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Year 4 > Urology > Flashcards

Urology Flashcards

1
Q

Side-Effects of Nitrofurantoin

A

Lung Fibrosis

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2
Q

What is the acceptable limit of residual urine in patients <65

A

50ml

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3
Q

What is the acceptable limit of residual urine in patients >65

A

100ml

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4
Q

What is the mian cause of acute urinary retention in men

A

Benign Prostatic Hyperplasia

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5
Q

Signs of acute urinary retention

A

Palpable urinary bladder

Abdominal tenderness

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6
Q

What exmainations should be done for someone in acute urinary retention

A

Rectal (DRE) and Neurological Exmination

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7
Q

What is the first line investiation for someoen with acute urinary retention

A

urine sample/culture

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8
Q

What is PSA not appropriate in acute urinary retention

A

Typically elevated anyways

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9
Q

What is the GOLD standard diagnostic for acute urinary retention

A

Bladder USS

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10
Q

What confirms diagnosis of acute urinary retention on USS

A

A colume >300cc

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11
Q

What urine volume confirms that a patient doe snot have acute urinary retention

A

<200 cc

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12
Q

Where and under what circumstances should patients be referred to gynecology or neurology with acute urinary retention

A

Those exhibiting symptoms

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13
Q

What is a complication of acute urinary retention

A

Post-obstructive diuresis

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14
Q

How is post-obstructive diuresis treated

A

IV Fluids

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15
Q

What is Mirabegron used for

A

Overactive bladder

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16
Q

Pharmacology of Mirabegron

A

Beta 3 agonist

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17
Q

What is the second line treatment for an overactiev bladder if antimuscarinics (Oxybutynin) are not tolerated

A

Mirabegron

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18
Q

First line management of predominantly voiding symptoms

A

Pelvic floor muscle training, fluid intake restrictions

Second line: Tamsulosin

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19
Q

First line management of an overactive bladder

A

Moderating fluid intake + Bladder retraining

Oxybutynin

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20
Q

First line management of nocturia

A

Furosemide 40mg

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21
Q

What is the most common form of prostate cancer

A

Adenocarcnioma

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22
Q

What is TURP Syndrome

A

Venosu destruction causing absoprtion of irrigation fluid and hyponatraemia (looks like SIADH)

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23
Q

Risk factors for TURP Syndrome

A 
Surgical Time > 1 hour
Height of bad >70 cm 
Resected > 60g 
Large blood loss
Perforation 
Large fluid use
CHF poorly controlled
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24
Q

What causes TURP syndrome

A

Irrigation with Glycine causes it to be absorbed, it is hypoosmolar causing it to be absorbed systemicatically

Glycine -> ammonia at the liver causing hyperammonia and visual diasturbances

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25
Q

Two serum blood tests abnormalities found in TURP syndrome

A

Hyponatraemia

Hyper-Ammonia

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26
Q

What is the criteria for 2 week wait referrals to exclude bladder cancer

A

A patient over 60 with non visible hameturia, dyruia or raised WCC that is unexplained

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27
Q

WHat tumour marker is seen in seminomas

A

Raised hCG

LDH

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28
Q

What tumour markers are seen in non-seminomas

A

AFP OR beta-hcg

LDH

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29
Q

FIrst line diagnosis of testicular cancer

A

USS

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30
Q

Risk factors for testicular cancer

A 
Infertility 
Cryptorchidism 
Family History 
Klinefleter's Syndrome
Mumps Orchitis
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31
Q

What causes gynecomastia in testicular cancer

A

Increased oestrogen:androgen ratio

germ cell tumours -> hCG -> Leydig cel ldysfunction -> increased oestradiol and testosterone production

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32
Q

When do communicating hydroceles resolve in neonates

A

Within a few months of life- reassure mothers

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33
Q

What is membranous urethral rupture

A

Consequence of a pelvic fracture:

Perineal oedema
Prostate displaced (usually unpalpable on PR)
Haematuria

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34
Q

WHat is the first line management of a stone obstruction with signs of infection

A

Urgent decompression - Ureteroscopy or nephrostomy + IV broad spectrum antibiotics

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35
Q

Management of stones < 2cm

A

Lithotripsy

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36
Q

Management of stones >2cm

A

Percutaneous nephrolithotomy

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37
Q

What is the first line investigation for suspected prostate cancer

A

Multiparametric MRI

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38
Q

What scale is used to decide if someoen should be offered a multiparametric MRI

A

Liker scale

> 3

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39
Q

What type of bladder cancer is increased by schistosomiasis

A

Squamous cell carcinoma

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40
Q

What pain relief should be first line for suspected stone colics

A

IM Diclofenac

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41
Q

What is the most common type of urethral injruy

A

Bulbar rupture

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42
Q

What causes a bulbar rupture

A

Saddle injuries (cikes)

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43
Q

Signs of a bulbar rupture

A

TRIAD; urinary retention, perineal haematoma, blood at meatus

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44
Q

Two types of membranous ruptures

A

Extra or intraperitoneal

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45
Q

First line invetsigation to diagnose urethral injuries (of all type)

A

Ascending urethrogram

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46
Q

Management of urethral injuries

A

Suprapubic catheter

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47
Q

Management of intraperitoneal baldder injuries

A

Laparotomy

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48
Q

management of extraperitoneal bladder injuries

A

Conservative management

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49
Q

Histological appearance of malignant Renal Cell carcinoma

A

Clear cell carcinoma: Mass arising from parenchyma that is septated and contains solid and liquid components

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50
Q

Where do transitional cell carcinomas usually arise from (part of the urinary tract)

A

Ureter

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51
Q

What condition gives rise to angiomyolipomas

A

TS

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52
Q

Wjhat condition commonly causes renal infarcts

A

Infective endocarditis

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53
Q

What medication makes kidney stones more likely?

A

Diuretics

54
Q

AT what tumour size should a kidney tumour be referred for a partial nephrectomy over a total nephrectomy

A

7cm or less

55
Q

What medictaion can be given to reduce the size of an RCC tumour

A

alpha-interferon

56
Q

Name some symptoms of prostate cancer

A 
Urgency
Hesitency
Poor flow
Post-micturition dribbling
Intermittency
Feeling of incomplete bladder emptying.
57
Q

First line invetsigation for suspected prostate cancer

A

§PSA test

58
Q

At what PSA level should a patient be referred to urology

A

> 3

59
Q

What glesson score indicates a low-grade prostate cancer

A

2-6

60
Q

What gleeson grade indicates a high grade prostate cancer

A

8-10

61
Q

How can we stage prostate cancer

A

Bone scan
CT
or an MRI

62
Q

What is the most common raidotherapy used for prostate cancer

A

Brachytherapy

63
Q

What enzyme is repsnosible for converting testosterone to dihydrotestosterone

A

5 alpha reductase

64
Q

Name a 5-alpha reductase inhibitor

A

Finasteride

65
Q

What two hormone treatments are available for prostate cancer (usually used in advanced stages)

A

gnRH agonists: Goserelin

Anti-androgen (recpetor blockers): Flutamide

Flutamide usually given for first two weeks and then goserelin to prevent surges in testosterone

66
Q

What chemotherapy is given for prostate cancer

A

Docetaxel

67
Q

How long should someone not excersise before taking a PSA test

A

48 hours

68
Q

How long should someone abstain before taking a PSa test

A

48 hours

69
Q

What are some contraindications to a pSA test

A 
UTIs
Masturbation or sex
Excercise
Biopsy in the past 6 weeks
DREs in the past week
Anal
70
Q

What is the first line treatment for BPH

A

alpha blockers

Second line: Finasteride

71
Q

What is the most common surgery for BPH

A

Transurethral resection of the prostate

72
Q

What neurological problem can cause chronic urinary retention

A

Spina bifida

73
Q

What medications may cause urinary retention

A

Tricyclics
Diazepam
baclofen
Oxybutynin

74
Q

What is the most common cause of urethritis

A

Gonnorrhoea

75
Q

Signs of a urethral stricture

A 
Reduced urine flow
Sparying of urine
Dribbling of urine
UTIs
Pain on passing urine
76
Q

What causes urethral strictures

A

Scare tissues from previous infections or catheterisations

77
Q

First line investigation for a urethral stricture

A

Flow rate of urine

78
Q

Treatment of a stricture

A

Widening + IV Antibiotics to prevent further infections

79
Q

Name three exmaination findings seen in epididymoorchitis

A

Tenderness and swelling on th eposterior side of the testicle

Pain relieved when elevating the testicle

Intact cremasteric reflex

80
Q

What is the only way you get isolate orchitis

A

Mumps

81
Q

Examination findings in orchitis

A

Testicular swelling and tenderness

Pain relieved on elevation

Normal cermasteric reflexes

82
Q

Name three exmaination findings in tetsicular torsion

A

Tender, high-riding testis

Pain gets worse when elevating the scrotum

Absent cremasteric reflexes

83
Q

Serum testosterone levels in cryptorchidism

A

Unilateral - NORMAL

Bilateral - Abnormal

84
Q

What other serum levels indicate cryptorchidism

A

Raised LH and FSH

Reduced Inhibin B

85
Q

What is a varciocele

A

Dilation of the pampiniform plexus

86
Q

In what testis is a varciocele mor common

A

Left testis

87
Q

Why is a rightsided varicocele a red fllag

A

Retroperitoneal tumour might be invading into the IVC

88
Q

What happens in the transillumination test for a varciocele

A

They don’t transilluminate

89
Q

Results of a val salva manoeuvre in a varciocele

A

Mass distends or gets bigger (or when coughing)

90
Q

What is a hydrocele

A

Fluid accumulation between the visceral and parietal layer of the tunica vaginalis of the testis

91
Q

What scrotal condition transilluminates?

A

Hydrocele

92
Q

Where do tetsicular tumours typically spread haematogenously

A

Lung sor the Brain

93
Q

What lymph nodes drain the scrotum

A

Superficial Inguinal lymph nodes

94
Q

Which tetsicular tumours have the best prognosis

A

Seminomas

95
Q

Microsocpic appearance of a seminoma

A

Fried-egg appearance

96
Q

What condition can give rise to calcium phosphate stones

A

Renal tubular acidosis type I and II

97
Q

What conditions reuslt in struvite stones formation

A

UTIs (proteus and klebsiella)

98
Q

Describe the appearance of struvite stones

A

Staghorn Calculi

99
Q

What stone cannot be seen on a CT KUB scan

A

Cystine stones

100
Q

What Imaging allows cysteine stones to be seen

A

USS (if they are larger than 5mm)

101
Q

How long should imaging take in all people with suspected stones

A

EMERGENCY (within 24 hours)

102
Q

When should someone with urinary tract stones be admitted

A 
Infection signs
Pain relief not working
Anuria
No Imaging within 24 hours
Diagnostic uncertainty
103
Q

When is watchful waiting appropriate for kidney stones

A

<5mm

104
Q

Within what timeframe should surgical treatment be considered for kidney stones

A

WIthin 48 hours of admission

105
Q

Why should surgery be considered for kdiney stones within 48 hours

A

Can cause irreversible kdiney dmagae (lowers eGFR)

106
Q

What is the first line antibiotic for pyelonephritis

A

Ciprofloxacin or co-amoxiclav for 7 days

107
Q

When shoudl prophylaxis be considered in patients for pyelonephritis

A

In women who get at least three infetcions in one year

108
Q

WHat is the prophylaxis used for pyelonephritis

A

Trimethoprim

109
Q

When should people with UTIs be referred for imaging or cystoscopy

A 
Not resopnded to treatment 
Previous history of tract disease
Haematuria
Women with recurrent infections
Serious or systemic inllness signs
110
Q

What is the two week wait rule for UTIs

A

Refer if over 45 and:
Unexplained visible haematuria without UTI or,

Visible haematuria which persists after treatment

111
Q

First line managemnet of UTIs

A

Trimethoprim or Nitrofurantoin

112
Q

Which patients should recieve 7 days course for UTIs

A

Men and pregnant women (anyone with complicated UTIs)

113
Q

In which patients should UTI treatment be limited to three days

A

WOmen

114
Q

If trimethoprim is unsuccessful in managing a UTI, what should be given

A

Nitrofurantoin

115
Q

What is the only requirement that gives nitrofurantoin preference over trimethoprim for UTI treatment

A

if eGFR > 45

116
Q

A patient comes to the GP complaining of haematospermia - what should be done (under 40)

A

Reassure that it is probably benign

> 40 = referral

117
Q

How often should PSA levels be monitored in someone undergoing the ‘watchful wait’ approach

A

Annually

118
Q

What is active surveillance

A

This is where monitoring is increased in frequency to make sure we only treat when the rate of threat increases

119
Q

Name three active surveillance approaches to prostate cancer

A

Every 4 months - measure PSA
Every 12 months - DRE
Every 12/18 months - MRI

120
Q

How do we manage hot flushes caused by hormonal treatment in prostate cancer

A

Medroxyprogesterone acetate

121
Q

How do we manage fatigue symptoms in people with prostate cancer

A

Supervised exercise

122
Q

Mangaement of gynecomastia caused by GnRH and flutamide

A

Radiotherapy

123
Q

Role of PSA

A

Liqudify semen and allow sperm to move more freely

124
Q

Diagnosis of acute prostatitis

A

MSU sample

125
Q

Management of acute prostatitis

A

Ciprofloxacin 500mg once daily

Follow up in 48 hours

126
Q

Management of chronic prostatitis

A

Just symptomatic management

127
Q

When are undescended testes typically checked for

A

3 days after birth

6-8 weeks of age

Then 4-5 months of age if found to be undescended

128
Q

What is a normal variant retractile testes

A

When the testes can only be felt in a warm bath

129
Q

When should we consider acute pyelonephritis over Lower UTIs in children

A

Systematic + Bacteriuria

No systemic symptoms + bacteriuria = lower UTIs

130
Q

What prophylaxis is given for UTIs

A

Trimethoprim 3 months

131
Q

Management of asymptomatic bacteriuria in pregnant woman

A

Nitrofurantoin 100mg immediately

Year 4 (16 decks)

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