B5-082 CBCL Hematuria Flashcards
(146 cards)
1
Q
cubiform clot is likely from the
A
bladder
2
Q
vermiform clot is likely from the
A
upper urinary tract
3
Q
hematuria at the start of urination may indicate
A
urethral/prostate issue
4
Q
hematuria at termination of urination may indicate
A
bladder neck issue
5
Q
oxidation of the indicator strip can be caused by
3
A
hematuria
myoglobin
providone-iodine antiseptics
confirm on centrifuged mid stream urine
6
Q
definition of microscopic hematuria
A
greater than 3 RBC/hpf
7
Q
standard work up of gross hematuria
A
- cystoscopy
- CT urogram or MR urography
- cytology
8
Q
standard workup of microscopic hematuria depends heavily on
2
A
H&P
risk stratification
9
Q
if a patient with microscopic hematuria is determined to be low risk
A
repeat urinalysis in 6 months
or cystography/US
10
Q
if a patient with microscopic hematuria is determined to be intermediate risk
A
cystoscopy and renal US
11
Q
if a patient with microscopic hematuria is determined to be high risk
A
cystoscopy and CT urogram
12
Q
factors that differentiate low risk vs high risk microscopic hematuria
4
A
- age
- smoking status
- number of RBC/hpf
- relevant history
13
Q
abnormal urinalysis after strenous exercise
A
exercise induced hematuria
non glomerular medical
14
Q
- gross hematuria, CT shows filling defect
- flank pain, AA, analgesic abuse, diabetes
A
papillary necrosis
non glomerular medical
15
Q
- renal stones on CT, IVP showing pathopneumonic brush stroke papilla
- flank pain, recurrent UTIs, urolithiasis
A
medullary sponge kidney
non glomerular medical
16
Q
family history of renal cystic disease
A
PKD
non glomerular medical
17
Q
- renal artery embolus, vein thrombus, AV fistula
- a fib, dehydration, bruit
A
renovascular disease
non glomerular medical
18
Q
- urine dipstick + for nitrates, positive urine culture, leukocytosis
- dysuria, fever
A
UTI
non glomerular surgical
19
Q
- CT scan demonstrating stone, hydronephrosis
- flank/groin pain, nausea/vomiting, fever
A
urolithiasis
non glomerular surgical
20
Q
- demonstrated on CT, cystoscopy, ureteroscopy
- constitutional symptoms, blood clots, pain
A
urologic malignancy
non glomerular surgical
21
Q
- enlarged prostate on DRE
- obstructive urinary symptoms
A
BPH
non glomerular surgical
22
Q
- friable tissue on cystoscopy
- history of pelvic radiation
A
radiation cystitis
non glomerular surgical
23
Q
- demonstrated on retrograde urethrogram
- obsructive urinary
A
urethal stricture
non glomerular surgical
24
Q
does anticoagulation therapy cause denovo hematuria?
A
no
however, can worsen it
25
if a dipstick is positive, must be confirmed with
microscopic analyisis of urine
26
chemotherapy that can cause hematuria
| 2
* mitotane
* cyclophosphamide
27
common risk factors for urinary tract malignancy in patients with microscopic hematuria
* over 35 years old
* analgesic abuse
* exposure to benzenes or aromatic amines
* male
* smoking
* history of irritation to GU tract
28
upper tract imaging of choice
CT urogram
29
lower urinary tract test of choice
cystoscopy
30
patients that catheterize themselves or elderly women may have
asymptomatic bacteriuria
| colonization
31
infection associated with anatomical/functional abnormality of the urinary tract, immunocompromised host, or MDR bacteria
complicated UTI
32
type P fimbriae is most commonly associated with
pyelonephritis
33
pathogen commonly causing UTIs in women of childbearing age
staph. sapro
34
best way to assure your getting urine from the bladder for urinalysis
catheterization
35
greater than 10 WBC/hpf is most sensitive for
| pyuria
UTI
36
management of uncomplicated UTI
nitrofurantoin x 5 days OR
TMP/SMX x 3 days
37
nitrofurantoin should not be used to treat
complicated UTI
38
how long should complicated UTI be treated for?
2 weeks
39
most common type of stone
calcium oxalate
40
precipitates with hypocitraturia
calcium oxalate
41
stone shaped like envelope or dumbbell
calcium oxalate
42
what stones can results from ethylene glycol, vitamin C over use, hypocitriuria, or malabsoprtion
calcium oxalate
43
treatment for calcium oxalate stones
* increase fluids
* decrease urinary calcium
* increase citrate
44
what stones form in acidic urine at a pH less than 6?
uric acid
45
rhomoid or rosette stones
uric acid
46
what stones are associated with a high protein diet, hyperuricemia (gout) hyperuricosuria, insulin resistance, leukemia
uric acid
47
treatment for uric acid stones
alkalization of urine
48
what type of stones are caused by urease-producing organisms
struvite
49
proteus causes
struvite stones
50
staghorn calculi
struvite stones
51
treatment of struvite stones
surgical removal and agressive treatment of infection
52
does E. coli produce urease?
no
53
* form in alkaline urine
* usually associated with metabolic disorders
calcium phosphate
54
treatment of calcium phosphate stones
manage underlying disorder
55
caused by AR disease cystinuria
cystine stones
56
in cystinuria, what 4 amino acids are unable to be transported normally?
* Cystine
* Ornithine
* Lysine
* Arginine
| COLA (all dibasic)
57
cystine stones appear in patients that are [...] for the recessive gene
homozygous
58
hexagonal cystals
cystine
59
wedge-shaped prism stone
calcium phosphate
60
treatment for cystine stones
* alkalization of urine
* Thiola (breaks disulfide bonds)
61
symptoms of urolithiasis
* colicky flank pain
* nausea, vomiting
* CVA tenderness
* hematuria
62
gold standard imaging for urolithiasis
non contrast CT scan
63
expectant management of urolithiasis
* pain control with NSAIDs
* tamsulosin (alpha blocker)
* observe for 2-4 weeks
64
2 options for urgent surgical intervention of urolithiasis
* stent
* percutaneous nephrostomy tube
65
why is treatment of the stone contraindicated in infection?
breaking the stone can release bacterial endotoxins
66
oral dissolution therapy works for which type of stones?
uric acid
67
any patients with recurrent stones warrants
metabolic workup
68
high serum calcium in a patient with recurrent stone can indicate
hyper PTH
69
increase in number of prostatic stromal and epithelial cells in the transition zone
BPH
70
what zone of the prostate surrounds the urethra?
transition zone
71
storage symptoms of BPH
* Frequency
* Urgency
* Nocturia
| FUN
72
empyting symptoms of BPH
* Weak stream
* Intermittent flow
* Straining to urinate
* incomplete Emptying
| WISE
73
mainstain drug therapy for BPH
alpha blocker
| -osins
74
gold standard for surgical treatment of BPH
TURP
75
cancers arising from parenchymal cells of urinary tract
RCC
76
risk factors for RCC
smoking
obesity
HTN
77
"enhancing renal mass" on CT
RCC
78
VHL gene
von-Hippel Lindau disease
| familial RCC
79
c-MET protooncogene
hereditary papillary RCC
| familial RCC
80
most common type of RCC
clear cell
81
cell of origin- PCT
| 2
* clear cell RCC
* papillary RCC
82
clear cell RCC is associated with [...] syndrome
von Hippel Lindau
83
most likely RCC to be multifocal
papillary
84
syndromes associated with papillary RCC
| 2
hereditary papillary RCC
familial leiomyomatosis
85
cell of origin- distal tubule/collecting duct
chromophobe RCC
| less aggressive
86
associated syndrome with chromophobe RCC
Birt-Hogg Dube
87
folliculin
chromophobe RCC
88
* oncocytomas
* fibrofolliculomas
* pulmonary cysts
* spontaneous pneumothoraces
chromophobe RCC
89
* retinal angiomas
* hemangioblastomas
* pheochromocytoma
* renal cysts
clear cell RCC
90
fumerate hydratase
familial leiomyomatosis
91
* Type II RCC
* cutaneous leiomyomas
* uterine fibroids
familial leiomyomatosis
92
# what stage of RCC
tumor within capsule
stage 1
93
# what stage of RCC
tumor invasion of perinephric fat
stage 2
94
# what stage of RCC
tumor involvement of regional lymph nodes and/or renal vena cava
stage III
95
# what stage of RCC
tumor involvement of adjacent organs or distant metastases
stage IV
96
# what treatment is indicated for this stage RCC
T1: small and localized
surveillance vs ablation vs partial nephrectomy
97
# what treatment is indicated for this stage RCC
T1a/T2: larger and localized
partial vs radial nephrectomy
98
# what treatment is indicated for this stage RCC
T3: locally advanced
radical nephrectomy
99
# what treatment is indicated for this stage RCC
T4M1
systemic therapy
100
cell of origin- renal papillae
renal medullary carcinoma
101
associated syndrome with renal medullary carcinoma
sickle trait
102
major risk factor for urothelial carcinoma
**smoking**
solvent exposure
103
most common site of urothelial carcinoma
bladder
104
diagnosis of **bladder** urothelial carcinoma
cystoscopy and resection
105
treatment of non-invasive low grade bladder urothelial carcinoma
resection/observation
| T1/T2
106
treatment of non-invasive high grade bladder urothelial carcinoma
intravesical therapy
BCG
| T1/T2
107
treatment of invasive or locally advance bladder urothelial carcinoma
| T2/T3
chemotherapy
radical cystectomy
108
treatment of T4 bladder urothelial carcinoma
chemotherapy
109
associated with Lynch syndrome (MLH1 MSH2)
upper tract UC
| colon cancer
110
management of low grade upper tract UC
endoscopic resection
111
management of high grade distal ureter UC
distal ureterectomy with reimplant to bladder VS
radical nephrourectomy
112
management of high grade upper ureter or renal pelvis upper tract UC
radical nephroureterectomy
113
renal masses are [...] until proven otherwise
RCC
114
most malignant causes of hematuria have
| symptoms
no other symptoms
115
[..] % of microscopic hematuria and
[...] % of gross hematuria are due
to a malignant cause
5% micro
25% gross
116
a UTI is considered complicated in what patient populations?
* immunocompromised
* males
* pregnancy
* diabetes
* sepsis
117
which patient population should be treated for asymptomatic bacturia?
pregnancy
118
are males or females at an increased risk of urologic malignancy?
males
119
risk factors of urologic malignancy in asymptomatic microscopic hematuria
| 4
* advancing age (>35)
* chronic inflammation (UTIs)
* prior radiation
* smoking
120
risk factors for RCC
* genetic mutations
* hypertension
* obesity
* smoking
| NOT age
121
the risk of malignancy with a solid enhancing renal mass is
80%
122
cell of origin for renal medullary carcinoma
papillae
123
cell of origin for chromophobe RCC
DCT
124
cell of origin for clear cell and papillary RCC
PCT
125
Lynch syndrome is associated with
upper tract UC
126
which type of cancer often causes obstruction, flank pain, and hematuria?
upper tract UC
127
which mutations are associated with Lynch syndrome?
MSH2
MLH1
| **upper tract UC**
128
sickle cell trait is associated with which cancer type?
renal medullary carcinoma
129
folliculin
Birt-Hogg Dube
| chromophobe RCC
130
c-Met
hereditary papillary RCC
| papillary RCC
131
TSC1
angiomyoplipomas
| benign renal tumors
132
VHL
clear cell RCC
133
43-68% of all microscopic hematuria cases are found to be caused by
idiopathic
134
before preceeding with upper tract imaging, what lab value should be obtained?
serum Cr
| assess renal function
135
type 1 RTA is associated with what kind of stones?
calcium phosphate
136
indications for urgent stone management
| 3
* fever
* UTI
* obstruction
137
cysteine is more soluble in [...] urine
alkaline
138
cysteine stones are caused by an [...] disorder
| mode of inheritance
autosomal recessive
139
perfect hexagon crystal
cysteine
140
the only clinical manifestation of cysteinuria is
urolithiasis
141
treatment of recurrent UTI in postmenopausal women with vaginal atrophy
estrogen
142
next best step in management for a patient with urinary retention due to BPH
catheterization
143
a [...] is required for work-up of suspected BPH
urinalysis
144
most common place to find prostate cancer
peripheral zone
145
[...] zone hyperplasia leads to increased resistance and outlet obstruction
transition
146
indications for treatment of BPH
| 4
* recurrent UTIs
* gross hematuria
* bladder stones
* acute urinary retention
