Corr Questions Flashcards
(600 cards)
1
Q
What are the causes of SUI in the female?
A
Urinary retention, DO, ISD, urethral hypermobility
2
Q
Is oral estrogen indicated in SUI?
A
NO
3
Q
What is the mechanism of Duloxetine?
A
serotonin and norepi reuptake inhibitor
4
Q
How does Duloxetine work?
A
by increasing serotonin and norepi at synapse (increased bladder neck contraction)
5
Q
IS an anterior repair indicated for SUI
A
NO, anterior colporrhaphy does not improve SUI
6
Q
What are the two main colposuspensions?
A
retropubic suspensions: Marshall-Marchetti-Krantz & Burch
7
Q
What is a side effect of MMK?
A
osteitis pubis due to suturing the periurethral tissue to the periosteum of the symphysis pubis
8
Q
Which colposuspension has longer success?
A
Burch
9
Q
what is the effectiveness of colposuspensions compared with slings?
A
both treat SUI, however slings cause less complications and less voiding dysfunction
10
Q
what is the complication of retropubic suspension?
A
pelvic organ prolapse
11
Q
what percentage of patients undergoing retropubic suspension will get POP?
A
14%
12
Q
does sling erosion into the vagina need treatment?
A
only when symptomatic, may try estrogen cream first
13
Q
erosion of a sling into the urethra or bladder requires what treatment?
A
removal of sling and repair
14
Q
Worsening voiding symptoms after SUI procedure should produce what ddx?
A
infection, obstruction, erosion
15
Q
Urethral obstruction in the immediate post operative period is treated with?
A
CIC and observation likely to resolve because its due to inflammation
16
Q
what are the signs of osteitis pubis?
A
suprapubic pain, fever, decreased thigh ADDuction tx: conservative
17
Q
radiation induced fistula should be repaired when?
A
at 6 months post radiation to allow formalization of tract
18
Q
how long should you wait after VVF repair to obtain a cystogram?
A
2-3 weeks
19
Q
martius flap is supplied by the internal pudendal art. After sacrifice of what artery?
A
external pudendal
20
Q
what is the most common cause of vesicouterine fistula?
A
cesarean section
21
Q
what is the imaging modality of choice for diagnosing vesicouterine fistula?
A
VCUG
22
Q
what is the most common cause of colovesical fistula?
A
diverticulitis
23
Q
what is the most common cuase of ureterocolic fistula?
A
Crohn’s disease and on the right
24
Q
do you have to open the peritoneum to use a peritoneal flap?
A
no, it is mobilized without opening the peritoneum
25
what is the treatment for ureterovaginal fistula?
most resolve with stent
26
What are the symptoms of autonomic dysreflexia?
HTN, Bradycardia, Flushing, headache
27
What is autonomic dysreflexia?
exaggerated sympathetic activity in response to stimuli below the level of the lesion
28
what spinal cord lesion is required for risk of autonomic dysreflexia?
above T8
29
what is the bladder finding during spinal shock?
acontractile and areflexic with closed bladder neck
30
What is the classic dysfunction found in spinal cord lesions above T6?
detrusor overactivity with smooth sphincter dyssynergia
31
what is the classic dysfunction found in spinal cord lesions below T6?
detrusor overactivity with striated sphincter dyssynergia
32
Ice water test is administered, what is the result?
no contractions are seen with a lesion below S2
33
what are the classic symptoms of Shy-Drager (multisystems atrophy)
DO, urgency with high PVR and ED in a young male
34
what nerve does lower abd surgery damage?
inferior hypogastric plexus (parasympathetic)
35
what is the result of damage to the inferior hypogastric plexus on the bladder?
detrusor areflexia and ED
36
what is the classic finding in lumbar disk disease?
normal bladder compliance with difficulty voiding
37
what nerve is damaged with inguinal hernia repair?
ilioinguinal nerve
38
what is the innervation of the ilioinguinal nerve?
upper thigh sensation along with base of penis and scrotum
39
what provides motor function to the cremasterics?
genitofemoral nerve
40
how is the genitofemoral nerve damaged during surgery?
it travels in the psoas and is injured during psoas hitch
41
what is the nerves responsible for erections?
inferior hypogastric plexus
42
what nerve is responsible for penile sensation?
pudendal on the dorsal surface
43
The cremasteric muscle is congruent with what abd muscle?
internal oblique
44
What kind of antibiotics can penetrate an infected renal cyst?
lipophilic antibiotics
45
what are the lipophilic antibiotics?
cipro, clinda, batrim, chloramphenicol
46
how can you treat Schistosomiasis of the bladder?
praziquantel
47
what is the sensory of the genitofemoral nerve?
sensation of the cord, scrotum and anterior thigh
48
The hypogastric artery is also known as what?
internal iliac
49
what is the arterial supply to the prostate?
branch of the inferior vesicle artery from the hypogastric artery
50
what nerves are responsible for detumescence?
T10-L3 superior hypogastric plexus
51
what is responsible for detumescence?
increased phospholipase C which increases inositol which increases calcium within the smooth muscle
52
Normal LH?
2.0-8.0
53
Normal FSH?
2.0-12
54
Normal AFP?
55
Normal Beta-HCG
56
What does the bulbocavernosus reflex test?
S2-S4 nerve roots
57
what happens to the ureter during bladder filling?
intramural ureteral pressure and contraction frequency increase
58
what is the mechanism by which a bladder decompensates?
as the bladder fills intramural tension increases, decreasing the blood flow causing hypoxia
59
what is the inhibitory neurotransmitter used in the cortex on the pontine
GABA
60
At what vertebral body does the spinal cord end?
L1-L2 (conus medullaris)
61
after abdominal resection injury to what nerve results in urinary retention?
inferior hypogastric plexus (parasympathetic)
62
what is the most common bladder finding in the elderly with incontinence?
detrussor overactivity with impaired contractility (urgency with elevated PVRs)
63
what is normal ureteral peristalsis pressure?
35cmH2O
64
What muscle does the Kegel exercise use?
pubococcygeus via Pudendal nerve(S2-S4)
65
What stains positive for HMB-45?
AML (&Melanoma)
66
what is the most common benign renal mass
papillary adenoma
67
what is the most common metastases to kidney
lymphoma/leukemia
68
name the renal pseudotumors
column of Bertin, fetal lobulation, dromedary hump, nodular compensatory hypertrophy
69
On a DMSA renal scan, what do true tumors look like?
decreased isotope uptake
70
Birt-Hogg-Dube is
autosomal dominant
71
BHD gene is on with what chromosome?
17
72
What percentage of BHD will have renal tumors?
25%
73
BHD may cause what other signs?
fibrofolliculomas, air filled pulmonary cysts, pneumothorax
74
Classic triad of Tuberous Sclerosis?
Mental retardation, seizures, adenoma sebaceum
75
TS is
autosomal dominant
76
TSC1 and TSC2 genes are located where
Chromosome 9 and Chromosome 16
77
what is the risk of RCC with TS?
2%
78
what is the risk of AML with TS?
60%
79
von Hippel Lindau is
autosomal dominant
80
VHL gene is located
Chromosome 3
81
name the non-urologic manifestations of VHL
cerebellar & spinal hemangioblastomas, retinal angiomas
82
name the urologic manifestations of VHL
renal cysts, clear cell RCC, pheochromocytomoas, epididymal cystadenomas, epididymal cysts
83
Clear cell RCC occurs in what percentage of VHL?
50%
84
oncocytoma arises from the?
Collecting duct
85
what type of cytoplasm does oncocytoma have?
eosinophilic
86
the cytoplasm is packed with what in oncocytomas?
mitochondria
87
what medication is FDA approved to shrink AML in patients with TS?
Everolimus
88
what is the risk of RCC from cysts acquired from renal failure?
1-3%
89
Clear cell RCC cytoplasm is full of what?
glycogen and lipids
90
Clear cell RCC arises from?
proximal tubule
91
the cytoplasm of Chromophobe RCC is filled with?
microvesicles
92
Chromophobe RCC arises from
collecting duct
93
Hale's colloidal iron stains positive for?
Chromophobe RCC
94
what is the most common form of RCC in patients with acquired cystic kidney disease?
Papillary RCC
95
why do patients get acquired cystic kidney disease?
renal failure
96
what is the most common RCC of patients on dialysis?
papillary RCC
97
papillary RCC arises from
proximal tubule
98
Papillary RCC is associated with what chromosomes?
polysomy 7 & 17, c-met mutation on Chromosome 7, Loss of Y-chromosome
99
what tumor has hobnail cells and stromal desmoplasia?
Collecting duct carcinoma
100
what is another name for collecting duct carcinoma?
Bellini duct carcinoma
101
what percentage of collecting duct carcinoma has mets at presentation?
40%
102
what renal tumor is associated with sickle cell trait?
renal medullary carcinoma
103
renal medullary carcinoma is seen in what race?
African American
104
what is the only renal tumor with racial predilection?
renal medullary carcinoma
105
Oncocytoma is associated with what syndrome?
BHD
106
Furhman grade does not consider what when formulating grade?
mitotic activity
107
what is the preferred treatment of a recurrence after nephrectomy?
tumor resection
108
RCC with solitary metastatic tumor, what is the treatment?
nephrectomy and meastasis resection
109
What is the only drug used in non-clear cell RCC?
temsirolimus
110
can you give chemo for RCC brain met?
no typically ineffective, tx with surgery or radiation to brain met
111
what drug achieved remission in metastatic clear cell RCC?
interleukin-2 (IL-2)
112
IL-2 is only effective against what type of RCC?
clear cell
113
what is mTor?
a protein that regulates hypoxia factors (HIF) & VEGF, when mTor is decreased cells reduce angiogenesis and proliferation
114
which mTor inhibitor is indicated in pts with short survival?
Temsirolimus
115
what drug is indicated in non clear cell RCC?
Temsirolimus
116
after failure of Tyrosine Kinase Inhibitors what can be used?
Everolimus
117
metastatic clear cell the preferred initial tx is?
sunitinib or pazopanib (TKIs)
118
Bevacizumab inhibits what
VEGF-A
119
what are the predictors of short survival?
2 or more metastatic sites, low hemoglobin, Ca >10, LDH >1.5 times normal, high ECOG
120
what indicates hyperfiltration injury after partial?
proteinuria
121
after how much kidney removed would hyperfiltration likely occur?
75% removed
122
how can you reduce risk of hyperfiltration injury?
ACE inhibitors
123
how does ACE inhibitors do that?
decreasing intraglomerular pressure
124
What is the risk of local recurrence of RCC in renal fossa?
125
what is the risk of RCC in the contralateral kidney?
1.20%
126
greater survival is seen with timing of metastasis in RCC
a longer inteval between RN and development of met (>2yr) is accociated with longer survival
127
medullary sponge kidney disease is associated with what chromosome?
RET oncogene
128
What is the differenatial diagnosis for Nephrocalcinosis?
Medullary sponge kidney, hyperparathyroidism, distal RTA (1), renal TB, papillary necrosis, hyperoxaluria
129
MSK disease has what appearance on KUB?
paint brush like appearance of calyces
130
What is the treatment for the cysts of medullary sponge kidney?
None
131
Multicystic dysplastic kidneys are associated with?
contralateral vesicoureteral reflux
132
All familial RCC disorders are
autosomal dominant
133
Papillary RCC type 1
cMet chromosome 7
134
Papillary RCC type 2
fumarate hydratase chromosome 1
135
Chromophobe RCC is associated with what chromosome?
folliculin, chromosome 17
136
what, if found in the bladder increases risk of upper tract TCC?
Inverted papilloma
137
if inverted papilloma is found in the bladder, what risk is increased?
upper tract TCC
138
what is the most important predictor of immediate graft function in living donor transplant?
donor urine output
139
why should the lower pole renal artery be preserved during transplant?
because it is blood supply to the upper ureter
140
most immunotherapy targets what?
IL-2 production which will inhibit T-cell activation
141
which immunotherapy has nephrotoxicity?
Tacrolimus/cyclosporin
142
which immunotherapy inhibits B-cell activation?
Rituximab
143
is CIC safe in transplant patients?
YES
144
Who can get IL-2?
good ECOG, no brain mets, normal cardiac & renal function
145
What agent can be used for non-clear cell
Temsirolimus
146
How do you know if a patient has short predicted survival?
3or more of the following:2 or more metastatic sites, low hemoglobin, calcium >10, LDH >1.5 times normal, systemic therapy initiated less than 1 year after the initial RCC dx
147
What agent is given to short survival patients?
Temsirolimus
148
What is indicated in AMLs?
Everolimus-in tuberous sclerosis patients whose AML does not require surgery
149
Is bevacizumab approved?
you must use it with Interferon alfa-2a
150
What is the mechanism of action for Bevacizumab?
Monoclonal antibody inhibits angiogenisis
151
Which agent will prevent good wound healing?
Bevacizumab, half life is 20 days
152
For metastatic RCC that is predominantly clear cell, the TKI preferred is?
sunitinib or pazopanib
153
Everolimus is indicated when?
treated of advanced RCC after failure of TKI
154
What is the only drug to achieve durable remission in patients with metastatic clear cell RCC?
IL-2
155
When is hyperfiltration injury most likely to occur?
if more than 75% of renal tissue is removed
156
what is hyperfiltration injury?
focal segmental glomerulosclerosis
157
what is an early harbinger of hyperfiltration injury?
proteinuria
158
How does ACE-inhibitors help prevent hyperfiltration injury?
reduces intraglomerular pressure
159
what is the treatment for solitary recurrence after nephrectomy?
resection wherever the recurrence is
160
invasive or free floating caval thrombus has a worse prognosis?
invasive
161
spermatogenesis occurs where?
in seminiferous tubules in the Sertoli Cell
162
how long does spermatogenesis in the ST take to complete?
74 days
163
Where does spermatozoa maturation take place
in the epididymis
164
where are mature sperm stored
cauda of the epididymis
165
what forms the blood-testis barrier
tight junctions between Sertoli Cells
166
what is sperm maturation?
as they travel through the epididymis, they acquire motility and ability to fertilize
167
what is the most common cause of male infertility?
varicocele
168
what is the most important risk factors for female infertility?
age >35
169
Cystic fibrosis transmembrane conductance regular gene is where?
Chromosome 7
170
CFTR causes
bilateral abscense of vas
171
CBAVD is associated with CFTR mutation
70%
172
Where are the Y micro-deletions?
long arm of Yq11 (AZF) region
173
A patient has a AZFc deletion, what is his chance of successful sperm extraction?
80%
174
a patient has a AZFa or AZFb deletion, what is their chance?
rare
175
what is the most common karyotype abnormality in male infertility?
Klinefelter's 47XXY
176
What does sperm agglutination denote?
antisperm antibodies
177
what is sperm agglutination?
refers to sperm stuck or bound together
178
what is the minimum endocrine eval for infertility?
Testosterone and FSH
179
What is the normal value for FSH?
2.0 -->12.0
180
based on FSH, how can you diagnose primary testicular failure?
when FSH>2 times normal
181
When is a transrectal ultrasound indicated?
low sperm count, low ejaculate volume, and palpable vas - suspecting obstruction
182
What is the indication for testis biopsy?
azospermia, normal testis size, at least one palpable vas, normal FSH
183
when should vasography be used?
ONLY intraop if you are going to repare a ductal obstruction
184
What is the treatment for anti-sperm antibodies in the serum or seminal fluid?
these are not clinically significant
185
Which antibodies can be found in the genital tract?
IgG and IgA, NOT IgM
186
most common location of fertilization
ampulla of the fallopian tube
187
most proximal site of motile sperm?
caudal epididymis
188
penile vibratory stimulation requires what nerves?
T10-S4 therefore the injury must be above this area
189
where does capacitation occur?
in contract with vaginal vault
190
what gives negative feed back on GnRH on the hypthalamus?
testosterone and estrogen
191
what converts testosterone to estrogen?
Aromatase
192
what genetic inheritence is Kallman's
X-linked
193
Y-microdeletions are found on what arm of the Y chromosome?
long arm Yq11
194
testis determining factor is found on what arm of the Y chromosome?
short arm
195
what is the fertility of Sertoli-cell only syndrome?
NONE should recommend adoption
196
what is the most important prognostic factor in vasectomy reversal?
time since vasectomy
197
how long can it take for sperm to return to ejaculate after vasectomy reversal?
one year
198
if the female is >37 and/or its been >15 years since vasectomy consider what?
ICSI
199
what is the treatment for sperm without acrosome (round head sperm)
ICSI
200
which testicluar germ cell type is most susceptible to damage from chemo/radiation?
spermatogonia
201
What are the causes of SUI in the female?
Urinary retention, DO, ISD, urethral hypermobility
202
Is oral estrogen indicated in SUI?
NO
203
What is the mechanism of Duloxetine?
serotonin and norepi reuptake inhibitor
204
How does Duloxetine work?
by increasing serotonin and norepi at synapse (increased bladder neck contraction)
205
IS an anterior repair indicated for SUI
NO, anterior colporrhaphy does not improve SUI
206
What are the two main colposuspensions?
retropubic suspensions: Marshall-Marchetti-Krantz & Burch
207
What is a side effect of MMK?
osteitis pubis due to suturing the periurethral tissue to the periosteum of the symphysis pubis
208
Which colposuspension has longer success?
Burch
209
what is the effectiveness of colposuspensions compared with slings?
both treat SUI, however slings cause less complications and less voiding dysfunction
210
what is the complication of retropubic suspension?
pelvic organ prolapse
211
what percentage of patients undergoing retropubic suspension will get POP?
14%
212
does sling erosion into the vagina need treatment?
only when symptomatic, may try estrogen cream first
213
erosion of a sling into the urethra or bladder requires what treatment?
removal of sling and repair
214
Worsening voiding symptoms after SUI procedure should produce what ddx?
infection, obstruction, erosion
215
Urethral obstruction in the immediate post operative period is treated with?
CIC and observation likely to resolve because its due to inflammation
216
what are the signs of osteitis pubis?
suprapubic pain, fever, decreased thigh ADDuction tx: conservative
217
radiation induced fistula should be repaired when?
at 6 months post radiation to allow formalization of tract
218
how long should you wait after VVF repair to obtain a cystogram?
2-3 weeks
219
martius flap is supplied by the internal pudendal art. After sacrifice of what artery?
external pudendal
220
what is the most common cause of vesicouterine fistula?
cesarean section
221
what is the imaging modality of choice for diagnosing vesicouterine fistula?
VCUG
222
what is the most common cause of colovesical fistula?
diverticulitis
223
what is the most common cuase of ureterocolic fistula?
Crohn's disease and on the right
224
do you have to open the peritoneum to use a peritoneal flap?
no, it is mobilized without opening the peritoneum
225
what is the treatment for ureterovaginal fistula?
most resolve with stent
226
What are the symptoms of autonomic dysreflexia?
HTN, Bradycardia, Flushing, headache
227
What is autonomic dysreflexia?
exaggerated sympathetic activity in response to stimuli below the level of the lesion
228
what spinal cord lesion is required for risk of autonomic dysreflexia?
above T8
229
what is the bladder finding during spinal shock?
acontractile and areflexic with closed bladder neck
230
What is the classic dysfunction found in spinal cord lesions above T6?
detrusor overactivity with smooth sphincter dyssynergia
231
what is the classic dysfunction found in spinal cord lesions below T6?
detrusor overactivity with striated sphincter dyssynergia
232
Ice water test is administered, what is the result?
no contractions are seen with a lesion below S2
233
what are the classic symptoms of Shy-Drager (multisystems atrophy)
DO, urgency with high PVR and ED in a young male
234
what nerve does lower abd surgery damage?
inferior hypogastric plexus (parasympathetic)
235
what is the result of damage to the inferior hypogastric plexus on the bladder?
detrusor areflexia and ED
236
what is the classic finding in lumbar disk disease?
normal bladder compliance with difficulty voiding
237
what nerve is damaged with inguinal hernia repair?
ilioinguinal nerve
238
what is the innervation of the ilioinguinal nerve?
upper thigh sensation along with base of penis and scrotum
239
what provides motor function to the cremasterics?
genitofemoral nerve
240
how is the genitofemoral nerve damaged during surgery?
it travels in the psoas and is injured during psoas hitch
241
what is the nerves responsible for erections?
inferior hypogastric plexus
242
what nerve is responsible for penile sensation?
pudendal on the dorsal surface
243
The cremasteric muscle is congruent with what abd muscle?
internal oblique
244
What kind of antibiotics can penetrate an infected renal cyst?
lipophilic antibiotics
245
what are the lipophilic antibiotics?
cipro, clinda, batrim, chloramphenicol
246
how can you treat Schistosomiasis of the bladder?
praziquantel
247
what is the sensory of the genitofemoral nerve?
sensation of the cord, scrotum and anterior thigh
248
The hypogastric artery is also known as what?
internal iliac
249
what is the arterial supply to the prostate?
branch of the inferior vesicle artery from the hypogastric artery
250
what nerves are responsible for detumescence?
T10-L3 superior hypogastric plexus
251
what is responsible for detumescence?
increased phospholipase C which increases inositol which increases calcium within the smooth muscle
252
Normal LH?
2.0-8.0
253
Normal FSH?
2.0-12
254
Normal AFP?
255
Normal Beta-HCG
256
What does the bulbocavernosus reflex test?
S2-S4 nerve roots
257
what happens to the ureter during bladder filling?
intramural ureteral pressure and contraction frequency increase
258
what is the mechanism by which a bladder decompensates?
as the bladder fills intramural tension increases, decreasing the blood flow causing hypoxia
259
what is the inhibitory neurotransmitter used in the cortex on the pontine
GABA
260
At what vertebral body does the spinal cord end?
L1-L2 (conus medullaris)
261
after abdominal resection injury to what nerve results in urinary retention?
inferior hypogastric plexus (parasympathetic)
262
what is the most common bladder finding in the elderly with incontinence?
detrussor overactivity with impaired contractility (urgency with elevated PVRs)
263
what is normal ureteral peristalsis pressure?
35cmH2O
264
What muscle does the Kegel exercise use?
pubococcygeus via Pudendal nerve(S2-S4)
265
What stains positive for HMB-45?
AML (&Melanoma)
266
what is the most common benign renal mass
papillary adenoma
267
what is the most common metastases to kidney
lymphoma/leukemia
268
name the renal pseudotumors
column of Bertin, fetal lobulation, dromedary hump, nodular compensatory hypertrophy
269
On a DMSA renal scan, what do true tumors look like?
decreased isotope uptake
270
Birt-Hogg-Dube is
autosomal dominant
271
BHD gene is on with what chromosome?
17
272
What percentage of BHD will have renal tumors?
25%
273
BHD may cause what other signs?
fibrofolliculomas, air filled pulmonary cysts, pneumothorax
274
Classic triad of Tuberous Sclerosis?
Mental retardation, seizures, adenoma sebaceum
275
TS is
autosomal dominant
276
TSC1 and TSC2 genes are located where
Chromosome 9 and Chromosome 16
277
what is the risk of RCC with TS?
2%
278
what is the risk of AML with TS?
60%
279
von Hippel Lindau is
autosomal dominant
280
VHL gene is located
Chromosome 3
281
name the non-urologic manifestations of VHL
cerebellar & spinal hemangioblastomas, retinal angiomas
282
name the urologic manifestations of VHL
renal cysts, clear cell RCC, pheochromocytomoas, epididymal cystadenomas, epididymal cysts
283
Clear cell RCC occurs in what percentage of VHL?
50%
284
oncocytoma arises from the?
Collecting duct
285
what type of cytoplasm does oncocytoma have?
eosinophilic
286
the cytoplasm is packed with what in oncocytomas?
mitochondria
287
what medication is FDA approved to shrink AML in patients with TS?
Everolimus
288
what is the risk of RCC from cysts acquired from renal failure?
1-3%
289
Clear cell RCC cytoplasm is full of what?
glycogen and lipids
290
Clear cell RCC arises from?
proximal tubule
291
the cytoplasm of Chromophobe RCC is filled with?
microvesicles
292
Chromophobe RCC arises from
collecting duct
293
Hale's colloidal iron stains positive for?
Chromophobe RCC
294
what is the most common form of RCC in patients with acquired cystic kidney disease?
Papillary RCC
295
why do patients get acquired cystic kidney disease?
renal failure
296
what is the most common RCC of patients on dialysis?
papillary RCC
297
papillary RCC arises from
proximal tubule
298
Papillary RCC is associated with what chromosomes?
polysomy 7 & 17, c-met mutation on Chromosome 7, Loss of Y-chromosome
299
what tumor has hobnail cells and stromal desmoplasia?
Collecting duct carcinoma
300
what is another name for collecting duct carcinoma?
Bellini duct carcinoma
301
what percentage of collecting duct carcinoma has mets at presentation?
40%
302
what renal tumor is associated with sickle cell trait?
renal medullary carcinoma
303
renal medullary carcinoma is seen in what race?
African American
304
what is the only renal tumor with racial predilection?
renal medullary carcinoma
305
Oncocytoma is associated with what syndrome?
BHD
306
Furhman grade does not consider what when formulating grade?
mitotic activity
307
what is the preferred treatment of a recurrence after nephrectomy?
tumor resection
308
RCC with solitary metastatic tumor, what is the treatment?
nephrectomy and meastasis resection
309
What is the only drug used in non-clear cell RCC?
temsirolimus
310
can you give chemo for RCC brain met?
no typically ineffective, tx with surgery or radiation to brain met
311
what drug achieved remission in metastatic clear cell RCC?
interleukin-2 (IL-2)
312
IL-2 is only effective against what type of RCC?
clear cell
313
what is mTor?
a protein that regulates hypoxia factors (HIF) & VEGF, when mTor is decreased cells reduce angiogenesis and proliferation
314
which mTor inhibitor is indicated in pts with short survival?
Temsirolimus
315
what drug is indicated in non clear cell RCC?
Temsirolimus
316
after failure of Tyrosine Kinase Inhibitors what can be used?
Everolimus
317
metastatic clear cell the preferred initial tx is?
sunitinib or pazopanib (TKIs)
318
Bevacizumab inhibits what
VEGF-A
319
what are the predictors of short survival?
2 or more metastatic sites, low hemoglobin, Ca >10, LDH >1.5 times normal, high ECOG
320
what indicates hyperfiltration injury after partial?
proteinuria
321
after how much kidney removed would hyperfiltration likely occur?
75% removed
322
how can you reduce risk of hyperfiltration injury?
ACE inhibitors
323
how does ACE inhibitors do that?
decreasing intraglomerular pressure
324
What is the risk of local recurrence of RCC in renal fossa?
325
what is the risk of RCC in the contralateral kidney?
1.20%
326
greater survival is seen with timing of metastasis in RCC
a longer inteval between RN and development of met (>2yr) is accociated with longer survival
327
medullary sponge kidney disease is associated with what chromosome?
RET oncogene
328
What is the differenatial diagnosis for Nephrocalcinosis?
Medullary sponge kidney, hyperparathyroidism, distal RTA (1), renal TB, papillary necrosis, hyperoxaluria
329
MSK disease has what appearance on KUB?
paint brush like appearance of calyces
330
What is the treatment for the cysts of medullary sponge kidney?
None
331
Multicystic dysplastic kidneys are associated with?
contralateral vesicoureteral reflux
332
All familial RCC disorders are
autosomal dominant
333
Papillary RCC type 1
cMet chromosome 7
334
Papillary RCC type 2
fumarate hydratase chromosome 1
335
Chromophobe RCC is associated with what chromosome?
folliculin, chromosome 17
336
what, if found in the bladder increases risk of upper tract TCC?
Inverted papilloma
337
if inverted papilloma is found in the bladder, what risk is increased?
upper tract TCC
338
what is the most important predictor of immediate graft function in living donor transplant?
donor urine output
339
why should the lower pole renal artery be preserved during transplant?
because it is blood supply to the upper ureter
340
most immunotherapy targets what?
IL-2 production which will inhibit T-cell activation
341
which immunotherapy has nephrotoxicity?
Tacrolimus/cyclosporin
342
which immunotherapy inhibits B-cell activation?
Rituximab
343
is CIC safe in transplant patients?
YES
344
Who can get IL-2?
good ECOG, no brain mets, normal cardiac & renal function
345
What agent can be used for non-clear cell
Temsirolimus
346
How do you know if a patient has short predicted survival?
3or more of the following:2 or more metastatic sites, low hemoglobin, calcium >10, LDH >1.5 times normal, systemic therapy initiated less than 1 year after the initial RCC dx
347
What agent is given to short survival patients?
Temsirolimus
348
What is indicated in AMLs?
Everolimus-in tuberous sclerosis patients whose AML does not require surgery
349
Is bevacizumab approved?
you must use it with Interferon alfa-2a
350
What is the mechanism of action for Bevacizumab?
Monoclonal antibody inhibits angiogenisis
351
Which agent will prevent good wound healing?
Bevacizumab, half life is 20 days
352
For metastatic RCC that is predominantly clear cell, the TKI preferred is?
sunitinib or pazopanib
353
Everolimus is indicated when?
treated of advanced RCC after failure of TKI
354
What is the only drug to achieve durable remission in patients with metastatic clear cell RCC?
IL-2
355
When is hyperfiltration injury most likely to occur?
if more than 75% of renal tissue is removed
356
what is hyperfiltration injury?
focal segmental glomerulosclerosis
357
what is an early harbinger of hyperfiltration injury?
proteinuria
358
How does ACE-inhibitors help prevent hyperfiltration injury?
reduces intraglomerular pressure
359
what is the treatment for solitary recurrence after nephrectomy?
resection wherever the recurrence is
360
invasive or free floating caval thrombus has a worse prognosis?
invasive
361
spermatogenesis occurs where?
in seminiferous tubules in the Sertoli Cell
362
how long does spermatogenesis in the ST take to complete?
74 days
363
Where does spermatozoa maturation take place
in the epididymis
364
where are mature sperm stored
cauda of the epididymis
365
what forms the blood-testis barrier
tight junctions between Sertoli Cells
366
what is sperm maturation?
as they travel through the epididymis, they acquire motility and ability to fertilize
367
what is the most common cause of male infertility?
varicocele
368
what is the most important risk factors for female infertility?
age >35
369
Cystic fibrosis transmembrane conductance regular gene is where?
Chromosome 7
370
CFTR causes
bilateral abscense of vas
371
CBAVD is associated with CFTR mutation
70%
372
Where are the Y micro-deletions?
long arm of Yq11 (AZF) region
373
A patient has a AZFc deletion, what is his chance of successful sperm extraction?
80%
374
a patient has a AZFa or AZFb deletion, what is their chance?
rare
375
what is the most common karyotype abnormality in male infertility?
Klinefelter's 47XXY
376
What does sperm agglutination denote?
antisperm antibodies
377
what is sperm agglutination?
refers to sperm stuck or bound together
378
what is the minimum endocrine eval for infertility?
Testosterone and FSH
379
What is the normal value for FSH?
2.0 -->12.0
380
based on FSH, how can you diagnose primary testicular failure?
when FSH>2 times normal
381
When is a transrectal ultrasound indicated?
low sperm count, low ejaculate volume, and palpable vas - suspecting obstruction
382
What is the indication for testis biopsy?
azospermia, normal testis size, at least one palpable vas, normal FSH
383
when should vasography be used?
ONLY intraop if you are going to repare a ductal obstruction
384
What is the treatment for anti-sperm antibodies in the serum or seminal fluid?
these are not clinically significant
385
Which antibodies can be found in the genital tract?
IgG and IgA, NOT IgM
386
most common location of fertilization
ampulla of the fallopian tube
387
most proximal site of motile sperm?
caudal epididymis
388
penile vibratory stimulation requires what nerves?
T10-S4 therefore the injury must be above this area
389
where does capacitation occur?
in contract with vaginal vault
390
what gives negative feed back on GnRH on the hypthalamus?
testosterone and estrogen
391
what converts testosterone to estrogen?
Aromatase
392
what genetic inheritence is Kallman's
X-linked
393
Y-microdeletions are found on what arm of the Y chromosome?
long arm Yq11
394
testis determining factor is found on what arm of the Y chromosome?
short arm
395
what is the fertility of Sertoli-cell only syndrome?
NONE should recommend adoption
396
what is the most important prognostic factor in vasectomy reversal?
time since vasectomy
397
how long can it take for sperm to return to ejaculate after vasectomy reversal?
one year
398
if the female is >37 and/or its been >15 years since vasectomy consider what?
ICSI
399
what is the treatment for sperm without acrosome (round head sperm)
ICSI
400
which testicluar germ cell type is most susceptible to damage from chemo/radiation?
spermatogonia
401
What are the causes of SUI in the female?
Urinary retention, DO, ISD, urethral hypermobility
402
Is oral estrogen indicated in SUI?
NO
403
What is the mechanism of Duloxetine?
serotonin and norepi reuptake inhibitor
404
How does Duloxetine work?
by increasing serotonin and norepi at synapse (increased bladder neck contraction)
405
IS an anterior repair indicated for SUI
NO, anterior colporrhaphy does not improve SUI
406
What are the two main colposuspensions?
retropubic suspensions: Marshall-Marchetti-Krantz & Burch
407
What is a side effect of MMK?
osteitis pubis due to suturing the periurethral tissue to the periosteum of the symphysis pubis
408
Which colposuspension has longer success?
Burch
409
what is the effectiveness of colposuspensions compared with slings?
both treat SUI, however slings cause less complications and less voiding dysfunction
410
what is the complication of retropubic suspension?
pelvic organ prolapse
411
what percentage of patients undergoing retropubic suspension will get POP?
14%
412
does sling erosion into the vagina need treatment?
only when symptomatic, may try estrogen cream first
413
erosion of a sling into the urethra or bladder requires what treatment?
removal of sling and repair
414
Worsening voiding symptoms after SUI procedure should produce what ddx?
infection, obstruction, erosion
415
Urethral obstruction in the immediate post operative period is treated with?
CIC and observation likely to resolve because its due to inflammation
416
what are the signs of osteitis pubis?
suprapubic pain, fever, decreased thigh ADDuction tx: conservative
417
radiation induced fistula should be repaired when?
at 6 months post radiation to allow formalization of tract
418
how long should you wait after VVF repair to obtain a cystogram?
2-3 weeks
419
martius flap is supplied by the internal pudendal art. After sacrifice of what artery?
external pudendal
420
what is the most common cause of vesicouterine fistula?
cesarean section
421
what is the imaging modality of choice for diagnosing vesicouterine fistula?
VCUG
422
what is the most common cause of colovesical fistula?
diverticulitis
423
what is the most common cuase of ureterocolic fistula?
Crohn's disease and on the right
424
do you have to open the peritoneum to use a peritoneal flap?
no, it is mobilized without opening the peritoneum
425
what is the treatment for ureterovaginal fistula?
most resolve with stent
426
What are the symptoms of autonomic dysreflexia?
HTN, Bradycardia, Flushing, headache
427
What is autonomic dysreflexia?
exaggerated sympathetic activity in response to stimuli below the level of the lesion
428
what spinal cord lesion is required for risk of autonomic dysreflexia?
above T8
429
what is the bladder finding during spinal shock?
acontractile and areflexic with closed bladder neck
430
What is the classic dysfunction found in spinal cord lesions above T6?
detrusor overactivity with smooth sphincter dyssynergia
431
what is the classic dysfunction found in spinal cord lesions below T6?
detrusor overactivity with striated sphincter dyssynergia
432
Ice water test is administered, what is the result?
no contractions are seen with a lesion below S2
433
what are the classic symptoms of Shy-Drager (multisystems atrophy)
DO, urgency with high PVR and ED in a young male
434
what nerve does lower abd surgery damage?
inferior hypogastric plexus (parasympathetic)
435
what is the result of damage to the inferior hypogastric plexus on the bladder?
detrusor areflexia and ED
436
what is the classic finding in lumbar disk disease?
normal bladder compliance with difficulty voiding
437
what nerve is damaged with inguinal hernia repair?
ilioinguinal nerve
438
what is the innervation of the ilioinguinal nerve?
upper thigh sensation along with base of penis and scrotum
439
what provides motor function to the cremasterics?
genitofemoral nerve
440
how is the genitofemoral nerve damaged during surgery?
it travels in the psoas and is injured during psoas hitch
441
what is the nerves responsible for erections?
inferior hypogastric plexus
442
what nerve is responsible for penile sensation?
pudendal on the dorsal surface
443
The cremasteric muscle is congruent with what abd muscle?
internal oblique
444
What kind of antibiotics can penetrate an infected renal cyst?
lipophilic antibiotics
445
what are the lipophilic antibiotics?
cipro, clinda, batrim, chloramphenicol
446
how can you treat Schistosomiasis of the bladder?
praziquantel
447
what is the sensory of the genitofemoral nerve?
sensation of the cord, scrotum and anterior thigh
448
The hypogastric artery is also known as what?
internal iliac
449
what is the arterial supply to the prostate?
branch of the inferior vesicle artery from the hypogastric artery
450
what nerves are responsible for detumescence?
T10-L3 superior hypogastric plexus
451
what is responsible for detumescence?
increased phospholipase C which increases inositol which increases calcium within the smooth muscle
452
Normal LH?
2.0-8.0
453
Normal FSH?
2.0-12
454
Normal AFP?
455
Normal Beta-HCG
456
What does the bulbocavernosus reflex test?
S2-S4 nerve roots
457
what happens to the ureter during bladder filling?
intramural ureteral pressure and contraction frequency increase
458
what is the mechanism by which a bladder decompensates?
as the bladder fills intramural tension increases, decreasing the blood flow causing hypoxia
459
what is the inhibitory neurotransmitter used in the cortex on the pontine
GABA
460
At what vertebral body does the spinal cord end?
L1-L2 (conus medullaris)
461
after abdominal resection injury to what nerve results in urinary retention?
inferior hypogastric plexus (parasympathetic)
462
what is the most common bladder finding in the elderly with incontinence?
detrussor overactivity with impaired contractility (urgency with elevated PVRs)
463
what is normal ureteral peristalsis pressure?
35cmH2O
464
What muscle does the Kegel exercise use?
pubococcygeus via Pudendal nerve(S2-S4)
465
What stains positive for HMB-45?
AML (&Melanoma)
466
what is the most common benign renal mass
papillary adenoma
467
what is the most common metastases to kidney
lymphoma/leukemia
468
name the renal pseudotumors
column of Bertin, fetal lobulation, dromedary hump, nodular compensatory hypertrophy
469
On a DMSA renal scan, what do true tumors look like?
decreased isotope uptake
470
Birt-Hogg-Dube is
autosomal dominant
471
BHD gene is on with what chromosome?
17
472
What percentage of BHD will have renal tumors?
25%
473
BHD may cause what other signs?
fibrofolliculomas, air filled pulmonary cysts, pneumothorax
474
Classic triad of Tuberous Sclerosis?
Mental retardation, seizures, adenoma sebaceum
475
TS is
autosomal dominant
476
TSC1 and TSC2 genes are located where
Chromosome 9 and Chromosome 16
477
what is the risk of RCC with TS?
2%
478
what is the risk of AML with TS?
60%
479
von Hippel Lindau is
autosomal dominant
480
VHL gene is located
Chromosome 3
481
name the non-urologic manifestations of VHL
cerebellar & spinal hemangioblastomas, retinal angiomas
482
name the urologic manifestations of VHL
renal cysts, clear cell RCC, pheochromocytomoas, epididymal cystadenomas, epididymal cysts
483
Clear cell RCC occurs in what percentage of VHL?
50%
484
oncocytoma arises from the?
Collecting duct
485
what type of cytoplasm does oncocytoma have?
eosinophilic
486
the cytoplasm is packed with what in oncocytomas?
mitochondria
487
what medication is FDA approved to shrink AML in patients with TS?
Everolimus
488
what is the risk of RCC from cysts acquired from renal failure?
1-3%
489
Clear cell RCC cytoplasm is full of what?
glycogen and lipids
490
Clear cell RCC arises from?
proximal tubule
491
the cytoplasm of Chromophobe RCC is filled with?
microvesicles
492
Chromophobe RCC arises from
collecting duct
493
Hale's colloidal iron stains positive for?
Chromophobe RCC
494
what is the most common form of RCC in patients with acquired cystic kidney disease?
Papillary RCC
495
why do patients get acquired cystic kidney disease?
renal failure
496
what is the most common RCC of patients on dialysis?
papillary RCC
497
papillary RCC arises from
proximal tubule
498
Papillary RCC is associated with what chromosomes?
polysomy 7 & 17, c-met mutation on Chromosome 7, Loss of Y-chromosome
499
what tumor has hobnail cells and stromal desmoplasia?
Collecting duct carcinoma
500
what is another name for collecting duct carcinoma?
Bellini duct carcinoma
501
what percentage of collecting duct carcinoma has mets at presentation?
40%
502
what renal tumor is associated with sickle cell trait?
renal medullary carcinoma
503
renal medullary carcinoma is seen in what race?
African American
504
what is the only renal tumor with racial predilection?
renal medullary carcinoma
505
Oncocytoma is associated with what syndrome?
BHD
506
Furhman grade does not consider what when formulating grade?
mitotic activity
507
what is the preferred treatment of a recurrence after nephrectomy?
tumor resection
508
RCC with solitary metastatic tumor, what is the treatment?
nephrectomy and meastasis resection
509
What is the only drug used in non-clear cell RCC?
temsirolimus
510
can you give chemo for RCC brain met?
no typically ineffective, tx with surgery or radiation to brain met
511
what drug achieved remission in metastatic clear cell RCC?
interleukin-2 (IL-2)
512
IL-2 is only effective against what type of RCC?
clear cell
513
what is mTor?
a protein that regulates hypoxia factors (HIF) & VEGF, when mTor is decreased cells reduce angiogenesis and proliferation
514
which mTor inhibitor is indicated in pts with short survival?
Temsirolimus
515
what drug is indicated in non clear cell RCC?
Temsirolimus
516
after failure of Tyrosine Kinase Inhibitors what can be used?
Everolimus
517
metastatic clear cell the preferred initial tx is?
sunitinib or pazopanib (TKIs)
518
Bevacizumab inhibits what
VEGF-A
519
what are the predictors of short survival?
2 or more metastatic sites, low hemoglobin, Ca >10, LDH >1.5 times normal, high ECOG
520
what indicates hyperfiltration injury after partial?
proteinuria
521
after how much kidney removed would hyperfiltration likely occur?
75% removed
522
how can you reduce risk of hyperfiltration injury?
ACE inhibitors
523
how does ACE inhibitors do that?
decreasing intraglomerular pressure
524
What is the risk of local recurrence of RCC in renal fossa?
525
what is the risk of RCC in the contralateral kidney?
1.20%
526
greater survival is seen with timing of metastasis in RCC
a longer inteval between RN and development of met (>2yr) is accociated with longer survival
527
medullary sponge kidney disease is associated with what chromosome?
RET oncogene
528
What is the differenatial diagnosis for Nephrocalcinosis?
Medullary sponge kidney, hyperparathyroidism, distal RTA (1), renal TB, papillary necrosis, hyperoxaluria
529
MSK disease has what appearance on KUB?
paint brush like appearance of calyces
530
What is the treatment for the cysts of medullary sponge kidney?
None
531
Multicystic dysplastic kidneys are associated with?
contralateral vesicoureteral reflux
532
All familial RCC disorders are
autosomal dominant
533
Papillary RCC type 1
cMet chromosome 7
534
Papillary RCC type 2
fumarate hydratase chromosome 1
535
Chromophobe RCC is associated with what chromosome?
folliculin, chromosome 17
536
what, if found in the bladder increases risk of upper tract TCC?
Inverted papilloma
537
if inverted papilloma is found in the bladder, what risk is increased?
upper tract TCC
538
what is the most important predictor of immediate graft function in living donor transplant?
donor urine output
539
why should the lower pole renal artery be preserved during transplant?
because it is blood supply to the upper ureter
540
most immunotherapy targets what?
IL-2 production which will inhibit T-cell activation
541
which immunotherapy has nephrotoxicity?
Tacrolimus/cyclosporin
542
which immunotherapy inhibits B-cell activation?
Rituximab
543
is CIC safe in transplant patients?
YES
544
Who can get IL-2?
good ECOG, no brain mets, normal cardiac & renal function
545
What agent can be used for non-clear cell
Temsirolimus
546
How do you know if a patient has short predicted survival?
3or more of the following:2 or more metastatic sites, low hemoglobin, calcium >10, LDH >1.5 times normal, systemic therapy initiated less than 1 year after the initial RCC dx
547
What agent is given to short survival patients?
Temsirolimus
548
What is indicated in AMLs?
Everolimus-in tuberous sclerosis patients whose AML does not require surgery
549
Is bevacizumab approved?
you must use it with Interferon alfa-2a
550
What is the mechanism of action for Bevacizumab?
Monoclonal antibody inhibits angiogenisis
551
Which agent will prevent good wound healing?
Bevacizumab, half life is 20 days
552
For metastatic RCC that is predominantly clear cell, the TKI preferred is?
sunitinib or pazopanib
553
Everolimus is indicated when?
treated of advanced RCC after failure of TKI
554
What is the only drug to achieve durable remission in patients with metastatic clear cell RCC?
IL-2
555
When is hyperfiltration injury most likely to occur?
if more than 75% of renal tissue is removed
556
what is hyperfiltration injury?
focal segmental glomerulosclerosis
557
what is an early harbinger of hyperfiltration injury?
proteinuria
558
How does ACE-inhibitors help prevent hyperfiltration injury?
reduces intraglomerular pressure
559
what is the treatment for solitary recurrence after nephrectomy?
resection wherever the recurrence is
560
invasive or free floating caval thrombus has a worse prognosis?
invasive
561
spermatogenesis occurs where?
in seminiferous tubules in the Sertoli Cell
562
how long does spermatogenesis in the ST take to complete?
74 days
563
Where does spermatozoa maturation take place
in the epididymis
564
where are mature sperm stored
cauda of the epididymis
565
what forms the blood-testis barrier
tight junctions between Sertoli Cells
566
what is sperm maturation?
as they travel through the epididymis, they acquire motility and ability to fertilize
567
what is the most common cause of male infertility?
varicocele
568
what is the most important risk factors for female infertility?
age >35
569
Cystic fibrosis transmembrane conductance regular gene is where?
Chromosome 7
570
CFTR causes
bilateral abscense of vas
571
CBAVD is associated with CFTR mutation
70%
572
Where are the Y micro-deletions?
long arm of Yq11 (AZF) region
573
A patient has a AZFc deletion, what is his chance of successful sperm extraction?
80%
574
a patient has a AZFa or AZFb deletion, what is their chance?
rare
575
what is the most common karyotype abnormality in male infertility?
Klinefelter's 47XXY
576
What does sperm agglutination denote?
antisperm antibodies
577
what is sperm agglutination?
refers to sperm stuck or bound together
578
what is the minimum endocrine eval for infertility?
Testosterone and FSH
579
What is the normal value for FSH?
2.0 -->12.0
580
based on FSH, how can you diagnose primary testicular failure?
when FSH>2 times normal
581
When is a transrectal ultrasound indicated?
low sperm count, low ejaculate volume, and palpable vas - suspecting obstruction
582
What is the indication for testis biopsy?
azospermia, normal testis size, at least one palpable vas, normal FSH
583
when should vasography be used?
ONLY intraop if you are going to repare a ductal obstruction
584
What is the treatment for anti-sperm antibodies in the serum or seminal fluid?
these are not clinically significant
585
Which antibodies can be found in the genital tract?
IgG and IgA, NOT IgM
586
most common location of fertilization
ampulla of the fallopian tube
587
most proximal site of motile sperm?
caudal epididymis
588
penile vibratory stimulation requires what nerves?
T10-S4 therefore the injury must be above this area
589
where does capacitation occur?
in contract with vaginal vault
590
what gives negative feed back on GnRH on the hypthalamus?
testosterone and estrogen
591
what converts testosterone to estrogen?
Aromatase
592
what genetic inheritence is Kallman's
X-linked
593
Y-microdeletions are found on what arm of the Y chromosome?
long arm Yq11
594
testis determining factor is found on what arm of the Y chromosome?
short arm
595
what is the fertility of Sertoli-cell only syndrome?
NONE should recommend adoption
596
what is the most important prognostic factor in vasectomy reversal?
time since vasectomy
597
how long can it take for sperm to return to ejaculate after vasectomy reversal?
one year
598
if the female is >37 and/or its been >15 years since vasectomy consider what?
ICSI
599
what is the treatment for sperm without acrosome (round head sperm)
ICSI
600
which testicluar germ cell type is most susceptible to damage from chemo/radiation?
spermatogonia
