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Block 34 Metabolic Flashcards > Urology > Flashcards

Urology Flashcards

1
Q

Background facts about stone disease

A

10% incidence

50% recur in 10 years

Can occur anywhere in the renal tract

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2
Q

What is the presentation of patients with renal stones

A

Renal colic
Loin to groin pain
Haematuria

Look for changes to GFR, creatinine and WCC
Low urine pH suggests Uris acid component

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3
Q

What is the gold standard. Investigations for renal stones

A

CT KUB

X-ray and ultrasound are also useful

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4
Q

What are the risk factors for developing renal stones

A

High protein intake
High salt intake
White ethnicity
Dehydration
Obesity
Hypercalcemia secondary to hypepraarhyroidism and sarcoidosis
Fhx

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5
Q

What is the conservative management of renal stones

A

Hydration
NSAIDs for pain relief
Anti-emetics

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6
Q

What other management options are available for stones

A
  • medical expulsion therapy via tamsulosin which is an alpha blocker.
  • shockwave lithotripsy - uses focused sound waves to break stone into smaller pieces which makes it easier to pass through
  • ureteroscopy + can be used in combination with laser lithotripsy
  • percutaneous neprholithotomy
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7
Q

What are the different types of renal stone compositions

A

Calcium oxalate

Calcium phosphate

Uric acid (only one that is radiolucent)

Struvite

Cysteine

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8
Q

What are the risk factors for UTIs in women

A

Sexually active
Post menopause
History of recurrent UTis
Diabetes
Increasing age

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9
Q

Investigations for UTI

A

Urine dipstick - nitrites and leukocyte esterase

Urine microscopy

Urine cultures

Ultrasound and CT KUB

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10
Q

Treatments for UTIs

A

Nitrofurantoin

Trimethoprim + sulfamethoxazole

Co-amoxiclav

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11
Q

What are the risk factors for UTIs in men

A

BPH
Urinary tract stones
Urethral strictures
Increasing age
Catheterisation

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12
Q

Treatment for UTI in men

A

Ciprofloxacin or levofloxacin

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13
Q

What are the risk factors for prostate cancer

A

Age
Black ethnic background
Family history

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14
Q

Investigations for prostate cancer

A

PSA testing
Prostate biopsy
Bone scan -
X-rays - lytic lesions

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15
Q

What zone do most prostate cancers occur in

A

Peripheral zone 75%
Transitional zone 20%
Central 5%

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16
Q

What treatment options are available for prostate cancer

A

Watchful waiting and active surveillance

Brachytherapy - low dose radiation close to source

External beam radiotherapy daily for 6- 8 weeks

Radical prostatectomy

Androgen deprivation therapy - bicalutamide

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17
Q

What drug is used as androgen deprivation therapy in prostate cancer

A

Bicalutamide - blocks the action of androgens on its receptor preventing growth. Does not alter amount of androgens produced

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18
Q

What scoring scale is used for prostate cancer

A

Gleasons

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19
Q

What types of histological types are there in bladder cancer

A

Transitional cell

Squamous cell

Adenocarcinoma

20
Q

What are the risk factors for bladder cancer

A

Smoking
Azo dyes
Age
Pelvic radiation
Schistosoma infection
Chemo drugs - cyclophosphamide
Family history

21
Q

What investigations to consider for bladder cancer

A

Urinalysis for haematuria

Urine Cytology - looks for any abnormalities under microscope

Cystoscopy - allows to see tumours

CT urogram - images any tumours

22
Q

What treatment options are available for bladder cancer

A

For non invasive cancer - transurethral resection of the cancer is done but this has a high recurrence rate
Chemotherapy - mitomycin C

Immunotherapy

Radical cystectomy

Radiotherapy

23
Q

What immunotherapy is used in bladder cancer:

A

BCG bacillus calmette guerin

24
Q

What chemo is used n bladder cancer

A

Mitomycin C

Alkylating agent which inhibits DNA replication and synthesis

25
Q

Types of kidney cancer

A

Renal cell: (affects the PCT )
- clear cell
- papillary
- chromophobe
-collecting duct
- unclassified

Sarcoma

Transitional cell - upper urothelial cancer (affects the renal pelvis and ureter)

Wilm’s tumour in children

26
Q

Risk factors for renal cancer

A

Male
Smoking
Increasing age
Obesity
Hypertension
Cystic disease
+ve FHx

27
Q

Symptoms of renal cancer:

A

Asymptomatic

Flank pain

Palpable mass

Hameutria

Red flag symtoms

Fever

28
Q

What imaging is done for renal cancer

A

Ultrasound
CT with contrast
MRI

CT chest - mets possible
Bone scan - bone mets possible
Biopsy

29
Q

Treatment for renal cancer

A

Surgery to remove tumour
Immunotherapy

30
Q

Presentation of wilms tumour

A

Age less than 5 usually

Abdominal pain
Hypotension or hypertension
Haematuria
Palpable mass
Varicoele
Anaemia
Lack of appetite

31
Q

Treatment of wilms tumour

A

Surgical removal -
Systemic chemo and radiotherapy

32
Q

Investigations for testicular cancer

A

Ultrasound Doppler
CT of abdomen and pelvis
MRI for staging

33
Q

Treatments for testicular cancer

A

Radical orchiectomy

External beam RT and chemo post surgery

34
Q

Risk factors for testicular cancer:

A

White background
Undescened testes
Previous history
Family history
HIV

35
Q

What can cause ED

A

Diabetes
Atherosclerosis
Obesity
Smoking
Pelvic radiotherapy and prostate surgery
Low testeosteorne
MS
Peyronies disease

Meds:
Alpha blockers
Anti-hypertensives

36
Q

Examples of storage symptoms

A

Urgency
Frequency
Nocturia
Incontinence

37
Q

Examples of voiding symptoms

A

Slow stream
Straining
Intermittency
Hesitancy
Terminal dribbling

38
Q

Inconticne symptoms can be measured using which symptom index

A

IPSS

International prostate symptom score

1-7 mild

8-19 moderate

20-35 severe

39
Q

LUTS can be caused by pathology in which dimensions

A

Prostate
Urethra
Bladder
Pelvic organs
Neurological disease (cauda equina or pelvic/sacral tumours)

40
Q

Symptoms that indicate that LUTS might be because of something neuro

A

Back pain
Sciatica
Ejeaculatiry disturbance
Sensory changes in perineum, legs or feet

41
Q

Acute loin pain but no stone. Differentials…

A

1) clot or tumour colic

2) PUJO

3) pyelonephritis

42
Q

Acute loin pain - non uro causes

A

AAA

MI or pneumonia

Ectopic or ovarian cyst rupture

Appendicitis, IBD flare
Intestinal obstruction

Testicular torsion

Prolapsed intervertebral disc

43
Q

Chronic loin pain causes

A

Cancer

Renal stones
Renal infection
PUJO
Ureteric reflux or stone

44
Q

Types of incontinence

A

Stress
Urge
Mixed
Overflow

Maybe be caused by internal sphincter weakness (neuromuscular defect)

Or bladder overactivity (infection, tumour or stone may also irritate bladder

45
Q

Causes of an enlarged liver

A

Infection
Congestion
Amyloid
Cancer + mets
Hydatid cysts
Cirrhosis
Abscess

46
Q

Causes of abdominal distension 5Fs

A
  • foetus
  • flatus
  • faeces
  • fat
  • fluid as it’s
47
Q

Treatments for incontinence

A

Lifestyle changes
Pelvic floor exercises
Sling
Collagen injections
Weight loss and smoking cessation
Oxybutynin
Alpha agonists
Botulinum injections into wall of detrusor

Block 34 Metabolic Flashcards (5 decks)

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