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Surg > Urology > Flashcards

Urology Flashcards

1
Q

What is the sympathetic nerve that innervates the external urethral sphincter?

A

Hypogastric

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2
Q

What is the voluntary nerve that innervates the external urethral sphincter?

A

Pudendal

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3
Q

What is the parasympathetic nerve that innervates the bladder?

A

Pelvic

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4
Q

What is the most common type of renal cancer?

A

Clear cell carcinoma (75%)

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5
Q

What is the most common type of bladder cancer?

A

Transitional cell/ urothelial cancer (90%)

Can be papilary/ solid

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6
Q

________________ carcinoma is the second most common type of bladder cancer and is usually invasive, and more common where schistosomiasis is widespread.

A

Squamous cell carcinoma

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7
Q

What is the most common type of prostate cancer?

A

Acinar adenocarcinoma

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8
Q

Which region of the prostate is most commonly affected by cancer?

A

Peripheral zone

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9
Q

Nitrofurantoin should only be used for UTI if the patient’s eGFR is above ____.

A

30

avoid or use with caution if below 45

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10
Q

A Tis bladder tumour means…..

A

Bladder carcinoma in situ

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11
Q

A Ta bladder tumour means….

A

Bladder carcinoma confined to epitheliium

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12
Q

A T1 bladder tumour means….

A

Bladder carcinoma in submucosa or lamina propria

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13
Q

A T3 bladder tumour means….

A

Bladder carcinoma extends into perivesical fat

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14
Q

A T4 bladder tumour means….

A

Bladder carcinoma has invaded adjacent organs

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15
Q

What are the treatment options for non-invasive bladder cancer (Tis-T1)?

A
  1. TURBT- Transurethral resection of bladder tumour
  2. Intravesical BCG
  3. Intravesical mitomycin
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16
Q

What are the treatment options for invasive bladder cancer (T2-T3)?

A
  1. Neoadjuvant/ adjuvant chemo (cisplatin)
  2. Radiotherapy
  3. Radical cystectomy
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17
Q

Which lymph nodes do bladder cancer spread to?

A

Iliac nodes

Para-aortic nodes

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18
Q

When spreading haematogenously where does bladder cancer usually spread to?

A
  1. Liver

2. Lungs

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19
Q

What is the first line scan for diagnosing/ staging prostate cancer?

A

MRI

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20
Q

___________ is acute inflammation of the foreskin and glans, and is associated with staph and strep infections, and diabetes.

A

Balanitis

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21
Q

________ is when the foreskin occludes the meatus, and can cause balanitis.

A

Phimosis

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22
Q

________ occurs when a tight foreskin is retracted and then cannot be replaced over the glans. This prevents venous return, leading to oedema and potential ischemia of the glans.

A

Paraphimosis

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23
Q

Do nephritic conditions usually have proteinuria or haematuria?

A

Haematuria

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24
Q

Do nephrotic conditions usually have proteinuria or haematuria?

A

Proteinuria

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25
Q

What triad of features are present in nephrotic syndromes?

A
  1. Proteinuria
  2. Hypoalbuminaemia
  3. Oedema
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26
Q

Which renal artery crosses the IVC?

A

Right renal artery

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27
Q

Name 4 or more causes of haematuria.

A
  1. Malignancy- bladder, renal, ureters
  2. UTI
  3. Renal calculi
  4. Glomerulonephritis
  5. Inflammation eg. BPH
  6. Polycystic kidney disease
  7. Drugs eg. Cyclophosphamide
  8. Sickle cell disease
  9. Trauma
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28
Q

Name 2 examples of nephritic syndromes.

A
  1. Post infectious eg. post Strep glomerulonephritis
  2. Immune complex mediated eg. IgA nephropathy
  3. Goodpasture’s syndrome
  4. ANCA associated nephropathy
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29
Q

Alport syndrome is an ____ linked inherited renal disorder, caused by a mutation in the gene for type 4 collagen. Features include haematuria, proteinuria, renal failure, sensorineural hearing loss and anterior lenticonus.

A

X linked

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30
Q

If the RBCs in haematuria are isomorphic what does this suggest about the source of the bleeding?

A

Isomorphic-suggests non glomerular source eg. GU tract or external source

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31
Q

If the RBCs in haematuria are dysmorphic what does this suggest about the source of the bleeding?

A

Dysmorphic- suggests glomerulus as source.

Management: USS and potential renal biopsy

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32
Q

If isomorphic RBCs are found in haemturia how should the patient be managed?

A
  1. Flexible cystoscopy
  2. Ultrasound scan
  3. CT scan
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33
Q

_______ are cylindrical bodies made of Tamm-Horsfall protein that are seen on urine microscopy, and form in the DCT. They can be made of RBCs, WBCS or granular.

A

Casts

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34
Q

“Spikes” on silver stain microscopy and a thickening GBM with IgG deposits are suggestive of which type of nephrotic syndrome?

A

Membranous nephropathy

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35
Q

Name 3 or more causes of proteinuria.

A
  1. Glomerular causes- Minimal change disease, membranous nephropathy, Focal segmental glomerulosclerosis
  2. Diabetes
  3. Amyloidosis
  4. SLE/ Lupus nephritis
  5. Myeloma
  6. Eclampsia in pregnancy
  7. CCF
36
Q

The commonest Glomerulonephritis in developed countries is…..

A

IgA nephropathy

37
Q

What are the 4 main features of acute nephritis?

A
  1. Haematuria
  2. Oliguria
  3. Oedema
  4. Hypertension
38
Q

Electron microscopy shows fusion of podocyte foot processes in which type of glomerulonephritis?

A

Minimal change disease

39
Q

Name 1 cause of minimal change disease (nephrotic syndrome).

A
  1. Idiopathic
  2. Drugs- NSAIDs or Lithium
  3. Hodkin’s lymphoma
40
Q

In nephrotic syndrome the proteinuria will be >____g/24hr. (ACR > ___)

A

> 3g/24hr

ACR > 350

41
Q

In nephrotic syndrome the hypoalbuminaemia will be

A

<30g/l

42
Q

Mirabegron is a Beta3 agonist used to treat….

A

Overactive bladder

43
Q

What are the 7 categories/ questions on the IPSS (International Prostate Symptoms Score)?

A
  1. Incomplete emptying
  2. Frequency
  3. Intermittency
  4. Urgency
  5. Weak stream
  6. Straining
  7. Nocturia
44
Q

A score of up to 7 on the IPSS (International Prostate Symptoms) score is considered _______ symptomatic.

A

Mildly symptomatic.

45
Q

Normal peak urinary flow rate is approx ___mls/sec.

A

15mls/sec

46
Q

Which zone of the prostate is enlarged in BPH?

A

Transitional (inner) zone

47
Q

Oxybutynin, Solifenacin and Tolterodine are ___________ drugs used as 1st line pharmacological therapy to treat ____________.

A

Antimuscarinic/ anticholinergic

Overactive bladder/ Urge incontinence

48
Q

Which type of urinary incontinence is usually caused by an incompetent urethral sphincter?

A

Stress incontinence

49
Q

What class of drug is Duloxetine, which can be used for stress incontinence?

A

SNRI

50
Q

Which drugs are used in the MVAC regimen for bladder cancer?

A

Methotrexate
Vinblastine
Adriamycin (Doxorubicin)
Cisplatin

51
Q

Name 3 treatment options for non-muscle invasive bladder cancer.

A
  1. TURBT
  2. Intravesical BCG
  3. Intravesical Mitomycin
52
Q

Name 3 treatment options for muscle invasive bladder cancer.

A
  1. Radical cystectomy
  2. Chemotherapy (eg. Cisplatin, Gemcitabine, MVAC)
  3. Radiotherapy
53
Q

Adults age ___yrs and over with VISIBLE haematuria and no UTI/treated UTI should be referred to haematuria clinic under the 2 week wait.

A

45 years

54
Q

Adults age ___yrs and over with NON-VISIBLE haematuria and raised WCC/dysuria should be referred to haematuria clinic under the 2 week wait.

A

60 years

55
Q

Does a CT Urogram involve contrast?

A

Yes

56
Q

Does a CT scan to investigate renal calculi usually involve contrast?

A

No

57
Q

What should be done as first line investigation for diagnosing prostate cancer; MRI scan or TRUS biopsy?

A

MRI

58
Q

List 2 or more sider effects/risks of TRUS biopsy for investigating prostate cancer.

A
  1. Rectal bleeding
  2. Sepsis
  3. Haematuria
  4. Urine retention
  5. Blood in semen
  6. Fever
  7. Pain
59
Q

A separate and cystic testicular swelling is most likely to be…..

A

Epididymal cyst

60
Q

A testicular and cystic testicular swelling is most likely to be…..

A

Hydrocele

61
Q

A testicular and solid testicular swelling is most likely to be…..

A

Tumour
Haematocele
Orchitis

62
Q

A separate and solid testicular swelling is most likely to be…..

A

Epididymitis/ Varicocele

63
Q

Varicoceles usually affect which testes?

A

Left

64
Q

A varicocele may be a presenting feature of which type of cancer?

A

Renal cell carcinoma

65
Q

What is the most common malignancy in men age 20-30yrs?

A

Testicular cancer

66
Q

________ are the most common type of testicular cancer and typically present in patients around age 35yrs.

A

Seminomas

67
Q

Alpha fetoprotein (AFP) and _____ tumour markers may be present in Non seminomatous germ cell tumours (teratomas and yolk sac tumours).

A

hCG

68
Q

Name 2 or more risk factors for testicular cancer.

A
  1. Undescended testes
  2. Klinefelter syndrome
  3. Infant hernia
  4. Family history
  5. Mumps orchitis
  6. Infertility
69
Q

Bell Clapper deformity increases the risk of which urological condition?

A

Testicular torsion

70
Q

Post TURP syndrome is a rare and life threatening complication of transurethral resection of the prostate, characterised by ___ temperature and ___ sodium levels.

A

Low temp

Low sodium

71
Q

The failure rate of male vasectomy is around 1 per _____ patients.

A

1/2000

72
Q

Around 33% of men with PSA 4-10 will have prostate cancer, and ___% of men with PSA of 10-20 will have cancer.

A

60%

73
Q

The classic triad below are features of which type of cancer?

  1. Haematuria
  2. Loin pain
  3. Abdominal mass
A

Renal cancer

74
Q

90-95% of urinary tract stones sized ___mm or less will pass spontaneously, and patients should be encouraged to increase fluid intake.

A

5mm or less

75
Q

Which category of analgesia are recommended in initial management of renal colic/ stones?

A

NSAIDs eg. Diclofenac

76
Q

Ureteroscopy is used to manage renal calculi in which patient group?

A

Pregnant women

77
Q

Around 80% of renal stones are made of calcium ________.

A

Oxalate

78
Q

If a renal stone is radiolucent (not visible on Xray) it is most likely to be made of which of the following?

Calcium oxolate
Calcium phosphate
Struvite
Urate

A

Urate

79
Q

Which of the surgeries below is suitable for most non complex renal stones?

Shock wave lithotripsy
Ureteroscopy
Percutaneous nephrolithotomy

A

Shock wave lithotripsy

80
Q

Name 1 cause of ACUTE urine retention.

A
  1. BPH
  2. Urethral stricture
  3. Blood clot
  4. Post surgery
  5. Constipation
  6. Cauda equina
  7. Anticholinergics
  8. Urinary calculi
81
Q

Name 1 cause of CHRONIC urine retention.

A
  1. Prostatic enlargement
  2. MS
  3. Pelvic mass/ tumour
  4. Diabetes
82
Q

Which organism usually causes acute bacterial prostatitis?

A

E coli

83
Q

Which of the following treatments is used 1st line for stress incontinence?

a-Duloxetine
b- Anticholinergics eg. Oxbutynin, Solifenacin
c- Botox injections
d- Pelvic floor exercises

A

Pelvic floor exercises

84
Q

Name 1 side effect of alpha blockers eg. Tamsulosin used for BPH.

A
  1. Hypotension/ postural hypotension
  2. Drowsiness
  3. Dry mouth
  4. Extra pyramidal signs
  5. Ejaculatory failure
85
Q

What does the appearance of “muddy brown” granular casts on urine microscopy suggest?

a- Glomerulonephritis
b- Acute tubular necrosis
c- Vasculitis

A

Acute tubular necrosis

86
Q

What is the most common type of urethral rupture in men; Membranous rupture or bulbar rupture?

A

Bulbar rupture

Occurs due to straddle type injury eg. Bicycles.

Surg (6 decks)

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