Fiser: Subspecialties (urology, ortho, gyn) Flashcards
which nerve is most at risk for injury in the lithotomy position?
peroneal
anterior to posterior of renal structures?
renal vein (anterior) renal aa renal pelvis (posterior)
which renal vein can be ligated?
the left can b ligated from the IVC 2/2 increased collaterals
what is the most common type of kidney stone?
calcium oxalate
which type of kidney stone do pts get who have had their TI resected?
calcium oxalate: due to increased oxalate absorption in colon
what are and what causes struvite stones?
magnesium ammonium phosphate stones, cause staghorn calculi, occur w infections (proteus mirabilis) that are urease producing
which kidney stones are radiolucent?
uric acid and cysteine
which patients (3) are more at risk for uric acid stones?
- ileostomies, gout and myelopoliferative disorders
what drug is used to prevent cysteine stones?
tiopronin
how do you resect testicular cancer?
inguinal incision- scrotal incisions will disrupt the lymphatics
what level correlates with testicular ca tumor bulk ?
LDH
MC types of testicular ca
germ cell: seminoma and non-seminoma (90%)
diagnosis and management of seminoma
- 10% have elevated b-hcg, do NOT hav elevated AFP
ALL get orchiectomy and retroperitoneal XRT
diagnosis and management of non-seminoma testicular ca
- 90% have elevated AFP and B-HCG
ALL get orchiectomy and RP LN dissection
Stage 2 or greater: Chemo
what chemotherapy agents do you give in testicular ca?
cisplatin, bleomycin, VP-16
how do you proceed when you get stage I prostate ca after a TURP?
nothing else
when do you give XRT and androgen ablation in prostate ca?
extracapsular invasion (T3+) or metastatic disease
1 primary tumor of the kidney
RCC
when can you perform wedge resection of metastatic RCC?
isolated lung or colon mets
MC location of RCC mets?
lung
1 tumor of the kidney
mets from breast ca
when do you perform a partial nephrectomy in RCC?
in patients who would otherwise require HD after nephrectomy, tumor <4cm and Cr >2.5
what is von-hippel lindau syndrome?
multifocal and recurrent RCC, renal cysts, CNS tumor and pheochromocytomas
risk factors for transitional cell ca of bladder?
smoking, aniline dyes, cyclophosphamide
what is T2 transitional bladder cancer and how do you manage?
T2 invades into muscle wall, manage w cystectomy w ileal conduit, chemo (MVAC: methotrexate, vinblastine, adriamycin, cisplatin) and XRT
squamous cell ca of bladder is related to what?
schistosomiasis infection
what layer hypertrophies in BPH?
transitional zone
initial therapy of BPH?
alpha blockers: terazosin, doxazosin (relax smooth muscle)
5-alpha-reductase inhibitors: finasteride
MOA finasteride
5-alpha-reductase inhibitors
inhibits conversion of testosterone to dihydrotestosterone, inhibits prostate hypertrophy
MC complication of TURP
retrograde ejaculation
how does left RCC cause a varicocele?
left gonadal vein inserts into left renal vein and obstruction of vein by renal tumor can lead to varicocele
what is the MC urinary tract abnormality?
ureteral duplication
what is MC primary cancer of the vagina?
squamous cell CA
what does diethylstilbestrol cause? (DES)
clear cell ca of vagina
what is botryoides?
rhabdosarcoma that occurs in young girls
management of vulvar cancer?
MC squamous cell CA
<2cm = stage 1, WLE and ipsilateral node dsxn w 2cm margins
>2cm = stage II or greater, radical vulvectomy w bilateral inguinal node dsxn, post op XRT if margins <1cm
which type of ovarian cancer has the worst prognosis?
clear cell type
stages of ovarian ca?
stage I: one or both ovaries only
II: limited to pelvis
III: throughout abdomen
IV: distant
what is meige’s syndrome?
pelvic ovarian fibroma that causes ascites and hydrothorax (excision of tumor cures syndrome)
where does cervical ca mets to first?
obturator nodes
what is postpartum pelvic thrombophlebitis? tx?
can lead to ovarian vein, IVC, and hepatic vein thrombosis
get liver failure w ascites after pregnancy
tx: heparin and abx
where does cartilage receive its nutrients from?
synovial fluid (osmotic)
what is the salter-harris classification?
classification of epiphyseal injuries:
type I and II: closed reduction
types III, IV, V: ORIF, cross the epiphyseal plate and can affect the growth
whats a jone’s fractue?
fx of 5th metatarsal, assoc w nonunion
which fx is assoc w avascular necrosis?
scaphoid, femoral neck, talus and hip dislocation
fx associated w compartment syndrome?
supracondylar humerus, tibia, calcaneus
biggest risk factor for nonunion?
smoking
injury assoc w anterior shoulder dislocation?
axillary nerve injury (closed reduction)
injury assoc w posterior shoulder dislocation?
axillary artery injury (seen in seizures and electrocution)
management of supracondylar humeral fracture in adults vs children?
adults: ORIF
children: nondisplaced = closed reduction, displaced = ORIF
what is a colles fracture?
fall onto outstretched hand, distal radius fx -> closed reduction
what is monteggia’s fx?
proximal ulnar fx and radial head dislocation
tx: ORIF
