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Finals > Urology > Flashcards

Urology Flashcards

1
Q

Causes of upper urinary tract obstruction

A
  • Kidney stones
  • Tumours pressing on the ureters
  • Ureter strictures (due to scar tissue narrowing the tube)
  • Retroperitoneal fibrosis (the development of scar tissue in the retroperitoneal space)
  • Bladder cancer (blocking the ureteral openings to the bladder)
  • Ureterocele (ballooning of the most distal portion of the ureter – this is usually congenital)
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2
Q

Causes of lower urinary tract obstruction

A
  • Benign prostatic hyperplasia (benign enlarged prostate)
  • Prostate cancer
  • Bladder cancer (blocking the neck of the bladder)
  • Urethral strictures (due to scar tissue)
  • Neurogenic bladder
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3
Q

6 causes of a neurogenic bladder, and what is it

A
  • MS
  • DM
  • Stroke
  • Parkinson’s disease
  • Brain or spinal cord injury
  • Spina bifida
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4
Q

What can be done to bypass an upper urinary tact obstruction ?

A

-> Nephrostomy : insering a thin tube through the skin at the back, through the kidney and into the ureter.

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5
Q

What can be done to bypass a lower urinary tract obstruction ?

A

-> Urethral or suprapubic catheter

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6
Q

Key SE of tamulosin

A
  • Postural hypOtension = leading to dizziness on standing or falls
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7
Q

How long do people require antibiotics for catheter associated infections ?

A

7 days

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8
Q

Symptoms seen in BPH

A

-> Hesitancy
-> Weak flow
-> Urgency
-> Frequency
-> Intermittency
-> Straining to pass urine
-> Terminal dribbling
-> Incomplete emptying
-> Nocturia

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9
Q

causes of a raised PSA

A
  • Prostate cancer
  • BPH
  • Prostatitis
  • Urinary tract infections
  • Vigorous exercise
  • Recent ejaculation or prostate stimulation
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10
Q

Cancerous prostate on DRE

A

Firm/hard, asymmetrical, craggy or irregular, with loss of the central sulcus

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11
Q

Medical management options of BPH

A
  1. Alpha-blockers (e.g., tamsulosin) relax smooth muscle, with rapid improvement in symptoms
  2. 5-alpha reductase inhibitors (e.g., finasteride) gradually reduce the size of the prostate
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12
Q

How do 5-alpha reductase inhibitors work ?

A
  • Converts testosterone to dihydrotestosterone (DHT), which is a more potent androgen hormone.
  • By inhibiting it, there is less DHT = reduction in prostate size
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13
Q

Four surgical treatment options for BPH

A
  1. Transurethral resection of the prostate (TURP)
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14
Q

Most common SE of finasteride

A

Sexual dysfunction (due to reduced testosterone)

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15
Q

2 classifications of prostatitis

A
  1. Acute bacterial prostatitis – acute infection in the prostate, presenting with a more rapid onset of symptoms
  2. Chronic prostatitis – symptoms lasting for at least 3 months
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16
Q

How can chronic prostatitis be classified ?

A
  1. Chronic prostatitis or chronic pelvic pain syndrome (no infection)
  2. Chronic bacterial prostatitis (infection)
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17
Q

Presentation of acute bacterial prostatitis

A
  • More acute onset of pelvic pain, LUTs, sexual dysfunction, pain with bowel movements and tender/enlarged prostate
    • Fever, myalgia, nausea, fatigue, sepsis
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18
Q

Presentation of chronic prostatitis

A
  1. Pelvic pain
  2. LUTs : dysuria, hesitancy, frequency and retention
  3. Sexual dysfunction, such as erectile dysfunction, pain on ejaculation and haematospermia (blood in the semen)
  4. Pain with bowel movements
  5. Tender and enlarged prostate on examination (although examination may be normal)
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19
Q

Management of acute prostatitis

A
  • Admission if systemically unwell
  • 14 oral quinolone (e.g ciprofloxacin)
  • Analgesia
  • Laxatives
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20
Q

Management of chronic prostatitis

A
  • Alpha blockers
  • Analgesia
  • CBT
  • Laxatives
  • Abx (if indicated)
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21
Q

5 RF for prostate cancer

A

Increasing age
Family history
Black African or Caribbean origin
Tall stature
Anabolic steroids

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22
Q

If not asymptomatic, how can prostate cancer present ?

A
  • LUTs
  • Haematuria
  • Erectile dysfunction
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23
Q

First line investigation for suspected prostate cancer

A
  • Multiparametric MRI (reported on a Likert scale)
  • > =3 prostate biopsy
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24
Q

How is prostate cancer diagnosed ?

A

Prostate biopsy

  1. Transrectal ultrasound guided biopsy (TRUS)
  2. Transperineal biopsy

(Risks : pain, bleeding, infection, urinary retention and ED)

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25
Q

How do you assess for bone metastasis in prostate cancer ?

A
  • Isotope bone scan
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26
Q

How is prostate cancer graded

A
  • Gleason grading system : the greater the score = the more poorly differentiated the tumour
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27
Q

How is prostate cancer staged ?

A

TNM staging

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28
Q

Management options for prostate cancer

A
  1. Surveillance or watchful waiting in early prostate cancer
  2. External beam radiotherapy directed at the prostate
  3. Brachytherapy
  4. Hormone therapy
  5. Surgery
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29
Q

Key complication of external beam radiotherapy for prostate cancer

A

Proctitis (inflammation in the rectum)

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30
Q

Side effects of brachytherapy

A
  • Cystitis and proctitis
  • Erectile dysfunction, incontinence and increased risk of bladder or rectal cancer
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31
Q

Hormone therapies used in prostate cancer

A
  1. Androgen-receptor blockers such as bicalutamide
  2. GnRH agonists such as goserelin (Zoladex) or leuprorelin (Prostap)
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32
Q

SE of hormone therapy used in prostate cancer

A

Hot flushes
Sexual dysfunction
Gynaecomastia
Fatigue
Osteoporosis

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33
Q

Key complication of radical prostatectomy done for prostate cancer

A

Erectile dysfunction and urinary incontinence

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34
Q
  • Soft, PAINLESS scrotal swelling anterior to and below testicle
  • Palpable testicle
  • Irreducible
  • TRANSILLUMINATED
A

Hydrocele

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35
Q
  • Scrotal mass than feels like a bag of worms
  • More prominant on standing, disappears on lying
  • Dragging sensation
  • Sub/infertility
A

Varicocele

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36
Q

what is a varicocele

A
  • Swelling of veins in the pampiniform plexus
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37
Q

what could be an underlying cause of a left sided varicocele ?

A
  • Renal cell carcinoma obstructing the left testicular vein
  • The left testicular vein drains into the left renal vein
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38
Q

Soft, round lump
Typically at the top of the testicle
Associated with the epididymis
Separate from the testicle

A

Epididymal cyst

39
Q

Causes of epididymo-orchitis

A

Escherichia coli (E. coli)
Chlamydia trachomatis
Neisseria gonorrhoea
Mumps

40
Q

Parotid gland swelling and orchitis

A

MUMPS (spares the epididymis)

41
Q

Presentation of epididymo-orchitis

A

Gradual onset (mins-hrs) - Unilateral :

  • Testicular pain and swelling
  • Pain relieved on elevation of tesicle
42
Q

Key differential for epididymo-orchitis

A

Testicular torsion

43
Q

what makes an STI the more likely underlying cause of epididymo-orchitis over an enteric organism like E.coli ?

A
  • Age under 35
  • Increased number of sexual partners in the last 12 months
  • Discharge from the urethra
44
Q

Management of epidiymo-orchitis caused by an enteric organism

A
  • Ofloxacin for 14 days
  • Send MSU
45
Q

Two important SE of quinolone Abx (e.g ciprofloxacin)

A
  1. Tendon damage and rupture (esp achilles tendon)
  2. Lowers seizure theshold (caution in pts with epilepsy)
46
Q

5 complications of epididymo-orchitis

A

Chronic pain
Chronic epididymitis
Testicular atrophy
Sub-fertility or infertility
Scrotal abscess

47
Q
  • Teenage boy with sudden onset unilateral testicular pain, triggered whilst playing sport
A

Testicular torsion

48
Q

Examination findings in testicular torsion

A
  • Firm swollen testicle
  • Elevated (retracted) testicle
  • Absent cremasteric reflex
  • Abnormal testicular lie (often horizontal)
    -Rotation, so that epididymis is not in normal posterior position
49
Q

what is one underlying cause of testicular torsion

A

Bell-clapper deformity

  • Fixation between testicle and tunica vaginalis is absent and so testicle hangs in horizontal position
50
Q

Management of testicular torsion

A
  • Nil by mouth, in preparation for surgery
  • Analgesia as required
  • Urgent senior urology assessment
  • Surgical exploration of the scrotum
  • Orchiopexy (correcting the position of the testicles and fixing them in place)
51
Q

what can be seen on USS in testicular torsion ?

A

Whirlpool sign -> spiral appearance to spermatic cord and blood vessels

52
Q

4 RF for testicular cancer

A

Undescended testes
Male infertility
Family history
Increased height

53
Q

Common presentation of testicular cancer

A
  • Typically = painless lump

Arises frm the testicle
Hard
Irregular
Not fluctuant
No transillumination

54
Q

What is a rare presentation of testicular cancer

A
  • Gynaecomastia
  • Particularly = leydig cell tumour
55
Q

Tumour markers for testicular cancer

A
  1. Alpha-fetoprotein – may be raised in teratomas (not in pure seminomas)
  2. Beta-hCG – may be raised in both teratomas and seminomas
  3. Lactate dehydrogenase (LDH) is a very non-specific tumour marker
56
Q

Diagnosis of testicular cancer

A

Scrotal USS

57
Q

Staging system for testicular cancer

A

Royal Marsden Staging System

  • Stage 1 – isolated to the testicle
  • Stage 2 – spread to the retroperitoneal lymph nodes
  • Stage 3 – spread to the lymph nodes above the diaphragm
  • Stage 4 – metastasised to other organs
58
Q

Common places for testicular cancer to metastasise to

A

Lymphatics
Lungs
Liver
Brain

59
Q

Course of antibiotics for UTI in men

A

7 days

60
Q

Complete contraindication to mitrofurantoin

A

METHOTRXATE USE

61
Q

4 RF for pyelonephritis

A
  • Female sex
  • Structural urological abnormalities
  • Vesico-ureteric reflux (urine refluxing from the bladder to the ureters – usually in children)
  • Diabetes
62
Q

Presentation of pyelonephritis

A
  • Same Sx as lower UTI +
  • Fever
  • Loin or back pain
  • N&V
63
Q

Management of pyelonephritis

A

7-10 days of Abx

  • Cefalexin
  • Co-amoxiclav (if culture results are available)
    -Trimethoprim (if culture results are available)
  • Ciprofloxacin (keep tendon damage and lower seizure threshold in mind)
64
Q

Possible causes of significant symptoms of pyelonephritis or those that don’t respond well to treatment

A
  • Renal abscess
  • Kidney stone obstructing the ureter, causing pyelonephritis
65
Q

How does interstitial cystitis present ?

A
  • Persistent symptoms of a lower urinary tract infection (>6 wks)
  • suprapubic pain -> worse with a full bladder, relieved by emptying
  • Frequency
  • Urgency
66
Q

what is seen on cystoscopy in 5-20% with interstitial cystitis

A

Hunner lesions : red, inflamed patches of the bladder mucosa associated with small blood vessels

67
Q

RF for bladder cancer

A

Increased age
Smoking
Aromatic amines in dye / rubber

68
Q

what kind of cancer does schistosomiasis cause

A

squamous cell carcinoma of the bladder

69
Q

Most common type of bladder cancer

A

Transitional cell carcinoma

70
Q

how does bladder cancer present ?

A

Painless haematuria

71
Q

when is a two week wait for bladder cancer advised ?

A
  • Aged over 45 with unexplained visible haematuria
  • Aged over 60 with microscopic haematuria PLUS:
    Dysuria or;
    Raised white blood cells on a full blood count
72
Q

how is a bladder cancer diagnosed

A

cystoscopy

73
Q

staging system for bladder cancer

A

TMN

74
Q

Most common type of kidney stone

A
  • Calcium based (oxalate or phosphate)
75
Q

RF for calcium based renal stones

A
  • Hypercalcaemia (calcium supplementation, hyperparathyroidism and cancer)
  • Low urine output
76
Q

Give 3 other type of renal stone

A
  • Uric acid : not visible on x-ray
  • Struvite : produced by bacteria, therefore, associated with infection
  • Cystine : associated with cystinuria, an autosomal recessive disease
77
Q

what is a staghorn calculus

A
  • The stone forms in the shape of the renal pelvis
  • Most commonly occurs with struvite stones
78
Q

Presentation of renal stones

A
  1. Renal colic (unilateral loin-groin pain, colicky)
  2. Haematuria
  3. N&V
  4. Reduced urine outpur
  5. Sepsis if infection present
79
Q

Investigation of choice for diagnosing kidney stones

A
  • Non contrast CT of kidneys, ureters and bladders ( CT KUB)
80
Q

Management of kidney stones

A
  • <5mm and asymptomatic = watchful waiting
  • 5-10mm = shockwave lithotripsy
  • 10-20mm shockwave lithotripsy or uteroscopy
  • > 20mm = percutaneous nephrolithotomy
81
Q

what 2 medications can be given to reduce the risk of recurrence of kideny stones

A
  • Potassium citrate with calcium oxalate stones
  • Thiazide diuretics
82
Q

Classic traid of renal cell carcinoma

A

Haematuria
Flank pain
Palpable mass

83
Q

Sub types of renal cdell adenocarcinoma

A

Clear cell (80%)
Papillary
Chromophobe

Wilm’s tumour (children <5)

84
Q

RF for renal cell carcinoma

A
  • Smoking
  • Obesity
  • Hypertension
  • End-stage renal failure
  • Von Hippel-Lindau Disease
  • Tuberous sclerosis
85
Q

Classic feature of metastatic renal cell carcinoma seen on X-ray

A

Cannonball metastases

86
Q

what paraneoplastic syndromes are seen in renal cell carcinomas

A
  1. Polycythaemia – due to secretion of unregulated erythropoietin
  2. Hypercalcaemia – due to secretion of a hormone that mimics the action of parathyroid hormone
  3. Hypertension – due to various factors, including increased renin secretion, polycythaemia and physical compression
  4. Stauffer’s syndrome – abnormal liver function tests (raised ALT, AST, ALP and bilirubin) without liver metastasis
87
Q

what is the specific number staging system used in renal cell carcinoma

A

-> Stage 1: Less than 7cm and confined to the kidney
-> Stage 2: Bigger than 7cm but confined to the kidney
-> Stage 3: Local spread to nearby tissues or veins, but not beyond Gerota’s fascia
-> Stage 4: Spread beyond Gerota’s fascia, including metastasis

88
Q

1st line management of renal cell carcinoma

A

Surgery

  • Partial nephrectomy (removing part of the kidney)
  • Radical nephrectomy (removing the entire kidney plus the surrounding tissue, lymph nodes and possibly the adrenal gland)
89
Q

In pts not suitable for surgery, how can renal cell carcinomas be managed

A

-> Arterial embolisation, cutting off the blood supply to the affected kidney
-> Percutaneous cryotherapy, injecting liquid nitrogen to freeze and kill the tumour cells
-> Radiofrequency ablation, putting a needle in the tumour and using an electrical current to kill the tumour cells

90
Q

what monoclonal antibody is given post renal transplant to prevent acute infection ?

A

Basiliximab : targets interleukin-2 receptor on T cells

91
Q

what is used as immunosuppression following renal transplant

A
  • Tacrolimus
  • Mycophenolate
  • Ciclosporin
  • Azathioprine
  • Prednisolone
92
Q

Give the common SE of certain immunosuppressant agents given post renal transplants

A
  1. Immunosuppressants cause seborrhoeic warts and skin cancers (look for scars from skin cancer removal)
  2. Tacrolimus causes a tremor
  3. Cyclosporine causes gum hypertrophy
    St4. eroids cause features of Cushing’s syndrom
93
Q

What Abx used in bladder ifnections is unhelpful in pyelonephritis

A

Nitrofurantoin

94
Q

Scrotal swelling commonly seen i nrenal cell caner

A

Left sided varicocele

Finals (92 decks)

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