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(SG) Phase 2A lectures > urology > Flashcards

urology Flashcards

1
Q

what is the normal function of the LUT?

A
  • to convert a continuous process of excretion (urine prod) to an intermittent process of elimination
  • store urine insensibly
  • void urine when convenient
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2
Q

what does the detrusor muscle do?

A

relaxes during storage

contracts during voiding

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3
Q

what does the distal sphincter in LUT do?

A

contracts during storage

relaxes during voiding

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4
Q

what is PS control of LUT?

A

cholinergic

s2-4

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5
Q

what is S control of LUT?

A

noradrenergic

t10-l2

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6
Q

what are 2 types of LUT symptoms?

A

storage and voiding

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7
Q

what are some storage symptoms of LUT?

A

frequency
nocturia
urgency
urgency incontinence

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8
Q

what are some voiding symptoms of LUT?

A 
hesitancy
straining
poor/intermittent stream
incomplete emptying
post micturition dribbling
haematuria
dysuria
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9
Q

what is BPH

A

benign prostatic hyperplasia

histological, increase in cell number

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10
Q

what is BPE

A

benign prostatic enlargement

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11
Q

why might BPH happen

A

bc of cell number increase
decrease in apoptosis
combo of 2

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12
Q

how are androgens liked to BPE/BPH?

A

don’t cause BPE

are a requirement for BPH

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13
Q

what do u look for in LUT history

A 
what symptoms - storage/voiding/mix?
duration
PMH
PSH
DHx
allergies
symptom scoring
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14
Q

what do u do in a gen exam?

A 
abdo exam
external genitalia
DRE
focused near exam
urinalysis
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15
Q

what investigations are there for LUT?

A

flow rates/residual vol
freq vol chart
imaging
PSA

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16
Q

what is acute retention of urine like

A

painful
upo 1L residual urine
normal u&e’s
pain relieved by catheterisation

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17
Q

what is chronic retention of urine

A

difficult to define

increased risk of infections/stones

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18
Q

what are LUT treatment aims?

A

improve urinary symptoms
improve QOL
reduce complications of bladder outflow obstruction

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19
Q

what are 3 drug treatments for LUT?

A

alpha-adrenergic antagonists: improves flow average

5-alpha-reductase inhibitors - inhibits conversion of testosterone to more active DHT: reduces size by 20-30%

anti-cholinergic - for overactivity

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20
Q

what are some indicates for surgery for LUT symptoms? (RUSHES)

A 
Retention
UTIs
Stones
Haematuria
Elevated creatinine
Symptom deterioration
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21
Q

what is TURP

A

trans-urethral resection of prostate

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22
Q

how do u diagnose AKI?

A

creatinine rise

urine output low

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23
Q

what is rhabdomyolysis?

A

serios syndrome due to muscle injury

results from death of muscle fibres - release of their contents into bloodstream

can lead to serious complications such as renal failure

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24
Q

what are 3 main causes of AKI?

A

pre-renal
intrarenal
post-renal

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25
Q

what are pre-renal AKI causes?

A

TRAUMA

  1. due to sudden/severe BP decrease
    2 .flow obstruction to kidneys
  2. D&V fluid loss
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26
Q

what are intrarenal AKI causes?

A

direct kidney damage
inflammation/infection
drugs
trauma

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27
Q

what are post-renal AKI causes

A

obstruction of urine flow (BPH, kidney stones, bladder injury, blood clots)

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28
Q

what is the most common AKI cause?

A

intrarenal

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29
Q

what is a medical emergency associated with AKI and what is its ECG finding?

A

hyperkalaemia

peaked t waves?

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30
Q

how do u manage hyperkalaemia

A

insulin/dextrose
IV fluid
salutamol

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31
Q

how do u manage AKI

A

identify risk factors
think abt common causes
dialysis indicators

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32
Q

what are some AKI risk factors?

A

age
comorbidities
reasons for admission
drugs

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33
Q

what are some indications for dialysis in AKI

A

pul oedema
persistent hyperkalemia
drug overdose
metabolic acidosis

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34
Q

what does prognosis of AKI depend on

A

early recognition/intervention

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35
Q

describe the kidneys in simple anatomical terms !

A

retroperitoneal organs
lie btwn t11-l3
blood supply from renal artery direct from aorta at L1

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36
Q

where do the ureters run?

A

over PSOAS muscle, cross iliac vessels at pelvic brim and insert into bladder trigone

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37
Q

how is urine transported down the ureter?

A

via peristalsis

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38
Q

where is pontine micturition centre n what does it do?

A

periaqueductal grey

coordination of voiding

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39
Q

where is the micturition reflex coordinated?

A

sacral micturition centre

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40
Q

what is the 2 diff reflexes after storage phase?

A

guarding reflex - inappropriate to void

micturition reflex - appropriate to void

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41
Q

where is the guarding reflex coordinated?

A

onus’s nucleus

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42
Q

what is normal adult bladder capacity

A

4-500ml

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43
Q

why does pressure remain low in the bladder?

A

as vol increases

pressure remains low due to “receptive relaxation” and detrusor muscle cmpliance

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44
Q

what happens during filling phase?

A

afferent pelvic nerves - slow firing signals to pons via spinal cord

S stimulation maintains detrusor muscle relaxation
somatic nerve stimulation

maintains urethral contraction

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45
Q

what kind of a reflex is micturition reflex?

A

autonomical spinal reflex

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46
Q

what happens for bladder emptying?

A

coordinated detrusor contraction with external sphincter relaxation to expel urine from bladder

positive feedback loop until all urine expelled

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47
Q

summarise storage

A
  1. receptive relaxation
  2. detrusor relaxation (sympathetic stimulation t11-l2)
  3. external urethral sphincter contracted (pudendal stimulation s2-4)
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48
Q

summarise micturition

A
  1. voluntary control from cortex and PMC
  2. detrusor contraction (PS stimulation s2-4)
  3. external urethral sphincter relaxation (pudendal inhibition s2-4)
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49
Q

what is the diff btwn m/f LUT symptoms?

A

women - incontinence

men - difficulty voiding, poor stream etc

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50
Q

what are some storage LUTS

A

frequency
urgency
nocturia
incontinence

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51
Q

what are some voiding LUTS

A 
slow stream
spraying
intermittency
hesitancy
straining
terminal dribble
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52
Q

what are some post-micturition LUTS

A

post-micturition dribble

feeling of incomplete emptying

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53
Q

what is OAB

A

overactive bladder

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54
Q

what is the diff btwn terminal and post-micturition dribble?

A

terminal - at end of stream

post-micturition - finish, trousers up, THEN

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55
Q

how many times a day is normal for urinating?

A

2-8x a day

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56
Q

how many times is it normal to go to the toilet during the night

A

once

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57
Q

define incontinence

A

involuntary loss of urine (failure of storage)

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58
Q

define urgency incontinence

A

associated with urgent desire to void which is difficult to defer

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59
Q

what is stress incontinence?

A

associated with coughing/straining

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60
Q

what is OAB? (overactive bladder)

A

urgency w/ frequency, w/ or w/o nocturne

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61
Q

how do u manage an OAB?

A

behavioural therapy (freq vol chart, caffeine etc)

anti-muscarinic agents

b3 agonists

botox

surgery

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62
Q

how do anti-muscarinics work for OAB?

why can they be bad?

A

decrease PS activity by blocking m2/3 receptors

BUT side effects: dry mouth

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63
Q

what is the main side effect associated with anti-muscarinics?

A

dry mouth

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64
Q

how do b3 agonists work for OAB?

A

increase sympathetic activity at b3 receptor in bladder

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65
Q

how does botox work for OAB?

A

blocks neuromuscular junction for Each release

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66
Q

what is stress incontinence usually secondary to in females?

A

birth trauma (denervation of pelvic floor, weakening of fascial support of bladder/urethra)

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67
Q

what is an obstructive cause for voiding problems in men?

and what is a treatment ?

A

BPE

give alpha blockers ± 5alpha reductase inhibitors

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68
Q

what does neurogenic incontinence need an understanding of?

A

the neurological condition and its implications

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69
Q

how does the prostate surround the urethra?

A

like a donut

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70
Q

what is the main function of the prostate?

A

to produce PSA which liquefies semen

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71
Q

what does PSA do

A

liquefies semen

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72
Q

what is the main biomarker for prostate cancer

A

PSA

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73
Q

what type of cancer is usually prostate cancer?

A

adenocarcinoma

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74
Q

what is PSA?

A

detected in small quantities in blood

prostate specific not cancer specific

elevated in BPE, prostatitis etc

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75
Q

what is grading in prostate cancer like ?

A

Gleason grading

higher score = more aggressive

76
Q

how do u treat prostate cancer?

A

surgery - prostatectomy
radiotherapy
observation - watchful waiting

77
Q

what is androgen deprivation therapy?

A

also called androgen suppression therapy

an antihormone therapy whose main use is in treating prostate cancer

prostate cancer cells usually require androgen hormones, such as testosterone, to grow

78
Q

what is the commonest site of metastasis for prostate cancer?

79
Q

what are the 2 types of haematuria?

A

visible vs non-visible

80
Q

what investigations do u do if someone has haematuria?

A

bloods - FBC, U&E, PSA
MSU/dipstick
cytology

81
Q

how does bladder cancer often present?

A

85% painless VH
recurrent UTIs
90%+ transition cell carcinoma

82
Q

what are some bladder cancer risk factors?

A

smoking
occupational
drugs
bladder stones

83
Q

how are most renal cancers picked up ?

A

incidentally

84
Q

what is epididymitis

A

inflamed epididymis

causes pain n swelling in testicles

85
Q

what are the most common causes of epididymitis n who does it usually affect?/

A

E. coli and chlamydia

young males!

86
Q

what is hydrocele?

A

excessive fluid in tunics vaginalis (serous space surrounding testis)

87
Q

what are the 2 main types of causes of hydrocele?

A

primary: absence of testis disease, large/tense, young boys
secondary: reaction to testicular pathology eg testicular tumours, painless

88
Q

how do testicular tumours present

A

80% painless testis lump - hard, lies within testis, can be felt above, doesn’t transiluminate

usually painless, short history

found incidentally

other presenting symptoms include hydrocele, pain, metastases

89
Q

what is orchidectomy/

A

surgical removal of testicle(s)

90
Q

more than 90% of testicular cancers develop in what?

A

germ cells (that prod sperm)

91
Q

what determines fluid movement?

A

hydrostatic pressure

osmotic pressure (salt n electrolytes)

oncotic pressure (protein)

92
Q

where are baroreceptors located

A

aortic arch

carotid sinus

93
Q

what are signs of hypovolaemia

A 
tacky
hypotension
low
reduced tissue turgor/urine output/weight
dry
94
Q

what are signs of hypervolaemia

A

normal pulse
high/normal BP
normal tissue turgor, urine output
increased weight

95
Q

what are some symptoms of hypovolaemia

A

thirst

dizziness

96
Q

what are some symptoms of hypervolaemia

A

breathlessness

leg oedema

97
Q

what is hypervolaemia

A

fluid overload

98
Q

how can fluid status be clinically assessed

A

BP/pulse

decreased turgor: skin remains elevated after being pulled up n released

99
Q

what are some sites of fluid accumulation?

A

pul oedema
ascites
bowel obstruction

100
Q

what is the aim of fluid management?

A

euvolaemia - no signs/symptoms of hypo/hypervolaemia

101
Q

which patients are at risk of hypovolaemia

A

elderly
short bowel syndrome
bowel obstruction
diuretics

102
Q

which patients are at risk of hypervolaemia

A

acute kidney injury
chronic kidney disease
heart/liver failure

103
Q

how do u manage hypovolaemia

A

oral fluid
IV fluid
treat reversible cause

104
Q

how do the stages of chronic kidney disease differ?

A

s1 - normal/raised GFR
s4 - severe decrease GFR
s5 - kidney failure - dialysis

105
Q

what is oligouria?

A

less than 400 mL/500 mL per 24h in adults

106
Q

what is anuria?

A

failure of kidneys to produce urine

107
Q

what do hypovolaemic patients need?

A

fluid replacement

108
Q

what do hypervolaemic patients need?

A

diuretics and fluid restriction

109
Q

why do advanced CKD patients need regular fluid status assessments?

A

they may be oligouric/anuric

110
Q

what are clinical features of glomerulonephritis

A

systemic inflammatory features

features of other organ system involvement

111
Q

lupus/lupus nephritis is more common in which ethnic backgrounds?

A

africans
hispanics
asians

112
Q

what is the most important thing to do in glomerulonephritis????

A

urine DIPSTICKKKK

113
Q

what is the arterial supply for the penis?

A

internal iliac

114
Q

what is PS nerve supply for the penis?

A

erectile s2-4

115
Q

what is S nerve supply for the penis?

A

T11-L2

point n shoot

116
Q

what happens in the erect state?

A

PS stimulation
arteriolar dilatation
trabecular smooth muscle relaxation

117
Q

when is the best time to take a blood test for testosterone?

A

morning bc it peaks then

118
Q

define erectile dysfunction

A

persistent inability to attain/maintain an erection sufficient to permit satisfactory sexual performance

119
Q

what is important abt the peripheral control of erections?

A

smooth muscle mediated

NO release important

120
Q

what is sig about erectile dysfunction?

A

can be the first presentation of HD… used as a screening tool

arteries that supply penis are slightly smaller than cardiac arteries - if atherosclerosis here, then most likely will be in heart

121
Q

what are risk factors for erectile dysfunction?

A

similar to CVS symptoms

122
Q

what do u physically examine on a patient with erectile dysfunction?

A

BP/HR
genitalia
prostatic enlargement
hypogonadism (small testes etc)

123
Q

how do u treat erectile dysfunction

A

lifestyle/risk factor modification

identify and treat reversible causes

124
Q

what are some curable causes of erectile dysfunction

A

hormonal - testosterone deficiency
testosterone replacement
psychosexual counselling

125
Q

how do u give testosterone

A

doesn’t have 1st pass metabolism in liver so can’t swallow

can have it IM, or as a gel

126
Q

what is 1st line treatment for erectile dysfunction

A

phosphodiesterase (PDE5) inhibitors

127
Q

what is the average age of onset for eating disorders

128
Q

what is the average age of seeing an eating disorder patient from time of development to seeing a specialist?

A

≈7 years

129
Q

what are the 2 types of eating disorders?

A

restricting

binge eating/purging

130
Q

what is bulimia nervosa?

A

recurrent episodes of binge eating characterised by:

eating in a discrete amt of time large amts of food AND/OR sense of lack of control over eating during an episode

recurrent inappropriate compensatory behaviour to prevent weight gain

131
Q

what is binge eating disorder

A

recurrent episodes of binge eating

132
Q

where do u often see bingers?

A

obesity clinics

133
Q

what are important issues to look out for in eating disorder patients?

A
  • severe restriction of food/fluid
  • electrolyte imbalance (ask pt if their fingers tingle, do they get cramps? K)
  • bone deterioration
  • physical damage eg tears to oesophagus
  • alcohol/drug intake
134
Q

what are some urgent signs to look for in an eating disorder patient?

A 
muscular weakness
breathing problems
deterioration of consciousness
cardiac signs
rapid weight loss
135
Q

what are the NICE guidelines for treating eating disorders?

A

CBT
family therapy

no evidence-based medications

136
Q

what is the full name for chlamydia?

A

chlamydia trachomatis

137
Q

what is the full name for gonorrhoea?

A

neisseria gonorrhoeae

138
Q

what is the diff btwn gonorrhoea and chlamydia?

A

gonorrhoea is “more vigorous” infection - onset is quicker n more noticeable.

also numerically less common

139
Q

what happens in chlamydia/gonorrhoea in males

A

dysuria, urethral discharge

complications mostly w chlamydia

140
Q

what happens in chlamydia/gonorrhoea in females

A

non-specific
discharge, menstrual irregularity, dysuria
female complications: pelvic inflammatory disease etc

141
Q

how do u treat chlamydia?

A

partner management
test for other STIs
1st line treatment - doxycycline

142
Q

how do u diagnose gonorrhoea

A

microscopy of gram stained smears of genital secretions

143
Q

how do u diagnose chlamydia

A

cell culture/Nucleic Acid Amplification Tests

144
Q

how do u treat gonorrhoea?

A

partner notification
test for other STIs
v bad for AB resistance

145
Q

syphilis is highly transmissible how?

A

through oral sex

146
Q

what happens in primary syphilis?

A

primary chancre - 95% genitals
incubation usually 3-5w
“chunky” lymph nodes

147
Q

what happens in secondary syphilis?

148
Q

what is the most common STI

149
Q

what are the primary/secondary/tertiary control strategies for STIs?

A

1 - reducing risk of acquiring STI
2 - case finding
3 - reducing morbidity/mortality

150
Q

why trace partners of STI sufferers?

A

break chain of transmission
prevent re-infection of index patient
prevent complications of untreated infection

151
Q

what are UTIs caused by

A

presence n multiplication of microorganisms in urinary tract

152
Q

what are some lower tract UTI symptoms

A

cystitis
prostatitis
epididymitits/orchitis
urethritis

153
Q

what are some upper tract UTI symptoms

A

pyelonephritis

154
Q

what is pyelonephritis

A

kidney inflammation

155
Q

what is cystitis

A

bladder inflammation

156
Q

what is orchitis

A

testicular inflammation

157
Q

what is bacteriuria

A

presence of bacteria in urine

can be symptomatic or asymptomatic

158
Q

what is pyuria

A

presence of leucocytes in the urine

associated w infection

159
Q

what is the most common pathogen for UTIs

A

E. coli (50%+)

160
Q

what is path of colonic flora to UTI?

A 
colonic flora
colonisation of vagina
colonisation of urethral meatus
ascent of bacteria - bacteriuria
UTI
161
Q

what are symptoms of UTI

A

frequency
dysuria
may have haematuria
may have pyrexia if upper tract

162
Q

how do u diagnose a UTI

A

urine dipstick sample

in urinalysis: blood, protein, pH, glucose (diabetic POV), ketones (sign of SKA), nitrates (highly predictive of UTI)

163
Q

WBC count above 10^4 indicates what?

A

infection present

164
Q

how do u treat an uncomplicated UTI

A

short 3day course

165
Q

what are 1st line AB?

A

nitrofurantoin

166
Q

where can u get stones?

A

anywhere from collecting duct to external urethral meatus

167
Q

what are some upper urinary tract stones?

A

renal stones

ureteric stones

168
Q

what are some lower urinary tract stones?

A

bladder stones
prostatic stones
urethral stones

169
Q

how can stones be prevented?

A 
overhydration
low salt (Na) diet
normal dairy intake
healthy protein intake
reduce BMI
active lifestyle
170
Q

which symptoms can stones cause?

A 
can be asymptomatic
loin pain
"renal" colic
UTI symptoms (dysuria, urgency, freq)
recurrent UTIs
haematuria
171
Q

what does SOCRATES stand for (history taking)

A 
Site
Onset
Character
Radiation
Associated features
Timing
Exacerbating/relieving factors
Severity
172
Q

what is renal colic?

A

pain results from UT obstruction

unilateral loin pain
rapid onset
unable to get comfy
radiates to groin and ipsilateral testis/labia
associated nausea/vomiting
spasmodic/colicky
classically severe 12/10, worse than labour

173
Q

how do u investigate ureteric colic

A

ABC and give analgesia/antiemetic

focused history n exam

urinalysis, blood count

174
Q

what is KUBXR

A

kidney, ureter and bladder xray - abdo

175
Q

what is pyonephrosis?

A

infection of kidneys’ collecting system

pus collects in renal pelvis - causes distension of kidney –> kidney failure

176
Q

what is the gold standard for diagnosis?

A

NCCT KUB

Non-contrast (computerised tomography)

177
Q

what is the govt’s alcohol strategy (2012)

A

minimum pricing
licensing
law

178
Q

what is max no. of alcohol units a week?

A

no more than 14

179
Q

what is substance misuse?

A

recurrent substance use resulting in a failure to fulfil major role obligations such as work/school/home life

180
Q

what is SADQ?

A

severity of alcohol dependence questionnnaire

20 questions - physical/affective withdrawals, relief drinking, freq, speed of onset

181
Q

what is dependance?

A

a state in which an organism functions only in the presence of a drug

manifests as a physical disturbance when the drug is withdrawn

182
Q

what is assisted withdrawal (detox)?

A

alcohol potentiates GABA - major inhibitory neurotransmitter in CNS

so GABA mediated meds!

183
Q

what is tolerance?

A

aa state in which an organism no longer responds to a drug

higher dose required to achieve same effect

184
Q

what is distribution/metabolism of alcohol like

A

extensively metabolised by liver
crosses BBB
particularly active in CNS grey matter ((high blood flow)

185
Q

what are withdrawal symptoms of alcohol?

A

headache
muscular pain
anxiety
hallucinations

(SG) Phase 2A lectures (14 decks)

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