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Things I don't know, but need to know, for fourth year > Urology > Flashcards

Urology Flashcards

1
Q

How would you manage a >60 year old male with unexplained non visible haematuria?

A

Urgent Referral to Urology via the cancer route

Raised WCC and or Dysuria also raise need for urgency.

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2
Q

Signs of Epididimo-Orchitis

A

Acute Pain and swelling

Pyrexia and Positive dipstick differentiates from torsion

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3
Q

What is orchitis often linked to?

A

Preceding viral infection

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4
Q

Antibiotic of choice used in a catheterised patient presenting with a UTI.

A

Usual organism is Pseudomonas. Gentamicin is first line.

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5
Q

Periureteric fat stranding is a sign of what?

A

Recent stone passage.

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6
Q

If symptoms of an enlarged prostate alongside an overactive bladder arent controlled by Alpha blocker and 5 Alpha Reductase Inhibitors. What can be done?

A

Add an Anticholinergic
Oxybutinin
Tolterodine

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7
Q

What are the two types of urethral trauma and what is the commonest?

A

Bulbar #

Membranous

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8
Q

Urinary retention + perineal haematoma +Blood at meatus

A

Bulbar rupture

Usually located to trauma to that area i.e straddle injuries

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9
Q

Prostate displaced upwards
Penile or perineal oedema
History of pelvic fracture

A

Membranous rupture

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10
Q

How are urethral injuries investigated and managed?

A

In a suspected urethral injury with urinary retention a suprapubic catheter is used.
An ascending urethrogram is used to check patency.

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11
Q

Painless smooth lump indistinguishable testicle
Transilluminates
Can cause discomfort but not pain

A

Hydrocoele

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12
Q

Single or multiple cysts
Painless
>40 years
Can get above and behind the lump

A

Ependidymal cyst

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13
Q

First line in prostate cancer treatment

A

Goserelin - synthetic GnRH agonist
initial worsening of symptoms
Overstimulates causing suppression of LH and FSH after a few weeks

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14
Q

What can be used to help reduce the flare up of symptoms post Goserelin induction?

A

Flutamide

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15
Q

A non steroidal anti androgen

A

Bicalutamide

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16
Q

A patient undergoing a Trans Urethral Resection of the Prostate suddenly develops Hyponatrameia hyper ammonia headaches and visual disturbances.

A

TURP syndrome
Glycine is hypotonic. It is used in irrigation. This draws out Na+ from the venous plexus during resection. It is also absorbed and broken down in the liver to form ammonia.
Hyponatraemia and Hyperammonia are caused.

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17
Q

Urothelial Cancers

A

Transitional cell - 90% cancers - strong smoking link
Squamous Cell - 8% - increased in areas with endemic schistosomiasis
Adenocarcinoma

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18
Q

Management of epidiymoorchitis of unknown cause.

A

IM ceftriaxone + Oral doxycycline for 10 days

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19
Q

30 % of children presenting with a UTI will have what?

A

Vesicoureteric reflex due to laterally displaced ureters

Recurrent UTIs and reflux nephropathy

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20
Q

How should recurrent UTIs in children be investigated?

A

Micturating Cystourethrogram

Dilated ureter, pelvic and calyces, ureteric tortuousity

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21
Q

What is the commonest line of testicular cancers?

A

Germ Cell tumours

Seminoma and Non seminoma

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22
Q

List some Non-Seminoma germ cell tumours

A

Embryonic
Yolk sac
Teratome
Choriocarcinoma

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23
Q

What are the other type of rarer testicular tumours

A

Leydig cell

Sarcoma

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24
Q

Commonest testicular tumour before the age of 25

A

Teratoma

Non Seminoma - bHCG and AFP

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25
Q

Commonest testicular tumour over 35 years old

A

Seminoma

26
Q

What are some generic symptoms of a testicular tumour

A

Painless lump, indiscernible from the testicle, Hydroceole, gynaecomastia
Increased oestrogen : androgen ratio

27
Q

increased hCG in 20% of testicular tumours

A

Seminoma

28
Q

Increased AFP bhCG in 80% of these testicular tumours

A

Non seminoma

29
Q

Increased LDH in 40% of these testicular tumours

A

Germ cell

30
Q

How are testicular cancers diagnosed and managed?

A

USS is first line - if suspicious testicle is removed surgically. Then specific type of cancer can be diagnosed.

31
Q

Testicular Appendage Torsion

A

Cremasteric reflex still present

Severe pain

32
Q

Torsion of the spermatic chord

A

Cremasteric reflex is absent

33
Q

How do you differentiate high from low pressure chronic urinary hypertension?

A

High pressure - Impaired renal function + bilateral hydronephrosis
Low-pressure - no impaired renal function or hydronephrosis

34
Q

Frank haematuria post catheterisation in a patient with chronic urinary retention.

A

Decompression haematuria

No intervention is required.

35
Q

What is used to treat schistosomiasis and when?

A

Praziquantel

Even asymptomatic

36
Q

List three of the drugs that should be used ( individually) alongside goserelin for the first three weeks of treatment to help reduce the tumour flair.

A

Bicalutamide
Cyproterone Acetata
Abirateron

37
Q

What should you be wary of post catheterisation in someone who had urinary retention?

A

Physiological Diuresis - up to 24 hours
Pathological Diuresis - over 48 hours

Loss of large volumes of salt and water - may require fluid replacement

38
Q

What is diagnostic of acute urinary retention?

A

300ml on USS

Can be less than this is signs and symptoms suggest

39
Q

What can the volume of urine removed within the first 15 minutes of catheterisation tell us?

A 
<200ml = no urinary retention
>400ml = catheter should stay in place
40
Q

What is the physiological post voiding volume remaining in the bladder?

A 
<65 = <50ml is normal
>65 = <100ml is normal
41
Q

How is prostate confined adenocarcinoma managed?

T1/2

A

Active watch and wait
Radical prostatectomy
Radiotherapy

42
Q

Post radiotherapy for prostate cancer what other cancers are they now at risk of?

A

Bladder
Colon
Rectal

43
Q

Antibiotic management of Pyelonephritis

A

IV Amoxicillin + Gentamicin 7 or 10 days
Co-Trimoxazole + Gentamicin in pen allergic

Step down - Co Trimoxazole or sensitivities

44
Q

Diagnosis of prostate cancer

A

PSA + Prostate exam -> multi parametric MRI
If >3 points on linkert scale -> TRUS biopsy
If <3 points on linkert scale -> patient given choice of having TRUS biopsy

45
Q

Priapism key investigation

A

Cavernous Blood gas - determine in ischaemic or not

46
Q

How is an ischaemic priapism managed?

A

Aspirate + Irrigate with saline
Phenylephrine repeated every 5 mins
Surgery

47
Q

How is non ischaemic priapism managed?

A

Observe

48
Q

Pain on intercourse
A hard lump on the penis
Penis is developing a bend

A

Peyronies disease
Inflammatory scar tissue causes bending
Surgery

49
Q

Management of erectile dysfunction

A

Check BMI BP, lipid profile and glucose/Hb1AC

9am testosterone levels -> if low test free unbound testosterone FSH and LH

50
Q

Varicocele affect on fertility?

A

Reduces it

Research whether surgery increases fertility

51
Q

Vesicoureteric reflux - diagnosis

A

Micturating cystourethrogram is diagnostic

DMSA scan to look for renal scarring

52
Q

Vesicoureteric reflex can cause

A

Recurrent UTI
Hydronephrosis
Reflux Nephropathy ( chronic pyelonephritis)
Renal scar can cause increased renin release and hypertension

53
Q

Grading vesicoureteric reflux

A

Grade I = reflux into ureter only
Grade II = reflux up to renal pelvises + no dilatation
Grade III = Reflux up to calyces + mild dilatation
Grade IV = Dilated up to calyces + moderate ureteral tortuosity
Grade V = Gross dilation and severe ureteral tortuosity

54
Q

Management of resolved testicular torsion?

A

Emergency surgery as very likely to reoccur

55
Q

Whats the strongest risk factor for testicular cancer?

A

infertility

56
Q

Timescale of PSA studies

A

> 6 weeks post biopsy
4 weeks post UTI
48 hours post ejaculation or vigorous exercise

57
Q

When is TURP used?

A

If someone presents with acute urinary retention despite being on both Alpha blocker a 5 Alpha Reductase inhibitors.

58
Q

How can regular UTIs post sexual intercourse be managed?

A

Post coital antibiotic prophylaxis

59
Q

Management of testicular torsion - surgery

A

Even if only unilateral symptoms both sides are fixed

60
Q

Management of vescioureteric reflux

A

All require prophylactic antibiotics.
Grade 1-3 will usually self-resolve
Grade 3-5 will require surgery

61
Q

Management of Bladder cancer

A

Superficial - transurethral resection = T1

T2 and over = Radical cystectomy

Things I don't know, but need to know, for fourth year (31 decks)

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