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Phase 2a NEW > Genitourinal > Flashcards

Genitourinal Flashcards

1
Q

LUTS

A

Lower urinary tract symptoms

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2
Q

Why males have a stronger bladder neck mechanism than females

A

Strong bladder neck mechanism in order to prevent reflux of ejaculate into the bladder

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3
Q

LUTS - Types

A

Storage
Voiding
Post-micturition

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4
Q

LUTS - Storage

A

Frequency
Urgency
Nocturia
Incontinence

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5
Q

LUTS - Voiding

A 
Slow stream
Spitting/spraying
Intermittency
Hesitancy
Straining
Terminal dribble
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6
Q

LUTS - Post-micturition

A

Post-micturition dribble

Feeling of incomplete emptying

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7
Q

Bladder diary

A

For LUTS patients

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8
Q

Incontinence

A

Involuntary loss of urine - failure of storage
Urgency incontinence - urgent desire to void which is difficult to defer
Stress incontinence - coughing/straining
Mixed incontinence - stress and urgency
Continuous incontinence- fistula
Overflow incontinence - full bladder
Social incontinence - dementia

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9
Q

Urgency incontinence

A

OAB - Overactive bladder (urgency with frequency, with or without nocturia, wet or dry)

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10
Q

Urodynamics

A

Diagnostic - Detrusor overactivity on OAB

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11
Q

OAB - Management

A 
Behavioural - Frequency volume chart, caffeine, alcohol
Anti-muscarinics - M2/3 blockers
B3 agonists
Botox - Potent toxin
Surgery - cystoplasty
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12
Q

Stress incontinence

A

F>M
Females management - Pelvic floor physio, duloxetine, surgery (artificial sphincter)
Male management - Surgery (artificial sphincter)

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13
Q

Voiding problems - Obstructive

A

BPE - Treat with alpha blockers, phosphodiesterase 5 inhibitor (viagra), last resort is TURP (surgery)
Urethral stricture
Prolapse/mass

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14
Q

Voiding problems - Non-obstructive

A

Treat with catheter

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15
Q

Spastic spinal cord injury

A 
Supra-conal lesion
Lost coordination
lost completion of voiding
Reflex bladder contractions
Detrusor sphincter dyssynergia 
Diagnostic - urodynamics - raised pressures
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16
Q

Flaccid spinal cord injury

A 
Conus lesion
Lost bladder contraction
Lost guarding reflex 
Lost receptive relaxation 
Areflexic bladder
Stress incontinence
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17
Q

Neurogenic bladder - Management

A

Artificial sphincter

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18
Q

Autonomic dysreflexia

A 
Occurs lesions above T6
Overstimulation of sympathetic NS below level of lesion in response to a noxious stimulus 
Headache
Severe hptn
Flushing 
Management - Catheter drainage
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19
Q

Convene drainage

A

No indwelling catheter

Basically a condom connected to a bag which drains urine

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20
Q

Suprapubic catheter

A

Goes through abdo instead of urethra

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21
Q

Bladder problems in MS

A

OAB syndrome

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22
Q

Prostate cancer - Risks

A

Increasing age
Family history - 1st-degree relatives
Ethnicity - Afro-carib raised risk, uncommon in far east

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23
Q

Prostate cancer

A

Histology - majority are adenocarcinoma in peripheral zone

Gleason grading system is diagnostic following DRE

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24
Q

Routes of spread

A

Haematogenous - spread to bone, lung, lung, liber and kidneys
Lymphatics
Local tissues

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25
Q

Prostate cancer staging

A

T1-T4 (spread of tumour)
N1 (mets in regional lymph nodes)
M1a,b,c (non-regional lymph nodes, bones, others)

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26
Q

Cancer - General symptoms

A

Wt loss
Fatigue
Night sweats
Loss of appetite

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27
Q

Prostate cancer - symptoms

A

Wt loss
Fatigue
Urinary (Voiding and storage) - slow stream, poor stream, frequent, terminal dribbling
Bone pain (indicative of advanced prostate cancer)

28
Q

Prostate cancer - Examination

A

DRE - Nodule, asymmetry, the difference in texture, bogginess
Overdistended bladder

29
Q

Prostate cancer - Investigations - PSA

A

PSA (Prostate surface antigen)
Glycoprotein produced only by prostate cells which is specific to the prostate but not to prostate cancer
High sensitivity but low specificity
Elevated level suggests prostate cancer

30
Q

Prostate cancer - Investigations - MRI

A

MRI prostate
Prior to biopsy
Can identify lesions to target with biopsy
Aids in local staging

31
Q

Prostate cancer - Investigations - Biopsy

A

Indicated by a palpably suspicious DRE regardless of PSA
Suspicious lesion on MRI
TRUS or transperineal
Gleason grading on results of biopsy

32
Q

Prostate cancer - Investigations - Stagibg imaging

A 
Bone scan (bone mets)
CT abdo
Look for lymph nodes (obturator region) and mets
33
Q

Prostate cancer - Treatment

A

Active surveillance
Radical prostatectomy (curative surgery)
Radiotherapy
Complications of surgery/radio - Urinary incontinence
Hormone therapy - Orchiectomy (surgical removal of both testicles - the main source of testosterone) LHRH agonists - Goserelin, antiandrogens - Flutamide
Chemo - Docetaxel
Bisphosphonates

34
Q

Prostate cancer

A

Androgen sensitive

35
Q

Prostate cancer - Prognosis

A

Hormone resistance + mets = bad prognosis

36
Q

Renal cancer - RFs

A 
Smoking
Environment - petroleum
Occupational - Asbestos 
Hormonal - obesity 
Genetic - VHL, BHD
37
Q

Renal cancer - Presentation

A

Triad - Mass, haematuria, pain
Mets symptoms if present
Varicocele (rare)

38
Q

Renal cancer - Bosniak classification

A 
1-4
2F - Septation
4 - Malignant 
Simple renal cyst- US
Complex - CT
39
Q

Renal cancer - Spread

A 
Local
Nodal
Renal vein
Organs
(Local, regional, distant - Host organ, lymph, distant organ(s) )
40
Q

Renal cell cancer - Genetic causes

A

VHL - Chromosome 3 mutation
TSC
BHD

41
Q

Commonest renal cancer

A

Clear cell RCC

42
Q

Renal cancer - Treatment

A 
Surveillance
Radical nephrectomy 
Partial nephrectomy 
Radiofrequency ablation 
TKIs
43
Q

Bladder cancer - RFs

A 
M>F
Age increasing 
Occupation (industry) - dyes, rubber, aromatic amines 
Schistosomiasis endemic areas
Smoking
Long term catheterisation
44
Q

Bladder cancer - Presentation

A 
Painless haematuria (painless due to no stimulus for pain)
Flank pain
Lower limb oedema 
Pelvic mass
Wt loss
Bone pain
45
Q

Bladder cancer - Staging indications

A

T2 = muscle-invasive

46
Q

Bladder cancer - Histology

A

Transitional cell carcinoma

47
Q

Bladder cancer - Investigations

A

CT bladder

Cystoscopy

48
Q

Bladder cancer - Treatment

A 
TURBT
Chemo
Cystectomy 
Radio
Palliative
49
Q

Testicular cancer

A

Adolescence
One of the most curable cancers
RFs - HIV, genetics (1st deg rel)

50
Q

Testicular cancer - Pathology

A

Germ cell tumours divided into seminomatous and non-seminomatous

51
Q

Testicular cancer - Presentation

A

Scrotal lump
Painless
mets symptoms if present
CNS symptoms

52
Q

Testicular cancer - Differential diagnosis

A 
Hydrocele
Epidydimal cyst 
Varicocele 
Tetsicular torsion 
Indirect inguinal hernia
53
Q

Testicular cancer - Investigations

A

US testes
CT brain
Tumour markers (raised) - AFP, HCG, LDH

54
Q

Testicular cancer - Treatment

A

Radical inguinal orchidectomy
Radio
Chemo

55
Q

Stones locations

A

Anywhere from collecting duct to the external urethral meatus

56
Q

Idiopathic kidney stone - Causes

A

Dehydrated, so concentrated urine consisting of calcium, oxalate, urate, cystine
Infection
Calcium oxalate is most common stone

57
Q

Mechanism of stone formation

A

Stones form from crystals in supersaturated urine especially when it becomes static

58
Q

Stones - Prevention

A 
Overhydration
Low salt diet
Reduce BMI
Active lifestyle 
Normal dairy intake
Moderate protein intake
59
Q

Uric acid stones

A

Only form in acid urine

60
Q

Kidney stones - Symptoms

A 
Tend to be asymptomatic
Loin pain/kidney pain
Haematuria 
Urgency 
Frequency 
Recurrent UTIs
N/V
61
Q

Pain history

A 
SOCRATES
Site - Loin, unilateral
Onset - Rapid
Radiation - Loin to groin
etc
62
Q

Loin pain - Differential diagnosis

A

Ruptured AAA
Bowel path - diverticulitis, appendicitis
Gynae - ovarian cyst, ectopic preg
Testicular torsion

63
Q

Kidney stones - Investigation

A

KUBXR (Kidney, ureter, bladder XR)
NCCT-KUB (CT) = Gold standard
Hydronephrosis - inflammatory renal dilation on imaging
USS - For preg/younger patients

64
Q

Kidney stones - Management

A 
NSAID
Opiates
IV fluids
Surgical
Lithotripsy - shock wave breaks up stones
Ureteroscope - ureter stone
Endoscope - bladder stone
Laser
65
Q

Pyonephrosis

A

Combination of infection and obstruction
Basically hydronephrosis where water is replaced with pus
Systemic sepsis leads to septic shock
Treatment - Drainage (nephrostomy) - ureteric stents help dilate ureter

66
Q

Urosepsis - Consequences

A

20 digit gangrene

67
Q

Sepsis 6

A

ABCDE
Abx
Resus

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