Surgery > Prostate > Flashcards

Prostate Flashcards

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1
Q

MC zone involved in prostate ca

A

peripheral zone

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2
Q

MC zone BPH

A

transitional zone

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3
Q

distal limit of TURP

A

verumontanum

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4
Q

injury to bladder neck in TURP causes

A

retrograde ejaculation

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5
Q

mc composition of endogenous stones of prostate

A

Ca PO4

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6
Q

precursor lesson for stones in prostate

A

corpora amylacea

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7
Q

mc organism in prostatitis

A

E coli

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8
Q

Rx acute prostatitis

A

antibiotics x 2-3 w

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9
Q

dx test for chronic prostatitis

A

3 tube test

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10
Q

rx chronic prostatitis

A

ab x 4-6 w

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11
Q

MC and earliest LUTS

A

frequency

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12
Q

symptoms that do not get corrected even after TURP

A

post mictural LUTS - dribbling, incomplete emptying

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13
Q

storage LUTS

A

frequency
nocturia
urgency
urge incontinence
nocturnal incontinence

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14
Q

voiding LUTS

A

hesitancy
poor flow
intermittent stream
post void dribbling
sensation of poor bladder emptying
episodes of near retention

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15
Q

DRE diff of BPH & CA

A

firm rubbery, mobile mucosa - BPH
hard nodular, fixed mucosa - CA

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16
Q

MC and early symptom of BPH

A

Increased frequency

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17
Q

Storage symptoms LUTS

A

frequency
Nocturia
Urgency
Urge incontinence
Nocturnal incontinence

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18
Q

Voiding or obstructive symptoms LUTS

A

hesitancy
Poor flow
intermittent stream
Post void dribbling
Sensation of poor bladder empty
Episodes of near retention

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19
Q

symptoms that do not resolve after TURP

A

Post mictural symptoms
Dribbling
Incomplete emptying

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20
Q

How do you differentiate BPH from prostate CA on DRE

A

BPH – firm rubbery prostate mucosa mobile
Cancer – hard nodular prostate mucousa fixed

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21
Q

Work up for prostatic disorder

A
  1. DRE
  2. Urine
  3. USG KUB
  4. serum PSA
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22
Q

normal level of PSA in 50 to 69 years age group

A

0–3 ng/ml

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23
Q

ioc >3-4 ng/ ml to diff BPH and prostate CA

A

TRUS guided trucut bx

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24
Q

at least —— cores have to be taken in Bx prostate

A

12

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25
uroflowmetry value suggestive of BOO
<10 ml/s
26
bladder pressure suggestive of BOO
>80 cm of water
27
Very low bladder pressure can be seen in
Neurogenic bladder
28
Young patients with clinical features of LUTS but prostate is normal, suspect?
hypertrophy of internal sphincter= Marion disease
29
static component of BPH is due to
Increased DHT causing stromal hyperplasia
30
dynamic component of PPH is due to
Alpha1a receptors increasing smooth muscle tone
31
changes in the urinary tract caused by BPH
Exaggerated posterior curve of urethra Bladder muscle hypertrophy , diverticula, trabeculations
32
IPSS score 0 to 7 management
obsv
33
IPSS score 8-19 management
medical
34
IPSS score 20-35 management
medical and sx
35
drugs which have a quick onset of action in BPH
Alpha 1A blockers - Tamsulosin , Alfuzosin
36
Drug which have a more sustained action in BPH
5 alpha reductase inhibitor finasteride Dutasteride
37
best medical mx
combination rx
38
most important indication of surgery in BPH
Involvement of upper UT
39
MC surgery performed for BPH
TURP
40
surgeries other than TURP for BPH
HOLEP TULIP
41
Most commonly used laser in BPH surgery
ND YAG
42
Best laser available for BPH surgery
KTPA green light laser
43
MC used irrigating fluid in TURP
isotonic glycine 1.5%
44
normal Saline as an irrigating fluid can only be used in TURP when
bipolar cautery is used (NS is not a good conductor of electricity)
45
most common vessel that bleeds during TURP where are they situated what are they branch of
Badenoch arteries 5 o’clock and 7 o’clock position inferior vesical artery
46
Arteries present at 10 o’clock positional branch of?
Flock arteries inferior vesical artery
47
How is clot retention after TURP prevented
Insertion of three way Foley
48
TURP syndrome is basically
Dilutional hypoNa
49
MX TURP syndrome
if Na> 120 mEq / L —> fluid restriction <120mEq —> 3% hypertonic Saline infusion gradually
50
CF TURP syndrome
altered sensorium headache nausea vomiting
51
Correction – – – – – per day should not be done as it can cause – – – – –
> 8 mEq/ L Central Pontine demyelinosis/ myelinolysis
52
MC complication of TURP
retrograde ejaculation
53
MC site of stricture post TURP
Bladder neck
54
MC gene mutated in prostate cancer
GSTP1
55
Screening for prostate cancer
annual from 50 years of age By DRE, PSA or both
56
IOC prostate cancer
TRUS guided trucut biopsy
57
local staging of prostate cancer can be detected by
mpMRI - multi parametric prostatic MRI
58
ix used for detecting distant met in prostate cancer
PSMA PET scan As FDG is not taken up by prostate
59
First lymph nodes involved in prostate cancer
obturator
60
Most common site of metastasis in prostate cancer
lumbar vertebrae
61
bony Mets in prostate cancer are osteoblast or osteolytic?
osteoblastic
62
indications of bone scan in prostate cancer
If PSA > 10 ng/ml Gleason > 7 If symptomatic
63
Gleeson score of (4+3) indicates
Intermediate unfavourable type
64
Gleeson score of 3+4 indicates
Intermediate favourable type
65
Low risk group , gleason score would be
<=6
66
Minimum and maximum score of Gleason
2-10
67
prognostic scores in prostate cancer
Partin table D’Amico score
68
radical prostatectomy structures removed
Prostate with upper urethra seminal vesicles LN
69
bilateral orchidectomy is indicated for which cancer
Prostate
70
most important prognostic factor for prostate cancer
Stage of the disease
71
Which vaccine can be used in prostate cancer
Sipleocel-T (CD54 extract)
72
treatment of hormone resistant Bony mets in prostate cancer
Radio pharmaceutical therapy using Ra 223 or strontium 89 which act by Alpha rays
73
First line management of metastatic prostate cancer
Androgen deprivation therapy
74
medical androgen deprivation therapy
LHRH analogues + anti androgens LHRH antagonist
75
Name LHRH analog
Goserelin Busarelin
76
name LHRH antagonist
degarelix
77
name Anti androgens
Flutamide Abiraterone Enzalutamide
78
Management of early prostate cancer
T1/T2A > 70 G1/G2 life expectancy <10 y then observe or else radical prostatectomy
79
MX of T2 B/T3/T4 and LN involvement > 70 year G1/G2 life expectancy < 10 years prostate cancer
radiotherapy +/- ADT
80
MX of T2 B/T3/T4 and LN involvement <70 year G3/G4/G5 life expectancy >10 years prostate cancer
Radiotherapy If good response then ADT if residual disease then radical prostatectomy
81
Radiotherapy for prostate cancer
usually brachy therapy I125 or palladium 103
Surgery
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