Summary of Essentials - Ch. 52-54 (GU)

Question 1

Presentation - N/V, testicular pain (<24 hours), superiorly displaced testicle, absent cremasteric reflex

Answer 1

Testicular torsion

Question 2

Pathognomonic finding for appendix testicular torsion?

Answer 2

Blue-dot sign

Question 3

Cremasteric reflex ___ in appendix testes torsion, ___ with testicula torsion

Answer 3

Present; absent

Question 4

Work-up of suspected testicular torsion?

Answer 4

If low suspicion - UA to r/o UTI or epidymo-orchitis

Doppler U/S

Question 5

Management of testicular torsion?

Answer 5

<6 hours - attempt manual detorsion followed by elective orchiopexy

> 6 hours - straight to OR for surgical detorsion, orchiectomy if necrotic

Question 6

Most common type of testicular tumor?

Answer 6

Seminoma

Question 7

Work-up of testicular mass?

Answer 7

U/S - solid mass in cancer
CT A/P for staging
Bx CONTRAINDICATED

Question 8

Rx testicular cancer?

Answer 8

Radical orchiectomy

Radiation (seminoma)
Chemo (most)
RPLND (non-seminomas)

Question 9

Which type of testicular cancer typically has elevated AFP/BCG levels?

Answer 9

Non-seminoma

Question 10

Presentation - pain with hematuria?

Answer 10

UTI or obstruction

Question 11

Presentation - painless gross hematuria?

Answer 11

Suspicious for malignancy, especially in the elderly

Question 12

Most common renal cancer?

Answer 12

RCC

Question 13

Most common bladder cancer?

Answer 13

Urothelial cell (transitional cell)

Question 14

Most common prostate cancer?

Answer 14

Adenocarcinoma

Question 15

Most common kidney stone type?

Answer 15

Calcium oxalate

Question 16

Work-up of hematuria?

Answer 16

1. Urine dipstick, microscopic UA
2. If kidney stone is suspected -> non-contrast CT; U/S if woman of childbearing age and children
3. If suspicious for malignancy -> CT urogram, urine cytology, cystourethroscopy

Question 17

Dysmorphic RBCs or RBC casts suggest what?

Answer 17

Glomerular cause

Question 18

Management of kidney stones?

Answer 18

<5 mm - will likely pass spontaneously
5-9 mm - individualized
>10 mm - lithotripsy, perc nephrostomy, ureteroscopy, rarely nephrolithotomy

Question 19

Rx renal cancer?

Answer 19

Partial or radical nephrectomy

Question 20

Rx bladder cancer?

Answer 20

Transurethral resection, infusion of mitomcyin or BCG, or radical cystectomy

Question 21

Rx prostate cancer?

Answer 21

External beam radiation
Brachytherapy
Androgen deprivation
Radical prostatectomy
Active surveillance