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Finals Revision > Urology > Flashcards

Urology Flashcards

1
Q

Why might someone with haematuria on a background of bladder cancer develop post-renal AKI?
What is the 1st line management of this?

A

Clot causing urethral blockage

Continuous bladder irrigation via 3-way catheter

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2
Q

How long must someone abstain from ejaculation/rigorous exercise before getting PSA?

A

48 hours

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3
Q

Most common cause of epidydimo-orchitis in males <35 y/o?
If >35 y/o or those who have anal sex?
What may be seen on exam?

A

<35: chlamydia

> 35: E coli or enterococcus

Erythematous, swollen testicle. Pain is relieved upon elevating the testicle

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4
Q

28 y/o man has painful testicle that came on 10 hours ago and has been getting worse. He is pyrexial, the testis is tender and there is associated hydrocele?

A

Acute infective epidydimo-orchitis

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5
Q

15 y.o boy develops acute pain in left hemiscrotum, O/E the superior pole of the testis is tender and cremasteric reflex is partially marked?

A

Torsion of testicular appendix (hydatid of morgagni)

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6
Q

Renal stone with sepsis?

A

IV antibiotics and renal decompression

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7
Q

23 y/o male with:

  • 1cm stone and hydronephrosis?
  • 1cm stone, no hydronephrosis?
  • 2.7cm staghorn calculus?
A
  • percutaneous nephrostomy
  • lithotripsy
  • percutaneous nephrolithotomy
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8
Q

What can cause acute urinary retention in females?

A
  • UTI
  • Neurogenic
  • Neoplasm
  • Fibroids
  • Constipation
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9
Q

Management of varicoceles:

  • mild?
  • mod or severe?
A

Mild - conservative

Mod-severe:

  • if asymptomatic and normal semen analysis: semen analysis every 1-2 years
  • if symptomatic or abnormal semen analysis: surgery
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10
Q

2 year old boy with hypertension and right flank mass. CT: non-calcified, irregular lesion affecting apex or R kidney and adrenal gland?

A

Nephroblastoma

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11
Q

Communicating hydrocele?
Non-communicating?
What can they develop secondary to?

A

Communicating:
Patency of processus vaginalis allowing peritoneal fluid to drain down into scrotum. In 5-10% newborns

Non-communicating:
caused by excessive fluid production in tunica vaginalis

Can develop 2 to:

  • epididymis-orchitis
  • torsion
  • tumours
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12
Q

Ix for hydrocele?

Management?

A

Ix:
usually a clinical diagnosis (non-tender swelling of hemiscrotum usually anterior and below testicle, can get above, transilluminates)
-> if any uncertainty, USS

Management:

  • infantile: resolve spontaneously within 1-2 years, rarely don’t resolve and may be fixed
  • adults: conservative approach if non-severe. Further investigation usually warranted to rule out cancer
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13
Q

What side are varicoceles most common on?
Presentation?
Ix?
Management?

A

Left

‘bag of worms’, may be assoc w subfertility

USS with doppler

Management:
Usually conservative
Occasionally surgery if pain or infertility

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14
Q

Epididymal cyst features?
Assoc w?
Ix?
Management?

A

Most common cause of scrotal swellings in primary care

Separate from the body of the testicle
Posterior to the testicle

Assoc:

  • PKD
  • CF
  • von hippel-lindau

Ix: may be confirmed by USS if needed

Management:
Supportive
Surgical removal or sclerotherapy may be attempted if larger or symptomatic

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15
Q

Neuropathic pain:
- if drug is not working, what should you do?
- what can be used for rescue therapy?
- what can be used for localised neuropathic pain e.g. post-herpetic?
If none of this working?

A

Switch to another one - they are used as mono therapies, don’t add them on top of each other

Tramadol rescue

Localised: capsaicin cream

If not working - refer to pain team

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16
Q

Types of bladder cancer?
Ix?
Management if superficial (CIS/T1)?
Management of T2+ (invasion into muscle)?

A

Transitional - 90%
Squamous - schistosomiasis
Ademocarcinoma - if neobladder formed

Ix: biopsy - cystoscopy
MRI for invasion
CT/PET CT for mets

Superficial - transurethral resection

T2+ - radical cystectomy with ileal neobladder or radical radiotherapy

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17
Q

High risk AAA rupture, indicating need for surgery?

Preferred treatment?

A

5.5+cm
Enlarging >1cm/year
Symptomatic

Ideally EVAR, open repair if unsuitable

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18
Q

AAA size and surveillance?

A

<3cm, normal

3 - 4.4cm - small, USS every 12 months

  1. 5 - 5.4 - medium, USS every 3 months
  2. 5+ - large, refer to vascular surgeon within 2 weeks
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19
Q

Is there screening for AAA?

A

Yes, single USS scan for males aged 65

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20
Q

6P’s of acute limb ischaemia?

A 
Pale
Pulseless
Painful
Paralysed
Paraesthetic
Perishing with cold

1 or more suggests acute limb ischaemia

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21
Q

Initial management of suspected acute limb ischaemia?

A

USS doppler
Analgesia - IV opioids
IV unfractioned heparin to prevent thrombus propagation
Immediate vascular review

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22
Q

What suggests thrombus causing limb ischaemia?

What suggests embolus?

A

Thrombus:

  • pre-existing claudcation with sudden deterioration
  • no obvious embolic source
  • Reduced/absent pulses in contralateral limb as well

Embolic:

  • sudden onset with no Hx claudication
  • obvious source e.g. AF, recent MI
  • contralateral limb fine
  • evidence of proximal aneurysm (abdo, popliteal)
23
Q

Management of superficial thrombophlebitis?

Specific to long saphenous vein?

A

General:
NSAIDs 8-12 days
Compression stockings (after ABPI)
since thrombophlebitis gives a 4% chance of forming clot

Long saphenous:
If proximal, USS to exclude DVT
Consider LMWH/Fondaparinux for up to 45 days

24
Q

Drugs given to folk with peripheral arterial disease?

A

Statin

Clopidogrel

25
Q

Drugs given to folk with peripheral arterial disease?

A

Statin

Clopidogrel

26
Q

Management of acute urinary retention?

A

USS initially to confirm

  • volume >300ml confirms diagnosis - catheter
  • if <200ml, not urinary retention
  • If >400ml, keep catheter in place

Reversible cause - UTI, BPH, neuro

27
Q

What typically causes ABPI >1.2?

A

Calcification e.g. in advanced age, PAD or diabetes

28
Q

Where may people be tender with AAA?

A

Abdo and loin (aorta is right sided)

29
Q

SE tamsulosin?
How long does it take finasteride to work? SE?
What does it do to PSA?

A

Talsulosin:
- dizziness, postural hypotension, dry mouth, depression

Finasteride:

  • takes up to 6 months to work
  • SE: erectile dysfunction, reduced livido, ejaculation problems, gynaecomastia (prevents conversion of testosterone to DHT)
  • Can raise PSA by up to 50%
30
Q

What can raise PSA levels that’s not cancer? (5)

A 
BPH
Prostatitis/UTI
Ejaculation/vigorous exercise in 48 hours prior
Urinary retention
Catheterisation
31
Q

Age peaks of priapism?

Causes?

A

Bimodal - 5-10 and 20-50 years

Causes: idiopathic, sickle cell, sildenafil, anti-hypertensives, antcoagulants, antidepressants, recreational drugs

32
Q

Presentation of priapism?

A

Persistent erection for >4 hours
Pain localised to penis
If not fully erect/not painful or Hx of trauma this suggests non-ischaemic

Ix:

  • Cavernosal blood gas - differentiate between ischaemic (low O2 and pH) and non-ischaemic
  • Doppler as alternative to assess blood flow in penis
  • FBC/toxicology for underlying cause
33
Q

Management of priapism if ischaemic and non-ischaemic?

A

Ischaemic is a medical emergency - can lead to permanent damage

If >4 hours - aspiration of blood from cavernous - combined with saline flush

If this fails - injection of vasoconstrictive agent e.g. phenylephrine

Surgery last resort

If non-ischaemic - not an emergency - suitable for observation

34
Q

Ix for intermittent claudication?

A

Duplex USS 1st line

MR angiography if surgery is planned

35
Q

What type of renal stones are radio-lucent?

A

Urate and xanthine - radio-lucent

Cystine - semi-opaque (1%)

Calcium oxalate (40%), mixed calcium oxalate/phosphate (25%), triple phosphate (struvite - 10%) and calcium phosphate (10%) all radio-opaque

36
Q

Indications for circumcision?

What must be ruled out before circumcision?

A

Phimosis
Recurrent balanitis
BXO
Paraphimosis

Hypospadias - foreskin used in repair

37
Q

Intermittent testicular torsion management?

A

Emergency fixation as prophylaxis

38
Q

Management options of prostate Ca if T1/T2?
Management options for T3/T4?
Hormonal options available? (3)

A

T1/T2: Conserative - watchful waiting, radical prostatectomy or radiotherapy

T3/T4: hormonal therapy, radical prostatectomy, radiotherapy

Hormonal therapy:
- Goserelin (GnRH agonist) - provides negative feedback to ant pit - cover with cyproterone at start

  • Cyproterone (anti-androgen) - prevents DHT binding to intracytoplasmic protein complexes
  • orchidectomy
39
Q

SE of radical prostatectomy?

Of radiotherapy?

A

Surgery: ED

Radio: bladder, colon or rectal cancer

40
Q

Things that suggest an organic cause of erectile dysfunction?

A 
Gradual onset
Normal ejaculation
Normal libido (unless hypogonadism)
Cardio/endocrine/neuro disease
Operations/radiotherapy
Drug use or PED's
Smoking, alcohol
41
Q

Ix for erectile dysfunction?

A

Free testosterone in morning
If low, repeat along with FSH/LH and PRL
Refer to endocrinology if abnormal

Also calculate QRISK and measure lipids and fasting glucose

42
Q

Management of ED?

A

Sildenafil - useful in ED of all aetiologies

Vacuum erection device - 1st line in those who don’t want viagra

Refer to urology if young
If keen cyclist tell them to cut down

43
Q

Obese 77 y/o with T2DM has leg pain at rest, it is worse at night and sometimes improves during the day, no ares of ulceration. What is likely ABPI?

A

> 1.2

Typical of diabetic ulceration

44
Q

What is the only testicular/scrotal problem that causes a lump and difficulty conceiving?

A

Varicocele

45
Q

Ix for hydronephrosis?
Management?
Management if hydronephrosis assoc w acute or chronic upper UTI?

A

1st line - USS
IVU - assess position of obstruction
If suspected renal colic - CTKUB

Management:
- remove obstruction
- acute upper UTI - nephrostomy
Chronic upper UTI - ureteric stent or pyeloplasty

46
Q

What type of cancer is a renal cell carcinoma?
How might it appear under imaging?
Ix?
Where do they metastasise to?

A

Adenocarcinoma, most common subtype is clear cell - may appear multifocal, calcified, and/or cystic

Ix:
- CT CAP 1st line
First line for any renal mass as benign masses rare

Met: lung, bone, brain

47
Q

Can hernias transilluminate?

A

If there is a thin walled bowel rarely they can e.g. in newborn

48
Q

What are high and low pressure chronic urinary retention?

A

High pressure - impaired renal function and bilateral hydronephrosis, typically due to bladder outflow obstruction

Low pressure - normal renal function and no hydronephrosis

49
Q

What drugs can cause urinary retention?

A 
TCA e.g. amitriptyline
Anticholinergics
Opioids
NSAIDs
Disopyramide
50
Q

Complication after relieving acute urinary retention?

Chronic urinary retention?

A

Acute - post-obstructive diuresis

  • Kidneys lose medullary concentration gradient so lose ability to concentrate urine
  • can lead to volume depletion and AKI - fluids
  • Will re-equilibriate on its own

Chronic - decompression haematuria

  • commonly occurs after catheterisation due to rapid decrease in bladder pressure
  • Just monitor, requires no further treatment
51
Q

What can cause intermittent claudication type symptoms of the buttocks?

A

Iliac stenosis

52
Q

At what stage will most people with renal cell cancer present?

A

Stage 4

53
Q

Test to assess if bladder is leaking after partial cystectomy?

A

Cystogram

54
Q

Painful mid-calf ulcer with mild pitting oedema - what type?

A

Arterial - oedema likely from heart failure

Finals Revision (29 decks)

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