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Medicine Finals > Urology > Flashcards

Urology Flashcards

1
Q

How are lower urinary tract symptoms in men investigated?

A

Digital rectal examination

Abdominal examination (palpable bladder?)

Urinary frequency volume chart

Urine dipstick

PSA - depending on patient preference

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2
Q

What are causes of a raised PSA?

A

Prostrate cancer

Benign prostatic hyperplasia

Prostatitis

Urinary tract infection

Vigorous exercise (notably cycling)

Recent ejaculation/prostate stimulation

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3
Q

How long after having prostatitis can PSA be checked?

A

Need to wait at least 1 month

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4
Q

What are management options for benign prostatic hyperplasia?

A

Medical options:

Alpha blockers (e.g. Tamsulosin) - rapid improvement in symptoms

5-alpha reductase inhibitors (e.g. Finasteride) - gradually reduces size of prostate

Surgical options

TURP

Open prostectomy

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5
Q

What are side effects of Tamsulosin (alpha blocker)?

A

Postural hypotension

Dry mouth

Dizziness

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6
Q

What are side effects of Finasteride?

A

Erectile dysfunction

Reduced libido

Ejaculation difficulty

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7
Q

What are lower urinary tract symptoms?

A

Urgency

Hesitancy

Weak flow

Straining

Dribbling

Incomplete emptying

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8
Q

How does chronic prostatitis present and what is seen on DRE?

A

Pelvic pain, LUTS, sexual dysfunction

Pain on bowel movement

DRE shows tender enlarged prostate

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9
Q

What is the most common cause of acute bacterial prostatitis?

A

E. coli

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10
Q

What are risk factors for acute bacterial prostatitis?

A

Recent UTI

Intermittent bladder catheterisation

Recent prostate biopsy

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11
Q

How does acute bacterial prostatitis present?

A

Fever

LUTS

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12
Q

How is acute bacterial prostatitis managed?

A

14 day course of Ciprofloxacin

Screen for STIs

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13
Q

What is the most common type of prostate cancer?

A

Adenocarcinoma

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14
Q

What are features of prostate cancer?

A

Prostate cancer is often asymptomatic

May be obstructive symptoms - hesitancy, retention, dribbling

May be haematuria

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15
Q

What investigations are used for prostate cancer?

A

First DRE/PSA

If findings suggestive of prostate cancer..

First line investigation for suspected prostate cancer = Multi-parametric MRI

Then prostate biopsy

Either transrectal or transperineal

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16
Q

What is the criteria for 2WW for prostate cancer?

A

Man 50-69 with raised PSA or DRE suggestive of prostate cancer

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17
Q

What is found on DRE in prostate cancer?

A

Asymmetrical, hard, Nodular prostate

However may be normal

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18
Q

How is prostate cancer managed?

A

Watchful waiting

External beam radiotherapy

Brachytherapy

Hormone therapy (if metastatic)

Surgery (if localised)

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19
Q

What are side effects of a prostatectomy?

A

Erectile dysfunction

Urinary incontinence

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20
Q

Where does a prostate cancer most commonly metastasise to? How can we look for these metastases?

A

Lymph nodes and bones

Bony mets can be found with an isotope bone scan

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21
Q

What are indications for conducting a PSA?

A

Abnormal DRE

Symptoms of malignancy + LUTS

If over 50 - can be done on request

If over 45 and family history/black ethnicity - can be done on request

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22
Q

What is TURP syndrome and how does it present?

A

Rare life threatening complication of transurethral prostate resection

Caused by irrigation with large volumes of glycine

Due to irrigation with glycine
Leads to fluid overload
Severe Hyponatraemia

Nausea
Headache
Can lead to respiratory distress

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23
Q

What is the most common scrotal swelling and how does it present?

A

Epididymal cyst

Separate and posterior to testes, possible to get above lump

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24
Q

Scrotal swelling: separate from testes, posterior to testicle, possible to get above the lump?

A

Epididymal cyst

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25
Q

Scrotal swelling: non-tender soft swelling which transilluminates?

A

Hydrocele

Congenital hydrocele usually resolves in a few months

In adults - urgent referral is needed

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26
Q

Scrotal swelling: feels like bag of worms, usually on the left?

A

Varicocele

Enlargement of the testicular veins

Associated with infertility and renal cell carcinoma

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27
Q

Which side is a varicocele usually on?

A

Left

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28
Q

What scrotal swelling is associated with renal cell carcinoma?

A

Varicocele

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29
Q

What cancer is associated with a Varicocele?

A

Renal cell carcinoma

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30
Q

Scrotal swelling: sudden severe onset testicular pain which is NOT eased on elevation? Absent cremasteric reflex

Diagnosis + management?

A

Testicular torsion

Urgent surgical exploration needed for detorsion and BILATERAL fixation

Nil by mouth prior to surgery

Provide analgesia

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31
Q

What are risk factors for testicular torsion?

A

Abnormal testicle lie

Bell-Clapper deformity

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32
Q

What does a loss of cremasteric reflex indicate?

A

Testicular torsion

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33
Q

Scrotal swelling: dysuria, urethral discharge, testicular pain eased on elevation?

A

Acute Epididymo-orchitis

Usually due to Chlamydia

Management is as for Chlamydia (Doxycycline)

In older men can be caused by E coli

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34
Q

What is priapism and what are causes? How is it investigated? How is it managed?

A

Persistent penile erection

Causes:idiopathic, sickle cell crisis, erectile dysfunction medication

Investigation: Cavernosal blood gas analysis

Management:

If ischaemic - aspiration

If non ischaemic - observe

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35
Q

What is the most common type of testicular cancer?

A

Germ cell tumour

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36
Q

What are risk factors for testicular cancer?

A

Infertility

Family history

Klinefelter’s

Undescended testes

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37
Q

What are features of testicular cancer?

A

Painless testicular lump - hard, irregular, not fluctuant, no trans illumination

May be a hydrocele

May be gynaecomastia (particularly in Leydig cell tumour)

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38
Q

What tumour markers may be raised in testicular cancer? Which type are they associated with?

A

If it’s a seminoma - HCG may be elevated

Non-seminoma - HCG / Alpha feto-protein

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39
Q

Which type of testicular cancer is associated with gynaecomastia?

A

Leydig cell tumour

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40
Q

What is the definitive diagnosis for testicular cancer?

A

Scrotal ultrasound

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41
Q

What are the most common places for testicular cancer to metastasise?

A

Lymph nodes

Lungs

Liver

Brain

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42
Q

Which type of testicular cancer has a better prognosis?

A

Seminoma

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43
Q

What to differentiate between organic and psychogenic causes of erectile dysfunction?

A

Organic - gradual onset, normal libido, lack of spontaneous erections

Psychogenic - sudden onset, decreased libido, normal spontaneous erections, problems in relationship

44
Q

Which medications can cause erectile dysfunction?

A

SSRIs

Beta blockers

Alcohol

Finasteride

45
Q

How is erectile dysfunction investigated?

A

Measure free testosterone between 9am and 11am

46
Q

How is erectile dysfunction managed?

A

Sildenafil

Phosphodiesterase type V inhibitors

47
Q

What are causes of haematuria?

A

Infection - UTI/Pyelonephritis

Vigorous exercise

Cancer - bladder/renal/prostate

Renal stones

BPH

Prostatitis

Renal causes - Glomerulonephritis

48
Q

What is the 2WW criteria for upper urinary tract cancer?

A

45 or over with unexplained visible haematuria

49
Q

What is the most common cause of UTI?

A

E. coli

50
Q

How does a UTI present?

A

Dysuria, frequency, urgency

Cloudy or offensive smelling urine

Lower abdominal pain

Low grade fever

In the elderly - delirium

51
Q

How are symptoms of a UTI investigated?

A

Urine dipstick - will show raised nitrites, raised leukocytes

MSU

52
Q

Urine dipstick result - raised leukocytes but nitrites normal?

A

Do not treat unless in pregnancy

53
Q

How is UTI treated?

A

Non-pregnant women = Nitrofurantoin/Trimethoprim

Pregnant women= Trimester 1/2 = Nitrofurantoin, at term = Trimethoprim (7 days)

Men = trimethoprim/Nitrofurantoin but longer course (7 days)

54
Q

When should asymptomatic bacteriuria be treated?

A

In pregnant women

55
Q

What is the most common cause of pyelonephritis?

A

E. coli

56
Q

What are risk factors for pyelonephritis?

A

Female

Structural abnormalities

Versico-ureteric reflux

Diabetes

57
Q

How does pyelonephritis present?

A

Triad

Loin pain

Fever

Nausea / vomiting

58
Q

How is suspected pyelonephritis diagnosed?

A

Urine dipstick - raised leukocytes and nitrites, may be haematuria

MSU is essential for diagnosing bacteria

Imaging may be conducted to exclude other pathologies

59
Q

What is the first line management for pyelonephritis (if no culture results available)?

A

Oral Cefalexin OR IV Co-Amoxiclav + IV Cephalosporin

60
Q

What is the most common type of bladder cancer?

A

Transitional cell carcinoma

61
Q

What are risk factors for bladder cancer?

A

Smoking

Aromatic amines (e.g. dye factory worker)

62
Q

What is the classic presentation of bladder cancer?

A

Painless visible haematuria

63
Q

Where do kidney stones most commonly get stuck?

A

Vesico-ureteric junction

64
Q

What is the most common kidney stone and how are they seen on x-ray?

A

Calcium oxalate

Radio-opaque

65
Q

What are causes of calcium oxalate kidney stones?

A

Dehydration

Hypercalcaemia

66
Q

How do renal stones present?

A

Renal colic - unilateral loin to groin pain (colicky)

Haematuria

Nausea/vomiting

Reduced urine output (if obstructive)

May be symptoms of sepsis

67
Q

How is renal colic investigated?

A

Urine dipstick usually shows haematuria

Non contrast CT-KUB = initial investigation of choice

Blood tests - calcium levels, U+Es, inflammatory markers

68
Q

How are renal stones investigated in children and pregnant women?

A

Ultrasound KUB

69
Q

How are renal stones initially managed?

A

IM Diclofenac for pain management

Anti-emetics if nausea is present

70
Q

How is a renal stone measuring less than 5mm managed?

A

Watchful waiting

71
Q

When can medical management be given for calculi and what is given?

A

Alpha blockers - if distal ureteric stone less than 10mm (Tamsulosin, Doxazosin)

If alpha blockers CI - Nifedipine

72
Q

How are stones managed if they are…

1) <5mm
2) <2cm
3) >2cm/staghorn
4) causing obstruction

A

1) Watch and wait
2) Shockwave lithiotripsy (if pregnant - try uteroscopy as lithotripsy is CI)
3) Percutaneous Nephrolithiotomy
4) Nephrostomy

73
Q

x

A

x

74
Q

x

A

x

75
Q

x

A

x

76
Q

x

A

x

77
Q

What is a stag-horn calculus?

A

Calculus made of struvite (magnesium ammonium phosphate)

78
Q

Which types of renal calculi is radio-lucent (not seen on x-ray)?

A

Uric acid + Xanthine

79
Q

How can renal stones be prevented?

A

Increase fluid intake

Low salt diet

Thiazide diuretic - will reduce calcium in urine by increasing calcium reabsorption

If uric acid stones - allopurinol

80
Q

What medication can be given to reduce the risk of renal calculi?

A

Calcium oxalate stones - potassium citrate/thiazide diuretics

Uric acid stones - allopurinol

81
Q

What is the most common type of renal cell carcinoma?

A

Adenocarcinoma - clear cell

82
Q

How does renal cell carcinoma classically present?

A

Haematuria

Flank pain

Palpable mass

83
Q

What is the most common occupational type of renal cell carcinoma?

A

Renal Transitional cell carcinoma

84
Q

What are risk factors for renal cell carcinoma?

A

Smoking

Obesity

Hypertension

End-stage renal failure

Tuberous sclerosis

85
Q

What paraneoplastic features are associated with renal cell carcinoma?

A

Polycythaemia - increased EPO production

Hypercalcaemia - secretion of PTH mimick

Hypertension - increased renin secretion

Stauffer’s syndrome - Abnormal LFTs without liver mets

86
Q

Which medication can cause acute urinary retention?

A

Tricyclic antidepressants

Anticholinergics

Alpha agonist

Alcohol

87
Q

What is hydronephrosis?

A

Kidneys become stretched/swollen due to build up of urine

88
Q

What are causes of unilateral hydronephrosis?

A

PACT

Pelvo-ureteric onstructiom

Aberrant renal vessels

Calculi

Tumours of the renal pelvis

89
Q

What are causes of bilateral hydronephrosis?

A

SUPER

Stenosis of urethra

Urethral valve

Prostatic enlargement

Extensive bladder tumour

Retro-peritoneal fibrosis

90
Q

How do you treat a calculi which has caused hydronephrosis and obstruction?

A

Urgent decompression with nephrostomy

91
Q

What medication can reduce the risk of calcium stones?

A

Thiazide diuretic e.g. bendroflumethiazide

92
Q

How long must you wait after ejaculation/vigorous exercise to check PSA?

A

48 hours

93
Q

How is bladder cancer investigated?

A
  1. urine dipstick
  2. CT Urogram + Flexible cystoscopy
  3. Biopsy
94
Q

Why does varicocele occur in renal cell carcinoma?

A

Compression of the left renal vein leading to compression of the testicular vein

95
Q

What is a Bell Clapper deformity?

A

The testes is not fixed to the tunica vaginalis - it hangs freely and therefore is able to rotate

96
Q

What is the most important risk factor for bladder cancer?

A

Smoking

97
Q

What is phimosis and paraphimosis?

A

Phimosis = foreskin is tight and cannot be retracted over the glans. Normal in babies + young children

Paraphimosis = foreskin cannot be returned to original position after being retracted. Usually following catheterisation

98
Q

When is urgent decompression with nephrostomy required for calculi?

A

Sepsis

Obstruction

99
Q

What infection is most associated with Staghorn calculi?

A

Proteus infections

100
Q

What is the difference between low pressure and high pressure chronic urinary retention?

A

High pressure leads to complications such as hydronephrosis and renal impairment

Low pressure does not

101
Q

How to manage hydrocele in an adult?

A

Urgent testicular ultrasound to rule out underlying tumour

102
Q

When to refer an infant for undescended testes?

A

6 months

103
Q

What is the upper limit for an acceptable post-void volume?

A

<65 years = 50ml

>65 years = 100ml

104
Q

Which calculi are radio-opaque?

A

Calcium oxalate

Calcium phosphate

105
Q

Which type of calculi is associated with an inherited disorder?

A

Cystine stones

106
Q

What are medical indications for circumcision?

A

Phimosis
Recurrent balanitis
Balanitis xerotica obliterans
Paraphimosis

107
Q

Scrotal swelling that you cannot get above?

A

Inguinoscrotal hernia

Medicine Finals (32 decks)

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