↑plts
- ↓excret*: renal insuff, drugs, hypoaldost, T4 RTA
- Cellular shift: rhabdomyolysis, tumor lysis sd, insulin def, acidosis, drugs, exo, bld resorpt*
- ↑intake: fruits, potatoes, iatrog
7
Q
Hyperkalemia (PE, dg)
A
Asympt; N/V, intest colic, areflexia, weak, arrhythm, paresthesia
Dg: repeat bld draw, ECG (tall + peak T, wide QRS, ↑PR, loss P), sine waves, VFib, card arrest
8
Q
Hyperkalemia (ttt)
A
K >6.5 or ECG changes: emergent ttt #1 Calcium gluconate (if sev) Bicar +/or insulin + glucose Beta⊕ helps Stop diet/fluid K+ Kayexalate removes K+ but !!! CI Loop diuretics Dialysis: if renal failure or sev refractory
9
Q
Hypokalemia (etiologies)
A
K <3.6
- Transcellular shifts: insulin, B2⊕, alkalosis
- GI loss: diarrh, laxative abuse, vomit, NG
- Renal loss: diuretics (loop, thiazid), hypoMg2+, 1* mineralocort excess, 2* hyperaldost, ↓vol, Bartter sd, Gitelman sd, drugs, DKA, T1-2 RTA, polyuria
10
Q
Hypokalemia (PE, dg, ttt)
A
Fatigue, weak, M cramps, ileus, hyporeflex, paresthesia, rhabdomyol, ascend paralysis
Dg: 24h or spot urine K+ (GI vs renal loss); ECG (flat T, U wave, ST depress*), AV block, cardiac arrest
ttt: underl cause, oral +/or IV K+ (not >20mEq/L/hr)
Replace Mg2+
11
Q
Hypercalcemia (etiologies, PE)
A
Ca >10.2 (corrected for albumin)
By hyperparathyr, cancer (breast, SCC, MM), Ca supplem, iatrog, immobil, Milk-alkali sd, Paget ds, adren insuff, acromeg, hyperthyr, Zollinger-Ellison sd, ↑vitA, ↑vitD, granulomatous ds (sarcoid, …)
Asympt; osteopenia, fx, kidn stones, anorex, constip, weak, fatig, alt ment status
12
Q
Hypercalcemia (dg, ttt)
A
Dg: total/ionized Ca, album, P, PTH
If suspic*: PTHrP (cancer), prot electrophor (MM), vit D (sarc, TB), ECG (short QT)
ttt: IV hydrat*, avoid thiazides; steroids for granulom ds
If Ca>14: IV fluids + calcitonin + bisphosph
13
Q
Hypocalcemia (etiologies, PE)
A
Ca <8.5 By hypoparath (post-surg, idiop), 2* hyperparath (CKD), malnutrit*, hypoMg2+, acute pancreatitis, vitD def, citrate chelat*, pseudohypoparath, DiGeorge sd
Abdo M cramps, dyspn, tetany, perioral/acral paresth, convuls*; Chvostek, Trousseau
14
Q
Hypocalcemia (dg, ttt)
A
Dg: ionized Ca + PTH (#1); Hx of thyroidect; Mg2+, album, vitD (25 + 1,25), ECG (prolong QT)
ttt: underl cause, Mg2+ replet*, PO Ca2+ supplem (IV if severe)
15
Q
Hypomagnesemia (etiologies, PE)
A
Mg <1.5
↓intake (malnutrit*, malabs, short bowel sd, TPN, PPIs)
↑loss (diuret, diarrh, vomit, hyperCa, alcoholism+++)
Miscellan: DKA, pancreatitis, ↑extracell volume
If sev: hyperreflexia, tetany, paresth, irritab, confus*, lethargy, seiz, arrhyth
16
Q
Hypomagnesemia (dg, ttt)
A
Dg: concurrent hypoCa and hypoK; ECG (prolong PR + QT)
ttt: IV/PO Mg supplem, !!! correct Mg first (before hypoCa and hypoK)
17
Q
Respiratory acidosis
A
Hypoventilat*
- Airway obstruct*
- Acute lung ds
- Chronic lung ds
- Opioids, narcotics, sedatives
- Weak respiratory muscles
18
Q
Metabolic acidosis with compensation (hyperventilation) + normal AG
A
- Diarrhea
- Glur sniffing
- Renal tubular acidosis
- Hyperchloremia
19
Q
Metabolic acidosis with compensation (hyperventilation) + ↑ AG
A
MUDPILES:
Methanol; Uremia; DKA; Paraldehyde; Iron/INH; Lactic acidosis; Ethylene glycol; Salicylates (late)
20
Q
Respiratory alkalosis
A
Hyperventilat*
- Early high altitude expo
- Aspirin (early)
21
Q
Metabolic alkalosis with compensat* (hypoventilation)
A
Chloride sensitive (hypochloremic, saline responsive, urine Cl <20):
- Vomiting
- Diuretic
Chloride resistant (saline resistant, urine Cl >20): -Hyperaldosteronism
22
Q
Renal tubular acidosis
A
Net ↓tubular H+ secret* or HCO3- reabsorpt*
Non-AG metabolic acidosis
Types: I; II; IV (#1 fqt)
23
Q
Renal tubular acidosis type I
A
Def H+ secret* (distal) HypoK Urin pH >5.3 Autoimmune dso; hypercalciuria; ifosfamide ttt: replace bicarb Compl: nephrolithiasis
24
Q
Renal tubular acidosis type II
A
Def HCO3- reabsorpt* (proximal) HypoK Urin pH 5.3 (then <5.3) MM; amyloidosis; Fanconi; cystinosis; ifosfamide ttt: thiazides, volume deplet* Compl: Rickets, osteomalacia
25
Renal tubular acidosis type IV
```
Aldost def or resistance (distal)
HyperK
Urin pH <5.3
Hyporeninemic hypoaldost (renal insuff); ACEIs/ARBs; heparin
ttt: furosemide, replace mineralocortic
```
26
Acute kidney injury (complications)
= Acute renal failure
Abrupt ↓fct*; retent* of creat+BUN
Oliguria (<500mL/d) not required
Compl: metabolic acidosis, e- abNl, volume overload; CKD!!!
27
Prerenal acute kidney injury (etiologies, PE, ttt)
↓renal perfus*
Hypovol, shock, cirrhosis, nephrot sd, renal art stenosis, hepatorenal sd, drugs (NSAIDs, ACEIs), CHF
Tachycard, hypoTN, other sympt (of liv failure, nephrot sd)
ttt: fluids, avoid nephrotoxic drugs; dialysis if AEIOU criteria
28
Prerenal acute kidney injury (labs)
```
BUN/Creat >20:1
FeNa <1%
Urin Na <20
Urin osm >500
Hyaline casts in urine
```
29
Intrinsic acute kidney injury (etiologies, PE, ttt)
Nephron injury
ATN (isch or toxin), AIN, glomerulonephritis, emboli, rhabdomyolysis
Hx drug expo (aminogl, NSAIDs, peni), contrast media
Creat spikes in 5-10d (drugs) or 24h (contrast)
ttt: IVF if contrast needed; nonionic contrast; stop meds
30
Intrinsic acute kidney injury (labs)
```
BUN/Creat <15:1
FeNa >2%
Urin Na >40
Urin osm <350
RBC casts (glomerulonephritis); WBC/eosino (AIN); muddy-brown cast (ATN); WBC (pyelonephritis); fatty (nephrot sd)
```
31
Postrenal acute kidney injury (etiologies, PE, ttt)
Urin outflow obstruct*
Prostat ds, pelvic tumor, intratubul obstruct* (crystalluria), bilat stones
↓urin output, suprapub pain, distend bladder, scan w/ postvoid residual >50mL
ttt: bladder cath
32
Postrenal acute kidney injury (labs)
BUN/Creat varies
FeNa >1-2%
Urin Na >40
Urin osm <350
33
Chronic kidney disease (etiologies, PE, dg)
>3mo of GFR <60 or kidney damage
Esp by DM, HTN, glomerulonephritis, PKD
Asympt until GFR <30; gradual signs of uremia (anorex, N/V, pericarditis, "frost", delirium, seiz, coma)
Dg: azotemia, fluid retent*, metab acidosis, hyperK, anemia, abNl hemostasis, hypoCa, hyperP, 2* hyperparath, urin (waxy casts), osteodystrophy
34
Chronic kidney disease (ttt, complications)
ttt: ACEIs/ARBs, HTN control, DDAVP (if abNl bleed), EPO, fluid restrict*, ↓Na/K/P intake, P binders/calcitriol (Osteodystr), hemodialysis, peritoneal dialysis, renal transplant
Compl: acquired renal cystic ds (if long-term dialys), CV (MI, sudden card death)
35
Carbonic anhydrase inhibitors
Acetazolamide
In proximal conv tubule
Inhib CA, ↑H reabs, block Na/H exchange
Side eff: hyperchlor metab acidosis, sulfa allergy
36
Osmotic diuretics
Mannitol, urea
In entire tubule
↑tub fluid osmolarity
Side eff: pulm edema (CHF + anuria)
37
Loop diuretics
Furosemide, ethacrynic acid, bumetanide, torsemide
In ascend loop of Henle
Inhib Na/K/2Cl transporter
Side eff: water loss, metab alkal, ↓K/Ca/Mg, ototoxicity, sulfa allergy, hyperuricemia
38
Thiazide diuretics
HCTZ, chlorothiazide
In distal conv tubule
Inhib Na/Cl transport
Side eff: water loss, metab alkal, ↓Na/K, ↑glu/Ca/uric acid, sulfa allergy, pancreatitis
39
K+-sparing diuretics
Spironolactone, triamterene, amiloride
In cortical coll tub
Aldost recep antag (spirono); block Na channel (triam/amil)
Side eff: metab acid, ↑K, antiandrogenic (gynecom; spironol)
40
Nephritic syndrome
Glomerular inflamm (glomerulonephritis)
Proteinuria <1.5g/d
Oliguria, macro/micro hematuria, HTN, edema (also pulm)
Dg: UA, ↓GFR, ↑BUN+crea, renal biopsy
ttt: salt+water restrict*+diuretics (HTN, fluid overload, uremia) +/- dialysis; sometimes CS
41
Postinfectious glomerulonephritis
```
Nephritic sd w/ immune complex
Recent (2-6wks) GAS inf; or any inf
Oliguria, cola-urin, HTN, edema
Low C3 (then Nl in 6-8wks); ↑ASO, ↑anti-DNase
Lumpy-bumpy imm.fluoresc
ttt: diuretics
```
42
IgA nephropathy (Berger ds)
```
Nephritic sd w/ immune complex
After URI or GI inf
Esp young men
Gross hematuria
Normal C3
ttt: GC; ACEIs (if proteinuria)
!!! Progress to ESRD
```
43
Henoch-Schonlein purpura
```
Nephritic sd w/ immune complex
Small Vx vasculitis; esp child
Triad: palpable purpura, arthralgia, abdo pain
Normal C3
ttt: GC
```
44
Granulomatosis with polyangiitis (Wegener ds)
Nephritic sd w/o Ig deposit
Granulom in nasopharyng + kidney w/ necrotizing vasculitis
Resp/sinus sympt; hemoptysis
c-ANCA; segmental necrotizing glomerulonephritis
ttt: ↑dose CS, cytotoxic agent, rituximab
45
Microscopic polyangiitis
```
Nephritic sd w/o Ig deposit
Small Vx vasculitis (kidney, lung); No granulomas
Resp sympt; hemoptysis; No nasophar
p-ANCA; necrotizing glomerulonephritis
ttt: GC, cyclophosphamide, rituximab
```
46
Eosinophilic granulomatosis with polyangiitis (Churg-Strauss)
```
Nephritic sd w/o Ig deposit
Small Vx vasculitis
Asthma, sinusitis, skin nodules/purpura, periph neurop
p-ANCA, ↑Ig-E
ttt: GC
```
47
Goodpasture syndrome
Nephritic sd w/ anti-GBM ds
Rapidly progress glomerulonephritis + pulm hge
Esp men in mid-20s
Hemoptysis, dyspn, +/-resp failure, No upper resp
Linear anti-GBM deposits (IF), iron def anem, macroph (sputum), pulm infiltr (CXR)
ttt: plasma exchange, pulse steroids
!!! ESRD progress*
48
Alport syndrome
```
Nephritic sd w/ anti-GBM ds
Heredit glomerulonephritis
Esp boys 5-20yo
Asympt hematuria, sensorineural deafness
GBM splitting (EM)
!!! progr renal failure; may recurr after transplant
```
49
Nephritic syndrome with low C3 (#dg)
- Postinfectious
- Membranoproliferative glomerulonephritis (and mixed cryoglobulinemia: purpura, arthralgia, nephrit sd, ↓C3, ⊕HCV)
- Lupus nephritis
50
Nephrotic syndrome (causes, PE)
Esp from systemic ds (DM, SLE, amyloidosis)
Proteinuria ≥3.5g/d; general edema, hypoalbuminemia (<3), hyperlipidemia, foamy urine, lipiduria
↑R inf, hypercoag (↑venous thromb/PE; loss antithromb3, prot C/S)
51
Nephrotic syndrome (dg, ttt)
Dg: spot prot/creat ratio, albu, lipid, ...; renal biopsy
ttt: prot+salt restrict*, diuretics, antihyperlipidemics
Imm.suppressant (sometimes); ACEIs; Strep pneumo vaccine (PPV23)
52
Minimal-change disease
```
#1 in child
Idiop; NSAIDs, hemato malign (Hodgkin)
↑R inf, thrombosis; sudden edema
Normal (light micro); fus* epith foot process + lipid-laden (EM)
ttt: steroids; excellent pg
```
53
Focal segmental glomerulosclerosis
#1 in adult; Idiop; IVDU, HIV, obes
Esp Afric/Amer man w/ uncontrolled HTN
Microsc hematuria; biopsy (sclerosis in capill tuft)
ttt: prednisone, cytotoxic ttt, ACEIs/ARBs
54
Membranous nephropathy
Ass w/ solid cancers, inf (HBV, malaria), autoimm (SLE), meds (NSAIDs, gold)
Spike+dome (granular deposits IgG+C3 at basement memb)
ttt: prednisone, cytotoxic ttt
55
Diabetic nephropathy
2 forms: diffuse hyalinizat* or nodular glomerulosclerosis (Kimmelstiel-Wilson)
Long-standing poorly controlled DM + retinop/neuropathy
Thick GBM, ↑mesangial matrix
ttt: tight glycem control, ACEIs/ARBs
56
Lupus nephritis
```
Nephrotic or nephritic sd
Severity of renal ds → overall pg
UA (prot or RBC)
Mesangial prolif; subendoth or subepith imm complex deposit*
ttt: prednison and cytotoxic med
```
57
Renal amyloidosis
1* (plasma cell dyscrasia); 2* (inf or inflamm)
MM or chronic infl ds (rheum arth, TB)
Nodular glomerulosclerosis; EM (amyloid fibrils); apple-green biref w/ Congo red stain
ttt: prednisone, melphalan; BMT in MM
58
Membranoproliferative nephropathy
Nephritic/nephrotic sd; ttt w/ CS and cytotoxic meds
T I: ass w/ HBV, HCV, cryoglob, SLE, subacute bact endocarditis
Tram-track, double BM, subendoth + mesangial deposits
Low C3
T II/III: esp idiop
Intramembran dense deposits
59
Nephrolithiasis (RF, PE)
RF: ⊕fam Hx, ↓fluid intake, gout, meds (allop, chemoth, loop diur), post-colectomy/ileostomy, enz def, RTA T1, hyperparath; esp older men
Acute severe colicky flank pain; radiat* testes/vulva; N/V
Shift posit*/uncomfort
60
Nephrolithiasis (dg, ttt)
Dg: UA (macro/micro hematuria), alter urin pH
Noncontrast abdo CT (#1) or AXR; US (#1 in child, pgnt)
KUB (if opaque stone)
ttt: hydrat* + analgesia (#1); <0.5cm pass; 0.5-3cm ttt w/ ESWL or percut nephrolithotomy or retrogr ureteroscopy;
alpha⊖ or CCB (facilitate passage)
Prevent: ↑fluid, ↑Ca intake, ↓prot/oxalate, ↓Na intake
61
Calcium oxalate / Calcium phosphate nephrolithiasis
#1 kidney stone
Esp idiopathic hypercalciuria, 1* hyperparath, fat malabs, alkaline urine
Urine: ↑pH (Ca-P) or ↓pH (Ca-Oxal); Radiopaque
ttt: hydrat*, ↓Na/prot intake, thiazide
Do Not ↓Ca intake
62
Struvite nephrolithiasis
Mg-NH4-PO4
Ass w/ urease-prod org (Proteus); Staghorn calculi
Urine: ↑pH; Radiopaque
ttt: hydrat*, AB if UTI, surg removal
63
Uric acid nephrolithiasis
Ass w/ gout, xanthine oxidase def, ↑purine turnover
Urine: ↓pH; Radiolucent
ttt: hydrat*, alkalinize urin w/ citrate, ↓diet purine/allopur
64
Cystine
Def in renal transport of aa (Cystine, Ornithine, Lysine, Arginine)
Hexagonal crystals, ⊕urin cyanide nitroprusside test
Urine: ↓pH; Radiopaque
ttt: hydrat*, ↓Na intake, alkalinize urine, penicillamine
65
Polycystic kidney disease (types)
Cystic dilat* of renal tubules
Cysts in spleen, liver, pancreas
ADPKD: #1, asympt until >30yo, 50% will have ESRD then dialysis by 60yo, ↑R cerebral aneurysm
ARPKD: more severe, infants/young child, renal failure, liver fibrosis, portal HTN; death in few years
66
Polycystic kidney disease (PE, dg, ttt)
Pain, hematuria +/- HTN, hepat cysts, cereb aneur, divertic, MVP
If cyst ruptur/inf: sharp local pain
Dg: US (#1) or CT; genetic test (ADPKD1, ADPKD2)
ttt: Prevent compl + ↓progr to ESRD
Early UTI ttt; BP control (ACEIs/ARBs)
When ESRD: dialysis; renal transplant
67
Hydronephrosis (etiologies, PE)
Dilat* of renal calyces
2* to obstruct*: ureteropelvic junct* (child), if adult BPH, neurogenic bladder, tumor, ...
2* to ↑output urinary flow and vesicoureteral reflux
Asympt; flank pain, ↓urin output, abdo pain, UTIs
68
Hydronephrosis (dg, ttt, complications)
Dg: US or CT; ↑BUN+crea
ttt: surg if anatomic obstruct*; laser/sound wave if calcul; ureteral stent; nephrostomy; Foley/suprapub cath (if low UT obstr)
Compl: if unttt, HTN, acute/chronic renal failure, sepsis, poor pg
69
Scrotal swelling (etiologies, PE)
- Painless: hydrocele, varicocele
- Painful: epididymitis, testic tors*
"Bag of worms" (varicoc; esp left side)
Prehn sign: ⊕ in epididymitis; ⊖ in tors*
70
Scrotal swelling (dg, ttt)
Dg: transilluminat* on US (⊕ in hydroc; ⊖ in varicoc)
Doppler (↑flow in inf; ↓flow in tors*); UA+Cx (gono, Ecoli, chlam)
ttt: hydroc (none); varicoc (surg if larg/sympt); inf (AB tetracycl/fluoroq; NSAIDs for pain); tors* (immed surg in <6h; orchiopexy bilateral!!!)
71
Erectile dysfunction (etiologies, RF)
- Initiate: psychol, endocrin, neuro
- Fill: arteriogenic
- Store: veno-occlusive dysfct*
RF: DM, atheroscl, meds (B⊖, SSRI, TCA, diuretics), HTN, heart ds, surg/radiat* prostate cancer, spinal cord injury
72
Erectile dysfunction (PE, dg, ttt)
```
Psy # organic: ⊕ nocturnal/early-morning erect* so nonorganic; situat* dependence
Neuro eval (anal tone, LE); hypogonadism eval
```
Dg: clinic; testosterone, gonadotropin, prolactin
ttt: psychotherapy; PDE5 inhib; testosterone (if hypogonadism)
If PDE5 inhib fails: pump, prostag inj, surg implant
73
Benign prostatic hyperplasia (PE)
Nl aging process; in >80% of men 80yo
Esp periurethral zone
- Obstruct sympt: hesitant, weak/intermitt stream, incompl empty, urin retent*
- Irritative sympt: nocturia, daytime fqcy, urge incont, hematuria
74
Benign prostatic hyperplasia (dg, ttt)
Dg: DRE (uniform enlarged, rubbery), UA+Cx, PSA
Creat (r/o obstr uropathy, renal insuff)
ttt: alpha⊖, 5 alpha-reductase inhib
TURP if mod-sev sympt/complic (renal insuff, recurr UTIs, bladd stones)
75
Prostate cancer (RF, PE, prevention)
In men: #1 cancer; #2 cause of cancer death
RF: adv age, ⊕fam Hx
Asympt, obstr urin sympt, lymphedema (obstr meta), back pain (bone meta)
DRE (palpable nodule, indurat*) (tender prost = prostatitis)
Prevent: annual DRE +/or PSA starting 50yo, earlier in Afr/Am or w/ 1st degree fam cancer
76
Prostate cancer (dg, ttt)
Dg: clinic, ↑PSA>4, transrectal biopsy (under US, defin dg)
Grade (Gleason); CT abdo/pelv + bone scan (meta; osteoblastic, ↑BMD)
ttt: watchful waiting (elder + low-grade); radical prostatectomy (ass w/ ↑R of incontinence or erect dysfct)
Radiat* (ass w/ ↑R of proctitis, GI sympt); PSA (follow-up)
If meta: androgen ablat* (GnRH agonist, orchiectomy, flutamide) + chemotherapy
77
Bladder cancer (RF, PE)
#1 fqt cancer of UT; esp men 60-70yo
Esp transitional cell carcinoma
RF: smok, ↑meat/fat, schistos, chronic cyclophosph, expo to aniline dye
Gross hematuria, other urin sympt (irritat)
78
Bladder cancer (dg, ttt)
Dg: cystoscopy w/ biopsy (#1), UA (hematuria), cytology, MRI/CT/bone scan (invas* + meta)
ttt: intravesicular chemoth (carcinoma in situ or large high-grade recurrent); resect* or intravesic BCG/mitomycin-C (superficial cancer); radical cystectomy or radiat* (invasive w/o meta or unresectable); chemoth alone (invasive + meta)
79
Renal cell carcinoma (RF, PE)
AdenoK from tubular epith cells
Spread: renal vein, IVC then meta lung and bone
RF: male, smok, obes, acquir cystic kidney ds in ESRD, vonHippel-Lindau
Triad: hematuria, flank pain, palpable mass
+/- ↓weight, mal, fever, varicocele, anemia or polycythemia
80
Renal cell carcinoma (dg, ttt)
Dg: CT (dg+stage); histo on nephrectomy piece (confirm)
ttt: surg resect* (cure if local); metastasectomy
Tyrosine kinase inhib (↓angiogenesis, cell prolif)
81
Testicular cancer (RF, PE, dg)
Esp men 15-34yo; but seminoma esp 40-50yo
Germ cells (95%)
RF: cryptorchidism, Klinefelter sd
Painless enlarged testes
Dg: testic US; CXR + CT abdo/pelv (meta); tumor markers
82
Testicular cancer (ttt)
ttt: radical orchiectomy
Platinum-chemoth for nonseminomatous
Radioth +/- chemoth: if seminoma
83
Testicular cancer (tumor markers)
Germ cell: seminoma (↑placental ALP); yolk sac (↑AFP), choriocarcinoma (↑B-hCG); teratoma (AFP, B-hCG)
Non-germ cell: leydig cell (↑testosterone, estrogen); sertoli cell (none); testicular lymphoma (none)
