Urology

Question 1

What is the name of the fascia that surrounds the kidney?

Answer 1

Gerota’s fascia

Question 2

What is the relationship of the renal vessels from anterior to posterior?

Answer 2

From anterior to posterior, renal vein, renal artery, and renal pelvis

Question 3

What is the relationship of the right renal artery to the IVC?

Answer 3

The right renal artery crosses posterior to IVC

Question 4

What is the relationship of the left renal vein to the aorta?

Answer 4

The left renal vein is anterior to the aorta

Question 5

What is the relationship of the ureters to the iliac vessels?

Answer 5

The ureters cross over the iliac vessels

Question 6

Which renal vein can be ligated and why?

Answer 6

The left renal vein because it has increased collaterals (left adrenal vein, left gonadal vein, and left ascending lumbar vein)

Question 7

What are the spermatic cord structures?

Answer 7

Testicular artery, pampiniform plexus, vas deferens , cremasteric muscle, genital branch of the genitofemoral nerve

Question 8

What is the most common cause of acute renal insufficiency following surgery?

Answer 8

Hypotension

Question 9

What are the symptoms of kidney stones?

Answer 9

Severe colicky pain, restlessness, hematuria

Question 10

What scan should you get if you suspect kidney stones?

Answer 10

CT scan—can demonstrate stones and associated hydronephrosis

Question 11

What are the most common kidney stones?

Answer 11

Calcium oxalate stones (75%)

Question 12

What patients are prone to calcium oxalate kidney stones?

Answer 12

Patients with terminal ileum resection due to increase oxalate absorption in the colon

Question 13

What are struvite stones and what causes them?

Answer 13

Made of magnesium ammonium phosphate. Occurs with infections that are urease producing (Proteus)

Question 14

What type of kidney stones are radiopaque?

Answer 14

Calcium oxalate and struvite stones

Question 15

What patients are at risk for Uric acid stones?

Answer 15

Patients with ileostomies, gout, and myeloproliferative disorders

Question 16

What type of kidney stones are radiolucent?

Answer 16

Uric acid stones and cysteine stones

Question 17

What patients are at risk for cysteine stones?

Answer 17

Associated with congenital disorders in the reabsorption of cysteine (cystinuria)

Question 18

How can you prevent cysteine stones?

Answer 18

Give tiopronin

Question 19

What are the surgical indications for kidney stones?

Answer 19

Intractable pain or infection
Progressive obstruction
Progressive renal damage
Solitary kidney

Question 20

What percentage of kidney stones are opaque?

Answer 20

90%

Question 21

At what kidney stone size is it unlikely to pass?

Answer 21

> 6 mm

Question 22

What are the treatment options for kidney stones?

Answer 22

Extra-corporeal shock wave lithotripsy, ureteroscopy with stone extraction or placement of stent past obstruction, percutaneous nephrostomy tube, open nephrolithotomy

Question 23

What is the number 1 cancer killer in men 25-35?

Answer 23

Testicular cancer

Question 24

What symptoms are present in testicular cancer?

Answer 24

Painless hard mass

Question 25

Are most testicular masses are malignant or benign?

Answer 25

Malignant

Question 26

What lab marker correlates with tumor bulk?

Answer 26

LDH

Question 27

90% of all testicular cancers are of what type?

Answer 27

Seminoma or nonseminoma

Question 28

What increases the risk of testicular cancer?

Answer 28

Cryptorchidism (undescended testes)

Question 29

What is the number one testicular tumor?

Answer 29

Seminoma

Question 30

What other lab values should you check in patients with suspected or confirmed testicular cancer?

Answer 30

B-hCG and AFP

Question 31

What lab values are increased in seminomatous tumors?

Answer 31

B-hCG | NOT AFP. If AFP is elevated, must treat like non-seminomatous

Question 32

What is the treatment for seminomatous testicular cancer?

Answer 32

Orchiectomy and retroperitoneal radiation | Complete surgical resection of residual disease after radiation and chemo

Question 33

When is chemo used in testicular cancer?

Answer 33

For metastatic disease and bulky retroperitoneal disease

Question 34

What types of non-seminomatous testicular CA are there?

Answer 34

Embryonal, teratoma, choriocarcinoma, yolk sac

Question 35

What lab results are often increased in non-seminomatous testicular cancer?

Answer 35

Alpha fetoprotein and beta-hCG

Question 36

What kind of tumors are more likely to metastasize to the retroperitoneum?

Answer 36

Tumors with increased teratoma components

Question 37

What is the treatment for nonseminomatous testicular cancer?

Answer 37

All stages get orchiectomy and retroperitoneal node dissection. If stage II or greater, give chemo. Surgical resection fo residual disease after above.

Question 38

What is the most common site of prostate cancer?

Answer 38

Posterior lobe

Question 39

What is the most common site of metastasis in prostate cancer?

Answer 39

Bone

Question 40

What kind of bone metastasis is often seen in prostate cancer? What is often seen on imaging?

Answer 40

Osteoblasts. Seen as hyper dense areas on x-rays

Question 41

What are some complications of surgery for prostate cancer?

Answer 41

Patients can become impotent, incontinent, and can develop urethral strictures

Question 42

How is the diagnosis of prostate cancer made?

Answer 42

By trasrectal biopsy, chest/abdomen, pelvis CT, PSA, alkaline phosphatase, and possible bone scan