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Gen Med and Surg - C.U > Urology > Flashcards

Urology Flashcards

1
Q

Risk factors for bladder cancer

A

smoking aromatic amine exposure

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2
Q

Most common type of bladder cancer

A

TCC

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3
Q

Most common presenting symptom in bladder cancer

A

haematuria

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4
Q

Gold standard investigation in bladder cancer

A

cystoscopy

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5
Q

Management of bladder cancer Superficial disease Invasive disease

A

Endoscopic resection and intravesical chemo Radical cystectomy / radical radiotherapy §

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6
Q

Most kidney cancers are?

A

adenocarcinomas

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7
Q

Hippel-Lindau disease =

A

familial variant of RCC

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8
Q

Clinical features of kidney cancer

A

haematuria loin pain weight loss abdo mass hypertension hypercalcaemia

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9
Q

where does kidney cancer usually spread to?

A

lungs / bone / lymph

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10
Q

Imaging in kidney cancer?

A

USS CT - gold standard

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11
Q

Treatment of choice in kidney cancer

A

nephrectomy

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12
Q

Symptoms of urinary obstruction

A

Hesitancy Poor stream Dribbling Incomplete voiding Retention

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13
Q

Key examination to be done in suspected BPH

A

PR - nodular prostate

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14
Q

Blood tests in BPH

A

FBC UandE PSA

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15
Q

Treatment of BPH Conservative Medical Surgical

A

Watch and wait Catheterise for retention Alpha blocker - tamsulosin 5 alpha 2 reductase inhibitors - finasteride TURP

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16
Q

Symptoms of bladder irritation

A

Frequency Nocturia Urgency

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17
Q

In which part of the prostate does BPH usually develop ->

A

Urethral prostate (centre)

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18
Q

In which part of the prostate does prostate cancer usually develop ->

A

Peripheral so presents late often

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19
Q

How is response to therapy measure in prostate cancer?

A

PSA

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20
Q

scans in prostate cancer

A

transurethral US CT/MR abdo for staging bone scan

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21
Q

Brachytherapy =

A

radioactive seeds implanted in the prostate

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22
Q

Treatment of prostate cancer Medical Surgical

A

Chemo / radio Hormone therapy Radical prostatectomy for T1 and T2

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23
Q

SE of radical prostatectomy

A

Impotence and incontinence

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24
Q

Where does prostate cancer often metastasie to?

A

bone

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25
Q

Causes of urine w/ puss

A

TB partially treated UTI Malignancy Kidney stones

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26
Q

Causes of a UTI (bacteria)

A

E.coli Staphlyococci Enterobacteria

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27
Q

Which bacteria are associated with stone formation?

A

proteus

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28
Q

Risk factors for a UTI

A

DM Pregnancy Abnormal urinary tract Stones Poor bladder emptying

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29
Q

Cystitis presentation

A

Dysuria Haematuria Suprapubic tenderness Nocturia

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30
Q

Prostatitis presentation

A

Back pain Tender prostate on examination

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31
Q

Pyelonephritis presentation

A

Loin to groin pain Fever Rigors Vomiting Renal angle tenderness Smelly urine increased frequency of micturition

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32
Q

Two main things on dip for a UTI

A

Nitrites Leukocytes

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33
Q

Further tests / imaging suggested for which groups with a UTI?

A

US/ KUB - frequent UTIs and a women - single UTI in man / child

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34
Q

Treatment for prostatitis

A

ciprofloxacin

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35
Q

Acute pyelonephritis treatment

A

admit for fluids Cefuroxime

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36
Q

Definition of polyuria

A

>3.5L/ 24hrs

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37
Q

Causes of polyuria

A

Polydipsia Hyperglycaemia Hypercalcaemia Hyperureamia Diabetes Diuretics

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38
Q

Associated symptoms with polyuria

A

Polydypsia Thirst Weight loss

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39
Q

Bed side investigations in polyuria

A

Fluid balance Weigh the patients Bloods - FBC, UandE, calcium, glucose, LFTs, osmolality Urine dip Urine culture Urine osmolality

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40
Q

Definition of oliguria

A

<300ml/ 24hrs

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41
Q

Causes of oliguria Pre renal Renal Postrenal

A

Hypotension - sepsis, cardiogenic, renal artery obstruction Glomerulonephritis AKI / failure Acute tubular nephrosis

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42
Q

Bedside tests in oliguria

A

BP Hydration status Bloods - FBC, UandEs, osmolality, glucose, calcium, bicarb, urate Urine dip Urine osmolality

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43
Q

Imaging in oliguria

A

US DMSA scan

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44
Q

What two conditions does haematuria differentiate?

A

Nephritic from nephrotic syndrome

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45
Q

BURPS - causes of haematuria

A

Bladder Urethra Renal Prostate Systemic causes

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46
Q

Bladder causes of haematuria

A

Trauma Cystitis Infection Stones Malignancy

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47
Q

Urethra / ureter causes of haematuria

A

Trauma Stones Tumour

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48
Q

Renal causes of haematuria

A

Trauma Infection Nephritic syndrome Trauma

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49
Q

Prostate causes of haematuria

A

Trauma Prostatitis TB Tumour

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50
Q

Systemic causes of haematuria

A

Bleeding disorder Drugs - anticoag / NSAIDs

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51
Q

Associated questions with haematuria

A

How much blood Which part of the stream What colour Pain B symptoms

52
Q

Causes of painful haematuria

A

Stones UTI

53
Q

Causes of painless haematuria

A

Nephritic syndrome Cancer Renal infection

54
Q

Bedside tests in haematuria

A

Urine dip, culture Early morning sample for TB

55
Q

Blood tests in haematuria

A

FBC U&Es CRP Clotting screen

56
Q

Imaging in haematuria

A

x-ray KUB CT urogram US

57
Q

Further tests in haematuria

A

Cystoscopy Renal biopsy

58
Q

Cancer usually causing canon ball chest mets

A

RCC

59
Q

Imaging to stage renal cancers

A

CT

60
Q

Commonest male cancer between 20-40 Subtypes of this cancer in this age group?

A

Testicular (seminoma / teratoma)

61
Q

Testicular cancer in those <10

A

Yolk sac

62
Q

How quickly does a torsion need to be fixed?

A

6hrs

63
Q

Most common cause of painful testicle

A

Orchitis

64
Q

Main imaging for testicular swelling

A

US

65
Q

Tumour marker for testicular cancer

A

Beta HCG Alpha fetoprotein

66
Q

Penile rash / lump on the penis ddx

A

Viral wart STD Fungal infection Penile cancer in situ

67
Q

Ddx of haematuria

A

UTI Bladder Ca Stone Trauma - exercise Rhabdomyolysis Sexual intercourse Nephrological - think nephrotic syndrome

68
Q

Painless frank haematuria is what till proven otherwise?

A

Bladder Ca

69
Q

What imaging should be chosen according to the type of haematuria?

A
70
Q

What grading system is used in prostate cancer

A

Gleason score

Typical Gleason Scores range from 6-10. The higher the Gleason Score, the more likely that the cancer will grow and spread quickly.

6 - PSA testing regularly

>8 - IMMEDIATE TREATMENT

71
Q

Complicatins of prostatectomy

A

Impotence (50%)

Urinary incontinence (10%)

72
Q

Renal pelvis parallel with which level of the spine

A

L1

73
Q

Where is the narrowing of the ureter

A

Pelvic brim

PUJ

VUJ

74
Q

Renal obstruction immediate treatment

A

Nephrostomy insertion

75
Q

important non urological ddx that can present like renal stone / pyelonephritis

A

AAA

76
Q

Haematuria + palpable bladder

A

think clot retention

77
Q

Management of clot retention in the bladder

A

ABCDE

3 way catheter with a wash out

78
Q

SE of clot retention

A

further bleeding - needing surgery

perforation

79
Q

Torsion of the testicle presenation

A

Loss of cremestaric reflex

Extreme pain (sudden onset)

sometimes changes to the skin colour

bell clapper deformity - horizontal lie and high riding

80
Q
A
81
Q

treatment of testicular torsion

A

Three point fixation (if viable)

and secure the other side

82
Q

Size of urological stone indicating medical management

”” surgical management

A

<10mm

>10mm

83
Q

Medical management of urological stones

A

Pain relief

Hydration

Anti emetic

alpha blocker to promote passage of stones

84
Q

Surgical management of uriteric stones

A

Surgical decompression - stent / percut nephrostomy

Extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy are considered first-line treatments. However, ureteroscopy in general is associated with better stone-free rates than ESWL.

85
Q

Medication in stress incontinence

A

alpha agonist

horomone replacement therapy

86
Q

Red flags in urology

A

Haematuria

Blood in stool

Change in bowel habts

Dysuria

Fever

Weight loss

Bone paom

87
Q

Voiding symptoms in urology hx (prostate problems)

A

Flow symptoms

  • hesitancy
  • intermitnent
  • weak
  • dribbling
  • straining
  • feeling of retention
  • erectile dysfunction
88
Q

Storage symptoms in urology hx (overactive bladder)

A

urgency

frequency

nocturia

incontinence

pads?

89
Q

Fluid questions in urology

A

alcohol

caffeine

late night drinking

limiting fluids

90
Q

Urology pmh q.

SH

FH

A

STI

UTIs

Kidney stones

Surgery

HTN

IHD

Diabetes

SH - alcohol / smoking / occupation

FH - prostate cancer etc

91
Q

What are you looking for in the prostate on PR exam?

A

Enlarged?

Smooth

Can you feel the sulcus

Hard / gritting / irregular / nodule

92
Q

Urology investigations

A

Urine dip - +ve send for culture

Bloods - PSA (look for a trend/ >10 / big jump

CRP

FBC

U&Es

LFTs

?bladder scan

93
Q

Investigations for prostate cancer

A

TRVS + biopsy

or if on warfarin do an MRI

Gleason score

94
Q

Life style management of LUTS in males

A

Cut out alcohol / caffeine / limit late night fluids

Physiotherapy

95
Q

Medications for BPH which relaxes smooth muscle

A

Tamsulosin (alpha blocker)

SE - hypotension, incontinence, retrograde ejaculation

96
Q

Medications for BPH which reduces the size of the prostate

A

5 AR inhibitors

SE - gynaecomastia

Erectile dysfunction

RE

Can take up to 6m to work

97
Q

Storage symptoms medication

A

Oxybutinin

SE

can’t shit / spit / see (dizzy and dry eyes) / pee

98
Q

Definition of poluria

A

Increased urine output

>3.5 L /24hrs

99
Q

4 groups of causes of polyuria

A

Too much fluid intake

Diuresis

Diabetes

Renal failure (acute/ chronic)

100
Q

Causes of diuresis

A

Hyperglycaemia

Hypercalcaemia

Hyperurea

Diuretics

101
Q

Tests in polyuria

A

Water balance - weight

Urine dipstick

Urine microscopy and culture

24hr urine collection

Bloods - FBC, U&E, Calcium, glucose, LFTs, osmolarity

Water deprevation test?

102
Q

Who are most likely to go into acute urinary retention?

A

Males > 60 y/o

103
Q

Most common cause of acute urinary retention

A

Secondary to BPH - enlarged prostate presses on the urethra, making the bladder wall thicker and less able to empty

104
Q

Cause of acute urethral obstruction

A

Stricture

Calculi

Cystocele

Constipation

Masses

Medications - anticholinergics, TAD, anti histamines, opioids, benzos

Neurological cause e.g. CES

105
Q

Symptoms of acute urinary retention

A

Inability to pass urine

Low abdo pain

106
Q

Examination for acute urinary retention

A

Abdo exam

PR

Neurological exam

Pelvic exam in women

107
Q

Investigations in urinary retention

A

Urine sample - urinalysis and culture

UandEs

FBC and CRP

Bladder USS - volume >300 cc

108
Q

Management of acute urinary retention

A

Catheterisation

measure volume of water drained in 15 mins

< 200 - not acute

> 400 - catheter should be left in place

109
Q

Most common cause of testicular cancer

A

Germ cell tumour

110
Q

Risk factors for testicular cancer

A

Infertility

Cryptorchidism

FH

Klinefelter’s syndrome

Mumps orchitis

111
Q

Most common presenting feature in testicular cancer

A

Painless lump

112
Q

First line diagnosis for testicular cancer

A

US

113
Q

Usual cause of epidiymo-ortchitis in men < 35 years

A

Chlamydia and Gonorrhoea

114
Q

Drug causing non infective epididymo-orchitis

A

Amiodarone

115
Q

Torison vs epididymo-orchitis presentation

A

Torsion - whole testes is painful

E-O - only epidiymis is painful

116
Q

Testicular torsion =

A

Twist of the spermatic cord resulting in testicular ischaemia and necrosis.

117
Q

What reflex is lost in testicular torsion

A

Cremestaric

118
Q

Risk factors for urinary incontinence

A

Advanced age

Previous pregnancy / childbirth

High BMI

Hysterectomy

FH

119
Q

3 types of incontinence

A

Urge

Stress

Overflow - bladder outflow obstruction causing e.g. prostate englargement

120
Q

Initial investigations in urinary incontinence

A

Bladder diary for 3 days

Urine dip and culture

Vaginal examination to exclude prolapse

121
Q

Management of urge incontinence

A

bladder retraining (lasts for a minimum of 6 weeks, the idea is to gradually increase the intervals between voiding)

bladder stabilising drugs: antimuscarinic is first-line. NICE recommend oxybutynin (immediate release), tolterodine (immediate release) or darifenacin (once daily preparation). Immediate release oxybutynin should, however, be avoided in ‘frail older women’

122
Q

Management of stress incontinence

A

pelvic floor muscle training: NICE recommend at least 8 contractions performed 3 times per day for a minimum of 3 months

surgical procedures: e.g. retropubic mid-urethral tape procedures

123
Q

urolithiasis =

A

Ureteric calculi

124
Q

1st line treatment of urinary obstruction

A

pain relief - ketrolac or morphine

rehydration

125
Q

Definitive treatment for obstructive uropathy and sepsis

A

Nephrostomy or Uriteric stent

+ Abx e.g. gent or ceftriaxone

126
Q

Treatment for obstructive uropathy without sepsis signs

A

Pain relief - ketorolac / morphine

Rehydration

Alpha blocker if stone <10mm e.g. tamsulosin / alfuzosin

or active stone removal (>10mm)

extracorporeal shock wave lithotripsy, ureteroscopy with laser lithotripsy, and percutaneous nephrolithotomy

127
Q

Complications of TURP

A

T ur syndrome

U rethral stricture/UTI

R etrograde ejaculation

P erforation of the prostate

Transurethral resection of the prostate (TURP) syndrome occurs when irrigation fluid enters the systemic circulation. The triad of features are:

  1. Hyponatraemia: dilutional
  2. Fluid overload
  3. Glycine toxicity

Gen Med and Surg - C.U (16 decks)

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