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Surgery Rotation EORE > Urology/Renal > Flashcards

Urology/Renal Flashcards

1
Q

what’s the MC type of bladder cancer?

A

transitional cell

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2
Q

what are the risk factors for bladder cancer?

A

smoking (MC), occupational exposure to dyes, rubber, leather, age >40 y/o, white males are 3x MC, pioglitazone

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3
Q

what’s the MC RF for bladder cancer?

A

smoking

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4
Q

what’s the s/s of bladder cancer?

A

painless gross or microscopic hematuria

irritative sx’s (frequency/urgency)

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5
Q

how do you dx bladder cancer?

A

cystoscopy with bx

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6
Q

what’s the tx for localized/superficial bladder cancer?

A

TURP

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7
Q

what’s the tx for invasive bladder cancer (advanced/involves muscular layer)?

A

radical cystectomy

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8
Q

what’s the tx for recurrent bladder cancer?

A

BCG vaccine intravesicular

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9
Q

where do most renal cell cancers originate from?

A

kidney

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10
Q

what are the RFs for renal cell carcinoma?

A

smoking***, dialysis, HTN, obesity, men

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11
Q

what are the s/s of renal cell carcinoma?

A

classic triad:

  1. hematuria, 2. flank/abd pain, 3. palpable mass

may have Left-sided varicocele, HTN and hypercalcemia

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12
Q

how do you dx renal cell carcinoma?

A

CT w/contrast

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13
Q

what’s the tx for stage 1-3 (locally advanced) of renal cell carcinoma?

A

radical nephrectomy

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14
Q

what’s the tx for bilateral involvement or pt with solitary kidney or localized disease (w/in kidney) of renal cell carcinoma?

A

partial nephrectomy

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15
Q

what’s Wilm’s tumor?

A

nephroblastoma MC in children w/in the 1st 5 years of life

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16
Q

who is Wilm’s tumor MC in?

A

children w/in the 1st 5 years of life

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17
Q

what’s the MC abdominal malignancy in children?

A

Wilm’s tumor

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18
Q

what’s the s/s of Wilm’s tumor?

A

painless, palpable abdominal mass** (MC sx) - doesn’t cross midline

hematuria, anemia, maybe HTN d/t renin secretion by tumor

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19
Q

how do you dx Wilm’s tumor?

A

abdominal U/S = best initial test

CT w/ contrast or MRI = more accurate test

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20
Q

what’s the tx for Wilm’s tumor?

A

Nephrectomy followed by chemotherapy (80-90% cure rate!)

En bloc resection of tumor if unilateral

Post surgical radiation tx if stage 3/4, pulmonary METS, or large tumor

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21
Q

where is the MC site of METS in Wilm’s tumor?

A

lungs

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22
Q

what’s the MC RF for nephrolithiasis?

A

decreased fluid intake

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23
Q

what are the 4 types of kidney stones?

A
  1. Calcium oxalate (MC) & phosphate
  2. Uric acid
  3. Struvite stones (Mg ammonium phosphate)
  4. Cystine (rare)
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24
Q

what is the MC type of kidney stones?

A

Ca oxalate

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25
Q

what can struvite kidney stones form?

A

Staghorn calculi (ex. Proteus***, Klebsiella, Pseudomonas, Serratia, Enterobacter)

a/w UTIs

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26
Q

what are the s/s of kidney stones?

A

renal colic pain - sudden, CONSTANT upper/lateral/flank pain over CVA radiating to groin/anteriorly

CVA tenderness

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27
Q

what’s the s/s of kidney stone in proximal ureter?

A

flank pain, CVAT

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28
Q

what’s the s/s of kidney stone in mid-ureter?

A

mid abdominal pain

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29
Q

what’s the s/s of kidney stone in distal ureter (UVJ)?

A

groin pain (b/c near bladder)

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30
Q

how do you dx kidney stones?

A

UA: microscopic or gross hematuria

Noncontrast CT abd/pelvis (MC initial dx test)

KUB radiographs only Ca and struvite stones are seen

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31
Q

what urine pH signifies calcium oxalate kidney stones?

A

pH 5.5-6.8

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32
Q

what urine pH signifies Uric acid, cystine kidney stones?

A

<5.0 (acidic)

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33
Q

what urine pH signifies struvite stones?

A

pH >7.2 (alkaline)

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34
Q

what’s the MC initial dx test ordered for dx of kidney stones?

A

Non-contrast abd/pelvis CT

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35
Q

what stones are seen on KUB x-rays?

A

Ca and struvite stones

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36
Q

what’s the tx for kidney stones <5mm?

A

will most likely pass through spontaneously

IVFs, analgesics, antiemetics, Tamsulon (alpha-blocker that can help passage)

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37
Q

what’s the tx for kidney stones >7mm?

A

won’t pass on their own

  1. Extracorporeal shock wave lithotripsy
  2. Uretoscopy +/- stent (provides immediate relief to an obstructed or at -risk kidney)
  3. Percutaneous nephrolithotomy (used for stones >10mm or struvite, or if other tx’s fail)
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38
Q

what’s renal artery stenosis cause?

A

secondary HTN (MCC)

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39
Q

what’s the MCC of secondary HTN?

A

renal artery stenosis

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40
Q

what’s the causes of renal artery stenosis?

A

atherosclerosis MC in elderly

fibromuscular dysplasia MCC in women < 50 y/o

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41
Q

what’s the s/s of renal artery stenosis?

A

severe/refractory HTN; abd (renal) bruit

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42
Q

what’s the GOLD STANDARD to dx renal artery stenosis?

A

renal arteriography

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43
Q

how do you treat renal artery stenosis?

A
  1. Surgical (revascularization)
    - Angioplasty w/ stent = definitive
  2. ACEIs/ARBs (inhibits RAAS system), but ***C/I if bilateral stenosis or solitary kidney b/c ACEI markedly reduces renal blood flow & GFR in these pts -> causes AKI!
44
Q

what’s the definitive tx for renal artery stenosis?

A

Surgical (revascularization)

-***Angioplasty w/ stent = definitive

45
Q

when are ACEIs/ARBs C/I in tx of renal artery stenosis?

A

if bilateral stenosis or solitary kidney b/c ACEI markedly reduces renal blood flow & GFR in these pts -> causes AKI

46
Q

what is a big RF for testicular cancer?

A

Cryptorchidism

47
Q

what side is testicular cancer MC on, right or left?

A

right side (b/c cryptorchidism occurs MC on the right side)

48
Q

what are the 2 types of testicular cancer?

A

germinal cell tumors (usu. malignant)
-seminoma or nonseminoma

non-germinal cell tumors

49
Q

what are sminoma testicular tumors?

A

Simple (lack tumor markers = normal serum alpha fetoprotein & b-hCG), sensitive (to radiation), slower growing, step-wise spread

50
Q

what are non-seminoma tumors?

A

embryonal cell carcinoma MC in boys = 10 y/o

***a/w incr. serum alpha-fetoprotein, increased B-hCG and radioresistance

51
Q

what are non-seminoma tumors a/w?

A

***a/w incr. serum alpha-fetoprotein, increased B-hCG and radioresistance

52
Q

what are the s/s of testicular cancer?

A
  1. painless testicular nodule, solid mass, or enlargement; may have hydrocele present
53
Q

how do you dx testicular cancer?

A

scrotal U/S

alpha-fetoprotein, B-hCG, LDH

54
Q

what is elevated in non-seminoma tumors?

A

alpha-fetoprotein, B-hCG

55
Q

what is pathogmnemonic for non-seminoma tumors?

A

alpha-fetoprotein elevation

56
Q

what’s the tx for low-grade (stage 1) non -eminoma (limited to testes) testicular tumor?

A

orchiectomy with retroperitoneal LN dissection (dx and therapeutic)

57
Q

what’s the tx of low-grade seminoma testicular cancer?

A

orchiectomy -> radiation

58
Q

what’s the tx of high-grade seminoma?

A

debulking chemotherapy -> orchiectomy & radiation

59
Q

what’s stage 2 of testicular cancer?

A

mass in testes + retroperitoneal LN

60
Q

what’s stage 1 of testicular cancer?

A

mass in testes only

61
Q

what’s stage 3 of testicular cancer?

A

mass in testes + distant mets

62
Q

what are RFs for acute urinary retention?

A

prostatitis

anti-cholinergic meds: diphenhydramine (Benadryl), oxybutynin (for overactive bladder)

alpha-agonist meds: pseudoephedrine

narcotics

63
Q

how do you dx BPH?

A

DRE -> uniformly enlarged, firm, rubbery, prostate

64
Q

what is tamsulosin, alfuzosin, doxazosin, terazosin and what d/o do they treat? what are their adrs? what’s their MOA?

A

alpha-1 blockers

MOA = smooth muscle relaxation of prostate & bladder neck -> decr. urethral resistance/obstruction -> increased urinary outflow

treat BPH acutely

adrs: dizziness & orthostatic hypotension

65
Q

what are Finasteride and Dutasteride, what d/o do they treat, what’s their MOA, and what’s their adrs?

A

5-alpha reductase inhibitors

MOA = androgen inhibitors -> inhibit conversion of testosterone -> suppress prostate growth, reduces bladder outlet obstruction

treat BPH

adrs: sex. or ejaculatory dysfunction, breast tenderness/enlargement

66
Q

what’s the tx for BPH?

A

alpha-1 blockers (Tamsulosin - most uroselective) for acute sx’s

5-alpha reductase inhibitors (finasteride and dutasteride) - take 6 months to work

surgery: TURP

67
Q

what are RFs for prostate cancer?

A

genetics, diet (high fat intake), obesity, AA

68
Q

what type of cancer is prostate cancer?

A

adenocarcinoma

69
Q

what are the s/s of prostate cancer?

A

urethral obstruction (freq/urgency/rentention/decr. stream)

back pain/bone pain -> incr. incidence of METS to bone

70
Q

how do you dx prostate cancer?

A

DRE: hard, nodular, enlarged asymmetrical prostate

Increased PSA (>10 = incr. likelihood for prostate ca & METS)

U/S w/ bx if PSA >4

71
Q

what’s the tx for prostate cancer if local disease?

A

radical prostatectomy

72
Q

what’s the tx for prostate cancer if advanced disease?

A

external beam radiation therapy, androgen deprivation

73
Q

what’s the tx for uncomplicated cystitis?

A
  1. Nitrofurantoin
  2. FQ’s (Cipro)
  3. Bactrim
74
Q

what is complicated cystitis?

A

underlying condition with risk of therapeutic failure (I.e. sx’s > 7 days, pregnant, DM)

75
Q

what’s the tx for complicated cystitis?

A

FQ PO or IV, Aminoglycosides

76
Q

what’s the treatment for cystitis if pregnant?

A

Amoxicillin, Nitrofurantoin

77
Q

what’s the tx for pyelonephritis?

A

FQ PO or IV

78
Q

if UA shows WBC casts, what’s the dx?

A

pyelonephritis

79
Q

what’s the definitive dx for cystitis /pyelonephritis?

A

urine culture

> 100,000 bacteria

80
Q

what results of UA indicate cystitis?

A

> 5 WBC, + leukocyte esterase, hematuria, + nitrites

81
Q

what’s the MC cause of prostatitis in men >35 y/o?

A

E. coli

82
Q

what’s the MC cause of prostatitis in men < 35 y/o?

A

Chlamydia & Gonorrhea

83
Q

what’s the s/s of prostatitis?

A

fever/chills in acute

frequency, urgency, dysuria

obstructive sx’s (decr. stream)

lowerback/abd pain, PERINEAL PAIN

84
Q

what’s the PE of acute prostatitis like?

A

exquisitely TENDER, normal/hot, BOGGY prostate

85
Q

what’s the PE of chronic prostatitis like?

A

NONTENDER, BOGGY prostate

86
Q

what should be avoided in acute prostatitis and why?

A

prostatic massage b/c may cause bacteremia

87
Q

what’s the tx for acute prostatitis >35 y/o?

A

FQ or Bactrim

88
Q

what’s the tx for acute prostatitis < 35 y/o?

A

Ceftriazone plus Doxy (or Azithro) - b/c caused by chlamydia and gonorrhea

89
Q

what’s the tx for chronic prostatitis?

A

FQ, Bactrim

if refractory -> TURP

90
Q

what’s the s/s of gonococcal urethritis?

A

abrupt onset of sx’s (esp. w/in 3-4 days)

opaque, yellow, white or clear thick discharge, pruritus

91
Q

what’s the s/s of non-gonococcal (chlamydia) urethritis?

A

purulent or mucopurulent discharge, pruritus, hematuria, pain with intercourse

92
Q

how do you dx urethritis?

A

Nucleic acid amplification (most sensitive and specific for chlamydia & gonorrhea)

93
Q

what’s the tx for Gonococcal urethritis?

A

Ceftriaxone IM x 1 dose

94
Q

what’s the tx for non-gonococcal (chlamydia) urethritis?

A

1g azithromycin or Doxy

95
Q

do you usually treat for gonococcal and chlamydia urehtirits together? if so, what’s the treatment?

A

yes you do

tx = Ceftriaxone IM x 1 dose + 1g Azithromycin or doxy

96
Q

what is CKD?

A

Progressive loss of renal function persisting >3 mo and typically irreversible

-GFR <60 ml/min or Cr >30 for >3 mo

97
Q

what GFR means ESRD?

A

GFR < 15

98
Q

what’s the tx for ESRD?

A

dialysis and/or transplant

99
Q

what is the MC cause of ESRD?

A

DM (d/t diabetic nephropathy)

100
Q

what’s the 2nd MC cause of ESRD?

A

HTN

101
Q

what’s the single best predictor of CKD progression?

A

proteinuria

-Spot UAlbumin/UCr Ratio (ACR) -> PREFERRED (vs 24hr urine collection)

102
Q

what’s the s/s of CKD?

A

asx until stage 3 o4 4

anemia (decr. EPO production)

fatigue, weakness

103
Q

what values of 24hr urine test suggest microalbuminuria and macroalbuminuria?

A

Microalbuminuria → 30-300 mg

Macroalbuminuria → >300 mg

104
Q

what is seen on UA for dx of CKD?

A

abnormal sediment: BROAD WAXY CASTS seen in ESRD

105
Q

what’s classically seen on renal U/S for dx of CKD?

A

small kidneys

106
Q

what is the definition of orthostatic hypotension?

A

Fall in systolic >20 mmHg from sitting to standing or fall in diastolic of >10 mmHg from sitting to standing

107
Q

what’s the FIRST-LINE tx for orthostatic hypotension?

A

Fludrocortisone

Surgery Rotation EORE (10 decks)

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