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Surgery > Urologic > Flashcards

Urologic Flashcards

1
Q

Neurological causes for urinary incontinence:
____
Spinal injury
Normal-pressure hydrocephalus

A

Multiple sclerosis

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2
Q

Potentially reversible causes for urinary incontinence:

diuretics
UTIs
____

A

Stool impaction

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3
Q

__ incontinence 2/2
urethral hyper-mobility
increased intra abd pressure

A

Stress

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4
Q

__ incontinence 2/2

autonomous contractions of the detrusor muscle

A

Urge

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5
Q

Treatment for urge incontinence

A

Anticholinergic (M3) medication (oxybutynin*)
Sympathomimetics (mirabegron**)
—————————————————-

*M3 antagonist causes antispasmodic effect on bladder smooth muscle

**Beta 3 agonist relaxes detrusor smooth muscle which increases the bladder’s storage capacity

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6
Q 
\_\_ incontinence 2/2
Loss of or weak detrusor contractility due to: 
Neurogenic bladder (multiple sclerosis)
Neuropathy (diabetes mellitus)
Spinal cord injuries
BPH
A

Overflow

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7
Q

Overflow incontinence 2/2
Absence of an urge to urinate/Incomplete bladder emptying → bladder overfilling → chronically distended bladder with ↑ bladder pressure → dribbling of urine (leak) when ___ pressure > sphincter outlet pressure

A

intravesical

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8
Q

Post void residual volume >50 ml in
Overflow incontinence treatment

Acute settings: ____
Long term: ___

A

intermittent catheterization

Scheduled voiding daily

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9
Q

Type of incontinence seen in multiple sclerosis or spinal cord injury
____ → simultaneous contractions of the detrusor muscle + urethral sphincter contraction → urine leaks

A

Detrusor sphincter dyssynergia

urinary retention and leaking without an associated urge to void

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10
Q

Work up for incontinence:

1st test → ____

If negative get:
→ ____
→ ____

A
  1. UA & urine culture (r/o UTI)
  2. Post void residual volume
  3. Renal ultrasound
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11
Q

1st line treatment for stress incontinence

A

Weight loss
decrease consumption of alcohol, caffeine
Kegel’s

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12
Q

1st line treatment for urge incontinence

A

Bladder training:

  • scheduled voiding
  • holding for as long as possible
  • relaxation/distraction techniques

*If that fails or sxs affect ADLs give oxybutynin or mirabegron

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13
Q

Stress incontinence treatment if refractory to 1st line or affecting quality of life

A

mid urethral urinary sling

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14
Q

The most common (∼ 95%) type of cancer of the bladder, ureter, renal pelvis, and proximal urethra in males

A

Transitional cell (urothelial) carcinoma

*Present from proximal urethra to renal pelvis

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15
Q

Urinary tract cancer risk factors:

___ use

Prolonged (occupational) exposure to ____

_____ ( Africa and the Middle East)

cyclophosphamide

A

Tobacco

Carcinogens (dyes, heavy metals, plastics, aromatic amines like benzidine)

Schistosomiasis

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16
Q

Painless gross hematuria throughout micturition (most commonly)
&
Irritative voiding symptoms (dysuria, urinary frequency, urgency)

associated with ___ carcinoma

A

Bladder

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17
Q

Diagnostics for suspected Urinary tract cancer:

  1. ___ indicated in all patients with hematuria
  2. _____ Imaging modality of choice to examine the entire urinary tract.
  3. ___ & biopsy direct visualization of urethral and bladder mucosa
A

Urinalysis

CT urography

Cystoscopy

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18
Q

Treatment for bladder cancer:
____
+/-
chemotherapy or chemoradiation

A

Radical cystectomy

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19
Q

Painless gross hematuria at the beginning of micturition

Bladder outlet obstruction
Irritative voiding symptoms

associated with ___ carcinoma

A

Urethral

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20
Q

Painless gross hematuria throughout micturition
Flank pain
associated with Carcinoma of ____ & ____

A

Renal pelvis (Kidney)
&
Ureters

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21
Q 
Upper urinary tract obstruction causes:
\_\_\_
Renal pelvis carcinoma
Ureteropelvic junction obstruction
\_\_\_\_
Ureteral carcinoma
A

Nephrolithiasis
Ureteral stricture

(Stones, Strictures, Tumors
cause Upper urinary tract obstructions)

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22
Q

Lower urinary tract obstruction (bladder outlet obstruction) causes:

Bladder carcinoma
Neurogenic bladder
BPH/ prostate cancer 
\_\_\_\_\_ (Congenital) 
urethral stricture
\_\_\_\_ (Mechanical)
A

posterior urethral valves

kinked/plugged catheter

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23
Q

Urinary retention
Suprapubic pain and mild distention
Palpable bladder
symptoms of what?

A

Lower urinary tract obstruction

bladder outlet obstruction

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24
Q

Labs in urinary tract obstruction

(↑/↓) BUN & Cr
(hyper/hypo)-kalemia

A

↑ BUN & Cr

hyperkalemia

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25
Q

Imaging modalities for diagnosing urinary tract obstruction:

Best initial test: ___

Best initial imaging study in cases of suspected nephrolithiasis: ____

A

Renal/Abd Ultrasound

CT abdomen/pelvis

26
Q

First-line imaging study to diagnose patients with suspected vesicoureteral reflux (VUR).

A

Contrast Voiding Cystourethrography

27
Q

Best workup for patients with suspected neurogenic bladder

A

Urodynamic studies

–Cystometry
–Electromyelogram (EMG)
–Pressure-flow study
–Leak point pressure
–Postvoid residual volume
28
Q

Nephrolithiasis: conservative treatment:
–Nsaids
– Explusion Therapy drug (1)

Urological interventions (2) for:
–Stones > \_\_ mm
–ANURIA, intolerable pain, PO intolerance
–Renal failure or Sepsis
–Retained stone after  \_\_\_ weeks
A

Tamsulosin (Alpha Antagonist); Nifedipine (CCB)

Lithotripsy Extracorporal shock wave (ESWL)
Uretero-renoscopy

10mm

4-6 weeks

29
Q

2 kidney stones causing

↑ Urine pH (alkalic)

A

Calcium phosphate stone
Struvite stone

(STUpid PHads are basic)

30
Q

3 kidney stones causing

↓ Urine pH (acidic)

A

Uric acid stones
Calcium oxalate stones
Cystine stones

31
Q

Hyperparathyroidism is associated with what type of kidney stones?

A

Calcium phosphate stone

makes sense since calcium & phosphate levels are affected by parathyroid hormone PTH

32
Q

Gout, leukemia, & chemotherapy are associated with what type of kidney stones?

A

Uric acid stones

33
Q

Hypocitraturia, Ethylene glycol (antifreeze), and IBD are associated with what type of kidney stones?

A

Calcium oxalate stones

*also with Vitamin C/ Hyperoxaluria

34
Q

2 Diagnostics for kidney stones

A

Urine microscopy

X-ray (or CT): radiopaque (except uric- radiolucent)

35
Q

Nephrolithiasis

Biconcave dumbbells or bipyramidal envelopes

A

Calcium oxalate stones

dumb Ox carrying envelopes to pyramids & caves

36
Q

Nephrolithiasis

Rounded rhomboids, rosettes, or needle-shaped

A

Uric acid stones

37
Q 
Nephrolithiasis
Rectangular prisms (coffin lid-appearance)
A

Struvite stones

In a rectangular coffin when you Stru-bite the dust

38
Q

Nephrolithiasis

Wedge-shaped prisms

A

Calcium phosphate stones

39
Q 
Nephrolithiasis presents with 
Severe unilateral and \_\_\_\_ pain 
Radiates to lower abdomen or groin
Nausea, vomiting
Dysuria
[\_\_-uria]
A

colicky flank (renal colic)

Hematuria

40
Q

__ & __ are the preferred diagnostic imaging for nephrolithiasis.

A

NC-CT of abdomen & pelvis (1st line)

U/S of abdomen & pelvis

41
Q 
Consult urology urgently for interventional treatment in 
Large stones (> \_\_ mm)
A

> 10 mm

42
Q

Conservative tx indicated for kidney stones < 10 mm

  • Hydration
  • Analgesia
  • 1st line medical expulsive therapy (MET): ___

*Treat concomitant UTI, if present.

A

tamsulosin (alpha 1 Antagonist)

  • Nifedipine (CCB) not 1st line
43
Q

Consult urology for Nephrolithiasis interventional tx if:

Uncontrolled \_\_\_\_
Large stones (> 10 mm)
Urosepsis
Acute renal failure
Solitary kidney 
complete obstruction
If conservative mngmt is unsuccessful after \_\_ weeks.
A

pain

4–6 weeks

44
Q

Consult urology for Nephrolithiasis interventional tx if:

Uncontrolled pain
Large stones (> 10 mm)
Urosepsis
Acute renal failure
\_\_ kidney 
\_\_\_ obstruction
If conservative mngmt is unsuccessful after 4-6 weeks.
A

Solitary

Complete

45
Q

2 non-surgical interventional procedures for ureteral stones

A

Uretero-renoscopy (URS)

extracorporeal shockwave lithotripsy (ESWL)
- acoustic pulse

46
Q

non-surgical interventional procedures for:

Renal stones >20 mm →
lower renal pole stones >10 mm →

A

percutaneous nephrolithotomy (PCNL)

47
Q

non-surgical interventional procedures for:

Lower renal pole stones 10mm or LESS→
Renal stones 20mm or LESS→

A

Lithotripsy extracorporeal shockwave (ESWL)

Uretero-renoscopy (URS)

48
Q

Low calcium diets increase the risk of calcium-containing stone formation because they increase __ reabsorption.

A

oxalate

also IBD and CF b/c of poor calcium absorption in tract

49
Q

Nephrolithiasis risk increases with pregnancy

bc urinary stasis s/t increased ___ levels

A

progesterone

Diagnostics → Renal U/S

50
Q

BPH management:

Small prostate (< 40 mL) or PSA < 1.5 →

Large prostate (> 40 mL) or PSA > 1.5 →

A

Tamsulosin (Alpha blocker)

Finasteride (5-alpha reductase inhibitor)

*Inadequate response to monotherapy → Combination of both meds above.

51
Q

___ ejaculation is a common complication of prostate surgery.

A

Retrograde

52
Q

Features of metastatic prostate cancer:

  2. Lymphedema
A

Bone pain

mets to spine

53
Q

The classical triad of renal cell carcinoma consists of

A

hematuria
flank pain
palpable flank mass

54
Q

Paraneoplastic syndromes of RCC (4)

A

EPO (Polycythemia)
Renin (HTN)
PTHrP (Hypercalcemia)
ACTH (hypercortisolism-cushing’s)

*25% present with symptoms related to paraneoplastic syndromes or bone pain/fx & hemoptysis

55
Q

Indicated in children with febrile UTI

A

Renal Ultrasound

(If they have another episode then get a
contrast voiding urethrogram)

56
Q

initial imagine if there is a concern for hydronephrosis and dilated ureter

A

Renal Ultrasound

57
Q

Imaging indicated if:
Child with 2+ episodes of febrile UTI
A renal anomaly detected on ultrasound

A

Contrast voiding cystourethrogram

micturating cystourethrogram

58
Q

Imaging performed if urethral injury suspected in penile fractures

A

Retrograde urethrogram

59
Q

Causes of Low-flow priapism (ischemic priapism)

-

A

Viagra (Sildenafil– PDE inhibitor)

TrazoBone

Sickle cell disease

60
Q

Diagnostic for suspected testicular torsion

A

Duplex ultrasound of the scrotum

61
Q

___ is contraindicated in boys with hypospadias (ventral/bottom of penis) that includes the foreskin.

A

Circumcision

*Foreskin may be needed for a skin flap when performing urethroplasty.

62
Q

Epispadias: urethra on the dorsal (top) penis.

Can present with urinary ____.

A

incontinence

Surgery (36 decks)

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