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Medical Finals 2020 > Urology > Flashcards

Urology Flashcards

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USMLE® Step 1 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
Q

How might kidney cancer present?

A

Flank pain
Haematuria
Palpable mass
May be found on incidental imaging

26
Q

What cells are usually involved in bladder cancers?

A 
Transitional cells (carcinomas account for 90% bladder tumours)
Squamous cell (metaplasia, carcinoma), can occur, schistomiasis is a risk)
27
Q

What does a ‘string of beads’ indicate on MR angiography?

A

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
Q

Give some potential causes of a bladder obstruction

A

Polycystic kidneys, ectopic kidneys, ureterocele, stricture
Tumours, radiation therapy, prostatitis
Trauma, AAA, pregnancy, BPH, lymphocoele

29
Q

What are common locations for renal stones?

A

Ureteropelvic junction
Vesicoureteric junction
Pelvic brim

30
Q

How might renal stones present symptom-wise?

A

Pain - colicky
Nausea or vomiting
Haematuria
Risk of sepsis with fever, tachycardia, low BP

31
Q

Give some differentials of colicky loin pain

A 
AAA
Pancreatitis
Renal stones
Gallstones
MSK
Pyelonephritis
32
Q

How are renal calculi treated?

A 
Supportively - most pass naturally
Analgesia - NSAIDs (Diclofenac)
Lithotripsy (ESWL)
Nephrectomy
IV Fluids
Smooth muscle relaxants (tamsulosin) CCB (nifedipine)
33
Q

What are the three types of urinary incontinence?

A

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
Q

What can you give in an overactive bladder?

A

Lifestyle change - caffeine reduction, bladder drill, reduced alcohol
Anti-cholinergic - Solifenacin
Botox - antiacetylcholine receptor blocker

35
Q

What is autonomic dysreflexia?

A

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
Q

Give some causes of haematuria

A 
Malignancy
Stones
Infection
Trauma
Renal artery disease
37
Q

What are risk factors for UTI?

A 
Elderly
Post-menopausal
Pregnancy
Sexual intercourse
Common in children
Catheterisation
Enlarged prostate
38
Q

What scale is used for prostate cancer?

A

Gleason

39
Q

What investigations are used in prostate cancer and which is most useful?

A

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
Q

Where does prostate cancer metastasise to?

A

Bone
Lung
Liver

41
Q

A patient presents with acute flank pain radiating to groin. What is your management?

A

Acute - IM diclofenac 75mg

Urgent surgical referal

42
Q

What investigation should be done on patients with renal stones?

A

Non-contrast CT KUB

43
Q

What urinary symptoms does BPH usually present with?

A

Weak or intermittant flow, straining, hesitancy
Urgency, frequency
Nocturia

44
Q

What are you management options for BPH?

A

Watchful waiting
A1A - tamsulosin
5ARI - finasteride

45
Q

What are some side effects of f-alpha-reductase inhibitors?

A

Erectile dysfunction, gynaecomastia, reduced libido

46
Q

What is a varicocele?

A

Mild ache, scrotum feels like ‘bag of worms’

Sign of malignancy due to renal vein compression

47
Q

Hydrocele feels like…?

A

Smooth, cystic lump

48
Q

Causes of hydronephrosis are…?

A

Unilateral - pelvic-ureteric obstruction (congenital or acquired), aberrant renal vessels, calculi, tumours

Bilateral - stenosis, urethral valve, prostatic enlargement, extensive bladder tumour, retroperitoneal fibrosis

49
Q

What should urinary flow rate be over?

A

14

50
Q

What is solifenacin and what is it used to treat?

A

An anticholinergic

Used for urgency and frequency and nocturia

51
Q

What is the most common kind of bladder cancer?

A

Transitional Cell

This cell type can be found from renal pelvis to proximal urethra

52
Q

What are risk factors for bladder cancer?

A

Smoking
Schistosomiasis
Radiation

53
Q

What are risk factors for testicular cancer?

A

Klinefelter’s syndrome
Family history
Male infertility
Cryptorchidism

54
Q

What tumour markers are tested for in testicular cancer?

A

Alpha fetoprotein

Beta-Human Chorionic Gonadotrophin

55
Q

What lymph node group is testicular cancer most likely to spread to?

A

Para-aortic nodes

56
Q

What kind of testicular cancer arises from all three embryonal layers?

A

Teratoma / Non-seminomatous germ cell tumour

57
Q

Does CKD lead to a high or low phosphate and what effects does this have?

A

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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