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T year LOBS surgery > Urology > Flashcards

Urology Flashcards

1
Q

what are symptoms and signs of a UTI?

A
  • dysuria
  • urinary frequency
  • haematuria
  • back/flank pain
  • fever
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2
Q

why do UTI have nitrites in dipstick?

A

produced by gram negative bacteria

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3
Q

what is the first line treatment for standard UTI?

A
  • trimethoprim or nitrofurantoin 3-7 days
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4
Q

what antibiotics are good for antibiotic resistance UTI?

A
  • ciprofloxacin
  • levofloxacin
  • amoxicillin
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5
Q

what should be given for men with UTI?

A
  • 7 days of nitrofurantoin or trimethoprim
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6
Q

how does standard treatment of UTI change in men with signs of prostatitis?

A

A 4 week course of fluoroquinolone as the bacteria may penetrate the prostatic fluid

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7
Q

what are symptoms ad signs of testicular torsion?

A
  • sudden onset of pain in one testicle
  • uncomfortable to walk
  • abdominal pain
  • N and V
  • abnormal positioning of the testicle
  • negative prehn sign
  • ascent cremasteric reflex
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8
Q

what are differentials of testicular torsion?

A

-epididymitis

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9
Q

how is epididymitis presentation different to testicular torsion?

A
  • epididymitis is:
    more gradual in onset
    positive prehn sign
    positive cremasteric reflex
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10
Q

what are causes of epididymitis?

A

young: chlamydia
old: UTI

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11
Q

what are signs of urinary tract stone disease?

A
  • colicky pain
  • haematuria
  • dysuria
  • frequency
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12
Q

what is the emergency management of an infected obstructed kidney?

A
  • decompression using nephrostomy to remove the urine.
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13
Q

what is lithotripsy?

A

A treatment for kidney stones

Shock waves pass through and breaks the stones up.

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14
Q

who cant have lithiotripsy?

A
  • pregnancy
  • obese
  • bleeding disorders
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15
Q

what is ureteronoscopy?

A
  • helps large stones pass through with a laser.

- useful when lithiotripsy fails

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16
Q

what stones are ureteronoscopy used for?

A
  • under 3 cm

- after lithiotripsy hasn’t worked

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17
Q

what stones is percutaneous nephrolithotomy used for?

A
  • large or irregular shaped stones
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18
Q

what is percutaneous nephrolithotomy?

A

a sham incision is made in the back to enter the kidney and a nephroscope threaded in.

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19
Q

what is stone dissolution?

A
  • irrigation with saline, heparin or citrate via a nephrostomy tube
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20
Q

what is stress incontinence?

A

involuntary urine leakage on effort/exertion such as sneezing/ coughing. common after childbirth

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21
Q

what is urge incontinence?

A

involuntary urine leakage accompanied or immediately preceeded by urgency. due to detrusor muscle over activity.

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22
Q

what are differentials of urgency?

A 
UTI
MS
parkinsons
bladder stones
malignancy
BPH
urethritis
overactive bladder
cystitis
neurogenic bladder
prostatitis
urethral stricture
ovarian cancer
acetone poisoning
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23
Q

what are voiding symptoms?

A

weak or intermittent urinary stream, straining, hesitancy, terminal dribbling
incomplete emptying

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24
Q

what are storage symptoms?

A

urgency
frequency
incontinence
nocturia

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25
Q

what is the medical management of BPH?

A

alpha blockers

- 5 alpha reductase inhibitors

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26
Q

what are examples of alpha blockers used for BPH?

A
  • tamsulosin
    doxazosin
    alfuzosin
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27
Q

what is first line for BPH after lifestyle changes?

A
  • alpha blocker
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28
Q

what are examples of 5 alpha reductase inhibitors used for BPH?

A

finasteride

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29
Q

how do 5 alpha reductase inhibitors work for BPH?

A

block conversion of testosterone to DHT which is responsible for prostate growth

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30
Q

when are 5 alpha reductase inhibitors used for BPH?

A

After lifestyle changes and alpha blockers have failed

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31
Q

what are adverse effects of 5 alpha reductase inhibitors?

A 
- impotence
reduced libido
breast tenderness
gynaecomastia
inhibit hair growth
32
Q

what are surgical options for BPH?

A
  • laser therapy
  • trans-urethral needle ablaton
  • transurethral resection
  • open prostatectomy
  • holmium laser enucleation of the prostate
33
Q

what is transurethral resection of the prostate?

A
  • removing the periurethral and transitional zones of the prostate to relieve obstruction
34
Q

what are complications of transurethral resection of the prostate?

A
  • retrograde ejaculation
  • impotence
  • blood transfusion
  • failure to void
35
Q

what is holmium laser enucleation of the prostate?

A
  • removes the prostate from it’s capsule in larger pieces and then these are removed endoscopically from the bladder
36
Q

what are two catheter options for urinary retention?

A
  • urethral catheter

- suprapubic catheter

37
Q

what is a suprapubic catheter?

A
  • the catheter is inserted into the abdomen via a cut in the abdomen.
38
Q

when are suprapubic catheters used?

A
  • urethral catheters are contraindicated
  • urethral injury
  • complete obstruction
  • bladder neck mass
  • BP
    prostate cancer
39
Q

when are suprapubic catheters contraindicated?

A

no palpable distended urinary bladder

  • coagulopathy
  • prior abdominal or pelvic surgery
  • pelvic cancer
  • pregnancy
  • morbid obese
40
Q

other than catheterisation what else can be offered for urinary retention?

A
  • urethral dilation by inserting a wider tube to remove a stricture
  • urethral stents
  • alpha blockers
  • bethanechhol chloride (increases detrusor muscle activity)
  • prostate resection
41
Q

what are complications of bladder outlet obstruction and urinary retention?

A
  • UTI
  • high pressure chronic retention
  • low pressure chronic retention
  • recurrent epididymitis
  • bladder calculi
  • recurrent haematuria from the prostate
  • weakening of the bladder muscles
  • detrusor hypertrophy
42
Q

what is obstructive uropathy?

A

when urine can’t drain through a ureter so backs up causing hydronephrosis

43
Q

what is high pressure chronic urine retention?

A

when the bladder is poorly complient and the intravesical pressure is >25 by the end of voiding. can result in chronic renal failure

44
Q

what is low pressure chronic urine retention?

A
  • the bladder is complient and the pressure remains low during filling. However complete detrusor muscle failure causes large residual volumes
45
Q

what are signs of renal cell carcinoma?

A
  • often asymptomatic
  • haematuria
  • loin pain
  • mass in the flank region
  • malaise, anorexia, weight loss
  • can have polycythaemia
  • hypertension (renin secretion)
  • anaemia
  • pyrexia
  • paraneoplastic syndromes
  • lower limb oedema
46
Q

what is a paraneoplastic syndrome?

A

Clinical featurs due to an altered immune response to a malignancy or due to substances produced by the tumour

47
Q

what cancers are paraneoplastic syndromes most commonly associated with?

A

lung, ovarian, lymphatic, breast

48
Q

what cancer is the worst for causing paraneoplastic syndrome?

A

small cell lung cancer

49
Q

what type of cancer is often in the prostate?

A

Adenocarcinoma

50
Q

where do most prostate cancers arise?

A

the peripheral zone

51
Q

what are signs of prostatic carcinoma?

A

often very few symptoms

  • lower urinary tract signs
  • back and skeletal pain
  • weight loss
  • anaemia
  • haematuria
52
Q

what are signs of bladder cancer?

A
  • frank macroscopic haematuria
  • bleeding in urine stream
  • suprapubic, urethral and penile tip pain
53
Q

what are risk factors of prostate cancer?

A
  • age
  • black population
  • family history
  • presence of PIN
54
Q

what genes are involved with prostate cancer?

A
  • sporadic; chromosome 8
    inherited; chromosome one

BRCA 2 carriers

55
Q

what grading is used for prostate adenocarcinoma?

A

gleason system

56
Q

what is PIN?

A

prostatic intraepithelial neoplasia

the cellular appearance of cancer but the basement membrane is still intact

57
Q

what are risk factors for renal cell carcinoma?

A
  • male
  • von hippel landau disease
  • smoking
  • obesity
  • end stage renal disease
  • polycystic kidneys
  • hypertension
58
Q

what is hippel landau disease?

A
  • autosomal dominant on chromosome 3
  • defect in VHL suppressor gene
  • high risk of renal cell carcinoma
59
Q

what are symptoms of von hippel lindau disease?

A
  • hypervascular tumours of the CNS and retina
  • phaeochromocytomas
  • pancreatic cystis
  • islet cell tumours
  • endolympahtic sac tumours
60
Q

what is the pathology behind hereditary papillary renal cell cancer?

A

autosomal dominant
development of multiples RCC’s
mutation in MET protooncogenes that regulates tyrosine kinase growth factors

61
Q

what are risk factors for testicular cancer?

A
  • family history
  • cryptochordism
  • previous testicular tumour
  • klinefelters syndrome
  • testicular atrophy
62
Q

what are the sex chromosomes in klinefleters syndrome?

63
Q

what lymph nodes does testicular cancer spread to?

A

0 para aortic

64
Q

what is the most common type of cancer in the bladder?

A

transitional cell carcinoma

65
Q

what are environmental causes of bladder cancer?

A
  • 2 naphthlamine, 4 aminobipphenyl, benzidine, NNBIS, 4 chlorotoluidine, phenacetin, cyclophosphamide
66
Q

what do different PSA levels mean?

A

> 4= can be BPH or cancer

>10- over half of cases cancer

67
Q

what is PSA?

A

a serine protease that liquefies semen

68
Q

where s PSA produced?

A

acini in the prostate

69
Q

what is AFP used to monitor?

A
  • liver cancer
  • testicular cancer
  • ovarian cancer
70
Q

what is first line imaging for patients with frank haematuria?

71
Q

what testicle is more often affected by a varicocoele?

A

the left side because it drains into the renal vein

72
Q

what is cryptorchidism?

A

failure of the testes to descend into the scrotum

73
Q

what is the management of cryptochidism?

A

ochiopexy at 6-18 months

74
Q

what are causes of Epididymo-orchitis

A

chlamydia
Ecoli
mumps
gonorrhoea

75
Q

what are clinical featurse of Epididymo-orchitis?

A
  • pain
  • swelling
  • dysuria
  • fever
76
Q

how does pregnancy change UTI treatment?

A

nitrofurantoin not in the 3rd trimester

trimethoprim not in the first trimester.

T year LOBS surgery (2 decks)

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