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phase 3b > Urology > Flashcards

Urology Flashcards

1
Q

Narrowest 3 points of ureters

A

Uteropelvic junction

Pelvic brim

Vesicoureteric junction

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2
Q

Types of renal stones

A

Mainly Calcium oxalate

Uric Acid

magnesium ammonium phosphate

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3
Q

Presentation of renal stones

A

Loin to groin renal colic pain

N&V

haematuria

fever

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4
Q

Investigation of renal stones

A

urinarysis (normal)

AXR (uric acid dont show)

CT

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5
Q

Management of renal stones

A

Conservative <5mm
analgesic: diclofenac, coedine
SM relaxants; alpha receptor blockers (tamsulosin)
CCB - nifedipine

>5mm or conservate doesnt work

  • extracorporeal shock wave lithotripsy
  • percuteaneous nephrolithomy (>2cm, stag horn: Mg ammonium phos)
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6
Q

Causes of urinary tract obstruction

A

Luminal - stones, blood clots, tumour Mural - stricture, neuromuscular problem Extramural - abdominal/pelvic mass/tumour, peritoneal fibrosis

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7
Q

Causes of acute urinary retention

A

Prostatic, urethral strictures, anticholinergics, alcohol, constipation, neurological

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8
Q

What is BPH?

A

Hyperplasia of connective and glandular tissue

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9
Q

Presentation of BPH

A

Storage symptoms - frequency, urgency, nocturia

Voiding symptoms - Hesitancy, Intermittent/incomplete emptying, post void dribbling, poor flow

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10
Q

Investigations for BPH

A

Symptoms score questionnaire

DRE (smooth symmetrical enlargement)

Abdo exam (palpable bladder - urinary retension)

PSA

Urine flow analysis

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11
Q

Treatment of BPH

A

lifestyle: avoid alcohol, caffeine
1st: alpha blockers - tamsulosin (decrease smooth muscle tone, s/e - drowsy, dizzy, dry)

5a-reductase inhibitors - finasteride

Surgical - TURP (transurethral resection of prostate)

  • TUIP (transurethral incision of prostate) removes less than TURP
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12
Q

Symptoms of RCC

A

1) haematuria
2) loin pain
3) abdo mass

anorexia, malaise, weight loss

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13
Q

Investigations of RCC

A

BP : HTN bc renin secreted by tumour

FBC: Erythrocytosis from XS EPO production. Anaemia of chronic disease

LDH and corrected Calcium: if high poor prognostic marker

LFT: elevated AST/ALT show mets

urine: haematuria and/or proteinuria

Imaging:US, *CT, MRI, CXR (cannonball metastases)

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14
Q

Management of RCC

A

1st line: if fit for surgery - partial or radical nephrectomy

1st line: if not fit for surgery - suveillance -> ablation

If RCC stage 4 (metastatic)

  • targeted molecular therapy: pazopanib
  • consider surgery, chemo and palliative radio
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15
Q

Most common prostate cancer

A

Adenocarcinoma arising from peripheral prostate

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16
Q

Innervation of ureters

A

T12-L2 (back and sides of abdo, top inner thigh & genitals

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17
Q

Parasympathetic nervous system function on detrusor

A

Causes detrusor contraction, from sacral spinal cord

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18
Q

Sympathetic nervous system function on detrusor

A

Causes detrusor relaxation, from lumbar spinal cord

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19
Q

Pathology of BPH

A

Inner transitional zone hyperplasia

Static component - increased bulk narrows lumen

Dynamic component - increased smooth muscle tone mediated by alpha adrenergic receptors

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20
Q

4 complications of BPH

A

Progression, sexual dysfunction, acute urinary retention, TURP syndrome

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21
Q

What is TURP syndrome?

A

Absorption of irrigation fluids into prostatic venous sinus

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22
Q

Presentation of Prostate Cancer

A
  • haematuria
  • haematospermia
  • LUTS
  • Incontinence
  • Impotence
  • Rectal Pain
  • weight loss, bone pain
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23
Q

factors that increase PSA

A

BPH, prostate cancer, bicyling, sex, prostatitis

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24
Q

Investigations for ?Prostate cancer

A

PSA

DRE

Urinalysis

Transurethral ultrasound of prostate (TRUS) ± biopsy

MRI

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25
Q

Possible findings on DRE

A
  1. normal- walnut sized, smooth, palpable, central sulcus
  2. cancer- hard craggy
  3. BPH - smooth, symmetrical enlargement
  4. Prostatitis - soft, boggy, tender
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26
Q

Where does prostate cancer commonly met to

A
  1. bone
  2. lymph nodes
  3. bladder
  4. rectum
  5. seminal vesicles
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27
Q

Scoring system for prostate cancer and how does it work

A

Gleason Score, 2 numbers, first and second most common type of growth X+Y=Z

1= small uniform glands

5= only occasional gland formation

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28
Q

Management of prostate cancer

A

Watchful waiting- no active management, repaeting PSA/DRE at intervals

Active surveillance - specific regime of tests view to treat radically

Radical prostatectomy - no mets, symptomatic/progressive disease. Remove prostate, seminal vesicels and surrounding connective tissue. SE= incontinence, sexual dysfunction, DVT

Radiotherapy - elderly, radical RT given everyday for several weeks, palliative given once to relieve symtoms

Androgen suppression - non localised disease. Bicalutaminde. LHRH antagonists (gosereline)

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29
Q

Stag horn canniculi

A

magnesium ammonium phosphate

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30
Q

How does finasteride work?

A

5 alpha reductase inhibs

block conversion of testosterone -> dihydrotestosterone

high dihydrotestosterone associated with larger prostate

31
Q

most common bladder cancer?

A

Transitional cell carcinoma

32
Q

presentation of bladder cancer

A
  • painless haematuria
  • UTI symptoms (dysuria) but -ve MC+S
  • flank pain: obstruction
33
Q

Bladder cancer investigations

A

Urinalysis: haematuria, RBC casts if glomerular bleeding

Urine cytology: +ve

Imaging: USS, CT, cystoscopy

34
Q

Management of bladder cancer

A

Non muscle invasive

TURBT + post op chemo ±BCG

Locally invasive

1st: radical/partial cystectomy + pre/post op chemo
2nd: immunotherapy - atezolizumab

Metastalic

1st: chemo + surgery/radio
2nd: immunotherapy -atezolizumab

35
Q

What does the spermatic cord contain?

A

Pampiniform plexus (veins)
tesicular nerves
testicular artery
Cremasteric artery
Nerve to cremasteric artery
Lymphatic vessesl
vas deferens

36
Q

What happens in testicular torsion and how does it present?

A

Spermatic cord twists cutting off blood supply to testicle -> testicular death

  • painful, swollen, tender testis
  • fever, nausea vomiting
37
Q

investigations for ? test torsion

A

USS doppler

cremasteric reflex (not super sensitive)

surgical exploration

38
Q

management of testicular torsion?

A

surgery

39
Q

When you would you diagnose AKI?

A

<48 hour increase in
1) serum creatinine >=26.4 above baseline

2) serum creatinine increase >50%
3) Oligouria <0.5mL/kg/hour for >6 hours

*average pt weight 70kg so <35mls/hour would be AKI

40
Q

How do you break down the causes of AKI?

A

Pre renal

Renal

Post renal

41
Q

What are the pre-renal causes of AKI?

A

dehydration

sepsis

42
Q

What are the renal causes of AKI?

A

Nephrotoxic meds

vasculitis

glomerulonephritis

43
Q

What are the post renal causes of AKI?

A

stones

strictures

tumours

prostate: BPH

44
Q

which drugs are nephrotoxic?

A

NSAIDs

gentamicin

antifungals

antivirals

45
Q

How does AKI present?

A

Altered UP

N&V, dehydration

confusion

46
Q

What would you find OE in a patient with AKI?

A

Increased JVP if fluid overloaded

BP low

47
Q

How do you manage a patient with AKI?

A

ABC

haemodynamic restoration: fluids and inotropes
Med review
Treat hyperkalaemia, infection
Urinalysis
Immunology: Bence Jones, ANA and anti-dsDNA

48
Q

which patients are at higher risk of developing AKI

A
  • CKD: decreased function
  • Db: metformin causes lactic acidosis, prescribed ACE I
  • Atherosclerotic disease: poor inflow, ACEI
  • CCF: poor inflow ACE
  • Elderly: have above
49
Q

How to prevent AKI

A
  • avoid nephrotoxins
  • monitor at risk pt
  • give IV sodium bicarb or 0.9% sodium chloride if at risk
50
Q

What causes erectile dysfunction

A

Physical: Age, meds, HTN, endocrine, trauma, MS

Psychological: Depression, relationship issues, unsure of sexual orientation

51
Q

Which meds are linked to ED?

A

HTN meds, chemo, anti D

52
Q

Which investigations would you carry out for ED?

A

random plasma gluoce: DM

serum testosterone, prolactin, LH, SHBG

TFT

FBC

LFT

53
Q

Medical management of ED?

A
  • sildenafil 30/60m before sex
  • tadalfil daily
  • alprostadil, TU injection
54
Q

Non medical management of ED?

A
  • vacuum device
  • penile/scrotal rings
  • kegal exercises
  • relationship/individual therapy
55
Q

Describe the anatomy of the penis

A

2 corpora cavernosa and 1 corpus spongiosum (surrounds urethra) which extends to form glans (tip) of penis

all 3 sponge like and contain large spaces between and loose networks of tissue

56
Q

Describe the physiology of an erection

A
  • blood flows into spaces causing distension and elevation of penis
  • Arteries dilate and veins contain valves which restrict outflow of blood.
  • Corpus spongiosum doesnt become erect so semen can leave urethra
57
Q

innervation of the penis

A

Erection: parasympathetic reflex S2 and S3

Ejaculation: sympathetic, L1 root

58
Q

what is nephritic syndrome?

A

inflammatory response to immune cells causes damage to basement membrane allowing proteins, WBC and RBC into urine

59
Q

What causes nephritic syndrome?

A

Bergers, post infectious, SLE

60
Q

How does nephritic syndrome present?

A

Haematuria

Oliguria

HTN

Odema/fluid retension

61
Q

Nephritic syndrome diagnosis and management

A

Dipstick

Diuretics, IVIG

62
Q

What is nephrotic syndrome?

A

Damage to basement membrane increases permeability of serum protein

proteinuria >3.5g/day

serum hypoalbuminaemia <30g/L

63
Q

What causes nephrotic disease?

A

minimal change disease

focal segmental glomerulosclerosis

SLE

64
Q

nephrotic syndrome presentation

A

Periorbital oedema (scrotal, vulval, ankle)

frothy urine (proteinuria)

Ascites

SOB

fatigue

65
Q

Investifations of nephrotic syndrome

A

Dipstick

MC+S

clotting: decreased AF-III

Hyperlipidaemia

66
Q

types of nephrotic syndrome

A

Steroid sensitive: minimal change

Steroid sensitive: focal segmental glomerulosclerosis

67
Q

Features of steroid sensitive nephrotic syndrome

A

reponds to steroids

doesnt lead to renal failure

diagnosed with microscopy and biopsy

68
Q

features of steroid resistant nephrotic syndrome

A
  • diagnosed with biopsy showing scarring
  • 1/3rd lead to renal failure
  • Mangement: ACEi, ARB, BP control
69
Q

ADPKD presentation

A

loin pain

nocturia

HTN

Kidney enlargement

gross haematuria post traums

70
Q

extra-renal presentation of ADPKD

A

-due to mass effect

dyspnoea
GORD
back pain

-due to cyst complications

haemorrage
infection
torsion
rupture

71
Q

Investigations for ADPKD

A

Urinalysis: infection, protein

MC+S: coliforms

FBC: high RBC (XS erythropoietin)

U&E: creatinine, eGFR

Imaging: USS, CT

Genetic testing

72
Q

Management of ADPKD

A

Lifestyle: Patient education, Screening, No contact sport (rupture), CVD lifestyle

Monitoring: BP, annual blods and USS

Medical

HTN: ACEI
UTI
Pregnancy: increased risk of severe HTN and pre-eclampsia

73
Q

What are the pros and cons for screening for ADPKD in utero?

A

+ family planning

+early detection and treatment of complications

  • insurance/employment discrimination
  • psychological effects of having incurable disease

phase 3b (15 decks)

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