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review course > SASP 2014 > Flashcards

SASP 2014 Flashcards

1
Q

when to use estrogen in exposed asymptomatic vaginal mesh

A

postmenopausal women only. no effect in premenopausal

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2
Q

complete bulbar disruption from straddle injury - mgmt

A

sp tube placement with delayed reconstruction

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3
Q

trans-scrotal orchiectomy for seminoma

A

XRT to include retroperitoneum, groin, and hemiscrotum

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4
Q

significance of scrotal violation for testicular ca

A

3% local recurrence vs 0.4%

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5
Q

finasteride blocks which 5 alpha reductase

A

type 2

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6
Q

what type of 5-alpha reductase is in the prostate

A

type 2

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7
Q

serum and prostatic testosterone with finasteride

A

decreased DHT causes reduced negative feedback, increased LH, and increased testosterone in serum and prostate

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8
Q

chance of viable disease, teratoma, necrosis in post chemo NSGCT mass

A

50%, 40%, 10%

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9
Q

most important factor in preserving upper tract renal function in urinary diversion

A

use of ileum over colon

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10
Q

why is ileum preferred for neobladder

A

less high pressure contractions noted on UDS vs colon

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11
Q

how much does capacity increase with ileal neobladder over 1 yr

A

7x

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12
Q

bacteria associated with renal deterioration in urinary diversion - 2

A

proteus, pseudomonas - these should be treated

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13
Q

nl intraop neobladder capacity

A

200 ml

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14
Q

what area of kidney is injured first during prolonged ischemia

A

medullary thick ascending loop of henle

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15
Q

why is ascending loop of henle more prone ton injury

A

rich in na-k-atpase

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16
Q

AUA BPS - what is low risk DVT patient

A

minor surg in pt < 40 yo w/o risk factors

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17
Q

AUA BPS - what is moderate risk DVT patient

A
  1. minor surg in pt w additional RF, 2. surg in 40-60 yo w/o additl RF
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18
Q

AUA BPS - what is high risk DVT patient

A
  1. surg in pt > 60 yo, 2. surg in pt 40-60 yo w additl RF (prior VTE, ca, hypercoagulable state)
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19
Q

AUA BPS - what is highest risk DVT patient

A

multiple RF (>40 yo, ca, prior VTE)

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20
Q

AUA BPS - what is a minor procedure

A

“short” procedure where pt ambulates early

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21
Q

female pelvic reconstructive surgery is considered x risk for DVT/VTE

A

anti-incontinence and pelvic reconstructive surgery is high risk if not cysto or sling

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22
Q

AUA BPS - DVT prophylaxis - moderate risk

A

heparin 5000 q 12 hrs or lovenox 40 daily or SCD if high bleeding risk

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23
Q

AUA BPS - DVT prophylaxis - high risk

A

heparin 5000 q 8 hrs or lovenox 40 daily or SCD if high bleeding risk

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24
Q

AUA BPS - DVT prophylaxis - highest risk

A

heparin 5000 q 8 hrs or lovenox 40 daily AND SCD

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25
Q

second treatment option for recurrent UTI after intercourse if failed nitrofurantoin

A

3 day course of bactrim b/c nitro is concentrated in urine and she prob has uropathogenic bacteria hiding in vag

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26
Q

mgmt of urethral perf with malleable vs inflatable penile prosthesis

A

malleable - can leave one cylinder in if its on uninvolved side and no spetal perf present. ipp - remove the entire thing

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27
Q

acute adrenal insufficiency sx - 3

A

n/v, abd pain, hypovolemia unresponsive to fluids

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28
Q

tx of acute adrenal insufficiency

A

hydrocortisone - dont delay for lab test

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29
Q

what would lab test be for acute adrenal insufficiiency - 2

A

morning serum cortisol, acth

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30
Q

what % of men havesuccessful erection with MUSE

A

40% (not very good)

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31
Q

7 motzer criteria

A
  1. karnoksky performance status < 80%, 2. LDH > 1.5 x nl, 3. hgb < lower limit of nl, 4. high corrected calcium > 10, 5. ABSENCE of prior nx, 6. presence of liver mets, 7. increased alk phos
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32
Q

low risk motzer - def and sig

A

0 RF, median survival 30 months

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33
Q

intermediate risk motzer - def and sig

A

1-2 risk factors, median survival 14 months

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34
Q

poor risk motzer - def and sig

A

> 3 RF, median survival 5 mo

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35
Q

imaging modality with highest sens/spec for prostate ca mets

A

18F - PET (superior to classic bone scan)

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36
Q

ddx of acidic azoospermic semen - 2

A

b/d EDO, CABVD

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37
Q

b/l EDO findings on TRUS - 3

A

midline urethral cysts, bilateral SV cysts, or a combination of these

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38
Q

% with CBAVD who have no CF mutation

A

30%

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39
Q

cause of CBAVD if no genetic abnormality found

A

mesonephric ductal-ureteral bud abnormality

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40
Q

assd finding in CBAVD pts with negative genetic testing and mgmt

A

5% w renal agenesis - do us

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41
Q

inverted papilloma - 2 types

A

type 1 - benign, type 2 - may have malignant behavior. histologically identical

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42
Q

inverted papilloma mgmt

A

have to do bladder and upper tract surveillance for 2 yrs

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43
Q

when doing captopril renography for RAS - mgmt of home medications - 2

A

have to be stopped for 2 weeks. if on ACE inhibitor - will significantly affect test result.

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44
Q

steroids for ureteral swelling

A

not used

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45
Q

what medication causes intraoperative floppy iris syndrome

A

flomax

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46
Q

ESRD and RCC screening- time frame

A

wait until 3 yrs on dialysis

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47
Q

medication for people with stent pain

A

flomax, (no benefit with anticholinergic, pyridium, toradol)

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48
Q

interstim infection mgmt

A

remove IPG and lead, dont reimplant at the same time due to risk of infection

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49
Q

incidence of malignancy in adrenal mass < 4 cm

A

almost all benign if no hx ca, 50% malig if hx ca

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50
Q

2 CT findings that suggest benign adrenal adenoma

A

< 10 HU and < 4 cm = 98% specificity of benign

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51
Q

when to resect adrenal masses - 2

A

> 4 cm or metabilically active

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52
Q

biochemical workup of adrenal mass < 4cm

A

cortisol and catecholamines, include aldosterone if hx HTN

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53
Q

coagulation of semen is dependent on

A

semenogelin

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54
Q

semenogelin aka

A

seminal vesicle specific antigen

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55
Q

what is benign urethrorrhagia

A

terminal gross heaturia and nl PE casued by transient inflammation of bulbar urethral epithelium. observe

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56
Q

first test in young male with low ejaculate volume and nl exam/labs

A

post ejaculate urine volume - least invasive and easy to fix

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57
Q

is locally advanced disease a contraindication to orthotopic neobladder?

A

no]

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58
Q

ipp pain with inflation - how to evaluate w/ imaging

A

MRI with IPP inflated will allow you to see if cylinders are buckling

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59
Q

what is SST deformity

A

floppy glans

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60
Q

how to fix SST deformity

A

move glans onto the distal portion of the cylinders with glansplasty

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61
Q

what is glansplasty

A

dorsal plication of glans back onto shaft of penis

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62
Q

prostatic utricle is analagous to what in female

A

distal 1/3 vagina.

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63
Q

embryologic origin of prostatic utricle

A

UG sinus

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64
Q

significance of leukocytes in semen of infertil male

A

indicate functional damage from DNA fragmentation due to sperm membrane lipid peroxidation from reactive oxygen species released from leukocytes. leukocytes dont = infection

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65
Q

best test to eval pseudoaneurism after kidney surgery

A

doppler - less radiation and gives same info

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66
Q

what space does TOT pass through

A

ischiorectal fossa, not obturator canal

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67
Q

outside-in course of tocar in TOT - 6

A

gracilis, adductor longus and brevis, obturator externus muscle, obturator membrane, obturator internus muscle.

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68
Q

when to get imaging in uncomplicated pyelo - 5

A

fever > 72 hrs, or hints of complicated UTI: DM, immunosupression, hx stones, sx obstruction.

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69
Q

clavien grade 1 complication

A

any deviation from nl postop course without need for pharmacoloic tx or other intervention

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70
Q

clavien grade 2 complication

A

with need for pharmacoligic intervention (including TPN, blood transfusion)

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71
Q

clavien 4 complication

A

life threatening complication

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72
Q

clavien 4a vs 4b

A

a - single organ dysfunction, b - multi organ dysfunction

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73
Q

pop Q “c” point value

A

0= at hymen, aka bad prolapse

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74
Q

microscopic finding in bacterial vaginosis

A

“clue cells”

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75
Q

findings in BV

A

vag discharge, vag pH>4.5, malodorous fishy vag discharge

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76
Q

RF for BV - 4

A

multiple sexual partners, new sex partner, use of IUD, douching

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77
Q

tx for BV

A

flagyl - treating pt is the same as tx partner. 1/3 recur

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78
Q

distal ureteral stone in prepubertal child - cant pass scope

A

ureteral dilation with urs is safe in prepubertal children. avoids need for stent and second anesthesia.

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79
Q

mgmt of ED in pt with early peyrones disease

A

pde5-i may reverse endothelial impairment. ICI may be associated with penile plaques.

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80
Q

C-arm position that minimizes radiation scatter

A

x ray tube below patient and as far from pt as possible.

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81
Q

location of PCNL puncture in horseshoe kidney itself

A

posterior and superior calyx

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82
Q

location of PCNL puncture needle passage in horseshoe kidney

A

more emdial, just lateral to paraspinus muscles

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83
Q

floppy glans in ipp due to 3

A

inadequate dilation, too short cylinder, or variation in corporal anatomy where corpora dont reach to glans

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84
Q

2 options for mgmt of poorly supported glans in ipp

A

remove current ipp and perforate corpora then reinsert ipp with rear tip extender or larger ipp.

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85
Q

chemo induced RTA type 1 looks like

A

acidosis, hypokalemia w no signs of dehydration of abnormal renal function

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86
Q

mgmt of RTA type 1 - chemo induced or otherwise

A

k citrate

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87
Q

next step in ECF mgmt if persistently high output continues after TPN/NPO started

A

agents to decrease bowel motility - loperamide, atropine

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88
Q

chronic anabolic steroid induced hypogonadism mgmt (nl FSH, low T) - 2

A

HCG replacement if 1 yr of exogenous steroid has not worked. clomiphine will also work but is less effective

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89
Q

why not give testoserone in chronic anabolic steroid induced hypogonadism mgmt (nl FSH, low T)

A

exogenous T will further supress central axis (FSH/LH)

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90
Q

initial mgmt of renal ein thrombosis due to prolonged delivery/prematurity

A

iv hydration to tx dehydration

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91
Q

success rate of cystoscopic fulguration of VVF

A

66% for fistula < 7 mm in size when used as primary or secondary tx

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92
Q

success of fibrin glue in VVF and caveat

A

75% success in fistula < 15mm in size but tend to break down at 1 yr

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93
Q

mgmt of testicular fracture

A

immediate surgical exploration - dont delay for us

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94
Q

imaging required after reimplant for VUR in kid

A

renal us to r/o hydronephrosis, VUG is optional

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95
Q

what does hydro look like at 2 and 3 months postop

A

if preop hydro is SFU grade 2 or higher, 60% resolve by 3 mo, 30% improve, and reminder are unchanged or worse

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96
Q

what to do if hydro is unchaged or worse at 3 mo

A

mag 3 and VCUG

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97
Q

postop mgmt of bulking agent injection - 2

A

VCUG and renal us

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98
Q

mgmt of traumatic injury to bladder neck, vag, and rectum

A

if stable - immediate repair of injuries and diverting colostomy, if unstable - nephrostomies or diverting ureteral stents

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99
Q

problem with delayed mgmt of bladder neck, vaginal rectal injury

A

high risk of fistula, abscess, osteomyelitis, and persistent bladder neck incontinence.

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100
Q

def of dysfunctional voiding

A

involuntary contraction of pelvic floor during voiding in a neurologically intact person

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101
Q

primary function of PTH

A

blocks calcium reabsorbtion in PCT and promote calcium reabsorbtion in ascending loop, DCT, and collectig duct.

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102
Q

enzyme converting vit D in kidney

A

1-hydroxylase

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103
Q

location of 1-hydroxylase

A

proximal tubule

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104
Q

precourser to Vit D production in skin

A

7-dehydroxycholesterol

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105
Q

where does vit D activation happen - both parts

A

25 hydroxylation in liver, 1-hydroxylation in kidney

106
Q

primary action of 1,25 vit d3

A

promote gut absorbtion of ca by stimulating formatoin of ca-binding protein within intestinal epithelium

107
Q

urinary urgency behavioral mgmt

A

rapid,short pelvic contractions (quick flicks) decrease DO/urgency and tell pt to delay voiding in response to urge to void (not to pee just in case or when the urge hits)

108
Q

alpha-mercaptopropionylglycine

A

oral agent for cystine stones that participates in thiol-disulfide exchange with cystine - increasing solubility

109
Q

newborn circumcisoin with re-approximation of foreskin edges mgmt

A

topical steroid for 6 weeks, if fails consider abx +/- dorsal slit. dont do revision circumcison in acute setting b/x poor result due to inflamed foreskin

110
Q

urethral hypermobility on PE suggests what finding

A

intrinsic sphincter deficiency

111
Q

persistent ISD after mid urethral sling - mgmt

A

pubovaginal sling is more durable than submucosal injection

112
Q

what kind of abscess is hydradenitis suppurativa

A

sterile

113
Q

nerve most likely injured during psoas hitch

A

femoral - tracks through psoas and exits under lateral aspect of the psoas under ilioinguinal ligament

114
Q

where does botox work in nerve pathway

A

postsynaptic parasympathetic efferent nerves to detrussor

115
Q

secondary effect of botox in bladder

A

decrease in afferent sensation (urgency) due to localized inhibition of detrussor muscle ATP, substance P, and reduction in afferent axonal capsasin and purinergic receptors

116
Q

tx for chancroid

A

azithromycin 1 gm po x 1

117
Q

alternative tx for chancroid - 2

A

erythromycin 500 mg po qid x 7d or ceftriaxone 250mg im x 1

118
Q

bacteria that causes chancroid

A

haemophilus ducreyi

119
Q

bp and autonomic dysreflexia

A

nl sc injury bp is low (approx 100 sbp), elevation of 20 mmhg suggests AD, and if > 120mmhg and pt is symtomatic consider as having AD

120
Q

how to use nitropaste in Autonomic dysreflexia

A

apply above level of lesion (vasoconstriction happens below). paste can be wiped off if rebound hypotension occurs

121
Q

second line agent for autonomic dysreflexia

A

sublingual nitroglycerine

122
Q

problem with nifedipine in autonomic dysreflexia

A

can cause severe rebound hypotension resulting in stroke or MI and not recommended any more

123
Q

posthypotensive episode mgmt in AD

A

monitor BP for 2 hrs to make sure they dont get rebound hypertension

124
Q

recommended methods to prevent AD - 5

A

terazosin 5 mg, prazosin mg, or tamsulosin 0.8mg the night before the exam, or nitropaste 2% 0.5 inch or captopril sublingual10-15 mins prior to exam

125
Q

nitropaste/nitroglycerine caveat

A

make sure they havent used PDE5 in last 24 hrs

126
Q

best way to deflate foley balloon that will not deflate with syringe, and what not to do

A

cut off valve and pass a wire. try not to pop the balloon as it will leave a fragment that has to be removed with cysto

127
Q

obtundation in kid with urinary stasis problem (prune belly) and e coli UTI

A

caused by hyperammonemia as urea splitting organisms generate alot of ammonia in the urine.

128
Q

T, LH, and FSH levels in androgen insensitivity

A

high T and LH (pituitary doesnt recognize T), nl FSH

129
Q

T, LH, and FSH levels in puberty

A

normal

130
Q

T, LH, and FSH levels in kleinfelters

A

high FSH and LH, low T

131
Q

T, LH, and FSH levels in sertoli only

A

high FSH and LH, low T

132
Q

how many patients will have residual ca after chemo for stage 2 testicular ca

A

20%

133
Q

what nodes drain right kidney

A

interaortocaval

134
Q

what is serenoa repens

A

saw palmetto

135
Q

effect of serenoa repens

A

no change in prostate size, AUA SI, flow rate, or change in rate of AUR

136
Q

initial mgmt of small cell of the prostate

A

chemo

137
Q

most concerning part of large ureterocele in kid with bilateral hydro

A

bladder outlet obstruction

138
Q

when to intervene in duplicated system with nonfunctioning upper pole

A

breakthrough febrile uti while on prophylactic abx

139
Q

initial mgmt for reflux in duplicated system

A

prophylactic abx

140
Q

tadalafil brand name

A

cialis

141
Q

how long to wait for nitrates with sildenafil, tadalafil, vardenafil

A

S,V - 24 hrs, T - 48 hrs

142
Q

ureteral injury at the time of pubovaginal sling - mgmt steps - 4

A

cysto/stent –> antegrade NU –> open repair only if previous 2 cannot be placed –> reimplant if significant devitalization of ureter

143
Q

how to increase glandular engorgement with ipp

A

PDE5

144
Q

partial nx in the setting of tumor thrombus

A

higher risk of recurrence and poor prognosis

145
Q

candida UTI in neonate mgmt

A

have to treat agressively due to risk of candidemia (upto 80%)

146
Q

tx of choice for candida uti in neonate

A

fluconazole

147
Q

first signal in T cell activation

A

APC presents antigen via MHC on APC

148
Q

second signal in T cell activation

A

stabilization and co stimulation btw APC and T cell via CD40/CD80

149
Q

third signal in T cell activation

A

interleukin stimulation

150
Q

additional mgmt for ileal conduit in pregnant female

A

none. same routine obstetric care.

151
Q

undescended testicle - distance of testicle form internal ring for 2 stage fowler stevens

A

> 2 cm with no vascular redundancy and you have to clip spermatic vessels.

152
Q

concern with acute hCG stimulation in one yr old

A

damage to seminerifous tubules

153
Q

what is the trial of mid urethral slings

A

showed equivelant efficacy (80% vs 77%) and greater risk of postop voiding dysfunction for retropubic (2.7%) vs trans obturator slings (0%)

154
Q

residual lung nodule in post chemo testis cancer mgmt

A

do wedge resection for tissue dx to determine if more tx is needed. needle biopsy is insufficient

155
Q

nl position of conus medularis

A

L2

156
Q

30 gm benign prostate and dutasteride

A

not considered a “large” prostate

157
Q

location of chromosomal mutation in Clear cell RCC

A

short arm of chr 3

158
Q

papillary type 1 mutation location

A

chromosome 7

159
Q

papillary type 1 mutation gene

A

c-met

160
Q

papillary type 2 mutation location

A

chromosome 1

161
Q

papillary type 2 mutation gene

A

fumarate hydratase

162
Q

oncocytoma mutation location

A

short arm of chr 17

163
Q

oncocytoma mutation gene

A

BHD1

164
Q

distal prostatic ducts are lined by what epithelium

A

pseudostratified

165
Q

lining of urethra - epithelium - male

A

proximal 2/3 = transtional, distal 1/3 = stratified squamous

166
Q

maturation arrest on testicular biopsy fertility mgmt

A

can do testicular sperm extration with more extensive biopsy

167
Q

mgmt of incontinence combined with high arch foot - initial mgmt

A

r/o tethered cord with MRI

168
Q

what is tethered cord

A

stretch induced functional disorder of SC with most caudal part of cord anchored by an inelastic structure.

169
Q

suspected chronic prostatitis in pt with bactiuria

A

get initial midstream cultures then treat bactiuria first with nitrofurantoin (dosnt effect prostate bacteria), then do localization cultures -

170
Q

mgmt of e coli chronic prostatitis

A

4-6 wks of FQ

171
Q

mgmt of failure of initial round with FQ in chronic prostatitis

A

second cycle with an alternative FQ

172
Q

alternative initial treatment to FQ in e coli chronic bacterial prostatitis

A

bactrim x 3 months

173
Q

ileal conduit in spinal cord injury patinet - where to place conduit

A

RUQ so they can reach it

174
Q

most sensitive test for confirming pheochromocytomy

A

PLASMA free metanephrines. metanehrine metabolism is uninterrupted

175
Q

new onset hydronephrosis after sphincter/sling in pt with neurogenic bladder caused by - 2

A

detrussor decompensation aka detrussor noncompliance not identified preop or patinet noncompliance with CIC/ timed voiding intervals

176
Q

target of abiraterone - 3

A

irreversibly inhibits products of CYP17 gene including 17,20-lyase and 17-alpha hydroxylase

177
Q

non-testosterone effect of abiraterone

A

decrease in cortisol and rise in ACTH due to blocing 17-alpha-hydroxylase resulting in increased mineralocorticoid effect (aldosterone)

178
Q

clinical manifestation of 17-alpha-hydroxylase blockage in abiraterone

A

hyper-aldosteronism aka HTN, hypokalemia, fluid retention

179
Q

hyperaldosteronism in abiraterone

A

give with cortisol to attenuate aldosterone effects

180
Q

ideal method to repair congenital penile curvature in teens

A

plication

181
Q

why is re-biopsy after ASAP necessary

A

this is a small foci of glands that exhibits features of adenocarcinoma due to insufficient biopsy material to make the diagnosis of prostate cancer and repeat biopsy is recommended.

182
Q

seizure after prolonged ileus and ngt suction due to

A

hypomagnesemia

183
Q

other causes of hypomagnesemia - 4

A

diuretics, DKA, alcoholism, prolonge NGT

184
Q

soda and stone risk

A

stopping soda over 3 yr period results in 35% decreased stone risk if acidified by phosphoric acid. not the same for those acidified by citric acid.

185
Q

independent factor with poor prognosis in pts with local recurence of RCC following radical nx

A

local recurrence + synchronous mets.

186
Q

best mgmt for local recurrence in RCC

A

surgical resection

187
Q

pts getting d penicillamine should get supplemental

A

vit b6

188
Q

side effects of d-penicillamine - 8

A

fever, rash, GI side effects, arthralgia, leukopenia, thrombocytopenia, proteinuria w/ nephrotic syndrome, polymyositis

189
Q

risk of recurrence with T1, T2, T3 RCC

A

7, 25, 40% ESPECIALLY during the 1st 3 yrs

190
Q

AUA guidelines for T1 RCC lesion followup

A

CXR, labs x 3 yrs. not routine CT

191
Q

AUA guidelines for T2-3 RCC lesion followup

A

cxr, labs, ct q 6 mo x 3 yrs then yearly to yr 5

192
Q

3 types of bladder dysfunction in PUV patinets

A

detrussor overactivity, decreased compliance, myogenic failure

193
Q

3 types of bladder dysfunction in PUV patinets and ages

A

detrussor overactivity (older child), decreased compliance (infant), myogenic failure (adolescnt)

194
Q

role of acetohydroxamic acid

A

decreases growth of residual struvite stone fragments, but doesnt stone recurrence in patients made stone free at the time of surgery

195
Q

acetohydroxamic acid and alcohol

A

nonpuritic macular rash of the face and upper extremeties that disappears 30-60 mins after starting

196
Q

when should intravesical chemo be administered post turbt

A

within 24 hrs

197
Q

effect of post turbt mitomycin

A

reduces SHORT term recurrence (<2yrs)

198
Q

DSD can be predicted by what finding in lumbosacral myelomeningocele

A

an intact sacral arc

199
Q

how to determine if someone has intact sacral arc - 3

A

most reliable is intact bulbocavernosal reflex. others include: LE movement, spontaneous voiding, nl anal sphincter tone

200
Q

burn to penile shaft characteristic

A

usually full thickenss

201
Q

first step in penile shaft burn

A

place sp tube. debriedment isnt necessary in the first few hrs after the injury

202
Q

urethra and penile shaft burn

A

dont instrument it or do any studies to avoid further damage

203
Q

PSA and finasteride/ dutasteride - timing

A

doubling psa in 1st yr OVERestimates PSA and can lead to an increased likelyhood of biopsy, after 2 yrs doubling can lead to UNDERestimating and less biopsies

204
Q

psa interpretation and finasteride/dutasteride

A

using a 0.3 ng/dl increase from nadir as a trigger for biopsy maintains sensitivity and specificity similar to an absolute value of 4 ng/dl

205
Q

abdominal mass and racoon eyes = ?

A

neuroblastoma

206
Q

what are racoon eyes

A

periorbital metastasis causing edema, proptosis, ecchymosis

207
Q

what condition leads to facial adenoma sebaceum

A

tuberous sclerosis

208
Q

how does hodgkins lymphoma present

A

fever, nightsweats, fatigue

209
Q

facial angiofibromata aka

A

facial adenoma sebaceum

210
Q

what do facial angiofibromas look like

A

firm, discrete, red/brown telangectic papules in nasolabial folds, chin, cheeks

211
Q

treatment for topical candida

A

clotrimazole

212
Q

treatment for scabies

A

premethrin

213
Q

partial nx is most appropriate for what kind of pediatric tumor

A

stage V wilms

214
Q

most common way to measure free testosterone

A

immunoassay

215
Q

problem with free testosterone immunoassay and alternative

A

not accurate, bioavailable T measures T with ultracentrifugation or dialysis

216
Q

if total T is low, whats the next step

A

check LH and prolactin to r/o central process

217
Q

problem with aromatase inhibitors for low T in obese pts with elevated estrogen

A

off label use that can result in elevated LFT and affect bone health

218
Q

if only total testosterone is available - how to calculate free T

A

calculate with total T, SHBG +/- albumin level

219
Q

selenium/vit E in prostate ca

A

no effect on outcome

220
Q

site of origin with WORST prognosis in pediatric RMS

A

prostate

221
Q

site of orgin/histology with BEST prognosis in pediatric RMS

A

vaginal origin or embryonal histology

222
Q

rationale for post urs imaging to confirm stone passage even if no endoscopic evidence of stones

A

documentation of: 1. clearance of stone fragments, 2. resolution of preop obstructive hydronephrosis, 3. r/o obstruction from ureteral stricture

223
Q

AUA guideline recommendation for post-URS radio-opaque vs radiolucent stone

A

radio-opaque, get kub and renal us, lucent get renal us alone ONLY if pt is asymptomatic. if symptomatic OR hydronehrosis is found - high likely hood of obstruction and need CT. alternatively, hydro pts can be observed

224
Q

most common paratesticular tumor

A

adenomatoid tumors

225
Q

where are paratesticular tumors located - 3

A

epididymis, testicular tunica, rarely spermaticord

226
Q

significance of adenomatoid tumors

A

considered benign, 20’s-30’s, < 4 cm, usu in epididymis

227
Q

what method prevents bladder prolapse at the time of vesicostomy

A

exteriorize the dome by placing vesicostomy cephelad to the urachus - immobilizes peritonealized portion of bladder.

228
Q

what is blocksom technique

A

exteriorizing dome of bladder

229
Q

testicular pain/swelling in teen - when to tx for std - 3

A

urethral discharge, + UA, admission of sexual activity

230
Q

hormone deprivation effect on gleason score

A

results in inaccurate score - artifically higher

231
Q

renal cystic condition that arises prior to formation of nephron

A

MCDK

232
Q

specifics of MCDK origin

A

results from abnormal differentiation of metanephric parenchyma early in development of the kidney

233
Q

ARPKD gene

A

PKHD1 gene

234
Q

ARPKD protein

A

membrane associated receptor like protein, fibrocystin

235
Q

outcome of abnormal fibrocystin secretion in ARPKD - 2

A

causes abnormal ductal development, stimulates fibrous connective tissue resulting in congenital hepatic fibrosis

236
Q

ADPKD genes - 2

A

PKD 1 an PKD 2

237
Q

ADPKD proteins - 2

A

polycystin-1 and 2

238
Q

polycystin protein function (or lack of) in PCKD

A

normally functions within calcium channels and disruption leads to cyst formation, fibrotic renal stroma that manifests in 2nd-3rd decade

239
Q

what is juvenile nephronophthisis

A

rare, most common genetic cause of childhood kidney failure characterized by fibrosis and cystic dysplasia of renal tubules

240
Q

mgmt of lichen sclerosus/BXO of meatus

A

distal urethroplasty w buccal mucosa

241
Q

why is buccal mucosa best in LS/BXO

A

field change to genital skin

242
Q

most common sites of origin of extragonadal germ cell tumors in decreasing order - 4

A

mediastinum, retroperitoneum, sacrococcygeal, pineal gland

243
Q

gross hematuria after vigorous exercise in teen, mgmt

A

can be normal in people free of congenital GU problems. mgmt is to repeat UA in 48-72 hrs as it will normalize

244
Q

difference btw benign hemoglobinuria in teen and myoglobinuria

A

no RBC’s in myoglobinuria

245
Q

failure to improve on PO vanc in c diff, mgmt

A

surg consult for colectomy improves survival

246
Q

current virulent c diff strain name

A

NAP 1 - thought to be due to use of FQ’s

247
Q

role of prophylactic lymphadnectomy in penile cancer without palpable nodes

A

improved survival if prophylactic vs at time of palpable nodes. not enough evidence currently for sentinel LN bx

248
Q

how to best dx renal pseudotumor

A

nuclear scan with cortical scanning agent (like DMSA, not MAG3) demonstrates activity in area in question. CT can also answer this but are more expensive/invasive

249
Q

candiduria and GU procedure

A

treat as UTI due to risk of fungemia. antifungal at time of procedure is not sufficient

250
Q

pathologic classificaiton of RCC with positive margin at resection

A

R1 - this doesnt affect T stage

251
Q

T3a v T3b vs T3c in RCC

A

T3a - isolated renal vein involvement. T3b - renal vein with infradiaphragmatic , T3c - supradiaphragmatic

252
Q

what condition is assd w testicles in hernia sac in girls

A

androgen insensitivity

253
Q

45XO/46XY and gonads

A

streak gonads

254
Q

who gets workup after pyelo

A

older M with peylo. younger sexually active male with CYSTITIS can be observed

255
Q

mgmt of resolved pyelo in 65 yo 1 month later - 2

A

do CT urogram and cysto to r/o GU pathology

256
Q

when is carbazitaxel used

A

docetaxel failure (progression while on)

257
Q

carbazitaxel MOA

A

tubulin-binding taxane drug

258
Q

carbazitaxel benefit

A

3 month survival benefit

259
Q

renal ablation followup

A

CT at 3 and 6 months, then yearly upto 5 yrs. CXR yearly

260
Q

definition of low risk RCC in followup AUA guidelines

A

T1N0 or NX regardless of furhman grade

261
Q

AUA followup of LOW risk after partal vs radical nx

A

partial - labs, CXR yearly to 3 yrs, abd CT/MRI within 3-12 months then yearly (f/u can be renal us) to yr 3, radical nx - CXR yearly, abd US**/ct/mri at 3-12 months then at discretion of clinician

262
Q

AUA followup of mod/high risk after surgery

A

labs, baseline abd imaging (CT or MRI only) at 3-6 mo then Q 6 months (can include US) for 3 yrs then q yr to 5 yrs. baseline CT chest at 3-6 mo then q 6 mo (can be CXR) x 3 yr then yearly to 5 yrs

review course (17 decks)

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