CM Flashcards
complications of hypospadias vs epispadias
infxn, fistula, cosmetic defect vs incontin, sexual dysfxn, dep/psych
is para/phimosis considered a uro emergency?
phimosis = no unless urinary block, pain, hematuria. paraphimosis = yes
cause of hydrocele? structures involved in communicating? if you can’t transilluminate it, what’s next step? how to tx?
fluid in tunica vaginalis. peritoneum, processus vaginalis, scrotum. US. reassurance b/c it’ll resolve by 1-2yo; if persists -> uro
causes of inguinal hernia? dx?
premature, connective tissue dz, abd wall defects, fhx. PE -> bowel sounds in scrotum, silk glove sign, US distinguish hydrocele from inguinal hernia
indirect vs direct inguinal hernia. how to tx?
fail to close internal inguinal ring after testicle goes thru it vs actual abd wall defect. surgeon referral; incarcerate & strangulated -> med emergency
3 types of cryptorchidism. dx? complications? tx?
abd vs ectopic vs inguinal. PE -> milking technique to chk testicle in inguinal canal; DO TESTICULAR EXAM FOR NEWBORNS. hernia, testicular ca, infertile, torsion. surg referral by 6mo old, hCG for testosterone, orchiopexy
causes of 2ndary hypogonad per Hardee. tx? cause of BPH? tx?
pit tumors/defect, hemochromatosis, OSA. PDE5-I, lifestyle, testosterone replace, surg. testost to DHT -> prostate growth; anticholinergic meds give BPH side effects. alpha blockers, 5a-reductase inhib (if >40g), PDE5-I, anticholinergics
USPTF prostate screen guidelines
screen 40-55yo, C for 55-69yo, D for >70, I for >75yo
where does tunica vaginalis originate and go to? 3 aa for spermatic fascia blood supply
peritoneum & descend down to surround testes. cremaster, testicular, vasal
penile ca cause swelling of which LN? what about scrotal infxn?
bil inguinal LN. ipsi inguinal LN
communicating hydrocele also known as per Chun? noncommunicating hydrocele for what age group; any hernia involved; tx?
congen ped indirect hernia. men >40yo; no; Lord’s procedure
how to tx varicocele? complications? neonatal torsion = ?
gonadal v embol; ligation (retroperitoneal, microsurg, lap). hydrocele formation, testicular atrophy. extravaginal torsion (tunica vaginalis & testicle twist around spermatic cord)
how to tx epididymitis for <35 vs >35 yo? tx Fournier’s gangrene?
rest x3d, NsAIDs, scrotal support. doxy, ceft x2wks vs FLQ x2-4wks. broad abx (PCN-G, AG, clinda, 3rd gen ceph), debride, reconstruction
how to tx urethral strictures. key features for penile fx?
incision/dilation, urethroplasty, suprapubic tube, urinary diversion. vigorous intercourse -> pop/snap -> eggplant deformity & detumescence
key features of priapism
high vs low flow; irreversible corporal dmg if lasting >6h, sickle cell or leukemia
castrate-resistant prostate ca can lead to what type of mets? tx for it?
bone mets -> IV bisphos, subq RANK ligand, radium (alpha particle mimicking Ca2+ complex breaking DNA -> mild myelo)
frontline prostatic ca mets tx?
ADT; lupron/GnRH agonist, anti-androgen biclutamide, bil orchiectomy; the others listed in goodnotes
testicular ca early vs late stage sxs. how to dx?
painless swelling, gynecomastia vs neck mass, cough/dyspnea, LBP, bone pain (mets), C/PNS sxs, uni/bil LE swelling (thrombosis). transcrotal doppler US, orchiectomy, NEVER BX; tumor markers for nonseminoma (HCG, AFP, LDH)
seminoma vs nonseminoma
40yo, no tumor markers, chemo or rad vs <40yo, yes tumor markers, CD30 pos, chemo, more aggressive
how to tx spermatocele? how to tx testicular ca?
remove whole cyst intact. sperm bank, orchiectomy, testicular prosthesis, retroperitoneal LN dissection if >3cm, resect lung mets
surg indic for varicocele? risk factors of epididymitis? risk factors for Fournier’s?
chronic scrotal pain, testicular size discrepancy >20%, infertile/abnl semen. underlying anomaly, sTI, prostatitis, recent urinary instrument. immunocomp, recent GI/U procedure, urethral stricture, perianal abscess
