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ABSITE > urology > Flashcards

urology Flashcards

1
Q

postobstructive diuresis mgmt

A

fluid resuscitation with one-half normal saline is a good starting point, aiming for approximately a 2:1 ratio of volume of urine output to fluid replacement.

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2
Q

testicular ca chemo

A

Bleomycin, etoposide, and cisplatin

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3
Q

dx of testicular ca

A

start with US. CT CAP for mets. LDH follows BULK. AFP and BHCG.
germ cell = seminoma (BHCG) or nonseminoma (AFP+BHCG)

20-35YO

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4
Q

seminoma

A

MC testicular tumor
10% have B-HCG elevation
NO AFP ELEVATION
ORCHIECTOMY +++ very sensitive to XRT
chemo if bulky bets

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5
Q

nonseminomatous ca

A

types: embryonal, teratoma, chorio, yolk sac

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6
Q

mgmt seminoma

A

orchiectomy and RP XRT (chemo if metastatic or bulky RP disease cisplatin, bleomycin, etoposide with surgery afterwards)

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7
Q

mgmt nonseminoma

A

orchietomy and RP DISSECITIO (no XRT)
chemo (cisplatin, bleo, etoposide) for stage II+ = beyond the testis with residual resection after

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8
Q

spread of nonseminoma

A

lymphatics EXCEPT choriocarcinoma which spreads HEME (like to lungs)

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9
Q

testicular ca resection

A

orchiectomy through INGUINAL incision (disrupts lymphatics with transscrotal incision)

use INGUINAL incision to avoid disrupting lymphatics via scrotal

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10
Q

mgmt ruptured testicle

A

debridement of the seminiferous tubules and closure of the tunica albuginea with absorbable suture

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11
Q

renal hilum order

A

vein
artery
pelvis

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12
Q

cord structures

A

testicular artery
pampiniform plexus
vas deferens (medial)
cremasterics
ilioinguinal nerve
genital branch of genitofemoral nerve

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13
Q

calcium oxalate stones on XR

A

radiopaque, MC

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14
Q

struvite stones

A

Mg Ammonium phosphate; radiopaque

Proteus, urease producing
staghorn calculi

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15
Q

uric acid stones

A

radioLUCENT (think lots of cells dying or whatever, and also ileostomy from loss of bicarb)

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16
Q

cysteine stones

A

radioLUCENT; cystinuria

mgmt: tiopronin

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17
Q

size not likely to pass (stone)

A

6mm

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18
Q

MC site of prostate ca

A

POSTERIOR lobe

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19
Q

MC met from prostate

A

bone (osteoblastic)

if PSA+ after 3 wks, need bone scan to see if metastasized alreADY

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20
Q

dx prostate ca

A

transrectal Bx, CT CAP, PSA, Alk phos

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21
Q

mgmt prostate ca if no capsular spread

A

radiation or radical prosatectomy + PLND

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22
Q

mgmt prostate ca if capsular spread or metastatic

A

XRT adn androgen ablation (leuprodie GnRH agonist, flutamide testosterone-R blockade, or b/l orchiectomy)

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23
Q

PSA after prostatectomy

A

0 at 3 weeks (otherwise get bone scan for mets)

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24
Q

prostate ca screening

A

black men or men wth fam hx: PSA q1-2 years starting 40-45 YO

normal risk: 40 YO PSA q1-2 yrs, go to Urology if PSA>7

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25
Q

normal PSA

A

<4

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26
Q

renal cell carcinoma dx

A

CT scan CAP (1/3 have mets at dx)

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27
Q

met from renal

A

LUNG (isolated lung or coon mets = wedge it out)

28
Q

mgmt renal ca

A

radical nephrectomy (kidney, adrenal, fat, Gerota’s, regional nodes), pull any tumor out of IVC; ten chemoXRT

29
Q

when to consider partial nephrectomy in renal cell ca

A

if needs HD after nephrectomy (tumor < 4 cm, Cr > 2.5)

30
Q

renal cell carcinoma paraneoplastic synd

A

epo, renin, PTHrP, ACTH, insulin

31
Q

transitional cell ca of renal pelvis mgmt

A

radical nephroureterectomy

32
Q

von hippel lindau

A

mutlifocal/recurrent RCC
renal cysts
pheos
CNS tumors

33
Q

MC tumor in kidney

A

met from BREAST

34
Q

renal cell pain vs painless

A

painful (flank)

35
Q

transitional cell pain vs painless

A

painless hematuria

36
Q

risk factor bladder ca

A

smoking
aniline dyes
arsenic
radiation
cyclophosphamide

37
Q

mgmt bladder ca

A

intravesical BCG or transurethral resection if T1
if muscle wall invaed (T2+), cystectomy with ileal conduit, chemo, and XRT
metastatic: chemo alone

38
Q

chemo for bladder ca

A

methotrexate, vinblastine, adriamycin (doxo), and cisplatin = MVAC

39
Q

squamous cell ca of bladder caused by

A

schistosomiasis infection

40
Q

torsion direction typically

A

TOWARD midline

41
Q

mgmt torsion

A

detorsion and b/l orchiopexy
orchiectomy if not viable

42
Q

mgmt BPH

A

alpha blocker (terazosin, doxazosin) to relax smooth muscle

5a reductase inhibitor (finasteride) to inhibit T to DHT and inhibit prostate hypertrophy

TURP if medical fails (renal insuff, stones, hematuria, UTIs, sx)st

43
Q

post TURP syndrome

A

hyponatremia 2/2 irrigation with water; can precipitate sz (cerebral edema)

mgmt: carefully correct with diuresis

44
Q

retrograde ejaculations

A

after TURP; common

45
Q

neurogenic bladder effect

A

neurogenic bladder above T12 = always pee
neurogenic obstructive uropathy below T12 = always retain

46
Q

ureteral duplication

A

usually with ectopic implantation into urethra vs vagina

mgmt: reimplant if sx

47
Q

ureterocele mgmt

A

resect and reimplant ureter if sx

48
Q

posterior urethral valaves

A

MC lack of urination in boy

mgmt: foley, DX with VCUG, then resect the valves

49
Q

vesicoureteral reflux w/u

A

many UTI’s; give ppx abx and then get VCUG

mgmt: reimplant with long bladder portion

50
Q

epispadia

A

dorsal urethral opening

mgmt: reconstruct

51
Q

hypospadia

A

ventral urethral opening

gmt: repair 6 mons with foreskin (KEEP IT)

52
Q

failed urachal closure

A

peeing thru umbilicus
mgmt: resect sinus and close bladder; relieve bladder outlet obstruction

53
Q

interstitialnephritis sx

A

eosinophilia, arthralgia, fever, rash

54
Q

priapism

A

> 4 hours

55
Q

jaboulay repair for hydrocele

A

most standard repair
complication: scrotal hematoma or recurrence

56
Q

functional kidney remnant necessary (otherwise just do a nephrectomy)

A

15-20%

57
Q

concern for clots in bladder (what kind of irrigation)

A

MANUAL irrigation

58
Q

bladder spasm tx

A

anticholinergics

59
Q

what fluid to treat severe post-obstructive diuresis?

A

D5 1/2NS at 50% UOP

60
Q

CI to ESWEL extra corporeal shock wave lithotripsy

A

pregnancy
disposition to easily bleed or stones that are several cm in size

61
Q

varicocele typically what side

A

mostly L because R drains directly into IVC

62
Q

isolated right varicocele concern

A

for a retroperitoneal process

63
Q

hydrocele location

A

between parietal and visceral layers of tunica vaginalis (mostly from patent processus vaginalis)

64
Q

spermatocele vs hydrocele difference on physical exam

A

palpable SPERMATOCELE.. not hydrocele

65
Q

scrotal vs inguinal approach to hydrocele operation

A

scrotal: for ADULT repair
inguinal: for PEDIATRIC

66
Q

mc MET FROM KIDNEY RCC

A

LUNG

67
Q
A

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