Urology

Question 0

Treatment for calciphylaxis?

Answer 0

Parathyroidectomy - hyperparathyroidism with calciphylaxis is an indication for this surgery.

Question 1

What is calciphylaxis?

Answer 1

Calciphic uremic arteriopathy

Calciphylaxis is a syndrome of vascular calcification, thrombosis and skin necrosis. It is seen almost exclusively in patients with Stage 5 chronic kidney disease. It results in chronic non-healing wounds and is usually fatal.

Question 2

m/c cause of urinary tract infections and intra-abdominal sepsis.

Answer 2

Gram-negative enteropathogens

Question 3

62 year old reports episode of gross, painless hematuria. Total hematuria rather than an initial or terminal hematuria. What is it? Management.

Answer 3

Blood is coming anywhere from the kidneys to the bladder, rather than the prostate or the urethra. Either infection or tumor can produce hematuria. Older patients without signs of infection, cancer is the main concern, and it could be either renal cell carcinoma or transitional cell cancer of the bladder or ureter.

CT scan and cytoscopy

Question 4

70 year old man is referred for evaluation because of a triad of hematuria, flank pain, flank mass. He also has hypercalcemia, erythrocytosis, and elevated liver enzymes.

Answer 4

Full-blown picture of renal cell carcinoma.

Do CT scan

Question 5

Total hematuria, unrelated to trauma. Where is the source?

Answer 5

The source is in the kidney, ureter, or bladder

Question 6

Hematuria unrelated to trauma that is initial or terminal hematuria? Where is the source?

Answer 6

The source is in the bladder, prostate, or urethra

Question 7

Work up for total hematuria unrelated to trauma?

Answer 7

IVP, sonogram, CT scan will reveal a renal source.

Only a cystoscopy will reveal early bladder tumors.

Question 8

Best test for pneumaturia

Answer 8

CT

Question 9

Best first test to evaluate testicular mass

Answer 9

Transillumination

U/S

Question 10

Peyronie disease. What is it? Relation to cancer?

Answer 10

Fibromatosis affecting the penis, results in induration, nodularity, and deformities.

Not associated with increased risk of cancer.

Question 11

What is fibromatosis?

Answer 11

Benign soft tissue tumors.

Proliferation of well-differentiated fibroblasts.

Aggressive clinical behavior, recurrence is common.

Question 12

Middle aged woman from South East Asia. Chronic low-grade fevers and weight loss for one year. Urinalysis shows sterile pyuria. IVP shows cavitary lesions in the right kidney.

Answer 12

Secondary tuberculosis affecting the kidneys by hematogenous dissemination

Question 13

Hemangioblastomas of the CNS (most frequently in the cerebellum and retina), Cysts of the pancreas and kidneys, renal cell carcinoma.

Answer 13

Von Hippel Lindau, AD VHL gene

Question 14

What is hemorrhagic cystitis? What is one of the most common etiologic agents of this form of cystitis?

Answer 14

Marked hematuria, resulting from extensive erosions of the urinary bladder mucosa.

Cyclophosphamide, radiation

Question 15

55-year-old man presents to urologist for evaluation of hypertension and material. What is it? Management.

Answer 15

Adult onset polycystic kidney disease, Autosomal dominant disease that presents with hypertension, renal cysts, hematuria, and possible renal failure usually after age 30.

There is a 10% – 20% incidence of berry aneurysms.

A magnetic resonance angiogram (MRA) of the brain is the standard option of screening

Question 16

Type of hematuria present in prosthetic carcinoma?

Answer 16

Terminal hematuria – present in the last aliquot of a fractionated urine collection

Question 17

What is an initial hematuria characteristic of?

Answer 17

Urethral lesions – Urethral carcinoma

Question 18

What are midstream or total hematuria characteristic of?

Answer 18

Upper urinary tract and vesical sources

Question 19

16-year-old boy on beer drinking binge develops severe colicky left flank pain. What is it?

Answer 19

Ureteropelvic junction obstruction - congenital narrowing at the ureteropelvic junction cannot accomodate increased flow with diuresis.

Question 20

Clinical presentation with vesicoureteral reflux?

Answer 20

Febrile + flank pain, seen in younger children that outgrow their problem.