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Medicine finals > Urology > Flashcards

Urology Flashcards

1
Q

What is the most common type of renal cancer?

A

Renal clear cell carcinoma

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2
Q

What metastases are commonly associated with renal cell carcinoma?

A

Cannon ball mets in lungs

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3
Q

What is the clinical triad which is suggestive of renal cancer?

A

Haematuria
Loin pain
Abdominal mass

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4
Q

What are risk factors for the development of renal cancer?

A 
Smoking
Obesity
HTN
LT dialysis
Von-Hippel-Lindau disease
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5
Q

Why does renal cancer cause a varicocele?

A

Compression of the renal artery causes back pressure on there testicular vessels

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6
Q

What are the different subtypes of renal cancer?

A 
Clear cell
Papillary
Chromophobe
Collecting duct carcinoma
Wilms Tumour - children <5
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7
Q

How can renal cancer be managed?

A

Surgery - partial/radical nephrectomy

+/- chemotherapy/radiotherapy

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8
Q

What paraneoplastic features are associated with renal cancer?

A

Polycythaemia - RCC secretes EPO

Hypercalcaemia - RCC secretes a hormone which mimics PTH

Stauffer syndrome

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9
Q

What is Stauffer syndrome?

A

Abnormal LFTs indicating an obstructive jaundice without any localised hepatic/biliary metastasis

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10
Q

What are the two main types of bladder cancer?

A

90% transitional

10% squamous cell

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11
Q

What are the main risk factors for transitional cell?

A

Smoking
Aromatic amines
Polycyclic aromatic hydrocarbons
Arsenic

(Hair dye, industrial paint, rubber)

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12
Q

What are the main risk factors for squamous cell carcinoma of the bladder?

A

Smoking

Schistosomiasis

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13
Q

How do bladder cancers present?

A

Painless haematuria

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14
Q

How are bladder cancers diagnosed?

A

Cystoscopy and biospy

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15
Q

Following a neobladder reconstruction, what type of cancer are people most at risk of?

A

Adenocarcinoma

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16
Q

How can a bladder cancer that does not invade the muscle be treated?

A

Transurethral Resection of Bladder Tumour (TURBT)

Chemo into bladder

Weekly treatments of BCG vaccine into bladder via catheter for 6 weeks, then every 6 months for 3 years

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17
Q

How can a bladder cancer that invades into the detrusor muscle be managed?

A

Radical cystectomy with ileal conduits
Radiotherapy
Chemotherapy

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18
Q

What is BPH?

A

Hyperplasia of stromal and epithelial cells of the prostate

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19
Q

How should BPH be investigated?

A

Urine dipstick
PSA prior to DRE
DRE - size, shape, characteristics of prostate

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20
Q

How can BPH be managed?

A

Reassurance and monitoring

Meds:
alpha blockers - tamsulosin
5a reducase inhibitors - finasteride

Surgery:
TURP (transurethral resection of prostate)
Open prostatectomy via abdo/perineal

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21
Q

What is a TURP, and what complications are associated with a TURP?

A

Shave off part of the prostate to create a wider space for urine to flow

Bleeding
Infection
Incontinence
Retrograde ejaculation
Urethral strictures
Erectile dysfunction
Failure to resolve symptoms
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22
Q

What is TURP syndrome?

A

Irrigation fluid enters systemic circulation causing:

  1. Dilutional hyponatraemia
  2. Fluid overload
  3. Glycine toxicity
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23
Q

What can cause PSA levels to be elevated?

A 
BPH
Prostatis and UTI 
Ejaculation
Vigorous exercise
Urinary retention
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24
Q

What is the most common type of prostate cancer?

A

Adenocarcinoma

25
Q

How can BPH present?

A 
Lower Urinary Tract Symptoms (LUTS)
Hesitancy
Frequency
Dribbling
Incomplete voiding
Nocturia
26
Q

How can prostate cancer present?

A

Similar to BPH
+ Haematuria
+ Erectile dysfunction
+ General signs of cancer

27
Q

How might a malignant prostate feel on DRE?

A

Firm/hard
Asymmetrical
Craggy/irregular
Loss of central sulcus

28
Q

How is a prostate cancer graded?

A

Gleason Score - assess the most dominant and 2nd most dominant biopsies

Grade 1: well differentiated
Grade 2/3: moderately differentiated
Grade 4: poor differentiated
Grade 5: anaplastic

Gives an overall score out of 10

29
Q

How can prostate cancer be managed?

A

Watchful waiting

Radiotherapy

Brachytherapy - radioactive seeds implanted into prostate to deliver target, constant radiotherapy

Hormonal - block androgens to slow/stop growth of prostate cancer

  1. Bilateral orchidectomy - gold standard
  2. LHRH agonists - causes chemical castration
  3. Androgen receptor blockers

Surgery - total prostectomy

30
Q

What are complications of radical treatment of prostate cancer?

A

Erectile dysfunction
Urinary incontinence
Radiation induced enteropathy
Urethral strictures

31
Q

If starting a patient on anti-androgen therapy, what else needs to be co-prescribed and why?

A

Flutamide - a synthetic anti-androgen

Anti-androgen drugs cause a transient increase in symptoms of prostate cancer the ‘flare effect’ due to the initial increase in LH production prior to receptor down regulation

32
Q

What are causes of epididymo-orchitis?

A

E.coli
Chlamdyia trachomatis
Neisseria gonorrhoea
Mumps

33
Q

How does a patient present with epididymo-orchitis?

A 
Gradual onset over minutes/hours
Usually unilateral
Testicular pain/tenderness
Dragging/heavy sensation
Urethral discharge (chlamdyia/gonorrohea)
Tender on palpation 
Swelling of testicles and epididymus
Erythema to scrotum
34
Q

How should epididymo-orchitis be managed?

A 
Admit if septic
2 weeks Abx - ciprofloxacin
Tight underwear for scrotal support
Abstain from intercourse during illness
USS to exclude torsion and tumours
35
Q

Describe testicular torsion

A

Urological emergency
Sudden onset unilateral testicular pain
Often triggered by activity

36
Q

How long do you generally have to sort out a testicular torsion before the damage from ischaemia is irreversible?

A

6 hours

37
Q

What is a major complication of testicular torsion?

A

Sub-fertility

infertility

38
Q

What are the anticipated examination findings in a patient with testicular torsion?

A 
Acutely tender testicle 
Firm testicle
Absent cremastic reflex
Abnormal lie 
(Horizontal lie, epididymus not in normal posterior position, testicle may be retracted)
39
Q

What is a Bell-Clapper deformity?

A

Testicle should be fixed posteriorly to the tunica vaginalis
In bell-clapper deformity, the fixation is absent, so testicles can rotate within tunica
As the testicle rotates, it twists the vessels cutting off the blood supply

40
Q

How should a testicular torsion be managed?

A

Emergency urological review
Immediate surgical scrotal exploration
(untwist the testicle, fix both testicles in correct position - orchiplexy, orchidectomy if delayed surgery/necrotic tissue)

41
Q

Describe how a testicular cancer may feel

A 
Non-tender
Arises from testicle
Hard without fluctuance 
Doesn't transilluminate
Irregular

Commonly between 15-40

42
Q

What is a hydrocele?

A

Build up of fluid in tunica vaginalis

43
Q

How does a hydrocele feel?

A

Soft, fluctuant, transilluminates

Irreducible with no bowel sounds

44
Q

What side do hydroceles commonly present on?

A

Left side

45
Q

What is a varicoele?

A

Swollen pampiniform plexus

46
Q

How can a varicole present?

A

Dragging/sore

47
Q

Describe a epididymal cyst

A

Soft, fluctuant lump at top of testicle

48
Q

Describe how an inguinal hernia presents as a testicular lump

A

Separated from hernia
Can’t get above it
Bowel sounds
Reducible

49
Q

What are the main types of testicular cancer?

A

Seminoma (average age 25)

Teratoma (average age 35)

50
Q

What tumour markers can be used in testicular cancer?

A

AFP - raised in teratomas
beta-HCG - raised in termatomas and seminoma
Lactate dehydrogenase

51
Q

Where can a testicular cancer metastasis to?

A

Lymphatics
Lungs
Liver
Brain

52
Q

How is testicular cancer managed?

A

Orchidectomy +/- prosthesis
Chemo/radiotherapy
Monitor with tumour markers and imaging

53
Q

What organisms can be responsible for pyelonephritis?

A

E.coli
Klebsiella
Enterococcus
Pseudomonas

54
Q

How can pyelonephritis present?

A 
High fever + rigors
Loin to groin pain 
Dysuria and urinary frequency 
Haematuria
Pain on palpation of renal angle
55
Q

What might be seen on dipstick in a patient with pyelonephritis?

A

Haematuria
Proteinuria
Leucocytes
Nitrites

56
Q

How can pyelonephritis be investigated?

A

CT-KUB
MSSU - cultures
DMSA scan - assess for renal scarring

57
Q

How can pyelonephritis be managed?

A 
Blood and urinary cultures
Broad spectrum abx (co-amoxiclav) 
IVF
Analgesia
Anti-pyretics
58
Q

What can be the result of chronic pyelonephritis?

A

Scarring
Can cause CKD
Can cause abscess formation
? Prophylactic abx

Medicine finals (12 decks)

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