Urology Flashcards
Management of urinary retention due to BPH?
2 way Foley catheter
Prescribe Doxazosin (alpha blocker) to relax prostate.
What term describes a blockage to urine flow along the urinary tract?
Obstructive uropathy
What term describes swelling of the kidneys secondary to obstruction to the outflow of urine?
Hydronephrosis
What is the name for when urine is able to reflux from the bladder back into the ureters?
Vesicoureteral reflux
What are the broad categories of causes of an acute kidney injury?
Pre-renal, renal and post-renal
What term describes over or under activity of the detrusor muscle of the bladder that may occur in multiple sclerosis?
Neurogenic bladder
What intervention can be used to bypass an upper urinary tract obstruction?
Nephrostomy
What options can be used to bypass a lower urinary tract obstruction, such as a urethral stricture?
Urethral catheter or suprapubic catheter
What is a notable side effect of tamsulosin?
Postural hypotension
What is the name of the standard two-way urinary catheter?
Foley catheter
What type of urinary catheter has a curved and slightly rigid tip to help navigate past an obstruction?
Coudé tip catheter
What is the risk of not replacing the foreskin after inserting a urinary catheter in a man?
Paraphimosis
What standard duration of antibiotics is used in patients with catheter-associated urinary tract infections?
7 days
What scoring system can be used to assess the severity of lower urinary tract symptoms in benign prostatic hyperplasia?
International Prostate Symptom Score (IPSS)
What two classes of medication can be used to treat benign prostatic hyperplasia? Give one example of each.
Alpha-blockers (e.g., tamsulosin) and 5-alpha reductase inhibitors (e.g., finasteride)
What is the most common surgical treatment for benign prostatic hyperplasia?
Transurethral resection of the prostate (TURP)
What term refers to when blood is present in the semen?
Haematospermia
How long do symptoms need to be present to diagnose chronic prostatitis?
At least 3 months
What is the National Institute of Health Chronic Prostatitis Symptom Index used to assess?
The severity of the symptoms (1) and their impact on quality of life (1) in chronic prostatitis
What investigation can be used to establish the causative organism in acute bacterial prostatitis?
Urine microscopy, culture and sensitivities (MC&S)
What would a fluctuant mass on examination of the prostate indicate?
Prostate abscess
What medication can be used to relax smooth muscle and improve symptoms in patients with chronic prostatitis?
Alpha-blockers / tamsulosin
What is the main hormone that plays a role in the growth of prostate cancer?
Testosterone
What is the most common site of prostate cancer metastasis?
Bones
What class of drug increases the risk of prostate cancer?
Anabolic steroids
What does PSA stand for?
Prostate-specific antigen
Where in the prostate is PSA produced?
Epithelial cells
What makes the PSA an unreliable screening test for prostate cancer?
High rate of false positives and false negatives
What is now the usual first-line investigation for suspected localised prostate cancer?
Multiparametric MRI of the prostate
What is the definitive investigation for establishing the diagnosis of prostate cancer?
Prostate biopsy
What scoring system is specific to prostate cancer and helps to determine what treatment is most appropriate?
Gleason grading system
What treatment involves implanting radioactive metal “seeds” into the prostate?
Brachytherapy
Name an androgen receptor blocker used in the treatment of prostate cancer.
Bicalutamide
What type of medication are goserelin and leuprorelin examples of?
GnRH agonists
Give two key complications of a radical prostatectomy.
Erectile dysfunction and urinary incontinence
What cause of orchitis might be associated with pancreatitis and parotid gland swelling?
Mumps
How do you test for mumps?
Saliva swap for PCR testing
What is the typical first line treatment for epididymo-orchitis in patients that are low risk for STIs?
Ofloxacin
Give three examples of quinolone antibiotics.
Ofloxacin
Levofloxacin
Ciprofloxacin
What existing medical condition would prevent you prescribing a quinolone antibiotic? Why is this?
Epilepsy
Quinolone antibiotics lower the seizure threshold
What significant adverse effect should you warn an otherwise healthy patient about when prescribing quinolone antibiotics?
Tendon damage / tendon rupture
What is the risk and consequence of a delay in diagnosing and treating testicular torsion?
Ischaemia and necrosis of the testicle, leading to sub-fertility or infertility
What abnormality in the scrotum increases the risk of testicular torsion?
Bell-clapper deformity
What sign may be seen on an ultrasound scan in testicular torsion?
Whirlpool sign
What procedure involves correcting the position of a testicle and fixing it in place?
Orchiopexy
Where does fluid collect when a patient has a hydrocele?
Within the tunica vaginalis
What can be done to distinguish a fluid-filled mass in the scrotum from a gas-filled or solid mass?
A fluid-filled mass will transilluminate by shining a torch through the skin
What venous plexus swells in patients with a varicocele and where does this drain into?
Pampiniform plexus which drains into the testicular vein
Which side are most varicoceles on? Why?
Left. Increased resistance in the left testicular vein is it drains into the renal vein, whereas the right testicular vein drains directly into the vena cava
What examination finding should raise suspicion of a retroperitoneal tumour in a patient with a varicocele?
Does not disappear when lying down
What is the most common cause of a soft, round lump at the top but separate from the testicle?
Epididymal cysts
What cells give rise to most testicular cancers?
Germ cells
What two groups can testicular tumours be broadly categorised into?
Seminomas and non-seminomas (mostly teratomas)
What type of testicular tumour can cause gynaecomastia?
Leydig cell tumour
What are the main tumour markers for testicular tumours?
Alpha-fetoprotein and beta-hCG
What staging system is used for testicular cancer?
Royal Marsden staging system
What are the four most common areas where testicular cancer metastasise?
Lymphatics
Lungs
Liver
Brain
What features would make you suspect pyelonephritis more than a lower urinary tract infection?
Fever
Loin/back pain
Nausea/vomiting
Renal angle tenderness on examination
What finding on a urine dipstick test is most suggestive of infection?
What other findings might indicate infection?
Nitrites
Leukocytes and red blood cells
What is the most common causative organism in urinary tract infections?
Escherichia coli (E. coli)
What is the most common reason for avoiding nitrofurantoin?
Renal impairment / eGFR < 45
What is the typical duration of antibiotics in an uncomplicated lower urinary tract infection in an otherwise healthy woman?
3 days
When should nitrofurantoin be avoided in pregnancy and why?
Third trimester due to neonatal haemolysis
What duration of antibiotics is used in pyelonephritis for patients suitable for management in the community?
7-10 days
What findings might be seen on cystoscopy in patients with interstitial cystitis?
Hunner lesions and granulations
What treatment for interstitial cystitis involves filling the bladder with water, to high pressure, during a cystoscopy?
Hydrodistention
What is the most common histological type of bladder cancer?
Transitional cell carcinoma
What chemicals previously used in the dye and rubber industries are a key risk factor for bladder cancer?
Aromatic amines
What infection is a risk factor for bladder cancer?
Schistosomiasis
What is the typical primary presenting complaint in patients with bladder cancer?
Painless haematuria
What is the investigation of choice in suspected bladder cancer?
Cystoscopy
What procedure may be performed during a cystoscopy to remove a non-muscle-invasive bladder cancer?
Transurethral resection of bladder tumour (TURBT)
What is the term used to describe medication injected given directly into the bladder through a catheter?
Intravesical
What medication can be given directly into the bladder as a form of immunotherapy as part of the treatment of non-muscle-invasive bladder cancer?
Bacillus Calmette-Guérin (BCG)
What is the most common solution for draining urine after a radical cystectomy?
Urostomy
What are the two main risk factors for calcium-based kidney stones?
Hypercalcaemia
Low urine output
What type of kidney stones cannot be seen on an x-ray?
Uric acid
What are staghorn calculi most often made of?
Struvite
What is the characteristic symptom of kidney stones?
Renal colic
What are the three big main of hypercalcaemia?
Calcium supplements
Hyperparathyroidism
Cancer
What is the most effective form of analgesia for treating pain associated with kidney stones?
NSAIDs
What medication can be used to help aid the spontaneous passage of stones?
Tamsulosin / alpha blockers
What treatment for kidney stones involves a machine that generates shock waves and directs them at the stone under x-ray guidance?
Extracorporeal shock wave lithotripsy
What treatment for kidney stones involves a camera inserted via an incision in the back, through the kidney and into the ureter, allowing the stones to be broken into small pieces and removed?
Percutaneous nephrolithotomy
What chemical in carbonated drinks promotes calcium oxalate formation in the kidneys?
Phosphoric acid
What may be added to water to reduce the risk of kidney stones?
Lemon juice
What dietary advice regarding calcium should be given to patients with a history of kidney stones?
Maintain a normal calcium intake (low dietary calcium might increase the risk of kidney stones)
Foods rich in what compound increase the risk of calcium kidney stones?
Oxalate
Foods rich in what compound increase the risk of uric acid kidney stones?
Purine
What is the classic triad of presenting features in renal cell carcinoma?
Haematuria
Flank pain
Palpable mass
What finding on a chest x-ray is suggestive of metastatic renal cell carcinoma?
Cannonball metastases
What paraneoplastic syndrome is associated with excessive unregulated erythropoietin production?
Polycythaemia
What operation typically requires a “hockey-stick” incision?
Renal transplant
What common skin lesions might suggest a patient is taking long-term immunosuppressants?
Seborrhoeic warts
What characteristic examination finding can suggest a patient takes tacrolimus?
Tremor
What characteristic examination finding can suggest a patient takes cyclosporine?
Gum hypertrophy
What unusual opportunistic infections can occur secondary to immunosuppressant medications?
Pneumocystis jiroveci pneumonia, cytomegalovirus and tuberculosis
