Week 7 Flashcards by Iseoluwa Ojo

Classifications of Hypospadias

From distal to proximal

Glandular
Coronal
Proximal penile
Mid shaft
Distal penile
Penoscrotal
Scrotal
Perineal

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Differential diagnosis for hypospadias?

Megameatus
Ventral urethra avulsion
Ambiguous genitalia

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The components of hypospadias repair?

Orthoplasty
Urethroplasty
Glanuloplasty
Meatoplasty
Scrotoplasty
Spongioplasty
Skin cover

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Orthoplasty - ___________
Urethroplasty - ___________
Glanuloplasty -_________
Meatoplasty -_____________
Scrotoplasty -________________
Spongioplasty -____________
Skin cover -_____________

Straightening of the penis

Correction of damage to the urethra

plastic surgery carried out on a glans

type of surgery to enlarge the urethral meatus at the end of the penis

surgical procedure used to either repair or treat an existing scrotum or to create a new scrotum

Surgery done on the corpus spongiosum to prevent urethrocutaneous fistula

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It is vital to never carry out circumcision in a child with any degree of hypospadias

T/F

With reason

The preputial skin may be needed for corrective surgery

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Hypospadias is a congenital malformation seen in 1 in ______ ______

300 boys.

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The 5Ps?

Pain
Pallor
Pulseless
Paresthesia
Paralysis

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the 4Ds indications for amputation

Dead/limb gangrene
Dying
Damn nuisance
Dangerous

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Timing of hypospadias repair is influenced by _________, __________, and ________

penile size, genital awareness, and anesthetic risks

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In select patients the __________ is a useful procedure for the correction of congenital or acquired chordee.

Nesbit operation

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What is continuous bladder irrigation? Continuous bladder irrigation (CBI) is a medical procedure that ____________________. It also __________________________ at the same time. Healthcare providers often use it to ______________________ after surgery on the urinary system.

flushes your bladder with a sterile liquid

removes urine (pee) from your body

prevent or remove blood clots

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Do not take _____ when you have cancer

Flagyl

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Risk factors for DVT

Mention 10

Age
Immobilization
Pregnancy
Injury or surgery
Cancer
OCP/ HRT
Smoking
IBD
genetics
Past history of DVT

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Bad girls get _______
Good girls get ________

Pregnancy

Fibroid

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Auscultation: bowel sounds

Peristalsis produces a ______ noises because the bowel contains a mix- ture of _____ and _______.

gurgling

fluid and gas

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Auscultation: bowel sounds

Normal bowel sounds are _____-pitched gurgles that occur every __________.

The absence of bowel sounds indicates that ________________. This may either be a primary or a secondary phenomenon.

low; few seconds

peri- stalsis has ceased

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If you can hear the heart and breath sounds but no bowel sounds over a 30-second period, the patient probably has a _____________.

para- lytic ileus

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Distension of the bowel caused by a mechanical intestinal obstruction is associated not only with ______eased bowel sounds, but also with a change in the _____________. They become _______ in nature with runs of ______- frequency gurgles, sounding like sea water enter- ing a large cave through a narrow entrance, often described as ‘ __________ ’.

incr; character of the sounds

amphoric; high

tinkling

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Having assessed the quality of the bowel sounds, it is important to listen for any systolic vascular bruits, which indicate ___________ or increased blood flow through, for example, a _______.

arterial stenosis

fistula

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Percussion of the abdomen causes pain if ___________ is present and is a useful method for mapping out a tender area

peritonitis

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When a part or the whole of the abdomen appears distended, the patient should be held at the ______ and the abdomen ________________ .

________ sounds – a ___________ – indicate that there is an intra-abdominal viscus, usually the _________, distended with a mixture of fluid and gas.

hips

shaken from side-to-side

Splashing; succussion splash

stomach

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An enlarged kidney can be pushed back and forth between the anterior and posterior hands. This is called ________.

It feels like patting a ball back and forth in a pool of water. Balloting is also used to palpate a _____ in a ___________

balloting

fetus; pregnant uterus.

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Acute pancreatitis is a condition in which _________________________ the pancreatic gland.

It may be caused by ______ of the pan- creatic duct, usually by a __________ obstructing the ampulla of Vater. It is also commonly secondary to _________

activated pancreatic enzymes autodigest

obstruction; small gallstone

alcohol abuse.

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The common presenting symptom in acute pancreatitis is ______ that begins suddenly, high in the ________, and steadily increases in severity until it is very severe, causing the patient to ________ and breathe __________.

It usually radiates through to the ———-.

pain; epigastrium

lie still ; shallowly; back

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In acute pancreatitis ________ relieves the pain, which is exacerbated by ________. Frequent ________ and ———— are very common, and are an important pointer to the correct diagnosis. There is persistent ______ between the bouts of vomiting.

Nothing; movement vomiting and retching nausea

Inflammation of a Meckel’s diverticulum produces symptoms and signs that are indistinguishable from those of ________, although the pain and tenderness are generally felt more towards the __________ than in the __________.

acute appendicitis centre of the abdomen right iliac fossa

Acute Crohn’s disease may present with ________ or ___________ discomfort and signs similar to those of appendicitis. A thick and tender _________ may be palpable in the ___________, and thickened ____________ may also be palpable in the ______________.

central or right iliac fossa terminal ileum ; right iliac fossa ileum and jejunum umbilical region.

The normal visceral innervation of the appendix comes from the __________ spinal segment. The corresponding somatic dermatome encircles the abdomen at the level of the ______________

tenth thoracic umbilicus (T10).

The inflamed appendix most commonly lies behind the ________ ( ________ ) so causes pain in the lateral part of the ___________ and the _______, but it may hang down into the pelvis and lie against the ________ or a ________________. In these circumstances, the patient may present with misleading ________ or ________ symptoms.

caecum; retrocaecal right iliac fossa ; flank bladder; loop of large bowel bladder or large bowel

Acute appendicitis may also present with intestinal obstruction –_______ and __________ – if the appendix ___________________________________ .

colic and abdominal distension lies too close to and inflames the terminal ileum (preileal or postileal)

Acute appendicitis A _________ usually precedes the onset of pain by a few hours, and most patients feel slightly nauseated. Many patients vomit _________.

loss of appetite once or twice

Most patients with appendicitis state that they had been __________ for a few days before the pain started, but a few complain of _________, which may lead to a mistaken diagnosis of __________, especially in children.

constipated diarrhoea; gastroenteritis

Acute appendicitis Some patients present with symptoms of generalized peritonitis – generalized abdominal pain, nausea and vomiting, sweating and sometimes rigors – especially if the ___________________.

initial stages of the disease go unoticed

A tender, indistinct mass may be felt in the right iliac fossa. It is usually impossible to feel below it because it is _______________. It is _____ to percussion. ___________ usually takes a few days to develop. ___________ should be suspected if the temperature is high and the mass is very tender

fixed posteriorly dull; An appendix mass An appendix abscess

The causes of abdominal distension can be remembered by repeating the letter ‘F’ six times: ______,_____,______,______,_____,_______ ; and other solid tumours (

fetus, flatus, faeces, fat, fluid and fibroids

Spigellian hernia These hernias appear at the ______ edge of the ____________ muscle along the ____________. The lump is still palpable when the abdominal wall muscles are _________, and it is felt to lie above them

outer; rectus abdominis linea semilunaris contracted

Resolved inflammed appendix gives rise to???

Mucocele of the appendix

Acute appendicitis may follow URTI T/F

Volkovich-kocher sign We believe that the sequence of pain initially in the _________ and ________ regions followed by pain in the ____________

epigastrium; periumbilical right lower quadrant

Blumberg's sign also referred to as?

rebound tenderness

Dunphy sign sharp pain in the _______ elicited by a _________________

RLQ voluntary cough

Markle's sign, or ____________ , is a clinical sign in which pain in the ____________ of the abdomen is elicited by the ____________ test

jar tenderness, right lower quadrant heel-drop test

heel-drop test (__________ to the __________, from __________ on the __________, with a __________ landing).

dropping ; heels standing ; toes, Jarring

Cachexia AKA ___________

Wasting syndrome

Psoas major: Originates from ________; attached to _______________ Psoas minor : origininates from ________; insert on the ___________

T12 – L5; lesser trochanter of the femur. T12 and L1 ; iliopectineal eminence

The Obturator externus (OE) muscle originates from the ______________ , inserts into the _________________ Obturator internus: Originates from the ________________________. attaches onto the _________________

rami of pubis and ischium; trochanteric fossa of the femur pubis and ischium at the obturator foramen greater trochanter of the femur.

ZONES OF THE PROSTATE BPH: CA: Prostatitis

Peripheral zone Transitional or periurethral No zone predilection

Prostatic diseases age BPH: CA: Prostatitis

>/= 50 >/= 60

Obstructive symptoms of Prostatic diseases

Weak stream Straining Intermittent Dribbling Incomplete emptying of the bladder Hesitancy at micturition

Irritative symptoms of Prostatic diseases

Frequency Urgency Nocturia Dysuria Urge incontinence

BPH is a premalignant lesion to prostatic carcinoma T/F

Infection involves _______ by _________.

tissue invasion microorganisms

_______ + ________= ejaculatory duct

Seminal vesicle Vas deferens

Machine to measure urine stream strength is ???

Uroflowmetry

Baden–Walker half way system of _______________ It consists of four grades: grade 0 – ____________ grade 1–____________ grade 2 –____________ grade 3 – ____________ grade 4 –____________

Pelvic organ prolapse grade 0 – no prolapse grade 1–halfway to hymen grade 2 – to hymen grade 3 – halfway past hymen grade 4 –maximum descent.

normal saline VS dextrose saline

Normal saline solution contains salt in the same concentration as blood. Dextrose-saline solution in addition to salt also contains dextrose (a form of sugar).

The simplest approach is to replace dehydration losses with _______. This ensures that the administered fluid _____________________, where it will do the most good to support blood pressure and peripheral perfusion.

0.9% saline remains in the extracellular (intravascular) compartment

Dextrose 5% in water is used to treat __________________ , ________ shock, or ____________ (fluid loss).

low blood sugar (hypoglycemia) insulin dehydration

__% normal saline ___% dextrose

0.9 5

The differences in particles mean that lactated Ringer's doesn't ____________ as normal saline does. This can be a beneficial effect to avoid _________.

last as long in the body fluid overload

WHO recommends that these homemade sugar-salt rehydration solutions should contain __________ of sugar and ___________ of salt added to ___________ of water. This results in a concentration of ____ mmol/liter of glucose and ____ mmol/liter of sodium.

8 level teaspoons 1 level teaspoon 1 liter 116; 86

Supine abdominal film shows _______ loops of _______ with the "stack of coins" appearance, suggesting _______________. On the erect abdominal film, multiple ___________ are noted that suggest ________.

dilated small bowel ; small bowel obstruction air-fluid levels; obstruction

Graham patch ________ patching is a surgical procedure for treating __________. It is also called a Graham patch after the surgeon who first performed this technique. This procedure uses _____________ to repair the injury because it is _________.

Omental perforated ulcers a patch of the omentum durable

Varicocele An ________ of the ______ within the scrotum. A varicocele may develop as a result of _____________ that are normally found in veins. In other cases, it may occur from _________ of a vein by a nearby structure.

An enlargement of the veins poorly functioning valves compression

Varicoceles occur on the left side in most cases because of the relation of ____________ to the ___________ (the ______________________________________). On the right side, the ____________________

the spermatic vein to the left renal vein spermatic vein opens at a sharp angle into the left renal vein spermatic vein opens into the much larger inferior vena cava.

Bladder outlet obstruction is an _________________ at the __________ and/or ________ that results in _______________ in the presence of high __________ and high _____________

impedance in the flow of urine bladder neck ; urethra low urine flow rate voiding pressure ; intravesical pressure

Common causes of BOO Mention 6

BPH Prostate cancer Bladder stones (calculi) Urethral strictures Bladder tumor Neurogenic bladder dysfunction

Long term effects of BOO? Obstructive __________ and _________ ________________(______ and ______) Recurrent ________ and ________ Bladder wall _________ and _______ Impaired destrusor _________ with ________ problems

Obstructive nephropathy and renal failure Upper tract dilatation (hydronephrosis and hydroureter) Recurrent UTI and hematuria Trabeculation and sacculation Contractility; voiding

Which BOO is more pronounced ? BPH or CA-P? With reason

BPH Because it’s mostly at the periurethral transitional zone

Prostate cancer metastasize early to the ________ because of the _______ vein of _________ that connects with the _________ venous plexus

Vertebrae; valveless Batson vertebral

Features suggestive of prostate cancer metastasis?

Inability to walk Low back pain

In acute urinary retention, the patient is ______________ , despite _____ with associated ________ and ___________ In chronic urinary retention, the patient ________________ but always have __________ ( residual of > ____ml, normal is >____ml. They may present with ____________, enuresis, and renal insufficiency

unable to pass urine ; urge Supra pubic pain and fullness still passes small quantity of urine some retained; 250; 50; overflow incontinence

Acute retention is (painless or painful?) and (gradual or sudden?) . Chronic retention is (painless or painful?) , and there is a chronically __________ bladder.

painful; sudden painless ; distended bladder.

Acute retention may develop in the presence of chronic retention, when the expression ___________ retention is sometimes used.

acute-on- chronic

Acute retention in the absence of bladder outlet obstruction is rare, and occurs only after a __________, _______ or an _______________.

surgical operation anaesthesia injury to the urethra

Patients with chronic retention may be symptom free except for the ______________ produced by the _____ bladder and can present with __________

abdominal swelling; large enuresis

What is enuresis?

involuntary leakage of urine at night

Percussion is useful in deciding whether a patient is in acute retention, as the bladder is ___________.

always dull

Percussion in acute retention The bladder may reach up to, or above, the umbilicus if the patient __________________________. A large bladder of this size indicates _________ retention.

has had chronic retention before the acute episode acute-on-chronic

You can not assess the size of the prostate gland gland, or the pelvis, when the _____________. It is better to defer the rectal examination for prostate assessment until after the retention has been relieved with a _______.

bladder is full catheter

Types of chronic urinary retention In the high-pressure type, the cause is ________________ . In the low-pressure type, the fault seems to lie with the _________________.

obstruction of the bladder outlet bladder muscle, which is atonic

The retention is of the _____ pressure type if a patient in chronic retention has the symptoms and signs of renal failure

high

___________ is pathognomonic of chronic retention.

Enuresis

Remember that a full bladder pushes the prostate ______wards and makes it feel _________.

down bigger

Prostatic cancer metastasizes to ______, particularly the ________ and ________. These bone deposits are nearly always _________ and _________, so tend to produce _______ rather than __________

bone; pelvis and lumbar spine osteosclerotic and osteoblastic bone pain; pathological fractures

Ureteric Coli may radiate to the _____,_____,_____ but not to the ______,______

Groin; labium; testicle Chest ; back of the leg

A dragging sensation in the scrotum that gets worse towards the end of the day is characteristic of ??

Varicocele

Anterior urethra = ??? And ??? Posterior urethra = ???? And ????

Penile and bulbar Membraneous; prostatic

Lower urinary tract symptoms(LUTS) are divided into _______ and ——— and _______

Storage voiding symptoms Post-micturition

LUTS frequency Urgency Nocturia Strangury Urge incontinence Stress incontinence Nocturnal enuresis Hesitancy Intermittency Straining Incomplete emptying Post-micturition dribble

Urinating too often during the day A compelling desire to urinate that is difficult to stop Waking up at night to pee atleast once A sensation of constantly needing to void Voiding involuntary after an intense urge to void Voiding involuntarily due to increase in intra-abdominal pressure Voiding involuntarily at night while sleeping Difficulty initiating micturition Urine starts and stops multiple times and on multiple occasions Muscular effort required to initiate , maintain or improve the urinary stream After micturition, feeling like the ladder is still full Loss of urine that continues after voiding

StORAGE LUTS are typical of ?? Voiding LUTS are typical of ??

Overactive bladder Bladder outlet obstruction

Timing of blood in relation to urinary stream Initial = ??? Throughout the stream= ???? Terminal = ????

Urethral pathology Bladder or upper tracts Bladder neck or prostatic pathology

Hematuria can be classified into ______ and _______

Visible Non-visible

Peak urine flow rate of ______= no major BOO Peak urine flow rate of ______=BOO is present

>15mL/s <10mL/s