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Phase3 Specialties - Imperial College London MBBS > MLA Urology > Flashcards

MLA Urology Flashcards

1
Q

What differentiates between acute urinary retention and chronic urinary retention?

A

Acute = pain and a palpable/percussible bladder

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2
Q

What is the volume threshold for urinary retention post-void?

A

> 200 mL

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3
Q

What is the volume threshold on bladder scan for acute retention?

A

> 500 mL

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4
Q

What is the first line management for acute urinary retention?

A

Immediate catheterisation

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5
Q

What drug should be prescribed prior to the removal of the catheter?

A

Alpha-adrenoreceptor blocker e.g., doxazosin

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6
Q

Following urinary retention, what is a common complication that requires monitoring?

A

Post-obstructive diuresis (assess renal function)

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7
Q

Benign prostatic enlargement anatomically affects which zone?

A

Transitional zone

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8
Q

Which scoring system is indicated to assess for BPH?

A

International Prostate Symptom Score

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9
Q

What is the first line medical therapy for BPH?

A

Alpha-1 antagonists e.g., tamsulosin, alfuzosin (if IPSS >7)

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10
Q

What are the adverse effects associated with alpha-1 antagonists?

A

Dizziness, postural hypotension, dry mouth, depression

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11
Q

What is the 2nd line medical therapy for BPH?

A

: 5-alpha-reductase inhibitors e.g., finasteride

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12
Q

5-alpha reductase inhibitors reduce the conversion of testosterone to what?

A

DHT

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13
Q

What are the adverse effects associated with 5-alpha reductase inhibitors?

A

Erectile dysfunction, reduced libido, ejaculation problems, gynecomastia

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14
Q

What is the surgical intervention for BPH?

A

Transurethral resection of the prostate

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15
Q

What is a common complication associated with Transurethral resection of the prostate ?

A

TURP syndrome - results in dilutional hyponatraemia

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16
Q

What is the major risk factor for squamous cell bladder carcinoma?

A

Endemic urinary schistosomiasis

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16
Q

What is the most common type of bladder cancer?

A

Transitional cell

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17
Q

What are the main risk factors for transitional cell bladder cancer?

A

Aromatic amines e.g., industrial paint processing, dye, rubber and textiles

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18
Q

What is the main clinical presentation associated with bladder cancer?

A

Frank painless haematuria

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19
Q

What are the NICE 2ww referral criteria for a >45 year for suspected bladder cancer?

A

Aged >45 years with unexplained visible haematuria in the absence of a UTI

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20
Q

NICE 2ww referral criteria for >60 years for suspected bladder cancer?

A

Aged >60 years with microscopic haematuria AND
Dysuria
or
Raised WCC on FBC

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21
Q

What the first line investigation following urine dipstick for suspected bladder cancer?

A

Cystoscopy

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22
Q

Which investigation provides a histological diagnosis for bladder cancer?

A

transurethral resection of bladder tumour

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23
Q

What is the management for low-risk non muscle invasive bladder cancer?

A

Discharge to primary care

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24
Q

What is the management for intermediate-risk non-muscle invasive bladder cancer?

A

Cytoscopic follow-up at 3, 9 and 18 months, and once a year thereafter – consider TURBT.

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25
Q

What is the management for high risk non-muscle invasive bladder cancer?

A

Intravesical BCG or radical cystectomy or TURBT + chemotherapy

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26
Q

What is the definitive management for muscle invasive bladder cancer?

A

cisplatin combination AND radical cystectomy/radiotherapy

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27
Q

What is the most common histological subtype of renal cell carcinoma?

A

Clear cell carcinoma

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28
Q

What are the risk factors associated with renal cell carcinoma?

A

Smoking, hypertension, obesity, long-term dialysis, genetic syndromes (VHL).

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29
Q

What are the three most common histological subtypes of renal cell carcinoma?

A
  1. Clear cell renal carcinomas - 70%
  2. Papillary renal carcinoma - 15%
  3. Chromophobe - 5%
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30
Q

What is the classic triad of symptoms associated with renal cell carcinoma?

A
  1. Visible haematuria
  2. Flank pain
  3. Palpable abdominal mass
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31
Q

Renal cell carcinoma commonly metastasises where?

A

Lungs - results in cannonball metastases

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32
Q

What are the three endocrine effects associated with renal cell carcinoma?

A
  • Secrete erythropoietin (polycythaemia)
  • Parathyroid hormone-related protein (hypercalcaemia), renin
  • ACTH
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33
Q

Which side are varicocele most commonly found in renal cell carcinomas?

A

left side

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34
Q

What is the investigation of choice to diagnose renal cell carcinoma?

A

CT thorax, abdomen and pelvis

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35
Q

What is the first line investigation for suspected renal cell carcinoma?

A

Urinalysis

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36
Q

Which large vessel does renal cell carcinoma tend to spread to via the Gerota’s fascia?

A

Inferior vena cava

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37
Q

What is the tumour size threshold for a partial nephrectomy in a renal cell carcinoma?

A

<7 cm

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38
Q

A T2 tumour > x cm = radical nephrectomy?

A

> 7 cm

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39
Q

What is the most common histological subtype for prostate cancer?

A

Adenocarcinoma (95%)

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40
Q

What is the strongest risk factor for prostate cancer?

A

Increasing age >50 years

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41
Q

What are the clinical features of prostate cancer?

A

Early prostate cancer is associated with an asymptomatic presentation.
* Lower back pain
* LUTS
* Lethargy
* Weight loss/anorexia
* Visible haematuria
* Erectile dysfunction
* Bone pain (metastatic disease)

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42
Q

On DRE, what are the findings consistent with prostate cancer?

A

Hard, asymmetric, craggy, hard nodular prostate.

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43
Q

What is the normal PSA range?

A

0-4 ng/mL

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44
Q

What can lead to falsely raised PSA?

A

BPE, prostatitis, recent DRE, urinary tract instrumentations and recent ejaculation

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45
Q

Ejaculation in the previous _ hours is a contraindication to PSA testing?

A

48 hours

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46
Q

Active UTI in the previous _ weeks is a contraindication to PSA testing?

A

6 weeks

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47
Q

Urological intervention in the previous _ weeks is a contraindication to PSA testing?

A

6 weeks

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48
Q

What two activities are are contraindications to PSA testing 48 hours before testing?

A

Ejaculation
Vigorous exercise

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49
Q

What is the first line diagnostic investigation of choice for suspected prostate cancer?

A

Multiparametric MRI

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50
Q

How frequently should PSA be monitored for prostate cancer?

A

Every 6 weeks for 6 months for 2 years

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51
Q

A PSA level > ng/mL in patients aged 50-69 years warrants a 2ww referral?

A

> 3.0

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52
Q

What is the management for low risk localised prostate cancer?

A

Active surveillance
PSA every 6-12 months
Prostate re-biopsy at 12 months

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53
Q

What do the two numbers mean in the Gleason score?

A

There are two grades: 1 for the most dominant grade 1-5, and 2 for the second most dominant grade.

2 is the best prognosis

10 is the worst

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54
Q

What scoring system is used to assess the extent of prostate cancer?

A

Gleason score

55
Q

What is the definitive management option of choice for intermediate-risk prostate cancer?

A

Radical prostatectomy

56
Q

When should a re-biopsy be performed for low risk prostate cancer?

A

12 months

57
Q

Which androgen deprivation therapy agent is associated with the management of intermediate risk prostate cancer?

A

(LHRH agonist e.g., goserelin) or GnRH antagonist e.g., degarelix.

58
Q

What is the acute complication associated with the use of GnRH agonists in the management of prostate cancer?

A

Causes tumour flare - use an anti-androgen to prevent a rise in testosterone e.g., bicalutamide

59
Q

What is the management of a tumour flare in prostate cancer?

A

Medroxyprogesterone acetate or cyproterone acetate.

60
Q

How is erectile dysfunction managed in the management of prostate cancer?

A

PDE-5 inhibitors

61
Q

Which drugs are associated with overflow incontinence?

A

ACEi, antidepressants, antimuscarinics, and antiparkinsonian drugs

62
Q

Which test is used to assess bladder compliance in patients with urinary incontinence?

A

Urodynamic tests

63
Q

What is the first line management for urge incontinence?

A

6-week trial of bladder retraining

64
Q

What is the 2nd line management for urge incontinence?

A

Oxybutynin

65
Q

What is the third line management for urge incontinence?

A

Botulinum A toxin or percutaneous sacral/posterior tibial nerve stimulation.

66
Q

What is the most common cause of prostatitis?

A

E. coli (~50%); pseudomonas aeruginosa

67
Q

What are the risk factors associated with prostatitis?

A

Urethral instrumentation, trauma, bladder, outflow obstruction or dissemination of infection.

68
Q

What is the first line antibiotic for the management of prostatitis?

A

Ciprofloxacin

69
Q

What class of antibiotic is Ciprofloxacin ?

A

fluoroquinolones

70
Q

What are the adverse effects associated with fluoroquinolones?

A

Tendonitis, tendon rupture, muscle pain, joint swelling, peripheral neuropathy

71
Q

What type of priapism is caused by sickle cell disease?

A

Low flow ischaemic (veno-occlusive)

72
Q

A prolonged erection by x > hours defines priapism?

A

4 hours

73
Q

Rigidity of what penile structure is implicated in the pathogenesis of priapism?

A

rigidity of the corpora cavernosa

74
Q

Ischaemic priapism is classically associated with what presentation?

A

progressive penile pain and erection is rigid + SOFT glans penis.

75
Q

What is the first line investigation for priapism?

A

Aspiration of blood from the corpora cavernosa to perform a cavernosal blood gas analysis (perform an ultrasound prior to aspiration).

76
Q

How does a Cavernosal blood gas differentiate between ischaemic versus non ischaemic priapism?

A
  • Results: Dark ischaemic blood – differentiates ischaemic and non-ischaemic priapism.
    o pO2 <30 | pCO2 >60 | pH <7.25
77
Q

Penile Doppler US findings in ischaemic priapism?

A

Sluggish non-existent blood flow (low-flow)

78
Q

What is the first line management of priapism?

A

Aspiration and irrigation with 0.9% saline solution

79
Q

What is the second line management of priapism?

A

Intracavernosal therapy with phenylephrine

80
Q

What is the third line management of priapism?

A

Surgical shunting

81
Q

Rupture of which structure is associated with a penile fracture?

A

tunica albuginea (during an erection)

82
Q

What eponymous sign is associated with a penile fracture?

A
  • Aubergine sign or Eggplant sign.
83
Q

What fascia is breached for there to be extensive haematoma into the perineum following a penile fracture?

A

Buck’s fascia

84
Q

What is the first line investigation of choice for a penile fracture?

A

Ultrasonography of the penis

85
Q

What is the immediate management for a penile fracture?

A

Urgent exploration and repair of the tunica albuginea (within 24 hours of presentation).

86
Q

What is the most common organism implicated in Balanitis?

A

o Candida albicans

87
Q

What is the characteristic clinical finding observed in Zoon’s balanitis?

A

Cayenne pepper spots (symmetrical orange0red lesions with pinpoint red spots)

88
Q

What is the first line management of candidal balanitis?

A

Clotrimazole cream 1%

89
Q

What is the first line management for anaerobic balanitis?

A

metronidazole

90
Q

What drug is the first line management for lichen sclerosus?

A

Clobetasol propionate - potent topical steroid

91
Q

What further investigation is indicated in a patient with Zoon’s balanitis?

A

Refer for penile biopsy to exclude penile intraepithelial neoplasia.

92
Q

What is the most common type of testicular cancer?

A
  • Seminomas
93
Q

What are the four most common non-seminoma germ cell testicular cancer?

A
  • Embryonal carcinoma
  • Yolk sac
  • Choriocarcinoma
  • Post-pubertal teratoma
94
Q

What are the common non-germ cell testicular cancers?

A

sex cord-stromal tumours e.g., Leydig/Sertoli/granulosa cell tumours.

95
Q

What are the risk factors associated with testicular cancer?

A
  • Cryptorchidism
  • Hypospadias
  • Decreased spermatogenesis and impaired fertility
  • Klinefelter’s syndrome
  • Mumps orchitis
96
Q

What is the clinical presentation of testicular cancer?

A

Present as a painless testicular mass or as an incidental finding on ultrasound.

97
Q

Which tumour cell marker is raised in a seminoma?

A

hCG

98
Q

Which two tumour cell markers are raised in a non-seminoma?

A

AFP or beta-hCG

99
Q

What is the first line investigation of choice for suspected testicular cancer?

A

Testicular ultrasound

100
Q

What is the first line management for testicular cancer?

A

Orchidectomy + division of the spermatic cord at the internal inguinal ring.

101
Q

Which deformity is associated with increasing the risk of testicular torsion?

A

Bell-clapper deformity

102
Q

Which reflex is absent in testicular torsion?

A

cremasteric reflex

103
Q

Which sign refers to sustained pain upon elevation of the testes?

A

Phren’s sign

104
Q

Is Phren’s sign positive or negative in testicular torsion?

A

Negative

105
Q

Which scoring system is used to indicate whether an immediate scrotal exploration is required in a patient with suspected testicular torsion?

A

TWIST Score

106
Q

What is the immediate management for testicular torsion?

A

Immediate scrotal exploration

107
Q

What is the definitive management of testicular torsion?

A
  • Bilateral orchidopexy (viable) – fix both testicles.
108
Q

Which two organisms are the most common cause of Epidiymo-orchitis in young males?

A

chlamydia trachomatis and Neisseria gonorrhoeae

109
Q

Which organism is the most common cause of Epidiymo-orchitis in older adults with a low sexual history?

A

E. coli

110
Q

What test is indicated in a young male with Epidiymo-orchitis?

A

NAAT testing

111
Q

What test is indicated in an older adult with a low sex history with suspected Epidiymo-orchitis?

A

Mid-steam urine sample and urine dipstick

112
Q

What is the management of Epidiymo-orchitis in a sexually active adult?

A

Ceftriaxone 1 g IM AND oral doxycycline 100 mg BDS for 10-14 days

113
Q

What is the antibiotic of choice for Epidiymo-orchitis (with a low sex history)?

A

Oral ofloxacin 200 mg BDS for 14 days or oral levofloxacin 500 mg OD for 10 days

114
Q

What is the first line of management of hydrocele in an infant?

A

Reassurance for 1-2 years - refer to paediatric surgeon is present after 12 months

115
Q

Which scrotal pathology transilluminates and confined to the scrotum (cannot get above the mass on examination)?

A

Hydrocele

116
Q

What is the conservative management for a hydrocele in an adult?

A

scrotal support e.g., supportive underwear

117
Q

Which plexus is enlarged in a patient with a varicocele?

A

pampiniform plexus

118
Q

Which vein is most implicated in the pathogenesis of a varicocele?

A

left testicular vein

119
Q

What is the clinical presentation of a varicocele?

A
  • Throbbing/dull pain or discomfort, worse on standing.
  • A dragging sensation
  • A ‘bag of worms’ sensation
  • Disappears when lying down
  • Asymmetry in testicular size
  • Sub-fertility or infertility
120
Q

What investigation is preferred as first line to confirm the diagnosis of a varicocele?

A

Doppler imaging

121
Q

Which bacteria is associated with Fournier Gangrene?

A

Group A streptococci

122
Q

Which drug increases the risk of Fournier gangrene?

A
  • SGLT-2 inhibitor
123
Q

What is the most common pre-existing condition associated with Fournier Gangrene?

A

Diabetes mellitus

124
Q

What is the definitive management for Fournier Gangrene?

A
  • Urgent surgical referral debridement and intravenous antibiotics
125
Q

What is the most common cause of erectile dysfunction?

A
  • Vasculogenic (most common):
  • Cardiovascular disease e.g., hypertension, peripheral arterial disease, hyperlipidaemia, type ½ diabetes mellitus, metabolic syndrome, smoking, obesity, major pelvic surgery.
126
Q

Which drugs are associated with erectile dysfunction?

A
  • Antihypertensives e.g., beta-blockers, verapamil, methyldopa, and clonidine.
  • Diuretics e.g., spironolactone and thiazides.
  • Antidepressants e.g., SSRIs, lithium
127
Q

What should be calculated in all patients with erectile dysfunction?

A

10-year cardiovascular risk

128
Q

What is the first line of investigation for patients with erectile dysfunction?

A

Serum testosterone level (taken between 9-11 am

129
Q

What is the first line of management for a young person with ED?

A

Referral to a urologist specialist.

130
Q

What drug is indicated in patients with ED?

A

Phosphodiesterase inhibitors (not for high cardiac risk):
* E.g., sildenafil and tadalafil – 50 mg tablets can be purchased over the counter,

131
Q

What is the first line analgesia for renal stones?

A

IM/rectal diclofenac, ibuprofen

132
Q

What is the second line analgesia if IM diclofenac is ineffective in renal stone management?

A

IV paracetamol

133
Q

What is the management of renal stones measuring 5-10 mm?

A

Shockwave lithotripsy

134
Q

What is the management of renal stones measuring >20 mm?

A

Percutaneous nephrolithotomy

135
Q

What is the investigation of choice for renal stones?

A
  • Non-contrast CT KUB

Phase3 Specialties - Imperial College London MBBS (12 decks)

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