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General Surgery > Urology > Flashcards

Urology Flashcards

1
Q

When during urination does blood appear, indicates what?

A

Initial - diseased urethra, distal to UG diaphragm

Terminal - disease near bladder neck, prostatic urethra

Throughout - disease in bladder or upper urinary tract

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2
Q

What are lower urinary tract symptoms? [FUN DISSH]

A

storage: frequency, urgency, nocturia

voiding: terminal dribbling, intermittency, poor stream, straining, hesitancy

others: polyuria, oliguria, urethral discharge

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3
Q

What causes storage problems?

A

UTI, stones, bladder tumour

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4
Q

What causes voiding problems?

A

BPH, prostate cancer, urethral stricture

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5
Q

Upper urinary tract symptoms

A

Loin pain/tenderness

Severe loin pain w radiation to iliac fossa, groin, genitalia

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6
Q

What causes upper urinary tract symptoms?

A

Renal infection, infarction, obstruction, glomerulonephritis

radiating pain caused by acute obstruction of renal pelvis/ureter by calculus/blood clots

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7
Q

Hallmark of malignancy in urology

A

Painless gross haematuria in patient >35 years old

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8
Q

Urine characteristics of glomerular bleeding

A

Frothy - proteinuria
Blood - smoky brown, “coca-cola”
no clots
some RBCs are dysmorphic
RBC cast may be present

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9
Q

Urine characteristics of extraglomerular bleeding

A

Red or pink blood
Blood clots may be present
Non frothy - no proteinuria
Normal RBC
RBC casts absent

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10
Q

Presence of RBC casts diagnostic of?

A

Glomerulonephritis / vasculitis

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11
Q

Different aetiologies for post-renal haematuria

A

Trauma
Infection
Stones
Tumours
BPH

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12
Q

Renal causes of haematuria usually present

A

microscopically

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13
Q

Risk factors for RCC

A

Smoking

Industrial exposure

Prior kidney irradiation

Family history - VHL, tuberous sclerosis

Acquired polycystic kidney disease - secondary to chronic dialysis

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14
Q

Types of RCC and which part of collecting duct system they arise from (3)

A

clear cell RCC - proximal tubule epithelium

Papillary RCC - distal tubule

Chromophobe RCC - collecting ducts

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15
Q

Prognosis of each type of RCC

A

clear cell - resistent to chemo & radio

papillary - type 1 good, type 2 poor

chromophobe - excellent

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16
Q

Ddx for renal masses
(split benign and malignant)

A

Benign:
- angiomyolipoma (most common benign)
- renal cysts
- renal abscess
- pyelonephritis
- renal oncocytoma

Malignant:
- RCC
- Wilm’s tumour (nephroblastoma) more common in kids
- Metastases
- Sarcoma

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17
Q

Triad of presenting symptoms for advanced renal tumours

A

Painless haematuria, flank pain, palpable flank mass

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18
Q

Common regional symptom of RCC

A

Left testicular varicocele

Tumour invades into left renal vein, blocks drainage of left testicular vein that empties

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19
Q

Paraneoplastic syndromes of RCC

A

Hypertension - renin overproduction

Hypercalcaemia - production of PTH-related peptide, acts like PTH, bone resorption

Polycythaemia - EPO production

Cushing’s, feminisation/masculinisation

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20
Q

Kidney tumour limited to kidney is stage ___, progression to stage ___ occurs when ___

A

2
3 - when tumour invades major vessels/adrenal gland

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21
Q

Difference between total and radical nephrectomy

A

Total: remove kidney

Radical: ligate renal artery/vein + remove kidney + Gerota’s fascia +/- adrenal gland

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22
Q

What is milk-alkali syndrome?

A

Repeated calcium & alkali ingestion leading to

hypercalcaemia + metabolic alkalosis + AKI

predisposes to stone formation

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23
Q

Non-modifiable risk factors for urolithiasis

A

Age
Gender (M)
Cystinuria
Inborn error of purine metab
Crohn’s - hyperoxaluria
HyperPTH - hypercalciuria
Gout - hyperuricosuria

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24
Q

Points of constriction of the ureter

A

Pelvic-ureteric junction (where pelvis of kidney meets ureter)

Pelvic brim (near common iliac artery bifurcation)

Vesico-ureteric junction (entry to bladder)

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25
Q

What stones are radiopaque on X ray?

A

Calcium oxolate
Calcium phosphate
Struvite (magnesium, ammonium, phosphate)

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26
Q

What stones are radiolucent on X ray?

A

Urate
Cystine

27
Q

Struvite stones are formed due to?

A

Infection with urease positive bacteria (Proteus, Staph. sapro, kleb)

Hydrolyse urea to ammonia, make urine alkali -> Staghorn calculi form

28
Q

Causes of stone formation (3)

A

Supersaturation
Infection
Drugs

29
Q

Ureteric stone presentation

A

Ureteric colic pain - severe, intermittent loin to groin (+- ipsilateral testis/labia)

Haematuria

Upper UT infection - fever

Stone at VUJ - frequency, urgency, dysuria

30
Q

Renal stones presentation

A

Asymptomatic unless block PUJ -> hydronephrosis -> infection -> pyonephrosis

Vague flank pain

Large staghorn calculi can completely fill kidney pelvis + calyces -> chronic renal failure

31
Q

Bladder stone symptoms

A

Storage LUTS - frequency, urgency

Dysuria

Haematuria

32
Q

Drugs that increase risk of stone formation

A

Acyclovir
Antacids
Salicylic acid

33
Q

When is a stone unlikely to pass with conservative management?

A

> 1 month, probably too large to pass on its own

34
Q

Complications of stone

A

Blocks urine flow -> UTI
Damage renal tissue
Bleeding
Increase in size

35
Q

Types of bladder cancer

A

Transitional cell carcinoma (most common)
Squamous cell carcinoma
Rhabdomyosarcoma (children)

36
Q

Risk factors for bladder cancer

A

Industrial exposure: rubber workers, textile/printing industries

Non-industrial:
smoking
analgesia abuse
chronic parasite infection - schistosoma (causes SCC)
chemo, chronic cystitis from radiation

37
Q

LUTS in relation to bladder cancer

A

Storage problems - carcinoma in situ

Voiding problems - cancer at neck of bladder/prostatic urethra

Dysuria, pyuria

38
Q

Where can bladder tumour invade and what does it cause?

A

Colon (vesico-colic fistula) - pneumaturia

Vagina (vesico-vaginal fistula) - incontinence

39
Q

Aetiologies of acute urinary retention

A

Mechanical:
- BPH
- Stricture - STD, instrumentation
- Stones

Functional:
- Drugs - anticholinergics
- UTI
- Spinal cord compression
- Neurogenic bladder

40
Q

Bladder is percussible when containing ___ of urine, palpable when more than ___

A

150mL
200mLs

41
Q

DDx classification for ARU

A

Mechanical - extraluminal, mural, luminal
Functional - infection, neurologic impairment, drugs, others

42
Q

Extraluminal causes of ARU

A

BPH
prostate cancer
constipation
pelvic masses
pelvic organ prolapse

43
Q

Mural causes of ARU

A

TCC of bladder neck
Strictures
Urethritis

44
Q

Luminal causes of ARU

A

Stones
Strictures
Foreign body
Blood clot

45
Q

Functional causes of ARU

A

neuro - cord compression (Cauda equina syndrome)
infection
drugs - anticholinergic, sympathomimetic, cardiac meds, pain meds, psychiatric meds
others - post anaesthesia, pain

46
Q

AdenoCA of prostate commonly occurs in ___ zone

A

peripheral zone

*palpable on DRE

47
Q

Symptoms of prostate cancer

A

symptoms of BPH (DISH) + haematuria + dysuria

48
Q

BPH commonly occurs in ___ zone

A

central

49
Q

Major stimulus of prostate hyperplasia

A

dihydrotestosterone

produced by testosterone via 5-alpha reductase

50
Q

BPH cardinal features

A
  • voiding LUTS
  • storage LUTS (complication of urine retention - UTI, stones)
  • haematuria
  • ARU
  • overflow incontinence
51
Q

Complications of BPH

A
  • hydroureter
  • hydronephrosis
  • pyonephrosis
  • pyelonephritis
  • hernia
52
Q

Enlarged prostate: ___ on DRE

A

> 3 finger breadth
intact median sulcus
no nodule
firm
smooth rectal mucosa, not attached to prostate

53
Q

Questions to differentiate testicular swellings (4)

A

1) Whether can get over testis
2) Whether can differentiate testis from epididymis
3) Whether transilluminable
4) Whether tender

54
Q

Testicular torsion happens in ___

A

peri-pubertal age group (12-18 yrs)

55
Q

How to differentiate torsion from epididymitis

A

Prehn sign

-ve in torsion: lifting testis does not relief pain
+ve in epididymitis

56
Q

What is Fournier gangrene

A

Necrotising fasciitis of the perineum & genital region frequently due to synergistic polymicrobial infection

57
Q

Risk factors of fournier gangrene

A

Diabetes, alcoholics, immunocompromised

58
Q

Scrotal varicocele commonly occurs on the ___. Why?

A

Left hemi-scrotum

Left spermatic vein enters left renal vein at perpendicular angle. Intravascular pressure in left renal vein higher than right (compressed between aorta and SMA). Higher backpressure -> varicocele.

59
Q

Risk factors for testicular tumour

A

Cryptorchidism - failure of testicle to descend
HIV
gonadal dysgenesis

60
Q

Most common type of testicular tumour

A

Germ cell tumours - especially seminomatous

61
Q

Seminoma prognosis

A

Excellent prognosis
Highly responsive to radiotherapy
Metastasize late

62
Q

Non-seminomatous germ cell tumour prognosis

A

Variable response
sensitive to chemo
metastasize early

63
Q

Testicular torsion causes irreversible damage after ___

A

12 hours

64
Q

Clinical presentation of testicular torsion

A

Acute abdomen (T10 innervation)
Nausea + vomiting

No voiding complaints, dysuria, fever, STD exposure

General Surgery (13 decks)

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