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Year 2 - Renal (DP) > Clinical (Week 3) > Flashcards

Clinical (Week 3) Flashcards

1
Q

What are the types of urethral incontinence?

A

Overflow
Urge
Stress
Mixed

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2
Q

What are the types of extraurethral incontinence?

A

Ectopic ureter

Fistula

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3
Q

A huge palpable bladder, often wet at night and renal impairment suggest what kind of incontinence?

A

Overflow

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4
Q

Frequency, urgency provoked by standing up/coughing/laughing and enuresis suggest what kind of incontinece?

A

Urge

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5
Q

What causes urge incontinence?

A

Detrusor overactivity:

- Contracting during inhibition of voiding

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6
Q

How can we diagnose urge incontinence?

A

Urodynamics

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7
Q

How can pelvic surgery or fractures result in urge incontinence?

A
  1. PNS nerves damaged
  2. Residual urine
  3. Infection
  4. Bladder irritation
  5. Overstimulation
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8
Q

What causes stress incontinence?

A

Increased intra-abdominal pressure without detrusor contraction

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9
Q

What causes stress incontinence?

A

Damage to the following during childbirth:

 - Pelvic floor
 - Urethral function
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10
Q

How does the bladder appear on abdominal exam in a patient with urinary retention?

A 
Painless
Palpable
Arises in pelvis
Cannot 'get below' it
Dull to percussion
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11
Q

How do we treat overflow incontinence?

A 
Assess renal function
Treat obstruction -> Catheterise
Rehabilitate bladder (Teach self-catheterisation)
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12
Q

What dietary advice in urge incontinence?

A

Caffeine

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13
Q

What medical therapy can be used to treat urge incontinence?

A 
Antimuscarinics:
     - Oxybutynin
     - Tolterodine
β3-adrenergics:
     - Mirabegran
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14
Q

What are some alternative treatments to treating urge incontinence? (Apart from medication)

A

Botox (unlicensed)
Neuromodulation
Enterocytoplasty

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15
Q

What lifestyle advice is given to assist in the treatment of stress incontinence?

A

Weight loss

Stop smoking

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16
Q

What is the first line treatment for stress incontinence?

A

Physiotherapy

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17
Q

What pharmacology treatment is available for stress incontinence?

A

Duloxetine (SSRI-5HT inhibitor)

Norepinephrin reuptake inhibitor

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18
Q

What surgery is available for stress incontinence?

A

Colposuspension

Minimally invasive ‘tape’ procedures

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19
Q

What can cause a vesico-vaginal fistula?

A

Prolonged obstructed labour

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20
Q

How do we define haematuria?

A

Presence of >=5 RBCs per high-field power
In 3/3 consecutive centrifuged samples
>=1 week apart

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21
Q

A patient with microscopic haematuria due to a lower urinary tract pathology are likely to have what symptoms?

A

Hesitancy
Frequency
Urgency
Dysuria

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22
Q

Symptomatic, microscopic haematuria from an upper urinary tract pathology usually presents with what symptom?

A

Renal colic

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23
Q

If there is profound haematuria what might you suspect?

A

Malignancy

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24
Q

How much blood much be present in 100ml of urine to be seen?

A

1ml

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25
Q

What are some non-pathological causes of red urine?

A

Menstruation

Food (Beetroot, blackberries, rhubarb)

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26
Q

How can myoglobin end up in the urine?

A

Rhabdomyolysis
McArdle syndrome
Bywaters/Crush syndrome

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27
Q

Which of the following drugs does not cause red urine:

  • Doxyrubicine
  • Furosemide
  • Chlorqine
  • Rifampicin
  • Nitrofurantoin
  • Senna
A

Furosemide

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28
Q

What toxins can cause red urine?

A

Lead

Mercury

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29
Q

What can cause brown urine?

A 
Urobillinogen:
     - Haemolysis
     - Icterus
     - Liver dysfunction
Porphyria
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30
Q

Patients over what age are at an increased risk of malignancy if they present with microscopic haematuria?

A

40 years

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31
Q

What past medical history might increase the risk of malignancy in a patient presenting with microscopic haematuria?

A

Urological disorder
Irritative voiding
UTI

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32
Q

Why is it important to drain a distended bladder slowly?

A

To prevent decompression haematuria

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33
Q

How do renal stones cause haematuria?

A

Scratch mucosa

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34
Q

What causes pneumaturia?

A

Connection between bowel and bladder

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35
Q

In regard to haematuria, what do the following indicate:

  • Fresh red blood
  • Dark blood with clots
  • Vermiform (wormlike) clots
A
  1. Active bleed
  2. Resolving bleed
  3. Kidney/UUT bleed -> Clot forms in ureter -> Frank pain
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36
Q

If blood is present in 1st voiding, where is the bleeding likely to be coming from?

A

Urethra

Prostate

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37
Q

Ingestion of Aristolochia increases the risk of what in what country?

A

Transitional cell cancer in China

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38
Q

Schistosomiasis is common in what country and what does it lead to an increased risk of?

A

Egypt

Squamous cell bladder cancer

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39
Q

When taking a history in a patient with haematuria, what cancer is a patient’s family history is very relevant?

A

Prostate

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40
Q

What can phenacetin abuse cause?

A

Renal epithelial cancer

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41
Q

What features of urinalysis may suggest a UTI?

A

Leukocytes
Protein
Nitrites
Blood

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42
Q

What is the definitive diagnostic method for UTI?

A

Urine culture (Send in Boricon container, must be received within 24 hours)

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43
Q

What is the gold standard investigation into haematuria (and renal problems)?

A

CT urogram (with IV contrast)

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44
Q

What is the first line investigation into haematuria in the case of trauma?

A

CT

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45
Q

How can we best view the bladder?

A

Cytoscopy/Urethrocytoscopy

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46
Q

What is acute urinary retention?

A

Anuria with increasing pain

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47
Q

What can precipitate BPH?

A 
Surgery/Anaesthesia
Catheterisation
Medications:
     - Sympathomimetics
     - Anticholinergics
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48
Q

If a patient has painful retention with

A

Alpha blocker before a trial without catheter:

 - Alfusozin
 - Tamsulosin
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49
Q

Which of the following is not associated with post-obstructive diuresis after chronic obstruction:

  • Uraemia
  • BPH
  • Oedema
  • CCF
  • Hypertension
A

BPH

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50
Q

What causes post-obstructive diuresis?

A 
Solute diuresis; Retained:
     - Urea
     - Na+
     - Water
Defect in kidney's concentrating ability
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51
Q

When should we suspect post-obstructive diuresis?

A

If urine output is >200ml/hr

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52
Q

How do we treat severe post-obstructive diuresis?

A

IV fluids

Na+ replacement

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53
Q

How long does a mild post-obstructive diuresis take to resolve on its own?

A

24-48 hours

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54
Q

What mediates the pain felt in ureteric colic?

A

Prostaglandins

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55
Q

How do we treat ureteric colic due to calculi?

A

NSAID +/- opiate

Tamsulosin for small stones expected to pass

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56
Q

What is the chance of a renal calculi passing if its diameter is

A

80%

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57
Q

When would we intervene in assisting the passage of a renal stone?

A

If not resolved in a month

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58
Q

Which of the following is not an indication for emergency treatment of a renal stone:

  • Pain unrelieved
  • Pyrexia
  • Persistent nausea/vomiting
  • Reduced urine output
  • High grade obstruction
A

Reduced urine output

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59
Q

What is the first line emergency treatment for a renal calculus?

A

Ureteric stent

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60
Q

If there is no infection, how could we treat a renal calculus?

A

Stone fragmentation or removal

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61
Q

When would we carry out a percutaneous nephrostomy in the treatment of a renal calculus?

A

If infected hydronephrosis

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62
Q

How do we induce clot retention in frank haematuria?

A

Use a 3-way irrigating haematuria catheter

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63
Q

What is the first line investigation for frank haematuria?

A

CT urogram

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64
Q

What is the second line investigation for frank haematuria?

A

Cytoscopy

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65
Q

A 16 year old boy presents with acute onset pain in his suprapubic area. He tells you it came on while he was playing rugby. He has vomited a number of times. On examination, the left testis appears high in the scrotum and there is absence of the cremasteric reflex

A

Spermatic cord torsion

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66
Q

What can obliterate landmarks in a scrotal/testicular examination?

A

Acute hydrocoele and oedema

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67
Q

What investigation can be useful for scrotum pathology?

A

Doppler USS

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68
Q

How can we resolve spermatic cord torsion?

A

2 or 3 point fixation with fine, non-absorbable sutures or removal of the necrotic testis

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69
Q

What is the most common anatomical precipitant of spermatic cord torsion?

A

Bell-Clapper deformity:

- Testis is inadequately affixed to the scrotum

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70
Q

A 18 year old boy presents with tenderness on the upper pole of his left testis. On examination, the testis is still mobile and the cremaster reflex is present. You notice a ‘blue dot’ sign

A

Torsion of testicular appendage

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71
Q

What are the common presenting symptoms of epididymitis?

A

Dysuria

Pyrexia

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72
Q

What can predispose to epididymitis?

A

UTI
Urethritis
Catheterisation

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73
Q

Which of the following is not present on investigation of a patient with epididymitis:

  • Present cremasteric reflex
  • Pyuria
  • Elevated testis
A

Elevated testis

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74
Q

On doppler USS of a patient with epididymitis, what would you expect to see?

A

Swollen epididymis

Increased blood flow

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75
Q

What is the appropriate management of epididymitis?

A

Analgesia
Ofloxacin:
- 400mg/day
- For 2 weeks

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76
Q

If we take a urine sample in a patient with epididymitis, what would we ask microbiology to do?

A

Culture

Chlamydia PCR

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77
Q

A patient presents with a mildly tender and itchy testis. On examination there is no fever and the testes are only very slightly tender.

A

Idiopathic Scrotal Oedema

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78
Q

What can precipitate paraphimosis?

A

Catheterisation

Cytoscopy

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79
Q

What is paraphimosis?

A

Painful swelling of foreskin distal to the phimatic ring

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80
Q

Which of these is not a recommended treatment for paraphimosis:

  • Iced glove
  • Granulated sugar for 1-2hours
  • Punctures in oedematous skin
  • Manual glans compression with distal foreskin traction
  • Dorsal slit
  • Emergency circumcision
A

Emergency circumcision:

Circumcision is often carried out after it resolves to prevent future episodes

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81
Q

What is priapism?

A

Prolonged erection (>4hrs)

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82
Q

True of false; priapism is most often associated with sexual arousal?

A

False

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83
Q

Which of the following is not a recognised cause of priapism:

  • Intracorporeal papaverine for ED (vasodilator)
  • Trauma
  • Paraphimosis
  • Sickle cell anaemia
  • Neurological conditions
  • Idiopathic
A

Paraphimosis

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84
Q

What causes ischaemic priapism and what is the pathophysiology?

A

Veno-occlusion or low-flow;

 - Vascular stasis
           - > Reduced venous outflow
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85
Q

How do the corpora cavernosum appear in ischaemic priapism?

A

Rigid and tender

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86
Q

What causes non-ischaemic priapism? How does this result in the condition?

A

Traumatic disruption of penile vasculature:

 - Unregulated blood entry/corpora filling
           - > ie. Arterial or high-flow priapism
87
Q

A fistula can also cause non-ischaemic priapism. What is the pathophysiology of this cause?

A

Fistula forms between cavernous artery and lacunar spaces:

- Blood bypasses normal helicine arteriolar bed

88
Q

In ischaemic priapism, how does aspirated blood from the corpus cavernosum appear?

A

Dark

Low oxygen/High carbon dioxide

89
Q

In non-ischaemic priapism, how does aspirated blood from the corpus cavernosum appear?

A

Normal

90
Q

Colour duplex USS can also be used to aid in the diagnosis of priapism; how will the flow appear in:

  1. The cavernosal arteries
  2. Non-ischaemic
A
  1. Minimal/Absent

2. Normal/High flow

91
Q

What is the initial management of ischaemic priapism?

A

Aspiration +/- saline irrigation

92
Q

What medical treatment can be given in ischaemic priapism?

A

α antagonist:

 - 100-200μg every 5-10mins
 - Max 1000μg
93
Q

When would surgical shunting be carried out in ischaemic priapism?

A

If in 2-3 days there is no response to intracavernosal therapy

94
Q

If response is very delayed in ischaemic priapism, what might have to occur?

A

Penile prosthesis

95
Q

What is Fournier’s Gangrene and what does it involved?

A

Necrotising fasciitis of male genitalia:

 - Skin
 - Urethra
 - Rectum
96
Q

Which of the following is not a risk factor for Fournier’s Gangrene:

  • DM
  • UTI
  • Local trauma
  • Periurethral extravasation
  • Perianal infection
A

UTI

97
Q

How does the scrotum appear in Fournier’s Gangrene?

A

Swollen

Crepitus on examination

98
Q

How do we confirm that there is gas present in Fournier’s Gangrene?

A

X-ray

USS

99
Q

How do we treat Fournier’s Gangrene?

A

Antibiotics

Debridement

100
Q

In what individuals is there an increased mortality in Fournier’s Gangrene?

A

Diabetics

Alcoholics

101
Q

What is Emphysema Pyelonephritis?

A

Acute necrotising fasciitis of:

 - Parenchyma
 - Perianal area
102
Q

What causes Emphysema Pyelonephritis?

A

Gas-forming uropathogens:

- Usually E. coli

103
Q

What patients usually get Emphysema Pyelonephritis?

A

Diabetics with ureteric obstructions

104
Q

What is often required in the treatment of Emphysema Pyelonephritis?

A

Nephrectomy

105
Q

What are the two most common causes of a perinephric abscess?

A

Rupture of acute cortical abscess into perinephric space
OR
Haematogenous spread

106
Q

True or false; almost all patients with a perinephric abscess present pyrexic?

A

False:

- 33% are apyrexial

107
Q

True or false; 50% of patients with a perinephric abscess have a flank mass on examination?

A

True

108
Q

On serum and urinary investigations, what would you expect?

A

High WCC
High serum creatinine
Pyuria

109
Q

What imaging modality is most useful in a suspected perinephric abscess?

A

CT

110
Q

How do we treat a perinephric abscess?

A

Antibiotics

Percutaneous/Surgical drainage

111
Q

On investigation there is a renal haematoma that is entirely subcapsular. There is no expansion and no parenchymal laceration. What class of renal trauma would this fall under?

A

1

112
Q

A kidney has a laceration >1cm in depth, but there is no collecting system rupture or extravasation. What class of renal trauma would this fall under?

A

3

113
Q

There is a laceration through the kidney’s cortex, medulla and collecting system. There is a contained haemorrhage. What class of renal trauma would this fall under?

A

4

114
Q

On investigation, the right kidney is shattered. There is evidence of hilum avulsion and a devascularised kidney. What class of renal trauma would this fall under?

A

5

115
Q

Which of the following is not an indication for imaging:

  • Frank haematuria in an adult
  • Frank/Occult haematuria in a child
  • Occult haematuria and shock (Systolic BP 5hrs
  • Penetrating injury with haematuria
A

Acute urinary retention >5hrs

116
Q

How do we investigate haematuria?

A

CT urogram

117
Q

After haematuria, what treatment do most patients receive?

A

Non-operative

118
Q

When would surgery be indicated as a treatment for haematuria?

A 
Persistent renal bleeding
Expanding perineal haematoma
Pulsatile perirenal haematoma
Urinary extravasation
Non-viable tissue
Incomplete staging
119
Q

What is a bladder injury most often due to?

A

Pelvic fracture

120
Q

What two symptoms suggest a bladder injury?

A

Suprapubic/Abdominal pain

Inability to void

121
Q

Which of the following is not a sign of a bladder injury:

  • Suprapubic tenderness
  • Overflow incontinence
  • Lower abdominal bruising
  • Guarding/Rigidity
  • Reduced bowel sounds
A

Overflow incontinence

122
Q

If blood was present as the external meatus or the catheter doesn’t pass easily?

A

Retrograde urethrogram

123
Q

What is the main imaging modality for investigating a bladder injury>

A

CT cystography

124
Q

Flame-shaped collection of contrast in the pelvis suggests what injury?

A

Extraperitoneal injury

125
Q

How do we treat a traumatic bladder injury?

A

Large bore catheter
Antibiotics
Repeat cystogram in 14 days

126
Q

A pubic rami fracture will damage what aspect of the urethra?

A

Posterior

127
Q

Where is the posterior urethra fixed?

A

Urogenital diaphragm and puboprostatic ligaments

128
Q

What is the most vulnerable part of the urethra to trauma?

A

Bulbomembranous junction

129
Q

Which of the following is not an examination feature of a urethral injury:

  • Blood at meatus
  • Inability to urinate (Palpably full bladder)
  • High riding prostate
  • Suprapubic pain
  • Butterfly perineal haematoma
A

Suprapubic pain

130
Q

How do we investigate urethral trauma?

A

Retrograde urethrogram

131
Q

How can a urethral injury be treated?

A

Suprapubic catheter

Delayed reconstruction after >=3 months

132
Q

What typically causes a penile fracture and what kind of injury is it?

A

Intercourse:

- Buckling injury -> Penis slips out and strikes pubis

133
Q

Which of the following is not a symptom of a penile fracture:

  • Cracking/Poping
  • Pain
  • Rapid detumescence
  • Discolouration
  • Swelling
  • Suprapubic bruising
  • Frank haematuria (20%)
A

Suprapubic bruising

134
Q

On USS investigation of a testicular injury, what must be assessed?

A

Integrity

Vascularity

135
Q

How is a penile fracture treated?

A

Prompt exploration and repair
Circumcision:
- Deglove penis
-> Expose all 3 compartments

136
Q

Early repair of a testicular injury can help improve what outcomes?

A

Improves testicular salvage
Reduces convalescence
Better preserves fertility an hormonal function

137
Q

What is the approximate weight of the prostate?

A

20g

138
Q

What is the inferior portion of the prostate called and what is it continuous with?

A

Apex

Continuous with striated sphincter

139
Q

What is the superior portion of the prostate called and what is it continuous with?

A

Base

Continuous with bladder neck

140
Q

What covers the prostatic urethra?

A

Transitional epithelium

141
Q

What is the verumontanum?

A

Landmark near the entrance of the seminal vesicles

142
Q

Where is the verumonatum?

A

Just distal to the urethral angulation

143
Q

What forms the ejaculatory ducts?

A

Union of seminal vesicles and each vas deferens

144
Q

Where do the ejaculatory ducts?

A

Drain to each side of the prostatic urethra

145
Q

Where is the transitional zone of the prostate?

A

Surrounding the prostatic urethra

146
Q

Where is the transitional zone of the prostate in relation to the verumonatum?

A

Proximal

147
Q

How much of the prostate does the transitional zone make up?

A

10%

148
Q

What percentage of prostate cancers arise in the transitional zone?

A

20%

149
Q

What shape is the central zone of the prostate and what does it surround?

A

Cone-shaped

Surrounding ejaculatory ducts

150
Q

How much of the prostate does the central zone make up?

A

20%

151
Q

What percentage of prostate cancers arise in the central zone?

A

1-5%

152
Q

Where does the peripheral zone of the prostate lie?

A

Posterolaterally

153
Q

How much of the prostate does the peripheral zone make up?

A

85-90%

154
Q

What percentage of prostate cancers arise in the peripheral zone? What type of cancers most commonly arise here?

A

70% of prostate adenocarcinomas

155
Q

What is the peak age for prostate cancers?

A

70-74 years old

156
Q

What regions have the highest incidence rates of prostate cancer?

A

Scandinavia

North America

157
Q

What region has the lowest incidence rate of prostate cancer?

A

Asia

158
Q

What race is has the highest incidence of prostate cancer?

A

Black men

159
Q

If a patient has one first degree relative who had prostate cancer, what is the risk increase?

A

2 times

160
Q

If a patient has one two degree relatives who had prostate cancer, what is the risk increase?

A

4 times

161
Q

Chromosomal mutations on what chromosomal arms can increase the risk of prostate cancer?

A

1q
8p
Xp

162
Q

What gene mutations can increase the risk of prostate cancer?

A

BRCA2

163
Q

Which of the following is not a typical presentation of prostate cancer:

  • Mostly asymptomatic
  • Suprapubic pain
  • Haematuria/Haematospermia
  • Bone pain
  • Weight loss
A

Suprapubic pain

164
Q

On PR exam of a prostate cancer, how will it feel?

A

Asymmetiric
Nodule
Fixed craggy mass

165
Q

What is PSA?

A

A glycoprotein (Kallikren-like Serine Protease) enzyme

166
Q

Where is PSA produced?

A

Secretory epithelium in prostate

167
Q

What is PSA involved in?

A

Liquefaction of semen

168
Q

In a normal individual, what levels should seminal and serum PSA be?

A

Seminal -> High

Serum -> Low

169
Q

What is the sensitivity and specificity of PSA for prostate cancer?

A

Sensitivity -> 90%

Specificity -> 40%

170
Q

Which of the following does not routinely raise PSA:

  • BPH
  • Prostatitis
  • Retention
  • Catheterisation
  • PR exam
A

PR exam

171
Q

What is the main indication for testing PSA?

A

Symptomatic patients

172
Q

WHat are indications for carrying out a trans-renal USS-guided prostate biopsy?

A

Men with abnormal:
- DRE
- PSA
Previous biopsies showing:
- rostatic Intraepithelial Neoplasia (PIN)
- Atypical Small Acinar Proliferation (ASAP)
Rising PSA

173
Q

How many biopsies are taken in a trans-renal USS-guided prostate biopsy?

A

5 from ech lobe (10 in total)

174
Q

What are some complications of a trans-renal USS-guided prostate biopsy?

A

Sepsis (0.5%)
Bleeding (0.5%)
Vasovagal fainting
Haematosperma/Haematuria for 2-3 weeks

175
Q

95% of prostate cancers are of this histological type?

A

Adenocarcinoma

176
Q

Put the following sites of prostatic cancer growth in order of which is invaded first to fifth:

  • Bladder base
  • Local extension
  • Seminal vesicle
  • Perineural invasion along ANS nerves
  • Urethra
A
  1. Local extension
  2. Urethra
  3. Bladder base
  4. Seminal vesicle
  5. Perineural invasion along ANS nerves
177
Q

What are the two most common sites for prostate cancer metastasize to?

A

Pelvic lymph nodes

Bones (sclerotic lesions)

178
Q

What is Gleason’s scoring?

A

Score based on microscopic architectual appearance of glands

179
Q

What is the initial Gleason score?

A

Less of basement membrane

180
Q

As the Gleason score increases, what happens microscopically?

A

Loss of structure

Replaced by disorganised cell growth

181
Q

How is the Gleason score calculated?

A

Two most abundant cell patterns assessed and added together:

- Score between 2 + 10

182
Q

A T3 prostate cancer extends through what?

A

Prostate capsule

183
Q

An organ-confined prostate tumour will have what TMN stage?

A

T1-2, N0, M0

184
Q

A locally advanced prostate tumour will have what TMN stage?

A

T3-4, N0, Mo

185
Q

A metastatic prostate tumour will have what TMN stage?

A

T1-4, N0-1, M1

186
Q

When would an organ-confined prostate cancer be treated?

A

If it worsens

187
Q

What radical surgery can cure an organ-confined prostate cancer?

A

Prostatectomy

188
Q

What are some side effects of prostatectomies?

A

Erectile dysfunction
Incontinence
Bladder neck stenosis

189
Q

What methods of radical radiotherapy can treat organ-confined prostate cancer?

A

External Beam Radiation Therapy (EBRT)

Brachytherapy

190
Q

What are some side effects of radical radiotherapy?

A

Irritative lower urinary tract symptoms

Haematuria

191
Q

What are the two mainstay treatments of locally advanced prostate cancer?

A

Radiotherapy and hormonal therapy

192
Q

When would watchful waiting be appropriate in a locally advanced prostate cancer?

A

If:

 - Asymptomatic
 - Well differentiated tumour
 - Life expectancy
193
Q

How can we carry out androgen deprivation in order to treat metastatic prostate cancer?

A 
Hormonal therapy:
     - LNRH analogues
     - Anti-androgens
Bilateral subcapsular orchidectomy
MAximum androgen blockade
194
Q

What non-steroidal oestrogen acts as an endocrine disruptor in metastatic prostate cancer?

A

Diethylstilbesterol

195
Q

How do LNRH agonists work?

A

Down-regulate LNRH receptors which causes suppression of LH/FSH/Testosterone secretion

196
Q

What happens initially on LNRH agonist therapy?

A

LNRH analogues initially increase LH/FSH secretion which increases testosterone production

197
Q

If a patient on LNRH agonist therapy has a flare up, what can 20% of patients suffer?

A

Catastrophic spinal cord compression

198
Q

How can we prevent an initial flare up of LNRH agonist therapy?

A

Anti-androgen cover:

 - 1 week before 1st dose
 - 2 weeks after 1st dose
199
Q

What are two examples of LNRH agonists?

A

Goserelin

Triptorelin

200
Q

Which of the following is not a side effect of LNRH agonists:

  • Reduced libido
  • Hot flushes
  • Weight gain
  • Gynaecomastia
  • Anaemia
  • Galactorrhoea
  • Osteoporosis
A

Galactorrhoea

201
Q

How do anti-androgens work?

A

Compete with testosterone and DHT:

 - On prostate cell nucleus
 - Promote apoptosis
 - Reduced CaP growth
202
Q

Give an example of a steroidal anti-androgen?

A

Cyproterone acetate

203
Q

What are some side effects of steroidal anti-androgens?

A

Reduced libido
Gynaecomastia
CVS toxicity
Hepatotoxicity

204
Q

Give some examples of non-steroidal anti-androgens?

A

Bicalutamide
Nilutamide
Flutamide

205
Q

What is the most common type of uroepithelial tumour?

A

Transitional cell

206
Q

What is the second most common type of uroepithelial tumour?

A

Squamous

207
Q

What is the most common type of transitional cell uroepithelial tumour?

A

Papillary (80%)

208
Q

True or false; 50% of non-papillary type uroepithelial tumours are malignant?

A

False - All are malignant

209
Q

How can transitional cell tumours appear?

A 
Single lesion:
     - Small and papillary
     - Bulky and sessile
Multiple discrete lesions
Diffuse, confluent lesions
210
Q

What do transitional cell tumours tend to be?

A

Multicentric

Bilateral

211
Q

What is the M:F ratio of urinary bladder cancer?

A

4:1

212
Q

What is the gold standard investigation for urinary bladder cancer and what sign appears?

A

CT urogram:

- Halo sign

213
Q

Put the following types of urinary bladder cancer in order of likelihood to calcify:

  • Squamous
  • Urachal
  • Transitional
A
  1. Transitional
  2. Squamous
  3. Urachal

Year 2 - Renal (DP) (15 decks)

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