Urology/Renal Flashcards
what’s the MC type of bladder cancer?
transitional cell
what are the risk factors for bladder cancer?
smoking (MC), occupational exposure to dyes, rubber, leather, age >40 y/o, white males are 3x MC, pioglitazone
what’s the MC RF for bladder cancer?
smoking
what’s the s/s of bladder cancer?
painless gross or microscopic hematuria
irritative sx’s (frequency/urgency)
how do you dx bladder cancer?
cystoscopy with bx
what’s the tx for localized/superficial bladder cancer?
TURP
what’s the tx for invasive bladder cancer (advanced/involves muscular layer)?
radical cystectomy
what’s the tx for recurrent bladder cancer?
BCG vaccine intravesicular
where do most renal cell cancers originate from?
kidney
what are the RFs for renal cell carcinoma?
smoking***, dialysis, HTN, obesity, men
what are the s/s of renal cell carcinoma?
classic triad:
- hematuria, 2. flank/abd pain, 3. palpable mass
may have Left-sided varicocele, HTN and hypercalcemia
how do you dx renal cell carcinoma?
CT w/contrast
what’s the tx for stage 1-3 (locally advanced) of renal cell carcinoma?
radical nephrectomy
what’s the tx for bilateral involvement or pt with solitary kidney or localized disease (w/in kidney) of renal cell carcinoma?
partial nephrectomy
what’s Wilm’s tumor?
nephroblastoma MC in children w/in the 1st 5 years of life
who is Wilm’s tumor MC in?
children w/in the 1st 5 years of life
what’s the MC abdominal malignancy in children?
Wilm’s tumor
what’s the s/s of Wilm’s tumor?
painless, palpable abdominal mass** (MC sx) - doesn’t cross midline
hematuria, anemia, maybe HTN d/t renin secretion by tumor
how do you dx Wilm’s tumor?
abdominal U/S = best initial test
CT w/ contrast or MRI = more accurate test
what’s the tx for Wilm’s tumor?
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
where is the MC site of METS in Wilm’s tumor?
lungs
what’s the MC RF for nephrolithiasis?
decreased fluid intake
what are the 4 types of kidney stones?
- Calcium oxalate (MC) & phosphate
- Uric acid
- Struvite stones (Mg ammonium phosphate)
- Cystine (rare)
what is the MC type of kidney stones?
Ca oxalate
what can struvite kidney stones form?
Staghorn calculi (ex. Proteus***, Klebsiella, Pseudomonas, Serratia, Enterobacter)
a/w UTIs
what are the s/s of kidney stones?
renal colic pain - sudden, CONSTANT upper/lateral/flank pain over CVA radiating to groin/anteriorly
CVA tenderness
what’s the s/s of kidney stone in proximal ureter?
flank pain, CVAT
what’s the s/s of kidney stone in mid-ureter?
mid abdominal pain
what’s the s/s of kidney stone in distal ureter (UVJ)?
groin pain (b/c near bladder)
how do you dx kidney stones?
UA: microscopic or gross hematuria
Noncontrast CT abd/pelvis (MC initial dx test)
KUB radiographs only Ca and struvite stones are seen
what urine pH signifies calcium oxalate kidney stones?
pH 5.5-6.8
what urine pH signifies Uric acid, cystine kidney stones?
<5.0 (acidic)
what urine pH signifies struvite stones?
pH >7.2 (alkaline)
what’s the MC initial dx test ordered for dx of kidney stones?
Non-contrast abd/pelvis CT
what stones are seen on KUB x-rays?
Ca and struvite stones
what’s the tx for kidney stones <5mm?
will most likely pass through spontaneously
IVFs, analgesics, antiemetics, Tamsulon (alpha-blocker that can help passage)
what’s the tx for kidney stones >7mm?
won’t pass on their own
- Extracorporeal shock wave lithotripsy
- Uretoscopy +/- stent (provides immediate relief to an obstructed or at -risk kidney)
- Percutaneous nephrolithotomy (used for stones >10mm or struvite, or if other tx’s fail)
what’s renal artery stenosis cause?
secondary HTN (MCC)
what’s the MCC of secondary HTN?
renal artery stenosis
what’s the causes of renal artery stenosis?
atherosclerosis MC in elderly
fibromuscular dysplasia MCC in women < 50 y/o
what’s the s/s of renal artery stenosis?
severe/refractory HTN; abd (renal) bruit
what’s the GOLD STANDARD to dx renal artery stenosis?
renal arteriography
how do you treat renal artery stenosis?
- Surgical (revascularization)
- Angioplasty w/ stent = definitive - 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!
what’s the definitive tx for renal artery stenosis?
Surgical (revascularization)
-***Angioplasty w/ stent = definitive
when are ACEIs/ARBs C/I in tx of renal artery stenosis?
if bilateral stenosis or solitary kidney b/c ACEI markedly reduces renal blood flow & GFR in these pts -> causes AKI
what is a big RF for testicular cancer?
Cryptorchidism
what side is testicular cancer MC on, right or left?
right side (b/c cryptorchidism occurs MC on the right side)
what are the 2 types of testicular cancer?
germinal cell tumors (usu. malignant)
-seminoma or nonseminoma
non-germinal cell tumors
what are sminoma testicular tumors?
Simple (lack tumor markers = normal serum alpha fetoprotein & b-hCG), sensitive (to radiation), slower growing, step-wise spread
what are non-seminoma tumors?
embryonal cell carcinoma MC in boys = 10 y/o
***a/w incr. serum alpha-fetoprotein, increased B-hCG and radioresistance
what are non-seminoma tumors a/w?
***a/w incr. serum alpha-fetoprotein, increased B-hCG and radioresistance
what are the s/s of testicular cancer?
- painless testicular nodule, solid mass, or enlargement; may have hydrocele present
how do you dx testicular cancer?
scrotal U/S
alpha-fetoprotein, B-hCG, LDH
what is elevated in non-seminoma tumors?
alpha-fetoprotein, B-hCG
what is pathogmnemonic for non-seminoma tumors?
alpha-fetoprotein elevation
what’s the tx for low-grade (stage 1) non -eminoma (limited to testes) testicular tumor?
orchiectomy with retroperitoneal LN dissection (dx and therapeutic)
what’s the tx of low-grade seminoma testicular cancer?
orchiectomy -> radiation
what’s the tx of high-grade seminoma?
debulking chemotherapy -> orchiectomy & radiation
what’s stage 2 of testicular cancer?
mass in testes + retroperitoneal LN
what’s stage 1 of testicular cancer?
mass in testes only
what’s stage 3 of testicular cancer?
mass in testes + distant mets
what are RFs for acute urinary retention?
prostatitis
anti-cholinergic meds: diphenhydramine (Benadryl), oxybutynin (for overactive bladder)
alpha-agonist meds: pseudoephedrine
narcotics
how do you dx BPH?
DRE -> uniformly enlarged, firm, rubbery, prostate
what is tamsulosin, alfuzosin, doxazosin, terazosin and what d/o do they treat? what are their adrs? what’s their MOA?
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
what are Finasteride and Dutasteride, what d/o do they treat, what’s their MOA, and what’s their adrs?
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
what’s the tx for BPH?
alpha-1 blockers (Tamsulosin - most uroselective) for acute sx’s
5-alpha reductase inhibitors (finasteride and dutasteride) - take 6 months to work
surgery: TURP
what are RFs for prostate cancer?
genetics, diet (high fat intake), obesity, AA
what type of cancer is prostate cancer?
adenocarcinoma
what are the s/s of prostate cancer?
urethral obstruction (freq/urgency/rentention/decr. stream)
back pain/bone pain -> incr. incidence of METS to bone
how do you dx prostate cancer?
DRE: hard, nodular, enlarged asymmetrical prostate
Increased PSA (>10 = incr. likelihood for prostate ca & METS)
U/S w/ bx if PSA >4
what’s the tx for prostate cancer if local disease?
radical prostatectomy
what’s the tx for prostate cancer if advanced disease?
external beam radiation therapy, androgen deprivation
what’s the tx for uncomplicated cystitis?
- Nitrofurantoin
- FQ’s (Cipro)
- Bactrim
what is complicated cystitis?
underlying condition with risk of therapeutic failure (I.e. sx’s > 7 days, pregnant, DM)
what’s the tx for complicated cystitis?
FQ PO or IV, Aminoglycosides
what’s the treatment for cystitis if pregnant?
Amoxicillin, Nitrofurantoin
what’s the tx for pyelonephritis?
FQ PO or IV
if UA shows WBC casts, what’s the dx?
pyelonephritis
what’s the definitive dx for cystitis /pyelonephritis?
urine culture
> 100,000 bacteria
what results of UA indicate cystitis?
> 5 WBC, + leukocyte esterase, hematuria, + nitrites
what’s the MC cause of prostatitis in men >35 y/o?
E. coli
what’s the MC cause of prostatitis in men < 35 y/o?
Chlamydia & Gonorrhea
what’s the s/s of prostatitis?
fever/chills in acute
frequency, urgency, dysuria
obstructive sx’s (decr. stream)
lowerback/abd pain, PERINEAL PAIN
what’s the PE of acute prostatitis like?
exquisitely TENDER, normal/hot, BOGGY prostate
what’s the PE of chronic prostatitis like?
NONTENDER, BOGGY prostate
what should be avoided in acute prostatitis and why?
prostatic massage b/c may cause bacteremia
what’s the tx for acute prostatitis >35 y/o?
FQ or Bactrim
what’s the tx for acute prostatitis < 35 y/o?
Ceftriazone plus Doxy (or Azithro) - b/c caused by chlamydia and gonorrhea
what’s the tx for chronic prostatitis?
FQ, Bactrim
if refractory -> TURP
what’s the s/s of gonococcal urethritis?
abrupt onset of sx’s (esp. w/in 3-4 days)
opaque, yellow, white or clear thick discharge, pruritus
what’s the s/s of non-gonococcal (chlamydia) urethritis?
purulent or mucopurulent discharge, pruritus, hematuria, pain with intercourse
how do you dx urethritis?
Nucleic acid amplification (most sensitive and specific for chlamydia & gonorrhea)
what’s the tx for Gonococcal urethritis?
Ceftriaxone IM x 1 dose
what’s the tx for non-gonococcal (chlamydia) urethritis?
1g azithromycin or Doxy
do you usually treat for gonococcal and chlamydia urehtirits together? if so, what’s the treatment?
yes you do
tx = Ceftriaxone IM x 1 dose + 1g Azithromycin or doxy
what is CKD?
Progressive loss of renal function persisting >3 mo and typically irreversible
-GFR <60 ml/min or Cr >30 for >3 mo
what GFR means ESRD?
GFR < 15
what’s the tx for ESRD?
dialysis and/or transplant
what is the MC cause of ESRD?
DM (d/t diabetic nephropathy)
what’s the 2nd MC cause of ESRD?
HTN
what’s the single best predictor of CKD progression?
proteinuria
-Spot UAlbumin/UCr Ratio (ACR) -> PREFERRED (vs 24hr urine collection)
what’s the s/s of CKD?
asx until stage 3 o4 4
anemia (decr. EPO production)
fatigue, weakness
what values of 24hr urine test suggest microalbuminuria and macroalbuminuria?
Microalbuminuria → 30-300 mg
Macroalbuminuria → >300 mg
what is seen on UA for dx of CKD?
abnormal sediment: BROAD WAXY CASTS seen in ESRD
what’s classically seen on renal U/S for dx of CKD?
small kidneys
what is the definition of orthostatic hypotension?
Fall in systolic >20 mmHg from sitting to standing or fall in diastolic of >10 mmHg from sitting to standing
what’s the FIRST-LINE tx for orthostatic hypotension?
Fludrocortisone