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Phase 2a - conditions > Urogenital > Flashcards

Urogenital Flashcards

1
Q

What are five examples of non-malignant scrotal disease?

A 
Epididymal cysts 
Hydrocele
Variocele
Haematocele 
Epidiymo-orchitis
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2
Q

What is a hydrocele?

A

Fluid in the tunica vaginalis.

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3
Q

What is a variocele?

A

Dilated vessels in the pampiniform plexus. ‘bag of worms’

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4
Q

What is a haematocele?

A

Blood in the tunice vaginalis.

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5
Q

What is epididymo-orchitis?

A

Inflammation of the epididymis and testis.

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6
Q

What is the presentation of testicular torsion?

A 
Sudden onset testicular pain 
Inflamed and tender testicle 
Unilateral
Abdominal pain 
Nausea and vomiting
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7
Q

What are the risks of testicular torsion?

A

Cuts off blood supply - ischaemia to the testicle occurs.

Infertility

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8
Q

What investigation could be carried out to confirm testicular torsion?

A

Ultrasound - but do not delay treatment.

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9
Q

What are the treatment options for testicular torsion?

A

Orchidopexy.

Or if too late orchidectomy.

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10
Q

What is the contents of the spermatic cord?

A

3 arteries - testicular artery, cremasteric artery, artery of the vas.
3 nerves - sympathetics, genital branch of genitofemoral, cremasteric.
3 other - lymph vessels, vas deferens, pampiniform plexus.

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11
Q

What are the causes of urinary obstruction?

A 
Prostatic hyperplasia 
Urethral structure
Urolithiases
Tumour 
Infection
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12
Q

What are the symptoms of an acute urinary tract obstruction?

A

LUTS and suprapubic pain

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13
Q

What are storage symptoms of LUTS?

A

Frequency
Nocturia
Urgency
Urgency incontinence

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14
Q

What are the voiding symptoms of LUTS?

A 
Hesitancy 
Straining 
Poor/intermittent stream
Incomplete emptying
Post micturition dribbling
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15
Q

What are the signs of a urinary tract obstruction?

A

Distended, palpable bladder
Dull to percussion
+/- large prostate

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16
Q

What are the possible complications of urinary tract obstruction?

A

Urinary retention
Interactive obstructive uropathy (damage to the kidneys)
UTIs

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17
Q

What is the volume of urine held in acute retention?

A

approx. 600mls

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18
Q

What is the volume of urine held in chronic retention?

A

approx. 1.5l

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19
Q

What investigations should be carried out for suspected prostatic hyperplasia?

A

Digital rectal exam
PSA (cancer?)
Ultrasound and biopsy - to exclude cancer
Frequency volume chart - to see LUTS

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20
Q

What is felt on DRE for prostatic hyperplasia?

A

Smooth

Enlarged

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21
Q

What zone of the prostate typically enlarges in BPH?

A

Transitional zone.

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22
Q

What lifestyle advice can be offered in BPH?

A

Avoid caffeine and alcohol

‘bladder training’ by progressively increasing time between voiding.

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23
Q

What are the pharmacological options available in BPH?

A

Alpha-adrenergic antagonists ie. tamsulosin.

5-alpha reductase inhibitors ie. finasteride

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24
Q

What is the action and SEs of alpha-adrenergic antagonists?

A

Reduce smooth muscle tone - symptomatic relief.

Low BP, dry mouth, ejaculatory failure, drowsiness.

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25
Q

What is the action and SEs of 5-alpha reductase inhibitors?

A

Decreases conversion of testosterone to dihydrotestosterone. Acts to shrink prostate size - no immediate effect.
Decreased libido and impotence.

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26
Q

What are the surgical options available in BPH?

A

Transurethral resection of the prostate (TURP)

Prostatectomy.

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27
Q

What are the two types of haematuria found in blood?

A

Visible

Non-visible

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28
Q

How can haematuria be detected?

A

Urine disptick

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29
Q

What are the causes of haematuria?

A 
UTI 
Recent catheterisation 
Recent vigorous exercise 
Bladder cancer 
Kidney cancer
Recent sexual activity
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30
Q

What is the histology of prostate cancer?

A

Adenocarcinoma

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31
Q

Where is the most common location for prostate cancer?

A

Peripheral zone

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32
Q

What are the risk factors for prostate cancer?

A

Older age
Family history
High levels of testosterone

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33
Q

What are the symptoms of prostate cancer?

A

LUTS - nocturia, hesitancy, poor stream, dribbling.

Weight loss - suggests mets

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34
Q

What does a DRE for prostate cancer show?

A

Hard

Irregular

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35
Q

What investigations are available for prostate cancer?

A 
DRE
PSA 
Ultrasound 
Biopsy 
MRI - staging
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36
Q

What is PSA?

A

Prostate-specific antigen

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37
Q

What is the function of PSA?

A

Normally produced by the prostate for semen liquidation.

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38
Q

Why may a PSA test be misleading?

A

It is not specific for cancer - raised in BPE, UTI, prostatitis.
Not all cases of prostate cancer have a raised PSA - can be a false negative.
A positive test may lead to further investigations which can be damaging.

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39
Q

Why can a PSA test be beneficial?

A

Can detect cancer early and allow for more treatment options.
Prostate is the commonest cancer in men with a high mortality so should be detected early.

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40
Q

What is the mainstay of diagnosis of prostate cancer from?

A

Raised PSA

Ultrasound guided needle biopsy.

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41
Q

What system is used to grade prostate cancer?

A

Gleason grading

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42
Q

What are the common sites of metastases for prostate cancer?

A

Bone
Lung
local structures

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43
Q

What are the management options for localised prostate cancer?

A

Low risk - active surveillance

Progressing - hormone therapy, prostatectomy, radiotherapy.

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44
Q

What are the management options for advanced prostate cancer?

A

Radiotherapy
Chemotherapy
Hormone therapy
Prostatectomy

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45
Q

What is the hormone therapy available in prostate cancer?

A

GnRH agonists - goserelin

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46
Q

What is the most common renal cancer?

A

Renal cell carcinoma

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47
Q

What is the presentation of a renal cell carcinoma?

A 
50% are incidental findings.
Haematuria 
Loin pain 
Abdominal mass
Malaise
Weight loss
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48
Q

Where are the common sites of metastases for renal cell carcinoma?

A

Bone
Liver
Lung

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49
Q

What investigations should be carried out in renal cell carcinoma?

A

Bloods - FBC, U&E, LFT, calcium
Urine dipstick and MSU
Ultrasound
MRI - staging

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50
Q

What is the management for localised renal cell carcinoma?

A

Radical nephrectomy

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51
Q

What are the management options for metastatic renal cell carcinomas?

A

Biological therapies

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52
Q

What are the types of bladder cancer?

A

> 90% transitional cell carcinoma
Squamous cell carcinoma
Adenocarcinoma

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53
Q

What are the risk factors for bladder cancer?

A 
Occupation - azo dye exposure, rubber
Schistosomiasis infection 
Radiation 
Smoking 
Male
54
Q

What is the presentation of bladder cancer?

A

Painless haematuria
Recurrent UTIs
Voiding irritability

55
Q

What is the investigations for bladder cancer?

A

Cystoscopy with biopsy - diagnostic
Urine - dipstick, cytology, microscopy
CT urogram - staging

56
Q

What is the firs lymph node to be affected in bladder cancer?

A

Para-aortic and iliac nodes.

57
Q

What stages of bladder cancer are non-muscle invasive?

A

Ta-T1

58
Q

What is the treatment for non-muscle invasive bladder cancer?

A

Tumour resection

Chemotherapy

59
Q

What stages of bladder cancer are muscle invasive?

A

T2-3 (T4 = metastatic)

60
Q

What is the treatment for muscle invasive bladder cancer?

A

Radical cystectomy

Radical radiotherapy

61
Q

What are the different types of testicular cancer?

A

Seminoma (55%)
Non-seminoma
Mixed germ cell
Lymphoma

62
Q

What is the epidemiology of testicular cancer?

A

Most common cancer in men 20-40

Undescended testicle = risk factor

63
Q

What is the presentation of testicular cancer?

A

Painless lump in testicle
Haematospermia
Pain

64
Q

What is the first site of lymph node spread?

A

Para-aortic lymph nodes.

65
Q

What investigations are carried out in testicular cancer?

A

Ultrasound
Biopsy
Serum tumour markers
CT/MRI - staging

66
Q

What is the management fo testicular cancer?

A

Orchidectomy
Radiotherapy
Chemotherapy

67
Q

What is defined as a urinary tract infection?

A

Pure growth of >10(5) organisms per ml of MSU

68
Q

What is bacteruria?

A

Bacteria in the urine

69
Q

What is pyuria?

A

Leucocytes in the urine

70
Q

What is an uncomplicated UTI?

A

UTI in a non-pregnant woman.

71
Q

What is a complicated UTI?

A

Anything else.

Pregnant, man, catheter, child, recurrent etc.

72
Q

What are the risk factors or a UTI?

A 
Female
Intercourse 
Pregnancy 
Menopause 
Immunosuppression 
Obstruction 
Catheters
73
Q

What are the causative agents of a UTI?

A

E.coli - most common
Proteus mirabilis
Klebsiella pneumoniae

74
Q

What makes the urinary tract resistant to colonisation usually?

A

Constant flow

pH

75
Q

What increases the hosts susceptibility to UTIs?

A

Obstruction - stasis

Short urethra

76
Q

Which pathogens show virulence factors which help them colonise the urinary tract?

A

Proteus - produces urase which increases the pH

E.coli - has fimbrae to adhere to surfaces.

77
Q

What are the symptoms of a UTI?

A

Frequency changes
Dysuria
Loin/abdo pain
Offensive smelling urine

78
Q

What investigations should be carried out in a UTI?

A

MSU - microscopy and sensitivities
Urine dipstick - raise nitrites and leucocytes
Bloods

79
Q

In what age demographic is asymptomatic bacteruria common?

A

> 65years old. DO not treat.

80
Q

What is the treatment for an uncomplicated UTI?

A

Three day course of nitrofurantoin (1st line)

Advice - fluids, void pre and post intercourse, hygiene.

81
Q

What is the management of a complicated UTI?

A

Always culture MSU.
Longer antibiotic course (7 days)
Advice - fluids, void pre and post intercourse, hygiene.

82
Q

How to investigate a possible UTI in a catheterised patient?

A

All catheters will eventually become colonised.
Cultures should be investigated with caution
Do not dipstick - will always be positive
Change catheter before treatment begins.

83
Q

Why do pregnant women require a UTI screen?

A

Much higher risk of cute pyelonephritis (20-40%)

84
Q

When can nitrofuratoin not be used in pregnancy?

A

Third trimester

85
Q

What is acute pyelonephritis?

A

Infection of the renal pelvis

86
Q

What are the symptoms of pyelonephritis?

A

High fever
Loin pain
Rigors
Nausea and vomiting

87
Q

What is the treatment for pyelonephritis?

A 
Fluid replacement 
IV antibiotics - borad spec co-amoxiclav/ciprofloxacin
Drain kidney 
Analgesia 
7-14 day antibiotic course
88
Q

What is the most common STI in the UK?

A

Chalamydia

89
Q

What are the symptoms of chlamydia?

A

Men - dysuria and discharge

Female - dysuria, discharge and menstrual irregularity.

90
Q

Why does chlamydia often go undetected?

A

Asymptomatic in 50% + of cases.

91
Q

How is chlamydia diagnosed?

A

Female - self collected vaginal swab/first void urine
Male - first void urine
The NAAT

92
Q

What is the treatment for chlamydia?

A

Doxycycline 100mg for 7 days

Partner notification

93
Q

What are the symptoms of gonorrhoea?

A

Dysuria, urethral discharge, menstrual irregularity.

94
Q

How is gonorrhoea diagnosed?

A

Swab from urethra/endocervix/rectum.

95
Q

What is the treatment for gonorrhoea?

A

Ceftriaxone IM injection

Partner notification

96
Q

What is the presentation of syphilis?

A

Primary chancre - will heal if not treated

Then a skin rash

97
Q

How is syphilis diagnosed?

A

Blood serology

98
Q

What is the treatment for syphilis?

A

Penicillin by injection.

Partner notification

99
Q

What are primary prevention strategies for STIs?

A

Awareness campaigns to reduce risk behaviour.
Education in schools
Pre/post-exposure prophylaxis

100
Q

What are secondary prevention strategies for STIs?

A

Easy access to tests and treatments.
Partner notification
Targetted screening

101
Q

What are tertiary prevention strategies for STIs?

A

Anti-retrovirals to HIV.

102
Q

Name five types of incontinence.

A 
Urgency 
Stress
Mixed 
Overflow 
Continuous
103
Q

What is the cause of urgency incontinence?

A

Detrusor overactivity usually.

104
Q

What is urgency incontinence?

A

Incontinence associated with the urgent desire to void which is almost unstoppable.

105
Q

What are the lifestyle changes that can be made in urgency incontinence?

A

Stop caffeine and alcohol
Bladder training
Weight loss

106
Q

What are the pharmacological option available in urgency incontinence?

A

Anti-muscarinic agents - decrease parasympathetic activity.
Beta-2 agonists - increase sympathetic
Botox - blocks neuromuscular junctions.

107
Q

What is stress incontinence?

A

Involuntary emission of urine when pressure in the abdomen increases suddenly - ie. cough or laugh.

108
Q

What is the anatomical association to stress incontinence?

A

Urethral sphincter deficiency.

109
Q

Why is stress incontinence more common in women?

A

Only one sphincter

Can occur secondary to pregnancy or birth.

110
Q

What is the management for stress incontinence?

A

1 - Pelvic floor exercises.

2 - surgery sometimes

111
Q

What is mixed incontinence?

A

A mixture of stress and urgency incontinence.

112
Q

What is overflow incontinence?

A

Involuntary leakage of urine from an overfull bladder as a result of retention.

113
Q

What nerves causes controls the detrusor muscle?

A

Sympathetic - relaxation

Parasympathetic - contraction

114
Q

What nerve control the external sphincter?

A

Pudendal nerve (S2-4)

115
Q

Describe the storage phase of micturition.

A

Bladder fills gradually - slow pelvic nerve firing - sympathetic stimulation - pudendal stimulation - receptive relaxation and external sphincter contraction.

116
Q

What nerve feeds information from the bladder back to the spinal cord?

A

Pelvic nerve

117
Q

Describe the voiding phase of micturition.

A

Fast pelvic nerve firing - parasympathetic stimulation - pudendal nerve inhibited - detrusor contraction and external sphincter relaxation.

118
Q

What is the guarding reflex?

A

Voluntary control of micturition inhibits the micturition reflex.

119
Q

Where is the guarding reflex controlled from?

A

Pontine micturition centre.

120
Q

What is erectile dysfunction?

A

Persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance.

121
Q

What are the causes of erectile dysfunction?

A 
Psychological 
End artery damage - CVD
Shunt artery-vein
Neurological damage 
Low testosterone 
Alcohol 
Smoking 
Diabetes
122
Q

What is the mechanism that generates an erection and how does it work?

A

In flaccidity - penile smooth muscle is contracted, arteries are constricted and veins are open.
In erection - smooth muscle is relaxed, arteries are dilated, veins are compressed against tunica albuginea and venous outflow is blocked.

123
Q

What stimulates an erection?

A

Parasympathetic supply releases NO - causes conversion of GTP to cGMP - stimulates PKG to open potassium channels and close calcium channel - less internal calcium - smooth muscle relaxation. cGMP inactivated by phosphodiesterase.

124
Q

What symptoms may indicate a psychological cause of erectile dysfunction?

A

Sudden onset
Good nocturnal and morning erection
Situational
Younger patient

125
Q

What investigations are carried out in erectile dysfunction?

A

Clinical exam
DRE
Fasting glucose
Morning testosterone

126
Q

What is the lifestyle advice given for erectile dysfunction?

A

Quit smoking
Less alcohol
Weight loss

127
Q

What is the pharmacological therapy available and its mechanism of action for erectile dysfunction?

A

PDE5 inhibitors - sildenafil (viagra), tadalafil. Inhibit Phosphodiesterase so less cGMP broken down, so erection lasts longer.

128
Q

Why may PDE5 inhibitors not work?

A

Failure of adequate stimulation , NO still needs to be stimulated to release.
Only effective 30-60 minutes after being taken - need to wait.

129
Q

What are the other options available for erectile dysfunction?

A

Intracavernous injections
Vacuum devices
Prosthesis

130
Q

What is a priapism?

A

4 hour + long erection - emergency as a risk of tissue death.

Phase 2a - conditions (11 decks)

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