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GS Medbear > Medbear Uro > Flashcards

Medbear Uro Flashcards

1
Q

Points of constriction in ureter?

A

Pelvic - Ureteric Junction
Pelvic Brim near bifurcation of common iliac arteries
Vesico-ureteric junction - entry to bladder

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2
Q

Types of ureter calculi?

A

Calcium Oxalate - 75%
Calcium phosphate - 10%
Struvite - 5~10%
Urate stones 5% Radiolucent
Cystine
Xanthine Radiolucent

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3
Q

Why is calcium oxalate stone significant (besides being 75%)

A

It causes symptoms when comparatively small owing to sharp surface

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4
Q

Which stones are caused by acidic urine

A

urate stones. The rest all alkaline urine.

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5
Q

Pain of calculi?

A

Pain - typically begins in early morning and intensifies over 15-30min
Develops in outbursts and related to movement of stones in ureter

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6
Q

Presentation of calculi?

A

Obstruction
Ulceration - haematuria
Chronic infection

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7
Q

Where can stones be?

A

kidneys
Ureter
Bladder

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8
Q

Are renal stones symptomatic

A

Mostly no, unless stone is lodged in PUJ causing hydronephrosis and subsequent infection -> pyonephrosis

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9
Q

Chracteristics of ureteric stones?

A

Even small stones cause severe symptoms
Severe intermittent loin-to-groin pain
Haematuria - 95%
Upper UTI
VUJ stone cause frequency, urgency, dysuria

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10
Q

What kind of diet to raise risk of stones?

A

High protein and sodium intake.

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11
Q

Predisposing conditions for stone formation?

A

Crohn’s
Gout
Renal Tubular Acidosis - Type 1, distal
Hyper PTH
Metastatic cancer, paraneoplastic syndrome

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12
Q

How to test for pyelonephritis on PE?

A

Positive renal punch (possibly)

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13
Q

PE is often unremarkable for stones

A

Yeaa

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14
Q

In PE, symptoms are often out of proportion to signs. What can be seen?

A

No guarding, no rebound

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15
Q

What does nitrite in urine mean?

A

it means UTI. Can be due to nitrite producing organisms like E. Coli, Klebsiella, Proteus

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16
Q

Principles of urolithiasis therapy?

A

Pain control
Treat any suspected UTI
Allow for spontaneous passage of stones OR active stone removal

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17
Q

Principles for Kidney stone removal?

A

Kidney stones often asymptomatic. Treat pre-emptively if u see any complications.
Observe if <5mm and monitor for growth. Treat if >7mm

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18
Q

Principles for ureteric stone removal?

A

Always symptomatic. Hence allow trial of passage if <7mm. Otherwise treat.

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19
Q

3 phases of CT Urogram?

A

Non-contrast phase for detection of stones
Renal parenchymal phase for detection of tumours
Excretory/delayed phase

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20
Q

Who is CT Urogram recommended for?

A

Patients with unexplained persistent gross haematuria

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21
Q

What is cystoscopy used for?

A

Gold Standard for evaluating lower urinary tract.
Can detect small bladder tumours as IVU may not detect tumours <1cm.
Biopsy can be taken together

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22
Q

Renal Cell Carcinoma etiology?

A

Mostly sporadic.
Higher rates seen in VHL disease and tuberous sclerosis complex.

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23
Q

Highest risk factor for RCC?

A

Smoking!!
2nd = prior kidney irradiation.
Family hx impt as well

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24
Q

Spread of RCC?

A

Infiltrate locally or by haematogenous spread

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25
Benign Differentials for RCC?
Angiomyolipoma Renal Cyst Renal adenoma / abscess Pyelonephritis Renal oncocytoma
26
Bosniak Classification of renal cysts
1 - simple cyst 2 - minimally complex 2F - Minimally complex, need follow up 3 - Indeterminate 4 - Clearly malignant
27
Triad of RCC?
Painless haematuria Mass in flank Flank Pain
28
How does mass feel in RCC?
Firm, homogenous, non-tender. Moves with respiration
29
Paraneoplastic syndromes of RCC?
Hypertension - renin overproduction Stauffer Syndrome -> ALP elevated Hypercalcaemia Cushings Syndrome Androgen imbalance - Gonadotropin release Polycythaemia - EPO prod by tumour ## Footnote can have hypoNa due to renin too
30
Cardinal signs of glomerular nephritis?
Hypertension Proteinuria Haematuria
31
What imaging for RCC?
CT Kidneys (best) US Kidneys Do bone scan + CT thorax for staging
32
What can be seen in RCC imaging?
Presumptive diagnosis made with imaging. Renal parenchymal mass with thickened irregular walls and enhancement after contrast injection suggests malignancy
33
How to differentiate cystic from solid renal mass with US?
3 criteria: Classical cysts are 1. Round and sharply demarcated with smooth walls 2. Anechoic 3. Strong posterior acoustic enhancement. No need for further evaluation if all 3 fulfilled. If not go for CT with contrast.
34
Where does testis develop from?
Mesoderm of urogenital ridge
35
4 Questions to be asked in scrotal swelling and pain
Can you get above the swelling? Can you identify the testis and epididymis? Is swelling transilluminable? Is swelling tender?
36
What is testicular torsion?
Sudden twisting of spermatic cord within the scrotum. Most commonly affects neonates and young men.
37
Pain of testicular torsion?
Sudden-onset unilateral testicular pain. Can radiate to lower abdo (T10 innervation), with N/V. Prev attacks of self-limiting pain, ppt by trauma, cycling, straining, sex
38
Clinical findings of testicular torsion?
High-riding testis Absent cremasteric reflex Negative Prehn sign
39
Most impt RF for prostatic CA?
Age >60
40
Clinical presentation of Prostatic CA?
- Persistent Painless hematuria 90%. Typically gross, painless, intermittent, occurs throughout the stream. - LUTS
41
congenital PUJ obstruction recurs at what age and how?
Recur in teenagers as loin pain
42
congenital PUJ obstruction management?
Close observation with prophylactic Abx first. Surgical intervention is called pyeloplasty.
43
What is stress incontinence?
Incontinence on increase of abdominal pressures
44
Risk factors for testicular torsion?
12-18yr age group Cryptorchidism - undescended testis
45
PE of testicular torsion shows?
Swollen and tender scrotum High riding in scrotum with transverse lie Absent cremasteric reflex Negative Prehn sign
46
Investigations for testicular torsion?
Colour Doppler US
47
How long before irreversible damage to testis in testicular torsion?
irreversible damage after 12 hrs of ischemia
48
Presentation of epididymo-orchitis?
Gradual testicular pain and swelling with UTI symptoms. Cremasteric reflex positive
49
Differentiate renal stone types on XR?
Urate and xanthine stones are radio-lucent. The rest all radio-opaque
50
What does Nitroprusside test for?
Cysteine kidney stones
51
What is spastic incontinence?
when the bladder muscle squeezes suddenly without warning, causing an urgent need to release urine.
52
Presentation of varicocele?
Dull aching, left scrotal pain - noticeable when standing and relieved by lying down. Testicular atrophy Lower fertility
53
Majority of varicoceles resolve by when?
1 year old mark
54
Is nocturia LUTS?
no
55
Examples of urological emergencies?
ARU, Testicular Torsion, priapism, post-TURP Haemorrhage
56
What is Jaboulay's procedure?
To evert tunica vaginalis. Subtotal excision of Tunica Vaginalis sac
57
By what age/month should testicles descend by?
6 months. After that unlikely to descend spontaneously
58
Surgery to descend testis into scrotum?
Orchidopexy
59
What conditions are undescended testis associated with?
Hernia Testicular CA Infertility
60
What can orchidectomy of torsioned testes cause?
Subfertility! Cuz contralateral testes can produce anti-sperm Ab
61
How does RBC type tell u origin of haematuria?
Dysmorphic RBC = glomerular bleed Isomorphic RBC = non-glomerular or urological
62
Why does varicocele mainly happen in left hemi-scrotum?
Left spermatic vein enters left renal vein at a 90 degree angle. Intravascular Pa in left renal vein is higher than right.
63
What is varicocele?
Dilatation of veins of pampiniform plexus of spermatic cord
64
How serious of PVRU before seeking consult?
When PVRU >300mL
65
Can trauma cause varicocele?
Yes - secondary varicoceles
66
Modifiable risk factors for urolithiasis?
Diet - low fluid, low Ca, high oxalate, high protein, high sodium, high fructose Dehydration - low urine volume Massive ingestion of Vit D or Vit C Milk-Alkali syndrome
67
Risk factors for RCC?
Smoking top Env exposure = cadmium in coke oven workers, asbestos, petroleum byproducts VHL syndrome Hereditary Papillary RCC (HPRCC) ADPKD (30% riskier)
68
Prostate volume for BPH?
30g according to Du Jingzeng
69
1st line treatment for BPH?
Alpha-blockers. Alfuzosin, Tamsulosin, Prazosin Blocks a-1-adrenergic receptors in bladder neck, prostate and urethra. Lowers outflow resistance and lowers bladder instability ## Footnote ADR include postural hypotension, dizziness, lethargy
70
Gold standard to find urogenital abnormalities?
CT urogram. XR KUB is not sensitive enough to find tumour.
71
Treatment principles for loca RCC without mets?
Radical nephrectomy. RCC is unresponsive to chemo/radiotherapy.
72
Surgical options for advanced RCC with mets?
Immunotherapy with high dose IL-2 Molecular targeted therapy (Sorafenib or Bevacizumab)
73
73
Does kidney stone cause LUTS?
No. usu more loin to groin pain

GS Medbear (14 decks)

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