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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
normal PSA
<4
26
renal cell carcinoma dx
CT scan CAP (1/3 have mets at dx)
27
met from renal
LUNG (isolated lung or coon mets = wedge it out)
28
mgmt renal ca
radical nephrectomy (kidney, adrenal, fat, Gerota's, regional nodes), pull any tumor out of IVC; ten chemoXRT
29
when to consider partial nephrectomy in renal cell ca
if needs HD after nephrectomy (tumor < 4 cm, Cr > 2.5)
30
renal cell carcinoma paraneoplastic synd
epo, renin, PTHrP, ACTH, insulin
31
transitional cell ca of renal pelvis mgmt
radical nephroureterectomy
32
von hippel lindau
mutlifocal/recurrent RCC renal cysts pheos CNS tumors
33
MC tumor in kidney
met from BREAST
34
renal cell pain vs painless
painful (flank)
35
transitional cell pain vs painless
painless hematuria
36
risk factor bladder ca
smoking aniline dyes arsenic radiation cyclophosphamide
37
mgmt bladder ca
intravesical BCG or transurethral resection if T1 if muscle wall invaed (T2+), cystectomy with ileal conduit, chemo, and XRT metastatic: chemo alone
38
chemo for bladder ca
methotrexate, vinblastine, adriamycin (doxo), and cisplatin = MVAC
39
squamous cell ca of bladder caused by
schistosomiasis infection
40
torsion direction typically
TOWARD midline
41
mgmt torsion
detorsion and b/l orchiopexy orchiectomy if not viable
42
mgmt BPH
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
post TURP syndrome
hyponatremia 2/2 irrigation with water; can precipitate sz (cerebral edema) mgmt: carefully correct with diuresis
44
retrograde ejaculations
after TURP; common
45
neurogenic bladder effect
neurogenic bladder above T12 = always pee neurogenic obstructive uropathy below T12 = always retain
46
ureteral duplication
usually with ectopic implantation into urethra vs vagina mgmt: reimplant if sx
47
ureterocele mgmt
resect and reimplant ureter if sx
48
posterior urethral valaves
MC lack of urination in boy mgmt: foley, DX with VCUG, then resect the valves
49
vesicoureteral reflux w/u
many UTI's; give ppx abx and then get VCUG mgmt: reimplant with long bladder portion
50
epispadia
dorsal urethral opening mgmt: reconstruct
51
hypospadia
ventral urethral opening gmt: repair 6 mons with foreskin (KEEP IT)
52
failed urachal closure
peeing thru umbilicus mgmt: resect sinus and close bladder; relieve bladder outlet obstruction
53
interstitialnephritis sx
eosinophilia, arthralgia, fever, rash
54
priapism
>4 hours
55
jaboulay repair for hydrocele
most standard repair complication: scrotal hematoma or recurrence
56
functional kidney remnant necessary (otherwise just do a nephrectomy)
15-20%
57
concern for clots in bladder (what kind of irrigation)
MANUAL irrigation
58
bladder spasm tx
anticholinergics
59
what fluid to treat severe post-obstructive diuresis?
D5 1/2NS at 50% UOP
60
CI to ESWEL extra corporeal shock wave lithotripsy
pregnancy disposition to easily bleed or stones that are several cm in size
61
varicocele typically what side
mostly L because R drains directly into IVC
62
isolated right varicocele concern
for a retroperitoneal process
63
hydrocele location
between parietal and visceral layers of tunica vaginalis (mostly from patent processus vaginalis)
64
spermatocele vs hydrocele difference on physical exam
palpable SPERMATOCELE.. not hydrocele
65
scrotal vs inguinal approach to hydrocele operation
scrotal: for ADULT repair inguinal: for PEDIATRIC
66
mc MET FROM KIDNEY RCC
LUNG
67
RCC paraneoplastic
renin epo PTHrP ACTH insulin
68
transitional ca in RENAL PELVIS
radical nephroureterectomy
69
oncocytoma in kidney
benign
70
angiomyolipomas in kidney
benign hamartoma.... look for tuberous sclerosis though

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