Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Uro > Uro 2020 > Flashcards

Uro 2020 Flashcards

1
Q

What is the maximum amount of botox that can be given within a 3 month period?

A

400 Units total, no matter what the indication

200U for neurogenic bladder + 200U for limb spasticity = 400, no more can be given for 3 mo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the max dose of botox approved for neurogenic detrusor overactivity?

A

200 U

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Initial treatment of renal artery fibroplasia?

A

HCTZ is often first step, if it does not appropriately lower BP then add Lisinopril
Rarely requires surgical intervention
Unlikely to progress to complete occlusion or alter renal functioning and therefore renal fxn scans are not necessary as further workup.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Treatment for retrograde ejaculation:

A

Pseudoephedrine
Retrograde ejaculation can be evaluated with a post-ejaculatory urinalysis (will differentiate b/w this and failure of seminal emission)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Characteristics of mixed gonadal dysgenesis:

A

Combination of a testis and contralateral streak gonad
Incomplete virilization (bifid scrotum, penoscrotal hypospadias, rudimentary uterus)
2nd most common etiology of ambiguous genitalia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Typical chromosomal status of patients with mixed gonadal dysgenesis:

A

Mosaic 45 XO/46 XY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Most common etiology of ambiguous genitalia:

A

45 XX DSD – female pseudohermaphroditism, CAH

Does not have testes present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Characteristics of pure gonadal dysgenesis:

A

Chromosomal structure – 46 XX or 46 XY

Bilateral streak gonads

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Characterisitics of hernia uteri inguinale:

A

aka persistent Mullerian syndrome
d/t failure of production of MIS or its receptor
Have normal appearing testes in abdomen w/fallopian tubes and a uterus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Best step to control presacral bleeding 2/2 sacral suture placement during a sacrocolpopexy:

A

Place a sterile tack into the sacrum at the site of the sacral sutures
The presacral bleeding at the venous level is more common when sutures are placed too low in the sacrum (closer to S2/3/4)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When is extracorporeal shock wave therapy an option in the treatment of Peyronie’s?

A

For penile pain

Should not be used to reduce curvature or treat calcified penile plaques or hourglass deformity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Common features seen in stomal stenosis of an ileal conduit:

A

Dilated ureters, hydronephrosis and an elongated/dilated conduit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Gold standard meds for detrusor overactivity:

A

antimuscarinics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Most common cause of bladder calculi s/p augmentation cystoplasty:

A

Poor emptying and mucus formation
Risk increases in patients with abdominal wall stomas
Catheterizing per urethra and daily bladder irrigation decrease risk of stone formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Function of genitofemoral n.

A

Runs anterior to psoas muscle
Provides sensation to anterior thigh (femoral br.)
Responsible for cremasteric reflex/innervation of cremasteric mm. and gives sensation to anterior scrotum (all from genital br.)

Ilioinguinal n. also provides sensation to anterior scrotum but not thigh

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Most likely nerve to be injured in lap. Varicocelectomy:

A

Genitofemoral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Function of iliohypogastric n.

A

Innervates internal oblique and tranversalis mm.

Provides sensation to lower abdominal wall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Function of posterior femoral cutaneous n.

A

Sensation to posterior scrotum, posterior thigh and perineum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What effect does a loop/Turnbull stoma have on complications post-cystectomy w/ileal conduit?

A

Turnbull/loop ileostomies have a decreased incidence of stomal stenosis, but have increased risk of parastomal hernias.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What effect does Allopurinol have on stone formation?

A

Increases risk of forming hypoxanthine stones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is often used in patients who form hypoxanthine or uric acid stones?

A

Potassium citrate to alkalinize the urine
These are v. common in Lesch-Nyhan patients, and risk increases with allopurinol which is typically necessary for them to take

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What should be done for Spina Bifida patients with worsening bladder disease prior to augmentation?

A

MRI of spine – often shows tethered spinal cord, syringomyelia, increased ICP d/t shunt malfunction, or partial herniation.

A corrected tethered cord can sometimes reverse bladder deterioration and prevent the need for augmentation.
MRI should always be sought when there is change on annual UDS in these patients.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Drug of choice for collecting duct carcinoma:

A

Cisplatin- or gemcitabine-based therapies
CD carcinoma is v. aggressive and does not respond to the typical txs of other renal cancers (clear cell or papillary) like IL-2, sunitinib, bevacizumab, temsirolimus and sorafenib

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

MoA and contraindications of Fibanserin (Addyi) used to treat hypoactive sexual desire disorder in women:

A

5HT1A agonist and 5HT2A antagonist. Also exerts DA and NE action
EtOH consumption is absolute contraindication (must sign contract to be prescribed) d/t effects on BP.
Only approved for pre-menopausal women, not contraindicated in pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Most common GU sarcomas in adults and histo based on age:

A

Paratesticular sarcomas are the most common GU sarcomas in adults
Liposarcoma is most common in adults
Embryonal rhabdomyosarcoma is most common in men <30yo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What additional therapies should be done for GU sarcomas if metastatic evaluation is normal?

A 
Liposarcomas – adjuvant XRT
Other sarcomas (rhabdomyosarcoma, malignant fibrous histiocytoma, angiosarcoma) – RPLND and post-op CXT if RPLNs are involved
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

How does syphilis have to be diagnosed before initiating treatment?

A

Non-treponemal test (RPR or VDRL) – if positive then have to get a treponemal test (FTA-Abs) or T. palladium particle agglutination (TP-PA). If both are + can initiate tx
Cannot initiate tx with only a + non-trep test (VDRL/RPR)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Most common cause of a false negative diuretic renogram:

A

Dehydration/inadequate fluid volume and therefore low urine flow at the time of the study
Renograms are dependent on adequate urine production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Common causes of false positive diuretic renograms:

A

Poor renal fxn
Inadeqaute dose of diuretic administered
Full bladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Signs/sxs of lidocaine toxicity:

A

Metallic taste
Dizziness
Lightheadedness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

How does citrate inhibit urinary stones?

A

It binds calcium and prevents formation of calcium oxalate and calcium phosphate crystals
Also inhibits the spontaneous nucleation of calcium oxalate.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

How does alkalinizing the urine help reduce stone formation?

A

It decreases uric acid and cystine stone formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

How should groin recurrence be treated after partial penectomy for SCCa?

A

Superficial and deep inguinal lymphadenectomy only on the side with obvious disease.
The contralateral side should be spared

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Current tx recommendations for b/l WIlm’s tumors in peds patients:

A

6 weeks of initial cxt w/o renal biopsy in patient’s w/high probability of Wilms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Characteristics on 20wk US that are considered prenatal hydronephrosis:

A

APRPD 4+mm or Calyceal dilatation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Most common intervention done in the prenatal period for significant BOO:

A

Vesicoamniotic shunt – tube similar to JJ stent that drains fetal bladder into amniotic cavity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is the pontine micturition center?

A

Center for integration and coordination of bladder and urethral activity
Suprasacral spinal cord injuries disrupt communication b/w pons and sacral cord – causes detrusor overactivity and detrusor/external sphincter dyssynergia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Acceptable indications for PCNL in pediatric pts:

A

Large stone burden >2cm
Staghorn stones
Significant sized cysteine stones
Previously reconstructed LUT precluding retrograde access to UVJ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Where is correct placement of an initial nephrostomy puncture in a horseshoe kidney compared to a normal kidney:

A

Position is more medial and through a posterior calyx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Median age of presentation for WIlm’s tumor:

A

3.5 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Initial treatment of stages I-IV Wilm’s tumors:

A

Nephrectomy

Stage V is b/l disease and undergoes cxt first

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Factor most likely to increase risk of a perirenal hematoma after SWL:

A

HTN

Complication is not a/w stone size or location

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Half life of AFP and tumor its most a/w:

A

t1/2 is 5-7 days
Elevated in 50-80% of NSGCT
EC and Yolk Sac tumors produce AFP; seminoma and chorio do not.
Decision to treat should not be made on a pt w/AFP <20

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Half life and tumor a/w bHCG:

A

t1/2 is 24-36hrs

bHCG is elevated in embryonal carcinoma, choriocarcinoma and seminoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Half life and tumor a/w LDH:

A

t1/2 is 24hrs

LDH is the most common isoenzyme elevated in GCT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Primary tumor staging of testicular tumors:

A

pTis: Intratubular germ cell neoplasia
pT1: Tm limited to testis and epididymis – no LV invasion. May invade tunica albuginea but not tunica vaginalis
- 1a: <3cm
- 1b: 3+ cm
pT2: Tm. limited to testis/epididymis w/LV invasion or involving the tunica vaginalis
pT3: Invades the spermatic cord w/or w/o LV invasion
pT4: Invades the scrotum w/or w/o LV invasion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Risk of relapse s/p orchiectomy for a pt. w/Seminoma:

A

15% risk of developing retroperitoneal relapse w/in first 2 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What type of testicular tumor are patients with Androgen Insensitivity at risk for?

A

If their testes are left undescended in situ theyre at risk of seminoma development

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What factors predict high probability of finding only fibrosis/necrosis in post-cxt residual masses/LNs a/w testicular tms?

A

Absence of teratoma in primary tumor
>90% reduction in retroperitoneal mass post-cxt
Size of post-cxt residual mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What is a common complication causing decreased turgor to the kidney during lap nephrectomy and what should be the first step to correct it?

A

Renal artery vasospasm can occur during hilar dissection – leads to reduced renal perfusion
1st step is to reduce insufflation pressure – increases renal perfusion.; often don’t need additional therapy after this.
If continued poor perfusion – topical papaverine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What drug best reduces the risk of men w/prostate ca from developing bone pathology or having worsening bone pathology when already present?

A

Denosumab or Bisphosphonate therapy
These prevent osteoporosis and reduce skeletal-related events
They also reduce analgesic use, but they do not improve survival

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What is the cause of acidic urine in pts w/DM-II who form uric acid stones?

A

Defective renal ammonia excretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What allows for bladder relaxation during filling?

A

Stimulation of B-2 and B-3 adrenergic receptors in the detrusor via the hypogastric n.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What T1 bladder cancers should undergo radical cystectomy?

A

Those with the following aggressive features:
Tumor size >3cm
Micropapillary histology
LV invasion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

How can the ilioinguinal nerve be separated from the cord structures during an inguinal approach to peds hernia?

A

By entering the cremater – ilioinguinal n. runs in the cremaster layer and can be spared by opening it and separating it from the remained of the cord.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What should be used to help prevent stone formation in pts taking topiramate?

A

Potassium citrate
Topiramate causes a chronic intracellular acidosis – high urine pH, low urinary citrate and hypercalciuria. K-citrate will help to prevent stone formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Why do endemic bladder stones form?

A

Aka primary idiopathic calculi

Form d/t high urinary excretion of ammonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

How to achieve adequate alpha blockade pre-op in pts w/Pheochromocytoma:

A

Phenoxybenzamine

If this does not achieve BP control can add Metyrosine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What is typically the dose-limiting toxicity associate with Abiraterone?

A

Hepatotoxicity

Need LFT monitoring biweekly for first 3 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What artery most reliably supplies the omentum?

A

R gastroepiploic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Where does PTH/VitD induced Ca absorption primarily occur?

A

Distal tubule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What is the minimum volume accepted for interpretability during Uroflow in UDS?

A

125cc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

How is detrusor pressure determined?

A

It is the difference between intravesical and abdominal pressures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What aspect of UDS is classically associated with intrinsic sphincter deficiency?

A

Low ALPP (abdominal leak point P) – <60 defines ISD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Characteristics of BOO on UDS:

A

Elevated voiding pressures and diminished uroflow
BOO cannot be ruled out when there is diminished pressure and low flow, but these are ore classically detrusor underactivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Normal detrusor voiding pressures in adult males and females:

A

Males: 40-60
Females: much lower pressures – often have undetectable voiding pressures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What are girls with turner syndrome Karyotype 45XO/46XY at risk of?

A

Dysgerminoma and gonadoblastome – require gonadectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What male organs are affected in Kallman syndrome?

A

Prostate, seminal vesicle, and testicular size are all often decreased.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What is a common way to evaluate for ejaculatory duct obstruction?

A

TRUS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What is the most accurate measure of renal function in patients with intestinal diversions?

A

Fractional excretion of sodium
Intestinal conduits absorb many other urine components such as creatinine, urea, and alkalizing substances so these are all going to be affected and inaccurate in urine samples.
Proteinuria and the ability to concentrate the urine will also be affected.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Syndromes at high risk for developing Wilms’ tumor and their features:

A
  1. Denys-Drash: male pseudohermaphroditism (proximal hypospadias, cryptorchidism), membranoproliferative glomerulonephritis, and nephroblastoma
  2. Beckwith-Wiedemann: macroglossia, nephromegaly, hepatomegaly
  3. WAGR: Wilms’ tm, aniridia, gonadoblastoma, intellectual disability
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

What is the only aspect of renal function preserved in chronic unilateral ureteral obstruction?

A

Urinary dilution

Urinary concentration, ammonia excretion, K and Na reabsorption are all impaired

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

How to diagnose and treat a confirmed UTI in a male with suspicion of chronic bacterial prostatitis:

A

First treat the UTI and sterilize the urine – get a midstream urine sample and tx w/Macrobid
Once urine is documented as sterile get localization testing – initial voided, midstream, expressed prostatic secretions and post-prostatic massage urinary specimens.
Once bacterial prostatitis has been confirmed tx E.coli w/4-6 weeks quinolone. Alternative is 3 months TMP-SMX
If patients fail initial quinolone therapy, switch to another quinolone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

What stone composition is most resistant to fragmentation by SWL?

A

Brushite
Cystine and Ca-Ox monohydrate are also extremely resistant.
Uric acid is not very resistant and Struvite is the most fragile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

When is the cutoff for orchiectomy in the setting of cryptorchidism?

A

Males >50yrs or those with anesthesia-related mortality risks outweighing surgical benefits should be observed and not undergo orchiectomy
12-50 = orchiectomy
<12 = pexy; >50 = observation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Sxs that merit tx of UTI in patients who do CIC:

A

Fever, flank/abdominal discomfort, increased leakage between CIC, increased spasticity, sxs of autonomic dysreflexia and malaise/lethargy.
Asymptomatic bacteriuria in these patients does not require tx as most are colonized

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What should be done first in the workup/treatment of suspected adrenal malignancy?

A

First do endocrine testing and CT chest for staging

May need bx if theres mass in chest to determine which is primary – chest and adrenal met to each other

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Most common causes of Autonomic dysreflexia:

A

1 is bladder distention, #2 is fecal impaction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Role of clomiphene citrate in male infertility:

A

It will increase the intratesticular testosterone levels in a patient w/low serum testosterone – will optimize the intratesticular environment for spermatogenesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

If the IMA is ligated how will the L colon maintain blood supply?

A 
Middle colic (br. of SMA) will supply proximal L colon, and middle/inferior hemorrhoidal aa. will supply distal L colon.
The marginal a. of Drummond will connect the 2 blood supplies to the L colon
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Recommended treatment of symptomatic submucosal ureteral stones:

A

These are often iatrogenically displaced fragments of stones.
Best treatment is laser excision and stent placement
If this fails, next step is resection of affected segment of ureter with repair.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

What is sphincter bradykinesia associated with?

A

Parkinson disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

What is commonly seen in patients with MS and suprasacral spinal cord injuries?

A

Detrusor overactivity with detrusor external sphincter dyssynergia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

What is the optimal way to administer mitomycin C?

A

Eliminate residual urine
Overnight fasting (dehydration)
Oral sodium bicarb (alkalinize the urine – reduces drug degradation)
Increase drug concentration to 40mg/20mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

What is a Martius flap composed of and where do you get it’s blood supply?

A

Composed of fibrofatty labial tissue
Blood supply comes from the posterior labial vessels inferiorly, external pudendal a. superiorly and obturator a. laterally
Typically used for distal fistulae involving bladder neck, trigone and urethra

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

What should be used as a flap for apical vesivovaginal fistulas using a transvaginal approach?

A

Peritoneum

Greater omentum can be used as flaps in this location during a transabdominal approach but not transvaginal.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

What are the exceptions to non-operative mgmt. of extraperitoneal bladder injuries?

A

Extraperitoneal injuries can be managed non-op w/catheter drainage
If the patient has bladder neck injury, rectal injury, or clot retention.
All intraperitoneal injuries should be repaired

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

What spinal level must injuries be below to have preserved psychogenic erections?

A

T9 and above have no psychogenic or reflex erections

Injuries below T9 have no reflex erections but have preserved psychogenic erections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Mgmt of lymphadenopathy in Verrucous carcinoma:

A

Observation – LAD is likely reactive in these cases.

Verrucous carcinoma has v. low likelihood of mets.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

What is the best way to detect persistent/recurrent CIS on follow up cystoscopy after treatment?

A

Blue-light fluorescent imaging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

What drug should be prescribed to patients who have recurrent calcium oxalate stones w/hyperuricosuria and normal urinary calcium?

A

Allopurinol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

When should a low sodium diet be advised to a patient with recurrent ca-ox stones?

A

If they have hypercalciuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Periop antibiotic recommendations for radical cystectomy:

A

2nd or 3rd gen cephalosporin 30min to an hr prior to incision and continued for 24hrs post-op

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

What prostatic enzyme is also found in the small intestine and salivary glands?

A

Prostate specific membrane antigen (PSMA)

95
Q

Types of testicular tumors:

A 
Germ cell tms (90-95%): Seminoma and Non-Seminoma
Stromal tms (5-10%): Leydig cell, Sertoli cell, and Granulosa cell tms
Others: Gonadoblastoma (rare – but most commonly found in intersex pts.)
96
Q

What is the most common b/l testis tumor?

A

Malignant lymphoma

97
Q

Most common tm in an undescended testis?

A

Typical/classic seminoma

98
Q

Most common testis tm in men >50yo:

A

Malignant lymphoma

99
Q

Most common testis tm in infants/children:

A

Yolk sac tumor

100
Q

Which side is cryptorchidism more common on?

A

The right – therefore testis tms are more common on the R.

101
Q

Risk factors for testis cancer:

A
  1. Cryptorchidism – biggest risk factor
  2. HIV
  3. Gonadal dysgenesis w/Y chromosome
  4. Testicular feminization >30yo
  5. Intratubular germ cell neoplasia/CIS (pTis)
  6. FHx – 1st degree relative
  7. Personal hx
  8. Infertility
  9. Klinefelter’s syndrome – risk of extra-gonadal/mediastinal germ cell cancer
102
Q

Most common side effect of Alprostadil for ED:

A

Penile pain – can include scrotum and extremities. NTD, just reassure patient

103
Q

What is a thiazide challenge often used for?

A

To unmask subtle primary hyperparathyroidism – will increase proximal tubular resorption of calcium and cause significant rise in serum calcium.
These patients should undergo parathyroidectomy to decrease stone formation.
If they have symptomatic or obstructive stones at time of diagnosis these should be treated prior to parathyroidectomy.

104
Q

What test compares means of 2 groups?

A

T-test

ANOVA compares means of >2 groups
Chi square compares proportions of 2 groups

105
Q

What is normal LPP?

A

> 60cm H2O

<60 indicates dysfunctional urethra/intrinsic sphincter deficiency

106
Q

What are indications for an autologous sling placement?

A

Severely dysfunctional urethra (low LPP 0-60)
Loss of urethral tissue (s/p synthetic mesh erosion into urethra, urethral diverticulectomy or urethrovaginal fistula repair)
Multiple previous anti-incontinence procedures

107
Q

What is an option for female patients with recurrent pyocystitis and supravesical diversions?

A

Vesicovaginostomy in – drains bladder and relieves sxs

Cystectomy can also be performed but not the best option in poor surgical candidates

108
Q

What organisms are likely to cause wound infections w/in the firs 24hrs post-op?

A

Strep and Clostridium
Both are characteristically invasive, painful and occur w/in 24hrs
Strep – thin, watery purulent discharge w/o frank abscess formation or foul smell
Clostridium – gray/reddish brown and foul smelling discharge. a/w wound crepitus and necrosis. Often have intra-op fecal contamination.
Staph infections occur >24hrs and have indurated areas of cellulitis, a/w abscess formation and thick yellow/cream colored pus

109
Q

What is the finding on a high-dose dexamethasone suppression test that establishes the diagnosis of Cushing’s Disease (xs pituitary ACTH secretion)?

A

Suppression of urinary 17-hydroxycorticosteroids

110
Q

What parameter on prenatal US early in pregnancy is most predictive of poor renal outcome?

A

Oligohydramnios

111
Q

What are the major effects of insufflation pressures >20?

A

1 – Tachycardia 2/2 decreased venous return and cardiac output
2 – Decreased GFR and oliguria 2/2 increased pressure on the renal parenchyma
3 – Hypercarbia/Resp Acidosis 2/2 expanded abd P resulting in decreased diaphragmatic movement and decreased pulmonary insufflation

112
Q

What effect does ejaculatory duct obstruction have on semen pH?

A

Causes it to be acidic – <7.0-7.2

bc seminal vesicles add alkaline fluid

113
Q

Preferred modality to assess urethral integrity in females?

A

Cystoscopy + vaginoscopy under anesthesia

RUG is preferred in males

114
Q

Cavernosal blood gas values in ischemic priapism:

A

PO2 <30
PCO2 >60
pH <7.25

115
Q

HTN in Cushing’s syndrome is primarily related to what?

A

Retention of water and salt

116
Q

Where does DDAVP exert its effects?

A

On the collecting ducts

117
Q

What is the main disadvantage of bladder autoaugmentation?

A

Limited increase in bladder capacity

118
Q

What is Fowler’s syndrome?

A

A cause of urinary retention in young women – a/w abnormally increased EMG activity resulting in impaired external sphincter relaxation.
It is often highly responsive to neuromodulation

119
Q

What drug has the most rapid onset of action in treating BCG sepsis?

A

Cycloserine – inhibits BCG growth w/in 24hrs

120
Q

What anti-androgen is most associated with painful gynecomastia?

A

Bicalutamide

121
Q

What is the most common cause of Hypokalemia in patients with HTN?

A

Diuretic treatment

122
Q

What should be considered in a child w/stranguria and gross hematuria with a normal US?

A

Urethral abnormality – congenital urethral polyp, stricture, etc.
Should evaluate with VCUG

123
Q

When should cystectomy, ileal conduit patients receive tx for asx bacteriuria?

A

If the culture grows mainly proteus or pseudomonas – these increase risk of deterioration to the upper tracts and increase risk of stone formation.

124
Q

Mean time to diagnosis of bowel leak post-diversion:

A

12d post-op
Some may occur as late as 30+ days
Risk factors: ischemia, local infection, drain placement onto the anastomosis, anastomosis of radiated bowel

125
Q

Primary mgmt. of urine leak post-diversion:

A

Maximal urinary drainage – place b/l stents if not placed intra-op + stomal catheter
If these fail, b/l PCN tubes can be placed
Surgical intervention only if all the above fail

126
Q

Lumbar plexus terminal branches and their roots:

A

Iliohypogastric (T12, L1) – iliac br, and hypogastric br
Ilioinguinal (L1) – sensory to upper scortum and base of penis/mons pubis and labia majora; motor to internal oblique and transversus mm.
Genitofemoral n. (L1, L2) – genital br: motor to cremaster m., sensation to ant. scrotum; femoral br sensation to ant. thigh
Lateral femoral cutaneous n. (L2, L3)
Femoral n. (L2,3,4) – flexion at hip, leg extension at knee; sensation to majority of medial LE
Obturator n. (L2,3,4) – adducts thigh; sensory to tiny portion of posteromedial thigh

127
Q

What roots give off to sciatic n.?

A

L4-S3

Provides sensory and motor innervation to back of thigh, leg and foot

128
Q

What houndsfield units are characteristic of an adrenal adenoma?

A

<10U

129
Q

What abx are required to tx pyelonephritis in patients w/PCKD and why?

A

Lipid soluble abx are required in order to penetrate the cysts.
Lipid-soluble abx include: Cipro, Levaquin, TMP, tetracycline, doxy, chloramphenicol

Aminoglycosides, cephalosporins, macrobid and ampicillin are all not lipid soluble and therefore not appropriate to tx these pts

130
Q

What should be the initial step in treating recurrent UTIs in a patient post-diversion?

A

Start with a program of mechanical pouch irrigation – can help decrease infections (though asx colonization may not decrease) and will help clear xs mucus that is produced in the early post-op period.
Ppx abx and urine acidification can be used in pts who fail initial steps

131
Q

What should be done when an incidental subcapsular renal hematoma is found on imaging?

A

Assess for the presence of a tumor – subcapsular hematomas can occur in the absence of malignancy but there should always be high suspicion when these are found
Repeat CT should be performed 3mo after initial to eval for tm once hematoma has been absorbed

132
Q

What is the common pathway to tx hemorrhagic cystitis?

A

Start with fulguration/clot evac/CBI
If these fail begin irrigations – Silver nitrate and 1% alum is often first, then move to Formalin, start with 1-2%, then 5%, then 10% if absolutely necessary (must assess for reflux first as formalin is toxic to the upper tracts)
If irrigations fail – internal iliac a. embolization
Last choice is diversion
Formaldehyde should not be used solely as the irrigant

133
Q

First step to restore BP after it drops once the adrenal v. is ligated during adrenalectomy for Pheo:

A

Saline bolus – restore intravascular volume

a-agonists may also be required

134
Q

Intra-op mgmt. of HTN spikes during adrenalectomy for Pheo:

A

Nitroprusside, nicardipine, nitrogylceride, or phentolamine

tachyarrhythmias can be controlled with lidocaine or esmolol

135
Q

Safest CXT agent to use in pts w/extensive prior bone marrow radiation:

A

Bleomycin – primary toxicity is pulmonary fibrosis, only has mild BMS effects at high doses
Cisplatin main toxicity is renal but can also have significant BMS effects
MTX, vinblastine and Adriamycin are all poor choices and have high BMS effects

136
Q

What is the superior hemorrhoidal a. a branch of?

A

Inferior mesenteric a.

middle and inferior hemorrhoidals are brs of internal iliac

137
Q

How do calcium stones appear on MRI?

A

As poorly visualized images – MRI does not visualize calcium and therefore doesn’t reliably identify urinary calculi.
Stones are noted as filling defects overlying the high signal intensity of urine on a T2 weighted image.
Stones are not visualized on T1 weighted images

138
Q

Tx of Stage 4S neuroblastoma:

A

Stage 4-S can include mets to the skin, liver and BM, but without bone mets on skeletal survey
Tx in children <1yr – observation, the mets will likely regress spontaneously
Children >1yr or those who mets don’t regress chemo is used

139
Q

What is the only indication to use ADT + docetaxel together for prostate ca?

A

Metastatic, hormone-sensitive prostate ca.

Currently no role in non-met disease

140
Q

Best tx option for locally advanced non-metastatic prostate ca?

A

XRT + ADT (2-3yrs)

141
Q

What is brushite?

A

Calcium phosphate stones with pH <6.6

Apatite stones are calcium phosphate with pH >6.6

142
Q

What should be suspected in a patient with recurrent Brushite stones?

A

Primary hyperparathyroidism – resorptive hypercalciuria

143
Q

What is xs meat consumption associated with?

A

Hyperuricosuria

144
Q

What is phosphate renal leak hypercalciuria associated with?

A

Elevated vitamin D levels – causes ca-ox or mixed ca-ox and ca-phos calculi

145
Q

Tx for ureteral obstruction post-reconstructive vascular surgery:

A

Most are caused by localized retroperitoneal fibrosis and can be treated w/4wk course of steroids

146
Q

What is the predicted bladder capacity of a child?

A

Average bladder capacity = [(age in yrs + 2) x 30]
So for a 3 year old, = (3+2) x 30 = 150
To determine fill rate for UDS divide avg. bladder capacity by 10 (150/10 = 15ml/min or less)

147
Q

Urethral lymph drain in women:

A

Distal urethra and labia drain to superficial and then deep inguinals
Proximal urethra drains primarily to external iliac and then secondarily to hypogastric and obturator LNs

148
Q

Most common metabolic disturbance in a patient w/ileal conduit:

A

Hypokalemic, hyperchloremic metabolic acidosis

149
Q

What metabolic disturbances occur with jejunal diversions?

A

Hyponatremic, hypochloremic, hyperkalemic metabolic acidosis

150
Q

What metabolic disturbances occur with stomach diversions?

A

Hypochloremic, hypokalemic, metabolic alkalosis

151
Q

Characteristics of renovascular HTN likely to respond to angiographic or surgical intervention:

A

Elevation of ipsilateral renal v. renin by at least 50% over peripheral and contralateral renal v. renin

152
Q

What is the tx of acute, uncomplicated cystitis in women?

A

3d of antibiotics – TMP-SMX is the recommended choice
Macrobid may be used but requires 5d to be equivalent to other abx
Fosfomycin may be used as a single dose therapy

153
Q

First step in diagnosing a vesicovaginal fistula:

A

VCUG

154
Q

How should enterococci UTIs be treated?

A

Most are sensitive to: Amoxicillin, Extended-spectrum pen derivatives (piperacillin), macrobid, and fosfomycin

Fluoroquinolones, clinda, aminoglycosides and cephalosporins don’t have adequate coverage

155
Q

Where are neurological lesions located when detrusor-external sphincter dyssynergia is seen on UDS?

A

Between the pons and sacral spinal cord

156
Q

How would the location of a lesion effect detrusor activity?

A

Lesions at or distal to the sacral spinal cord would likely result in detrusor areflexia

Lesions above the pons result in detrusor overactivity w/synergistic activity of the proximal and distal sphincter mechanisms

Lesions between the pons and sacral cord result in detrusor external sphincter dyssynergia

157
Q

Characteristics of RCC in VHL:

A

Has both solid renal masses and renal cysts that contain either frank cancer or a lining of abnormal clear cells that represent incipient carcinoma
Therefore surgical tx of RCC in VHL requires excision of all solid and cystic lesions
Partial nephrectomy should be delayed until renal masses are >3cm

158
Q

What are typical UDS findings in a patient with a functional neobladder?

A

Increased Pabd and Pves with decreased Purethra

159
Q

What is the treatment of a phimotic ring?

A

Phimotic rings are pathologic causes of phimosis – occur d/t chronic inflammation causing a dense fibrotic ring to form.
Tx w/topical steroid ointment

160
Q

When should revascularization be recommended in renal a. stenosis?

A

When there’s >75% occlusion either b/l or in a solitary kidney
Revascularization is unlikely to help when there is severe renal loss (Cr >4)

161
Q

What drugs should be avoided in combo w/PDE5 inhibitors as they increase serum levels?

A

P450 (CYP3A4) inhibitors like the Protease inhibitors (idinavir, and ritonavir), ketoconazole and macrolide abx
If taken together doses of PDE5 inhibitors should be lowered

162
Q

What does the presence of nitrites on UA suggest?

A

G- nitrate splitting bacteria (E. coli, proteus, serratia, klebsiella)
G+ and pseudomonas do not cause +nitrite and should be considered for coverage in a +UA w/-nitrite

163
Q

What are the most common bacteria a/w Struvite stone formation?

A

Proteus and S. aureus – both are urease producing

164
Q

When should Sipuleucel-T be used in castration-resistant prostate ca?

A

In men with asymptomatic or minimally symptomatic mets

165
Q

What is the most common source of bleeding after division of the renal hilum on the left?

A

Lumbar vein

166
Q

How do checkpoint inhibitors work?

A

Through the PD-1 and PD-L1 receptor/ligand complex which normally function to inhibit T-cell response.

167
Q

What do mutations in SLC7A9 or SLC3A1 cause?

A

Cystinuria

168
Q

Tx pathway of cystinuria:

A

Start with hydration and alkalinization of urine – increased potassium citrate
Next is chelation therapy with a-mercaptoproprionylglycine (tiopronin) or d-penicillamine

169
Q

If fluids need to be given for pathologic diuresis in a post-obstructive patient what should be given?

A

0.45% NS
LR and NS should not be given
Most patients don’t need fluids and can just take PO liquids

170
Q

How are scrotal dog bites best managed?

A

They’re managed as penetrating trauma
Explore, irrigate, debride and primary repair/closure of any injured structures
US is not indicated unless there is evidence of testicular injury on exam
human bites are managed similarly but w/o primary closure

171
Q

What is renal blood flow primarily autoregulated by?

A

Afferent arteriolar tone

Autoregulation is present in both innervated and denervated kidneys

172
Q

How will pheochromocytomas appear on T2 MRIs?

A

As a bright “light bulb” – this is not pathognomonic as adrenocortical ca. may also appear like this as well as mets
Pheos will not have high T1 signal on MRI

173
Q

How will adrenocortical carcinomas appear on imaging?

A

Typically >4cm w/heterogenous appearance often w/calcifications and necrosis.
HU on non-con CT typically >25HU
<50% washout demonstrated at 10min post-contrast imaging
Adrenal mets also have similar features on CT and must be distinguished by hx

174
Q

What are common features of a JG cell tumor?

A

Often in teens and young adults (<20yo)
Cause increased renin and secondary hyperaldosteronism – cuases HA, polydipsia, polyuria and hypokalemia (from increased aldosterone)
Tx w/surgical excision
differentiate from aldosteronomas that cause hypokalemia, but suppress renin secretion

175
Q

What is the first renal function impaired by ureteral obstruction?

A

Water reabsorption – causes concentrating defect

Thought to be 2/2 defects of aquaporin water channels in the CD

176
Q

How would ureteral necrosis present post-kidney transplant?

A

Presents 1-2 weeks post-op (unlike faulty ureteroneocystostomy which presents immediately)
Ureteral necrosis will cause leakage of urine, increased serum creatinine, increased drain output and increased wound drainage.
May also cause mild hydro of transplant
Initial mgmt. is endourological, but open repair may be necessary to decrease risks of infection

177
Q

What is the first choice drug to give someone whose cortisol levels don’t drop post-adrenalectomy?

A

As long as there is no evidence of ACTH dependent disease and it is thought to be adrenal in nature Metyrapone is the DoC – will block conversion of 11-deoxycortisol to cortisone

178
Q

What is the most common pattern of voiding dysfxn in a patient with expected pelvic plexus injury?

A

Failure of bladder contraction/decreased compliance (areflexia)
Fixed striated sphincter tone – continually increases outlet resistance
Bladder neck incompetence

179
Q

Why won’t patients with h/o PUV respond to DDAVP for nocturnal enuresis?

A

Bc they often develop Nephrogenic DI 2/2 early obstruction and develop concentrating defects
They will be resistant/unresponsive to increased levels of ADH and DDAVP

180
Q

What ischemia time periods are typically acceptable for phallus re-implantation?

A

6hours warm ischemia time

16hours cold ischemia time

181
Q

Deletions/mutations on Chromosome 3 are most common in which subtype of RCC?

A

Clear cell – most common type of RCC a/w VHL

182
Q

What intravesical therapy should be used in pts on steroids?

A

Mitomycin C
BCG and interferon are less efficacious in an immunosuppressed pt. as they require mounting of an immune response to work

183
Q

Normal washout time on a MAG-3 scan:

A

<20min

184
Q

What is globozoospermia and how should it be treated?

A

Condition where the sperm heads are missing their acrosome and therefore unable to penetrate the oocyte
Sperm will have round/spherically shaped heads on evaluation
The only method that will result in pregnancy is ICSI – placing the sperm directly into the oocyte
If a varicocele is present in these men, varicocelectomy will not result in resolution of the problem

185
Q

What is the dominant pattern of bladder dysfxn in prepubertal boys w/persistent incontinence post-PUV resection?

A

Detrusor overactivity

186
Q

What are the 3 patterns of bladder dysfunction in boys post-resection of PUV?

A

Myogenic failure – typically presents post-puberty
Detrusor overactivity – typically presents pre-pubertal w/persistent incontinence
Decreased compliance w/a small bladder

187
Q

What is normal micturition initiated by?

A

Originates in the pons and is under voluntary control – complete relaxation of striated external sphincter comes first
Then detrusor pressure rises followed by the opening of the vesical neck and urethra

188
Q

How should direct injury to the penile urethra be managed?

A

Primary surgical repair.

189
Q

What are non-malignant causes of persistently elevated B-hCG post-orchiectomy?

A

Hypogonadism (can be 2/2 alcoholism or chronic opioids)

Marijuana use

190
Q

What are non-malignant causes of persistently elevated AFP post-orchiectomy?

A

Liver damage – often 2/2 drugs, hepatitis and alcohol abuse

191
Q

What is the mgmt. of renal a. aneurysms in women of childbearing age?

A

Surgical resection – if they rupture during pregnancy results are catastrophic
All renal a. aneurysms >1.5cm should be surgically resected, <1.5 can be treated conservatively

192
Q

What is the most common solid renal tumor in infants?

A

Congenital mesoblastic nephroma – mean age of 3.5mos

Require radical nephrectomy, excellent outcomes once removed

193
Q

Following CXT what size must all LNs be under to avoid needing a RPLND?

A

All LNs must be <1cm – otherwise RPLND is indicated

194
Q

What tumor marker indicates NSGCT parts in a tumor that is histologically pure seminoma?

A

AFP – limited to cells of cytotrophoblast and indicates that there is presence of yolk sac elements (NSGCT)

195
Q

When is RPLND indicated in patients w/NSGCT?

A

If there is residual mass/LNs >1cm following CXT

196
Q

What imaging should be done in a patient suspected to have an ectopic ureter?

A

MRI urogram

197
Q

What is the embryology that explains the pathology of an ectopic ureter?

A

Cephalad origin of the ureteral bud on the mesonephric duct

198
Q

What is the most frequent UDS finding in patients with tethered cord?

A

Detrusor overactivity

199
Q

What will be seen on bx of eosinophilic cystitis and how is it treated?

A

Diffuse inflammatory cells and eosinophils throughout the entire bladder wall
Tx: Oral abx, steroids and antihistamines
In asx children, observation is appropriate

200
Q

What effect does male obesity have on sex hormone binding globulin (SHBG)?

A

It decreases SHBG – also increases estradiol and decreases testosterone

201
Q

What other organ should be evaluated when a man is found to have bilateral absence of vas deferens?

A

Kidneys – renal agenesis is found in 11% of men with congenital bilateral absence of vasa.

202
Q

What effect does age have on sex hormone-binding globulin?

A

SHBG concentration increases with age and results in a decreased level of bioavailable testosterone

203
Q

What is the threshold of sperm concentration considered to be fertile in a man?

A

> 48 million sperm is considered to be fertile
13.5M – 48M is considered to be appropriate for IUI
<13 needs IVF/ICSI

204
Q

What is brown colored sperm often associated with?

A

Spinal cord injury

205
Q

What are the common differentials of seminal hypovolemia?

A

Retrograde ejaculation
Ejaculatory ductal obstruction
Accessory sex gland hypoplasia

206
Q

What is the first step in workup of seminal hypovolemia?

A

Postejaculatory urinalysis – can exclude or diagnose retrograde ejaculation and is the least invasive first step of workup

207
Q

What assays can be used to directly assess sperm DNA fragmentation?

A

The TUNEL assay – terminal deoxynucleotidyl transferase dUTP nick end labeling assay
and the comet assay at neutral pH (not acidic or alkaline)

208
Q

What is the expected endocrine evaluation of a patient with Kallman Syndrome?

A

Low testosterone
Low LH
Low FSH
Patients have soft, small testicles bilaterally and azoospermia.

209
Q

What is the expected endocrine profile in a patient with androgen receptor insensitivity?

A

Significantly elevated testosterone
Mildly elevated LH
Elevated Estradiol
Normal FSH

210
Q

What is the innervation of the adrenal medulla?

A

Preganglionic sympathetic nerve fibers (thoracic splanchnic nerves) from lower T spine and L spinal cord travel through the sympathetic chain to reach a nerve plexus at the adrenal capsule. The nerves then traverse through the cortex to reach the medulla

211
Q

What are adrenal rests?

A

Ectopic adrenal tissue – can be derived from either cortex or medulla.
Typically found in the vicinity of the adrenals in proximity of the celiac axis, but can be found along the path of gonadal descent.
In patients with CAH adrenal rests can present as testes masses

212
Q

What part of the adrenal is aldosterone synthesized in?

A

In the zona glomerulosa of the adrenal cortex

It is synthesized in the smooth ER and mitochondria in the cells of the ZG

213
Q

What type of cells are chromaffin cells?

A

They are postganglionic sympathetic neurons that have lost their axons and dendrites

214
Q

What is the HU of a normal adrenal gland?

A

Normal adrenal tissue has a density of 10HU or less on non-con CT

215
Q

What is the only region of the adrenal cortex that does not atrophy with pituitary failure?

A

Zona glomerulosa – ACTH does not have much regulation on this region as compared to the ZF and ZR

216
Q

What amino acid are catecholamines produced from?

A

Tyrosine – produces Epi, Norepi and Dopamine

217
Q

What are the biggest promoters of ACTH release?

A

CRH is number one, but oxytocin and vasopressin (ADH) also play a role

218
Q

What is the most important variable in modulating the HPA axis?

A

Stress – psychologic or physiologic

219
Q

When is the highest level of cortisol detected in healthy patients?

A

In the morning – around 8AM/after waking

Nadir is reached around 11pm

220
Q

Syndromes associated with an increased incidence of ACC:

A 
Li-Fraumeni
Beckwith-Wiedemann
Lynch Syndrome
Carney complex
MEN-1
Neurofibromatosis type I
FAP
McCune-Albright syndrome
221
Q

What are two suggested factors to be associated with tumorigenesis of sporadic ACC?

A

Loss of TP53 function and increased expression of IGF

222
Q

What is the most common hormone secreted by ACC?

A

Cortisol – typically results in Cushing Syndrome

Androgens are the second most common

223
Q

What is the mean attenuation of ACC on non-con CT?

A

About 39HU

224
Q

What are the criteria to classify prostate cancer as “very low risk”?

A 
Clinical T1c
PSA 10 or less
PSA density <0.15
Gleason score 6(3+3)/GG1
Up to 3 +biopsy cores with no core >50% involvement
225
Q

What are the criteria to classify prostate cancer as Low Risk?

A

PSA <20

GG1/Clinical stage T1-T2a

226
Q

What are the criteria to classify prostate cancer as Intermediate Risk?

A

PSA 10-20 OR GG2-3 OR clinical stage T2b-c
Favorable: GG1 w/PSA 10-19 OR GG2 w/PSA <10
Unfavorable: GG2 w/PSA 10-19 or stage T2b-c OR GG3 w/PSA <20

227
Q

What are the criteria to classify prostate cancer as High Risk?

A

PSA >20 OR GG4-5 OR Clinical stage T3+

228
Q

What are neurons in Onuf’s nucleus responsible for?

A

Onuf’s nucleus resides in anterior horn of S2-S4 regions of the sacral spinal cord.
It contains the pudendal motor neurons that innervate the external striated urethral sphincter

229
Q

What is responsible for bladder sensation and contraction?

A

Bladder sensation – involves parasympathetics in the dorsal sacral spinal cord
Bladder contraction – involves parasympathetics in the ventral sacral spinal cord
Bladder relaxation does not involve parasympathetics – it is sympathetics

230
Q

What are the current guidelines for surveillance of patients at moderate to high risk for RCC recurrence?

A

Moderate to high risk patients are those with pT2-4 disease and any N+ patients
Surveillance guidelines: abdominal CT and CXR every 6mo for 3 years and then annually until year 5.

231
Q

What is first line therapy in patients with dRTA?

A

Potassium citrate

232
Q

How to calculate FeNa?

A

FeNa = (Plasma Cr x Urine Na) / (Plasma Na x Urine Cr)

233
Q

What is “spinning-top urethra” often associated with?

A

External sphincter overactivity – can be seen on VCUG

234
Q

What should be the next step in a patient with verrucous carcinoma of the penis and palpable inguinal LN?

A

Observation – verrucous ca has v. low likelihood of mets and therefore LNs should be observed for a period as many are reactive

Uro (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions