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Urology > Uro Competencies > Flashcards

Uro Competencies Flashcards

1
Q

UTI in adult ( male or female). the story

A

hx dysuria, frequency, urgency, foul smelling urine. if Pyelo - also hace CVA tenderness/ Chills. Px: fever, chills? Ix: UA- R+M to look for leukocytosis, hematuria, nitries and nitrites/ C+S for bug. tx: septra/nitro

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2
Q

DDX of UTI ( urinary frequency, dysuria, hesitatnct etc)

A

pyelonephritis, BPH, prostatitis, GU malignancy, obstruction, vesicouteral reflex

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3
Q

what are the common organisms that cause UTI?

A

KEEPS! Klebsiella, Ecoli, Enterobacter, Psudomonas, Proteus, Saphrophyticus
Atypicals= TB, mycoplasma, Chlmydia, fungi

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4
Q

gross Hematuria in adults

A

hx: seeing blood. Can be painful or painless, transient or sustained, Initial, midsteam or end of stream, glomerular or nonglomerular. Ask about TICS: tumour, infxn + resp infxns, Calculi, sickcle cell DDX: think prerenal, renal and postrenal.Px: HTN? ix: UA RM- see blood, casts or not, C/S- re infxn. Image upper and lower urinary tract: cystoscopy, U/S or CT. Then tx

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5
Q

DDX gross hematuria

A

Pseudohematuria- beets, vaginal bleeds,
Prerenal : blood things like sickle cell,
Renal- IgA nephropathy after resp infx, renal parenchymal mass/tumour, stones, infexn (pyelo)
Post renal- Stones, tumour, trauma, bladder tumour, obstruction like BPH, urethral stricture/

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6
Q 
Gross hematuria+ pyuria/dysuria
Unilateral flank pain + hematuria
Obstructive sx+ gross hematuria 
ran a marathon, hematuria
transient microhematuria
A 
if under 40 probs benign, if over 40 can be bladder cancer and needs ful workup
dx? UTI
stone
BPH
exercise-induced
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7
Q

story of BPH

A

Older man ( 50% of 50 yr old men, 80% 80 yo men) with FUNWISE sx AKA LUTS sx( frequency, urgency, nocturia, weak stream, incomplete emptying, straining, intermittent flow. px: DRE: large, syymetrical, smooth rubbery prostate. ix: U/A excluse UTI, PSA to r/o malignancy=- biopsy, PVR to measure distention, trus urethral ultrasound/ cystopscy for surgical planning. tx: conservative watch, meds ( flomax A1 blocker + 5A reductase inhibitors work synergistically). Surgery botox, HIFU, TURP/ laser ablation, open prostatectomy

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8
Q

pathophys BPH

A

etiology unknown, just as yuo get older, your prostate gets bigger. DHT binds to receptors and casues increased prostate growth, so we use 5A reductase inhibitors to stop testosterone from being converted to DHT. The periurethral region is involved.

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9
Q

what is the symptom scoring system using in BPH?

A

IPSS scoring - intern’l prostate symptom score

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10
Q

story renal colic

A

male who eats 10lbs strawberries nad lactose intolerant so eats no calcium wth classic triad : flank pain, colicky radiating to scrotum/ labia + hematuria+ N/V/D. Px: things above Ix: CBC( WBC count), UA for pyuria/bacteruria and pH- Lytes and Cr ( assess obstruction). Then image abdomen: Xray KUB or CT noncontrast KUB. tx depending on stone type, but generally conservative= fluids, antiemetics, analgesia if under 7mm.over 8mm = needs ureteral stent, ESWL, percutanous removal

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11
Q

what are the stone types and how do we treat them

A

OPUS: Oxalate Phosphate Uric Struvite

1) calcium oxalate, having low calcium and lots of Oxalate ( cholcoate) is bad.
2) calcium phosphate-
3) urin acid - gout associated, hs of excess meat intake, or low urine volumes
4) struvite - from proteus or urease positive bacteria making urine alkaline.

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12
Q

testicular torison

A

Hx: 12yo boy sleeping in bed, or hs trauma. px: high riding, horizontal testicle. Absent cremasteric reflex, neg prehns sign. DDX: epidiymitis, orchitis, appendix testis torison, hematocele. ix: if had time, dopple tx: detort manually or go to OR if have time where you can fix the testicals to the scrotum bilaterally ( orchidopexy)

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13
Q

what is the most common reason for testicular torsion?

A

bell clapper deformity - where testicle is not adequantely afixed to scrotum.

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14
Q

epididymitis

A

hx: unprotected sex, UTI, immunocompromised px: positive prehns, cermasteric reflex present, purulent discharge, tender, swollen. ix: doppler to r/o torsion, UA- pyuria ( increasdwhites) = supports dx. tx abx ( ceftriazone and doxy to cover the most likely infectious organisms chlamydia/gonorrhea)

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15
Q

orchitis

A

usually bacterial/ mumps so get UA, C/S, urethral CS, Ab testing for mumps ( viral cause). Tx abx based on susceptibility, viral = supportive tx

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16
Q

undescended testis

A

hx of prematurity, CP/ neural tube defects/ disorders of sexual development, genetic causes ( prader wili, klienfelter) truimsomy 21. Px: see if its palpable or not. tx: usually comes down by 6 months, if ot exploratory surgery, and orchipexy ( fix testicle to scrotum). issue: increased cancer risk, pts needs to be taught testicular self examination

17
Q

scrotal mass!

A

DDX: Testicular( tumour, mass, cyst, epididymal), Fluids( hydrocele, varicoele, hematocele), Nontesticular: tumour of surrounding layers, inguinal hernia
hx- variable depending on the issue. common hx: varicocele ( heavy/painful by end of day, better when lying down). inguinal hernia: with valsalva, can be painful once incarcerated.

18
Q

DDX renal colic ( so what should you think of if someone has uncomfortable, colicky abdomen?)?

A

Life Threatening: AAA, Appendicitis, ectopic, septic stone
GI: Biliary colic, cholecystitis, pancreatitis, ulcers, IBD
Gyne: PIC, ovarian torsion, endometriosis
GU: renal abscess, stone, peylo, acute glomerulonephritis
Other:lumbar disc herniation, herpes zoster, fitz-hugh-curtis syndrome

19
Q

where are three common places for stones to be found?

A

Ureteropelvic junction ( kidney pelvis - ureter)
Mid ureter, where iliac artery crosses
Uretero-vesicular junction ( where ureter talks to bladder)
- give them an alpha blocker, ketoralac ( NSAID to decreasee ureter pressure)+ water to drink to pee to move stone along

20
Q

phimosis - remember the difference between young males under 3 years and older adult population

A

when you cant retract the foreskin, either in children due to normal adhesions or in oler adults due to edema. When babies cant retract = called physiologic phimosis. Patient will come in with “painful erection”, bleeding, dysuria. Px: shows edematous penis. Ix: none needed. Tx: kids: steroid scream 2x daily for 6 weeks to loosen tissues and allow for retraction. definitive tx is circumscision. In adult males, its due to poor hygiene/ balantitis, so need to squeeze out edema under anasthesia and discuss hygiene.

21
Q

Renal cell carcinom

A

person with von-hippel-lindau comes in bleeding, their back hurts/ flank hurts, and they have a lump in their side. Make sure its not renal cysts, hydronephrosis, pyelo, ADRENAL issue, Tuberosclerosis, polycystic kidney kidsease px: see lump, may be hypertensive. Ix UA- hematoruia and cytology, Abdo U/S or CT with contrast ( procedure of choice for solid renal mass), CBC ( anemia?), Alp ( bone mets?), CXR ( lung mets?). Tx: partial or radial nephrectomy. ablative techniques are an alternatuve for lederly. If unresectable, use immunotherapyies

22
Q

what are the kinds of RCC possible, and how do they spread?

What things do we need to order re investigations?

A

1) clear cell/ conventional is the most common type. 2) papillary 3) chromophobe 4) collecting duct renal carcinoma .cancer mets go to lungs, long bones, lymph nodes, opposite kidney, so check these places, and also think about paraneoplastic syndromes ( a cancer might be in the lung, but its still going to give you an anemia, mess with your calcium levels, give you fever, liver disease, and hypertension irregardless of location). So you gotta check these things.

23
Q

testicular cancer

A

dd

24
Q

bladder cancer

A

dd

25
Q

prostate cancer

A

an older man with high fat diet, and doping testosterone has FUNWISE symptoms, wtloss fatigue, hematuria, hemospermia. You think its prostate cancer, but it could also be BPH, or prostatitis, so you so px: DRE- enlarged, but since scared Ix: transRECTAL u/S, transrectal biopsy, PSA, bone scan + CT for mets. tx: gnRH agonists ( to spike and then drastically lower testosterone levels), estrogen, radical prostatectomy,+ external beam radiotherapy/ brachy therapy

Urology (13 decks)

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