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Surgery Rotation EORE > Urology/Renal > Flashcards

Urology/Renal Flashcards

(107 cards)

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1
Q

what’s the MC type of bladder cancer?

A

transitional cell

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2
Q

what are the risk factors for bladder cancer?

A

smoking (MC), occupational exposure to dyes, rubber, leather, age >40 y/o, white males are 3x MC, pioglitazone

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3
Q

what’s the MC RF for bladder cancer?

A

smoking

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4
Q

what’s the s/s of bladder cancer?

A

painless gross or microscopic hematuria

irritative sx’s (frequency/urgency)

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5
Q

how do you dx bladder cancer?

A

cystoscopy with bx

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6
Q

what’s the tx for localized/superficial bladder cancer?

A

TURP

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7
Q

what’s the tx for invasive bladder cancer (advanced/involves muscular layer)?

A

radical cystectomy

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8
Q

what’s the tx for recurrent bladder cancer?

A

BCG vaccine intravesicular

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9
Q

where do most renal cell cancers originate from?

A

kidney

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10
Q

what are the RFs for renal cell carcinoma?

A

smoking***, dialysis, HTN, obesity, men

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11
Q

what are the s/s of renal cell carcinoma?

A

classic triad:

  1. hematuria, 2. flank/abd pain, 3. palpable mass

may have Left-sided varicocele, HTN and hypercalcemia

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12
Q

how do you dx renal cell carcinoma?

A

CT w/contrast

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13
Q

what’s the tx for stage 1-3 (locally advanced) of renal cell carcinoma?

A

radical nephrectomy

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14
Q

what’s the tx for bilateral involvement or pt with solitary kidney or localized disease (w/in kidney) of renal cell carcinoma?

A

partial nephrectomy

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15
Q

what’s Wilm’s tumor?

A

nephroblastoma MC in children w/in the 1st 5 years of life

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16
Q

who is Wilm’s tumor MC in?

A

children w/in the 1st 5 years of life

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17
Q

what’s the MC abdominal malignancy in children?

A

Wilm’s tumor

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18
Q

what’s the s/s of Wilm’s tumor?

A

painless, palpable abdominal mass** (MC sx) - doesn’t cross midline

hematuria, anemia, maybe HTN d/t renin secretion by tumor

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19
Q

how do you dx Wilm’s tumor?

A

abdominal U/S = best initial test

CT w/ contrast or MRI = more accurate test

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20
Q

what’s the tx for Wilm’s tumor?

A

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

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21
Q

where is the MC site of METS in Wilm’s tumor?

A

lungs

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22
Q

what’s the MC RF for nephrolithiasis?

A

decreased fluid intake

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23
Q

what are the 4 types of kidney stones?

A
  1. Calcium oxalate (MC) & phosphate
  2. Uric acid
  3. Struvite stones (Mg ammonium phosphate)
  4. Cystine (rare)
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24
Q

what is the MC type of kidney stones?

A

Ca oxalate

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25
what can struvite kidney stones form?
Staghorn calculi (ex. Proteus***, Klebsiella, Pseudomonas, Serratia, Enterobacter) a/w UTIs
26
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
27
what's the s/s of kidney stone in proximal ureter?
flank pain, CVAT
28
what's the s/s of kidney stone in mid-ureter?
mid abdominal pain
29
what's the s/s of kidney stone in distal ureter (UVJ)?
groin pain (b/c near bladder)
30
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
31
what urine pH signifies calcium oxalate kidney stones?
pH 5.5-6.8
32
what urine pH signifies Uric acid, cystine kidney stones?
<5.0 (acidic)
33
what urine pH signifies struvite stones?
pH >7.2 (alkaline)
34
what's the MC initial dx test ordered for dx of kidney stones?
Non-contrast abd/pelvis CT
35
what stones are seen on KUB x-rays?
Ca and struvite stones
36
what's the tx for kidney stones <5mm?
will most likely pass through spontaneously IVFs, analgesics, antiemetics, Tamsulon (alpha-blocker that can help passage)
37
what's the tx for kidney stones >7mm?
won't pass on their own 1. Extracorporeal shock wave lithotripsy 2. Uretoscopy +/- stent (provides immediate relief to an obstructed or at -risk kidney) 3. Percutaneous nephrolithotomy (used for stones >10mm or struvite, or if other tx's fail)
38
what's renal artery stenosis cause?
secondary HTN (MCC)
39
what's the MCC of secondary HTN?
renal artery stenosis
40
what's the causes of renal artery stenosis?
atherosclerosis MC in elderly fibromuscular dysplasia MCC in women < 50 y/o
41
what's the s/s of renal artery stenosis?
severe/refractory HTN; abd (renal) bruit
42
what's the GOLD STANDARD to dx renal artery stenosis?
renal arteriography
43
how do you treat renal artery stenosis?
1. Surgical (revascularization) - Angioplasty w/ stent = definitive 2. 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!
44
what's the definitive tx for renal artery stenosis?
Surgical (revascularization) | -***Angioplasty w/ stent = definitive
45
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
46
what is a big RF for testicular cancer?
Cryptorchidism
47
what side is testicular cancer MC on, right or left?
right side (b/c cryptorchidism occurs MC on the right side)
48
what are the 2 types of testicular cancer?
germinal cell tumors (usu. malignant) -seminoma or nonseminoma non-germinal cell tumors
49
what are sminoma testicular tumors?
Simple (lack tumor markers = normal serum alpha fetoprotein & b-hCG), sensitive (to radiation), slower growing, step-wise spread
50
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
51
what are non-seminoma tumors a/w?
***a/w incr. serum alpha-fetoprotein, increased B-hCG and radioresistance
52
what are the s/s of testicular cancer?
1. painless testicular nodule, solid mass, or enlargement; may have hydrocele present
53
how do you dx testicular cancer?
scrotal U/S alpha-fetoprotein, B-hCG, LDH
54
what is elevated in non-seminoma tumors?
alpha-fetoprotein, B-hCG
55
what is pathogmnemonic for non-seminoma tumors?
alpha-fetoprotein elevation
56
what's the tx for low-grade (stage 1) non -eminoma (limited to testes) testicular tumor?
orchiectomy with retroperitoneal LN dissection (dx and therapeutic)
57
what's the tx of low-grade seminoma testicular cancer?
orchiectomy -> radiation
58
what's the tx of high-grade seminoma?
debulking chemotherapy -> orchiectomy & radiation
59
what's stage 2 of testicular cancer?
mass in testes + retroperitoneal LN
60
what's stage 1 of testicular cancer?
mass in testes only
61
what's stage 3 of testicular cancer?
mass in testes + distant mets
62
what are RFs for acute urinary retention?
prostatitis anti-cholinergic meds: diphenhydramine (Benadryl), oxybutynin (for overactive bladder) alpha-agonist meds: pseudoephedrine narcotics
63
how do you dx BPH?
DRE -> uniformly enlarged, firm, rubbery, prostate
64
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
65
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
66
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
67
what are RFs for prostate cancer?
genetics, diet (high fat intake), obesity, AA
68
what type of cancer is prostate cancer?
adenocarcinoma
69
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
70
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
71
what's the tx for prostate cancer if local disease?
radical prostatectomy
72
what's the tx for prostate cancer if advanced disease?
external beam radiation therapy, androgen deprivation
73
what's the tx for uncomplicated cystitis?
1. Nitrofurantoin 2. FQ's (Cipro) 3. Bactrim
74
what is complicated cystitis?
underlying condition with risk of therapeutic failure (I.e. sx's > 7 days, pregnant, DM)
75
what's the tx for complicated cystitis?
FQ PO or IV, Aminoglycosides
76
what's the treatment for cystitis if pregnant?
Amoxicillin, Nitrofurantoin
77
what's the tx for pyelonephritis?
FQ PO or IV
78
if UA shows WBC casts, what's the dx?
pyelonephritis
79
what's the definitive dx for cystitis /pyelonephritis?
urine culture >100,000 bacteria
80
what results of UA indicate cystitis?
>5 WBC, + leukocyte esterase, hematuria, + nitrites
81
what's the MC cause of prostatitis in men >35 y/o?
E. coli
82
what's the MC cause of prostatitis in men < 35 y/o?
Chlamydia & Gonorrhea
83
what's the s/s of prostatitis?
fever/chills in acute frequency, urgency, dysuria obstructive sx's (decr. stream) lowerback/abd pain, PERINEAL PAIN
84
what's the PE of acute prostatitis like?
exquisitely TENDER, normal/hot, BOGGY prostate
85
what's the PE of chronic prostatitis like?
NONTENDER, BOGGY prostate
86
what should be avoided in acute prostatitis and why?
prostatic massage b/c may cause bacteremia
87
what's the tx for acute prostatitis >35 y/o?
FQ or Bactrim
88
what's the tx for acute prostatitis < 35 y/o?
Ceftriazone plus Doxy (or Azithro) - b/c caused by chlamydia and gonorrhea
89
what's the tx for chronic prostatitis?
FQ, Bactrim if refractory -> TURP
90
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
91
what's the s/s of non-gonococcal (chlamydia) urethritis?
purulent or mucopurulent discharge, pruritus, hematuria, pain with intercourse
92
how do you dx urethritis?
Nucleic acid amplification (most sensitive and specific for chlamydia & gonorrhea)
93
what's the tx for Gonococcal urethritis?
Ceftriaxone IM x 1 dose
94
what's the tx for non-gonococcal (chlamydia) urethritis?
1g azithromycin or Doxy
95
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
96
what is CKD?
Progressive loss of renal function persisting >3 mo and typically irreversible -GFR <60 ml/min or Cr >30 for >3 mo
97
what GFR means ESRD?
GFR < 15
98
what's the tx for ESRD?
dialysis and/or transplant
99
what is the MC cause of ESRD?
DM (d/t diabetic nephropathy)
100
what's the 2nd MC cause of ESRD?
HTN
101
what's the single best predictor of CKD progression?
proteinuria -Spot UAlbumin/UCr Ratio (ACR) -> PREFERRED (vs 24hr urine collection)
102
what's the s/s of CKD?
asx until stage 3 o4 4 anemia (decr. EPO production) fatigue, weakness
103
what values of 24hr urine test suggest microalbuminuria and macroalbuminuria?
Microalbuminuria → 30-300 mg Macroalbuminuria → >300 mg
104
what is seen on UA for dx of CKD?
abnormal sediment: BROAD WAXY CASTS seen in ESRD
105
what's classically seen on renal U/S for dx of CKD?
small kidneys
106
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
107
what's the FIRST-LINE tx for orthostatic hypotension?
Fludrocortisone

Surgery Rotation EORE (10 decks)

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