Ferg 3 - Hematuria

Front 1

6 main causes of hematuria

Back 1

"GP TITS"
Glomerulonephritis
Prostatic (BPH)
Tumors
Infection
Trauma
Stone

Front 2

what tests for everyone who presents with gross, painless hematuria?

Back 2

cystoscopy
microscopy (urine culture)

WBC, platelet, creatinine, INR, PTT

Front 3

how to distinguish b/w hematuria from glomerulonephritis and from malignancy in terms of microscopy and urine dipstick

Back 3

microscopy: glomerulonephritis pts will have crenated RBCs, and RBC casts/granular casts

urine dipstick: glomerulonephritis pts will have severe proteinuria; whereas non-glomerular only shows trace protein

Front 4

what is the most common cause of renal malignancies in adults?

Back 4

RCC (90%)

Front 5

RFs for RCC?

Back 5

-smoking
-male
-hereditary aspect
-PATIENTS ON DIALYSIS (acquired cystic disease of dialysis)

Front 6

von Hippel-Lindau syndrome is the best-known hereditary form of which cancer?

Back 6

RCC

Front 7

what is the "classic triad" and what are its components

Back 7

=the three most common Sx a/w RCC. 10% of ppl with RCC have all three.

gross hematuria (40%)
flank pain (40%)
palpable flank mass (20%)

Front 8

what are paraneoplastic syndromes a result of?

Back 8

cytokines/hormones from teh primary tumor

Front 9

list some paraneoplastic syndromes a/w RCC

Back 9

elevated ESR
HTN
anemia
weight loss/cachexia
fever of unknown origin
HYPERcalcemia
polycythemia (erythropioetin)

Front 10

stage T3a of RCC would be confined within...

Back 10

gerota's fascia - but may invatde adrenal or perirenal fat

Front 11

what is the only curative therapy for RCC

Back 11

surgical resection

Front 12

what does radical nephrectomy refer to?

Back 12

complete removal of contents of gerota's fascia (kidney, perirenal fat, adrenal gland)

Front 13

is RCC responseive to immunotherapy? chemotherapy? radiotherapy?

Back 13

immunotherapy - no
chemotherapy - no
radiotherapy - no

Front 14

where do you find most cases of TCC

Back 14

in the bladder

Front 15

occupational exposure to aniline dyes and aromatic amines is a RF for what cancer?

Back 15

TCC

Front 16

what are 5 different primary renal tumors?

Back 16

1. RCC
2. TCC
3. oncocytoma (very low malignant potential)
4. sarcomas
5. wilms tumor

Front 17

what is an angiomyolipoma?

Back 17

benign lesion made up of SMCs, bl vessels and adipocytes

dx with a CT

not a tumor persay, more like a hamartoma

Front 18

best Tx for a localized RCC in one kidney

Back 18

if the opposite kidney is normal, your safest bet is to do a RADICAL NEPHRECTOMY

but if there is a clear margin of normal kidney around the tumor in the maimed kidney, then partial nephrectomy may be just as good a cure.

Front 19

3 RFs for the development of TCC

Back 19

1. smoking
2. previous abdominal/pelvic irradiation (e.g. Tx of cervix cancer)
3. exposure to aniline dyes and aromatic amines

Front 20

what are the two common behaviours of TCC?

Back 20

1. superficial (low grade)
2. muscle invasive (hi grade)

Front 21

will bleeding in bladder TCC be constant or intermittent?

Back 21

intermittent

Front 22

Tx options for pt with superficial TCC of the bladder

Back 22

-transurethral resection of all visible tumors
-regular followup exams

IF tumor is multifocal, recurs radiply, or can't be fully resected, then:
-->intravesical chemo

Front 23

Tx of TCC invading detrusor (invasive, hi grade)

Back 23

radical cystectomy
-urine divered to ileum, or urinary resevoir made with a bowel segment

Front 24

Tx for TCC of renal pelvis
a) with normal contralateral kidney/ureter
b) with metastatic TCC or locally advanced, unresectable

Back 24

a) radical nephroureterectomy (kidney, ureter, and sm. cuff oc bladder)
b) chemo - but complete response rate = low

Front 25

4 life threatening conditions that may present with abdominal/flank Sx similar to renal colic

Back 25

1. abd. aortic aneurysm
2. abd. aortic dissection
3. ectopic pregnancy
4. appendicitis

Front 26

is renal colic a/w nausea/vomiting?

Back 26

yes

Front 27

if stone is <4mm, what is its chance of spontaneous passage?

Back 27

90%

Front 28

if stone is b/w 5-7mm, what is its chance of spontaneous passage?

Back 28

50%

Front 29

if stone is >8 mm, what is its chance of spontaneous passage

Back 29

<20%

Front 30

ESWL is best for stones that are under what size? if larger, why is ESWL not as useful

Back 30

<20 mm
if larger, the fragments may still be too large to pass

Front 31

waht stones are resistant to ESWL?

Back 31

cystine

Front 32

can you use ESWL in pregnancy?

Back 32

no

Front 33

what are teh most common types of stones

Back 33

calcium oxalate

Front 34

tea or cola coloured urine suggests

Back 34

glomerulonephritis

Front 35

if you develop hematuria 1-2 days after an Upper rest tract infection, the Dx is usually

Back 35

post-streptococcal GN
OR
IgA nephropathy

Front 36

is goodpasture's syndrome AB mediated>

Back 36

yes

Front 37

which of teh following malignancies are often a/w pain/outflow obstruction

renal carcinoma
prostatic carcinoma
urethral carcinoma
bladder carcinoma
ureteric carcinoma

Back 37

ureteric
prostatic
urethral

(whereas renal and bladder are usually painless)

Front 38

80% of renal tumors of childhood are caused by?

Back 38

wilms' tumor

Front 39

name the tumor: a kidney tumor of renal blastema with a mix of primitive renal epithelial and stromal elements

Back 39

wilm's tumor

Front 40

name 3 types of urothelial carcinomas

Back 40

1. TCC
2. squamous cell carcinoma
3. adenocarcinoma (rare)

Front 41

schistosomiasis is a/w waht type of UT cancer?

Back 41

urothelial ca.

Front 42

from a histological p.o.v, what is the most common type of RCC?

Back 42

clear cell

Front 43

what do the "clear cells" in clear cell RCC contain

Back 43

lipid and glycogen

Front 44

why does RCC have a propensity to metastasize to the lung?

Back 44

b/c it tends to invade the renal vein

Front 45

besdies the lung, what is another common area that RCCs metastasize to?

Back 45

bone

Front 46

waht is teh 5 year survival for RCC?

Back 46

50%

Front 47

what are the 3 major ways of classifying TCCs?

Back 47

noninvasive papillary

invasive

carcinoma in situ (hi grade)

Front 48

what is the difference in nat. Hx of papillary TCC vs. carcinoma in situ (CIS) TCC?

Back 48

papillary - generally low grade; can be resected; often recur - risk of developing CIS


CIS TCC: hi risk of evolving into invasive carcinoma