Surgery Part 3 Flashcards
1
Q
Weight of kidney
A
150 to 160 g
2
Q
Pain fibers of the ureter
A
T12 to L2
3
Q
Prostate gland size
A
4 x 3 x 2 cm
4
Q
Weight of prostate gland
A
15 to 18 grams
5
Q
Blood supply of prostate gland
A
Inferior vesical a.
Middle hemorrhoidal a.
Internal pudental a.
6
Q
Venous drainage of prostate
A
Pelvic plexus –> hypogastric v.
Connection with Batson’s plexus, hence brain/spine mets in prostate cancer
7
Q
Nerve supply of prostate
A
Motor and sensory (parasympathetic): S3 to S4
Vasomotor (sympathetic): Hypogastric n.
8
Q
Weight and covering of testes and epididymis
A
20 g, tunica albuginea
9
Q
Blood supply of testes and epididymis
A
from aorta just below renal a.
10
Q
Venous drainage of testes and epididymis
A
R spermatic v. directly into IVC
L spermatic v. drains into L renal v.
11
Q
Blood supply of urinary bladder
A
Superior, middle and inferior branches of hypogastric a.
12
Q
Autonomic nerve supply or urinary bladdder
A
sacral cord
pre-sacral and epigastric plexus
13
Q
Process of normal micturition
A
Bladder contraction coincides with decrease in outlet resistance
14
Q
Mitcturition center
A
Pons
15
Q
Motor pathway to urinary bladder
A
pelvic n.
16
Q
Erectile bodies in penis
A
corpora cavernosa (2) and corpus spongiosum (1, ventral body)
17
Q
Somatic sensory n. of penis
A
S3 to S4 (ilioinguinal)
18
Q
Sympathetic vasomotor n. of penis
A
hypogastric
19
Q
Parasympathetic n. of penis
A
S2 - S4 via nervi erigentes –> cavernosal n. (impotence if injured in pelvic surgery)
20
Q
LUTS may be caused by
A
prostatic enlargement
urethral stricture
21
Q
Causes of erectile and ejaculatory dysfunction
A
Endocrinologic
Vasculogenic
Neurogenic
22
Q
Significant findings in urinalysis
A
RBC > 3/hpf
WBC > 5/hpf
23
Q
Semen analysis
A
2-5 days sexual abstinence Volume of 1.5 ml 15M spermatozoa per ml 10% motility 4% normal morphology 2 abnormal semen analysis for confirmation
24
Q
Normal bladder capacity is
A
400 to 600 ml
25
Normal filling pressure
<15 cm water
26
First sensation of bladder filling
1/3 of normal capacity (200 ml?)
27
Which WINSURF (LUTS) symptoms are obstructive and which are irritative?
Obstructive: WISR
Irritative: NUF
```
Weak stream
Intermittency
Nocturia
Straining
Urgency
Retention
Frequency
```
28
How does Proteus cause urinary infections?
Urea splitting causes urinary alkalinization and precipitation of calcium
(xanthogranulomatous pyelonephritis)
29
Perinephric abscess common in diabetic patients
Emphysematous pyelonephritis
30
Reiter's syndrome
conjunctivitis
non-gonococcal urethritis
arthritis
31
Risk factors for nephrolithiasis
Poor fluid intake
Hypercalcemia
Renal tubular acidosis
32
pH >7 on urinalysis
suggest presence of urea-splitting organisms and possible struvite stones
(pH < 5: uric acid stones)
33
Stones of this size rarely pass spontaneously
< 6 mm
34
Recurrent UTI progressing to struvite stones caused by
Klebsiella
Proteus
Pseudomonas
35
Stone-provoking medications
1. Acetzolamide
2. Cal supplements or Vit D
3. Vit C
36
What kind of stones cannot be broken down in shockwave lithotripsy?
```
cystine stones
calcium monohydrate (variable success)
```
37
BPH vs prostate cancer location
BPH: starts in periurethral/transitional zone hence LUTS symotoms
Prostate cancer: peripheral portion of gland
38
Elevated PSA is elevated in ___ % of men with BPH
25 to 30%
39
Maximal urinary flow rate
>15ml/second
40
TURP syndrome
Short-term complications: due to absorption of hypotonic irrigation fluid = hyponatremia, blood loss, urinary retention, infection
Long-term complications: Incontinence, impotence, retrograde ejaculation, bladder neck contracture, urethral strictures
41
Retro or suprapubic prostatectomy
Prostates > 60 to 80 grams
42
Second most common cancer in genitourinary system
Prostate cancer (95% is adenoCA)
43
Common sites of mets of prostate cancer
bone, lung, liver, adrenals
44
Renal parenchymal tumors
Renal cell carcinoma 85%
Wilm's tumor/adenomyosarcoma 14%
Sarcomas of interstitial tissues 6%
45
Risk factors for renal cell carcinoma
Male sex
Smoking
Von Hippel-Lindau syndrome
Other parenchymal tumors
46
Triad of renal cell carcinoma
pain - stretching of renal capsule
mass - lower pole lesions
hematuria - occur in late stages, erosion of tumor into collecting system
47
Why does RCC of L kidney present with new onset L varicocele?
Left gonadal v. drains into the left renal v.
48
Stauffer's syndrome
Renal cell carcinoma + hepatic cell dysfunction
49
Sites of metastasis of renal cell carcinoma
lungs, liver, brain, bone, inferior vena cava/heart
50
Classification of open fractures
Gustilo and Anderson
- size of wound
- amount of contamination
- severity of fracture
51
Fracture of distal radius with the fragment displaced dorsally, "silver fork", FOOSH
Colles' fracture
52
Fracture of the distal radius with the fragment displaced volarly, "reverse silver fork"
Smith's fracture (Reverse Colles')
53
Hutchinson's/Chauffeur's fracture
Fracture of the radial styloid or scaphoid
54
Monteggia's fracture
Fracture of the ulna with dislocation of the radial head
55
Galeazzi's fracture
Fracture of the distal radius with dislocation of DRUJ
56
Piedmont's fracture
Fracture of the radial shaft at the junction of the middle and distal thirds without an associated fracture of the ulna (Galleazi without ulna)
57
Hard signs of peripheral arterial injury (operation mandatory)
pulsatile hemorrhage
absent pulses
acute ischemia
58
Soft signs of peripheral arterial injury (further evaluation indicated)
proximity to vasculature
significant hematoma
associated nerve injury (A-A index of < 0.9)
thrill or bruit
59
Most commonly dislocated joint
glenohumeral joint (anterior > posterior)
closed reduction: Stimson/Hippocratic technique
60
Bankart lesion
tear in glenoid labrum
61
Hill-Sach's lesion
compression fracture of the humeral head
62
Trendelenburg sign
DDH
| Patient stands bearing weight on the affected hip, the pelvis is tilted downward on the normal side
63
Galeazzi sign
DDH
| With the knees and hips flexed, there is shortening of the dislocated side
64
Barlow's test
click! (adduction)
65
Ortolani test
sensation of hip reducing back into acetabulum (abduction)
66
Management of DDH
```
Up to 6 months: Pavlik harness
6 months to 15 months: Spica cast
15 months to 2 years: femoral osteotomy
2 years and more: Synovial joint types and examples:
acetabular and/or femoral osteotomies
```
67
Another name for Legg-Calve-Perthes disease
Coxa Plana
(LCPD)
Avascular necrosis of the frmoral head
M >F
Age: 4 to 10 years old
Trendelenburg gait
68
Adolescent hip disorder, displaced femoral head on the femoral neck
Slipped Capital Femoral Epiphysis (SCFE)
painful limp located in the thigh or knee with loss of abduction and internal rotation of the hip
69
Trethowan's sign
SCFE
Klein's line does not intersect the lateral part of the superior femoral epiphysis on AP xray of pelvis
Tx: percutaneous pinning or screw fixation through the growth plate
70
Osgood-Schlatter disease
Ossification in the distal patellar tendon at the point of its tibial insertion, tendon fragments due to chronic tensile stress in athletes
71
Salter-Harris
pediatric fracture of growth plate
```
Type I to VI
Type I to V: SALT ER
I - straight across
II - above
III - lower/beLow
IV - two/through
V - erasure of growth plate/cRush
VI - bone bridge across growth plate (healing)
```
72
Difference between Finkelstein's and Eichhoff's test
Finkelstein's: examiner grasps thumb
Eichhoff's: patient flexes thumb, clench fist over it
Both: the examiner ulnar deviates
73
Tendons involved in De Quervain/Stenosing tenosynovitis
EPB - extensor pollicis brevis
APL - abductor pollicis longus
Surgical release: partial resection of extensor retinaculum
74
Tests for bicipital tendonitis (long head of biceps tendon)
Speed test
Yergason test
Palm-Up test
Surgical repair: arthroscopic decompression, acromioplasty, anterior acromionectomy
75
Fixed or flexible deformity of the DIP joint of the toe
Mallet toe
76
Flexion deformity of the PIP joint of the toe, hyperextension of the MTP and DIP joints
Hammer toe
77
Degenerative changes in the musculotendinous cuff
Supraspinatus tendinitis or Subacromial bursitis
