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Surgery Clerkship > Urology > Flashcards

Urology Flashcards

1
Q

Posterior urethral valve pathology

A

Posterior valve causes difficulty in getting urine out of bladder

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2
Q

Posterior urethral valve patient presentation?

A

No urine output on day 1 of life, increased creatinine. Baby may or may not have had oligohydramnios.

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3
Q

How to diagnose posterior urethral valve?

A

Voiding cystourethrogram

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4
Q

How to treat posterior urethral valve

A

Place a catheter, resect and reimplant

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5
Q

Epispadias

A

Urethra implants on the dorsal surface of the penis

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6
Q

Hypospadias

A

Urethra implants on the ventral surface of the penis

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7
Q

How to treat epi and hypospadias?

A

DO NOT circumcise, save the foreskin to rebuild penis

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8
Q

Ureteropelvic junction obstruction pathogenesis

A

Narrow lumen ureter that gets “obstructed” with high flows

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9
Q

How does ureteropelvic junction obstruction present?

A

Patient is fine with normal flows, but when a large diuresis occurs (drinking alcohol), patient experiences colicky abdominal pain.

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10
Q

How to diagnose ureteropelvic junction obstruction?

A

IV pyelogram

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11
Q

How to treat ureteropelvic junction obstruction?

A

Stent or surgery

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12
Q

Pathogenesis of low implantation of the ureter?

A

1 ureter drains into bladder just fine. The other drains directly into the urethra,

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13
Q

What type of patients present with low implantation of the ureter?

A

Boys are usually asymptomatic, but girls will present with normal voiding but a constant leak.

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14
Q

How to diagnose low implantation of the ureter?

A

With iv pyelogram

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15
Q

Pathogenesis of vesicoureteral reflux

A

2 way bladder - ureter valves allow bacteria to ascend to ureters and kidneys

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16
Q

Patient presentation of vesicoureteral reflux?

A

Frequent UTIs or any pyelonephritis

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17
Q

How to diagnose vesicoureteral reflux?

A

IV pyelogram

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18
Q

How to treat vesicoureteral reflux?

A

Surgery, empiric antibiotic prophylaxis

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19
Q

Cryptorchidism?

A

Undescended testicle

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20
Q

How does patient with cryptorchidism present?

A

With a missing testicle.

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21
Q

How to treat cryptorchidism

A

Wait one year to descend. If testicle doesn’t descend bring it into scrotum. Remove after puberty (from like 18-20) to avoid cancer.

Can also try 1 month of gonadotropin before doing anything.

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22
Q

Hematuria in kids?

A

Hematuria in kids is almost always abnormal (unless in the case of huge trauma). If pediatric patient has any blood in urine, do an u/s, IVP, or ct scan.

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23
Q

Patient presentation of renal cell carcinoma?

A

Patient has hematuria and flank pain with a palpable mass. Patient may also have anemia or polycythemia.

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24
Q

How to diagnose renal cell carcinoma?

A

Ultrasound, ct scan to stage, biopsy.

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25
Q

How to treat renal cell carcinoma?

A

Surgical resection and chemo

26
Q

Risk factors for the development of bladder cancer?

A

Smoking, exposure to analine dyes

27
Q

How does patient with bladder cancer present?

A

Asymptomatic hematuria, hydronephrosis or hydroureter

28
Q

How to diagnose bladder cancer

A

U/s showing hydronephrosis/hydroureter, cystoscopy.

Best is biopsy, stage with CT

29
Q

How to treat bladder cancer?

A

Surgical resection.

30
Q

Prostate cancer pathogenesis

A

Prostate ca grows in response to 5-DHT.

31
Q

How does patient with prostate cancer present?

A

With obstructive symptoms, increased PSA, or nodular prostate found on DRE.

32
Q

How to diagnose prostate cancer?

A

PSA, transrectal bio0psy for determination of gleason score.

33
Q

How to treat prostate cancer?

A

Resection, radiation, antiandrogens (flutamide), GnRH analogs (leuprolide), orchiectomy

34
Q

How does testicular cancer present?

A

Painless mass in 15-25 year old, mass doesn’t transilluminate.

35
Q

How to diagnose testicular cancer?

A

Remove testicle and look. NEVER fna, because it can seed.

36
Q

Tumor markers of seminoma

A

LDH and HCG

37
Q

How to treat seminoma?

A

Platinum based chemotherapy.

38
Q

Tumor marker of endodermal sinus tumor?

A

AFP

39
Q

BPH patient presentation

A

Urinary frequency but no dysuria. Trouble initiating stream, dribbling, interrupted stream

40
Q

How to diagnose BPH

A

U/a, urine culture, look at creatinine. NEVER biopsy or get PSA.

41
Q

How to treat BPH

A

Alpha blockers (tamsulosin), 5-alpha-reductase inhibitors (finasteride), foley, TURP

42
Q

Pathogenesis of erectile dysfunction?

A

Psychogenic or organic (vascular)

43
Q

How does patient with ED present?

A

Trouble achieving or maintaining erections.

44
Q

How to distinguish vascular from psychogenic ED?

A

Nighttime tumescence (postage stamp)

45
Q

How to treat ED

A

If psychogenic, patient should undergo psychotherapy. If organic, PDE inhibitors (sildenafil) or prosthesis. Note: PDE inhibitors are not good for ED due to trauma, surgery, or radiation.

46
Q

Testicular torsion pathogenesis

A

Testicle twists and strangulates vascular supply.

47
Q

Patient presentation for testicular torsion?

A

Sudden onset pain, no other symptoms, testicle has a horizontal lie.

48
Q

How to diagnose testicular torsion?

A

Clinical diagnosis with ultrasound

49
Q

How to treat testicular torsion?

A

Surgical untwisting with a bilateral orchipexy.

50
Q

Epididymitis pathogenesis

A

STD in patients less than 40, E.coli in patients >40

51
Q

How does patient with epididymitis present?

A

Sudden testicular pain no other symptoms but a tender epididymis. Testicle in vertical lie

52
Q

How to treat epididymitis?

A

In patients 40 use cipro

53
Q

Patient presentation with bacterial prostatitis?

A

Patient has chills, fever, nausea vomiting, tender prostate on DRE and Ua that shows WBC and bacteria.

54
Q

How to treat bacterial prostatitis?

A

NEVER repeat DRE. If it’s bacterial, treat with a fluoroquinolone. If it’s not bacterial, treat with NSAIDS

55
Q

How to diagnose stones?

A

UA CT scan

56
Q

How to treat stones

A

If 3cm, surgery

If in between ESWL

57
Q

How to distinguish torsion from epididymitis?

A

In torsion the cord is not tender. In epididymitis the cord is tender. Also epididymitis is marked by fever and pyuria.

58
Q

What, besides testicular torsion, is a urologic emergency? How to treat

A

Combination of obstruction and infection. For example, ureteral stone + spiking fever and rigors. Patient requires IV antibiotics and immediate surgical decompression.

59
Q

What happens if somebody with bacterial prostatitis keeps getting DRE?

A

Could lead to septic shock.

60
Q

When is it okay not to work up hematuria in an adult?

A

After large trauma if there’s trace blood.

61
Q

Cause of pneumaturia

A

Fistula between GI tract and bladder most commonly in sigmoid colon from diverticulitis.

Surgery Clerkship (11 decks)

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