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Medicine, Year 3, Metabolic Medicine > Clinical Topic 3: Haematuria > Flashcards

Clinical Topic 3: Haematuria Flashcards

1
Q

What are the three zones of the Prostate called? Which is the largest zone?

A

Peripheral zone (largest)
Central zone
Transitional zone

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2
Q

Which zone of the prostate does Benign Prostatic Hyperplasia commonly affect?

A

Transitional zone

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3
Q

What is the most common type of Prostate cancer?

A

Adenocarcinoma (most common)

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4
Q

Mutations in what genes are associated with Prostate Adenocarcinoma?

A

BRCA1

BRCA2

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5
Q

Outine the how a Gleason score is produced?

A

Gleason is comprised of two scoring patterns which range from 1 to 5 each. These two scores are added together to make a score of 10

2 = Best prognosis
10 = Worst prognosis
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6
Q

A “boggy” prostate is associated with..?

A

Prostatitis

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7
Q

What are some risk factors associated with Prostate Cancer?

A

Old age, obesity, high fat and low fibre diet, family history, Afro-carribean ethnicity

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8
Q

Which circumstances may raise a PSA level and for how long?

A
  • Benign Prostatic Hyperplasia
  • Prostatitis (for at least 1 month)
  • Urinary Tract Infection (for at least 1 month)
  • Ejaculation (for at least 48 hours)
  • Vigorous exercise (for at least 48 hours)
  • Urinary retention
  • Trauma
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9
Q

According to NICE, what is a normal PSA level in patients aged 50-69?

A

< 3 ng/ml

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10
Q

What does active surveillance comprise of in patients with Prostate cancer?

A

10 core biopsies + 1 re-biopsy

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11
Q

Which zone of the prostate does Prostatic cancer commonly affect?

A

Peripheral zone

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12
Q

What is are two common complications of Prostatectomy?

A

Urinary incontinence

Erectile dysfunction

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13
Q

Prostate cancer commonly metastasises where?

A

Vetrabrae and pelvis

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14
Q

In what Prostate Cancer patients is the “watch and wait” more appropriate to do?

A

Elderly
Multiple co-moribidies
Low Gleason score

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15
Q

Why is hormonal therapy indicated in patients with Prostate cancer? What are the types of hormonal therapy?

A

Testosterone stimulates prostatic tissue, hence:

  • Bilateral orchiectomy
  • Goserelin (GnRH agonist)
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16
Q

What are the two types of Radiotherapy offered to patients with Prostate cancer?

A

External beam therapy

Brachytherapy

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17
Q

What tests can be performed to diagnose Prostate Cancer?

A
  • Digital Rectal Exam (DRE)
  • Prostate Specific Antigen (PSA)
  • Transrectal Ultrasound +/- Biopsy (TRUS)
  • MRI / CT scan
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18
Q

Renal Cell carcinomas typically form from what cells and where in the kidney?

A

Polygonal epithelial cells in the PCT

19
Q

What is the classic triad of symptoms associated with Renal Cell Carcinoma?

A

Flank pain
Palpable mass
Haematuria

20
Q

Renal Cell Carcinomas associated with Von Hippel Lindau disease are caused by what genetic mutation on what chromosome? What is the inheritance pattern?

A

VHL gene on 3p chromosome

Autosomal dominant

21
Q

Sporadic renal cell carcinomas commonly occur where in the kidneys?

A

Upper poles of kidney

22
Q

What are the treatment options for renal cell carcinoma?

A

If localised, total or partial nephrectomy
Medications such as Alpha interferon, IL-2, RTK inhibitors

RCCs are usually resistant to chemotherapy / radiotherapy

23
Q

What paraneoplastic syndromes are associated with Renal Cell Carcinoma?

A
  • Release of EPO -> polycythaemia
  • Release of Renin -> hypertension
  • Release of PTHrP -> hypercalcaemia -> ACTH -> cortisol -> Cushing’s
24
Q

If a renal cell carcinoma invades the left renal vein, what affect can this have? What this also happen if RCC invades the right renal vein?

A

Invasion of left renal vein prevents drainage to the left testicle, leading to a varicocele formation

Does not happen in right sided invasion, as the right testicular vein directly drains into the IVC, not causing varicocele formation

25
Q

What is the most likely common site of distant metastasis associated with renal cell carcinoma? Why?

A

Lungs due to renal vein draining into IVC

26
Q

What are the two main cancers which affect the bladder?

A

Transitional Cell Carcinoma (TCC)

Squamous Cell Carcinoma (SCC)

27
Q

What are the risk factors for Transitional Cell Carcinoma?

A

PEESAC

P - Phenacetin 
E - Ethanol (drinking alcohol)
E - Emptying (delayed emptying / stasis)
S - Smoking
A - Aniline dyes
C - Cyclophosphamide
28
Q

What are the risk factors for Squamous Cell Carcinoma of the Bladder?

A

Smoking

Schistosomiasis

29
Q

What is the first-line investigation for diagnosing Bladder Cancer?

A

Flexible Cystoscopy

30
Q

Following neobladder reconstruction, patients are at increased risk of which cancer?

A

Adenocarcinoma

31
Q

What is the treatment option for Bladder carcinoma in situ, and Invasive Bladder cancer?

A

BCIS - Transurethral resection

Invasive Cancer - Radical cystectomy

32
Q

What is the most common benign tumour in the kidneys? Where is it commonly found? Which condition is it commonly associated with

A

Angiomyolipoma, commonly affects the R kidney. Associated with tuberous schlerosis

33
Q

What is the most common malignant tumour in children? What are is the main symptom and what are other symptoms?

A

Wilm’s tumour

Abdominal mass* (main symptom)
Painless haematuria
Flank pain

34
Q

What two conditions are associated with Wilm’s tumour?

A

WAGR (Wilm’s, Aniridia, Genitourinary Malformation, Retardardtion)
Beckwith Weiderman syndrome

35
Q

What is the epidemiology of testicular cancer?

A

Most common malignancy in males aged 20-30

36
Q

95% of testicular cancers are what? What can this be further divided into?

A

Germ cell tumours:

  • Seminomas
  • Non-seminomas, i.e. Embryonal, Yolk, Teratoma, Choriocarcinoma
37
Q

What is the diagnostic test of choice for testicular cancers?

A

Ultrasound

38
Q

What are the risk factors of Testicular cancer?

A 
Infertility
Undescended testes
Family history
Kleinfelter's syndrome
Mumps Orchitis
39
Q

What is the general treatment for Testicular cancer?

A

Orchiectomy

Chemotherapy + Radiotherapy

40
Q

During the first stages of treatment, goserelin may cause a transient increase in symptoms of prostatic cancer, called the “flare effect”. What can be done to prevent this?

A

Pre-treatment with Flutamide

41
Q

What is the first and second-line treatment for BPH?

A

First-line: Alpha 1 antagonists

Second-line: 5-alpha reductase inhibitors

42
Q

What is the most common organism associated with Prostatitis?

A

E. coli

43
Q

In non-seminomas testicular tumours, what markers may be elevated?

A

Raised AFP

Raised hCG

Medicine, Year 3, Metabolic Medicine (9 decks)

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