Urology Flashcards
Non-cystic manifestations associated with adult polycystic kidney disease?
-MITRAL valve prolapse
-intracranial berry aneurysms
-colonic diverticula
-renal cell carcinoma
How might urethral trauma present?
Scrotal haematoma / perineal bruising
Blood at external urethral meatus
High riding prostate on rectal exam OR absence of palpable prostate on exam
(If suspected, refer urgently to urology)
Risk factors for CKD?
Black/Asian ethnicity
HTN
Cardiovascular disease
Smoking
Chronic NSAID use
Proteinurea
Urinary outflow obstruction
Which of these UTI abx can discolour urine?
Nitrofurantoin
Trimethoprim
Nitrofurantoin - turns urine brown ‘Nasty nitrofurantoin’
Sterile pyuria means?
Most common cause in UK?
Presence of leukocytes in urine without infection
Partially or recently treated UTI
Foods to be avoided when preventing renal stones?
Chocolate!
Tea
Nuts
Strawberries
Rhubarb
Spinach
Beans
Beetroot
UTI abx choice in pregnancy?
Nitrofurantoin
(Avoid trimethoprim in pregnancy. Teratogenic risk in 1st trimester)
Deteriorating renal function after CT with contrast - cause?
Acute tubular necrosis
What is Berger’s disease (IgA nephropathy) and how does it present?
Most common type of glomerulonephritis in ADULTS worldwide
Visible haematuria 24-48 hours after URTI
What is Wegener’s granulomatosis (granulomatosis with polyangiitis/GPA)?
Systemic vasculitis - affects small and medium vessels.
Classic triad: upper, and lower respiratory tract involvement and glomerulonephritis
Often also involves cutaneous, ocular, musculoskeletal and peripheral nervous system
Most appropriate action for a pt with a ?blocked catheter post-TURP?
Bladder washout
Which staph organism causes UTIs in young fit adults, particularly young, sexually active women?
Staph saprophyticus
‘Phyt = fit young people!’)
Older patient with urinary incontinence, dementia and abnormal gait. Dx?
Normal pressure hydrocephalus! This is the classic triad of symptoms
Pt with gastric carcinoma - vague back pains, raised ESR/CRP. Ct shows BL hydronephrosis with drawing together of ureters in midline and peri-aortic mass. Dx?
Retro peritoneal fibrosis
Complications of phimosis?
Inability to clean under foreskin is associated with;
-stones in preputial sac
-cancer of penis
2 types of phimosis and how they are treated?
1 physiological (without scarring/primary) - conservative
- Pathological (secondary/ due to scarring) - circumcision. Short course of corticosteroids can benefit mild scarring
Blood gas for pt with chronic renal failure should show what?
Metabolic acidosis with respiratory compensation
How does exercise affect serum potassium levels?
Causes hypERkalaemia
Insulin injections cause what to serum potassium?
HypOkalaemia (why fluids with K are given with insulin infusions)
Most likely organism to have caused acute epididymo-orchitis in:
-man under 35?
-men over 35
Under 35: STI ie chlamydia or gonorrhoea
Over 35: non-STI is E Coli, Pseudomonas
Medical treatment for BPH?
A-1 Adrenergic receptor antagonists ie tamsulosin
5a-reductase inhibitors ie finasteride
Surgical options for BPH?
Transurethral microwave thermotherapy (TUMT)
Transurethral needle ablation (TUNA)
Transurethral resection of prostate (TURP)
What is Alport syndrome?
How does it present?
X-linked/autosomal recessive rare gene defect for type IV collagen in basement membranes
Sensorineural deafness, pyelonephritis, haematuria, renal failure
In men >60, what is the commonest cause of painless, visible haematuria?
Transitional cell carcinoma of the bladder
30 y/o woman with longstanding stress incontinence and pelvic pain. Bimanual reveals pain on palpitation of urethra, bladder neck and locator ani. Dx?
Interstitial cystitis (bladder pain syndrome)
Nephrogenic diabetes insipidus.
Blood results show? (Electrolytes and osmolalities)
Causes?
Tx?
Low urine osmolality
High serum osmolality/sodium
HypOkalaemia, hypercalcaemia
Causes: CKD, lithium
Treatment:
Desmopressin
Thiazide diuretics
NSAIDs
Sodium restriction
55 y/o, hx of RA, presents with HTN and oedema. BL renal masses, urinalysis reveals proteinuria and renal biopsy fluoresces bright green under polarised light after Congo red staining. Dx?
Renal amyloidosis
Mean age of Wilm’s tumour presentation?
How does it present?
3.5 years (<5)
Abdo pain, abdominal mass, HTN, fever (caused by tumour necrosis), haematuria, anaemia
First line tx for pyelonephritis?
CEFALEXIN for 7-10 days
Triad of HUS? (haemolytic uraemic syndrome?)
Acute renal failure
Microangiopathic haemolytic anaemia
Thrombocytopenia (low Plts)
What is HUS caused by?
Mostly INFECTION- E Coli
How does HUS present?
Profuse diarrhoea that turns bloody 1-3 days later
Fever, abdominal pain, vomiting
Most common type of prostate cancer?
Adenocarcinomas
Grading system for prostate cancer?
Gleason score
How to differentiate testicular tumour from haematoma?
Haematoma are usually painful and scrotum likely to be swollen
Note: testicular tumours are the most common malignancy in young men !
What type of cancer can the BCG vaccine be used in the treatment for?
Bladder cancer!
Which cause of testicular swelling will transilluminate?
Hydrocele
What is used to classify chronic kidney disease?
-eGFR
AND
-urinary albumin to creatinine ratio (ACR)
How to classify direct and indirect initial hernias, by relation to inferior epigastric artery?
Indirect - LATERAL to inferior epigastric artery
Direct - MEDIAL to inferior epigastric artery (slide into my DMs, straight through the peritoneum!)
Anatomical position of femoral vs inguinal hernias?
Inguinal - in line of inguinal ligament, between anterior iliac spine and pubis
Femoral - BELOW inguinal Ligament, lateral and inferior to pubic tubercle (down and out!)
Which people are more prone to femoral hernias?
Older, slender females
Which people are more likely to get inguinal hernias?
Men (8x commoner!)
1-3% of young children
Risk factors for inguinal hernias
-in infants?
-in adults?
Infants: prematurity, male sex
Adults: male, obesity, constipation, chronic cough, heavy lifting
IVX and MX for inguinal hernia?
USS
Surgery (risk of incarceration, obstruction and strangulation outweigh risks of operation!)
Which testicle is more likely to be affected by cryptorchidism?
Right
Complications of cryptorchidism?
Torsion
Impaired fertility
testicular malignancy
When to refer if unilateral undescended testis?
At 3 months - refer to paeds Surg - ideally before 6 months
Before having PSA checked, what should men not do/have ?
No UTI
No ejaculation in last 48 hours
No vigorous exercise in last 48 hours
No prostate biopsy in last 6 weeks
Causes of increased and decreased specific gravity (concentration) of urine?
Increased:
-DEHYDRATION, renal artery stenosis, heart failure, SIADH, Proteinuria
Decreased:
-excessive fluid intake, renal failure, pyelonephritis, diabetes insipidus
What is Fanconi syndrome?
How does it present?
Inherited/acquired disturbance of renal tubular transport
Polyuria, polydipsia, dehydration, bone deformities (rickets/osteomalacia)
What is Nephrocalcinosis ?
Parenchymal calcium deposition (usually from hypercalcaemia) - shows up on abdominal xrays
What to do with phenytoin in chronic renal impairment?
No change - metabolised in liver
What to do with furosemide in chronic renal failure?
INCREASE dose size - need higher doses due to lower number of functioning nephrons!
What to do with cephalosporins in chronic renal failure?
Reduce dose frequency
Complications of post strep glomerulonephritis?
HTN
Pulmonary oedema
Acute renal failure
what is a varicocoele and how does it present? Which testicle are they more common in?
Abnormal dilatation of pampiniform venous complex caused by venous reflux
Usually asymptomatic, rarely painful, scrotum feels like ‘bag of worms!’ Usually cannot be palpated lying down, only when standing
Left testicle
Difference in relation to testes of
Hydrocele?
Spermatocele?
Hydrocele - superior and anterior to testis - May not be able to feel testis
Spermatocele - superior and posterior (feel testis separately)
Cancer relations to COCP
-risk of which cancers?
-protective against which cancers?
Increased risk of breast & cervical cancer (note, only current breast cancer is contraindication, not cervical cancer!)
Decreased risk of ovarian; endometrial, and colorectal cancer
Legal age for sexual activity in England, Wales, Scotland or Northern island?
Beneath which threshold age can an individual NEVER consent to sexual activity in England & Wales?
16!
13!
From what gestation would be considered:
Pre-term?
Term?
Post-term?
Pre-term = <37 weeks
Term = 37 until <42 weeks
Postterm = 42+ weeks
When taking the combined oral contraceptive, what do you need to do if:
-you miss one pill (>24 hours late)?
-you miss 2 pills?
-if 2 or more pills are missed from FIRST 7 tablets of pack and UPSI occurred?
-one pill: TAKE NEXT PILL AS SOON AS REMEMBERED, even if this means taking 2 pills together. No other action.
-2 pills: take active pill as soon as remembered, resume normal pill-taking AND use additional contraception/abstain for next 7 days
-EMERGENCY CONTRACEPTION recommended
When is a pill considered missed for the;
-traditional POP?
-DSG POP?
Action if missed?
-3 hrs ie 27 hrs from last pill!
-12 hrs ie 36 hrs from last pill
Emergency contraception needed if UPSI from time pill missed until correct pill taking resumed for 48 hours
Cancer risk for
-combined HRT
-Oestrogen only HRT?
Combined - BREAST cancer, ovarian cancer
Oestrogen only - ENDOMETRIAL cancer, breast cancer, ovarian cancer
When is contraception required in menopause:
-if age >50?
-if ages <50?
->50 = 1 year after last period
<50 = 2 years from last period!
How is obesity defined in pregnancy?
BMI >30 at BOOKING
When to avoid nitrofurantoin in pregnancy?
At TERM - risk of neonatal haemolysis
When should trimethoprim be avoided in pregnancy?
Teratogenic risk in FIRST trimester (folate antagonist) therefore best avoided
When should a pregnancy be visible on TVUS?
TA US?
5 weeks from last period
6 weeks from last period/ hCG 4000-6500
Management for ectopic pregnancy?
Medical?
Surgical?
Medical - single high dose methotrexate
Surgical - laparoscopic salpingectomy, unless RFs for infertility, then salpingotomy
Changes to cardio respiratory system in pregnancy?
-Decreased blood pressure (in 1st/2nd trimesters, increases to pre-pregnancy in 3rd trimester)
-Bounding/collapsing pulse
-Ejection systolic murmur (>90%)
-Increased heart rate
-Increased tidal volume
Treatment for hyperthyroidism in pregnancy
-1st trimester/looking to get pregnant?
-beyond 1st trimester
-Planning pregnancy/1st trimester = Propylthiouracil ‘preparing pregnancy’
-beyond 1st trimester - carbimazole
Commonest types of cervical cancer?
-squamous cell carcinoma (75%)
-adenocarcinoma (20%)
What gestation to start giving anti-D in threatened/spontaneous miscarriages for rhesus negative women?
> 12 weeks - before this is not an indication for anti-D!
3 degrees of uterine prolapse?
First - cervix remains within vagina
Second - cervix protrudes through introitus
Third - uterus lies entirely outside introitus
First line emergency contraception?
Cooper IUD -as most effective!
What are the 3 emergency contraceptive options and how long since UPSI are they licensed for use?
- Levonorgestrel (inhibits ovulation)
Licensed for 3 days (72 hrs) of UPSI - Ullipristal acetate (inhibits/delays ovulation) licensed for 5 days (120 hours of UPSI)
- Copper IUD (directly toxic to sperm)
Licensed for 5 days of UPSI or within 5 days of expected ovulation
Dose change for levonorgestrel if >70kg or BMI >26?
Double dose! (Take 2 1.5mg tabs instead of 1)
What to check before prescribing emergency contraception?
Exclude pregnancy! Do not prescribe if pregnant!
Creatinine- how to stage CKD 1/2/3
1: creatinine 1.5-1.9x baseline
2: creatinine 2-2.9x baseline
3: 3 or more x baseline
