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Finals > Urology > Flashcards

Urology Flashcards

1
Q

What is BPH?

Which areas enlarge?

A

Benign, nodular or diffuse proliferation of musculofibrous and glandular layers of the prostate

Enlarged inner TZ

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2
Q

LUTS from BPH are caused by what 2 components?

A

Static - increased tissue bulk –> narrow urethral lumen

Dynamic –> prostate smooth muscle tone increased

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3
Q

What are LUTS?

A

Storage = FUN
Frequency, urgency, nocturia

Voiding = HIP
Hesitancy, incomplete emptying, poor-flow

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4
Q

Ix in BPH?

A

DRE, TRUSS +/- biopsy, PSA

Urinalysis, USS KUB

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5
Q

Scoring system for BPH?

A

IPSS - International prostate symptom score (/35)

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6
Q

Behavioural mx for BPH?

A

Avoid caffeine, alcohol
Void twice
Bladder training
Limit fuilds

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7
Q

Mx in BPH?

A

W+W

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8
Q

Pharma mx in BPH?

A

Alpha-blocker (tamsulosin, doxazosin)

5-alpha reductase inhibitor (finasteride)

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9
Q

Mechanism of alpha-blocker?

SEs?

A

Smooth muscle relaxation

Post hypo, dry mouth

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10
Q

Mechanism of 5-a reductase inhibitors?

A

Reduced conversion of testosterone to dihydrotestosterone

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11
Q

Mx of abnormal DRE / PSA?

A

Surgical referral

If prostate small - TURP / TUVP

If big - open prostatectomy

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12
Q

Comps of BPH

A

Progression
Sexual dysfunction
Urinary retention
TURP

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13
Q

Causes of urinary retention?

A 
BPH / Ca
Calculi
Bladder cancer
Faecal impaction
Infection
Anticholinergics
Alcohol
Neurological
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14
Q

Ix in acute urinary retention?

A 
USS bladder (post-voidal)
Urinalysis
CT abdo pelvis
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15
Q

Mx of acute urinary retention

A

Immediate bladder decompression –> catheter

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16
Q

What type of Ca is prostate?

A

adenocarcinoma

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17
Q

Spread of prostate cancer?

A

Haematogenous [bone, lung, liver]

Local [seminal vesicles, bladder, rectum]

Lymph nodes

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18
Q

Prostate Ca grading?

A

Gleason score [level of differentiation]

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19
Q

Screening for prostate Ca?

A

PSA

look this up*

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20
Q

Pres of prostate Ca?

A

LUTS, haematuria

if mets –> bone pain, wt loss, anorexia, lethargy

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21
Q

Ix in prostate cancer?

A

PSA
DRE
TRUSS + biopsy
MRI / CT for staging

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22
Q

Mx for prostate Ca?

A

Radiotherapy (external or brachy)

Prostatectomy

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23
Q

Mx of mets in prostate Ca?

A

Androgen deprivation therapy –> goserelin, castration
Bisphosphonates
Palliative radio

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24
Q

Usual ca in bladder?

A

Transitional cell carcinoma (90%)

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25
Q

RFs for bladder Ca?

A

Smoking
Occupational (rubber + dye)
Age
HNPCC

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26
Q

Ix in bladder ca?

A

Urine dip, MC+S
KUB USS
Cystoscopy
CT urogram

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27
Q

Comps of bladder ca?

A

Hydronephrosis
Spread
Retention
Recurrence

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28
Q

Mx of bladder ca?

A

Cystectomy + chemo

29
Q

Causes of haematuria?

A 
UTI
Warfarin
Coagulopathy
Menstruation contamination
Pyelonephritis
Trauma

Stones
Malignancy
BPH

30
Q

Ix in haematuria?

A

Urine dip, MC+S
DRE
Bloods [FBC, coag, PSA]
Imaging [USS KUB,

31
Q

Causes of UTI?

A

E.coli

Staph. saprophyticus

32
Q

Abx in UTI?

A

Women –> Trimethoprim/nitrofurantoin

Men –> ciprofloxacin

33
Q

When is UTI complicated?

A 
Functional impairment
Structural impairment
Kidney involved
Pregnancy
Catheter
Immunosuppressed
34
Q

Complicated hospital admission UTI mx?

A

IV gentamicin

35
Q

Prostatitis causative organism?

A

E. coli

36
Q

o/e prostatitis?

A

Warm, soft, exquisitely boggy

37
Q

ix in prostatitis?

A

Urinalysis, MC+S
PSA
STI screen
TRUSS

38
Q

Mx of prostatitis?

A

Ciprofloxacin + NSAID + relieve obstruction

39
Q

Urethritis cause?

A

Post unprotected sex –> N. gonorrhoea, C. trachomatis

40
Q

If urethritis untreated?

A

Reactive arthritis, meningitis, IE

41
Q

DDx in epididymo-orchitis that you must r/o!

A

torsion

42
Q

ix in epididymo orchitis

A

USS

First catch urine for NAAT + gram stain

43
Q

Mx of epididymo orchitis?

A

STI - Ceftriaxone IM + doxycycline

UTI - levofloxacin

44
Q

Most common types of renal stone?

A

Calcium oxalate

45
Q

Ix for nephrolithiasis?

A 
NCCT
Urinalysis
FBC (?infection)
U+Es
KUB USS
46
Q

Mx of nephrolithiasis?

A

Medical [Hydration, Pain relief, Anti emetic]

Surgical [ESWL, nephrostolithotomy]

47
Q 
Epididymal cyst
Pres?
Ix?
Assos w?
Mx?
A

Small painless cyst, b/l

USS - transilluminates

CF

Benign, needs no mx

48
Q

Varicocele?
Pres?
Ix?
Mx?

A

Abnormal dilation of internal spermatic veins and pampniform plexus

Painless mass ‘bag of worms’

Examination, USS

Reassurance, if large –> surgery

49
Q

Hydrocele?
Pres?
Ix?
Mx?

A

Collection of serous fluid between layers of tunica vaginalis/spermatic cord

Testicular swelling, enlarged post activity. Not separate to testis and will transilluminate.

USS

W+W

50
Q

Testicular Ca?
Pres?
Ix?
Mx?

A

Seminoma (30-65yo) Teratoma (20-30yo)

Painless nodule. Haemospermia.

BALUC
B-HCG
AFP
LDH
USS
CT

Radical orchidectomy +/- chemo / radio

51
Q

Mx of stress incontinence?

A

Pelvic floor
Physio
Surgery
Sling (TVT, TOT)

Male –> artificial sphincter, male sling

52
Q

Mx of urge incontinence?

A

Behavioural [F/V chart, avoid caffeine + alcohol]

Drugs [antichoinergics (oxybutinin), B3 agonists (mirabegron), botulinum toxin]

Bladder augmentation [detrusor myectomy, cystoplasty (from small bowel)]

53
Q

Neurogenic bladder
Pathophys?
Leads to..?
Pres?

A

Peripheral nerve/spinal nerve damage at S2-4
Leads to hypotonic bladder; high residual volume, predisposes to infection and overflow

Overflow incontinence (can be flaccid or spastic); increased UTI + calculi; hydronephrosis

54
Q

Aims of mx of neurogenic bladder?

A

Bladder safety –> protect the kidneys
Continence control
Preserve body image

55
Q

Complications of transurethral resection of prostate?

A

TURP

TUR syndrome
Urethral stricture/UTI
Retrograde ejaculation
Perforation of prostate

56
Q

Features of TUR sydnrome?

A

Hyponatraemia: dilutional
Fluid overload
Glycine toxicity

57
Q

How does rhabdomyolysis cause AKI?

A

Acute tubular necrosis

58
Q

Causes of raised PSA?

A

BPH / Ca
Prostatitis / UTI
Ejaculation
Urinary retention

59
Q

Gold standard ix for stones?

A

Non-contrast CT

60
Q

Gold standard ix for bladder Ca?

A

flexible cystoscopy

61
Q

Mx of acute upper urinary tract obstruction due to stone?

A

Nephrostomy

ESWL for smaller stones

62
Q

Causes of hydronephrosis?
u/l
b/l

A

Uni - PACT [Pelvic uereteric obstruction, Aberrant renal vessels, Calculi, Tumours]

Bilat - SUPER [Stenosis of urethra, Urethral valve, Prostatic enlartgement, Extensive bladder tumour, Retro-peritoneal fibrosis]

63
Q

Mx of chronic urinary tract obstruction?

A

Ureteric stent or pyeloplasty

64
Q

RCC usual pres?

Paraneoplastic features?

A

Haematuria

HTN + polycythaemia

65
Q

Nephroblastoma vs neuroblastoma on imaging?

A

Neuroblastoma is usually calcified

66
Q

CI to circumcision?

A

Hypospadias

67
Q

Most common renal malignancy?

A

Renal adenocarcinoma

68
Q

DDx of testicular torsion?

What test can you do o/e to differentiate?

A

Torsion of testicular appendage –> cremasteric reflex is preserved when torsion affects the appendage ONLY

Finals (20 decks)

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