Surgery, Gyne Flashcards
A 26 yr old man is diagnosed to have retinal capillary hemangioma for which he underwent laser therapy. MRI of the brain with gadolinium reveals 2 small cystic enhancing nodules in the cerebellum. Renal u/s multiple cysts in both kidneys. The most likely dx?
Von Hipple-Lindau disease
- Retinal n CNS hemangioblastoma ( particularly in the cerebellum, with a classic cystic nodular radiographic appearance) - r the most common associated tumors
- RCC is another manifestation- clear cell subtype n bilateral. They r often preceded by multiple renal cysts which r considered premalignant.
A 67 yr old comes with painless hematuria present throughout micturation. Has hx of smoking. Examination shows enlarged prostate. U/A shows RBCs no other abnormalities. The most appropriate next step is? A) cystoscopy
B) abdominal u/s C) PSA
Cystoscopy- bladder ca is the most common malignancy of the urinary tract
- usually hematuria is throughout micturation but tumors at bladder neck can present with terminal hematuria
A 35 yr old comes with headaches n recurrent epistaxis. She was previously told that she had raised BP. Her BP today is 170/100. Left upper quadrant bruit is present. U/S reveals lt kidney size of 8cm, rt kidney 12cm.
Dx?
Measurement of renin in the rt n lt renal veins, serum aldosterone levels would look like?
Renal aa stenosis- although most cases of RAS occur in elderly with atherosclerosis, young women can have it secondary to fibromuscular dysplasia
Rt renal- low -
Lt renal renin- high- low perfusion-> increased renin secretion, atrophy
Aldosterone- high
What’s the mechanism of hypertension in ADPKD?
Cystic expansion leading to localized renal ischemia-> renin release.
- ACEIs r the drugs of choice
A 19 yr old comes with headache. BP is 175/100, systolic bruit is heard under the rt ear. Most likely cause of her htn?
Fibromuscular dysplasia.
- young, 90% females
- renal n carotid aas r mostly involved ( abdominal n below ear bruit)
A 59 yr old comes with a month of dysuria, urgency, frequency. He also has suprapubic pain. Has hx of smoking. U/A shows RBC20-30/hpf, otherwise normal. Most likely Dx?
Bladder ca.- although it commonly presents with painless hematuria, the tumor can protrude into the bladder lumen, decrease the volume, cause bladder overactivity n pts can present with voiding sxs.
Suprapubic pain indicates an advanced tumor that has penetrated the mm
- the fact that there r no abnormalities on u/a other than RBCs is suggestive ( rules out infections)
A 26 yr old para 2 woman on her immediate postpartum day, 6hrs after spontaneous vaginal delivery presents with involuntary dribbling of small amounts of urine. She’s been unable to empty her bladder. She was given epidural anesthesia during labor. She has suprapubic tenderness on examination
The best next step in the mx
Urethral catheterization.
It’s self limiting but she needs catheterization to relieve her current retention
A patient presented with ureteral colic. RF is normal, no signs of infection. U/s shows 4mm stone in the ureter. He is given NSAID injection n the next step in the mx?
What r the indications for urgent urologic consultation during the mx of ureteric colic?
Discharge home with instructions to strain the urine n drink 2L/day
- IV(forced) hydration is not proven superior to oral hydration so no need for admission…
- <5mm pass spontaneously,5-10 with the help of alpha 1blockers eg tamsulosin,
- urosepsis( FEVER, CHILLS), Anuria, AKI, refractory pain; >10mm stone require urgent urologic evaluation.
A pt comes with pelvic fracture and urethral injury( clinical Dx) The next step in the mx is?
Retrograde urethrography.
Immediate surgical repair is not the recommendation. The urethrography helps to confirm the dx n plan the surgery.
Obstructive LUTs in an otherwise healthy young man with no hx of trauma or previous illness is suggestive of?
Urethral stricture. Which is commonly idiopathic.
