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1. 4th year > urology > Flashcards

urology Flashcards

1
Q

modifiable risk factors in incontinence

A 
weight loss 
caffeine consumption
alcohol 
medication review e.g. diuretics
carbonated drinks 
amount being drunk
also discuss incontinence pads
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2
Q

investigations in incontinecne

A 
vaginal exam / PR exam in males
bladder diary (3 days)
urine dip + culture
bladder scan
urodynamic testing
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3
Q

management of stress incontinence 1st line

A

lifestyle

supervised pelvic floor exercises for 3 months

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4
Q

management of stress incontinence

A

surgery

duloxetine - last line

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5
Q

tx urge incontinence 1st line

A

bladder retraining 6 weeks

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6
Q

2nd line tx urge incontinence

A

anticholinergics

oxybutynin, tolterodine, darifenacin, solifenacin

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7
Q

SEs of anticholinergics

A

dry mouth, dry eyes, urinary retention, constipation and postural hypotension

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8
Q

alternative to anticholinergics in tx of urge incontinence

A

mirabegron - beta 3 agonist

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9
Q

what is a CI to the use of mirabegron and what should be monitored while taking it

A

contraindicated in uncontrolled hypertension

measure BP before treatment and 1 month after

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10
Q

invasive treatments of urge incontinence

A

botox

surgery

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11
Q

some drugs that cause acute urinary retention

A
  • Anticholinergics e.g. antipsychotics or antihistamines
  • tricyclic antidepressants e.g. amitriptyline
  • opioids
  • benzodiazepines
  • NSAIDs
  • Disopyramide
  • alcohol
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12
Q

treatment acute urinary retention

A

catheter - monitor fluid balance and beware if urine output > 200ml/hr - post obstructive diuresis

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13
Q

dx investigation of urinary retention

A

bladder ultrasound scan, volume > 300 confirms (but dont always need to meet this)

if > 400 leave catheter in place

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14
Q

ix done in acute urinary retention

A

urine dup and culture
U+E, creatinine
FBC CRP
PSA - NOT DONE as is typically elevated in acute scenario

PV, PR and neuro exam

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15
Q

tx post-obstructive diuresis

A

IV fluids and sodium replacement

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16
Q

what can occur after catheterisation for chronic retention due to the rapid decrease in pressure in the bladder

A

decompression haematuria

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17
Q

where is hypospadias found

A

inferior (ventral) surface of penis

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18
Q

when is hypospadias corrected

A

1 year

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19
Q

tx penile candidiasis

A

topical clotrimazole 2 weeks

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20
Q

tx penile dermatitis - allergic, contact, eczema or psoriasis

A

mild topical steroid

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21
Q

tx bacterial balanitis

A

oral fluclox or clarith

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22
Q

tx anaerobic balanitis

A

saline washing +/- topical or oral metronidazole if not settling

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23
Q

tx penile lichen sclerosis (balanitis xerotica obliterans)

A

high potency topical steroid (clobetasol)

circumcision

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24
Q

what kind of balanitis is seen with reactive arthritis

A

circinate balanitis

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25
Q

circinate balanitis tx

A

mild topical steroid

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26
Q

general treatment balanitis

A

saline washing
wash under foreskin properly
mild topical steroid ST

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27
Q

main risk factors for SCC of penis

A

hrHPV

non-circumcised

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28
Q

ix SCC of penis

A

biopsy

US and MRI for invasion

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29
Q

name 3 precursor lesions of penile SCC

A

bowens - leukoplakia
erythroplasia of queryat - erythroplakia
bowenoid papulosis - multiple reddish papules

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30
Q

tx penile SCC in situ

A

circumcision or topical 5FU

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31
Q

sentinel nodes of penile cancer

A

inguinal

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32
Q

2 main causes of priapism

A

haemoglobinopathy - sickle cell

use of drugs e.g. sildenafil, cocaine

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33
Q

ix to differentiate ischaemic and non-ischaemic priapism

A

cavernoal blood gas analysis

USS

FBC and toxicology

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34
Q

1st line tx ischaemic priapism > 4 hours

A

aspiration of blood from cavernosa

often + injection of saline flush

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35
Q

tx ischaemic priapism if aspiration and injection of saline fails

A

injection of vasoconstrictor e.g. phenylephrine

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36
Q

1st line tx non-ischaemic priapism

A

observation

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37
Q

factors indicating organic cause of ED

A

gradual onset symptoms
lack of tumescence
normal libido

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38
Q

drugs causing ED (2)

A

SSRI

BB

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39
Q

main RF for ED

A

CVD

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40
Q

ix for ED

A

lipid and fasting glucose
free morning testosterone
- if low do FSH, LH and prolactin

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41
Q

tx ED

A

PDE-5 inhibitors- sildenafil (viagra)

- prescribe regardless of cause / can be purchased

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42
Q

what is phimosis

A

cant retract foreskin

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43
Q

what is paraphimosis

A

cant replace foreskin

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44
Q

what part of the prostate is palpable on DRE

A

posterior aspect - peripheral zone

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45
Q

list the main obstructive urinary symptoms “prostatism”

A 
poor stream
straining
hesitancy - difficulty starting 
terminal dribbling
incomplete emptying
overflow incontinence
nocturia
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46
Q

ix for BPH

A 
urine dip and culture
PSA
uroflowmetry
urinary frequency-volume chart for 3 days 
IPSS
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47
Q

1st line tx BPH

A

uroselective a-blocker

tamsulosin, terazosin, alfuzosin

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48
Q

SE of alpha blocker

A

dizziness
postural hypotension
dry mouth
depression

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49
Q

2nd line treatment BPH

A

5-a reductase inhibitor
finasteride
dutasteride

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50
Q

SE of 5-a reductase inhibitor

A

ED
reduced libido
ejaculation problems
gynaecomastia

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51
Q

how long do 5-a reductase inhibitors take to work and what do they do

A

shrink prostate

6 months

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52
Q

what do alpha blockers do in BPH

A

relax bladder and prostate smooth muscle

53
Q

what drug could be used if there are storage and voiding problems despite use of alpha blocker

A

antimuscarinic - tolterodine, darifenacin

54
Q

surgery for BPH

A

TURP

55
Q

SE of TURP

A

ED

retrograde ejaculation

56
Q

is there prostate cancer screening

A

no - but if a man asks for PSA / risk factors then do PSA

57
Q

how many prostate cancer present

A

usually clinically silent
may present as bone pain (mets)
hard craggy mass on PR
locally advanced - urinary symptoms

58
Q

what are the upper limits of PSA

A

50 - 69 = 3

> 70 = 5

59
Q

1st line ix in prostate cancer

A

multiparametric MRI

60
Q

investigation of prostate cancer if likert scale >= 3

A

prostatic biopsy - 6 on each side

61
Q

most common spread of prostate cancer

A

haematogenous

- bone, lungs, liver

62
Q

presentation of prostate bone mets

A

osteosclerotic lesions usually in lumbosacral region
low back pain
raised ALP, PSA and prostatic acid phosphatase

63
Q

grading of prostate cancer

A

gleason

64
Q

treatment prostate cancer if elderly, low gleason score, multiple comorbidity

A

watchful waiting/active surveillance

- candidates for this should have at least 10 core biopsies and at least 1 rebiopsy

65
Q

tx prostate cancer localised disease

A

radical prostatectomy and removal of obturator nodes

66
Q

tx prostate cancer other than radical prostatectomy

A

radical radiotherapy
hormonal therapy
chemotherapy
bilateral orchidectomy (form of hormonal)

67
Q

SE radical radiotherapy of prostate

A

increased risk of bladder, colon and rectal cancer

68
Q

tx metastatic prostate cancer

A

androgen deprivation therapy - hormonal, steroids, chemo

radiotherapy - bone mets

69
Q

what chemotherapy drug is used in prostate cancer

A

docetaxel

70
Q

hormonal therapies are used in prostate cancer: synthetic GnRH agonists

A

goserelin

71
Q

hormonal therapies are used in prostate cancer: anti-androgen

A

cyproterone acetate

72
Q

hormonal therapies are used in prostate cancer: non-steroidal antiandrogen

A

bicalutamide

73
Q

hormonal therapies are used in prostate cancer: androgen synthesis inhibitor

A

abiraterone

74
Q

what is important to prescribe with synthetic GnRH agonists and why

A

testosterone rises initially for 2-3 weeks before falling so cover with anti-androgen to prevent tumour flare

75
Q

how would a tumour flare present

A

bone pain, bladder obstruction

76
Q

are non-steroidal or steroidal antiandrogens used more

A

non-steroidal (bicalutamide)

77
Q

when might an androgen synthesis inhibitor (abiraterone) be used in prostate cancer

A

metastatic prostate cancer in patients with no/mild symptoms after androgen deprivation therapy has failed, before chemo

78
Q

what is prehn’s sign

A

testicular torsion - elevation of the testis doesnt ease the pain

79
Q

tx communicating hydrocele in new born males

A

nothing - usually resolves in a few months

transinguinal ligation of PPV if not healed by 1-2 years old

80
Q

describe the mass of a hydrocele

A

transilluminates
can ‘get above’
confined to scrotum
soft, non-tender

81
Q

ix hydrocele to exclude tumour

A

ultrasound

82
Q

“bag of worms”

A

variocele

83
Q

variocele can be a presenting feature of what

A

renal cell carcinoma

84
Q

dx variocele

A

ultrasound + doppler studies

85
Q

scrotal swelling separate from body of testicle, found posteriorly

A

epididymal cyst

86
Q

describe a testicular tumour mass

A

firm, painless testicular mass that cannot be transiluminated
heaviness in scrotum

87
Q

common presenting feature of testicular cancer

A

gynaecomastia

88
Q

tx all testicular tumours

A

dont biopsy

radical orchidectomy via inguinal approach

89
Q

tumour marker: bHCG

A

highly malignant testicular teratoma

sometimes seminoma

90
Q

tumour marker: AFP

A

non-seminoma

yolk sac component of teratoma

91
Q

tumour marker: PLAP

A

seminoma

92
Q

main RF for germ cell testicular tumour

A

undescended testis

93
Q

ix testicular tumour

A

ultrasound - first line

94
Q

AFP is never raised in a ______ testicular tumour

A

pure seminoma

95
Q

tumour marker: LDH

A

tumour burden - raised in 40% germ cell tumours

96
Q

what lymph nodes do testicular tumours spread to

A

para-aortic

97
Q

age group of seminoma

A

30-50

98
Q

“potato tumour”

A

seminoma

semolina used in rice pudding - rice is a carb - potato tumour

99
Q

seminomas are highly responsive to chemo/radio

A

radio

100
Q

what testicular tumours occur in younger males

A

non-seminoma

- teratoma, embryonal, yolk sac, choriocarcinoma

101
Q

age group of teratoma

A

20-30

can occur in childhood

102
Q

tumour marker of trophoblastic teratoma

A

bHCG

103
Q

tumour marker of teratoma with yolk sac elements

A

AFP

104
Q

can you “get above” an inguinal hernia

A

no

105
Q

variocele typically occurs on what side

A

left

106
Q

tender boggy prostate

A

acute bacterial prostatitis

107
Q

most common cause of acute bacterial prostatitis

A

E coli

108
Q

tx acute bacterial prostatitis

A

ofloxacin 14 days

109
Q

unilateral testicular pain and swelling, pain relieved when elevate testis

A

epididymo-orchitis

110
Q

ix epididymo-orchitis

A

urine culture and CT PCR

111
Q

most common cause of epididymo-orchitis

A

chlamydia

112
Q

tx epididymo-orchitis

A

passmed - ceftriaxone 500mg IM single dose + doxycycline 100mg oral BD 10-14 days

lecture for epididymitis

113
Q

ix bladder injury

A

CT cystogram

114
Q

urinary retention, perinal haematoma and blood at meatus is the typical triad of

A

bulbar urethral injury

115
Q

ix urethral injury

A

ascending/retrograde urethrogram

116
Q

causes of haematuria

A 
cancer - bladder, renal, prostate
stones
BPH
prostatitis
urethritis
nephritic syndrome
117
Q

drugs causing red/orange urine (2)

A

rifampicin

doxorubicin

118
Q

ix haematuria (primary care, bloods etc)

A

urine dip and culture
U+E, ACR
BP
urine microscopy

119
Q

ix haematuria suspecting bladder cancer

A

cystoscopy

120
Q

treatment acute loin pain

A

NSAID +/- opioid

121
Q

tx small stone expected to pass <5mm

A

tamsulosin (alpha blocker)

122
Q

treatment renal stone not expected to pass if no infection and <2cm total

A

ureteric stent/ureteroscopy

ECSL - stone fragmentation (CI in pregnancy)

123
Q

treatment renal stone if infected or hydronephrosis

A

percutaneous nephrostomy

124
Q

tx clot retention post frank haematuria

A

3 way irrigating catheter

125
Q

ix frank haematuria

A

CT urogram / USS + cystoscopy

126
Q

blue dot sign, cremasteric reflex present

A

torsion of appendage

127
Q

ix perinephric abscess

A

CT

128
Q

ix renal trauma

A

CT with contrast

1. 4th year (23 decks)

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