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Year 3 > MedEd urology > Flashcards

MedEd urology Flashcards

1
Q

What is the most common cause of epididymitis in people under 35?

A

Gonorrhea and chlamydia

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2
Q

What bacteria causes most UTIs?

A

E coli

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3
Q

What are differentials for scrotal mass?

A 
Testicular torsion
Epididymitis/ orchitis
Testicuar cancer
Variocele
Hydrocele
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4
Q

What is testicular torsion?

A

Twisting of spermatic cord resulting in constriction of vascular supply and ischaemia of testicular tissue

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5
Q

What are the types of testicular torsion and which is more common? How are they differentiated?

A

Intravaginal- most common and within the tunica vaginalis

Extravaginal- entire testes and tunica vaginalis twists

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6
Q

What are RF for testicular torsion?

A

If intravaginal- age under 25 years and bell clapper deformity

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7
Q

How will someone with testicular torsion present?

A 
Painful
Swollen hot tender erythemous scrotum
Unilateral 
Raised affected testicle
Absent cremasteric reflex
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8
Q

How do you perform the cremasteric reflex?

A

Stroke the inner thigh of the affected testicle and see if it rises

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9
Q

How quickly do you have to treat testicular torsion?

A

Within 6 hrs of symptom onset

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10
Q

What is GS investigation for testicuar torsion? What is second line

A

Emergency exploration of the scrotum within 6hrs of symptom onset
Testicle twisted back and bilateral orchidopexy
second line manual de torsion if surgery is not availbale

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11
Q

What is epididymitis/orchitis?

A

Inflammation of the epididymis or testes

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12
Q

What are causes of epididymitis/orchitis? Describe organisms in under and over 35s

A

Bacterial infection- chlamydia most common or gonorrhea if under 35
If over 35 mainly klebsiella, e coli, enterococcis faecalis
Non infective= trauma, vasculitis, medication

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13
Q

What are RF for epididymitis/orchitis?

A

Unprotected sex
Bladder outflow obstruction
UTI
Immunosupressed- more likely atypicals eg candida

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14
Q

How does epididymitis/orchitis present?

A 
Painful
Swollen, hot tender erythemous scrotum 
Unilateral
Presents over a few days
urinary syptoms= dysuria, retention
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15
Q

How can you differentiate epididymitis/orchitis from testicular torsion?

A

Different RF
Testicular torsion usually in younger people but epidid= all ages
Cremasteric reflex painful but may be present in epidid vs absent in testicular torsion
There will be dysuria and urgency in epididymitis/orchitis

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16
Q

What inevstigations are done for for epididymitis/orchitis? What will be seen

A

Urine dip, MSU and MC&s bedside
Bloods- WCC high, UEs
Imaging- colour duplex USS

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17
Q

How is epididymitis/orchitis managed?

A 
Conservative= bed rest and scrotal elevation
Medical= analgesia, abx to target infection
Surgical= exploration of the testes if torsion can't be excluded and abscess drainage if abscess develops
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18
Q

What is variocele?

A

Dilated veins of the pampiniform plexus forming a scrotal mass

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19
Q

How does variocele arise?

A

high hydrostatic pressure (esp left renal vein)

imcompetent veinous valves

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20
Q

What side is variocele more common in?

A

Left

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21
Q

How will variocele present?

A

Asympotmatic

Looks like a bag of worms

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22
Q

What investigations are done for variocele?

A

Examine the patient standing up
May be fertility analysis
May do ultrasound if it doesnt diminish when they lie down

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23
Q

In what position will variocele be less prominent? Why is this important?

A

Lying down
You have to examine them standing up
If it doesnt reduce when they lie down there is a problem

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24
Q

How is variocele managed?

A

Reassure and observe

If fertility is comprimised then surgery

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25
Q

What is hydrocele?

A

A collection of serous fluid in the tunica vaginalis

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26
Q

What are the types of hydrocele and how do they differ?

A

Communicating- processus vaginalis is open- peritoneal fluid flows in from abdomen
Non communicating- processus vaginalis is closed

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27
Q

What are RF for hydrocele?

A

Male
Children
Non communicating- trauma, infection, testicular torsion, testicular cancer
Communicating- increased intraperitoneal fluid eg ascites

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28
Q

How does hydrocele present?

A 
Asymptomatic
Scrotal swelling
Possible to get above swelling
Enlarges after activity eg coughing and straining
Will transilluminate
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29
Q

What investigations are done for hydrocele? Why are they done

A

Clinical diagnosis
Urine dip- rule out infection
USS- exclude tumor
Bloods- exclude testicular tumor markers

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30
Q

How is hydrocele managed?

A

Observe

If too uncomfortable offer surgery

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31
Q

What are the types of testicular cancers?

A

Seminomas

Non seminomatous germ cell tumors

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32
Q

What are RF for testicular cancer?

A

Cryptorchidism
Ectopic testes
Testicular atrophy
FHX

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33
Q

How does testicular cancer present

A 
Painless hard nodular unilateal testicular mass
Lymphadenopathy
Gynaecomastia
Back ache
Hydrocele
34
Q

How is testicular cancer inevstigated?

A

FBC, UEs, LFTs
Tumor markers- alpha fetoprotein, beta HCG, LDH
Image w testicular ultrasound, CT AP, CXR

35
Q

What tumor markers are checked for testicular cancer?

A

alpha fetoprotein, beta HCG, LDH

36
Q

Where does testicular cancer metastase to and how?

A

Through para aortic lymph nodes to chest

37
Q

How is testicular cancer managed?

A

Ochiectomy

Chemotherapy

38
Q

What is UTI?

A

Presence of a pure growth of >10^5 organisms per mL of fresh MSU

39
Q

What is cystitis?

A

Infection of bladder

40
Q

What are RF for UTI?

A 
Female
Sexual intercourse
Immunosupression
Catheterisation
Urinary tract obstruction- BPH, urinary tract calculi
41
Q

Why are females at higher risk of UTI?

A

Urethra is way smaller in length than in a man

42
Q

How will UTI present?

A 
Storage symptoms (bladder doesnt want to store urine as its inflammed):
Increased frequency
Urgency
Dysuria
Foul smelling
43
Q

How does pyelonephritis present?

A

Flank pain
Fever
Malaise

44
Q

What is GS investigation for UTI? What else will you do and what will you see?

A

MSU for MC&s

first line Urine dip- +nitrates and WC

45
Q

What is the most common abx for UTI

A

Nitroflurotonin

46
Q

What are the 3 points of urinary tract calculi commonly?

A

Ureteropelvic junction
Pelvic brim where ureters cross iliac vessels
Ureterovesical junction

47
Q

How do kidney stones arise?

A

Urinary solutes are high in the urine- they supersaturate and precipitate out of the solution

48
Q

What are RF for kidney stones?

A 
Dehydration
high protein intake
High salt
structural abnormality
PMHx
FHx
49
Q

How is more likely to get kidney stones?

A

Males
30-50 y/o
Hot and dry countries (causes dehydration)

50
Q

How will kidney stones present?

A 
Intially sympotatic
If it gets stuck:
Acute severe loin to groin pain= renal colic
Nausea and vomitting
Unable to lie still, writhing in pain
Urgency, frequency and haematuria
Heamaturia is usually microscopic
51
Q

What are investigations for kidney stones? What is GS imaging? What will you see?

A

First line urine dip
Pregnancy test if female to rule out ectopic pregnancy
Bloods- FBC, WCC to rule out UTI, UEs/Cr/Ca to check kidney function
GS imaging- non contrast CT KUB

52
Q

How are kindey stones managed?

A 
Acute= fluids, analgesia (diclofenac), anti emetics (ondansetron), urine collection to collect and analysed passed stone
<5mm= leave to pass
<10mm= alpha blocker (tamsulosin), if not passed in 4-6 weeks surgery
>10mm= surgery first line extracoroporeal shock wave lithotripsy
53
Q

What are complications of kidney stones?

A 
Pyelonephritis
Septicaemia
Obstruction
Urinary retention
Hydronephrosis
54
Q

What is BPH?

A

Diffuse hyperplasia of the periurethral zone

55
Q

Who is more likely to get BPH?

A

Increasing age

Afro carribeans

56
Q

How does BPH present?

A

Lower urinary tract symptoms:
Storage= urgency, frequency
Voiding= hesitancy

Bone pain
FLAWS

57
Q

What acronym is used to remember storage and voiding symptoms

A

FUND HIPS:
Fund= storage symptoms= frequency, urgency, nocturia, dysuria
Hips= voiding= hesitency, incomplete voiding, poor stream

58
Q

How is BPH investigated? What will you see? What is GS imaging

A

Urinalysis to exclude UTI
DRE- smoothly enlarged palpable midline grooce
PSA- high
UEs to check renal function
GS imaging- transrectal US guided needle biopsy

59
Q

What is used to check for mets in prostate cancer?

A

Isotope bone scan

CXR

60
Q

How is BPH managed?

A

Lifetsyle adv= avoid caffeine
Review thier medications- anticholinergics cause it
1st line= alpha tamsulosin (a1 blocker)
2nd line= 5a reductase inhib= finasteride
surgery= transurethral resection of prostate

61
Q

What are the 2 main types of bladder cancer? Which is more common

A

urothelial carcinoma- most common

squamous cell carcinoma

62
Q

What are RF for bladder cancer

A

General: males, over 55 years

Urothelial- smoking, carcinogen exposure, aromatic amines, arsenic, painters and hairdressers

63
Q

How will bladder cancer present?

A

Painless macroscopic haematuria
FLAWS
Storage and voiding problems- FUND HIPS

64
Q

What are investigations for bladder cancer?

A 
1st line= urinalysis
FBC
ALP- high if bone mets
UEs
GS imaging- cystoscopy and biopsy
Also do MRI, to check mets isotope bone scan and CXR
65
Q

What type of testicular torsion is more common in neonates?

A

Extravaginal

66
Q

What is the difference between intravaginal and extravaginal testicular torsion?

A 
Intravaginal= twisting is within the tunica vaginalis 
Extravaginal= twisting is of the entire testes and tunica vaginalis
67
Q

What deformity increases risk of intravaginal testicular torsion?

A

Bell clapper deformity

68
Q

What bacterial organisms cause epdidymitis/orchitis in under 35s?

A

Chlamydia most commonly

Gonorrhea

69
Q

What bacterial organisms cause epdidymitis/orchitis in over 35s?

A

Klebsiella

E coli

70
Q

What should happen in variocele when you get the patient to lie down?

A

The vessels should disappear

71
Q

What lymph nodes are involved with metastasis of testicular cancer?

A

Para aortic

72
Q

What will you see on MC&S and MSU in pyelonephritis?

A

White cell casts

73
Q

What are the types of urinary tract calculi and which is most common?

A

Calcium oxalate is most common
Struvite
Urate/uric acid
Hydroxyapatite

74
Q

What urinary tract calculi is not visible on x ray?

A

Urate or uric acid

75
Q

What are some causes of urinary tract calculi?

A

High Ca, uric acid, oxalate or Na
Metabolism eg hyperparathyroidism causing high ca
Infection
Drugs

76
Q

What is the difference between BPH and prostate cancer on DRE?

A

BPH= smoothly enlarged prostate with palpable midline groove
Prostate cancer= asymmetrical hard nodular prostate with loss of midline sulcus

77
Q

What is the difference between PSA levels in BPH and prostate cancer?

A

Levels are high in both (>4)

78
Q

What is the GS ix for prostate cancer and BPH?

A

Transrectal US guided needle biopsy

If cancer then isotope bone scan to check for mets

79
Q

What professions are more likely to have bladder cancer?

A

Painters

Hairdressers

80
Q

What type of kidney stones are patients predisposed to if they have recurrent UTIs with recurrent urease positive bacteria?

A

Struvite

Year 3 (104 decks)

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