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urology Flashcards

1
Q

*retracted testes with negative cremasteric reflex

A

Testicular torsion

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2
Q

*adult with a hydrocele

A

Refer urgently for a testicular US - could be a tumour

In babies - resolves within a year usually

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3
Q

First line investigation for testicular mass

A

Ultrasound

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4
Q

*periureteric fat ‘stranding’

A

Can indicate the passage of a recent renal stone

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5
Q

Most common type of renal stone

A

Calcium oxalate

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6
Q

Which renal stones are NOT opaque (radiographically)

A

Urate
Cystine
Xanthine

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7
Q

*stag-horn calculus

A

These renal stones involves the renal pelvis and are composed of struvite

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8
Q

Gold standard for suspected urolithiasis

A

CT KUB (ct of kidneys, ureters and bladder)

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9
Q

Management of acute urinary retention

A

Emergency !
Catheterisation and decompression

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10
Q

What may develop after catheterisation due to acute urinary retention

A

Post-obstructive diuresis

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11
Q

What occupational exposure is a recognised risk of developing transitional cell cancer

A

Aniline dye

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12
Q

*transilluminates, not tender to touch

A

Hydrocele

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13
Q

Gold standard for renal calculus

A

CT non-contrast

US + X-ray brings up accuracy only a bit

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14
Q

What is hydronephrosis

A

When stone comes down the tract and stretches it

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15
Q

Small stone

A

<4mm

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16
Q

Medium sized stone

A

> 4mm - 2cm

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17
Q

Large kidney stone

A

> 2cm

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18
Q

Management of small sized kidney stone

A

Conservative management + observe

On the US a year on check up to see if its gotten any bigger

But should pass by itself

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19
Q

Renal colic included symptoms

A

Flank pain radiating down leg / groin
Nausea
Microcytichaematuria

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20
Q

Management of medium sized stone

A

ESWL
FLexible URS + Laser
PCNL

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21
Q

What is ESWL

A

‘Shockwave lithotripsy’

—> patient put under sedation , ballon attached to skin over flank , high frequency sound waves target the stone - which then fragments and get passed down the ureter

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22
Q

Side effects of ESWL

A

Haematoma to gut
Haematuria

Quite aggressive tool but effective

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23
Q

What is flexible URS + laser

A

‘Urothroscopy’ = camera going through ureter to the stone

Once the stone is found , the laser fragments the stone into smaller pieces which is then passed

Can’t have anaesthetic , infection risk - the stone harbours bacteria as well as external source, hydronephrosis developing into pyelonephritis

But has a higher clearance rate than ESWL (90% success rate)

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24
Q

Management for large stone

A

PCNL = percutaneous nephrolithodotomy

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25
Q

What is PCL

A

Patient goes under anaes. Needle inserted through skin via wire , a tract is built from outside to kidney and camera goes in and then breaks stone —> which are then extracted externally

Benefit = can be more specific in target and can clear completely (highest rate of clearance)

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26
Q

Side effects of PCNL

A

Risk of bleeding
Injury to associated structures (diaphragm —> pneumothorax, liver, spleen etc)

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27
Q

First line for renal colic

A

Diclofenac (NSAIDs)

28
Q

How to decide who goes to theatre with a ureteric stone

A
  1. Pain (not controlled)
  2. Single kidney (bilateral , one missing)
  3. Infection - can spread very rapidly to the rest of the body
  4. Stone >7mm cannot be managed conservatively
  5. Multiple stones
29
Q

What are the two management options of ureteric stones

A
  1. ESWL
  2. Uretothroscopy (main)
30
Q

Renal stone vs ureteric stone symptoms

A

Ureteric = 12/10 pain , this one is worse due to back flow pressure back into the kidney

31
Q

What is the JJ stent

A

Stent between kidney and the bladder - to stop scarring / sclerosis from laser and stuff which would cause blockage

Patient brought back in a few weeks later to get stent removed

32
Q

Risk factors for pyelonephritis

A

Female
DM
On steroids
Immunocompromsied
Past urological procedures
History of stones

33
Q

How does pyelonephritis present

A

Macroscopic haematuria
Flank and back pain
Fever

34
Q

*loin percussion tenderness

A

Pyelonephritis

Percussing with a closed fist over the flank - due to the oedema around the kidney the neural supply is even more sensitive - patient has severe pain

35
Q

Mx of stable pyelonephritis

(Normal vitals and no significant fever)

A

= oral abx for up to 7 days

36
Q

Mx of unstable pyelonephritis

A

Admit to hospital
IV abx (but need a culture before staring abx - if culture taken after the abx can mask what’s there)

37
Q

What are the causative organism common in pyelonephritis

A

E.coli
Klebsiella
Pseudomonas

(All gram neg.) and can be treated with trimethoprim (oral) or co-trimoxazole (oral)

38
Q

Patient admitted with pyelonephritis caused by gram neg - what is the treatment ?

A

IV gentamicin

39
Q

Treatment of pyelonephritis caused by gram +

A

Co-amoxiclav.

(If don’t know causative organism then can prescribe both co-amoxiclav. and gentamicin)

40
Q

Treatment of pyelonephritis due to anaerobe ?

A

Metronidazole

41
Q

Pregnancy complications of pyelonephritis

A

Premature labour
IUGR
Stillborn

42
Q

Why does every pregnant mother get a urine dipstick in first trimester

A

Rule out infection just in case - can do foetal damage

43
Q

Safest antibiotic for pregnant woman with pyelonephritis

A

Trimethoprim
Amoxicillin

Also cephalosporins

44
Q

Investigation for prostate cancer - initial

A

MRI prostate (lymph nodes, mets, local cancer)

45
Q

Diagnostic for prostrate cancer

A

MRI (gold standard)

46
Q

Who qualifies for an MRI of prostate in suspicion

A

PSA <20
T1/T2 (localised)
<80 years

47
Q

*PSA >20 , T3/T4 disease
What investigation appropriate ?

A

Bone scan (for mets —> osteoblastic areas)

CT of chest , abdo, pelvis (for lymph nodes)

48
Q

What is normal PSA

A

<4

49
Q

PET scan after treatment of prostate cancer ?

A

Check for radiotherapy damage

50
Q

PIRADS grading system ?

A

Local cancer for prostate cancer (4/5 is typical for cancer)

51
Q

Commonest place on the prostate for cancer to develop ?

A

Peripheral zone

(Can be detected on DRE)

For BPH cancer is in the transitional zone (presses on the ureter)

52
Q

Treatment for prostate cancer

A

A. Localised cancer and patient is healthy (no bone mets/lymphadenopathy) —> robotic prostatectomy (removal of prostate and capsule (tissue around it)), can also give localised radiotherapy (brachytherapy)

B. Locally advanced (ie lymph nodes but no mets) —> radiotherapy OR hormonal (usually no surgery)

C. Metastatic (PSA = 150, bone mets, back pain etc) —> hormonal therapy with GnRH agonist / antagonist (definitely no surgery)

53
Q

How do GnRH work to help metastatic prostate cancer

A

GnRH released by hypothalamus —> LH/FSH to be released from ant. Pit. —> testosterone (released from testes and reticularis) —> AGONIST : causing LH/FSH to downregulate ( chronically, acutely this causes an increase in testosterone initially ) —> leading to cessation of testosterone production

*need to use and anti-androgen with a GnRH agonist to stop testosterone flair , why antagonist is used by itself - no flair

54
Q

What needs to be co-prescribed with GnRH Agonist

A

Anti-androgens (ie -amides)

55
Q

Limitation of hormonal therapy in treatment of prostate cancer

A

Only lasts about 3 years - body changes to keep up with hormonal change —> would then start to use chemo.

56
Q

What is PSA density

A

For every gram of prostate per PSA

> 0.15mg/dl tells of cancer (normal should be 0.1)

Can use this to distinguish between BPH and cancer

57
Q

Causes of BPH

A
  1. Testosterone
  2. Genetic
  3. Oestrogen diet (soya + red meat)
  4. Idiopathic (mainly)
58
Q

What is IPSS

A

International prostate stimulation score

Measures age, quality of life, obstructive symptoms, bladder related symptoms

59
Q

*nocturnal incontinence

A

Retention , patient in trouble

60
Q

Investigation for BPH

A
  1. PSA
  2. Uroflow (chart on how fast man is peeing)
  3. Bladder scan (to check for post-void residual)
61
Q

Management of BPH

A
  1. Conservative - dietary (stop caffeine (causes detrusor muscle dysfunction - incontinence)), timed voiding, nocturia - stopping fluid 2-3 hours before bed and have one set alarm to wake up and go
  2. Alpha block - tamsulosin 0.4mg 1d SYMPTOMATIC CONTROL BY RELAXING TRIGONE AND PROSTATIC URETHRA (causing it to widen —> easier passage of urine, no change in prostate size)
  3. 5-a-reductase inhibitors - finesteride (reduces size of prostate by 1/3, the epithelium)
62
Q

Side effects of tamsulosin

A

Postural hypotension
Dry ejaculations (could be used as male contraception!)
Contraindicated in acute closed angle glaucoma

63
Q

MoA of Finesteride

A

Stops conversion of testosterone —> DiHydroTestosterone (active)

Therefore side effects can include: anxiety, decrease in libido, increase chance of ED, depression

64
Q

Resection of prostate in BPH ?

A

If prostate is >20-80g and no response to 5-a-reductase etc

Then TURP (transurethral resection of prostate) , peeling back layers of prostate

65
Q

What is Steam therapy for BPH

A

Steam injected into prostate (9 seconds each) and this causes coagulative necrosis

Benefits = no loss of sexual function , no bleeding (like in TURP)

66
Q

Treatment of prostate hyperplasia of >80g

A

HOLFP

‘Homeum Laser enucleation of the prostate’

Laser peels of prostate of the capsule around it, the central and transitional zone peeled away , this is pushed into the bladder where it is then sucked out

Benefits - day procedure (no prostate left)

67
Q

Limitation of TURP

A

Prostate could regrow

everything (29 decks)

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