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  • 4 Assay جراحة اسئلة السنوات السابقة Urology, Hernia د محمد المرقبي

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    4_Assay_جراحة_اسئلة_السنوات_السابقة_Urology,_Hernia_د_محمد_المرقبي

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    8 views23 pages

    4 Assay جراحة اسئلة السنوات السابقة Urology, Hernia د محمد المرقبي

    Uploaded by

    aalmurad05

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    of 23
    ABLud) Cs) gual) Aiud Aa) jal) bse] Hernia & Urology @ asi) what are classiftatian oF henia x ¢ Lassi Fication avceosding he clinical presentation i OReducit le hewea reduce itselF when the pactieat down or reduced by doctor O trredue ble henia + the Content Cann’ t vetan +o the abdeme, but thee is wo other Comp Licetion @obstracted hentai- Bowel is abstracted but in hernia has geod Blood Supply @ steamaplated hernia \- Blood supply and 4s cadet Lead to itchemiq @ inF Lammed hema- '-e9 Content inflammed ~e accte appendicitis 5 salpingitis. %& Classification accor ding te sites Qinguinal hema + indirect inguinelkeraia , xivect inguinal Femoral hernia Nernia B Epiqastric hernia ® Tacisional hernia 6 Unk\iealherata Opaca Umbii calheraia @ Lithe’s hernia @ Ruchdalek heraig © spegelian hernia @Wiatus hernia a2) what ave the managment oF abstracted Cotrangald) heraia ? # abstracted hemigt Boal icckstruction but bovd in hernia has goed Lload Supply # Strangulated hernia + Blood Supply oF 11% content 1S impared ~e Ischemia FTReatments- - Pre operative treatment i OResuscitation with adagqnate Frais CIV Fuad) @ Empty Stomach with NGT 8 Give. ankihistes © catheterization te monihe we immediate opertimy open ac , delivary cemtarh, ina'sion oF Neck » excision oF omentum, Ugatior the Sac and vepair oF posterior wall. ~ Cassue Viability Qs) what are the treatment oF inguinal hernia o Surgery treatment oF Choice t eheenistomy '> -€xciSion oF Sac abler reduction oF Content Nev nigvehaphy Im Pepa oF Postenorwaell oF Canal. by prelene iv tow layer Bassin vepair) or darning # Hernoplosyy + Mesh repair mean Use of prolene Mesh @ Qs) what ave the Cause oF Scvetal swelling © I Mydrocele 2- epididymaleyst 3- Spermatocele Y- pematacele 5. Turrour (Ben/gn /malignact) 6- Varicecele F- inguinal hernia 8 Testicular torsion g- epi ddyme orehibs Qss) what are the treatment oF tuvsion testis ? K History and examination» Gudlen onset sever pein -seollens moderate, Nery tender - Nausea and Vomiting -high riding comp aved - Cremas tric veF lex 1s abset to Combyatateral - Prehes Sign —e elevation oF tests doesn't relieve. pain - ho vizontal testis x Investigation -Dovplex U/e CBleood Flow) ~ Nuclear scan ~Urgent explovation ~Bilateral testicular Fixation (orchide pexd) toprevenk recurmat ~manval detorsion @ @s9) what ave the classification oF Undeserded testis or D/P oF empty scatem ? Q Retyactil testis + overach've oF cremestvic ve Flex @ ectopic tests + abnormal tests migrmtion below the extemal ving oFing ulead canal C peyinium + Femerat , base oF Penis.) 8 atephy | abseat @ Lncomplete descad 95% + testis may. be intaaldemnal oringuinal ov pre scvetal apwhat ave the Risk Factorand Ftolagy of Untesealed preted inkath testis ? - small recqastation - led birth weight = Teales -abnumel gubenaculum = Lees, He OG - Low Testeran Clow Androgen) - loo LK _ decrease intra able minok pressuce C gale chiagis 5 Prune belly Syrdvome) as what ove the long term complication oF Undes ended fests? ? c © cancer Wo Fold @ SubFe tility orinkectily @TRauma (Testicle torsion Se inguinah hernia, ® Qa)whatare the mencgmet oF Undeseded testis ? Full bistery and examnatin and investiga tion - Fall examination is required iF kets palpable , te i doctify Lecatton , assess For associated Congenital deFeet ~iF neither fests is palpable consider chimesomat analysis: and hormonal fecing CHigh LHL Low testesterone tm dicate anevehia) a Treatment s- Sholkle Peformed Lithin Let Year ~ Hormonal theapy CLHRHHCG) Stinwtate « ee Vecterone production CSurgen\ Consist oF inguinal exploration, mebilization DAEs oF Spermatic ar} . Location oF processus, Vaginalis aad: Securing teshis th Serotal wall Corekis pe xy) - Pepiescopy or epen Sgey : arduhate are the managment oF Necicoureteric veFlax (VUR)® ~ Sradel sreFlux , inte New dilated Urefer ~ gradelL b -veFlux ,into pelvis and calyces without Ulatetion -qrode I + ~ Milbte modembe dilatation oF Ureter vernal Pelvis and Calyces withminimal blunting oF Fotnices -grade IW” b moderate Ueteal Tertousity and Ulatation o¥ pelvis and calyces . gradeV y Guess dilatation oF the Ureter, peluis, and Galyces and Ureteal tor huosit ~Hisdecy sand exawinastion ~ Failure te the - UTT 5 dy sucia ~ Momiting and dachen ~Saprpebic orobdoninal paia ~ Fever _Uvinanalss , culture —p UTIL old fS - TSMSA Scan ae Tessas: ~ Cerect Secondary re Flux mast primay (Vuk) qade LTE —euill resilve spontansusly (esp) = grode at reselution 50% ~ obsservation and medical treatment ave wily recommended Cankbisht) - SF Pica indication For anbive Flax Sager: Gre) G- UTE despite prophylats Astibubics CReenk thoogh uTi) -VCUG, te liegnesis and grade. B- Now Complaince with mediak treatment @- qrade WL, Vespicially with Pye Lo Mephitis: Q- Failure «F venal growth , New Scar p07 deterioration aF renal Fanctan © ReFlax thet persist ingick spesist aFter pebety. veFlux associated with Cong. tnt tab aknowmality atthe oie eg Bladde- divertiada- Qa}whet are Signs and Symptons oF Benign prostatic Hypecplasia p #Samptoms © obshaction Symptoms vhishancy sincomplete bla deem emp ty doup le Voi dng , post Noiding drippling » Shaintag to Uninate, Q Tritative Symptoms & Urgency » Freguangy » Mae turia: by Examination vectal_efamn + Rubbery » Smosth » Symmetrical »mabile oY - Seprapubic blader dstension Symptom aSsessmtat by the international prostate symptome care, ~ 0-4 mild ~ &-19 moderate ~ Sever 26-35: Q what ave the iaves putin and treatnoat oF BPH A Laves fyetion » (Labractocy) Uninanaly sis = S.cveatinine ~Sesh Cerostate specific) ~ Teaging Antigen —U/S i» te TEAS Win) Prostate Volume , and bladder ant- vest dud Urine @wieteh Fat wtting » Geom oF) ,mild Synprom @ & Mekkeat Neg Dalpha Wocker y “Vamsulosin @ Sua lapka veluctase inkibiterss Finasteride. CbsizeoF gent) , O Hegieattheepyy — Trdietion O Re Factory Uvinary retension BRecavet UTE @ recurrent cracs haemnatucia OBtadde- stone AF, Lage diverhotar aTY Pe oF Suegecy QTRacs Urethead Ascetion oF prostate (Gold Standard) Q open Prostatectomy % toe Lage > 1009 rans © Minimal tnvesive thenpy @ Laser theapy - ® Hype thecanta-i- OTRenstethead Needle ablation oF prstate '- @ TRans Ue teat elects Vapociaahin oF prostate = Trans Uretheal incision oF prostate © High intensity Focused Us ie @ Inte Uretheral s teats e Neu Methal s- Pes tatic artey em bol:zation - 32) what are the risk Factor~ and pathology and . oe oF prostate cancer 9 wD DaFrican- American : @ oad age ® Family histor ®@ DiataG wet Fat, redmeat @ ene He: ~ adeno carcinoma BD%o oF Caces- ~ Major tumow— From peiphral Zene- amet a History and etaminecion and investigation *CIF ~€arly Stage Reymptenatic ~ obstructive Voi Sng Symptom 2 hi Stancy yintecni Ment Urinary steean hematuria pmag growth to bladder Neck and Uethea. w advanced i = edema oF Lowerertremifies = Spread to vegional L.N- ~ Pelvic and pejneal discamlart metastasis !- = most Commonly (Ene) 1 Pathologtcat HK, spinel cord Canapression + ~ Visceral metastasis Crare) Live, Pertonealsoms , Pleural O-Tigttal rectal exom shard. Fixed A symorety @- Prostate specibic Mwtigen @ Trans rectal u/ Ss hype echoicavea in pephral Zone @ proshete biobsy athe ~HB - RET ~ AK phes phatase CTScan- MRT * Grode Goleasen ) ~ rade T - well differentiation: - gre. deTD}. Moderate dif ferertiction «grade TIT » Poor— di FFerecha-Hon grade Wo. anaplastic x Stealing & =n Neon palpable prostate cancer» only palhslegy.Cbiobs4) - “Te {+ palpable tumoure , con Fined te prostate gland IT» extoasioa threagh prastatie capsule » seminal Vesicle TH J. Pavasion adjacent Stacters. Bla en Neck , vectum, pelvic Not Me regional. L.N Ma Nacmetceiats Nit to cegronat LN M1 & metastasis » (Bone ‘- Type Based ons grade, stage , Life expectancy vo Asynptemehec LE < loyear. and, Associated medi dibs - o watel es 3 @ Radical prrsttedtinys T1.Te, Ne Mo LiFeexpectiny Y loyea © 8 Bededea Segges nal). *K Hermon Theapy (tent) adiaction therapy (Brochyfleap3.- ne ae iFmetastic conce-— @cye Oey Ohish intensity @ QA) What are the managment oF Renaltrarma? . Staging oF Renal injucy + cTScan ~GradeT = contusion or Subcapeular haematoma . Mo Parenchy. ~mek Laceatin > Grade IE» 1eM decpparenchyral Laceaton oF Gorter, N@ exhavasahonr of Uvine ~GradeW s~ Parenchymal laceatian - invelving corten, Me lula ty Syste ov Venal artery ov renal Vera injure completely shattered Kidney eravulsion oF Renal and ¢ ~Hacmolgnamically Stable patient \- ~Hrs ty wer Nature oF trauma ( Blunt or penetrating) ~ Ta vestiqoctin —e Haewatuia ,»F Bow , RET KR Undieotion Fur renal imaging . @ Macescopic Kaematuria Oreneteating chest oc abdeminal child with miereseepie ha emachuta Veanma( Knives, bullet) a Rapid acceleration or deceleraton 9: Fall From akigh ® @ Mecsascopre hacmaberia with hypstensive patient (SBP Fe» Neo Hfo oF acceleration and or deceleatton Ctmayieg and albmiccion ts Not reguired) QMacascepic heemeturia: instable patient “Glscaw wlrTestvn: “TVEWOL, sobseeting Gens AUR, @ gredeMand grade require Nephrectomy ae Setgery_indicated s- © patriot develop shock » does wet vecpond te resuscitation @ decrease haweg lebin @® Urinary extravasation expanding pevireant haematoma © pulsatile perivenal haematoma @ exparding and Jor pulsatile periveral haematena suggests arerel pedicte @ Q34) what avethe Causes oF hematuria ~ 14h Nephropathy -GRM disease. ~ Hereditary wreghdtis Calport’s yndrome) Non- glomenlar “Up per tract \- x Lewer tract UrcLithiasis « cystitis ~ PYelewephritis ~ Benign prostatic typeplasic ~ Renal cancer ~ excersise Cmaathon) - ~TYansittonal cell Corinoma - Trst ramentetion ~ Us nay obstruction - Men sec - Benign hematuria ~ Benign hematuria, Qa What ave the Couses oF Renal masses 2 Benign malliqnoat QUEL pelvic Tonction obstruction @ head cull cavcinema @ obstructed mega Urete— @ wiles tumor QB Sever grate oF ReFlax B Sarcoma © Polycystic Kidney disease @ bymp hora @ Simple reralayst @7rese Gabscess © metastatic tumonrs @ Angio mel ipo @ QI what are the type of Renal etones and BrieF talk about Cammonst Aype ? x TIPe_ (composition oF Renal stoned Radio opequ RedioLucent @ ca oxalate Go%) @uric acid 8% @ co phosphate (20%) © xanthine vare othe~ Q@ Stravite (mg sAmmanium, ph) Silieates 9 indinavie @D cystine # Calcium oxabter FYIFD , Pabsoption Pintoke Sarcoidosis »Neoplasma , hy perthg roidisin y Rena Hypecelcinin ! Hypepare thy vei desn a immeb: lization —Thoa “PW KG acidic Urin woe Best media For cootalate stone aes: ; re Tusinay exse ~pietany Poxalat rich Food 4 p Calcium diet 2 Leg hyperraluia enterre hypecexaluria v Cancel by small bowel diverse ' i ter diarhen , of pantieatic nsaF Ficiney Wo Lead +e Fat ab serphin ‘Leading to conples with Calcium ——> Facili toting Fre | oxalat absorption bythe Colon Je Plenagmect 8F Nephretithiasts Medical therapy © Fluid intake oF 25-20L [doy Qlimst Sodium te Y-sahbey Govoid excess Calcium Supplement Lek animel protein © Limit oxalote-rich Food BS maintain wo rmal cpeciah medical theory © BMT ® gpecial medical therapy _ Limi oxalate and calcum in Food _ Pyridoxine ~> benloginons Praduction oF oxalate = pebassium Ckro¥eand Sodinm bicars onate Lb alkaline ph oF Urine eqiel ents? © Shock wove Lithotripsy (G wt) + G Retrograde intrarenal. Gu rgcey © Uvetrescopy orn] Lepentapt fakes, Satay @ a3?) what ave the Value oF Urine analysis oF Renal gtones® xUrinalysis Rpecihie gravity may indicate relative bh dation status «PAE acidic ph. aot ph: ca-oxalate ca- phosphate Qric Red: Struvite chene Cystine clone & Urine Microscepy RBC we Re , bacteria # Cry ctalucta i> Can deVine stone type me Hexagenal crystals © cystine - w> rhambsidel crystals + Uric Kad ms cof Fin Lid ey clale + Wipe phosphate * Urine Callore © 18 mandatory iF clruvite cones ove Saspected or (F S/S oF inkection is present we DY hour Urine catleckion 9a) what are the nisk Factor CactioLegy) of Urinary shee? gi diatacy Pacey LT calcium and Vit DS supplementation gcinkectian _ animal protein ixtak x metication _pwater intakes het weather Cony abonermedity wabesily xBM # Geegmphic Genetic ¥ othe Sarcoidosis Alsrcms5ing BS Sondre Hyperparadlyeidion 2 QaQ) what arethe clinical Feature oF Reval Systen Stones? O Asymphemactic Pain ts most Clinical Feature + @- stone pre duce Ureteral Symptom mp obetradkion the Flow of Urine distension oF Ure ten, calyceal System, vernal cepsule~ Pain @- Renak colic. Sable onset «F Seugr Flankpain Last Qe- 6 min) Paik is paroxysmal prestLless , Unable to get comFertable. ©- Location oF pain + « Ure tere pelvic Function ~o classic Flank pain = Mid weeter no Lower abdominal pain - Uveter Vesicl Junction ve cyroin or ve Ferred Nectes- Lilia majera pain ~ Urethea > pain and acute Urine retencion Q- Stone Located in vesical and Uretero Vesi cal qunction Dy suria Ucgeny + Frequanyy » shia ,omall lum Veided ©. UST ~e Nowsen . Vomiting. Fever, Hills —s inkeckion @\s) what are the Type oF Guagicl thempy For Nepbadith- -asis? Sucpicel Therapy > ® Sheck wove Lithstripsy (S wi) > — high enecgyForsed wave that Can travel in air and weten = Wove cax travel Safely through Skin and internal Wesue @ ~ Sone As adifFerent densi ty and when asheckK wave hit it and they shatter and Fragmented and Facilitating +o pass S portaneousl * Treatment depends on Stone size. Lecotion » cempesit on _ hardness and body habitus mits Tdeally all stones Less than Let in any Lo tation in the Kidney Canbe treated by Sol sn Coup ligsiten & Skin bruising 3 Pevinephaie hamecrhage , Sub capsular heam- atoma , Porcreatitis, Urasepsis an d (stein etracse] which+ accumulate in the Ureter and Cause obstruction Fegnansy, bleeding , ob shruction below level -F Stones ~ relative + cardiac pacemaker, anencySm a ealeiFed arteries OD Peredcteneons Negbrolithetomy » PONE ~Needl past to veratpelvis -dilatatimthe trad , Nepheescepy ~ Stone removal with grasp (29 or Frag mantetion Ucing electo. th ydranlic , Urasear o¢ Laser Lithotipsy by Nephroscepy . Nep dro story tube or Ureteral cteat is left For drainge —> Complication ‘> hemorrhage » perforation , extravasation damage to oman , Ueleal obchuction . in Fechian fro sepsis > Contraindedien’> Bleeding dia theeic 5 Urinary track iwhectin Obesity - splenoneqaly , inter position oF Colon © Retrograde inWarenal Qa ras © Urchrescepy re distal Ureter pe Ureterand intiayenal access ~ Tigi d and Flexble Uretrsscopy = Ur ‘troscopy _ Sake iw patient with mubid obesity, 2P feqnancy Bleeding disthesis toy Failure , mucosal abracion, PePoretian , shire oF U NENT oy False passage 2 Uretert avulsion © ops / Laprascept frabetic suqecy = SPpen Sergey nas been veduced rates(\-S%) Bie S.wl. Uretrscopy > Pent - Tniication | Fasture oF endoscopy . Complex Clones eave alenormaltty 4 Mon Functioning Ri Ave G4) what are the risk Factor~ and pathology and Managment oF Bladder Cancer . 9 + RE: ToitAge. median Rye 6S) 2 ae Bee Nes: =M>F Bil - Telbacte omeking = Occupational exapeswe’: Beazidine, Napthalamine ~ mutochonat WRAS. KRAS2 Fuléker, xeiar medio ib ae en RRQL.FGFR, CGenetis) macliune Scthers heirs Cayes) _ shighesoma Weemedebann , Stone A Wi topatheles sy Bip oF Basser cancer ate Vransitionct cell Carcine ma Grigone) - Soifo = Seqnames cell Coreinoma Anbey to Clateral wall SAgene are moe Commoels}) Hultiplesite Schastosoma Wecemetolsinwn 9¢ History = -paimLess 3Ye ec Hematacia, C&o-eh) ~o malign . dysania, yeency » Frequancy Cashcp) Pelvic or bene Pain, L-L aedema Ci Line Vessele) ancy Until preved othewised Compress eo - Flank Pon Frem We teal obstruchen Cadvanced) x E xaminohent- s Nothing SigniFicanth desing physical exeminedion > palpable mass - attention de GotenNagnak aie» prostate. Cleeaectensien) Pele ~ assesament of Pixalo. oF theRiadder tothe Soieunding x investigahon -— A) —Uyinanalyss «Ah wricrescopy fe detecthenaturia eoialectien Urine Cuiture te rleouk mFecton TE Saspeted + Voiding Usnocy cgtolegy i mesthelphal ie DaQre Ss tumours maybe missed ~ Urinaey Hamenr marker testing B) Timasing : «ETS can oF aladenen Spelvic with Contract -YIRT s$Renal WS = Titra Venons pyelegrephs IVP) Cy) Gysteseepy + (omieery Sue d For detect Bradder cancer se ae TRy. in sity Cacelnoma (lal Nevegional “Ty j~ United to Lamina prepa 1 : “The Muscle Sup ander) = —_—_ TTR L Beyond Bladder wall Cperivepica) issue

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