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Surgery > Urology 2 > Flashcards

Urology 2 Flashcards

1
Q

Presentation of obstructive uropathy?

A

upper:
loin to groin pain
oliguria
vomiting
impaired renal function

lower:
urine retention
difficulty passing urine
impaired renal function

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2
Q

Causes of obstructive uropathy?

A

upper:
stones
tumour
strictures
retroperitoneal fibrosis
bladder cancer
ureterocoele

lower:
BPH
prostate cancer
bladder cancer
urethral strictures
neurogenic bladder

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3
Q

Causes of neurogenic bladder?

A

MS
DM
stroke
Parkinson’s
spinal cord injury
spina bifida

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4
Q

Mx of obstructive uropathy?

A

bypassing the obstruction

nephrostomy in upper
urethral or suprapubic catheter in lower

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5
Q

Complications of obstructive uropathy?

A

pain
AKI
CKD
infection
hydronephrosis
urinary retention
overflow incontinence

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6
Q

Indications for urinary catheter?

A

urinary retention
neurogenic bladder
surgery
output monitoring
bladder irrigation
delivery of meds

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7
Q

Prostate exam results?

A

BPH -> smooth, symmetrical and slightly soft, with maintained central sulcus

prostate cancer -> firm/hard, asymmetrical, irregular, craggy and loss of central sulcus

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8
Q

Mx of BPH?

A

medical:
alpha blockers (tamsulosin- immediate relief of symptoms)
5-alpha-reductase inhibitors (finasteride- decrease size of prostate over 6 months)

surgical:
TURP

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9
Q

Complications of TURP?

A

urinary incontinence
erectile dysfunction
retrograde ejaculation
urethral strictures
failure to resolve symptoms
TURP syndrome

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10
Q

RFs for prostate cancer?

A

age
FHx
Black
tall stature
anabolic steroids

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11
Q

Presentation of prostate cancer?

A

asymptomatic
LUTS
haematuria
erectile dysfunction
mets

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12
Q

Causes of raised PSA?

A

prostate cancer
BPH
prostatitis
UTI
vigorous exercise (cycling)
recent ejaculation
prostate biopsy
DRE

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13
Q

Investigations for prostate cancer?

A

multiparametric MRI
TRUS biopsy
trans-perineal biopsy
isotope bone scan

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14
Q

Gleason scoring of prostate cancer?

A

grading based on histology
out of 10

the grade of the most prevalent pattern in the biopsy + the grade of the second most prevalent pattern in the biopsy

6 low risk
7 intermediate
8-10 high risk

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15
Q

Grading of prostate cancer?

A

Gleason score
TNM

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16
Q

Mx of prostate cancer?

A

watch and wait
TURP
external beam radiotherapy/brachytherapy
radical prostatectomy
hormone therapy (GnRH agonists, androgen receptor antagonists)

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17
Q

Most common organisms causing epididymo-orchitis?

A

E coli
Neisseria gonorrhoea
Chlamydia
mumps

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18
Q

Diagnosing epididymo-orchitis?

A

differentiate if caused by STI or enteric organism

urine C&S
NAAT
charcoal swab
saliva swab
serum antibodies for mumps
US

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19
Q

Mx for epididymo-orchitis?

A

Enteric:
ofloxacin
levofloxacin
co-amoxiclav

STI:
IM ceftriaxone (gonorrhoea)
doxycycline (chlamydia)

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20
Q

Complications of epididymo-orchitis?

A

chronic pain
chronic epididymitis
testicular atrophy
subfertility
scrotal abscess

21
Q

Presentation of testicular torsion?

A

firm swollen testes
retracted testes
absent cremasteric reflex
abnormal testicular lie
rotation

22
Q

Mx of testicular torsion?

A

surgical emergency

surgical exploration
bilateral orchidopexy

23
Q

DDx for scrotal/testicular lump?

A

hydrocele
varicocele
epididymal cyst
testicular cancer
epididymo-orchitis
inguinal hernia
testicular torsion

24
Q

Presentation of hydrocele?

A

testicle palpable within hydrocele
soft, fluctuant, may be large
irreducible
no bowel sounds
transilluminated
can ‘get above’ it

25
Q

Presentation of varicocele?

A

throbbing/dull pain
dragging sensation
subfertility
‘bag of worms’
more prominent on standing

26
Q

Left varicocele may indicate?

A

RCC

27
Q

Presentation of epididymal cyst?

A

soft, round lump
typically at top of testicle
separate from the testicle
may be able to transilluminate

28
Q

RFs for testicular cancer?

A

undescended testes
infertility
FHx
incr. height

29
Q

Investigations for testicular cancer?

A

scrotal US
AFP (teratomas)
LDH (both)
bhCG (both)

30
Q

Mx of testicular cancer?

A

surgery
chemorads
sperm banking

31
Q

RFs for bladder cancer?

A

smoking
incr. age
aromatic amines
schistosomiasis (SCC)

32
Q

Types of bladder cancer?

A

transitional cell carcinoma (90%)
SCC (5%)

33
Q

Presentation of bladder cancer?

A

painless haematuria (bladder cancer until proven otherwise)

34
Q

Investigations for bladder cancer?

A

cystoscopy + biopsy

35
Q

Staging of bladder cancer?

A

TNM

non-muscle infiltrative
muscle infiltrative (T2-T4)

36
Q

Mx of bladder cancer?

A

MDT
TURBT
intravesical chemotherapy post-surgery
intravesical BCG

radical cystectomy
urostomy with ileal conduit

chemorads

37
Q

Complications of renal stones?

A

obstruction leading to AKI
infection leading to sepsis

38
Q

Investigations for renal stones?

A

urine dipstick
bloods
calcium
non-contrast CT KUB
US in pregnant women

39
Q

Mx of renal stones?

A

IM diclofenac
antiemetics
antibiotics
tamsulosin can help

<5mm -> watchful waiting
<2cm -> lithotripsy
pregnant women ->ureteroscopy
complex -> percutaneous nephrolithotomy
upper obstruction -> nephrostomy

40
Q

Prevention of renal stones?

A

2.5-3 litres a day
normal calcium intake
lemon juice

thiazides
potassium citrate

41
Q

Types of RCC?

A

adenocarcinomas:
clear cell
papillary
chromophobe

42
Q

RFs for RCC?

A

smoking
obesity
HTN
von-Hippel-Lindau disease
end-stage renal failure
tuberous sclerosis

43
Q

Presentation of RCC?

A

asymptomatic

flank pain, abdo mass, haematuria

paraneoplastic syndromes

mets

44
Q

Paraneoplastic syndromes associated with RCC?

A

polycythaemia
hypercalcaemia
HTN
Stauffer’s syndrome
Cushing’s

45
Q

Staging of RCC?

A

TNM

Stage 1 - <7cm
Stage 2 - >7cm
Stage 3 - not beyond Gerota’s fascia
Stage 4 - beyond Gerota’s fascia

46
Q

Mx of RCC?

A

partial or radical nephrectomy

arterial embolisation
percutaneous cryotherapy
radiofrequency ablation

47
Q

Benefits of renal transplant?

A

add 10 years to life compared to dialysis

48
Q

Scar associated with renal transplant?

A

hockey-stick scar

49
Q

Complications of renal transplant?

A

rejection, failure, electrolyte imbalances

infections, SCC, NHL

PCP, CMV, TB

Surgery (10 decks)

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