Edited, memorised or added to reading list

on 16-Apr-2016 (Sat)

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Flashcard 1332539952396

Tags
#exam #nephrology
Question
What is a renal cause of AKI?
Answer
inj d/t dysfn of renal parenchyma.

look for:
-systemic ft's (ds could also be affecting kidneys)
-HTN (NB: hypo for pre-renal)
-mild to mod ECF volume overload
-anemia/thrombocytopenia
-***abn urine sediment (RBC, WBC, protein, abn casts)***


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Flashcard 1332543622412

Tags
#exam #nephrology
Question
What are 2 methods of urine evaluation?
Answer
1) dip stick → **alb, Hg, WBC**, others (glu, pH, urobilinogen, specific gravity)
2) microscopy → cells, crystals, casts


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Flashcard 1332546243852

Tags
#exam #nephrology
Question
What are 3 types of renal AKI causes?
Answer
1) tubulo-interstitial → acute tubular necrosis (atn), allergic/acute interstitial nephritis (ain), tubular obstruction
2) glomerular → prolif ds, non-prolif ds (rarely causes aki)
3) vascular → arteries (renal a stenosis, vasculitis), arterioles (atheroembolic ds, vasculitis), capillaries (thrombotic microangiopathies, vasculitis), veins/venules (thrombosis)


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Flashcard 1332556467468

Tags
#exam #nephrology
Question
What is ATN (acute tubular necrosis)?
Answer
  • 2nd most common cause of AKI
  • d/t ischemia/toxins
  • look for signs of ↓ volume (pre-renal hypotension can cause ATN)
  • **hemegranular casts** = dx


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Flashcard 1332558302476

Tags
#exam #nephrology
Question
What is allergic/acute interstitial nephritis (ain)?
Answer
interstitial inflm d/t:
  • usually allergic rxn to drugs (abx, NSAIDS, PPIs, etc)
    • usually present 7-10d post-exposure
    • urine → RBC, WBC, protein, **WBC casts**
  • autoimmune ds
  • inf's


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Flashcard 1332560137484

Tags
#exam #nephrology
Question
What is prolif glomerulonephritis?
Answer
  • too many cells in glomerulus so can't filter → AKI
  • present w/:
    • rapid ↓ in GFR
    • ​HTN, anemia
    • ↑ inflm markers
    • other systemic ft's (if 2ndary)
    • ECF volume full/mildy overloaded
  • urine → **RBC casts** (nephrologic emerg)


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Flashcard 1333239352588

Tags
#exam #nephrology
Question
CKD and Indications for dialysis
Answer
•**Persistent metabolic disturbances refractory to medical therapy
– Hyperkalemia
– Metabolic acidosis
• Fluid overload refractory to diuretics
• Progressive uremia
– Encephalopathy
– Persistent nausea and vomiting
– Evidence of malnutrition
• Pericarditis**


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Flashcard 1333245119756

Tags
#exam #nephrology
Question
Sodium [...] determines [...]
Sodium concentration determines intracellular fluid (ICF) volume
Sodium concentration does NOT predict ECF volume status
Answer
**Sodium content determines extracellular fluid (ECF) volume status
Sodium concentration determines intracellular fluid (ICF) volume
Sodium concentration does NOT predict ECF volume status**


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Flashcard 1333246954764

Tags
#exam #nephrology
Question
Sodium content determines extracellular fluid (ECF) volume status
Sodium [...] determines [...]
Sodium concentration does NOT predict ECF volume status
Answer
**Sodium content determines extracellular fluid (ECF) volume status
Sodium concentration determines intracellular fluid (ICF) volume
Sodium concentration does NOT predict ECF volume status**


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Flashcard 1333248789772

Tags
#exam #nephrology
Question
Sodium content determines extracellular fluid (ECF) volume status
Sodium concentration determines intracellular fluid (ICF) volume
Sodium [...] does NOT predict [...]
Answer
**Sodium content determines extracellular fluid (ECF) volume status
Sodium concentration determines intracellular fluid (ICF) volume
Sodium concentration does NOT predict ECF volume status**


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Flashcard 1333256916236

Tags
#exam #nephrology
Question
Na balance:

input (determined by diet)

output
--small extrarenal loss
--Renal excretion controlled by [...]
• Activation of RAAS results in [...]
Answer
**Renin‐Angiotensin‐Aldosterone System (RAAS)

sodium retention**


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Flashcard 1333260586252

Tags
#exam #nephrology
Question
H2O balance:

input (thirst → intake)

output
--extrarenal loss small
--Renal excretion controlled by [...]
• Release of ADH results in [...]
Answer
**antidiuretic hormone (ADH)
water retention**


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Flashcard 1333268450572

Tags
#exam #nephrology
Question
Hyponatremia ALWAYS a result of [...]
Answer
**Hyponatremia ALWAYS a result of relative water retention**


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Flashcard 1333270285580

Tags
#exam #nephrology
Question
Why is there H2O retention in hyponatremia?
Answer
**ADH** (main cause)
no kidney fn/GFR
no osmoles to excrete in urine


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Flashcard 1333292305676

Tags
#exam #nephrology
Question
Treatment of Life‐Threatening Hyperkalemia
Answer
**Four principles of management:
(1) Stabilize myocardium
--Give Calcium Gluconate IV

(2) Shift potassium into cells
--IV insulin
--IV or inhaled beta2‐agonist

(3) Potassium excretion
--90% renal - ↑ ECFV w/ IV saline to promote flow to CCD, then give IV furosemide
--10% GI - promote diarrhea (cation exchange resins) -
avoid post-op use

(4) Hemodialysis - if above insufficient**


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Flashcard 1333294664972

Tags
#exam #nephrology
Question
pH = [...]
plasma CO2 = 40mmHg
plasma HCO3 = 24mmol/L
plasma anion gap = 12mEq/L
Answer
pH = 7.40
plasma CO2 = 40mmHg
plasma HCO3 = 24mmol/L
plasma anion gap = 12mEq/L


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Flashcard 1333296499980

Tags
#exam #nephrology
Question
pH = 7.40
plasma CO2 =
[...]
plasma HCO3 = 24mmol/L
plasma anion gap = 12mEq/L
Answer
pH = 7.40
plasma CO2 = 40mmHg
plasma HCO3 = 24mmol/L
plasma anion gap = 12mEq/L


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Flashcard 1333298334988

Tags
#exam #nephrology
Question
pH = 7.40
plasma CO2 = 40mmHg
plasma HCO3 =
[...]
plasma anion gap = 12mEq/L
Answer
pH = 7.40
plasma CO2 = 40mmHg
plasma HCO3 = 24mmol/L
plasma anion gap = 12mEq/L


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Flashcard 1333300694284

Tags
#exam #nephrology
Question
pH = 7.40
plasma CO2 = 40mmHg
plasma HCO3 = 24mmol/L
plasma anion gap =
[...]
Answer
pH = 7.40
plasma CO2 = 40mmHg
plasma HCO3 = 24mmol/L
plasma anion gap = 12mEq/L


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Flashcard 1333302529292

Tags
#exam #nephrology
Question
Four Primary Acid‐Base Disorders:

Metabolic acidosis: pH [...] and [...]
Metabolic alkalosis: pH [...] and [...]
Respiratory acidosis: pH < 7.4 and ↑PCO2
Respiratory alkalosis: pH > 7.4 and ↓PCO2

Answer
Four Primary Acid‐Base Disorders:

Metabolic acidosis: pH < 7.4 and ↓[HCO3‐]
Metabolic alkalosis: pH > 7.4 and ↑[HCO3‐]
Respiratory acidosis: pH < 7.4 and ↑PCO2
Respiratory alkalosis: pH > 7.4 and ↓PCO2


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Flashcard 1333304364300

Tags
#exam #nephrology
Question
Four Primary Acid‐Base Disorders:

Metabolic acidosis: pH < 7.4 and ↓[HCO3‐]
Metabolic alkalosis: pH > 7.4 and ↑[HCO3‐]
Respiratory acidosis: pH
[...] and [...]
Respiratory alkalosis: pH [...] and [...]
Answer
Four Primary Acid‐Base Disorders:

Metabolic acidosis: pH < 7.4 and ↓[HCO3‐]
Metabolic alkalosis: pH > 7.4 and ↑[HCO3‐]
Respiratory acidosis: pH < 7.4 and ↑PCO2
Respiratory alkalosis: pH > 7.4 and ↓PCO2


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Flashcard 1333308034316

Tags
#exam #nephrology
Question
Five Steps to Solving Acid Base Problems
Answer
(1) Look at the pH: Acidemia vs Alkalemia

(2) What is the primary problem?:
Compare HCO3 vs pCO2

(3) Is there adequate compensation?
met acid = 1:1 (pCO2)
met alk = 1:0.7 (pCO2)
R acid A = 1:10 (pCO2)
R acid C = 3:10 (pCO2)
R alk A = 2:10 (pCO2)
R alk C = 5:10 (pCO2)

(4) a) What is the Anion Gap?
AG = Na – (Cl + HCO3)
--Normal is 12 +/‐ 2 mmol/L

b) Is there an Osmolar Gap?
Osmolar gap = Osm(meas) – Osm(calc)
Osm(calc) = 2Na + Urea + Glucose
--Normal is upto 10 mosm/kg

(5) Is there another metabolic disorder?
Does the Δ AG = Δ HCO3?
Δ AG = Δ HCO3 (only AGMA)
Δ AG < Δ HCO3 (AGMA + met alk)
Δ AG > Δ HCO3 (AGMA + NAGMA)


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Flashcard 1333309869324

Tags
#exam #nephrology
Question
met acid causes w/ ↑ AG
Answer
**• Lactic acidosis
• Ketoacidosis

--diabetic
--alcoholic
--starvation
• Toxins
– Methanol
– Ethylene glycol
– Salicylates
• Severe chronic kidney disease**


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Flashcard 1333312228620

Tags
#exam #nephrology
Question
met acid causes w/ normal AG
Answer
**NaHCO3 Loss
– GI (Diarrhea)
– Renal (Low urine NH4+, Seen in chronic kidney disease or renal tubular acidosis)**


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Flashcard 1333315636492

Tags
#america #benefit #borat #cultural #for #glorious #kazakhstan #learnings #make #nation #of
Question
"What type of dog is this?"
Answer
"You're welcome."


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Flashcard 1333380648204

Tags
#exam #urology
Question
What are the complications of prostatectomy?
Answer
peri-op: anesthetic risks, bleed/transf, UTI, wound inf, MI, DVT/PE, bowel/rectal/bladder/ureteric injury, etc

post-op: erectile dysfn, stress urinary incontinence, urethral strictures, LUTS, PCa recurrence


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Flashcard 1333389823244

Tags
#exam #urology
Question
How do you prevent Ca stones?
Answer
Diet
--**↑ fluid
--↓ animal protein, Na, oxalate, EtOH
--do NOT ↓ Ca intake (Ca binds oxalate)**


meds
--hydrochlorothiazide (hypercalciuria) - promote Ca reabsorption
--K citrate (↑ pH & citrate lvl in urine)


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Flashcard 1333391658252

Tags
#exam #urology
Question
What causes struvite stones?
Answer
inf w/ urea-splitting bugs (proteus, klebsiella, pseudomonas) → alkaline urine (pH>7.5)
--**NOT ECOLI**


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Flashcard 1333395852556

Tags
#exam #urology
Question
What causes cystine stones?
Answer
d/t aa transport problem (autosomal recessive defect)
--↓ reabsorption of COLA (cystine, ornithine, lysine, arginine)


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Flashcard 1333403192588

Tags
#exam #urology
Question
DDx of renal colic
Answer
**• Acute ureteric obstruction (other causes)
– UPJ obstruction
– Sloughed papilla
– Clot colic from gross hematuria
• Pyelonephritis (fever, pyuria, flank pain) without a stone
• Acute abdominal crisis: appendicitis, diverticulitis, biliary colic, bowel obstruction, pancreatitis
• Ruptured abdominal aortic aneurysm (AAA)
• Gynecological: ectopic pregnancy, torsion / rupture of ovarian cyst
• Radiculitis (L1) – herpes zoster, nerve root compression**


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Flashcard 1333408697612

Tags
#exam #urology
Question
Indications for admission or urgent intervention in kidney stone ds
Answer
**– Pain not controlled with oral analgesics
– Fever and urinary tract infection with obstructing stone
– Refractory vomiting
– Solitary kidney with obstruction OR bilateral obstructing stones → RENAL FAILURE
– Severe hematuria**


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Flashcard 1333441989900

Tags
#urology
Question
What evaluations do you do for ED?
Answer
Hx & p/e

investigations:
--uncontrolled DM
--hypogonadism
--RF for CV ds (lipid profile)


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Flashcard 1333443824908

Tags
#urology
Question
What are the rx for ED?
Answer
counselling, oral meds, injections, intraurethral, other devices, penile implant (3rd line)

1st line: lifestyle/drug therapy moderations, psychosocial counselling, androgen replacement therapy (younger men), oral (PDE5 inhibs - tadalafil, sildenafil, vardenafil)


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Flashcard 1333445659916

Tags
#urology
Question
benign renal lesions
Answer
renal cyst
angiomyolipoma
oncocytoma


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Flashcard 1333447494924

Tags
#urology
Question
What is a renal cyst?
Answer
--fluid-filled sac in the kidney parenchyma
--most common benign renal mass
--uses Bosniak classification (likelihood of malig)
--anechoic on u/s with post-acoustic enhancement


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Flashcard 1333449329932

Tags
#urology
Question
what is an angiomyolipoma?
Answer
--solid lesion
--the presence of fat is pathognemonic for AML
--usually asx
--hyperechoic on u/s
--no calcifications
--no lymphadenopathy
--rx if risk of bleeding (≥4cm) or symptomatic or pregnant


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Flashcard 1333452213516

Tags
#urology
Question
What is the rx for angiomyolipoma?
Answer
--angioembolization (#1)
--partial/radical nephrectomy depending on size


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Flashcard 1333454048524

Tags
#urology
Question
what is an oncocytoma?
Answer
benign renal lesion that's hard to tell apart from carcinoma
--need pathology for dx


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Flashcard 1333455883532

Tags
#urology
Question
What is renal cell carcinoma?
Answer
--85% of renal cancers
--peak @ 60-70y/o, males


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Flashcard 1333457718540

Tags
#urology
Question
What are risk factors of renal cell carcinoma?
Answer
smoking, exposures, ESRD, HTN, obesity, rad rx


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Flashcard 1333459553548

Tags
#urology
Question
What are mets sites of renal cell carcinoma?
Answer
LN, lung, liver, bone, adrenal gland, brain, the other kidney


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Flashcard 1333461388556

Tags
#urology
Question
What are s&s of renal cell carcinoma?
Answer
--usually asx unless adv/mets
--paraneoplastic syndrome (10-20%) - polycythemia, anemia, HTN, fever, hypercalcemia, neuromyopathy, non-mets hepatic dysfn, amyloidosis, cachexia


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Flashcard 1333463223564

Tags
#urology
Question
What are the histology cell types of renal cell carcinoma?
Answer
--clear cell (70%)
--papillary (10%)
--chromophobe (5%) - less aggressive, less mets
--collecting duct (<1%) - very aggressive, more mets
--other (<1%)


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Flashcard 1333465058572

Tags
#urology
Question
how do you dx renal cell carcinoma?
Answer
imaging
--u/s + CT (pre & post contrast) - look for enhancement, calcifications, staging
--usually solid & hypoechoic on u/s

MRI - if young/pregnant/can't CT
--look for enhancement
--can differentiate b/w clear cell & papillary

percutaneous bx
--if unsure of dx, if may alter mgmt, if good IR & GU pathologist


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Flashcard 1333466893580

Tags
#urology
Question
How can you rx renal cell carcinoma?
Answer
surgery (main)
--radical nx (gold standard for oncologic control)
--partial nx (pref if feasible)
--thermal ablation (newer)

tumours are chemo-resistant
rad not as good

active surveillance


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Flashcard 1333473185036

Tags
#urology
Question
[...] is the most common type of bladder cancer
Answer
Urothelial carcinoma
NB: >90%; cancer of lining of bladder


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Flashcard 1333475020044

Tags
#urology
Question
What are the risk factors for bladder cancer?
Answer
#1 = smoking
--occupational carcinogens
--arsenic exposure
--aristolochic acid (chinese herb)
--chronic cystitis
--genetics
--Fhx
--schistosomiasis UTI
--iatrogenic (rad, cyclophosphamide - chemo)


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Flashcard 1333477117196

Tags
#urology
Question
What are s&s of bladder cancer?
Answer
--hematuria (most common) - if present, urothelial carcinoma unless proven otherwise
--pain
--LUTS
--constitutional sx


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Flashcard 1333478952204

Tags
#urology
Question
how do you dx bladder cancer?
Answer
--urine tests (cytology) - 98% SP, 34% SN - operator-dependent - detects shed cells in urine
--imaging (CT abdo/pelvis = best; or abdo u/s)
--cystoscopy
--bx - transurethral resection of bladder tumour (TURBT) for pathology


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Flashcard 1333480787212

Tags
#exam #urology
Question
[...] is the biggest factor in bladder cancer mgmt
Answer
**Invasion into the bladder wall msc**

NB:
--non-msc invasive UC (most common ~70%) - lower mets, higher recurrence
--msc invasive UC (~30%) - higher mets, death


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Flashcard 1333483408652

Tags
#urology
Question
What is the mgmt for non-msc invasive UC?
Answer
--TURBT = dx & rx
--single dose IV chemo post-op (kills remaining cells post-TURBT)
--surveillance cystoscopy
--surveillance of upper tracts (ureters & kidney) - ~5% risk of upper tract cancer
--intravesical rx for induction & maintenance (prevent progression)​
  • immunotherapy (BCG)
  • chemo (MMC) - decreased effectiveness


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Flashcard 1333485243660

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#urology
Question
What is the mgmt for msc-invasive UC?
Answer
--TURBT is mainly for dx
--major extirpative therapy + reconstruction (ileal conduit, neobladder) - removal of bladder
--adjunct - chemo (neo = increased survival; post-surg = less evidence)
--bladder-sparing options - aggressive TURBT

gold standard = radical cystectomy + pelvic LN dissection + neoadjuvant chemo


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Flashcard 1333488913676

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#urology
Question
What structures form from the wolffian duct?
Answer
Epididymis, vas deferens, seminal vesicles, ejaculatory duct


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Flashcard 1333490748684

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#urology
Question
What structures form from the mullerian duct?
Answer
Uterus, fallopian tubes, upper part of the vagina


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Flashcard 1333492583692

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#urology
Question
Hypothalamus ( [...] ) -> pituitary gland ( [...] ) -> testis -> [...] & [...] cells

sertoli cells ( [...] ) -> hypothal
leydig cells ( [...] ) -> hypothal
-neg feedback loops
Answer
Hypothalamus (GnRH) -> pituitary gland (LH/FSH) -> testis -> sertoli & leydig cells

sertoli cells (inhibin) -> hypothal
leydig cells (T&E) -> hypothal
​-neg feedback loops


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Flashcard 1333494418700

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#urology
Question
What forms the testis blood barrier?
Answer
sertoli cells
--forms immunocompetent area for sperm to survive
--haploid sperm are foreign to the body


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Flashcard 1333496253708

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#urology
Question
What matures & stores sperm?
Answer
epididymis
--it takes 3mo for sperm to mature and develop to be ejaculated
--sperm get transported to vas
--sperm gain motility in the tail (?) of epididymis
--smoking interrupts (something) at head of epididymis
--infections & toxins interrupt the body
--something about mt?


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Flashcard 1333498613004

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#urology
Question
What questions do you ask on duration of infertility?
Answer
--primary (no pregnancy) vs secondary (miscarriage/birth)
--prev rx
--female factor (anovulation, tubal obstruction)


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Flashcard 1333505690892

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#urology
Question
Inferitility hx: childhood & development
Answer
cryptochidism
pubertal development


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Flashcard 1333507525900

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#urology
Question
infertility hx: pmh
Answer
systemic illness


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Flashcard 1333509360908

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#urology
Question
infertility hx: surgical hx
Answer
abdo, pelvic, scrotal surgery


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Flashcard 1333511195916

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Question
infertility hx: infections
Answer
STD's, prostatitis, orchitis (post-pubertal mumps)


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Flashcard 1333513030924

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#urology
Question
infertility hx: environmental gonadotoxins
Answer
smoking, recreational drugs (marijuana), anabolic steroids, pesticides (DBCP), workplace chemicals (solvents)


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Flashcard 1333514865932

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Question
infertility hx: meds
Answer
hormonal (pre-testicular)
--androgens, anti-androgens, estrogens
gonadotoxic (testicular)
--chemo/alkylating agents
--abx, sulfasalazine
sperm-toxic (post-testicular)
--CCB's


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Flashcard 1333516700940

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#urology
Question
infertility hx: sexual hx
Answer
1. Erectile Function/Libido
2. Lubricants
3. Frequency of intercourse
4. Timing of intercourse


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Flashcard 1333518535948

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#urology
Question
infertility p/e
Answer
--general apperance (kleinfelter's)
--CNS: quadraplegic, etc
--gynecomastia
--abdo mass/scar

Genital exam
--penile anatomy (position of meatus)
--testis size (4x2cm), consistency, location
--presence of vas deferens
--epididymal congestion
--varicocele (grade 1-3)


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Flashcard 1333520370956

Question
What should you take note about testicular varicoceles?
Answer
--one of main causes of infertility
--most occurs on Lt or both
--if pt comes in w/ new Rt mass, think retroperitoneal mass or other (not varicocele)

--gr 1 = not visible, can see reflux of bloodflow w/ valsalva
--gr 2 = in between
--gr 3 = visible


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Flashcard 1333522205964

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Question
infertility evaluations
Answer
--semen analysis x2
--hormonal profile


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Flashcard 1333524040972

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#urology
Question
azoospermia ddx
Answer
pre-testicular
--hypothalamus, pituitary

testicular
--testicular failure, non-obstructive azoospermia

post-testicular
--obstruction or absence of Wolffian structures


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Flashcard 1333525875980

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Question
What are FSH, LH, and T values for pre-testicular, testicular, and post-testicular azoospermia?
Answer
FSHLHT
pre-testicularlowlowlow norm
testicularhighhigh/normnorm
post-testicularnormnormnorm


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Flashcard 1333527710988

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Question
infertility genetic screening
Answer
karyotype
--klinefelters (XXY)
--robersonian translocation
--XX male

Y-chromosome microdeletion


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Flashcard 1333529545996

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#urology
Question
what is klinefelter syndrome?
Answer
--47, XXY + variants
--sterile
--gynecomastia
--eunuchoid (indeterminate sex ft's)
--delayed puberty
--high FSH, high LH, low T


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Flashcard 1333531381004

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Question
Klinefelter's infertility rx
Answer
microdissection testicular sperm extraction (micro-TESE)

in vitro fertilization (IVF)

intracytoplasmic sperm injection (ICSI)


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Flashcard 1333561527564

Tags
#exam #urology
Question
when do you suspect undescended testis?
Answer
prematurity
scrotal asymmetry
testicle not in scrotum @ birth


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Flashcard 1333563362572

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#exam #urology
Question
there is no value in u/s for [...]
(pediatric urology)
Answer
non-palpable testis


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Flashcard 1333565197580

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#exam #urology
Question
What should you think if you see a "boy" with bilat impalpable gonads?
Answer
--always think disorder of sexual differentiation (congenital adrenal hyperplasia)
--these pt are salt-wasters (can die)
--actually female


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Flashcard 1333567032588

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#exam #urology
Question
pediatric acute scrotum
-most important dx
-ddx
Answer
acute scrotum = surgical emergency

most imp dx
--testicular torsion
  • emergent scrotal exploration
  • time is key!
  • testicular atrophy rates increase sig after 6-8h of ischemia

ddx
--epididymis (positive/neg urinalysis)
--testicular torsion (acute onset, cremaster reflex neg)


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Flashcard 1333568867596

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#exam #urology
Question
How can you prevent paraphimosis?
Answer
paraphimosis = foreskin trapped behind glans of penis

--remember to reduce the foreskin after inserting a foley catheter


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Flashcard 1333570702604

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#exam #urology
Question
[...] grade antenatal hydronephrosis = worse
Answer
higher


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Flashcard 1333572537612

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#exam #urology
Question
what is posterior urethral valves?

Who's at risk? When do you suspect it?
Answer
--only affects males
--most common congenital bladder obstruction
--suspect if bilat hydronephrosis
--look for the key hole sign


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Flashcard 1333574372620

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#exam #urology
Question
What is the mgmt for post urethral valves?
Answer
neonate: if suspected, place catheter after birth to bypass obstruction


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Flashcard 1333576207628

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#exam #urology
Question
What happens with isolated primary nocturnal enuresis?
Answer
spontaneous resolution (7% @ 7y/o to <1% in adults)

invasive investigations not indicated if normal p/e


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Flashcard 1333578042636

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Question
What are the LUT innervations?
Answer
--pons (central control centre)
--sympa (T10-12) @ T6 vertebral level
  • storage, innervates β3 receptors
  • α receptors
--para (S2-4) - muscarinic receptor for voiding
--somatics (S2-4) - skeletal muscles (S234 keeps the urine off the floor)


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Flashcard 1333580926220

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Question
What are causes for failure to store urine?
Answer
--overactive bladder -> urgency incontinence
--incompetent outlet -> stress incontinence


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Flashcard 1333582761228

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#urology
Question
What are reasons for failure to empty urine?
Answer
--hypoactive/tonic bladder
--obstructive outlet (less likely in females)
(both lead to overflow incontinence)


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Flashcard 1333584596236

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#urology
Question
mixed incontinence = [...] + [...]
Answer
stress
urgency


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Flashcard 1333586431244

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Question
what causes continuous/total incontinence?
Answer
--fistula (vesicovaginal), ectopic ureter, etc
--no sense of urgency


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Flashcard 1333588266252

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Question
What is the mgmt for urinary incontinence?
Answer
--artificial urinary sphincter
--male advance sling system


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Flashcard 1333590101260

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Question
What is OAB (over active bladder)?
Answer
--sense of urgency
--freq (>8/day)
--nocturia
--wet vs dry (wet - incontinence, more in females, UMN neuropathy, d/t lesions above parasympathetics)


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Flashcard 1333592460556

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Question
What is stress incontinence?
Answer
--most common type
--almost only in females
--males if prostatectomy injury
--increased pressure on bladder
--risk factors: parity, obesity, COPD, etc


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Flashcard 1333594295564

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Question
With a [...] you can have initial retension of urine from detrusor areflexia due to spinal shock
Answer
With a cerebrovascular accident (CVA) you can have initial retension of urine from detrusor areflexia due to spinal shock

NB: CVA = stroke


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Flashcard 1333596130572

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Question
With a cerebrovascular accident (CVA) you can have [...] of urine from [...] due to spinal shock
Answer
With a cerebrovascular accident (CVA) you can have initial retension of urine from detrusor areflexia due to spinal shock


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Flashcard 1333597965580

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Question
With a cerebrovascular accident (CVA) you can have initial retension of urine from detrusor areflexia due to [...]
Answer
With a cerebrovascular accident (CVA) you can have initial retension of urine from detrusor areflexia due to spinal shock


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Flashcard 1333599276300

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Question
What bladder sx do you see with MS and why?
Answer
bladder sx - detrusor over activity urgency incontinence most common

due to uncoordinated sphincter & bladder activity
--sphincter shut while bladder contracting -> backflow of urine


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Flashcard 1333601111308

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Question
What is the mgmt of urgency incontinence?
Answer
--behavioural therapy - education (timed voiding, pelvic msc training, etc)
--med
  • antimuscarinics to prevent contractions
  • β3 agonist for relaxation
--if refractory, surgery
  • botox - prevents exocytosis + release of neurotransmitters (for neurogenic detrusor overactivity); can have increased retention which is problem for older pt's
  • permanent implant - stimulates & modulates nn
  • bladder augmentation (reconstruction) - increase capacity of bladder + decrease pressure of bladder (use ileum)


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Flashcard 1333602946316

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#urology
Question
What is the mgmt for stress incontinence?
Answer
--no medical rx
--mian is surgery
  • pubovaginal sling
  • burch procedure (bladder neck suspension)
  • TVT (synthetic sling)
  • periurethral injection (not done much in Canada)
--behavioural & physio


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