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Julia PCP2 > Genitourinary > Flashcards

Genitourinary Flashcards

1
Q

Name 3 types of stones. Which is the most common?

A
  1. Calcium oxalate (70%)
  2. Uric acid
  3. Magnesium ammonium phosphate
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2
Q

What are some risk factors for ureteric stone development?

A

Dehydration

Diet high in animal protein &salt

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3
Q

What are the initial investigations for a suspected stone?

A
  • FBE, UEC
  • Serum calcium & uric acid
  • MSU
  • CT-KUB and plain KUB
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4
Q

What are some indications for intervention for a ureteric stone?

A
  • Infection/sepsis
  • Renal impairment
  • Bilateral obstructions
  • Solitary kidney
  • Inability to control symptoms
  • Prolonged obstruction
  • Unlikely to pass spontaneously
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5
Q

What organism usually causes obstructive pylonephrosis?

A

E. coli

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6
Q

What is the management of obstructive pylonephrosis?

A
  • IV Abs (gentamicin?)
  • Urgent decompression
  • Supportive care (fluids, monitoring)
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7
Q

What are some medical treatments for ureteric stones?

A
  • a-blockers, eg. Tamsulosin 0.4mg OD for 2 weeks

- calcium channel blockers & steroids not as effective

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8
Q

What are the surgical options for a ureteric stone?

A
  • JJ stent & delayed management
  • Ureteroscopy & lithotrospsy
  • Shock wave lithotripsy
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9
Q

What is the likely make-up of a radiolucent stone?

A
  • Uric acid (or cystine)

- Form in acidic urine

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10
Q

What are some strategies to prevent stone recurrence?

A
  • Adequate fluid intake
  • Dietary modification
  • Urinary alkalinization
  • Medical therapy - allopurinol, thiazide diuretics
  • Cystinuria
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11
Q

What are 5 causes of urological haematuria?

A
  • Obstructive uropathy
  • Carcinoma of the prostate
  • Nephritis
  • Trauma
  • Tumour
  • TB
  • Thrombosis
  • Haematological
  • Infection/inflammation
  • Stones
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12
Q

Which common drugs can make the urine beetroot red?

A
  • Pyridium
  • Nitrofurantoin
  • Rifampin
  • Ibuprofen
  • Phenytoin
  • L-DOPA
  • Chloroquine
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13
Q

What is the acute work-up for haematuria?

A
  • Bloods: Hb, clotting, creatinine
  • MSU -> M/C/S
  • Upper tract imaging: CT-IVP, U/S
  • Cystoscopy
  • Others: urine cytology, PSA, urinalysis
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14
Q

What are the obstructive urinary symptoms?

A

Poor flow, hesitancy, intermittency, terminal dribbling

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15
Q

What are the irritative urinary symptoms?

A

Frequency, urgency, nocturia, incontinence

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16
Q

What are the 3 most common causes of obstructive urinary symptoms?

A
  • BPH
  • Prostate cancer
  • Stricture
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17
Q

What are 5 causes of irritative urinary symptoms?

A
  • UTI
  • Secondary to obstruction
  • Bladder cancer
  • Stone
  • Diabetes
  • TB
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18
Q

What is your work-up for lower urinary tract symptoms?

A
  • MSU
  • UEC
  • PSA
  • Bladder diary
  • Voiding flow rate
  • US - residual urine, hydronephrosis
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19
Q

Which drugs can be used in lower urinary tract symptoms?

A
  • Alpha blockers

- 5-alpha reductase inhibitors

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20
Q

What are the surgical options for treatment of lower urinary tract symptoms?

A
  • TURP
  • BNI (bladder neck incision)
  • Open prostatectomy
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21
Q

What is acute urinary retention?

A

Sudden and PAINFUL inability to pass urine

22
Q

What are some painless causes of urinary retention?

A
  • Neurogenic
  • Longterm voiding detrusor dysfunction
  • Ageing
23
Q

What can precipitate acute urinary retention?

A
  • Medication (anticholinergics)
  • UTI
  • Diuresis (esp. ALCOHOL)
  • Postoperative
24
Q

What are common causes of acute urinary retention in females?

A
  • Urethritis/UTI
  • Meatal stenosis/stricture
  • Tumour
  • Urethral diverticulum
  • Urethral stone
  • Extrinsic compression - prolapsed uterus or pelvic mass
25
Q

What are the appropriate size catheters for: men, women & haematuria?

A

Men: 12-14F
Women: 14-16F
Haematuria: 22-24F

26
Q

What is the management of obstructive nephropathy?

A
  • Admit
  • Monitor urine hourly
  • Replace urine volume with 1/2 volume 0.9% NaCl
  • Monitor UECs regularly
  • Replace magnesium & phosphate as required
27
Q

What are the treatment options for AUR?

A
  • Alpha-blocker & TOV
  • Surgery: TURP, laser, open
  • Long-term IDC
28
Q

Differential diagnosis of a painless scrotal lump?

A

Hydrocoele, epididymal cyst, varicoele, benign tumour, idiopathic scrotal oedema, testicular cancer, lymphoma, inguinal hernia, ascites

29
Q

What 3 serum markers might be elevated in testicular cancer?

A
  • alpha-fetoprotein
  • beta-HCG
  • LDH
30
Q

Which lymph nodes do the testicles drain to first?

A

Retroperitoneal lymph nodes (require CT abdomen & pelvis for staging)

31
Q

What are the treatment options for testicular cancer?

A
  • Inguinal orchidectomy
  • Chemotherapy (BEP)
  • Retroperitoneal lymph node dissection
32
Q

What are the main investigations for suspected testicular cancer?

A
  • Serum tumour markers

- Urgent scrotal U/S

33
Q

What 2 places does testicular cancer commonly metastasize to first?

A
  • Retroperitoneal lymph nodes

- Chest

34
Q

What are the differentials for an acute scrotum?

A
  • Testicular torsion
  • Trauma
  • Epididymo-orchitis
  • Testicular appendage torsion
  • Acute indirect inguinal hernia
35
Q

What conditions can predispose to testicular torsion?

A
  • Cryptorchidism

- Bell clapper deformity

36
Q

What are the physical findings in testicular torsion?

A
  • Tender, firm, high-riding testicle with a horizontal lie
  • Absent cremasteric reflex
  • Epididymis not posterior to testis
37
Q

What are the common causative bacteria in epididymo-orchitis?

A

Men 35: E. coli & other GNBs

38
Q

What are the risk factors for epididymo-orchitis?

A
  • IDC
  • Chronic retention
  • Structural abnormality
  • Instrumentation
39
Q

What are the physical examination findings in epididymo-orchitis?

A
  • Swollen, tender testis
  • Fever
  • Hydrocoele
40
Q

What investigations should be ordered in suspected epididymo-orchitis?

A
  • U/S - to rule out torsion
  • Urinalysis & MSU
  • Urine/urethral swab for PCR
41
Q

Which antibiotics should be used in epididymo-orchitis?

A

GNB coverage: trimethoprim, cephalexin, augmentin or norfloxacin for 2 weeks
-give ampicillin & gentamicin via IV until afebrile

STI coverage: ceftriaxone & azithromycin & doxycycline

42
Q

What are the macroscopic & microscopic features of papillary bladder cancer in situ?

A
  • Cytologically malignant cells
  • Lack of cohesiveness
  • Mucosal reddening, granularity or thickening
43
Q

What conditions predispose to carcinoma of the bladder?

A
  • Smoking
  • Industrial exposure to arylamines
  • Schistosomiasis
  • Long-term use of analgesics
  • Long-term exposure to cyclophosphamide
44
Q

What are the histological features of a testicular seminoma?

A

Large cells with distinct borders, pale nuclei, prominent nucleoli & sparse lymphocytic infiltrate

45
Q

What are the 3 broad classifications of testicular neoplasms?

A
  • germ cell tumours
  • sex cord stromal tumours
  • lymphoma
46
Q

What are common germ cell tumours of the testicles?

A
  • Seminoma
  • Embryonal carcinoma
  • Yolk sac tumour
  • Choriocarcinoma
  • Teratoma
  • Mixed tumours
47
Q

In which region of the prostate does hyperplasia typically arise?

A

Transitional zone

48
Q

In which region of the prostate does carcinoma typically arise?

A

Peripheral zone

49
Q

What does a Gleason score confer?

A

Degree of differentiation of cells (GRADE)

50
Q

What are first-line antibiotics in uncomplicated UTI?

A

Trimethoprim (but NOT in pregnancy)

Julia PCP2 (21 decks)

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