Clin Med Final

Enlargement of the prostate. nodules on the urethra and resistance to urine flow. PSA elevated. voiding symptoms, hesitancy, poor flow, storage symptoms, frequency, nocturia, noctournal incontinence, urgencyDoes not lead to cancerTx: alpha blockers, 5-alpha-reductase

Benign Prostatic Hyperplasia

BPH complications:

Acute urinary retentionurinary tract infectionsbladder stonesbladder damagekidney damagehydronephrosis

Gold standard for surgical intervention for BPH

Trans-urethral Resection of the Prostate (TURP). Laser Vaporization of the prostate is also popular

Bladder exposed on the abdominal wall, pelvic bones widely separated, abnormal formation of the prostate, penis or female genitaliacongenital

Bladder Exstrophy

oligohydramnios (reduced amniotic fluid) causes renal agenesisSupernumerary or Duplicated Kidney

Potter's Syndrome (Potter's Sequence)

obstruction prevents flow of urine from the cyst


Exposed spinal cord enclosed in a sac on the child's back, nerve difficulties emptying the bladder

Spina Bifida

absence of one of both testes from the crotum.. seen at birth4-40 fold increase in testicular cancer


Venous plexus in the scrotumsee with transillumination. 15-30 yo can get this from abdominal ascities


Fluid around the testicle, from peritoneum wrapped around the testicle, called the tunica vaginalis


Loss of support of the urethra due to damage to pelvic support structures as a result of childbirthLeaking small amounts of urine with activities which increase abdominal pressure such as coughing, sneezing and liftingdue to insufficient strength of the pelvic floor muscles to prevent the passage of urine

Stress urinary incontinence

Uninhibited contractions of the detrusor muscleLeaking of large amounts of urine with insufficient warning to get to in timeexercisinginvoluntary loss of urine occurring for no apparent reason while suddenly feeling the need to urge to urinate kegels helps

Urge Urinary incontinence

Pain is renal colic and comes in waves, symptoms include, nausea, vomiting, fever, blood in the urine and painful urination

Kidney stones

Most common kidney stone...shows up on x-ray

calcium oxalate

most common cause of kidney stones


infection stones", often in the presence of infection by urea-splitting bacteria

Struvite stones

tx for uric acid kidney stones


muzzle"inability to retract foreskin from the glands of the penis (dital to proximal)non-emergent


inability to replace the cover of the glans with the foreskinemergentthe foreskin becomes trapped behind the glans penis, and cannot be reduced to its normal position covering the glans peniscannot be pulled back over the glans into normal anatomical position


opening of urethra is small

meatal stenosis

spermatic cord twists, cutting off testicle's blood supply, rapid onsetirreversible ischemia begins after 6 hourssudden, severe, testicular pain, and nausea

testicular torsion

bell-clapper deformity

congenital testicular torsion testis is inadequately affixed to the scrotum allowing it to move freely on its axis

Most common type of bladder cancer

transitional cell carcinoma

Pain during urination, frequent urination, urge to urinate

suspect bladder cancer

most common contributor to urinary bladder cancer

tobacco smoke30% workplace carcinogens

Usually no symptoms, but eventually symptoms include, frequent urination, nocturia, difficulty starting stream, hematuria and dysuria...agent orange

suspect prostate cancer

evaluation of prostate cancer

rectal ultrasound

two types of prostate cancer

adenocarcinoma and glandular cancer

Most common cancer in males aged 20-39 years, the most common to start, rarely seen before the age of 15 yearsFirst sign cancer is a lump or swelling in the testes

suspect testicular cancer

evaluation of testicular cancer

ultrasoundCT scansinguinal Do not perform biopsy-increases the risk of spreading into the scrotum

True or false if you suspect testicular cancer you should biopsy it

False. this can lead to it spreading into the scrotum

most common type of kidney cancer in adults

Renal Call Carcinoma

Symptoms include, blood in the urine (40%), flank pain (40%), mass in the abdomen or flank (25%), weight loss (33%), fever (20%), high blood pressure (20%), night sweats

suspect renal cell carcinoma

Classic Triad, Hematuria, Flank Pain and Abdominal Mass

Renal cell carcinoma

Risk factors for renal cell carcinoma


these patients are 30 times more likely than the general public to develop renal cell carcinoma

acquired cystic disease of the kidney

Typically occurs in childrenthe most common kidney tumor in kidsunilateralpainless abdominal tumor that can be easily felt

Wilms' Tumor (nephroblastoma)

bilateral Wilms' tumor

Denys-drash syndrome

Pelvic Pain and Abdominal Swelling (Bloating and Distention)hormone therapy after menopause, fertility medication and obesity

Ovarian cancer

suspect ovarian cancer

perform a laparoscopy

bleed, pain, rupturemost are benignclassified according to whether they are a variant of the normal menstrual cycle, called a Functional Cyst, or they are not normal

ovarian cysts

large vs giant ovarian cysts

large- over 5 cmgiant- over 15 cm

while large ovarian cysts are not usually prone to _____ they more commonly _____


most common type of Ovarian Cyst (2 cm)

Follicular Cyst

common type of giant ovarian cysts

dermoid cyst

Amenorrhea with Infertility, Hirsutism and Enlarged Polycystic Ovaries

Polycystic Ovary Syndrome (PCOS), or Stein-Leventhal Syndrome

A String of Pearls" (on ultrasound) , abnormally large number of eggs, irregular or no periods or heavy periods, excess body and facial hair, acne, pelvic pain, trouble getting pregnant and patches of thick velvety skin


most common from of vulvovaginitis

irritant vaginitis

biggest problem with osteoporosis


type of osteoporosis common in women after Menopause, due to the decrease in estrogen production after menopause

primary type 1

type of osteoporosis occurs after age 75 and is seen in females and males at a ratio of 2:1

Primary Type 2, Senile Osteoporosis

type of osteoporosis at any age equally, chronic predisposing medical problems, or prolonged use of medications such as glucocorticoids

secondary osteoporosis, Steroid-Induced Osteoporosis

risk factors for breast cancer

obesity, alcohol, hormone replacement therapy during menapause, ionizing radiation, early age at first menstruation, having children late or not at all

screening recommendations for breast cancer

Recommends screening every two years in women 50 to 74 years old

type of breast cancer with Peau d'orange

inflammatory breast cancer

type of breast cancer resemble eczema and redness

Paget's Disease

lumps in breast that cause discomfort

fibrocystic breast disease

Non-cancerous tumors composed of fibrous and glandular tissuebreast mice because they move around a lot, cause a lot of pain

fibroadenomas of the breast

the most common organism responsible for mastitis

S. aureaus

breast diseasefever, pain, erythema, rapid onset of symptomsEarly Stages, present with local pain, redness, swelling and warmthLater Stages, systemic symptoms like fever and abscess and develop very quickly without any warning


Non-puerperal Mastitis, lesions of the breast occurring unrelated to pregnancy and breastfeedingBreast tenderness or warmth to the touchSwelling of the breastPain Skin redness, often in a wedge-shaped patternFever of 101 F (38.3 C) or greaterShivering and chills


Non-puritic red rash palms and solesno scarring

secondary syphilis

granulomatous gummae on skin looks like SCC, also cardio and neuro symptoms

tertiary syphilis

when can treponemes (syphilis) cross the placenta?what can it cause in the infant?

10-15 weekskeratitis, malfromed teeth, facial deformation (saddle nose), CNS abnormalities

What type of cells does neisseria like to colonize?

mucosal non-ciliated, columnar epithelia cells

how soon after infection do gonorrhea appear?

2-7 days

Test for gonorrheaTX?

nucleic acid amplification testgram stain of dischargeIM ceftriazone + oral azithromycin or doxycycline

how does chlamydia affect women?Men?

Women- >80% asymptomatic, can ascend to upper genital tract and cause PID which can lead to tubal infertilityMen- most commonly Urethritis, asymptomatic in 30-40%rarely spreads upwards to epidymitis or prostate

Which STD can present with Reiters syndrom?


Wet mount of vaginal discharge or urethral exudate in men reveals jerky, parasite cell movements

Trichomonas vaginalis

What is the most common cause of neonatal conjunctivitis in the US?


This contreceptive does not increase the risk for arterial and venous diseae.


Implantation anywhere besides __________ is considered an ectopic pregnancy

endometrial lining

stomach pain in a woman suspect ______ 1st

ectopic pregnancy

premature separation of the placenta from its implantation site before delivery is a know risk factor for it is:

placenta abruptionhypertension

abnormally adherent placenta that has invaded into or beyond endometrium

placenta accreta

plaenta implants over the internal cervical os

placenta previa

how do you diagnose endometrial cancer?

Dilation and Curettage (D&C)pap smear is not sufficient

estrogen alone increases or decreases endometrial cancerestrogen plus progesterone increases or decreases endometrial cancer


tx for endometrial cancer

bilaterasalpingo-oophorectomy (total abdominal hysterectomy)

most common reason for a hysterectomy in the USalso most common benign tumor in females during middle and late reproductive years

uterine fibroid (leiomyoma)

uterine fibroid origninates from the _____ layer of the uterus


if these ligaments rupture you have a high chance of having uterine prolapse most common caus3

Uterosacral ligamentstrauma during childbirth

true or false endometriosis is a risk factor for ovarian cancer


most common type of ovarian cyst

follicular cyst

most common endocrine disorder among women between 18 and 44

Polycystic ovary syndrome

How do you diagnose PCOS

Rotterdam criteria: (at least 2)no ovulation, high androgen levels, ovarian cysts

endometriosis improves or gets worse with menopause


major cause of Cervical intraepithelial neoplasia

infection of the cervix with HPV 16, 18, 31, and 33

How often and at what age should pap smears be done?

every 3 years ages 21-65

most common type of Cervical cancer

SCC-90%Adenocarcinoma- 10%

what percentage of cervical cancers can be prevented with the HPV vaccine?what strains of hpv cause the most cervical cancer?

90%16 and 18 - 75%

What is the name of the HPV vaccines?what age is it give to?

Gardasil Cervarix9-26

most common causes of cervicitis

chalamydia-40%gonorrheaother infections

what device repairs serious cystoceles

pessary- holds the bladder in place

2 main causes of rectocele

childbirth hyesterectomyq

most vulva cancer is what type of cell

Squamous cell -90%2nd most common is melanoma (50-80 yo)

3 main types of vaginitis

Bacterial vaginosis- Gardnerellavaginal Candidiasis- CandidiasisTrichomoniasis

gold standard for surgical treatment of BPH

Trans-urethral Resection of the Prostate (TURP)Holmium Laser Enucleation of the Prostate up and coming

most common birth defect of male genitalia


Which one of these reasons would you not correct an undescended testicle herniapaintumortorsion fertility


Kegel exercise will help which type of incontinencestressurge


pain from a kidney stone can be confused with pain from ________

retroperitoneal abdominal aortic aneurysm

men with bell clapper deformity are more susceptible to

testicular torsion

in which one of these is the cremasteric reflex typically presenttesticular torsionepididymitis


testicular torsion results in the surface of the testicle being rotated toward or away form the midline


most common type of bladder cancer is know as _____ cell carcinoma aka _____ cell carcinoma


how do you diagnose bladder cancer?most common symptom?

biopsy during systoscopyhematuria

which of these is not a risk factor for prostate cancerobesityred meat consumptionfamily historysmokingracemilk productshigh blood pressure


which of these is not a common symptom of testicular cancer?strotal heavinesslow back paindysuriagyenocomastia


tumor markers for tsticular cancer


most testicular cancers arise fromgerm cellsleudig cells sertoli cells

germ cells

most common cancer in men age 20-40most common kidney cancer in adults

testicular cancerRenal Cell Carcinoma

which of these is not a sign of Renal Cell carcinomaAbdominal mass Flank painblood in the urineincreased urgencyfeverhigh blood pressure

increased urgency

Triad of Renal Cell Carcinoma

Abdominal massFlank painHematuria

why do patients with RCC develop anemia

depression of eerythropoietin

protytipal patient with wilm's tumor

adolesenet without developmental abnormalitiesunilateral nephroblastomas

true or false you biopsy a Wilm's tumor


Which of these is not indicative of renal failureoliguriahematuriasudden increase in creatine and BUNdecrease in kidney function


what is the major complication with acute tubular necrosis


classic triad of interstitial nephritis


triad of nephritic syndromeusually result form what bacteria

oliguriahypertension edemastrep pyogens not involving the kidney

blood in the urine, decrease in amount of urine, presence of HTN

Nephritic syndrome

acute post strep glomerulonephritis results from a strept infection of the kidney

Falseusually 1-4 weeks after pharyngeal infection

triad of glomerulonephritis


What test can show all of theseinfectionformed elementshematuria proteinuria


This urine cast is not indicative of renal diseaseHyaline castsred cell castsrenal tubular cell castscoarse granula castsbroad, waxy casts

hyaline casts

This urine cast is present after strenuous exercise and ferbile diseaseHyaline castsred cell castsrenal tubular cell castscoarse granula castsbroad, waxy casts

hyaline casts

This cast is indicative of glomerulonephritisHyaline castsred cell castsrenal tubular cell castscoarse granula castsbroad, waxy casts

red cell casts

This cast is indacative of pyelonephritis or interstitial nephritisHyaline castsred cell castsrenal tubular cell castscoarse granula castsbroad, waxy casts

White cell casts

These indicate acute tubular necrosis or interstitial nephritisHyaline castsred cell castsrenal tubular cell castscoarse granula castsbroad, waxy casts

renal tubular cell casts

these are indicative of chronic kidney diseaseHyaline castsred cell castsrenal tubular cell castscoarse granula castsbroad, waxy casts

broad waxy casts

gold standard for evaluating gfr

cockcroft-gault equationccr=(130-age)weight(kg)/Pcr72)pcr is serium creatineccr is creatine clearance

which one of these would you not see an elevated BUNHeart failureGi bleedPredinose useCentral DIRenal artery stenosisLiver diseaseSIADH

Central DI

most common cause of intrinsic acute kidney injury

acute tubular necrosis

membranous neuropathy makes us suspicious of what

hep b and carcinoma

most common cause of end stage renal disease in the US

diabetic neuropathy

when would you start dialysis on a patient with ESRD

when gfr is 10 ml/min/1.73m2when gfr is 10-15 with uremic sx, fluid overload not responsive to diuresis, and refractory hyperkalemia