Urology/Renal Flashcards
1
Q
What are irritative symptoms of BPH?
A
increased frequency, urgency, nocturia
2
Q
What are obstructive sx of BPH?
A
hesitancy, weak or intermittent stream, incomplete emptying, terminal dribbling
3
Q
What two classes of drugs may worsen BPH?
A
Sympathomimetics (Pseudoephedrine) and anticholinergics
4
Q
uniformly, enlarged, firm, nontender rubbery prostate?
A
BPH
5
Q
What is PSA used for?
A
Risk of symptom progression in BPH
6
Q
What is a normal PSA level?
A
< 4 ng/ml
7
Q
How often should mild symptoms of BPH be monitored?
A
annually
8
Q
Best initial txt for rapid relief of BPH?
A
Alpha blockers (Tamsulo-sin)
9
Q
What is a sde of alpha blockers?
A
hypotension
10
Q
What drug reduces the size of the prostate?
A
5-alpha reductase inhibitors (Finaste-ride)
11
Q
Txt for refractory BPH?
A
TURP
12
Q
What is a sde of TURP?
A
sexual dysfunction, urinary incontience
13
Q
What is a sde of Finasteride?
A
sexual dysfunction, decreased libido, breast enlargement/tenderness
14
Q
MC cause of erectile dysfunction?
A
vascular
15
Q
What test is used to evaluate sleep erections?
A
nocturnal penile tumescence
16
Q
1st line txt for erectile dysfunction?
A
phosphodiesterase- 5 inhibitors (Sildenfil)
17
Q
What is the mechanism of phosphodiestrase 5 inhibitors?
A
increases GMP and potentiates nitric oxide mediated penile smooth muscle relaxation
18
Q
C/I for Viagra?
A
pts who use nitrates and cardiovascular dx
19
Q
What is a adv rxn of Viagra?
A
headache, flushing, rhinitis, visual disturbances, hearing loss
20
Q
What lie is seen in testicular torsion?
A
horizontal lie
21
Q
What lie is seen epididymitis?
A
vertical lie
22
Q
What is Prehn sign?
A
pain relief w/ scrotal elevation
23
Q
What is cremasteric reflex?
A
elevation of testicle after stroking the inner thigh
24
Q
What two signs are negative in testicular torsion?
A
Phren and cremasteric reflex
25
What is the definitive dx for testicular torsion?
emergency surgical exploration
26
What dx tool can be used in testicular torsion?
testicular doppler ultrasound
27
Txt for testicular torsion?
urgent detorsion & orchiopexy
28
What time frame should a testicular torsion be repaired?
< 6hrs
29
If surgery is not available what procedure can be done in testicular torsion?
manual detorsion
30
MC cause of prostatitis in age >35y?
E. coli
31
MC cause of prostatitis in age < 35yr
Chlamydia & Gonorrhea
32
MC cause of chronic prostatitis?
E. coli
33
What sx are seen in acute prostatitis?
fever, chills, perineal pain, frequency, urgency, dysuria
34
exquisitely tender, normal or hot, boggy prostate
Acute prostatitis
35
non-tender, boggy prostate
chronic prostatits
36
What sx are seen in chronic prostatitis?
recurrent UTIs or intermittent dysfunction
37
What should be avoided in acute prostatitis?
prostatic massage
38
Txt for acute prostatitis in >35yr?
Fluoroquinolones or Bactrim
39
Txt for acute prostatitis in <35yr?
Ceftriaxone + Doxycycline (Azithromycin)
40
Txt for chronic prostatitis?
Fluoroquinolones or Bactrim. Alpha blockers
41
Txt for refractory chronic prostatitis?
TURP
42
MC nephrotic syndrome in children?
Minimal change disease
43
MC primary nephrotic disease in caucasian males?
membranous nephropathy
44
MC secondary cause of nephrotic disease in adults?
DM
45
Symptoms seen in nephrotic syndrome?
generalized edema, frothy urine, DVT
46
What is the biggest RISK with nephrotic syndrome?
DVT
47
What is the initial test for dx nephrotic syndrome?
UA
48
Fatty casts are seen in what disease?
nephrotic syndrome
49
What is the gold standard test for dx nephrotic syndrome?
24 urine protein > 3.5g/day
50
What is the definitive dx for nephrotic syndrome?
renal biopsy
51
1st Txt for nephrotic syndrome?
glucocorticoids
52
What is the txt for steroid resistant nephrotic syndrome?
Cyclosporine
53
What is used to reduce protein loss in nephrotic syndrome?
ACE or ARBS
54
What causes DVT in nephrotic syndrome?
loss of protein C, S, and antithrombin III
55
What 4 things are seen in nephrotic syndrome?
proteinuria, hypoalbuminemia, hyperlipidemia, edema
56
What 4 things are seen in nephritic syndrome?
hypertension, hematuria (RBC casts), azotemia, proteinuria
57
What is the MC cause of acute glomerulonephritis?
IgA Nephropathy (Berger's dx)
58
Seen after URI or GI infection, due to overproduction of IgA?
Berger's disease
59
Most common seen after group A strep infection?
post-infectious glomerulonephritis
60
2-14y boy w/ facial edema after srep w/ scanty, cola colored dark urine
post-infectious glomerulonephritis
61
Pt presents with acute glomerulonephritis + hemoptysis?
Goodpasture's disease
62
Hallmark for acute glomerulonephritis?
hematuria. (cola or tea colored urine)
63
What is common on PE forglomerulonephritis?
hypertension
64
RBC casts?
acute glomerulonephritis
65
Txt for IgA nephropathy?
ACE inhibitors, +/- Corticosteriods
66
Txt for post-streptococcal AGN?
SUPPORTIVE
67
What is the MC cause of AIN?
Drug hypersensitivity
68
What 4 drugs are related to causing AIN?
NSAIDS, Penicillins, Sulfa drugs, Cephalosporins
69
What symptoms are seen in acute intersitital nephritis?
fever, eosinophilia, maculopapular rash
70
What is seen on UA for acute interstitial nephritis?
WBC casts and EOSINOPHILURIA
71
Txt for AIN?
Remove the offending agent
72
What stain is used for eosinophils in AIN?
Hansel or Wright
73
What type of genetic disorder is PKD?
autosomal dominant disorder
74
What is the patho behind PKD?
vasopressin stimulates cystogenesis
75
What are extrarenal manifestations of PKD?
cerebral "berry" aneurysms, mitral valve prolapse, colonic diverticula
76
DOC for PKD?
renal ultrasound
77
What test should be done after being dx with PKD?
genetic testing
78
Txt for simple PKD cyst?
observation, periodic reevaluation. ACE or ARB
79
Txt for multiple PKD cyst?
supportive, increased fluid intake
80
What are the presenting sx of PKD?
abdominal flank pain, hematuria (YEAP looks a lot like kidney stones!)
81
MC common type of prostate cancer?
adenocarcinoma
82
What is the strongest risk factor for prostate cancer?
age
83
What ethnicity has the highest risk factor for prostate cancer?
African Americans
84
Back or bone pain in prostate cancer indicates?
mets to the bone
85
hard, indurated, nodular, enlarged, asymmetrical prostate?
prostate cancer
86
Most accurate test for prostate cancer dx?
transrectal US guided needle biopsy
87
At what PSA level should a bone scan be done to rule out mets?
>10
88
Adverse effects of prostatectomy?
incontinence & erectile dysfunction
89
Txt for advanced prostate cancer?
hormonal therapy ( orchiectomy/Flutamide + GnRH agonists)
90
T/F screening should be done for prostate cancer?
FALSE
91
MC cause of pyelonephritis?
E.coli
92
Sx of pyelonephritis?
fever, chills, back or flank pain, n/v
93
What is seen on PE for pyelo?
+ CVA tenderness, fever, tachy
94
Wbc cast?
pyelonephritis
95
Definitive dx for pyelonephritis?
urine culture
96
1st Txt for pyelonephritis?
Fluoroquinolones
97
Txt for pyelonephritis in pregnancy?
IV Ceftriaxone
98
Txt for pyelonephritis in pregnancy if allergic to pencillin?
Aztreonam
99
Txt for resistant pyelonephritis out pt?
IV ceftriaxone or gentamicin followed by oral fluoroquinolone
100
MC stone in nephrolithiasis?
calcium oxalate
101
Sx of nephrolithiasis?
sudden, constant upper lateral back or flank pain radiating to the groin, hematuria
102
IOC for nephrolithiasis?
non con CT abdomen & pelvis
103
IOC for pregnant or children in nephrolithiasis?
renal US
104
What 2 stone types are only radiopaque on KUB?
calcium & struvite
105
Txt for kidney stones <5mm?
spontaneous passage
- IV fluids & analgesics
- Tamsulosin
106
Txt for kidney stones >5-10mm?
Extracorporeal shock wave lithotripsy
107
Txt for kidney stones >10mm (1cm) or struvite?
Percutaneous nephrolithotomy
108
Txt for obstructed or at risk kidney stone?
Ureteroscopy w/ or w/o stent
109
Txt for kidney stones >2cm
surgical excision
110
Txt for 1-2cm kidney stones?
lithotripsy (extracorporeal or transurethral)
111
MC cause of painless scrotal swelling?
hydrocele
112
Sx of hydrocele?
dull ache, heavy sensation, translucency
113
TOC for hydrocele?
testicular ultrasound
114
Txt for hydrocele?
none, self-limited
115
A hydrocele puts a patient at risk of what?
hernia
116
What is a communicating hydrocele?
peritoneal/abdominal fluid enters the scrotum via a patent processus vaginalis
117
What is a non-communicating hydrocele?
fluid from mesothelial lining of the tunica vaginalis
118
Where is fluid located in a hydrocele?
fluid located anterior and lateral to the testis
119
MC type of bladder cancer?
transitional cell
120
MC cause of bladder cancer?
smoking
121
What occupation is at risk for bladder cancer?
dyes, leather, rubber (beauticians & auto workers)
122
What medication can cause bladder carcinoma?
Cyclophosphamide
123
MC symptom in bladder cancer?
painless gross hematuria
124
2nd MC symptom in bladder cancer?
dysuria
125
Gold standard for dx bladder cancer?
cystoscopy
126
Preferred dx of bladder cancer?
CT urography
127
Txt for localized or superficial bladder cancer?
transurethral resection of bladder tumor (electrocautery)
128
Txt for invasive bladder cancer?
radical cystectomy
129
Tx for recurrent bladder cancer?
BCG vaccine
130
MC cause of epididymitis <35yr?
Chlamydia trachomatis
131
MC cause of epididymitis >35yr?
E.coli
132
Best initial test for epididymitis?
scrotal ultrasound
133
Txt for epididymitis <35yr?
Doxy (Azithromycin) + Ceftriaxone
134
Txt for epididymitis > 35yr?
Fluoroquinolones
135
IOC for hydronephrosis?
ultrasound
136
Txt for hydronephrosis?
removal of obstruction
137
What is the MC surgically correctable cause of male infertility?
varicocele
138
Where are most varicocele?
left sided
139
Dull ache or heavy sensation in the scrotum?
varicocele
140
What is felt on PE for varicocele?
soft scrotal mass with a "bag of worms" superior to the testicle
141
Initial TOC for varicocele?
ultrasound
142
Txt for varicocele?
observation
| surgery
143
A sudden onset left sided varicocele in an older man may indicate?
renal cell carcinoma
144
MC cause of acute cystitis?
E.coli
145
MC cause of acute cystitis in sexually active women?
Staphylococcus saprophyticus
146
Irritative symptoms of cystitis?
dysuria, frequency & urgency
147
Definitive dx of cystitis?
urine culture
148
1st line txt for acute cystitis?
nitrofurantoin or bactrim
149
2nd line txt for acute cystitis?
Fluroquinolones
150
What med can be used as a bladder analgesic?
Phenazopyridine
151
Sde of Phenazopyridine?
turns the urine orange
152
Txt for complicated UTI?
PO or IV Fluoroquinolones, Aminoglycosides
153
Txt cystitis during pregnancy?
amoxicillin, augmentin, cephalexin
154
What drug should be avoided in the 1st trimester in a woman with acute cystitis?
Trimethoprim-sulfamethoxazole (bactrim)
155
What meds should be avoided in pregnant women with acute cystitis?
Bactrim, Aminoglycosides, Fluoroquinolones, Doxycycline
156
MC type of renal tumor?
clear cell
157
Risk factors for renal cell carcinoma?
smoking, hypertension, obesity, men, dialysis
158
Classic triad of renal cell carcinoma?
hematuria, flank or abdominal pain, palpable abdominal mass
159
MC site of mets for renal cell carcinoma?
Lungs
160
Initial test for dx renal cell carcinoma?
CT
161
Txt for renal cell carcinoma?
radical nephrectomy
162
MC cause of secondary hypertension?
renal artery stenosis
163
MC cause of renal artery stenosis in the elderly?
atherosclerosis
164
Who should renal artery stenosis be suspected in?
HTN resistant on > 3 drugs
Abdominal bruit
Acute kidney injury after initiation of ACE inhibitors
165
Definitive dx for renal artery stenosis?
Renal catheter arteriography
166
Definitive txt for renal artery stenosis?
Revascularization (angioplasty or bypass)
167
When are ACE or ARB contraindicated in renal artery stenosis txt?
w/ bilateral stenosis or in patients with a solitary kidney
168
In chronic kidney disease what is the GFR defined as?
< 60 ml/min
169
MC cause of prerenal failure?
hypovolemia
