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105 Cards in this Set
- Front
- Back
Foreskin can't be retracted over the glans
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Phimosis
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Foreskin has been left retracted behind the glans, resulting in painful engorement and edema of the glans
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Paraphimosis
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Presence of a persistent, usually painful erection of the penis
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Priapism
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Acute inflammatory condition of the penis associated with penile curvature and, in some case, pain
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Peyronie's Disease
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Collection of fluid between the 2 layers of the tunica vaginalis
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Hydrocele
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Should be suspected if history reveals fluctuation in the volume of the mass with crying, activity, or defecation and if it can be decompressed
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Hydrocele
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Hydrocele Dx
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Transillumination
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Engorgement of the internal spermatic veins above the testis
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Varicocele
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"Bag of worms"
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Varicocele
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Should diminish in size/disappear when patient supine
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Vaicocele
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Rotation of testis on its axis
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Testicular Torsion
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"Bell-Clapper's Deformity"
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Testicular Torsion
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Painful testis that have a "high-lie" as compared to other testis
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Testicular Torsion
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Pain often increases with scrotal elevation and usually have loss of ipsilateral cremasteric reflex
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Testicular Torsion
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Testicular Torsion Dx
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US with Doppler
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Testicular Torsion Tx
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Surgery
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Infection of the bladder most commonly due to Enterobacteriaceae
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Acute Cystitis
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3 causes of Acute Cystitis
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E. coli
Klebsiella Proteus (alkaline) |
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When should you do a urine culture to Dx Acute Cystitis?
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Recurrent infections
Pregnant women Men Children DM |
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Acute Cystitis Dx
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Urinalysis
+ leukocyte esterase and nitrates |
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Acute Cystitis Tx
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Bactrim
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Infectious inflammatory disease of the kidney parenchyma/renal pelvis
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Acute Pyelonephritis
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Presents with fever, flank pain, shaking chills, and IVS
Fever often persists for 3-5 days after ABX initiated |
Acute Pyelonephritis
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Acute Cystitis Tx
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Bactrim
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Infectious inflammatory disease of the kidney parenchyma/renal pelvis
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Acute Pyelonephritis
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Presents with fever, flank pain, shaking chills, and IVS
Fever often persists for 3-5 days after ABX initiated |
Acute Pyelonephritis
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Acute Pyelonephritis Tx
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Moderately = FQ x7-10 days
Severe = Ceftriaxone and FQ (inpatient) F/U Urine culture |
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Presents with perineal, sacral, or suprapubic pain, fever and IVS
As swelling occurs, OVS and acute urinary retention Markedly tender, warm, boggy prostate |
Acute Bacterial Prostatitis
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Prostatic massage in Acute Bacterial Prostatitis?
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No bc may cause bacterermia
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Acute Bacterial Prostatitis Tx
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FQ for 2-4 wks
F/U urine culture |
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Most common cause of Acute Bacterial Prostatitis
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E. coli
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Most common causes of Chronic Bacterial Prostatitis
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E. coli
Enterococcus |
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Expressed prostatic secretions demonstrate increased number of leukocytes
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Chronic Bacterial Prostatitis
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Chronic Bacterial Prostatitis Dx
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Culture
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Chronic Bacterial Prostatits Tx
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FQ for 6-12 weeks
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Acute inflammatory infection of the epididymis/testicles
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Acute Epididymo-Orchitis
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Acute Epididymo-Orchitis Causes
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<40 yo = N. gonorrhoeae and C. trachomatis
>40 yo = E. coli |
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Acute Epididymo-Orchitis in <40 yo associated with
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Urethritis
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Acute Epididymo-Orchitis >40 yo associated with
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UTI and Prostatitis
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Presents with urethritis symptoms (penile tip pain and discharge) or cystitis symptoms
Pain develops in scrotum, which may radiate along spermatic cord or to the flank |
Acute Epididymo-Orchitis
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Prehn's sign
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Acute Epididymo-Orchitis
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Elevation of the scrotum above the pubic symphysis improves pain from epididymitis
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Prehn's sign
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Acute Epididymo-Orchitis Tx
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Bed rest, scrotal elevation, and NSAIDs
PLUS UTI/prostatitis = FQ x 1day STI = ceftriaxone IM + doxy PO x10days |
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Orchitis or Testicular Torsion = Emergency?
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Testicular Torsion
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4 types of Renal Calculi
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Calcium oxalate and phosphate
Struvite Uric acid Cystine |
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Radiopaque stone assocated with hypercalcemia, hypercalcuria or are idiopathic
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Calcium oxalate and phosphate
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Magnesium-ammonium-phosphate stone
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Struvite
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Associated with Proteus UTI
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Struvite
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Staghorn calculi
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Struvite
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Stone associated with gout, high purine diet, acid urine
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Uric acid
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Renal stone associated with genetic renal abnormalities
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Cystine
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What makes a urinary stone a medical emergency?
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Fever. Suggests infection from obstruction.
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Kidney stones Dx gold standard
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Spiral CT
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Ureteral Stone Tx
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<6mm = conservative measures (pain control)
Failure of passage, larger stone = ureteroscopic stone extraction or extracorpeal shock wave lithotripsy |
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Renal Stone Tx
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<2cm = ESWL
Larger stones best treated with percutaneous nephrolithotomy |
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Urinary Incontinence
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DIAPPERS:
Delirium Infection Atrophic urethritis or vaginitis Pharmaceuticals Psychologic factors Excess urinary output Restricted mobility Stool impaction |
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Detrusor overactivity
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Urge incontinence
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Overactive bladder
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Urge incontinence
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Loss of small amounts of urine with activities that increas intraabdominal psi
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Stress incontinence
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Dribbling incontince after voiding
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Urethral obstuction
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Detrusor underactivity
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Overflow incontinence
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Chronic urinary retention
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Overflow incontinence
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Urge incontinence Tx
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Behavioral therapy
Pelvic floor rehab Meds |
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Urge incontinence meds (5)
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Oxybutinin
Toterodine Trospium Solifenacin Darifenacin |
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Stress inconinence Tx
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Behavioural theapy
Pelvic floor rehab Surgery |
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Uretheral Obstruction Tx
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BPH = alpha blocking agents
Intermittent or indwelling catheterization Surgery |
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Overflow incontinence Tx
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Augmented voiding techniques
Intermittent or indwelling cath |
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ED Tx
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Sildenafil
Vardenafil Tadalafil |
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Presence of less than 20 million sperm/mL
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Oligospermia
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Absence of sperm
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Azoospermia
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At what point is infertitlity workup needed?
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After six months of unprotected sex
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Most common benign tumor in men
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BPH
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BPH Dx
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DRE and focused urological exam
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BPH Tx
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Alpha blockers
5alpha Reductase Inhibitors |
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Alpha blockers used in BPH (5)
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Terazosin
Doxazosin Tamsulosin Alfuzosin Silodosin |
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5alpha Reductase Inhibitors (2)
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Finasteride
Dutasteride |
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Detrusor overactivity
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Urge incontinence
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Overactive bladder
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Urge incontinence
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Loss of small amounts of urine with activities that increas intraabdominal psi
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Stress incontinence
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Dribbling incontince after voiding
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Urethral obstuction
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Detrusor underactivity
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Overflow incontinence
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Chronic urinary retention
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Overflow incontinence
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Urge incontinence Tx
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Behavioral therapy
Pelvic floor rehab Meds |
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Urge incontinence meds (5)
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Oxybutinin
Toterodine Trospium Solifenacin Darifenacin |
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Stress inconinence Tx
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Behavioural theapy
Pelvic floor rehab Surgery |
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Uretheral Obstruction Tx
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BPH = alpha blocking agents
Intermittent or indwelling catheterization Surgery |
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2nd leading cause of cancer-related death
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Prostate Cancer
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Most common cancer diagnosed in men
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Prostate Cancer
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May be manifested as focal nodules or areas of induration within the prostate on DRE, but a large number of men will have normally palpable prostates with elevated PSA levels
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Prostate Cancer
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Prostate cancer screening
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PSA combined with DRE
>= 50 yo >= 40 yo with family history/African American |
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Prostate cancer Dx
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Transrectal US (TRUS) guided biopsy
Used with MRI to stage |
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Majority of Prostate Cancers
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Adenocarcinomas
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Second most common urologic cancer
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Bladder Cancer
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Cancer linked to cigarette smoking and exposure to industrial dyes/solvents ("rubber factory")
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Bladder Cancer
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Bladder Cancer Dx gold standard
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Cystoscopy with transurethral resection
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Common presenting symptom of bladder cancer
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Hematuria
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Most common kind of bladder cancer
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Transitional Cell Carcinomas
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Solid tumors of the kidney are this until proven otherwise
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Renal Cell Carcinoma
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Renal Cell Carcinoma Triad
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Flank pain
Hematuria Mass |
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Renal Cell Carcinoma Dx
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CT
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Renal Cell Carcinoma Tx
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Radical nephrectomy
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Most common symptom is painless enlargement of the testis possibly with sensation of heaviness
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Testicular Cancer
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Testicular Cancer Dx
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Inguinal orchiectomy
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Testicular Cancer Tx
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Inguinal orchiectomy
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Most common type of Testicular Cancer
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Germ Cell Tumors (Seminomas)
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