urology, organ transplant

Question 1

is spermatic cord tender or nontender in testicular torsion?

Answer 1

nontender

Question 2

emergency operation in testicular torsion. whats the operation?

Answer 2

untwist AND orchioplexy. oftentimes other side is also orchioplexy’d

Question 3

lifting the scrotum helps the discomfort/pain in testicular torsion or acute epididymitis?

Answer 3

acute epididymitis

Question 4

obstruction + infection of urinary tract together is dire emergency. what is tx?

Answer 4

1. IV abx
2. immediate decompression of obstruction, by ureteral stent or percutaneous nephrostomy
3. if further surgery or procedures needed,do at later safer date

Question 5

why is intravenous pyelogram rarely used anymore? (the risks)

Answer 5

risk for nephrotoxicity and allergic rxns

Question 6

urologic workup. 3 tests and their uses?

Answer 6

1. sonogram - dilatation, obstruction
2. CT - renal tumors
3. cystoscopy - early bladder cancer

Question 7

3 requirements of care for pyelonephritis

Answer 7

1. hospitalization
2. IV abx
3. urologic workup (sonogram or CT)

Question 8

old guy who has sx of what looks like UTI including diffuse low back pain, + tender prostate on rectal exam. dx?

Answer 8

acute bacterial prostatitis

Question 9

you dx acute bacterial prostatitis. what do you have to do/not do, in addition to IV abx?

Answer 9

do not give any more rectal exams to feel prostate. repeated massage could lead to septic shock

Question 10

newborn boy doesn’t urinate during first day of life. what are 2 main diff dx for this?

Answer 10

posterior urethral valves most common cause

could also be meatal stenosis

Question 11

diagnostic test and tx for posterior urethral valves? (classic picture is newborn boy that doesn’t urinate on first day)

Answer 11

dx: voiding cystourethrogram
tx: endoscopic fulguration or resection to get rid of the valves

Question 12

hypospadias or epispadias that you need to use foreskin (skin of prepuce) for urethral reconstruction?

Answer 12

hypospadias

Question 13

epispadias is associated w/ what other abnormality/malformation?

Answer 13

bladder exstrophy

Question 14

what study do you use to find vesicoureteral reflux

Answer 14

voiding cystourethrogram

Question 15

how does infection from vesicoureteral reflux present?

Answer 15

child with uti like sx. so if child has UTI and it’s not the usual young girl potty training, need to workup for underlying causes like this

Question 16

how does low implantation of ureter present in a male? female?

dx test?

Answer 16

male - normal
female - no incontinence or anything, but always wet b/c urine drips into vagina

dx: vaginoscopy to find ectopic ureter

Question 17

adolescent who binge drinks for the first time, develops colicky flank pain. dx?

Answer 17

uretopelvic junction (UPJ) obstruction, congenital malformation

Question 18

workup for hematuria to rule out cancer. what 2 studies?

Answer 18

1. start with CT

2. cystoscopy

Question 19

diagnostic test for prostatic cancer?

Answer 19

transrectal needle biopsy

Question 20

true or false, renal cell carcinoma can cause elevated liver enzymes

Answer 20

TRUE

Question 21

young male with painless testicular mass. what do you suspect? workup?

Answer 21

suspect testicular cancer

workup: biopsy, measure AFP and beta-HCG preoperatively for monitoring/follow up

Question 22

meds for urinary retention? 2. and their MOA

Answer 22

tamsulosin - alpha blocker

finasteride, dutasteride - 5-alpha reductase inhibitor

Question 23

surgical option for BPH (causing urinary retention). usually when refractory to meds

Answer 23

transurethral resection of prostate (TURP)

Question 24

post-op urinary retention can masquerade as _____. how to differentiate/confirm?

Answer 24

masquerade as incontinence. pt will not report need to urinate but have involuntary release of small amts of urine.
palpable huge distended bladder confirms that this is actually overflow incontinence from urinary retention

Question 25

what size ureteral stones have a 70% chance of passing and thus require only fluids, pain control, and watchful waiting?

Answer 25

3mm or less

Question 26

pneumaturia (passing gas in urine) is most commonly caused by _____ which is most commonly caused by _______

Answer 26

diverticulitis -> fistulization between bladder and GI tract(sigmoid colon) -> pneumaturia

note: cancer of sigmoid colon and bladder cancer can also cause fistulization but not as common

Question 27

if pt has pneumaturia, what study do you need to order, to rule out what?

Answer 27

sigmoidoscopy to rule out cancer

Question 28

hyperacute organ rejection is caused by what

Answer 28

preformed antibodies -> vascular thrombosis

Question 29

how to prevent hyperacute organ rejection (2)

Answer 29

ABO matching and lymphocytotoxic crossmatch

Question 30

acute organ transplant rejection timeframe

Answer 30

after first 5 days, usually within 3 months

Question 31

how to diagnose acute transplant rejection

Answer 31

biopsy

Question 32

maintenance protocols for organ transplant (2-3)

Answer 32

tacrolimus
mycophenolate mofetil
+/- prednisone

Question 33

what is special about liver transplant rejection (or what you suspect to be acute rejection)

Answer 33

technical problems are more common than immunologic rejection. so if liver enzymes are elevated, need to rule out biliary obstruction by ultrasound and vascular thrombosis by Doppler

Question 34

what is special about heart transplant acute rejection

Answer 34

signs of dysfunction from rejection occur too late clinically, so must monitor regularly by routine ventricular biopsies

Question 35

first line therapy for acute transplant rejection?

2nd line?

Answer 35

1st line = steroid boluses

2nd line = antilymphocyte agents (e.g. OKT3) or antithymocyte serum

Question 36

tx for chronic rejection

Answer 36

there is none. irreversible. GG