Tables Combined Flashcards
1
Q
What urologic imaging procedures have no radiation exposure?
A
Ultrasound, MRI.
Hint: Imagine the sound of the ocean and the mysterious magnetic resonance of the earth – all natural, no radiation!
2
Q
What are the examples of urologic imaging procedures with minimal radiation exposure (less than 0.1 mSv)?
A
Chest radiographs.
3
Q
What are the examples of urologic imaging procedures with low radiation exposure (0.1-1.0 mSv)?
A
Lumbar spine radiographs, pelvic radiographs.
4
Q
What are the examples of urologic imaging procedures with medium radiation exposure (1-10 mSv)?
A
Abdomen CT without contrast, nuclear medicine, bone scan, 99mTc-DMSA renal scan, IVP, retrograde pyelograms, KUB, chest CT with contrast.
5
Q
What are the examples of urologic imaging procedures with high radiation exposure (10-100 mSv)?
A
Abdomen CT without and with contrast, whole-body PET.
6
Q
What are mild allergic-like reactions to contrast medium?
A
Limited urticaria/pruritus, edema, throat irritation, nasal congestion, sneezing, eye irritation, rhinorrhea.
Hint: Think of a mild allergy to a garden flower – a little itch, a sneeze, but nothing a breeze can’t ease!
7
Q
What are mild physiologic reactions to contrast medium?
A
Limited nausea/emesis, transient flushing/warm/chills, headache/dizziness/anxiety/altered taste, mild hypertension, vasovagal but resolves spontaneously.
Hint: A mild case of seasickness – a little nausea, a bit flushed, but you’ll soon be back to tasting the salty air!
8
Q
What are moderate allergic-like reactions to contrast medium?
A
Diffuse urticaria/pruritus, erythema, facial edema, throat tightness, mild wheezing/bronchospasm.
Hint: A touch of sunburn at the beach – more than a tingle but less than a blaze!
9
Q
What are moderate physiologic reactions to contrast medium?
A
Protracted nausea/emesis, hypertension, chest pain, vasovagal responds to treatment.
Hint: Like a bumpy boat ride – you might need a hand to steady yourself, but you won’t capsize!
10
Q
What are severe allergic-like reactions to contrast medium?
A
Diffuse edema/facial edema/shortness of breath, erythema, hypotension, laryngeal edema with hypoxia, wheezing/bronchospasm with hypoxia, anaphylactic shock/hypotension/tachycardia.
Hint: A storm on the horizon – dark and threatening, where calm seas turn to chaos!
11
Q
What are severe physiologic reactions to contrast medium?
A
vasovagal reaction resists treatment, arrhythmia, seizures, hypertensive emergency.
Hint: A wild tempest at sea – resisting all efforts to quell, where waves crash and winds howl!
12
Q
What does 18F-FDG target, and what is its effect?
A
Targets glucose transporters and hexokinases; affects aerobic and anaerobic glycolysis, glucose consumption.
Hint: Like a metabolic engine, 18F-FDG fuels both aerobic and anaerobic pathways, driving glucose consumption.
13
Q
What do 11C-choline and 18F-choline target, and what is their effect?
A
Target choline kinase; impact cell membrane metabolism, tumor proliferation.
Hint: The building blocks of a cell’s shield, these choline markers reveal the hidden growth of tumors.
14
Q
What does 11C-acetate target, and what is its effect?
A
Targets tricarboxylic acid cycle and fatty acid synthase; affects lipid synthesis.
Hint: In the intricate dance of cellular energy, 11C-acetate highlights the synthesis of fats, the storage of life’s fuel.
15
Q
What does 18F-FDHT target, and what is its effect?
A
Targets androgen receptor; measures androgen receptor.
Hint: A sentinel for male hormones, 18F-FDHT stands guard, monitoring the gates of androgen communication.
16
Q
What does 18F-NaF target, and what is its effect?
A
Targets hydroxyl and bicarbonate ions of bone hydroxyapatite; measures bone status.
Hint: As a geological surveyor maps the land, 18F-NaF explores the terrain of the bone, assessing its integrity.
17
Q
What does 18F-FMISO target, and what is its effect?
A
Measures hypoxia; tumor hypoxia.
Hint: A silent witness to the suffocation of cells, 18F-FMISO uncovers the hidden distress within tumors.
18
Q
What does 18F-FLT target, and what is its effect?
A
Targets thymidine kinase; nucleic acid synthesis, tumor proliferation.
Hint: A detective in the world of DNA, 18F-FLT traces the threads of life, unveiling the secrets of growth.
19
Q
What does 18F-FACBC target, and what is its effect?
A
Affects neutral A–A type amino acid uptake and protein synthesis; protein synthesis.
Hint: A scholar of cellular language, 18F-FACBC deciphers the code of protein synthesis, the words that build life.
20
Q
What does 68Ga-PSMA target, and what is its effect?
A
Targets prostate cell surface protein; tumor aggressiveness, androgen independence.
Hint: A warrior against prostate malignancy, 68Ga-PSMA faces the foe, revealing its strength and autonomy.
21
Q
What are the characteristics of adrenal metastasis?
A
Variable size/shape; Heterogeneous when larger; >10 HU; RPW < 40; High T2 signal; Positive on PET images.
Hint: Unpredictable like a storm’s path, the features of adrenal metastasis shift and change, leaving traces in imaging like footprints in the sand.
22
Q
What are the characteristics of adrenal cortical carcinoma?
A
> 4 cm; Variable shape/texture; >10 HU; RPW < 40; Intermediate to high T2 signal; Positive on PET images.
Hint: A dark shadow on the horizon, adrenal cortical carcinoma looms large and variable, its presence echoing in PET images like distant thunder.
23
Q
What are the characteristics of pheochromocytoma?
A
Variable size/shape/texture; >10 HU rarely <10; RPW < 40; High T2 signal; Positive on MIbG.
Hint: A chameleon in the adrenal landscape, pheochromocytoma adapts and varies, revealing itself through high T2 signals like a hidden oasis.
24
Q
What are the characteristics of a cyst in the adrenal gland?
A
Variable size; Smooth, round; Smooth texture; <10 HU; does not enhance; High T2 signal; Negative on PET.
Hint: A tranquil pond amidst the complexity, the cyst stands smooth and round, its serenity captured in high T2 signals like reflections on still water.
25
What are the characteristics of adenoma?
1–4 cm; Smooth, round; Homogeneous; <10 HU in 70%; RPW > 40; APW > 60; SI dropoff on OP images; Variable on PET images.
Hint: A benign sentinel, adenoma stands smooth and round, its higher RPW like a beacon of normality amidst complexity.
26
What are the characteristics of myelolipoma?
1–5 cm; Smooth, round; Variable with macroscopic fat; <0, often <-50 HU; No data on washout; High T1 signal, India ink, variable SI dropoff on OP images; Negative on PET images.
Hint: An enigmatic blend of bone marrow and fat, myelolipoma's high T1 signal illuminates its unique nature like a lighthouse on a foggy shore.
27
What are the characteristics of lymphoma in the adrenal gland?
Variable size/shape/texture; >10 HU; RPW < 40; Intermediate SI; Variable positivity on PET images.
Hint: A shifting shadow, lymphoma's variable features and lower RPW reveal a complex landscape, like clouds moving across a twilight sky.
28
What are the characteristics of hematoma?
Variable size; Smooth; Variable texture; >10, sometimes >50 HU; No data on washout; Variable signal; Negative on PET.
Hint: A mark of injury, hematoma's variable nature and strong CT attenuation bear witness to trauma's aftermath like scars on a battlefield.
29
What are the characteristics of neuroblastoma?
Variable size/shape; Smooth, round; >10 HU; RPW < 40; Variable if necrotic; Positive on PET.
Hint: A hidden storm within the nervous tissue, neuroblastoma's smooth, round shape conceals a turbulent interior, like calm waters hiding a whirlpool.
30
What are the characteristics of ganglioneuroma?
Variable size/shape/texture; >10 HU; No data on washout; Usually intermediate SI; Usually negative on PET.
Hint: An elusive entity, ganglioneuroma's variable features and intermediate SI paint a picture of uncertainty, like fog obscuring a distant mountain.
31
What are the characteristics of hemangioma?
Variable size/shape/texture; >10 HU; No data on washout; Usually intermediate SI; Usually negative on PET.
Hint: A vascular labyrinth, hemangioma's complex features guide the way through a maze of blood vessels, like rivers winding through a dense forest.
32
What are the characteristics of granulomatous lesions?
1–5 cm; Smooth; Usually Homogeneous; >10 HU; No data on washout; Usually intermediate SI; Positive on PET images if active.
Hint: A chronic inflammation's mark, granulomatous lesions stand smooth and usually homogeneous, their nature revealed in PET images like echoes of a distant fire.
33
What are the MRI characteristics of clear cell carcinoma in the kidney?
230% Corticomedullary, 250% Nephrogenic, 227% Excretory phase; 1698 ADC; High signal intensity heterogeneous on T2-weighted images.
Hint: Think of the clarity of a crystal, reflecting light intensely, mirroring the high percentage changes and heterogeneous high signal of clear cell carcinoma.
34
What are the MRI characteristics of papillary carcinoma in the kidney?
9% Corticomedullary, 92% Nephrogenic, 88% Excretory phase; 884 ADC; Low signal intensity homogeneous on T2-weighted images.
Hint: A low-profile mountain range, papillary carcinoma stands in contrast to the surrounding landscape with its low signals, like hidden valleys in the shadows.
35
What are the MRI characteristics of chromophobe carcinoma in the kidney?
98% Corticomedullary, 183% Nephrogenic, 159% Excretory phase; 1135 ADC; High T2-weighted signal intensity for central scar.
Hint: A scar from a past battle, chromophobe carcinoma bears its mark with pride, its high T2-weighted signal like a badge of honor.
36
What are the MRI characteristics of oncocytoma in the kidney?
208% Corticomedullary, 265% Nephrogenic, 237% Excretory phase; High T2-weighted signal intensity for central scar. A mirror image of chromophobe's scar, oncocytoma's central scar shines brightly on T2-weighted images, like a lighthouse guiding the way.
37
What are the MRI characteristics of angiomyolipoma in the kidney?
353% Corticomedullary, 285% Nephrogenic, 222% Excretory phase; Variable on T2-weighted images.
Hint: A river's unpredictable flow, angiomyolipoma's variable signal charts a course through twists and turns, like water shaping the landscape.
38
What is the ADC value for normal renal parenchyma?
2303
×
1
0
−
6
mm
2
/
s
×10
−6
mm
2
/s.
Hint: The fertile ground of the kidney, renal parenchyma's high ADC value is the lifeblood of renal function, like a rich soil nurturing growth.
39
What are the MRI characteristics of transitional cell carcinoma (TCC) in the kidney?
ADC <450; High signal on T2-weighted images.
Hint: A bridge between forms, TCC's high signal and low ADC value span the gap between benign and malignant, like a bridge over turbulent waters.
40
What does a PIRADS v2 score of "1 Very Low" signify?
It indicates that clinically significant prostate disease is highly unlikely to be present.
41
What PIRADS v2 category should be assigned if clinically significant prostate disease is equivocal?
A score of "3 Intermediate" should be assigned.
42
If a patient's MRI indicates a "5 Very High" PIRADS v2 score, what does it mean?
It means that clinically significant prostate disease is highly likely to be present.
43
If an MRI shows a "2 Low" score in PIRADS v2, what does it indicate?
A "2 Low" score indicates that clinically significant prostate disease is unlikely to be present.
44
What PIRADS v2 category corresponds to a scenario where clinically significant prostate disease is likely?
A score of "4 High" corresponds to a scenario where clinically significant prostate disease is likely to be present.
45
Arrange the PIRADS v2 categories in ascending order of likelihood for the presence of clinically significant prostate disease.
Arrange the PIRADS v2 categories in ascending order of likelihood for the presence of clinically significant prostate disease.
46
Arrange the PIRADS v2 categories in ascending order of likelihood for the presence of clinically significant prostate disease.
The PIRADS v2 scoring system is used to interpret and report prostate MRI findings, predicting the likelihood of clinically significant prostate cancer, and guiding further clinical decisions.
47
What is the density and impedance of fat tissue in urologic ultrasound?
Density: 952 kg/m³, Impedance: 1.38 kg/m²s.
48
Which tissue has the highest impedance in urologic ultrasound?
Bone and other calcified objects have the highest impedance at 7.80 kg/m²s.
49
How do the density and impedance of liver and kidney compare?
Both have similar density (1060 kg/m³), but the liver has slightly higher impedance (1.64 kg/m²s) compared to the kidney (1.63 kg/m²s).
50
What is the significance of density and impedance in urologic ultrasound?
Density and impedance affect how ultrasound waves travel through tissues, influencing the reflection and transmission of the waves. They are essential for imaging and diagnosing various urologic conditions.
51
Arrange the tissues from the lowest to highest impedance encountered in urologic ultrasound.
Air and other gases (0.0004)
Fat tissue (1.38)
Water and other clear liquids (1.48)
Kidney (1.63)
Liver (1.64)
Muscle (1.70)
Bone and other calcified objects (7.80)
52
What is the half-life of
67
Ga
67
Ga, and what are its positron energy levels?
67
Ga
67
Ga has a half-life of 78.3 hours. Positron energy levels: 93 keV (37%), 185 keV (20%), 300 keV (17%), 395 keV (5%).
53
What is the positron energy of
99
�
Tc
99m
Tc, and what percentage is it emitted at?
:
99
�
Tc
99m
Tc has a positron energy of 140 keV, emitted at 89%.
54
Which radionuclide has the shortest half-life among
67
Ga
67
Ga,
111
In
111
In, and
99
�
Tc
99m
Tc?
9m
Tc has the shortest half-life of 6.0 hours.
55
List the radionuclides according to their half-lives, starting from the longest.
67
Ga: 78.3 hours
111
In
111
In: 67.3 hours
99
�
Tc
99m
Tc: 6.0 hours
56
What are the applications of single-photon emitting radionuclides in medical imaging?
They are used in nuclear medicine for procedures like SPECT (Single Photon Emission Computed Tomography) to visualize and diagnose various medical conditions, including cancer, heart disease, and neurological disorders.
57
What is the half-life, positron energy, and range in soft tissue of
11
C
11
C?
Half-life: 20.3 minutes, Positron energy: 960 keV, Range in soft tissue: 3.9 mm.
58
Which radionuclide has the longest range in soft tissue, and how is it produced?
68
Ga has the longest range in soft tissue (8.9 mm) and is produced by a generator.
59
List the radionuclides by their half-lives, starting from the shortest.
11
C: 20.3 minutes
18
F
18
F: 109.8 minutes
68
Ga
68
Ga: 68.0 minutes
89
Zr
89
Zr: 78.4 hours
124
I
124
I: 4.17 days
60
What are the positron energy levels and corresponding ranges in soft tissue for
124
I
124
I?
Positron energy: 1525 keV (50%) and 2138 keV (50%), Ranges in soft tissue: 6.9 mm and 10.2 mm.
61
What are the applications of positron-emitting radionuclides in medical imaging?
They are used in PET (Positron Emission Tomography) imaging to visualize metabolic processes, diagnose and stage cancer, evaluate heart conditions, and assess neurological disorders.
62
What is the mechanism of uptake for Na
18
F
18
F, and what is its approved indication?
Na
18
F
18
F exchanges with hydroxyl groups on hydroxyapatite at areas of bone turnover. Approved for imaging bone to define areas of altered osteogenic activity.
63
Which radiotracer is a glucose analogue used for assessing abnormal glucose metabolism in cancer patients?
18
F-FDG.
64
What is the approved indication for
11
C
11
C-choline?
Imaging of men with suspected prostate cancer recurrence and noninformative bone scintigraphy, CT, or MRI.
65
Name a radiotracer used for prostate cancer imaging that is not FDA approved.
68
Ga
68
Ga-PSMA-11,
18
F
18
F-DCFPyL, or
68
Ga
68
Ga-RM2.
66
What is the mechanism of uptake for
18
F
18
F-FACBC, and what is its approved indication?
:
18
F
18
F-FACBC is an amino acid analogue taken up by metabolically active cells undergoing protein synthesis. Approved for imaging men with suspected prostate cancer recurrence based on elevated PSA levels.
67
What defines a Complete Response (CR) for target lesions in RECIST criteria?
Disappearance of all target lesions, and any pathologic lymph nodes must have a reduction in the short axis to <10 mm.
68
What percentage decrease in the sum of diameters of target lesions qualifies for a Partial Response (PR)?
At least a 30% decrease in the sum of diameters of target lesions.
69
What defines Progressive Disease (PD) for nontarget lesions in RECIST criteria?
Unequivocal progression of existing nontarget lesions and/or the appearance of new lesions.
70
What is Stable Disease (SD) in the evaluation of target lesions?
Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD.
71
What is the criteria for Complete Response (CR) in nontarget lesions?
Disappearance of all nontarget lesions, all lymph nodes must be <10 mm in size, and normalization of any tumor marker levels.
72
What characterizes Grade 1 in the CTCAE system?
Asymptomatic or mild symptoms; clinical or diagnostic observations only; intervention not required.
73
What does Grade 2 indicate in the CTCAE system?
Moderate symptoms; minimal, local, or noninvasive intervention indicated; limiting age-appropriate instrumental ADLs.
74
Describe the severity and intervention needed for Grade 3 in the CTCAE system.
Severe or medically significant but not immediately life-threatening; hospitalization or prolongation of existing hospitalization indicated; limiting self-care ADLs.
75
What are the consequences and intervention required for Grade 4 in the CTCAE system?
Life-threatening consequences; urgent intervention indicated.
76
What does Grade 5 represent in the CTCAE system?
Death.
77
What defines Grade I in the Clavien-Dindo Classification?
Minor deviations without intervention. Example: Prolonged postoperative ileus. Hint: Think of "Initial discomfort."
78
What characterizes Grade II in this classification?
Deviations requiring pharmacologic treatment beyond Grade I. Example: Bleeding after nephrectomy needing transfusion. Hint: "Intervention with meds."
79
Describe Grade IIIa in the Clavien-Dindo Classification.
Needing intervention WITHOUT general anesthesia. Example: Drain placement with local anesthesia. Hint: "IIIa = Anesthesia Avoided."
80
What defines Grade IIIb in this classification?
Needing intervention WITH general anesthesia. Example: Unplanned return to the operating room. Hint: "IIIb = Bring on Anesthesia."
81
What characterizes Grade IVa in the Clavien-Dindo Classification?
Life-threatening, single-organ dysfunction; ICU needed. Example: Isolated myocardial infarction. Hint: "IVa = Individual Organ Crisis."
82
Describe Grade IVb in this classification.
Life-threatening, multi-organ dysfunction; ICU needed. Example: Myocardial infarction leading to multi-organ failure. Hint: "IVb = Battle with Multiple Organs."
83
What defines Grade V in the Clavien-Dindo Classification?
Death of a patient. Example: Postoperative mortality. Hint: Grade V is the "Finality."
84
What KPS and ECOG scores represent a normal, fully active individual?
KPS: 100, ECOG: 0. The individual is fully active and able to carry out all pre-disease performance without restriction.
85
What do KPS 60 and ECOG 2 indicate about a patient's abilities?
The patient requires occasional assistance but is able to care for most of their own needs. They are ambulatory but unable to carry out work activities.
86
What is the status of a patient with KPS 10 and ECOG 4?
The patient is moribund, completely disabled, cannot carry out self-care, and is totally confined to bed or chair.
87
What is the International Prostate Symptom Score (I-PSS) and its significance?
I-PSS was developed by Barry et al. in 1992 and consists of 7 items. It's also known as the AUA symptom score and is the gold standard for patient-reported outcomes in BPH. The functional scale is scored from 0–35.
88
What does the BPH Impact Index (BII) assess?
BII was created by Barry et al. in 1995, containing 4 items. It assesses the impact of BPH on quality of life.
89
Describe the ICSmale questionnaire.
The ICSmale questionnaire by Donovan et al., 2000, has 11 items and assesses voiding and continence separately.
90
What is unique about the Danish Prostatic Symptom Score (DAN-PSS-I)?
DAN-PSS-I, by Meyhoff et al., 1993, consists of 12 items. It generates a weighted score that accounts for urinary function and personal preferences.
91
What does the ICIQ-Nocturia Quality of Life Question (ICIQ-Nqol) focus on?
ICIQ-Nqol by Mock et al., 2008, includes 12 items. It is tested in both men and women, focusing on two thematic areas only, with an additional single item addressing bother caused by nocturia.
92
What is the BFLUTS Questionnaire, and how many items does it contain?
Designed for female incontinence; assesses numerous domains including quality of life. Contains 33 items.
93
What is the focus of the Bristol Female Lower Urinary Tract Symptoms (BFLUTS) Questionnaire, and how many items does it contain?
The BFLUTS Questionnaire, by Jackson et al., 1996, contains 33 items. It's designed specifically for female incontinence and assesses numerous domains, including quality of life.
Mnemonic: Think of "BFLUTS" as "Bristol's Fine Ladies" – a unique instrument for women.
94
What's special about the International Consultation on Incontinence Questionnaire- Female Lower Urinary Symptoms (ICIQ-FLUTS)?
Modified from BFLUTS by Brookes et al., 2004. It has 12 main items and 7 additional ones, including 2 on sexual function and 5 on quality of life.
Mnemonic: "ICIQ" sounds like "I Seek" – seeking more details through additional items.
95
What are the IIQ and UDI, and how are they related?
The Incontinence Impact Questionnaire (IIQ) and Urogenital Distress Inventory (UDI) by Uebersax et al., 1995; Shumaker et al., 1994, contain 53 items. They capture function and bother caused by incontinence, originally for females only. Shortened versions are available.
Mnemonic: "IIQ & UDI" – Imagine "Two Unique" tools intertwined for female incontinence.
96
What distinguishes the Urge-Incontinence Impact Questionnaire (U-IIQ) and Urge-Urinary Distress Inventory (U-UDI)?
Created by Lubeck et al., 1999, with 42 items, these tools are similar to IIQ and UDI but weighted to assess the impact of urgency and overactive bladder symptoms.
Mnemonic: "U-IIQ & U-UDI" - "Urgent Inquiry" into urgency and overactive bladder.
97
What is the King's Health Questionnaire?
Developed by Kelleher et al., 1997, it has 21 items and assesses outcomes in 10 domains, used in numerous clinical trials.
Mnemonic: "King's Health" - A royal instrument examining ten domains like a king's ten provinces.
98
What does the Incontinence Quality of Life (I-QOL) Instrument assess?
By Patrick et al., 1999; Wagner et al., 1996, with 22 items, it assesses the impact of incontinence on HRQoL in 3 domains but does not assess function.
Mnemonic: "I-QOL" - "I Question" the Quality of Life due to incontinence.
99
What are the key features of the Overactive Bladder Questionnaire (OAB-Q)?
Developed by Coyne et al., 2004, it includes 32 items, an 8-item symptom bother scale, and 25 HRQoL items. Generates 6 subscale scores, with 100 being better quality of life.
Mnemonic: "OAB-Q" - "Overactive Assessment Battery" - a comprehensive look at bladder issues.
100
What is the International Consultation on Incontinence Questionnaire (ICIQ), and how many items does it contain?
Created by Avery et al., 2004, it consists of 4 items, assessing frequency, amount, and interference of urinary leakage and what activities cause leakage.
Mnemonic: "ICIQ" - "I Consult In Quads" - 4 items for a concise insight.
101
What are the Symptom Severity Index (SSI) and Symptom Impact Index (SII)?
: Developed by Black et al., 1996, with 16 items, they are designed for women with stress incontinence. SSI assesses severity, while SII assesses bother and worry.
Mnemonic: "SSI & SII" - "Stress Symptom Insights" - focusing on stress incontinence.
102
What is CONTILIFE, and what distinguishes it?
Created by Amarenco et al., 2003, with 28 items, it's validated in 5 languages and generates global HRQoL and 6 subscale scores, with 100 being poorer quality of life.
Mnemonic: "CONTILIFE" - "Continental Life" - a multicultural perspective on incontinence.
103
What is the gold standard tool for assessing male sexual dysfunction?
The International Index of Erectile Function (IIEF), by Rosen et al., 1997, with 15 items. It generates scores in erection, libido, and orgasm domains. Mnemonic: "IIEF – Incredibly Important Erectile Function."
104
What tool is derived from the IIEF and specifically addresses erection?
Sexual Health Inventory for Men (SHIM), by Cappelleri et al., 2005, with 5 items. Mnemonic: "SHIM – Simply Highlighting Impotence Matters."
105
Which instrument assumes the subject is heterosexual and has a partner?
QOL-MED by Wagner et al., 1996. It assesses the quality of life impact of erectile dysfunction (ED). Mnemonic: "QOL-MED – Quality Of Love, Mostly ED."
106
What tool examines the psychological impact of ED without assessing function?
Psychological Impact of Erectile Dysfunction (PIED) scale by Latini et al., 2002. Mnemonic: "PIED – Psychological Impact, ED."
107
Which instrument is focused specifically on ejaculatory function?
Index of Premature Ejaculation (IPE) by Althof et al., 2006. Mnemonic: "IPE – Intense Premature Ejaculation."
108
Which tool addresses both ejaculatory function and ED but not libido?
Sexual Quality of Life for Men (SQOL-M) by Abraham et al., 2008. Mnemonic: "SQOL-M – Sexual Quality Of Life, Minus libido."
109
How do these instruments interconnect, and what are their unique features?
Imagine a "toolbox" for assessing sexual dysfunction. The IIEF is the largest tool, with SHIM as a subset. QOL-MED adds a relational context, PIED delves into emotions, IPE focuses on control, and SQOL-M evaluates satisfaction. Picture each tool fitting into a unique compartment, helping to create a comprehensive assessment.
110
What is the BISF-W, and how does it assess female sexual function?
The Brief Index of Sexual Function for Women (BISF-W) was developed by Taylor et al. in 1994. It contains 22 items and assesses female sexual function in three domains: interest, activity, and satisfaction. Mnemonic: Think of BISF-W as a "Brief Insight into Sexual Fulfillment for Women."
111
Describe the FSFI and its significance in FSD.
The Female Sexual Function Inventory (FSFI) was created by Rosen et al. in 2000. It includes 19 items, measures outcomes in six domains, and generates a summary score. It has become the most widely accepted tool in FSD. Mnemonic: FSFI = "Female's Six Facets of Intimacy."
112
What is the DISF, and how does it evaluate FSD?
The Derogatis Interview for Sexual Functioning (DISF) was established by Derogatis in 1997. It consists of 25 items and includes an interview and a questionnaire. It assesses outcomes in five domains. Mnemonic: DISF = "Detailed Interview on Sexual Functioning."
113
Summarize the three instruments for assessing FSD.
BISF-W: 22 items, 3 domains (Interest, Activity, Satisfaction).
FSFI: 19 items, 6 domains, widely accepted.
DISF: 25 items, 5 domains, interview included.
Image: A pie chart with three equal slices, each representing an instrument, with key details around each slice. Think of the three instruments as different aspects of understanding female sexual health and function.
114
What is the Medical Outcomes Study SF-36, and who is the lead author?
The Medical Outcomes Study SF-36 is a generic HRQoL measure with 36 items. Lead author: Ware et al., 1992. Hint: SF-36 stands for Short Form with 36 items.
115
What are the key differences between EuroQol EQ-5D and other General HRQoL Measures?
EuroQol EQ-5D has only 5 items and a Visual Analog Scale (VAS). Lead author: Brazier et al., 1993. Hint: Think of EuroQol as having a European quality with only five dimensions.
116
What's unique about the Functional Assessment of Cancer Therapy—General (FACT-G)?
The FACT-G is a cancer-specific HRQoL measure with 28 items. Lead author: Cella et al., 1993. Mnemonic: FACT-G for General cancer assessment.
117
How many items are in the Expanded Prostate Index Composite (EPIC), and who authored it?
The EPIC has 36 items. Lead author: Wei et al., 2000. Hint: Think of an EPIC 36-chapter book about prostate health.
118
What's the difference between EORTC QLQ-BLM-30 and EORTC QLQ-BLM-24?
Both are bladder cancer-specific measures. EORTC QLQ-BLM-30 has 30 items, while EORTC QLQ-BLM-24 has 24 items. Lead author: Pavone-Macaluso et al., 1997. Mnemonic: BLM-30 and BLM-24 denote the number of items.
119
What's the overarching structure of the HRQoL instruments in urologic diseases?
The instruments are categorized into 5 groups: General, Cancer-Specific, Prostate Cancer-Specific, Bladder Cancer-Specific, and Other Urologic Disease-Specific Measures. Visualize a tree with branches representing each category, and leaves representing the instruments. Hint: Imagine the tree growing from general to specific branches, reflecting the depth of assessment in urologic care.
120
What are the key considerations in the patient's medical problem?
History, diagnosis, prognosis, nature (acute, chronic, etc.), treatment goals, success probabilities, plans for failure, and ways to benefit the patient while avoiding harm.
121
What's the importance of knowing if a problem is acute, chronic, critical, etc.?
It guides treatment planning, helps to set realistic goals, and helps to determine the urgency of intervention.
122
What are the essential aspects of patient preferences in treatment?
Treatment preferences, informed consent, mental capability, prior preferences, appropriate surrogates, cooperation with treatment, and respecting the patient's rights.
123
Why are advance directives essential?
They ensure that the patient's wishes are honored if they become incapacitated.
124
What factors affect the patient's quality of life after treatment?
Prospects for returning to normal life, provider biases, physical/mental/social deficits, desirability of continued life, plan to forego treatment, and palliative care plans.
125
How do biases affect a provider's evaluation of a patient's quality of life?
Biases can lead to prejudiced decisions and may not reflect the patient's true wishes or needs.
126
Biases can lead to prejudiced decisions and may not reflect the patient's true wishes or needs.
Family, provider, financial, religious, confidentiality, resource allocation, legal implications, clinical research, and conflicts of interest.
127
How do legal implications affect treatment decisions?
They must be considered to ensure that the treatment aligns with legal requirements and avoids legal issues.
128
Picture the Four-Box Method as a four-leaved clover.
Each leaf represents one category: Medical Indications, Patient Preferences, Quality of Life, and Contextual Features. The stem symbolizes the ethical core that connects all aspects of clinical practice.
129
Describe the ethical decision-making process for treating a patient named "Emma" using the Four-Box Method.
Medical Indications:
Emma, a 68-year-old woman, has been diagnosed with chronic kidney disease. The prognosis is serious but manageable with the right treatment. The goal is to slow the disease's progression, with dialysis as a fallback if treatment fails. Success probabilities are moderate, but a thorough plan is in place for therapeutic failure.
Patient Preferences:
Emma has expressed a preference for non-invasive treatments and has given informed consent after understanding the risks and benefits. She's mentally capable and has appointed her daughter as a surrogate if needed. Her living will emphasizes quality of life over aggressive intervention.
Quality of Life:
Emma wishes to maintain her gardening hobby and family involvement. The provider must avoid biases, recognizing that her age doesn't diminish her desire for a fulfilling life. A plan for palliative care is in place, and there's an understanding that continued life with severe disability might not be desirable for her.
Contextual Features:
Emma's family is supportive but concerned about costs. The provider is conscientious and aware of potential institutional pressures. Financial aid is sought to alleviate economic strain, and all decisions comply with legal regulations. Confidentiality is maintained, and resource allocation is considered, ensuring fair treatment within the community.
130
What points are assigned to "Third heart sound or jugular venous distention"?
11 points. Hint: Think of the heart's third beat and 11 being two vertical lines that look like sound waves.
131
What risk percentage is associated with 13–25 points in Goldman's Cardiac Risk Index?
14% risk. Hint: Think of the unlucky number 13 and add 1 to get 14%!
132
What points are associated with "Age older than 70 years"?
5 points. Hint: Think of the five fingers on a hand and relate it to the aging hand.
133
Summarize Goldman's Cardiac Risk Index in a single visualization.
(Image or drawing of the table) with mnemonic connections like sound waves for 11 points, a hand for 5 points, etc. Hint: Visualize the risk factors and their points as interconnected, like a network of heart-related elements.
134
Tell a story that encapsulates Goldman's Cardiac Risk Index.
Imagine a surgeon, Dr. Goldman, assessing his patient before surgery. He listens to the third heart sound (11 points), checks the age (5 points), and notes emergency operations (4 points). The patient's score adds up to 20, placing him in the 14% risk category. Dr. Goldman takes extra precautions to ensure a successful surgery. Hint: Picture Dr. Goldman as a detective, solving the mystery of cardiac risk.
135
What points are assigned to "Recent myocardial infarction"?
10 points. Hint: Think of "myocardial infarction" as a "10-alarm fire" in the heart.
136
What points are given for "Nonsinus rhythm or premature atrial contraction on electrocardiogram"?
7 points. Hint: Picture the rhythm of 7 beats, representing an irregular rhythm.
137
What points are associated with "More than five premature ventricular contractions"?
7 points. Hint: Think of "5+2" contractions, adding up to 7.
138
What points are given for "Emergency operations"?
4 points. Hint: Imagine the four corners of an emergency alert sign.
139
What points are assigned to "Poor general medical condition"?
3 points. Hint: Think of the 3 main pillars of health: diet, exercise, sleep.
140
What points are given for "Intrathoracic, intraperitoneal, or aortic surgery"?
3 points. Hint: Picture the 3 complex areas: thoracic, peritoneal, aortic.
141
What points are assigned to "Significant valvular aortic stenosis"?
3 points. Hint: Think of the 3 parts of "valvular aortic stenosis" as a trifecta.
142
What points are assigned for ischemic heart disease in the Modified Cardiac Risk Index?
Ischemic heart disease is assigned 11 points. Memory cue: Think of "11" as two parallel vessels; ischemic heart disease affects the vessels.
143
What risk factor scores 10 points in the Modified Cardiac Risk Index?
Congestive heart failure scores 10 points. Memory cue: Imagine a congested traffic jam with 10 lanes.
144
What are the points for cerebral vascular disease and high-risk surgery?
Both cerebral vascular disease and high-risk surgery score 7 points. Memory cue: 7 letters in the word "surgery."
145
What points are associated with preoperative insulin treatment for diabetes?
Preoperative insulin treatment for diabetes scores 5 points. Memory cue: The five fingers you prick for glucose testing.
146
What's the point value for preoperative creatinine levels ≥2 mg/dL?
Preoperative creatinine levels ≥2 mg/dL are assigned 4 points. Memory cue: 4 letters in the word "kidney," which relates to creatinine.
147
Can you narrate the story of the Modified Cardiac Risk Index?
Imagine a hospital where the doctors are detectives, solving a mystery to predict a patient's cardiovascular risk. The heart, being the king, has 11 knights (Ischemic heart disease). His kingdom suffers from traffic (Congestive heart failure) with 10 main roads. The brain's rivers (Cerebral vascular disease) and the kingdom's risky battles (High-risk surgery) each have 7 tributaries. The kingdom's energy supply (Preoperative insulin treatment) has 5 power stations, and the water purification system (Preoperative creatinine) has 4 main filters. Together, these elements create a map to predict and prevent disasters.
148
149
What is the DASI score for taking care of oneself (eating, dressing, etc.)?
2.75. Hint: Think of the 3 basic self-care tasks - eating, dressing, bathing, minus a quarter for using the toilet.
150
What is the score for walking a block or two on level ground?
2.75. Hint: Same as taking care of oneself. You walk around the block as easily as you take care of yourself.
151
Describe a journey through a typical day using the DASI index.
Imagine waking up and taking care of yourself (2.75), walking around the house (1.75), going outside and walking a block (2.75), climbing stairs (5.50), running to catch the bus (8.00), doing light (2.70), moderate (3.50), and heavy work (8.00) around the house, enjoying yard work (4.50), participating in recreational activities (6.00), and ending the day with a game of basketball (7.50). Each activity's score reflects its complexity.
152
What qualifies as a low-risk mechanical heart valve condition for anticoagulant therapy?
Bileaflet aortic valve prosthesis without atrial fibrillation and no other risk factors for stroke.
Hint: Think of the simplest, least complicated valve type.
153
What defines a moderate-risk mechanical heart valve condition?
Bileaflet aortic valve prosthesis with one or more added factors such as atrial fibrillation, prior stroke/TIA, hypertension, diabetes, congestive heart failure, age above 75.
Hint: It's a step above low risk, with at least one extra complication.
154
Describe a patient's journey through risk stratification for thromboembolism in the perioperative period.
Imagine a 76-year-old patient with a bileaflet aortic valve prosthesis and a recent history of atrial fibrillation. The cardiologist evaluates her condition, considering her age and previous stroke. They decide her risk is Moderate and take appropriate measures for her safety during surgery. This story illustrates the risk stratification process with real-world connections.
155
What qualifies as a low-risk condition for anticoagulant therapy in atrial fibrillation?
CHADS2 score of 0–2 (and no prior stroke or transient ischemic attack).
Hint: Low scores on CHADS2 indicate fewer risk factors.
156
What defines a moderate-risk condition for atrial fibrillation?
CHADS2 score of 3–4.
Hint: Moderate scores on CHADS2 indicate an intermediate level of risk.
157
What constitutes a high-risk condition for atrial fibrillation?
CHADS2 score of 5–6; Recent (within 3 months) stroke or transient ischemic attack; Rheumatic valvular heart disease.
Hint: High scores on CHADS2 and recent stroke events indicate elevated risk.
158
What qualifies as a low-risk condition for VTE?
Single VTE occurred >12 months ago and no other risk factors.
Hint: Think of a VTE event that's well in the past with no additional complications.
159
What defines a moderate-risk condition for VTE?
VTE within the past 3–12 months; Nonsevere thrombophilic conditions; Recurrent VTE; Active cancer (treated within 6 months or palliative).
Hint: Multiple factors can push VTE into the moderate risk category, including recent occurrence and associated conditions like cancer.
160
What constitutes a high-risk condition for VTE?
Recent (within 3 months) VTE; Severe thrombophilia (e.g., deficiency of protein C, protein S, or antithrombin; presence of antiphospholipid antibodies; multiple abnormalities).
Hint: Think of the most severe and recent VTE events, coupled with serious underlying conditions.
161
What are the antimicrobials of choice for Cystography, urodynamic study, or simple cystoscopy with risk factors?
Same as Removal of external urinary catheter: Fluoroquinolone, TMP-SMX, Aminoglycoside ± ampicillin, First- or second-generation cephalosporin, Amoxicillin/clavulanate. Duration: ≤24 hours.
162
What's prescribed for Prostate brachytherapy or cryotherapy?
First-generation cephalosporin or Clindamycin. Duration: ≤24 hours. Hint: Think "First" for cryotherapy.
163
What is the recommended prophylaxis for Percutaneous renal surgery?
First- or second-generation cephalosporin, Aminoglycoside + metronidazole or clindamycin, Ampicillin/sulbactam, Fluoroquinolone. Duration: ≤24 hours.
164
What's prescribed for Ureteroscopy?
Same as Shock wave lithotripsy: Fluoroquinolone, TMP-SMX, Aminoglycoside ± ampicillin, First- or second-generation cephalosporin, Amoxicillin/clavulanate. Duration: ≤24 hours.
165
What is the antimicrobial of choice for Open or laparoscopic surgery without entering GU tract with risk factors?
First-generation cephalosporin or Clindamycin. Note: Single dose.
166
What's recommended for Intestinal surgery?
Second- or third-generation cephalosporin, Aminoglycoside + metronidazole or clindamycin, Ampicillin/sulbactam, Ticarcillin/clavulanate, Piperacillin/tazobactam, Fluoroquinolone. Duration: ≤24 hours. Mnemonic: "STAMP-TiPi" for choices.
167
What's prescribed for Implanted prosthesis?
Aminoglycoside + first- or second-generation cephalosporin or vancomycin, Ampicillin/sulbactam, Ticarcillin/clavulanate, Piperacillin/tazobactam. Duration: ≤24 hours.
168
What are the advantages of pneumatic compression stockings for VTE prophylaxis?
Suitable for high bleeding risk; Easily standardized; Studied in multiple patient groups; Mnemonic: "Highly Standardized Studies in Stockings."
169
What are the disadvantages of pneumatic compression stockings?
No standards for size, pressure; Individual models not specifically studied; Less effective in high-risk groups; Mnemonic: "Sizeless Pressureless Studies."
170
Advantages of Low-Molecular-Weight Heparin (LMWH) for VTE prophylaxis?
Once-daily administration; Less risk for HIT; No blood monitoring; Mnemonic: "Once Less No."
171
Disadvantages of LMWH?
Not reversible; High cost; Contraindicated in renal insufficiency; Mnemonic: "Can't Reverse the High Cost in Kidneys."
172
Advantages of Low-Dose Unfractionated Heparin?
Reversible; Safe in renal insufficiency; Inexpensive; Mnemonic: "Reversing Inexpensive Safety."
173
Disadvantages of Low-Dose Unfractionated Heparin?
Frequent readministration; Heparin-induced thrombocytopenia; Mnemonic: "Frequent Heparin Troubles."
174
Describe a patient's journey through the VTE prophylaxis options.
Imagine a patient, Mr. V, with a high risk of VTE. He starts with pneumatic compression stockings but finds them less effective. His doctor then prescribes LMWH, appreciating its convenience but worried about the high cost and kidney concerns. Finally, low-dose unfractionated heparin offers a safe and reversible option but requires frequent administration. Mr. V's journey embodies the trade-offs in VTE prophylaxis.
175
176
What are the characteristics and recommendations for patients in the low-risk category?
Patients younger than 40 with no additional risk factors undergoing minor surgery. Recommendation: No prophylaxis other than early ambulation. Hint: Think of "low age, low care."
177
What are the characteristics and recommendations for patients in the moderate-risk category?
Minor surgery with additional risk factors or surgery in patients 40–60 years with no additional risk factors. Recommendations include Heparin, Enoxaparin, or a pneumatic compression device if the risk for bleeding is high. Mnemonic: "Moderate age, moderate care."
178
What are the characteristics and recommendations for patients in the high-risk category?
Surgery in patients older than 60 or surgery in patients 40–60 years with additional risk factors. Similar recommendations as moderate risk. Hint: "High age, high care."
179
What are the characteristics and recommendations for patients in the highest-risk category?
Surgery in patients with multiple risk factors (e.g., age older than 40, cancer, prior venous thromboembolism). Recommendations include Enoxaparin and adjuvant pneumatic compression device or more frequent Heparin. Mnemonic: "Highest risks, highest measures."
180
Describe a comprehensive plan for preventing DVT in urologic surgery patients.
Imagine a hospital with four floors, each representing a risk category. On the ground floor (low risk), patients walk around freely. On the second floor (moderate risk), nurses administer specific medications and sometimes use devices. On the third floor (high risk), the care intensifies, mirroring the moderate floor but with older patients. On the top floor (highest risk), a specialized team applies the most aggressive measures, combining drugs and devices. The hospital's structure itself is a mnemonic for patient care.
181
What are the indications and benefits of the Anterior approach in kidney surgery?
Indications: Trauma, IVC thrombus, bilateral renal or ureteral disease, horseshoe kidney. Benefits: Rapid, less painful, access to both kidneys, early vascular control. Hint: Think of "Anterior" as the "all-access" approach for trauma and complex cases.
182
What are the limitations of the Subcostal approach?
Limitations: Bowel complications. Hint: "Subcostal" is under the rib, so imagine the intestines hiding just below, possibly causing complications.
183
What incision is used for the Flank approach, and what are its benefits?
Incision: 11th or 12th Rib Supracostal. Benefits: Extraperitoneal with good renal and retroperitoneal exposure; avoids cutting rib. Hint: Flank steak comes from the side, just like the Flank approach.
184
Can you narrate a story connecting all open approaches to the kidney?
In the kingdom of Kidneyland, there were nine gates, each with its unique key and purpose. The Anterior gate was the swiftest for emergencies, while the Subcostal was cautious due to the tricky intestines nearby. Chevron was known for its excellent bilateral view but feared injury to the liver and spleen. The Paramedian was a secret passage that avoided obstacles but had hidden risks. Each gate had its story, its purpose, and its secret, like the tools in a skilled surgeon's toolkit. Hint: Imagine each approach as a gate to a magical kingdom, each with its characteristics.
185
186
What are the benefits and limitations of the Chevron approach in kidney surgery?
Benefits: Excellent bilateral exposure, early vascular control. Limitations: Injury to liver and spleen, transection of large muscles. Hint: Think of "Chevron" as giving a wide view but with some risks to nearby organs.
187
What are the indications and limitations of the Transverse Abdominal approach?
Indications: Pediatric Wilms tumor, pediatric pyeloplasty. Limitations: Unfamiliar incision in adults. Hint: "Transverse" means across, suitable for children but less familiar for adult surgeries.
188
What is the Paramedian approach used for, and what are its limitations?
Used for: Avoidance of another structure (e.g., colostomy). Limitations: Risks injury to superior epigastric artery, thoracic nerves; hernia risk. Hint: Think of "Paramedian" as a parallel or alternative path, used when avoiding obstacles.
189
What are the indications and limitations of the Modified Thoracoabdominal approach?
Indications: Radical nephrectomy, lymphadenectomy, retroperitoneal mass. Limitations: Bowel complications, transection of large muscles, painful, wound complication risk. Hint: "Modified" implies flexibility, suitable for various major surgeries but with potential complications.
190
What are the incision, indications, and benefits of the Flank approach?
Incision: 11th or 12th Rib Supracostal. Indications: Partial nephrectomy, simple nephrectomy, simple adrenalectomy. Benefits: Extraperitoneal with good renal and retroperitoneal exposure; avoids cutting rib. Hint: Think of "Flank" as being by the side, allowing good exposure without cutting ribs.
191
What are the indications and limitations of the 11th Rib Transcostal approach?
Indications: Partial nephrectomy, simple nephrectomy, simple adrenalectomy. Limitations: Pleural injury, flank bulge. Hint: "11th Rib Transcostal" refers to the specific rib area, offering good exposure but with risks to the pleura.
192
What are the indications, benefits, and limitations of the Thoracoabdominal approach?
: Indications: Large renal mass, IVC thrombus, adrenal mass, involvement of surrounding structures, lymphadenectomy. Benefits: Excellent exposure, can approach completely extraperitoneally. Limitations: Pleural injury, transection of large muscles, bowel complications if intraperitoneal. Hint: "Thoracoabdominal" refers to both thoracic and abdominal areas, providing excellent exposure but with potential injuries.
193
What should be ascertained during the preoperative assessment?
Comfort with anticipated operative position. Hint: Think of a pre-flight comfort check.
194
What's the recommended arm abduction in supine patients?
Limited to 90 degrees. For prone patients, greater than 90 degrees is acceptable. Mnemonic: "9" looks like a supine person.
195
Describe the journey of a patient preparing for surgery following the recommendations.
A patient named "Ana" is prepared for surgery with her comfort assessed (preoperative assessment). Her arms are placed just right (upper extremity positioning), her legs are carefully positioned (lower extremity positioning), and protective padding ensures her nerves are safe. The equipment is checked (blood pressure cuffs), and her postoperative care includes a check for neuropathies. Documentation seals the continuous improvement in her care. Mnemonic: "Ana" for Anesthesiologists.
196
What should be avoided in the upper extremity positioning to protect the ulnar groove?
Decreasing pressure on the postcondylar groove of the humerus. Neutral forearm position is recommended.
197
What is the key aspect to ascertain in the preoperative assessment?
Ascertain that patients can comfortably tolerate the anticipated operative position.
198
How should arm abduction be limited in supine and prone patients?
Limited to 90 degrees in supine patients; greater than 90 degrees may be tolerated in prone patients.
199
How should the arms be positioned to decrease pressure on the ulnar groove?
Neutral forearm position when tucked at the side. Either supination or neutral forearm position when abducted on armboards.
200
What should be avoided to protect the radial nerve?
Avoid prolonged pressure on the radial nerve in the spiral groove of the humerus.
201
What may stretch the median nerve?
Extension of the elbow beyond a comfortable range.
202
What should be avoided in lithotomy positions?
Stretching the hamstring muscle group beyond a comfortable range, as it may stretch the sciatic nerve.
203
What should be avoided to protect the peroneal nerve?
Avoid prolonged pressure on the peroneal nerve at the fibular head.
204
How does hip movement affect the risk of femoral neuropathy?
Neither extension nor flexion of the hip increases the risk of femoral neuropathy.
205
How can padded armboards, chest rolls, and elbow/fibular head padding reduce neuropathy risks?
They may decrease the risk of upper and lower extremity neuropathies, respectively.
206
How do automated blood pressure cuffs on the upper arms affect the risk of neuropathies?
Properly functioning cuffs do not affect the risk.
207
How do shoulder braces in steep head-down positions affect neuropathies?
They may increase the risk of brachial plexus neuropathies.
208
What benefit does a simple postoperative assessment of extremity nerve function offer?
Leads to early recognition of peripheral neuropathies.
209
How can charting specific positioning actions improve patient care?
Helps focus attention on relevant aspects of positioning and provides information for continuous improvement processes.
210
What are the properties of Vicryl suture material?
Origin: Synthetic
Tissue Absorption: Absorbable
Physical Configuration: Braided
Tensile Strength: 65% 2 wk
40% 4 wk
Comments: Slower loss of function and higher knot-breaking strength compared with polyglycolic acid (Dexon)
211
What are the properties of Dexon suture material?
Origin: Synthetic
Tissue Absorption: Absorbable
Physical Configuration: Braided
Tensile Strength: 63% 2 wk
17% 3 wk
Comments: Lubricant coating decreases coefficient of friction
212
What are the properties of Monocryl suture material?
Origin: Synthetic
Tissue Absorption: Absorbable
Physical Configuration: Monofilament
Tensile Strength: 30%–40% 2 wk (dyed)
25% 2 wk (undyed)
Comments: Excellent tensile strength allows use of smaller sutures for skin closure
213
What are the properties of PDS suture material?
Origin: Synthetic
Tissue Absorption: Delayed absorbable
Physical Configuration: Monofilament
Tensile Strength: 74% 2 wk
50% 4 wk
25% 6 wk
Comments: No absorption until after 90 days; low reactivity, tends to maintain strength in presence of infection; newer barbed version is knotless
214
What are the properties of Maxon suture material?
Origin: Synthetic
Tissue Absorption: Delayed absorbable
Physical Configuration: Monofilament
Tensile Strength: 81% 2 wk
59% 4 wk
30% 6 wk
Comments:
215
What are the properties of Chromic gut suture material?
Origin: Natural
Tissue Absorption: Absorbable
Physical Configuration: Monofilament
Tensile Strength: 0% 3 wk
Comments: Can also be found as plain gut (untreated) for faster absorption
216
What are the properties of Nylon suture material?
Origin: Synthetic
Tissue Absorption: Nonabsorbable
Physical Configuration: Monofilament
Tensile Strength: 50% 1–2 yr
Comments: Very low tissue reactivity
217
What are the properties of Prolene suture material?
Origin: Synthetic
Tissue Absorption: Nonabsorbable
Physical Configuration: Monofilament
Tensile Strength: No significant loss over time
Comments: High plasticity, extremely smooth surface (requires extra knot throws)
218
What are the properties of Silk suture material?
Origin: Natural
Tissue Absorption: Nonabsorbable
Physical Configuration: Braided
Tensile Strength: Degraded over time
Comments: Braided for easier handling; can be prone to infection
219
What are the properties of Mersilene suture material?
Origin: Synthetic
Tissue Absorption: Nonabsorbable
Physical Configuration: Braided or monofilament
Tensile Strength: No significant loss over time
Comments: Braided should not be used in infection
220
What is the recommended size of straight—french gauge for a child of age NEWBORN?
Answer: 4.0–6.0
221
What is the recommended size of straight—french gauge for a child of age 1–11 MO?
Answer: 6.0–8.0
222
What is the recommended size of straight—french gauge for a child of age 12–23 MO?
Answer: 8.0
223
What is the recommended size of straight—french gauge for a child of age 2–6 YR?
Answer: 10.0
224
What is the recommended size of straight—french gauge for a child of age 7–12 YR?
Answer: 10.0–12.0
225
What is the recommended size of straight—french gauge for a child of age >12 YR?
14.0
226
What is the recommended size of balloon—french gauge for a child of age NEWBORN?
6.0
227
What is the recommended size of balloon—french gauge for a child of age 1–11 MO?
: 6.0–8.0
228
What is the recommended size of balloon—french gauge for a child of age 12–23 MO?
8.0
229
What is the recommended size of balloon—french gauge for a child of age 2–6 YR?
: 8.0–10.0
230
What is the recommended size of balloon—french gauge for a child of age 7–12 YR?
12.0–14.0
231
What is the recommended size of balloon—french gauge for a child of age >12 YR?
: 14.0–16.0
232
233
What happens to heart rate at 40 mm Hg pressure?
Heart rate decreases at 40 mm Hg pressure.
Mnemonic: Heart gets tired at 40.
234
What is the pattern for mean arterial pressure across the given pressures?
Mean arterial pressure increases at all levels.
Mnemonic: Pressure goes up, so does the mean.
235
What is the pattern in glomerular filtration rate with increasing pressure?
Stable at 5 mm Hg, then decreases progressively as pressure increases.
Mnemonic: Pressure on the kidneys slows them down.
236
What happens to arterial pH as pressure rises?
Arterial pH remains stable until 20 mm Hg, then decreases.
Mnemonic: High pressure = lower pH.
237
Describe the effects of pressure using the submarine analogy.
As a submarine dives deeper, the engine (heart) works harder but tires at 40 mm Hg. The filtration system (kidneys) slows down, and the air system struggles to maintain balance, leading to increased CO2 and decreased pH.
Mnemonic: Diving deep affects the heart, kidneys, and air balance.
238
What is the overall complication rate for total abdominal procedures?
The overall complication rate for total abdominal procedures is 13.2%. Mnemonic: '13' as 'A' for abdominal, and '2' as two types of procedures.
239
What is the vascular injury rate for total abdominal procedures?
The vascular injury rate for total abdominal procedures is 2.8%. Visualize '28' as the age of a healthy adult.
240
What are the intraoperative and postoperative complications for pelvic procedures?
Intraoperative complications are 3.6%, and postoperative complications are 19% for pelvic procedures. Imagine 3.6 as '3 to 6,' referring to the hours of surgery, and 19 as the number of hours for recovery.
241
What are the applicability of EHL in intracorporeal lithotripters?
Bladder, Ureter, Kidney, Flexible
242
What are the contact of EHL in intracorporeal lithotripters?
1 mm from stone
243
What are the mechanism of EHL in intracorporeal lithotripters?
Electric spark produces vapor bubble, creating shockwaves to fracture stones
244
What are the tissue effects of EHL in intracorporeal lithotripters?
>1 mm distance from mucosa <500 mJ—no injury, >1000 mJ—ureteric perforation
245
What are the advantages of EHL in intracorporeal lithotripters?
Able to reach lower pole, Inexpensive
246
What are the disadvantages of EHL in intracorporeal lithotripters?
Significant tissue damage at higher energy, Durability of probe tip
247
What are the probe sizes of EHL in intracorporeal lithotripters?
1.6, 1.9, 3.3, 9 Fr
248
What are the mnemonic of EHL in intracorporeal lithotripters?
Electric Eel (EHL) reaches lower poles underwater
249
What are the applicability of Ultrasonic in intracorporeal lithotripters?
Bladder, Ureter, Kidney, Flexible
250
What are the contact of Ultrasonic in intracorporeal lithotripters?
Direct contact
251
What are the mechanism of Ultrasonic in intracorporeal lithotripters?
Rapidly vibrating probe tip, fragmentation, simultaneous aspiration
252
What are the tissue effects of Ultrasonic in intracorporeal lithotripters?
Mucosal stripping, No muscularis damage
253
What are the advantages of Ultrasonic in intracorporeal lithotripters?
Most efficient single modality, In-line suction for stone removal
254
What are the disadvantages of Ultrasonic in intracorporeal lithotripters?
Reduced efficiency in hard stones
255
What are the mechanism of Pneumatic in intracorporeal lithotripters?
Ballistic tip strikes stone like a jackhammer
256
What are the tissue effects of Pneumatic in intracorporeal lithotripters?
Focal areas of hemorrhage and mucosal erosions
257
What are the advantages of Pneumatic in intracorporeal lithotripters?
Least traumatic, Works well on harder stones, Least expensive
258
What are the criteria for evaluation of microhematuria as per the American Urological Association?
3 or more RBCs/HPF on a single UA, for adults. Cystoscopy if ≥35 years old or with risk factors. CT urogram is preferred for imaging, and biomarkers are not recommended.
259
How does the Japanese guideline differ from the American Urological Association's in evaluating microhematuria?
The Japanese guideline recommends evaluation if there are 5 or more RBCs/HPF on a single UA for adults ≥40 years old, with risk factors. Ultrasound is used for imaging, and cytology may be considered.
260
Can you recall the journey of various medical organizations and their unique guidelines for evaluating asymptomatic microhematuria?
Imagine a global medical conference where representatives from various medical bodies gather to discuss their guidelines for evaluating microhematuria. The American Urological Association focuses on adults with 3 or more RBCs/HPF, advising a CT urogram. The Canadians agree on the criteria but leave imaging to provider discretion. Kaiser Permanente stresses the importance of CT urogram or IVP + RUS but finds no consensus on cytology. The ACOG & AUGS target women, specifically never-smoking women between 35–50 years. The Japanese have a more stringent requirement of 5 RBCs/HPF and prefer ultrasound, while the Dutch recommend cytology if the evaluation is negative. The ACP and NICE, however, remain reserved in their guidelines. This conference paints a global picture of diverse yet interconnected guidelines.
261
What are the examples and risk factors associated with the Neoplasm category in the differential diagnosis of asymptomatic microhematuria?
Examples: Bladder cancer, ureteral or renal pelvis cancer, renal cortical tumor, prostate cancer, urethral cancer.
Risk Factors: Age, gender, tobacco use, family history, occupational exposure, etc.
Mnemonic: Neoplasm = Never Be Unaware of Risk Factors (N = Neoplasm, B = Bladder, U = Ureteral, R = Renal, F = Family).
262
What are the examples and risk factors associated with the Infection/Inflammation category in the differential diagnosis of asymptomatic microhematuria?
Examples: Cystitis, pyelonephritis, urethritis, tuberculosis, schistosomiasis, hemorrhagic cystitis.
Risk Factors: Gender, dysuria, fever, travel to endemic areas, etc.
Mnemonic: Infections Cause Pain; Understand The Symptoms (I = Infection, C = Cystitis, P = Pyelonephritis, U = Urethritis, T = Tuberculosis, S = Schistosomiasis).
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What are the examples and risk factors associated with the Calculus category in the differential diagnosis of asymptomatic microhematuria?
Examples: Nephroureterolithiasis, Bladder stones, Benign prostatic enlargement.
Risk Factors: Flank pain, family history, prior stone, male, older age, obstructive symptoms.
Mnemonic: Nephro's Big Bladder (N = Nephroureterolithiasis, B = Bladder stones, B = Benign prostatic enlargement).
264
What are the examples and risk factors associated with the Medical Renal Disease category in the differential diagnosis of asymptomatic microhematuria?
Examples: Nephritis, IgA nephropathy.
Risk Factors: Hypertension, azotemia, dysmorphic erythrocytes, cellular casts, proteinuria.
Mnemonic: Never Ignore High Azotemia (N = Nephritis, I = IgA, H = Hypertension, A = Azotemia).
265
What are the examples and risk factors associated with the Congenital or Acquired Anatomic Abnormality category in the differential diagnosis of asymptomatic microhematuria?
Examples: Polycystic kidney disease, Ureteropelvic junction obstruction, Ureteral stricture, etc.
Risk Factors: Family history, history of UTI, surgery, radiation, etc.
Mnemonic: Pure Ureteral Feelings During Family Histories (P = Polycystic, U = Ureteropelvic, F = Fistula, D = Diverticulum, F = Family, H = History).
266
What are the examples and risk factors associated with the Other category in the differential diagnosis of asymptomatic microhematuria?
Examples: Exercise-induced hematuria, endometriosis, hematologic or thrombotic disease, etc.
Risk Factors: Recent vigorous exercise, cyclic hematuria, family history, sickle cell disease, etc.
Mnemonic: End Each Hematologic Abnormality Right (E = Exercise-induced, E = Endometriosis, H = Hematologic, A = Arteriovenous, R = Renal vein thrombosis).
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