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Phase II Surgery > Urology > Flashcards

Urology Flashcards

1
Q

What is the most likely causative organism(s) in epidiymitis?

A

E.coli in older males, especially those with a history of BPH.
Neisseria gonorrhoea and chlamydia trachomatis are the most likely cause in younger men.

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2
Q

Which testicular problem is closely associated with a viral mumps infection?

A

Orchitis

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3
Q

What symptoms are common in a patient with a UTI?

A 
Dysuria
Frequency
Urgency
Cloudy or offensive smelling urine
Haematuria
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4
Q

What symptoms are typical of urinary obstruction (stone, tumour, BPH etc.)?

A 
Hesitancy
Weak flow
Post-micturition dribbling
Incomplete emptying of bladder
Sometimes haematuria
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5
Q

What pain relief is most effective for ureteric colic?

A

NSAIDs e.g. Diclofenac - effective in reducing oedema and reducing ureteric smooth muscle stimulation.
Often given PR

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6
Q

List some risk factors for ureteric stones.

A 
Dehydration
Family history
Previous stone
Hypertension
Metabolic disorders e.g. Problems with calcium
Increased BMI
Anatomical abnormalities of kidney
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7
Q

What are some possible points of obstruction for ureteric stones?

A

PUJ
Pelvic brim (as ureter crosses common iliac artery)
VUJ

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8
Q

Name some situations where you don’t wait for a ureteric stone to pass and need to admit the patient and surgically remove the stone.

A

Uncontrolled pain
Infected obstructed system
Bilateral obstruction
Solitary kidney

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9
Q

What is clot retention?

A

When large clots can become wedged in the urinary tract and cause acute urinary retention, occurs as a result of bleeding in the urological tract. Treatment involves a 3-way catheter with irrigation.

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10
Q

Name some non-malignant causes of a raised PSA

A 
Older age
BPH/enlarged prostate
Prostatitis
UTI
Ejaculation
Vigorous exercise
(DRE has only minimal effect on PSA, so you can do a PSA test after DRE).
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11
Q

Name a medication that can falsely lower the PSA.

A

Finasteride (used to treat enlarged prostate or hair loss).

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12
Q

If a patient presents with flank pain, what life-threatening differential must be ruled out?

A

Ruptured AAA

Also consider gynae e.g. Ruptured ectopic pregnancy if it’s a woman

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13
Q

What is the underlying pathophysiology in the formation or renal stones?

A

Form due to supersaturation of urine with various components e.g. Elevated urinary calcium, oxalate or Uric acid levels.

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14
Q

Why do low urinary citrate levels increase the risk for formation of all types of stones?

A

Citrate inhibits stone aggregation.

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15
Q

What are the different types of haematuria?

A

Macroscopic - considered to be malignancy until proven otherwise
Microscopic
Symptomatic
Asymptomatic

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16
Q

How can a proteus infection lead to formation of renal stones? Which type of stone is likely to be formed?

A

Proteus produces the enzyme urease which can reduce the acidity of urine, allowing stones to form. Once the stone starts to form bacteria can sequester within the stone. The patient often has a history of chronic and recurrent UTIs that are resistant to antibiotic therapy. Leads to struvite stone formation.

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17
Q

What is a stag horn calculus?

A

Branched stone that fills all or part of the renal pelvis and branches into several other calyces. They are most often composed of struvite.

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18
Q

Name some complications of a TURP?

A

TURP syndrome
Urethral stricture/UTI
Retrograde ejaculation
Perforation of the prostate

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19
Q

What is TURP syndrome?

A

Complication of a TURP procedure where irrigation fluid enters the systemic circulation leading to:

  • dilutional hyponatraemia
  • fluid overload
  • glycine toxicity
20
Q

What are the 3 histological subtypes of bladder cancer?

A

Transitional cell carcinoma
Squamous cell carcinoma
Adenocarcinoma

21
Q

What is schistosomiasis?

A

Infection of shistosomes from infested water. Can infect urinary or GI tract. Risk factor for developing bladder cancer.

22
Q

What scoring system is used for prostate cancer?

A

Gleason scoring system - graded based on histological appearance, higher scores are associated with a poorer prognosis.

23
Q

What is the histological subtype of most prostate cancers?

A

Adenocarcinoma

24
Q

What is PSA?

A

Prostate specific antigen, a serum protein which anticoagulates semen to allow fertilisation.

25
Q

What are the 2 types of prostate biopsy?

A

TRUS (trans rectal ultrasound guided), done under local, has a higher risk of infection/sepsis
Transperineal - better for accessing the anterior part of the prostate, done under general, lower risk of infection

26
Q

What imaging is the best for diagnosing prostate cancer?

A

MRI

27
Q

What hormonal therapy is most commonly used in the treatment of prostate cancer and how does it work?

A

LHrH (releasing hormone) agonists e.g. goserelin - reduce testosterone production, therefore reducing growth of the prostate. Erectile dysfunction is a common side effect of hormonal treatment.

28
Q

What classification system is used for testicular cancer?

A

Royal Marsden classification system.

29
Q

What is biopsy not performed for testicular cancer?

A

It may cause seeding of the cancer, instead diagnosis is made with imaging and tumour markers.

30
Q

What is multi-drug resistant gram negative organism (MGNO)?

A

Organisms that are resistant to multiple drugs, this is much worse than MRSA or C.difficile and is usually caused by overtreatment of asymptomatic bacteriuria. You will have to try IV meropenem as a last resort!

31
Q

What is the difference between a complicated and uncomplicated UTI?

A

Uncomplicated - caused by a normal organism in a urinary tract with normal structure and function, most common in young sexually active females.
Complicated - structural/functional abnormality of genitourinarty tract e.g. obstruction, neurogenic bladder, catheter, stones and renal transplant.

32
Q

Name 3 causative organisms of urinary tract infections.

A

Usually gram negative bacteria e.g.
E.coli
Staphylococcus saphrophyticus
Klebsiella pneumoniae

33
Q

How long do antibiotics need to be given for in treatment of a urinary tract infection?

A

3 days for uncomplicated UTI in females

7-10 days for complicated UTI in females or in males.

34
Q

How can recurrent UTIs in women be managed?

A

Exclude structural abnormalities with US or cystoscopy.
Conservative advice - good fluid intake, avoid synthetic underwear and perfumed soaps.
Antibiotics - post-coital single dose antibiotics, self-start antibiotics at the first sign of infection, low-dose prophylactic antibiotics.

35
Q

Name 3 antibiotics that can be used in the treatment of urinary tract infections.

A

Trimethoprim (not in 1st trimester of pregnancy - neural tube defects)
Nitrofurantoin (not in 3rd trimester of pregnancy - haemolytic anaemia of newborn)
Ciprofloxacin sometimes used

36
Q

Which antibiotics are used in the management of pyelonephritis?

A

Can usually be managed in primary care with oral ciprofloxacin or augmentin for 7-10 days. If the patient is very unwell then may need hospital admission to rule out obstruction and to give IV antibiotics.

37
Q

What is the management for acute prostatitis?

A

Analgesia
Antibiotics - ciprofloxacin or levofloxacin
May need hospital admission and IV antibiotics if very unwell.

38
Q

What is the management for chronic prostatitis?

A

Alpha blockers - tamsulosin
NSAIDs
Prostatic masssage

39
Q

How do causative organisms of prostatitis and epididymis-orchitis differ between men of different age groups?

A

Younger men <35 - more likely to be due to sexual transmission of Neisseria gonorrhoea or chlamydia trachomatis.
Older men >35 - more likely to be due to enteric transmission of E.coli, proteus spp., Klebsiella pneumoniae and Pseudomonas aeruginosa.

40
Q

What is the most common cause of viral orchitis?

A

Mumps

41
Q

Which drug is associated with drug-induced epididymitis?

A

Amiodarone - rare side effect of high drug concentrations.

42
Q

What is balanitis xerotica obliterans?

A

Condition where you get scarring of the foreskin, can lead to phimosis.

43
Q

What do you need to monitor patient for after inserting catheter to relieve urinary retention?

A

Post obstructive diuresis

44
Q

Why are patients with chronic retention more likely to develop UTIs and calculi?

A

Due to stasis of urine.

45
Q

What is post obstructive diuresis?

A

When patients who have had resolution of urinary retention with a catheter start producing lots of urine - the kidneys can over diurese due to loss of the corticomedullary concentration gradient which can lead to a worsening AKI. Need to have IV fluids to prevent a worsening AKI.

Phase II Surgery (7 decks)

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