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Thursday, April 25, 2013

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3- Urology
====== 


Place:
Lecture hall 4the dept itself is dept 17,,,u can go there (dept 17) to attend operations..they start each day from 9 am except Wednesday


Explanation & Attendance:
**Dr.ahmed el shanoufi gives most of the lectures and he is so amazing..so attend for him

Those who attend everyday will get a bonus( i think 2 extramarks in this endround exam)
Dr.shenoufi also gives sometimes bonus to those who participate frequently and answer some questions

((((Starting from 1/1/2013...The dr said those who never attend even one day may be banned from entering the exam,,so try to attend some days))))

Exam:
20 mcqs - 21 Qs(one is bonus)



An important advice:
Solve previous round exams...they r repeated a lot (COPY AND PASTE!)

21 Qs (one is bonus) in 14 subjects
These titles are for this special not for last year exam
1 Symptomatology
2 Investigations
3 4 Congenital (upper UT & lower UT)
5 6 Trauma (upper UT & lower UT)
7 8 Infections (upper UT & lower UT)
 9 Stones
10 Obstructive uropathy
11 12 13 14 Oncology (BPH - Cancer prostate - Bladder - Renal)
a question for each subject


  • Medad note:
http://www.medadteam.org/forum/index.php?showtopic=19404


some important points in the curriculum
thanks to Dr. Nahla Aly
Most important investigation in all the covered malignancies is CT EXCEPT :Prostate and the structure above it : BIOPSY
*Prostate: TRUS and BIOPSY
*UB : Cystoscopy and BIOPSY
*MOST IMP INVESTIGATION IN RENAL TRAUMA IS CT (Diagnostic and staging)
 *MOST IMP INVESTIGATION IN UB TRAUMA IS ASCENDING CYSTOURETHROGRAPHY
 *Renal operations covered are usually through a posterior incision EXCEPT RENAL TRAUMA : MIDLINE INCISION TO FIND RENAL VESSELS AND LIGATE THEM ASAP
IVP is NOT mainly used to detect function of the kidney ..
 MORE IMPORTANT IN DETECTING FUNCTION OF KIDNEY IS : RENOGRAPHY = RADIOACTIVE ISOTOPE SCANNING

  • MAIN line of TTT of BPH if uncomplicated is ALPHA 1 BLOCKER EVEN IF GLAND IS VERY LARGE .. 5 alpha reductase inhibitors are only ADJUVANTS if gland is huge
     CALCULAR ANURIA = REMOVE OBSTRUCTION 1ST
     Blood Vessels :
    - Common iliac artery is the artery that narrows a portion of the ureter >> common site for stones
    - Inferior mesentric is the artery that prevents ascent of horse shoe kidney
    Most Common Cause for UTI is E Coli
    Most Common Cause for urethritis is gonnorhea
    Anuria = < 200 ml
    Most Common Cause for renal injury = blunt trauma
    Most Common Cause for urethral injury is iatrogenic




    uro exam 1st round

    1- urgency means
    a- sudden sever desire of micturation with escape of urine
    b- escape of urine due to physical stress
    c- escape of urine due to defective urethral sphincters
    d- all of the above
    e- non of the above
    answer e

    2- the best investigation of renal fun is ==> radiograme (radio isotope scan )
    3- the most commoncause of uti is ==> e coli
    4- ttt of localized prostatic cancer>>>radiotherapy
    5- prostatic carcinoma>>>adinocarcinoma
    6- ttt of chronic retention due to bph>>>>turp
    7- bilharzia>>>common affect lower ureter
    8- (choose incorrect)blaaaaaaaaaaaaa blaaaaaaaaaaaaaablaaaaaaaaaaaaaachemotheapy and radiotherapy don't improve prognosis(the answer)
    9- post uretheral valve diagnosed by micturating cystouretherography
    10- horse shoe kidney ....renal pelvis lies anteriorly
    10 - renal injury (choose the wrong )mostly treated by surgery
    11- rupture urethera ....make catheterization (incorect answer)
    12- cancer bladder invading muscle is treated by radical cystectomy

    13- bladder injury
    a- intra or extra peritoneal
    b- due to fracure pelvis
    c- ascending cystourethrography is the best invest
    d- all of the above
    answer d

    14- the most effective invest in cancer bladder is ==> cystoscopy and biobsy
    15- ESWL best done in.....radioopaque stone less than 2cm
    16- stones a most common type is
    a- uric acid
    b-mostly radiolucent
    c-always symptomatic
    d all of the above
    e non of the above
    answer e

    17- renal cell carcinoma
    a-metastasis is treated by immunotherapy
    b-CT is best inv
    c-it is adenocarcinoma
    d- all of above
    answer is d


    Another exam (also same exam of the Group of 31 Dec 2012) :



    NB:
    1- the exam is easy enshalla and the questions are repeated a lot..but some with small obvious modifications
    2- concentrate on : Investigations of choice in each subject ............main method of management in subjects (like BPH and cancers and their rate of invasion)
    3- students will be divided into 2 groups ..one enters before the other to take the exame...then the Dr corrects the papers at the same time and gives students their makrs ( and the bonuses if they have).




    1) Horse-shoe kidney:
    A. Ascent is arrested by inferior mesentric a.
    B. Renal pelvis lies anteriorly.
    C. Resection is rarely indicated.
    D. All of the above.
    E. Non of the above.

    D

    2) Urgency:
    A. Sudden strong desire of micturation with escape of urine.
    B. Loss of internal sphincteric control.
    C. Escape of urine with physical straining.
    D. All of the above.
    E. Non of the above.

    E
    there are 2 types of urgeny
    with or without continence
    urgency alone as in question means urgency without incontinence

    3) Posterior urethral valve:
    - Best diagnosed by Micturating Cystourethrogram (MCU).

    4) Patient with post-traumatic pelvic fracture, investigation of choice to detect urethral integrity:
    - Ascending urethrography.

    5) Renal trauma, conservative treatment:
    A. Pedicle injury.
    B. Penetrating trauma.
    C. Lacration > 2 cm not reaching the pelvicalcyeal system (Grade III).
    D. Persitent bleeding.

    C

    6) Urinary stones:
    A. Ca oxalate is the commonest stone.
    B. Radiolucent stones are more common.
    C. Always symptomatic.
    D. All of the above.
    E. Non of the above.

    A

    7) Stone in the lower ureter may be treated by:
    A. Medical ttt.
    B. Ureteroscopy.
    C. Open surgery.
    D. All of the above.
    E. Non of the above.

    D


    8) Ideal stone to be treated by Extra-corporeal stone lithtripsy ESWL:
    - Radio-opaque renal stone < 2 cm.

    9) Regarding bilharziasis, which of the following is false:
    A. Commonly occurs in the upper ureter.
    B. May present with terminal hematuria.
    C. Mainly caused by schistosoma hematobium.
    D. Treatment includes anti-bilharzial drugs.

    A

    10) Commonest organism to cause UTI is:
    - E. Coli.


    11) Regarding BPH:
    A. Age of presentation is in the 40s.
    B. There is a corrolation between size of the prostate & frequency of symptoms.
    C. Present by frequency, nocturia, hesitancy & weak stream.

    C

    12) Patient with BPH and chronic retention is best treated by:
    A. Alpha blockers.
    B. TRUP or open surgery.

    B
    Chronic retention is a complication & operation should be performed before the bleddaer muscle losses its function

    13) Advanced prostatic carcinoma may be treated by:
    A. Simple prostatectomy.
    B. Radical prostatectomy.
    C. Bilateral orchiectomy.
    D. Brachytherapy.
    E. Intravesical BCG.

    C

    14) Regarding cancer prostate:
    A. DRE shows that prostate is hard nodular assymtrical.
    B. PSA is the best tumour marker for diagnosis & F/U.
    C. Bone metastases are osteoblastic.
    D. All of the above.
    E. Non of the above.

    D

    15) Calcular anuria:
    A. Urine output is < 200 cc/d.
    B. Bladder is usually empty.
    C. Drainage of the obstructed kidney is very important.
    D. All of the above.
    E. Non of the above.
    D

    16) Most important investigation for bladder carcinoma is:
    - Cystoscopy & biopsy.

    17) ttt of muscle invading cancer bladder includes:
    - Radical cystectomy & urinary diversion.

    18) About renal cell carcinoma RCC:
    A. Always occur in the upper pole of the kidney.
    B. Hematuria, pain & mass are common presentations.
    C. Best treated by simple nephrectomy.
    B

    19) About Wilm's tumour all are true except:
    A. Accounts for 10% of childhood malignancies.
    B. Age of presentation is < 7 years.
    C. Commonly present with an abdominal mass.
    D. Radical nephrectomy is the treatment of choice.
    E. Radiotherapy & chemotherapy do not improve the condition.

    E

    20) Best radiological investegation for renal function is:
    - Renogram.

    21) Bladder injury:
    A. Commonly due to pelvic fracture.
    B. May be intra or extraperitoneal.
    C. Investegation of choice is ascending urethrogram.
    D. All of the above.
    E. Non of the above.

    D


    ......
    1. MCQs for many doctors
    http://www.mediafire.com/?a95vsrp7uk9bi

    • some questions in the last 2 pages
    http://www.4shared.com/file/145451795/5ac6664e/urology2.html

    • Dr shanufi revisionthis one from 2011 
    http://www.4shared.com/audio/eHKK9Ghh/uro1.html
    http://www.4shared.com/audio/6muBOm1b/uro2.html

    Another recording
    http://www.mediafire.com/?nncolnlt04f00op

    recording for the a revision - for the group before the last one this year
    http://www.mediafire.com/?443443634m72f46
    http://www.mediafire.com/?hdgbiccoisssmu0


    NB ( source ) :
    medad note is more than enough for this exam

    but u can also study the whole chapter from the source u like
    ( dept..shayeb..haseeb..matary) to feel relieved before the final exam

    BUT

    u have to see medad note and study(or read well) from it for this special..bcs it the summary of what the dr says..which is sometimes arranged in a different manner than the book with some extra points 



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