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MRCS > genitourinary path + anatomy > Flashcards

genitourinary path + anatomy Flashcards

1
Q

What is the danger of someone with LUTS due to prostate Ca undergoing radiotherapy

A

They might go into retention

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2
Q

Patient with prostate Ca is about to have RT- why should they have a TURP instead of an alpha blocker to relieve sx?

A

They need a definitive mx- hence TURP instead of tamsulosin

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3
Q

Effect of 5 alpha reductase on the prostate

A

It converts testosterone into the more active dihydrotestosterone which increases prostate growth

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4
Q

Example of a 5 alpha reductase inhibitor

A

Dutasteride, finasteride

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5
Q

lymphatic drainage of cervix

A

obturator nodes

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6
Q

What do the superficial inguinal lymph nodes drain?

A

anal canal, bladder, vagina

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7
Q

The pectinate line divides the pelvic rectum and the anal canal- what are the lymphatic drainage of the 2

A

pelvic rectum- external iliac/ common iliac nodes

anal canal- superficial inguinal lymph nodes

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8
Q

nerve supply to
internal
external
anal sphincters

A

external= pudendal
internal= lower rectal branches of the parasympathetic nerves

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9
Q

What is the other name for the testicular appendix and where does it originate from

A

Hydatid of Morgagni

Remnant of the Muerllerin duct

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10
Q

What is the remnant of the Wolffian duct called?

A

epididymal appendix

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11
Q

risk factors for undescended tests

A

Twins
low birth weight
premature

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12
Q

presenting sx for Wilm’s tumour

A

abdo mass/ pain
hypertension
haematuria

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13
Q

Epidemiology Wilm’s tumour:
age
race
Fhx

A

<5 yrs
afro-Caribbean
+ FHx

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14
Q

What is the risk of prolonged TURP surgery

A

TURP syndrome

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15
Q

Describe the changes seen in TURP syndrome

A

Fluid overload
glycine toxicity
HTN + reflex bradycardia
dilutional hyponatraemia
reduced plasma osmolality = brain oedema

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16
Q

What are the 5 classifications of undescended testes

A

retractile
ectopic
atrophic

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17
Q

arterial supply of prostate

A

prostatic arteries from INTERNAL iliac

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18
Q

venous drainage of prostate

A

prostatic venous plexus drains into
internal iliac veins
which connect
internal vertebral and Batons venous plexuses

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19
Q

What are the zones of the prostate

A

4 zones: (middle outwards)
transitional
central (posterior)
peripheral (posterior)
fibromuscular stromal zone (anterior)

transitional, central and peripheral are glandular areas

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20
Q

Which zone does prostate Ca arise in

A

peripheral zone

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21
Q

Which zone does BPH arise in

A

transitional zone

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22
Q

How many lobes does the prostate have

A

4:
anterior
posterior
median
lateral

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23
Q

What are the 3 parts of the urethra (proximal-distal)

A

prostatic
membranous
spongy

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24
Q

which part of the urethra recieves semen from the ejaculatory ducts

A

prostatic urethra

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25
Q

2 commonest surgical procedures for the management of hydrocele

A

Lord’s (plication)
Jabouley’s (excision + eversion of hydrocele sac)

26
Q

What is a hypospadia

A

when the urethral meatus is on the VENTRAL aspect of the penis

27
Q

What are the 3 features of a hypospadia

A

-ventral meatus
-ventral bend of penis (Chordee)
-doral hooded foreskin

28
Q

Mx of hypospadia

A

urethroplasty

29
Q

At what age are hypospadias corrected and what specifically should parents be counselled not to do until mx has been discussed

A

Age= 6-18 months

Do not do a circumsition as foreskin maybe vital for reconstruction

30
Q

What are the 3 classes of hypospadias

A

Based on location of meatus:

-anterior/ glandular (most common)
-middle (shaft/ penile)
-posterior (penoscrotal/ scrotal/ perineal)

31
Q

Short/ long term complications post urethroplasty for hypospadia

A

Short:
bleeding
infection
blocked catheter
bladder spasms

Long:
urethral fistula
urethral/ meatal stenosis/ stricture
urethral diverticula
poor cosmesis
spraying urine
voiding dysfunction

32
Q

What is cystinuria

A

An autosomal recessive condition where there excess cystine (amino acid) in the urine that forms stones/ crystals causing renal colic

33
Q

Hos is cystinuria diagnosed

A

24hr urine collection
USS/ CT KUB
Urinanalysis

34
Q

Management of cystinuria

A

prevent stones forming:
-d penicillamine
-alkalinisation of urine (potassium citrate/ sodium bicarb/ acetazolamide)
-drink water

35
Q

What is priapism

A

Sustained painful erection without sexual stimulation lasting >4 HOURS

36
Q

Types of priapism

A

Low flow/ ischaemic= painful

High flow/ non-ischaemic= painless

37
Q

Mx of the types of priapism

A

Low flow:
1- aspirate blood with 21-gauge cannula from cavernosa

if doesn’t work
2-give alpha-1 adrenoceptor agonist every 5-10mins up to 1 hr
(monitor BP/HR)

if doesn’t work
3-surgery asap

High flow:
conservative mx

38
Q

risk factors for SCC bladder Ca

A

Schistosomiasis
long term indwelling catheter

39
Q

Why is the internal vertebral/ Batsons venous plexus significant in prostate cancer

A

They ae valveless veins hence allow for metastases

40
Q

Lymph drainage of testes vs scrotum

A

testes = para-aortic/ lumbar nodes

scrotal = superficial inguinal nodes

41
Q

lymph drainage of the uterus

A

fundus= para-aortic
body + cervix= internal + external iliac + superficial inguinal nodes

42
Q

what are the muscles/ ligaments that support the uterus

A

muscle= pelvic floor muscles main support

ligaments=
broad ligament
round ligament
ovarian ligament
cardinal ligament
uterosacral ligament

43
Q

What is the origin/ insertion/ function of the uterine ligaments

A

broad
-uterus to lateral pelvic walls
-provides support and keeps in anteverted position

round
-uterine horns to labia majora (through inguinal canal)
-keep correct position

ovarian
-uterus to ovary
-connects uterus to ovary

cardinal
-cervix to lateral pelvic walls
-contains the uterine artery and veins

uterosacral
-cervix to sacrum
-help support + correct position

44
Q

What are the structures at attach at the perineal body

A

6 structures:
-superfical +
-deep transverse perineal muscles
-bulbospogiosus
-external anal +
-urethral sphincter
-anterior fibres of levator ani

45
Q

what are the contents of the superficial perineal pouch

A

ischiocarvernosus
bulbospongiosus
superficial transverse perineal muscle

46
Q

what divides the superficial and deep perineal pouches

A

perineal membrane

47
Q

what are the contents of the deep perineal pouch

A

external urethral sphincter
membranous urethra
deep transverse perineal muscle
internal pudendal artery
dorsal nerve of penis/ clitoris

48
Q

what lies between the deep perineal pouch and the pelvic floor/ levator ani

A

ischiorectal fossa

49
Q

what are the muscles that make up the pelvic floor

A

coccygeous + levator ani

levator ani:
puborectalis
pubococcygeous
iliococcygeous

50
Q

what does the ilioinguinal nerve give sensory supply to ?

A

79

51
Q

common pathogen causing epididymitis in
men <35
older men/ children

A

> 35= gonorrhoea/ chlamidya
older/children= E.coli

52
Q

What is a rare, non-infectious cause of epididymitis

A

amiodarone

53
Q

Nerve supply of the internal and external anal sphincters

A

internal= hypogastric plexus
external= inferior rectal nerve

54
Q

Contents of obturator foramen

A

obturator
artery
vein
nerve

55
Q

Structures that pass through the greater sciatic foramen
-above the piriformis
-below the piriformis

A

above piriformis:
-superior gluteal nerve + artery

below:
-inferior gluteal nerve + artery
-sciatic nerve
-nerve to obturator internus/ quadratus femoris
-posterior femoral nerve
-pudendal nerve

56
Q

Structures passing through the lesser sciatic foramen into the perineum

A

-internal pudendal artery + vein
-pudendal nerve
-nerve to obturator internus
-obturator tendon

57
Q

Organisms causing UTI in:
-sexually active woman
-had recent instrumentation
-no other risk factors
-foreign body present (mesh/ sutures)

A

-sexually active woman= staphylococcus saprophyticus

-had recent instrumentation= staph aureus

-no other risk factors= E.coli

-foreign body present (mesh/ sutures)= pseudomonas

58
Q

What do the below renal conditions appear as on a DTPA renogram

-tumour
-renal cyst
-acute tubular necrosis
-transplant rejection
-calculus/ obstruction

A

-tumour= hypervascular flush/ increased flow

-renal cyst= cold spots (no blood supply)

-acute tubular necrosis= preserved perfusion BUT delayed uptake and excretion of the radioisotope

-transplant rejection= diminished perfusion AND delayed uptake and excretion of the radioisotope

-calculus/ obstruction= affected kidney not draining

59
Q

Management options for:
-muscle invasive
vs
-non muscle invasive bladder cancer

A

MIBC:
radical cystectomy/ RT/ RT then radical sugery

NMIBC:
-TURBT
-BCG immunotherapy
-TURBT + post-op mitomycin C chemo

60
Q

Abx for UTI in pregnant women

A

cefalexin

nitro + trimethoprim are teratogenic

MRCS (22 decks)

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