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MRCS > urology > Flashcards

urology Flashcards

1
Q

Which scan gives information about the renal cortex and medulla but not the ureter and draining systems

A

DMSA scan

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2
Q

What type of info does a MAG3 renogram give

A

Imaging for patients with pre-existing renal impairment

Gives info on renal function

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3
Q

Which scan gives poor image quality in patients with reduced GFR/ chronic renal impairment

A

DTPA scan

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4
Q

Describe the nervous control of an erection

A

Erection is controlled by both Autonomic (sym/parasympathetic) and somatic nerves

Autonomic- nervi erigentes/ pelvic splanchnic nerves S2-4:
-para= causes erection
-symp= causes ejaculation/ detumescence

Somatic:
-onufs nucleus- origin of pudendal nerve in the anterior horn of the sacral part of the spinal cord (S2-4)
[controls muscles of continence + orgasm]

-dorsal penile nerve

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5
Q

What are the muscles involved in an erection

A

ischiocarvernosus
bulbocarvenosus

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6
Q

What is priapism

A

unwanted, sustained erection for >4hours

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7
Q

Causes of priapism

A

blood: leukaemia/ sickle cell

neuro: spinal cord transection

trauma: causing arteriovenous malformation in the penis

drugs: ED meds

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8
Q

Tx of priapism

A

-ice/ cold shower
-aspirate blood from carvernosum
-injected cavernus with alpha adrenergic agonists

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9
Q

Investigations for priapism

A

-blood test for leukaemia/SCA
-aspirate blood from cavernosa to determine if high/low flow priapism

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10
Q

How to alpha adrenergic agonists treat priapism

A

they cause constriction of blood vessels

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11
Q

What is high vs low flow priapism

A

High= priapism due to unregulated arterial flow into the cavernosa, PAINLESS

Low= due to veno-occlusion, high intra-cervenosal pressures, PAINFUL, needs emergency tx

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12
Q

Commonest type of bladder cancer

A

Transitional cell carcinoma

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13
Q

Commonest type of penile cancer

A

SCC

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14
Q

Tx of penile cancer

A

Orchidectomy via the inguinal approach (not scrotal)

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15
Q

Presentation of a patient with posterior urethral valves

A

Age: child
PC: urinary hesitancy/ poor flow/ renal scarring

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16
Q

What investigations would you carry out for an incidental adrenal lesion found on CT

A

Hormonal assay includes:
-serum morning and midnight cortisol levels
-serum K, aldosterone + renin
-24hr urine cortisol excretion
-24hr urine catecholamine excretion
-dexamethasone suppression test

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17
Q

What determines the likelihood of malignancy in adrenal lesions

A

likelihood = size of lesion

lesions >4cm have 25% chance of being malignant

18
Q

Causes of hydronephrosis

A

unilateral=PACT

-PUJ obstruction
-abherrant renal vessels
-calculi
-Tumour of renal pelvis

bilateral=SUPER

-stenosis of urethra
-urethral valve
-prostatic enlargement
-extensive bladder tumour
-retroperitoneal fibrosis

19
Q

Ix for hydronephrosis

A

-IV urogram (position of obstruction)
-pyelogram (retro/ antegrade)
-non contract CT (renal calculi)

20
Q

Mx of an acut vs chronic upper ureteric obstruction

A

acute= nephrostomy
chronic= ureteric stent

21
Q

Which medications cause pseudohaematuria

A

rifampicin
quinine
methyldopa
levadopa
phenytoin

22
Q

Which foods cause pseudohaematuria

A

beetroot
rhubarb
blackberries

23
Q

Side effect of the drug cyclophosphamide

A

haemorrhagic cystitis

24
Q

Drugs that can cause interstitial nephritis/ tubular necrosis (haematuria)

A

aminoglycosides
sulphonamides
quinine
penicillins
NSAIDs

25
Q

What is the optimal operative procedure for a testicular cancer and why

A

orchidectomy via inguinal approach

(prevent spread to other lymphatic fields)

26
Q

What is the management of a hydrocele in a child vs adult (which surgical approach)

A

CHILD: ligation of the patent processus vaginalis via an INGUINAL approach

ADULT: Jaboulay/ lords procedure via SCROTAL approach (hydrocele sac excision/ plication)

27
Q

Features associated with adult polycystic kidney disease

A

other cysts= liver/ pancreas/ berry aneurysms

HTN/ haematuria/ renal calculi (urea)/ renal mass

28
Q

What type of tumour is found in the kidney and is pink coloured on dissection

A

TCC

29
Q

Which presentations of renal colic would require more urgent management

A

Obstruction/ structural abnormalities (eg horseshoe kidneys), recent renal transplant

obstruction + infection= surgical emergency (needs decompression!)

30
Q

Renal colic: when would mx included watchful waiting

A

renal OR ureteric calculi <5mm

31
Q

When would you use ESWL to treat renal/ureteric calculi

A

renal calculi <10mm

ureteric calculi 5-10mm

32
Q

When would you use ureteroscopy to treat renal/ureteric calculi

A

renal/ ureteric calculi 10-20mm

33
Q

When would you use percutaneous nephrolithotomy to treat renal/ureteric calculi

A

renal calculi >20mm

34
Q

Difference between ESWL/ ureteroscopy and PCNL

A

ESWL (not going through urinary tract or skin, lithotripsy but stones cant be extracted)

ureteroscopy (ureteroscope inserted through urethra and shockwaves sent, stones extracted)

PCNL (through skin and stones extracted)

35
Q

What are the types of medical mx of BPH

A

5 alpha reductase inhibitors (finasteride)

alpha blockers (tamsulosin)

36
Q

What is the MOA of the medications used to treat BPH

A

5 alpha reductase inhibitors= prevent conversion of testosterone- dihydrotestosterone (hence prostate doe not increase in size)

alpha blockers (relax smooth muscles of the prostate and the bladder, prostate may continue to grow)

37
Q

Which medical therapy used in the treatment of BPH does NOT reduce the risk of urinary retention

A

alpha blockers

38
Q

Which bacteria increase the risk of getting staghorn calculi

A

Proteus mirabilis
urease producing bacteria

39
Q

what is the most radiodense type of renal calculi

A

calcium phosphate

40
Q

What are staghorn calculi made of

A

Struvite

41
Q

Family history of stones and metabolic disorders- what type of stones form?

A

Cystine

42
Q

At what age does foreskin become retractile

A

at puberty (approx 16 y/o)

MRCS (22 decks)

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