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Flashcards in Pestana Urology Deck (44)
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1

How does testicular torsion differ from acute epididymitis in terms of AGE GROUP?

Testicular torsion: young adolescent Acute epididymitis: young men

2

How does testicular torsion differ from acute epididymitis in terms of SYMPTOMATOLOGY?

Testicular torsion: sudden onset of severe testicular pain, NON-tender cord, NO fever, NO pyuria, NO history of mumps Acute epididymitis: sudden onset of severe testicular pain, TENDER cord, FEVER, PYURIA

3

How does testicular torsion differ from acute epididymitis in terms of PHYSICAL EXAM?

Testicular torsion: testes is "high riding" and with a "horizontal lie" Acute epididymitis: testes is in a normal position

4

How does testicular torsion differ from acute epididymitis in terms of TREATMENT?

Testicular torsion: immediate surgical intervention (untwisting + orchiopexy) Acute epididymitis: antibiotics

5

What should you suspect if a patient who is waiting for a stone to pass suddenly develops chills, fever spikes, and flank pain? What should you do immediately? 2

IV antibiotics + immediate decompression of the urinary tract above the obstruction via ureteral stent or percutaneous nephrostomy

6

Plan of care for UTI in women?

empiric antibiotics

7

Plan of care for UTI + pyelonephritis in women?

empiric antibiotics + UC + urologic w/u to r/o concomitant obstruction (CT or sono)

8

Plan of care for UTI in children or men?

empiric antibiotics + UC + urologic w/u to r/o concomitant obstruction (CT or sono)

9

Benefit of IVP? Limitations? 3 What two tests has replaced IVP? 3

benefit: excellent views of KUB limitations: cannot detect early bladder allergic reactions to the dye, contraindicated in patients with limited renal function (Cr >2) Replaced: CT (best for kidney tumors), and Sonograms (best for obstruction), Cystoscopy (best for early cancers)

10

What imaging modality can aid in detecting early carcinomas of the bladder?

cystoscopy

11

What are the symptoms of pyelonephritis? Treatment? 3

chills, fever N, V flank pain Treatment: hospitalization, IV antibiotics, and urologic w/u (CT or sono)

12

Acute bacterial prostatitis is commonly seen in this age group. How do they usually present? Treatment? Precautions to take and why?

older men chills, fever dysuria, frequency diffuse back pain exquisitely tender prostate on rectal exam Tx: IV abx Precautions: AVOID rectal exams because continued prostatic massage can lead to SEPTIC SHOCK

13

common reason for a new born boy to not urinate during the first few days of life

posterior urethral valves

14

Posterior Urethral Valves

Dx? 

Tx-3?

Dx = Voiding Cystourethrogram

Tx = Catheterization vs. endoscopic fulguration vs. resection

15

What should you avoid doing in a male infant with obvious hypospadias and why?

avoid circumcision because the skin of the prepuce will be needed for the reconstruction

16

What should you do when a child presents with UTI?

urologic w/u - look for vesicoureteral reflux or congenital anomaly

17

What are some symptoms of vesicoureteral reflux with infection? How is it diagnosed and treated?

fever, chills, dysuria, frequency low abdominal pain, perineal pain, flank pain Dx: voiding cystourethrogram Tx: long-term antibiotics until the child "grows out of the problem"

18

A mother brings her 6yo girl to you because "she has failed miserably to get proper toilet training." On questioning you find out that the little girl perceives normally the sensation of having to void and voids normally and at appropriate intervals, but also happens to be wet with urine all the time. What is the most likely diagnosis and why is there a discrepancy in her symptoms? What would you recommend?

Low-implantation of a ureter - one ureter empties into the vagina and has no sphincter; the other ureter is normally implanted and accounts for her normal voiding patterns Recommend: corrective surgery

19

A 16-year-old boy goes on a beer-drinking binge for the first time in his life. Shortly thereafter he develops colicky flank pain. What is the most likely diagnosis?

Ureteropelvic junction obstruction - allows a NORMAL urinary output to flow without difficulty, but if a large diuresis occurs, the narrowed area cannot handle it, thus causing the colicky flank pain

20

What is the w/u of hematuria?

CT scan followed by cystoscopy

21

How does RCC usually present? 3 What other symptoms could be associated? Diagnosis? Treatment?

hematuria, flank pain, flank mass hyperCa, erythrocytosis, and elevated liver enzymes Dx: CT scan Treatment: surgery

22

What is bladder cancer closely associated with?

smoking

23

How does bladder cancer usually present?

hematuria

24

How is bladder cancer usually diagnosed?

CT scan + cystoscopy, most likely diagnosis is bladder cancer

25

How is bladder cancer usually treated? 2

surgery intravesical BCG lifelong close follow-up due to high rate of recurrence

26

A 59-year-old black man has a rock-hard, discrete, 1.5-cm nodule felt in his prostate during a routine physical examination. What is the most likely diagnosis? What is the best next step in management?

Prostate cancer Next step: transrectal needle biopsy

27

Treatments for localized prostate cancer?

surgical resection +/- radiation

28

Treatments for metastatic prostate cancer? 2

1) androgen ablation (LHRH agonist, anti-androgens like flutamide) 2) surgical (orchiectomy)

29

A 78-year-old man comes in for a routine medical checkup. He is asymptomatic. When a physician had seen him 5 years earlier, a PSA had been ordered, but he notices as he leaves the office this time that the study has not been requested. He asks if he should get it. What is the best next step in management?

He should NOT get the test NB: After a certain age, most men get prostate cancer, but die of SOMETHING ELSE. As a rule, ASYMPTOMATIC PROSTATIC CANCER is not treated after the age of 75, and therefore, there is NO point in looking for it

30

A 25-year-old man presents with a painless, hard testicular mass. What is the most likely diagnosis? Next best step in management and treatment?

Testicular cancer - shoot to kill first, and ask questions later! Dx: biopsy + radical orchiectomy via inguinal route Tx: platinum based chemoRx (most are exquisitely radiosensitive and chemosensitive)