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7 Renal: Cystic-Neop

Step Up to Medicine, Chap 7: Cystic Dz, Vascular Dz, Stones, and Neoplasms

QuestionAnswer
Which vascular abnormality is associated with adult polycystic kidney disease? Intracerebral berry aneurysm
MCC of secondary HTN? Renal a stenosis
Cause of renal a stenosis in young women? Fibromuscular dysplasia
Which commonly used drug is contraindicated in pts with renal artery stenosis? ACE-i
Can MRA dye be used in pts with renal failure? Yup! It's not nephrotoxic.
Tx for renal artery stenosis? Revascularization with PRTA.
MC site of urinary stone impaction? Uretovesicular j'n
MC and preventable risk factor for stones? Low fluid intake
MC type of stones? Appearance on radiographs? Calcium stones; radiodense.
Appearance of uric acid stones on radiographs? Radiolucent (can't be seen on plain films); req's CT, US, or IVP for detection
Struvite stones are seen in which pts? Those with recurrent UTIs due to urease-producing organisms (proteus, klebsiella, serratia, enterobacter spp)
Hexagon shaped crystals that are poorly visualized. Cystine stones
What is the correlation between the size of a stone and its ability to pass? <0.5cm can pass spontaneously. >1cm usually can't.
Classic presentation of nephrolithiasis? Sudden onset of colicky flank pain that radiates into groin. UA shows hematuria.
Hematuria + pyuria indicates what? Stone with concomitant infection
How can urine pH help identify stones? Alkaline urine indicates urease stones. Acidic urine suggests uric acid stones.
Most sensitive test for detecting stones? Spiral CT without contrast
Medical tx for preventing calcium stones? Thiazide diuretics
Medical tx for preventing uric acid stones? Allopurinol
Gold std for diagnosing urinary tract obstruction? Contraindications? Intravenous urogram (aka IVP). Contraindicated in pregnancy, allergy to contrast material, or renal failure.
Majority of prostate cancers are what type of neoplasm? Adenocarcinomas
If PSA is >10 but DRE is negative, what should be done? Transrectal ultrasonography (TRUS) should be done regardless of DRE findings.
If DRE is abnormal but PSA is not elevated, what should be done? Transrectal ultrasonography (TRUS) should be done regardless of PSA levels.
If PSA is <4 and DRE is negative, what should be done? Annual follow up.
Most important risk factor for prostate cancer? Age
In what direction does prostate cancer grow? From the periphery to the center, so obstruction occurs later in the disease.
Does DRE change PSA levels? No, but prostatic massage can elevate PSA.
Treatment for locally invasive prostate cancer? Radiation therapy plus androgen deprivation (not curative, but slows local spread)
Tx for metastatic prostate cancer? Orchiectomy, antiandrogens, and LH-releasing hormone agonists
Areas of metastasis for renal cell carcinoma? Lung, liver, brain, and bone
Majority of bladder cancers are what type? Transitional cell CA
Classic presentation of bladder cancer? Painless hematuria
MC type of testicular cancer? Germ cell tumors
Non-germ cell testicular tumors assoc'd with precocious puberty in children and gynecomastia in adults Leydig cell tumors
What factor is elevated in choriocarcinoma? beta hCG
What factor is elevated in embryonal tumors? AFP
Surgical approach for orchiectomy for testicular cancer? Inguinal approach b/c scrotal incision may lead to tumor seeding of the scrotum.
Young man with firm, painless testicular mass should be presumed to have what? Testicular cancer until proven otherwise
Tx for seminoma? Inguinal orchiectomy and radiation (very radiosensitive tumors)
Tx for nonseminomatous tumors? Orchiectomy and retroperitoneal lymph node dissection with or without chemo
Difference between testicular torsion and epididymitis? Testicular torsion has more acute onset and is NOT assoc'd with fever.
Tx for testicular torsion? Immediate surgery: detorsion and orchipexy to the scrotoum (perform bilaterally to prevent torsion in contralateral testicle). If surgery is delayed beyond 6h, infarction may occur and testicle may not be salvageable (needs orchiectomy)
MC organsism causing epididymitis in children and old men? E coli
MC organism causing epididymitis in young men? Chlamydia, gonorrhea
Clinical features of epididymitis? Swollen, tender testicle; dysuria,; fever/chills; scrotal pain; and scrotal mass
Tx for epididymitis? R/o testicular torsion and administer abx
Created by: sarah3148