GU/GYN

Question 1

R renal artery crosses anterior or posterior to IVC

Answer 1

Posterior!

Anterior to renal calyx

Question 2

L renal v crosses anterior or posterior to aorta

Answer 2

Anterior

Question 3

Which renal v can be ligated due to icnreased collaterals

Answer 3

Left renal v

Question 4

Seminal vesicles are connected to

Answer 4

vas deferens

Question 5

Spermatic cord structures

Answer 5

testicular artery, pampiniform plexus, vas deferens, cremasteric muscle, ilioinguinal nerve, genital branch of genitofemoral nerve

Question 6

calcium oxalate stones are increased in pts whop have had what previous surgery

Answer 6

TI resection due to increased oxalate absorption in colon

Question 7

Struvite stones occur with infections with what bacteria

Answer 7

Proteus mirabilis
Urease producing
Cause staghorn calculi

Question 8

Uric acid stones are increased in pts with what 3 diseases

Answer 8

ileostomies
gout
myeloproliferative disorders
They are RADIOLUCENT

Question 9

Which type of stone is radiopaque

Answer 9

Struvite

Question 10

How to prevent cysteine stones

Answer 10

tiopronin

Question 11

Stones greater than what size are unlikely to pass

Answer 11

6 mm

Question 12

1 testicular tumor

Answer 12

seminoma

Question 13

Seminoma - sensitivity to XRT?

Answer 13

Extremely sensitive

Question 14

Seminoma with AFP elevation

Answer 14

Shouldn’t be! Treat like non seminomatous

Question 15

tx for seminoma

Answer 15

orchiectomy and retroperitoneal XRT

Question 16

Chemo in seminoma - what types and when

Answer 16

Reserved for mets or bulky retroperitoneal disesase

cisplatin, bleomycin, VP-16

Question 17

90% of non seminomatous testicular CA have what markers

Answer 17

AFP and b-HCG

Question 18

At what stage do non seminomatous testicular CA receive adjuvant chemo

Answer 18

Stage II or greater

Cisplatin, bleomycin, VP-16

Question 19

MC site of prostate ca

Answer 19

posterior lobe

Question 20

most common mets for prostate CA

Answer 20

bone

Question 21

what are options if intracapsular prostate CA and no mets (T1 and T2)

Answer 21

XRT
OR
radical prostatectomy + pelvic LND (if life span >10 years)

Question 22

Option for prostate CA with extracapsular invasion or metastatic disease

Answer 22

XRT + androgen ablation with leuoprolide, flutamide or bilateral orchiectomy

Question 23

Leuprolide MOA

Answer 23

GnRH agonist

Question 24

Flutamide MOA

Answer 24

testosterone receptor blocker

Question 25

Stage IA prostate CA found with TURP - tx?

Answer 25

nothing

Question 26

With prostatectomy, how long should it take for PSA to go to 0?

Answer 26

3 weeks | If it doesnt decrease get bone scan to check for mets

Question 27

What should worry you in a pt with prostate CA with increased alk phos

Answer 27

mets or extracapsular disease

Question 28

Most common location for RCC met

Answer 28

lung

Question 29

Radical nephrectomy takes what organs along with the kidney

Answer 29

adrenal gland | Also fat, Gerotas fascia, and regional nodes

Question 30

Partial nephrectomy is indicated in RCC if..

Answer 30

pt would require dialysis after nephrectomy (tumor <4 cm, cr > 2.5)

Question 31

MC tumor in kidney

Answer 31

metastasis from breast CA

Question 32

RCC paraneoplastic syndromes

Answer 32

renin, erythropoietin, PTHrp, ACTH, insulin

Question 33

Tx for transitional cell CA of renal ppelvis

Answer 33

radical nephroureterectomy

Question 34

multifocal and recurrent RCC, renal cysts, CNS tumors, pheochromocytoma

Answer 34

Von Hippel Lindau

Question 35

T1 bladder CA

Answer 35

muscle wall not involved

Question 36

Tx for T1 bladder CA

Answer 36

intravesical BCG or transuretheral resection

Question 37

Tx for T2 or greater bladder CA

Answer 37

cystectomy with ileal conduit, chemo and XRT

Question 38

Chemo for bladder CA

Answer 38

MVAC - methotrexate, vinblastine, adriamycin and cisplatin

Question 39

Squamous cell CA of bladder is assoc with wha kind of infection

Answer 39

schistosomiasis

Question 40

What kind of suture for ureteral trauma repair

Answer 40

absorable (to avoid stone formation)

Question 41

Where does BPH arise from

Answer 41

transitional zone

Question 42

MOA of finasteride

Answer 42

5 alpha reductase inhibitors | inhibits conversion of testosterone to dihydrotestosterone which inhibits prostate hypertrophy

Question 43

What is post TURP syndrome

Answer 43

hyponatremia secondary to irrigation with water, can precipitate seizures from cerebral edema

Question 44

neurogenic bladder can be caused by a nerve injury above what level

Answer 44

T-12

Question 45

neurogenic obstructive uropathy (incomplete emptying) caused by nerve injury below what level

Answer 45

T12 | Can also occur with APR

Question 46

Tx of uretropelvic obstruction

Answer 46

Pyeloplasty

Question 47

Tx of veiscoureteral reflux

Answer 47

prophylactic abx and see if child outgrows it | Surgical tx is reimplantation of ureter with long bladderp ortion

Question 48

Most common urinary tract abnormality

Answer 48

ureteral duplication | can sometimes see ectopic ureter

Question 49

MC reason for newborn boy not to urinate

Answer 49

posterior urethral valves

Question 50

Hypospadias is when urethral opens where

Answer 50

Vewntral

Question 51

Repair for hypospadias

Answer 51

At 6 months with penile skin - use foreskin so NOOO circumcision in these pts!

Question 52

Varicocele is worrisome for

Answer 52

Renal cell CA | left gonadal vein inserts into left renal vein -- obstructure by renal tumor causes varicocele

Question 53

Sterile epidydimitis can occur secondary to

Answer 53

Increased abodominal straining

Question 54

Tx of failure of closure of urachus

Answer 54

Resection of sinus/cyst and closure of bladder, relieve lbladder outlet obstruction

Question 55

RBC casts seen in

Answer 55

glomerulonmephritis

Question 56

WBC casts are seen in

Answer 56

pyelonephritis or glomerulonephritis

Question 57

tx for priapism

Answer 57

aspiration of cprpus cavernosum with diliute epinephrine or phenylephrine

Question 58

SCC of penis tx

Answer 58

penectomy with 2 cm margin

Question 59

phimosis found at time of laparotomy tx

Answer 59

dorsal slit

Question 60

What ligament allows anteversion of uterus

Answer 60

round ligament

Question 61

what ligament contains uterine vessels

Answer 61

broad ligament

Question 62

infundibular ligament contains what

Answer 62

ovarian artery, nerve and vein

Question 63

Can see most pregnancies on US at what stage

Answer 63

6 weeks

Question 64

CT delivers how many rads

Answer 64

2.5 rad (0.025 Gy)

Question 65

Fetal pole usually seen with beta HCG at

Answer 65

6000

Question 66

Gestational sac usually seen with beta HCG at

Answer 66

1500

Question 67

MC site of ectopic pregnancy

Answer 67

ampullary portion of fallopian tubes

Question 68

MC site of endometriosis

Answer 68

ovaries

Question 69

#1 primary vaginal CA

Answer 69

squamous cell CA

Question 70

DES (diethylstilbestrol) can cause what CA?

Answer 70

clear cell CA of vagina

Question 71

Majority of vulvar CA are what type

Answer 71

squamous cell CA

Question 72

<2 cm vulvar cA: treatment?

Answer 72

WLE and ipsilateral inguinal node dissection, 2 cm margins

Question 73

Tx of >2 cm vulvar ca

Answer 73

Stage II or greater | Radical vulvectomy - bilateral labia with bilateral inguinal dissections, postop XRT if close margins <1 cm

Question 74

worst prognosis ovarian CA

Answer 74

clear cell

Question 75

ovarian CA stage III

Answer 75

spread throughout abdomen

Question 76

ovarian CA stage I

Answer 76

one or both ovaries only

Question 77

tx for ovarian CA

Answer 77

``` TAH BSO for all stages PLUS plevic and paraaoritc LN dissection omentectomy 4 quadrant washes chemo ```

Question 78

chemo for ovarian CA

Answer 78

cisplatin and paclitaxel

Question 79

what is a krukenberg tumor and what does path show

Answer 79

stomach CA that has metastasized to ovary | pathology classically shows signet ring cells

Question 80

what is Meiges syndrome

Answer 80

pelvic ovarian fibroma that causes ascites and hydrothorax

Question 81

MC malignant tumor in female genital tract

Answer 81

endometrial CA

Question 82

worst prognosis endometrial CA

Answer 82

clear cell

Question 83

what stages receieve mandatory XRT in endometrial CA

Answer 83

Stage III/IV

Question 84

Endometrial CA in cervix is what stage

Answer 84

II

Question 85

Tx of stage I or II endometrial CA

Answer 85

TAH + BSO or XRT

Question 86

Endometrial CA in vagina, peritoneum and ovary - what stage

Answer 86

III

Question 87

Cervical CA assoc with what HPV subtypes

Answer 87

16 and 18

Question 88

Where does cervical CA travel to (what nodes) first

Answer 88

obturator

Question 89

stage I and IIa cervical CA - what tx?

Answer 89

TAH

Question 90

stage IIb to IV cervical CA - what tx?

Answer 90

chemo - XRT

Question 91

Cervical CA in upper 2/3 of vagina, waht stage?

Answer 91

II

Question 92

Cervical CA in bladder and rectum, what stage?

Answer 92

IV

Question 93

ovarian cysts in post menopausal patient - what characteristics mandate oophorectomy with intraoperative frozen sections

Answer 93

``` septated increased vascular flow on doppler solid components OR papillary projections ```

Question 94

Tx of abnormal uterine bleeding if <40 years old

Answer 94

clomiphene citrate (anovulation) or GnRH agonists such as leuoprolide (leiomyoma)

Question 95

markers for granulosa cell tumor

Answer 95

inhibin

Question 96

presence of AFP with ovarian neoplasm strongly suggests what kind of tumor

Answer 96

endodermal sinus tumor

Question 97

elevated LDH and ovarian tumor is likely

Answer 97

dysgerminoma