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Revision > Urology > Flashcards

Urology Flashcards

1
Q

Management of renal stones

  • < 0.5cm
  • 0.5 - 2cm
  • > 2 cm
A 
<0.5 - increase fluid intake 
.5-2 = 
   - ESWL (preferred)
   - Ureteroscopy w/ dorm is basket
> 2 cm =
- PCNL ( percutaneous nephrolithiotomy)

*** only 1 kidney + stone of any size +/- Anura,fever = Percutaneous nephrostomy
Stent to drain urine first

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2
Q

Stones + fever + hydronephrosis
What does it indicate?
Treatment?

A

Obstructive Uropathy

Tx - percutaneous nephrostomy

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3
Q

Percutaneous nephrostomy vs percutaneous nephrolithiotomy

A

Nephrostomy = stoma catheter to pelvicalyceal system for decompression
I.e draining obstructed fluid

Nephrolithiotomy = removal of stone percutaneously via scope

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4
Q

Imaging for suspected renal stone

A

Non- enhancing CT KUB

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5
Q

Unilateral loin/flank pain + positive hCG =

A

Suspected ectopic pregnancy

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6
Q

Features of inguinal hernia

A

Inguinoscrotal swelling - can’t get above it
+ cough impulse
May be reducible

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7
Q

Features of testicular tumours

Investigations required

A

Discrete testicular nodule / may have associated hydro electric
Symptoms of metastatic disease

  • US Scrotum , serum AFP, Beta HCG
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8
Q

Features of acute epididymo-orchitis

Treatment

A 
Dysuria, painful micturition
Pain and urethral discharge 
\+- fever
Tender, red scrotal skin
\+ve phren’s sign

Tx - antibiotics

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9
Q

Most cases of acute epididymis-or hit is are due to

A

Chlamydia ( sexually active male)

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10
Q

What is Prehn’s sign ?

A

Relief of scrotal pain by elevating testicle

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11
Q

Features of epididymis cysts

Diagnostic test

A

Develop slowly
Can be single or multiple
May contain clear or opalescent fluid
M >40 yrs

  • painless, non tender
  • lies above and behind testis (upper pole, post part of testes)

= US - diagnostic

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12
Q

Features of hydrocele

A

Non painful , fluctuate
Clear fluid
Transilluminates
May be presenting feature of testicular ca in young men

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13
Q

Features of testicular torsion

Treatment

A

Severe, sudden onset of testicular pain
Adolescents and young males
Tender + phren’s sign -ve

Tx - urgent exploratory surgery + fixation *always fix the contra lateral testis

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14
Q

Features of varicocele

A 
Varicosities of pan-pinniform  plexus 
Bag of worms 
Typically on the left side
Dull ache/dragging pain - worse after excercise or at end of the day 
May show cough impulse
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15
Q

Why does varicocele typically occur on the left side?

A

Left testicular vein drains into renal vein directly at right angle - high pressure

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16
Q

What can varicocele’s be a presenting feature of ?

A

Renal cell carcinoma

Renal pain + hematuria + varicocele

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17
Q

Investigation for varicocele

Management

A

Scrotal Doppler
US is diagnostic

M- reassurance unless in severe pain or infertility
= surgery

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18
Q

Management of testicular malignancy

A

Orchidectomy via inguinal approach

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19
Q

Treatment of epididymal cyst

A

Excision via scrotal approach

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20
Q

Management of hydrocele

A

Children - inguinal approach
- underlying pathology is patent processus vaginalis = processus is fixed.

Adults - scrotal approach
= hydrocele excised or plicated

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21
Q

Major complications of untreated chlamydia/ N. Gonorrhoea in males and females

A

Males - epididymitis , epididymo-orchitis

Females - salpingitis

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22
Q

Important association of mumps that is not always seen

A

Or hit is
4-5 days post -parotitis
Local severe pain + tenderness, impalpable testes, swollen scrotum

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23
Q

When do we suspect interstitial cystitis ?

What’s the next step?

A

Urinary urgency + frequency + suprapubic pain
+ negative culture

  • it is a dx of exclusion
    Next step - cystoscopy to R/O bladder ca
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24
Q

What is seen on cystoscopy of 10% of patients with interstitial cystitis?

A

Hunner’s ulcers

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25
Q

1st and 2nd line treatment of interstitial cystitis

A

1 - bladder training (pelvic floor relaxation) + avoid triggers coffee, NSAIDS for pain
2- amitriptyline, Gabapentin

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26
Q

What is a vesicovaginal fistula?

Common causes

A

Tract between bladder and vagina
Cause - gynaecological/urinary surgeries esp hysterectomy
- pelvic radiotherapy

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27
Q

Diagnostic test for vesicovaginal fistula?

A

3 swab test / vaginal gauze test

3 sponges placed in vagina 1 above the other
Bladder - filled with methylene blue via catheter
Swabs removed after 10 mins

RESULTS

Top swab wet but not discoloured - ureterovaginal fistula
Top or middle swab blue - vesicovaginal fistula
Top and middle swab dry, last swab discoloured - urethrovaginal fistula

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28
Q

Cause of stress incontinence

Treatment

A

Weak bladder outlet
Weak pelvic floor muscles

Tx - pelvic floor excercise (8 contractions/ 3x per day) *of choice

  • If fails - surgical retro public mid-urethral tape = free-tension vaginal tape
  • If surgery not possible - Duloxetine
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29
Q

Cause of urge incontinence

Treatment

A

Detrusor over-activity
Tx :
- bladder drill (retraining)
= gradually increase periods between voiding for 6 weeks

  • meds - antimuscarininc (immediate release oxybutynin)
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30
Q

Breakdown of LUTS in BPH

A

Voiding (obstructive) - weak flow, straining, hesitancy dribbling, incomplete emptying

Storage symptoms (irritative)- urgency, frequency, incontinence, nocturis

Post -micturition - dribbling

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31
Q

Complications of BPH

A

UTI, retention, obstructive uropathy

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32
Q

DRE findings BPH

A

Firm enlarged smooth

Not nodular

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33
Q

BPH management

A

Watchful wait

Meds -
-1st line = alpha 1 blockers - tamsulosin, doxazocin, alfuzocin
= side effects - postural hypotension, drowsiness, dyspnea, cough
- 5 alpha reductive inhibitors - finasteride

Surgery - TURP

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34
Q

Tamsulosin vs Finasteride in BPH

A

Tamsulosin tried FIRST
Finasteride is drug of choice if :
LUTS + prostate enlargement + **RAISED PSA >1.4

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35
Q

Urinary flow obstruction, relieved with catheter

What should be tried before jumping to surgery?

A

Tamsulosin + refer for trial without catheter (TWOC)

TWOC for 1-2 days after giving Alpha 1 blockers - they relax the smooth muscle of prostate and bladder

The trial is to see if voiding will happen or if further management needed

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36
Q

What is TURP syndrome?

A

During TURP - excessive irrigation is done to allow good visualisation
Fluid can leak = Dilutional hypOnatremia

= presents as confusion and agitation

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37
Q

What is the most common cancer in adult males in the UK?

A

Prostate ca

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38
Q

Risk factors of prostate ca

A

Afro Caribbean
Increasing age
Obesity
Family history 5-10%

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39
Q

Features of prostate ca

A

Early localised prostate ca - asymptomatic
Other possible features
- BOO - hesitancy, retention
-Hematuria, hematospermia
- pain - back, suprapubic, perineal or testicular
Weight loss

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40
Q

Prostate ca on DRE

What is the appropriate/initial investigation?

A

Asymmetrical, irregular, hard, nodular enlargement
Loss of median sulcus

I-
1st line = Multiparametric MRI
Serum PSA - most appropriate F/U investigation

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41
Q

When should you suspect prostate ca based on PSA?

A

40-49 yrs - PSA >_ 2.0 ng/ml
50-69 yrs >= 3
>70 - >= 5

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42
Q

Most common tumours causing bone mets

A

Prostate
Breast
Lung

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43
Q

Most common sites of bone mets

A 
Spine- 
= cauda equine syndrome - saddle paresthesia, unable to initiate voiding, back pain —— Urgent MRI spine 
Pelvis 
Ribs 
Skull
Long bones
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44
Q

Features of bone mets

A

Pathological fractures
Hypercalcemia*****
Raised ALP
Increased thirst

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45
Q

Features of local spread of prostate ca

A

Ureter - occluded ureter

Loin pain & anuria - obstructive uropathy (impaired RFTs)

46
Q

Bladder ca

Risk factors

A

Middle age to elderly males/females
Gross painless hematuria

+-
- smoking
Increased age
Exposure to paints, dyes

47
Q

Unilateral flank pain and anuria post op abdominal surgery
Likely diagnosis?
Investigation

A

Ureteric injury
I - renal ultrasound
=renal hydronephrosis

48
Q

Why are patients with sarcoidosis vulnerable to kidney stones?

A

Hypercalcemia

Sarcoidosis = erythema nodosum, bilateral hilar lymphadenopathy, polyarthralgia, hypercalcemia, fever

Nodosum - tender red nodules over shins

49
Q

What is the most common malignancy in men aged 20-35?

A

Testicular ca

50
Q

Most common type of testicular ca

A

Germ cell tumour - 95% of cases

GCT divided into seminoma
Non seminomas : incl embryonal, yolk sac, teratoma, choriocarcinoma

51
Q

Features of testicular ca

Diagnosis

A

Young man
Painless non tender lump on testis itself
Grows in size

Dx - US 1st line
Request LDH

52
Q

What increases the risk of testicular ca by x10?

A

History of undescended testis (crypto-orchidism)

Esp seminoma - Order LDH

53
Q

CA 15-3 is a marker for

54
Q

CA 125

A

Ovarian ca

55
Q

CA 19-9

A

Pancreatic ca

56
Q

CEA

A

Colorectal ca

57
Q

PSA

A

Prostate ca

58
Q

AFP

A

Liver (HCC)

Teratoma (testicles,ovaries)

59
Q

LDH is a marker for

A

Testicular seminoma

60
Q

What increases the risk of testicular ca by x10?

A

History of undescended testis (crypto-orchidism)

Esp seminoma - Order LDH

61
Q

CA 15-3 is a marker for

62
Q

CA 125

A

Ovarian ca

63
Q

CA 19-9

A

Pancreatic ca

64
Q

CEA

A

Colorectal ca

65
Q

PSA

A

Prostate ca

66
Q

AFP

A

Liver (HCC)

Teratoma (testicles,ovaries)

67
Q

LDH is a marker for

A

Testicular seminoma

68
Q

Elderly man/woman + hematuria

Suspect ?

A

Bladder ca

69
Q

What is the commonest type of bladder ca

A

Transitional cell cancer

70
Q

Investigations for bladder ca

Greatest RF?

A

Flexible cystoscopy = cystourethroscopy

Other - CT urogram- to look for renal & ureteric ca

71
Q

Investigations for

  • > 40 yrs old + frank hematuria
  • <40 +hematuria
A
  1. Cystoscopy + CT Urogram

2. CT KUB for stones as malignancy less likely

72
Q

Persistence of hematuria after successful treatment of UTI
>45 + no RF
What should be done?

A

Refer for urology/nephrology appointment
Routine - 2 week wait
Cystoscopy might be done by urologist

73
Q

Flank pain + hematuria (micro/gross)+ HTN

What do you suspect?

74
Q

What is an important association of ADPKD?

A

Intracranial aneurysm

75
Q

Features of ADPKD

A

Autosomal dominant
50% of children will be affected
Can lead to progressive CKD

76
Q

Diagnosis of ADPKD

A

Ultrasound - can detect cysts

77
Q

Hematuria + hemoptysis
Suspected diagnosis
What investigations?

A

Dx - Goodpasture

Ix- Anti-GBM Abs

78
Q

Hematuria + renal impairment + bloody diarrhoea

Suspect -

A

Haemolytic Uremic Syndrome

79
Q

What is reflux nephropathy?

A

Urine goes back to kidneys
= dilated pelvicalyceal system = repeated UTIs = progressive renal failure

*young children

80
Q

Important cause of reflux nephropathy

A

Congenital abnormality

81
Q

Dx of reflux nephropathy
Initial
Gold standard
For parenchymal damage (cortical scars)

A
  1. Renal US + urinalysis + culture & sensitivity
  2. MCUG
  3. DMSA
82
Q

Management of reflux nephropathy

A

Initial - low dose antibiotics = trimethoprim daily

If fails or there is parenchymal damage = surgery (re-implant ureters)

83
Q

Define recurrent UTI

A

2 UTIs in 6 months
Or
3 UTIs in 12 months

84
Q

Work up for recurrent UTI

A

Mid stream urine - microscopy + culture
KUB - look for renal stone
US KUB - stones hydronephrosis, postvoid residual volume

If all normal - cystoscopy

85
Q

Indications for spiral CT

A

Ureteric calculi
Pancreatitis
Aneurysm

86
Q

Prolonged indwelling catheter + UTI
What is this called?
What should be done?

A

Bluish purple urine bag syndrome - bacterial colonisation

Do urine culture

87
Q

When should asymptomatic bacteria not be treated?

A

Indwelling catheter
Non-pregnant female
Adult male

88
Q

Where can a raised PSA be seen?

A

Prostate ca
BPH
UTI
After ejaculation, excercise and DRE

** avoid ejaculation 48 hrs before serum PSA

89
Q

Cystitis is mainly seen due to which organism ?

90
Q

Dysuria+loin pain + rigours
Likely dx?
Initial investigation?

A

Acute pyelonephritis

Urinalysis then urine culture

91
Q

Treatment of:
Upper UTI
Lower UTI

A

Upper - Cipro or Co-amoxiclav

Lower - Trimethoprim or Nitrofurantoin

92
Q

Investigation. of:
Hematuria <40 yrs
Hematuria >40

A

<40 - US followed by CT scan

>40 yrs - cystoscopy

93
Q

Initial investigation of UTI

A

Urine dipstick

94
Q

Management of scrotal trauma

A

Reassure - if no pain after few hours

Ongoing pain - surgical exploration for fear of testicular torsion

95
Q

What organism causes acute bacterial prostatitis ?

A

Gram negative bacteria via urethra

E.Coli most common

96
Q

Risk factors for acute bacterial prostatitis?

A

Recent UTI
Urge it all instrumentation
Intermittent bladder catherisation
Recent prostate biopsy

97
Q

Features of acute bacterial prostatitis

A

Local Pain - can be referred to rectum and back
Obstructive symptoms
Suprapubic tenderness

98
Q

DRE findings in acute prostatitis

A

Tender boggy prostate gland

99
Q

Management acute prostatitis

A

14 day course - Quinoloe (cipro, ofloxacin)
Start empirically! Don’t wait for culture result
Consider screening for STIs

100
Q

Management of recurrent UTIs in post menopausal women

A

Vaginal oestrogen
= restores premenopausal flora and acidic pH
Improves urogenita atrophy, prolapse and cystocele
If fails - long term ABx

101
Q

Treatment of:
Upper UTI
Lower UTI

A

Upper - Cipro or Co-amoxiclav

Lower - Trimethoprim or Nitrofurantoin

102
Q

Investigation. of:
Hematuria <40 yrs
Hematuria >40

A

<40 - US followed by CT scan

>40 yrs - cystoscopy

103
Q

Initial investigation of UTI

A

Urine dipstick

104
Q

Management of scrotal trauma

A

Reassure - if no pain after few hours

Ongoing pain - surgical exploration for fear of testicular torsion

105
Q

What organism causes acute bacterial prostatitis ?

A

Gram negative bacteria via urethra

E.Coli most common

106
Q

Risk factors for acute bacterial prostatitis?

A

Recent UTI
Urge it all instrumentation
Intermittent bladder catherisation
Recent prostate biopsy

107
Q

Features of acute bacterial prostatitis

A

Local Pain - can be referred to rectum and back
Obstructive symptoms
Suprapubic tenderness

108
Q

DRE findings in acute prostatitis

A

Tender boggy prostate gland

109
Q

Management acute prostatitis

A

14 day course - Quinoloe (cipro, ofloxacin)
Start empirically! Don’t wait for culture result
Consider screening for STIs

110
Q

Management of recurrent UTIs in post menopausal women

A

Vaginal oestrogen
= restores premenopausal flora and acidic pH
Improves urogenita atrophy, prolapse and cystocele
If fails - long term ABx

Revision (31 decks)

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