GU

Question 1

Bladder Cancer Staging

Answer 1

Ta: papillary, exophytic lesions
Tis: “flat tumor”, high-grade intraepithelial neoplasm w/out invasion into sub epithelial connective tissue
T1: invasion into mucosa or lamina propria
T2: invasion into muscle
T3: extends beyond muscle into perivesical fat
T4: Extends into adjacent organs

Question 2

Bladder Cancer Tx

Answer 2

T1 or less lesions: TURBT + intravesical chemo (mitomycin C; as this reduces recurrence rate) + intravesical immunotherapy (BCG; decreases invasion and progression rate; not needed for Ta lesions)

High-grade T1 lesions on initial rsxn path –> repeat TURBT

T2+ lesions: radical cystoprostatectomy w/ extended LND + ileal diversion. +/- neoadj chemo

Question 3

DDx Young male with groin mass

Answer 3

Hernia, hydrocele, testicular mass

Question 4

Workup for young male with groin mass

Answer 4

Transillumination: distinguish between hydrocele and inguinal hernia

Question 5

Causes of painless scrotal swelling

Answer 5

hydrocele of tunica vaginalis

cyst of epididymis

Question 6

MCC of painful scrotal swelling

Answer 6

acute epididymo-orchitis

Question 7

Difference between inguinal hernia and hydrocele

Answer 7

Hydrocele: transilluminates, may increase in size with Valsalva or throughout the day if communicating, may indicate underlying malignancy, reducible if communicates but recurs quickly

inguinal hernia: does not transilluminate, size increases with valsalva, benign, reducible unless incarcerated

Question 8

Tx of Renal cell carcinoma with IVC thrombus

Answer 8

Radical nephrectomy with IVC thrombectomy

Poorly responsive to chemorads (no neoadjuvant or adjuvant chemo)

Advanced renal cell carcinoma managed with targeted therapy: pembrolizumab, IL-2, mTOR inhibitors

Question 9

Ovarian cancer staging

Answer 9

Stage 1: limited to ovaries
a: 1 ovary, b: both ovaries, c: malignant ascites/peritoneal washing
Stage 2: Pelvic extension
a: uterus/Fallopian tubes, b: other pelvic tissues, c: malignant ascites/peritoneal washing
Stage 3: Extension beyond pelvis
a: microscopic peritoneal dz, b: <2cm, c: >2cm
Stage 4: Distant mets

Question 10

Yolk sac tumor of ovary tumor marker elevation

Answer 10

AFP

Question 11

HCG elevated in what tumors

Answer 11

Germ cell tumors

seminoma, dysgerminoma, choriocarcinoma, embryonal carcinoma

Question 12

Inhibin tumor marker for what cancers

Answer 12

Mucinous and endometroid carcinoma

Sex cord-stomal tumor (granulosa, Sertoli-Leydig tumors)

Question 13

Epithelial ovarian cancer tumor marker

Answer 13

CA-125

Question 14

Urethral Injury Grading System

Answer 14

Grade 1: contusion, blood at urethral meatus, RUG normal. Tx: foley
Grade 2: Stretch. Tx: foley
Grade 3: partial disruption. Tx: foley; +/- suprapubic drainage with delayed urethral recon
Grade 4: Complete disruption, <2cm urethral separation. tx: urinary diversion w/ suprapubic catheter & delayed recon
Grade 5: complete disruption, >2cm urethral separation, tx: urinary diversion w/ suprapubic catheter & delayed recon

Question 15

Renal anatomy

Answer 15

Upper poles more medial than lower poles
Adrenals & renals surrounded by Gerota fascia
Gerota fascia fuses on all sides except inferiorly
Usually 1 renal artery and 1 renal vein
MC variation is supernumerary renal arteries arising from lateral part of aorta.
Ant -> post: renal vein, artery, then pelvis (VAP)
R renal artery cross posterior to IVC, R renal vein drains directly into IVC

Question 16

Ureter blood supply

Answer 16

Proximal: medial, branches of renal artery
Middle: medial, branches of gonadal artery & aorta
Distal: lateral, branches from CIA & IIA

Question 17

Main use for Serum tumor markers

Answer 17

Used for subsequent follow-up of disease status after primary treatment

Also helpful at time of diagnosis but not diagnostic