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Medicine year 3 TCD > Urology > Flashcards

Urology Flashcards

1
Q

BPH presentation

A

Storage and voiding symptoms

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2
Q

BPH diagnosis

A

History, DRE, urinalysis, PSA

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3
Q

Where is BPH most common

A

Transition zone of prostate around the urethra (why LUTS presents sooner than in cancer)

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4
Q

BPH treatment options

A

alpha blockers - eg tamsulosin, decrease smooth muscle tone of prostate and bladder, First line
5-alpha reductase inhibitors eg finasteride, reduce DHT production
Surgical treatment- Transurethral resection of prostate (TURP)

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5
Q

Type of cancer and location of prostate cancer

A

Adenocarcinoma and peripheral zone of prostate

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6
Q

Risk factors of prostate cancer

A

Age, obesity, anabolic steroids, black origin, family history- BRCA2 and Lynch

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7
Q

Prostate cancer presentation

A

LUTS similar to BPH, haematuria, erectile dysfunction. generalised symptoms of advanced met cancer

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8
Q

Prostate cancer diagnosis

A

PSA, prostate exam, multiparametric MRI (first line for suspected prostate cancer), prostate biopsy (depends on MRI results eg Likert 3 or above and clinical suspicion)

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9
Q

Prostate cancer scoring system

A

Gleason score. Made up of adding 2 numbers. Score of 6 is low risk, 7 is intermediate risk, 8 is high risk.

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10
Q

Localised prostate cancer management

A

watchful waiting
radical prostatectomy if it’s low grade
external beam radiotherapy (can cause proctitis though)

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11
Q

2 WW referral for prostate cancer

A

PSA > 4 ng/mL
abnormal DRE

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12
Q

Bladder cancer risk factors

A

Smoking
Occupational carcinogens (dye, rubber, cable factory work)
Schistomiasis - most common cause of squamous cell carcinoma in countries w/ a high prevalence of the infection

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13
Q

Bladder cancer risk factors

A

Smoking
Occupational carcinogens (dye, rubber, paint, cable factory work)- working w/ aromatic amines
Schistosomiasis - most common cause of squamous cell carcinoma in countries w/ a high prevalence of the infection
Age
Male
Caucasians

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14
Q

Types of bladder cancer

A

95% transitional cell carcinoma
5% squamous cell carcinoma- higher in areas of schistosomiasis

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15
Q

Presentation of bladder cancer

A

Painless haematuria
Voiding symptoms
Or recurrent UTI which doesn’t clear w/ Abx

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16
Q

Diagnosis of bladder cancer

A

Flexible cystoscopy + biopsy

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17
Q

management of bladder cancer

A

trans urethral resection of bladder tumour (TURBT) in non muscle invasive bladder cancer
intravesical chemotherapy is used after TURBT to reduce recurrence risk, eg mitomycin
high risk: TURBt + intravesical BCG
Detrusor muscle involved- radical cystectomy, often use a urostomy for urine drainage after

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18
Q

schistosomiasis presentation

A

fever, urticaria/angioedmea (rash on skin), arthralgia/myalgia

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19
Q

schistosomiasis risk factors

A

contact w/ fresh water, activies eg swimming , fishing etc

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20
Q

increased cancer risk of which type if schistosomiasis

A

squamous cell carcinoma

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21
Q

what is schistosomiasis

A

parasitic flatworms attacking UT/IT

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22
Q

Renal cell carcinoma- type of cancer?

A

adenocarcinoma

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23
Q

renal cell carcinoma subtypes?

A

80% Clear cell
15% Papillary
5% Chromophobe

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24
Q

renal cell carcinoma risk factors

A

Age, male, smoking, hypertension, Acquired cystic disease of the kidney, chronic paracetamol use, Von Hippel Lindau Disease

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25
renal cell carcinoma presentation
painful haematuria flank pain palpable mass non-specific cancer symptoms
26
renal cell carcinoma 2 week wait referral criteria
Aged over 45 w/ unexplained visible haematuria, either w/o a UTI or persisting after treatment for a UTI
27
renal cell carcinoma diagnosis
CT contrast abdomen +/- MRI and image guided biopsy
28
how do we classify/stage renal cell carcinoma
TNM staging Bosniak classification
29
Paraneoplastic features of renal cell carcinoma
Polycythaemia- high RBCs due to secretion of unregulated EPO Hypercalcaemia - due to secretion of a hormone that mimics the action of parathyroid hormone HTN- due to increased renin Stauffer's syndrome- abnormal LFTs (raised ALT, AST, ALP and bilirubin) w/o liver metastases
30
renal cell carcinoma management
surgery is first line- may involve partial nephrectomy or radical nephrectomy. nephrectomy is recommended even in metastatic disease. When unsuitable for surgery- can use arterial embolisation, percutaneous cryotherapy, radiofrequency ablation
31
Kidney stones common formation points
Ureteropelvic junction (ureter coming into the renal pelvis) Pelvic brim Vesico-ureteric junction
32
kidney stones causes:
Hypercalcaemia High salt intake Dehydration male white ancestry eating anything brown/red (tea/coffee/coke/rhubarb/strawberries/radish) Hyperparatyhroid
33
kidney stones presentation
Colicky pain Loin to groin N/V Haematuria Reduced urine output symptoms of infection
34
Diagnosis of kidney stones
Non contrast CT KUB is first line and gold standard USS if pregnant or hydronephrosis AXR shows calcium based stones urine dipticks will show haematuria U&Es- reduced eGFR, inflammatory markers
35
Management of kidney stones
Analgesia- NSAIDs eg IM diclofenac, ibuprofen. IV paracetamol Symptom control- antiemetics eg metoclopramide, antibiotics Watchful waiting in stones less than 5mm Surgical intervention required in larger stones, stones that don't pass spontaneously or where there's complete obstruction or infection- eg Extracorporeal shockwave lithotripsy, Ureteroscopy + laser lithotripsy, Percutaneous nephrolithotomy, open surgery
36
types of kidney stone?
Calcium oxalate (85%) on CT is radiopaque + spiky, can reduce risk by low protein/salt diet/ thiazide diuretics Calcium phosphate - CT is radiopaque and white/smooth. risk factor is alkaline urine. Uric acid - CT is radiolucent + brown/smooth. Not visible on x ray. Caused by excess tissue breakdown. Struvite- produced by bacteria so associated w/ infection. CT - slightly radiopaque, staghorn calculus
37
Management of localised advanced prostate cancer
hormonal therapy radical prostatectomy radiotherapy- external beam and brachytherapy
38
Management of metastatic prostate cancer
hormonal therapy- reduce androgen therapy give synthetic GnRH agonist eg Goserelin. Initially cover this w/ an anti androgen to prevent a rise in testosterone eg, bicalutamide, cyproterone acetate abiraterone bilateral orchidectomy chemotherapy w/ docetaxel
39
Management of recurrent kidney stones
increase oral fluid intake (2.5-3 litres daily) add fresh lemon juice to water avoid carbonated drinks reduce salt intake maintain normal calcium intake potassium citrate in patients w/ calcium oxalate stones thiazide diuretics eg indapamide in pts w/ calcium oxalate stones
40
UTI is more common among?
Females due to shorter urethra
41
most common UTI bacteria
E. Coli
42
UTI Symptoms
Increased frequency and urgency Dysuria (pain when passing urine), burning suprapubic pain maybe haematuria
43
UTI diagnosis
urine dip: leukocyte esterase Nitrites- gram negative bacteria like e coli break down nitrates to nitrites. RBCs show haematuria Presence of nitrites or leukocytes + RBCs = patient likely to have UTI nitrites + leuocytes = requires UTI treatment only nitrites are present- treat for UTI
44
UTI management
3 days of Abx for a simple lower UTI in women - Trimethoprim or Nitrofurantoin 5-10 days for immunosuppressed women, w/ abnormal anatomy or impaired kidney function 7 days of Abx for men, pregnant women or catheter related UTIs: for men - trimethoprim or nitrofurantoin offered first line under prostatitis is suspected. for pregnant women: first line- nitrofurantoin (avoid in 3rd trimester), second line - amoxicillin or cefalexin
45
Haematuria differentials
Bladder cancer (usually painless) Renal cancer UTI Stones Nephrological disease eg glomerulonephritis Prostate disease Systemic disease eg SLE, GPA
46
2 week wait referral criteria for haematuria
45+ w/ a) unexplained visible haematuria w/o UTI - RCC b) visible haematuria persisting/recurring after UTI treatment - bladder cancer c) 60+ w/ unexplained non-visible haematuria and dysuria or raised WCC - bladder cancer d) non urgent referral for bladder cancer if 60+ w/ recurrent or persistent unexplained UTI
47
testicular torsion risk factors
10-30 y/o Bell Clapper Deformity- testicle not attached to tunica vaginalis at posterior, higher chance of torsion.
48
testicular torsion presentation
sudden sharp unilateral testicular pain abdo pain N&V
49
testicular torsion signs
firm swollen testicle retracted upwards (elevated) loss of cremasteric reflex abnormal testicular lie (often horizontal) Rotation of epididymis Can diagnose based on clinical signs, on USS whirlpool sign tho
50
testicular torsion management
analgesia orchidopexy - fixation of testicle within scrotum, usually bilateral. Orchidectomy if delayed surgery/ presence of necrosis
51
testicular cancer risk factors
20-30 year old male Infertility Undescended testes family history Klinefelters
52
testicular cancer types
Germ cell (produce gametes) - 95%; Seminoma, Non-seminoma (embryonic, yolk sac, teratomas) Non-Germ Cell - 5%; Leydig Cell Carcinoma, Sarcoma
53
testicular cancer presentation
painless testicular lump Hard + irregular Non Translucent Gynaecomastia in Leydig Cell cancer
54
Testicular cancer investigation first line
Scrotal USS
55
testicular cancer markers
AFP: raised in teratomas Beta-HCG raised in teratomas + seminomas Lactate dehydrogenase : non specific tumour marker
56
testicular cancer staging
Royal Marsden Staging
57
testicular cancer management
depends on whether seminoma or non-seminoma Orchidectomy Chemotherapy Radiotherapy Sperm banking
58
Prognosis of testicular cancer
seminomas have a slightly better prognosis, both over 95% 5 year survival.
59
Testicular cancer long term side effects
infertility, hypogonadism, peripheral neuropathy, hearing loss
60
hydrocele presentation
painless soft scrotal swelling palpable testicle transilluminable no bowel sounds
61
varicocele- what is it?
pampiniform plexus veins become swollen, most common on the left due to increased resistance in the left testicular vein. left sided varicocele can indicate an obstruction of the left testicular vein caused by a RCC. Can cause impaired fertility due to raising temperature, testicular atrophy
62
varicocele presentation
dragging sensation throbbing/dull pain, worse on standing sub/infertility
63
varicocele signs
scrotal mass feels like a bag of worms more prominent on standing disappears when lying down, if not then raises concerns about retroperitoneal tumours obstructing drainage of the renal vein
64
epididymal cysts what are they
occur at head of epididymis. fluid filled sac. v common around 30% incidence. usually harmless and not associated w/ infertility or cancer
65
epididymal cysts- symptoms
may be asymptomatic, or painless swelling in upper testicle
66
epididymal cysts signs
soft fluctuant mass separate to testicle, typically at the top may be able to transilluminate large cysts
67
indirect inguinal hernia what is it
bowel herniates thru the inguinal canal and into the scrum
68
indirect inguinal hernia symptoms
soft fluctunat bulge in the scrotum. painless swelling in upper testicle

Medicine year 3 TCD (10 decks)

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