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Urology > Urology > Flashcards

Urology Flashcards

1
Q

Differential Diagnosis: Renal Mass

A 
Splenomegaly
Hepatomegaly
Adrenal Pathology
Retroperitoneal Mass
Colon Mass
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2
Q

Reasons Serum Creatinine is a better indicator of renal function than Serum Urea

A

Less influenced by diet
More specific for renal function
Production rate relatively constant
State of hydration has little effect unless GFR affected

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3
Q

Advantages: Ultrasonography

A 
Real-time
Accurate anatomical information
Non-invasive
Available
Safe
Mobile
First choice: children, babies
Distinguish solid vs cystic
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4
Q

Disadvantages: Ultrasonography

A 
Certain structures not visualised
Operator dependent
No renal function information
Equipment quality dependent
Limited in obesity
No scout image
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5
Q

Components: Cystoscope

A

Light source
Fibre-optic cable
Red lens system/ fibre-optic system
Sheath for irrigation fluid

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6
Q

Difference between rigid and flexible cystoscope

A

Rigid: Red Lens System
Flexible: Fibre Optic System

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7
Q

Procedures that can be done by cystoscopy

A

Biopsy for histology
Stone removal
Resection of tumours (prostate, bladder)

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8
Q

Complications of cystoscopy

A

Perforation
Infection
Irritation by contrast media

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9
Q

Types of catheter material

A

Latex

Silicone (silastic)

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10
Q

Time of indwelling for different catheters

A

Latex: 1 week max
Silicone: 3 months max

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11
Q

Advantages of different catheters

A

Latex: cheap
Silicone: little urethral damage

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12
Q

Disadvantages of different catheters

A

Latex: irritable to urethra, forms encrustations
Silicone: expensive

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13
Q

Indications for suprapubic cystostomy

A

Suspected traumatic urethral injury
Urinary retention (only if unable to pass TUC)
Necrotising Fasciitis of the Perineum
Temporary urinary diversion required (e.g. after surgery)
Neuropathic bladder (only if unable to pass TUC)
Transurethral catheter in situ with development of acute epididymitis

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14
Q

Define Enuresis

A

Persistence of inappropriate voiding beyond the age of anticipated control

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15
Q

Medical management of enuresis

A

Tricyclic Antidepressants e.g. Imipramine
Desmopressin e.g. DDAVP
Anticholinergics e.g. Oxybutinin (Ditropan - only with presence of daytime symptoms)

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16
Q

Imipramine mechanisms in enuresis

A

Lighten level of sleep
Anticholinergic effect on bladder (less detrusor contraction)
Alpha-adrenergic effect on bladder neck (contraction)

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17
Q

Imipramine side effects

A 
Anxiety
Behavioural/personality changes
CIT symptoms
Alopecia
Cardiac dysrythmia
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18
Q

Desmopressin mechanisms in enuresis

A

Corrects abnormal nocturnal ADH surge
Decreases nocturnal urine production
Increases water resorption in collecting ducts

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19
Q

Desmopressin side effects

A

Headaches
Facial flushing
Nausea
Hypnatraemia

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20
Q

Locations of ectopic testes

A 
Pre-pubic
Femoral canal
Contralateral scrotum
Perineum
Superficial inguinal pouch
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21
Q

Complications of undescended testes

A 
Psychological problems
Infertility
Malignancy
Inguinal hernia
Trauma
Torsion
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22
Q

Potential findings in infants with UTI

A 
Hyrdonephrosis
Stones
Vesico-Ureteric Reflux
Posterior Urethral Valves
Ureterocoele
Baldder Diverticuli
Acute Pyelonephric Ischaemia
Pelvic-Ureteric Junction obstruction
Neuropathic bladder
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23
Q

Medical indications for circumcision

A 
True phimosis
Paraphimosis
Genital warts affecting foreskin
Recurrent balanitis/phosthitis
Superficial penile carcinoma involving foreskin only
Foreskin trauma
Inadequate previous circumcision
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24
Q

Surgical principles of all circumcision

A

Asepsis
Haemostasis
Protection of glans
Adequate excision but not excessive

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25
Q

Methods of circumcision

A

Clamps
Shields
Surgical excision

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26
Q

Contraindications to Circumcision

A 
Prematurity
Current illness
Blood dyscrasia
Hypospadias
Chordee
Buried penis
Webbed penis
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27
Q

Complications of Circumcision

A 
Haemorrhage
Infection
Meatal ulcer
Skin complications (phimosis, concealed penis, chordee, skin bridge)
Glanular injury
Necrosis
Urethrocutaneous fistula
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28
Q

Causes of Necrosis in circumcision

A

Use of diathermy with clamp
Use of local anaesthetic with adrenaline
Use of tourniquet
Tight dressings

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29
Q

Special investigations in a man with LUTS

A 
Urine MCS
Urine Dipsticks
PSA
Ultrasound
AXR
Prostate Biopsy
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30
Q

Innervation of bladder function

A

Sympathetic: Contract proximal sphincter
Parasympathetic: Contract detrusor muscle
Somatic: Voluntary contraction of external sphincter

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31
Q

Medical therapy of incontinence

A

Alpha-agonists: increase internal sphincter tone
Oestrogens: increase bladder neck tone
Anti-cholinergics: relax detrusor muscle, increase bladder capacity

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32
Q

Haematological causes of haematuria

A

Anticoagulants
Leukaemia
Haemophilia

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33
Q

Causes of vesico-colic fistula

A

Crohn’s disease
Diverticulitis
Sigmoid colon carcinoma

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34
Q

UTI commoner in women because:

A

Shorter urinary tract

Proximity to faecal reservoir

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35
Q

Diabetes predisposes to UTI because:

A

Glucose in urine = culture medium
Impaired WBC function
Autonomic neuropathy

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36
Q

Antibiotic treatment of acute pyelonephritis

A

Co-amoxyclav
Cephalosporins
Gentamycin
Quinolones

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37
Q

Causes of penile pain during erection

A

Peyronie’s disease

Priapism

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38
Q

Medical conditions associated with Erectile Dysfunction

A 
Ischaemic Heart Disease
Diabetes Mellitus
Hypertension
Dyslipidaemia
Depression
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39
Q

Aetiological factors of ED

A 
Vasculogenic
Neurogenic
Chronic Systemic Disease
Hormonal
Drugs
Penile Problems
Diabetes Mellitus
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40
Q

Side effects of PDE5 inhibitors

A

Headaches
Flushing
Rhinitis
Dyspepsia

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41
Q

Oral medication in Peyronie’s disease

A

Vitamin E
PABA
Colchicine

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42
Q

Intralesional Agents for Peyronie’s disease

A

Verapamil
Interferon
Cortisone

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43
Q

Treatment options for condylomata accuminata of foreskin

A 
Salicylic Acid
Podophylin
Interferon
Imiquimal
5-fluoro-uracil ointment
Tri-chloro-acetic acid
Circumcision
Laser
Cryotherapy
Cauterisation
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44
Q

Possible causes of varicocoele

A

Congenital absence of valves in spermatic veins
Compression of left renal vein between aorta and superior mesenteric artery
Neoplastic obstruction of renal vein and IVC
Right-angled T-junction of left testicular vein to left renal vein

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45
Q

Complications of Varicocoele

A

Infertility
Testicular atrophy
Pain/discomfort

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46
Q

Special investigations when diagnosing urogenital TB

A 
Semen analysis
Pus swab from scrotal sinus
Early morning urine culture (Louwenstein-Jensen)
Histology
Cystoscopy
CXR
IVP
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47
Q

Pre-testicular factors causing male infertility

A 
Calcium Channel blockers
Smoking
Chemotherapy
Anabolic steroids
Alcohol
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48
Q

Triad of abnormalities in prune belly syndrome

A

Cryptorchidism
Urogenital tract abnormalities
Congenital absence of abdominal wall musculature

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49
Q

Causes of death in prune belly syndrome

A

Non-functioning renal tissue

Pulmonary hypoplasia

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50
Q

Cause of female pseudohermaphroditism

A

Congenital adrenal hyperplasia

Enzymatic deficiency in glucocorticoid metabolic pathways

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51
Q

Characteristics: female pseudohermaphriditism

A

Salt and water wasting
Hypertension
Hyperpigmentation

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52
Q

Factors affecting gender assignment

A

Fertility
Phallus size
Family wishes

53
Q

Surgical management of posterior urethral valves

A

Endoscopic disruption
Vesicostomy
Upper tract diversion

54
Q

Indications for transurethral catheterisation in chronic urinary retention

A

Renal failure
UTI
Incontinence

55
Q

Complications of TUC in chronic urinary retention

A

Post-obstructive diuresis

Haematuria

56
Q

Underlying systemic conditions predisposing to necrotising fasciitis

A 
Diabetes Mellitus
AIDS
Malnutrition
Chronic alcoholism
Chemotherapy
Transplant patient
Steroid therapy
57
Q

Antibiotics in necrotising fasciitis

A

Penicillin
Metronidazole
Cephalosporin/Aminoglycosides

58
Q

Surgical management of Priapism

A

Aspiration and Irrigation
Embolisation of internal pudendal artery
Glans puncture technique
Corpospongiosal shunt

59
Q

Indications for Surgery in bladder injury

A 
ALL intraperitoneal ruptures
Severe bleeding
Large urine leak
Penetrating bone fragment
Laceration of vagina/rectum
Penetrating injuries
Surgery for other organs
60
Q

Complications of bladder injury

A

Peritonitis
Abscess
Urinary fistulae
Osteitis

61
Q

Signs of urine in peritoneal cavity

A

Abdominal distension
Ileus
Urinary ascites
Increased urea and creatinine

62
Q

Complications of urethral injuries

A 
Stricture
Impotence
Urine leakage
Para-urethral abscess
Necrotising fasciitis
Cystitis/Epididymitis
63
Q

Causes of penile injury

A 
Iatrogenic
Blunt 
Penetrating
Avulsion
Strangulation
64
Q

DM causes ED why?

A

Autonomic neuropathy
Microvascular disease
Atherosclerosis

65
Q

Signs of Psychogenic Erectile Dysfunction

A 
Sudden onset
Morning erections
Situation-specific
Premature ejaculation
Psychiatric history
66
Q

Signs of Organic ED

A

Gradual onset
Gradual worsening
No morning erections
Erections not rigid enough

67
Q

Treatment of ED

A 
Psychotherapy
Vitamin E
PDE5-inhibitors
Testosterone
ICI
Intra-urethral capsules
Vacuum device
Penile prosthesis
Arterial surgery
Venous ligation
68
Q

Causes of Priapism

A 
Idiopathic
ICI
Pharmaceuticals
Haematological disease
Malignancy
Spinal injury
Perineal injury
69
Q

Causes of Urinary Retention

A

Underlying bladder outflow obstruction
Underlying detrusor weakening
Precipitating events

70
Q

Precipitating events for urinary retention

A 
Cystitis/prostatitis
Pharmaceuticals
Alcohol
Post-operatively
Cardiac failure
Constipation
71
Q

Contraindications to SPC

A

Empty/Fibrotic/Small bladder
Macroscopic haematuria
Previous lower abdominal surgery
Skin infection on lower abdominal wall

72
Q

Complications of SPC

A 
Bowel injury
Haematuria
Migration
Bleeding
Infection
73
Q

Causes of sterile pyuria

A 
Urogenital TB
Treated gram negative UTI
Urolithiasis
Papillary necrosis
Bladder carcinoma
Radiotherapy of bladders
Schistosomiasis
74
Q

Causes of papillary necrosis

A 
Urogenital TB
Diabetes Mellitus
Analgesic abuse
Recurrent UTIs with VUR
Sickle cell disease
75
Q

Bladder complications of schistosomiasis

A 
UTI
Bladder wall calcification
Reduced capacity bladder
Bladder calculi
Squamous metaplasia
SCC
76
Q

IVP findings in schistosomiasis

A 
Calcified bladder wall
Calcified ureters
Granulomata of bladder wall
Filling defect of bladder
Irregular bladder wall
Small bladder capacity
Hydro-ureteronephrosis
77
Q

Surgical treatment of schistosomiasis

A

Enterocystoplasty
Ureteric reimplantation
Radical cystectomy and urinary diversion

78
Q

Ureteric complications of schistosomiasis

A

Atony
VUR
Ureteric stricture
Renal failure

79
Q

Common sites of genitourinary TB

A 
Bladder
Kidney
Ureter
Epididymis
Seminal vesicles
Prostate
80
Q

Cystoscopy findings in GUTB

A

Erythema
Bleeding
Granulations
Golf hole ureteric openins

81
Q

IVP findings in GUTB

A 
Moth-eaten calyces
Papillary necrosis
Cavities in medulla
Infundibular stenosis
Blunted calyces
Straight ureters
PUJ obstruction
Hydro-ureteronephrosis
Small bladder
82
Q

Criteria for renal donors

A 
no renal disease
no malignancy
no diabetes
no active infection
negative serology
ABO compatibility
negative lymphocytotoxic cross-match
83
Q

Benign renal tumours

A

Oncocytoma
Adenoma
Angiomyolipoma

84
Q

Aetiology: TCC of the bladder

A

Smoking
Industrial carcinogens
Drugs
Pelvic irradiation

85
Q

Drugs causing Transitional Cell Carcinoma

A

Analgesics

Cyclophosphamide

86
Q

Industries implicated in TCC

A 
Rubber
Printing
Dye
Petroleum
Leather
87
Q

Aetiology: Squamous Cell Carcinoma of the bladder

A

Bladder calculi
Recurrent UTI
Indwelling catheter
Schistosomiasis

88
Q

Aetiology: Renal Cell Carcinoma

A

Smoking
Obesity
Acquired cystic disease
Von Hippel-Lindau disease

89
Q

Radical nephrectomy removes what?

A

Kidney
Adrenal Gland
Perinephric fat

90
Q

Indications for heminephretomy in RCC

A

<4cm incidentaloma
bilateral tumours
poor total renal function
unilateral tumour with solitary kidney

91
Q

RCC treatment option

A

Radical nephrectomy
Heminephrectomy
Immunotherapy
Renal artery embolisation

92
Q

DDX: painless scrotal mass

A 
Hydrocele
Varicocele
Epididymal cyst
Chronic epididymitis
Tumour
Inguinal hernia
93
Q

DDX: painful scrotal mass

A

Strangulated inguinal hernia
Acute epididymitis
Tumour - haemorrhaging
Scrotal trauma

94
Q

Risk factors for testicular tumours

A 
Undescended testis
Infertility
Atrophy of testis
Orchitis
Carcinoma in situ
Intersex
95
Q

Tumour markers in testicular tumours

A

B-HCG
AFP
LDH

96
Q

Treatment of testicular tumours

A

Radical orchiectomy
Chemotherapy
Radiotherapy

97
Q

Aminoacids in Cystineuria

A

Cystine
Ornithine
Lysine
Arginine

98
Q

Complications of renal stones

A

UTI
Obstruction
Chronic irritation

99
Q

Neuropathic Bladder complications

A 
Renal failure
Calculi
Recurrent UTI
Vesicoureteric reflux
Urethral diverticulum/fistula
SCC bladder
Autonomic dysreflexia
100
Q

Aetiology of BPH

A 
Male sex
Age
Hormones
Geographical
Race/Diet
Fat
Genetics
Stromal epithelial interaction
101
Q

Causes of LUTS

A 
BPH
Prostate carcinoma
Urethral stricture
Bladder neck contracture
Neurogenic bladder dysfunction
Diabetes mellitus
102
Q

Medical Management of BPH

A

A-Adrenergic blockers

5-A-reductase inhibitors

103
Q

Surgical indications in BPH

A 
Renal failure
Recurrent haematuria
Recurrent UTI
Hydronephrosis
Contraindicated medical treatment
Failed medical treatment
Previous prostatic surgery
104
Q

Complications of TURP

A 
TURP-syndrome
Secondary haemorrhage
Septicaemia
Retrograde ejaculation
Incontinence
Urethral stricture
105
Q

Aetiology: Prostate carcinoma

A 
Age
Genetics
Race
Geography/Environment
Hormones
106
Q

Pathology of Prostate ca

A

Adenocarcinoma
TCC
Sarcoma
SCC

107
Q

Causes of raised PSA

A 
BPH
Prostate Ca
Prostatitis
Urinary retention
Prostatic procedures
Age
108
Q

Medical treatment in prostate ca

A

Luteinising-Hormone Releasing Hormone
Oestrogens
Anti-androgens (flutamide)

109
Q

Orchiectomy complications

A 
bleeding
wound sepsis
psychological trauma
hot flushes
ED
osteoporosis
110
Q

Signs of spinal cord compression

A

motor dysfunction
sensory loss
urinary retention

111
Q

Treatment: spinal cord compression

A

high dose steroids
urgent castration
radiotherapy to spinal cord

112
Q

Complications: Renal Injury

A 
Haemorrhage
Secondary Haemorrhage
Urinary extravasation
Infection
Ileus
Renal infarction
Hypertension
Death
113
Q

Indications for surgery in renal injury

A 
Haemodynamic instability
Renal artery thrombosis
Suspected visceral damage
Suspected renal pelvis injury
Non-functioning of major part of kidney
114
Q

Causes of secondary haemorrhage in renal injury

A

Pseudoaneurysm

AVF

115
Q

Commonly isolated bacteria in necrotising fasciitis

A 
Enterobacteria
Bacteroides
Streptococci
Staphylococci
Peptostreptococci
Clostridia
116
Q

Early signs of necrotising fasciitis

A

Pain
Erythema
Swelling of scrotum
Pyrexia

117
Q

Late signs of necrotising fasciitis

A 
Cyanosis/blistering of skin
Crepitus
Cutaneous necrosis
Extension to abdomen and thighs
Septicaemia
Death
118
Q

DDX of necrotising fasciitis

A 
Scrotal cellulitis
Scrotal abscess
Strangulated inguinal hernia
Penile gangrene
Scrotal gangren
Pyoderma gangrenosa
119
Q

Indications for intervention in renal colic

A 
Renal failure
UTI
Failure of stone progression
Large stone
Anuria
Repeated colic
Convenience
120
Q

Semen analysis pattern in varicocele

A

Oligospermia
Teratospermia
Asthenospermia

121
Q

Renal injury Grade 1

A

Contusion/Haematoma

122
Q

Renal Injury Grade 2

A

Laceration <1cm parenchymal without urinary extravasation

123
Q

Renal injury Grade 3

A

Laceration >1cm without collecting system rupture or urinary extravasation

124
Q

Renal injury Grade 4

A

Laceration extending through cortex, medulla and collecting system
Main renal artery injury with contained haemorrhage

125
Q

Renal injury Grade 5

A

Shattered kidney

Avulsion of hilum with devascularised kidney

126
Q

Causes of Vesico-Ureteric Reflux

A 
Congenitally short submucosal tunnel
Bladder outflow obstruction
Iatrogenic
Duplex ureters
Ureterocele
127
Q

Complications of VUR

A

Chronic Pyelonephritis
Hypertension
Chronic Renal Failure

128
Q

Indications for Surgery in VUR

A 
Failure to prevent UTIs
Poor medical compliance
Very severe reflux
Associated pathology
Persistent VUR in female adolescents
129
Q

Surgery for VUR

A

Subureteric Teflon Injection

Reimplantation of ureter

Urology (1 decks)

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