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2a RRS > GU > Flashcards

GU Flashcards

1
Q

what is the comonest male malignancy in 15-44yos

A

testicular cancer

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2
Q

what is most common type of testic cancer

A

germ cell tumours of whihc 50% = seminoma (sperm producing tissue)

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3
Q

RF of testicular cancer

A

fam Hx
undescended tester
klinefelters syndrome

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4
Q

Cfs of testicular cancer

A 
painless lump
haematospermia
secondary hydrocele
mets? - abdo mass (enlarged nodes)
back pain (bones)
dyspnoea (lungs)
"dragging sensation"
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5
Q

Ix of testic cacner

A

bloods -alpha fetoprotein (made by yolk sac tumurs and others)
beta - hCG (= beta humanchorionic gonadotropin) NEVER IN NORM MEN
lactate dehydrogenase
biopsy = inguinal orchiectomy
CT to assess metastasis

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6
Q

Management of Testicular tumours

A

Radical orchiectomy plus Radiotherapy

chemo

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7
Q

5yr survival rate for testic cancer

A

90%

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8
Q

Staging system for Testicular tumour

A

Stage 1 no metastasize
2 spread to infradiaphragmatic
3 supradiaphragmatic
4 involvement into the lungs

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9
Q

where does prostate cancer most often spread to

A

metastasis to bone and lymph nodes

or spread locally to bladder, seminal vesicles, rectum

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10
Q

Presentation of prostate cancer

A

LUTS, voiding and storing,
+ haematuria, dysuria
Back pain ( also found in prostatitis)
weight loss and anemia

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11
Q

Epidimeology assosiations and risk factors of prostate cancer

A

+ve family history, Age
increased testosterone (Black people)
BRCA2 gene

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12
Q

What type of cancer is prostate cancer and which cells does it originate from

A

adenocarcinoma, originating from epithelium in the TRANSITIONAL ZONE of prostate

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13
Q

Physical examinations for prostate cancer

A

DRE shows hard irregular prostate

examination could show enlarged lymph nodes (late stage)

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14
Q

Investigations for Prostate cancer

A

PSA- Elevated
Transrectal ultrasound and biopsy - diagnostic and graded

CT/MRI used to identify spread.
Bone scan

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15
Q

why does PSA elevation not necces mean prostate cancer

A

PSA increases in BPH (more cells)
after ejaculation
infection
catheters

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16
Q

what scoring system used for Prostate cancer

A 
gleason scoring (/10) 
6 or less = low grade
7=intermed
8-10 = high
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17
Q

DDx of prostate cancer

A

BPH
prostatitis
bladder tumours

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18
Q

complication of prostate cancer

A

spinal cord compression

19
Q

Mx of prostate cancer (metasised)

A

hormone therapy -
STIM INHIB SHRINKS
antiandrogen FIRST - increases testosterone production
high GNRH (Goserelin) therefore pit gland resistent
give LH anatgonist (flutamide ) = no testosterone
+radiotherapy

20
Q

Mx - localised

A

active surveillence
if progressing =
radical Prostatectomy + supplementary chemo and radiotherapy

21
Q

SE of hormone therapy in prostate cancer

A

loss of libido

osteroporosis

22
Q

what is the biomarker in prostate cancer and where found

A

PCA3 - in urine

23
Q

what converts testosterone to dihydrotestosterone

A

5-alpha reductase

24
Q

what does testosterione get converted to

A

dihydrotestosterone (DHT)

25
Q

why is dihydrotestosterone assos w BPH

A

more potent than testosterone and can cross cell membrane and bind to recepotors and inib apoptosis= HYPERPLASIA

26
Q

what is BPH

A

increased size of prostate without malignancy

prolif og musculofibrous/glandular tissue

27
Q

Rf of BPH

A

age
obesity
fam hx

28
Q

what does digital rectal exam show in BPH

A

smooth and enlarged

29
Q

CFs of BPH

A

LUTS
storage - freq, urgency, nocturia
voiding - hesitancy, dysuria, incomplete voiding, post micturation dribbling, poor stream
haematuria, dysuria - Cancer??

30
Q

Dx of BPH

A 
DRE - smooth enlarged
PSA - excl malignancy
Transrectal ultrasound - size 
palp bladder?
Urinalysis: MSU MS and C. all comes back clear, eliminates UTI
dipstick
31
Q

what does α1-adrenergic receptors do

A

vasoconstiction, induces contraction of the urinary bladder

32
Q

lifestyle changes to someone with BPH = mild

A

less caffiene
less alcohol
bladder training

33
Q

complications of BPH

A 
stones 
haematuria 
infections
retention 
renal disease
34
Q

Differential for LUTS voiding and storing

A 
BPH
UTI 
Prostatic carcinoma 
Bladder cancer 
Overactive bladder 
prostatitis
35
Q

Management of BPH

pharamacological

A

5 alpha reductase inhibitor - finasteride (SE = reduced libido)
= decrease in testosterone conversion to dihydrotestosterone
alpha 1 anatagonist - TAMSULOSIN
SE-dry mouth dizzy
or orchiectomy as testosterone linked

36
Q

5-alpha reductase inhib used in BPH

A

finasteride

37
Q

alpha blocker used in BPH

A

tamsulosin (alpha 1 anatagonist)

38
Q

indications for surgey in BPH

A 
RUSHES
retention 
UTI recurrent 
Stones 
Haematuria 
elevated creatinine 
symptoms deterioration (uncontrolled)
39
Q

what is treatment for overactive bladder syndrome

A

Anticholinergics- tolterodine

40
Q

Surgery options for BPH

A

Transurethral resection of prostate (TURP)
Transurethral Incision of Prostate (TUIP)
Prostatectomy

41
Q

what are symptoms of urinary retention

A 
Painful
confusion 
fever 
flank pain 
LUTS
42
Q

what can cause urinary retention

A 
any urethral obstruction 
BPH 
malignancy from outside 
stones,
Anticholinergics 
Iatrogenic
43
Q

treatment of urinary retention

A

Urethral catheter and treat underlying causes

2a RRS (26 decks)

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