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EOR General Surgery > Urology / Renal (5%) > Flashcards

Urology / Renal (5%) Flashcards

1
Q

Causes of orthostatic hypotension

A 
Medications
Hypovolemia
Anemia
Heart dz
Diabetes
Parkinson's Disease
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2
Q

Treatment for orthostatic hypotension

A
  1. Tx underlying etiology
  2. Have pts rise slowly from sitting to standing
  3. Increase fluid and sodium intake
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3
Q

Treatment for orthostatic hypotension if conservative measures fail

A

Fludrocortisone - first line therapy

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4
Q

Most common solid tumor in men 15-40 y/o

A

Testicular Carcinoma

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5
Q

Risk factors for testicular carcinoma

A

Cryptorchidism - 40 fold risk
Caucasians
Klinefelter’s syndrome

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6
Q

Most common type of testicular carcinoma

A

Germinal Cell Tumors

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7
Q

Seminomas are more common in ____________, while nonseminomatous carcinomas of the testicles are more common in _________

A

Men (30-40)

Boys < 10 y/o

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8
Q

Signs/symptoms of testicular carcinoma

A
  1. Painless testicular nodule, solid mass or enlargement
  2. Hydrocele present in 10%
  3. Gynecomastia
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9
Q

Diagnosis of testicular carcinoma

A
  1. Scrotal ultrasound

2. Alpha-fetoprotein, BhCG, LDH

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10
Q

Management of low-grade nonseminoma testicular carcinoma

A

Orchiectomy with retroperitoneal lymph node dissection

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11
Q

Management of low-grade seminoma testicular carcinoma

A

Orchiectomy, radiation

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12
Q

Management of high-grade seminoma testicular carcinoma

A

Debulking chemotherapy

Followed by orchiectomy and radiation

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13
Q

Most common abdominal malignancy in children - usually presents within 5 y/o

A

Wilms Tumor

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14
Q

Signs/Symptoms of Wilms Tumor

A

Painless, palpable, abdominal mass - MC
Hematuria
HTN
Anemia

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15
Q

Diagnosis of Wilms Tumor

A
  1. Abdominal ultrasound - best initial

2. CT w/ contrast or MRI

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16
Q

Management of Wilms Tumor

A

Nephrectomy followed by chemotherapy

Lung is common site for METS

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17
Q

Most common form of bladder carcinoma

A

Transitional cell

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18
Q

Risk factors for bladder carcinomas

A
  1. Smoking

2. Occupational exposure

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19
Q

Medications that are known to cause bladder cancer

A
  1. Cyclophosphamide

2. Pioglitazone

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20
Q

Signs/Symptoms of bladder cancer

A

Painless gross or microscopic hematuria

Irritative sx

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21
Q

Diagnosis of bladder cancer

A

Cystoscopy with biopsy

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22
Q

Management of bladder cancer that is localized/superficial

A

Transurethral resection bladder tumor (TURBT)

Intravesical chemo

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23
Q

Management of bladder cancer that is invasive (advanced or involving muscular layer)

A

Radical cystectomy
Chemo
XRT

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24
Q

Management of recurrent bladder CA

A

BCG (bacillus calmette-guerin) vaccine intravesicular

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25
95% of tumors originating in the kidney are _______________
Renal cell carcinomas
26
Renal cell carcinomas are tumors of the ___________ ___________ __________
Proximal convoluted tubule | Most metabolically active
27
Risk factors for renal cell carcinoma
Smoking Dialysis HTN Obesity
28
Classic triad of renal cell carcinoma
1. Hematuria 2. Flank/abdominal pain 3. Palpable mass 4. Left sided varicocele - blocks testicular vein drainage
29
Diagnosis of renal cell carcinoma
1. CT scan - first test to be done 2. Ultrasound 3. MRI
30
Management of renal cell carcinoma for stages I-III
Radical nephrectomy | Usually resistant to chemo and radiation
31
Management of renal cell carcinoma that has bilateral involvement or pt has solitary kidney
Partial nephrectomy
32
Renal artery stenosis causes reduction of blood flow to the kidney, leads to ______
CKD
33
With renal artery stenosis, pts may present with _________ _______ __________
Flash pulmonary edema
34
Most common etiology of renal artery stenosis in women < 50 y/o
Fibromuscular dysplasia
35
Clues to diagnosis of renal artery stenosis
1. Resistant HTN 2. Exaggerated rise in creatinine when given ARB or ACE 3. Abdominal bruit
36
Diagnosis of renal artery stenosis
Should only do testing if revascularization will be done 1. Duplex doppler ultrasound, CTA, or MRA 2. Gold standard - renal arteriography
37
Treatment of renal artery stenosis
Angioplasty w/ stenting IF BP cannot be controlled with meds Worsening renal function Recurrent flash pulmonary edema
38
Most common types of stones in nephrolithiasis
1. Calcium oxalate 2. Calcium phosphate Other types: uric acid, struvite stones, cystine stones
39
Characteristics of struvite stones in nephrolithiasis
Staghorn appearance | Caused by urea splitting bacteria (proteus)
40
Risk factors for nephrolithiasis
Decreased fluid intake Medications (loop diuretics, chemo drugs) Gout
41
Signs/Symptoms of nephrolithiasis
Renal colic - acute flank pain that radiates to groin Pain over CVA N/V Unable to find comfortable position
42
Diagnosis of nephrolithiasis
1. Urinalysis - will show hematuria in 80% 2. Non-contrast helical CT scan - test of choice! 3. KUB - will only visualize calcium stones 4. Intravenous pyelography - gold standard
43
Treatment of nephrolithiasis < 5 mm in diameter
80% chance of spontaneous passage 1. IV fluids, analgesics, antiemetics 2. Tamsulosin - may facilitate passage
44
Treatment of nephrolithiasis > 7 mm in diameter
Extracorporeal shock wave lithotripsy Ureteroscopy +/- stent Percutaneous nephrolithotomy - used for stones > 10 mm
45
Prevention of future nephrolithiasis
1. Adequate hydration 2. Decrease animal protein intake 3. Thiazide diuretics are used for recurrent calcium stones
46
Metabolic Acidosis formula
Decreased pH Decreased bicarb Decreased CO2
47
Metabolic Alkalosis formula
Increased pH Increased bicarb Increased CO2
48
Respiratory Acidosis formula
Decreased pH Increased bicarb Increased CO2
49
Respiratory Alkalosis formula
Increased pH Decreased bicarb Decreased CO2
50
An anion gap over _____ is considered an elevated anion gap
12
51
MUDPILERS
``` Methanol Uremia Diabetic/alcoholic ketoacidosis Paraldehyde/propylene glycol Isoniazid / iron Lactic acidosis Ethylene glycol Rhabdomyolysis Salicylates ```
52
When can you treat an acidotic patient with sodium bicarb?
If pH < 7.2 Life-threatening ventricular arrhythmia Inadequate compensatory response
53
Risks of sodium bicarbonate therapy
Hypernatremia Hyperosmolarity Volume overload
54
Disorder that may cause hypernatremia
Diabetes insipidus
55
In surgical patients, hypernatremia may result from:
Loop diuretics | Also from gastrointetstinal losses
56
In the acute setting, rapid hypernatremia can cause ________________
Intracerebral hemorrhage
57
Causes of hypervolemic hyponatremia - patient will usually have edema
Renal failure CHF COPD Severe liver disease
58
Causes of normovolemic hyponatremia
SIADH
59
Causes of hypovolemic hyponatremia
``` Renal losses of sodium Diuretic use Aldosterone deficiency Renal failure Subarachnoid hemorrhage ```
60
Treatment of hypervolemic hyponatremia
Volume restriction and loop diuretic
61
Treatment of normovolemic hyponatremia
SIADH - fluid restriction
62
How do you correct hypernatremia?
D5W
63
Treatment of hypovolemic hyponatremia
Salt and water replacement
64
Should not increase serum sodium concentration faster than _________ mEq/L/hr
0.5
65
Hyperkalemia can result from:
Renal or adrenal insufficiency Metabolic acidosis Iatrogenic causes
66
Most important results of severe hyperkalemia
Myocardial effects Peaked T wave is first sign Finally: complete heart block, ventricular tachycardia, cardiac standstill occur
67
Treatment of hyperkalemia
10-20 mL of 10% calcium gluconate Can give Kayexalate (takes longer) Most effective method: hemodialysis
68
Hypokalemia is common in surgical patients due to:
GI losses - vomiting, diarrhea, fistula | Use of diuretics
69
Treatment for hypokalemia
1. Oral potassium unless severe or pt is symptomatic
70
Treatment for hypercalcemia (when not due to parathyroidism):
Saline diuresis Furosemide Calcitonin - reduces bone resportion
71
Signs of hypocalcemia
Trousseau's | Chvostek Sign
72
Trousseau's Sign
Seen in hypocalcemia | BP cuff inflated - spasms in muscles of hand/forearm
73
Chvostek Sign
Seen in hypocalcemia | Tap facial nerve - twitch on same side of face
74
Treatment of hypocalcemia is symptomatic/severe
IV calcium therapy
75
Diseases that cause hypermagnesemia
Renal failure | Addison's disease
76
Treatment for hypermagnesemia
Calcium infusion followed by immediate dialysis
77
In surgical patients, hypomagnesemia is a result of:
GI losses | Reduced absorption
78
Treatment for hypomagnesemia
Magnesium infusion | If treatment not urgent, give oral supplements
79
Most common cause of hyperphosphatemia
Renal insufficiency
80
Treatment of hyperphosphatemia
Treat underlying renal failure | Phosphate-binding antacids
81
Treatment of hypophosphatemia
Oral or parenteral phosphate

EOR General Surgery (10 decks)

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