Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is a risk factor for calcium oxalate stones

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are ssx of kidney stones

A

NOT peritonitic

Loi to groin tenderness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is main differential ddx for kidney stones

A

Ruptured AAA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what clinical pictures can kidney stones present as

A

Renal colic

Pyelonephrosis (EMERGENCY)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When should you admit kidney stones

A 
pain not controlled 
impaired renal function 
single kidney 
pysexia / sepsis 
stone >5mm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How do you manage hydronephrosis / pyelonephrosis ( infection

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

how common is BPH

A

very common, 70% of men over 70 years old

although only about half have sx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Sx of BPH

A

Frequency
Urgency
Urge incontinence
Nocturia

Hesistancy
Incomplete voiding
Poor stream

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Examination findings BPH

A

on DRE: prostate is smoothly enlarged with palpable midline groove

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Ix BPH

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Management of BPH

A
  1. Watchful waiting
  2. Medical:
    - Alpha 1 ANTAGONIST (tamlosulin)
    - 5alpha reductase inhibitor (finasteride)
  3. Surgical - TURP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

how does tamlosulin work

A

decreases smoooth muscle tone of prostate and bladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what are risks with TURP

A

OVER-IRRIGATION, causing leakage into circulation

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Prostate cancer ix

A
  1. PSA testing
  2. Multi-parametric MRI (if +ve PSA + high index clin suspition)
  3. TRUS guided biopsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

how do you manage prostate cancer

A

radical prostatectomy
radiotherapy

hormonal therapy if appropriate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
what is the most common malignant cause of abdominal mass in children 2-5 years old
Wilms tumour
26
differentials for haematuria
Cancer: - renal cancer - bladder cancer - prostate cancer ``` Urinary tract calcili Renal calculi Radiation cystitis Trauma Infection: UTI, infection, schistosomiasis, TB ```
27
what is the MAJOR CAUSE of PAINLESS VISIBLE HAEMATURIA
BLADDER CANCER
28
how do you investigate visible haematuria
urine dip, MSU FBC, CRP if suspecting bladder cancer: Refer to urology for Flexible cystoscopy + CT urogram (to look at upper urinary tract)
29
how do urology investigate non-visible haematuria
Flex cystoscopy + US KUB (instead of CT urogram)
30
How do you manage bladder cancer
Trans urethral resection of bladder tumour | 3 way catheter, keep in overnight
31
Risk factors for bladder cancer (based on histology)
TCC: - smoking - dyes (aromatic amines) - cyclophosphamides SCC: - long term catheterisation - smoking - schistosomiasis
32
Testicular cancers types
SEMINOMA (around 40yo) | NON-SEMINOMA (teratoma, yolk sac)
33
what age group do teratomas occur in
20-35
34
What age group do Yolk sac tumours occur iin
10 year old
35
RF for testicular cancer
cryptorchidism (failed descent of testis in scrotum) orchidopexy as chld mumps orchitis infertility
36
S/S testicular cancer
painless lump rapidly growing, feels craggy and irrecular gynaecomastia
37
tumour markers for testicular cancer
AFP == elevated in NON SEMINOMA hCG = elevated in both LDH = elevated in SEMNOMA
38
what are tumour markers very useful for in testicular cancer? especially which one and why
useful for monitoring response to treaatment | LDH is especially useful as t measures level of tumour necrosis
39
Ix for testicular cancer
urine dip, MCS (exclude infection) USS + tumour markers (AFP, hCG, LDH) Consider CT
40
Mx testicular cancer
orchidectomy + chemotherapy (BEP) +- radiotherapy | offer sperm banking
41
what approach do you need to take for orchidectomy
INGUINAL APPROACH (as this follows the lymphatic drainage of testes >> it avoids risk of spread)
42
How is epididymitis different to testicular cancer on exaMINATION
epididimytis is posterior, feels separate from testis
43
What is testicular torsion
twisting of spermatic cord > venous outflow obstruction > arterial occlusion > testicilar infarct
44
RF testicular tosion
trauma imperfectly descended testes bell clapper deformitiy
45
sx testicular torsion
sudden severe hemiscrotal pain no pain relief on scrotal elevation (-ve Prehn sign) abdo pain and vomiting
46
Which TWO SIGNS Occur in testicular torsion
Prehn sign NEGATIVE (no pain relief on scrotal elevation ) | Cremasteriic reflex ABSENT (stroking innner part of thigh fails to pull scrotum ipsilaterallhy=
47
How do you clinically differentiate testic torsion from hydradid of Morgani
hydradid of Morgani: - superior pole pain - cremasteric reflex +ve
48
How do you ix testic torsion
Doppler USS (only if it doesnt delay tx)
49
mx testic torsion
surgical exploration + bilateral orchidopexy within 6 hours!!!!!
50
What are organic (not psychological) differentials for ED
atherosclerosis (do QRisk score, which includes CV risk factors) abnormla endocrine picture (check testosterone )
51
manageement of ED
Sildenafil second line: vacuum devices
52
what is a vasectomy
cutting of vas deferens | better contraception than female (failure rate only 1 in 2000)
53
how invasive is a vasectomy -- how soon can you go home
under LA | Go home wiithin hours
54
when does a vasectomy start working
NOT immedate | semen analysis needs to be done at 16 weeks and 20 weeks before unprotected sex
55
what is vasectomy reversal success rate
55% within 10 years
56
Abx for uncomplicated UTI in women
Trimethoprim or nitrofurantoin | 3 days
57
Abx for UTI in pregnancy
Nitrofurantoin 7 days (aboid at term) OR Amoxiicilliin 7 days
58
Abx for UTI in men or catheterised patients
Trimethoprim or nitrofurantoin 7 days
59
what is a Hydrocoele
collection of fluid in the tunnica vaginalis, in the testis
60
sx of hydrocoele
asymptomatic scrotal swelling scrotum larger in evening or after exercise (due to change in abdominal pressures) transilluminates cannot be separated from testcles
61
ix of hydrocoele
urine dip, MSU (exclude infection) USS testis (exclude lump) TRANSILLUMINATES
62
Management hydrocoele
watchful waiting Aspiration for symptomatic relief Surgical repair
63
2 possible causes of hydrocoele
* Non-communicating hydrocele: tumour, infection, trauma, testicular torsion, epididimytis * Communicating hydrocele: increased intra-abdo fluid/pressure (e.g. shunt, ascites)
64
what is varicocoele
scrotal swelling due to dilated veins in pampiniform plexus of spermatic cord, forming a scrotal mass
65
epidemiology of varcicoele
15 % male population, so very common | incidence highest after puberty
66
what is the biggest complication of varicocele
INFERTILITY
67
where is varicocele most likely to occur
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
ix for varicocoele
doppler USS
69
presentation of varicocele
asymptomatic bag of worms on palpation dragging/ heavy sensation dull ache
70
Examiination findings in varicocele
sidee with varicocele hangs low | swelling reduces with lying down
71
mx varicocele
generally conservative | ooccasional surgery
72
differential for scrotal mass (always split anatomically!)
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
what is the most common organism to cause prostatitis
E coli
74
RF prostatitis
recent UTI urogenitaal instumentation intermittent catheterisatiion recent prostate biopsy
75
sx prostatitis
referred pain obstructive voiding sx fevers, rigors
76
Ix prostatitis
DRE: tender boggy prostate
77
mx prostatitis
Quinolone e.g. ciprofloxacin 14 days
78
which organisms are involved with the formation of staghorn calculi
Ureaplasma urealyticum and Proteus infections
79
what score do you use for prostate cancer and how does it work
Grade 1-5 for two worse slices | sum up the grades
80
how do you manage localised prostate cancer
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
is circumcision available on NHS
NO
82
What are medical indications for circumcision on NHS
phimosis recurrent balanitis balanitis xerotica obliterans paraphimosis
83
what must you exclude before circumcision
hypospadias as foreskin would be needed for surgical repair
84
what is first line ix for testicular cancer?
USS
85
what must you NEVER do in testicular cancer
NEVER do a biopsy / FNA because you risk spreading the cancer
86
what ix are necessary for all ED
lipids, glucose (Qrisk) Free morning testosterone
87
what iix are necessary in ED if testosterone is low
do FSH, LH, prolactin if these are low, then refer to endocrinology
88
what routes can you give diclofenac in for stones and why?
IM if very severe pain | PR/PO otherwise
89
when do you refer a man with uncomplicated UTI
at the SECOND UTI
90
when do you need to treat a cathheterised pt with UTI?
only if symptomatic! do not treat if asymptomatic bacteriuria
91
what is stress incontinence due to
weakened or damaged muscles (pelvic floor / urethral sphincter) leading to small loss incontinence
92
what is urge incontinence due to
detrusor overactvity
93
what is functional incontinence due to
inability to get to the toilet in time (due to mobility)
94
ix for incontinence
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
mx stress incontinence
Conservative: - lifestyle - WL (if BMI >30) - pelvic floor exercisies Medical/ surgical - offer Burch colposuspension or SNRI duloxetiine
96
risk factors for stress incontinence
``` age children traumatic delivery pelvic surgery obesity ```
97
mx urge incontinence
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 3. Surgical - Botox injection, sacral nerve stimulation
98
commonest type of pancreatic cancer
adenocarcinoma
99
how does epididimo orchitis present
dysuria urethral discharge swelling (prehn p+ve)
100
what is the commonest cause of epididimo orchitis
chalmydia (esp <35)
101
what is MoA of Goserelin
GnRH agonist >> so it decreases LH levels by overstimulating the pituitary > decreases testosterone levels
102
What must you co-prescribe Goserelin with
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 >> which is later desensitised)
103
what is a complication of acute urinary retention
post-obstructive diuresis - kidneys diuresis due to the loss of their medullary concentration gradient. - it takes time re-equilibrate >> this can lead to volume depletion and worsening of any acute kidney injury - may require IV fluids to correct this temporary over-diuresis
104
what is balanitis
inflammatino of the glans penis
105
cause of balanitis
STI dermatitis bacterial fungaal infection (esp if immunocompromised or diabetes)
106
how do you manage recurrent balanitis
circumcision
107
how do you detect an inguinal hernia on examination in the testis
if you CANNOT GET ABOVE IT | + separate to the testis
108
what does hydronephrosis mean in the context of ureteric stone
that the ureter is almosst completely occluded by the stone > very bad
109
what is the general cause of hydronephrosis
OBSTRUCTION of renal / ureteric tracts so kidneys can no longer drain
110
how do you manage hydronephrosis
nephrostomy tube ( to relieve obstruction)
111
complications of radical prostatectomy
erectyle dysfunction | incontinence
112
key ix with hydronephrosis
renal USS
113
how do you manage RCC
nephrectomy it is often non responsive to chemo or radiotherapy
114
how do you manage bladder cancer
1. intravescicular immunotherapay | 2. radical cystectomy (if invasive) or transurethral resection of bladder tumour (if in situ)
115
how does urethritis cause urinary retention?
by causing urethral oedema this may occur for instance with UTI /STI

Y6 Senior Med (29 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions