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3a > Urology > Flashcards

Urology Flashcards

1
Q

What are the risk factors for prostate cancer?

A

Increasing age
FH
Black ethnicity
Anabolic steroids

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2
Q

Where in the prostate do most prostate cancers occur in?

A

Peripheral zone

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3
Q

Where does prostate cancer most commonly metastasise to?

A

Lymph nodes

Bone

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4
Q

What are the symptoms of prostate cancer?

A 
Asymptomatic
Back pain
Nocturia
Hesitancy
Poor stream
Terminal dribbling 
Haematuria
Erectile dysfunction
Weight loss
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5
Q

Which cells produce prostate-specific antigen (PSA)?

A

Epithelial cells

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6
Q

What can cause a raised PSA?

A 
Prostate cancer
BPH
Prostatitis 
UTIs
Exercise
Recent ejaculation
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7
Q

How would a benign prostate feel on DRE?

A

Smooth, soft and central sulcus

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8
Q

How would prostatitis feel on DRE?

A

Enlarged, tender, warm

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9
Q

How would a cancerous prostate feel on DRE?

A

Firm, craggy and loss of central sulcus

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10
Q

What is the referral wait time if you suspect prostate cancer?

A

2 weeks

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11
Q

What investigations can you do to confirm diagnosis of prostate cancer?

A

Multiparametric MRI
Prostate biopsy
Isotope bone scan

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12
Q

What are the risks of a prostate biopsy?

A 
Pain
Bleeding 
Infection
Urinary retention
Erectile dysfunction
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13
Q

Which system is used to grade prostate biopsies?

A

Gleason - the greater the score, the poorly differentiated the tumour is and worse the prognosis is

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14
Q

Which system is used to stage prostate cancer?

A

TNM staging

tumour, lymph nodes and mets

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15
Q

How would you manage localized prostate cancer?

A

Radical prostatectomy
Radical radiotherapy
Hormone therapy - androgen receptor blockers
Watchful waiting

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16
Q

How would you manage metastatic prostate cancer?

A

Androgen deprivation: GNrH analogues + LH antagonists

Radiotherapy

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17
Q

How would you manage castration resistant prostate cancer?

A

2nd line hormone therapy e.g. enzalutamide
Chemo e.g. docetaxel
Bisphosphonates

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18
Q

What is the key complication of radiotherapy?

A

Proctitis = inflammation in rectum

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19
Q

What are the key complications of radical prostatectomy?

A

Erectile dysfunction

Urinary incontinence

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20
Q

Which cells does testicular cancer arise from?

A

Germ cells

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21
Q

Name the types of testicular cancer

A

Seminoma
Non-seminoma
Mixed

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22
Q

What are the risk factors of testicular cancer?

A 
Undescended testis
Previous testicular tumour  
FH
Infertility
Infant hernia
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23
Q

What are the signs of testicular cancer?

A

Painless lump on testicle

Gynaecomastia

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24
Q

Which type of tumour causes gynaecomastia?

A

Leydig cell

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25
Q

How does a testicular cancer lump appear?

A 
Non tender
Arise from testicle
Hard
Irregular
Not fluctuant 
No transillumination
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26
Q

What scans would you do to diagnose testicular cancer?

A

Scrotal USS

CT

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27
Q

What are the tumour markers for testicular cancer?

A

Alpha-fetoprotein
Beta-hCG
Lactate dehydrogenase (LDH)

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28
Q

How would you manage testicular cancer?

A

Radical orchidectomy - testis and spermatic cord are removed
Radiotherapy
Chemo
Sperm banking - treatment can cause infertility

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29
Q

How does an epididymal cyst appear?

A

Cyst on epididymis (top of testicle) which contains clear or milky fluid

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30
Q

A hydrocele is a collection of fluid where?

A

Tunica vaginalis

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31
Q

What are the clinical features of a hydrocele?

A 
Testicle is palpable within hydrocele
Soft 
Irreducible 
No bowel sounds (separate from hernia)
Transilluminated
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32
Q

What is hydrocele secondary to?

A

Testicular cancer
Testicular torsion
Epididymo-orchitis
Trauma

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33
Q

A varicocele is dilated veins of what structure?

A

Pampiniform plexus

The pampiniform plexus is a venous plexus, which is found in the spermatic cord and drains the testes. The pampiniform plexus drains into the testicular vein. It plays a role in regulating the temperature of blood entering the testes by absorbing heat from the nearby testicular artery. The testicles need to be at an optimum temperature for producing sperm.

34
Q

What are the complications of a varicocele?

A

Testicular atrophy

Impaired fertility

35
Q

Varicoceles are the result of increased resistance in the testicular vein. Where do the right and left testicular veins drain into?

A

Right testicular vein —> inferior vena cava

Left testicular vein —> Left renal vein

36
Q

Which side do varicoceles most commonly occur in and why?

A

Left, due to increased resistance in left testicular vein

37
Q

A left-sided varicocele can indicate an obstruction of the left testicular vein caused by what?

A

Renal cell carcinoma

38
Q

What are the symptoms of a varicocele?

A

Dull pain

Infertility

39
Q

What are the signs of a varicocele?

A

Scrotal mass that feels like a bag of worms
More prominent on standing
Disappears when lying down

40
Q

Which conditions can cause erectile dysfunction?

A 
MS
Hypogonadism 
Hyperthyroidism
Cord lesions 
Pelvic surgery
41
Q

Which drugs can cause erectile dysfunction?

A

Beta blockers
Diuretics
Anti-psychotics
Anti-depressants

42
Q

Which hormones are needed to produce an erection?

A

Testosterone

Nitric oxide

43
Q

Which hormone returns penis to flaccid state?

A

Phosphodiesterase

44
Q

What are the signs of erectile dysfunction?

A

Fibrous plaque and deviated penis - Peyronies disease
Prostatic enlargement
Small testes - hypogonadism

45
Q

Which investigations can you do to determine cause of erectile dysfunction?

A

Morning testosterone - if this is low, measure prolactin, FSH + LH
Nocturnal penile tumescence
Arteriography

46
Q

How would you conservatively manage erectile dysfunction?

A

Counselling
Stop smoking and reduce alcohol
Penile ring

47
Q

Which medications can you give for erectile dysfunction?

A

Oral phosphodiesterase inhibitors e.g. sildenafil
Intracavernous injections
Prostheses

48
Q

What is a prolonged erection called?

A

Priapism

49
Q

What are the symptoms of chlamydia in a male?

A

Dysuria

Urethral discharge

50
Q

What are the complications of chlamydia in a male?

A

Epididymo-orchitis

Reactive arthritis

51
Q

Which investigation is done in males for chlamydia?

A

First void urine sample

52
Q

How would you treat chlamydia?

A

Doxycycline for 7 days

53
Q

What are the symptoms of gonorrhoea in a male?

A

Urethral discharge
Dysuria
Tenesmus
Proctitis

54
Q

What are the complications of gonorrhoea in a male?

A

Prostatitis
Sepsis
Reactive arthritis
Infective endocarditis

55
Q

Which investigation is done in males for gonorrhoea?

A

Male urethra sample

56
Q

What kind of bacteria is gonorrhoea?

A

Gram -ve diplococci

57
Q

How would you treat gonorrhoea?

A

1g ceftriaxone IM

58
Q

What are the symptoms of primary syphilis?

A

Non tender ulcers on genitals

59
Q

What are the symptoms of secondary syphilis?

A 
Skin rash
Mucous membrane lesions
Lymphadenopathy
Fever
Headache
Fatigue
Weight loss
60
Q

What are the symptoms of tertiary syphilis?

A

Focal neurological deficits
Seizures
Skin granulomata

61
Q

Which investigation is done in males for syphilis?

A

Blood test

62
Q

How would you treat syphilis?

A

Parenteral benzylpenicillin

63
Q

What are the symptoms of genital herpes?

A 
Flu like prodrome
Papule lesions burst into ulcers around genitals
Urethral discharge
Dysuria
Urinary retention
64
Q

How would you treat genital herpes?

A

Analgesia
Topical lidocaine
Antivirals

65
Q

What are the risk factors for UTI?

A

Catheter
Sexual intercourse
Pregnancy

66
Q

What are the symptoms of UTI?

A 
Dysuria
Suprapubic pain
Frequency
Urgency
Incontinence
Haematuria
Cloudy urina
Confusion - elderly
67
Q

How would a UTI appear on a urine dipstick?

A

Nitrites
Leukocytes
Red blood cells

NICE guidelines: UTI is likely with presence of nitrites OR leukocytes, AND red blood cells

68
Q

A midstream urine (MSU) sample sent for microscopy, culture and sensitivity testing will determine the infective organism and the antibiotics that will be effective in treatment. Which patients would you not do a MSU in?

A

Prgenant women
Patients with recurrent UTIs
Atypical symptoms
Symptoms do not improve after antibiotics

69
Q

Which organism most commonly causes UTI?

A

E. coli (gram -ve, rod shaped)

70
Q

Name the two first line antibiotics for UTI

A

Trimethoprim

Nitrofurantoin

71
Q

When can you not give nitrofurantoin?

A

In patients with eGFR <45

72
Q

How long is an antibiotic course for men with UTI?

A

7 days

73
Q

What are the causes of upper urinary tract obstruction?

A

Kidney stones
Tumour
Ureter stricture
Ureterocele

74
Q

What are the causes of lower urinary tract obstruction?

A

BPH
Prostate cancer
Urethral strictures
Neurogenic bladder

75
Q

Benign prostatic hyperplasia (BPH) is a very common condition affecting men in older age (usually over 50 years). It is caused by hyperplasia of the stromal and epithelial cells of the prostate. What are the symptoms of this?

A 
Hesitancy
Weak flow
Urgency
Frequency
Intermittency
Straining
Terminal dribbling
Nocturia
76
Q

What is used to score severity of lower urinary tract symptoms?

A

International prostate symptom score (IPSS)

77
Q

How would you investigate BPH?

A

PSA
DRE
Urine dipstick
Urinary frequency volume chart

78
Q

Which zone of the prostate does BPH affect?

A

Inner transitional zone

79
Q

Which drugs would you give to treat BPH?

A

Alpha blockers e.g. tamsulosin

5-alpha reductase inhibitor e.g. finasteride

80
Q

Which surgery can you do for BPH?

A

Transurethral resection of the prostate (TURP)
Transurethral electrovaporisation of the prostate (TEVAP/TUVP)
Prostatectomy

81
Q

What is the main side effect of alpha blockers?

A

Postural hypotension

82
Q

What is the main side effect of finasteride and why?

A

Sexual dysfunction due to reduced testosterone

3a (13 decks)

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