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EOR Family Medicine > Urology / Renal > Flashcards

Urology / Renal Flashcards

1
Q

Most common types of stones in nephrolithiasis

A
  1. Calcium oxalate
  2. Calcium phosphate
    Other types: uric acid, struvite stones, cystine stones
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2
Q

Characteristics of struvite stones in nephrolithiasis

A

Staghorn appearance

Caused by urea splitting bacteria (proteus)

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3
Q

Risk factors for nephrolithiasis

A

Decreased fluid intake
Medications (loop diuretics, chemo drugs)
Gout

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4
Q

Signs/symptoms of nephrolithiasis

A

Renal colic - acute flank pain that radiates to groin
Pain over CVA
N/V
Unable to find comfortable position

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5
Q

Diagnosis of nephrolithaisis

A
  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
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6
Q

Treatment of nephrolithiasis <5 mm in diameter

A

80% chance of spontaneous passage

  1. IV fluids, analgesics, antiemetics
  2. Tamsulosin - may facilitate passage
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7
Q

Treatment of nephrolithiasis > 7 mm in diameter

A

Extracorporeal shock wave lithotripsy
Ureteroscopy +/- stent
Percutaneous nephrolithotomy - used for stones > 10 mm

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8
Q

Prevention of future nephrolithiasis

A
  1. Adequate hydration
  2. Decrease animal protein intake
  3. Thiazide diuretics are used for recurrent calcium stones
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9
Q

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

A

Testicular Carcinoma

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10
Q

Risk factors for testicular carcinoma

A

Cryptorchidism - 40 fold risk
Caucasians
Klinefelter’s synddrome

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11
Q

Most common type of testicular carcinoma

A

Germinal Cell Tumors

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12
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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13
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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14
Q

Diagnosis of testicular carcinoma

A
  1. Scrotal ultrasound

2. Alpha-fetoprotein, BhCG, LDH

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15
Q

Management of low-grade nonseminoma testicular carcinoma

A

Orchiectomy with retroperitoneal lymph node dissection

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16
Q

Management of low-grade seminoma testicular carcinoma

A

Orchiectomy, radiation

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17
Q

Management of high-grade seminoma testicular carcinoma

A

Debulking chemotherapy

Followed by orchiectomy and radiation

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18
Q

Risk factors for cystitis (women)

A

Sexual intercourse
Spermicidal use
Pregnancy
Postmenopausal

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19
Q

Risk factors for cystitis (men)

A

Rare - should have workup

> 50 y/o: BPH, prostate cancer

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20
Q

Most common etiology for cystitis

A

E. coli
Staph, saprophyticus (sexually active women)
Enterococci for indwelling catheters

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21
Q

Dysuria (burning), increased frequency, urgency, hematuria, suprapubic discomfort

A

Acute cystitis

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22
Q

Fever and tachycardia, back/flank pain + CVAT, N/V

A

Pyelonephritis

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23
Q

Diagnosis of cystitis/pyelonephritis

A
  1. Urinalysis
  2. Dipstick
  3. Urine Culture
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24
Q

If urinalysis shows WBC casts

A

Pyelonephritis

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25
Q

Indications for urine culture with cystitis/pyelonephritis

A 
Complicated UTI
Infants/children
Elderly
Males
Urologic abnormalities
Refractory to tx
Catheterized pts
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26
Q

Conservative treatment for cystitis

A

Increase fluid intake, void after intercourse

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27
Q

Management of cystitis

A
  1. Phenazopyridine (Pyridium) turns urine orange
  2. Nitrofurantoin, Ciprofloxacin, Bactrim, Fosfomycin
  3. Pregnant: amoxicillin/augmentin
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28
Q

Management of pyelonephritis

A

Fluoroquinolones IV or PO aminoglycoside

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29
Q

Immunologic inflammation of the glomeruli causing protein and RBC leakage into the urine

A

Glomerulonephritis

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30
Q

HTN, hematuria (RBC casts), dependent edema (proteinuria), and azotemia (nitrogen in blood) are hallmarks

A

Glomerulonephritis

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31
Q

Types of glomerulonephritis

A
  1. IgA Nephropathy (Berger’s Dz)
  2. Post Infectious
  3. Membranoproliferative/Mesangiocapillary
  4. Rapidly Progressive Glomerulonephritis (RPGN)
  5. Goodpasture’s Dz
  6. Vasculitis
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32
Q

Most common cause of acute glomerulonephritis in adults worldwide

A

IgA nephropathy (Berger’s dz)

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33
Q

Glomerulonephritis that often affects young males within days (24-48 hours) after URI or GI infection

A

IgA nephropathy

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34
Q

Diagnosis of IgA nephropathy

A

IgA mesangial deposits on immunostaining

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35
Q

Management of IgA nephropathy

A

ACEI +/- corticosteroids

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36
Q

Glomerulonephritis that is most common after GABHS

A

Post infectious

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37
Q

Glomerulonephritis that classically presents as a 2-14 y/o boy with facial edema up to 3 weeks after Strep with scanty, cola-colored dark urine (hematuria and oliguria)

A

Post infectious glomerulonephritis

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38
Q

Diagnosis of post infectious glomerulonephritis

A 
Increased antistreptolysin (ASO) titers, low serum complement
Biopsy: hypercellularity, increased monocytes/lymphocytes, immune humps
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39
Q

Management of post infectious glomerulonephritis

A

Supportive, +/- antibiotics

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40
Q

Glomerulonephritis due to SLE, viral hepatitis (HCV, HBV), hypocomplementemia, cryoglobulinemia

A

Membranoproliferative/Mesangiocapillary glomerulonephritis

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41
Q

Glomerulonephritis associated with poor prognosis (progresses to end stage renal failure within weeks/months)

A

Rapid progressive glomerulonephritis (RPGN)

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42
Q

Crescent formation on biopsy

A

Rapidly progressive glomerulonephritis

Due to collapse of crescent shape of Bowman’s capsule

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43
Q

Management of rapidly progressive glomerulonephritis

A

Corticosteroids + cyclophosphamide

44
Q

Two types of glomerulonephritis that only present with RPGN:

A

Goodpasture’s disease

Vasculitis

45
Q

Glomerulonephritis with + Anti-GBM antibodies

A

Goodpasture’s disease

46
Q

Diagnosis of goodpasture’s disease

A

Linear IgG deposits

47
Q

Management of goodpasture’s disease

A

High dose corticosteroids + cyclophosphamide + plasmapheresis

48
Q

Glomerulonephritis that is characterized by lack of immune deposits and + ANCA antibodies

A

Vasculitis

Can either have P-ANCA or C-ANCA

49
Q

The presence of _________ in nephritic distinguishes nephritis from nephrotic

A

Gross hematuria

50
Q

Signs/Symptoms of glomerulonephritis

A 
Hematuria
Edema
HTN
Fever, abdominal pain, flank pain
Oliguria
51
Q

Diagnosis of glomerulonephritis

A
  1. Urinalysis
  2. Increased BUN, creatinine
  3. Renal biopsy gold standard
52
Q

Proteinuria, hypoalbuminemia, edema, hyperlipidemia

A

Nephrotic syndrome

53
Q

Edema is the predominant feature, in:

A

Nephrotic syndrome

54
Q

Diagnosis of nephrotic syndrome

A
  1. Urinalysis - protein > 3.5

2. Biopsy - hypocellular

55
Q

Normal on light microscopy, loss of podocytes on electron microscopy

A

Minimal change disease

56
Q

Complications of nephrotic syndrome

A

Transudative pleural effusion
DVTs
Frothy urine

57
Q

Prostate hyperplasia causing bladder outlet obstruction

58
Q

Frequency, urgency, nocturia

A

Irritative symptoms of BPH

59
Q

Hesitancy, weak/intermittent stream force, incomplete emptying

A

Obstructive symptoms of BPH

60
Q

Diagnosis of BPH

A
  1. DRE - uniformly enlarge, firm, rubbery prostate
  2. Increased PSA (>4)
  3. Urine cytology (if increased risk of bladder CA)
61
Q

Management of BPH

A
  1. Observation - avoid antihistamines and anticholinergics
  2. 5 Alpha Reductase Inhibitors - Finasteride and Dutasteride
  3. Alpha -1 Blockers: Tamsulosin, Alfuzosin, Terazosin
  4. TURP - transurethral resection of prostate
62
Q

S/E of 5 alpha reductase inhibitors (Finasteride, Dutasteride)

A

Decreased libido, sexual or ejaculatory dysfunction, breast tenderness/enlargement

63
Q

S/E of alpha 1 blockers: tamsulosin, alfuzosin, doxazosin

A

Dizziness and orthostatic decreased BP, retrograde ejaculation

64
Q

Prostate gland inflammation secondary to an ascending infection

A

Prostatitis

65
Q

Most common causes of prostatitis when > 35 y/o

A

E. coli (MC)
Pseudomonas
Klebsiella
Proteus

66
Q

Most common causes of prostatitis when < 35 y/o

A

Chlamydia and gonorrhea MC

67
Q

Most common cause of chronic prostatitis

A

E. coli, enterococci, trichomonas

68
Q

Fever/chills, malaise, arthralgias, irritative and obstructive urinary symptoms, lower back/abdominal pain, perineal pain

A

Prostatitis

69
Q

Chronic prostatitis usually presents as:

A

Recurrent UTIs

Intermittent dysfunction

70
Q

Physical exam for acute prostatitis

A

Exquisitely TENDER, normal or hot, boggy prostate

71
Q

Physical exam for chronic prostatitis

A

Usually non tender boggy prostate

72
Q

Diagnosis of prostatitis

A
  1. Urinalysis and urine culture
  2. Avoid prostate massage in acute prostatitis
  3. Transrectal ultrasound
73
Q

Management of acute prostatitis > 35 y/o

A

Fluoroquinolones or TMP-SMZ

If hospitalized, IV fluoro

74
Q

Management of acute prostatitis < 35 y/o

A

Tx for gonorrhea and chlamydia

Ceftriaxone plus Doxy

75
Q

Management of chronic prostatitis

A

Fluoroquinolones, TMP-SMZ

Transurethral resection of the prostate for refractory chornic prostatitis

76
Q

Epididymal pain and swelling thought to be secondary to retrograde infxn or reflux or urine

A

Epididymitis

77
Q

Epididymitis is usually _________, while orchitis is usually _________

A

Bacterial

Viral

78
Q

Most common causes of orchitis and epididymitis in men < 35 y/o

A

Chlamydia, gonorrhea

79
Q

Most common causes of orchitis and epididymitis in men > 35 y/o and children

A

Enteric organisms most common

E. coli, Klebsiella

80
Q

1/3 of postpubertal men with _________ have concomitant orchitis

81
Q

Gradual onset of scrotal pain, erythema and swelling. Most commonly unilateral. +/- groin or abdominal pain. Fever, chills, irritative symptoms

A

Epididymitis and orchitis

82
Q

Relief of pain with elevation of the affected scrotum

A

Positive Prehn’s Sign

Epididymitis and orchitis

83
Q

Elevation of the testicle after stroking the inner thigh

A

Positive Cremasteric Reflex

Epididymitis and orchitis

84
Q

Diagnosis of epididymitis / orchitis

A
  1. Scrotal ultrasound - increased testicular blood flow, enlarge epididymitis
  2. UA: pyuria (WBC), bacteriuria
  3. CBC: leukocytosis
  4. Urine culture
  5. STD testing
85
Q

Symptomatic treatment for orchitis

A

Bed rest, scrotal elevation, cool compresses and analgesics (NSAIDs)

86
Q

Management of acute epididymitis

A

Gonorrhea and chlamydia: doxycycline plus ceftriaxone IM
Enteric organisms: Fluoroquinolones
Children: Cephalexin or amoxicillin

87
Q

Management of chronic epididymitis

A

4-6 week trial of abx

88
Q

Most common cause of urethritis in men < 30 y/o

89
Q

Anal, vaginal, penile or pharyngeal discharge, may cause septic arthritis

A

Urethritis and cervicitis - gonorrhea

90
Q

Culture shows gram negative diplococci in polymorphonuclear leukocytes

91
Q

Management of gonorrhea

A

Ceftriaxone IM plus Doxycycline or Azithromycin

92
Q

Most common overall bacterial cause of STDs in the US

93
Q

Purulent or mucopurulent discharge, pruritus, dysuria, dyspareunia, hematuria

A

Urethritis - Chlamydia

94
Q

Abdominal pain + cervical motion tenderness

A

PID - Chlamydia

95
Q

Diagnosis of chlamydia

A

Nucleic acid amplification - test of choice for both gonorrhea and chlamydia

96
Q

Management of chlamydia

A

Azithromycin or doxycycline

97
Q

Most common cause of urethritis

A

Chlamydia

Gonococcal (2nd most common)

98
Q

Urethritis with abrupt onset of symptoms (especially within 3-4 days). Opaque, yellow, white, or clear thick discharge, pruritus

A

Gonococcal urethritis

99
Q

Urethritis of 5-8 days with purulent or mucopurulent discharge, pruritus. Hematuria, pain with intercourse

A

Chlamydia urethritis

100
Q

Complications of men with urethritis

A

Epididymitis, prostatitis, infertility, reactive arthritis

101
Q

Complications of women with urethritis

A

Pelvic inflammatory disease, infertility, ectopic pregnancy, premature delivery, septic arthritis

102
Q

Diagnosis of urethritis

A

Nucleic acid amplification

103
Q

Management of gonococcal urethritis

A

Ceftriaxone IM x 1 dose

104
Q

Management of nongonococcal urethritis

A

Azithromycin or doxycycline

105
Q

Inflammation of the glans penis and the foreskin (prepuce) in uncircumcised males

A

Balanoposthitis

106
Q

Pts who are unable to void due to severe penile and preputial edema require urgent bladder catheterization to relieve obstruction and need urologic consultation

A

Balanoposthitis

107
Q

Management of balanoposthitis

A

Conservative: reinforcement of proper hygiene, avoidance of forced retraction of foreskin
Topical low potency corticosteroid therapy (hydrocortisone), aqueous emollient cream

EOR Family Medicine (14 decks)

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