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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
2 commonest surgical procedures for the management of hydrocele
Lord's (plication) Jabouley's (excision + eversion of hydrocele sac)
26
What is a hypospadia
when the urethral meatus is on the VENTRAL aspect of the penis
27
What are the 3 features of a hypospadia
-ventral meatus -ventral bend of penis (Chordee) -doral hooded foreskin
28
Mx of hypospadia
urethroplasty
29
At what age are hypospadias corrected and what specifically should parents be counselled not to do until mx has been discussed
Age= 6-18 months Do not do a circumsition as foreskin maybe vital for reconstruction
30
What are the 3 classes of hypospadias
Based on location of meatus: -anterior/ glandular (most common) -middle (shaft/ penile) -posterior (penoscrotal/ scrotal/ perineal)
31
Short/ long term complications post urethroplasty for hypospadia
Short: bleeding infection blocked catheter bladder spasms Long: urethral fistula urethral/ meatal stenosis/ stricture urethral diverticula poor cosmesis spraying urine voiding dysfunction
32
What is cystinuria
An autosomal recessive condition where there excess cystine (amino acid) in the urine that forms stones/ crystals causing renal colic
33
Hos is cystinuria diagnosed
24hr urine collection USS/ CT KUB Urinanalysis
34
Management of cystinuria
prevent stones forming: -d penicillamine -alkalinisation of urine (potassium citrate/ sodium bicarb/ acetazolamide) -drink water
35
What is priapism
Sustained painful erection without sexual stimulation lasting >4 HOURS
36
Types of priapism
Low flow/ ischaemic= painful High flow/ non-ischaemic= painless
37
Mx of the types of priapism
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
risk factors for SCC bladder Ca
Schistosomiasis long term indwelling catheter
39
Why is the internal vertebral/ Batsons venous plexus significant in prostate cancer
They ae valveless veins hence allow for metastases
40
Lymph drainage of testes vs scrotum
testes = para-aortic/ lumbar nodes scrotal = superficial inguinal nodes
41
lymph drainage of the uterus
fundus= para-aortic body + cervix= internal + external iliac + superficial inguinal nodes
42
what are the muscles/ ligaments that support the uterus
muscle= pelvic floor muscles main support ligaments= broad ligament round ligament ovarian ligament cardinal ligament uterosacral ligament
43
What is the origin/ insertion/ function of the uterine ligaments
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
What are the structures at attach at the perineal body
6 structures: -superfical + -deep transverse perineal muscles -bulbospogiosus -external anal + -urethral sphincter -anterior fibres of levator ani
45
what are the contents of the superficial perineal pouch
ischiocarvernosus bulbospongiosus superficial transverse perineal muscle
46
what divides the superficial and deep perineal pouches
perineal membrane
47
what are the contents of the deep perineal pouch
external urethral sphincter membranous urethra deep transverse perineal muscle internal pudendal artery dorsal nerve of penis/ clitoris
48
what lies between the deep perineal pouch and the pelvic floor/ levator ani
ischiorectal fossa
49
what are the muscles that make up the pelvic floor
coccygeous + levator ani levator ani: puborectalis pubococcygeous iliococcygeous
50
what does the ilioinguinal nerve give sensory supply to ?
79
51
common pathogen causing epididymitis in men <35 older men/ children
>35= gonorrhoea/ chlamidya older/children= E.coli
52
What is a rare, non-infectious cause of epididymitis
amiodarone
53
Nerve supply of the internal and external anal sphincters
internal= hypogastric plexus external= inferior rectal nerve
54
Contents of obturator foramen
obturator artery vein nerve
55
Structures that pass through the greater sciatic foramen -above the piriformis -below the piriformis
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
Structures passing through the lesser sciatic foramen into the perineum
-internal pudendal artery + vein -pudendal nerve -nerve to obturator internus -obturator tendon
57
Organisms causing UTI in: -sexually active woman -had recent instrumentation -no other risk factors -foreign body present (mesh/ sutures)
-sexually active woman= staphylococcus saprophyticus -had recent instrumentation= staph aureus -no other risk factors= E.coli -foreign body present (mesh/ sutures)= pseudomonas
58
What do the below renal conditions appear as on a DTPA renogram -tumour -renal cyst -acute tubular necrosis -transplant rejection -calculus/ obstruction
-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
Management options for: -muscle invasive vs -non muscle invasive bladder cancer
MIBC: radical cystectomy/ RT/ RT then radical sugery NMIBC: -TURBT -BCG immunotherapy -TURBT + post-op mitomycin C chemo
60
Abx for UTI in pregnant women
cefalexin nitro + trimethoprim are teratogenic

MRCS (22 decks)

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