Surgery > PROSTATE & TESTES > Flashcards

PROSTATE & TESTES Flashcards

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1
Q

Which zone of the prostate is the most common site for adenocarcinoma?

A

The peripheral zone.

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2
Q

Which prostate zone is most commonly associated with benign prostatic hyperplasia (BPH)?

A

The transitional zone.

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3
Q

Which prostate zone is rarely involved in prostate conditions?

A

The central zone.

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4
Q

What are common symptoms of Benign Prostatic Hyperplasia (BPH)?

A

Hesitancy, weak stream, nocturia, and incomplete emptying (LUTS).

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5
Q

What diagnostic tools are used for BPH?

A

Uroflowmetry, digital rectal exam (DRE), and PSA to rule out prostate cancer.

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6
Q

What is the typical finding on a digital rectal exam for BPH?

A

A smooth, rubbery prostate.

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7
Q

What are the medical treatments for BPH?

A

Alpha blockers (e.g., tamsulosin) and 5-alpha reductase inhibitors (e.g., finasteride, dutasteride).

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8
Q

What surgical procedure is commonly used for BPH?

A

Transurethral resection of the prostate (TURP).

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9
Q

What is the distal limit of resection during a TURP?

A

The verumontanum.

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10
Q

What is the most common complication of TURP?

A

Retrograde ejaculation.

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11
Q

What is TURP syndrome characterized by?

A

Hyponatremia and water intoxication.

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12
Q

What causes TURP syndrome?

A

The use of distilled water in monopolar cautery.

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13
Q

What is the most common site for prostate cancer (adenocarcinoma)?

A

The peripheral zone.

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14
Q

What diagnostic methods are used for prostate cancer?

A

PSA, digital rectal exam (DRE), Transrectal ultrasound (TRUS), and TRUS-guided biopsy (gold standard).

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15
Q

What is the typical finding on a digital rectal exam for prostate cancer?

A

A hard, nodular prostate.

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16
Q

What is the gold standard for diagnosing prostate cancer?

A

TRUS-guided biopsy (typically 12-core, sextant).

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17
Q

What imaging techniques are used for staging prostate cancer?

A

MRI with PIRADS (Prostate Imaging Reporting and Data System) and PSMA PET.

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18
Q

What does the Gleason score represent in prostate cancer?

A

The grade of differentiation of the cancer, ranging from 1 (well-differentiated) to 5 (anaplastic).

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19
Q

How is the total Gleason score calculated?

A

By adding the two most prevalent Gleason patterns.

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20
Q

What Gleason score is considered low risk?

A

Gleason 6.

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21
Q

What Gleason scores correspond to Group 2 and Group 3?

A

Group 2 is 3+4, and Group 3 is 4+3.

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22
Q

What Gleason scores are associated with Group 4 and Group 5?

A

Group 4 is 8, and Group 5 is 9-10.

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23
Q

What is the management for localized prostate cancer?

A

Active surveillance (for low risk) or radical prostatectomy.

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24
Q

What are treatment options for locally advanced prostate cancer?

A

Androgen deprivation therapy (e.g., GnRH agonists like goserelin), external beam radiation therapy (RT), and chemotherapy.

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25
What are treatment options for metastatic prostate cancer?
Orchiectomy and anti-androgens (e.g., flutamide).
26
What PSA level is generally considered a cutoff for further investigation, and what should be done?
A PSA level >4 ng/mL, which should be repeated and may be age-adjusted.
27
What are the most common sites for prostate cancer metastases?
Bone (osteoblastic metastases), specifically the spine and pelvis.
28
What is the mnemonic for testicular tumor markers, and what does it stand for?
The mnemonic is 'SHAL'. It stands for Seminoma (hCG, AFP never) and All (LDH).
29
What are the typical tumor markers for Seminoma?
Seminoma typically shows mildly elevated hCG and positive/variable LDH. AFP is never elevated in seminomas.
30
What are the typical tumor markers for Non-seminomatous Germ Cell Tumors (GCT)?
Non-seminomatous GCTs typically show elevated hCG, AFP, and LDH.
31
Which specific non-seminomatous germ cell tumor is the most common in children, and what marker is associated with it?
Yolk sac tumor (also known as endodermal sinus tumor) is the most common non-seminomatous germ cell tumor in children, and it is associated with elevated AFP.
32
Which non-seminomatous germ cell tumor is associated with significantly elevated hCG?
Choriocarcinoma is associated with significantly elevated hCG.
33
What are the tumor markers for Leydig cell tumors?
Leydig cell tumors typically do not have specific tumor markers, but they can lead to elevated testosterone and estrogen levels.
34
What are the clinical features associated with Leydig cell tumors?
Leydig cell tumors can present with gynecomastia and precocious puberty.
35
What are the tumor markers for Sertoli cell tumors?
Sertoli cell tumors typically do not have specific tumor markers.
36
What are the clinical features associated with Sertoli cell tumors?
Sertoli cell tumors can present with estrogenic symptoms.
37
What is the most common type of testicular tumor overall?
Seminoma is the most common testicular tumor overall.
38
What is the most common testicular tumor in adults?
Seminoma is the most common testicular tumor in adults.
39
What is the most common testicular tumor in children?
Yolk sac tumor (endodermal sinus tumor) is the most common testicular tumor in children.
40
What are the three main tumor markers used in the context of testicular tumors?
The three main tumor markers are AFP (Alpha-fetoprotein), hCG (human chorionic gonadotropin), and LDH (lactate dehydrogenase).
41
What is the initial imaging investigation for suspected testicular tumors?
The initial investigation is a scrotal ultrasound (USG).
42
What is the investigation used for staging testicular tumors?
Staging is typically done with a contrast-enhanced computed tomography (CECT) scan of the abdomen and pelvis.
43
What is the recommended procedure for biopsy of a suspected testicular tumor?
Biopsy via fine-needle aspiration (FNAC) or core needle biopsy is never performed. The recommended procedure is a high inguinal orchiectomy.
44
What are the potential complications of violating the scrotum during surgery for testicular tumors?
Complications include tumor upstaging and local recurrence.
45
What is the standard treatment for Stage I seminoma?
Treatment for Stage I seminoma typically involves orchiectomy, possibly followed by radiotherapy, and surveillance.
46
What is the standard treatment for non-seminomatous germ cell tumors (NSGCT)?
Treatment for NSGCT usually involves orchiectomy followed by chemotherapy (BEP regimen: bleomycin, etoposide, cisplatin), and potentially retroperitoneal lymph node dissection.
47
What does the BEP chemotherapy regimen consist of?
The BEP regimen consists of Bleomycin, Etoposide, and Cisplatin.
48
Which type of testicular tumor is known for being radiosensitive?
Seminoma is known for being radiosensitive.
49
What are the special features or notes for Lymphoma as a testicular tumor?
Lymphoma as a testicular tumor is more common in the elderly, often bilateral, and is the most common testicular tumor in individuals over 60 years old.
50
What is the most common testicular tumor in adults?
Seminoma
51
What is the most common testicular tumor in children?
Yolk sac tumor (endodermal sinus)
52
What are the common tumor markers for testicular cancer?
AFP (Alpha-fetoprotein), hCG (human chorionic gonadotropin), and LDH (lactate dehydrogenase)
53
What is the initial investigation for a suspected testicular tumor?
Scrotal Ultrasound (USG)
54
What is the staging investigation for testicular cancer?
Contrast-enhanced computed tomography (CECT) of the abdomen and pelvis
55
What is the recommended surgical approach for testicular tumors, and why is biopsy avoided?
High inguinal orchiectomy is always performed. Fine-needle aspiration cytology (FNAC) or biopsy is never done to avoid tumor upstaging and local recurrence.
56
What are the potential complications of violating the scrotum during surgery for a testicular tumor?
Tumor upstaging and local recurrence.
57
What is the treatment for Stage I seminoma?
Orchiectomy, with the potential addition of radiotherapy and/or surveillance.
58
What is the treatment for non-seminomatous germ cell tumors (NSGCT)?
Orchiectomy followed by chemotherapy (BEP regimen: bleomycin, etoposide, cisplatin), with the potential addition of retroperitoneal lymph node dissection.
59
How does testicular torsion differ from epididymo-orchitis in terms of pain onset?
Testicular torsion has a sudden, severe onset of pain, while epididymo-orchitis has a gradual onset.
60
What is the status of the cremasteric reflex in testicular torsion versus epididymo-orchitis?
The cremasteric reflex is absent in testicular torsion and present in epididymo-orchitis.
61
What is Phren's sign, and how does it present in testicular torsion and epididymo-orchitis?
Phren's sign refers to relief of pain upon elevation of the scrotum. It is negative (no relief) in testicular torsion and positive (relief on elevation) in epididymo-orchitis.
62
What are the Doppler Ultrasound findings for testicular torsion and epididymo-orchitis?
Doppler USG shows absent blood flow in testicular torsion and increased vascularity in epididymo-orchitis.
63
What is the management for testicular torsion?
Surgical detorsion, typically followed by bilateral orchiopexy.
64
What is the management for epididymo-orchitis?
Antibiotics.
65
What is the characteristic physical finding of a varicocele, and how does it change when lying down?
A varicocele is described as a 'bag of worms' and disappears when the patient lies down.
66
Which side is most commonly affected by varicocele?
The left side.
67
What is a varicocele associated with?
Infertility.
68
What are the indications for surgery in cases of varicocele?
Symptoms, infertility, or testicular atrophy.
69
What is the recommended timing for orchiopexy in cryptorchidism (undescended testis) to preserve fertility?
Between 6 to 12 months of age.
70
What is the most common location for an undescended testis?
The superficial inguinal pouch.
71
What are the potential complications of cryptorchidism?
Infertility and an increased risk of malignancy, with intra-abdominal testes carrying the greatest risk (seminoma).
72
What is the most common complication following a transurethral resection of the prostate (TURP)?
Retrograde ejaculation.
73
Which tumor marker is most useful for monitoring testicular cancer, according to the Lance Armstrong mnemonic?
LDH (lactate dehydrogenase).
74
What is the recommended timing for orchiopexy in cases of cryptorchidism (undescended testis) to preserve fertility?
6-12 months
75
What is the most common site for an undescended testis (cryptorchidism)?
Superficial inguinal pouch
76
What are the potential complications of cryptorchidism?
Infertility and malignancy
77
Which location of an intra-abdominal undescended testis carries the greatest risk of malignancy, specifically seminoma?
Intra-abdominal
78
What is the most common complication of TURP (Transurethral Resection of the Prostate)?
Retrograde ejaculation
79
What is the most common type of testicular tumor overall?
Seminoma
80
What is the most common type of testicular tumor in children?
Yolk sac tumor
81
Which marker is primarily used for monitoring testicular cancer?
LDH (Lactate Dehydrogenase)
82
What mnemonic can be used to remember LDH as a marker for testicular cancer?
Lance Armstrong mnemonic
83
What is considered an early marker of recurrence for testicular cancer?
hCG/AFP rising
84
What maneuver is used to differentiate between a testicular and a paratesticular mass?
Chevassu’s maneuver
85
What condition is described by the phrase 'bag of worms' that disappears when recumbent?
Varicocele
86
What diagnostic tool is recommended to establish a baseline for varicocele?
USG Doppler
87
What is the most common type of bladder cancer in developed countries, and where does it typically arise?
Urothelial (Transitional cell) carcinoma is the most common type in developed countries and arises from the lateral wall of the bladder.
88
What is the most common type of bladder cancer overall, and what is its classic presenting symptom?
Urothelial (Transitional cell) carcinoma is the most common type overall, and its classic presenting symptom is painless hematuria.
89
In which regions is squamous cell carcinoma of the bladder most common, and what is its typical prognosis?
Squamous cell carcinoma is most common in Schistosomiasis endemic regions and has a poor prognosis.
90
What conditions are associated with squamous cell carcinoma of the bladder?
Chronic stones, schistosomiasis, and chronic irritation are associated with squamous cell carcinoma of the bladder.
91
What is adenocarcinoma of the bladder associated with, and where does it typically occur?
Adenocarcinoma of the bladder is associated with urachal remnants and exstrophy, and it occurs rarely at the dome of the bladder.
92
What is the most common modifiable risk factor for bladder cancer?
Smoking is the most common modifiable risk factor for bladder cancer.
93
Name some other risk factors for bladder cancer besides smoking.
Other risk factors include exposure to textile dyes/aniline, cyclophosphamide, chronic stones, and schistosomiasis.
94
Besides painless hematuria, what other symptoms can present with bladder cancer?
Irritative voiding symptoms can also present with bladder cancer.
95
What is the most common site for bladder cancer to occur?
The lateral wall is the most common site for bladder cancer.
96
What is the gold standard investigation for diagnosing bladder cancer?
Cystoscopic biopsy is the gold standard investigation for diagnosing bladder cancer.
97
What imaging modality is used for staging bladder cancer, and what scoring system is associated with it?
MRI pelvis with VI-RADS is used for staging bladder cancer.
98
Are urine tumor markers commonly used for bladder cancer diagnosis?
Urine NMP22/Tumor markers are rarely used for bladder cancer diagnosis.
99
Describe the staging of bladder cancer: Ta.
Ta indicates non-invasive papillary bladder cancer.
100
Describe the staging of bladder cancer: T1.
T1 indicates submucosal invasion of bladder cancer.
101
Describe the staging of bladder cancer: T2.
T2 indicates muscle invasion by bladder cancer.
102
Describe the staging of bladder cancer: T3/T4.
T3/T4 indicates bladder cancer that has spread outside the bladder wall. T4 specifically involves invasion into adjacent organs like the prostate, vagina, or pelvic wall.
103
What is the management for superficial bladder tumors (Ta, T1)?
Transurethral resection of bladder tumor (TURBT).
104
What is the management for muscle-invasive bladder tumors (T2+)?
Radical cystectomy with ileal conduit.
105
What are the treatment options for non-invasive high-grade bladder cancer or carcinoma in situ?
Intravesical Bacillus Calmette-Guerin (BCG) or mitomycin C.
106
What is the most common type of bladder cancer histology?
Urothelial/transitional cell carcinoma.
107
What is the most common presentation of bladder cancer?
Painless hematuria.
108
What markers can be used to detect bladder cancer?
NMP22 and microscopy.
109
What is the most common location for bladder tumors?
Lateral wall.
110
What imaging modality is best for assessing muscle involvement in bladder cancer?
MRI pelvis.
111
What are common complications of bladder cancer?
Hydronephrosis, bladder contraction, and metastases (lung, bone, liver).
112
What is the most common type of penile cancer overall?
Squamous cell carcinoma.
113
What are risk factors for squamous cell carcinoma of the penis?
Elderly age, uncircumcised status, HPV infection, and smoking.
114
What are typical features of penile squamous cell carcinoma?
Slow growth, appearing as an ulcer or nodule, often on the shaft or sulcus. Phimosis can be a risk factor.
115
What is Bowen's disease?
Carcinoma in situ of the squamous cell type, appearing as a white plaque on the shaft of the penis. It is precancerous.
116
What is Erythroplasia of Queyrat?
Squamous cell carcinoma in situ located on the glans, presenting as a red, velvety lesion. It is precancerous.
117
What is phimosis?
A condition where the foreskin is too tight to be retracted over the glans. It predisposes to poor hygiene, infection, and cancer.
118
What is paraphimosis?
A condition where the retracted foreskin gets stuck behind the glans. It is painful, considered an emergency, and carries a risk of ischemia.
119
What is balanoposthitis?
Inflammation of the glans and prepuce, often infectious. It is associated with diabetes, poor hygiene, and old age.
120
What is the typical presentation of penile cancer?
Painless ulcer or growth that may bleed.
121
What are the most common sites for penile cancer?
Glans, prepuce, and coronal sulcus.
122
How is penile cancer staged?
Using the Jackson staging system, which describes the extent from the glans/prepuce to the shaft and scrotum.
123
What imaging modalities are used for penile cancer staging?
MRI of the pelvis and CT scan of the abdomen to assess lymph node status.
124
What is the typical pattern of spread for penile cancer?
It spreads first to the inguinal lymph nodes, then to the pelvic lymph nodes.
125
When should a biopsy be performed for suspected penile cancer?
Always before initiating treatment.
126
What are the management options for penile cancer in situ (Bowen's disease, Erythroplasia of Queyrat)?
Topical 5-FU, laser excision, or Mohs micrographic surgery.
127
How are small lesions of penile cancer typically managed?
Wide local excision and glanuloplasty.
128
What are the surgical options for invasive penile cancer?
Partial or total penectomy, and inguinal lymph node dissection if nodes are palpable.
129
What adjuvant therapies can be used for penile cancer?
Radiation therapy (RT) and chemotherapy (e.g., cisplatin, bleomycin, methotrexate).
130
What is hypospadias?
A congenital disorder characterized by a ventral urethral opening.
131
What are the subtypes of hypospadias?
Penile, scrotal, and perineal subtypes.
132
What is the most common location for hypospadias?
Glanular or coronal.
133
What is 'chordee' in the context of penile disorders?
Ventral penile curvature.
134
When is the optimal timing for surgical management of hypospadias?
Between 6-12 months of age, before toilet training.
135
What surgical procedures are used to manage hypospadias?
Orthoplasty and urethroplasty.
136
What is epispadias?
A congenital disorder characterized by a dorsal urethral opening.
137
Is epispadias more or less common than hypospadias?
Rarer.
138
What is the most common site for bladder cancer (UB Ca)?
Lateral wall.
139
What is the most common site for penile cancer?
Glans.
140
What are the most common precursors to penile cancer?
Erythroplasia of Queyrat and Bowen's disease.
141
What is the most common cause of painless hematuria in the elderly?
Bladder cancer (UB Ca).
142
What is the most common indication for a radical cystectomy?
Muscle invasion (T2/T3) of the bladder.
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