Urology Flashcards

1
Q

adolescent boy complains of very severe pain of sudden onset in right testicle; the testes is swollen, very painful, high riding and has a horizontal lie; the cord is not tender - dx?

A

testicular torsion

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2
Q

tx. of testicular torsion

A

emergency surgery followed by bilateral orchiopexy

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3
Q

young, sexually active man presents with severe pain of recent onset in right scrotal contents; he has a high fever and pyuria. His testes are no normal position, but they are swollen and painful, the cord is also tender - dx?

A

acute epididymitis

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4
Q

management of acute epididymitis

A

do USG to r/o torsion (to be safe)

antibiotic therapy

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5
Q

pt is being observed for a ureteral stone expected to pass; he develops chills, a very high fever and flank pain - dx?

A

infection + obstruction = urologic emergency!

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6
Q

tx. of urinary obstruction + infection

A

massive IV antibiotic therapy

stone extraction - if pt is septic, decompression w/ ureteral stent or percutaneous nephrostomy

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7
Q

you have a man, child or febrile patient suspected of having a UTI - what do you do?

A

start work-up with USG

- these groups dont usually get UTIs

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8
Q

62 yo man presents with chills, fever, dysuria, urinary frequency, diffuse low back pain and exquisitely tender prostate on rectal exam - dx?

A

acute bacterial prostatitis

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9
Q

management of acute bacterial prostatitis

A

IV antibiotics

do not do any more DREs or vigorous prostate massage - can lead to septic shock

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10
Q

otherwise healthy newborn boy has not urinated in first 24 hours of life; on exam he has a big, distended urinary bladder - what do you do?

A

likely due to obstruction

  • first check meatus; if not, posterior urethral valves
  • drain bladder with catheter
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11
Q

how do you diagnose and tx posterior urethral valves?

A

dx. voiding cystourethrogram

tx. endoscopic fulguration or resection for tx

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12
Q

newborn with urethral opening in ventral side of penis - management?

A

hypospadias

  • do not do circumscision!
  • surgical reconstruction eventually
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13
Q

little girl is brought in because she perceives the sensations of having to void and voids normally but happens to be wet with urine all the time - dx and management?

A

low implantation of one ureter - into vagina

  • symptoms only in girls
    dx. with IVP and tx. with surgery
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14
Q

pt goes on a beer drinking binge for first time ever and shortly after develops colicky flank pain

A

ureteropelvic junction obstruction

- allows normal urine output w/o difficulty but if large diuresis, narrow opening cannot handle it

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15
Q

where is the source with total hematuria?

A

kidney, ureter or bladder

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16
Q

where is the source with initial or terminal hematuria?

A

bladder, prostate or urethra

17
Q

what are you concerned about with total hematuria in an older pt?

A

cancer - do CT scan and cystoscopy to R/o

18
Q

75 yo pt is referred for evaluation of hematuria, flank pain and a flank mass; he has hypercalcemia, erythrocytosis and elevated liver enzymes - dx? test?

A

dx. renal cell carcinoma

test - do a CT scan

19
Q

55 yo chronic smoker reports 3 instances of painless, gross total hematuria in part 2 months; he previously had irritative voiding symptoms and tx. for UTI. He is not febrile and urinary cultures are negative - dx?

A

bladder cancer

20
Q

dx of bladder cancer

A

CT scan first, then cystoscopy

21
Q

tx of bladder cancer

A

surgery
intravesical BCG
- very high rate of local recurrence

22
Q

dx. of prostate cancer

A

transrectal biopsy

CT scan to assess extent of spread/mets

23
Q

tx. of bone mets from prostate cancer

A

androgen ablation

  • surgical (orchiectomy)
  • LHRH agonists
  • anti-androgens
24
Q

when is surveillance for prostate cancer usually stopped?

A

> age 75; however, if man is in good general health, may consider testing

25
management approach to testicular cancer
USG confirms testicular mass serum markers - AFP, bHCG (dont change next step) radical inguinal orchiectomy platinum-based chemotherapy
26
tx. of acute urinary retention due to underlying BPH
indwelling bladder catheter for atleast 3 days
27
tx. of renal colic due to 3 mm stone
watch and wait - will likely pass on its own | - pain meds, plenty of fluids
28
tx. of large renal stones
shock wave lithotripsy
29
contra-indications for shock wave lithotripsy
pregnancy bleeding diathesis stones that are several cm big
30
pt presents bc he noticed bubbles of air coming out along with urine as he urinates; has has symptoms of mild cystitis - dx?
pneumaturia - fistula between bowel and bladder - MC from sigmoid colon to dome of bladder due to diverticulitis
31
dx. study of choice in pneumaturia
CT scan
32
impotence due to a crush injury of perineum
vascular injury | - vascular reconstruction may help
33
impotence due to abdominoperineal resection of rectal cancer
nerve injury
34
diabetic man with generalized arteriosclerotic occlusive disease notices gradual loss of erectile function; first they didnt last as long, then the quality was poor and now he is completely impotent
organic impotence | - tx. sildenafi