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Y6 Senior Med > Urology > Flashcards

Urology Flashcards

1
Q

How do renal stones present

A

severe loin to groin pain
nausea and vomiting
urinary urgency, frequency, retention
haematuria

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2
Q

what are most common types of renal stones

A

Calcium oxalate (85%)
calcium phosphate
Struvite (from proteus mirabilis)
Uric acid, xanthine (radio-lucent)

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3
Q

what is a risk factor for calcium oxalate stones

A

Metabolic (hypercalciuria, hyperurcaema, hypercysturia)
Low fluid intake
Structural abnormality

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4
Q

What are ssx of kidney stones

A

NOT peritonitic

Loi to groin tenderness

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5
Q

What is main differential ddx for kidney stones

A

Ruptured AAA

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6
Q

What basic bedside and blood ix do you need for kidney stones

A

Urine dip + MCS

Blood (FBC, CRP, UE; calcium, urate, phosphate)

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7
Q

What is the definitive ix for kidney stones

and what are the findings

A

CT-KUB (non contrast)

stone or peri-ureteric fat stranding

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8
Q

what clinical pictures can kidney stones present as

A

Renal colic

Pyelonephrosis (EMERGENCY)

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9
Q

When should you admit kidney stones

A 
pain not controlled 
impaired renal function 
single kidney 
pysexia / sepsis 
stone >5mm
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10
Q

How should you manage a renal colic prior to referral to UROLOGY

A

Mx sepsis (sepsis &)
Mx pain (PR/IM diclofenac or diamorphine + antiemetic)
Check UE
Get CT KUB to confirm stone (Urology otherwise will not accept - could be a AAA)

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11
Q

How do urology manage renal stones (renal colic - not emergency)

A

<5mm = will likely pass spontaneously. Treat expectantily, consider alpha blocker (tamlosulin) or CCB

<2cm = lithotrypsy (Extracorporeal Shockwave Lithotripsy

Complex stone e.g. staghorne = NEPHROLIITHOTOMY

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12
Q

How do you manage hydronephrosis / pyelonephrosis ( infection

A

aggressive fluid resus
broad spec abx
urgent de-obstruction with PERCUTANEOUS NEPHROSTOMY

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13
Q

What do you do for renal colic patient who is discharged home (i.e. pt is well, pain is mild and well controlled)

A

outpatient visit in 4 weeks with CT-KUB (may need lithotripsy or surgical removal)
safety net
encourage high fluid intake

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14
Q

how common is BPH

A

very common, 70% of men over 70 years old

although only about half have sx

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15
Q

Sx of BPH

A

Frequency
Urgency
Urge incontinence
Nocturia

Hesistancy
Incomplete voiding
Poor stream

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16
Q

Examination findings BPH

A

on DRE: prostate is smoothly enlarged with palpable midline groove

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17
Q

Ix BPH

A

urine dip and MCS
Bloods: UE, PSA
Bladder scan (if retention)

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18
Q

Management of BPH

A
  1. Watchful waiting
  2. Medical:
    - Alpha 1 ANTAGONIST (tamlosulin)
    - 5alpha reductase inhibitor (finasteride)
  3. Surgical - TURP
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19
Q

how does tamlosulin work

A

decreases smoooth muscle tone of prostate and bladder

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20
Q

How does finasteride work

A

blocks conversion of testosterone to dihydrotestosterone

causes reduction of prostate volume, but takes time to work (approx 6months)

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21
Q

what are risks with TURP

A

OVER-IRRIGATION, causing leakage into circulation

this causes hyponatraemia, fluid overloading, glycine toxic ity (confusion, coma)

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22
Q

Prostate cancer ix

A
  1. PSA testing
  2. Multi-parametric MRI (if +ve PSA + high index clin suspition)
  3. TRUS guided biopsy
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23
Q

When should you NOT do a PSA

A

48 hours of vigorous exercise / ejaculation
1 week of DRE
4 weeks of proven UTI / prostatitis
if 6 weeks from prostate biopsy

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24
Q

how do you manage prostate cancer

A

radical prostatectomy
radiotherapy

hormonal therapy if appropriate

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25
Q

what is the most common malignant cause of abdominal mass in children 2-5 years old

A

Wilms tumour

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26
Q

differentials for haematuria

A

Cancer:

  • renal cancer
  • bladder cancer
  • prostate cancer
Urinary tract calcili 
Renal calculi 
Radiation cystitis 
Trauma 
Infection: UTI, infection, schistosomiasis, TB
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27
Q

what is the MAJOR CAUSE of PAINLESS VISIBLE HAEMATURIA

A

BLADDER CANCER

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28
Q

how do you investigate visible haematuria

A

urine dip, MSU
FBC, CRP

if suspecting bladder cancer:
Refer to urology for Flexible cystoscopy + CT urogram (to look at upper urinary tract)

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29
Q

how do urology investigate non-visible haematuria

A

Flex cystoscopy + US KUB (instead of CT urogram)

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30
Q

How do you manage bladder cancer

A

Trans urethral resection of bladder tumour

3 way catheter, keep in overnight

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31
Q

Risk factors for bladder cancer (based on histology)

A

TCC:

  • smoking
  • dyes (aromatic amines)
  • cyclophosphamides

SCC:

  • long term catheterisation
  • smoking
  • schistosomiasis
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32
Q

Testicular cancers types

A

SEMINOMA (around 40yo)

NON-SEMINOMA (teratoma, yolk sac)

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33
Q

what age group do teratomas occur in

A

20-35

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34
Q

What age group do Yolk sac tumours occur iin

A

10 year old

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35
Q

RF for testicular cancer

A

cryptorchidism (failed descent of testis in scrotum)
orchidopexy as chld
mumps orchitis
infertility

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36
Q

S/S testicular cancer

A

painless lump
rapidly growing, feels craggy and irrecular
gynaecomastia

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37
Q

tumour markers for testicular cancer

A

AFP == elevated in NON SEMINOMA
hCG = elevated in both
LDH = elevated in SEMNOMA

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38
Q

what are tumour markers very useful for in testicular cancer? especially which one and why

A

useful for monitoring response to treaatment

LDH is especially useful as t measures level of tumour necrosis

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39
Q

Ix for testicular cancer

A

urine dip, MCS (exclude infection)
USS + tumour markers (AFP, hCG, LDH)
Consider CT

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40
Q

Mx testicular cancer

A

orchidectomy + chemotherapy (BEP) +- radiotherapy

offer sperm banking

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41
Q

what approach do you need to take for orchidectomy

A

INGUINAL APPROACH (as this follows the lymphatic drainage of testes&raquo_space; it avoids risk of spread)

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42
Q

How is epididymitis different to testicular cancer on exaMINATION

A

epididimytis is posterior, feels separate from testis

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43
Q

What is testicular torsion

A

twisting of spermatic cord > venous outflow obstruction > arterial occlusion > testicilar infarct

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44
Q

RF testicular tosion

A

trauma
imperfectly descended testes
bell clapper deformitiy

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45
Q

sx testicular torsion

A

sudden severe hemiscrotal pain
no pain relief on scrotal elevation (-ve Prehn sign)
abdo pain and vomiting

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46
Q

Which TWO SIGNS Occur in testicular torsion

A

Prehn sign NEGATIVE (no pain relief on scrotal elevation )

Cremasteriic reflex ABSENT (stroking innner part of thigh fails to pull scrotum ipsilaterallhy=

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47
Q

How do you clinically differentiate testic torsion from hydradid of Morgani

A

hydradid of Morgani:

  • superior pole pain
  • cremasteric reflex +ve
48
Q

How do you ix testic torsion

A

Doppler USS (only if it doesnt delay tx)

49
Q

mx testic torsion

A

surgical exploration + bilateral orchidopexy within 6 hours!!!!!

50
Q

What are organic (not psychological) differentials for ED

A

atherosclerosis (do QRisk score, which includes CV risk factors)
abnormla endocrine picture (check testosterone )

51
Q

manageement of ED

A

Sildenafil

second line: vacuum devices

52
Q

what is a vasectomy

A

cutting of vas deferens

better contraception than female (failure rate only 1 in 2000)

53
Q

how invasive is a vasectomy – how soon can you go home

A

under LA

Go home wiithin hours

54
Q

when does a vasectomy start working

A

NOT immedate

semen analysis needs to be done at 16 weeks and 20 weeks before unprotected sex

55
Q

what is vasectomy reversal success rate

A

55% within 10 years

56
Q

Abx for uncomplicated UTI in women

A

Trimethoprim or nitrofurantoin

3 days

57
Q

Abx for UTI in pregnancy

A

Nitrofurantoin 7 days (aboid at term)
OR
Amoxiicilliin 7 days

58
Q

Abx for UTI in men or catheterised patients

A

Trimethoprim or nitrofurantoin 7 days

59
Q

what is a Hydrocoele

A

collection of fluid in the tunnica vaginalis, in the testis

60
Q

sx of hydrocoele

A

asymptomatic scrotal swelling
scrotum larger in evening or after exercise (due to change in abdominal pressures)
transilluminates
cannot be separated from testcles

61
Q

ix of hydrocoele

A

urine dip, MSU (exclude infection)
USS testis (exclude lump)
TRANSILLUMINATES

62
Q

Management hydrocoele

A

watchful waiting
Aspiration for symptomatic relief
Surgical repair

63
Q

2 possible causes of hydrocoele

A
  • Non-communicating hydrocele: tumour, infection, trauma, testicular torsion, epididimytis
  • Communicating hydrocele: increased intra-abdo fluid/pressure (e.g. shunt, ascites)
64
Q

what is varicocoele

A

scrotal swelling due to dilated veins in pampiniform plexus of spermatic cord, forming a scrotal mass

65
Q

epidemiology of varcicoele

A

15 % male population, so very common

incidence highest after puberty

66
Q

what is the biggest complication of varicocele

A

INFERTILITY

67
Q

where is varicocele most likely to occur

A

on the LEFT
as the left testicular vein drains at 90 degree angle, is longer than the right, lacks terminal valve to prevent backflow

68
Q

ix for varicocoele

A

doppler USS

69
Q

presentation of varicocele

A

asymptomatic
bag of worms on palpation
dragging/ heavy sensation
dull ache

70
Q

Examiination findings in varicocele

A

sidee with varicocele hangs low

swelling reduces with lying down

71
Q

mx varicocele

A

generally conservative

ooccasional surgery

72
Q

differential for scrotal mass (always split anatomically!)

A

SCROTAL SKIN: sebaceous cyst, melanoma
INTRA-VAGINAL (within processus vaginalis): hydrocele, epidydimal cyst, epididimits, torted hydratid
INTRA TESTICULAR: ooschitis, testicular abscess, testicular cancer, lymphoma
OTHER: inguinal hernia

73
Q

what is the most common organism to cause prostatitis

A

E coli

74
Q

RF prostatitis

A

recent UTI
urogenitaal instumentation
intermittent catheterisatiion
recent prostate biopsy

75
Q

sx prostatitis

A

referred pain
obstructive voiding sx
fevers, rigors

76
Q

Ix prostatitis

A

DRE: tender boggy prostate

77
Q

mx prostatitis

A

Quinolone e.g. ciprofloxacin 14 days

78
Q

which organisms are involved with the formation of staghorn calculi

A

Ureaplasma urealyticum and Proteus infections

79
Q

what score do you use for prostate cancer and how does it work

A

Grade 1-5 for two worse slices

sum up the grades

80
Q

how do you manage localised prostate cancer

A

conservative: active monitoring, watchful waiting (if low gleason score or elderly)

radical prostatectomy: surgical removal of prostate and obturator nodes

radiotherapy (external beam and brbachytherapy)

81
Q

is circumcision available on NHS

A

NO

82
Q

What are medical indications for circumcision on NHS

A

phimosis
recurrent balanitis
balanitis xerotica obliterans
paraphimosis

83
Q

what must you exclude before circumcision

A

hypospadias

as foreskin would be needed for surgical repair

84
Q

what is first line ix for testicular cancer?

A

USS

85
Q

what must you NEVER do in testicular cancer

A

NEVER do a biopsy / FNA

because you risk spreading the cancer

86
Q

what ix are necessary for all ED

A

lipids, glucose (Qrisk)

Free morning testosterone

87
Q

what iix are necessary in ED if testosterone is low

A

do FSH, LH, prolactin

if these are low, then refer to endocrinology

88
Q

what routes can you give diclofenac in for stones and why?

A

IM if very severe pain

PR/PO otherwise

89
Q

when do you refer a man with uncomplicated UTI

A

at the SECOND UTI

90
Q

when do you need to treat a cathheterised pt with UTI?

A

only if symptomatic!

do not treat if asymptomatic bacteriuria

91
Q

what is stress incontinence due to

A

weakened or damaged muscles (pelvic floor / urethral sphincter) leading to small loss incontinence

92
Q

what is urge incontinence due to

A

detrusor overactvity

93
Q

what is functional incontinence due to

A

inability to get to the toilet in time (due to mobility)

94
Q

ix for incontinence

A

speculum (if F - exclude pelvic organ prolapse)
Valsalva maneuvre to check for fluid leakage
Urine dip / MCS (exclude DM or UTI)

  1. Bladder diaries (min 3 days)
  2. Urodynamic testinig (if mixed - measures pressures inside bladder and urethra)
95
Q

mx stress incontinence

A

Conservative:

  • lifestyle
  • WL (if BMI >30)
  • pelvic floor exercisies

Medical/ surgical
- offer Burch colposuspension or SNRI duloxetiine

96
Q

risk factors for stress incontinence

A 
age 
children 
traumatic delivery 
pelvic surgery 
obesity
97
Q

mx urge incontinence

A

COnservative:

  • lifestyle advice (avoid fizzy drink)
  • bladder training for 6 weeks (hold off going to toilet)

Mediical:
1
- antimuscarinic (oxybutinin, tolterodine)
- ADH analogue (desmopressin)

2.
- Mirabegron

  1. Surgical
    - Botox injection, sacral nerve stimulation
98
Q

commonest type of pancreatic cancer

A

adenocarcinoma

99
Q

how does epididimo orchitis present

A

dysuria
urethral discharge
swelling (prehn p+ve)

100
Q

what is the commonest cause of epididimo orchitis

A

chalmydia (esp <35)

101
Q

what is MoA of Goserelin

A

GnRH agonist&raquo_space; so it decreases LH levels by overstimulating the pituitary > decreases testosterone levels

102
Q

What must you co-prescribe Goserelin with

A

3 week cover of anti androgen e.g. FLUTAMIDE; CYPROTERONE ACETATE

these prevent the initial rise in testosterone(due to initiial increased LH and FSH, due to GnRH agonisst&raquo_space; which is later desensitised)

103
Q

what is a complication of acute urinary retention

A

post-obstructive diuresis

  • kidneys diuresis due to the loss of their medullary concentration gradient.
  • it takes time re-equilibrate&raquo_space; this can lead to volume depletion and worsening of any acute kidney injury
  • may require IV fluids to correct this temporary over-diuresis
104
Q

what is balanitis

A

inflammatino of the glans penis

105
Q

cause of balanitis

A

STI
dermatitis
bacterial
fungaal infection (esp if immunocompromised or diabetes)

106
Q

how do you manage recurrent balanitis

A

circumcision

107
Q

how do you detect an inguinal hernia on examination in the testis

A

if you CANNOT GET ABOVE IT

+ separate to the testis

108
Q

what does hydronephrosis mean in the context of ureteric stone

A

that the ureter is almosst completely occluded by the stone > very bad

109
Q

what is the general cause of hydronephrosis

A

OBSTRUCTION of renal / ureteric tracts

so kidneys can no longer drain

110
Q

how do you manage hydronephrosis

A

nephrostomy tube ( to relieve obstruction)

111
Q

complications of radical prostatectomy

A

erectyle dysfunction

incontinence

112
Q

key ix with hydronephrosis

A

renal USS

113
Q

how do you manage RCC

A

nephrectomy

it is often non responsive to chemo or radiotherapy

114
Q

how do you manage bladder cancer

A
  1. intravescicular immunotherapay

2. radical cystectomy (if invasive) or transurethral resection of bladder tumour (if in situ)

115
Q

how does urethritis cause urinary retention?

A

by causing urethral oedema

this may occur for instance with UTI /STI

Y6 Senior Med (29 decks)

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