Urology and Renal Flashcards
What are the average values for HCO3, pH and CO2
HCO3: 20-26
pH: 7.35-7.45
CO2: 35-45
what is the presentation of bladder carcinoma
painless hematuria in a smoker
what is the most common type of bladder carcinoma
transitional cell carcinoma
what is the gold standard initial diagnostic test for bladder carcinoma
cystoscopy with biopsy
what is the treatment of bladder carcinoma
surgery, biological therapy, and chemo
what is CKD
progression of ongoing loss of kidney function (GFR) or presence of kidney damage
what is the presentation of kidney damage
proteinuria - urinary albumin excretion
what are etiologies of CKD
DIabetes
HTN
chronic GN
interstitial nephritis, PKD, obstructive uropathy
what are broad waxy casts a sign of
chronic renal failure
what is the treatment of CKD
key to slow the progression
- ACEi/ARBs
- managing comorbiditis (HTN, glycemic control, cholesterol control, tobacco cessation)
- maintain hemoglobin at 11-12
- dietary management
- pneumococcal vaccination
what is the presentation of UTI
pain with urination, foul smelling urine, frequent urination
what is the presentation of pyelonephritis
pain with urination, fever, chills
whatis the presentation of urethritis
pain with urination, frequent urge to urinate, pain during intercourse
what is the presentation of urolithiasis/nephrolithiasis
pain with urination, sharp pain, flank pain
what is the most common cause of edema
chronic venous insufficeincy
what is lymphedema
surgical removal of lymph notes for tx of cancer can cause swelling of a limb(s) with thickening of skin on the side of surgery
what are symptoms of edema
sensation of “heavy legs”, itching, and pain
hyperpigmentation, stasis dermatitis, lipodermatosclerosis, atrophie
icreased size of abdomen (with ascites)
difficulty breathing (with chest edema)
what electrolyte disorder presents with peaked T waves
hyperkalemia
what electrolyte disorder presents with flattened T waves, U waves
hypokalemia
what electrolyte disorder presents with long QT
hypocalcemia
what electrolyte disorder presents with short QT
hypercalcemia
what electrolyte disorder presents with tall T waves
hypomagnesemia
what electrolyte disorder presents with prolonged PR interval widened QRS
hypermagnesemia
what electrolyte disorder presents with low urin sodium and polyuria
diabetes insipitus
how is hyponatremia defined
plasma sodium concentration less than 135mEq/l
how is hypernatremia defined
plasma sodium concentration greater than 145 mEq/L
what is the presentation of nephrolithiasis
colicky flank pain radiating to the groin, hematuria, CVA tenderness and N/V
what is the gold standard diagnostic test for nephrolithiasis
CT scan (spiral CT) without contrast of abdomen and pelvis
what are the types of nephrolithiasis (4)
- calcium oxalate (MC)
- struvite
- Uric acid
- cystine
what are the general treatment measures for nephrolithiasis
analgesia
vigorous fluid hydration
abx
alpha-blocker therapy (Flomax)
How is orthostatic hypotension classified
drop of >20 mmHg systolic, 10mmHg diastolic, 15BPM increase in pulse 2-5 minutes after change from supine to standing
what is the presentation of renal cell carcinoma
hematuria
frlank pain
abdominal mass (palpable)
what are the types of RCC
renal clear cell (MC)
transitional cell
what is the risk factor for RCC
Smoking
how is RCC diagnosed
US or CT then biopsy
what is the treatment for RCC
surgery with radical nephrectomy - curative
what is renal vascular disease
narrowing of one or both of the renal arteries
what causes renal artery stenosis
atherosclerosis or fibromuscular dysplasia
how is renal vascular disease diagnosed
US = first imaging in age < 60
Renal arteriography = GS
what is the treatment of renal artery stenosis
percutaneous transluminal angioplasty (PTA) + stent placement or with surgical bypass of stenotic segment
what is the presentation of testicular carcinoma
firm, painless, non-tender testicular mass and feeling of heaviness in the scrotum
what is the most common type of testicular carcinoma
seminoma
what are risk factors for testicular carcinoma
cryptorchidism
how is testicular carcinoma diagnosed
US
tumor markers: AFP, betaHcg
what is POUR
postoperative urinary retnetion
what are obstructive causes of urinary retnetion
urethral stricture, bladder calculi or neoplasm, FB
what is are neurogenic causes of urinary retention
MS, parkinsons, CVA, post op retention
what are traumatic causes of urinary retention
urethral, bladder or spinal cord injury
what are the extraurinary cause of urinary retention
fecal impaction, AAA, rectal or retroperitoneal mass
what are infectious causes of urinary retention
local abscess, cystitits, genital herpes, zoster
what are risk factors for acute urinary retention
male, prostatic enlargement, epidural, spinal or prolonged anesthesia, antihistamine and narcotic use
what is detrusor sphincter dyssyynergia
consequence of neurological pathology: SCI or MS
urethral sphincter muscle dyssynergically contracts during voiding causing the flow to be interrupted and bladder pressure to rise
what is Wilms Tumor
child with painless, unilateral abdominal mass with no other signs/symptoms, also known as neuroblastoma
A 55-year-old woman presents to the clinic with bilateral lower extremity edema that has progressively worsened over the past two months. She has a history of hypertension and type 2 diabetes mellitus. On examination, her blood pressure is 150/90 mmHg, and she has pitting edema up to her mid-shins. Laboratory tests reveal serum creatinine of 1.8 mg/dL (baseline 1.2 mg/dL), albumin of 3.0 g/dL, and urine dipstick positive for protein. Which of the following is the most likely cause of her edema?
A Venous insufficiency
B Congestive heart failure
C Nephrotic syndrome
D Lymphatic obstruction
E Hypothyroidism
c. nephrotic syndrome
A 65 year-old male with a 60 pack-year smoking history presents with painless hematuria for two days. He also complains of frequency and dysuria. He denies a history of recent upper respiratory tract infection. Which of the following is the most likely diagnosis?
A Bladder cancer
B Wegener’s granulomatosis
C IgA nephropathy
D Benign prostatic hypertrophy
a. bladder cancer
Which of the following is most frequently associated with bladder cancer?
A Hematuria
B Dysuria
C Urgency
D Frequency
a. hematuria
A 48 year-old female presents to the clinic complaining of hematuria. The patient states that she was found to have hematuria during an insurance physical examination. The patient denies dysuria or frequency. She also denies pain in the abdomen, flank or meatus. She denies any history of previous nephrolithiasis. Urinalysis reveals the urine to be yellow and slightly hazy with a positive dipstick for hemoglobin. Microscopic reveals 5-7 RBCs/HPF without WBCs, bacteria, casts, or crystals. What is the next diagnostic study this patient should undergo?
A CT urography
B Intravenous pyelogram
C Abdominal ultrasound
D Cystoscopy
a. CT urography
What is TURB
transurethral resection of the bladder
A 68-year-old man presents to the emergency department with acute urinary retention. He has a history of benign prostatic hyperplasia (BPH) and hypertension. He denies fever, back pain, or lower abdominal pain. His medications include tamsulosin and amlodipine. On examination, his abdomen is soft, non-tender, and a palpable bladder is noted. Digital rectal examination reveals an enlarged, non-tender, and firm prostate. Which of the following is the most appropriate initial management?
A Oral antibiotics
B Immediate cystoscopy
C Bladder catheterization
D Intravenous fluids
E Prostate-specific antigen (PSA) testing
c. bladder catheterization
what is cystitits and what is the most common etiology
infection of the bladder characterized by dysuria without urethral discharge
E.coli is the most common
what is the presentation of cystitis
dysuria, urgency, frequency, hematuria, new onset incontinuence, abdominal/suprapubic pain, abscence of fever, chills or flank pain
how is cystitis diagnosed
urine dipstick: nitrite, leukocyte esterase
UA: pyuria, bacteriumia
CBC: lenuocytotis
Urine Culture: GS
blood cultures
what is the treatment of cystitis
Nitrofuratoin, bactrim, or fosfomycin
what is the tx of postcoital UTI
single dose TMP-SMX or cephalexin may reduce freqnecy of UTI in sexually active women
what is the treatment of Lower UTI in pregnancy
Nitrofurantoin (macrobid): 100mg PO BID x 7days
Cephalexin (Keflex): 500mg PO BID x 7d days
what is the presentation of pyelonephritis
dysuria + fever + flank pain + N/V + CVA tenderness
what is the etiology of Pyelonephritis
E. coli
what is the treatment of pyelonephritis
oral considered best initial outpt treatment
Cipro
Levofloxacin
Cephalexin
when are IV abx indicated for pyelonephritis
In pts who are toxic or unable to tolerate oral abx
Ceftriaxone 1g IV once daily
what is the management of pyelonephritis in pregnant women
Hospital admission for parenteral antibiotics
IV/IM ceftriaxone
how is recurrent UTI defined
Two uncomplicated UTIs in 6 months OR 3+ uncomplicated UTIs in the previous year
what is inflammation of the urethra caused by infectious or noninfectious causes (trauma, FB)
Urethritis
what are the common etiologies of urethritis
C. trachomatis, N. gonorrhoeae, trichomonas, vaginalis
how is urethritis diagnosed
NAAT of first voided urine (Nucleic acid amplification test)
what is the presentation of epididymitis
dysuria, unilateral scrotal pain and swelling
what is a positive prehn’s sign
relief with elevation of scrotum is a classic sign
what presents as onset of fever, chills and lwoer back pain combined wtih urinary frequency, urgency and dysuria
prostatitis
A 21-year-old female with type one diabetes mellitus presents with a 3-day history of nausea, dysuria, and urinary frequency. On examination, there is suprapubic tenderness and costovertebral angle tenderness on the left, and urinalysis shows pyuria and bacteriuria. The patient is admitted to the hospital for management. What is an appropriate treatment for this patient pending culture results?
A PO ciprofloxacin for 3 to 5 days
B IV ceftriaxone for 7 to 14 days
C PO amoxicillin for 7 to 14 days
D IV ciprofloxacin for 3 to 4 days
b. IV ceftriaxone for 7-14 days
A 37-year-old female with a history of type II diabetes mellitus presents to the emergency department complaining of blood in her urine, left-sided flank pain, nausea, and fever. She also states that she has pain with urination. Vital signs include: temperature is 102 deg F (39.4 deg C), blood pressure is 114/82 mmHg, pulse is 96/min, respirations are 18, and oxygen saturation of 97% on room air. On physical examination, the patient appears uncomfortable and has tenderness on the left flank and left costovertebral angle. Which of the following is the next best step in management?
A Obtain an abdominal CT scan
B Obtain blood cultures
C Obtain a urine analysis and urine culture
D Begin intravenous treatment with ceftazidime
E No treatment is necessary
c. obtain UA and culture
A 55-year-old woman undergoes a total abdominal hysterectomy. Postoperatively, she is stable but requires fluid replacement. Her serum sodium is 138 mEq/L, potassium is 4.0 mEq/L, and creatinine is 1.0 mg/dL. She weighs 70 kg. Which of the following is the most appropriate choice for postoperative fluid replacement?
A 0.9% Normal Saline at 125 mL/hour
B 5% Dextrose in Water (D5W) at 125 mL/hour
C Lactated Ringer’s solution at 125 mL/hour
D 3% Hypertonic Saline at 125 mL/hour
E 0.45% Half Normal Saline at 125 mL/hour
c. LR solution at 125mL/hr
A patient with the following ABG has what type of acid-base disorder? ph 7.52, PCO2 25, Bicarb 22 PH (7.35-7.45 normal) CO2 (35-45 normal) HCO3 (20-26 normal)
A Respiratory acidosis
B Respiratory alkalosis
C Metabolic acidosis
D Metabolic alkalosis
b. respiratory alkalosis
A patient with the following ABG has what type of acid-base disorder? ph 7.52, PCO2 40, Bicarb 38 PH (7.35-7.45 normal) CO2 (35-45 normal) HCO3 (20-26 normal)
A Respiratory acidosis
B Respiratory alkalosis
C Metabolic acidosis
D Metabolic alkalosis
d. metabolic alkalosis
A patient with the following ABG has what type of acid-base disorder? ph 7.30, PCO2 60, Bicarb 22 PH (7.35-7.45 normal) CO2 (35-45 normal) HCO3 (20-26 normal)
A Respiratory acidosis
B Respiratory alkalosis
C Metabolic acidosis
D Metabolic alkalosis
a. respiratory acidosis
A patient with the following ABG has what type of acid-base disorder? ph 7.30, PCO2 40, Bicarb 16 PH (7.35-7.45 normal) CO2 (35-45 normal) HCO3 (20-26 normal)
A Respiratory acidosis
B Respiratory alkalosis
C Metabolic acidosis
D Metabolic alkalosis
c. metabolic acidosis
Patients with recurrent urinary stone disease should be educated to maintain a diet restricted in
A sodium and protein
B carbohydrates and fat
C bran
D fluids
a. sodium and protein
Increased sodium intake will increase sodium and calcium excretion and increase monosodium urate saturation. Protein also increases calcium, oxalate and uric acid excretion. All these factors can lead to stone formation.
A 38 year-old female presents with right flank pain for several days, shaking chills, fever to 102°F, and general malaise. The flank pain has been intermittently severe, and she has a history of kidney stones. Urinalysis reveals 3+ red blood cells, 3+ leukocyte esterase, trace protein and negative glucose. Which of the following findings would most likely be seen on a renal ultrasound?
A Small echogenic kidneys
B Cysts
C Hydronephrosis
D Capsular hemorrhage
c. hydronephrosis
A 32 year-old female patient presents with renal colic and hematuria. The patient has a long-standing history of unresponsive treatment for urinary tract infections with documented Proteus species. Urinalysis reveals crystals resembling coffin lids. KUB reveals a staghorn calculus in the right kidney. Which of the following is the best clinical intervention?
A High fluid intake with a low salt diet
B A low purine diet
C Laser lithotripsy
D Percutaneous nephrolithotomy
d. percutaneous nephrolithotomy
Percutaneous nephrolithotomy is currently the primary surgical intervention of choice for struvite stones.
The most effective preventive strategy to prevent recurrence of renal lithiasis is which of the following?
A increase in hydration
B early treatment of urinary tract infection
C limitation of calcium intake
D use of probenecid
a. increase in hydration
Which of the following is the most common composition of kidney stones?
A calcium oxalate
B uric acid
C struvite
D calcium phosphate
a. calcium oxalate
A 40 year-old patient with a history of recurrent kidney stones presents with acute onset of right flank pain and hematuria. The patient is afebrile and pain is poorly controlled on oral medications. On CT scan a 1 cm stone is noted in the renal pelvis. Which of the following is the most appropriate intervention for this patient?
A Antibiotics
B Shock wave lithotripsy
C Ureterolithotomy
D Fluid hydration
b. shock wave lithotripsy
A 54-year-old man comes to the urgent care because he was awoken suddenly from his sleep this morning with severe left flank pain radiating to his left testicle with associated nausea and vomiting. He is afebrile and vital signs are normal. He is constantly moving to find a comfortable position. On physical examination, left flank tenderness is noted with no direct testicular tenderness. Urinalysis reveals a pH of 5.5 and microscopic hematuria, but is otherwise unremarkable. Which of the following is the most likely diagnosis?
A Acute epididymitis
B Appendicitis
C Diverticulitis
D Nephrolithiasis
D. Nephrolithiasis
what is a characteristic symptom of renal calculi?
flank pain radiating toward the bladder
Which of the following factors is most commonly associated with the development of orthostatic hypotension in elderly individuals?
A Autonomic dysfunction due to aging and comorbid conditions like diabetes mellitus
B Increased physical activity and exercise
C High dietary salt intake
D Hyperthyroidism
E Chronic use of decongestant medications
a. autonomic dysfunction due to aging and comorbid conditions like DM
A 65-year-old woman presents with recurrent episodes of dizziness and near-fainting, especially when standing up quickly. To confirm the diagnosis of orthostatic hypotension, which of the following is the most appropriate next step?
A Tilt table test
B 24-hour ambulatory blood pressure monitoring
C Measurement of serum electrolytes
D Orthostatic vital signs measurement
E Echocardiogram
d. orthostatic vital signs measurement
A patient diagnosed with orthostatic hypotension due to autonomic dysfunction is experiencing frequent dizziness and lightheadedness. What is the most appropriate initial treatment for this patient?
A Increase fluid and salt intake
B Start beta-blocker therapy
C Prescribe fludrocortisone
D Initiate high-dose diuretic therapy
E Begin regular use of compression stockings
a. increase fluid and salt intake
A patient diagnosed with orthostatic hypotension due to autonomic dysfunction is experiencing frequent dizziness and lightheadedness. What is the most appropriate initial treatment for this patient?
A Increase fluid and salt intake
B Start beta-blocker therapy
C Prescribe fludrocortisone
D Initiate high-dose diuretic therapy
E Begin regular use of compression stockings
a. increase fluid and salt intake
Which clinical feature is most frequently associated with renal cell carcinoma?
A Hematuria
B Flank pain
C Hypocalcemia
D Fever
E Weight loss
a. hematuria
A 60-year-old female with no significant past medical history presents with flank pain and a recent onset of anemia. Imaging studies reveal a solid mass in her right kidney. What is the most appropriate next step in the evaluation of this mass?
A Renal biopsy
B Urine cytology
C CT scan of the abdomen and pelvis with contrast
D MRI of the abdomen
E Serum creatinine level
c. CT scan of abdomen and pelvis with contrast
A 65-year-old man is diagnosed with localized renal cell carcinoma in the left kidney. He has no metastases and normal renal function. What is the most appropriate initial treatment for this patient?
A Systemic chemotherapy
B Targeted therapy with tyrosine kinase inhibitors
C Radiation therapy
D Active surveillance
E Radical nephrectomy
e. radical nephrectomy
A 55-year-old man with a history of smoking and hyperlipidemia presents with sudden onset of severe hypertension and a decrease in renal function. He also reports episodic flank pain. Which of the following is the most likely diagnosis?
A Acute glomerulonephritis
B Renal artery stenosis
C Chronic kidney disease
D Renal cell carcinoma
E Pyelonephritis
b. renal artery stenosis
A 62-year-old woman with uncontrolled hypertension despite multiple antihypertensive medications undergoes evaluation for secondary causes. On physical examination, a bruit is heard over the right upper quadrant of the abdomen. What is the most appropriate diagnostic test to confirm the suspected diagnosis of renal artery stenosis?
A Renal ultrasound with Doppler
B CT angiography of the renal arteries
C Magnetic resonance angiography (MRA) of the renal arteries
D Renal biopsy
E 24-hour urine collection for metanephrines
b. CT angiography orf renal arteries
A 70-year-old man is diagnosed with renal artery stenosis after presenting with difficult-to-control hypertension and an abdominal bruit. His renal function is stable. What is the most appropriate initial management for this patient?
A Medical management with antihypertensive medications
B Immediate surgical revascularization
C Percutaneous transluminal renal angioplasty with stenting
D Chronic dialysis
E Nephrectomy
a. medical management with antihypertensive medications
A 51-year-old man with diagnosed renal artery stenosis presents with elevated BUN and creatinine levels and has recently been diagnosed with hypertension. Which antihypertensive medication should be avoided in this patient?
A Hydrochlorothiazide-Triamterene
B Prazosin
C Nifedipine
D Verapamil
E Furosemide
A. hydrochlorothiazide-triamterene
Which of the following is the most appropriate intervention for a stage I testicular seminoma?
A Watchful waiting
B Chemotherapy initially
C Orchiectomy and radiation
D Orchiectomy and chemotherapy
c. orchiectomy and radiation
Which of the following increases the risk of developing testicular cancer?
A Low socioeconomic status
B History of cryptorchidism
C Multiple episodes of epididymitis
D Being of African-American ethnicity
E Frequent bicycling
b. hx of cryptorchidism
A 23-year-old male presents with a hard mass on the testicle. There has been no previous infection or trauma to the area. Which of the following is the initial diagnostic evaluation to pursue?
A Serum alpha fetoprotein levels (AFP)
B Serum human chorionic gonadotropin hormone (HCG)
C Computed tomography (CT) scan of the abdomen and pelvis
D Testicular ultrasound
E Magnetic resonance imaging (MRI) of the scrotum
d. testicular ultrasound
A 28-year-old man visits the clinic for his annual check-up following successful treatment for testicular cancer with an orchiectomy two years prior. Which tumor marker is most effective for detecting an early recurrence of testicular cancer?
A Carcinoembryonic antigen (CEA)
B Prostate specific antigen (PSA)
C CA 125 glycoprotein
D Alpha fetoprotein (AFP)
E Carbohydrate antigen 19-9 (CA19-9)
d. Alpha fetoprotein (AFP)
what are indications for dialysis
Uremic symptoms
GRF <10mL/Min/1.73m2
fluid overload unresponsive to diuresis
refractory hyperkalemia
Which of the following best describes the classic history of a patient presenting with Wilms tumor?
A A 10-year-old child with a history of urinary tract infections and hematuria
B A 15-year-old adolescent with flank pain and weight loss
C An infant with a history of cryptorchidism and a scrotal mass
D A 3-year-old child with an asymptomatic abdominal mass and hypertension
E A 5-year-old child with nocturnal enuresis and lower back pain
d. a 3-year old with an asymptomatic abdominal mass and HTN
A 4-year-old boy presents with hematuria and a palpable mass in the right abdomen. His parents report he has been more fatigued than usual. An abdominal ultrasound shows a solid mass in the right kidney. What is the most appropriate next step in the evaluation of this child?
A Renal biopsy
B CT scan of the abdomen and chest
C Urine catecholamine levels
D Serum alpha-fetoprotein (AFP) level
E Bone marrow biopsy
b. CT scan of the abdomen and chest
A 5-year-old girl is diagnosed with a localized Wilms tumor in her left kidney. There is no evidence of metastasis or involvement of surrounding structures. What is the most appropriate initial treatment for this patient?
A Systemic chemotherapy
B Nephron-sparing surgery
C Radiation therapy
D Radical nephrectomy followed by chemotherapy
E Observation with serial imaging
d. radical nephrectomy followed by chemo
