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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
Scrotal swelling: non-tender soft swelling which transilluminates?
Hydrocele Congenital hydrocele usually resolves in a few months In adults - urgent referral is needed
26
Scrotal swelling: feels like bag of worms, usually on the left?
Varicocele Enlargement of the testicular veins Associated with infertility and renal cell carcinoma
27
Which side is a varicocele usually on?
Left
28
What scrotal swelling is associated with renal cell carcinoma?
Varicocele
29
What cancer is associated with a Varicocele?
Renal cell carcinoma
30
Scrotal swelling: sudden severe onset testicular pain which is NOT eased on elevation? Absent cremasteric reflex Diagnosis + management?
Testicular torsion Urgent surgical exploration needed for detorsion and BILATERAL fixation Nil by mouth prior to surgery Provide analgesia
31
What are risk factors for testicular torsion?
Abnormal testicle lie Bell-Clapper deformity
32
What does a loss of cremasteric reflex indicate?
Testicular torsion
33
Scrotal swelling: dysuria, urethral discharge, testicular pain eased on elevation?
Acute Epididymo-orchitis Usually due to Chlamydia Management is as for Chlamydia (Doxycycline) In older men can be caused by E coli
34
What is priapism and what are causes? How is it investigated? How is it managed?
Persistent penile erection Causes:idiopathic, sickle cell crisis, erectile dysfunction medication Investigation: Cavernosal blood gas analysis Management: If ischaemic - aspiration If non ischaemic - observe
35
What is the most common type of testicular cancer?
Germ cell tumour
36
What are risk factors for testicular cancer?
Infertility Family history Klinefelter’s Undescended testes
37
What are features of testicular cancer?
Painless testicular lump - hard, irregular, not fluctuant, no trans illumination May be a hydrocele May be gynaecomastia (particularly in Leydig cell tumour)
38
What tumour markers may be raised in testicular cancer? Which type are they associated with?
If it’s a seminoma - HCG may be elevated Non-seminoma - HCG / Alpha feto-protein
39
Which type of testicular cancer is associated with gynaecomastia?
Leydig cell tumour
40
What is the definitive diagnosis for testicular cancer?
Scrotal ultrasound
41
What are the most common places for testicular cancer to metastasise?
Lymph nodes Lungs Liver Brain
42
Which type of testicular cancer has a better prognosis?
Seminoma
43
What to differentiate between organic and psychogenic causes of erectile dysfunction?
Organic - gradual onset, normal libido, lack of spontaneous erections Psychogenic - sudden onset, decreased libido, normal spontaneous erections, problems in relationship
44
Which medications can cause erectile dysfunction?
SSRIs Beta blockers Alcohol Finasteride
45
How is erectile dysfunction investigated?
Measure free testosterone between 9am and 11am
46
How is erectile dysfunction managed?
Sildenafil | Phosphodiesterase type V inhibitors
47
What are causes of haematuria?
Infection - UTI/Pyelonephritis Vigorous exercise Cancer - bladder/renal/prostate Renal stones BPH Prostatitis Renal causes - Glomerulonephritis
48
What is the 2WW criteria for upper urinary tract cancer?
45 or over with unexplained visible haematuria
49
What is the most common cause of UTI?
E. coli
50
How does a UTI present?
Dysuria, frequency, urgency Cloudy or offensive smelling urine Lower abdominal pain Low grade fever In the elderly - delirium
51
How are symptoms of a UTI investigated?
Urine dipstick - will show raised nitrites, raised leukocytes MSU
52
Urine dipstick result - raised leukocytes but nitrites normal?
Do not treat unless in pregnancy
53
How is UTI treated?
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
When should asymptomatic bacteriuria be treated?
In pregnant women
55
What is the most common cause of pyelonephritis?
E. coli
56
What are risk factors for pyelonephritis?
Female Structural abnormalities Versico-ureteric reflux Diabetes
57
How does pyelonephritis present?
Triad Loin pain Fever Nausea / vomiting
58
How is suspected pyelonephritis diagnosed?
Urine dipstick - raised leukocytes and nitrites, may be haematuria MSU is essential for diagnosing bacteria Imaging may be conducted to exclude other pathologies
59
What is the first line management for pyelonephritis (if no culture results available)?
Oral Cefalexin OR IV Co-Amoxiclav + IV Cephalosporin
60
What is the most common type of bladder cancer?
Transitional cell carcinoma
61
What are risk factors for bladder cancer?
Smoking Aromatic amines (e.g. dye factory worker)
62
What is the classic presentation of bladder cancer?
Painless visible haematuria
63
Where do kidney stones most commonly get stuck?
Vesico-ureteric junction
64
What is the most common kidney stone and how are they seen on x-ray?
Calcium oxalate Radio-opaque
65
What are causes of calcium oxalate kidney stones?
Dehydration Hypercalcaemia
66
How do renal stones present?
Renal colic - unilateral loin to groin pain (colicky) Haematuria Nausea/vomiting Reduced urine output (if obstructive) May be symptoms of sepsis
67
How is renal colic investigated?
Urine dipstick usually shows haematuria Non contrast CT-KUB = initial investigation of choice Blood tests - calcium levels, U+Es, inflammatory markers
68
How are renal stones investigated in children and pregnant women?
Ultrasound KUB
69
How are renal stones initially managed?
IM Diclofenac for pain management Anti-emetics if nausea is present
70
How is a renal stone measuring less than 5mm managed?
Watchful waiting
71
When can medical management be given for calculi and what is given?
Alpha blockers - if distal ureteric stone less than 10mm (Tamsulosin, Doxazosin) If alpha blockers CI - Nifedipine
72
How are stones managed if they are... 1) <5mm 2) <2cm 3) >2cm/staghorn 4) causing obstruction
1) Watch and wait 2) Shockwave lithiotripsy (if pregnant - try uteroscopy as lithotripsy is CI) 3) Percutaneous Nephrolithiotomy 4) Nephrostomy
73
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75
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77
What is a stag-horn calculus?
Calculus made of struvite (magnesium ammonium phosphate)
78
Which types of renal calculi is radio-lucent (not seen on x-ray)?
Uric acid + Xanthine
79
How can renal stones be prevented?
Increase fluid intake Low salt diet Thiazide diuretic - will reduce calcium in urine by increasing calcium reabsorption If uric acid stones - allopurinol
80
What medication can be given to reduce the risk of renal calculi?
Calcium oxalate stones - potassium citrate/thiazide diuretics Uric acid stones - allopurinol
81
What is the most common type of renal cell carcinoma?
Adenocarcinoma - clear cell
82
How does renal cell carcinoma classically present?
Haematuria Flank pain Palpable mass
83
What is the most common occupational type of renal cell carcinoma?
Renal Transitional cell carcinoma
84
What are risk factors for renal cell carcinoma?
Smoking Obesity Hypertension End-stage renal failure Tuberous sclerosis
85
What paraneoplastic features are associated with renal cell carcinoma?
Polycythaemia - increased EPO production Hypercalcaemia - secretion of PTH mimick Hypertension - increased renin secretion Stauffer’s syndrome - Abnormal LFTs without liver mets
86
Which medication can cause acute urinary retention?
Tricyclic antidepressants Anticholinergics Alpha agonist Alcohol
87
What is hydronephrosis?
Kidneys become stretched/swollen due to build up of urine
88
What are causes of unilateral hydronephrosis?
PACT Pelvo-ureteric onstructiom Aberrant renal vessels Calculi Tumours of the renal pelvis
89
What are causes of bilateral hydronephrosis?
SUPER Stenosis of urethra Urethral valve Prostatic enlargement Extensive bladder tumour Retro-peritoneal fibrosis
90
How do you treat a calculi which has caused hydronephrosis and obstruction?
Urgent decompression with nephrostomy
91
What medication can reduce the risk of calcium stones?
Thiazide diuretic e.g. bendroflumethiazide
92
How long must you wait after ejaculation/vigorous exercise to check PSA?
48 hours
93
How is bladder cancer investigated?
1. urine dipstick 2. CT Urogram + Flexible cystoscopy 3. Biopsy
94
Why does varicocele occur in renal cell carcinoma?
Compression of the left renal vein leading to compression of the testicular vein
95
What is a Bell Clapper deformity?
The testes is not fixed to the tunica vaginalis - it hangs freely and therefore is able to rotate
96
What is the most important risk factor for bladder cancer?
Smoking
97
What is phimosis and paraphimosis?
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
When is urgent decompression with nephrostomy required for calculi?
Sepsis | Obstruction
99
What infection is most associated with Staghorn calculi?
Proteus infections
100
What is the difference between low pressure and high pressure chronic urinary retention?
High pressure leads to complications such as hydronephrosis and renal impairment Low pressure does not
101
How to manage hydrocele in an adult?
Urgent testicular ultrasound to rule out underlying tumour
102
When to refer an infant for undescended testes?
6 months
103
What is the upper limit for an acceptable post-void volume?
<65 years = 50ml | >65 years = 100ml
104
Which calculi are radio-opaque?
Calcium oxalate | Calcium phosphate
105
Which type of calculi is associated with an inherited disorder?
Cystine stones
106
What are medical indications for circumcision?
Phimosis Recurrent balanitis Balanitis xerotica obliterans Paraphimosis
107
Scrotal swelling that you cannot get above?
Inguinoscrotal hernia

Medicine Finals (32 decks)

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