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Alice's finals cards > Urology > Flashcards

Urology Flashcards

1
Q

What is the term which refers to urine refluxing from the bladder into the ureters?

A

Vesico-uteric reflux

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2
Q

What is the presentation of upper urinary tract infection?

A

Loin to groin or flank pain

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3
Q

Name some common causes for upper urinary tract obstruction

A 
Kidney stones 
Tumours
Ureter strictures
Retroperitoneal fibrosis
Bladder cancer
Utereocele
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4
Q

Name some common causes for lower urinary tract obstruction

A 
BPH
Prostate cancer
Bladder cancer
Urethral strictures
Neurogenic bladder
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5
Q

What is a neurogenic bladder and what are its common causes?

A

Abnormal function of the nerves which innervate the bladder and urethra which results in under or over activity of the detrusor muscle and sphincters.

Causes include:
MS
Diabetes
Stroke
PD
Brain or spinal injury
Spina bifida
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6
Q

What is the management of obstructive uropathy?

A

Nephrostomy

Uretral or suprapubic catheter

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7
Q

What is hydronephrosis?

A

Swelling of the renal pelvis and calyces in the kidney

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8
Q

What are the LUTS which occur with BPH?

A 
Hesitancy
Weak flow
Urgency
Frquency
Intermittency
Straining
Terminal dribbling
Incomplete emptying
Nocturia
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9
Q

Which scoring system can be used to assess the severity of LUTS in BPH?

A

The international prostate symptom score (IPSS)

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10
Q

What should be done on initial assessment of men with LUTS?

A 
DRE
Abdo exam (for palpable bladder)
Urinary frequency volume chart
Urine dipstick
PSA
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11
Q

What are the medical management options for BPH?

A

Alpha-blockers (eg tamsulosin)
5-alpha reductase inhibitors (finasteride)

Alpha blockers are used to treat immediate symptoms as 5-alpha reductase inhibitors gradually reduce the size of the prostate

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12
Q

How do 5-alpha reductase inhibitors work and how long does it take to see an effect?

A

5-alpha reductase converts testosterone to dihydrotestosterone which is a more potent androgen hormone. 5-alpha reductase blockers reduce the levels of dihydrotestosterone which reduces the size of the prostate. It takes up to 6 months of treatment for the effects to result in an improvement in symptoms.

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13
Q

What are the surgical management options for BPH?

A

TURP
Transuretheral electrovaporisation of the prostate
Holumium laser enucleation of the prostate
Open prostectomy

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14
Q

What is a notable side effect of alpha-blockers?

A

Postural hypotension

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15
Q

What is a notable side effect of finasteride?

A

Sexual dysfunction

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16
Q

What is the most common complication of TURP?

A

Retrograde ejactulation

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17
Q

What are the two types of prostatitis?

A

Acute bacterial

Chronic (sx >3 months)

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18
Q

What are the symptoms of chronic prostatitis?

A 
>3 months of:
Pelvic pain
LUTS
Sexual dysfunction
Pain with bowel movements
Tender and enlarged prostate
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19
Q

What are the symptoms of acute bacterial prostatitis?

A 
Fever
Myalgia
Nausea
Fatigue
Sepsis
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20
Q

Which investigations should be done in cases of chronic prostatitis?

A

urine dipstick
Urine MC&S
Chlamydia and gonorrhoea NAAT testing

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21
Q

What is the management of acute bacterial prostatitis?

A

Oral abx for 2-4 weeks (ciprofloxacin)
Analgesia
Laxatives

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22
Q

What is the management of chronic prostatitis?

A

Alpha blockers
Analagesia
antibiotics
Laxatives

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23
Q

What are the key risk factors for prostate cancer?

A 
Increasing age
Family history
Black african or caribbean origin
Tall stature
Anabolic steroids
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24
Q

What are the common symptoms of prostate cancer?

A 
Hesitancy
Weak flow
Terminal dribbling
Nocturia
Haematuria
ED
Weight loss, bone pain, cauda equina if advanced
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25
Q

What are the investigations which can be done for ?prostate Ca?

A

DRE
PSA
Multiparametric MRI
Biopsy

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26
Q

Which grading system is used in prostate cancer?

A

Gleason grading system

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27
Q

Which staging system is used in prostate cancer?

A

TNM

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28
Q

What is a key complication of external beam radiotherapy in prostate cancer?

A

Proctitis

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29
Q

What is brachytherapy?

A

Metal “seeds” are implanted into the prostate which delivers continuous and targeted radiotherapy to the prostate

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30
Q

What are the most common drugs in hormone therapy for prostate cancer?

A 
Androgen receptor blockers (bicalutamide)
GnRH agonists (goserelin)
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31
Q

What are the common side effects of hormone therapy in prostate cancer?

A 
Hot flushes
Sexual dysfunction
Gynaecomastia
Fatigue
Osteoporosis
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32
Q

What are the key complications of radical prostatectomy?

A

Erectile dysfunction and urinary incontinence

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33
Q

What are the 4 common causes of epididymo-orchitis?

A

E.coli
Chlamydia
Gonorrhoea
Mumps

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34
Q

How does epididymo-orchitis present?

A

Gradual onset over minutes to hours

Unilateral

testicular pain, dragging or heavy sensation

Swelling of testicle

Tenderness on palpation

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35
Q

What is a key differential for epididymo-orchitis?

A

Testicular torsion

36
Q

What investigations can be done to establish the cause of epididymo-orchitis?

A 
Urine MC&S
Chlamydia and gonorrhoea NAAT testing
Charcoal swab
Saliva swab (for mumps)
Ultrasound (torsion and tumours
37
Q

Which antibiotic is usually first line in epididymo-orchitis?

A

ofloxacin (if STI not suspected)

38
Q

What is found on examination in testicular torsion?

A

Firm swollen testicle
Elevated (retracted) testicle
Absent cremasteric reflex
Abnormal testicular lie

39
Q

What is a congenital deformity which is a common cause of testicular torsion?

A

Bell-clapper deformity

40
Q

What is the test which can confirm a diagnosis of testicular torsion and which sign is seen?

A

A scrotal ultrasound

Whirlpool sign

41
Q

What is a hydrocele?

A

A collection of fluid within the tunica vaginalis which surrounds the testes

42
Q

What is found on examination in hydrocele?

A

Testicle is palpable

Soft, fluctuant and large

Irreducible and no bowel sounds (distinguishing from a hernia)

Can be transilluminated

43
Q

What are the 5 causes of hydrocele?

A 
Testicular cancer
Testicular torsion
Epididymo-orchitis
Trauma
Idiopathic
44
Q

How can hydrocele be managed?

A

Exclude serious causes

Conservative

In large or symptomatic cases- surgery, aspiration or sclerotherapy

45
Q

What is a varicocele?

A

Occurs when the veins in the pampiniform plexus become swollen. They are the result of increased resistance in the testicular vein

46
Q

On which side to varicoceles usually occur?

A

Left

The right testicular vein drains directly into the inferior vena cava. The left testicular vein drains into the left renal vein. Most varicoceles (90%) occur on the left due to increased resistance in the left testicular vein. A left-sided varicocele can indicate an obstruction of the left testicular vein caused by a renal cell carcinoma.

47
Q

What is the presentation of varicoceles?

A

Throbbing or dull pain
Dragging sensation
Sub-fertility or infertility

Scrotal mass feels like a bag of worms. It is more prominent when standing and disappears when lying down

48
Q

How are varicoceles managed?

A

Ultrasound with doppler to confirm the diagnosis

Semen analysis and hormone profiles if concerned about fertility

Uncomplicated cases can be managed conservatively

49
Q

What is a epididymal cyst which contains sperm called?

A

Spermatocele

50
Q

What is found on examination with epididymal cysts?

A 
Soft, round lump
Typically at the top of the testicle
Associated with the epididymis
Separate from the testicle
May be able to transluminate
51
Q

What are the 2 sub-types of testicular cancer?

A

Seminomas

Non-seminomas (usually teritomas)

52
Q

What are the risk factors for testicular cancer?

A

Undescended testes
Male infertility
Family Hx
Increased height

53
Q

What is the usual presentation of testicular cancer?

A

Painless lump

Gynaecomastia is associated with leydig cell tumours

54
Q

What are the 3 tumour markers for testicular cancer?

A 
Alpha fetoprotein (teratomas)
Beta hCG (teratomas and seminomas)
Lactate dehyrdogenase (very non-specific)
55
Q

Which staging system is used in testicular cancer?

A

Royal Marsden

56
Q

Where does testicular cancer often metastasise to?

A

Lymphatics
Lungs
Liver
Brain

57
Q

What is the presentation of pyelonephritis?

A

Fever
Loin to groin pain
Nausea and vomiting
Renal angle tenderness

58
Q

What is seen on a urine dipstick to suggest a UTI?

A

Nitrites or
leukocytes +RBCs

Nitrites is a better indication of UTI than leukocytes and RCs

59
Q

Which groups of patients with UTI symptoms should have MSUs sent?

A

Pregnant patients
Patients with recurrent UTIs
Atypical symptoms
When symptoms do not improve with abx

60
Q

What is the most common cause of UTI? What does these bacteria look like under a microscope?

A

E.coli

Gram-negative, anaerobic, rod shaped

61
Q

When should nitrofurantoin be avoided in UTI treatment?

A

In GFR <45

The last trimester of pregnancy (neonatal haemolysis)

62
Q

How long should abx be prescribed for in UTI management?

A

3 days- women
5-10 days- immunosupressed, abnormal anatomy
7 days- men, pregnant women, catheter related

63
Q

What are the complications from UTI in pregnancy?

A

Pyelonephritis
Premature rupture of membranes
Pre-term labour

64
Q

When should trimethoprim be avoided in UTI treatment?

A

The first trimester of pregnancy. Works as a folate antagonist

65
Q

What are the risk factors for pyelonephritis?

A

Female
Structural urological abnormalities
Vesico-ureteric reflux
Diabetes

66
Q

What are 2 differentials for the cause of pyelonephritis in patients who do not respond to treatment?

A

Renal abscess

Kidney stones

67
Q

Which type of scan can be used to assess for renal scarring?

A

DMSA

68
Q

What is interstitial cystitis?

A

Chronic condition causing inflammation in the bladder. Also called bladder pain syndrome and hypersensitive bladder syndrome

69
Q

What is the presentation of interstitial cystitis?

A

Suprapubic pain
Frequency
Urgency
for more 6 weeks

70
Q

What is the diagnostic investigation for interstitial cystitis and what is seen?

A

Cystoscopy

Hunner lesions and granulations

71
Q

What are the main risk factors for bladder cancer?

A

Smoking, increased age
Aromatic amines (in fabric dye and rubber)
Schistosomiasis

72
Q

Which is the most common type of bladder cancer?

A

Transitional cell carcinoma

73
Q

Which type of bladder cancer is associated with schistosomiasis?

A

Squamous cell carcinoma

74
Q

What is the presentation of bladder cancer?

A

Painless haematuria

2 week wait for >45 yo with unexplained visible haematuria
Aged over 60 with microscopic haematuria plus dysuria or raised WCC

75
Q

How is bladder cancer investigated?

A

Cystoscopy

76
Q

What are the management options for bladder cancer?

A 
TURBT
Intravesical chemotherapy
BCG vaccine into bladder wall
Radical cystectomy
Chemo and radiotherapy
77
Q

What are the 2 key complications of kidney stones?

A

Obstruction and infection

78
Q

What is the most common type of kidney stone?

A

Calcium oxalate

79
Q

Which type of kidney stone cannot be seen on x-ray?

A

Uric acid

80
Q

Which type of kidney stone is associated with infection because it is made by bacteria?

A

Struvite

81
Q

What is the investigation of choice for kidney stones?

A

non-contrast CT KUB

82
Q

What is the most effective form of analgesia in kidney stones?

A

IM diclofenac

83
Q

What are the treatment options for kidney stones?

A

Extracorporeal shock wave lithotripsy (ESWL)

PCNL

Open surgery

84
Q

What is the classic triad of symptoms in renal cell carcinoma?

A

Haematuria, flank pain, palpable mass

85
Q

What can be seen on chest xray when RCC metastisises?

A

Cannonball metastases

86
Q

What is the classic scar left in kidney transplant?

A

Hockey stick scar

Alice's finals cards (21 decks)

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