Urology/Renal (Alice) Flashcards
1
Q
2 mcc of edema
A
chronic venous insufficiency
DVT
2
Q
swelling of limbs w. thickening of skin post op on the side of the surgery
A
lymphedema
3
Q
surgery mc associated w. lymphedema
A
breast ca
4
Q
rxn to some meds vs inherited d.o that causes fluid to leak out of bv’s into tissues
A
angioedema
5
Q
4 meds commonly associated w. edema
A
oral dm
htn meds
nsaids
estrogens
6
Q
edema around the eyes and lower legs
A
renal dz
7
Q
edema in the legs/abdomen/lungs
A
chf
8
Q
3 sx of edema
A
heavy legs
hyperpigmentation
sob
9
Q
work up for edema
A
low suspicion for dvt: d-dimer
US
ABI
UA
10
Q
tx for edema
A
compression stockings
leg elevation 30 mins, 4x daily
Na restriction
diuretics
11
Q
contraindication for diuretics w. edema
A
chronic venous insufficiency
12
Q
mc type of bladder ca
A
transitional cell carcinoma
13
Q
painless hematuria in a smoker is _ until proven otherwise
A
bladder ca
14
Q
gs dx for bladder ca
A
cystoscopy w. bx
15
Q
tx for bladder ca
A
-endoscopic resection w. cystoscopy q 3 mos
-recurrent or multiple lesions: chemo
16
Q
6 rf for bladder ca
A
smoking
aromatic amines
schistosomiasis
truck drivers
petroleum workers
cyclophosphamide
17
Q
tx for bladder ca
A
stage 0: TURB + chemo
stages II/III: radical cystectomy, lymph node dissection
stage IV: cystectomy + chemo
18
Q
indications for partial cystectomy w. bladder ca
A
suprficial, isolated tumor
apical w. 3 cm margin from any orifices
19
Q
how does bacillus calmette guerin work for bladder ca tx
A
attenuated tb vaccine -> initiates immune response
20
Q
classic sign of urinary retention in elderly pt’s
A
ams
21
Q
what is POUR
A
post op urinary retention
22
Q
rf for POUR
A
spinal anesthesia
epidural anesthesia
23
Q
5 causes of urinary retention
A
obstructive
neurogenic
traumatic
extraurinary
infectious
24
Q
4 obstructive causes of urinary retention
A
stricture
calculi
neoplasm
foreign body
25
4 causes of neurogenic urinary retention
MS
parkinsons
CVA
post op
26
3 traumatic causes of urinary retention
injury to: urethra, bladder, spinal cord
27
3 causes of extraurinary urinary retention
fecal impaction
AAA
rectal/retropeitoneal mass
28
4 causes of infectious urinary retention
abscess
cystitis
genital herpes
zoster
29
7 rf for urinary retention
male
bph
epidural
spinal/prolonged anesthesia
antihistamines
narcotics
pelvic/perineal procedures
30
POUR dx
inability to void w.in 8 h after surgery or 8 h after catheter removal
31
3 complications of urinary retention
infxn
ischemia
long term dysfxn
32
acute urinary retention is (painless vs painful):
chronic urinary retention is:
acute: painful
chronic: painless
33
4 sx of chronic urinary retention
frequent urination of small amt
sensation of fullness
suprapubic dullness
rounded midline mass
34
chronic urinary retention is caused by _ dyssynergia
detrusor muscle
35
5 causes of chronic urinary retention
SCI
MS
obstructive
recurrent UTI/bladder infxns
constipation/encopresis
36
dx of urinary retention is made by _ mL of urine on a PVR
>/= 500 mL
37
tx for urinary retention
catheterization x 24 hr followed by voiding trial
38
tx for detrusor sphincter dyssenergia
botox
surgical incision of bladder neck
39
w. massive bladder distension, how much urine can be drained immediately
1 L
slow drainage of remaining to avoid vasovagal
40
cystitis is characterized by
dysuria w.o urethral discharge
41
6 sx of cystitis
dysuria
urgency
frequency
hematuria
new onset incontinence
malodorous urine
42
gs dx for cystitis
**urine culture:**
women: > 100 k CFU/mL
men or cath pt: > 1,000 CFU/mL
43
tx for cystitis
44
sx of cystitis that are relieved w. voiding
hunner's ulcer on cystoscopy
interstitial cystitis
45
sx of pyelonephritis
dysuria
fever
flank pain
n/v
CVA tenderness
46
tx for pyelonephritis
cipro
levo
cephalexin
toxic/unable to tolerate PO abx/pregnant: ceftriaxone
47
5 indications for hospitalization w. pyelo
persistent fever > 101
persistent pain
inability to take fluids or PO meds
suspected urinary obstruction
unable to adhere to tx
48
definition of recurrent UTI
2 uncomplicated UTI x 6 mos
OR
3 uncomplicated UTIs in the previous year
49
definition of UTI relapse (2)
recurrence of UTI w.in 2 weeks of tx
caused by the same organism
50
refinition of UTI reinfection
recurrent UTI caused by different bacteria
51
which is mc: UTI relapse or reinfection
reinfection
52
UTI prophylaxis
once daily low dose:
nitro vs bactrim vs cephalexin vs cipro
53
2 causes of urethritis
infectious
noninfectious (trauma/foreign body)
54
2 mc pathogens associated w. urethritis
c. trachomatis
n. gonorrhea
55
3 sx of urethritis
discharge
dysuria
pruritis
56
dx for urethritis (4)
**NAAT of first voided urine**
gram stain
UA w.culture
prostate exam
57
tx for urethritis
(-) gonococci: azithro vs doxy
(+) gonococci: azithro PLUS ceftriaxone (tx for gonorrhea and chlamydia)
recurrent: metro vs tinidazole PLUS azithro
58
dysuria
unilateral scrotal pain/swelling
epididymitis
59
mcc of epididymitis: <35 yo vs >35 yo
< 35 yo: chlamydia, gonorrhea
> 35 yo: e.coli
60
what PE sign is associated w. epididymitis
prehn sign: relief w. elevation of scrotum
61
tx for epididymitis
> 35 yo: levofloxacin vs ofloxacin
< 35 yo: doxy PLUS ceftriaxone
62
indicaton to tx sexual partner w. epididymitis
contact w.in 60 days of sx onset
63
sudden onset: f/c, lbp, frequency, urgency, dysuria
prostatitis
64
mcc of prostatitis
< 35 yo: chlamydia, gonorrhea
> 35 yo: e.coli
65
tx for prostatitis
< 35 yo: azithro vs doxy PLUS ceftriaxone
> 35 yo: fluoroquinolones vs bactrim **x 1 month**
66
what tx is contraindicated for prostatitis
prostate exam/massage -> can lead to sepsis
67
3 indications for increased maintenance fluid needs
fever
hyperventilation
increased catabolic rate
68
body fluids are _molar
isomolar
69
when fluid losses from any site amount >/= _ mL, electrolytes should be measured periodically and fluids should be adjusted
1500 mL
70
when should IVF orders be reevaluated
q 24 hr
q 4-6 hr POD 1
71
general maintenance IVF guidelines according to Smarty PANCE
2,000-2,500 mL 5% dex in NS OR in LR daily
72
_ should not be added to IVF in the first 24 post op bc it naturally enters circulation as a result of operative trauma and increased aldosterone
K+
73
fluid loss thru a NGT < _ can be replaced by incvreased maintenance IVF by a similar amt
500 mL/d
74
protocol for IVF potassium replacement
20 mEq K+ added to every L of fluid
75
3 indications for potassium replacement
good urine flow
demonstrated deficiency AFTER pathologic losses
not anticipated to start enteral feeding soon
76
mc type of kidney stone
calcium oxylate
77
urea splitting organism that is the mcc of infected kidney stones
struvite
78
mc location for kidney stone obstruction
UVJ
79
mc tx for kidney stones
lithotripsy
80
gs test for kidney stones
CT abd/pelvis
81
UA finding of kidney stones
RBC
82
pain management for kidney stones
1. toradol
2. morphine
3. opiates - demerol vs dilaudid
4.
83
2 indications for lithotripsy
stones > 6 cm
intractable pain
84
stones < _ mm are likely to pass w. hydration and tamsulosin
5
85
4 types of kidney stone
calcium oxalate
struvite
uric acid
cystine
86
common cause of calcium oxalate stones
hyperparathyroidism
87
pt's w. calcium oxalate stones should avoid _ juice
grapefruit
88
struvite stones are associated w. (3)
chronic UTI
klebsiella
proteus
89
rf for uric acid stones
persistently acidic urine:
excess meat/etoh
gout
90
young boy w. kidney stones probs has what type
cystine
91
gs dx for kidney stones
CT w.o contrast
92
tx for kidney stones
pain management
hydration
abx if UTI
tamsulosin
+/- lithotripsy
93
3 indications for hospitalization w. kidney stones
intractable pain despite oral meds
anuria
renal colic PLUS UTI and/or fever
94
management of renal stones based on size
< 5 mm: usuall spontaneously pass
5-10 mm: probs need elective lithotripsy
> 10 mm: stent vs nephrostomy vs lithotripsy
95
gs management of stones > 10 mm
nephrostomy
96
indication for KUB/IVP w. kidney stones
severe pain
*helps find site of obstruction*
97
pt's w. recurrent kidney stones should maintain a diet restricted in (2)
sodium
protein
98
primary surgical intervention of choice for struvite stones
percutaneous nephrolithotomy
99
UA showing crystals that resemble coffin lids
struvite kidney stones
100
definition of orthostatic hypotn
after a change from supine to standing, drop of:
> 20 mmHg SBP
> 10 mmHg DBP
OR both
101
6 causes of orthostatic hypotn
autonomic dysfxn: DM, age
meds
postprandial
vagal/carotid sinus hypersensitivity
hypovolemia
adrenal insufficiency
102
drugs that can cause orthostatic hypotn (lots!)
etoh
alpha blockers (-zosins)
antidepressants
antihypertensives
antiparkinsonism
antipsychotics
bb
diuretics
muscle relaxants
narcotics
PDE5 inhibitors
sedatives
vasodilators
103
dx for orthostatic hypotn
BP and HR measured after 5 min supine and at 1 and 3 min after standing
104
what may help dx autonomic dysfxn hypotn
tilt table test
105
tx for orthostatic hypotn (3)
increased Na
fludrocortisone
midodrine
106
renal cell carcinoma triad
flank pain
hematuria
palpable abdominal/renal mass
107
most significant rf for renal cell carcinoma
smoking
108
transitional cell carcinoma (mc type of bladder cancer) is aka
urothelial carcinoma
109
what bacteria is associated w. transitional cell carcinoma
schistosoma haematobium
110
mc non cutaneous ca among males
prostate
111
screening guidelines for prostate ca
PSA at 50 yo
40 if AA
112
mc type of prostate ca
adenocarcinoma
113
mc site of metastasis for prostate ca
bone
114
dietary rf vs protective factor for prostate ca
rf: high fat
protective: soy
115
tissue of origin for renal cell carcinoma
renal tubular epithelium
116
pt pop at greatest risk for renal cell carcinoma
AA
117
anemia associated w. renal cell carcinoma
normochromic/normocytic
118
lab finding of renal cell carcinoma
hypercalcemia
119
dx for renal cell carcinoma
CT
bx
120
tx for renal cell carcinoma
radical nephrectomy
121
sites of metastasis for renal cell carcinoma
lung
liver
brain
tumor thrombus to renal vein or IVC
122
syndrome associated w. renal cell carcinoma and liver dz
stauffer's syndrome
123
concern w. adult w. new onset left varicocele
left renal cell carcinoma
*left gonadal vein drains into left renal vein*
124
antihypertensive med contraindicated in pt's w. renal a stenosis
ACEI
125
what is renal a stenosis
narrowing of renal a -> impedes bloodflow to kidney -> causes renovascular htn (secondary htn)
126
PE finding of renal a stenosis
renal a bruit
127
3 sx of renal a stenosis
HTN prior to 30 yo
HTN plus CAD or PVD
htn resistant to 3 or more drugs
128
pt is place on ACEI and all of a sudden develops acute renal failure or sharp rise in BUN/Cr
renal a stenosis
129
dx for renal a stenosis: initial vs gs
initial: US
**gs: renal arteriography**
130
tx for renal a stenosis
-percutaneous transluminal angioplasty (PTA) PLUS stent
-bypass
nephrectomy
131
mcc of renal a stenosis
**atherosclerosis**
other: fibromuscular dysplasia
132
young woman w. htn makes you think
renal a stenosis due to fibromuscular dysplasia
133
2 meds to avoid in pt's w. renal a stenosis
ACEI
K+ sparing diuretics
134
2 tumor markers for testicular ca
bHCG
alpha fetoprotein
135
mc presentation of testicular ca
firm, painless, nontender testicular mass
136
mc solid tumor in men 15-40 yo
testicular ca
137
mc type of testicular ca
seminoma
138
rf for testicular ca
hx of cryptochordism
139
dx for testicular ca
1. bHCG and alpha fetoprotein
2. scrotal US
3. look for mets
140
3 mc sites of metastasis for testicular ca
abdomen
brain
lung
141
definitive tx for testicular ca
orchiectomy
+/- chemo
142
what type of testicular ca is radiosensitive and can be treated w. xrt
seminomatous
143
_ can be used to identify early relapse in testicular ca
alpha fetoprotein
144
what is cryptochordism
failure of testicle to descend into the scrotum
145
t/f: orciopexy as an adult removes the risk of testicular ca
f!
146
tumor marker for testicular ca based on type
nonseminomatous: (+) AFP and/or bHCG
seminomatous: +/- AFP positive
147
what 2 types of testicular ca almost never have an elevated AFP
choriocarcinoma
seminoma
148
what type of testicular ca almost always has elevated bHCG
choriocarcinoma
149
major s.e of retroperitoneal lymph node dissection
ED
150
stages of ckd
1: GFR >/= 90
2. GFR 60-89
3. GFR 30-59
4. GFR 15-29
5. GFR < 15
151
2 major rf for ckd
dm
htn
152
t/f: ckd is an independent rf for cvd
t!
153
7 lab findings of ckd
elevated SCr x 3+ mos
GFR < 60 x 3 + mos
persistent proteinuria
anemia
hyperK
hyperphos
hypoCa
154
UA finding of CKD
broad waxy casts
155
acid/base effect of ckd
metabolic acidosis
high anion gap
156
US findings of ckd
symmetrically small echogenic kidneys
157
target bp for ckd pt's
< 130/80
158
indication for ckd referral to nephrology
stage 3+
159
dietary management of ckd (4)
protein restriction 0.6-0.8 g/day
sodium 2 g/day
K+ restriction
phos restriction
160
indication for kidney transplant w. ckd
dialysis
ckd 5
161
t/f: most pt's w. ckd will die from cvd before receiving transplant
t!
162
hemodialysis requires a vein > _ mm
the _ vein is ideal for this
5 mm
cephalic
163
classic hemodialysis access fistula
radial a to cephalic vein (cimino fistula)
164
2 problems with prosthetic dialysis grafts (used when autogenous fistulas are difficult)
poor patency
high risk for infxn
165
common second line autogenous fistula formation (preferred over prosthetic graft)
transposing basilic vein to the subcutaneous tissue
166
all veins used for dialysis require _ (2) prior to cannulization
dilation
arterialization of the wall
167
flow rates of at least _ are required for dialysis
300 cc/min
168
2 complications of newly created dialysis AV access
arterial steal
distal extremity ischemia
169
gs imaging for peripheral AVM
MRI
170
imaging used to help w. AV fistulas for dialysis
angiography
171
4 indications for dialysis
uremic sx
GFR < 10
fluid overload unresponsive to diuretics
refractory hyperkalemia
172
4 uremic sx
pericarditis
encephalopathy
GI
azotemia
173
2 types of dialysis
hemodialysis
peritoneal
174
acquired thru an AV fistula or prosthetic graft
hemodialysis
175
dialysis instilled into peritoneal cavity thru an indwelling catheter
peritoneal dialysis
*peritoneal membrane is the dialyzer*
176
3 complications of hemodialysis
infxn
thrombosis
aneurysm
177
how often is hemodialysis performed
3-5 x/week
3-5 hr/session
178
complications of peritoneal dialysis
peritonitis: n/v, abd pain, diarrhea, constipation, fever
179
mc renal tumor in kids
wilms
180
mc presentation of wilms tumor
palpable abdominal mass that does not cross the midline
181
4 sx of wilms tumor
elevated renin -> htn
fever
hematuria
anemia
182
imaging to r.o mets w. wilms tumor
CXR
183
wilms tumor is same same
nephroblastoma
184
pt pop mc affected by wilms tumor
otherwise healthy kids < 4 yo
:(
185
2 rf for wilms tumor
fam hx
horseshoe kidney
186
4 conditions associated w. wilms tumor (nephroblastoma)
**wagr:**
wilms tumor
aniridia
GU anomalies (horseshoe kidney)
retardation
187
dx for wilms tumor/nephroblastoma (4)
US
CT
bx
CXR
188
never do _ when you suspect wilms tumor
palpate the abdomen
*increases risk of rupturing encapsulated tumor*
189
tx for wilms tumor
surgical resection
chemo
190
classic hpi for wilms tumor
parents found when dressing or bathing kid
191
umbilical defect
macroglossia
gigantism
visceromegaly
beckwith wiedemann syndrome
