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Medical Finals 2020 > Urology > Flashcards

Urology Flashcards

1
Q

What antibiotics do you use for prostatitis?

A

First line - flourquinolones (ciprofloxacin)

Second line - trimethoprim-sulfamethoxazole

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2
Q

What are some common bacterial causes of prostatitis?

A

Gram negative - e.coli, enterobacter, pseudomonas, proteus, STIs

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3
Q

How might prostatitis present?

A

Acutely - very unwell patient with fever, malaise, arthralgia
Lower back pain
Urinary symptoms - frequency, urgency, dysuria, nocturia, hesitancy

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4
Q

What findings may occur on examination in prostatitis?

A

Prostate may feel boggy, normal or nodular. It may be tender on palpation or hot to touch.

Diagnosis is made on urine culture and microscopy - bacterial growth and WBC, lipid-laden macrophages and oval fat bodies under microscope.

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5
Q

What are some differentials for lower back pain, fever and urinary symptoms?

A
  • prostatitis
  • BPH
  • urinary tract stones
  • foreign body in urinary tract
  • bladder cancer
  • prostatic abscess
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6
Q

What investigation is used for hydronephrosis?

A

Ultrasound

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7
Q

What are some potential causes of hydronephrosis?

A
  • pelvic ureteric obstruction
  • abhorrent vessels
  • calculi
  • tumours
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8
Q

What can cause painful testicular problems?

A
  • testicular torsion

- orchitis

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9
Q

What is variocele?

A

Fluid collection in the testicles

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10
Q

How do you determine a hernia?

A

Ask the patient to cough

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11
Q

A patient presents with a smooth lump in the testes. What is a possible cause?

A

Epididymal cyst

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12
Q

Recurrent UTIs could be a sign of….?

A

Bladder cancer

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13
Q

Where does a bladder cancer metastasise to?

A

Liver
Lung
Adrenals

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14
Q

What investigation do you do for prostate cancer?

A

Transrectal ultrasound guided biopsy

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15
Q

What are some potential complications of TRUS?

A

Retention

Incontinence

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16
Q

What is your medical management in prostate cancer?

A

1 - antiandrogens (tamoxifen)

2 - LHRH agonists

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17
Q

What is soldenafil?

A

Phosphodiasterase inhibitor

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18
Q

What are the 3 symptoms for filling, voiding and post-micturation?

A

Filling - urgency, nocturia, frequency
Voiding - hesitancy/intermittancy, straining, weak stream
Post-micturation - dribbling, incomplete emptying

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19
Q

What are the 4 types of renal stones?

A 
Calcium oxalate
Cystine
Uric Acid
Calcium phosphate
Struvite
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20
Q

Which renal stones are seen on x-ray?

A 
Uric acid - radiolucent
Struvite - slightly radio-opaque
Calcium phosphate - radio-opaque
Calcium oxalate - radio-opaque
Cysteine - radiodense
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21
Q 
Give key features of each of these types of renal stone.
Calcium oxalate
Cystine
Uric Acid
Calcium phosphate
Struvite
A

Calcium oxalate - hypercalcuria is a risk
Cystine - inherited recessive disorder, multiple may form
Uric Acid - low urinary pH, can be caused by tissue breakdown
Calcium phosphate - high urinary pH, renal tubular acidosis association
Struvite - Mg, ammonium, phosphate, chronic infections

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22
Q

Post-renal AKI is managed how?

A

Continuous bladder irrigation
There is an obstruction to the bladder outlet causing the AKI, so the first line management is to relieve the obstruction

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23
Q

Give 5 risk factors in renal cancers

A 
Smoking
Obesity
Heavy metals
PCKD
Hypertension
24
Q

What classification is used to describe renal malignancies?

A

Bosniak classification

25
How might kidney cancer present?
Flank pain Haematuria Palpable mass May be found on incidental imaging
26
What cells are usually involved in bladder cancers?
``` Transitional cells (carcinomas account for 90% bladder tumours) Squamous cell (metaplasia, carcinoma), can occur, schistomiasis is a risk) ```
27
What does a 'string of beads' indicate on MR angiography?
Fibromuscular dysplasia Proliferation of cells in the walls of the artery Causes vessels to bulge or narrow, can cause an acute AKI after the start of an ACE-i
28
Give some potential causes of a bladder obstruction
Polycystic kidneys, ectopic kidneys, ureterocele, stricture Tumours, radiation therapy, prostatitis Trauma, AAA, pregnancy, BPH, lymphocoele
29
What are common locations for renal stones?
Ureteropelvic junction Vesicoureteric junction Pelvic brim
30
How might renal stones present symptom-wise?
Pain - colicky Nausea or vomiting Haematuria Risk of sepsis with fever, tachycardia, low BP
31
Give some differentials of colicky loin pain
``` AAA Pancreatitis Renal stones Gallstones MSK Pyelonephritis ```
32
How are renal calculi treated?
``` Supportively - most pass naturally Analgesia - NSAIDs (Diclofenac) Lithotripsy (ESWL) Nephrectomy IV Fluids Smooth muscle relaxants (tamsulosin) CCB (nifedipine) ```
33
What are the three types of urinary incontinence?
Urgency incontinence - an urgent desire to voice Stress incontinence - coughing or straining association, common in pelvic floor problems Mixed incontinence - stress and urgency combination Overflow - full bladder Continuous - fistula
34
What can you give in an overactive bladder?
Lifestyle change - caffeine reduction, bladder drill, reduced alcohol Anti-cholinergic - Solifenacin Botox - antiacetylcholine receptor blocker
35
What is autonomic dysreflexia?
Occurs in nerve lesions below T6 A painful stimuli to the sympathetic nervous system causes bradycardia, high blood pressure but has no feedback to stop it Causes headaches, flushing, strokes and requires reversal with GTN spray
36
Give some causes of haematuria
``` Malignancy Stones Infection Trauma Renal artery disease ```
37
What are risk factors for UTI?
``` Elderly Post-menopausal Pregnancy Sexual intercourse Common in children Catheterisation Enlarged prostate ```
38
What scale is used for prostate cancer?
Gleason
39
What investigations are used in prostate cancer and which is most useful?
Prostate-Specific Antigen (PSA) - not specific, rises with BPE, UTI, prostatitis DRE (Digital Rectal Examination) - PR - prostate feels hard and craggy Transrectal Ultrasound-Guided Needle Biopsy - diagnostic, usually only done if symptomatic
40
Where does prostate cancer metastasise to?
Bone Lung Liver
41
A patient presents with acute flank pain radiating to groin. What is your management?
Acute - IM diclofenac 75mg | Urgent surgical referal
42
What investigation should be done on patients with renal stones?
Non-contrast CT KUB
43
What urinary symptoms does BPH usually present with?
Weak or intermittant flow, straining, hesitancy Urgency, frequency Nocturia
44
What are you management options for BPH?
Watchful waiting A1A - tamsulosin 5ARI - finasteride
45
What are some side effects of f-alpha-reductase inhibitors?
Erectile dysfunction, gynaecomastia, reduced libido
46
What is a varicocele?
Mild ache, scrotum feels like 'bag of worms' | Sign of malignancy due to renal vein compression
47
Hydrocele feels like...?
Smooth, cystic lump
48
Causes of hydronephrosis are...?
Unilateral - pelvic-ureteric obstruction (congenital or acquired), aberrant renal vessels, calculi, tumours Bilateral - stenosis, urethral valve, prostatic enlargement, extensive bladder tumour, retroperitoneal fibrosis
49
What should urinary flow rate be over?
14
50
What is solifenacin and what is it used to treat?
An anticholinergic | Used for urgency and frequency and nocturia
51
What is the most common kind of bladder cancer?
Transitional Cell This cell type can be found from renal pelvis to proximal urethra
52
What are risk factors for bladder cancer?
Smoking Schistosomiasis Radiation
53
What are risk factors for testicular cancer?
Klinefelter's syndrome Family history Male infertility Cryptorchidism
54
What tumour markers are tested for in testicular cancer?
Alpha fetoprotein | Beta-Human Chorionic Gonadotrophin
55
What lymph node group is testicular cancer most likely to spread to?
Para-aortic nodes
56
What kind of testicular cancer arises from all three embryonal layers?
Teratoma / Non-seminomatous germ cell tumour
57
Does CKD lead to a high or low phosphate and what effects does this have?
High phosphate, leads to increase in calcium being ‘dragged’ from the bone, results in osteomalacia, lack of vitamin D Secondary parathyroidism – low calcium and high phosphate and low vitamin D

Medical Finals 2020 (25 decks)

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