Week 7 Flashcards
Classifications of Hypospadias
From distal to proximal
Glandular
Coronal
Proximal penile
Mid shaft
Distal penile
Penoscrotal
Scrotal
Perineal
Differential diagnosis for hypospadias?
Megameatus
Ventral urethra avulsion
Ambiguous genitalia
The components of hypospadias repair?
Orthoplasty
Urethroplasty
Glanuloplasty
Meatoplasty
Scrotoplasty
Spongioplasty
Skin cover
Orthoplasty - ___________
Urethroplasty - ___________
Glanuloplasty -_________
Meatoplasty -_____________
Scrotoplasty -________________
Spongioplasty -____________
Skin cover -_____________
Straightening of the penis
Correction of damage to the urethra
plastic surgery carried out on a glans
type of surgery to enlarge the urethral meatus at the end of the penis
surgical procedure used to either repair or treat an existing scrotum or to create a new scrotum
Surgery done on the corpus spongiosum to prevent urethrocutaneous fistula
It is vital to never carry out circumcision in a child with any degree of hypospadias
T/F
With reason
The preputial skin may be needed for corrective surgery
Hypospadias is a congenital malformation seen in 1 in ______ ______
300 boys.
The 5Ps?
Pain
Pallor
Pulseless
Paresthesia
Paralysis
the 4Ds indications for amputation
Dead/limb gangrene
Dying
Damn nuisance
Dangerous
Timing of hypospadias repair is influenced by _________, __________, and ________
penile size, genital awareness, and anesthetic risks
In select patients the __________ is a useful procedure for the correction of congenital or acquired chordee.
Nesbit operation
What is continuous bladder irrigation? Continuous bladder irrigation (CBI) is a medical procedure that ____________________. It also __________________________ at the same time. Healthcare providers often use it to ______________________ after surgery on the urinary system.
flushes your bladder with a sterile liquid
removes urine (pee) from your body
prevent or remove blood clots
Do not take _____ when you have cancer
Flagyl
Risk factors for DVT
Mention 10
Age
Immobilization
Pregnancy
Injury or surgery
Cancer
OCP/ HRT
Smoking
IBD
genetics
Past history of DVT
Bad girls get _______
Good girls get ________
Pregnancy
Fibroid
Auscultation: bowel sounds
Peristalsis produces a ______ noises because the bowel contains a mix- ture of _____ and _______.
gurgling
fluid and gas
Auscultation: bowel sounds
Normal bowel sounds are _____-pitched gurgles that occur every __________.
The absence of bowel sounds indicates that ________________. This may either be a primary or a secondary phenomenon.
low; few seconds
peri- stalsis has ceased
If you can hear the heart and breath sounds but no bowel sounds over a 30-second period, the patient probably has a _____________.
para- lytic ileus
Distension of the bowel caused by a mechanical intestinal obstruction is associated not only with ______eased bowel sounds, but also with a change in the _____________. They become _______ in nature with runs of ______- frequency gurgles, sounding like sea water enter- ing a large cave through a narrow entrance, often described as ‘ __________ ’.
incr; character of the sounds
amphoric; high
tinkling
Having assessed the quality of the bowel sounds, it is important to listen for any systolic vascular bruits, which indicate ___________ or increased blood flow through, for example, a _______.
arterial stenosis
fistula
Percussion of the abdomen causes pain if ___________ is present and is a useful method for mapping out a tender area
peritonitis
When a part or the whole of the abdomen appears distended, the patient should be held at the ______ and the abdomen ________________ .
________ sounds – a ___________ – indicate that there is an intra-abdominal viscus, usually the _________, distended with a mixture of fluid and gas.
hips
shaken from side-to-side
Splashing; succussion splash
stomach
An enlarged kidney can be pushed back and forth between the anterior and posterior hands. This is called ________.
It feels like patting a ball back and forth in a pool of water. Balloting is also used to palpate a _____ in a ___________
balloting
fetus; pregnant uterus.
Acute pancreatitis is a condition in which _________________________ the pancreatic gland.
It may be caused by ______ of the pan- creatic duct, usually by a __________ obstructing the ampulla of Vater. It is also commonly secondary to _________
activated pancreatic enzymes autodigest
obstruction; small gallstone
alcohol abuse.
The common presenting symptom in acute pancreatitis is ______ that begins suddenly, high in the ________, and steadily increases in severity until it is very severe, causing the patient to ________ and breathe __________.
It usually radiates through to the ———-.
pain; epigastrium
lie still ; shallowly; back
In acute pancreatitis
________ relieves the pain, which is exacerbated by ________.
Frequent ________ and ———— are very common, and are an important pointer to the correct diagnosis.
There is persistent ______ between the bouts of vomiting.
Nothing; movement
vomiting and retching
nausea
Inflammation of a Meckel’s diverticulum produces symptoms and signs that are indistinguishable from those of ________, although the pain and tenderness are generally felt more towards the __________ than in the __________.
acute appendicitis
centre of the abdomen
right iliac fossa
Acute Crohn’s disease may present with ________ or ___________ discomfort and signs similar to those of appendicitis.
A thick and tender _________ may be palpable in the ___________, and thickened ____________ may also be palpable in the ______________.
central or right iliac fossa
terminal ileum ; right iliac fossa
ileum and jejunum
umbilical region.
The normal visceral innervation of the appendix comes from the __________ spinal segment. The corresponding somatic dermatome encircles the abdomen at the level of the ______________
tenth thoracic
umbilicus (T10).
The inflamed appendix most commonly lies behind the ________ ( ________ ) so causes pain in the lateral part of the ___________ and the _______, but it may hang down into the pelvis and lie against the ________ or a ________________. In these circumstances, the patient may present with misleading ________ or ________ symptoms.
caecum; retrocaecal
right iliac fossa ; flank
bladder; loop of large bowel
bladder or large bowel
Acute appendicitis may also present with intestinal obstruction –_______ and __________ – if the appendix ___________________________________ .
colic and abdominal distension
lies too close to and inflames the terminal ileum (preileal or postileal)
Acute appendicitis
A _________ usually precedes the onset of pain by a few hours, and most patients feel slightly nauseated. Many patients vomit _________.
loss of appetite
once or twice
Most patients with appendicitis state that they had been __________ for a few days before the pain started, but a few complain of _________, which may lead to a mistaken diagnosis of __________, especially in children.
constipated
diarrhoea; gastroenteritis
Acute appendicitis
Some patients present with symptoms of generalized peritonitis – generalized abdominal pain, nausea and vomiting, sweating and sometimes rigors – especially if the ___________________.
initial stages of the disease go unoticed
A tender, indistinct mass may be felt in the right iliac fossa. It is usually impossible to feel below it because it is _______________. It is _____ to percussion.
___________ usually takes a few days to develop. ___________ should be suspected if the temperature is high and the mass is very tender
fixed posteriorly
dull; An appendix mass
An appendix abscess
The causes of abdominal distension can be remembered by repeating the letter ‘F’ six times: ______,_____,______,______,_____,_______ ; and other solid tumours (
fetus, flatus, faeces, fat, fluid and fibroids
Spigellian hernia
These hernias appear at the ______ edge of the ____________ muscle along the ____________. The lump is still palpable when the abdominal wall muscles are _________, and it is felt to lie above them
outer; rectus abdominis
linea semilunaris
contracted
Resolved inflammed appendix gives rise to???
Mucocele of the appendix
Acute appendicitis may follow URTI
T/F
T
Volkovich-kocher sign
We believe that the sequence of pain initially in the _________ and ________ regions followed by pain in the ____________
epigastrium; periumbilical
right lower quadrant
Blumberg’s sign
also referred to as?
rebound tenderness
Dunphy sign
sharp pain in the _______ elicited by a _________________
RLQ
voluntary cough
Markle’s sign, or ____________ , is a clinical sign in which pain in the ____________ of the abdomen is elicited by the ____________ test
jar tenderness,
right lower quadrant
heel-drop test
heel-drop test (__________ to the __________, from __________ on the __________, with a __________ landing).
dropping ; heels
standing ; toes,
Jarring
Cachexia
AKA
___________
Wasting syndrome
Psoas major: Originates from ________; attached to _______________
Psoas minor : origininates from ________; insert on the ___________
T12 – L5; lesser trochanter of the femur.
T12 and L1 ; iliopectineal eminence
The Obturator externus (OE) muscle originates from the ______________ , inserts into the _________________
Obturator internus: Originates from the ________________________. attaches onto the _________________
rami of pubis and ischium; trochanteric fossa of the femur
pubis and ischium at the obturator foramen
greater trochanter of the femur.
ZONES OF THE PROSTATE
BPH:
CA:
Prostatitis
Peripheral zone
Transitional or periurethral
No zone predilection
Prostatic diseases age
BPH:
CA:
Prostatitis
> /= 50
> /= 60
</= 25
Obstructive symptoms of Prostatic diseases
Weak stream
Straining
Intermittent
Dribbling
Incomplete emptying of the bladder
Hesitancy at micturition
Irritative symptoms of Prostatic diseases
Frequency
Urgency
Nocturia
Dysuria
Urge incontinence
BPH is a premalignant lesion to prostatic carcinoma
T/F
F
Infection involves _______ by _________.
tissue invasion
microorganisms
_______ + ________= ejaculatory duct
Seminal vesicle
Vas deferens
Machine to measure urine stream strength is ???
Uroflowmetry
Baden–Walker half way system of _______________
It consists of four grades:
grade 0 – ____________
grade 1–____________
grade 2 –____________
grade 3 – ____________
grade 4 –____________
Pelvic organ prolapse
grade 0 – no prolapse
grade 1–halfway to hymen
grade 2 – to hymen
grade 3 – halfway past hymen
grade 4 –maximum descent.
normal saline VS dextrose saline
Normal saline solution contains salt in the same concentration as blood. Dextrose-saline solution in addition to salt also contains dextrose (a form of sugar).
The simplest approach is to replace dehydration losses with _______. This ensures that the administered fluid _____________________, where it will do the most good to support blood pressure and peripheral perfusion.
0.9% saline
remains in the extracellular (intravascular) compartment
Dextrose 5% in water is used to treat __________________ , ________ shock, or ____________ (fluid loss).
low blood sugar (hypoglycemia)
insulin
dehydration
__% normal saline
___% dextrose
0.9
5
The differences in particles mean that lactated Ringer’s doesn’t ____________ as normal saline does. This can be a beneficial effect to avoid _________.
last as long in the body
fluid overload
WHO recommends that these homemade sugar-salt rehydration solutions should contain __________ of sugar and ___________ of salt added to ___________ of water. This results in a concentration of ____ mmol/liter of glucose and ____ mmol/liter of sodium.
8 level teaspoons
1 level teaspoon
1 liter
116; 86
Supine abdominal film shows _______ loops of _______ with the “stack of coins” appearance, suggesting _______________.
On the erect abdominal film, multiple ___________ are noted that suggest ________.
dilated
small bowel ; small bowel obstruction
air-fluid levels; obstruction
Graham patch
________ patching is a surgical procedure for treating __________. It is also called a Graham patch after the surgeon who first performed this technique. This procedure uses _____________ to repair the injury because it is _________.
Omental
perforated ulcers
a patch of the omentum
durable
Varicocele
An ________ of the ______ within the scrotum.
A varicocele may develop as a result of _____________ that are normally found in veins. In other cases, it may occur from _________ of a vein by a nearby structure.
An enlargement of the veins
poorly functioning valves
compression
Varicoceles occur on the left side in most cases because of the relation of ____________ to the ___________ (the ______________________________________). On the right side, the ____________________
the spermatic vein to the left renal vein
spermatic vein opens at a sharp angle into the left renal vein
spermatic vein opens into the much larger inferior vena cava.
Bladder outlet obstruction is an _________________ at the __________ and/or ________ that results in _______________ in the presence of high __________ and high _____________
impedance in the flow of urine
bladder neck ; urethra
low urine flow rate
voiding pressure ; intravesical pressure
Common causes of BOO
Mention 6
BPH
Prostate cancer
Bladder stones (calculi)
Urethral strictures
Bladder tumor
Neurogenic bladder dysfunction
Long term effects of BOO?
Obstructive __________ and _________
________________(______ and ______)
Recurrent ________ and ________
Bladder wall _________ and _______
Impaired destrusor _________ with ________ problems
Obstructive nephropathy and renal failure
Upper tract dilatation (hydronephrosis and hydroureter)
Recurrent UTI and hematuria
Trabeculation and sacculation
Contractility; voiding
Which BOO is more pronounced ?
BPH or CA-P?
With reason
BPH
Because it’s mostly at the periurethral transitional zone
Prostate cancer metastasize early to the ________ because of the _______ vein of _________ that connects with the _________ venous plexus
Vertebrae; valveless
Batson
vertebral
Features suggestive of prostate cancer metastasis?
Inability to walk
Low back pain
In acute urinary retention, the patient is ______________ , despite _____ with associated ________ and ___________
In chronic urinary retention, the patient ________________ but always have __________ ( residual of > ____ml, normal is >____ml. They may present with ____________, enuresis, and renal insufficiency
unable to pass urine ; urge
Supra pubic pain and fullness
still passes small quantity of urine
some retained; 250; 50; overflow incontinence
Acute retention is (painless or painful?) and (gradual or sudden?) .
Chronic retention is (painless or painful?) , and there is a chronically __________ bladder.
painful; sudden
painless ; distended bladder.
Acute retention may develop in the presence of chronic retention, when the expression ___________ retention is sometimes used.
acute-on- chronic
Acute retention in the absence of bladder outlet obstruction is rare, and occurs only after a __________, _______ or an _______________.
surgical operation
anaesthesia
injury to the urethra
Patients with chronic retention may be symptom free except for the ______________ produced by the _____ bladder and can present with __________
abdominal swelling; large
enuresis
What is enuresis?
involuntary leakage of urine at night
Percussion is useful in deciding whether a patient is in acute retention, as the bladder is ___________.
always dull
Percussion in acute retention
The bladder may reach up to, or above, the umbilicus if the patient __________________________. A large bladder of this size indicates _________ retention.
has had chronic retention before the acute episode
acute-on-chronic
You can not assess the size of the prostate gland gland, or the pelvis, when the _____________. It is better to defer the rectal examination for prostate assessment until after the retention has been relieved with a _______.
bladder is full
catheter
Types of chronic urinary retention
In the high-pressure type, the cause is ________________ .
In the low-pressure type, the fault seems to lie with the _________________.
obstruction of the bladder outlet
bladder muscle, which is atonic
The retention is of the _____ pressure type if a patient in chronic retention has the symptoms and signs of renal failure
high
___________ is pathognomonic of chronic retention.
Enuresis
Remember that a full bladder pushes the prostate ______wards and makes it feel _________.
down
bigger
Prostatic cancer metastasizes to ______, particularly the ________ and ________.
These bone deposits are nearly always _________ and _________, so tend to produce _______ rather than __________
bone; pelvis and lumbar spine
osteosclerotic and osteoblastic
bone pain; pathological fractures
Ureteric Coli may radiate to the _____,_____,_____ but not to the ______,______
Groin; labium; testicle
Chest ; back of the leg
A dragging sensation in the scrotum that gets worse towards the end of the day is characteristic of ??
Varicocele
Anterior urethra = ??? And ???
Posterior urethra = ???? And ????
Penile and bulbar
Membraneous; prostatic
Lower urinary tract symptoms(LUTS) are divided into _______ and ——— and _______
Storage
voiding symptoms
Post-micturition
LUTS
frequency
Urgency
Nocturia
Strangury
Urge incontinence
Stress incontinence
Nocturnal enuresis
Hesitancy
Intermittency
Straining
Incomplete emptying
Post-micturition dribble
Urinating too often during the day
A compelling desire to urinate that is difficult to stop
Waking up at night to pee atleast once
A sensation of constantly needing to void
Voiding involuntary after an intense urge to void
Voiding involuntarily due to increase in intra-abdominal pressure
Voiding involuntarily at night while sleeping
Difficulty initiating micturition
Urine starts and stops multiple times and on multiple occasions
Muscular effort required to initiate , maintain or improve the urinary stream
After micturition, feeling like the ladder is still full
Loss of urine that continues after voiding
StORAGE LUTS are typical of ??
Voiding LUTS are typical of ??
Overactive bladder
Bladder outlet obstruction
Timing of blood in relation to urinary stream
Initial = ???
Throughout the stream= ????
Terminal = ????
Urethral pathology
Bladder or upper tracts
Bladder neck or prostatic pathology
Hematuria can be classified into ______ and _______
Visible
Non-visible
Peak urine flow rate of ______= no major
BOO
Peak urine flow rate of ______=BOO is present
> 15mL/s
<10mL/s
