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Year 6 > Urology > Flashcards

Urology Flashcards

1
Q

Bloods for testicular cancer

A

AFP, FBC, bHCG, LDH, U+E

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2
Q

Tumour markers in each testicular cancer

A

AFP- non seminomas GC 60%
hCG- teratoma 40%, choriocarcinoma, seminoma 10%
LDH- seminomas 20%- so seminomas can essentially have normal markers

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3
Q

Differential for lump in testicles

A

Skin- sebaceous cyst
Tunica vaginal- hydrocele, epidymitis, epi cyst
Testes- cancer, orchitis

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4
Q

Initial investigations for lump

A

Bloods
USS

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5
Q

USS highly suspicious of testicular cancer what do you do next

A

Orchidectomy - send of for histor
and maybe CT

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6
Q

What approach are testicles removed

A

Inguinal approach- since tunica vaginalis surrounds (part of peritoneum)

Offer prosthesis

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7
Q

After testicle removed what do you do next?

A

CT TAP
?Chemo

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8
Q

Differentials for hameaturia

A

Renal, bladder, prostate cancer
GN
Trauma
Infection
Renal stone

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9
Q

Ix for painless haematuria

A

CT urogram- visible haem, non- USKUV
MSU
Bloods
Urine dip
Flexible cystoscopy

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10
Q

Tx of bladder cancer

A

Transurethral bladder tumour resection

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11
Q

Stoma in RIF producing urine

A

If urine out of it- ileal conduit
Had cystostescemy

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12
Q

What can’t you do before psa testing

A

 6 weeks of a prostate biopsy
4 weeks following a proven UTI / prostatitis
 1 week of DRE
48 hours of vigorous exercise AND/OR ejaculation

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13
Q

Indications for circumcision

A

Phimosis
Recurrent balantitis

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14
Q

Investigation for kidney stones

A

Non contrast CT KUB

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15
Q

Mx for pain for kidney stones

A

PR/IM diclofenac- do not give in CVS

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16
Q

Mx of kidney stones

A

<0.5cm- expectant
<2cm- lithotripsy
<2cm and pregnant- uteroscopy
Complicated/staghorn- nephrolithotomy
Hydronephrosis/infection- percutaneous nephrostomy + ABx

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17
Q

Which size catheter for men and women

A

16-18 French for men
12-14 women

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18
Q

Mx of BPH and their SE

A

A1 antagonist- if urinary sx -tamsulosin- dizziness, dry mouth, depression

5a reductase inhibitors- if prostate enlarged- fiansteride- ED, reduced libido, ejaculation problems, gyane

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19
Q

Ix for prostate cancer

A

PSA testing
Multi parametric MRI
TRUS guided biopsy

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20
Q

Mx of prostate cancer

A

Localised- T1/2- depends on life expectancy- active monitoring, prostatectomy
Advanced- T3/4- hormonal, radical prostateectomy- causes ED
Metastatic- GnRH agonist- Goserelin + 3w cover of anti androgen- flutamide

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21
Q

How does acute urinary retention present

A

Suprapubic tenderness
Dull to percuss
Can present with acute confusional state in elderly

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22
Q

What can cause acute urinary retention

A

Large prostate- in men usually due to BPH
Can also be due to urethral strictures, calculi, cystocele
Pelvic fracture- urethral trauma – suprapubic catheter s
Drugs- anticholinergics, TCA, antihistamines, opioids

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23
Q

How renal tumours can present

A

Haematuria, loin pain, loin mass
Varcocele
Can also present with paraneoplastic syndrome- polycythaemia, bushings, high calcium
Cannon ball mets in lungs

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24
Q

What one thing must you not do as in Ix for testicular cancer

A

Biopsy

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25
Q

Ix for testicular torsion

A

-ve cremasteric reflex- stroke leg- raise
Prehns test -ve- elevation relives pain

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26
Q

RF for ED

A

CVD RF- metabolic syndrome
ETOH
Drugs- SSRI, BB, finasteride

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27
Q

Mx of ED

A

PDE-4 inhibitors- sildenafil

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28
Q

What occurs in a vasectomy

A

Local
Cut the vas deferens

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29
Q

Complications of vasectomy

A

Bruising
Haematoma
Infection
Chronic pain
Sperm granuloma
Doesn’t work immediately
Failure-1/2000

30
Q

Interpretation of MC&S results

A

Single organism- >10^5
E coli or staph saprophytic - >10^3
White cells- inflammation
Epithelial- failed

31
Q

Sterile pyuria MC&S results

A

Prior Abs
Catheter
TB
STI

32
Q

Mx of UTI

A

Non pregnant- 3 days trimethoprim/nitro
Pregnant- asymptomatic- 7 days- nitro but avoid at term
Men- 7 days
Cathererised- asymptomatic- none, symptoms- 7 days

33
Q

Sx of prostatitis

A

Referred pain- perineum, panic, rectum
Voiding symtoms
+- fever

RF- recent UTI, catheterisation, biopsy

34
Q

Ix for prostatitis

A

DRE- tender, boggy prostate
Screen for STI

35
Q

Mx of prostatitis

A

Quinilone 14d

36
Q

Incontinence Ix

A

Urine dipstick and MC&S to rule out DM and UTI
Bladder diaries
Urodynamic testing - 2nd

37
Q

Mx of incontinence

A

Stress- WL if BMI >30- pelvic floor
2nd- surgical or duloxetine

Urge- bladder train for 6 weeks
Anti muscarinic- oxybutinin- increases risk of falls so not to elderly

38
Q

Ix for varicocele

A

Doppler USS

39
Q

Mx of varicocele

A

Conservative
Surgical

40
Q

What is bubbly urine a sign of

A

Enterovesiular fistula

41
Q

Complication of TURP

A

TURP syndrome
Irrigation into system
causing triad of hyponatraemia
Fluid overload and glycine toxicity

42
Q

Why don’t you remove catheter in someone who’s hasn’t moved bowels

A

Since constipation can cause urinary retention, especially in elder ladies

43
Q

Balantis Xerotica obliterans sx

A

Painful itchy white spots - lichen sclerosis
Hyperkeratotic
Associated with phimosis

44
Q

Ix of priapism

A

Cavernosal blood gas
Shows ischaemic vs non ischaemic

45
Q

Types of urethral injury

A

Bulbar- straddle injury - most common
Urinary retention, perineal haematoma

Membranous
Pelvic fracture
Prostate displaced upwards, oedema

46
Q

CI to circumcision

A

Hypospadias

47
Q

When not to use nitro

A

GFR lower than <45

Near term of pregnancy
Use amoxicillin instead

48
Q

Hydrocele vs inguinal hernia

A

Cant get above hernia

49
Q

When should you be allowed to have unprotected sex after vasectomy

A

Use additional contraception until semen analysis reveals azoospermia- 2x

50
Q

What should you measure after acute urinary retention

A

Serum creatinine

51
Q

If medical doesn’t work for BPH what should you offer

A

TURP

52
Q

Deciding tx of prostate cancer

A

Gleason >7 is high grade
Life expectancy
Can- laparoscopic prostatectomy if Gleason is high and young

53
Q

How RCC can cause oedema

A

IVC obstruction

54
Q

Constant Incontinence after childbirth

A

Vesicovaginal fistula

55
Q

When is there irreversible necrosis in testicular torsion

A

4-6 hours after sx start

56
Q

What are patients who’ve received radiotherapy for prostate cancer at risk of

A

Colon cancer
Bladder cancer
Rectal cancer

57
Q

Biggest RF for testicular cancer

A

Infertility

58
Q

Types of renal stones

A

Calcium oxalate
Calcium phosphate- most opaque-
Uric- malignancy- high breakdown- radio Lucent
Cystine- metabolic- Lucent
Struvite- staghorn

Stones may form after illness due to dehydration

59
Q

How Renal cell carcinoma may be seen on CT

A

A mass contains solid and liquid components, and is septated.

60
Q

Organism causing staghorn calculus

A

Proteus Miribalis

61
Q

Tx of torsion

A

Bilateral orchidopexy

62
Q

Ix of hydronephrosis

A

USS of renal tract

63
Q

Goserelin SE

A

Bone pain
Urinary retention

64
Q

What medication can help with High calcium and stones formation

A

Thiazides

65
Q

If suspect hydrocele what should you do next

A

Urgent USS

66
Q

Signs of renal colic and high temperature tx

A

IV ABx and renal decompression

67
Q

Bilateral hydronephrosis tx

A

Catheter can be sufficient- for urethral problems

68
Q

Conditions associated with epididymal cysts

A

Von hippel Lindau
CF
PKD

69
Q

Test to assess whether suture in bladder has healed

A

Cystogram

70
Q

Tuberous sclerosis With renal mass

A

Angiomyolipoma

71
Q

Renal cancer associated with textiles

A

Renal transitional cell carcinoma

Year 6 (28 decks)

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