Urology / Renal Flashcards
1
Q
Most common types of stones in nephrolithiasis
A
- Calcium oxalate
- Calcium phosphate
Other types: uric acid, struvite stones, cystine stones
2
Q
Characteristics of struvite stones in nephrolithiasis
A
Staghorn appearance
Caused by urea splitting bacteria (proteus)
3
Q
Risk factors for nephrolithiasis
A
Decreased fluid intake
Medications (loop diuretics, chemo drugs)
Gout
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
5
Q
Diagnosis of nephrolithaisis
A
- Urinalysis - will show hematuria in 80%
- Non-contrast helical Ct scan - test of choice!
- KUB - will only visualize calcium stones
- Intravenous pyelography - gold standard
6
Q
Treatment of nephrolithiasis <5 mm in diameter
A
80% chance of spontaneous passage
- IV fluids, analgesics, antiemetics
- Tamsulosin - may facilitate passage
7
Q
Treatment of nephrolithiasis > 7 mm in diameter
A
Extracorporeal shock wave lithotripsy
Ureteroscopy +/- stent
Percutaneous nephrolithotomy - used for stones > 10 mm
8
Q
Prevention of future nephrolithiasis
A
- Adequate hydration
- Decrease animal protein intake
- Thiazide diuretics are used for recurrent calcium stones
9
Q
Most common solid tumor in men 15-40 y/o
A
Testicular Carcinoma
10
Q
Risk factors for testicular carcinoma
A
Cryptorchidism - 40 fold risk
Caucasians
Klinefelter’s synddrome
11
Q
Most common type of testicular carcinoma
A
Germinal Cell Tumors
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
13
Q
Signs/Symptoms of testicular carcinoma
A
- Painless testicular nodule, solid mass or enlargement
- Hydrocele present in 10%
- Gynecomastia
14
Q
Diagnosis of testicular carcinoma
A
- Scrotal ultrasound
2. Alpha-fetoprotein, BhCG, LDH
15
Q
Management of low-grade nonseminoma testicular carcinoma
A
Orchiectomy with retroperitoneal lymph node dissection
16
Q
Management of low-grade seminoma testicular carcinoma
A
Orchiectomy, radiation
17
Q
Management of high-grade seminoma testicular carcinoma
A
Debulking chemotherapy
Followed by orchiectomy and radiation
18
Q
Risk factors for cystitis (women)
A
Sexual intercourse
Spermicidal use
Pregnancy
Postmenopausal
19
Q
Risk factors for cystitis (men)
A
Rare - should have workup
> 50 y/o: BPH, prostate cancer
20
Q
Most common etiology for cystitis
A
E. coli
Staph, saprophyticus (sexually active women)
Enterococci for indwelling catheters
21
Q
Dysuria (burning), increased frequency, urgency, hematuria, suprapubic discomfort
A
Acute cystitis
22
Q
Fever and tachycardia, back/flank pain + CVAT, N/V
A
Pyelonephritis
23
Q
Diagnosis of cystitis/pyelonephritis
A
- Urinalysis
- Dipstick
- Urine Culture
24
Q
If urinalysis shows WBC casts
A
Pyelonephritis
25
Indications for urine culture with cystitis/pyelonephritis
```
Complicated UTI
Infants/children
Elderly
Males
Urologic abnormalities
Refractory to tx
Catheterized pts
```
26
Conservative treatment for cystitis
Increase fluid intake, void after intercourse
27
Management of cystitis
1. Phenazopyridine (Pyridium) turns urine orange
2. Nitrofurantoin, Ciprofloxacin, Bactrim, Fosfomycin
3. Pregnant: amoxicillin/augmentin
28
Management of pyelonephritis
Fluoroquinolones IV or PO aminoglycoside
29
Immunologic inflammation of the glomeruli causing protein and RBC leakage into the urine
Glomerulonephritis
30
HTN, hematuria (RBC casts), dependent edema (proteinuria), and azotemia (nitrogen in blood) are hallmarks
Glomerulonephritis
31
Types of glomerulonephritis
1. IgA Nephropathy (Berger's Dz)
2. Post Infectious
3. Membranoproliferative/Mesangiocapillary
4. Rapidly Progressive Glomerulonephritis (RPGN)
5. Goodpasture's Dz
6. Vasculitis
32
Most common cause of acute glomerulonephritis in adults worldwide
IgA nephropathy (Berger's dz)
33
Glomerulonephritis that often affects young males within days (24-48 hours) after URI or GI infection
IgA nephropathy
34
Diagnosis of IgA nephropathy
IgA mesangial deposits on immunostaining
35
Management of IgA nephropathy
ACEI +/- corticosteroids
36
Glomerulonephritis that is most common after GABHS
Post infectious
37
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)
Post infectious glomerulonephritis
38
Diagnosis of post infectious glomerulonephritis
```
Increased antistreptolysin (ASO) titers, low serum complement
Biopsy: hypercellularity, increased monocytes/lymphocytes, immune humps
```
39
Management of post infectious glomerulonephritis
Supportive, +/- antibiotics
40
Glomerulonephritis due to SLE, viral hepatitis (HCV, HBV), hypocomplementemia, cryoglobulinemia
Membranoproliferative/Mesangiocapillary glomerulonephritis
41
Glomerulonephritis associated with poor prognosis (progresses to end stage renal failure within weeks/months)
Rapid progressive glomerulonephritis (RPGN)
42
Crescent formation on biopsy
Rapidly progressive glomerulonephritis
| Due to collapse of crescent shape of Bowman's capsule
43
Management of rapidly progressive glomerulonephritis
Corticosteroids + cyclophosphamide
44
Two types of glomerulonephritis that only present with RPGN:
Goodpasture's disease
| Vasculitis
45
Glomerulonephritis with + Anti-GBM antibodies
Goodpasture's disease
46
Diagnosis of goodpasture's disease
Linear IgG deposits
47
Management of goodpasture's disease
High dose corticosteroids + cyclophosphamide + plasmapheresis
48
Glomerulonephritis that is characterized by lack of immune deposits and + ANCA antibodies
Vasculitis
| Can either have P-ANCA or C-ANCA
49
The presence of _________ in nephritic distinguishes nephritis from nephrotic
Gross hematuria
50
Signs/Symptoms of glomerulonephritis
```
Hematuria
Edema
HTN
Fever, abdominal pain, flank pain
Oliguria
```
51
Diagnosis of glomerulonephritis
1. Urinalysis
2. Increased BUN, creatinine
3. Renal biopsy gold standard
52
Proteinuria, hypoalbuminemia, edema, hyperlipidemia
Nephrotic syndrome
53
Edema is the predominant feature, in:
Nephrotic syndrome
54
Diagnosis of nephrotic syndrome
1. Urinalysis - protein > 3.5
| 2. Biopsy - hypocellular
55
Normal on light microscopy, loss of podocytes on electron microscopy
Minimal change disease
56
Complications of nephrotic syndrome
Transudative pleural effusion
DVTs
Frothy urine
57
Prostate hyperplasia causing bladder outlet obstruction
BPH
58
Frequency, urgency, nocturia
Irritative symptoms of BPH
59
Hesitancy, weak/intermittent stream force, incomplete emptying
Obstructive symptoms of BPH
60
Diagnosis of BPH
1. DRE - uniformly enlarge, firm, rubbery prostate
2. Increased PSA (>4)
3. Urine cytology (if increased risk of bladder CA)
61
Management of BPH
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
S/E of 5 alpha reductase inhibitors (Finasteride, Dutasteride)
Decreased libido, sexual or ejaculatory dysfunction, breast tenderness/enlargement
63
S/E of alpha 1 blockers: tamsulosin, alfuzosin, doxazosin
Dizziness and orthostatic decreased BP, retrograde ejaculation
64
Prostate gland inflammation secondary to an ascending infection
Prostatitis
65
Most common causes of prostatitis when > 35 y/o
E. coli (MC)
Pseudomonas
Klebsiella
Proteus
66
Most common causes of prostatitis when < 35 y/o
Chlamydia and gonorrhea MC
67
Most common cause of chronic prostatitis
E. coli, enterococci, trichomonas
68
Fever/chills, malaise, arthralgias, irritative and obstructive urinary symptoms, lower back/abdominal pain, perineal pain
Prostatitis
69
Chronic prostatitis usually presents as:
Recurrent UTIs
| Intermittent dysfunction
70
Physical exam for acute prostatitis
Exquisitely TENDER, normal or hot, boggy prostate
71
Physical exam for chronic prostatitis
Usually non tender boggy prostate
72
Diagnosis of prostatitis
1. Urinalysis and urine culture
2. Avoid prostate massage in acute prostatitis
3. Transrectal ultrasound
73
Management of acute prostatitis > 35 y/o
Fluoroquinolones or TMP-SMZ
| If hospitalized, IV fluoro
74
Management of acute prostatitis < 35 y/o
Tx for gonorrhea and chlamydia
| Ceftriaxone plus Doxy
75
Management of chronic prostatitis
Fluoroquinolones, TMP-SMZ
| Transurethral resection of the prostate for refractory chornic prostatitis
76
Epididymal pain and swelling thought to be secondary to retrograde infxn or reflux or urine
Epididymitis
77
Epididymitis is usually _________, while orchitis is usually _________
Bacterial
| Viral
78
Most common causes of orchitis and epididymitis in men < 35 y/o
Chlamydia, gonorrhea
79
Most common causes of orchitis and epididymitis in men > 35 y/o and children
Enteric organisms most common
| E. coli, Klebsiella
80
1/3 of postpubertal men with _________ have concomitant orchitis
Mumps
81
Gradual onset of scrotal pain, erythema and swelling. Most commonly unilateral. +/- groin or abdominal pain. Fever, chills, irritative symptoms
Epididymitis and orchitis
82
Relief of pain with elevation of the affected scrotum
Positive Prehn's Sign
| Epididymitis and orchitis
83
Elevation of the testicle after stroking the inner thigh
Positive Cremasteric Reflex
| Epididymitis and orchitis
84
Diagnosis of epididymitis / orchitis
1. Scrotal ultrasound - increased testicular blood flow, enlarge epididymitis
2. UA: pyuria (WBC), bacteriuria
3. CBC: leukocytosis
4. Urine culture
5. STD testing
85
Symptomatic treatment for orchitis
Bed rest, scrotal elevation, cool compresses and analgesics (NSAIDs)
86
Management of acute epididymitis
Gonorrhea and chlamydia: doxycycline plus ceftriaxone IM
Enteric organisms: Fluoroquinolones
Children: Cephalexin or amoxicillin
87
Management of chronic epididymitis
4-6 week trial of abx
88
Most common cause of urethritis in men < 30 y/o
Gonorrhea
89
Anal, vaginal, penile or pharyngeal discharge, may cause septic arthritis
Urethritis and cervicitis - gonorrhea
90
Culture shows gram negative diplococci in polymorphonuclear leukocytes
Gonorrhea
91
Management of gonorrhea
Ceftriaxone IM plus Doxycycline or Azithromycin
92
Most common overall bacterial cause of STDs in the US
Chlamydia
93
Purulent or mucopurulent discharge, pruritus, dysuria, dyspareunia, hematuria
Urethritis - Chlamydia
94
Abdominal pain + cervical motion tenderness
PID - Chlamydia
95
Diagnosis of chlamydia
Nucleic acid amplification - test of choice for both gonorrhea and chlamydia
96
Management of chlamydia
Azithromycin or doxycycline
97
Most common cause of urethritis
Chlamydia
| Gonococcal (2nd most common)
98
Urethritis with abrupt onset of symptoms (especially within 3-4 days). Opaque, yellow, white, or clear thick discharge, pruritus
Gonococcal urethritis
99
Urethritis of 5-8 days with purulent or mucopurulent discharge, pruritus. Hematuria, pain with intercourse
Chlamydia urethritis
100
Complications of men with urethritis
Epididymitis, prostatitis, infertility, reactive arthritis
101
Complications of women with urethritis
Pelvic inflammatory disease, infertility, ectopic pregnancy, premature delivery, septic arthritis
102
Diagnosis of urethritis
Nucleic acid amplification
103
Management of gonococcal urethritis
Ceftriaxone IM x 1 dose
104
Management of nongonococcal urethritis
Azithromycin or doxycycline
105
Inflammation of the glans penis and the foreskin (prepuce) in uncircumcised males
Balanoposthitis
106
Pts who are unable to void due to severe penile and preputial edema require urgent bladder catheterization to relieve obstruction and need urologic consultation
Balanoposthitis
107
Management of balanoposthitis
Conservative: reinforcement of proper hygiene, avoidance of forced retraction of foreskin
Topical low potency corticosteroid therapy (hydrocortisone), aqueous emollient cream
