Dr. Pestana's Notes--Urology & Transplant

Question 1

Testicular torsion is seen in young adolescents. They have testicular pain of sudden onset and are negative for these sxs; importantly, the spermatic cord [IS/IS NOT] tender.

Answer 1

no fever, pyuria, or hx of recent mumps; IS NOT

Question 2

Testicular torsion is described by swollen, tender testes that are ____ and with a _____. Immediate ___ needs to be done, and many surgeons also fix the other side.

Answer 2

high riding; horizontal lie; orchiopexy

Question 3

_____ happens in young men w/ sudden onset of testicular pain with ___ and _____; importantly, the spermatic cord [IS/IS NOT] tender.

Answer 3

Acute epididymitis; fever; pyuria; IS

Question 4

Tx acute epididymitis includes _____, and also must do ____ to rule out testicular torsion (b/c it’s an emergency)

Answer 4

abx; sonogram

Question 5

Besides testicular torsion, ____ and _____ of the urinary tract is a dire emergency. It can lead to destruction of the kidney in ____ hours and potentially death due to ____.

Answer 5

obstruction; infection; a few; sepsis

Question 6

Patient who is passing ureteral stone who suddenly develops ____, _____ and ____ probably has obstruction and infection of the urinary tract.

Answer 6

chills; fever spike (104 to 105); flank pain

Question 7

Tx obstruction and infection of the urinary tract with ____, also must decompress the urinary tract [ABOVE/BELOW] the obstruction. This can be done via ureteral ____ or percutaneous _____.

Answer 7

abx; above; stent; nephrostomy

Question 8

UTIs are very common in ______ of _____ age. They have frequency, painful urination and small volumes of cloudy and malodorous urine. Tx includes ______.

Answer 8

women; reproductive; empiric abx

Question 9

More serious UTIs, like _____ or any UTI in _____ or _____ requires urinary cultures to rule out _____ as the reason for serious infection.

Answer 9

pyelonephritis; children; young men; obstruction

Question 10

IVP stands for _____. Currently it has been replaced by other, safer tests. IVP gives excellent view of kidneys, collecting system, ureters and sometimes the bladder (cannot see _____ in the bladder)

Answer 10

intravenous pyelogram; early carcinomas

Question 11

IVPs give a good idea of ______, both for the renal parenchyma, ureter and bladder (relux). Limitations are potential ______. IVPs should not be done in pts with a creatinine greater than ______.

Answer 11

function; allergic rx to dye; 2

Question 12

___ is the best test for renal tumors. ____ is the best to look for dilation/obstruction. Only _____ can look at bladder mucosa in detail and aid in detecting early cancers.

Answer 12

CT; Sonogram: cytoscopy

Question 13

____ produces chills, high fever, nausea and vomiting with flank pain. Hospitalization, IV abx guided by cultures, and urologic workup with ____ or ____ are required.

Answer 13

Pyelonephritis; CT; sonogram

Question 14

_____ is seen in older men w/ chills, fever, dysuria, urinary fq, diffuse low back pain and exquisitely tender prostate on rectal exam.

Answer 14

Actue bacterial prostatisis

Question 15

Tx for Actue bacterial prostatisis is _____. Should NOT repeat any more _____ because it could lead to septic shock.

Answer 15

IV abx; rectal exams

Question 16

_____ is the MC reason for a newborn boy not to urinate during the first day of life.

Answer 16

Posterior urethral valves (meatal stenosis)

Question 17

Posterior urethral valves requires _____ to relieve the bladder. Dx includes a voiding _____ and ______ or resection will get rid of them

Answer 17

catheterization; cystourethrogram; endoscopic fulguration

Question 18

In ____, the urethral opening in on the ventral side of the penis. _____ should NEVER be done because the extra skin may be used for plastic reconstruction.

Answer 18

hypospadias; circumcision

Question 19

UTI in children should always lead to urologic workup, including a ______ test.

Answer 19

vesicoureteral reflux

Question 20

_____ causes burning on urination, fq, low abdominal and perineal pain, flank pain and fever/chills in a child. Dx includes a voiding cystourethrogram and Tx includes ______ (long-term until child grows out of problem).

Answer 20

Vesicoureteral reflux; empiric abx

Question 21

_____ is usually asxs in little boys but leads to needing to void and wetness with urine all the time in little girls. Dx includes ____ and tx includes sx

Answer 21

Low implantation of a ureter; vaginoscopy

Question 22

____ is suggested when normal UOP can flow w/o difficulty whereas a large diuresis causes colicky flank pain [Ex. when adolescent drinks beer for the first time and voids]

Answer 22

Ureteropelvic junction (UPJ) obstruction

Question 23

_____ is the MC presentation for cancers of the kidney, ureter or bladder. The workup begins w/ a _____ and continues with _____, which is the only reliable way to rule out cancer of the bladder.

Answer 23

Hematuria; CT scan; cystoscopy

Question 24

_____ produces hematuria, flank pain and flank mass, as well as hypercalcemia, erythrocytosis and elevated LFTs. CT shows [HOMOGENIC/HETEROGENIC] solid tumor with potential growth into the ____ or _____. Tx = sx

Answer 24

RCC; heterogenic; renal vein; IVC

Question 25

MC bladder cancer is ____ and it is associated strongly w/ _____. Best dx is ____, followed by CT.

Answer 25

transitional cell cancer; smoking; cytoscopy

Question 26

Tx bladder cancer includes both _____ and ______. High recurrence rate makes lifelong f/u a necessity.

Answer 26

surgery; intravesical BCG

Question 27

____ cancer incidence increases w/ age. Most are _____ and sought via rectal exam and _____.

Answer 27

Prostate; asymptomatic; PSA levels

Question 28

Dx prostate cancer via _____, guided by sonogram. ____ helps assess and choose therapy. Choices for tx are either ____ or ____.

Answer 28

transrectal needle bx; CT; surgery; radiation

Question 29

In prostate cancer, widespread bone mets responds to ____ (surgical or medical) for a few years. Surgical approach is _____. Medical approach is ______

Answer 29

androgen ablation; orchiectomy; LH-releasing hormone agonists or anti-androgens, like flutamide

Question 30

Testicular cancer affects ___ men in whom it presents as a [PAINFUL/PAINLESS] mass. B/c mostly malignant, bx is done with a _____ by inguinal route and blood samples of ____ and ____ are taken for f/u.

Answer 30

young; radical orchiectomy; AFP; beta-hCG

Question 31

Most ____ cancers are extremely radiosensitive and chemosensitive (Pt-based), which offers many successful tx options in advanced, mets.

Answer 31

testicular

Question 32

Acute urinary retention is MC seen in men w/ _____. It is often precipitated by a ___, the use of ____ and abundant fluid intake. Tx w/ indwelling catheter for at least ___ days.

Answer 32

BPH; cold; antihistamines; three

Question 33

Long-term therapy for acute urinary retention is ____. For very large glands, ____ is used. TURP, standing for ____, is rarely done but can tx BPH.

Answer 33

alpha blockers [tamsulosin]; 5∂reductase inhibitors [finasteride, dutasteride]; transurethral resection of the prostate

Question 34

Postop urinary retention can sometimes look like _____, but there will be a huge, distended bladder–this indicates ___ incontinence from retention. Tx w/ ___

Answer 34

incontinence; overflow; indwelling catheter

Question 35

_____ incontinence is seen in middle-age women who have had many pregnancies and vaginal deliveries. They leak small amounts of urine whenever ____ suddenly increases.

Answer 35

Stress; intrabdominal pressure

Question 36

Tx stress incontinence includes surgical repair of the pelvic floor muscles, especially in cases w/ large _____. Pelvic floor exercises can also help for early cases

Answer 36

cystoceles

Question 37

Small ureteral stones, ____ or less, at the ureterovesical junction have a ____ chance of passing spontaneously. Such cases can be handled w/ ____, fluids and watchful waiting.

Answer 37

3mm; 70%; analgesics

Question 38

Large ureteral stones, about ____, at the ureterovesical junction have a ____ chance of passing spontaneously. Intervention is required and includes ______, basket extraction, sonic probes, laser beams and open surgery. Also give tons of fluids.

Answer 38

7mm; 5%; ESWL (extracorporeal shock-wave lithotripsy; limitations include preg, bleeding diathesis, stones >several cms)

Question 39

Pneumaturia is almost always caused by ______ from diverticulitis.

Answer 39

fistualization btw bladder and GI [mostly sigmoid colon]

Question 40

Workup of pneumaturia includes ____ first. ____ is done later to rule out cancer. Tx = sx

Answer 40

CT; Sigmoidoscopy

Question 41

____ impotence has sudden onset, is partner or situation specific and does not interfere w/ nocturnal erections. Tx is ____.

Answer 41

Psychogenic; psychotherapy

Question 42

____ impotence, if caused by trauma, will also have sudden onset [ex. pelvic surgery–nerve disruption, trauma to perineum–arterial disruption]. Sometimes chronic disease like ____ or ____ can cause a gradual onset. There is an absence of nocturnal erections.

Answer 42

Organic; diabetes; arteriosclerosis

Question 43

Medications for organic impotence include _____; other options include ____ surgery for those with arterial injury, ____ devices and prosthetic implants.

Answer 43

tadalafil/sildenafil/vardenafil; vascular; suction

Question 44

For organ donation, virtually all ______ patients are potential candidates, regardless of age. Donors with specific ____ can be used for recipients who have the same disease.

Answer 44

brain-dead; infections

Question 45

A positive _____ is the ONLY ABSOLUTE CONTRAINDICATION to organ donation.

Answer 45

HIV status

Question 46

____ rejection is a vascular thrombosis that occurs w/in minutes of re-establishing blood supply due to preformed antibodies. This is prevented by ____ matching and _____ crossmatch.

Answer 46

Hyperacute; ABO; lymphocytotoxic

Question 47

_____ rejection occurs after the first 5 days and usually w/in the first 3 months. Signs of organ _____ is suggestive and organ bx is confirmatory.

Answer 47

Acute; dysfunction

Question 48

In the case of acute rejection of the liver, ____ problems are more common than immunologic rejection. Therefore when liver function deteriorates post-transplant [GGT, ALP, bili], the first thing to do is to rule out ______ and ______.

Answer 48

mechanical; biliary obstruction; vascular thrombosis

Question 49

In the case of acute rejection of the heart, signs of functional deterioration occur too late to allow therapy. Thus routine _____ are done at set intervals.

Answer 49

ventricular biopsies [by way of IJV]

Question 50

First line of therapy for acute rejection is ____ boluses. If unsuccessful, ______ agents (OKT3) have been used but are more toxic. Newer, ____ serum is better tolerated.

Answer 50

steroid; antilymphocyte; anti-thymocyte

Question 51

_____ rejection is seen years post-transplant with gradual insidious loss of organ function. It is irreversible and poorly understood.

Answer 51

Chronic