Urology

TCC of bladder napthylamine (from dyes) or rubber/smoking

Squamous cell ca is due to chronic bladder calculi.

Testicular Ca: Primary / Secondary.

Primary GCT / Non- GCT

GCT non-seminomatous (non-germinomatous) or Seminomatous/Germinomatous

- Germ/Sem: 40%, more common, grows slower, 30-40yo (pure sems have NO AFP), spread via
paraaortic LNs.
- Nongerminomatous: Less common, Grow faster, younger ~25, lower 5 YSR, not sensitive to radiation,
sen to platinum-based chemotherapy regimens. Teratomas (aggressive, spread by haem and
sometimes LN) (AFP and BHCG) AFP (yolk sac), b HCG (choriocarcinoma), LDH NSGCT
- Testicular ca may have elevated GGT - ?significance
- Resection: inguinal approach to control vessels and Vas.

Calculi: radioopaque vs radiolucent:

- Lucent 1) uric acid (gout)/xanthine/indinavir (HIV)
- Opaque 1) struvite: staghorn calculi: struvite (proteus/ammonia splitting organism) 2) calcium oxalate:
chocolate/peanuts/loop diuretics/CAI

Testosterone is produced by Leydig cells (interstitial cells)

Ca of prostate arises at peripheral palpable but few symptoms. >50yo 50% of men have malignant
change. >90yo 90% of men

PCT reabsorbs ca and phosphate under influence of PTH

JG apparatus secretes rennin and is at MD of DCT

Calcitriol (1,25 OH Ca) promotes Ca and Phosphate absorption from gut and kidney

Sertoli cells form the bloodballsbarrier

Male urethra narrow at orifice, bladder neck, proximal to navicular fossa. Prostatic urethra widest.

Ureter narrow at pelvic junction, SIJ, crossing over of _ and entry into bladder.
Cardiology

Cardiac action potential:

Digoxin works in AF/AF by slowing down the conduction in the AV node and increasing its refractory
period, digoxin can reduce the ventricular rate. The arrhythmia itself is not affected, but the pumping
function of the heart improves owing to improved filling.

Exact MOA of digoxin: Binds to Na-K ATPase, prevents throwing out of Na, (causes build up of Na in
myocytes causes a narrowing of gradient between EC Na and IC Na causes reduced activity at
the Na-Ca exchanger (which needs a steep Na gradient to throw Ca out) IC Ca accumulates

Digoxin works by increasing Ca intracellularly to increase cardiac contractility in refractory heart failure
(despite ACEI and diuretics)
Pulmonology

Lung cancer benzopyrene (paint/printing), arsenic (TCM/mining), nickel, asbestos

SCLC: SIADH/ACTH (arises from AUPD, amine uptake and peptide secretion) cells.)

NSLC: SqCLC, Adenocarcinoma, Largecell undifferentiated.

SqCLC: PTH secretion

Lung compliance is the reciprocal of elastance. Fluid lining the alveoli (discounting surfactant) tends to
cause alveoli to collapse due to surface tension. Surfactant reduces surface tension prevents
collapse.

Lights in alt units: <3g/100ml, LDH<200iu/L, WCC<1000/ml, glc <3mmol/L

Lung cancer T1: less than 3cm, T2 : within a lobar bronchus but >2cm from carina or >2cm from pleura.
1cm LN <7% malignant filtration. 1-2cm 40-60%, >2cm

Miscellaneous

Absorbable suture
catgut
pds - vessels ((Polydioxanone))
monocryl - white/purpl
vicryl - purple
synthetics polyglycolic acid (Biovek), polylactic acid, p, and caprolactone.

Non-absorbable sutures
silk
nylon
prolene ((Polypropylene))
steel

Wound healing: Pltlets(clotting) neutrophils macs Fibroblasts / myofibroblasts endothelial

Immediate
5days
Clean eg CTVS, non bowel surgery
Clean contaminated inflammation no spillage
Contaminated - spillage
Dirty pus
Staph: GRAM POSITIVE. Divided into coagulase positive vs negative:

1-3days

Six positive: S. aureus, S. delphini, S. hyicus, S. intermedius, S. lutrae,S. pseudintermedius and S.

schleiferi subsp. coagulans.
Negative: Staph epidermidis:
Strept bovis infective endocarditis search for colon cancer with prophylactic colonoscopy
Hypertriglyceridemia is due to deficiency of lipoprotein lipase (hydrolyses lipids in VLDL and
chylomicrons) Insulin enhances LPL synthesis
Hagen Poiseuille law = flow rate is the fourth power of radius
Venturi
Pressure head
Laplace law
Parkland formula for burns fluid replacement:crystalloids 2-4ml/kg/%burn in 24hr, in first 8h and in
next16h
Mount Vernon formula: colloids 444,66,12

Fibrothecoma (secretes estrogen) and is a/w endometrial hyperplasia. An associate R hydrothorax =

Meigs syndrome
Balanitis inflammation of glans penis (a/w DM). Balanoposthitis Foreskin AND glans penis
Spermatocele appears at upper pole of testes, adj to epididymis