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EOR - Surgery > Urology/Renal > Flashcards

Urology/Renal Flashcards

1
Q

2 mcc of edema

A

chronic venous insufficiency
DVT

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2
Q

swelling of limbs w. thickening of skin post op on the side of the surgery

A

lymphedema

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3
Q

surgery mc associated w. lymphedema

A

breast ca

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4
Q

rxn to some meds vs inherited d.o that causes fluid to leak out of bv’s into tissues

A

angioedema

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5
Q

4 meds commonly associated w. edema

A

oral dm
htn meds
nsaids
estrogens

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6
Q

edema around the eyes and lower legs

A

renal dz

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7
Q

edema in the legs/abdomen/lungs

A

chf

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8
Q

3 sx of edema

A

heavy legs
hyperpigmentation
sob

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9
Q

work up for edema

A

low suspicion for dvt: d-dimer
US
ABI
UA

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10
Q

tx for edema

A

compression stockings
leg elevation 30 mins, 4x daily
Na restriction
diuretics

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11
Q

contraindication for diuretics w. edema

A

chronic venous insufficiency

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12
Q

mc type of bladder ca

A

transitional cell carcinoma

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13
Q

painless hematuria in a smoker is _ until proven otherwise

A

bladder ca

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14
Q

gs dx for bladder ca

A

cystoscopy w. bx

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15
Q

tx for bladder ca

A

-endoscopic resection w. cystoscopy q 3 mos
-recurrent or multiple lesions: chemo

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16
Q

6 rf for bladder ca

A

smoking
aromatic amines
schistosomiasis
truck drivers
petroleum workers
cyclophosphamide

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17
Q

tx for bladder ca

A

stage 0: TURB + chemo
stages II/III: radical cystectomy, lymph node dissection
stage IV: cystectomy + chemo

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18
Q

indications for partial cystectomy w. bladder ca

A

suprficial, isolated tumor
apical w. 3 cm margin from any orifices

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19
Q

how does bacillus calmette guerin work for bladder ca tx

A

attenuated tb vaccine -> initiates immune response

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20
Q

classic sign of urinary retention in elderly pt’s

A

ams

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21
Q

what is POUR

A

post op urinary retention

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22
Q

rf for POUR

A

spinal anesthesia
epidural anesthesia

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23
Q

5 causes of urinary retention

A

obstructive
neurogenic
traumatic
extraurinary
infectious

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24
Q

4 obstructive causes of urinary retention

A

stricture
calculi
neoplasm
foreign body

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25
Q

4 causes of neurogenic urinary retention

A

MS
parkinsons
CVA
post op

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26
Q

3 traumatic causes of urinary retention

A

injury to: urethra, bladder, spinal cord

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27
Q

3 causes of extraurinary urinary retention

A

fecal impaction
AAA
rectal/retropeitoneal mass

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28
Q

4 causes of infectious urinary retention

A

abscess
cystitis
genital herpes
zoster

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29
Q

7 rf for urinary retention

A

male
bph
epidural
spinal/prolonged anesthesia
antihistamines
narcotics
pelvic/perineal procedures

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30
Q

POUR dx

A

inability to void w.in 8 h after surgery or 8 h after catheter removal

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31
Q

3 complications of urinary retention

A

infxn
ischemia
long term dysfxn

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32
Q

acute urinary retention is (painless vs painful):
chronic urinary retention is:

A

acute: painful
chronic: painless

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33
Q

4 sx of chronic urinary retention

A

frequent urination of small amt
sensation of fullness
suprapubic dullness
rounded midline mass

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34
Q

chronic urinary retention is caused by _ dyssynergia

A

detrusor muscle

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35
Q

5 causes of chronic urinary retention

A

SCI
MS
obstructive
recurrent UTI/bladder infxns
constipation/encopresis

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36
Q

dx of urinary retention is made by _ mL of urine on a PVR

A

> /= 500 mL

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37
Q

tx for urinary retention

A

catheterization x 24 hr followed by voiding trial

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38
Q

tx for detrusor sphincter dyssenergia

A

botox
surgical incision of bladder neck

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39
Q

w. massive bladder distension, how much urine can be drained immediately

A

1 L
slow drainage of remaining to avoid vasovagal

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40
Q

cystitis is characterized by

A

dysuria w.o urethral discharge

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41
Q

6 sx of cystitis

A

dysuria
urgency
frequency
hematuria
new onset incontinence
malodorous urine

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42
Q

gs dx for cystitis

A

urine culture:
women: > 100 k CFU/mL
men or cath pt: > 1,000 CFU/mL

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43
Q

tx for cystitis

A

</= 65 yo: nitro vs bactrim vs fosfomycin
complicated: cipro
postcoital: single dose bactrim vs cephalexin
pregnant: nitro vs cephalexin

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44
Q

sx of cystitis that are relieved w. voiding
hunner’s ulcer on cystoscopy

A

interstitial cystitis

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45
Q

sx of pyelonephritis

A

dysuria
fever
flank pain
n/v
CVA tenderness

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46
Q

tx for pyelonephritis

A

cipro
levo
cephalexin

toxic/unable to tolerate PO abx/pregnant: ceftriaxone

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47
Q

5 indications for hospitalization w. pyelo

A

persistent fever > 101
persistent pain
inability to take fluids or PO meds
suspected urinary obstruction
unable to adhere to tx

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48
Q

definition of recurrent UTI

A

2 uncomplicated UTI x 6 mos
OR
3 uncomplicated UTIs in the previous year

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49
Q

definition of UTI relapse (2)

A

recurrence of UTI w.in 2 weeks of tx
caused by the same organism

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50
Q

refinition of UTI reinfection

A

recurrent UTI caused by different bacteria

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51
Q

which is mc: UTI relapse or reinfection

A

reinfection

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52
Q

UTI prophylaxis

A

once daily low dose:
nitro vs bactrim vs cephalexin vs cipro

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53
Q

2 causes of urethritis

A

infectious
noninfectious (trauma/foreign body)

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54
Q

2 mc pathogens associated w. urethritis

A

c. trachomatis
n. gonorrhea

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55
Q

3 sx of urethritis

A

discharge
dysuria
pruritis

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56
Q

dx for urethritis (4)

A

NAAT of first voided urine
gram stain
UA w.culture
prostate exam

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57
Q

tx for urethritis

A

(-) gonococci: azithro vs doxy
(+) gonococci: azithro PLUS ceftriaxone (tx for gonorrhea and chlamydia)
recurrent: metro vs tinidazole PLUS azithro

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58
Q

dysuria
unilateral scrotal pain/swelling

A

epididymitis

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59
Q

mcc of epididymitis: <35 yo vs >35 yo

A

< 35 yo: chlamydia, gonorrhea
> 35 yo: e.coli

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60
Q

what PE sign is associated w. epididymitis

A

prehn sign: relief w. elevation of scrotum

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61
Q

tx for epididymitis

A

> 35 yo: levofloxacin vs ofloxacin
< 35 yo: doxy PLUS ceftriaxone

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62
Q

indicaton to tx sexual partner w. epididymitis

A

contact w.in 60 days of sx onset

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63
Q

sudden onset: f/c, lbp, frequency, urgency, dysuria

A

prostatitis

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64
Q

mcc of prostatitis

A

< 35 yo: chlamydia, gonorrhea
> 35 yo: e.coli

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65
Q

tx for prostatitis

A

< 35 yo: azithro vs doxy PLUS ceftriaxone
> 35 yo: fluoroquinolones vs bactrim x 1 month

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66
Q

what tx is contraindicated for prostatitis

A

prostate exam/massage -> can lead to sepsis

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67
Q

3 indications for increased maintenance fluid needs

A

fever
hyperventilation
increased catabolic rate

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68
Q

body fluids are _molar

A

isomolar

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69
Q

when fluid losses from any site amount >/= _ mL, electrolytes should be measured periodically and fluids should be adjusted

A

1500 mL

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70
Q

when should IVF orders be reevaluated

A

q 24 hr
q 4-6 hr POD 1

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71
Q

general maintenance IVF guidelines according to Smarty PANCE

A

2,000-2,500 mL 5% dex in NS OR in LR daily

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72
Q

_ should not be added to IVF in the first 24 post op bc it naturally enters circulation as a result of operative trauma and increased aldosterone

A

K+

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73
Q

fluid loss thru a NGT < _ can be replaced by incvreased maintenance IVF by a similar amt

A

500 mL/d

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74
Q

protocol for IVF potassium replacement

A

20 mEq K+ added to every L of fluid

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75
Q

3 indications for potassium replacement

A

good urine flow
demonstrated deficiency AFTER pathologic losses
not anticipated to start enteral feeding soon

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76
Q

mc type of kidney stone

A

calcium oxylate

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77
Q

urea splitting organism that is the mcc of infected kidney stones

A

struvite

78
Q

mc location for kidney stone obstruction

A

UVJ

79
Q

mc tx for kidney stones

A

lithotripsy

80
Q

gs test for kidney stones

A

CT abd/pelvis

81
Q

UA finding of kidney stones

A

RBC

82
Q

pain management for kidney stones

A
  1. toradol
  2. morphine
  3. opiates - demerol vs dilaudid
    4.
83
Q

2 indications for lithotripsy

A

stones > 6 cm
intractable pain

84
Q

stones < _ mm are likely to pass w. hydration and tamsulosin

A

5

85
Q

4 types of kidney stone

A

calcium oxalate
struvite
uric acid
cystine

86
Q

common cause of calcium oxalate stones

A

hyperparathyroidism

87
Q

pt’s w. calcium oxalate stones should avoid _ juice

A

grapefruit

88
Q

struvite stones are associated w. (3)

A

chronic UTI
klebsiella
proteus

89
Q

rf for uric acid stones

A

persistently acidic urine:
excess meat/etoh
gout

90
Q

young boy w. kidney stones probs has what type

A

cystine

91
Q

gs dx for kidney stones

A

CT w.o contrast

92
Q

tx for kidney stones

A

pain management
hydration
abx if UTI
tamsulosin
+/- lithotripsy

93
Q

3 indications for hospitalization w. kidney stones

A

intractable pain despite oral meds
anuria
renal colic PLUS UTI and/or fever

94
Q

management of renal stones based on size

A

< 5 mm: usuall spontaneously pass
5-10 mm: probs need elective lithotripsy
> 10 mm: stent vs nephrostomy vs lithotripsy

95
Q

gs management of stones > 10 mm

A

nephrostomy

96
Q

indication for KUB/IVP w. kidney stones

A

severe pain

helps find site of obstruction

97
Q

pt’s w. recurrent kidney stones should maintain a diet restricted in (2)

A

sodium
protein

98
Q

primary surgical intervention of choice for struvite stones

A

percutaneous nephrolithotomy

99
Q

UA showing crystals that resemble coffin lids

A

struvite kidney stones

100
Q

definition of orthostatic hypotn

A

after a change from supine to standing, drop of:
> 20 mmHg SBP
> 10 mmHg DBP
OR both

101
Q

6 causes of orthostatic hypotn

A

autonomic dysfxn: DM, age
meds
postprandial
vagal/carotid sinus hypersensitivity
hypovolemia
adrenal insufficiency

102
Q

drugs that can cause orthostatic hypotn (lots!)

A

etoh
alpha blockers (-zosins)
antidepressants
antihypertensives
antiparkinsonism
antipsychotics
bb
diuretics
muscle relaxants
narcotics
PDE5 inhibitors
sedatives
vasodilators

103
Q

dx for orthostatic hypotn

A

BP and HR measured after 5 min supine and at 1 and 3 min after standing

104
Q

what may help dx autonomic dysfxn hypotn

A

tilt table test

105
Q

tx for orthostatic hypotn (3)

A

increased Na
fludrocortisone
midodrine

106
Q

renal cell carcinoma triad

A

flank pain
hematuria
palpable abdominal/renal mass

107
Q

most significant rf for renal cell carcinoma

A

smoking

108
Q

transitional cell carcinoma (mc type of bladder cancer) is aka

A

urothelial carcinoma

109
Q

what bacteria is associated w. transitional cell carcinoma

A

schistosoma haematobium

110
Q

mc non cutaneous ca among males

A

prostate

111
Q

screening guidelines for prostate ca

A

PSA at 50 yo
40 if AA

112
Q

mc type of prostate ca

A

adenocarcinoma

113
Q

mc site of metastasis for prostate ca

A

bone

114
Q

dietary rf vs protective factor for prostate ca

A

rf: high fat
protective: soy

115
Q

tissue of origin for renal cell carcinoma

A

renal tubular epithelium

116
Q

pt pop at greatest risk for renal cell carcinoma

A

AA

117
Q

anemia associated w. renal cell carcinoma

A

normochromic/normocytic

118
Q

lab finding of renal cell carcinoma

A

hypercalcemia

119
Q

dx for renal cell carcinoma

A

CT
bx

120
Q

tx for renal cell carcinoma

A

radical nephrectomy

121
Q

sites of metastasis for renal cell carcinoma

A

lung
liver
brain
tumor thrombus to renal vein or IVC

122
Q

syndrome associated w. renal cell carcinoma and liver dz

A

stauffer’s syndrome

123
Q

concern w. adult w. new onset left varicocele

A

left renal cell carcinoma

left gonadal vein drains into left renal vein

124
Q

antihypertensive med contraindicated in pt’s w. renal a stenosis

A

ACEI

125
Q

what is renal a stenosis

A

narrowing of renal a -> impedes bloodflow to kidney -> causes renovascular htn (secondary htn)

126
Q

PE finding of renal a stenosis

A

renal a bruit

127
Q

3 sx of renal a stenosis

A

HTN prior to 30 yo
HTN plus CAD or PVD
htn resistant to 3 or more drugs

128
Q

pt is place on ACEI and all of a sudden develops acute renal failure or sharp rise in BUN/Cr

A

renal a stenosis

129
Q

dx for renal a stenosis: initial vs gs

A

initial: US
gs: renal arteriography

130
Q

tx for renal a stenosis

A

-percutaneous transluminal angioplasty (PTA) PLUS stent
-bypass
nephrectomy

131
Q

mcc of renal a stenosis

A

atherosclerosis

other: fibromuscular dysplasia

132
Q

young woman w. htn makes you think

A

renal a stenosis due to fibromuscular dysplasia

133
Q

2 meds to avoid in pt’s w. renal a stenosis

A

ACEI
K+ sparing diuretics

134
Q

2 tumor markers for testicular ca

A

bHCG
alpha fetoprotein

135
Q

mc presentation of testicular ca

A

firm, painless, nontender testicular mass

136
Q

mc solid tumor in men 15-40 yo

A

testicular ca

137
Q

mc type of testicular ca

A

seminoma

138
Q

rf for testicular ca

A

hx of cryptochordism

139
Q

dx for testicular ca

A
  1. bHCG and alpha fetoprotein
  2. scrotal US
  3. look for mets
140
Q

3 mc sites of metastasis for testicular ca

A

abdomen
brain
lung

141
Q

definitive tx for testicular ca

A

orchiectomy
+/- chemo

142
Q

what type of testicular ca is radiosensitive and can be treated w. xrt

A

seminomatous

143
Q

_ can be used to identify early relapse in testicular ca

A

alpha fetoprotein

144
Q

what is cryptochordism

A

failure of testicle to descend into the scrotum

145
Q

t/f: orciopexy as an adult removes the risk of testicular ca

A

f!

146
Q

tumor marker for testicular ca based on type

A

nonseminomatous: (+) AFP and/or bHCG
seminomatous: +/- AFP positive

147
Q

what 2 types of testicular ca almost never have an elevated AFP

A

choriocarcinoma
seminoma

148
Q

what type of testicular ca almost always has elevated bHCG

A

choriocarcinoma

149
Q

major s.e of retroperitoneal lymph node dissection

A

ED

150
Q

stages of ckd

A

1: GFR >/= 90
2. GFR 60-89
3. GFR 30-59
4. GFR 15-29
5. GFR < 15

151
Q

2 major rf for ckd

A

dm
htn

152
Q

t/f: ckd is an independent rf for cvd

A

t!

153
Q

7 lab findings of ckd

A

elevated SCr x 3+ mos
GFR < 60 x 3 + mos
persistent proteinuria
anemia
hyperK
hyperphos
hypoCa

154
Q

UA finding of CKD

A

broad waxy casts

155
Q

acid/base effect of ckd

A

metabolic acidosis
high anion gap

156
Q

US findings of ckd

A

symmetrically small echogenic kidneys

157
Q

target bp for ckd pt’s

A

< 130/80

158
Q

indication for ckd referral to nephrology

A

stage 3+

159
Q

dietary management of ckd (4)

A

protein restriction 0.6-0.8 g/day
sodium 2 g/day
K+ restriction
phos restriction

160
Q

indication for kidney transplant w. ckd

A

dialysis
ckd 5

161
Q

t/f: most pt’s w. ckd will die from cvd before receiving transplant

A

t!

162
Q

hemodialysis requires a vein > _ mm
the _ vein is ideal for this

A

5 mm
cephalic

163
Q

classic hemodialysis access fistula

A

radial a to cephalic vein (cimino fistula)

164
Q

2 problems with prosthetic dialysis grafts (used when autogenous fistulas are difficult)

A

poor patency
high risk for infxn

165
Q

common second line autogenous fistula formation (preferred over prosthetic graft)

A

transposing basilic vein to the subcutaneous tissue

166
Q

all veins used for dialysis require _ (2) prior to cannulization

A

dilation
arterialization of the wall

167
Q

flow rates of at least _ are required for dialysis

A

300 cc/min

168
Q

2 complications of newly created dialysis AV access

A

arterial steal
distal extremity ischemia

169
Q

gs imaging for peripheral AVM

A

MRI

170
Q

imaging used to help w. AV fistulas for dialysis

A

angiography

171
Q

4 indications for dialysis

A

uremic sx
GFR < 10
fluid overload unresponsive to diuretics
refractory hyperkalemia

172
Q

4 uremic sx

A

pericarditis
encephalopathy
GI
azotemia

173
Q

2 types of dialysis

A

hemodialysis
peritoneal

174
Q

acquired thru an AV fistula or prosthetic graft

A

hemodialysis

175
Q

dialysis instilled into peritoneal cavity thru an indwelling catheter

A

peritoneal dialysis

peritoneal membrane is the dialyzer

176
Q

3 complications of hemodialysis

A

infxn
thrombosis
aneurysm

177
Q

how often is hemodialysis performed

A

3-5 x/week
3-5 hr/session

178
Q

complications of peritoneal dialysis

A

peritonitis: n/v, abd pain, diarrhea, constipation, fever

179
Q

mc renal tumor in kids

A

wilms

180
Q

mc presentation of wilms tumor

A

palpable abdominal mass that does not cross the midline

181
Q

4 sx of wilms tumor

A

elevated renin -> htn
fever
hematuria
anemia

182
Q

imaging to r.o mets w. wilms tumor

A

CXR

183
Q

wilms tumor is same same

A

nephroblastoma

184
Q

pt pop mc affected by wilms tumor

A

otherwise healthy kids < 4 yo

:(

185
Q

2 rf for wilms tumor

A

fam hx
horseshoe kidney

186
Q

4 conditions associated w. wilms tumor (nephroblastoma)

A

wagr:
wilms tumor
aniridia
GU anomalies (horseshoe kidney)
retardation

187
Q

dx for wilms tumor/nephroblastoma (4)

A

US
CT
bx
CXR

188
Q

never do _ when you suspect wilms tumor

A

palpate the abdomen

increases risk of rupturing encapsulated tumor

189
Q

tx for wilms tumor

A

surgical resection
chemo

190
Q

classic hpi for wilms tumor

A

parents found when dressing or bathing kid

191
Q

umbilical defect
macroglossia
gigantism
visceromegaly

A

beckwith wiedemann syndrome

EOR - Surgery (13 decks)

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