Urology Flashcards
1
Q
Geniturinary tract pain could be due to
A
- Obstruction: stone/retention
- Inflammation
2
Q
Parenchymatous organ inflammation (pyelonephritis, epididmitis) produces_____ Pain, while inflammation of the mucosa of a hollow viscous, such as bladder produces________
A
Severe, discomfort
3
Q
Site of renal pain is
A
At the costovertebral angle just lateral to sacro-spinalis muscle, beneath 12th rib
4
Q
Where does renal pain radiate to?
A
Flank anteriorly towards upper abdomen and umbilicus, and might be to the testis/labium
5
Q
Describe the character of renal pain?
A
Inflammatory: steady dull aching
Obstruction: fluctuating colicky
6
Q
Justify: obstructive renal pain is associated with GI symptoms
A
Due to reflex stimulation of the celiac ganglion
7
Q
Lower urinary tract symptoms divides into:
A
- Voiding (obstructice) symptoms
- Storage (irritative) symptoms
8
Q
Mention bladder irritative symptoms
A
Frequency
Urgency
Nocturia
9
Q
Mention LUT obstructive symptoms
A
Hesitancy
Intermittency
Abdominal straining
Weak stream(bifid)
Post voiding dribbling
Sense of incomplete evacuation
10
Q
Define hematuria
A
Presence of blood in urine > 3 RBC’s per high power microscopic field
11
Q
Initial hematuria indicates
A
Indicates problem of urethra or prostate
12
Q
Terminal hematuria
A
Bladder or prostate
13
Q
Total hematuria
A
Kidney, ureter or bladder
14
Q
Define infertility
A
Couple failing to conceive after 1 yr of regular unprotected intercourse
15
Q
Normal Urine pH
A
5.5-6.5
16
Q
Highly acidic urine is found in
A
Hyperuricosuria
17
Q
Normal WBCs in urine microscopy
A
Male: up to 2/ HPF
Females: up to 5/HPF
18
Q
Chemical dipsticks screen for:
A
Glucose, pH, protein, hemoglobin, ketones
19
Q
Normal serum creatinine
A
Adults: 0.8-1.2mg/dl
Infants: 0.1-0.4 mg/dl
20
Q
Why is BUN much less accurate than creatinine in indicating GFR
A
As its influenced by many factors such as: dietary protein and hydration
21
Q
Normal BUN/Creatinine ratio
A
10/1 to 20/1
High: dehydration, renal ds, bleeding
Low: pregnancy, low prtn diet and hepatic ds
22
Q
PSA
A
Prostatic specific antigen < 4 ng/ml
4-10 grey zone
>10 malignancy?
23
Q
If PSA > 10, perform:
A
TRUS guided biopsy check for malignancy
24
Q
If PSA is in grey area what do we do next?
A
Grey zone 4-10 ng/ml
Get a PSA Free/ total ratio
25
TRUS
Transrectal ultrasound scan: prostate viewing
26
Most used screening imaging study in urology
Ultrasound
27
Disadvantage of U/S
No functional data
Poor anatomical imaging of ureter
28
To detect mass and torsion in testis use
Scrotal Doppler U/S
29
Advantages of IVU
Anatomical and functional data of urinary tract
30
Disadvantage of IVU
Contract allergy and adverse effects
Radiation exposure
31
Phases of IVU imaging
Immediate film
Nephrogram phase (5-15min)
Ureterogram phase (30min)
Cystogram phase (45 min)
Post voiding film
32
Cobra head appearance on IVU
Ureterocele
33
Key hole sign
Posterior uretheral valve anomaly
34
Uses of CT in urology
1. Radiolucent/radio-opaque stone detection
2. Tumor detection & staging
3. Urinary tract trauma
35
Varicocele commonest side
Left side
36
Uses of MRI in urology
Replacing CT when contraindicated
Renal/ adrenal tumors
Vascular invasion
37
Renal isotope scan uses
1. Need for surgery: onstructive or nonobstructive hydronephrosis
2. Evaluate split renal function
3. Monitor effect of therapy
38
MAG3 isotope
Evaluate Renal function and plasma flow as it is cleared by tubular secretion & no glomerular filtration
39
DPTA
Evaluate obstruction and renal function as it is cleared by glomerular filtration
40
DMSA isotope
Cleared by filtration and secretion
Used to evaluate renal scarring (renal cortical image)
41
Most common type of kidney injury?
Blunt retroperitoneal
42
Meteorism
Abdominal distention, nausea and vomiting within 24-48 hr due to retroperitoneal hematoma involving splanchnic nerves
43
Kidney injury grading
Grade 1: subcapsular hematoma only
Grade 2: perirenal hematoma and <1cm cortical laceration; without urinary extravasation
Grade 3: grade 2+ > 1cm cortical laceration
Grade 4: laceration thru corticomedullary junction with urinary extravasation + segmental vessel injury contained hematoma
Grade 5: shattered kidney, pedicle injury, avulsion
44
Early complications of kidney injury
1- anuria
2- clot retention
3. Paralytic ileus
4- perinephric abscess
5- urinary fistula
6. Pseudohematohydronephrosis
7. Intraperitoneal hem + peritonitis
45
Late complications of kidney injury
1. Hydronephrosis: periureteral fibrosis
2. Nephroptosis: tear of supporting tissue
3. Hypertension: fibrosis of kidney
4. Aneurysm of renal artery
46
Gold standard investigation for kidney injury
CT contrast
47
Initial evaluation test for kidney injury
Ultrasound
48
Lack of parenchymal contrast enhancement using CT contrast suggests
Arterial injury
49
Why is ultrasound not a gold standard test in renal injury?
It only identifies retroperitoneal hematoma, but does not clearly delneate lacerations or vascular or collecting injuries
50
When is intravenous pyelography indicated in renal injury
“Single shot’’ intra-operative IVP in haemodynamically unstable patients is better instead of CT (no time)
51
Indications of nephrectomy
In extensive renal injuries or unstable, patient in a normal contralateral kidney
In an unstable patient with low body temperature and coagulopathy in a normal contralateral kidney
52
The treatment of choice for the majority of renal injuries is
Non-operative management
53
Indications for surgical management of kidney injury
1. Haemodynamically instability
2. Exploration for associated injuries
3. Grade 4 and 5 injury
4. Expanding or pulsatile peirenal haematoma
5. Pre-existing renal pathology requiring surgery
6. Vascular injuries after failed and angiographic treatment.
54
The two most common signs and symptoms of major bladder injuries are
Gross haematuria and abdominal tenderness
55
The standards of care in urethral injury is
Suprapubic cystostomy
56
Eggplant deformity
Trauma of penis: Swelling and ecchymosis of the penis due to rupture of Tunica Albina the cover the corporal cover no
57
Tear in tunica albugenia is investigated by
Penile duplex
58
Flame shaped collection of contrast in the pelvis
Extra-peritoneal injury
59
Most extraperitonial bladder rupture heal within____ days
10 days
60
Blunt extra peritoneal bladder rupture is managed by?
Foley catheter drainage
61
What is the most common cause of urethral stricture?
Endoscopic / catheter trauma
62
What are the management steps upon suspected testicular torsion?
1. scrotal duplex to confirm diagnosis
2. Immediate surgical exploration and don’t wait for laboratory studies.
63
Clot retention is confirmed by?
Cystoscopy
64
During distal radio-cephalic AV fistula care must be taken not to injure
Dorsal branch of radial nerve.
65
Care must be taken not to injure_____ during brachio-cephalic or brachio-basilic fistula
Median nerve at cubital fossa
66
Autogenous access needs _______weeks for proper vein maturation
6-8 weeks
67
Advantages of autogenous AV access over prosthetic AV graft?
1. Resist infection
2. Longer estimated usage time
68
Prothetic arteriovenous graft needs_______weeks to start using it
1-2 weeks
69
Define a cyst
A sac containing fluid lined by epithelium or endothelium
70
In dermoid or branchial cyst the contents are like ____
Tooth paste
71
The wall of a false cyst is lined by
Fibrous or granulation tissue
72
Examples of a pseudo cyst
1. Pseudo cyst of the pancreas(encysted collection of fluid in the lesser sac)
2. Tumor Cystic degeneration
73
Complications of cysts
1. Infection
2. Hemorrhage
3. Torsion
4. Calcification
74
Cock’s peculiar tumor
Infection complicating sebaceous cyst on the scalp by forming an ulcer
75
Type or shape of the incision to treat sebaceous cyst
Elliptical incision to avoid recurrence
76
Complications of sebaceous cyst
Infection
cock’s peculiar tumor: ulceration
sebaceous horn
77
Mention 4 types of dermoid cyst
Sequestration dermoid
Tubulodermoid
Teratomatous dermoid
Implantation dermoid
78
Common side of sebaceous cyst
Face, scalp and scrotum, but never palms and soles
79
XRay or CT must be performed before excision of a head dermoid cyst. Why
Exclude communication with intracranial dermoid
80
Describe a sequestration dermoid cyst
Cystic, smooth, rounded, not attached to skin, but maybe adherent to underling structures, there may be indentation of underlying bone. It is lined by epidermis and contain a paste like desquamated material.
81
Mucus cyst more common in
Female
Middle age
Dorsal DIP Joint
82
Immobile and ill-defined swelling at friction points (bone&skin)
Bursitis
83
Hallmark symptom of bursitis is
Localized swelling at the joint
84
Semimembranous bursitis is located on
Medial side of popliteal fossa
85
Semimembranousus TTT
Primary type: excision
Secondary type: treat cause
86
Midline popliteal fossa’s swelling
Baker’s cyst
87
Baker’s cyst happens mostly secondary to:
Osteoarthritis
88
Hallus valgus
Bunion
89
Example for an adventitious bursae
Bunion
90
Preferred type of biopsy in soft tissue tumours
True cut needle biopsy
91
Common site for diffuse lipoma is
Neck
92
Lipoma can occur anywhere in the body except
The cranium
93
The line of cleavage in lipoma facilitates
Enucleation of the tumour
94
The line of cleavage encapsulated lipoma occurs between
True capsule (fibrous capsule )
false capsule (surrounding tissue)
95
Lipoma is classified according to
Capsule
Structure:
Site
96
What is the commonest type of lipoma? And it’s favourable site.
Subcutaneous lipoma; back, shoulder buttocks, forehead and limbs
97
Pathognomonic signs of subcutaneous lipoma
A well defined slippery edge and Dimpling of skin on displacement of the swelling (lobulation)
98
Dercum’s disease (adiposis dolorosa)
Tender deposit of fat, specially on the trunk and is an associated condition with multiple lipomatosis
99
Subsynovial lipoma can be mistaken for?
Baker’s cyst
100
Retroperitoneal lipoma may grow into ______size
Enormous
101
Most dangerous lipoma is:
Sub-mucous lipoma:
Larynx: respiratory obstruction
Intestine: intussusception
102
Treatment of lipoma
Surgical excision indicated if a lipoma is causing trouble on account of its site, size, appearance, or the presence of pain
103
Neurofibroma origin
Connective tissue of nerve sheet . In relation to cranial 5&8 or a peripheral nerve
104
Describe neurofibroma
Arise from any nerve usually in subcutaneous tissue, firm, tender, well defined slowly growing swelling that can be moved across, but not along the nerve from which it arises.
105
Von Recklinghausen’s disease
Generalized neurofibromatosis (AD)
106
Types of neurofibroma
1. Solitary neurofibroma
2. Generalized neurofibromatosis
3. Acoustic neuroma
4. Plexiform neurofibomatosis
5. Elephentiasis neurofibromatosa
107
Gamma knife radio-surgery
Acoustic neuroma
108
Pachydermatocele
Plexiform neurofibromatosis
109
Types of neuroma
Tumors in sympathetic system
1. Gangiloneuroma
2. Neuroblastoma
3. Myelinic neuroma
110
Neuroblastoma resembles_______ and disseminate by________ and is treated by_______
Round cell sarcoma, blood , surgery +/- chemo
111
Common sites of Gangileoneuroma
Connection with sympathetic plexus so:
In the neck, thorax or retroperitoneal tissue
112
Myelinic neuroma consists of_______only and arises in connection with ________ or ______
Nerve fibers, spinal cord or pia matter
113
A lobulated encapsulated, soft, whitish swelling that displace the nerve from which it rises
Schwanoma (neurilemmoma)
114
Varieties of fibroma
1. Soft subcutaneous nodule (fibroma mole)
2. Pedunculate lesion of oral mucosa ( fibroma durum)
3. Pleomorphic fibroma
115
Aggressive fibromatosis
Desmoid tumor
116
Example of intermediate tumor (locally invasive)
Desmoid tumor
117
Histology of desmoid tumor
Uncapsulated, composed of fibrous tissue containing multinucleated giant cells
118
Soft tissue tumours that can be treated by chemo
Desmoid tumor and neuroblastoma
119
Commonest site of desmoid tumor
Anterior abd wall and shoulder girdle
120
Urine will pass to _______ in an interior bulbar urethra injury (fall astride)
Connective tissue of scrotum
121
Pelvic fracture with highly displaced prostate (non palpable on PR) and a perineal oedema is suggestive of
Membranous urethral rupture
122
What is the normal intra-vesical pressure at the beginning of micturition?
30 cm of water
123
Mention some features seen in bladder compensation to BPH
Detrusor muscle hypertrophy
Trabiculation
Cellules
Diverticula
124
Describe trabiculations of the bladder
muscle bundle with deposit of interstitial collagen fibers, becomes taut, and give an interwoven appearance to the mucosa)
125
Score used to ttt BPH
IPSS International prostate symptom score
0-7 mild
8-19 moderate
20-35 severe
126
If BPH is associated with hematuria then _________ is mandatory to rule out other bladder pathology
Cystoscopy
127
DD and what to exclude when making a diagnosis of BPH
Urethral stricture (cystoscopy)
Bladder neck contracture (cystoscopy)
Trauma (history)
Bladder stone (pain and hematuria)
UTI (urinalysis and culture)
Cancer prostate (DRE and high PSA)
Neurogenic bladder DM
128
Adverse effects of alpha blockers
Asthenia
First dose phenomenon
Dizziness
Postural hypotension
Retrograde ejaculation
129
Finastride is a competitive injibitor of type ___ 5alpha reductase enzyme while dutasteride is a competitive inhibitor for type ______
Maximum volume suppression of BPH achieved after ______
2 (prostate only)
1&2 (1 in prostate, liver and skin)
6 months
130
Relative surgery indication in BPH
1. Hematuria
2. Recurrent lower UTI
3. Bladder stone
4. Moderate symptoms (moderate IPSS)
5. Bad compliance
131
Absolute indication of surgery in BPH
1. Severe symptoms (severe IPSS)
2. Recurrent acute retention
3. Upper urinary tract affection
4. Uraemia
5. Failure of medical treatment
