Urology and Renal Flashcards by Lindsey Dutton

What are the average values for HCO3, pH and CO2

HCO3: 20-26
pH: 7.35-7.45
CO2: 35-45

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what is the presentation of bladder carcinoma

painless hematuria in a smoker

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what is the most common type of bladder carcinoma

transitional cell carcinoma

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what is the gold standard initial diagnostic test for bladder carcinoma

cystoscopy with biopsy

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what is the treatment of bladder carcinoma

surgery, biological therapy, and chemo

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what is CKD

progression of ongoing loss of kidney function (GFR) or presence of kidney damage

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what is the presentation of kidney damage

proteinuria - urinary albumin excretion

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what are etiologies of CKD

DIabetes
HTN
chronic GN
interstitial nephritis, PKD, obstructive uropathy

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what are broad waxy casts a sign of

chronic renal failure

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what is the treatment of CKD

key to slow the progression
- ACEi/ARBs
- managing comorbiditis (HTN, glycemic control, cholesterol control, tobacco cessation)
- maintain hemoglobin at 11-12
- dietary management
- pneumococcal vaccination

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what is the presentation of UTI

pain with urination, foul smelling urine, frequent urination

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what is the presentation of pyelonephritis

pain with urination, fever, chills

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whatis the presentation of urethritis

pain with urination, frequent urge to urinate, pain during intercourse

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what is the presentation of urolithiasis/nephrolithiasis

pain with urination, sharp pain, flank pain

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what is the most common cause of edema

chronic venous insufficeincy

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what is lymphedema

surgical removal of lymph notes for tx of cancer can cause swelling of a limb(s) with thickening of skin on the side of surgery

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what are symptoms of edema

sensation of “heavy legs”, itching, and pain
hyperpigmentation, stasis dermatitis, lipodermatosclerosis, atrophie
icreased size of abdomen (with ascites)
difficulty breathing (with chest edema)

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what electrolyte disorder presents with peaked T waves

hyperkalemia

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what electrolyte disorder presents with flattened T waves, U waves

hypokalemia

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what electrolyte disorder presents with long QT

hypocalcemia

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what electrolyte disorder presents with short QT

hypercalcemia

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what electrolyte disorder presents with tall T waves

hypomagnesemia

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what electrolyte disorder presents with prolonged PR interval widened QRS

hypermagnesemia

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what electrolyte disorder presents with low urin sodium and polyuria

diabetes insipitus

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how is hyponatremia defined

plasma sodium concentration less than 135mEq/l

how is hypernatremia defined

plasma sodium concentration greater than 145 mEq/L

what is the presentation of nephrolithiasis

colicky flank pain radiating to the groin, hematuria, CVA tenderness and N/V

what is the gold standard diagnostic test for nephrolithiasis

CT scan (spiral CT) without contrast of abdomen and pelvis

what are the types of nephrolithiasis (4)

- calcium oxalate (MC) - struvite - Uric acid - cystine

what are the general treatment measures for nephrolithiasis

analgesia vigorous fluid hydration abx alpha-blocker therapy (Flomax)

How is orthostatic hypotension classified

drop of >20 mmHg systolic, 10mmHg diastolic, 15BPM increase in pulse 2-5 minutes after change from supine to standing

what is the presentation of renal cell carcinoma

hematuria frlank pain abdominal mass (palpable)

what are the types of RCC

renal clear cell (MC) transitional cell

what is the risk factor for RCC

Smoking

how is RCC diagnosed

US or CT then biopsy

what is the treatment for RCC

surgery with radical nephrectomy - curative

what is renal vascular disease

narrowing of one or both of the renal arteries

what causes renal artery stenosis

atherosclerosis or fibromuscular dysplasia

how is renal vascular disease diagnosed

US = first imaging in age < 60 Renal arteriography = GS

what is the treatment of renal artery stenosis

percutaneous transluminal angioplasty (PTA) + stent placement or with surgical bypass of stenotic segment

what is the presentation of testicular carcinoma

firm, painless, non-tender testicular mass and feeling of heaviness in the scrotum

what is the most common type of testicular carcinoma

seminoma

what are risk factors for testicular carcinoma

cryptorchidism

how is testicular carcinoma diagnosed

US tumor markers: AFP, betaHcg

what is POUR

postoperative urinary retnetion

what are obstructive causes of urinary retnetion

urethral stricture, bladder calculi or neoplasm, FB

what is are neurogenic causes of urinary retention

MS, parkinsons, CVA, post op retention

what are traumatic causes of urinary retention

urethral, bladder or spinal cord injury

what are the extraurinary cause of urinary retention

fecal impaction, AAA, rectal or retroperitoneal mass

what are infectious causes of urinary retention

local abscess, cystitits, genital herpes, zoster

what are risk factors for acute urinary retention

male, prostatic enlargement, epidural, spinal or prolonged anesthesia, antihistamine and narcotic use

what is detrusor sphincter dyssyynergia

consequence of neurological pathology: SCI or MS urethral sphincter muscle dyssynergically contracts during voiding causing the flow to be interrupted and bladder pressure to rise

what is Wilms Tumor

child with painless, unilateral abdominal mass with no other signs/symptoms, also known as neuroblastoma

A 55-year-old woman presents to the clinic with bilateral lower extremity edema that has progressively worsened over the past two months. She has a history of hypertension and type 2 diabetes mellitus. On examination, her blood pressure is 150/90 mmHg, and she has pitting edema up to her mid-shins. Laboratory tests reveal serum creatinine of 1.8 mg/dL (baseline 1.2 mg/dL), albumin of 3.0 g/dL, and urine dipstick positive for protein. Which of the following is the most likely cause of her edema? A Venous insufficiency B Congestive heart failure C Nephrotic syndrome D Lymphatic obstruction E Hypothyroidism

c. nephrotic syndrome

A 65 year-old male with a 60 pack-year smoking history presents with painless hematuria for two days. He also complains of frequency and dysuria. He denies a history of recent upper respiratory tract infection. Which of the following is the most likely diagnosis? A Bladder cancer B Wegener's granulomatosis C IgA nephropathy D Benign prostatic hypertrophy

a. bladder cancer

Which of the following is most frequently associated with bladder cancer? A Hematuria B Dysuria C Urgency D Frequency

a. hematuria

A 48 year-old female presents to the clinic complaining of hematuria. The patient states that she was found to have hematuria during an insurance physical examination. The patient denies dysuria or frequency. She also denies pain in the abdomen, flank or meatus. She denies any history of previous nephrolithiasis. Urinalysis reveals the urine to be yellow and slightly hazy with a positive dipstick for hemoglobin. Microscopic reveals 5-7 RBCs/HPF without WBCs, bacteria, casts, or crystals. What is the next diagnostic study this patient should undergo? A CT urography B Intravenous pyelogram C Abdominal ultrasound D Cystoscopy

a. CT urography

What is TURB

transurethral resection of the bladder

A 68-year-old man presents to the emergency department with acute urinary retention. He has a history of benign prostatic hyperplasia (BPH) and hypertension. He denies fever, back pain, or lower abdominal pain. His medications include tamsulosin and amlodipine. On examination, his abdomen is soft, non-tender, and a palpable bladder is noted. Digital rectal examination reveals an enlarged, non-tender, and firm prostate. Which of the following is the most appropriate initial management? A Oral antibiotics B Immediate cystoscopy C Bladder catheterization D Intravenous fluids E Prostate-specific antigen (PSA) testing

c. bladder catheterization

what is cystitits and what is the most common etiology

infection of the bladder characterized by dysuria without urethral discharge E.coli is the most common

what is the presentation of cystitis

dysuria, urgency, frequency, hematuria, new onset incontinuence, abdominal/suprapubic pain, abscence of fever, chills or flank pain

how is cystitis diagnosed

urine dipstick: nitrite, leukocyte esterase UA: pyuria, bacteriumia CBC: lenuocytotis Urine Culture: GS blood cultures

what is the treatment of cystitis

Nitrofuratoin, bactrim, or fosfomycin

what is the tx of postcoital UTI

single dose TMP-SMX or cephalexin may reduce freqnecy of UTI in sexually active women

what is the treatment of Lower UTI in pregnancy

Nitrofurantoin (macrobid): 100mg PO BID x 7days Cephalexin (Keflex): 500mg PO BID x 7d days

what is the presentation of pyelonephritis

dysuria + fever + flank pain + N/V + CVA tenderness

what is the etiology of Pyelonephritis

E. coli

what is the treatment of pyelonephritis

oral considered best initial outpt treatment Cipro Levofloxacin Cephalexin

when are IV abx indicated for pyelonephritis

In pts who are toxic or unable to tolerate oral abx Ceftriaxone 1g IV once daily

what is the management of pyelonephritis in pregnant women

Hospital admission for parenteral antibiotics IV/IM ceftriaxone

how is recurrent UTI defined

Two uncomplicated UTIs in 6 months OR 3+ uncomplicated UTIs in the previous year

what is inflammation of the urethra caused by infectious or noninfectious causes (trauma, FB)

Urethritis

what are the common etiologies of urethritis

C. trachomatis, N. gonorrhoeae, trichomonas, vaginalis

how is urethritis diagnosed

NAAT of first voided urine (Nucleic acid amplification test)

what is the presentation of epididymitis

dysuria, unilateral scrotal pain and swelling

what is a positive prehn's sign

relief with elevation of scrotum is a classic sign

what presents as onset of fever, chills and lwoer back pain combined wtih urinary frequency, urgency and dysuria

prostatitis

A 21-year-old female with type one diabetes mellitus presents with a 3-day history of nausea, dysuria, and urinary frequency. On examination, there is suprapubic tenderness and costovertebral angle tenderness on the left, and urinalysis shows pyuria and bacteriuria. The patient is admitted to the hospital for management. What is an appropriate treatment for this patient pending culture results? A PO ciprofloxacin for 3 to 5 days B IV ceftriaxone for 7 to 14 days C PO amoxicillin for 7 to 14 days D IV ciprofloxacin for 3 to 4 days

b. IV ceftriaxone for 7-14 days

A 37-year-old female with a history of type II diabetes mellitus presents to the emergency department complaining of blood in her urine, left-sided flank pain, nausea, and fever. She also states that she has pain with urination. Vital signs include: temperature is 102 deg F (39.4 deg C), blood pressure is 114/82 mmHg, pulse is 96/min, respirations are 18, and oxygen saturation of 97% on room air. On physical examination, the patient appears uncomfortable and has tenderness on the left flank and left costovertebral angle. Which of the following is the next best step in management? A Obtain an abdominal CT scan B Obtain blood cultures C Obtain a urine analysis and urine culture D Begin intravenous treatment with ceftazidime E No treatment is necessary

c. obtain UA and culture

A 55-year-old woman undergoes a total abdominal hysterectomy. Postoperatively, she is stable but requires fluid replacement. Her serum sodium is 138 mEq/L, potassium is 4.0 mEq/L, and creatinine is 1.0 mg/dL. She weighs 70 kg. Which of the following is the most appropriate choice for postoperative fluid replacement? A 0.9% Normal Saline at 125 mL/hour B 5% Dextrose in Water (D5W) at 125 mL/hour C Lactated Ringer's solution at 125 mL/hour D 3% Hypertonic Saline at 125 mL/hour E 0.45% Half Normal Saline at 125 mL/hour

c. LR solution at 125mL/hr

A patient with the following ABG has what type of acid-base disorder? ph 7.52, PCO2 25, Bicarb 22 PH (7.35-7.45 normal) CO2 (35-45 normal) HCO3 (20-26 normal) A Respiratory acidosis B Respiratory alkalosis C Metabolic acidosis D Metabolic alkalosis

b. respiratory alkalosis

A patient with the following ABG has what type of acid-base disorder? ph 7.52, PCO2 40, Bicarb 38 PH (7.35-7.45 normal) CO2 (35-45 normal) HCO3 (20-26 normal) A Respiratory acidosis B Respiratory alkalosis C Metabolic acidosis D Metabolic alkalosis

d. metabolic alkalosis

A patient with the following ABG has what type of acid-base disorder? ph 7.30, PCO2 60, Bicarb 22 PH (7.35-7.45 normal) CO2 (35-45 normal) HCO3 (20-26 normal) A Respiratory acidosis B Respiratory alkalosis C Metabolic acidosis D Metabolic alkalosis

a. respiratory acidosis

A patient with the following ABG has what type of acid-base disorder? ph 7.30, PCO2 40, Bicarb 16 PH (7.35-7.45 normal) CO2 (35-45 normal) HCO3 (20-26 normal) A Respiratory acidosis B Respiratory alkalosis C Metabolic acidosis D Metabolic alkalosis

c. metabolic acidosis

Patients with recurrent urinary stone disease should be educated to maintain a diet restricted in A sodium and protein B carbohydrates and fat C bran D fluids

a. sodium and protein ## Footnote Increased sodium intake will increase sodium and calcium excretion and increase monosodium urate saturation. Protein also increases calcium, oxalate and uric acid excretion. All these factors can lead to stone formation.

A 38 year-old female presents with right flank pain for several days, shaking chills, fever to 102°F, and general malaise. The flank pain has been intermittently severe, and she has a history of kidney stones. Urinalysis reveals 3+ red blood cells, 3+ leukocyte esterase, trace protein and negative glucose. Which of the following findings would most likely be seen on a renal ultrasound? A Small echogenic kidneys B Cysts C Hydronephrosis D Capsular hemorrhage

c. hydronephrosis

A 32 year-old female patient presents with renal colic and hematuria. The patient has a long-standing history of unresponsive treatment for urinary tract infections with documented Proteus species. Urinalysis reveals crystals resembling coffin lids. KUB reveals a staghorn calculus in the right kidney. Which of the following is the best clinical intervention? A High fluid intake with a low salt diet B A low purine diet C Laser lithotripsy D Percutaneous nephrolithotomy

d. percutaneous nephrolithotomy ## Footnote Percutaneous nephrolithotomy is currently the primary surgical intervention of choice for struvite stones.

The most effective preventive strategy to prevent recurrence of renal lithiasis is which of the following? A increase in hydration B early treatment of urinary tract infection C limitation of calcium intake D use of probenecid

a. increase in hydration

Which of the following is the most common composition of kidney stones? A calcium oxalate B uric acid C struvite D calcium phosphate

a. calcium oxalate

A 40 year-old patient with a history of recurrent kidney stones presents with acute onset of right flank pain and hematuria. The patient is afebrile and pain is poorly controlled on oral medications. On CT scan a 1 cm stone is noted in the renal pelvis. Which of the following is the most appropriate intervention for this patient? A Antibiotics B Shock wave lithotripsy C Ureterolithotomy D Fluid hydration

b. shock wave lithotripsy

A 54-year-old man comes to the urgent care because he was awoken suddenly from his sleep this morning with severe left flank pain radiating to his left testicle with associated nausea and vomiting. He is afebrile and vital signs are normal. He is constantly moving to find a comfortable position. On physical examination, left flank tenderness is noted with no direct testicular tenderness. Urinalysis reveals a pH of 5.5 and microscopic hematuria, but is otherwise unremarkable. Which of the following is the most likely diagnosis? A Acute epididymitis B Appendicitis C Diverticulitis D Nephrolithiasis

D. Nephrolithiasis

what is a characteristic symptom of renal calculi?

flank pain radiating toward the bladder

Which of the following factors is most commonly associated with the development of orthostatic hypotension in elderly individuals? A Autonomic dysfunction due to aging and comorbid conditions like diabetes mellitus B Increased physical activity and exercise C High dietary salt intake D Hyperthyroidism E Chronic use of decongestant medications

a. autonomic dysfunction due to aging and comorbid conditions like DM

A 65-year-old woman presents with recurrent episodes of dizziness and near-fainting, especially when standing up quickly. To confirm the diagnosis of orthostatic hypotension, which of the following is the most appropriate next step? A Tilt table test B 24-hour ambulatory blood pressure monitoring C Measurement of serum electrolytes D Orthostatic vital signs measurement E Echocardiogram

d. orthostatic vital signs measurement

A patient diagnosed with orthostatic hypotension due to autonomic dysfunction is experiencing frequent dizziness and lightheadedness. What is the most appropriate initial treatment for this patient? A Increase fluid and salt intake B Start beta-blocker therapy C Prescribe fludrocortisone D Initiate high-dose diuretic therapy E Begin regular use of compression stockings

a. increase fluid and salt intake

Which clinical feature is most frequently associated with renal cell carcinoma? A Hematuria B Flank pain C Hypocalcemia D Fever E Weight loss

a. hematuria

A 60-year-old female with no significant past medical history presents with flank pain and a recent onset of anemia. Imaging studies reveal a solid mass in her right kidney. What is the most appropriate next step in the evaluation of this mass? A Renal biopsy B Urine cytology C CT scan of the abdomen and pelvis with contrast D MRI of the abdomen E Serum creatinine level

c. CT scan of abdomen and pelvis with contrast

A 65-year-old man is diagnosed with localized renal cell carcinoma in the left kidney. He has no metastases and normal renal function. What is the most appropriate initial treatment for this patient? A Systemic chemotherapy B Targeted therapy with tyrosine kinase inhibitors C Radiation therapy D Active surveillance E Radical nephrectomy

e. radical nephrectomy

A 55-year-old man with a history of smoking and hyperlipidemia presents with sudden onset of severe hypertension and a decrease in renal function. He also reports episodic flank pain. Which of the following is the most likely diagnosis? A Acute glomerulonephritis B Renal artery stenosis C Chronic kidney disease D Renal cell carcinoma E Pyelonephritis

b. renal artery stenosis

A 62-year-old woman with uncontrolled hypertension despite multiple antihypertensive medications undergoes evaluation for secondary causes. On physical examination, a bruit is heard over the right upper quadrant of the abdomen. What is the most appropriate diagnostic test to confirm the suspected diagnosis of renal artery stenosis? A Renal ultrasound with Doppler B CT angiography of the renal arteries C Magnetic resonance angiography (MRA) of the renal arteries D Renal biopsy E 24-hour urine collection for metanephrines

b. CT angiography orf renal arteries

A 70-year-old man is diagnosed with renal artery stenosis after presenting with difficult-to-control hypertension and an abdominal bruit. His renal function is stable. What is the most appropriate initial management for this patient? A Medical management with antihypertensive medications B Immediate surgical revascularization C Percutaneous transluminal renal angioplasty with stenting D Chronic dialysis E Nephrectomy

a. medical management with antihypertensive medications

A 51-year-old man with diagnosed renal artery stenosis presents with elevated BUN and creatinine levels and has recently been diagnosed with hypertension. Which antihypertensive medication should be avoided in this patient? A Hydrochlorothiazide-Triamterene B Prazosin C Nifedipine D Verapamil E Furosemide

A. hydrochlorothiazide-triamterene

Which of the following is the most appropriate intervention for a stage I testicular seminoma? A Watchful waiting B Chemotherapy initially C Orchiectomy and radiation D Orchiectomy and chemotherapy

c. orchiectomy and radiation

Which of the following increases the risk of developing testicular cancer? A Low socioeconomic status B History of cryptorchidism C Multiple episodes of epididymitis D Being of African-American ethnicity E Frequent bicycling

b. hx of cryptorchidism

A 23-year-old male presents with a hard mass on the testicle. There has been no previous infection or trauma to the area. Which of the following is the initial diagnostic evaluation to pursue? A Serum alpha fetoprotein levels (AFP) B Serum human chorionic gonadotropin hormone (HCG) C Computed tomography (CT) scan of the abdomen and pelvis D Testicular ultrasound E Magnetic resonance imaging (MRI) of the scrotum

d. testicular ultrasound

A 28-year-old man visits the clinic for his annual check-up following successful treatment for testicular cancer with an orchiectomy two years prior. Which tumor marker is most effective for detecting an early recurrence of testicular cancer? A Carcinoembryonic antigen (CEA) B Prostate specific antigen (PSA) C CA 125 glycoprotein D Alpha fetoprotein (AFP) E Carbohydrate antigen 19-9 (CA19-9)

d. Alpha fetoprotein (AFP)

what are indications for dialysis

Uremic symptoms GRF <10mL/Min/1.73m2 fluid overload unresponsive to diuresis refractory hyperkalemia

Which of the following best describes the classic history of a patient presenting with Wilms tumor? A A 10-year-old child with a history of urinary tract infections and hematuria B A 15-year-old adolescent with flank pain and weight loss C An infant with a history of cryptorchidism and a scrotal mass D A 3-year-old child with an asymptomatic abdominal mass and hypertension E A 5-year-old child with nocturnal enuresis and lower back pain

d. a 3-year old with an asymptomatic abdominal mass and HTN

A 4-year-old boy presents with hematuria and a palpable mass in the right abdomen. His parents report he has been more fatigued than usual. An abdominal ultrasound shows a solid mass in the right kidney. What is the most appropriate next step in the evaluation of this child? A Renal biopsy B CT scan of the abdomen and chest C Urine catecholamine levels D Serum alpha-fetoprotein (AFP) level E Bone marrow biopsy

b. CT scan of the abdomen and chest

A 5-year-old girl is diagnosed with a localized Wilms tumor in her left kidney. There is no evidence of metastasis or involvement of surrounding structures. What is the most appropriate initial treatment for this patient? A Systemic chemotherapy B Nephron-sparing surgery C Radiation therapy D Radical nephrectomy followed by chemotherapy E Observation with serial imaging

d. radical nephrectomy followed by chemo

Urology and Renal Flashcards

(111 cards)