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3B GH > Urology > Flashcards

Urology Flashcards

1
Q

what spinal level do the kidneys sit at

A

T12 to L3

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2
Q

which kidney is lower and why?

A

right

liver above

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3
Q

what hormone is responsible for concentrating urine

A

ADH

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4
Q

what is an end artery? and an e.g.

A

the only artery that supplies oxygenated blood to a portion of tissue. e.g. Renal/ splenic artery

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5
Q

where is adh made?

A

hypothalamus, stored in and released from the pituitary

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6
Q

where in the kidneys do renal stones form?

A

collecting ducts

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7
Q

classic places where renal stones obstruct?

A
  1. pelviureteric junction [betw renal pelvis +ureter]
  2. pelvic brim
  3. vesicoureteric junction
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8
Q

most common age + sex for renal calculi

A

20-40

male

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9
Q

describe characteristic pain of renal colic

A

v severe
loin to groin
w/ N+V

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10
Q

what can differentiate the pain of peritonitis & renal colic- viewing patient from the end of the bed

A

renal colic - can’t lie still

peritonitis - lie still

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11
Q

sx of pyelonephritis

A

loin pain
fever, rigors
N+V

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12
Q

presentation of renal caluli

A 
loin to groin pain
N+V
infection [fever]
haematuria, proteinuria
anuria
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13
Q

Ix in renal calculi

A

U+E, FBC, Ca2+, PO43-, glucose, bicarb, urate
dipstick and MC+S
CT [non-contrast]
KUB XR

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14
Q

Mx of renal calculi

A 
analgesia
fluids
antibiotics if infection
pass spontaneously 
OR nifedipine/tamsulosin
US waves 
Surgery
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15
Q

Indications for urgent intervention (delay kills glomeruli) in renal calculi

A 
Infection AND obstruction
Sepsis
Impending AKI
Solitary kidney
Bi-lateral stones
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16
Q

Risk Factors of renal calculi

A 
Dehydration
Drugs (steroids, aspirin)
Recurrent UTIs
Urinary tract abnormalities
Family history
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17
Q

Types of luminal urinary tract obstruction

A

Stones
Blood clot
Sloughed papilla
Tumour (renal, uriteric, bladder)

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18
Q

Types of mural urinary tract obstruction

A

Stricture (congenital/acquired)
Schistosomiasis
Neuromuscular disfunction (bladder)

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19
Q

Causes of extra-mural urinary tract obstruction

A

Abdo/pelvic mass/tumour
Retroperitoneal fibrosis
Post surgery

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20
Q

Causes of lower tract obstruction (urinary retention) - name 4

A 
BPH
Prostate CA
other pelvic malignancy
Urethral stricture
Anti cholinergics
Blood Clot (from bladder lesion)
Constipation
Post-op
Alcohol
Infection
Neuro (cauda equina, MS)
DM
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21
Q

surgical sieve for differentials

A 
VITAMIN C+D
Vascular
Infective/Inflammatory
Trauma
Autoimmune
Metabolic
Iatrogenic
Neoplasia
Congenital
Degenerative
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22
Q

what are the 2 types of kidney CA + which is the most common

A

RCC [parenchyma] - 90%

transitional cell carcinoma/ urothelial

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23
Q

name 5 differentials for haematuria

A 
renal calculi
bladder CA [squamous/TCC]
kidney RCC/TCC
cystitis
pyelonephritis
prostate CA/ BPH/ prostatitis
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24
Q

name the 3 causes of rigors

A

pyelonephritis
cholecystitis
abscess

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25
Q

important aspects of the social Hx in urology/ haematuria Hx

A

smoking
occupations [dye]
travel Hx - schisto

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26
Q

Ix in haematuria

A 
dipstick
FBC, U+E, clotting, CRP, PSA
US kidney
cystoscopy
CT urogram
diffusion weighted MRI [prostate CA]
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27
Q

2 types of drugs used for BPH

A

Tamsulosin - alpha 1 blocker [relaxes smooth muscle]

Finasteride - 5a-reductase inhibitor [blocks testosterone]

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28
Q

what aspect of a cancer do diffusion weighted MRI and contrast CT pick up

A

^vascularity compared to normal tissue

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29
Q

how do you differentiate a hydrocoele from a hernia?

A

can get above hydrocoele

hydrocoele transluminates

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30
Q

Ix in recurrent UTI

A

cystoscopy

US kidney [scarring]

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31
Q

Sx of chronic lower urinary tract obstruction

A

frequency
poor stream
terminal dribbling
hesitancy

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32
Q

possible examination findings in chronic lower urinary tract obstruction e.g. Pt with hesitancy, poor stream, terminal dribbling etc.

A

enlarged prostate on PR

large palpable full bladder

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33
Q

complications of chronic lower urinary tract obstruction e.g. BPH

A

renal failure

UTI

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34
Q

Ix in urinary tract obstruction

A

FBC, U+E, PSA
dipstick, MC+S
US [hydronephrosis]
CT

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35
Q

upper urinary tract obstruction Mx

A

nephrostomy
ureteric stent
+ alpha blocker for stent pain
pyeloplasty to widen PUJ

36
Q

lower urinary tract obstruction Mx

A

catheter - urethral or suprapubic
clot retention - 3 way catheter and bladder washout
alpha blocker for BPH

37
Q

what picture might an ABG show in acute urinary retention

A

metabolic acidosis

[resp compensated]

38
Q

sx of BPH

A 
hesitancy
frequency
urgency
terminal dribbling
nocturia
overflow incontinence
poor flow
haematuria
39
Q

which areas of the prostate enlarge in BPH and carcinoma

A

inner transitional zone in BPH

peripheral layer in CA

40
Q

Ix in BPH

A 
MSU
PSA, U+E
PR exam
US bladder [residual]
US kidney [hydroneph]
transrectal US
\+/- biopsy

[MRI prostate]
[cystoscopy]

41
Q

what order should you to PSA venepuncture + PR exam?

A

venepuncture 1st as PR can increase PSA

42
Q

tamsulosin / alpha blocker side effects

A

dizzy

sexual dysfunction

43
Q

main side effect of finasteride

A

sexual dysfunction

44
Q

risks of TURP [transurethral resection of prostate]

A 
impotence
incontinence
retrograde ejaculation
bleeding
infection
clot retention
TURP syndrome [absorption of washout - CNS/CVS/hyponatraemia Sx]
45
Q

Mx of retroperitoneal fibrosis

A

surgery/stent

steroids

46
Q

sx of renal cell carcinoma

A

loin pain
haematuria
abdo mass

malaise
weight loss
anorexia
pyrexia

[rarely - varicocoele]

47
Q

Ix in RCC

A

BP
FBC, ESR, U+E, ALP [mets]

urine dipstick + cytology

US, CT, MRI, CXR

48
Q

what change might you see in BP of RCC patient + why

A

^ from renin secretion

49
Q

FBC findings in RCC

A

polycythaemia from erythropoetin secretion

50
Q

RCC lung mets - appearance on CXR

A

cannon ball mets

51
Q

Mx of RCC

A

nephrectomy
[cryotherapy, ablation if unfit for surgery]

metastatic: IL2, temsirolimus

[radio and chemo resistant]

52
Q

tcc of the bladder presentation

A 
painless haematuria
frequency
urgency
dysuria
obstruction
recurrent UTIs
53
Q

Ix in suspected bladder TCC

A 
urine microscopy /cytology
cystoscopy + biopsy
contrast XR
CT urogram 
MRI [nodes]
54
Q

sx of prostate CA

A

asymptomatic

frequency, urgency, hesitancy, nocturia, poor stream etc

obstruction

weight loss

bone pain

55
Q

Ix in Prostate CA [/exam]

A 
DRE
PSA
transrectal US + biopsy
bone scan
CT/MRI
56
Q

Mx options for prosate Ca

A

Pt choice,
active surveillance

prostatectomy
radiotherapy [ext/brachy]

hormone therapy
LHRH agonist Goserelin

analgesia
bisphos for ^calc

57
Q

presentation and examination findings in prostatitis

A 
UTIs
retention
pain
haematospermia
boggy prostate of DRE
58
Q

mx of acute prostatitis

A

analgesia

levofloxacin for 28 days

59
Q

risk factors for bladder CA

A 
smoking
schisto
cysitis
rubber industry
pelvic irradiation
60
Q

TCC of bladder Mx

A 
TURBT 
radical cystectomy in more advanced
BCG
chemo
radio
reconstruction or urostomy
palliative care
61
Q

causes of incontinence in men

A

BPH

pelvic surgery/ TURP

62
Q

describe the 2 categories of incontinence in women

A

stress & urge
stress = weak pelvic floor
urge = detrusor overactivity

63
Q

give 5 risk factors for female incontinence

A 
age
obesity
prolapse
weak pelvic floor muscles
pregnancy
following childbirth
stroke
parkinsons
dementia
64
Q

ix in female incontinence

A

urodynamic studies

65
Q

Mx of urinary incontinence

A 
rule out UTI + faecal impaction
consider diuretic use
consider retention overflow [palpable bladder]
weight loss
pelvic floor exercises

STRESS:
pessary for prolapse
surgery to stabilise urethra
duloxetine

URGE:
rule out neuro cause
vaginitis > topical oestrogen 
antimuscarinics [tolterodine]
mirbegron
botox
nerve stimulation
surgery - clam ileocystoplasty
66
Q

side effects of antimuscarinics for incontinence

A 
dry mouth
dry eyes/skin
constipation
drowsy
retention
^HR
abdo pain
sinusitis
oedema
weight gain
67
Q

important testicular examination findings:

  1. testicular lump = what, until proven otherwise?
  2. acute tender enlarged testis = what, until proven otherwise?
A
  1. CA

2. torsion

68
Q

if you cannot feel above a scrotal mass, what is it likely to be

A

inguinoscrotal hernia

69
Q

a scrotal mass that is separate from the testis and feels cystic

A

epididymal cyst

70
Q

secondary hydrocoeles occur following….

A

infection
trauma
tumour

71
Q

Mx of hydrocoele

A

resolve on their own
OR
aspiration
surgery

72
Q

differentials for a solid testicular mass

A 
tumour
orchitis
haematocoele
gumma [syphilis]
granuloma
73
Q

solid scrotal mass, separate from testis, differentials?

A

epididymitis

varicocoele

74
Q

causes of epididymo-orchitis

A 
chlamydia
e.coli
mumps
gonorrhoea
TB
75
Q

Sx of epididymo-orchitis

A

tender swelling of testis
sudden onset
fever
dysuria

76
Q

Mx of epididymo-orchitis

A 
Abx
analgesia
STI screen/ treat partners
scrotal support
drainage of abscess
77
Q

visible distended scrota blood vessels that feel like ‘a bag of worms’. diagnosis?

A

varicocoele [dilated veins of the pampiniform plexus]

78
Q

presentation of testicular tumour

A 
typically painless testis lump 
haematospermia
hydrocoele
can have pain
SOB [lung mets]
abdo mass [nodes]
79
Q

Ix in testicular CA

A

CXR
CT
biopsy
tumour markers [AFP, BHCG]

80
Q

Mx of testicular CA

A

orchidectomy

radio, chemo

81
Q

in testicular torsion how long do you have to save the testis?

A

6 hours

82
Q

presentation of testicular torsion

A

sudden onset of pain in one testis
abdo pain
N+V

83
Q

differentials of testicular torsion

A 
epidiymo-orchitis
tumour
trauma
hydatid torsion
idiopathic scrotal oedema
acute hydrocoele
84
Q

complications of maldescended or ectopic testes

A 
infertility
^risk of testicular CA
^risk of torsion
^risk of hernias
and other urinary tract abnormalities
85
Q

name the only type of renal stone that is genetic/ inherited

A

cystine

3B GH (16 decks)

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