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298 Cards in this Set
- Front
- Back
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In what population is ureteropelvic junction obstructions more common
|
"infant boys
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pathogenesis of ureteropelvic junction obstruction
|
abnormal organization of smooth muscle w abnormal depostition of collagen
|
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Ureteritis follicularis
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accumulation of lymphocytes forming follicles with germinal centers which elevates the mucosa and can cause obstruction
|
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ureteritis cystic
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very small cysts lined by flattened urothelium that are found on the mucosa
|
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fibroepithelial polyp
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"benign, vascularized connective tissue projecting into the lumen, can impede flow"
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Most common malignant tumor of the ureters
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transistional carcinomas
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Intrinsic obstructive lesions
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"Diverticuli
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Extrinsic Obstuctive lesions
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"Pregnancy
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Hydroureter
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ureter exands and dilates
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Hydeonephrosis
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"kidney expands
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pyelonephritis
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"infection due to statis of urinary flow usually ascending and unilateral
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Sclerosing Retroperitoneal Fibrosis
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fibrous proliferation of inflammatory process encasing retroperitoneal structures causing hydronephrosis
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what is the cause and epidemiology of sclerosing retroperitoneal fibrosis
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"drugs, 70% idiopathic, late to middle age associated with other inflammatory conditions"
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definition of cystitis
|
inflammation of the bladder
|
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Predisposing factors for cystitis
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"calculi, obstruction, diabetes, instrumentation, immunodeficiency, cytotoxic drugs, radiation"
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clinical features of cystitis
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"frequency
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aka hunner ulcer"
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"morbitity and pain
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Malakoplakia
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"due to chronic inflamm
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Michaelis gutmann bodies
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"laminated mineralized concretions in macrophages
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polyploid cystitis
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inflammation results in polyps
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cystitis cystica"
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"metaplastic
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nephrogenic metaplasia
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"injury resulting in cuboidal metaplasia, form papillary structures looking like cancer"
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Transitional cell hyperplasia
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"benign or malignant
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papillomas
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"younger age group
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PUNLMP
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"larger, but similar to papillomas
|
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Low grade papillary urothelial carcinoma
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"orderly
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high grade papillary urothelial carcinoma
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"hyperchromatic nuclei
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carcinoma in situ
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"malignant cells in a flat urothelium
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Exophytic carcinoma
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"large polyploid fungating mass
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Squamous cell carcinoma (bladder)
|
"less common
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adenocarcinoma (bladder)
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"rare, dont see glands
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Bladder tumors- path and epidem
|
"older males
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mesenchymal tumors
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"leiomyoma
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what tumors metastasize to the bladder
|
"breast, melanoma, lung, kidney, stomach, stomach, pancreas, ovary"
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Nerve supply for the bladder
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L4-S2
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Urinary system shares autonomic innervation with
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GI
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How can you check the external urinary sphincter
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"Check the anal sphincter, they share innervation paths"
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Where does the L testicular vein drain
|
L Renal Vein
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Where does the right testicular vein drain
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Vena Cave
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How does kidney pain present
|
Unrelenting pain unaffected by movement or position
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Uretal Pain presents:
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"severe, crescendo, radiates into testicle or labia"
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Things that can increase urinary frequency
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"increased fluids/diuretics
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most common cause of hematuria
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infecttion
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Blood in urine during the entire urination
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"Bladder, upper tracts"
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Blood in urine only in beginning
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distal prostate urethra
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Blood only at end of urination
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prostatic urethra
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definition of incontinence
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involuntary loss of urine
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Stress incontenance
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increase in abd pressure and loss of some tone of the urinary sphincters
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Urge incontinence
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inability to coluntarily inhibit the detrusor
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paradoxical incontinence
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bladder is overfilled and the overflow is released
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Most common cause of urethral discharge
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"chlamydia
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Sx of bladder outlet obstruction
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"slowing of stream
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phimosis
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narrowing of the distal prepuce making it difficult to retract
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condyloma acuminata
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hpv viral wart
|
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peyronie's disease
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fibrous plaque on the penile shaft making it curve during erection
|
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cryptorchidism
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undescended teste
|
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DDx for scrotal mass
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"hydrocele
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how do you treat overactive bladder
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"adernergics
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Tx for enlarged prostate
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A-adernergic antagonist
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What organisms are normal flora of the GU tract
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"none, its sterile"
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Urethritis
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"dysuria, frequency, and urgency
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Cystitis
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"same as urethritis, plus suprapubic pain, bacteria, WBC and RBC in urine"
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Pyelonephritis
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"all the sx of cystitis, plus flank pain, fever, chills and WBC casts in urine"
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Most common UTI pathogen
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E. coli
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Other bugs that cause UTI
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"S. saprophyticus (15%)
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Unusual UTI pathogens
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"Ureaplasma
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What bacteria use a hematogenous route to cause UTI
|
"S. aureus
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Dx of community acquired UTI
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"9/10: dysuria, smell will be UTI
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What bacteria can be identified with nitrites in urine
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E. coli
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virulence factors for E. coli
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"Fimbriae
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Proteus
|
"pili, biofilm, urease (elevates pH >7.9) flagella"
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What UTI pathogen can produce a red pigment
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serratia
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novobiocin resistant"
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saprophyticus
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novobiocin sensitive"
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S. epidermidis
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Alkaline encrusted cystitis
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Corynebacterium urealyticum
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3 arterial supplies to the adrenals
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"phrenic
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Aldosterone is made in the
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zona glomerulosa
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glucocorticoid is made
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zona fasiculata
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androgens are made
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zona reticularis
|
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Primary Aldosteronism
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"conn syndrome
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Dx primary aldosteronism
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"HTN
|
|
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Screening for primary aldosteronism
|
"Na deprivation: Renin stays low but should get high from lack of Na
|
|
|
Tx for primary aldosteronism
|
Spironolactone
|
|
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ACTH dependent Cushing Disease
|
"Mostly pituitary pumping out ACTH
|
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ACTH independent Cushing Syndrome
|
Tumor in zona fasiculata
|
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Cushing Dx
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"24 hr urine- high cortisol
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Dexamethasone suppression test
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"Give low dose dexameth
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|
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congenital adrenal hyperplasia
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"cannot make cortisol, makes huge amounts of sex steroid instead
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Test for pheo
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"24 hr urine VMA
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Rule of 10 for pheo
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"familial
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Stouffer Syndrome
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"kidney cancer, extremely high LFTs"
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How do you decide whether or not to image someone with GU trauma
|
"anyone w gross hematuria
|
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|
Grade 1 kidney injury
|
"hematoma, enclosed within gerotas fascia"
|
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Grade 2 kidney
|
"shallow laceration, doesn't pierce cortico-medullary junction"
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grade 3 kidney
|
"deeper laceration, goes through cortico-medullary junction"
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Grade 4 kidney
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"Violation of the collecting system
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Grade 5 kidney
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shattered kidney
|
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What is a key sign on CT for a grade 4 kidney
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"Cortical rim sign
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Why do you not need to intervene with grades 1-3
|
"all enclosed within capsule, will self resolve with bedrest"
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When do you operate on renal trauma
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"pt in or and retroperitoneum fills with blood, unstable pt and must do exploratory"
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|
important imaging study for bladder trauma and what does it tell you
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"cystography with voiding study
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how do you treat an extraperitoneal bladder injury
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"only need a catheter, will self resolve"
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Anterior urethral trauma
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"2dary to straddle injury
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Posterior urethral trauma
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"2ndary to pelvic fracture
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management of distal urethral injury
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"retrograde urethrogram
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T1 images
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Fat is bright
|
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T2 images
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Fluid is bright
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How does detrusser hyperreflexia present on a cystometrogram
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bladder goes off as soon as water is added
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How does overactive bladder present on a cystometrogram
|
"small volume added, bladder contracts"
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How does atonic bladder present on a cystometrogram
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"bladder doesnt feel anything, doesnt contract"
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How does sphincter-detrussor dysynergia present on a cystometrogram
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bladder wants to push urine out but sphincter wont relax
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what increases the risk of UTI
|
"systemic disease
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presentation of a pyelo
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"chills, moderate fever, flank pain, NVD, malaise"
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DDx for pyelo
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"Pancreatitis
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Causes of painless hematuria
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"Renal neoplasm
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Painful hematuria
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"UTI
|
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What does LH stimulate
|
Leydig cells to secrete testosterone
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what does FSH stimulate
|
sertoli cells to initiate spermatogenesis
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maturation of sperm
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spematogonia-spematocyte-spermatids
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consideration in performing a vasectomy
|
"if reversed after 5 years have 100% return of sperm
|
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Reasons for infertility
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"viral infection
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Analytes for sperm
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"volume, density, motility, fwd progression, morphology"
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hormonal testing for fertility
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"fsh, lh, prolactin, testosterone"
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most common cause of male infertility
|
varicocele
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What method makes all older methods of reproductive assistance obsolete
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"ICSI- intracytoplasmic sperm injection
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what more serious problems can be associated with ED
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"diabetes, HTN, CVD, PVD, neurologic problems"
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chronic disease associated with low testosterone
|
"diabetes
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first line therapeutics for ED
|
"PDE5 inhib
|
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2nd line for ED
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"Intraurethral, injections, combination"
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how do PDE5 inhibs work
|
"PDE5 breaks down cGMP which, cGMP causes vasodilation, SMC relaxation, and erection
|
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ADR of PDE5 inhibs
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"blocks PDE6 in retina- colorblind
|
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Where does most BPH arise in the prostate
|
periurethral zone
|
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Why is the basal cell layer important in identifying prostate pathology
|
"Prostatic CA will no have a basal layer, BPH will"
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What bacteria are responisble for acute prostatitis
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"E coli, gm neg rods, enterococci, staph"
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What is the most common chronic prostatitis
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Abacterial prostatitis
|
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Granulomatous Prostatitis
|
"BCG therapy for bladder CA
|
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Prostatic infarct
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"common in large prostates
|
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Prostate Calculi
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"stones, looks like bird shot
|
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Pathogenesis of BPH
|
"epithelial cells dont undergo apoptosis but become senescent, get net increase in cells
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Most common cancer in men
|
Prostatic Adenocarcinoma
|
|
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Best screening approach for Prostatic adenocarcinoma
|
PSA (baseline at 50) and DRE
|
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Prostate CA genetics
|
"X linked AR gene, CAG repeats (length inversely related to risk)
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|
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Firm gritty consistency on DRE
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"Prostate CA
|
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What kind of bone metastasis comes from prostate cancer
|
"osteoblastic tumors, mostly im lumbar
|
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How does prostate cancer metastasize
|
"periprostatic tissue, lymphatics, or hematogenous"
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Microscopic appearence of prostate ca
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"no basal layer
|
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Prostatic Intraepithelial Neoplasia
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glands are benign but lined with atypical cells
|
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Gleason grading system
|
"take best looking set of cells and worst looking set and rank 1-5, add up the 2 scores
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what is better to look at than just simply the PSA
|
"density- prostate size/psa value
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how does free PSA corelate to ca risk
|
free psa is lower in cancer pts than pts with BPH
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|
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2 types of testicular tumors
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"Germ cell (seminomas/nonseminomas)
|
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Germ cell tumor demo
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"young 15-24
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What do most germ cell tumors arise from
|
"intratubular germ cell neoplasia
|
|
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Testicular cancer genetics
|
"cKIT
|
|
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seminoma
|
"Painless, very large
|
|
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Morphology of seminoma
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"Tan homogeneous cut surface
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Seminoma Microscopically
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"Sheets of uniform cells, Clear cytoplasm well defined borders
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Anaplastic seminoma
|
"greater cellularity
|
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Spermaticytic Seminoma
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"later age group 65+
|
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Embryonal Carcinoma
|
"smaller but more aggressive
|
|
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Histological difference between seminoma and embryonal carcinoma
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"seminoma has cKIT
|
|
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endodermal sinus tumor"
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"infants/children
|
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Key structure in yolk sac tumor
|
schiller duval bodies
|
|
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Schiller duval body
|
"endodermal sinus -like
|
|
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What markers can be seen in yold sac tumors
|
"AFP, A1AT"
|
|
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Choriocarcinoma
|
"Very malig and aggressive
|
|
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2 cell types in choriocarcinoma
|
"synctiotrophoblasts- large irregular eosinophillic, HCG +
|
|
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teratoma with malignant transformation
|
"benign teratoma that has cancerous cells. can be squamous cell, adeno, sarcoma whatever"
|
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Teratocarcinoma
|
teratoma with embryonal carcinoma
|
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Teratocarcinoma morphology
|
"mutlicystic
|
|
|
Painless enlargement of the testes
|
germ cell tumor
|
|
|
biological markers for germ cell tumors
|
"HCG, AFP, Lactate dehydrogenase (tumor burden)"
|
|
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leydig cell tumors
|
"any age, testicular swelling
|
|
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Features of leydig cell tumor
|
"golden brown homogenous cut surface
|
|
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Sertoli cell tumor
|
"silent
|
|
|
Growing N gonorrhoeae
|
"needs iron in media
|
|
|
pilli"
|
Gonnorhea
|
|
|
Por proteins
|
form pores allow for antigenic variation
|
|
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Opa protein
|
binding of pilin to epithelium
|
|
|
Clinical gonnorhea in men
|
"urethritis
|
|
|
clinical gonnorhea in women
|
"Cervix
|
|
|
Migratory arthralagia
|
gonorrhea
|
|
|
Leading cause of purulent arthritis in adults
|
gonnorhea
|
|
|
Fitz-Hugh-Curtis syndrome
|
"inflammation of the lining of the liver. RUQ pain
|
|
|
Lab Dx of gonnorhea
|
"Gram neg diplos
|
|
|
Beta lactamase pos or neg for gonnorhea
|
"Positive, cannot use PCN"
|
|
|
Treponema Pallidum
|
syphilis
|
|
|
Tests for T pallidum
|
"VDRL
|
|
|
Primary syphilis
|
"non painful erosion of surface layer with active spirochetes
|
|
|
2ndary syphilis
|
"lesions all over body
|
|
|
tertiary syphilis
|
"gummas, neuro sx"
|
|
|
Congenital syphilis
|
"organ malformations, can be fatal
|
|
|
Tx for syphilis
|
"PCN
|
|
|
Most common bacterial STD
|
Chlamydia
|
|
|
Chlamydia sx in women
|
"80% asymptomatic
|
|
|
Chlamydia Sx in men
|
"postgonococcal urethritis
|
|
|
tx for chlamydia
|
"Azithro
|
|
|
Oral herpes
|
"type 1
|
|
|
Genital herpes
|
HSV 2
|
|
|
local and systemic sx of herpes infection
|
"pain, itching, dysuria
|
|
|
incubation of herpes
|
5 days
|
|
|
tx for herpes
|
"acyclovir, famiclovir, valacyclovir
|
|
|
Disseminated neonatal herpes
|
"encephalitis
|
|
|
Gold standard for herpes testing
|
viral culture
|
|
|
Tzanck smear
|
"herpes test
|
|
|
Transmission of CMV
|
"saliva, genital secretions
|
|
|
Clinical CMV
|
"nothing really
|
|
|
Congenital CMV
|
"bad if primary infection in utero
|
|
|
Transmission of HPV
|
"breaks in skin, STD, birth and exposure to birtch canal"
|
|
|
HPV course of infection
|
"can be subclinical and clear in 1-2 years
|
|
|
what HPV strains are associated with cancer
|
"16, 18"
|
|
|
what HPV causes laryngeal papillomas
|
"6, 11"
|
|
|
HPV causing warts
|
"6, 11, 16"
|
|
|
Epidermodysplasia verruciformis
|
"Tree man
|
|
|
Gardisil
|
"quadrivalent
|
|
|
Cervarix
|
"Divalent
|
|
|
testosterone and the prostate
|
"5 alpha reductase changes it to DHT, which is more powerful. "
|
|
|
what increases Sex hormone binding globulin to testosterone
|
binding increased by estrogen and thyroxine
|
|
|
what decreases Sex hormone binding globulin to testosterone
|
"Androgens, GH, Insulin"
|
|
|
Action of androgens
|
"increases sperm production
|
|
|
main indication for androgen therapy
|
"testicular insuffiency
|
|
|
Danazol
|
"reduces estrogen overstimulation
|
|
|
contraindications for androgens
|
"Breast cancer
|
|
|
Anti androgens
|
"treats androgen stim'd tumors
|
|
|
GnRH
|
agonist but will negatively feedback the brain to stop producing androgens
|
|
|
Leuprolide
|
"Supress synthesis of androgens
|
|
|
Nafarelin
|
"nasal spray androgen suppressor
|
|
|
Ketoconazole
|
"reduces synthesis and hydroxylation
|
|
|
Dutasteride"
|
"5Areducase inhib
|
|
|
Flutamide
|
"Blocks androgen receptor
|
|
|
Pine bark
|
safe but no benefit to CV health
|
|
|
why are so many botanicals that dont work still on market
|
no major side effects
|
|
|
Black Cohosh
|
has estrogenic effects
|
|
|
Echinacea
|
"stims immune system but then downregulates it
|
|
|
what are the 2 ways the FDA can ban a product
|
"reports of toxic or fatal effects
|
|
|
FeverFew
|
"Interferes with prostaglandins
|
|
|
Garlic
|
"No effects in studies
|
|
|
Ginger
|
"Claimed: N/V reduction
|
|
|
Ginkgo
|
"Some CV benefits
|
|
|
Ginseng
|
"Claim: CNS stimulant
|
|
|
Abd mass in child/infant
|
85% urologic origin
|
|
|
Most common peds abd tumor
|
Wilms Tumor
|
|
|
Megaureter
|
"dilated ureter from obstruction
|
|
|
when do infants get a voiding cystourethrogram
|
After first UTI
|
|
|
Most important info for urologist regarding hypospadias
|
"position or urethral meatus
|
|
|
cryptochordism infants should be refered to a urologist:
|
3 mo
|
|
|
Hydrocolpos may have obstruction of drainage at
|
cervical os
|
|
|
Trichomoniasis
|
Foul smelling grey frothy bubbly vaginal dishcharge
|
|
|
Strawberry cervix
|
Trichomoniasis
|
|
|
causes of bacterial vaginosis
|
"gardnerella
|
|
|
Clue Cell
|
bacterial vaginosis
|
|
|
Whiff test
|
add KOH to wetmount- fish smell means bacterial vaginosis
|
|
|
Chandelier Sign
|
"while doing pelvic exam its so uncomfortable pt jumps up
|
|
|
Argyll Robertson Pupil
|
"Accommodation reflex but no light reaction
|
|
|
Chancroid
|
"painful, railroad track sign
|
|
|
Lymphogranuloma Inguinale
|
"Klebsiella granulomatis
|
|
|
what is the most important criterea for therapy of BPH
|
Symptom and bothersom score
|
|
|
International Prostatic Symptom Score
|
"Incomplete empying
|
|
|
Bother Score
|
"How much discomfort
|
|
|
Leading GU cancer in men
|
"Prostate
|
|
|
Biggest link to kidney cancer
|
Tobacco
|
|
|
Classic triad of RCC
|
"Hematuria
|
|
|
Paraneoplastic sx of RCC
|
"Hypercalcemia
|
|
|
RCC cell types
|
"Clear cell
|
|
|
Tx for RCC
|
"Surgery (90% are malig)
|
|
|
2nd most common GU cancer
|
bladder
|
|
|
What is the most common cell type in bladder cancer (US only)
|
transitional cell
|
|
|
Most common cell type for bladder cancer world wide
|
squamous (schistosomiasis link)
|
|
|
Superficial bladder cancer
|
"will recure
|
|
|
Tx for muscle invasive bladder cancer
|
"chemo+radiation
|
|
|
Goblet sign
|
"urethral cancer
|
|
|
Tx for ureter CA
|
"nephroureterctomy is gold standard
|
|
|
Signs and sx of testicular cancer
|
"painless mass
|
|
|
Tx for Penile cancer
|
"partial penectomy
|
|
|
When is a prostate tumor palpable
|
"1 cm3
|
|
|
How long does it take a prostate tumor to become palpable
|
6-8 years
|
|
|
Catagory I prostatitis
|
Acute Bacterial
|
|
|
Category II Prostatitis
|
Chonic Bacterial
|
|
|
What prostatitis do you avoid DRE
|
Cat I
|
|
|
Categrory III prostatitis
|
"Chronic Pelvic Pain Syndrome aka abacterial chronic prostatitis
|
|
|
Cat IIIa Prost
|
"White cells in ejaculate
|
|
|
Cat III b prostatitis
|
"non inflam
|
|
|
Cat IV prostitis
|
"asymptomatic inflammatory prostititis
|
|
|
Biggest risk for stone formation
|
previous stone hx
|
|
|
Most common stone type
|
calcium oxalate
|
|
|
2nd most common stone
|
Calcium phosphate
|
|
|
Magnesium levels in pt with CaOx
|
usually deficient
|
|
|
Struvite Calculi
|
"Staghorn
|
|
|
Uric acid stone
|
"Men
|
|
|
pain of a stone
|
"crescendo, movement doesnt change the pain
|
|
|
1st study to order when suspect Kidney stone
|
"CT, no contrast"
|
|
|
Tx for renal calculi
|
"Observe, Pain control, Force fluids, strain pee
|
|
|
What do you do for your pt after stone is passed
|
"stone analysis
|
|
|
most common mass in the scrotum
|
hydrocele
|
|
|
Congenital Hydrocele
|
"communicates with peritoneal cavity, gets big when baby cries"
|
|
|
Spermatocele
|
"smaller mass, cyst in head of epididymis, seperation from testicle"
|
|
|
What masses in testicle will change from standing to lying down
|
"varicocele, inguinal hernia"
|
|
|
when is hematuria significant
|
"always, even 3 rbc on a field is significant"
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