SASP 2021 Flashcards
Abiaterone mechanism
CYP-17 inhibitor –| blocks both androgen & glucocorticoid production
Abiaterone leads to increases in ___corticoids leading to adverse effects such as ____
mineralocorticoids
hypertension, hypokalemia, peripheral edema, nausea/vomiting, weakness
_____ prescriptions can lead to a false positive metanephrine test when working up adrenal masses
tricyclic anti-depressants
Arterial insufficiency is suspected when peak systolic velocity is
25
Venous leak is suspected when end diastolic velocity is >____
5
Treatment for primary bladder neck obstruction in young man
TUIP
Renal artery aneurysms that are completely calcified do not have to be treated unless the patient wishes to ____
become pregnant
Most common nerve injured during lap varicocelectomy - ___ nerve leading to sensory loss in ___
genitofemoral nerve
sensory loss on anterior thigh
Topiramate leads to stone formation through _____uria
hypocitraturia
On abdominal exploration for undescended testes, most common finding is ____
peeping testis at entry to inguinal ring
Adrenal adenomas have Hounsfield units
10
Malignant adrenal lesions have
60
Decision to proceed with deep inguinal node LND for penile cancer is based on _____
positive superficial inguinal nodes at time of ILND
Injury below vertebral level ____ is considered a sacral spinal cord lesion
L1
In a patient with flank pain and hydro s/p reimplant, next diagnostic test should be ____
VCUG to r/o VUR
Concern for female bladder outlet obstruction with Qmax
12
Thiazide induced hyperCa++ is associated with ___ PTH, ___ phosphorus, and ___ K
normal PTH and phosphorus
Low K
Hypertophied testes in prepubertal boy is >___ cm in length
> 2 cm
Most common stone compositions in gout patients are ___ and ___
uric aid
caox monohydrate
The concept of hypofractionation for prostate cancer treatment is to deliver higher fraction sizes per treatment, which in turns shortens treatment duration, and thereby confers favorable implications for patient convenience, cost, and resource utilization. Specifically, conventional XRT fractionation involves a fraction size of 180 to 200 cGy, while moderate hypofractionation is defined as a fraction size between 240 cGy and 340 cGy. Multiple prospective randomized trials have compared moderate hypofractionation to conventional fractionation and have reported no statistically significant difference in cancer outcomes. The toxicity of moderate hypofractionation versus conventional fractionation has likewise been assessed from clinical trial results, with similar rates of acute and late genitourinary toxicity consistently reported from these series. Meanwhile, mildly increased risks of acute gastrointestinal (GI) toxicity have been reported with moderate hypofractionation, with similar late rates of GI toxicity. These trials have included patients across the spectrum of disease risk, with high-risk patients comprising nearly 20% of the studied populations to date, and no evidence of a significant interaction between treatment effect and risk group. As such, per current ASTRO/ASCO/AUA guidance, moderate hypofractionation should be offered to men with high-risk prostate cancer receiving external beam XRT (EBRT) to the prostate as long as the intended treatment does not include the pelvic lymph nodes, as the clinical target volume in the majority of studies evaluating moderate hypofractionation did not include the pelvic lymph nodes.
Preservation of the sacral nerve arcs, as indicated by an intact bulbocavernosus reflex, suggests the potential for detrusor-sphincter dyssynergia. While other parameters such as lower extremity movement, spontaneous voiding, and normal anal sphincter tone may also suggest the presence of intact sacral arcs, the bulbocavernosus reflex is the most clinically specific. Unlike spinal cord injury, in patients with lumbosacral spina bifida, neural function and urodynamic findings cannot be predicted by the level of the lesion.
The patient’s findings are classic for chancroid which is due to H. ducreyi. It affects men three times more than women. It is associated with inguinal adenopathy that is typically unilateral and tender with a tendency to become suppurative and fistulize. Single-dose treatment with azithromycin 1 gram orally or ceftriaxone 250 mg intramuscularly is first line therapy. While ciprofloxacin can be a secondary regimen, resistance to ciprofloxacin has been reported in some regions. Acyclovir, penicillin, or doxycycline are not indicated. Patients should be reexamined in five to seven days. Sexual partners should be treated if sexual relations were held within two weeks before or during the eruption of the ulcer.
Urinary concentrating defects following obstructive lesions may produce nephrogenic diabetes insipidus. This is often seen with PUV. It may be extremely difficult to reduce urinary volumes due to a fixed concentrating defect that is unresponsive to DDAVP. With large urine volumes, this boy is likely experiencing overflow incontinence and possibly poor bladder contractility. Therefore, antimuscarinics, onabotulinumtoxinA or imipramine would be unlikely to improve his urinary incontinence. With a fixed concentrating defect, fluid restriction may be dangerous, risking severe dehydration. Timed, double voiding would be the best initial treatment to aid in bladder emptying and would potentially reduce his incontinence.
The phase III METEOR trial compared everolimus versus cabozantinib for patients with disease progression after previous tyrosine kinase inhibitor therapy (as is the case here) and demonstrated a significantly improved overall survival with cabozantinib (21.4 months) versus everolimus (16.5 months). Cabozantinib was also associated with a significantly improved objective response rate and progression-free survival. Based on these trial findings, cabozantinib is listed by the National Comprehensive Cancer Network (NCCN) as a category 1 preferred option for patients with progression after tyrosine kinase inhibitor therapy, and specifically should be used preferentially over everolimus in eligible patients. Further, cabozantinib can be used in patients with chronic kidney disease.
Nivolumab is an immune checkpoint inhibitor antibody that blocks the interaction between PD-1 and its ligands. Nivolumab also has category 1 designation in this setting by the NCCN due to the results from a phase III randomized trial which noted superior overall survival for nivolumab (25 months) versus everolimus (19.6 months) among previously treated patients. However, the immune-mediated mechanism of nivolumab renders this agent not a good choice for a patient with an active autoimmune disease (lupus) requiring treatment and patients requiring glucocorticoid treatment were excluded from the aforementioned clinical trial.
For a similar reason, pembrolizumab (as part of a combination regimen with axitinib) would not be recommended.
Sunitinib, while an option for this patient, is listed by the NCCN as a category 2A option for second-line therapy, as limited prospective data exist to demonstrate its efficacy following progression on tyrosine kinase inhibitor therapy.
Meanwhile, high-dose interleukin-2 represents an option for highly selected patients, specifically those with excellent performance status and normal organ function but is listed by the NCCN as a category 2B treatment choice.
Blood supply to the rectum arises proximally from the superior rectal artery, which branches from the inferior mesenteric artery, and distally from the middle and inferior rectal arteries. When the inferior mesenteric artery is ligated, blood supply to the rectum is maintained by the middle rectal artery, which is a branch of the anterior division of the internal iliac (hypogastric) artery, and the inferior rectal artery, a branch of the internal pudendal artery also arising from the anterior division of the hypogastric artery. The superior mesenteric, ileocolic, middle sacral, and external iliac arteries do not provide blood supply to the rectum.
