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Surgery Clerkship > Urology > Flashcards

Urology Flashcards

(61 cards)

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1
Q

Posterior urethral valve pathology

A

Posterior valve causes difficulty in getting urine out of bladder

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2
Q

Posterior urethral valve patient presentation?

A

No urine output on day 1 of life, increased creatinine. Baby may or may not have had oligohydramnios.

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3
Q

How to diagnose posterior urethral valve?

A

Voiding cystourethrogram

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4
Q

How to treat posterior urethral valve

A

Place a catheter, resect and reimplant

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5
Q

Epispadias

A

Urethra implants on the dorsal surface of the penis

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6
Q

Hypospadias

A

Urethra implants on the ventral surface of the penis

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7
Q

How to treat epi and hypospadias?

A

DO NOT circumcise, save the foreskin to rebuild penis

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8
Q

Ureteropelvic junction obstruction pathogenesis

A

Narrow lumen ureter that gets “obstructed” with high flows

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9
Q

How does ureteropelvic junction obstruction present?

A

Patient is fine with normal flows, but when a large diuresis occurs (drinking alcohol), patient experiences colicky abdominal pain.

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10
Q

How to diagnose ureteropelvic junction obstruction?

A

IV pyelogram

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11
Q

How to treat ureteropelvic junction obstruction?

A

Stent or surgery

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12
Q

Pathogenesis of low implantation of the ureter?

A

1 ureter drains into bladder just fine. The other drains directly into the urethra,

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13
Q

What type of patients present with low implantation of the ureter?

A

Boys are usually asymptomatic, but girls will present with normal voiding but a constant leak.

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14
Q

How to diagnose low implantation of the ureter?

A

With iv pyelogram

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15
Q

Pathogenesis of vesicoureteral reflux

A

2 way bladder - ureter valves allow bacteria to ascend to ureters and kidneys

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16
Q

Patient presentation of vesicoureteral reflux?

A

Frequent UTIs or any pyelonephritis

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17
Q

How to diagnose vesicoureteral reflux?

A

IV pyelogram

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18
Q

How to treat vesicoureteral reflux?

A

Surgery, empiric antibiotic prophylaxis

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19
Q

Cryptorchidism?

A

Undescended testicle

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20
Q

How does patient with cryptorchidism present?

A

With a missing testicle.

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21
Q

How to treat cryptorchidism

A

Wait one year to descend. If testicle doesn’t descend bring it into scrotum. Remove after puberty (from like 18-20) to avoid cancer.

Can also try 1 month of gonadotropin before doing anything.

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22
Q

Hematuria in kids?

A

Hematuria in kids is almost always abnormal (unless in the case of huge trauma). If pediatric patient has any blood in urine, do an u/s, IVP, or ct scan.

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23
Q

Patient presentation of renal cell carcinoma?

A

Patient has hematuria and flank pain with a palpable mass. Patient may also have anemia or polycythemia.

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24
Q

How to diagnose renal cell carcinoma?

A

Ultrasound, ct scan to stage, biopsy.

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25
How to treat renal cell carcinoma?
Surgical resection and chemo
26
Risk factors for the development of bladder cancer?
Smoking, exposure to analine dyes
27
How does patient with bladder cancer present?
Asymptomatic hematuria, hydronephrosis or hydroureter
28
How to diagnose bladder cancer
U/s showing hydronephrosis/hydroureter, cystoscopy. Best is biopsy, stage with CT
29
How to treat bladder cancer?
Surgical resection.
30
Prostate cancer pathogenesis
Prostate ca grows in response to 5-DHT.
31
How does patient with prostate cancer present?
With obstructive symptoms, increased PSA, or nodular prostate found on DRE.
32
How to diagnose prostate cancer?
PSA, transrectal bio0psy for determination of gleason score.
33
How to treat prostate cancer?
Resection, radiation, antiandrogens (flutamide), GnRH analogs (leuprolide), orchiectomy
34
How does testicular cancer present?
Painless mass in 15-25 year old, mass doesn't transilluminate.
35
How to diagnose testicular cancer?
Remove testicle and look. NEVER fna, because it can seed.
36
Tumor markers of seminoma
LDH and HCG
37
How to treat seminoma?
Platinum based chemotherapy.
38
Tumor marker of endodermal sinus tumor?
AFP
39
BPH patient presentation
Urinary frequency but no dysuria. Trouble initiating stream, dribbling, interrupted stream
40
How to diagnose BPH
U/a, urine culture, look at creatinine. NEVER biopsy or get PSA.
41
How to treat BPH
Alpha blockers (tamsulosin), 5-alpha-reductase inhibitors (finasteride), foley, TURP
42
Pathogenesis of erectile dysfunction?
Psychogenic or organic (vascular)
43
How does patient with ED present?
Trouble achieving or maintaining erections.
44
How to distinguish vascular from psychogenic ED?
Nighttime tumescence (postage stamp)
45
How to treat ED
If psychogenic, patient should undergo psychotherapy. If organic, PDE inhibitors (sildenafil) or prosthesis. Note: PDE inhibitors are not good for ED due to trauma, surgery, or radiation.
46
Testicular torsion pathogenesis
Testicle twists and strangulates vascular supply.
47
Patient presentation for testicular torsion?
Sudden onset pain, no other symptoms, testicle has a horizontal lie.
48
How to diagnose testicular torsion?
Clinical diagnosis with ultrasound
49
How to treat testicular torsion?
Surgical untwisting with a bilateral orchipexy.
50
Epididymitis pathogenesis
STD in patients less than 40, E.coli in patients >40
51
How does patient with epididymitis present?
Sudden testicular pain no other symptoms but a tender epididymis. Testicle in vertical lie
52
How to treat epididymitis?
In patients 40 use cipro
53
Patient presentation with bacterial prostatitis?
Patient has chills, fever, nausea vomiting, tender prostate on DRE and Ua that shows WBC and bacteria.
54
How to treat bacterial prostatitis?
NEVER repeat DRE. If it's bacterial, treat with a fluoroquinolone. If it's not bacterial, treat with NSAIDS
55
How to diagnose stones?
UA CT scan
56
How to treat stones
If 3cm, surgery If in between ESWL
57
How to distinguish torsion from epididymitis?
In torsion the cord is not tender. In epididymitis the cord is tender. Also epididymitis is marked by fever and pyuria.
58
What, besides testicular torsion, is a urologic emergency? How to treat
Combination of obstruction and infection. For example, ureteral stone + spiking fever and rigors. Patient requires IV antibiotics and immediate surgical decompression.
59
What happens if somebody with bacterial prostatitis keeps getting DRE?
Could lead to septic shock.
60
When is it okay not to work up hematuria in an adult?
After large trauma if there's trace blood.
61
Cause of pneumaturia
Fistula between GI tract and bladder most commonly in sigmoid colon from diverticulitis.

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