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URN Biweekly 2 > Urology- Fleck > Flashcards

Urology- Fleck Flashcards

1
Q

Called to ER to see a 42 yo female
Fever to 102, tachycardia, hypotension
Flank pain, UA with bacteria, increased WBC
Exam….flank tenderness to percussion

What next?
Imaging?

A

thinking infection; CT w/out contrast

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2
Q

CT w/ and w/out contrast shows stones the best

A

CT w/out

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3
Q

this type of imaging avoids radiation but gives us less information

A

renal US

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4
Q

1 differential when you suspect infection in pt. w/ flank pain, fever, WBC’s

A

pyelonephritis

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5
Q

Dx?

A

pyelonephritis on CT

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6
Q

huge kidney stone seen (in renal pelvis area)

A

xanthogranulomatous pyelonephritis

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7
Q

chronic pyelonephritis usually a/w what microbe and type of kidney stone

A

Proteus; struvite

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8
Q

bear claw sign

A

XGP

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9
Q

foamy macrophages

A

XGP

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10
Q
A

renal abscess

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11
Q
A

renal abscess w/ obstructing stone

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12
Q

air is seen

A

emphysematous pyelonephritis

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13
Q

air seen

A

emphysematous pyelonephritis

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14
Q
A

ureterolithiasis

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15
Q

how to treat pt?
Called to ER to see a 42 yo female
Fever to 102, tachycardia, hypotension
Flank pain, UA with bacteria, increased WBC
Exam….flank tenderness to percussion

A

identify pathogen
drain infection
Ab’s

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16
Q
A

ureteral stents

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17
Q

65 yo male w/ enlarged prostate

A

prostate abscess

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18
Q

how to treat prostate abscess

A

drain infection
Ab’s

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19
Q

24 year old female with history of “recurrent UTI”
All cultures negative, Labs normal
CC: Urgency, frequency, dysuria
UA normal without RBCs, WBCs or bacteria

Pain with a full bladder, relief with emptying

A

interstitial cystitis

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20
Q

Inflammatory Bladder Condition
No Known Cause
No Perfect Treatment or Cure…Treatment Algorithm to follow
ALL cultures negative

A

interstitial cystitis

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21
Q

pain and pressure in the pelvis; constantly peeing; Ab’s do not help

A

interstitial cystitis

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22
Q

hemorrhaging seen

A

interstitial cystitis

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23
Q

Cystoscopy under anesthesia with short-duration, low-pressure hydrodistension may be undertaken as a treatment option

A

for interstitial cystitis

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24
Q

hemorrhaging in bladder

A

interstitial cystitis

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25
Q

If ________are present, then fulguration (withelectrocautery) and/or injection of triamcinolone should be performed

A

Hunner lesions

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26
Q
A

Hunner lesion/ulcers

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27
Q

this rarely requires cystectomy

A

ulcerative cystitis

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28
Q
A

ulcerative cystitis

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29
Q

post void dribbling
dyspareunia
dysuria

A

urethral diverticulum

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30
Q

most common cancer in urethral diverticulum

A

adenocarcinoma

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31
Q

most common urethral cancer

A

squamous

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32
Q

most common bladder cancer

A

transition epithelium (urothelium)

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33
Q

what imaging does the best when looking at pelvic fluid

A

MRI

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34
Q
A

urethral diverticulum

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35
Q
A

urethral diverticulum

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36
Q

how to treat urethral diverticulum

A

surgery

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37
Q

67 year old man with intermittent painless gross hematuria and persistent microscopic hematuria
Long smoking history
UA with 50 RBC/HPF but no bacteria
Normal Creatinine
Normal physical

A

bladder cancer

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38
Q

1 cause of bladder cancer

A

smoking (and aniline dye exposure)

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39
Q

standard hematuria evaluation

A

CT Urogram; cystoscopy

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40
Q

gross painless hematuria (more than 3 RBC’s for microscopic field)

A

bladder cancer

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41
Q

drugs and myoglobinuria (secondary to rhabdomyolysis) can cause what

A

red urine

42
Q

gross hematuria, what are your top 2 differentials

A

cancer
stones

43
Q
A

ADPKD

44
Q

enhancement seen

A

RCC

45
Q
A

RCC

46
Q

treatment for RCC

A

remove mass

47
Q

stage of cancer when confined to kidney

A

stage I and II

48
Q

stage of cancer when it reaches Gerota’s fascia

A

stage III

49
Q

stage of cancer when it reaches renal vein/IVC

A

stage IV

50
Q

renal cancer guidelines decide between 2 things

A

nephrectomy or ablation

51
Q
A

papillary bladder tumor

52
Q

1 treatment to prevent recurrent bladder cancer

A

BCG (medicine injected into bladder)

53
Q
A

transitional cell carcinoma of renal pelvis

54
Q

“field” disease of all urothelial tissue…a urothelial cancer in the kidney is associated with increased incidence of cancer in the ureter, bladder and contralateral kidney

A

urothelial carcinoma

55
Q

treatment for urothelial carcinoma

A

remove entire ureter/kidney/part of bladder

56
Q
A

kidney stones

57
Q

best thing to do to get kidney stone to pass

A

ESWL (shock wave)

58
Q

alpha blocker used to help kidney stone pass

A

Flomax (Tamsulosin)

59
Q

27 year old involved in MVA
Multiple Pelvic Fractures
Urology called to ER
Blood at urethral meatus

what are we worried about?

A

urethral disruption
bladder rupture
renal/ureteral trauma

60
Q

what to use to evaluate urethra

A

retrograde urethrogram

61
Q

what to use to evaluate the bladder

A

CT cystogram

62
Q

what to use to evaluate the kidneys and ureters

A

CT urogram

63
Q

what not to do if suspected urethral disruption

A

do not put a catheter in

64
Q

what can get torn in men who have a “saddle” injury

A

membranous uretha

65
Q
A

membranous urethral tear

66
Q

to treat urethral disruption

A

suprapubic tube

67
Q

2 types of bladder rupture

A

extraperitoneal and intraperitoneal

68
Q

what test to order to view bladder rupture

A

CT Cystogram

69
Q

what type of bladder rupture

A

intraperitoneal bladder rupture

70
Q

type of bladder rupture

A

extraperitoneal

71
Q

which bladder rupture heals on its own with catheter placed

A

extraperitoneal bladder rupture

72
Q

what is the usual treatment for renal trauma

A

do nothing and let it heal on its own

73
Q

overactivity or discoordination w/ high pressure voiding (potential renal damage)

A

supra sacral lesions

74
Q

acontractile compliant bladder (less risk of renal damage)

A

sacral lesions

75
Q

what type of injuries have high risk of kidney damage

A

spinal cord injuries

76
Q

Up to 3 months after a traumatic spinal cord injury the bladder is atonic—manage with catheter

A

spinal shock

77
Q

triad: elevated bp, bradycardia, sweating

A

autonomic dysreflexia

78
Q

only occurs in SCI at or above T6

A

autonomic dysreflexia

79
Q

manage spinal shock with what

A

w/ catheter

80
Q

how to treat autonomic dysreflexia

A

drain the bladder

81
Q
A

overactive bladder

82
Q

poor compliance of bladder puts patients at risk for what

A

renal failure

83
Q

sympathetic nerve causing relaxation of bladder promoting bladder filling

A

hypogastric n.

84
Q

parasympathetic n. causes contraction of bladder promoting voiding

A

pelvic (splanchnic)

85
Q

innervates external urethral sphincter providing voluntary control over voiding

A

pudendal n (somatic)

86
Q

____ stimulation in bladder wall promotes relaxation

A

beta 3

87
Q

Damage to _____ and _____ nerve can lead to Urinary retention

A

sacral and pelvic

88
Q

anti-cholinergic medication used for overactive bladder (M3 antagonist)

A

Oxybutynin

89
Q

this medication used for overactive bladder has lots of side effects

A

oxybutynin

90
Q

beta-3 agonist used for overactive bladder (detrusor relaxation)

A

Mirabegron

91
Q

M3 agonist used for atonic bladder

A

Bethanechol

92
Q

SE to worry about with anticholinergics

A

memory loss

93
Q

SE of mirabegron to be aware of

A

increase in bp

94
Q

alpha blocker used for BPH and has SE of orthostatic hypotension

A

Tamsulosin

95
Q

erectile dysfunction meds cause what to decrease in size

A

prostate gland

96
Q
A

duplicated ureters

97
Q

most common urinary congenital anomaly

A

duplicated ureter

98
Q

congenital anomaly seen in Turner’s and Trisomies

A

horseshoe kidney

99
Q
A

pelvic kidney (pancake kidney)

100
Q

what type of drug to use for kidney stone passage

A

alpha blockers (Tamsulosin)

101
Q

best thing for kidney stone having trouble leaving the system

A

shock wave

URN Biweekly 2 (15 decks)

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