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89 Cards in this Set
- Front
- Back
What is the definition of hematuria?
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>3 RBC/high powered field in urinary sentiment
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If someone has a positive dipstick for hematuria, what should you do?
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LOOK AT THE URINE UNDER THE SCOPE
PPV of the dipstick is 35% |
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What is more severe: gross or microscopic hematuria?
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Gross
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If you have gross hematuria, where are possible places where you could have lesions?
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Initial: urethra
Terminal: bladder neck/prostate Total: interior of bladder/upper tract |
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If the urine is red but the dipstick is negative for blood, what should you think?
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Something else is causing the red urine!
Dyes |
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What shoud you think if the dipstick is + but there are no RBC under the scope?
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False positie test
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If there are bacteria in the urine, what should you think?
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Possible infection at any point in the genitourinary tract
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If you see proteinuria(<2+) or dysmorphic RBCs/casts, what should you tink?
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Glomerulonephritis
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What is flank pain indicative of while taking a history of someone with kidney related disease?
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Stones
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If someone presents with urologic symptoms and have dysuria/bladder irritability, what should you think?
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Bladder, prostateinfection
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How does someone with sicke cell or diabetes present with renal symptoms?
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Papillary necrosis
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What environmental exposures put a person at incrased risk for renal or urothelial cancers?
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Tobacco use
Environmental exposures to aromatic dyes |
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If someone presents with visible blood at the urethral meatus, what should you tink?
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Urethral source of the hematuria
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If somoene presents with fever, hematuria, and costovertebral angle tenderness, what should you tink?
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Pyelonephritis
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If someone presents with hematuria and positive for an infection, what should you do?
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Treat with antibiotics and see what happens
If hematuria clears, don't do anything else If it doesn't work them up |
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What are the imaging modalities that are commonly used when a person presents with hematuria?
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Intravenous uretogram
Abdominal film + US CT scan |
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What are the big three on you differential diagnosis fo hematuria?
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Infection
calculi Cancer Farther down: Obstruction Trauma/Exertional hematuria Medical renal disease Benign familial hematuria |
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What are some infections that can cause hematuria?
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Kidney infections:
Pyelonephritis Pyonephrosis Renal abscess Bladder infections Prostate infections Urethritis |
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Where are some of the different places that calculi are that can cause hematuria?
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Kidney
Ureter Bladder |
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What are some of the cancerous causes of hematuria?
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Kidney
Upper collecting system Bladder Urethra Prostate |
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What are some benign neoplasms/lesions that can cause hematuria?
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Kidney:
-simple cysts -cystic renal diseases -angiomyolipoma Ureter: -hemangioma Bladder -endometrioma Urethra -condyloma |
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What are some kinds of obstructions that can cause hematuria?
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Obstructions of the ureter:
-Ureteropelvic junction -Intrinsic strictures -Extrinsic obstruction Bladder -Outlet obstruction (BPH Uretura -strictures |
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Can you assume that truama/exertional is the cause of hematuria?
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NO!
You've got to still do the full workup; you can't miss something |
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What is the classic presentation of a person with ureteropelvic junction obstruction?
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Young: it's congenital
Flow dependent: increased fluid intake, more pain *caused by histologic disorganization |
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What parts of the GU system are especiall vulnerable to obstruction? What site is the most commonly congenitally obstructed?
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Ureteropelvic junction
Crossing of the iliac vessels Ureterovesical junction UPJ |
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What diagnostic tests are good to order up for ureteropelvic junction obstruction?
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Diuretic renal scintigraphy: the obstructed kidney will get rid of the tracer faster
IV urogram: hydronephrosis, nonvisualization of the effected side |
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What is the treatment for ureteropelvic junction obstruction?
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Generally, it's minimally invasive
Put in a stent, it's usually fixed |
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What is the primary cause of UPJO?
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It's congenital.
Histological disorganization at the UPJ: -Loss of longitudinal muscle fibers -Increased collagen -Attenuation of muscle bands Also, crossing vessels, high insertion, kinks, bands |
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What are secondary cases of UPJO?
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CANCER-->external compression
Scarring due to doctors effing with things |
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If a kidney has been for a long time without function, what should you do?
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Just take it out!
They recover function poorly. |
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What is more serious: non-obstructive or obstructive dilation of the urinary tract?
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Obstructive
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What are causes of non-obstructive dilation of the urinary tract?
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Ureteral reflux
Prior obstruction Extra-renal pelvis Diuresis |
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How does obstruction cause damage to the kdieny?
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Increased pressure causes a loss of organ function
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What does an obstructed kidney look like on ultrasound?
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TOo much fluid inside-->hydronephrosis
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What changes occur upon ultrasonography with restrictive indices in an obstructed kidney?
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Decreased diastolic flow velocity
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What is the best test to look for an obstructed kidney?
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Whitaker test
Look at the pressure within he renal pelvis |
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What are the treatment options for UPJO?
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Most invasive --> least invasive
Open pyeloplasty Laparoscopic pyeloplasty Percutaneous endopyelotomy Retrograde baloon dilation, dendopylotemy |
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What are the symptoms of an acutely obstructing distal uretral calculus?
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Sudden onset of flank pain
Initial gross hematuria Restless, moving about Nausea |
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How can you tell that a stone is lodged in the distal ureter?
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Distal ureter shares innervation with the bladder --> frequent urination.
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What is the expected radiation of the pain in a stone?
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Flank-->scrotum
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What is the difference in the presentation of someone with a peritoneal problem versus a stone?
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If you have a peritoneal process, you're rigid on the table. Everything hurts. If you've got a retroperitoneal process, you're rolling around, trying to get away from the pain.
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What is the differential diagnosis for an acute ureteral obstruction?
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Intrinsic: calculi, tumor, clot, edema
Extrinsic: compression by tumor, lymph node |
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What imaging studies should you order when there's acute ureteral obstruction?
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1. KUB + US
2. CT - most diagnostic KUB IVU Ultrasound |
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If a stone is 5 mm, what's it's chance of passing?
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50%
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What types of stones won't show up on CT?
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People who are on antiretrovirals won't have their stones show up on CT
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What will an obstructed kidney look like on CT?
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It wont' have as much contrast going to it: there's vasoconstriction to prevent blood flow from going to it.
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What would be reasons for doing an IV urography instead of a CT?
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Already compromised renal function
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What types of stones are dissolvable? Are they radiolucent or radioopaque?
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Uric acid
Radio-lucent |
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What is the most common cause of a filling defect on a contrast study?
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Urothelial neoplasm
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What are indications for surgical treatment of urolithiasis?
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Upper tract UTI
Significant obstruction Pain refractory to oral meds Other: -Staghorn calculi -Long-standing ureteral calculi -Occupational reasons |
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How does one take density of stones into account when considering treatment modalities?
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Less dense: SHOCKWAVES
More dense: more invasive procedures |
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When should you think about doing a metabolic assessment of someone with renal calculi?
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Young
FH Chronic: -Multiple calculi present -Residual calculi after tx. -More than 1 stone in past year |
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What factors in the urine favor stone formation?
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Hypercalcemia
Hyper oxaluria Hyperuricosuria |
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What factors in the urine inhibit stone growth?
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Citrate
Mg |
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What is a common presentation of someone with pyelonephritis?
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Initial dysuria, urinary frequency, urgency
Febrile Fight flank pain CVAT |
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How can you distinguish pyelonephritis from a UTI?
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Systemic involvement
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What is the most common bug to cause acute pyelonephritis?
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E. Coli
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What are possible complications from acute pyelonephritis?
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Papillary necrosis
Pyonpehrosis Abscess Sepsis |
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What are some factors that can predispose a person to pyelonephritis?
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Obstruction
Calculi Vesico-ureteral reflux Debilitated: DM, ill, immune suppressed |
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What is the treatment for a person who is obstructed with acute pyelonephritis?
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Drain the kidney: otherwise, it's an incubation pot for bacteria!
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What type of person is most likely to get Renal cell carcinoma?
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60ish years old
Man Smoking puts you at increased risk |
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What is the presentation of a person with renal cell carcinoma?
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Gross hematuria
Flank pain |
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What is the most lethal carcinoma of the GU system?
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Renal cell carcinoma: 30%!
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What are risk factors for RCC?
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Cigs
Obesity HTN Occupationsl exposures Dialysis Hereditary |
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What are some hereditary risk factors for RCC?
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von Hippel-Lindau disease
Tuberous sclerosis |
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What is the conduit for RCCs to spread through the body?
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Along the veins! WILD!
There are some that can make it all the way to the PULMONARY ARTERY! WILD!!! |
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Where are the most common sites of metastasis for RCC?
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Lung
Liver Bone Adrenal Other kidney |
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What is the most common type of RCC?
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Clear cell
RCCCC: Renal cell carconima clear cell |
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What's the inheritance of von-hippel lindau syndrome?
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Autosomal dominant
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What kinds of tumors happen in von-hippel lindau syndrome?
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Cerebellar
Retinal RCC |
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What is the the most common gene mutation in RCC?
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VHL mutation
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What are the most common symptoms/signs of RCC?
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Hematuria (30-60%)
Flank pain (14-51%) Flankmass (21-47%) |
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What is Stauffer's syndrome? What does it signify?
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LFT elevation
Liver problems secondary to kidney cancer |
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What percent of renal masses are simple cysts?
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85%
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What sign on ultrasound signifys a simple cyst?
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Posterior acoustic enhancement. No reflection back through the cyst. At the back there's a lot more amplitude that can reflect back--> posterior enhancement
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What signs on ultrasound make you think of a stone?
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Posterior shadowing. All of the waves are absorbed up front by the stone, so the stuff behind looks slighgly like a shadow.
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What makes you think of a solid mass upon ultrasound of hte kidney?
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Solid mass;no shadowing,but different density than the kidney parenchyma itself
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What's the gold standard for kidney mass diagnosis?
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CT
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If the kidney tumor is larger than 4 cm, what should you think?
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RCC!
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If the kidney tumor is under 4 cm, what should you think?
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1: STILL RCC
Others: Oncocytoma Angiomyolipmoa Inflammatory mass Lymphomas |
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What does an oncocytoma look like on CT?
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Stellate scar in the middle
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Are oncocytomas benign or malignant?
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Benign
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Are lipomas benign or malignant?
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Benign
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What is the staging for RCC?
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1: <7 cm
2: >7 cm 3: Other structures, a lymph node 4. Mets, more spreading |
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What is the treatment for RCC stages 2, 3?
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Radial nephrectomy
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What is the treatment for RCC stage 4?
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Systemic therapy
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What is the presentation of someone with ADPKD?
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Middle aged
FH HTN - ALMOST ALWAYS! |
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Where else can you get cysts in a person with ADPKD?
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Hepatic
Pancreatic Splenic Cerebral aneurysms |
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What makes a cyst complicated?
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Hemorrhage
Infection |