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Pass Med finals pack > surgery - urology > Flashcards

surgery - urology Flashcards

1
Q

what is paraphimosis?

A
  • commonly affects uncircumsized males
  • when foreskin can no longer be pulled forward over tip of penis
  • foreskin becomes swollen and stuck
  • may stop blood flow to tip of penis
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2
Q

what is phimosis?

A

inability to retract foreskin

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3
Q

what is balanitis?

A
  • pain and inflammation (swelling and irritation) of the glans (head) of penis
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4
Q

hydrocele is a collection of fluid in the…

A

tunica vaginalis

surrounding the testis

cystic or fluctuant in nature

would not be distinguishable from the testis itself

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5
Q

testicular malignancy is always treated with…

A

orchidectomy via an inguinal approach

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6
Q

management of varicoceles…

A

conservatively

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7
Q

the following points to what diagnosis?

  • inguinoscrotal swelling, cannot get above it
  • cough impulse may be present
  • may be reducible
A

inguinal hernia

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8
Q

the following points to what diagnosis?

  • discrete testicular nodule
  • symptoms of metastatic disease
A

testicular tumours

  • USS scrotum
  • serum AFP and beta HCG
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9
Q

the following points to what diagnosis?

  • single or multiple cysts
  • may contain clear or opalescent fluid
  • usually occur over 40 years of age
  • painless
  • lie above and behind testis
  • usually possible to get above the lump on examination
A

epidiymal cysts

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10
Q

the following points to what diagnosis?

  • non-painful, soft fluctuant swelling
  • can get above it
  • transilluminate
  • usually contain clear fluid
A

hydrocele

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11
Q

the following points to what diagnosis?

  • severe, sudden onset testicular pain
  • risk factors include abnormal testicular lie
  • typically affects adolescents and young males
  • on examination testis is tender
  • pain not eased by elevation
A

testicular torsion

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12
Q

brainstorm some possible reasons for acute urinary retention in males?

A
  • secondary to BPH
  • urethral strictures, calculi, cystocele, constipation or masses
  • medications affecting nerve signals to bladder: anticholingerics, tricyclic antidepressants, antihistamines, opioids and benzodiazepines
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13
Q

investigations for acute urinary retention:

A
  • urinalysis and culture
  • serum U&Es and creatine to assess kidney injury
  • FBC and CRP for infection
  • PSA not appropriate as typically elevated
  • USS to confirm
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14
Q

how is acute urinary retention managed?

A
  • decompressing bladder via catheterisation
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15
Q

what is epididymo-orchitis ?

A
  • infection of the epididymis and testes
  • pain and swelling
  • due to local spread of infections from genital tract such as chlamydia trachomatic and neisseria gonorrhoeae
  • E-coli in males with low STI risk
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16
Q

important differential for epididymo-orchitis?

A
  • testicular torsion
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17
Q

45 y/o female

  • fluctuating loin to groin pain
  • visible haematuria
  • unable to get comfortable

indicative of:

A

renal stones

- CT KUB gold standard investigation for suspected urolithiasis

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18
Q

calculi or stones that form in the urinary tract:

A
  • urolithiasis
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19
Q

initial management of renal colic?

A
  • NSAID
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20
Q

initial investigations for patients with renal colic?

A
  • urine dipstick and culture
  • serum creatinine and electrolytes to check renal function
  • FBC and CRP to look for associated infection
  • calcium/urate: look for undelrying causes
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21
Q

three treatment options for renal stone?

A
  • shockwave lithotripsy: uncomfortable
  • ureteroscopy: retrograde through ureter into renal pelvis, if pregnant
  • percutaneous nephrolithotomy
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22
Q

51 y/o male

  • swelling L testicle
  • OE: unilateral swelling of L side of scrotum
  • feels separate to testicle itself
  • does not trans-illuminate
  • no superior border
  • can’t be felt in top of scrotum

most likely

A

inguinoscrotal hernia

- swelling you can’t get above

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23
Q

Often history of dysuria and urethral discharge

Swelling may be tender and eased by elevating testis

Most cases due to Chlamydia

Infections with other gram negative organisms may be associated with underlying structural abnormality

likely to be:

A

acute epididymorchitis

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24
Q

This is a gentleman presenting with macroscopic haematuria, dysuria and weight loss.

  • known to have had malaria and schistosomiasis

describe thought process to differential

A
  • source of urinary blood: bladder, prostate, ureters or kidneys
  • combination or dysuria with haematuria points to bladder
  • weight loss suggests malignancy
  • 90% of bladder cancers are transitional cell carcinoma
  • schistosomiasis is a major risk factor for development of squamous cell carcinoma of the bladder
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25
Q

what is the most effective management option in renal cell carcinoma?

A
  • radical nephrectomy

- RCC often resistant to radiotherapy or chemotherapy

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26
Q

renal cell carcinoma typically presents with a triad of:

A
  • haematuria
  • abdominal mass
  • loin pain
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27
Q

describe the two different types of hydrocele?

A
  • communicating: caused by patency of processus vaginalis allowing peritoneal fluid to drain into scrotum
  • non-communicating: caused by excessive fluid production within the tunica vaginalis
28
Q

56 y/o male

  • lethargy, haematuria and haemoptysis
  • OE: hypertensive and has right loin mass - CT shows lesion affecting upper pole of right kidney
  • small cystic centre

likely diangosis?

A
  • renal adenocarcinoma
  • most common renal tumours
  • typically affect renal parenchyma
29
Q

why might renal adenocarcinoma cause haemoptysis?

A
  • cannon ball metastasis in lung

- may cause haemoptysis

30
Q

management for metastatic prostate cancer disease?

A

synthetic GnRH agonist

  • e.g. goserelin
  • cover initially with anti-androgen to prevent rise in testosterone

anti-androgen

orchidecotmy

31
Q

management for localised prostrate cancer T1/T2

A
  • conservative
  • radical prostatectomy
  • radiotherapy
32
Q

management for localised advanced prostate cancer T3/T4

A
  • hormonal therapy
  • radical prostatecotmy: erectile dysfunciton common complication
  • radiotherapy
33
Q

57 y/o male

  • 3 day hx lower back pain, pain on urination, low grade fever
  • tender boggy prostate
  • diffuse lower abdo pain

Urine dip: 2+ of blood in urine

suspected diangosis?

A

prostatitis

- urine sample should be sent for culture

34
Q

most common pathogen associated with acute bacterial prostatitis?

A
  • acute bacterial prostatitis
  • caused by gram negative bacteria entering the prostate gland via the urethra
  • E.coli
35
Q

management for acute bacterial prostatitis?

A
  • 14 day course of a quinolone

- consider STI screening

36
Q

what is a varicoele?

A

abnormal enlargement of testicular veins

diagnosis: doppler
management: conservative

37
Q

Lower urinary tract symptoms in men

VOIDING:

A
  • hestitancy
  • poor or intermittent stream
  • straining
  • incomplete emptying
  • terminal dribbling
38
Q

Lower urinary tract symptoms in males:

STORAGE:

A

Frequency
Urgency
Urinary incontinence
Nocturia

39
Q

management for predominantly voiding symptoms?

A
  1. conservative: pelvic floor, bladder training
  2. ‘moderate or severe symptoms’ - alpha blocker
  3. if prostate enlarged, high risk of progression - 5-alpha reductase inhibitor
40
Q

management for predominantly overactive bladder?

A
  1. conservative: moderating fluid intake
  2. bladder retraining
  3. anti-muscarinic drugs
41
Q

Management of nocturia

A
  1. conservative: moderating fluid intake at night
  2. furosemide 40mg in late afternoon
  3. desmopressin
42
Q

36 y/o builder

  • 1 day hx pain in his groin on right side
  • intermittent
  • extremely severe
  • radiates across from flank
  • ? dehydrated

dipstick
- ++ blood

could be:

A

ureteric calculus

  • right sided loin to groin pain
  • with microscopic haematuria
43
Q

70 y/o male

  • 6 week hx of increased urinary frequency and urgency
  • feeling of incomplete emptying
  • OE DRE: enlarged prostate, feels hard and craggy, raised PSA

what type of cancer is this?

A

adenocarcinoma often in 95% of cases

44
Q

in the acute management of renal colic what is the recommended choice of analgesia?

A

IM diclofenac

45
Q

causes of unilateral hydronephrosis?

4

A

PACT

  • pelvic ureteric obstruction
  • aberrant renal vessels
  • calculi
  • tumours of renal pelvis
46
Q

causes of bilateral hydronephrosis?

5

A

SUPER

  • stenosis of urethra
  • urethral valve
  • prostatic enlargement
  • extensive bladder tumour
  • retro-peritoneal fibrosis
47
Q

investigation of hydronephrosis?

A
  • USS first line
  • IVU assess position of the obstruction
  • CT is renal colic sus
48
Q

management of hydronephrosis?

A
  • remove obstruction and drainage of urine
  • acute upper urinary tract obstruction: nephrostomy
  • chronic upper urinary tract obstruction: ureteric stent or pyeloplasty
49
Q

most common organism causing staghorn calculus?

A
  • proteus mirabilis
50
Q

4 complications of TURP : transurethral resection of the prostate

A

T- transuretral resection of the prostate syndrome

U - urethral stricture

R - retrograde ejaculation

P - perforation of the prostate

51
Q

A 20-year-old complains of severe pain and swelling of the scrotum after a cystoscopy. He had mumps as a child. The testis is tender. The urine dipstick is positive for leucocytes.

A

epidiymo-orchitis

- to differneitate from testiular torision do dipstick

52
Q

An 8-year-old presents with scrotal swelling. He has just recovered from an acute viral illness with swelling of the parotid glands. On examination both testes are tender and slightly swollen.

A

orchitis

may be associated with mumps viral infection

53
Q

what investigation of choice in diagnosing bladder cancer?

A

cystoscopy

54
Q

The first-line investigation of a testicular mass

A

USS

55
Q

A 34-year-old man presents in general practice with a painful right scrotal swelling. He has a past medical history of von Hippel-Lindau syndrome. On examination, a 4mm lump can be felt posterior to and separate to the right testicle. There is no erythema, gross scrotal enlargement, or dysuria. The patient is apyrexial with normal vital signs. Tumour markers are normal.

A

epididymal cyst
- cause of scrotal swelling which can be palpated as separate from body of testicle

would not be epididymo-orchitis
- cause of unilateral testicular pain and swelling

56
Q

68 y/o male

  • nocturia sometimes with urgency
  • finding it difficult to begin urinating
  • poor stream

DRE: enlarged but smooth prostate

what may be given to relieve symptoms?

A

BPH

Alph a-1 antagonist: promotes relaxation of the smooth muscle of prostate and bladder to reduce LUTS

such as tamsulosin

57
Q

A 31-year-old man presents as he and his partner have been having problems conceiving. On examination there is a diffuse lumpy swelling on the left side of his scrotum. This is not painful and the testicle, which can be felt separately, is normal.

A

varicocele

58
Q

A 62-year-old man presents with nocturia, hesitancy and terminal dribbling. Prostate examination reveals a moderately enlarged prostate with no irregular features and a well defined median sulcus.

A

benign prostatic hyperplasia

- alpha-1 antagonist is first line

59
Q

tumour marker in pancreatic cancer

A

CA 19-9

60
Q

tumour marker in ovarian cancer

A

CA125

61
Q

tumour marker in testicular cancer

A

beta HCG

62
Q

common presentation of testicular cancer?

A

painless testicular lump in a 27 year old male

63
Q

Testicular torsion can involve testicular appendage or spermatic cord.

in which type is the cremasteric reflex preserved?

A
  • cremasteric reflex preserved when torsion affects the appendage only
64
Q

Urine culture shows a Proteus infection. An x-ray demonstrates a stag-horn calculus in the left renal pelvis. What is the most likely composition of the renal stone?

A

struvite
- stag horn calculi are composed of struvite and form in alkaline urine

  • ammonia producing bacteria therefore predispose
65
Q

A 69-year-old male presents with haematuria. He worked in the textile industry. He has a left flank mass. A CT IVU shows a lesion of the left renal pelvis.

A

renal transitional cell carcinoma

  • rare form of renal cancer
  • risk factors include exposure to chemicals in the textile, plastic and rubber industry
66
Q

first-line investigation in suspected prostate cancer

A

multiparametric MRI

Pass Med finals pack (40 decks)

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