Fiser: Subspecialties (urology, ortho, gyn)

Question 1

which nerve is most at risk for injury in the lithotomy position?

Answer 1

peroneal

Question 2

anterior to posterior of renal structures?

Answer 2

renal vein (anterior)
renal aa
renal pelvis (posterior)

Question 3

which renal vein can be ligated?

Answer 3

the left can b ligated from the IVC 2/2 increased collaterals

Question 4

what is the most common type of kidney stone?

Answer 4

calcium oxalate

Question 5

which type of kidney stone do pts get who have had their TI resected?

Answer 5

calcium oxalate: due to increased oxalate absorption in colon

Question 6

what are and what causes struvite stones?

Answer 6

magnesium ammonium phosphate stones, cause staghorn calculi, occur w infections (proteus mirabilis) that are urease producing

Question 7

which kidney stones are radiolucent?

Answer 7

uric acid and cysteine

Question 8

which patients (3) are more at risk for uric acid stones?

Answer 8

• ileostomies, gout and myelopoliferative disorders

Question 9

what drug is used to prevent cysteine stones?

Answer 9

tiopronin

Question 10

how do you resect testicular cancer?

Answer 10

inguinal incision- scrotal incisions will disrupt the lymphatics

Question 11

what level correlates with testicular ca tumor bulk ?

Answer 11

LDH

Question 12

MC types of testicular ca

Answer 12

germ cell: seminoma and non-seminoma (90%)

Question 13

diagnosis and management of seminoma

Answer 13

• 10% have elevated b-hcg, do NOT hav elevated AFP

ALL get orchiectomy and retroperitoneal XRT

Question 14

diagnosis and management of non-seminoma testicular ca

Answer 14

• 90% have elevated AFP and B-HCG
  ALL get orchiectomy and RP LN dissection
  Stage 2 or greater: Chemo

Question 15

what chemotherapy agents do you give in testicular ca?

Answer 15

cisplatin, bleomycin, VP-16

Question 16

how do you proceed when you get stage I prostate ca after a TURP?

Answer 16

nothing else

Question 17

when do you give XRT and androgen ablation in prostate ca?

Answer 17

extracapsular invasion (T3+) or metastatic disease

Question 18

1 primary tumor of the kidney

Answer 18

RCC

Question 19

when can you perform wedge resection of metastatic RCC?

Answer 19

isolated lung or colon mets

Question 20

MC location of RCC mets?

Answer 20

lung

Question 21

1 tumor of the kidney

Answer 21

mets from breast ca

Question 22

when do you perform a partial nephrectomy in RCC?

Answer 22

in patients who would otherwise require HD after nephrectomy, tumor <4cm and Cr >2.5

Question 23

what is von-hippel lindau syndrome?

Answer 23

multifocal and recurrent RCC, renal cysts, CNS tumor and pheochromocytomas

Question 24

risk factors for transitional cell ca of bladder?

Answer 24

smoking, aniline dyes, cyclophosphamide

Question 25

what is T2 transitional bladder cancer and how do you manage?

Answer 25

T2 invades into muscle wall, manage w cystectomy w ileal conduit, chemo (MVAC: methotrexate, vinblastine, adriamycin, cisplatin) and XRT

Question 26

squamous cell ca of bladder is related to what?

Answer 26

schistosomiasis infection

Question 27

what layer hypertrophies in BPH?

Answer 27

transitional zone

Question 28

initial therapy of BPH?

Answer 28

alpha blockers: terazosin, doxazosin (relax smooth muscle) | 5-alpha-reductase inhibitors: finasteride

Question 29

MOA finasteride

Answer 29

5-alpha-reductase inhibitors | inhibits conversion of testosterone to dihydrotestosterone, inhibits prostate hypertrophy

Question 30

MC complication of TURP

Answer 30

retrograde ejaculation

Question 31

how does left RCC cause a varicocele?

Answer 31

left gonadal vein inserts into left renal vein and obstruction of vein by renal tumor can lead to varicocele

Question 32

what is the MC urinary tract abnormality?

Answer 32

ureteral duplication

Question 33

what is MC primary cancer of the vagina?

Answer 33

squamous cell CA

Question 34

what does diethylstilbestrol cause? (DES)

Answer 34

clear cell ca of vagina

Question 35

what is botryoides?

Answer 35

rhabdosarcoma that occurs in young girls

Question 36

management of vulvar cancer?

Answer 36

MC squamous cell CA <2cm = stage 1, WLE and ipsilateral node dsxn w 2cm margins >2cm = stage II or greater, radical vulvectomy w bilateral inguinal node dsxn, post op XRT if margins <1cm

Question 37

which type of ovarian cancer has the worst prognosis?

Answer 37

clear cell type

Question 38

stages of ovarian ca?

Answer 38

stage I: one or both ovaries only II: limited to pelvis III: throughout abdomen IV: distant

Question 39

what is meige's syndrome?

Answer 39

pelvic ovarian fibroma that causes ascites and hydrothorax (excision of tumor cures syndrome)

Question 40

where does cervical ca mets to first?

Answer 40

obturator nodes

Question 41

what is postpartum pelvic thrombophlebitis? tx?

Answer 41

can lead to ovarian vein, IVC, and hepatic vein thrombosis get liver failure w ascites after pregnancy tx: heparin and abx

Question 42

where does cartilage receive its nutrients from?

Answer 42

synovial fluid (osmotic)

Question 43

what is the salter-harris classification?

Answer 43

classification of epiphyseal injuries: type I and II: closed reduction types III, IV, V: ORIF, cross the epiphyseal plate and can affect the growth

Question 44

whats a jone's fractue?

Answer 44

fx of 5th metatarsal, assoc w nonunion

Question 45

which fx is assoc w avascular necrosis?

Answer 45

scaphoid, femoral neck, talus and hip dislocation

Question 46

fx associated w compartment syndrome?

Answer 46

supracondylar humerus, tibia, calcaneus

Question 47

biggest risk factor for nonunion?

Answer 47

smoking

Question 48

injury assoc w anterior shoulder dislocation?

Answer 48

axillary nerve injury (closed reduction)

Question 49

injury assoc w posterior shoulder dislocation?

Answer 49

axillary artery injury (seen in seizures and electrocution)

Question 50

management of supracondylar humeral fracture in adults vs children?

Answer 50

adults: ORIF children: nondisplaced = closed reduction, displaced = ORIF

Question 51

what is a colles fracture?

Answer 51

fall onto outstretched hand, distal radius fx -> closed reduction

Question 52

what is monteggia's fx?

Answer 52

proximal ulnar fx and radial head dislocation | tx: ORIF