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Surgery > Urology (KIDNEY 1) > Flashcards

Urology (KIDNEY 1) Flashcards

1
Q

Kidneys develop from the

A

Metanephrine buds

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2
Q

In horseshoe kidney assent is restricted by the

A

Inferior mesenteric vessels

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3
Q

Physiological lobulations in kidney, that are persist in adult are known as

A

Dromedary Humps

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4
Q

Which kidney is preferred as donor kidney and why

A

left kidney because Left renal vein is longer

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5
Q

What is nutcracker syndrome?

A

Left renal vein is compressed between superior, mesenteric artery and aorta

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6
Q

What is renal collar?

A

Left renal vein splits to encase the aorta

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7
Q

IOC for duplication of ureteric system

A

IVU ( Intravenous urogram )

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8
Q

What is Weigert Meyer Rule

A

Ureter draining the upper pole/ectopic ureter will open more medially and distally in an ectopic location as compared to normal ureter
Males : open into urethra
females : open into vagina

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9
Q

Drooping Lily sign is seen in

A

Duplication of malrotated pelvis

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10
Q

Infantile PCKD is Autosomal……

A

Recessive

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11
Q

In Infantile PCKD , PKHD is o chromosome

A

6

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12
Q

Adult PCKD is autosomal

A

Dominant

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13
Q

In adult PCKD , PKD 1 is on chromosome ….. and PKD 2 is on chromosome…..

A

16 & 4

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14
Q

Prenatal scan diagnosis for PCKD should have

A

If more than 3 cysts weather unilateral or bilateral
two or more cyst in both kidneys

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15
Q

Fused portion in the horseshoe kidney lies at the level of

A

L3–L4

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16
Q

On IVU which sign can be seen in horseshoe kidney

A

Flower vase appearance,
handshake sign

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17
Q

Management in asymptomatic, patient with horseshoe kidney

A

No management require

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18
Q

Management in presence of hydronephrosis or malrotated pelvis with stone formation in patient of horseshoe kidney is

A

Pyeloplasty

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19
Q

What is hydronephrosis?

A

Aseptic dialatation of pelvi-calyceal
system due to intermittent partial/complete block to flow of urine

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20
Q

 Most common cause of acquired hydronephrosis is

A

Renal stone (sloughed papillae)
Intra luminal cause

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21
Q

Most common congenial cause of hydronephrosis

A

PUJ obstruction
Intramural cause (within the wall)

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22
Q

IOC in pelvi-ureteric Justin obstruction

A

MAG-3 scan (can assess the function in the left kidney)

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23
Q

Management of symptomatic patients of PUJ obstruction

A

Anderson -Hynes dismembered pyeloplasty

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24
Q

TCC of ureter in IVU shows

A

Goblet sign

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25
Q

What is Ureterocele

A

Dilution of the terminal end of the ureter

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26
Q

IVU sign in the ureterocele shows

A

Cobra head/Adder head

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27
Q

Management of Aberrant renal vessel

A

Pyeloplasty
Never cut the aberrant vessel bc it can devascularize a portion of kidney

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28
Q

Retrocaval ureter

A

 Right sided ureter goes behind the IVC

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29
Q

IVU SHOWS WHICH SIGN In retrocaval ureter

A

Fish hook / reverse J sign

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30
Q

What is the management of retrocaval ureter

A

Lateralization of ureter. If lateralization fails uretero-ureterostomy is done after cutting the segment

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31
Q

Retroperitoneal Fibrosis is also known as

A

Ormond’s disease

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32
Q

Name drug induced retroperitoneal fibrosis

A

Methysergide , bromocriptine

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33
Q

IgG4 mediated retroperitoneal fibrosis associated with

A

Dupuytren’s contracture and Peyronie’s disease

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34
Q

IVU sign in retroperitoneal fibrosis

A

Maiden’s waist anomaly

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35
Q

Which renal isotopes scan is the best to asses the function?

A

MAG3 scan Is the BEST
Others: DTOA

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36
Q

Which renal isotopes scan assess the structure or scarring

A

DMSA

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37
Q

What is Nephrostomy

A

Surgery to make an opening from the outside of the body to the renal pelvis

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38
Q

When should we save the hydro nephrotic kidney

A

If the Hydro nephrotic kidney contributes to greater than 20% to total GFR

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39
Q

What is consecration product

A

Amount of solute in a solution

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40
Q

What are the stone inhibiting factor?

A

Citrate
Tamm Horsfall proteins

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41
Q

Stone formation can occur if

A

Concentration product is >formation product

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42
Q

What are the most common renal stones?

A

Calcium oxalate stones
Formed in acidic urine

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43
Q

Crystals of monohydrated stones are

A

Dumbbell shaped
They’re very hard stones

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44
Q

Crystals of dihydrated stones are

A

Enveloped shaped
They’re known as mulberry stones due to spiculated margins

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45
Q

What are the dietary advice we should give to patient to prevent recurrent calcium oxalate stones

A

Decrease fat content
Increase calcium intake
Large dose of pyridoxine

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46
Q

Triple phosphate stones also known as

A

Staghorn / Struvite stones
Formed in alkaline urine, usually infected with Proteus

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47
Q

Triple phosphate stones crystals are

A

Coffin lid type

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48
Q

What is the medical management for recurrent triple phosphate stone

A

Aceto-hydroxamic acid

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49
Q

Which stones are very hard to break by ESWL

A

Cystine stone(radio opaque )

50
Q

Recurrent cysteine stones are managed with

A

D-penicillamine

51
Q

radiolucent stone are

A

Ammonium urate stone
Uric acid crystals

52
Q

Most common radiolucent stones is

A

Uric acid stone
form in acidic / noninfected urine

53
Q

Uric acid stones are seen conditions with

A

Tumor lysis syndrome and gout

54
Q

Recurrent uric acid stone can be managed with

A

Allopurinol 

55
Q

Which type of pain is present if the stone is in renal pelvis or upper ureter?

A

Loin to Groin

56
Q

Upper ureter stone pain can radiate to

A

Inner aspect of the thigh

57
Q

Upper or Mid ureter stone pain can radiate to

A

ilio-hypogastric nerve

58
Q

Lower ureter stone pain can radiate to

A

ilio-inguinal nerve

59
Q

What is Stranguary?

A

It is seen if the stone is impacted in the intramural portion, intense painful urge to pass urine, but on trying to can only pass one or two drops of bloody urine most common acquired cause of hydronephrosis



60
Q

What is dietl crisis

A

intermittent ureteropelvic junction (UPJ) obstruction causing episodic abdominal pain, most often due to an aberrant accessory renal artery or vein
Patient with renal stones can present with this

61
Q

IOC for a patient presented with renal stones

A

NCCT Abdomen or NCCT KUB

62
Q

When should ESWL should done

A

When stone is >5-6 mm and/or in symptomatic patients 

63
Q

Complications of ESWL

A

Pain (most common)
Hematuria
Stone street- multiple fragments are generated and it clogs the ureter. Also known as Steinstrasse.

64
Q

Stone is …….. in size. It is contraindications of ESWL.

A

1.5 cm

65
Q

Why lower calyx stones are contraindicated for ESWL?

A

Because the fragments will have to travel in antigravity direction to be removed via Urine

66
Q

Which basket is used to retrieve the stone. ?

A

Dormia basket

67
Q

Which lasers can be used to shatter stones?

A

Holmium: YAG laser

68
Q

How to differentiate between gallbladder stones and ureteric stones

A

In the lateral view, gallbladder stones are anteriorly placed, and ureteric stones are posteriorly placed 

69
Q

What is the first line management in symptomatic patient or > 5 to 6MM size ureteric stone

A

URS
If URS fails/stone is impacted ureterolithotomy is done

70
Q

What is the most common stones in the bladder?

A

Mixed Urate stones

71
Q

What is jack stones

A

Spiculated margins which are calcium oxalate stones

72
Q

What is the first line management for bladder stones?

A

Perurethral cystolithotomy
If it is contraindicated, suprapubic, cystolithotomy is done

73
Q

VUR is most commonly seen in

A

3 -5 % girls, and 1 to 2% boys
<3 months of age more common in boys and >3 months of age more common in girls

74
Q

Grades of VUR is assessed by

A

IVU/MCU

75
Q

What is pyelonephritis

A

Inflammation of the kidney due to a bacterial infection.

76
Q

Which endoscopic methods are used in management of grade IV & V VUR

A

Sting and Hit procedure

77
Q

Which investigation is best to document renal scarring due to VUR

A

DMSA scan ( remember S for Scarring)💡

78
Q

Which zone of the peritoneum is associated with maximum mortality

A

ZONE 1 (it is associated with major vessels)

79
Q

Which zone injuries are most common

A

Zone 3

80
Q

What is the IOC in stable patient with suspected renal injury

A

CECT

81
Q

What is the IOC in unstable patient with suspected renal injury

A

Single shot intravenous urogram
Not FAST as bowel gas will obscure the retroperitoneum

82
Q

IOC for vascular injury

A

Single shot intravenous urogram

83
Q

What is urinoma

A

urinoma is a collection of urine that forms in the back of your abdomen.

84
Q

What is meteorism?

A

48-72 hours after retro peritoneal Hematoma. Can develop colonic distention due to pressure over splanchnic nerves

85
Q

What is boari flap repair

A

Bladder flap for reconstructing lower end of ureter

86
Q

Putty kidney is

A

Kidney filled with pus

87
Q

Earliest lesion in renal TB is

A

Papillary ulcer

88
Q

If uretero pelvic junction is affected it is known as

A

Kerr’s kink

89
Q

What is the earliest manifestation of bladder

A

Paleness of bladder mucosa

90
Q

MC organism responsible for pyelonephritis

A

E. coli

91
Q

Which classification is used for renal Cyst (benign tumor)

A

Bosniak Classification

92
Q

Name benign tumor of the kidney

A
  1. Angiomyolipoma
  2. Oncocytoma
93
Q

Massive retroperitoneal hemorrhage Wunderlich syndrome - Lenk’s triad includes

A

Pain , Flank mass , Hypotension (no hematuria).

94
Q

MC benign tumor of the ovary is

A

Oncocytoma

95
Q

Familial relation of oncocytoma includes

A

Birt Hogg Dube syndrome

96
Q

CECT findings in oncocytoma are

A

Central stellate scar(also in focal nodular hyperplasia of liver, also in chromophobe RCC)

97
Q

Other name for RCC are

A

Grawitz tumor / Hypernephroma /Internist tumor

98
Q

Most common syndrome associated with RCC

A

Von Hippel Lindau (chr 3)

99
Q

Psammoma bodies are seen in

A

Papillary carcinoma

100
Q

Which RCC has the best prognosis

A

Chromophobe RCC

101
Q

Which RCC has the worst prognosis

A

Collecting duct / Bellini.

102
Q

Triad seen in RCC are

A

Hematuria , Pain , Mass

103
Q

Most common site of distant metastases in RCC

A

Cannonball metastasis to lung

104
Q

What is the MC presentation patient will present with in RCC

A

Hematuria

105
Q

MC increased lab value in PNS

A

Increased ESR

106
Q

What is Stauffer syndrome

A

Non metastatic hepatic dysfunction: inc in IL-6 , inc in bilirubin , ALP , Liver emzymes

107
Q

What is lambert-eaton syndrome

A

A condition in which the body’s immune system attacks the connection between nerves and muscles 

108
Q

Which structures removed in radical nephrecromy

A

Removal of kidney With gerota fascia , para aortic LN , ureteric removal till pelvic brim +/- ipsilateral adrenal glands (in T4 tumor)

109
Q

What does mTOR inhibitor do

A

Blocks a protein called mTOR which helps control cell division
Sirolimus , Everolimus

110
Q

What is the Most common pediatric renal malignancy

A

Wilm’s tumor

111
Q

What is 2nd most common abdominal malignancy

A

Wilm’s tumor (most common is Neuroblastoma)

112
Q

Familial association of Wilm’s tumor are

A

Beckwidth weidmann syndrome
Denys-Drash syndrome
WAGR syndrome

113
Q

Most important prognostic factor in Wilm’s tumor is

A

Histology

114
Q

Boggy granulomatous prostatitis is aka

A

Watermelon prostate

115
Q

Gas in and around kidney on CECT is seen in

A

Emphysematous pyelonephririts

116
Q

MC organism causing renal carbuncle

A

Staph . Aureus

117
Q

Bear’s claw appearance on CT is seen in

A

Xnathogranulomatous pylonephritis

118
Q

Angiomyolipoma is bosniak type

A

3

119
Q

What bleed is associated with autosomal dominant polycystic kidney disease?

A

Subarachnoid

120
Q

Coliky abdominal pain from loin to goin is characteristic of what condition?

A

Renal colic

Surgery (30 decks)

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