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Phase2 > Genitourinary > Flashcards

Genitourinary Flashcards

1
Q

KIDNEY CANCER

What Type accounts for 90% of cases?

A

Renal cell carcinoma

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2
Q

KIDNEY CANCER

Where does renal cell carcinoma arise from?

A

Proximal renal tubular epithelium

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3
Q

KIDNEY CANCER

Aetiology?

A

Loss in 3p chromosome tumour suppressor gene which causes increased expression of epidermal growth factors

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4
Q

KIDNEY CANCER

Risk factors

A

Smoking
Drinking
Long term dialysis

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5
Q

KIDNEY CANCER

Symptoms?

A

1) Haematuria
2) Loin pain
3) Abdo pain
4) weight loss
5) anorexia

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6
Q

KIDNEY CANCER

Diagnostic tests?

A
  • incidental ultrasound- 25% will have mets

-10% have classic symptoms

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7
Q

KIDNEY CANCER

How can it spread?

A

It can spread directly through the renal vein or haematogenously via the blood

Direct- Varicocele

Blood- bone, liver, lung

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8
Q

KIDNEY CANCER

Investigations?

A
  • ultrasound
  • CT of chest and abdomen to find mets
  • IV contrast CT to check individual renal function
  • high blood pressure
  • FBC- polycythaemia due to EPO secretion
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9
Q

KIDNEY CANCER

Treatment?

A
  • radical or partial nephrectomy
  • Angiogenesis- targeting agents for unresectable tumours/ mets

(Tyrosine kinase inhibitors- Sunitinib and sorafenib if mets)

chemo or radio resistant

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10
Q

KIDNEY CANCER

Prognosis score?

A
  • stage
  • size
  • grade
  • necrosis
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11
Q

BLADDER CANCER

What type accounts for 90% of cases?

A

Transitional cell carcinoma

There is also squamous cell carcinoma

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12
Q

BLADDER CANCER

What is the cause?

A

Schistosomiasis (snail fever- parasitic flatworms called schistosomes)

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13
Q

BLADDER CANCER

Risk factors?

A
  • smoking
  • alcohol
  • schistosomiasis
  • aromatic amines from the rubber industry
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14
Q

BLADDER CANCER

How is it graded?

A

Grade 1 = differentiated
Grade 2 = intermediate
Grade 3 = poorly differentiated

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15
Q

BLADDER CANCER

Common spreads?

A

Blood- lung, livers

Lymph- iliac & para-aortic nodes

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16
Q

BLADDER CANCER

Symptoms?

A

Painless and haematuria

Recurrent UTIs

Irritable voiding

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17
Q

BLADDER CANCER

Diagnostic Tests?

A

Urine analysis- ‘MC&S and cytology

Cystoscopy with biopsy

CT urogram for staging

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18
Q

BLADDER CANCER

Risk groups\?

A

1) >45 with unexplained visible haematuria
2) >60 with unexplained non visible haematuria
3) Visible haematuria that persists after a UTI

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19
Q

BLADDER CANCER

Staging?

A

Tis- carcinoma in situ
Ta- just epithelium
T1- lamina propria
T2- superficial muscle involved
T3- deep muscle involved
T4- invasion beyond bladder

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20
Q

BLADDER CANCER

Treatment of Tis/ Ta/ T1 tumours?

A

1) Transurethral resection of bladder tumour (TURBT)

2) Diathermy

3) Chemo for multiple small tumours

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21
Q

BLADDER CANCER

Treatment for T2/ T3 tumours?

A

1) Radical cystectomy or radiotherapy as this preserves the bladder

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22
Q

BLADDER CANCER

treatment for T4 tumour?

A

palliative chemo/ radio + chronic catheter

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23
Q

ACUTE KIDNEY INJURY

Diagnostic criteria/ what is it?

A

1) Rise in creatinine >26 umol/ L in 48 hrs

2) rise in creatinine >1.5x baseline

3) Urine outpyut <0.5ml/kg/hr for 6 hours

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24
Q

ACUTE KIDNEY INJURY

If there is reduced excretion, what rises?

A

urea

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25
Q

ACUTE KIDNEY INJURY

Risk Factors?

A
  • Age >75
  • CKD
  • HF
  • Peripheral Vascular Disease
  • Sepsis
  • Dehydration
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26
Q

ACUTE KIDNEY INJURY

Tests?

A
  • Urgent ABG (K+)
  • Urine dipstick
  • Bloods- U&E, creatinine, CRP
  • ECG
  • CXR
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27
Q

ACUTE KIDNEY INJURY

Aetiology of Pre-Renal? (70%)

A
  • Hypotension of any cause
  • SEPSIS/ hypovolaemia
  • ACE inhibitors
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28
Q

ACUTE KIDNEY INJURY

Aetiology of Intrinsic Renal? (20%)

A
  • Acute tubular necrosis
  • result of pre-renal damage such as nephrotoxins
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29
Q

ACUTE KIDNEY INJURY

Aetiology of Glomerular?

A

Primary golmeruolnephritis

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30
Q

ACUTE KIDNEY INJURY

Aetiology of Post-Renal?

A
  • Obstruction (stones, clots, tumours, BPH)
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31
Q

ACUTE KIDNEY INJURY

What happens if it is left untreated?

A

Acute tubular necrosis

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32
Q

ACUTE KIDNEY INJURY

How is pre-renal damage suggested and investigated?

A

Suggested by hypotension/ history

Ix- fluid assessments and treated with IV fluids/ resus

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33
Q

ACUTE KIDNEY INJURY

How is Intrinsic Renal suggested, investigated and treated?

A

suggested by: Causative drugs/ haematuria. proteinuria on dipstick

Ix- dipstick / renal screen / biopsies

Treat= Early referral

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34
Q

ACUTE KIDNEY INJURY

Investigation and treatment of Post-Renal?

A

Ix= USS and CT of ureter kidney and bladder (CTKUB)

catheterise and refer to urology to treat obstruction

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35
Q

ACUTE KIDNEY INJURY

Complications?

A

1) Hyperkalaemia
2) Acute pulmonary oedema
3) ECG- tall T waves, wide QRS, absent P waves

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36
Q

ACUTE KIDNEY INJURY

How is acute pulmonary oedema treated?

A

high flow O2 + furosemide + Diamorphine + GTN

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37
Q

ACUTE KIDNEY INJURY

How is hyperkalaemia treated?

A

Calcium gluconate / insulin/glucose and salbutamol

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38
Q

ACUTE KIDNEY INJURY

What is the treatment if the injury is very severe?

A

haemodialysis / haemofiltration

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39
Q

CHRONIC KIDNEY DISEASE

Definition?

A

Impaired renal function for >3 months, based on abnormal structure or function of the kidney,

OR GFR <60ml/min/1.73m2 with or without kidney damage

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40
Q

CHRONIC KIDNEY DISEASE

What is evidence of other renal damage?

A

1) haematuria
2) proteinuria
3) evidence of systemic disease

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41
Q

CHRONIC KIDNEY DISEASE

Cause?

A

1) DM
2) HTN
3) Glomerulonephritis
4) Pyelonephritis
5) 20% unknown

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42
Q

CHRONIC KIDNEY DISEASE

Which groups are screened for CKD? (checking eGFR)

A

1) HTN
2) DM
3) Systemic diseases that affect kidney
4) CVS disease
5) Structural renal damage

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43
Q

CHRONIC KIDNEY DISEASE

Signs and Symptoms?

A

Anaemia = reduced EPO
CNS = fits and coma
PNS = polyneuropathy
CVS = HF, HTN , PVD, Pericarditis
Renal = polyuria, nocturia, oedema

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44
Q

CHRONIC KIDNEY DISEASE

Possible affects on bone?

A

1)renal phosphate retention

2) Impaired vit-D production

3) Bone pain/ osteodystrophy/ osteomalacia

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45
Q

CHRONIC KIDNEY DISEASE

Tests?

A

Bloods- Hb, FBC, Glucose (DM), U+E, Calcium, PTH

Urine- dipstick, albumin : creatine ratio, MC&S

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46
Q

CHRONIC KIDNEY DISEASE

What are the 5 different stages?

A

GFR SCORES (ml/min/1.73m2)
1- >90

then go down in 15s e.g 2=60+ 3a=45+ 3b= 30+

5- <15 = established renal failure (over 3 months)

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47
Q

CHRONIC KIDNEY DISEASE

treatment?

(lifestyle control)
(oedema)
(acidosis)
(anaemia)
(CVS)
(osteodystrophy)

A

1) Smoking and glycaemic control, BP with ACE-I, CCB, ARB
6) Osteodystrophy and PTH levels - give vit D and calcium

5) CVS- statins and aspirin
4) Anaemia - Iron
2) Oedema - diuretics
3) Acidosis - bicarbonate

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48
Q

KIDNEY STONES/ RENAL COLIC/ CALCULI

Epidemiology?

A

M:F 3:1, 15% so common, onset around 40-60 years

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49
Q

KIDNEY STONES/ RENAL COLIC/ CALCULI

Where are they classically deposited?

A

1) Pelviuretic junction
2) Pelvic brim
3) Vesicouretic junction

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50
Q

KIDNEY STONES/ RENAL COLIC/ CALCULI

Types?

A

1) Calcium oxalate (75%)
2) Magnesium ammonium sulphate (15%)
3) Urate (5%)
4) Hydroxyapatite (5%)
5) Cysteine (1%)

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51
Q

KIDNEY STONES/ RENAL COLIC/ CALCULI

Aetiology of calcium oxalate stones?

A

-Hypercalcaemia
- Hyperoxaluria (too much oxalate e.g. from rhubarb/spinach)

  • Excessive dietary calcium
  • excessive bone resorption
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52
Q

KIDNEY STONES/ RENAL COLIC/ CALCULI

Aetiology of Urate stones?

A
  • Hyperuricaemia (gout)
  • acidic urine
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53
Q

KIDNEY STONES/ RENAL COLIC/ CALCULI

Aetiology of Cysteine stones?

A

Cysteinuria (genetic)

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54
Q

KIDNEY STONES/ RENAL COLIC/ CALCULI

Possible causative organism?

A

1) Klebsiella
2) proteus
3) psuedomonas

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55
Q

KIDNEY STONES/ RENAL COLIC/ CALCULI

How is acidic urine produced?

A

1) Urease breakdown produces NH3, this increase pH of urine and increases stone risk

2) loss of bicarbonates = acidic & decreased uric acid solubility

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56
Q

KIDNEY STONES/ RENAL COLIC/ CALCULI

signs and symptoms/

A
  • Asymptomatic
  • Awful ‘loin to groin’ pain
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57
Q

KIDNEY STONES/ RENAL COLIC/ CALCULI

What are the symptoms? (3)

A
  • Haematuria
  • Vomit/ nausea
  • Sweating
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58
Q

KIDNEY STONES/ RENAL COLIC/ CALCULI

tests?

A

Urine- dipstick + mid-stream specimen for MC&S

Imaging - Non-contrast CT of KUB or KUB X-Ray

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59
Q

KIDNEY STONES/ RENAL COLIC/ CALCULI

treatment?

A

Pain = diclofenac
infection= Abx

If 1-2cm = Extra-corporeal shockwave lithotripsy (ESWL)

  • Surgery (uretoscopy) / keyhole (percutaneous stone surgery)
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60
Q

Prevention methods for recurrent kidney stones?

A

1) lots of water
2) Normal dietary calcium
3) Urate = allopurinol/ HCO3-
4) oxalate= pyridoxine
5) Thiazide diuretics reduce calcium excretion

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61
Q

URINARY TRACT OBSTRUCTION

Aetiology?

A

Lumen - stone, cancer, blood clot
Wall - congenital, nephropathic bladder, stricture
Outside of the Wall, prostate disease, tumour, surgery

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62
Q

What is Hydronephrosis?

A

Dilation of renal pelvis

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63
Q

URINARY TRACT OBSTRUCTION

upper tract Symptoms?

A
  • loin to groin pain
  • worse with fluid
  • enlarged kidney
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64
Q

What is anuria?

A

no urine- complete bilateral obstruction

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65
Q

What is polyuria?

A

Partial block and loss of concentration mechanisms = excess urination

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66
Q

URINARY TRACT OBSTRUCTION

lower tract symptoms?

A
  • terminal dribbling
  • poor flow
  • incomplete emptying feeling
  • enlarged bladder/prostate
  • suprapubic pain
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67
Q

URINARY TRACT OBSTRUCTION

tests?

A

Bloods
urine
ultrasound then CT second line if hydronephrosis

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68
Q

URINARY TRACT OBSTRUCTION

treatment?

A

Upper= nephrostomy (opening between kidney and skin) or uretic stent

Lower= Catheter

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69
Q

HAEMATURIA
What are the types?

A

visible and non visible

70
Q

HAEMATURIA

If the red blood cells shape is normal where is the problem likely to be?

A

lower tract

71
Q

HAEMATURIA

If the red blood cell shape is abnormal where is the problem likely to be?

A

upper tract

72
Q

HAEMATURIA

investigation?

A

dipstick and MSU (mid stream urine)

73
Q

HAEMATURIA

False positive causes?

A

blood= menstruation/ exercise

redness= rifampicin/ beetroot

74
Q

HAEMATURIA

Causes? pre, renal and post renal

A

Pre- renal = drugs (NSAIDs/ anti- coagulants)

Renal= Renal stones/ cysts/ disease/ infection

Post renal= kidney/ bladder cancer/ ureteric stones/ strictures `

75
Q

AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE (ADPKD)

Which two mutations are associated? AND

What is the prevalence

A

PKD1 (85%) - on chromosome 16

PKD” (15%)- on chromosome 4

1 in 1000

76
Q

AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE (ADPKD)

Signs?

A
  • loin pain
  • polyuria/haematuria
  • liver cysts (80%)
  • renal enlargement/ cysts
77
Q

AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE (ADPKD)

treatment?

A

treat HTN with the target ,130/80

Dialysis for end stage renal failure (ESRF)

increase H20 and reduce salt

78
Q

AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE (ADPKD)

How do you decrease cyst proliferation?

A

Tolvaptan = decrease cAMP which decreases cyst proliferation

79
Q

AUTOSOMAL RECESSIVE POLYCYSTIC KIDNEY DISEASE (ARPKD)

What mutation is associated and what is the prevalence?

A

PKHD1 on chromosome 6

1 in 40,000

80
Q

AUTOSOMAL RECESSIVE POLYCYSTIC KIDNEY DISEASE (ARPKD)

What is it?

A

Multiple renal cysts and congenital hepatic fibrosis

81
Q

AUTOSOMAL RECESSIVE POLYCYSTIC KIDNEY DISEASE (ARPKD)

treatment?

A

genetic counselling

82
Q

BENIGN PROSTATIC HYPERPLASIA

What is it?

A
  • Hyperplasia of central glandular and connective tissue
  • Inner zone enlarges in contrast to peripheral expansion in prostate carcinoma
83
Q

Give some LUTS?

A

1) Storage = urgency, frequency, nocturia

2) Voiding = Dribbling, hesitancy, intermittent/ poor flow

3) Post micturition dribbling

84
Q

BENIGN PROSTATIC HYPERPLASIA

Signs?

A
  • nocturia
  • frequency increases
  • dribbling
  • hesitancy
  • large smooth prostate
85
Q

BENIGN PROSTATIC HYPERPLASIA

Lifestyle changes?

A

1) Avoid caffeine/ alcohol
2) Relax when voiding
3) Void twice in a row
4) Bladder training - learning to hold on

86
Q

BENIGN PROSTATIC HYPERPLASIA

Treatment?

A

1st- alpha blockers - Tamsulosin

2nd - 5-alpha reductase - Finasteride

3rd - Surgery

87
Q

BENIGN PROSTATIC HYPERPLASIA

Side effects of Tamsulosin?

A
  • drowsy
  • depression
  • dizzy
  • low BP
  • dry mouth
  • ejaculatory problems
88
Q

BENIGN PROSTATIC HYPERPLASIA

How does Finasteride work?

A

IT DECREASES TESTOSTERONE CONVERSION TO DIHYDROTESTOSTERONE

89
Q

BENIGN PROSTATIC HYPERPLASIA

What are two different types of surgery that can be done?

A

transurethral resection of prostate (TURP)
transurethral incision of prostate (TUIP)

90
Q

BENIGN PROSTATIC HYPERPLASIA

Side effects of TURP and TUIP?

A

impotence (no erection) and increased libido

91
Q

PROSTATE CANCER

What is it?

A

Adenocarcinoma in peripheral prostate

92
Q

PROSTATE CANCER

What’s the difference between BPH and cancer?

A

1) hard craggy prostate with cancer (peach stone rather than peach skin)

2) Metastases (weight loss and possible bone pain)

93
Q

PROSTATE CANCER

If the PSA is normal, what investigation must be done?

A

transrectal US and prostate biopsy

94
Q

PROSTATE CANCER

How is it staged?

A

with CT and TNM system.

95
Q

PROSTATE CANCER

How is it graded?

A

Gleason Score, Pathologist gets 2 samples and grades 1-5, tumour then graded out of 10.

96
Q

PROSTATE CANCER

Treatment?

A

gold standard= Radical Prostectomy if <70 years

2) radical radiotherapy

3) GnRH/LHRH agonists

97
Q

PROSTATE CANCER

Treatment of metastatic disease?

A

GnRH agonists

98
Q

What can raise PSA? (prostate-specific antigen)

A

1) BPH
2) Prostate cancer
3) Perineal trauma
4) Biopsy
5) Surgery

> 4ng/ml is abnormal

99
Q

NEPHROTIC SYNDROME

Aetiology?

A

Primary - focal segmental glomerulosclerosis,
minimal change disease, membranous nephropathy

Secondary - Hep B/C, SLE, Diabetic nephropathy, amyloidosis

100
Q

NEPHROTIC SYNDROME

Three classic symptoms?

A

1) Proteinuria
2) Hypalbuminaemia
3) Oedema

101
Q

NEPHROTIC SYNDROME

pathology?

A

Injury to podocytes= proteinuria

102
Q

NEPHROTIC SYNDROME

Features?

A
  • pitting oedema
  • protein on urine dipstick
  • low serum albumin
103
Q

NEPHROTIC SYNDROME

treatment?

A

1) Reduce oedema - loop diuretics - furosemide

2) Reduce proteinuria - ACE-I / ARB

3) Reduce risk of complications with statins / vaccines

104
Q

Treatment of Minimal Change disease / Membranous Nephropathy?

A
  • steroids (cyclophosphamide)
  • treat underlying cause (ACE-I/ARB)
105
Q

What is Haemodialysis?`

A

Toxins are removed by blood passing over a semi-permeable membrane against dialysis fluid flowing in the opposite direction, and blood is always meeting a less concentrated solution

106
Q

What is Ultrafiltration?

A

a negative transmembrane pressure created and is used to clear excess fluid

107
Q

What is Peritoneal Dialysis?

A

when the peritoneum is used as a S-P membrane and a catheter is inserted into the cavity and water is removed by varying osmolarity of dialysate

108
Q

Why is renal transplant the best treatment?

A

cost effective and high life expectancy

109
Q

What medicine is given alongside renal transplant?

A

Immunosuppression = Basiliximab

Maintenance = azathioprine / prednisolone

110
Q

GLOMERULONEPHRITIS

What is it and what are the features of leaky glomeruli?

A

inflammation of glomeruli and nephrons

haematuria + proteinuria, high BP, deteriorating kidney function and 25% cause of all ESRF

111
Q

NEPHRITIC SYNDROME

What is it and what are the features?

A

Rapidly deteriorating kidney function

  • Oedema
  • HTN
  • Proteinuria
  • Haematuria
  • oliguria
112
Q

NEPHRITIC SYNDROME

causes?

A

ANCA positive vasculitis
SLE
post strep infection

113
Q

NEPHRITIC SYNDROME

tests?

A
  • Dipstick - red cell casts seen on urine microscopy
  • MC&S
  • Renal Biopsy
  • Bloods - Autoantibodies, FBC, U+E, CRP, ESR
114
Q

NEPHRITIC SYNDROME

Treatment?

A

BP control 130/80 and ACE-I / ARB

115
Q

What is the most common glomerulonephritis?

A

IgA nephropathy - associated with tonsillitis

116
Q

INCONTINENCE

What does a bladder diary show?

A

1) no of incontinent episodes
2) Volume of urine
3) no of times passed
4) functional bladder capacity
5) night/ 24 hr volume

117
Q

INCONTINENCE

Storage pathology?

A

1) high storage centres - pontine storage centre - PAG
2) Pudendal (somatic) and hypogastric (sympathetic, B3)
3) Nerves prevent detrusor contraction

118
Q

INCONTINENCE

Voiding pathology?

A

1) High centres - pontine micturition centre - PAG
2) Pelvic splanchnic nerve @ M3 receptors
3) Contract detrusor

119
Q

INCONTINENCE

What may cause urge incontinence in a man?

A
  • enlarged prostate
120
Q

INCONTINENCE

Precipitants?

A
  • cold, water, coffee, obesity
121
Q

INCONTINENCE

Causes?

A
  • detrusor overactivity, stroke, DM, UTI
122
Q

INCONTINENCE

Diagnosis?

A

urodynamic studies show random increases in pressure

123
Q

INCONTINENCE

What is Stress Incontinence

A

leakage from incompetent sphincter (when intra-abdo pressure increases such as a sneeze)

124
Q

INCONTINENCE

What is Stress incontinence common in?

A

Pregnancy and the elderly (pelvic floor weakness)

125
Q

INCONTINENCE

treatment of stress?

A

1) Pelvic floor exercises
2) Surgery

126
Q

INCONTINENCE

treatment of urge?

A

1) Avoid caffeine and alcohol
2) bladder training and weight loss
3) Pads and condoms catheter
4) M3 antagonists / B3 agonists

127
Q

TESTICULAR CANCER

Types?

A
  • Germ cell tumours
  • teratomas
  • seminomas
128
Q

TESTICULAR CANCER

Staging?

A

1- no evidence of mets
2- intradiaphragmatic involved
3- supradiaphragmatic involved
4- lung involvement

129
Q

TESTICULAR CANCER

Clinical features?

A
  • painless lump
  • cough
  • dyspnoea (LUNG METS)
  • back pain (para-aortic mets)
130
Q

TESTICULAR CANCER

Investigations?

A

1) US to see tumour
2) alpha FP and beta hCG
3) EXCISION BIOPSY

131
Q

TESTICULAR CANCER

treat?

A

local - radical orchidectomy

seminoma with mets - radiotherapy (below diaphragm) Chemo (above diaphragm)
Teratoma = chemo

132
Q

UTI’s

What is bacteriuria?

A

> 10 cubed per ml

133
Q

UTI’s

name 3 lower UTI’s

A
  • prostatitis
  • cystitis
  • urethritis
134
Q

UTI’s

name an upper UTI

A

pyelonephritis (renal pelvis)

135
Q

UTI’s

Causative organisms?

A

1) E.coli
2) Coagulase positive staph
3) Proteus mirabilia
4) Klebsiella pneumonia

2,3,4 can cause renal stones due to urease production

136
Q

UTI’s

Lower symptoms?

A
  • Dysuria
  • Frequency
  • Haematuria
  • Smelly urine
  • Suprapubic pain
137
Q

UTI’s

Upper symptoms?

A
  • fever
  • vomit
  • loin pain
  • oliguria
138
Q

UTI’s

What is a reinfection?

A

> 2 weeks after eradication

139
Q

UTI’s

What is recurrence?

A

> <7 days and implies kidney problem

140
Q

UTI’s

Investigation

A
  • Dipstick - if leucocyte and nitrate positive - treat empirically
  • send off for MSU for MC&S
141
Q

UTI’s

Treat?

A

1) Drink lots of water
2) Lower = trimethoprim
3) Upper = IV co-amoxiclav

142
Q

STI’s

Primary, secondary and tertiary prevention ideas?

A

P - Posters, school teaching, pre/post exposure prophylaxis of HIV

S- Partner tracing, screening <25 for chlamydia

T- HAART, prophylactic Abx

143
Q

STI’s

Partner notification benefits?

A
  • Prevents re-infection
  • Breaks chain of infection
  • Prevents complications
144
Q

STI’s
Causative organisms?

A
  • Chlamydia trochomatis
  • Neisseria gonorrheoae
  • Treponema Pallidum = syphilis
145
Q

STI’s

symptoms of C+G?

A
  • dysuria and discharge
  • women = menstruation irregularity
146
Q

STI’s

Diagnosis of C+G?

A

men = first void urine

women = vaginal swab

the nucleic acid amplification test

147
Q

STI’s

Treat?

A

C = PO doxycycline & partner notification

G = IM ceftriaxone and PO azithromycin

148
Q

STI’s

What is Syphilis until proven otherwise?

A

genital ulcer

149
Q

STI’s
Treat?

A

IM penicillin

150
Q

STI’s

Symptoms of secondary syphilis?

A
  • MAcular rash
  • Mucous membrane lesions
  • Bone pain
  • Alopecia
151
Q

STI’s

Cycle of Syphilis?

A
  • first 2 years is ‘early syphilis’

then latent

then ‘late syphilis’ follows

152
Q

what are Epidydimal Cysts?

A

collection of fluid in epididymis that can be diagnosed by feeling a cyst in the scrotum separate to testes

153
Q

What is Hydrocele?

A

Cystic fluid in the tunica vaginalis

154
Q

Primary and secondary cause of Hydrocele?

A

P - Potent processus vaginalis

S- infection, tumour or trauma

155
Q

What is Varicocele

A

Dilated pampniform plexus that feels like a bag of worms. Solid and separate from testes that is a dull ache and resolved by surgery

156
Q

TESTICULAR TORSION

What is it?

A

Twisting of spermatic cord - no blood supply

157
Q

TESTICULAR TORSION

Chances of testes being saved after:

24 hours?
6 hours?

A

after 24 hours - 90% unsavable

before 6 hours - 90% savable

158
Q

TESTICULAR TORSION

Symptoms?

A

sudden onset pain in one testes

  • nausea
  • vomit
  • abdo pain
159
Q

TESTICULAR TORSION

Signs?

A

inflammation one testes (red, tender, swollen)

160
Q

TESTICULAR TORSION

What is the difference between epididymo-orchitis

A

epididymo-orchitis is normally slower onset of pain + UTI symptoms

161
Q

TESTICULAR TORSION

Treat and Ix?

A
  • Doppler US + Surgeyr (untwisting of SC and fixed to scrotum)
162
Q

EPIDIDYMO-ORCHITIS

Cause?

A
  • <35 chlamydia
  • > 35 normally UTI
163
Q

EPIDIDYMO-ORCHITIS

Features?

A

painful testes, discharge, dysuria

164
Q

EPIDIDYMO-ORCHITIS

Investigations?

A

urine sample

165
Q

EPIDIDYMO-ORCHITIS

Treatment?

A

STI - Doxycycline + azithromycin

UTI - Ciprofloxacin / Ceftriazone

166
Q

ERECTILE DYSFUNCTION

Pathology of erection?

A

1) Sexual stimulation by PNS = NO release = NO build up = cGMP build up

2) cGMP closes Ca2+ channels and opens K+

3) hyperpolarises cells and causes of relaxation of smooth muscle

4) This allows engorgement of blood vessels

167
Q

ERECTILE DYSFUNCTION

What is proof of psychological ED?

A

still get morning erection

168
Q

ERECTILE DYSFUNCTION

Cause?

A

General - smoke, diabetes, alcohol + CVS disease

Endocrine - hyperthyroidism, hypogonadism,

Neuro - cord lesions, MS

Drugs - Digoxin, Beta blockers, Diuretics, finasteride

169
Q

ERECTILE DYSFUNCTION

Bloods?

A
  • glucose, U+E, FBC, LH/FSH, prolactin, testosterone, thyroid function
170
Q

ERECTILE DYSFUNCTION

treatment?

A

1st - oral PDE5 inhibitor - increases cGMP - Sildenafil

2nd - Vacuum aids / intracavernosal injection

3rd- prosthetics

171
Q

What drug should be avoided in the 1st trimester of pregnancy?

A

Trimethoprim, Nitrofurantion should be used instead

172
Q

Complications of Nephrotic Syndrome?

A

Atherosclerosis due to high cholesterol
high blood pressure
AKI and CKD

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