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07. QUESTIONS and Tables (2912) > SASP 2013 > Flashcards

SASP 2013 Flashcards

1
Q

most common cause of post AUS incontinence 3 yrs out

A

urethral atrophy

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2
Q

most common cause of post AUS incontinence 3 yrs out - mgmt

A

(urethral atrophy) downsize cuff, move to more proximal or distal location, add second cuff in tandem

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3
Q

LMWH and spinal anesthesia

A

risk of spinal hematoma - FDA black box warning.

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4
Q

who is at “increased risk” for DVT - 4

A

previous DVT, malignancy, immobility, paresis

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5
Q

localized SCC urethral in female - tx

A

circumfrencial excision including excision of anterior vag wall. Distal urethral tumors usually low stage, 70-90% cure rate

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6
Q

outcome of tx for localized urethral ca

A

usually low stage, 70-90% cure rate

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7
Q

how much urethra can be excised and maintain continence in female

A

distal 1/3

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8
Q

when to do groin dissection in female urethral cancer

A

(+) inguinal/pelvic LN w/o distant mets or if adenopathy develops during surveilance.

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9
Q

when to do anterior pelvic exenteration in female urethral cancer

A

proximal urethral ca as part of multimodal approach w/ chemoradiation

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10
Q

cisplatin nephrotoxicity due to

A

direct toxic effect on renal tubular cells.

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11
Q

what predisposes to cisplatin nephrotocity

A

Azotemia and dehydration

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12
Q

ureteroiliac fistula with no bleeding at the time of angio

A

do provacative maneuver - stent removal or mechanical friction of ureter (PRG 60% dx, angio 4/14 dx)

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13
Q

osmolarity of proximal tubule fluid reabsorbtion

A

iso-osmotic

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14
Q

sodium transport in prox tubule

A

active transport. most chloride and bicarbonate reabsorbed with sodium

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15
Q

renal lymphoma origin, and type

A

90% are not primary, non-hodgkins is most common

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16
Q

hints at renal lymphoma

A

multifocal masses, bilateral and regional lymphadenopathy

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17
Q

mgmt of intraoperatively discovered renal lymphoma

A

finish case - no need for nx. plan for chemo

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18
Q

transverse vaginal septum findings

A

distended upper vagina and presence of uterus. most common in middle and upper 1/3 vagina.

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19
Q

how does transverse vaginal septum happen

A

arises from failure in fusion of canalization of UG sinus and Man ducts.

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20
Q

where does transverse vaginal septum occur

A

most common in middle and upper 1/3 vagina.

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21
Q

vaginal atresia def

A

ug sinus fails to contribute to formation of distal vagina.

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22
Q

MRKH

A

partial or complete absence of the vagina and uterine abnormalities. uterus partially or completely abscent. ovaries and fallopian tubes are present and may be normal or hypoplastic.

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23
Q

MRKH type 1

A

involves Man structures (vagina and uterus)

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24
Q

MRKH type 2

A

concurrent abnormalities of heart, kidneys, or otologic system

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25
Q

androgen insensitivity syndrome - genital abnormalities

A

missing uterus, salpinx, upper 2/3 vagina.

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26
Q

how do structures regress in androgen insensitivity syndrome

A

these regress under influence of MIF secreted from testis

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27
Q

imperforate hymen findings

A

visible bulging membrane at vaginal introitus

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28
Q

macroscopic vs microscopic penile reimplantation oafter amputation

A

microscopic has reduced penile skin loss, urethral stricture, loss of penile sensation. equivelant rate of erectile function (50%)

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29
Q

erectile function outcome after penis with micro vs macroscopic repair

A

50%. repair does not influence outcome.

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30
Q

difference in complications (urethral stricture, penile skin loss, with microvascular vs macroscopic repair of amputated penis

A

all less with microvascular reapir

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31
Q

bulky penile cancer - mgmt

A

neoadjuvant chemo may allow for future resection.

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32
Q

Trabulsi EJ, Hoffman-Censits: chemotherapy for penile and urethral ca. urol clin n am. 2010

A

cisplatin, ifosfamide, paclitaxel in TxN2-3 followed by LND showed objective response rate of 55% and complete pathologic response rate of 10%

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33
Q

kub radiation vs ct

A

x ray 0.25mSv to stomach, ct = 50x

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34
Q

concordance between retroperitoneal and pulmonary mets path in testicular cancer

A

75% concordance

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35
Q

why is postchemo thoracotomy with mass resection important in testicular cancer

A

25% discordant path with retroperitoneum and can be curative if viable tumor

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36
Q

mgmt of lung masses s/p rplnd for active tumor in testicular ca

A

curative if teratoma, helpful in a subset with viable tumor

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37
Q

when is pet helpful in testicular ca

A

6 weeks post chemo if > 3 cm postchemo seminoma

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38
Q

where is pet not helpful in testicular ca

A

NSGCT, and non-abdominal masses (mediastinal, pulmonary) b/c hasnt been studied competely

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39
Q

when to abort ipp placement - 2

A

urethral injury, significant crural perforation

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40
Q

2 predictors of obstructive azoospermia

A

96% likelyhood of OA if testis longitudinal axis > 4.6 cm and FSH < 7.6

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41
Q

when does fecundity of female plummet

A

after 37 yo

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42
Q

what parameter dictates TRUS in infertility w/u

A

semen volume < 1.5ml. must have nl vas

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43
Q

what is young’s syndrome and assd sx (2)

A

thick epididymal secretions cause obstructive azoospermia. have assd bronchiectasis, sinusitis

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44
Q

immotile cilia syndrome found in x?

A

kartagener’s syndrome

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45
Q

most common karyotypic abnormality in infertile male

A

kleinfelter’s

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46
Q

definition of primary testicular failure

A

FSH > 2x nl

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47
Q

abnormalities on TRUS suggesting ejaculatory duct obstruction - 4

A
  1. SV > 1.5 cm AP plane, 2. dilated ejaculatory ducts > 2.3 mm diameter, 3. calcifications in ejaculatory duct, 4. midline cystic structure in prostate
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48
Q

what is kallman’s syndrome

A

most common cause of hypogonadotropic hypogonadism. x linked defect with hypothalamic dysfunction and absent GnRH. anosmia and absent puberty

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49
Q

prader wili syndrome - gu problem and sx

A

hypogonadotropic hypogonadism. absent GNRH secretion. obesity, small hands/feet, MR, short

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50
Q

laurence moon bardet biedl syndrome

A

hypogonadotropic hypogonadism. polydactyly, retinitis pigmentosa

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51
Q

prolactinoma most common sx - 2

A

decreased libido and ED

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52
Q

prolactinoma initial tx

A

prolactin antagonist - bromocriptine

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53
Q

kleinfelter’s - definition and findings (4)

A

47 XXY - small firm testis (sclerosis of seminiferous tubules), gynecomastia (elevated [estrogen]), azoospermia, hypogonadism

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54
Q

kleinfelter’s and infertility

A

azoospermic but viable sperm with nl karyotype can be found on testis biopsy. candidates for ICSI

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55
Q

sertoli cell only syndrome - def

A

germ cells (sperm and precursors) absent. leydig cells present outside tubules. azoospermia and high FSH

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56
Q

sertoli cell only syndrome and infertility

A

25-50% can have sperm retrieved –> ICSI

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57
Q

RCC T2a vs T2b

A

T2a 7-10 cm, T2b > 10 cm

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58
Q

renal us finding most suggestive of renal artery stenosis

A

increased peak systolic velocity (> 180cm/sec)

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59
Q

what is renal aortic ratio

A

ratio of renal peak systolic velocity (PSV) to aortic PSV. > 3.5 = > 60% stenosis

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60
Q

what is an abnormal renal aortic ratio

A

RAR > 3.5 = > 60% stenosis

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61
Q

treatment for kallman’s desiring fertility

A

first step - HCG and recombinant FSH, if no response then give IV GNRH (expensive and annoying)

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62
Q

how does azoospermia happen in kallman’s

A

inadequate intratesticular testosterone and natural absence of pituitary hormones

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63
Q

incidence of upper trace deterioration s/p RC/IC

A

50% with long term followup

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64
Q

how does finasteride supress bph hematuria

A

intraprostatic supression of VEGF. if hematuria persiste, r/o upper tract source

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65
Q

persistent hematuria in BPH after finasteride and controlling prostate bleeding

A

if hematuria persistes, r/o upper tract source

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66
Q

prolactinoma associated lab finding

A

low testosterone

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67
Q

mgmt of mildly elevated prolactin with nl testosterone level

A

rarely clinically significant. first repeat prolactin

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68
Q

next step in mildly elevated prolactin in any setting

A

always repeat test because high interassay variability

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69
Q

neurovascular bundle on the prostate travels between what layers of fascia

A

levator and prostatic fascia

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70
Q

3 layers of fascia covering prostate

A

levator fascia, denonviers fascia, and prostatic fascia

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71
Q

mgmt of post uretral bulking agent retention

A

CIC with small catheter (10-14 fr). large or indwelling catheterwill push mucosal blebs apart or cause molding around the catheter

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72
Q

prolonged retention after bulking agent mgmt

A

SPT preferred

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73
Q

ureterolithiasis and early pregnancy

A

trial of hydration and analgesia. if fails, stent with us

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74
Q

nl bladder compliance is due to

A

bladder wall vesicoelasticity

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75
Q

AZFa and/or AZFb deletion + AZFc = x on biopsy

A

sertoli only phenotype

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76
Q

what does FISH identify

A

aneuploidy in chr 3,7,17, and homozygous loss of 9p21

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77
Q

positive fish in the setting of previous bladder ca- mgmt and rationale

A

random bladder biopsies. 2007 yoder - 63% with negative cysto, cytology, and ct had recurrence

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78
Q

upper tract investigation for positive fish and negative cysto , ct, cytology

A

dont do it, rarely positive

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79
Q

initial eval for luts if nocturia present

A

h/p, PE, DRE, UA, frequency/volume chart. uds, cysto, cr not part of initial eval

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80
Q

gold std for disseminated orvisceral kaposi sarcoma

A

doxorubicin

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81
Q

how often does leakage from urinary diversion spontaneously resolve

A

20-60%.

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82
Q

mgmt of post RC/IC leak

A

conservative if pt not septic. place foley in conduit. if stomal catheter doesnt decrease abd drain output, place nephrostomies.

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83
Q

how do zolendronic acid and bisphosphonates help in prostate ca

A

reduce bone resorption by inhibiting osteoclastic activity. ZA reduces skeletal events

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84
Q

bad complication of bisphosphonates

A

osteonecrosis of mandible. usually associated with dental work or who have poor dentition or chronic dental diseaes. stop if planned dental work

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85
Q

what receptor is used fort cell interaction with dendrytic cells

A

via MHC 2 receptor

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86
Q

what happens to t cell after activated by dendrytic cell

A

release TNF, interluken, and other cytokines for augmented cellular/humoral response

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87
Q

what response is provoked by dendritic/APC’s

A

activation of T cells via interaction of t-cell’s MHC2.

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88
Q

how are b cells stimulated

A

by dendrytic cell direct stimulationby antigen

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89
Q

what happens to b cell after activated

A

differentiates into antibody producing plasma cell

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90
Q

when to do laparoscopy for calyceal diverticulum

A

anterior location and > 2 cm diverticulum

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91
Q

when do ureteroscopy for calyceal diverticulum

A

anterior and < 2 cm stone

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92
Q

when do pcnl for calyceal diverticulum

A

posterior diverticulum

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93
Q

what pathologic factor predicts poor response to chemo in bladder cancer

A

micropapillary does not respond to chemo

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94
Q

what pathologic types respond better to neoadjuvant chemo - 2

A

small cell and squamous

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95
Q

lesion location for striated sphincter dyssenergia

A

between pons and sacral spinal cord

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96
Q

lesion above pons and uds

A

DO with synergistic activity of proximal and distal SC

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97
Q

lithotripsy method best for uncorrected bleeding disorders

A

urs/ll. ESWL is contraindicated

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98
Q

mgmt of bladder spasms refractory to opioids after reimplant

A

torodol is effective in reducing bladder spasms after bladder surgery when anticholinergics fail

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99
Q

renal artery aneurysm in F considering pregnancy and why

A

surgical repair. endovascular stent will require lifelong anticoagulation

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100
Q

first step in alkalinizing urine for uric acid stones

A

k citrate.

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101
Q

2nd line to alkalinize urine in uric acid stones if k citrate fails

A

add acetazolamide - increases urinary bicarbonate and h reabsorbtion

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102
Q

when to give allopurinol in uric acid stones

A

if elevated urinary uric acid level

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103
Q

what not to give in uric acid stones

A

thiazides increase uric acid level

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104
Q

how to dx and manage benign excessive urinary frequency in children

A

continence maintained, and frequency does not persist at night. reassure that is assd w emotional stress and will go away in 3-6 mo.

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105
Q

eponym for vesicouterine fistula and triad

A

youssef syndrome - seen in 20%: menouria, amenorrhis, chronic urinary incontinance

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106
Q

etiologies of vesicouterine fistula - 3

A

s/p c-section (incorporation of bladder into closure), D&C, vaginal delivery after prior c-section

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107
Q

presentations of vesicouterine fistula

A

60% intermittent/cyclical gross hematuria (menouria-menustral tissue passed through urine), 20% chronic urinary incontinence (urine passes via incompetent uterine sphincter), 20% youssef syndrome: menouria, amenorrhia, chronic urinary incontinance

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108
Q

mgmt of vesicouterine fistula

A

< 6 months - conservative with foley and endocrine supression of menustral flow - 50% success. > 6 mo and no desired fertility- do hysterectomy. if desired fertility juxtapose tisue in repair

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109
Q

condyloma lata definition

A

manifestation of secondary dyphilis. flesh colored or hypopigmented, macerated papules or plaques.

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110
Q

what kind of stones do ketogenic diet and topiramate cause

A

calcium phosphate

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111
Q

why do ca phos stones form with ketogenic diet and topiramate

A

they alkalinize urine

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112
Q

autonomic dysreflexia assd w injury above

A

T5 although can happen w injuries above T6-10

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113
Q

autonomic dysreflexia stimulated by - 4

A

overfilled bladder, colonic distension, decub ulcer, silent orthopedic fx

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114
Q

tx of autonomic dysreflexia if removal of noxious stimuli doesnt help

A

1/2 to 1 inch nitropaste, or oral/sublingual nifedipine. can get rebound hypotension (with nitroglycerine - wipe off paste)

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115
Q

POP-Q definition of Aa and Ba

A

Aa - midline of anterior vaginal wall (AVW), 3 cm proximal to meatus corresponds to urethrovesical junction. +/-3 from hymenal plane. Bamost dependant part of any part of AVW btw Aa and vaginal cuff or anterior vaginal fornix. no prolapse = -3, yes prolapse = distanc btw vaginal apex and hymenal plane

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116
Q

POP-Q definition of C and D

A

C = most distal (dependent) edge of cervix or leading edge of vaginal cuff, D = only if cervix present - deepest point of posterior fornix. correlates w where uterosacral ligaments attach to posterior cervix

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117
Q

POP-Q definition of Ap and Bp

A

Ap - midline of posterior vag wall (PVW), 3 cm prox to posterior hymen - +/- 3 cm from hymenal plane. Bp - most distal (dependent) position of any part of upper PVW btw Ap and vaginal cuff/ posterior fornix. no prolapse = -3, + value beyond hymen

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118
Q

POP-Q definition of gh and pb

A

gh - anterior posterior measurement from muddle of meatus to posterior midline hymen. pb - measured from posterior margin of genital hiatus to mid anal opening

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119
Q

POP-Q TVL definition

A

measured by reducing point C or D to its most superior position

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120
Q

POPQ - Stage 0 - II

A

0 - no prolapse. all points - 3 and D or C = TVL; I - most distal portion of prolapse is >1 distal to hymen (ie -1); II - prolapse is -1 to +1 to hymenal plane

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121
Q

POP-Q Stage III and IV

A

III - max prolapse is > 1 cm outside hymenal plane, but 2 cm less than max possible protrusion (aka TVL); IV - eversion of total vagina. extends beyond TVL - 2 (stage III)

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122
Q

ureterocalycostomy is reserved for - 4

A

failure of less invasive tx, intrarenal pelvis, dilated lower calyces, lengthy proximal ureteral stricture

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123
Q

acute viral cystitis - def

A

sudden onset gross hemturia, bladder wall thickening, urgency/frequency.

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124
Q

acute viral cystitis - tx

A

supportive. antimuscarinics for sx. ribavirin if highly symptomatic or immunosupressed

125
Q

aleep apnea and enuresis

A

causes nocturnal diuresis by: hypoxioa @ sleep –> increased R atrial pressure –> increased atrial naturetic peptide (elevated intrathoracic pressure sue to diaphragmatic contration against closed airway) –> increased nocturnal UOP.

126
Q

2 cm ureteral stricture in transplanted kidney mgmt

A

pyeloureterostomy to native ureter. stents are difficult to place in transplant. nephrostomy = infection. balloon dilation fails in transplant and nl kidneys. pyelovesicostomy = reflux and infection

127
Q

new onset incontinence in SCI and detrussor areflexia - why

A

due to abnormal detrussor compliance. suggested by DLPP > 15 @ 200 cc

128
Q

how to tx deteriorated detrussor compliance in SCI

A

start with antimuscarinics

129
Q

mgmt of elevated DLPP in SCI

A

antimuscarinic

130
Q

DESD tx in SCI

A

dantrolene. relaxes skeletal muscle

131
Q

ephedrine effect in SCI bladder

A

increases sphincter tone and DLPP

132
Q

what is double dye test for fistula

A

rx pyridium several days before visit. methylene blue via urethra. 3 gauze placed in vagina - upper near vag cuff, mid in vag and above bladder neck, lower below bladder neck and urethra (external)

133
Q

how to reduce need for revision of mitrofanoff when initial difficulty passing catheter

A

leave catheter through superficial stoma nightly. dont place full time due to risk of plugging with mucous and introduction of bacteria.

134
Q

L stent - what is it?

A

knot tied 1-2 inches from tip of catheter. insert upto knot nightly to stent cutaneous portion of stoma and tape in place. Mickelson. J urol, 2009

135
Q

severe burn to penis and scrotum - initial tx

A

remove foley within 72 hrs, place spt. remove foley early to prevent urethral slough/ fistula formation

136
Q

when to skin graft penoscrotal burn

A

split or full thickeness once granulation tissue present and all necrotic tissue removed

137
Q

first step in assessing new onset hydro in transplant

A

foley and cystogram to r/o reflux.

138
Q

if cr does not decrease after foley placement for hydro in txp, whats next?

A

r/o ureteral stricture. nephrostomy drains kidney and allows for study of ureter if cr > 2 (false positive mag 3)

139
Q

most common cause for complication of ureter in txp

A

most comm related to vascular viability of ureter causing leakage or ureteral stenosis.

140
Q

RF for ureteral complication in txp - 4

A

advanced donor age, delayed graft function, severe graft rejection, > 2 arteries

141
Q

large length ureteral avulsion during urs - mgmt

A

nephrostomy preserves function and minimizes urine extravisation - discuss mgmt w pt. not UU or reimplant

142
Q

VUR suspected on antenatal us when x

A

degree of hydro varies with serial us.

143
Q

metabolism of viagra may be inhibited by 4 meds

A

ritonavir, ketoconazole, itraconazole and protease inhibitors by blocking CYP3A4

144
Q

high fat meals and PDE inhibitors

A

inhibit absorbtion of sildenafil and vardenafil, not tadalafil (cialis). does not affect metabolism

145
Q

idiopathic oligospermia - when is clomiphine not effective

A

elevated FSH

146
Q

when to consider anti-sperm antibody testing - 3

A

low motility with nl concentration, sperm agglutination, abnormal post coital test (with shaking sperm)

147
Q

risks for anti-sperm ab’s - 3

A

genital duct obstruction, hx genital infection, trauma/surgery

148
Q

anti-sperm ab types

A

IgG and IgA, not IgM. ab’s are significant if found bound to sperm

149
Q

where does ureteric bud arise

A

off the mesonephric duct

150
Q

ectopic ureteral insertion into vagina is due to

A

ureteral bud arising or interacting PROXIMALLY on the mesonephric duct

151
Q

wolffian/mesonephric remnants in males - 3

A

appendix epididymis, paradidymis (organ of giraldes) (tubules btw effecent ducts and vas), vas aberrans of haller

152
Q

where does proximal ureteric bud on mesonephric duct end up in male - 4

A

epididymis, vas, SV, prostate

153
Q

where does proximal ureteric bud on mesonephric duct end up in female - 3

A

epoophoron, oophoron, gartner’s duct. ureter ruptures into fallopian tube, uterus, upper vag, or vestibule

154
Q

wolffian/mesonephric remnants in females- 4

A

appendix vesiculosa, epoophoron (tubules in broad ligament), paroophoron of waldeyer (persistent tubules in broad ligament near uterus, gartner’s duct (persistent duct in broad ligament, along lateral uterus, or vag wall)

155
Q

mullerian/ paramesonephric remnant in M - 2

A

appendix testis, prostatic utricle

156
Q

mullerian/ paramesonephric remnant in F

A

morgagni’s hydatid

157
Q

standard definition for significant bacteriuria and exception

A

> 105 CFU/ml in urine.

158
Q

exception for standard definition for bactiuria CFU count

A

pyuria/dysuria syndrome

159
Q

kids with renal dysplasia and surgical procedures - renal consideration

A

at increased risk of reversible ARF.

160
Q

ARF in kid with CKD and metabolic acidosis correction with sodium bicard - what to watch out for?

A

monitor ionized calcium - can drop precipitously

161
Q

signs of hypocalcemia - 3

A

cramping, tetany, prolonged QT on EKG

162
Q

sign of resolved spinal shock

A

return of DTR’s

163
Q

clostridium perfrigens infection findings - 4

A

suspect when colon injury, toxic appearance, bronze discoloration of skin. crepitus may be absent.

164
Q

clostridium perfrigens gram stain and shape

A

anaerobic G+, club shaped

165
Q

clostridium perfrigens tx

A

double coverage with PCN + clinda or flagyl

166
Q

turp gluid absorbion rate

A

20ml/min

167
Q

TUR syndrome - when do pts become symptomatic

A

na <125 mEq/ml

168
Q

TUR syndrome - sx

A

confusion, nausea, vomiting, hypertension, bradycardia, visual disturbances

169
Q

sorbitol as TURP irrigant

A

inert sugar - doesnt result in hyperglycemia

170
Q

2009 AUA guideline for initial eval of femal SUI beyond hx, physical

A

PVR, UA/ ucx, objective demonstration of SUI

171
Q

earliest sign of sepsis

A

respiratory alkalosis from sepsis induced tachypnea

172
Q

long term use of NSAID results in x

A

acute interstitial nephritis w/ proteinuria, WBC casts w/o eosinophiluria (eosinophiluria found when due to methicillin).

173
Q

acute interstitial nephritis in lupus tx

A

observation

174
Q

UA finding in lupus nephritis

A

RBC casts

175
Q

what is procidentia

A

complete uterine prolapse

176
Q

GU eval of advanced uterine prolapse

A

upper tract imaging

177
Q

complete uterine prolapse - gu considerations and mgmt

A

can cause bilateral ureteral obstruction. initial mgmt = vaginal pessary followed by hysterectomy

178
Q

failed proximal hypospadius x 2 mgmt

A

resection of scarred urthral plate with 2 stage BMG

179
Q

aldosterone levels primarily regulated by - 2

A

angiotensin II via RAS, and serum potassium levels. produced in zona glomerulosa

180
Q

paratesticular rabdomyosarcoma with neg CT scan mgmt

A

< 10 yo = chemo alone. > 10 yo = ipsilateral RPLND as 50% will have microscopic disease not seen w CT

181
Q

positive LN on RPLND for paratesticular rhabdomyosarcoma

A

retroperitoneal radiation + chemo

182
Q

threshold for IPP in priapism

A

> 36 hrs. although morbid, it preserves penile length and makes ipp placement easier.

183
Q

mgmt of BCG cystitis

A

r/o bacterial infection and give antimuscarinic if neg.

184
Q

lowering BCG dose in BCG cystitis

A

dont do it as decreases theraputic efficacy

185
Q

cipro for bcg cystitis

A

negative effect on bcg as partially tuberculocidal

186
Q

most important parameter indicative of postnatal renal outcome when prenatal hydro present

A

presence of oligohydramnios and renal cortical cysts

187
Q

prenatal renal us with renal echogenicity

A

unreliable as marker for renal function UNLESS renal cortical cysts are present

188
Q

2 tests for rhabdo

A

serum CPK and spot urine for myoglobin

189
Q

RF for rhabdo during surgery

A

BMI> 25, male, prolonged OR time, full table flexion, prolonged use of kidney rest

190
Q

most common problem after hypothermia and circulatory arrest

A

coagulopathy and hemorrhage due to platelet and clotting factor dysfunction.

191
Q

what hampers K replacement for hypokalemia

A

serum potassium rise with replacement in the setting of hypokalemia is blunted b/c 80% of K goes into intraellular space

192
Q

pathognomonic for neurofibromatosis

A

cafe-au-lait spots

193
Q

VHL phys exam findings - 4

A

hemangioblastomas of cerebellum, RCC, cystadenomas of epididymis, retinal angioma

194
Q

what syndrome has AML’s

A

tuberous sclerosis

195
Q

substitution of carboplatin for cisplatin in bladder ca…

A

decreases response rate by 3x. improved renal safety profile. galsky. ann oncol 2012

196
Q

initial eval when suspecting pituitary adenoma

A

ophtho to eval visual field defects and mri of the pituitary.

197
Q

imaging for pituitary adenoma

A

MRI, ct isnt sensitive enough

198
Q

how high does prolactin get in renal failure/ stress

A

< 50 nd/ml

199
Q

how to give formalin

A

start at 1%, then 5%, then 10%. do cystogram first to r/o VUR. if present, occlude UO’s w/ fogarty and place patient head up. very painful and needs general anesthesia.

200
Q

what is formaldehyde solution

A

37% solution of formaldehyde gas dissolved in water. do not use intravesically

201
Q

what is formalin solution

A

1-10% formaldehyde diluted in nl saline

202
Q

recurrent SUI 10 yrs after initial sling mgmt

A

repeat retropubic mid urethral sling or autologous fascial sling.

203
Q

what kind of sling placement is more successful in redo sling

A

retropubic>transobturator likely more successful due to higher rate of intrinsic sphincter dysfunction in pts requiring repeat surgery.

204
Q

where can nephrogenic adenoma happen

A

any urothelial surface, even transplanted urotheial graft

205
Q

nephrogenic adenoma sx

A

hematuria/ irratitive voiding sx

206
Q

nephrogenic adenoma histology

A

subepithelial tubular structures similar to loops of henle

207
Q

nephrogenic adenoma mgmt

A

TUR and antibiotic prophylaxis x 1 yr (UTI is associated causative factor). dont do surveilance cysto due to risk of further urothelial trauma

208
Q

multicystic dysplastic kidneys and assd findings

A

25% have contralateral VUR

209
Q

when to do circ in baby with VUR

A

if breakthrough infection while on abx

210
Q

genitofemoral nerve entrapment can be seen after what 2 procedures

A

transplantation or psoas hitch

211
Q

genitofemoral nerve anatomy

A

arises from L1-2, pierces anterior psoas at L3-4, descends past ureter and splits to genital and femoral branches near ingiunal ligament.

212
Q

genitofemoral nerve supplies

A

cremaster muscle, spermaticord, scrotum, thigh

213
Q

lateral cutaneous nerve injury presents as

A

anterior and lateral thigh paresthesia sx of burning/tingling that increase with standing, walking, hip extension

214
Q

most important single prognostic marker for outcome in RCC

A

tumor stage

215
Q

persistent hydronephrosis after PUV resection

A

hydro and VUR resolve in 50% s/p ablation. re-eval in 12-18 months

216
Q

SIADH in RCC mets to brain - tx for symptomatic?

A

hypertonic saline to raise serum na no more than 2 mEw/l/hr or 25 mEw/l/24 hrs and fluid restriction

217
Q

SIADH in RCC mets to brain - tx for asymptomatic?

A

fluid restriction if asymptomatic +/- lithium or demeclocycline

218
Q

myelomeningocele with new incontinence - next step

A

uds to eval etiology of incontinence.

219
Q

myelomeningocele with new incontinence - when to get MRI - 3

A

if uds shows new abnormal findings, or onset of LE weakness or other neuro exam abn

220
Q

RF for renal vein thrombosis in infant

A

umbilical artery catheter

221
Q

renal vein thrombosis in infant - 3 sx

A

abdominal mass, hematuria, THROMBOCYTOPENIA

222
Q

renal artery thrombosis in infant cause and sx

A

prolonged umbilical artery catheter and mass and hematuria

223
Q

henoch schonlein purpura - sx

A

systemic vasculitis presenting at 4-6 yo w/ palpable purpuritic rash, abd pain w GI bleed, and arthritis

224
Q

calciphylaxis - what is it & significance

A

dry gangrene. ESRD patinets - mortality within 6 months of ESRD

225
Q

calciphylaxis - what does it look like?

A

microscopic calcification in arterioles and capillaries leading to dry necrosis

226
Q

calciphylaxis - mgmt

A

leave it alone - doesnt heal well - poor blood supply

227
Q

stepwise mgmt of chylous ascites

A

medium chain fatty acids, then TPN + NPO, then IV/SQ somatostatin

228
Q

how does somatostatin work in chylous ascites

A

decreases absorbtion of fat, inhibiting gastric, intestinal, pancreatic secretions, and inhibiting motor activity of intestines –> reduced flow in major lymphatic channels and reduced leakage

229
Q

continent urinary diversion and elevated ammonium level

A

urinary ammonium reabsorbed by intestine and converted to urea via urea cycle.

230
Q

continent urinary diversion and liver effects of sepsis

A

endotoxin release from sepsis can cause hepatic dysfunction disrupting normal ammonium –> urea leading to elevated ammonium and coma. urea splitting organisms also cause this

231
Q

continent urinary diversion and liver dysfunction - mgmt - 2

A

give lactulose or neomycin

232
Q

what is pca3

A

detects mrna from DD3 gene (specific to prostate ca)

233
Q

REDUCE trial and PCA3

A

PCA3 measured in 1000 ppl with negative prior bx and results correlated with second biopsy.

234
Q

PCA3 use

A

evaluate risk of prostate cancer in history of prior negative biopsy, (< 35 = low risk)

235
Q

PCA3 affected by infection, prostate vol, 5-ARI - T/F

A

FALSE

236
Q

SGBH and estrogen/progesterone

A

estrogen increases, progesterone decreases

237
Q

infertility and thyroid disease

A

HYPERthyroidism and thyrotoxicosis elevate SGBH, decrease testosterone. hypothyroidism has opposite effect

238
Q

what lowers SGBH - 5

A

insulin administration, glucocorticoid stress, liver disease, nephrotic syndrome, progesterone

239
Q

purpose of detubularization of bowel

A

reduce intraluminal pressure (upper tract deterioration) by increaseing radius of reservoir (laplace’s law), and eliminating peristalsis

240
Q

horseshoe kidney assd w 2 renal issues

A

UPJO and wilms tumor

241
Q

ADPKD assd w/ x?

A

berry aneurysm, higher likelyhood of bleeding due to assd HTN

242
Q

ARPKD assd w x

A

liver failure

243
Q

colchicine and acute peyrones

A

colchicine helps with acute phase penile pain but has bad GI side effects

244
Q

when is penile plication useful in peyrones?

A

if curvature < 60 deg. lots of shortening if > 60

245
Q

haugnes JCO 2010

A

mediastainal and subdiaphragmatic radiation has HR for 2nd malig/CV disease of 3.7. chemo HR 1.9, smoking HR 1.7

246
Q

sperm drainage in testicle (6 steps)

A

seminiferous tubules (200-300) –> tubuli recti (20-30) –> rete testis (in testicular mediastinum) –> ductuli efferentes –> caput epididymis –> cauda epididymis

247
Q

UU of distal ureter?

A

never indicated

248
Q

presentation of pouchitis in continent diversion

A

abdominal pain, explosive leakage from stoma due to hypercontractility of bowel. tx w > 10 days abx

249
Q

spermicide use in women

A

increases risk for UTI by disrupting nl vag floura

250
Q

3 common misconceptions re UTI in adult women

A

does not reduce risk: wiping front to back, urinating after intercourse, increasing fluid intake

251
Q

post-adrenalectomy mgmt for pheo

A

repeat metabolic testing (plasma free metanephrines) after adrenalectomy to document normalization of chromaffin cell fxn. only do MIBG if abnormal serum test. can have residual/unidentified tumor

252
Q

% pheo malignant or multifocal

A

10-20%

253
Q

rectal blood supply - 4

A

superior rectal (hemorrhoidal), IMA, middle hemorrhoidal, and inferior rectal artery

254
Q

if IMA ligated, where does rectal blood supply come from

A

middle hemorrhoidal (from posterior hypogastric a.), and inferior rectal (from internal pudendal)

255
Q

groin pain with tenderness over symphisis pubis in athelte and mgmt

A

osteitis pubis. anti-inflammatory

256
Q

corpora amylacea?

A

calcifications between transition zone and peripheral zone seen on TRUS in large adenomas

257
Q

indications for removal of multicystic dysplastic kidney - 4

A

HTN, solid mass, respiratory or GI distress

258
Q

acetohydrozamic acid - what does it do/ not do

A

decreases rate of stone growth in pts with struvite stone, does not impact rate of stone recurrence

259
Q

mgmt of ureteroenteric stx for conduit

A

open surgical revision. low longterm success with endoscopic tx.

260
Q

hyponatremia in vomiting

A

vomiting= loss of salt and fluid. kidneys reabsorb all sodium. results in hypovolemia and hyponatremia and low urine [sodium].

261
Q

how do renal disease, addisons, and excess diuretics cause hyponatremia

A

excess excretion of sodium

262
Q

when is extra sedation needed in eswl - 5

A

if stone is overlying a rib, female, young, hx anxiety/depression, prior ESWL

263
Q

active surveilance protocol - PSA and biopsy (ref)

A

PSA q 3 mo x 2 yrs then q 6 mo, bx at 1 yr, then q 3-5 yrs until age 80.

264
Q

which preemies are at risk for stones - 2

A

severe ventilatory problems and bronchopulmonary dysplasia due to need for lasix (increased 10x u ca excretion) to control ht failure.

265
Q

preemies and lasix - long term outcome (2) and mgmt

A

eventually can cause hyper PTH and bone changes. switch to thiazide

266
Q

urethroplasty injury causing difficulty w ejaculation

A

bulbocavernosus muscle - rythmic contractions responsible for antegrade ejaculation

267
Q

weiss criteria for adrenal masses? 9

A

distinguish benign from malignant adrenal lesions. need >/= 3: mitotic rate > 5/HPF, atypical mitosis, venous invasion, high nuclear grade, absence of cells w clear cytoplasm ( 1/3 tumor), necrosis, sinusoidal invasion, capsular invasion.

268
Q

hx hip prosthesis and stone surgery abx

A

single dose oral FQ or IV amp/gent

269
Q

lab to follow while on sunitinib

A

T4, TSH.

270
Q

why follow TSH in pts on sunitinib and mgmt

A

upto 85% develop hypothyroidism within 12-50 wks and risk increases with duration of tx. reversible once stopped. get baseline thyroid tests and check frequently. start synthroid

271
Q

most common cause of daytime incontinence in 7 yo

A

infrequent voididng

272
Q

daytime incontinence in 7 yo - mgmt

A

timed voididng, voiding diary. can take months to reverse.

273
Q

causes of anatomic bladder outlet obstruction in women - 4

A

cystocele (bladder prolapse), bladder neck sling, external striated sphincter dyssenergia, bladder neck obstruction

274
Q

bladder neck does not relax in female voiding mgmt

A

can tx with alpha blocker

275
Q

when is biofeedback useful in female LUTS

A

pelvic floor spasticity

276
Q

how to remember intestinal segs

A

phuck cl (ph, k, cl). ph starts elevated (other 2 low) with gastric, jejunum, ileum/colon

277
Q

jejunal diversion metabolic abnormalities - 4

A

hyponatremia, hypochloremia, hyperkalemia, acidosis

278
Q

ileocolic poich metabilic abn

A

hyperchloremic metabolic acidosis with mild hypokalemia

279
Q

ureterosigmoidostomy electrolite abnormality

A

metabolic acidosis with profound hypokalemia

280
Q

infant with diabetes insipidus - mgmt

A

overnight fluid restriction until 3% body weight lost or urine osmolality is > 600. if no improvement restrict for a second day and give desmopressin

281
Q

DI with response to desmopressin - mgmt

A

central DI should be investigated - head CT

282
Q

low urine pH and stone type

A

uric acid and CaOx

283
Q

highest renal acid load food

A

cheese

284
Q

foods with negative potential renal acid load

A

fluits and vegetables - encourage these

285
Q

dairy and stones

A

dairy intake encouraged. cheese has high potential renal acid load (predisposes to uric acid/ caox stones), milk and yogurt have minimal PRAL

286
Q

who gets endoscopic mgmt of UTUC

A

solitary kidney, bilateral disease, renal dysfunction, decrepid or small, lowgrade, noninvasive.

287
Q

roscigno, shariat j urol 2009

A

UTUC - T2-4 N0 have no improved CSS vs Nx. node dissection does not help in UTUC

288
Q

most comon causes of iatrogenic injuries to neonate bladder - 4

A

umbilical vessel catheterization, forceful expression of over distended bladder, cysto, inguinal hernia repair. can cause forniceal rupture if VUR present

289
Q

credoiding and spina bifida neonate

A

dont start until uds to make sure they dont have reactive external sphincter.

290
Q

credaneuver and sphincter

A

stimulates reflex response to external sphincter increasing urethral resistance

291
Q

sports drink and urine

A

increase urinary citrate. do not cause hypernatruria. lots of calories

292
Q

what are clinical T1 lesions in prostate cancer

A

clinically inapparent tumor - not seen on imaging or on exam

293
Q

clinical T1c prostate ca def

A

PSA disgnosed lesion with nl DRE and us

294
Q

what is clinical T2 prostate cancer

A

nodule palpable on exam - either unilateral or bilateral

295
Q

clinical T2a vs t2b prostate ca def

A

T2a - < 1/2 of one lobe, T2b > 1/2 of one lobe on DRE or nodule on TRUS

296
Q

clinical T2c prostate ca def

A

bilateral nodule on DRE

297
Q

GU abnormalities associated with imperforate anus - 6

A

VUR (40%), renal agenisis (25%), renal ectopy (25%), rectourethral/vaginal fistula (20-30%), neurogenic bladder (15-25%), tethered cord (2-8%).

298
Q

GU abnormalities associated with HIGH/SUPRA LEVATOR imperforate anus

A

rectourethral fistula, neurogenic bladder, tethered cord

299
Q

non obstructive azoospermia hints - 2

A

FSH > 7.6 and testis axis < 4.8 cm - 90% chance of NOA

300
Q

mgmt of nonobstructive azoospermia

A

testicular sperm extraction for ICSI

301
Q

omental blood supply for vesicovaginal fistula

A

mobilize off the left of stomach, preserving right gastroepiploic (larger and originate more caudal vs left - shorter course to pelvis)

302
Q

indication for sperm motility testing

A

motility < 5%

303
Q

what usually causes sperm motility< 5%

A

flagellar defects. most nonmotile sperm are viable

304
Q

kallman’s syndtome and infertility

A

hypogonadotropic hypogonadism and azoospermia

305
Q

eosinophilic granulomatous cystitis - what is it

A

mass like lesion with irritative sx and hematuria. bx - intense inflammation, granulomatous rxn, and eosinophilic infiltrate. benign and self limiting

306
Q

eosinophilic granulomatous cystitis - mgmt

A

if minimal sx, observation or TUR/laser ablation. diffuse lesion - antihistamines and steroids

307
Q

antisperm ab’s and motility

A

low motility, but non-motile sperm are dead :-x

308
Q

benefits of zolendronic acid

A

decrease bone pain from cap mets and skeletal related events. No survival advantage

309
Q

what is denosumab

A

rank ligand inhibitor and decreases skeletal related events and helps prevent SRE due to osteoporosis

07. QUESTIONS and Tables (2912) (18 decks)

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