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Clinical Surgery > Urology > Flashcards

Urology Flashcards

1
Q

Predominant composition of urinary stones

A
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2
Q

Presentation of Urinary Tract Stones

A
  • acute onset severe 10/10 flank pain that
    radiates to the groin
  • Waxes and wanes.
  • Patients will struggle to sit comfortably and will pace/walk around.
  • Can be associated with vomiting, nausea or haematuria.
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3
Q

Risk Factors for Urinary Stones

A
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4
Q

Complications of Urinary Stones

A
  • Recurrent UTI
  • Pain
  • Urosepsis
  • Renal Failure
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5
Q

Investigations for Urinary Stone

A
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6
Q

Treatment of obstructive ureteric stone + Sepsis?

A
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7
Q

What is the Sepsis 6?

A

Give:

  • Oxygen (>94%)
  • Fluids (30mL/kg of isotonic crystalloid fluid)
  • IV Antibiotics

Take:

  • Lactate Levels
  • Blood Culture
  • Urine Output Monitoring
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8
Q

Treatment of obstructive ureteric stone (NOT Spetic)

A
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9
Q

Treatment of Non-Obstructing Stone (Usually in Kidney)

A
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10
Q

Basics of Ureteric Stone Prevention

A

Fluid intake >3 Liters daily

Low Salt Diet

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11
Q

Differential Diagnosis of Acute Urinary Retention?

  • Males
  • Females
  • Both
A
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12
Q

Complications of Benign Prostatic Hyperplasia (BPH)

A
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13
Q

Investigations of Benign Prostatic Hyperplasia (BPH)

A
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14
Q

Medical Treatment of Benign Prostatic Hyperplasia (BPH)

A
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15
Q

Surgical Treatment of of Benign Prostatic Hyperplasia (BPH)

A
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16
Q

Most Common metastasis of prostate cancer

A

Bone (Axial Skeleton)

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17
Q

Investigations for Prostate Cancer

A

History/exam (DRE)

Labs: PSA blood test

Imaging:

  • Multiparametric MRI of prostate: Most useful method to image prostate. Given PIRADS score, rated from 1-5 with 1 being low risk for malignancy with 5 a very high risk of malignancy
  • Bone Scan/CT TAP to evaluate for metastatic disease
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18
Q

Classification of Prostate Cancer?

A

Gleason score used for histological diagnosis and grading of prostate cancer, with the two most common tissue patterns present used to give an overall grade.
■ E.g. 3+4=7
■ However not the same as 4+3=7, which is considered more severe as 4 is the predominant tissue pattern type

19
Q

Conservative treatment of Prostates Cancer (young vs. Old Man)

A
20
Q

Indication for Surgical Treatment of Prostate Cancer?

Procedures?

Complications?

A
20
Q

Indication for Radiation Theraoy of Prostate Cancer?

Procedures?

Complications?

A
20
Q

Indication for Medical Treatment of Prostate Cancer?

Complications

A
21
Q

Rapid Access Prostate Clinics

  • Ages Screened
  • What is checked
  • What are the thresholds for referral
A
22
Q

Risk factors for Renal Neoplasms

A
23
Q

Differential Diagnosis of Renal Tumors

A
24
Q

Paraneoplastic Syndromes Associated with Renal Neoplasm

A

Anemia

Polycythemia (Ectopic EPO Secretion)

Hypertension (Renin)

Cushing’s Syndrome (ACTH)

Hypoglycemia (Insulin)

Hypercalcemia (PTH-Like Substance)

25
Q

Complications of Renal Neoplasm

A

Metastases:

  • lung metastases
  • bone metastases
  • venous involvement can cause lower limb edema

Paraneoplastic Syndromes

  • Anemia
  • Polycythemia (Ectopic EPO Secretion)
  • Hypertension (Renin)
  • Cushing’s Syndrome (ACTH)
  • Hypoglycemia (Insulin)
  • Hypercalcemia (PTH-Like Substance)
26
Q

Investigations for Renal Neoplasm

A
27
Q

Treatment of Renal Neoplasm

A

Immunotherapy: Interferon Alpha

Surgery:

  • Partial Nephrectomy (Nephron-Sparing)
  • Radical Nephrectomy
  • Cryoablation and Radiofrequency Ablation:

Conservative: Active surveillance can be considered in patients with a tumour <3cm

28
Q

Risk factors for Urothelial Cell Carcinoma

A

Smoking

Exposure to ionising radiation or arsenic

Occupational exposure to amines
or hydrocarbons (textile industry)

29
Q

Investigations for Urothelial Cell Carcinoma

A
30
Q

Treatment for Urothelial Cell Carcinoma

A

Trans urethral resection of bladder tumour (TURBT)

  • Needed initially for all for histological diagnosis/grading
  • Adequate for patients with non-muscle invasive disease
  • need surveillance flexible cystoscopies at
    regular intervals to ensure no recurrence.

Radical cystectomy and ileal conduit formation

  • Used for muscle invasive disease
  • Usually open procedure under GA

Radiotherapy/Chemotherapy: Palliative/ Metastatic setting

31
Q

Epidemiology of Testicular Tumors

A
32
Q

Types of Testicular Tumor

A
33
Q

Risk Factors for Testicular Tumor

A

History of Cryptorchidism (absence of at least one testicle from the scrotum)

Family history

Caucasian

Maternal Estrogen Exposure

HIV

34
Q

Investigations for Testicular Tumor

A

Exam of external genitalia

  • Exam contralateral testes first
  • Assess size, mass, painful or painless. Hard mass arising from testicle is suggestive of malignancy

Labs

  • Tumour markers: alpha fetoprotein, HCG, LDH.

Imaging: Urgent ultrasound testes – ~ 100% sensitivity for detection of testicular tumours

35
Q

Treatment of Testicular Tumor

A

Radical inguinal orchidectomy +/- insertion of testicular prosthesis

36
Q

Differential Diagnosis of Acute Testicular Pain

A
37
Q

Investigations for Acute Testicular Pain

A

US testes is best step to investigate pain or swelling of scrotum

However, if suspicion of testicular torsion remember this is a clinical diagnosis – straight to surgical exploration!!

Other investigations: urine culture and STI screen if considering epididymal-orchitis

38
Q

Treatment of Testicular Tortion

A

emergent scrotal exploration + orchidopexy (fixation of testicle)

39
Q

Treatment of Epididymitis/orchitis

A

antibiotics depending on local protocols and cause (UTI vs STI)

40
Q

Treatment of Hydrocele

A

managed conservatively or be offered surgical repair with Jaboulay or Lords procedure

41
Q

Treatment of Testicular Varicocele

A

managed conservatively or offered testicular vein embolization or ligation if bothersome.

42
Q

Treatment of Testicular Trauma

A

exploration if concerned about testicular rupture, otherwise conservatively managed with rest, elevation, and analgesia.

Clinical Surgery (20 decks)

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