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GU: Block 2 Flashcards

1
Q

Most simple renal cysts are at ? originating from ?

What are the three US criteria for a benign cyst

A

Outer cortex from renal tubule dilation

Demarcated/smooth walls
Enhanced back wall
Anechoic

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2
Q

What are the CT criteria for a simple renal cyst?

What is the next step if the cyst meets or does not meet criteria?

A

Thin, sharp demarcation
No contrast enhancement

Meets= periodic eval
Fails= urology referral
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3
Q

What are the essentials for Dx of PKD

What are compelling but not required parts of PKD?

A

Multiple bilateral cysts HTN+Mass= suggestive

FamHx
Palpable kidneys

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4
Q

What is the MC inherited kidney dz?

What are the genetic mutations that lead to this dz?

A

Auto Dom PKD

ADPKD1
ADPKD2- slower/longer life

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5
Q

How does ADPKD present

How is it Dx and what criteria is needed by age for Dx

A

HTN
Abdominal/flank pain
Hematuria

US w/ 2 or more (<59) or 4 or more (>60)

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6
Q

What will ADPKD present and be seen on labs?

What class of medications can and can NOT be used for chronic pain in these PTs

A

Low pH
HTN
Dec GFR w/ + FamHx

\+= TCAs
- = NSAIDs
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7
Q

What is the MC cause of hematuria in ADPKD PTs

What Dx is considered if hematuria is persistent?

A

Cyst ruptures into renal pelvis

Renal cell carcinoma, especially men >50y/o

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8
Q

How does a ADPKD infection present?

When does PT w/ ADPKD need to be screened for cerebral aneurysms?

A

Flank pain Fever Leukocytosis

FamHx
Elective surgery
Profession, high risk

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9
Q

Medullary Sponge Kidney Dz is AKA ?

What type of genetic defect causes this?

A

Lenarduzzi kidney
Cacchi Ricci dz

Auto Dom MCKD1/2 mutation

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10
Q

When is Medullary Sponge Kidney Dz present and dx

Although mostly ASx and benign, what can PTs present w/?

What may be seen on lab results due to the decreased ability to concentrate urine?

A

Present at birth
Dx 40-50y/o

Hematuria UTIs Nephrolithiasis

High urine pH
HyperCa

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11
Q

What may be seen on x-rays of PTs w/ Medullary Sponge Kidney?

How is this condition Dx?

A

Calculi beyond calyces

CT showing DCT dilation and calcification in collecting system

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12
Q

Define ‘bouquet of flowers’ seen in Medullary Sponge Kidney

Define the ‘paint brush appearance’

A

IV pyelogram- ectatic DCDs w/ micro calcification

Dilated tubules in medulla

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13
Q

How are PTs w/ Medullary Sponge Kidney Tx

What PTs are likely to develop acquired renal cystic dz?

A

Thzd- dec HyperCa
Alkali therapy- tubular acidosis

Dialysis
Long standing RF

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14
Q

Acquired renal cystic dz has a higher rate of ? than other cystic d/ox

How/why does this progress to ESRD?

A

Conversion to malignancy

Loss of nephron mass/fibrosis

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15
Q

How does Acquired Renal cystic dz present, Dx and Tx

How can you differentiate between acquired renal dz or PCKD?

A

Pain/hematuria
Dx: US/CT scan
Tx: Transplant/nephrectomy

FamHx/genetics
GFR

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16
Q

What kidney dz is common in younger PTs and almost universally progresses to ESRD?

What is the difference between the two types?

What do they both have in common?

A

Juvenile Nephronophthisis- Medullary Cystic Dz

Juvenile- auto recessive
Medullary- auto dom

Multiple cysts at corticomedullary junction/medulla

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17
Q

What happens as JNMCDz progresses in severity?

How does the adult/child form of JNMCDz present?

What is a later presentation of JNMCDz?

A

Interstitial inflammation and glomerular sclerosis

Polyuria Pallor Lethargy,
Reqs salt/water d/t wasting

HTN

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18
Q

What does juvenile nephrolithisis form cause?

What will be seen on US/CT images?

A

Growth retardation
ESRD by 20y/o

Small scarred kidney w/ medullary cysts

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19
Q

Ca of ureter/renal pelvis are rare but are more common in ? PT populations?

The majority of these that do develop are ? type

A 
Smokers* 
Thorotrast exposure
Lynch syndrome
Analgesic abuse
Bladder Ca
Balkan nephropathy

Urothelial cell Ca

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20
Q

What are the clinical findings of UT Cas?

What will be seen on CT/Urography

A

Hematuria
Less common: bleeding/pain
Pos urine cytology

Hydronephrosis
Unilateral non-visualization of collecting system
Filling defects

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21
Q

How are Cas of the UT Tx?

What are the essentials of Dx for these conditions?

A

Laparoscopic excision
Open nephroureterectomy
Ureter excision (distal lesion)

Triad: Mass Pain Hematuria
Fever/weight loss- prominent

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22
Q

Renal cell Ca peak during ?, are more predominant in ? and may be associated w/ ?

What are the RFs?

What is the only known environmental RF for renal cell Ca?

A

6th decade
M>F
Paraneoplastic syndromes

Physical inactivity
Obesity
DM

Smoking

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23
Q

Where do Renal Cell CA originate from within the kidney?

A

Proximal tubule cells

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24
Q

What lab findings may be seen during renal cell Ca?

Some PTs may develop Stauffer Syndrome which is ?

A

Hematuira
Anemia
HyperCa

Reversible hepatic dysfunction w/ inc tests, no metastatic dz

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25
Q

What four images may be ordered to assess PTs w/ renal cell CA and why

A

CT/MRI w/ contrast- most valuable- staging, pre-op planning and contralateral kidney eval

CXR/CT- pulm metastases

Bone scan- bone pain/elevated AlkPhos

Brain images- high metabolic burden/neuro deficits

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26
Q

Any discovered solid renal mass is ? until Dx

What are the possible solid masses that could be present?

A

Renal cell Ca

Angiomyoplipoma- fat density

Pelvis urothelial Ca- central involvement of collecting system, + urinary cytology

Oncocytomas- indistinguishable from Ca pro-operatively

Abscess/Tumor- superoanterior to kidney

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27
Q

How are different types of renal cell Ca Tx

A

Nephrectomy- primary Tx, >7cm carcinomas

Partial- single kidney, bilateral lesion or significant renal dz

Radiofrequency/cryosurgical ablation- tumors <4cm

Percutaneous biopsy- histology/grade for Tx

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28
Q

What Tx combo has the best benefit for renal cell Ca PTs?

Where are different renal cell Cas referred to?

A

Surgery w/ ImmunoTherapies

Solid mass/renal cell Ca- urologist
Metastatic dz- oncologist and urologist

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29
Q

Define Benign Oncocytoma

This type of tumor can be seen in ? other organs

A

Primary kidney tumor indistinguishable w/out surgery

Salivary glands
Adrenals
Para/thyroids

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30
Q

Define Angiomyolipomas

What PT population is more likely to have these?

A

Rare benign tumors of fat, smooth muscle and vessels

Tuberous sclerosis
Middle age women

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31
Q

What image finding is Dx of angiomyolipomas?

Most don’t require intervention if under ? size

A

CT identification of fat component

ASx and <5cm diameter
>5cm= prophylactically Tx w/ emoblization Tx

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32
Q

If angiomyolipomas start to bleed how are they Tx

What types of Cas are likely to metastases to kidneys?

A

Angiographic embolization
Nephrectomy

Lung Ca- MC
Breast
Stomach
Contralateral kidney
Lymphoma= enlarged, not mass
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33
Q

What paraneoplastic Sxs can be present w/ renal cell Cas?

A 
HyperCa
Fever
Cachexia
Liver dysfunction
Amyloidosis
Polymyalgia rheumatica
Anemia
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34
Q

Define Nephroblastoma

What is the MC site for metastases?

A

MC primary malignant renal tumor of Peds <15y/o
2nd MC malignant abdominal tumor of childhood after neuroblastoma

Lung Nodes Liver

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35
Q

Nephroblastoma is AKA ? and almost all are located ?

? PT population is at higher risk for this type of tumor?

A

Wilm’s Tumor, Unilateral

AfAm

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36
Q

Classic Wilm’s Tumor is made up of ? cells

How are these Tx?

A

Blastemal Stromal Epithelial

Surgery and Chemo, possibly radiotherapy

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37
Q

What is the MC presentation of Wilm’s Tumor

What other findings can be seen at presentation

A

ASx abdominal mass

Constitutional Sxs
HTN
Abdominal pain
Painless hematuria

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38
Q

What are two rare facts about Wilm’s Tumors

Any abdominal mass in Peds is considered ? and ? is sequence of images ordered

A

Anemia- microcytic, ACDz
Thrombus to IVC

Ca
Doppler US of renal vein/IVC
CT defines extent

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39
Q

When are partial nephrectomys preferred for Tx of Wilm’s Tumors

Wilm’t Tumor is associated w/ ? dzs

What types of poorer outcomes and how are they Tx?

A

Unilateral tumor
Predisposing syndromes- Denys-Drash/WAGR

WAGR
Denys-Drash
Beckwith-Wiedemann

Anaplastic- chemo

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40
Q

What would be seen on PE of Wilms Tumor

What images are ordered for Dx purposes?

A

Non-tender firm mass that rarely crosses mid-line

US- initial
CT/MRI
Surgical excision/biopsy- definitive

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41
Q

? is the MC solid renal tumor seen in neonates and is the MC benign renal tumor of childhood

What is the difference between this MC and WIlms Tumors

What is the TxOC for mesoblastic nephomas?

A

Mesoblastic nephroma

MN- dx before 3mon
Wilms- rarely dx before 6mon

Radical nephrectomy

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42
Q

? is the prevalent renal malignancy during 2nd decade of life

What process causes GU pain?

What type of pain presents late and is a poor indicator?

A

RCC

Distension (obstruct/distend)
Inflammation on capsule

Malignancy

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43
Q

? is infection pain

How does it present?

A

Pyelonephritis/Peritonitis

Constant pain w/ PT laying still

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44
Q

? is obstruction pain?

How does it present?

A

Renal colic- ureter paristalsis against obstruction

Wax/waning pain causing PTs to move

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45
Q

How/where is renal colic pain assessed?

Where can this pain radiate to?

A

CVA tenderness

Umbilicus
Ipsilateral testicle/labia

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46
Q

If ureter becomes obstructed, how does the type/location of pain indicate the site of the obstruction?

A

Upper- referred pain to scrotum/labia

Mid- R/LLQ pain

Lower- bladder irritability; UVJ stone

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47
Q

How does prostatic pain present?

What are three causes of flaccid penile pain?

What are two causes of erect penile pain?

A

Inflamed perineum radiating to lumbar, inguinal or LE

Balanitis
Paraphimosis
STI

Priapism
Peyronie’s Dz

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48
Q

What are the irritative voiding Sxs

What are the obstructive Sxs

A

Frequency inc Urgency Nocturia Dysuris

Hesitancy 
Weak
Intermittent
Double void
Dribbling
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49
Q

Define Incontinence

What are the different categories

A

Involuntary loss of urine

Urge Stress Overflow Functional Atonic

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50
Q

Define Hematospermia

What can cause this condition?

A

Blood in ejaculate

Inflamed prostate/seminal vesicles, normally benign

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51
Q

Define Pneumaturia

What can cause this to happen?

A

Gas/air in urine causing bubbly/malodorous urine

Bladder/GI fistula due to colon Ca, Diverticulitis, Crohns

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52
Q

What is the MC Sx of an STI

What DDx needs to be r/o in elderly PTs w/ bloody d/c?

A

Urethral d/c w/ dysuria

Urethral carcinoma

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53
Q

What type of urinary tract issues do and don’t present w/ fevers?

What are 3 DDxs that the fever could possible be associated w/?

A 
\+= pyelonephritis
- = acute cystitis

Prostatitis Malignancy Epididymitis

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54
Q

Urology PTs complaining of malaise may be due to ?

Any type of hematuria is worked up w/ ?

A

Cancer
CKDz

Upper tract imaging
Cytoscopy

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55
Q

Analgesic use causes ? etiology of hematuria?

ABX cause ? etiology of hematuria

What drug used for Chemo/ImmSupp can cause hematuria?

A

Papillary necrosis

Interstitial nephritis

Cyclophophamide

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56
Q

Other than analgesics, what other issues can cause papillary necrosis?

Lower tract sources of gross hematuria, w/out presence of infections, is MC due to ?

A

DM, Sickle Cell

Urothelial Ca of bladder

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57
Q

Microscopic hematuria in male PTs is MC from ?

PTs on ? class of drugs is concerning and requires full work up?

A

BPH Stricture Stone

Antiplatelets/coags

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58
Q

What is the lab criteria to Dx hematuria

Gross hematuria in adults is ? until disproven

A

> 3 RBC/HPF

Malignancy

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59
Q

Gross hematuria w/ >3 RBCs/HPF can be seen in ? conditions

What type of urine sample is best for evaluating hematuria?

What criteria can be detected by dip stick and what is the f/u tests?

A

Urinary calculi
UTIs
Kidney/Bladder Ca

1st morning void

2 RBCs/HPF
3 samples 1wk apart for confirmation

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60
Q

What can cause false-pos dipstick results during hematuria work ups?

A

Bacteria
Oxidizing agents
Menses
Beets/Rhubarb

Myo/Hbgglobinuria
Exercise
Concentrated urine
HCl

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61
Q

What can cause false-neg dipstick results during hematuria work ups?

+ hematuria with proteinuria, dysmorphic RBCs and casts suggest ?

A

High Vit-C levels

Renal origins

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62
Q

What hematuria presentation suggests a UTI

What is recommended for these PTs after Tx to ensure hematuria resolution?

A

Positive urine culture
Irritative voiding Sxs
Bacteruria

Test of cure

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63
Q

What is the f/u test for a positive dipstick UA?

Why would culture/sensitivity be performed?

Why would urine cytology be performed?

A

Urine microscopy

ID/Tx infections w/ repeat UA in 4-6wks

Persistent/unexplained hematuria
R/o Ca

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64
Q

What are the 3 types of hematuria in reference to presence during flow?

How do these correlate to the cause of the blood?

A

Initial: blood at beginning; urethritis, stricture

Terminal: blood at end; posterior urethral polyps, vesicle neck tumors

Total: bladder, upper tract, TB

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65
Q

What imaging modality is used for evaluating the upper GU tract?

What type may be ordered for evaluating for other conditions?

A

Helical/spiral CT for stones

CT-IVP
Pelvic CT w/ and w/out contrast

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66
Q

What is cystoscopy used to assess?

This procedure ordered for ? PTs

A

Bladder/urethral neoplasms
Benign prostatic enlargement
Radiation/chemical cystitis

Gross hematuria
>35y/o w/ ASx micro hematuria

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67
Q

When do PTs w/ hematuria need to be referred?

A 
Absence of clear benign etiology:
Infection
Menstruation
Exercise
Medical renal dz
Viral illness
Trauma
Recent urological procedure
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68
Q

Why would a PT w/ hematuria be referred to nephrology?

Why would they be referred to urology?

A

Renal parenchymal etiology

Calculi/Ureter/Cystic/Urethral origin

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69
Q

What are the 5 ROS questions asked for hematuria?

What is the DDx for hematuria acronym

A 
Fever/Pain
Sxs of bladder irritability
Trauma/menses
Urethral d/c
Dysuria

PP ON THIS
Period 
Prostate/Papillary necrosis
Obstructive uropathy
Nephritis syndrome
Trauma Tumor TB Thrombosis
Hematological 
Infection**/Inflammation
Stones*- 1st MC
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70
Q

Define Pseudohematruia

What can cause this?

A

Dipstick +, Microscopic -

Hgburia- black urine
Mgburia- rhabdo
Food- beets, berries
Artificial coloring
Drugs: Levodopa Ibuprofen Phenytoin Sulfameth Pyridium Rifampin Nitro
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71
Q

Acute UTIs usually have ? microbes while chronic UTIs usually have ?

What two microbes are responsible for most non-nosocomial, uncomplicated UTIs?

A

Single
Two or more

E Coli
Coliform

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72
Q

What test is recommended for PTs w/ suspected UTIs?

What is the intrinsic defense mechanism for defending against UTIs?

A

Urine culture

Efficient bladder emptying

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73
Q

What part of the bladder is a natural protection against bacterial adherence?

What are the antimicrobial properties of urine?

A

Glycosaminoglycan layer

High osmolality
Extremes of pH

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74
Q

What part of the female GU tract are natural defenses against UTIs?

What part of the male GU tract is a natural defense?

A

Vaginal flora

Prostatic fluid contains Zinc, prevents ascending infections

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75
Q

What are the RFs for UTIs?

What is the MC route for UTIs to begin?

A

Retention Stasis Reflux
Pregnancy Obstruction
Neuro condition DM
Foreign bodies

Ascending from urethra, MC as pyelonephritis from E Coli

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76
Q

What is an uncommon route for UTIs to begin?

What is a rare route?

What are conditions could cause direct extension infections?

A

Hematogenous spread

Lymphatic spread

Intraperitoneal abscess from IBD/PID

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77
Q

What microbes cause uncomplicated UTIs?

What microbes cause nosocomial/hospital acquired infections?

A

E Coli- MC
Klebsiella Enterobacter Enterococci Proteus

Pseudomonas
Staph

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78
Q

ASx bacteriuria does not require Tx unless ?

What are the essentials of Dx for acute cystitis?

A

Pregnant- Amox/Cephalexin
Invasive procedure
Catheter/imaging

Afebrile
Pos urine culture
Irritative Sxs (FUND)

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79
Q

Acute cystitis is MC from ? microbe introduced via ?

What virus can rarely cause acute cystitis?

A

E Coli
Urethra

Adenovirus

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80
Q

Uncomplicated cystitis in men is rare and implies ?

What are the common S/Sxs of acute cystitis

A

Anatomic defect
Prostatitis
Infected stone
Chronic urine retention

Irritative voiding Sxs
Gross hematuria
Sxs after intercourse

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81
Q

What may be seen on labs of acute cystitis

What two results are suggestive?

What is the criteria for a positive culture but not required for Dx

A

Bacteriuria Pyuria Hematuria

Leukocyte esterase
Nitrates

10^5/mL CFUs

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82
Q

What PT populations are expected to be colonized w/ bacteria?

Since uncomplicated cystitis in males is rare, what tests are done when assessing acute cystitis?

When/why would a follow on CT be needed?

A

Indwelling Foley
Suprapubic catheters

Cystoscopy
Abdominal US
Postvoid residual tests

Recurrent infection
Anatomic abnormality
Pyelonephritis

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83
Q

What are the 6 non-infectious causes of cystitis-like Sxs?

A

Bladder Ca
Chemo- cyclophos
Pelvic irradiation

Voiding dysfunction
Interstitial cystitis
Psychosomatic d/o

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84
Q

How can UTI risks be reduced?

How can these risks be reduced in female PTs who get UTIs after intercourse?

Post-menopause women w/ recurrent UTIs >3x/year may benefit from ?

A

Hydrate, frequent voids

Void before/after
Post-coital ABX

Topical estrogens

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85
Q

Criteria to be labeled uncomplicated UTI

What cases are labeled as a complicated UTI?

A

Acute cystitis in otherwise healthy non-pregnant adult woman

Everyone else

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86
Q

How are uncomplicated acute cystitis PTs Tx

Which one is the DOC for Tx of pregnant Pts

A

Nitrofurantoin
Trimeth/Sulfameth

Nitrofurantoin

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87
Q

What is the urinary analgesic used for acute cystitis Tx?

What PT education has to go w/ this Rx?

A

Phenazopyridine

Discoloration of urine, fabric and contacts

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88
Q

How are female PTs w/ recurrent (>3/year) acute cystitis’ managed?

What meds may be used?

A

Candidate for prophylaxis ABX
Uro refer/consult first

Trimeth/Sulfameth
Nitrofur
Cephalexin
Single dose at bed/prior to intercourse

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89
Q

What is the first line med used for Tx of ASx Bacteriuria and simple cystitis in pregnant PTs?

Define Acute Pyelonephritis

A

Amoxicillin
Cephalexin

Infection of renal parenchyma and renal pelvis

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90
Q

What microbes can cause acute pyelonephritis?

What are two less common microbe etiologies?

A

Gram Neg- MC (KEEPP)

Enterococcus
Staph via hematogenous

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91
Q

What would be seen on microscopy of pyelonephritis?

What would be seen on CBC results

A

White cell casts

Leukocytosis
L-shift

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92
Q

What images are ordered fr pyelonephritis?

When would an abscess be suspected in these PTs?

A

Renal US- uncertain etiology/complicated dz
CT- dec perfusion

No improvement w/ continued fever/bacteremia

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93
Q

Define Emphysematous Pyelonephritis

When can pyelonephritis PTs be Tx outpatient?

A

Gas producing organisms causing complications after pyelonephritis in DM PTs

F/u <48hrs
Uncomplicated
Non-pregnant
Compliant

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94
Q

What meds are used for Tx of pyelonephritis

What are the 3 parts of Tx covered by these meds?

A

FQ- Levo/Cipro
Alt: Trimeth/Sulfameth
Augmentin

PO ABX
Pain
Anti0-emetics

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95
Q

When Tx pyelonephritis, if susceptibility is unknown and TMP/SMX is used, what med is added to Tx regime?

When do PTs w/ pyelonephritis need to be admitted?

A

1g IV Ceftriaxone

Pregnant
RF
IV ABX
Multi-resistant microbes
Obstruction 
Severe/complicated- septic,

DM
Imaging needed
No improvement after 48hrs

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96
Q

How long are PTs being Tx for pyelonephritis Tx w/ ABX

What meds are used while admitted?

What drugs are used for initial IV dose?

A

InPT/IV- 24hrs after fever resolution then PO ABX X 14days

Ceftriax Cipro Piper-Tazo

Ceftriax Cipro Genta

97
Q

PTs being Tx for pyelonephritis in patient may be d/c after 72hrs and placed on ? ABX

PTs w/ this Dx may have fevers x __Hrs but imaging is ordered after __hrs

A

TMP/SMX Levo Cipro

x72, 48hrs

98
Q

What lab order is mandatory after pyelonephritis Tx

What are the two categories of acute epididymitis?

A

Urine culture- test of cure

Sex/Anal transmitted
Non-sexually transmitted

99
Q

PTs <35y/o w/ epididymitis have ? until proven otherwise?

PTs >35y/o w/ epididymitis usually have?

Men participating in insertive anal intercourse may have ? microbes

A

STI- G/C

UTI, Prostatitis from enteric Gram-neg rods

Enteric organisms

100
Q

Cardiac PTs on ? drug can have medication induced epididymitis?

What PE findings of acute epidiymitis is usually apparent?

A

Amiodarone

Scrotal swelling/tenderness

101
Q

PTs w/ epididymitis that have white cells w/out a visible organism seen on smears represent ? due to ?

What will be seen on UA results in PTs w/ non-sexual transmitted forms?

A

Nongonoccoccal urethritis
C trachomatis

Bacteriuria Pyuria Hematruia

102
Q

What is the gold standard of Dx acute epididymitis?

What images may be ordered to r/o more severe causes of PTs Sxs?

A

Gram stain

US, r/o torsion

103
Q

What are 3 DDx for acute epididymitis and how are the r/o as primary Dx?

A

Tumor- painless enlargement of testis, neg UA, normal epidiymis

Torsion- acute onset in younger PTs, + Prehn sign

Distal ureter stone- referred pain to ipsilateral scrotum, w/ norm US

104
Q

How are acute epididymitis cases Tx

A

Acute phase: rest elevate ice

Sex transmitted: Ceftriax and PO DOxy

Insertive anal: Ceftriax and PO Cipro

Non-sex transmitted- FQN

105
Q

When do PTs being Tx for epididymitis need to be re-evaluated

What is the gold standard for Dx urethritis

A

S/Sxs not resolving after 3 days

Urine culture of Gram-Neg diplococci

106
Q

Define Urethral Syndrome in Women

What are the two types

A

G/C/HSV causing Sx urethritis

Internal dysuria: no pathogen, urgency
External dysuria: vulvular herpes/candidiasis causing pain w/ contact w/ urine

107
Q

Female PTs w/ acute onset of urine urgency/frequency, hematuria and bladder tenderness suggest ?

How are PTs w/ G/C Tx and how long do they need to avoid sex

A

Bacterial cystitis

Chla: Azith 1g or Doxy
Gon: Ceftriax plus Chla Tx
7days

108
Q

When is a Dx of vesicoureteral reflux considered

What images may be ordered?

This condition may present w/ ? indicative Sx

A

Any child UTI prior to toilet training

US/VCUG w/ referral

Fever

109
Q

Define Interstitial Cystitis

What Dx findings may be seen on PE imaging?

A

Pain w/ bladder filling, urgency and frequency

Submucosal petechiae/ulcers on cystoscopic exam

110
Q

What is the key take away to interstitial cystitis?

Although an unknown etiology, what is this Dx associated w/?

A

Dx of exclusion:
Neg UA culture cytology

Severe allergies
IBS/IBDz

111
Q

What is the pathophys behind interstitial cystitis development?

What will these PTs present complaining of?

A

Disrupted glycosaminoglycan layer, urine irritants enter nerves/tissue of bladder

Bladder pain relieved w/ voiding

112
Q

What part of PTHx needs to be assessed for suspected interstitial cystitis?

What are the names of the lesions seen on cystoscopy and required for Dx?

A

Cyclophos usage

Hunner lesion

113
Q

How is interstitial cystitis Tx

A 
Amitriptyline- first line
Nifedipine
IV Dimethyl Sulfoxide
TENS
Last, surgery0 cystourethrectomy w/ urinary diversion or SCS
114
Q

Urinary stone dz is the third most prevalent behind ?

What are the essentials for Dx and images of this condition?

A

Infections
Prostatic dzs

Flank pain w/ N/V
US
Non-contrast CT* Gold standard

115
Q

Define Urolithiasis

Define Nephrolithiasis

Define Ureterolithiasis

A

Stone formation anywhere in urinary tract

Stone in kidney

Stone in ureter

116
Q

Urinary stone formation requires saturated urine that is dependent upon ?

A

pH
Ionic strength
Complexation
Solute concentration

117
Q

What are the 5 types of urinary stones

A

Struvite- Mg Ammonium phosphate (stag horn)

Uric acid- may also have CaOx

Cystine

MC: Ca oxalate/phosphate

118
Q

What are the most important RFs leading to stone development?

What two geographic factors can contribute to formation?

A

High protein/Na diet
Inadequate hydration
Sedentary lifestyle

High humidity/temps

119
Q

What genetic factor can increase prevalence?

What types of stones develop due to acidic/alkaline urine?

A

Cystinuria- AutoRec d/o, homozygous PTs have inc cysteine excretion leading to stone formation

Acidic: uric acid, cystine
Alkaliine: struvite

120
Q

Alkaline urine w/ ? 2 microbes have inc stone development

CaOx stones develop between what pHs and w/ ? RFs?

A

Proteus
Klebsiella

5.5-6.8
Hypercalciura
Inc Na, protein
Dec water, urine citrate

121
Q

CaPhos stones develop between ? pH

? PT populations are at inc risk of oxalate stone formation?

What other RF increases chances of oxalate formation?

A

> 7.5

IBD- dec gut Ca to bind w/ oxalate

> 2g/day ascorbic acid

122
Q

What is the strongest promoter for urinary stone formation?

What is the most important inhibitor of formation?

A

Urinary oxalate

Urinary citrate- binds to Ca and dec amount available for stone formation

123
Q

What impacts the amount/level of urinary citrate available for regulation?

Women w/ recurrent UTIs are MC to produce ? stones

A

Acidosis- dec
Alkalosis- inc

Struvite stones, but overall Ca is more common in women

124
Q

What pH and microbes promote the formation of struvite stones?

Define a Staghorn Calculi

A

> 7.2
Urease producing bacteria (Proteus Pseudomonas Providencia Klebsiella Staph Mycoplasma)

Upper tract stone involving renal pelvis and extends x 2 calyces, usually struvite

125
Q

What is the only amino acid not soluble in urine?

Cystine stones develop at ? pH

A

Cystine

<5.5

126
Q

Stone appearance on x-ray

A

Ca- opaque
Phos- opaque
Struvite- opaque/dense

Cystine- lucent
Uric acid- lucent

127
Q

What are the RFs for uric acid stones

What is the most important contributor to this type of stone formation?

A

Hyperuricemia
Myeloproliferative d/o
Malignancy
Abrupt/dramatic weight loss

pH <5.5

128
Q

How do PTs w/ obstructing urinary stone present?

If stone becomes lodged at the uretovesical junction, how will PT present?

A

Sudden/wakes from sleep
Severe flank pain w/ N/V
Constantly moving

Urinary urgency/frequency
Testicular/penile tip pain

129
Q

What labs are ordered for urinary stone work up?

What pH ranges are stones seen in?

A

Chem 17

<5.5: uric acid, cysteine
5.5-6.8: Ca oxalate
>7.2: struvite
>7.5: Ca phosphate

130
Q

What is the gold standard imaging for Dx of urinary stones?

What is the alternative if this is not available but ? is the con?

A

Non contrast spiral/helical CT

KUB, does not exclude if negative

131
Q

Most stones ? size will pass spontaneously

What meds may be given to the PT

A

6mm or less

Analgesic
Antiemetic
Alpha blocker to facilitate passage

132
Q

What type of urinary stone presentation requires emergent urology consult?

Stones that are bigger than ? or don’t pass w/in ? need referral

A

Obstructive urinary calculi w/ fever and infected urine (pus under pressure)

> 6mm
4wks

133
Q

How are stones extracted if located in lower 1/3 of tract?

What is the TxOC for 75% of cases that can’t pass?

A

Ureteroscope

Extracorporeal Shock Wave Lithotripsy

134
Q

ESWL Tx works well for stones that are ? size or location

How do PTs get ready for this procedure?

A

Renal pelvis
Upper 2/3 of ureter
<1.5cm

D/c NSAIDs 3d prior

135
Q

When would a percutaneous nephrolithotomy procedure be conducted?

What is done during this procedure?

A

Stone in renal collecting system
Upper 2/3 of ureter
>2cm

Needle insertion into calyx, dilation for stone to pass into kidney

136
Q

When are open stone surgery procedures conducted?

What are the 5 steps to Tx of acute stones

A

Complex anatomy
Obstructions
Large infected struvites

Inc fluid intake
Pain control
Confirmation
Admit- failure to control pain, infection, comorbidity
Refer- infection, large, comorbidity
137
Q

How are PTs that recurrently form stones managed?

What dietary prevention strategies can be done?

A

24hr urine q6mon
Serum PTH
Uric acid
CT q12mon

Maintain Ca intake
Avoid soda/Vit C
Inc bran/water
Dec salt/protein

138
Q

PTs that are recurrent stone makers are managed w/ ? meds

Erection is a neurovascular event based on ? triad

A

High urine Ca: Tzd
Low urine citrate/pH: K citrate therapy

Autonomic/Somatic nerves
Cavernosal arteries
Corpora cavernosa/pelvis relaxation

139
Q

What neurotransmitter is responsible for initiating/maintaining erections?

What other ones help?

A

NO

Vasoactive intestinal peptide
ACh
Prostaglandins

140
Q

What are the 7 steps needed for an erection?

A

Nerve impulse

Messenger release

Inflow inc

Outflow dec

Cavernous filling

Accumulation

Erection

141
Q

What two muscles control rigidity to penis?

Organic ED may be an early sign of ?

A

Bulbocavernosus
Ischiocavernosus

CV dz

142
Q

? is a common benign fibrotic d/o of penis causing pain, deformity and dysfunction

What is the MC cause of ED?

A

Peyronie

Dec arterial flow due to vascular dz

143
Q

Psychogenic ED can be categorized as what two types?

A

Generalized: unresponsiveness, inhibition

Situation: partner, performance, distress/adjustment

144
Q

How can organic ED be simply classified?

What can cause this type of ED?

A

No evening/morning wood

Neuro Hormonal Arterial Venous Drugs

145
Q

What Hx questions are asked when assessing ED?

A

Dec libido- androgen deficiency

Anejaculation- androgen deficiency, DM, surgery, radiation

Premature ejaculation

Anorgasmia

146
Q

What meds can cause ED?

A

Anti-HTN: BB TZD Spironolactone Clonidine

Antidepressant

Opioid

Doxazosin/Terazosin

147
Q

Rapid onset of ED suggests ?

Nonsustainable erection suggests ?

Complete loss of nocturnal erections suggests ?

A

Psychogenic
Trauma

Anxiety
Venous leak

Vascular/Neuro Dz

148
Q

What labs are ordered for ED work up

What special test is used to determine organic from psychogenic ED?

A

Lipids Glucose TSH
T/Prolactin

Nocturnal tumescence
PDE-5 inhibitor trial
Direct injection
Imaging

149
Q

PTs w/ psychogenic ED may benefit from ? Tx

MOA of PDE-5 inhibitor

A

Sex therapy/counseling

Allows cGMP to be unopposed, enhances blood flow

150
Q

What are the adverse effects of using PDE-5 inhibitors

PDE-5s need to be used w/ caution or are c/i when used w/ ?

A

HOTN
Priapism

Caution- A-blockers
C/i- nitro/nitrates

151
Q

What are the relative c/i to using PDE-5 inhibitors?

What food needs to be avoided?

A

Coronary ischemia not on nitrates
HF
HOTN/multiple anti-HTN meds
CYP450-3A4 inhibs (Eryth Cime Ket Itra)

Grapefruit juice

152
Q

Directions for using Sildenafil

What education piece is applicable for all PDE-5 inhibitors?

A

1hr before on empty stomach, lasts 4hrs
Fatty meal= delayed absorption

Stimulation still needed for erections

153
Q

What PDE-5 inhibitor is similar to Sildenafil but lasts x 24hrs?

What are the benefits of using Tadalafil?

A

Vardenafil

Onset 30-60min
Lasts 36hrs
FDA approval BPH w/ ED

154
Q

Which PDE-5 inhibitor may be taken w/ the shortest plan of intercourse

What is the method of administration for Alprostadil

A

Avanafil- 15min prior

Prostaglandin E2 via syringe/suppository

155
Q

How are PTs w/ documented androgen insufficiency and ED managed?

What must be done prior to Rx this med?

A

Androderm- injection/patch of Testosterone

R/o prostate Ca

156
Q

What erection assistance is given to PTs w/ venous d/o who fail injection therapy?

What is the last resort of Tx ED

A

Vacuum

Inflatable penile implant

157
Q

When is vascular reconstruction a Tx consideration for ED?

What can cause retrograde ejaculation?

A

Trauma induced arterial occlusions
Congenital venous occlusions

Bladder neck disruption

158
Q

How is primary premature ejaculation Tx?

What causes secondary premature ejaculation?

A

Behavior mod/sex health
Anesthetic/systemic meds

ED

159
Q

Define Oligozoospermia

Define Azoospermia

A

<15mil sperm in ejaculate

Complete absence of sperm

160
Q

How long does spermatogenesis take?

What medications can affect spermatogenesis?

What meds affect sperm motility?

A

74 days

Cimetidine Finasteride Tesosterone
SSRI/Spironolactone

Sulfasalazine
Nitrofuantoin

161
Q

What med causes retrograde ejaculation

What medication lowers FSH

A

Tamsulosin

Phenytoin

162
Q

What affect does varicoceles have on sperm

What issues can dec overall spermatogenesis?

A

Abnormal motility/morphology

Obesity
CV/Thyroid/Liver dz

163
Q

DM can have ? effect on sperm

What is the initial study done for infertility work up?

A

Dec genesis
Retro/ane ejaculation

SA after 3d abstinence
Two samples, two occasions separated by 60 days

164
Q

What are the normal values of SA results?

What is the next step if low ejaculate volume is noted?

A

Volume: 1.5-5mL
Concentration: +15M
Motility: >45%
Morphology: >3%

Post-ejac UA

165
Q

Define Oligozoospermia

What is the next step if this is found?

A

Abnormal sperm concentration

Repeat SA
Abnormal- get T/Prl, LH, FSH
Normal- repeat again

166
Q

What is the sequence of SA testing needed for confirmation

What endocrine evaluations are done during infertility?

A

1st result- confirm w/ 2nd
Same= done
Different- do 3rd test
Need 2 like results

T FSH LH Prl Estradiol

167
Q

When is genetic testing warranted for infertility?

Why would a transrectal US be ordered for infertility?

__% of infertility cases will remain a mystery after work ups

A

<10mill or azoospermia

Low volume w/o evidence of retrograde ejaculation

25%

168
Q

Prostate growth is only stable between ? ages?

What is a common PE finding of acute bacterial prostatitis

What therapeutic Tx step is avoided in these PTs

A

30-45y/o

Exquisite tenderness during DRE

Prostatic massage, may cause septicemia

169
Q

What are the MC microbes causing prostatitis

How does this condition present?

A

E coli
Pseudomonas

Sudden perineal, sacral and suprapubic pain w/ fever

170
Q

When Tx acute bacterial prostatitis, when do PTs need to be re-evaluated?

What is the next step for them?

A

24-48hrs of ABX w/ no improvement

Pelvic CT/transrectal US

171
Q

What meds are used for Tx of acute bacterial prostatitis

What two meds are added for Tx any STIs

A

FQN- Cipro w/ f/u at 14days
Trimeth/Sufameth, dec efficacy
Fosfomycin- Tx multi-drug resistant Ecoli

Ceftriax and Doxy

172
Q

PTs w/ bacterial prostatits that have abnormal VS or systemic Sxs are admitted and Tx w/ ?

What is the only microbe associated w/ chronic bacterial prostatitis

A

Piper-Tazo
Cefotaxime w/ aminoglycoside

Enterococcus

173
Q

How does chronic prostatitis present

What follow on test is usually ordered to assess urinary retention?

A

Low back/perieneal pain
Boggy prostate

Post void residual volume

174
Q

PTs w/ chronic prostatitis and systemic Sxs are admitted for Tx w/?

How are they Tx outpatient?

What meds can be added for pain relief

A

Ampicillin and Gentamycin
3rd gen Cephalosporin
FQN

Any x 4-6wks:
PO Trimeth/Sulfameth
FQN
Beta lactam ABX

NSAIDs
Alpha blockers -osin

175
Q

What is the MC and prominent S/Sxs of non-bacterial prostatitis

What will be seen on lab results

A

Pain during/after ejaculation

Inc leukocytes
Neg cultures of expressed prostate secretions and urine

176
Q

After excluding all other Dxs but prior to giving non-bacterial prostatitis Dx, what must be r/o?

How are non-bacterial prostatitis PTs Tx

A

Bladder Ca

-osins
PDE-5 inhibs
Therapy/psych/counseling

177
Q

What process promotes prostate cell proliferation?

? is the MC benign tumor in men and is ? related

A

5 alpha reductase converts testosterone into DHT

BPH, age

178
Q

What are the two primary factors associated w/ development of BPH?

This hyperplastic process is an over growth of ? cells located in ? area

A

DHT, Age

Stroma, Epithelium
Transition

179
Q

What is the most important tool used in BPH evaluation

What ortho issue must be r/o in PTs during a BPH work up?

A

AUA questionnaire: 7 questions scaled 0-5pts

Cauda equina

180
Q

How does a prostate feel during DRE if BPH is present

Serum PSA is only obtained if ?

Why is a serum BUN/Cr needed?

A

Smooth Firm Elastic enlargement

PTs life expectancy is >10yrs

R/o postrenal azotemia

181
Q

If PTs BPH AUA score is 8 or more, what additional studies are considered?

CT/US are only needed if ?

A

Urodynamic
PVR

Urinary tract dz
BPH complications: SUCH Stones UTI CKDZ Hematuria

182
Q

How are BPH PTs Tx based on AUA scores

When is surgery an absolute indication?

A

0-7: monitor
8-35: medical/surgical therapy

Failed catheter removal
Bladder diverticula
BPH sequelae: recurrent UTI hematuria stones CKDz

183
Q

What meds are used for BPH

A

Alpha blockers:
Praz/Doxa/Terazosin

Alpha-1a blockers:
Tamsul/Alfuzosin (fewer s/e)

5-RA inhibitors:
Finasteride x 6mon minimum, also reduces PSA x 50%
Dutasteride

PDE-5 inhib:
Tadalafil- Tx BPH and ED

184
Q

What phytotherapy can be used for BPH although not proven to provide benefit?

A

P africanum
E purpurea
H rooperi

Palmetto berry
Pollen extract
Trembling poplar

185
Q

What ‘minimally’ invasive procedures may be done for BPH Txs

What conventional procedure is done?

A 
TULIP
TUNA
Implants
Microwave hyperthermia
Electrovaporization

TURP

186
Q

What surgical procedure is performed when prostate is too large to remove endoscopically?

? is the MC non-cutaneous cancer in US men?

A

TUIP
Open simple prostatectomy

Prostate cancer

187
Q

? is the 2nd leading cause of Ca related deaths

What are the RFs?

A

Prostate

Age AfAm FamHx
High fat intake

188
Q

PSA levels above ? suggest but are not Dx inclusive of prostate Ca

If PT has elevated BUN/Cr means ?

If PT has elevated AlkPhos means ?

A

> 4ng/mL

Urine retention/obstruction

Skeletal metastases

189
Q

What is the preferred method for prostate ca imaging/biopsy?

When are PTs referred for this procedure?

A

TRUS biopsy from apex, mid and base

Abnormal DRE/elevated PSA

190
Q

When PTs PSA is >20ng, they may be referred for ? imaging test?

Current screening recommendations include ?

A

Radionuclide bone scan

DRE PSA and TRUS

191
Q

PSA screenings is a Grade C and only recommended for ? age groups?

Do not screen PTs over ? age

A

55-69

> 70y/o, Grade D

192
Q

When/why would prostate screening be initiated at 50?

When would it be initiated at 45y/o?

A

50y/o w/ average risk

Black men
FDR Dx <60y/o
BRCA 1 mutation

193
Q

Most prostate Cas are ? type
that start ?

Define Gleason score

A

Adenocarcinomas
Peripheral zone

2-10
Correlates to volume, stage and prognosis

194
Q

What is removed during a radical prostatectomy

Who are the ideal candidates for this surgery?

A

Seminal vesicles
Ampullae of Vas Deferens
Prostate

T1 and T2

195
Q

Define Brachytherapy

Most prostate Ca are ? depenent and can be Tx w/ ?

A

Implantation of radioactive source into prostate (palladium iodine iridium)

Hormone dependent
Androgen suppression w/ hormone therapy

196
Q

What is the acronym used for prostate Ca prognosis

What can be used/done for prostate cancer prevention

A

CAPRA- CAncer of the Prostate Risk Assessment

Antioxidant- Lycopene
Cruciferous veggies
Vit D
Omega 3s
Polyphenols (green tea)
197
Q

Define Balantitis

Define Balanoposthitis

A

Inflammation of glans

Inflammation of gland and/or foreskin d/t CAlbicans

198
Q

Balanoposthitis may be the sole presenting sign of ? Dx

How is this Tx

A

DM

Nystatin
Clotrim/Fluconazole
Recurrent- circumcision refer

199
Q

When is an PO Cephalosporin added to Tx of balanoposthitis

What are the two types of phimosis

A

Cephalexin

Physiologic- born that way
Pathologic- infection/scar

200
Q

How is a phimosis temporarily Tx

What is the definitive Tx

What can be done to avoid the need for surgical Tx

A

Dilate preputial ostium

Dorsal slit, Circumcision

Topical steroids HC 1% w/ daily retractions

201
Q

Define Paraphimosis

After reduction, all PTs need to have /

A

Retracted foreskin trapped behind glans

Uro refer for circumcision

202
Q

What breaks during a penile fracture

What may need to be done to preserve urethral integrity

A

Tear of penil tunica albuginea

Retrograde urethrography

203
Q

Define Epispadias

Define Hypospadias

A

Meatus opens on dorsal side

Meatus opens on ventral side

204
Q

Facts of Epispadias

Facts of Hypospadias

A 
More common
Associated w/ feminization
No circumcisions
Repaired prior to 18mon, usually 6mon
Great prognosis

Common incontinence due to improper development of sphincter
Dorsal curvature
Poor prognosis

205
Q

Define Chordee

This may be associated w/ ?

A

Abnormal ventral curvature of penis d/t short urethra/fibrous tissue on corpus spongiosum

Hypospadias

206
Q

Define Peyronie Dz

This condition is associated w/ ? other PE finding

How is it Tx

A

Acquired malformation of tunica albuginea

Dupuytren contracture

Collagen clostridial injection- only FDA approved
CCBs
Interferon injection

207
Q

Define Priapism

Since this is not an arousal problem, what can cause it?

A

Erection >4hrs, ischemic injury to corpora cavernosa

Pelvic tumor/infection
Sickle
Leukemia
Penile/spine trauma

208
Q

What are the two types of priapisms

Both types require ?

A

Non-ischemic: high flow from injury sparing erectile function, Tx may not be required

Ischemic: low flow, Tx w/ needle aspiration or phenylephrine

Urology referral

209
Q

When are penile cancers more likely to show their rare existence?

What are the RFs?

Almost all are ? type

A

6th decade

HPV
Uncircumcised
Phimosis

Squamous cell*- glands
Bowen Dz- red plaque on shaft
E of Q- red ulceration/Bowen on glans

210
Q

How are penile Cas Tx

How are urethral strictures Tx

A

Biopsy required

Internal urethrotomy
Open surgical repiar

211
Q

What is the MC referral to urology for the scrotum for?

Why are these concerning?

A

Mass

Masses arising from tests are usually malignant
Arising from epididymis/spermatic cord usually benign

212
Q

How do malignancies of the testes present on PE?

Where do hydroceles collect fluid

How are these differentiated and more commonly seen

A

Painless, firm and solid that don’t transilluminate

Parietal/visceral of tunica vaginalis

1st year of life
Transillumination

213
Q

Where do epididymal cysts grow?

Difference between epididymal cyst and spermatocele

A

Caput of epididymis

EC: <2cm
Sp: >2cm on head of epididymis

214
Q

Define Varicocele

When are these concerning?

A

Dilated pampiniform plexus of spermatic veins, MC on L

Unilateral R side
Dilated when PT supine
Sudden onset/rapid growth

215
Q

Why are R sided varicoceles concerning?

How are they managed?

A

Retroperitoneal malignancy

CT scans

216
Q

Define Indirect Hernia

Define Direct Hernia

A

Congenital patent vaginalis, through inguinal ring

Protrude through abdominal viscera through posterior wall of inguinal canal

217
Q

When are torsions most common?

This happens due to inadequate fixation to ? structure

How can this occur w/out activity?

A

Neonates
Post-puberty

Tunica vaginalis

Cremaster contraction during REM

218
Q

What is the most sensitive PE test for torsion?

What is the test of choice

How is the Open Book procedure done?

A

Absent cremaster reflex

Doppler US

R- counter clockwise
L- clockwise

219
Q

? is the MC cause of scrotal pain

What causes this?

How does this present and how is it differentiated

A

Epididymitis and Epididymo-orchitis

MC- infectious: G/C, urethritis
Non-STI: UTI, prostatitis, Gram-Neg rods

Post strain w/ fever
Pos Phrehn sign

220
Q

How are Epididymitis and Epididymo-orchitis Tx

“Blue dot” on testes indicates ? issue

A

STI: Ceftriax and Doxy/Azith
Non-STI: Cipro/Levo
Bed rest, elevation for both

Torsion of appendix testis, slower/more gradual onset

221
Q

Define Fourniers Gangrene

What population is this seen in

A

Necrotizing fasciitis of perineum and scrotal skin

DM

222
Q

Post void residual volume less than ? is considered adequate and normal

What is the DIAPPERS acronym stand for

A

<50mL

Delirium
Infection
Atrophic
Pharm
Psych
Excessive output
Restricted mobility
Stool impact
223
Q

What are the 4 established causes of urinary incontinence

What are the RFs

A

Destrusor over activity- urge
Urethral incompetence- stress
Obstruction
Detrusor over activity- over flow

F: FamHx Obesity* Age Multiparity
M: DM Age Prostate Neuro

224
Q

What is the MC cause of established geriatric incontinence

What is the corner stone to detrusor over activity Tx

A

Urge incontinence, detrusor over activity

Bladder training on schedule

225
Q

PCKDz may be associated w/ ? cardiac valve issues?

RCC prognosis

A

MVP
Aortic abnormalities/aneurysms

T1: <7cm, encapsulated w/ 90% 5yr survival rate

226
Q

How is detrusor over activity Tx

If behavior therapies don’t work what meds are used?

What med can be given specifically for the overactive bladder Sxs?

A

Kegels

Tolterodine, Oxybutynin

Miragegron- B3 agonist

227
Q

What is an alternate Tx for detrusor over activity if PO meds are avoided?

Men w/ BPH and detrusor over activity and post-voiding residual volume of 150mL or less can benefit from ? combo

A

Botox A injections

Antimuscarinic + A-blocker

228
Q

Instantaneous urine leakage in response to stress indicates?

This can be seen in men that have had ?

A

Urethral incompetence- 2nd MC cause in older females

Radical prostectomy

229
Q

How is the cough stress test conducted?

How is stress incontinence Tx

A

Cough w/ full bladder
Instant leak- stress incontinent
Delay/persistent leak- uninhibited bladder contraction

Weight loss
Kegel/Pessarie/cones
Sling surgery- last, best

230
Q

How is urethral obstruction incontinence Tx

What is the least common cause of incontinence

A

Surgical decompression
Catheter
A-blockers
Finasteride if BPH present, 6mon wait time

Detrusor underactivity due to sacral motor dysfunction

231
Q

What lab result shows urinary incontinence due to detrusor under activity?

How is this form Tx

A

Reatined urine volume >450mL

Bladder training

232
Q

? is the 2nd MC urologic Ca

What type of Ca are these

A

Bladder at 73y.o

Epithelial (Uro, Squamous, Adeno)

233
Q

What are the biggest RFs for bladder Ca

How is a Dx confirmed

A

Smoking
Industrial dye/solvents
Schistosomiasis

Cystoscopy and Biopsy

234
Q

How is bladder Ca staged

A 
Ta
T1
T2
T3a
T3b
T4- prostate invasion
Ta/1= superficial
T2+= invasive
235
Q

What is the initial Tx for all bladder tumors

What is the prognosis

A

Transurethral resection

Ta-T1= good, 81%
T2/3- 50-75% 5yr after radical -ectomy

236
Q

? is the MC neoplasm in men 15-35y/o

How is this MC Dx

A

Testicular ca

Orchiectomy

237
Q

Most testicular Ca are ? tumors

They are slightly more common on ? side

What is the primary RF

A

Germ cell

R

Cryptochordism

238
Q

What lab results may be increased in testicular Ca work ups

What sequence of images are ordered during work up?

How are these Tx

A

LDH AFP hCG

US
Orchiectomy
CT/PET

Radical orchiectomy

239
Q

Secondary tumors/metastasis are rare in testicular Ca except for ?

What is the 5yr prognosis?

A

Lymphoma

Stage 1-3: almost 100%

IPAP (212 decks)

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