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CMS III - Urology Test #1
Winter Semester 2011
269
Medical
Graduate
04/25/2011

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Cards

Term
Is the pain of infection constant or intermittent? Is the pain of obstruction constant or intermittent?
Definition
infection - constant
obstruction - intermittent
Term
Upper ureteral obstruction may result in pain referred to where?
Definition
scrotum in males or to the labium in females
Term
Midureteral obstruction may cause pain where?
Definition
ause pain in the lower quadrant - can be confused with appendicitis (on R side) and diverticulitis (on L side)
Term
What does severe suprapubic discomfort indicate?
Definition
Acute retention
Term
What does a Painless distended bladder indicate?
Definition
Chronic retention
Term
What does Distal urethral pain with urination indicate?
Definition
Acute cystitis
Term
Where does prostatic pain radiate to?
Definition
lumbosacral ,
inguinal canals,
lower extremities
Term
What is Pain in the flaccid penis is secondary to usually?
Definition
STD or Paraphimosis
Term
What does pain in the erect penis secondary to usually?
Definition
Peyroine disease or priapism
Term
How long may pain from treated acute epididymitis last?
Definition
may persist for months
Term
What is the normal measurement of a testicle and what is the normal consistency?
Definition
measure 4.5 x 2.5
Rubbery Consistency
Term
Where does the epididymus lie in relationship to the testis?
Definition
posteriolateral
Term
Are masses arising from within the testes usually malignant or benign?
Definition
malignant
Term
Are masses arising from the epididymis and spermatic cord structures usually malignant or benign?
Definition
benign
Term
What is tranillumination used for?
Definition
distinguishing solid and cystic lesions
Term
If a pt presents with usually painless, firm, solid lesions within the substance of the testis that do not transilluminate, what condition do you suspect?
Definition
Testicular tumor
Term
14 y/o male pt presents with intense pain in scrotum that began this morning and has increasingly worsened. Scrotum is enlarged, red, and edematous. He is N/V and has a temp of 99.7F. The testicle is quite tender, is located high in scrotum with a transverse lie and the cremasteric reflex is absent. What condition do you suspect?
Definition
Testicular torsion
Term
In what age do 2/3rds of testicular torsion cases occur?
Definition
2nd generation
Term
What type of invagination is described as a torsion occurring within the tunica vaginalis?
Definition
Intravaginal torsion
Term
What type of invagination is described as a torsion involving twisting testis, cord and processus vaginalis?
Definition
Extravaginal torsion
Term
In which type of pts is Extravaginal torsion MC?
Definition
particular in newborns, and in undescended testis
Term
What imaging should be used for testicular torsion?
Definition
Doppler US is diagnostic. Decreased flow is torsion.
Term
What does increased flow on the doppler U/S of the testes indicative of?
Definition
think inflammation (reliable in first 12 hours).
Term
Pt presents with heaviness in his scrotum and mass. His girlfriend said he should come in, but says he feels this is normal for him. What condition do you suspect?
Definition
Hydrocele
Term
What condition is described as a collection of fluid between the two layers of tunica vaginalis?
Definition
Hydrocele
Term
When is a hydrocele MC?
Definition
More common in 1st year of life
Term
When is a hydrocele painful?
Definition
Painful if large or infected
Term
How is the diagnosis of a hydrocele made?
Definition
made with transillumination
Term
Which type of hydrocele is described as a closure of processus vaginalis traping peritoneal fluid?
Definition
Non-communicating hydrocele
Term
Which type of hydrocele is described as failure of closure of processus vaginalis?
Definition
Communicating Hydrocele
Term
Which type of hydrocele is described as closure of distal processus, trapping fluid in mid portion of processus vaginalis?
Definition
Hydrocele of cord
Term
What is the treatment for a hydrocele?
Definition
Watchful waiting
Term
What condition is described as engorgement of the internal spermatic veins above the testis, resulting from incompetence of the venous valves of internal spermatic venous system?
Definition
Varicocele
Term
What side is a varicocele MC?
Definition
MC found on the Left side
Term
Where does the L spermatic vein empty into?
Definition
empties into L renal vein
Term
Where does the R spermatic vein empty into?
Definition
Inferior Vena Cava
Term
If varicocele presents solely on right side, remains dilated while pt assumes the supine position, or if they occur abruptly or enlarge rapidly, what condition should you suspect?
Definition
be suspicious of retroperitoneal or renal mass causing obstruction
Term
What kind of lasting effects can occur from a varicocele?
Definition
May cause atrophy of both testes, may lead to infertility
Term
When is surgery indicated for a varicocele?
Definition
Surgery indicated if assoc with infertility and/or pain
Term
A 42 y/o male presents to your practice complaining of swelling in his groin. States he noticed the swelling when he went to shower after doing heavy lifting in the garden. What condition do you suspect?
Definition
Hernia
Term
Which type of hernia is usually found within the scrotum?
Definition
indirect inguinal hernia
Term
Which type of hernia is described as coming through the external inguinal ring, so examining fingers cannot get above it within the scrotum?
Definition
Indirect inguinal hernia
Term
What is the treatment for a inguinal hernia?
Definition
Surgery or support belt
Term
Where is a spermatocele palpable?
Definition
near upper pole of the testicle
Term
Is a spermatocele painful?
Definition
Not usually
Term
What is the treatment for a spermatocele?
Definition
watchful waiting or surgery if it becomes symptomatic
Term
What MUST any mass, in any pt, at any time felt to be in the testicle be addressed with?
Definition
direct contact with a urologist.
Term
Are masses rising from within the testes usually malignant or benign?
Definition
malignant
Term
When a hydrocele is diagnosed, what must you perform and why?
Definition
Perform complete testicular exam so don’t miss associated testicular tumor (10% of cases)
Term
If varicocele is on the R side, enlarges quickly or remains dilated while pt is supine, what studies and evaluations must you perform?
Definition
F/up with careful abdominal exam and appropriate imaging, such as CT scan
Term
When is a surgery indicated for varicocele?
Definition
needed if infertility or pain
Term
If a pt c/o of heaviness in their testes, what might you suspect?
Definition
Hydrocele or spermatocele
Term
What condition is described as position of urethral meatus located on dorsal aspect of penis?
Definition
Epispadias
Term
What may epispadias be associated with?
Definition
incontinence
Term
Which is more common epispadias or hypospadias?
Definition
Hypospadias
Term
What can increase the incidence of hypospadias?
Definition
Estrogens and progestins given during pregnancy
Term
What is hypospadias associated with?
Definition
infertility
Term
When should hypospadias be surgically corrected?
Definition
Should be surgically corrected by age 2
Term
At what gestational week can you determine the sex of the child based on viewable genitalia?
Definition
Week 10
Term
What condition is described as foreskin cannot be retracted behind the glans?
Definition
Phimosis
Term
What is the MC cause of phimosis?
Definition
Chronic infection from poor local hygeine
Term
What type of CA can develop under the foreskin with phimosis?
Definition
SCC
Term
What condition is an inflammation of the glans penis?
Definition
Balantitis
Term
What condition is an inflammation of the foreskin?
Definition
Posthitis
Term
What condition is described as the foreskin has been left retracted behind the glans, resulting in painful engorgement and edema of glans?
Definition
Paraphimosis
Term
What are the complications of untreated paraphimosis?
Definition
may result in glandular ischemia with arterial occlusion and necrosis of the glans
Term
How should paraphimosis be tx initially?
Definition
Firmly squeeze glans x 5 minutes to reduce tissue edema/decrease size.
Term
What is the definitive treatment for paraphimosis?
Definition
circumcision
Term
What condition is described as palpable dense, fibrous plaque of varying size involving tunica albuginea?
Definition
Peyronie's disease
Term
Where is the usual location of the plaque in Peyronie's disease?
Definition
usually near dorsal midline on the tunica albuginea
Term
What condition has Peyronie's disease been associated with?
Definition
Dupuytren’s contracture of the tendons of the hand
Term
What is the only proven tx option for peyronie's disease?
Definition
Surgery
Term
In what % of pts does spontaneous remission of Peyronie's disease occur? When did this occur?
Definition
50%; Within 1 - 2 yrs
Term
What condition is described as Uncommon condition of prolonged painful erection…”greater than 4 hrs”?
Definition
Priapism
Term
What is the MC cause of Priapism?
Definition
Idiopathic
Term
What other conditions are associated with causing Priapism?
Definition
Leukemia
Sickle Cell Dz
Pelvic Tumors
Pelvic Infections
Penile Trauma
Spinal Cord Trauma
Certain Meds
Term
Is priapism ischemic or non-ischemic?
Definition
true urologic emergency (ischemic)
Term
Should Hypospadiac males be circumcised? why or Why not?
Definition
should not be circumcised because skin will later be needed for reconstructive surgery
Term
How do you treat a fungal cause of phimosis?
Definition
clotrimazole of nystatin
Term
How do you treat a bacterial cause of phimosis?
Definition
bacitracin or neomycin-polymyxin B-bacitracin
Term
How do you treat a dermatitis cause of phimosis?
Definition
topical steroids
Term
What imaging test would you use to identify the depth of the plaque in peyronie's disease?
Definition
U/S
Term
What condition has pathophysiology described as The major abnormality is believed to be physiologic obstruction of the venous drainage causing buildup of highly viscous, poorly oxygenated blood within the corpora cavernosa?
Definition
Priapism
Term
What condition is described as is a noncancerous enlargement of the prostate gland that may restrict flow of urine from the bladder?
Definition
BPH
Term
What diagnosis is a histologic diagnosis that refers to the proliferation of smooth muscles and epithelial cells within the prostatic transition zone?
Definition
BPH
Term
What is the MC benign tumor in men?
Definition
BPH
Term
What is the medical management treatment for BPH symptoms?
Definition
Alpha-blocker Therapy decreases tone of the Prostate which decreases resistance
Term
What are the irritative voiding c/o BPH due to?
Definition
result from the secondary response of the bladder to the increased outlet resistance
Term
What are the 3 storage "irritative" symptoms of BPH?
Definition
1- frequency,
2 - nocturia,
3 - urgency
Term
What are the four voiding symptoms of BPH?
Definition
1 - feeling of incomplete emptying,
2- intermittency,
3 - straining,
4 - weak stream
Term
What is the most important tool in evaluate BPH?
Definition
AUASI (BPH screening tool)
Term
On DRE you find the prostate is smooth, firm, elastic with enlargement noted. What does this finding suggest? If induration was present, what would you do?
Definition
BPH; with induration r/o CA
Term
What procedure is Not recommended to determine the need for tx in BPH but may assist in determining the surgical approach in pts opting for invasive therapy?
Definition
Cystoscopy
Term
What tx should pts with mild sx of BPH receive?
Definition
Watchful Waiting; recommend annual f/u
Term
What tx should pts with moderate sx of BPH receive?
Definition
Start medical therapy - Alpha Blockers
Term
What tx should pts with severe s/s of obstructive uropathy and fluid/electrolyte abnormalities receive?
Definition
ADMIT
Term
What are the absolute surgical indications for BPH?
Definition
refractory urinary retention,
large bladder diverticula

Recurrent UTI
Recurrent gross hematuria
Bladder stones
Renal insufficiency
Term
Which drugs are alpha blockers?
Definition
Tamsulosin (Flomax)
Alfuzosin (Uroxatral)
Doxazosin (Cardura)
Terazosin (Hytrin)
Silodosin (Rapaflo)
Term
What are the side effects of Alpha Blockers?
Definition
Orthostatic hypotension
Ejaculation changes
Nasal congestion
Weakness
Term
What medical therapy is best for pts with larger prostates (>40gm)?
Definition
5 alpha-reductase inhibitors
Term
What med works by blocking the conversion of testosterone to dihydrotestosterone?
Definition
5 alpha-reductase inhibitors
Term
Which drugs are 5 alpha-reductase inhibitors?
Definition
Finasteride (Proscar)
Dutasteride (Avodart)
Term
What are the SE of the 5 alpha-reductase inhibitors?
Definition
Decreased libido
Ejaculation changes
Erectile dysfunction
Term
What meds act by decreasing acetylcholine effects on the smooth muscles of the bladder?
Definition
Antimuscarinics
Term
What are the Antimuscarinics? What drugs are they used in combo with?
Definition
tolterodine, Detrol (esp. in combination with alpha blockers)
Term
What minimally invasive procedure is described as 2 curved needles (which extend just beyond cystoscope) deliver RF energy into prostate? How long can the irritative voiding last after the procedure?
Definition
TUNA (Transurethral Needle Ablation); can last several weeks after procedure
Term
What procedure for treating BPH is described as Microwaves heat prostate and create thermal necrosis? How long can irritative voiding last after the procedure?
Definition
TUMT (Transurethral Microwave Thermotherapy); irritative voiding can last for a few weeks after the procedure
Term
Out of the minimally invasive procedures for treating BPH is the most superior when comparing symptom scores and flow rate improvement ?
Definition
Transurethral resection of the prostate (TURP)
Term
What is the alternative to TURP that comes closest to matching its results in both terms of symptom relief and improvement in flow rates?
Definition
Transurethral Incision of the Prostate (TUIP)
Term
When is an open simple prostatectomy used instead of a TURP?
Definition
When prostate is too large to remove endoscopically (> 100 g in size)
Term
At the following ages, what is their risk for BPH?
41 - 50 y/o?
51 - 60 y/o?
> 80 y/o?
Definition
41-50 yrs = 20%
51-60 yrs = 50%
>80 yrs = >90%
Term
What score on the AUASI indicates Mild, Moderate and Severe BPH symptoms?
Definition
1-7, Mild
8-19, Moderate
20-35, Severe
Term
What are the forms of Phytotherapy?
Definition
Saw palmetto
African plum
Rye pollen
Pumpkin seeds
Term
What neurotransmitters initiate an erection?
Definition
nitric oxide, acetylcholine, prostaglandins
Term
What are some organic causes of ED?
Definition
smoking
alcohol
diabetes
Term
What are some endocrine causes of ED?
Definition
hypogonadism
hyperthyroidism
Elevated PRL
Term
What are some neurologic causes of ED?
Definition
spinal cord lesions
MS
autonomic neuropathy
Term
What are some pelvic surgery causes of ED?
Definition
bladder neck
TURP (Prostate)
Term
What drugs can induce ED?
Definition
Antihypertensives (beta-blockers and diuretics),
digoxin,
major tranquilizers,
alcohol,
estrogen,
antidepressants,
cimetidine,
steroids
Term
What are the risk factor's for ED?
Definition
Age > 40y/o
DM, Dyslipidemia, HTN
Neurogenic Dz
Psychological Dz
Renal Failure
Hormonal D/o
Previous Prostate CA tx
Previous Trauma
Drug Use, Smokers, Alcoholics
Obesity, Sedentary Lifestyle
Term
Which meds can lead to ED?
Definition
Anti-HTN (BB, Thiazide Diuretics, Spirinolacton, Clonidine)
Prostate Agents (Alpha Blockers- Doxyzosin, Terazosin, 5-alpha reductase inhibitors)
Anti-Depressants - Cimetidine, Ketaconazole
Term
What is Nocturnal penile tumescence testing used for?
Definition
To differentiate between organic and psychological cause
Term
What will men who do not have organic dysfunction causing their ED probably benefit from?
Definition
behaviorally oriented sex therapy
Term
Before giving hormone replacement therapy for documented androgen deficiency, what must you r/o first?
Definition
Prostate CA
Term
What class of meds is used in vasoactive therapy for the treatment of ED?
Definition
prostaglandins (Papaverine, Phentolamine, Alprostadil)
Term
What med is used for tranurethral therapy?
Definition
Alprostadil (MUSE) - Prostaglandin
Term
What med stimulates adenyl cyclase to increase intracellular levels of cAMP causing smooth-muscle relaxation and vasodilation?
Definition
Alprostadil (Prostaglandin E1)
Term
How does Sildenafil (Viagra) work?
Definition
inhibits phosphodiesterase 5 (an inhibitor of erection) and allows cGMP to function unopposed
Term
When is sildenafil (viagra) contraindicated?
Definition
Concomitant organic nitrates or nitric oxide donors (eg, sodium nitroprusside)
Term
What can coconmittant use of alpha-blockers (eg doxyzosin) and Sildenafil lead to?
Definition
may lead to symptomatic hypotension.
Term
How many viagra (sildenafil) do you take per day?
Definition
1
Term
How long does sildenafil (viagra) last?
Definition
lasts 4
Term
How long does Vardenafil (Levitra) last?
Definition
lasts 4 hrs
Term
How often do you take Cialis (Tadalafil)?
Definition
Once every 2 days
Term
What is the rate of onset with Cialis? How long does it last?
Definition
Onset within 30 - 60 min; Lasts 36hrs
Term
What is the max amount of time for use for Yohimbine?
Definition
10 weeks
Term
What are the adverse effects of PDE-5 Inhibitor?
Definition
Hypotension
Temporary color vision disturbances
Mild HA
Facial flushing
Priapism
Term
What are the contraindications of PDE-5 Inhibitor?
Definition
Men using nitrates, men on alpha-blockers
Term
Which alpha-blocker is ok to use with PDE-5 Inhibitor?
Definition
Flomax (tamsulosin) with Cialis
Term
What are the relative contraindications for PDE-5 Inhibitors?
Definition
Active coronary ischemia in men not on nitrates
CHF
Borderline hypotension, or on mult. HTN agents
P450 - 3A4 inhibitors (E-mycin, cimetidine, Ketaconazole, Itraconazole)
Term
What lifestyle changes may help improve ED?
Definition
Regular exercise
Healthy diet
Smoking cessation
Decrease alcohol intake
Limit long-distance cycling…or change seat
Term
In what pts is urinary incontinence MC?
Definition
older pts
Term
Is the bladder neck muscle smooth or skeletal? Voluntary or Involuntary?
Definition
Bladder Neck = smooth and involuntary
Term
Is the external sphincter muscle smooth or skeletal? Voluntary or Involuntary?
Definition
External Sphincter = skeletal and Voluntary
Term
What test can be used to dx a bladder fistula?
Definition
Cystograms
Term
What test can be used to diagnose bladder neck descent problems?
Definition
Cystograms
Term
What test is used to evaluate bladder capacity, accommodation, sensation, voluntary control, contractility, and response to pharmacologic intervention?
Definition
Cystometry
Term
What condition is described as Pts lose urine at all times and in all positions?
Definition
Total Incontinence
Term
What is the cause of total urinary incontinence?
Definition
anatomic abnormalities, either congenital or acquired
Term
What is the treatment for total urinary incontinence?
Definition
Surgery
Term
What condition is described as loss of urine associated with activities that result in an increase in intra-abdominal pressure?
Definition
Stress Incontinence
Term
What is the cause of stress incontinence?
Definition
Associated with pelvic floor laxity and poor support of the vesicourethral sphincteric unit
Term
Which urinary incontinence does not have pts becoming incontinent in the supine position?
Definition
Stress Incontinence
Term
What are the findings of stress incontinence on a lateral stress cystogram?
Definition
Bladder neck will descend below the midportion of the pubic symphysis
Term
What treatment offers the best results and highest cure rates for stress incontinence?
Definition
Surgery (“sling”)
Term
What condition is described as uncontrolled loss of urine that is preceded by a strong, unexpected urge to void?
Definition
Urge Incontinence
Term
Which type of incontinence is unrelated to position or activity?
Definition
Urge Incontinence
Term
What condition is associated with detrusor hyperreflexia or sphincteric dysfunction?
Definition
Urge Incontinence
Term
What conditions are commonly associated with urge incontinence?
Definition
Inflammatory conditions or neurogenic bladder d/o
Term
What is the treatment for urge incontinence?
Definition
Toilet Re-Training
Anticholinergic meds (antispasmotics)
- Oxybutinin (Ditropan)
- Tolterodine (Detrol)
Tricylic antidepressants
- Imipramine (Tofranil)
Term
What incontinence can result from chronic urinary retention?
Definition
Overflow incontinence
Term
What is the tx for overflow incontinence?
Definition
catheterization and tx of underlying condition (cause of retention)
Term
What percentage of men > 65y/o are affected by ED?
Definition
25%
Term
What nervous stimulation is responsible for an erection?
Definition
autonomic and somatic nerve supply
Term
Which arteries supply blood to get an erection?
Definition
Pudendal Arteries
Term
What does an erection with injection of vasoactive substances mean?
Definition
vascular system is intact
Term
In pts who fail to achieve erection with injection of vasoactive substances on serial attempts using increasing doses or combination of drugs, what is indicated?
Definition
Additional vascular testing and vascular reconstructive surgery in an attempt to correct their ED
Term
What is considered infertility?
Definition
Failure to conceive after 1 yr of trying
Term
How many couples are affected by infertility?
Definition
15 - 20%
Term
What are the "cornerstones" to lab eval of infertility after H&P?
Definition
Endocrinologic profiles and detailed semen analysis
Term
What is the term describing Presence of < 20 million sperm/ml in the ejaculate?
Definition
Oligospermia
Term
What term describes Complete absence of sperm?
Definition
Azoospermia
Term
If there is a complete absence of sperm, what condition might you first suspect? How would you dx it?
Definition
retrograde ejaculation; UA
Term
How long does spermatogenesis take?
Definition
74 days
Term
What prior testicular insults can lead to infertility?
Definition
testicular torsion, cryptorchidism, trauma, groin surgery
Term
What infections can lead to infertility?
Definition
Mumps orchitis, epididymitis
Term
What meds can lead to infertility?
Definition
Cimetidine,
spironolactone,
nitrofurantoin,
sulfasalazine,
alpha-blockers (Cimetidine)
Term
What are the risk factors for infertility?
Definition
Sexual habits
Previous fertility (pt and partner)
Partner age (>35?)
Endocrine d/o
Systemic dz (renal failure, cirrhosis, sickle cell)
Other dz (CF, Klinefelter’s)
Poor dietary intake
Term
What may be a finding in s/p viral orchitis causing infertility?
Definition
Atrophy of testicles
Term
How many hours must a pt getting a semen analysis abstain from sex prior to the test?
Definition
72 hrs
Term
What is the normal sperm count?
Definition
>20 million/ml
Term
Within what timeframe of collection should the semen be analyzed?
Definition
within 1 hr
Term
What is the normal volume of semen?
Definition
Normal volume = 1.5 – 5 ml
Term
What is the normal motility of sperm?
Definition
50-60% motile cells
Term
What is the normal morphology?
Definition
> 30% normal morphology
Term
What is the best predictor of fertility in semen?
Definition
sperm morphology
Term
If sperm counts are low, what further eval is indicated?
Definition
Endocrinologic eval including serum FSH, LH, and testosterone
Term
If the sperm count is zero, what f/u should be done?
Definition
Serum FSH, fructose, testicular biopsy and U/A
Term
If there is an abnormal sperm count, what is the f/u?
Definition
repeat semen analysis …repeat semen analysis
Term
How much time between repeat semen analysis?
Definition
separated by at least 60 days
Term
What imaging can be done during an infertility eval to r/o subclinical varicocele?
Definition
Scrotal U/S
Term
What imaging study may be required in pts with suspected ductal obstruction?
Definition
Vasography
Term
What is the “gold standard” procedure for diagnosing pelvic, inguinal, scrotal, and vasal obstruction?
Definition
Vasography
Term
What is vasography being replaced by?
Definition
TRUS
Term
What is the MC neoplasm in men aged 20-35?
Definition
Testicular CA
Term
What is the 'typical' presentation of testicular CA?
Definition
pt-identified painless mass
Term
What is necessary for dx of testicular CA?
Definition
Orchiectomy necessary for dx
Term
What type of tumors are 90-95% of all primary testicular tumors?
Definition
germ cell tumors - arising from spermatogenic cells within seminiferous tubules
Term
Which testes is MC affected by testicular CA? Why?
Definition
right side, which parallels increased incidence of cryptorchidism on the right side
Term
What are the risk factors for testicular CA?
Definition
Cryptorchidism
Testicular trauma, torsion
Infection-related testicular atrophy
Chemical exposures/pollutants
Term
Which imaging study can readily determine whether mass is intra or extratesticular in origin?
Definition
Scrotal U/S
Term
What biochemical markers can be pos in testicular CA?
Definition
Human chorionic gonadotropin (hCG)
Alpha-fetoprotein
Lactate dehydrogenase (LDH)
Term
Once dx of testicular cancer has been established by inguinal orchiectomy, how is clinical staging of the dz is accomplished?
Definition
accomplished by chest, abdominal, and pelvic CT scanning
Term
What is the MC testis tumor in pts > 50 y/o?
Definition
Lymphoma
Term
What is the MC primary site of CA with secondary metastasis to testes?
Definition
Prostate CA
Term
What are the essentials of diagnosis in bladder CA?
Definition
Irritative Voiding Symptoms
Hematuria
Pos Cytology
Filing defect within bladder
Term
What is the 2nd MC GU CA?
Definition
bladder CA
Term
Is bladder CA more common in men or women?
Definition
men
Term
What is the mean age of pts when diagnosed with bladder CA?
Definition
65 y/o
Term
What is a risk factor for bladder CA?
Definition
#1 - Smoking
Chronic cystitis
Term
What is the MC presenting symptom in bladder CA?
Definition
Hematuria
Term
What is the FDA approved screening test for bladder CA used in high risk pts?
Definition
BLADDERCHEK
Term
How is bladder CA confirmed?
Definition
cystoscopy with bx (after obtaining urinary cytology)
Term
What is the initial form of tx for all bladder CA that is diagnostic, allows for staging, and will control superficial cancers?
Definition
Transurethral resection
Term
What treatment is described as Immuno or chemotherapeutic agents delivered directly into bladder by a urethral catheter?
Definition
Intravesical chemotherapy
Term
What is used to treat metastatic bladder CA?
Definition
Chemo
Term
What is the "classic triad" of symptoms in renal cell carcinoma?
Definition
flank mass, hematuria, and pain
Term
What is the origination of renal cell carcinoma?
Definition
proximal tubule cells
Term
What is the peak age of incidence for renal cell carcinoma?
Definition
6th decade
Term
What percentage of pts already have metastasis with initial presentation of renal cell carcinoma?
Definition
25 - 33%
Term
What is a major RF for renal cell carcinoma? What are some other RF?
Definition
Cigarette Smoking;FHx, horseshoe kidney, acquired renal cystic dz, obesity
Term
What is the MC presentation of renal cell carcinoma?
Definition
hematuria
Term
What is the most valuable imaging test for renal cell carcinoma?
Definition
CT scan
Term
What is the primary treatment for localized renal cell carcinoma?
Definition
Radical nephrectomy
Term
What is the 5-yr dz-free survival of Tumors confined to renal capsule?
Definition
90-100%.
Term
What is the 5-yr dz-free survival of Tumors extending beyond the renal capsule?
Definition
50-60%
Term
What is the 5-yr dz-free survival of node-positive tumors?
Definition
0-15%
Term
What is the MC solid renal tumor of childhood?
Definition
Wilms tumor or nephroblastoma
Term
With Wilm's tumor, what is the peak age of onset?
Definition
3 y/o
Term
What condition is described as unilateral generally large, multilobulated, kidney tumor that is gray or tan in color with focal areas of hemorrhage and necrosis?
Definition
Wilms tumor
Term
What are the #1 and #2 sites of metastasis of a Wilms Tumor?
Definition
#1 - Lung
#2 - Liver
Term
What is the MC presentation of Wilms tumor?
Definition
abdominal mass
Term
What is the tx for Wilms tumor?
Definition
Multimodal approach to tx, incorporating surgery, radiation therapy, and chemotherapy
Term
What is the second leading cause of CA related death?
Definition
Prostate CA
Term
What are the RF for prostate CA?
Definition
Aging
African American
FHx positive for prostate cancer
High fat intake (primarily a dz of the overfed)
Toxic exposures (smoking, welding, agent orange)
Term
Where does CA of the prostate metastasize to?
Definition
Bone, bladder and less commonly the testes
Term
What is found on DRE in prostate CA?
Definition
Induration
Term
What complication may locally advanced dz of the prostate with bulky regional LAD lead to?
Definition
lymphedema of lower extremities
Term
What marker is a glycoprotein produced only in the cytoplasm of benign and malignant prostate cells?
Definition
PSA
Term
What PSA level are most organ-confined cancers are assoc with?
Definition
<10
Term
What PSA level are more advanced dz including seminal vesicle invasion, lymph node involvement, or occult distant mets associated with?
Definition
PSA levels >40
Term
How is prostatic CA dx?
Definition
Transrectal US-guided bx
Term
What imaging study has been used largely in staging prostate CA?
Definition
Transrectal US
Term
What is the normal PSA value for white males ages:
40 - 49?
50 - 59?
60 - 69?
70 - 79?
Definition
40 - 49 = <2.5
50 - 59 = <3.5
60 - 69 = <4.5
70 - 79 = <6.5
Term
What is the normal PSA value for AA males ages:
40 - 49?
50 - 59?
60 - 69?
70 - 79?
Definition
40 - 49 = <2
50 - 59 = <4
60 - 69 = <4.5
70 -79 = <5.5
Term
What rate of change in PSA is linked to an increased likelihood of CA?
Definition
PSA change >0.75
Term
What type of CA are the majority of prostate CA?
Definition
adenocarcinomas
Term
What grading system is used with prostate CA?
Definition
Gleason grading system
Term
What is the tx for prostate CA?
Definition
radiation and radical prostatectomy
Term
What continents are most affected by penile CA?
Definition
Africa and South America
Term
What are the RF for penile CA?
Definition
Poor Hygeine
Uncircumcised
Term
At what age is penile CA MC?
Definition
MC in 6th decade
Term
What may penile CA begin as?
Definition
Leukoplakia or condylomata lesion
Term
If velvety red lesion on penis, what condition do you suspect?
Definition
Bowen dz (carcinoma in situ)
Term
What is the MC site of penile CA?
Definition
Glans
Term
What is the MC type of penile CA?
Definition
SCC
Term
What is mandatory in the treatment of penile CA?
Definition
biopsy to r/o benign conditions (syphilis, condylomata or chancroid)
Term
What is the treatment for a primary lesion in penile CA?
Definition
Fluorouracil (Effudex) cream 5% or laser tx
Term
What is the treatment for a invasive penile CA?
Definition
Complete excision with adequate margins
Complete penectomy if involves shaft
Term
Where does penile CA primarily spread?
Definition
Spreads primarily to inguinal lymph nodes
Term
What is the tx for inoperable penila CA and bulky inguinal mets?
Definition
Chemo
Term
What is the 5 yr survival rate for penile CA for pts with node negative dz?
Definition
65% - 90%
Term
What is the 5 yr survival rate for penile CA for pts with pos inguinal nodes?
Definition
30% - 50%
Term
What muscle is part of the spermatic cord?
Definition
cremaster muscle
Term
Where is the hydrocele located?
Definition
between the two layers of tunica vaginalis
Term
What side is a varicocele MC found on?
Definition
L side
Term
What side of the penis is a hypospadias on?
Definition
Ventral side
Term
What side of the penis is a epispadias on?
Definition
dorsal
Term
What side of the penis is a epispadias on?
Definition
dorsal
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