Imported: Renal_ Zel : Urology I

Front 1

I. What is good for looking for renal obstruction or stones?

Back 1

1. IVU

Front 2

a. KUB=

Back 2

Kidney, Ureter, Bladder plain film xray of the abdomen

b. Limited in scope

Front 3

What is one concern with use of IVU?

Back 3

allergic reaction to IV contrast

Front 4

What is a risk in using a retrograde ureterogram?

advantage?

Back 4

If there is a stone, you can dislodge it or move it up the urinary tract

No risk of alergic reaction, you putting the dye in directly to the ureter

Front 5

what will give you a good picture of the bladder? What will this study help you see?

Back 5

VOIDING CYSTOURETHROGRAM (VCUG)

diagnostic of vesicoureteral reflux

Front 6

What is best for seeing a renal mass versus cyst?

Back 6

Ultrasound

Front 7

what can measure post void residual CC in the bladder?

Back 7

Ultrasound

Front 8

what do you use to diagnose renal calculi?

Back 8

Non contrast spiral CT used to locate renal calculi.

again no risk of allergic rxn

Front 9

renal masses, pathology, and to delineate btw renal mass and cyst...not ultrasound

Back 9

CT

Front 10

What gives clear deliniation of masses, if you can't tell what something is on CT?

Back 10

MRI

Front 11

narrowing of the glans penis, normally found in newborns, can be due to trauma. What is this?

Can be a cause of in little kids?

Back 11

urethral meatal stenosis


can cause obstruction so they cannot void...thus after using the bathroom little kids still have urine in them, so when they go to bed, they wet it

Front 12

. Inflammation of prepuce (foreskin) associated with the inability to retract the prepuce over the glans penis =

What is this associated with?

tx?

Back 12

PHIMOSIS

Often associated with balanitis – inflammation of the glans penis

circumcision

Front 13

what is PEYRONIE’S DISEASE

what is the pathology behind it?

Back 13

Angulation of penis during erection

. Pathology – fibrosis of the tunica albuginea of the corpus cavernosum, the tunica can then no longer stretch, causing the angulation

Front 14

Dude goes to bone a chick. He slangs his thang out and is like, yeah bitch, thats whats up. As he starts to get an erection his dong hooks and he can't insert. The girl laughs, and he tries to explain that he simply has...

Back 14

Peyronie's disease

Front 15

POTABA and large doses of Vit E will help treat what?

Back 15

Peyronies (hooked dick)

Front 16

this is a STD that grows in warm moist places (like foreskin). Looks like the dude dipped his wang in cauliflower. What is this? What caused it? Tx?

Back 16

CONDYLOMATA ACUMINATA

Caused by HPV

Laser surgery

Front 17

this is usually caused by syphilis and is painless. Can be found on the glans penis, it will not have a purulent exudate

Back 17

Syphylitic (Hard Chancre)

Front 18

this is usually very painful, the base of the chancre is usually purulent. Due to what?

Back 18

Chancroid (Soft chancre)

Hemophylis ducreyi

Front 19

TPA can help you find what?

Back 19

spirochetes in Hard Chancres

Front 20

what can be a distinguishing feature btw hard and soft chancres?

Back 20

soft May have painful inguinal lymphadenopathy

Front 21

in order to diagnose gonococcal urethritis, what must you see?

Back 21

Gonorrhea IN THE CYTYOPLASM OF THE CELL

Front 22

what is the clap?

Back 22

gonorrhea

Front 23

which form of urethritis is more common: gonococcal or non?

Back 23

nongonococccal

Front 24

Thick yellow purulent discharge is associated with what urethritis?

Back 24

Gonococcal

Front 25

Pt may not even know they have a discharge, but could have dysuria or clear discharge...what type of urethritis?

Back 25

Nongonococcal

Front 26

If you diagnose either Nongonococcal or Gonococcal or even Syphilis, what do you need to do?

Back 26

examine the sexual partner(s)

you dirty human

Front 27

URETHRAL MEATAL STENOSIS in females may cause what?

Back 27

recurrent UTI

Front 28

In young males may be what can be a cause of enuresis

Back 28

Urethral meatal stenosis

Front 29

most common site of urethral meatal stenosis?

Back 29

Bulbous urethra – most common site

Front 30

in congenital meatal stenosis, what can be a cause of this obstruction? 2

which is more common

Back 30

posterior urethral valves :more common

anterior urethral valves

these are near the urethral sphcinter, and they are remnants from a structure that should have been removed after birth, but remains, and can lead to bed wetting/retention

Front 31

this will cause urine to leak out of the tear, leading to difficulty in voiding, can cause scrotum swelling and lower abdominal pain

Back 31

Total avulsion of the urethra

Front 32

What do you make sure you NEVER do for a partial urethral avulsion?

Back 32

NEVER CATHETERIZE. May convert partial to total avulsion

Front 33

dude comes in with after a motorcycle injury and has swelling in the scrotum, lower abdominal swelling, and blood from the urrethral meatus....

Back 33

Total urethral avulsion

Front 34

What are the 2 types of prostatitis? which is most common

Back 34

bacterial

non-bacterial- most common

Front 35

pt comes in with dysuria, frequency, fever, hesitancy, and perineal discomfort.. What are you thinking? what feature of this problem distinguishes it from another type?

Back 35

Bacterial prostatitis

bacterial will have high temp

Front 36

pt has a clear white discharge with minimal dysuria, frequency, hesitancy, and perineal discomfort.. What do they have?

Back 36

Non-bacterial prostatitis (the white charge is due to the prostatic secretions)

Front 37

how do you treat someone with non-bacterial prostatitis?

Back 37

Stop alcohol and caffeine use

hot tub baths

Cipro (or Bactams)

Front 38

which form of prostatitis will be loaded with white blood cells?

Back 38

Bacterial

Front 39

if you suspect bacterial prostatitis what should you NOT do

Back 39

OMIT THE DIGITAL RECTAL EXAM

that thing is super tender, also, can spread the bacteria and lead them to be septic

Front 40

what leads to BPH

Back 40

long time testosterone

age

Front 41

What is BOOS? what is it seen in commonly?

Back 41

Bladder outlet obstruction symtoms

BPH

Front 42

a 60 year old man comes to your office complaining of having to urinate frequently, decreased urinary stream, have to get up at night, when he finishes he still feels like he has to go...what does he likely have?

Back 42

BPH

Front 43

what do you need to do to look for carcinoma of the prostate?

Back 43

Digital rectal exam and PSA

Front 44

PSA < 4.0

PSA >4.0

Back 44

PSA < 4.0 : benign

PSA >4.0: carcinoma

Front 45

what is Free PSA? when do you do it?

Back 45

PSA that is not conjugated with a protein

When a person has a large prostate and high regular PSA...it will help you distinguish carcinoma or not

less free PSA is associated with Carcinoam

Front 46

Free PSA >25-29%

Back 46

benign disease

Front 47

Free PSA <7%

Back 47

carcinoma

Front 48

tx for BPH?

Back 48

alpha blockers and 5 alpha reductase inhibitor

Front 49

typical symptoms of carcinoma of the prostate?

Back 49

BOING

usually assymptomatic

Front 50

if you are black, what age do you start getting PSA? white? family history of cancer?

Back 50

black: 40 annually

white: 50 annually

history: 40 annually

Front 51

you are doing a digital rectal exam and feel a rock hard prostate..what is likely going on?

Back 51

Carcinoma of the prostate

Front 52

hyperechocic areas on transrectal ultrasound is suspicious of what?

Back 52

prostate Carcinoma

Front 53

what must you have before you can treat a pt for with carcinoma?

Back 53

tissue positive of cancer...

F'in Obamacare.

Front 54

The higher the PSA the higher the what?

Back 54

Malignancy

Front 55

Gleason score >8 pt will have what?

**

Back 55

recurrent Malignant disease

Front 56

if you do a prostatectomy, what are some important post surgical problems?

Back 56

could be incontinent (try for less than 1%)

also will not be able to bone (no erection)

Front 57

given the option of radiation or prostectomy, what would you probably try?

Back 57

radiation

longevity is about the same

procedure is more well tolerated, can be done on an outpatient basis

Front 58

in cystitis, what gets inflammed leading you to feel like you have to pee

Back 58

trigone

Front 59

why do you do a urine culture and sensitivity for a pt with cystitis?

Back 59

grow out the specific bacteria and can treat them with the right ABX

this will stop recurrent infection

Front 60

if a person has recurrent UTIs, what do they require?

Back 60

UROLOGICAL CONSULT

Front 61

how do you differentiate btw bladder carcinoma and hemorrhagic cystitis

Back 61

hemorhaggic: burning on urination

cancer: painless hematuria

Front 62

woman with gross hematuria, painful, getting up at night, miserable, urine loaded with WBC

Back 62

HEMORRHAGIC CYSTITIS

Front 63

35 year old woman presents with bladder pain as it fills with urine. They get suprapubic pain that is relieved by voiding. Pt also has frequency, urgency, and nocturia (even up to every 20 minutes)

What does she have?
What will the urinalysis be like?

Back 63

INTERSTITIAL CYSTITIS

Urinalysis will be normal! (sterile urine)

Front 64

what causes INTERSTITIAL CYSTITIS?

Back 64

the interstitium becomes inflammed and you get fibrosis of this layer of the bladder

it is no longer elastic and stretchy, as it stretches, you are tearing the interstitial area of the bladder.

they will end up having a smaller bladder giving them the need to urinate

Front 65

as you distend the bladder you start to see hemorrhagic areas showing up in the mucosa...what is this called? seen in?

Back 65

glomerulations

INTERSTITIAL CYSTITIS

Front 66

what is BCG? what is it a possible tx for?

Back 66

initiates immune response in the bladder

interstitial cystitis

Front 67

most common carcinoma of the bladder?

Back 67

Transitional Cell Carcinoma (TCC)

Front 68

adenocarcinoma will form in what 2 places?

Back 68

dome- fetal urachus

or trigone

both are glandular

Front 69

Squamous cell carcinoma is the largest cause of bladder cancer where?

Back 69

EGYPT

due to schistosomiasis

Front 70

Painless gross hematuria always requires a urological eval... why?

Back 70

they could have CARCINOMA

Front 71

Biggest cause of Transitional Cell Carcinoma?

Back 71

SMOKING

Front 72

pt with recurrent transitional cell carcinoma is treated how?

Back 72

Instill BCG into the bladder

this initiates an immune response in the bladder that allows them to fight off the cancer

aka this is fucking badass

Front 73

if the muscularis is invaded of the bladder, what is the tx? what about adenocarcinoma? what about squamous?

Back 73

cystectomy for all

Front 74

What normally leads to stone formation?

Back 74

bladder obstruction (urine stagnation)

Front 75

folley catheter can lead to what problem

Back 75

you can have a piece flake off and cause a stone!

Front 76

what is the key to treating stones?

Back 76

treat the underlying problem

Front 77

how do you get a diverticuli?

Back 77

weakness in the detrusor muscle that allows a small sack to pouch out off the bladder

Front 78

what 2 things can lead 2 bladder diverticuli?

Back 78

1) Secondary to bladder outlet (have to push hard to get urine out and blow out the detrusor muscle!)

2) Secondary to neurogenic bladder (get a spastic high pressure bladder)

Front 79

if you see Christmas tree bladder what is going on?

Back 79

the bladder has multiple diverticula, normally due to neurogenic bladder

Front 80

pt presents with recurrent UTI but is otherwise asymptomatic. this can normally be due to high pressure on the bladder and may have a stone sitting just outside the bladder on xray

Back 80

Diverticuli

Front 81

what is the normal cause of epidiymitis?

Back 81

normally secondary to abacterial prostatitis

the secretions from the prostate and get pumped backwards

can be viral or mumps

NOT BACTERIAL normally

Front 82

pt comes in with pain in the scrotum. May have some swelling and has fever. What do they have? What can this be secondary to?

Back 82

EPIDIYMITIS

post strenuous work (will push on prostate and cause secretions to push back)

Front 83

what is Prehn’s sign?

Back 83

elevation of the testie that relieves pain

Front 84

how do you rule out torsion of the testis?

Back 84

Nuclear scan (will not show up hot)

look for blood flow to the testis

Front 85

Tx for epidiymitis?

Back 85

. Bed rest
b. Scrotal support
c. Warm soaks or sit baths
d. Force fluids
e. Antibiotics - Keflex or Doxycycline for 21-28 days
f. Anti inflammatory/analgesics

Front 86

what is a non-tender mass on the testis?

Back 86

hydrocele

Front 87

2 keys to the physical exam for hydrocele?

Back 87

transluminate

rule out testicular mass

Front 88

If you transluminate a mass on the teste, what must you do next? What will confirm that you only have a hydrocele?

Back 88

Ultrasound of the testis

nice non-echoic mass with nothing in it=hydrocele

Front 89

What causes a spermatocele?

Back 89

rete testes or ducts in the epididymis

becomes obstructed and causes a mass

Front 90

What will be different on aspiration of fluid for a hydrocele and a spermatocele?

Back 90

Hydrocele:clear fluid

Spermatocele: sperm

Front 91

blockage of a duct conveying sperm=

Back 91

spermatocele

Front 92

Symmetrical well demarcated mass usually in area of head
of the epididymis (may occur anywhere in epididymis)
2) Usually non tender
3) Transilluminates if large
4) Usually can palpate testis as separate organ

Back 92

spermatocele

Front 93

why do you NOT cut out spermatoceles?

Back 93

people will end up with a painful scar...

get chronic testicular pain

Front 94

what can lead to testicular torsion

Back 94

inproper development of the gubernaculum (remember this is what is responsible for pulling the ball down and keeping it in place; without it, you get a bell clapper teste that can let that bad boy slang all over the place)

Front 95

man comes in with an acute onset of severe pain in the scrotum. they can't sit still and nothing relieves the pain, lifting the testes does not help. What do they have?

Back 95

Torsion

Front 96

mother brings in one year old child because he won't stop crying and is writhing around in pain. The child has been crying for sometime with no seeming relief of what is ailing him. The mom is concerned. You are thinking?

Back 96

Torsion

Front 97

painful ball, one higher than the other and one with swelling. What should you do next?

Back 97

Nuclear scan, look for blood flow to the testes

Front 98

How long do you have to treat a torsion?

Back 98

6-8 hours or you are going to lose that ball

Front 99

Tx for torsion of the testes

Back 99

orchiopexy (fix the testes in place) of BOTH sides

Front 100

what is a positive Prehn's sign

Back 100

lift the ball and the pain goes away

Front 101

painless hematuria=

Back 101

bladder cancer

Front 102

Female pt. presents after repeated infection and obstruction of periurethral glands (GC, Normal Vaginal Flora). She complains of having to pee a lot, pain on intercourse, and post micturation dribbling.

Back 102

Diverticuli

Front 103

N. gonorrhea gram stain and shape?

Back 103

Gram -

diplococci

Front 104

Good test to order if you are looking for metastases of Prostate Cancer

Back 104

Bonescan

Front 105

T/F

Females have a shorter urethra and are therefore more likely to get UTI/Cystitis

Back 105

True