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Finals Revision > Urology > Flashcards

Urology Flashcards

1
Q

What is a staghorn calculus?

A

A stone in the renal pelvis and at least 2 of the calices

Usually a struvite stone

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2
Q

What is the risk of a second stone after the initial one?

A

50% chance

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3
Q

Risk factors for renal stones

A

High protein + salt diet, dehydration, age 20-50, gout, hyperparathyroidism, sarcoidosis, myeloproliferative disease, steroids, FH
Anatomy: horseshoe kidney, PUJO

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4
Q

What are the types of renal stones?

A 
75% Calcium
10-15% Struvite
5-10% Uric acid
1% Cystine
(Endevamir stones)
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5
Q

What type of stones do chemo patients mostly get?

A

Uric acid- tumour lysis syndrome

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6
Q

What is the most important differential of a renal stone presentation?

A

Ruptured AAA

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7
Q

What investigation is used to diagnose renal stones?

A

CTKUB

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8
Q

Management of renal stones

A

Conservative- analgesia, if <6mm 60% will pass spontaneously
Medical: urinary alkalination prevents formation of stones
Surgical: Stenting, lithotripsy, PCNL, ureteroscopy, radical nephrectomy

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9
Q

Indications for surgery in renal stones

A

AKI, unmanageable pain, UTI or other infection in tract, unlikely to pass

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10
Q

What is the best analgesia for ureteric colic?

A

PR Diclofenac

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11
Q

What are lower urinary tract syptoms?

A
  1. Storage Sx- frequency, urgency, nocturia

2. Voiding Sx- hesitancy, poor stream, intermittent stream, straining

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12
Q

Which of sympathetic and parasympathetic stimulation causes weeing and not weeing?

A 
Parasympathetic = Peeing (detrusor contraction)
Sympathetic = Stop peeing (detrusor relaxation)
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13
Q

What is Benign Prostatic Hyperplasia?

A

Hyperplasia of cells in transitional zone of prostate

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14
Q

Which nerve root does the parasympathetic supply to the bladder come from?

A

Pelvic nerve

S2-S4

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15
Q

Which receptors and neurotransmitters are involved in parasympathetic response of the bladder?

A

Acetylcholine release - works on M3 muscarinic Ach receptors

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16
Q

What is normal urine output?

A

> 0.5ml/kg/hr

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17
Q

Causes of urinary retention

A

BPH, Nerve dysfunction, Infection, Constipation, Drugs (anticholergics, antidepressants, opioids), Prolapse, Prostate/Bladder Ca, Meatal stenosis

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18
Q

Management of Urge incontinence

A 
Lifestyle- reduce caffeine, weight loss
Bladder training- 1st line
Anticholinergics- Oxybutinin, Tolterodine
Botulinum Toxin A
Surgery- augmentation cystoplasty
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19
Q

Which nerves does the Cauda Equina include?

A

L2-L5 + coccylgeal nerve

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20
Q

Red Flags for Cauda Equina syndrome?

A

Saddle/perineal anaesthesia
Incontinence/retention of urine/faeces
Reduced anal tone
Paralysis/loss of sensation lower limbs

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21
Q

Investigation of Cauda Equina syndrome

A

Urgent MRI

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22
Q

Name the 4 sections of the male urethra

A
  1. Prostatic
  2. Membranous
  3. Bulbar
  4. Penile
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23
Q

What are Lower Urinary Tract Symptoms?

A

Storage: urgency, daytime urinary frequency, nocturia, urinary incontinence, sensation of incomplete emptying
Voiding: hesitancy, weak or intermittent urinary stream, straining, incomplete emptying, terminal dribbling

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24
Q

What is found on PR examination in BPH?

A

Smooth enlarged prostate

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25
Q

Which parts of a urine dip are raised in a UTI?

A

Leukocytes, Nitrites, high pH, Blood

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26
Q

Management of BPH

A

Conservative: limit caffeine, pads for incontinence
Medical: Alpha blockers eg Tamsulosin/Doxazocin (relax prostate smooth muscle), 5-alpha reductase inhibitors- Finasteride (stop conversion of testosterone to stop hyperplasia of prostate)
Surgical: TURP- Transurethral resection of prostate

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27
Q

Risks of Transurethral resection of prostate (TURP)?

A

Bleeding, UTI, urinary incontinence, ED, injury to rectum, urethral strictures, lymphocele (cysts)
TURP syndrome

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28
Q

What is TURP syndrome?

A

Fluid overload and hyponatraemia from irrigation fluid absorbed through venous sinuses

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29
Q

Presentation of TURP syndrome

A

Respiratory distress, N&V, confusion, haemolysis, acute renal failure, reflex bradycardia

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30
Q

Management of TURP syndrome

A

Furosemide + Hypertonic saline

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31
Q

Where is ADH produced and stored?

A

Produced in hypothalamus

Stored in pituitary gland

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32
Q

Action of ADH

A

Increases water permeability in some places, allowing water reabsorption and concentration of urine
Increases urea permeability in inner medullary collecting duct
Increase of sodium absorption in ascending loop

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33
Q

Functions of the kidney

A
  1. Producing + concentrating urine
  2. Electrolyte regulation
  3. Renin production/BP regulation
  4. Erythropoeitin production
  5. Conversion of vitamin D to active hydroxylated form
  6. Acid-base regulation
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34
Q

What is normal plasma osmolality?

A

285-295

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35
Q

Equation for serum osmality

A

2 x (Na + K) + BUN/2.8 + Glucose/18

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36
Q

Functions of Angiotensin II

A

Arterioles- vasoconstriction
Kidney- stimulates Na+ reabsorption
Sympathetic nervous system: increased release of noradrenaline
Adrenal cortex: release of aldosterone
Hypothalamus: increased thirst + stimulates ADH release

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37
Q

Examples of ACE inhibitors

A

Ramipril
Lisinopril
Enalapril

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38
Q

Mechanism of action of ACE inhibitors

A

Inhibit ACE –> reduce Angiotensin II

  • Reduced alveolar resistance
  • Reduced arteriolar vasoconstriction
  • Reduced cardiac output
  • Increased sodium excretion in kidneys
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39
Q

Side effects of ACE inhibitors

A

Dry cough, hyperkalaemia, headache, dizziness, fatigue, renal impairment, angioedema

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40
Q

Causes of Urinary tract obstruction

A

Pregnancy, stones, BPH, prostate cancer, other tumours, polyps in ureter, anticholinergic drugs, spinal cord injury, strictures due to surgery, radiotherapy or drugs, ureterocele, abscesses, rectal impaction

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41
Q

What is a ‘Page Kidney’?

A

Systemic hypertension secondary to extrinsic compression of the kidney by a subcapsular collection eg haematoma, seroma, urinoma

  • -> reduced blood flow to renal parenchymal tissue and induction of renin secretion
  • -> RAAS activated
  • -> Hypertension
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42
Q

Main sign of Page Kidney

A

Hypertension

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43
Q

What is the nervous supply to the ureters?

A

Sympathetic- T10-L1

Parasympathetic- S2-S4

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44
Q

What is the most likely location of a ureteric stone?

A

Narrowest locations:

  1. Ureteropelvic junction
  2. Where ureter passes over pelvic brim
  3. Vesicoureteric junction
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45
Q

Complications of ureteric obstruction

A

Hydronephrosis- obstructed kidney
Pyonephrosis- infected obstructed kidney
Stones due to urinary stasis

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46
Q

Presentation of ureteric colic

A

Pain in loin/flank, radiates to testicles/labia due to T12-L1 innervation
N&V, haematuria, fever, sweats, dysuria, urinary frequency, straining

47
Q

What is the most common type and location of prostate cancer?

A

Adenocarcinoma in peripheral zone (transitional)

48
Q

Findings on DRE in prostate cancer

A

Prostate feels hard and craggy

49
Q

Investigations of prostate cancer

A

Raised PSA
Needle biopsy
CT/MRI

50
Q

What score is used for classifying prostate cancer?

A

Gleason score: histology of prostate cancer 1-5

51
Q

What are urinary stones made from?

A
  1. Calcium
  2. Uric acid
  3. Struvite
  4. Cysteine
52
Q

Management of Prostate cancer

A

T1-2: Active surveillance, radical prostatectomy, radical radiotherapy
T3-4: Androgen deprivation therapy, external beam radiotherapy

53
Q

What is Brachytherapy?

A

Places radioactive sources inside the patient to damage cancer cells DNA and their ability to grow and divide

54
Q

What is Androgen deprivation therapy?

A

Reduces testosterone
Surgical: bilateral orchidectomy
Medical: LHRH analogue eg Goserelin- down-regulation of LH receptors on testes –> stop producing testosterone

55
Q

How do you manage the initial surge in testosterone upon starting androgen deprivation therapy?

A

Give anti-androgen- Cyproterone citrate

56
Q

What is Pyelonephritis?

A

Infection of the renal cortex and medulla

57
Q

Aetiology of pyelonephritis

A

Ascending (from UTI) or Haematogenous (IVDU, endocarditis)

58
Q

What are the most common causative organisms of pyelonephritis?

A

E coli, Klebsiella, Proteus miribalis

59
Q

Presentation of Pyelonephritis

A

Loin pain, fever, rigors, N&V

Tenderness in renal angle

60
Q

What is found on urinalysis in Pyelonephritis?

A

Blood, protein, leukocytes

61
Q

Investigation of Pyelonephritis

A

Ultrasound KUB

62
Q

Management of Pylonephritis

A

Gentamicin IV (but nephrotoxic)

63
Q

Risk factors for Pyelonephritis

A

Vesicoureteric reflux, calculi, catheter, pregnancy, diabetes, primary biliary cirrhosis, immunocompromise, BPH

64
Q

Complications of Pyelonephritis

A

Sepsis, parenchyma renal scarring, recurrent UTIs, preterm labour in pregnancy

65
Q

What is pyonephrosis?

A

Pus in upper collection system of kidney

66
Q

Presentation of Pyonephrosis

A

Fever, flank pain

67
Q

Findings on USS of Pyonephrosis

A

Urinary tract obstruction
Dilatation of pelvicalyceal system
Echogenic debris in collecting system

68
Q

Management of Pyonephrosis

A

Emergency insertion of percutaneous nephrostomy

69
Q

Causes of raised PSA

A 
Prostate cancer
BPH
Prostatitis
UTI
Old age
TURP
Urinary catheterisation
Acute urinary retention
70
Q

Investigation in suspected Pyonephrosis

A

Ultrasound KUB

71
Q

Which 4 substances can urolithiasis be caused by?

A
  1. Calcium oxalate
  2. Calcium phosphate
  3. Urate
  4. Struvite
72
Q

Where do urinary stones tend to lodge?

A

Narrowings:

  1. PUJ
  2. Pelvic brim
  3. VUJ
73
Q

Presentation of Urolithiasis

A

Intense loin to groin pain, loin tenderness

Microscopic haematuria

74
Q

Investigations in Urolithiasis

A

Urine dipstick: microscopic haematuria
Blood calcium + urate levels
Abdo x-ray- 50% radio-opaque
CTKUB

75
Q

What % of stones can be seen on x-ray?

A

50% of stones radio-opaque

76
Q

Management of Urolithiasis

A

Stones < 7mm left to pass naturally

Surgery: Lithotripsy, Lithaloplaxy, Percutaneous nephrolithotomy

77
Q

Management of recurrent urate stones

A

Allopurinol

78
Q

Most common type of bladder cancer in UK

A

Transitional cell carcinoma

79
Q

Types of bladder cancer

A
  1. Transitional cell carcinoma
  2. Squamous cell carcinoma
  3. Adenocarcinoma
80
Q

Risk factors for bladder cancer

A

Age, smoking, male
TCC: exposure to aromatic amines
SCC: Schistosomiasis, long-term indwelling catheter, hx recurrent bladder stones

81
Q

Presentation of bladder cancer

A

Painless haematuria, acute urinary retention (clots stuck), urinary frequency, dysuria, suprapubic pain
Anaemia, palpable pelvic mass

82
Q

Investigations of bladder cancer

A

FBC for anaemia

Cystoscopy, CT/MRI

83
Q

Management of bladder cancer

A

Low-grade non-invasive: TURBT, intravesical mitomycin C chemo
High-grade invasive: radical cystectomy, lymphadenectomy, radical radiotherapy, chemotherapy

84
Q

Presentation of testicular torsion

A

Typically teenage boys
Acute, sudden onset testicular pain, hot swollen testicle, high-lying transverse testis
Absent cremasteric reflex

85
Q

Which reflex can be tested in suspected testicular torsion?

A

Cremasteric reflex- absent

Testicle retracted on stroking of the inner thigh

86
Q

Risk factors for testicular torsion

A

Often triggered by activity

‘Bell-Clapper’ deformity- testicle normally fixed by tunica vaginalis- fixation is absent

87
Q

Management of testicular torsion

A

Medical emergency- 6hr window after onset before ischaemia is irreversible
Urgent urological assessment
Immediate scrotal exploration, bilateral orchidopexy, orchidectomy

88
Q

Complications of testicular torsion

A

Subfertility

Psychological

89
Q

Presentation of testicular cancer

A

Non-tender irregular lump arising from testicle, hard without fluctuance/transillumination

90
Q

Typically age group for testicular cancer

A

Age 15-40

91
Q

How is testicular cancer diagnosed?

A

USS

92
Q

Tumour markers for testicular cancer

A

AFP- seminoma
BhCG- more in teratomas
Lactate dehydrogenase

93
Q

Management of testicular cancer

A

Orchidectomy/chemo/radiotherapy

94
Q

Types of testicular cancer

A

50% Teratoma

50% Seminoma

95
Q

What is an Epididymal cyst?

A

Smooth extratesticular spherical cysts in the head of the epididymus
Benign

96
Q

Average age for presentation with Epididymal cyst?

A

Age 40

97
Q

Presentation of Epididymal cyst

A

Well-defined, fluctuant lump which will transilluminate

Testis is palpable separate from cyst

98
Q

Investigation of Epididymal cyst

A

Scrotal USS

99
Q

Management of Epididymal cyst

A

Surgery if painful/big

100
Q

What is a Hydrocele?

A

Abnormal collection of fluid within the remnants of the processus vaginalis

101
Q

Types of Hydrocele

A

Simple
Communicating
Non-communicating

102
Q

Causes of a simple Hydrocele in older people

A

Trauma, testicular torsion, varicocele, testicular tumour

103
Q

Prognosis of simple Hydrocele

A

Usually disappears within 1-2yrs if neonatal

104
Q

What is a communicating Hydrocele?

A

Persistence of the processus vaginalis –> free flow of peritoneal fluid

105
Q

What is a non-communicating Hydrocele?

A

Excessive production of fluid within processus vaginalis

106
Q

Presentation of Hydrocele

A

Scrotal enlargement with non-tender smooth cystic swelling

Lies anterior + below testis, will transilluminate

107
Q

Investigation of Hydrocele

A

USS if unsure

108
Q

Management of Hydrocele

A

Observation if < 2yrs old
Therapeutic aspiration if large
Surgical removal

109
Q

What is a Varicocele?

A

Abnormal dilatation of testicular veins in panpiniform plexus

110
Q

On which side is Varicocele more common?

A

Left

111
Q

Presentation of Varicocele

A

Usually asymptomatic
Testis feels like a ‘bag of worms’
Poor sperm production + reduced semen quality –> infertility

112
Q

Investigation of Varicocele

A

Colour doppler studies

Sperm count

113
Q

Management of Varicocele

A

Surgery if pain/infertility

Finals Revision (13 decks)

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