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Year 2 > Genitourinary: Part 6 > Flashcards

Genitourinary: Part 6 Flashcards

1
Q

What aged men are effected by testicular tumours

A

15-44

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2
Q

What percentage of testicular tumours arise from germ cells

A

96%

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3
Q

Name two germ cell tetsicular tumours

A

Seminomas

Teratomas

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4
Q

What age people does teratomas effect

A

Infants

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5
Q

What age people do seminomas effect

A

25-40 years

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6
Q

Name three non-germ cell tumours

A
  1. Leydig cells
  2. Sertoli cell tumours
  3. Sarcomas
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7
Q

Risk factors for testicular tumours

A
  1. FAMILY HISTORY
  2. Infant hernia
  3. Undescended testis
  4. Infertility
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8
Q

Clinical presentation of testicular tumours

A
  1. Painless lump in testicles
  2. Tetsicular or abdo pain
  3. Cough and dyspnoea (due to lung metastases)
  4. Back pain - para-aortic lymph node metastasis)
  5. Abdo mass
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9
Q

Differential diagnosis of testicular tumours

A
  1. Testicular torsion
  2. Lymphoma
  3. Hydrocele
  4. Epididymal cyst
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10
Q

Diagnostics for testicular tumours

A
  1. ULTRASOUND
  2. BIOPSY + HISTOLOGY
  3. SERM tumour markers
  4. CXR + CT - assess tumour staging
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11
Q

Why is an ultrasound used in testicular tumours

A
  1. Differentiate between masses in the body of the testes and intrascrotal swellings
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12
Q

Name some serum tumour markers

A
  1. Alpha-fetoprotein

2. Beta subunit of hCG (B-hCG)

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13
Q

Level of AFP and B-hCG in teratomas

A

RAISED

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14
Q

Level of AFP and B-hCG in seminomas

A

Normal AFP and raised B-hCG in some

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15
Q

Treatment of testicular tumours

A
  1. RADICAL ORCHIDECTOMY via inguinal approach

2. Sperm storage offered

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16
Q

Treatment of seminomas with metastases below diaphragm

A

RADIOTHERAPY only

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17
Q

What are widespread testicular tumours treated

A

CHEMOTHERAPY

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18
Q

What are teratomas treated with

A

CHEMOTHERAPY

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19
Q

Define UTI

A
  1. Inflammatory response of the urothelium to bacterial invasion, usually associated with bacteria and pyuria
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20
Q

What boundaries define UTI

A
  1. > 10^5 organisms/ml in fresh mid-stream urine
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21
Q

What 5 pathogens account for UTI

A 
KEEPS
K = Klebsiella spp.
E = E.coli (MOST COMMON)
E = Enterococci 
P = Proteus spp.
S = Staphylococcus spp (coagulase negative)
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22
Q

Three ways we classify UTIs

A
  1. LOCATION: Lower UTI vs Upper
  2. CLINICAL RISK: Uncomplicated vs complicated
  3. TIMING: Single/isolated vs Unresolved
    Acute vs Chronic
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23
Q

What strain of e.coli causes UTI

A

UPEC - uropathogenic strains of E.coli

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24
Q

What structures are found on the surface of E.coli

A
  1. FIMBRIAE/PILLI
  2. Glcocalix
  3. Acid polysaccharide coat that resists phagocytosis
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25
Q

What structures do bacteria adhere to

A
  1. UROTHELIUM
  2. VAGINAL EPITHELIUM
  3. VAGINAL MUCUS
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26
Q

Under what circumstance is rate of adhesion highest

A
  1. Oestrogen depletion due to the loss of lactobacilli and pH rises causing increases colonisation by colonic flora and reduction in vaginal mucus secretion
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27
Q

In what people is oestrogen-depleted UTI common in

A

Post-menopausal women

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28
Q

What antigen increases susceptibility to RECURRENT UTIs if you have it

A

HLA-A3

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29
Q

3 ways UTI causing bacteria defends itself against the host

A
  1. CAPSULE - resists phagocytosis
  2. TOXIC cytokines
  3. ENZYME PRODUCTION
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30
Q

What enzyme secrete urease against the host

A

GRAM NEGATIVE: Proteus, Klebsiella and pseudomonas

GRAM POSITIVE: Staphylococci + Mycoplasma

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31
Q

Host defence mechanisms against UTI causing bacteria

A
  1. ANTEGRADE flushing of urine
  2. Tamm-Horsfall protein - antimicrobial
  3. Low urine pH and high osmolarity
  4. Urinary IgA
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32
Q

Name the UTI in the upper tract

A
  1. PYELONEPHRITIS
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33
Q

Name the UTI in the lower tract

A
  1. Cystitis
  2. Prostatitis
  3. Epididymo-orchitis
  4. Urethritis
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34
Q

What is an uncomplicated UTI I

A

UTI in healthy non-pregnant women with normally functioning urinary tract

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35
Q

What is a complicated UTI

A
  1. Infection in patients with abnormal urinary tract (stones, obstruction, systemic diseases involving the kidney like diabetes)
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36
Q

Problems with complicated UTIs

A

treatment failure

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37
Q

What complications can reuaslt from complicated UTIs

A

Renal papillary necrosis and renal abscess

38
Q

In what gender are complicated UTIs found

A

MEN - associated with urological abnormalities like bladder outlet obstruction

39
Q

Risk factors for UTIs

A
  1. FEMALES
  2. Sex
  3. Pregnancy
  4. Menopause
  5. Decrease in host defence
  6. Urinary tract obstruction resulting in urine stasis
  7. Catheter
40
Q

What route does UTI transmission occur in

A

Ascending transurethral route - sex and urethral catheter

41
Q

Why are women more susceptible to UTIs

A

Shorter urethra and more proximal to anus

42
Q

What is pyelonephritis

A

Infection of the renal parenchyma and soft tissues of the renal pelvis and upper ureter

43
Q

What causes pyelonephritis

A 
KEEPS:
Klebsiella spp.
E.coli (MAJORLY)
ENTEROCOCCUS spp.
Proteus spp.
Staphylococcus app - coagulase negative
44
Q

Risk factors for pyelonephritis

A
  1. Structural renal abnormalities
  2. Stones
  3. Catheterisation
  4. Pregnancy
  5. Diabetes
  6. Immunocompromised patients
45
Q

Where does UPEC come from

A

Patient’s own flora

46
Q

What three ways can you get pyelonephritis

A
  1. Ascending transurethral route
  2. Bloodstream
  3. Lymphatics
47
Q

Three adhesive features of UP e.coli

A
  1. P pilli to allow ureteral ascent
  2. Aerobactin - Fe acquisition
  3. Haemolysin - pore formation
48
Q

Clinical presentation of pyelonephritis

A
  1. Triad of: Loin pain, fever and pyuria
  2. Rigors
  3. Headaches
  4. Haematuria
  5. Bacteruria
  6. Malaise, nausea and vomiting
  7. Oliguria if AKI
49
Q

Differential diagnosis of pyelonephritis

A
  1. Diverticulitis
  2. Abdo aortic aneurysm
  3. Kidney stones
  4. Cystitis
  5. Prostatitis
50
Q

Diagnostics of pyelonephritis

A
  1. Tender loin on examination
  2. Urine dipstick
  3. Midstream urine microscopy, culture and sensitivity - GOLD
  4. FBC
  5. URGENT ULTRASOUND
51
Q

What features of urine dipstick indicate pyelonephritis

A
  1. Detects nitrites - bacteria break down nitrates to release nitrites
  2. Detect leucocyte elastase
  3. Foul-smelling urine
  4. Dipstick positive for proteins
52
Q

FBC results for pyelonephritis

A
  1. Elevated WCC

2. CRP and ESR raised in acute infection

53
Q

Why is ultrasound done for pyelonephritis

A
  1. calculi
  2. Obstruction
  3. Abnormal urinary anatomy
  4. Incomplete bladder emptying
54
Q

How is pyelonephritis treated

A
  1. rest
  2. Cranberry juice
  3. WATER
  4. ANALGESIA
  5. Antibiotics
  6. Surgery to drain abscess and stones
55
Q

Antibiotics for pyelonephritis

A
  1. ORAL CO-AMOXICLAV or CIPROFLOXACILLIN

IV GENTAMICIN/CO-AMOXICLAV if severe

56
Q

What is cystitis

A

Urinary infection of the bladder

57
Q

What gender is cystitis common in

58
Q

Common cause of cystitis

59
Q

Risk factors of cystitis

A
  1. Urinary obstruction
  2. Previous damage to bladder epithelium
  3. Stones
  4. Poor bladder emptying
60
Q

Clinical presentation of cystitis

A
  1. Dysuria
  2. Frequency
  3. Urgency
  4. Suprapubic pain
  5. Haematuria
  6. Offensive urine
  7. Abdominal/loin tenderness
61
Q

Diagnostics of cystitis

A
  1. Urine microscopy and sensitivity of sterile mid-stream urine
  2. Urine dipstick: Positive for leucocytes, blood and nitrites
62
Q

treatment of cystitis

A
  1. ANTIBIOTICS: TRIMETHOPRIM or CEFALEXIN

2nd line:
CIPROFLOXACIN or CO-AMOXICLAV

63
Q

What is prostatitis

A

Inflammation of prostate gland

64
Q

What condition is prostatitis associated with

65
Q

What causes acute prostatitis

A
  1. Strep faecalis
  2. E.coli
  3. Chlamydia
66
Q

What causes chronic prostatitis

A
  1. Bacterial: Strep faecalis, E.coli or chlamydia

2. Non-bacterial; elevated prostatic pressure, pelvic floor myalgia

67
Q

Risk factors for prostatitis

A
  1. STI
  2. UTI
  3. Indwelling catheter
  4. Post-biopsy
  5. Increasing age
68
Q

Clinical presentation of acute prostatitis

A
  1. Systemically unwell
  2. Fever, riggers and malaise
  3. Pain ejaculation
  4. LUTS symptoms
  5. Pelvic pain
69
Q

Clinical presentation of chronic prostatitis

A
  1. Acute symptoms over 3 months
  2. Recurrent UTIs
  3. Pelvic pain
70
Q

Differential diagnosis of prostatitis

A
  1. Cystitis
  2. BPH
  3. Calculi
  4. Bladder neoplasia
  5. Prostatic abscess
71
Q

Diagnostics for prostatitis

A
  1. DRE
  2. Urine dipstick
  3. Mid-stream urine microscopy and sensitivity
  4. Blood culture
  5. STI screen
  6. Trans-urethral ultrasound scan
72
Q

Treatment for acute prostatitis

A
  1. ANTIBIOTICS: IV GENTAMICIN + IV CO-AMOXICLAV/ IV TAZOCIN or CARBAPENEM
  2. 2-4 weeks on CIPROFLOXACIN once well
  3. TRUSS abscess drainage
73
Q

Second line treatment for acute prostatitis

A

TRIMETHPRIM

74
Q

Treatment for chronic prostatitis

A
  1. 4-6 week course of CIPROFLOXACIN (usually doesn’t work)
  2. TAMSULOSIN
  3. IBUPROFEN
75
Q

Complications of prostatisti s

76
Q

What is urethritis

A

Inflammation of urethra

77
Q

What usually causes urethritis

78
Q

What gender is effected by urethritis

79
Q

Most common cause of urethritis

80
Q

Main causes of urethritis

A

Gonococcal: Neisseria gonorrhoea

Non-gonococcal: Chlamydia trahcmoatis
Mycoplasma genitalium
Ureaplasma urealyticum
Trichomonad vaginalis

81
Q

Non-infective causes of urtrhitis

A
  1. Trauma
  2. Urethral stricture
  3. Irritation
  4. Stone
82
Q

Risk factors for Urethritis

A
  1. Sex
  2. Unprotected sex
    3/ Male to male sex
  3. Male
83
Q

Clinical presentation of urethritis

A
  1. Asymptomatic
  2. Dysuria + discharge (blood + pus)
  3. Urethral pain
  4. Penile discomfort
  5. Skin lesions
  6. Systemic symptoms
84
Q

Differential diagnosis of urethritis

A
  1. Candida balantis
  2. Epididyimitis
  3. Cystitis
  4. Acute prostitis
  5. Urethral malignancy
85
Q

Diagnostics of urethritis

A
  1. Nucleic acid amplification test
  2. Microscopy of gram-stained smears of genital secretions
  3. Blood culture
  4. Urine dipstick
  5. Urethral smear
86
Q

Describe NAAT in females

A
  1. Self collected vaginal swab (endocervical swab, first void urine)
87
Q

NAAT in males

A

First void urine

88
Q

Pro of NAAT

A

High specificity and sensitivity

89
Q

Why is urine dipstick used in urethritis

A

Excludes UTI

90
Q

treatment of chlamidya

A
  1. AZITHROMYCIN or 1 week oral DOXYCYCLINE
91
Q

Treatment for chlamydia in pregnant women

A
  1. ORAL ERYTHROMYCIN for 14 days or ORAL AZITHROMYCIN stat
92
Q

How is Gonorrhoea treated

A
  1. IM CEFTRIAXONE with ORAL AZITHROMYCIN

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