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Clinical: General Surgery > Urology and Renal > Flashcards

Urology and Renal Flashcards

1
Q

What are the average values for HCO3, pH and CO2

A

HCO3: 20-26
pH: 7.35-7.45
CO2: 35-45

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2
Q

what is the presentation of bladder carcinoma

A

painless hematuria in a smoker

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3
Q

what is the most common type of bladder carcinoma

A

transitional cell carcinoma

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4
Q

what is the gold standard initial diagnostic test for bladder carcinoma

A

cystoscopy with biopsy

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5
Q

what is the treatment of bladder carcinoma

A

surgery, biological therapy, and chemo

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6
Q

what is CKD

A

progression of ongoing loss of kidney function (GFR) or presence of kidney damage

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7
Q

what is the presentation of kidney damage

A

proteinuria - urinary albumin excretion

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8
Q

what are etiologies of CKD

A

DIabetes
HTN
chronic GN
interstitial nephritis, PKD, obstructive uropathy

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9
Q

what are broad waxy casts a sign of

A

chronic renal failure

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10
Q

what is the treatment of CKD

A

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

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11
Q

what is the presentation of UTI

A

pain with urination, foul smelling urine, frequent urination

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12
Q

what is the presentation of pyelonephritis

A

pain with urination, fever, chills

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13
Q

whatis the presentation of urethritis

A

pain with urination, frequent urge to urinate, pain during intercourse

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14
Q

what is the presentation of urolithiasis/nephrolithiasis

A

pain with urination, sharp pain, flank pain

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15
Q

what is the most common cause of edema

A

chronic venous insufficeincy

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16
Q

what is lymphedema

A

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

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17
Q

what are symptoms of edema

A

sensation of “heavy legs”, itching, and pain
hyperpigmentation, stasis dermatitis, lipodermatosclerosis, atrophie
icreased size of abdomen (with ascites)
difficulty breathing (with chest edema)

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18
Q

what electrolyte disorder presents with peaked T waves

A

hyperkalemia

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19
Q

what electrolyte disorder presents with flattened T waves, U waves

A

hypokalemia

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20
Q

what electrolyte disorder presents with long QT

A

hypocalcemia

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21
Q

what electrolyte disorder presents with short QT

A

hypercalcemia

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22
Q

what electrolyte disorder presents with tall T waves

A

hypomagnesemia

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23
Q

what electrolyte disorder presents with prolonged PR interval widened QRS

A

hypermagnesemia

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24
Q

what electrolyte disorder presents with low urin sodium and polyuria

A

diabetes insipitus

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25
Q

how is hyponatremia defined

A

plasma sodium concentration less than 135mEq/l

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26
Q

how is hypernatremia defined

A

plasma sodium concentration greater than 145 mEq/L

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27
Q

what is the presentation of nephrolithiasis

A

colicky flank pain radiating to the groin, hematuria, CVA tenderness and N/V

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28
Q

what is the gold standard diagnostic test for nephrolithiasis

A

CT scan (spiral CT) without contrast of abdomen and pelvis

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29
Q

what are the types of nephrolithiasis (4)

A
  • calcium oxalate (MC)
  • struvite
  • Uric acid
  • cystine
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30
Q

what are the general treatment measures for nephrolithiasis

A

analgesia
vigorous fluid hydration
abx
alpha-blocker therapy (Flomax)

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31
Q

How is orthostatic hypotension classified

A

drop of >20 mmHg systolic, 10mmHg diastolic, 15BPM increase in pulse 2-5 minutes after change from supine to standing

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32
Q

what is the presentation of renal cell carcinoma

A

hematuria
frlank pain
abdominal mass (palpable)

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33
Q

what are the types of RCC

A

renal clear cell (MC)
transitional cell

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34
Q

what is the risk factor for RCC

A

Smoking

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35
Q

how is RCC diagnosed

A

US or CT then biopsy

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36
Q

what is the treatment for RCC

A

surgery with radical nephrectomy - curative

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37
Q

what is renal vascular disease

A

narrowing of one or both of the renal arteries

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38
Q

what causes renal artery stenosis

A

atherosclerosis or fibromuscular dysplasia

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39
Q

how is renal vascular disease diagnosed

A

US = first imaging in age < 60
Renal arteriography = GS

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40
Q

what is the treatment of renal artery stenosis

A

percutaneous transluminal angioplasty (PTA) + stent placement or with surgical bypass of stenotic segment

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41
Q

what is the presentation of testicular carcinoma

A

firm, painless, non-tender testicular mass and feeling of heaviness in the scrotum

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42
Q

what is the most common type of testicular carcinoma

A

seminoma

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43
Q

what are risk factors for testicular carcinoma

A

cryptorchidism

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44
Q

how is testicular carcinoma diagnosed

A

US
tumor markers: AFP, betaHcg

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45
Q

what is POUR

A

postoperative urinary retnetion

46
Q

what are obstructive causes of urinary retnetion

A

urethral stricture, bladder calculi or neoplasm, FB

47
Q

what is are neurogenic causes of urinary retention

A

MS, parkinsons, CVA, post op retention

48
Q

what are traumatic causes of urinary retention

A

urethral, bladder or spinal cord injury

49
Q

what are the extraurinary cause of urinary retention

A

fecal impaction, AAA, rectal or retroperitoneal mass

50
Q

what are infectious causes of urinary retention

A

local abscess, cystitits, genital herpes, zoster

51
Q

what are risk factors for acute urinary retention

A

male, prostatic enlargement, epidural, spinal or prolonged anesthesia, antihistamine and narcotic use

52
Q

what is detrusor sphincter dyssyynergia

A

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

53
Q

what is Wilms Tumor

A

child with painless, unilateral abdominal mass with no other signs/symptoms, also known as neuroblastoma

54
Q

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

A

c. nephrotic syndrome

55
Q

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

a. bladder cancer

56
Q

Which of the following is most frequently associated with bladder cancer?
A Hematuria
B Dysuria
C Urgency
D Frequency

A

a. hematuria

57
Q

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

a. CT urography

58
Q

What is TURB

A

transurethral resection of the bladder

59
Q

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

A

c. bladder catheterization

60
Q

what is cystitits and what is the most common etiology

A

infection of the bladder characterized by dysuria without urethral discharge
E.coli is the most common

61
Q

what is the presentation of cystitis

A

dysuria, urgency, frequency, hematuria, new onset incontinuence, abdominal/suprapubic pain, abscence of fever, chills or flank pain

62
Q

how is cystitis diagnosed

A

urine dipstick: nitrite, leukocyte esterase
UA: pyuria, bacteriumia
CBC: lenuocytotis
Urine Culture: GS
blood cultures

63
Q

what is the treatment of cystitis

A

Nitrofuratoin, bactrim, or fosfomycin

64
Q

what is the tx of postcoital UTI

A

single dose TMP-SMX or cephalexin may reduce freqnecy of UTI in sexually active women

65
Q

what is the treatment of Lower UTI in pregnancy

A

Nitrofurantoin (macrobid): 100mg PO BID x 7days
Cephalexin (Keflex): 500mg PO BID x 7d days

66
Q

what is the presentation of pyelonephritis

A

dysuria + fever + flank pain + N/V + CVA tenderness

67
Q

what is the etiology of Pyelonephritis

A

E. coli

68
Q

what is the treatment of pyelonephritis

A

oral considered best initial outpt treatment
Cipro
Levofloxacin
Cephalexin

69
Q

when are IV abx indicated for pyelonephritis

A

In pts who are toxic or unable to tolerate oral abx
Ceftriaxone 1g IV once daily

70
Q

what is the management of pyelonephritis in pregnant women

A

Hospital admission for parenteral antibiotics
IV/IM ceftriaxone

71
Q

how is recurrent UTI defined

A

Two uncomplicated UTIs in 6 months OR 3+ uncomplicated UTIs in the previous year

72
Q

what is inflammation of the urethra caused by infectious or noninfectious causes (trauma, FB)

A

Urethritis

73
Q

what are the common etiologies of urethritis

A

C. trachomatis, N. gonorrhoeae, trichomonas, vaginalis

74
Q

how is urethritis diagnosed

A

NAAT of first voided urine (Nucleic acid amplification test)

75
Q

what is the presentation of epididymitis

A

dysuria, unilateral scrotal pain and swelling

76
Q

what is a positive prehn’s sign

A

relief with elevation of scrotum is a classic sign

77
Q

what presents as onset of fever, chills and lwoer back pain combined wtih urinary frequency, urgency and dysuria

A

prostatitis

78
Q

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

A

b. IV ceftriaxone for 7-14 days

79
Q

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

A

c. obtain UA and culture

80
Q

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

A

c. LR solution at 125mL/hr

81
Q

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

A

b. respiratory alkalosis

82
Q

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

A

d. metabolic alkalosis

83
Q

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

a. respiratory acidosis

84
Q

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

A

c. metabolic acidosis

85
Q

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

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.

85
Q

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

A

c. hydronephrosis

86
Q

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

A

d. percutaneous nephrolithotomy

Percutaneous nephrolithotomy is currently the primary surgical intervention of choice for struvite stones.

86
Q

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

a. increase in hydration

87
Q

Which of the following is the most common composition of kidney stones?
A calcium oxalate
B uric acid
C struvite
D calcium phosphate

A

a. calcium oxalate

88
Q

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

A

b. shock wave lithotripsy

89
Q

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

A

D. Nephrolithiasis

90
Q

what is a characteristic symptom of renal calculi?

A

flank pain radiating toward the bladder

91
Q

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

a. autonomic dysfunction due to aging and comorbid conditions like DM

92
Q

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

A

d. orthostatic vital signs measurement

93
Q

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

a. increase fluid and salt intake

94
Q

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

a. increase fluid and salt intake

95
Q

Which clinical feature is most frequently associated with renal cell carcinoma?
A Hematuria
B Flank pain
C Hypocalcemia
D Fever
E Weight loss

A

a. hematuria

96
Q

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

A

c. CT scan of abdomen and pelvis with contrast

97
Q

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

A

e. radical nephrectomy

98
Q

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

A

b. renal artery stenosis

99
Q

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

A

b. CT angiography orf renal arteries

100
Q

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

a. medical management with antihypertensive medications

101
Q

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

A. hydrochlorothiazide-triamterene

102
Q

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

A

c. orchiectomy and radiation

103
Q

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

A

b. hx of cryptorchidism

104
Q

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

A

d. testicular ultrasound

105
Q

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)

A

d. Alpha fetoprotein (AFP)

106
Q

what are indications for dialysis

A

Uremic symptoms
GRF <10mL/Min/1.73m2
fluid overload unresponsive to diuresis
refractory hyperkalemia

107
Q

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

A

d. a 3-year old with an asymptomatic abdominal mass and HTN

108
Q

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

A

b. CT scan of the abdomen and chest

109
Q

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

A

d. radical nephrectomy followed by chemo

Clinical: General Surgery (10 decks)

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