外科：泌尿科

65 flashcards · Other · by Wanying Koh

1. Renal cysts classification?

   Bosniak classification, 5 categories

2. Renal trauma classification

   AAST renal injury classfication

3. 1) prostate cancer occurs at? 2) BPH occurs at?

   1) peripheral zone (70%) / transitional zone (20%) 2) transitional zone

4. causes for increase in PSA

   use of 5a-reductase inhibitor (cut PSA up to 1/2) old age BPH (~6) prostate Ca acute prostatitis (~30) prostate abscess DRE foley insertion

5. T-cell - APC signals in renal transplantation signal 1: signal 2: signal 3:

   (APC x T cell) signal 1: MHC II x TCR ==> produce IL-2 signal 2: CD80, CD86 x CD28 signal 3: IL-2 x TCR

6. postinfarction syndrome s/s lasts for how long

   fever, flank pain, nausea 3 days Post-infarction syndrome is a very common occurrence after renal artery embolization. Because of renal infarction as a result of the embolization, patients often experience severe flank pain and fever after the procedure.

7. Adult vs. child polycystic kidney disease 特性 1) inheritence 2) mutation 3) age

   Adult vs. child 1) AD // AR 2) chromo 16 PKD1, chromo 4 PKD2 // chromo 6 PKHD1 3) 30-50y , since young

8. ADPKD in adults which type is more severe, and has earlier onset? PKD1 or PKD2

   PKD1

9. late stage/metastatic RCC clear cell type tx 1) 2) 3) ---- 不能用哪些治療 1) 2)

   1) target therapy: mTOR inhibitor: everolimus, temsirolimus VEGF inhibitor: bevacizumab TKI: sunatinib, sorafenib 2) biologic modifiers: interferon-a 3) OP: resection of brain meta, lung meta ---- 不能用哪些治療 1) RT 2) CT

10. post renal transplant 其他prophylactic處置 bacteria virus candida hypertension (treatment, not prophylaxis) peptic ulcer arterial thrombosis

    Baktar (trimethoprim-sulfamethoxazole if CMV(+): valganciclovir fluconazole/Mycelex troche B-blockers, CCB, hydralazine antacids LMWH, heparin, aspirin

11. renal transplant patients 不能吃什麼藥物

    NSAIDs. may take acetaminophen for pain

12. tuberous sclerosis AML vs. non-TS AML 1) unilateral or bilateral ? 2) 多發性 or 一顆？ 3) histology same or different between the two? 4) method of Dx?

    1) bilateral // unilateral 2) 多發 // 一顆 3) both have similar histology 4) U/S (白) + CT scan (黑)

13. how long to wait for renal transplant after tumor resection: most tumors breast, RCC, lymphoma bladder cancer in-situ lesion

    2 years 5 years 2 years no need to wait

14. Hx: car accident 3 months ago CC: hematuria Dx? Tx?

    renal pseudoaneurysm transcatheter arterial embolization (Renal pseudoaneurysms occur after renal trauma, surgery or percutaneous procedures)

15. most common reason for oligouria / no urine output post-renal transplant

    acute tubular necrosis

16. most common reason for death in renal transplant patients

    tissue rejection NOT infection

17. straddle injury most commonly injures which part of urethra

    bulbous urethra (NOT membranous)

18. pelvic fracture most commonly injures which part of urethra

    membranous urethra

19. mild dilatation of pelvis and reflux of contrast into ureter & pelvis which grade of VUR?

    grade 3

20. which doesnt affect detrusor distensibility: interstitial cystitis low anterior resection for rectal Ca detrusor fibrosis TURP for BPH

    TURP for BPH

21. bladder carcinoma in situ tx

    complete TUR + BCG

22. UPJ obstruction more common on which side

    left side

23. pelvic injury mostly involves intraperitoneal or extraperitoneal type of bladder injury?

    extraperitoneal

24. treatment of VUR grade 5

    Percutaneous nephrostomy

25. pregnancy GA 28 weeks: hydronephrosis in male fetus diagnosis?

    posterior urethral valve

26. quick dx of gonorrhea

    尿道分泌物的抹片 染色，在100x magnification 觀察WBC 內有無gonorrhea bactera (NOT urine discharge)

27. bloodflow of testicular torsion vs. epididymitis

    decreased bloodflow // increased bloodflow

28. congenital bilateral absence of vas deferens most commonly associated w what disease

    cystic fibrosis 纖維化囊腫

29. most accurate diagnostic tool for epididymitis

    color doppler sonography

30. what diagnostic imaging tool is used for urethral trauma

    retrograde urethrogram (pyelogram -- for ureter & renal pelvis)

31. staging of prostate cancer w invasion of seminal vesicle

    T3b

32. prostatitis dx

    mid-stream urine sample --> bacterial cx (NO massaging of prostate)

33. TURP syndrome s/s x4

    bradycardia hypertension nausea conscious disturbance

34. hormonal therapy for prostate ca

    LHRH agonist：goserelin，leuprolide LHRH antagonist estrogen （少用） ketoconazole androgen-R antagonist：flutamide

35. treatment of BPH

    a-adrenergic blockers (tamsulosin, doxazosin, terazosin, alfuzosin) 5a-reductase inhibitors (finasteride) cholinergic (bethanechol - detrusor contraction - 幫助排尿) anticholinergic (抑制排尿 - help w irritative/storage s/s)

36. BPH causes what changes in prostate bladder compliance inc/dec? detrusor contractability inc/dec? detrusor stability inc/dec? detrusor hyper/hypo -trophy?

    dec. bladder compliance dec. detrusor contractibility detrusor instability detrusor hypertrophy

37. meds to decrease prostate volume

    5a-reductase inhibitor female hormones anti-androgenic-R agent

38. most important factor to consider for ESWL

    size & number of stones

39. Example of: low pH stone? high pH stone?

    low ph: uric acid stone high pH: infection stone (struvite/MgNHP)

40. which renal tubular acidosis type is associated with renal stones

    RTA type I

41. infection stone (struvite/MgNHP) 無法單純用 ABx treatment because?

    recurrent infection (NOT due to ABx resistance) 可以給 prophylactic ABx to prevent recurrent infection

42. KUB 看不到的stones

    XIU - xanthine, indinavir, uric acid (all radiolucent)

43. size of stone suitable for: ESWL 喝水 conservative therapy

    <1cm stone <0.5cm stone (50% 排出率)

44. monohydrate vs. dihydrate calcium oxalate (草酸鈣）stones more opaque on KUB

    monohydrate calcium oxalate stones

45. most common bacteria in uncomplicated UTI

    O serogroup E.coli

46. stroke pts 最常見的排尿障礙

    detrusor hyperreflexia

47. overactive bladder seen in 1) 2) 3) 4)

    1) lesion at S2-4 之上 2) urge incontinence 3) stroke 4) BPH

48. overactive bladder tx (medication)? contraindicated in which patients

    anticholinergics C/I in pts w closed angle glaucoma

49. most common factor for erectile dysfunction

    mixed factors (psychogenic + organic)

50. most common reason for female pseudohermaphroditism

    congenital adrenal hyperplasia

51. 1) venogenic erectile dysfunction 定義 2) examples

    1) erection 時有 venous leakage --> 無法維持勃起 2) examples corpus cavernosa smooth muscle 病變 tunica albicans DM peyronie's disease

52. Nitrates can/cannot be used together with PDE5 inhibitor

    cannot

53. most common correctable cause of male infertility

    varicocele (not testicular torsion)

54. testosterone levels highest during which part of the day

    dawn/morning

55. interstitial cystitis 好發族群 s/s 有沒有 hematuria, pyuria?

    40yo females NO hematuria/pyuria, s/s 應該是 nocturia, frequency, suprapubic pain

56. most common meta to bladder

    malignant melanoma

57. seminoma tx

    OP as first line then CT or RT based on patho/staging

58. prognosis of germ cell tumor , spread by seminoma non-seminoma

    seminoma - good prognosis , spread by LN non-seminoma - poor prognosis , spread by blood SLB NAB

59. erection vs ejaculation nerves prostate gland surgery will injure which n. that causes ED

60. orchidopexy in cryptochordism pts when is best timing

    <10mo can OBS but if testis still undescended , OP at 10-18mo to decrease risk of testis cancer. beyond this age doesnt dec risk

61. Stauffer syndrome cause

    due to RCC causing secretion of GMCSF --> increase in IL-6 that in turn causes liver damage

62. can decrease prostate volume medication when can you see the biggest results good results in prostates of all sizes?

    5a-reductase inhibitor (-asteride) after usage of 3-6mo continuously 大 prostate 較有效，小prostate 沒有效

63. epididymitis 幼兒 年輕人 中年人 causes

    anatomical abnormalities ----- s/s tx in 兒童 STI ---- ABx ceftriaxone, doxy (chylamydia, gonorrhea) UTI

64. in old men, low testosterone can cause

    obesity - insulin resistance osteoporosis hot flush

65. FSH and LH stimulates which cells fructose produced by

    FSH --> Sertoli cells --> spermiogenesis LH --> Leydig cells --> testosterone fructose produced by seminal vesicle