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Year 2 MBChB > Urology > Flashcards

Urology Flashcards

1
Q

What does BPH present with?

A

LUTS: voiding symptoms, storage symptoms

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2
Q

What are voiding symptoms?

A

Weak or intermittent flow, straining, hesitancy, dribbling, incomplete emptying

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3
Q

What are storage symptoms?

A

Urgency, frequency, urgency incontinence and nocturia

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4
Q

What is the management of BPH?

A

Watch and wait, alpha blocker (tamsulosin), 5 AR inhibitor (finasteride)

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5
Q

What is the effect of alpha blockers in BPH?

A

Decreased smooth muscle tone

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6
Q

What are the side effects of alpha blockers?

A

Dizziness, postural hypotension, dry mouth, depression

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7
Q

What is the mode of action of 5-AR inhibitors?

A

Block conversion of testosterone to DHT - shrinks prostate

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8
Q

What are some key things with finasteride?

A

Takes around 6m, reduced PSA concentrations by 50%

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9
Q

What are side effects of finasteride?

A

Erectile dysfunction, reduced libido, ejaculation probs, gynaecomastia

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10
Q

What increases the risk of bladder cancer?

A

Smoking, exposure to hydrocarbons (dyes, rubber), schistosomiasis

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11
Q

What is the commonest bladder malignancy?

A

Transitional cell carcinoma

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12
Q

What is the growth pattern of transitional cell carcinomas?

A

Papillary

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13
Q

How are superficial bladder malignancies managed?

A

TURBT

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14
Q

What are the medical benefits for circumcision?

A

Reduced risk of penile cancer, UTIs and STIs

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15
Q

What are the features of epididymo-orchitis?

A

Unilateral testicular pain and swelling, urethral discharge

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16
Q

What is the most important differential of epididymo-orchitis?

A

Testicular torsion

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17
Q

What is the management of epididymo-orchitis?

A

Ceftriaxone 500mg IM + doxycycline 100mg PO BD 10-14 days

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18
Q

What is epididymo-orchitis commonly caused by?

A

Chlamydia, gonorrhoea, e coli

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19
Q

What does blood at the meatus indicate?

A

Urethral injury

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20
Q

What are the triad of signs for bulbar rupture?

A

Urinary retention, perineal haematoma, blood at meatus

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21
Q

What injury causes bulbar rupture?

A

Straddle type

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22
Q

What injury causes membranous rupture?

A

Pelvic fracture

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23
Q

What is found on PR in membranous rupture?

A

Prostate displace upwards

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24
Q

What investigation is done in urethral injury?

A

Ascending urogram

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25
Q

What is the management of urethral injury?

A

Suprapubic catheter

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26
Q

What is the investigation for bladder injury?

A

IVU or cystogram

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27
Q

What is the management of bladder injury?

A

Laparotomy if intraperitoneal, conservative if extra

28
Q

What examinations should be done in LUTS?

A

urinalysis, PR, PSA, frequency-volume chart

29
Q

What are conservative measures for BPH?

A

Pelvic floor muscle training, bladder training, prudent fluid intake and containment products

30
Q

What is urge incontinence?

A

Need to go and can’t hold

31
Q

What is the management of nocturne?

A

Furosemide 40mg in late afternoon may be helpful, desmopressin may also be helpful

32
Q

What is the pathology of most prostate cancers?

A

Adenocarcinoma

33
Q

What is the most common cause of scrotal swellings seen in primary care?

A

Epididymal cysts

34
Q

What are the features of Epididymal cysts?

A

Separate from body of testicle, found posterior to testicle

35
Q

What conditions are associated with Epididymal cysts?

A

PCKD, CF, von Hippel-Lindau syndrome

36
Q

How are testicular things diagnosed?

37
Q

What is a hydrocele?

A

Accumulation of fluid within the tunica vaginalis

38
Q

What are the two types of hydrocele?

A

Communicating and non-communicating

39
Q

What is a communicating hydrocele?

A

Caused by potency of the processus vaginalis allowing peritoneal fluid to drain down

40
Q

Who are communicating hydroceles common in?

A

Newborns - resolve in first few months of life

41
Q

What is a non-communicating hydrocele?

A

Excessive fluid production within the tunica vaginalis

42
Q

What are the features of a hydrocele?

A

Soft non-tender swelling of semi-scrotum; usually anterior to and below testicle. You can get above mass on exam and it transilluminates

43
Q

What is a varicocele?

A

Varicosities of the pampiniform plexus

44
Q

What are the features of a varicocele?

A

More common on left side, ‘bag of worms’, sub fertility

45
Q

What may a varicocele be a presenting feature of?

A

Renal cell carcinoma because testicular vein drains into renal vein

46
Q

What are the most common testicular cancers?

A

Germ cell tumours

47
Q

How can germ cell tumours be divided?

A

Seminomas and non-seminomas

48
Q

What is the peak age for teratomas?

49
Q

What is the peak age for seminomas?

50
Q

What are the tumour markers doing in seminomas?

A

AFP usually normal, HCG elevated in 10%, LDH elevated in 15%

51
Q

What are the tumour markers doing in a teratoma/yolk sac tumour?

A

AFP elevated 70%, HCG elevated in 40%

52
Q

What is the management of a hydrocele in adults?

A

Lords or Jabouley procedure

53
Q

What is the management of a hydrocele in children?

A

Transinguinal ligation of PPV

54
Q

What is testicular torsion?

A

Twist of spermatic cord resulting in testicular ischaemia and necrosis

55
Q

What are the features of testicular torsion?

A

Severe sudden pain, N&V, swollen tender testis - skin may be red, cremasteric reflex is lost

56
Q

What is the cremasteric reflex?

A

Elevation of the testes on stroking inner aspect of thigh

57
Q

What is the success rate of vasectomy reversal?

A

up to 50% if done within 10 years

58
Q

What is OAB/urge incontinence due to?

A

Detrusor overactivity

59
Q

What is stress incontinence?

A

Leaking when laughing or coughing

60
Q

What is the management of urge incontinence?

A

Bladder retaining –> oxybutynin

61
Q

When should oxybutynin be avoided?

A

In frail older women

62
Q

What is the management of stress incontinence?

A

Pelvic floor exercises –> surgery if severe and not improving

63
Q

What is the investigation of choice to detect calculi?

64
Q

When is IVU indicated?

A

Visualisation of renal excretion and to assess course of ureters

65
Q

What is the investigation of choice for bladder cancer?

A

Cystoscopy

66
Q

What is the investigation of choice for prostate cancer?

A

TRUS biopsy

Year 2 MBChB (8 decks)

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