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SASP > SASP 2012 2 > Flashcards

SASP 2012 2 Flashcards

1
Q

mech for low urine ph in idiopathic stone formers

A

insulin resistance. Ammonia production/ excretion results in unbuffered h+ –> acid urine

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2
Q

insulin role in kidney

A

insulin stimulates amoniagenisis in proximal renal tubule

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3
Q

dent’s disease

A

x linked recessive nephrolithiasis. Hypercalciuria, nephrocalcinosis, stones, proteinurina, progressive renal failure, +/- rickets

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4
Q

std vs extended LN dissection @ radical cystectomy

A

standard - bifrucation of common illiac artery. Extended = IMA

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5
Q

enterovesical fistula causes -3

A

dverticulitis, regional enteritis, sigmoid ca

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6
Q

pneumaturia

A

60% in diabetics. Get ua/ ucx first

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7
Q

class for temsirolimus

A

mTOR (involved in growth/ proliferation of cells)

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8
Q

who benefits from temsirolimus

A

3 or more of poor risk factors: 1. LDH> 1.5x nl, 2. HBG below nl, 3. serum ca >10, 4. dx of rcc to tx > 1 yr, 5. multiple organ mets, 6. karnovsky of 60-70

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9
Q

multiple system atrophy findings

A

open bladder neck at rest in uds is most telling in a male. MSA often assd w ED. No ED, include parkinsons in ddx

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10
Q

multiple system atrophy eponym

A

shy-drager

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11
Q

etoposide and platinum long term AE

A

cardiovascular toxicity and econdary malignancy. Also in radiation

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12
Q

renal bloodlfow is autoregulate by

A

afferent glomerular artiolar resistance.

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13
Q

distal tubuloglomerular feedback

A

Changes in rate of fluid flow in the distal tubule elicit changes in afferent glomerular arteriolar resistance. Happens in innervated and denervated kidneys

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14
Q

idiopathic ca oxalate stone formers and randalls plaques

A

in IDIOPATHIC stone formers - ca phos crystals form in BM of think loop of henle. Plaques progress into interstitum and vasa recta then erode through papillary surface and provide anchored site for ca ox stones. Different mech for other stone types

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15
Q

repeat biopsy of previously negative elevated psa

A

rebiopsy with anterior apical horn bx - 30-50%. Similar yield to saturation biopsy

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16
Q

what exactly is in sipuleucel-T

A

autologous peripheral blood mononuclear cells with APC’s activated ex vivo with proteins c/o prostatic acid phosphatase fused to GMCSF

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17
Q

sipuleucel-T premedication

A

tylenol and benadryl

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18
Q

calcium reabsorbtion induced by PTH and vit D happens in X in kidney

A

distal tubule. Also happens in prox tubule, but not under hormonal influence

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19
Q

bone scan delayed radiotracer in kidney

A

get functional imaging to r/o obstruction

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20
Q

Penile cancer Ta, T1a, T1b, T2, T3

A

Ta - noninvasive veruccous ca, T1a - subepithelial connective tissue, no LVI not poorly differentiated, T1b - invades SECT + LVI or poorly differentiated, T2 - inv corpus vacernosum or spongiosum, T3 - inv urethra

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21
Q

penile ca cN1-3

A

N0 - no nodes, N1 -mobile unilateral ing LN, N2 - mobile multiple or bilateral ing NL, N3 - fixed in LN or pelvic LN uni or bilateral

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22
Q

idiopathic DO

A

random episodes of incontenence. CMG fails to ID involuntary bladder contraction in 50% w/ clinical urge incont.

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23
Q

increased stone formation during pregnancy

A

absorbtive hypercalciuria 2/2 placental production of 1,25-vit D. increased intestinal absorbtion of ca and pth supression. (unrelated) inc citrate and GAG excreation (inhibit stones)–> No change in stone risk

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24
Q

ECOG score

A

0 - fully active, no restriction, 1 - no strenuous activity (light housework only) ,2 - no work activities, out of bed > 50%, 3 - limited self care and bed> 50%

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25
Q

factors for increased leakage in neobladder

A

short functional urethral length, non nerve sparing, decreased membranous urethral sensation, increased time after diversion.

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26
Q

persistent hyperoxaluria after low oxalate diet - tx

A

pyridoxine (b6), cofactor in AGT (glyoxylate –> glycine). Otherwise glyoxalate –> oxalate via LDH

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27
Q

interferon and BCG?

A

interferon does not help outcome. Give standard RDA vitamins

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28
Q

mcrpc with docetaxel failure - next agent

A

carbazitaxel. Others with survival benefit - abiraterone, sipuleucel-T

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29
Q

renal insufficiency from atherosclerotic renal artery dz - most important prognostic factor

A

89% with serum cr < 3 will have improvement.

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30
Q

when is renal biopsy helpful in renal vascular htn

A

if cr > 4

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31
Q

most accurate way to determine length of graft in urethroplasty

A

ultrasound identifies length of stricture and scarred spongiosal tissue.

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32
Q

post transplant lymphoproliferative EBV + mass in kidney -tx?

A

reduce or stop immunosupression

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33
Q

antimuscarinic an DLPP

A

does not decrease DLPP in NGB

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34
Q

who gets ammonium acid urate stones

A

chronic diarrhea & history of laxative abuse; or ileal resecion or large colectomy. Pts have low sodium excretion

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35
Q

pH for uric acid stone

A

<5.5

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36
Q

what helps platelet dysfunction in ESRD

A

desmopressin, cryoprecipitate, conjugated estrogens, erythropoietin, dialysis

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37
Q

neuroblastoma in children age

A

50% present < 2 yo.

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38
Q

neuroblastoma feels like and assd sx

A

large, hard, fixed. Catecholamine release

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39
Q

wilms masses feel like

A

smooth, not fixed

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40
Q

most common renal tumor in kids < 6 mo

A

congenital mesoblastic nephroma

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41
Q

cirsoid AV fistula. What is it

A

congenital, complex fistula.

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42
Q

cirsoid AV fistula tx and who to tx

A

nephrectomy. Embolization not possible - coil migration. Tx HTN, cardiomegaly, ht failure, hematuria, lesion expansion

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43
Q

SCC of head, neck, or lung and kidney stones

A

production of PTHRP causes ectopic hyperparathyroidism and absorbtive hypercalciuria.

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44
Q

prostate utricle is analagous to X in females

A

distal 1/3 of vagina. PU enlarged due to lack of androgen action prox hypospadius

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45
Q

where is cowpers duct cyst confined to

A

bulbous and prostatic urethra

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46
Q

one kidney one clip - where does htn come from

A

volume and sodium excess

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47
Q

one kidney one clip - tx

A

diuretic

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48
Q

2 risk factors for malignancy in pheo

A

tumor > 5 cm, extra-adrenal tumor

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49
Q

mitotane use

A

palliation in metastatic adrenal cortical carcinoma

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50
Q

metyrapone and aminogluthamide use

A

ameliorate hormonal production in metastatic adrenal cortical carcinoma

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51
Q

metastatic pheo chemo agents

A

cyclophosphamide, vincristine, dacarbazine

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52
Q

why not treat asymptomatic e coli

A

asymptomatic assd with self agglutinating ecoli that have lost their o-polysaccharide surface antigen. Treatment is followed by new e coli with intact O surface antigen leading to acute sx

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53
Q

spinal shock definition

A

supression of somatic and autonomic activity below level of injury. Lasts 6-12 wks

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54
Q

spinal shock to T8 - 3 findings

A

Detrussor overactivity, smooth sphincter synergia (T8 is below sympathetic outflow), absent guarding reflex

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55
Q

initial management of cystinuria

A

hydration, +/- alkali therapy

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56
Q

Cystine pH for dissolving

A

> 7.5 (ca phos stones may happen)

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57
Q

cystine stone medications (3)

A

d-penicillamine (lots of side effects), alpha-mercaptopurine (Thiola). Captopril is last line if cant tolerate other meds

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58
Q

Pediatric postinfectious glomerulonephritis. Timeframe and sx

A

preceeded by pharyngeal or skin strep 7-21 days earlier. Painless gross hematuria, mild proteinuria, edema, htn.

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59
Q

what is acetohydroxamic acid

A

urease inhibitor for management of infected stones

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60
Q

post infectious glomerulonephritis tx/prognosis

A

excellent, supportive

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61
Q

post infectious glomerulonephritis labs

A

low C3, streptozyme test positive

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62
Q

what is natural cycle artificial insemination

A

allowing woman to ovulate without meds.

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63
Q

male infertility and natural cycle insemination

A

no better than timed vaginal intercourse.

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64
Q

when is IUI useful (3)

A

mechanical problems (hypospadius, retrograde ejaculation, impotence). Preg rate improved with ovulation induction if abn semen parameters.

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65
Q

when is natural cycle IUI useful

A

pure cervical factor infertility

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66
Q

tubal abnormality best assisted reproductive technique

A

IVF. (inseminated sperm otherwise need to ascend fallopian tubes)

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67
Q

PUV voiding dysfunction and incontinence mgmt

A

if high urine output, will see hydro, nocturnal drainage will help. Otherwise try timed voiding before uds test. Don’t give oxybutinin - can cause retention due to kyogenic dysfunction.

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68
Q

geriatric UTI - low CFU

A

in previously asymptomatic, treat for 7 days with abx

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69
Q

stone in mid-proximal ureter and pain type

A

flank pain radiationg anteriorly

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70
Q

stone in distal ureter and pain type

A

irritative voiding sx or pain radiating to penis, scrotum, labia.

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71
Q

first line in kid with urinary frequency

A

timed voiding, voiding diary

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72
Q

benefit of transurethral incision of prostate

A

maintain antegrade ejaculation. 1 incision 5%, 2 incisions 15%

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73
Q

retrograde ejacualtion % after turp, laser vaporization

A

95%. Same for laser

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74
Q

primary source of radiation @ flouro

A

scatter from patient.

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75
Q

2 ways to minimize radition exposure during flouro

A

maximize distance form patient, primary beam under patient

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76
Q

2 known defects in primary enuresis

A
  1. reduced functional bladder capacity, 2. mild OAB, 3. elevated arousal threshold while sleeping
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77
Q

how to use nocturnal enuresis alarm. Timeframe, % success

A

parent has to make sure kid gets up. Takes 3-4 months. 80% success

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78
Q

DESD implies location of lesion where

A

between pons and lower spinal cord

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79
Q

skin graft of choice for large volume scrotal skin loss and pro/con

A

split thickness. Pro’s: high success rate, can cover large area, mimmic rugated appearance of scrotum. Cons: lack of hair, may retract.

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80
Q

how to minimize split thickeness skin graft

A

avoid expansion of graft - 2:1 or 3:1. do not place in acute injury site (bacteria)

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81
Q

thigh pouch and scortal injury

A

temporizing, except in debilitated patients.

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82
Q

why are child kidneys more suseptible to trauma than adult - 4

A

more pliable thoracic cage, weaker abdominal muscles, less perirenal fat, lower position in abdomen

83
Q

when to image suspected renal injury in adults/kids

A
  1. significant deceleration or high velocity injury (fall > 15 ft, hi speed MVC, significant abdominal blow), 2. trauma resulting in fx rib cage or spine, 3. gross hematuria, 4. micro hematuria assd w shock (SBP <90))
84
Q

what sacral foramen does interstim lead go to

A

S3.

85
Q

sign of correct interstim lead placement

A

bellows reflex (contraction of perineal area) and plantar flexion of ipsilateral great tow

86
Q

sign of interstim placed 1 foramen too high

A

S2. plantar flexion and rotation of foor with sensation in buttock

87
Q

postobstructive diuresis and persistent elevated cr- mgmt?

A

renal us to r/o upper tract obstruction

88
Q

hemihypertrophy in kid - genetic abnormality and mgmt

A

WTR1 or WTR2. renal us q 3 mo

89
Q

time to sperm after vasoepididymostomy

A

3-15 months, mean 6.

90
Q

ultimate sperm count after VE and timing

A

sperm count and motility similar if sperm @ 6 mo or delayed

91
Q

deciding factor for doing VE

A

presence of sperm in epididymal fluid

92
Q

test to identify ectopic ureter

A

T2 MRI as good as MRU for fluid filled structures

93
Q

testiclular lymphoma - age, types, us presentation

A

possible multiple lesions on us, most common testis tumor > 50 yo, all lymphoma types possible but diffuse hystiocytic most common.

94
Q

penoscrotal hypospadius, nonpalpable testis - test

A

first - r/o CAH with 17 oh progesterone level. Tx dehydration/salt loss if CAH ASAP

95
Q

reason for OCP and decreased libido

A

decreased testosterone

96
Q

OCP effects

A

increased SHBG by liver, this lowers testosterone (irreversible binding). Estrogen may decrease and progesterone may increase (no effect on libido)

97
Q

rb mutation in bladder cancer correlated with

A

found in 30%. Sddociated with higher stage at dx and decreased patient survival.

98
Q

chromosomal analysis and bladder cnacer outcome

A

low grade are diploid, triploid and tetraploid have poorer prognosis.

99
Q

best prdictor of post turbt recurrence in well-moderate differentiated

A

post turbt cysto @ 3 mo - if negative have an 80% chance of no further recurrence

100
Q

urinary concentration results from x in kidney

A

hypertonic medullary interstitial fluid - causes water to diffuse out of collecting ducts then to medullary blood vessels. High adh levels - more concentrated, low adh - more dilute

101
Q

3 ct findings suggestive of vesicoenteric fistula

A
  1. bladder wall thickening, 2. air in the bladder, 3. colonic diverticula
102
Q

rate of definitive dx for VE fistula on cysto

A

35-46%

103
Q

conervative management of poor risk patient with VE fistula

A

long term abx

104
Q

AFP elevated in seminoma means

A

indicative of nonseminomatous tumor

105
Q

nonseminomatiou tumor with retroperitoneal LN tx

A

3 cycles cysplatin based chemo - BEP

106
Q

4 yo w nonacute phymosis - tx

A

seroid cream -90% success

107
Q

4 yo w phymosis - who gets circ

A

severe blanitis, obstructive voiding sx

108
Q

PDE5I and alpha blocker - precautions (2)

A

start PDE5 or alpha -x at lowest recommended dose. Don’t take at the same time

109
Q

nelson’s syndrome - what Is it

A

10-20% s/p bilateral adrenalectomy for cyshings develop pituitary chromophobe adenoma

110
Q

nelsons synd - sx

A

hyperpigmentation, headaches. Visual disturbances (growing tumor)

111
Q

how to avid vesicostomy prolapse

A

place stoma at bladder dome- this immobilizes posterior wall of bladder

112
Q

hypercoagulability seen in what type of ESRD and why

A

nephrotic. Loss of antithrombin 3, protein c and protein s

113
Q

general cause of hypercoagulability in esrd

A

hyperhomocysteinemia

114
Q

2 most common complication of intravesical mitomycin c

A

contact dermatitis rash (9%), chemical cystitis 6-41%

115
Q

ddavp@ surg for outpatinet hypospadius - fluids and postop

A

ns, drink thirst postop

116
Q

testosterone replacement in postprostatectomy w undetectable psa

A

after “prudent interval.” informed consent with patient. “close followup”

117
Q

old, decrepid with 6 mm HG ureteral tumor mgmt

A

urs/ ablation. Avoid major abd surgery

118
Q

stepwise diagnosis of SUI - 3?

A
  1. cough with pelvic exam, 2. full bladder supine stress test, 3. uds to deliniate leakage.
119
Q

post ebrt neobladder - considerations

A

ok if ureter, urethra, bowel not affected by RT. higher risk of incontinance

120
Q

primary hyper pth - how to finalize diagnosis if equivocal

A

thiazide challenge differentiates renal hypercalciuria (s ca and pth should remain nl and urinary ca returns to nl) from primary hyper pth (become overtly hypercalcemic and s pth become elevated without change in u ca

121
Q

resorbtive hypercalciuria aka

A

primary hyperparathyroidism

122
Q

primary hyperparathyroidism - s ca, PTH, fasting urinary ca, intestinal ca absorbtion, tx

A

s ca HI, PTH HI, fasting urinary ca HI, intestinal ca absorbtion HI, tx parathyroidectomy

123
Q

renal hypercalciuria - s ca, PTH, fasting urinary ca, intestinal ca absorbtion, tx

A

s ca NL, PTH HI, fasting urinary ca HI, intestinal ca absorbtion HI, tx thiazide, low sodium diet, K citrate

124
Q

traumatic renal injury - predictors of persistent bleeding - 4

A

Grade 3 or 4 injuries - medial hematoma, hematoma > 3.5 cm thick, presence of vascular contrast blush - increased risk of intervention.

125
Q

treatment options for persistent bleedingin gr 3-4 renal inj

A

IR - angio w/ selective embolization

126
Q

orthostatic proteinuria def

A

elevated protein excretion in kids while uprisht and nl protein excretion while supine. causes - left RV entapment, subtle glomerular abnormality, exaggerated hemodynamic response to upright position, nl variant. excellent prognosis. no tx

127
Q

orthostatic proteinuria - dx

A

any kid w >1+ proteinuria - UA and first morning spot protein : cr ratio. void before sleep, remain supine, if AM r:cr <0.2 (normal) dx orthostatic proteinuria

128
Q

% with y chromosome microdeletion and finding

A

7%. assd w azoospermia or severe oligospermia and elevation in FSH

129
Q

where do y chromosome microdeletions happen and most common type

A

long arm of Y - borken down in to AZFa (prox), b(mid), c (distal)

130
Q

y chromosome microdeletion with sperm

A

75% with AZFc have sperm on testicular biopsy. no sperm with AZF a or b.

131
Q

absence of vas and FSH

A

have obstructive azoospermia picture with normal FSH

132
Q

nonobstructive azoospermia and FSH

A

elevated FSH

133
Q

bone loss in ADT and pathologic fx risks (%’s)

A

bone loss (6.5-17.3%) in ADT and pathologic fx (4% at 5 yrs and 20% at 10 yrs) risks (%’s)

134
Q

initial tx for osteoporosis

A

weight bearing exercise, calcium and vitamin D

135
Q

time to correct creatinine in newborn

A

reflect’s child’s cr at 7-10 D

136
Q

long term renal fxn in PUV determined by

A

nadir cr at 1 yo. <0.8 is good prognosis

137
Q

when is renal development completed

A

34 wks GA

138
Q

ureteral peristalsis originate from?

A

intrinsic smooth muscle pacemaker sites in the minor calyces. denervated or transplanted kidneys maintain peristalsis

139
Q

renal innervation - 2

A

preganglionic sympathetic input - T8 to L1. postganglionic sympathetic fibers from celiac and aorticorenal ganglia. parasympathetic from vagus nerve. no role in ureter

140
Q

significance of ductal carcinoma of prostate

A

associated with high grade disease and recurrence

141
Q

ductal carcinoma pathologic features

A

automatically graded as 4+4 as it shares cribiform pattern and is associated with hi grade dz/recurrece.

142
Q

what zone does prostate ca arise from

A

peripheral zone

143
Q

triad of leydig tumor in children and tx

A

precocious puberty, testis mass, elevated 17-ketosteroid. tetis sparing therapy - usually benign

144
Q

leydig tumor may present similar to X and mgmt

A

hyperplastic nodule of CAH when steroid replacement is inadequate. also has elevated 17-ketosteroid. glucocorticoid tx will cause regression of hyperplastic nodule

145
Q

CAH with 21-hydroxylase deficiency and urine finding

A

elevated 17-ketosteroid AND elevated urinary pregnanetriol

146
Q

sterilization vs high level disinfectant - specific risk

A

sterilization kills everything. HLD cant kill large numbers of bacterial spores unless exposed for promonged time

147
Q

acute adrenal insufficiency sx

A

fever, nausea/vomiting, abdominal pain, hypotension, abdominal distension, lethargy, hyponatremia, hypokalemia

148
Q

preop sunitinib can contribute to x syndrome postop

A

acute adrenal insufficiency

149
Q

test to confirm adrenal insufficency

A

ACTH stim test to confirm adrenal insufficiencyi

150
Q

most reliable test to confirm renal function in ileal conduit

A

FENA - sodium handling is not affected in ileal segments. BUN, cr, alkalinizing agents, and ostmotic content affected

151
Q

what cancer is more common in kleinfelters and its features

A

breast cancer, 80% estrogen receptor positive (anything increasing estrogen is contraindicated)

152
Q

hypogonadal man with hx breast cancer - mgmt

A

give aromatase inhibitor - decreases conversion of testoserone to estrogen, increasing [T]. dont give exogenous T as some will be converted to estrogen

153
Q

isolated node metastasis on final prostatectomy path - mgmt

A

lifelong lhrh agonist. ECOG 3807. LN+ at higher risk of systemic recurrence

154
Q

what type of bacteria convert nitrate to nitrite

A

gram negative, except pseudomonas - lacks enzyme. G+ dont make nitrite. G - examples - e coli, serratia marcescens, klebsiella oxytoca, proteus mirabilis

155
Q

no muscle in tubt specimen- % with residual tumor

A

20-40%

156
Q

turners syndrome chromosomes

A

45XO

157
Q

GU abnormality in turners syndrome

A

horseshoe kidney

158
Q

turner syndrome findings

A

short stature, webbed neck, shield chest

159
Q

mosiac turners syndrome and specific abnormality

A

dysgerminoma and gonadoblastoma - need orchiectomy

160
Q

one treatment for stones due to chronic diarrhea

A

K citrate corrects acidosis. can give liquid if pills seen in stool

161
Q

what was PLCO

A

ransomization of 75K men to PSA (6 yrs) DRE 4 {yrs). screening increased detectino of prostate cancer. survival same in screened and control, same number of advanced cancer in both groups

162
Q

hemolytic uremic syndrome triad

A

hemolytic microangiopathic anemia, thrombocytopenia, renal insufficiency

163
Q

henoch-schonlein purpura - what is it

A

systemic vasculitis. purpuritic rash, abdominal pain, GI bleed, arthritis. presents at 4-6 yo

164
Q

membranous glomerulonehritis - what is it

A

most common cause of nephritis, less common in kids. glomerular subepithelial immune deposits on electron microscopy

165
Q

what is alports syndrome

A

inherited d/o of glomerular basement membrane due to type 4 collagen associated with hearing loss. glomerular vasculature abnormality on biopsy

166
Q

how to follow patients with IgA nephropathy

A

24 hr urine cr and protein. biopsy if severe disease.

167
Q

clinical sx iga npehropathy - 2

A

painess gross hematuria, RBC on UA without casts

168
Q

IgA nephropathy biopsy findings

A

glomerulonephritis with immunoglobulin deposits on mesangial areas

169
Q

benefits of daily dosing of aminoglycosides

A

reduced nephrotoxicity, more cost effective administration (nursing and serum levels), maximizes bacterial killing by optimizing peak concentration to MIC.

170
Q

how do aminoglycosides kill bacteria

A

concentration and time dependent killing. once dialy dosing maximizes these

171
Q

aminoglycoside ideal dosing

A

7mg/kg/dose gent, 5-7 mg/kg tobramycin.

172
Q

adjustment of aminoglycoside dose too high

A

space out medication to maximize concentration dependent killing

173
Q

ditinguish essential htn from pheo

A

oral clonidine test - essential htn will get significant drop in plasma catecholamine

174
Q

cowpers gland duct cyst - radiographic finding vs prostatic utricle

A

CGC - diverticulum of bulbous urethra, PU - enters prostatic urethra

175
Q

cowpers duct gland anatomy and %

A

ducts open into urethra in the bulb and travel to the glands located in UG membrane adjacent to membranous urethra. cysts in 2.3% autopsied males

176
Q

2 fx that are independent predictors of urethral injury

A

medial inferior ramus and pubic diastesis

177
Q

independent molecular predictors of RCC prognosis -3

A

high carbonic anhjydrase IX, absent vimentin, absent p53

178
Q

complete duplication association with upper and lower pole

A

upper pole ectopic and obstructed. lower pole reflux

179
Q

in complete duplication why does reflux happen into upper pole alone

A

insertion into bladder neck or urethra - lack of trigonal support with inadequate submucosal tunnel

180
Q

most predictive factor of fibrosis on postchemo rplnd for GCT

A

normal post chemo CT scan with no NL > 8 mm asss with 90% chance of fibrosis at RPLND

181
Q

% with germ cell tumor or teratoma on postchemo RPLND

A

if tumor markers negative, 10-20% with viable tumor, 30% with teratoma

182
Q

age for classic testicular tumors - 0-10, 20-30, 25-35, 30-40, >50

A

0-10 yolk sac, 20-30 Choriocarcinoma, 25-35 embryonal/teratoma, 30-40 classic seminoma, >50 malignant lymphoma

183
Q

Half life HCG, AFP, LDH

A

HCG 1-3, AFP 5-7, LDH 4

184
Q

HCG is always elevated for x

A

choriocarcinoma

185
Q

AFP is never elevated in

A

pure choriocarcinoma or pure seminoma

186
Q

2 reasons for false HCG elevation

A

elevated LH (bilateral orchiectomy…), weed

187
Q

pathognomonic path finding in leydig tumor

A

reinke crystals

188
Q

2 testosterone producing tumors

A

leydic cell tumors, sertoli cell tumors

189
Q

yolk sac tumor pathognomonic path finding

A

schiller-duvall bodies

190
Q

granulosa cell tumor

A

75% present within one month of birth, orchiectomy is curative

191
Q

classic seminoma relapse rate and risk factors

A

0-1 RF 15%, 32% > 1 RF. risk factors: tumor > 4 cm, rete testis invasion

192
Q

relapse for seminoma after chemo vs radiation

A

chemo - retroperitoneum, radiation - pelvis

193
Q

post chemo followup for seminoma

A

pet scan 6 weeks post chemo. if no pet scan, observe masses < 3 cm, biopsy lesions > 3 cm

194
Q

nonseminoma risk factors for relapse

A

LVI (most important), >/= pT2, embryonal cell predominance, absence of yolk sac.

195
Q

ideal fluid replacement for hypernatremic child

A

1/4 ns @ 1.5-2x maint

196
Q

factor in gsw with most impace on tissue damage

A

velocity

197
Q

ureteral contusion post gsw mgmt

A

cysto, stent

198
Q

timeframe for leiomyosarcoma of cord

A

1st 2 decades of life

199
Q

post resection of leiomyosarcoma of cord mgmt

A

high risk of local recurrence even if negative margin. do ingional orchiectomy with high ligation of cord with resection of scar. chemoradiation if microscopic diesase on resection path.

200
Q

what is medial umbilical ligament

A

obliterated hypogastric artery. in fetus carries de oxygenated blood to umbilical artery and placenta. after birth, hypogastric artery distal to superior vesical artery is coverted to fibrous cord

201
Q

CBAVD next step

A

CFTR testing - often have mutation of 5T polymorphism of CFTR gene. ideally test both partners if considering sperm retrieval and ICSI. if both positive, child has 50% chance of clinical CF

202
Q

followup schedule for low risk patient with NSGCT

A

chest/abdomen at 3 and 12 months (JCO 2007)

203
Q

who is at risk for retrorenal colon

A

pts with NGB

204
Q

mgmt of colonic perforation with nephrostomy

A

withdraw tube into colon, low residue diet, broad spectrum abx. remove nephrostomy @ 7 -10 days if no evidence of extravisation or fistula formation. explore if peritonitis, intraperitoneal perf, sepsis

SASP (1 decks)

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