Urology Flashcards
LUTS sx in men
Storage/irritative:
- F requency
- U rgency
- N octuria
- D ysuria
Voiding/obstructive
- H esistancy
- I complete emptying
- P oor stream
- S training
- Other = terminal dribbling, overflow incontinence
Compare signs and sx of BPH and prostate cancer
Both:
FUND HIPS
Severe pain if acute urinary retention
BPH:
DRE => smoothly enlarged porstate w/ palpable midline groove
Prostate cancer:
DRE => asymmetrical hard nodule prostate
Malignancy sx => bone pain, cord compression, FLAWS, paraneoplastic (hypercalcaemia)
Ix for BPH
U&Es: check for any decrease in kidney function
USS urinary tract
Mx for BPH
Conservative
- watchful waiting; typically if pts are older
Medical
- 5-alpha-reductase inhibitor (finasteride)
- alpha-blockers (tamsulosin to relax smooth muscles)
Surgery
- transurethral resection of prostate (TURP)
- open prostatectomy
Emergency
- urinary retention => catheterise!!
Ix for prostate cancer
PSA (low specificity)
MRI (first line)
Transrectal ultrasound-guided biopsy
LFTs/bone profile; mets
RFs for bladder cancer
Dye stuffs
Pelvic irradiation
Smoking
Chronic UTIs
Schistosomiasis ('developing' countries)Sx and ix for bladder cancer
Sx: FLAWS, FUND (no HIPS), painless macroscopic haematuria (main PC)
Ix: cytoscopy w/ biopsy (majority are transitional cell carcinomas, few are squamous cell), CT/MRI (for staging)
What are the different types of urinary incontinence?
Stress
=> physical movement/activity places stress on the bladder, poor closure of bladder during childbirth is RF
Urge
=> urine leaks as you feel sudden intense urge to pee, detrusor overactivity
Functional
=> aware of need to pee but unable to go due to physical/mental reasons
Overflow
=> involuntary release of urine from full bladder, in absence of any need to urinate
What types of kidney stones can you get?
Calcium oxalate (most common)
Magnesium ammonium phosphate; struvite (renal horn calculus)
Urate (infectons)
Cysteine (cystinuria)
Sx and signs of nephrolithiasis
Often asymptomatic
Severe loin to groin pain (writhing in bed)
Nausea and vomiting
Consider leaking AAA, especially in elderly
Ix for nephrolithiasis
Urine dipstick - microscopic haematuria U&Es - check renal function, can cause AKI USS Non-contrast CT-KUB - GOLD-STANDARD
Mx for nephrolithiasis
<5mm
- allow to pass spontaneously
- increased fluid intake (dehydration risk factor)
- keep stone for analysis (determine cause)
> 5mm
=> Surgey
- ureteroscopic lithotripsy
- extracorporeal shockwave lithotripsy (non-invasive)
- percutaneous nephrolithotomy (staghorn calculus)
Emergency
- signs of obstructed/infected kidneys => urgent nephrostomy to relieve obstruction
Sx + signs of testicular torsion
Swollen + erythematous scrotum
Nausea + vomiting
Sudden-onset severe hemi-scrotal pain
Typically occurs in boys and young men
Mx for testicular torsion
Duplex ultrasound
Exploratory surgery within 6 hours
Necrotic tissue may need removal
Both testicles fixed in place
Ddx of swollen + erythematous scrotum
Testicular torsion
Epididymo-orchitis
Strangulated inguinal hernia
Scrotal mass ddx
Hydrocele
Epididymitis + orchitis
Varicocele
Testicular cancer
Hydrocele summary card
Baby or old men, idiopathic, infection, trauma, tumour causing excessive collection of serous fluid in tunica vaginalis
- transilluminates, asymptomatic swelling, can get above swelling, swelling cannot be separated from testicle
Epididymitis + orchitis summary card
< 35 (Chlymadia/Gonococcus), > 35 (Coliforms, i.e. ENterobacter, Klebsiella), mumps, Candida can cause inflammation of epididymitis or testes
- fever, penile discharge (if STI), less acute onset than torsion, painful, swollen and tender testis/epididymitis
Varicocele summary card
Dilated veins of pampiniform plexus, more common on left, associated with infertility
- usually asymptomatic, swelling may reduce when lying down, scrotum feels like ‘a bag of worms’
Testicular cancer summary card
Commonest malignancy in 20-40 yo males Painless hard testicular mass, testicular swelling/discomfort, backache (mets via para-aortic nodes) - seminoma - non-seminoma (teratoma) - sertoli/leydig cell tumours
Testicular cancer tumour markers
Raised AFP
- yolk sac tumour, embryonomal caricnoma
- NOT a seminoma
Raised beta-hCG
- most testicular cancers
Raised LDH
- most testicular cancers
*Teratoma, no markers
Ix for scrotal masses
Check for infection
- urine dipstick, MSU, sexual health hx if indicated
- bloods: FBC, CRP
O/E
- can you get above the mass? (if not = inguinal hernia)
- does it transilluminate? (if yes = fluid)
- is it reducible?
Ix for testicular cancer
Tumour markers (AFP, beta-hCG, LDH)
Testicular USS
CT to allow for staging
Why are varicoceles more common on the left testes?
Left testicular vein connects to the left renal vein at 90 degrees so increased reflux from compression of the left renal vein or a lack of effective valves is more likely to present with a varicocele > right testes
A 67-year-old man has been urinating around 12-14 times per day over the past 6 months. His stream is ‘weak’ and often takes a long time to get going. After he has finished urinating, he does not feel fully empty and often dribbles a little bit. DRE reveals a smoothly enlarged prostate gland with a palpable midline sulcus. A diagnosis of benign prostatic hyperplasia is made. He is eager to avoid surgery if possible. Which treatment would be best for him?
A Oxybutynin B Solifenacin C Tamsulosin D Nitrofurantoin E Co-trimoxazole
C Tamsulosin
A 75-year-old owner of a dye factory has experienced 4 episodes of ‘bright red’ blood in his urine over the past 2 weeks. He does not feel any pain when urinating. He has also noticed that he has lost some weight recently despite not changing his eating habits or exercise levels. What is the most likely diagnosis?
A Pyelonephritis B Glomerulonephritis C Bladder Cancer D Prostate Cancer E Ureteric Stone
C Bladder Cancer
An 80-year-old man has had considerable difficulty urinating. He goes about 10-12 times per day, including at night, and has described his stream as being very poor. He has also experienced lower back pain over the last 6 weeks. On digital rectal examination, an asymmetrically enlarged, nodular prostate gland is palpated. Which first-line investigation should be used to confirm the diagnosis?
A PSA B Acid phosphatase C MRI Scan D Transrectal ultrasound guided biopsy E Isotope bone scan
C MRI Scan
A 43-year-old woman presents to her GP having wet herself several times since the birth of her third child, 4 months ago. Whenever she laughs or coughs, a little bit of urine leaks out without her control. Which type of incontinence does she have?
A Functional incontinence B Stress incontinence C Urge incontinence D Overflow incontinence E Double incontinence
B Stress incontinence
A 65-year-old woman has wet herself several times over the past 3 months. She says that she will be going about her usual daily activities and will suddenly become overwhelmed by the feeling of needing to urinate. Before she can even think about finding a toilet, she has wet herself. Which type of incontinence is this?
A Functional incontinence B Stress incontinence C Urge incontinence D Overflow incontinence E Double incontinence
C Urge incontinence
A 42-year-old man presents with severe pain in his right flank. He adds that the pain moves towards his right groin. Although he is writhing around in pain, no abnormalities are detected on abdominal examination.
Urine Dipstick: + blood
Which investigation would you do next?
A Renal ultrasound B Cystoscopy C CT-KUB D MRI E Urine MC&S
C CT-KUB
Which type of urinary tract stone is most common?
A Magnesium ammonium phosphate B Calcium oxalate C Cysteine D Urate E Hydroxyapatite
B Calcium oxalate
A 13-year-old boy is brought to A&E with sudden-onset pain and swelling in his scrotum, which began an hour ago whilst playing a football match. After arriving at hospital, he begins to vomit. On examination, his right hemiscrotum is red and swollen. What is the most appropriate first step in his management?
A Doppler ultrasound of the testes B CT Scan C Exploratory surgery D Empirical antibiotics E Abdominal X-ray
C Exploratory surgery
A 50-year-old man has developed a swollen scrotum that has been bothering him for the past 2 weeks. The swelling is uncomfortable but not painful. On examination, the left hemiscrotum is enlarged, fluctuant and non-tender. It is possible to get above the swelling, however, the left testicle cannot be distinguished from the swelling. When a pen torch is shone on the swelling, it illuminates brightly. What is the most likely diagnosis?
A Varicocoele B Hydrocoele C Testicular tumour D Epididymal cyst E Indirect inguinal hernia
B Hydrocoele
A 30-year-old man has developed a swollen scrotum that he first noticed a week ago. He adds that the swelling feels like a ‘bag of worms’, and is uncomfortable but not painful. On examination, the patient’s scrotum looks normal when lying down, however, the left hemiscrotum becomes swollen when he stands up. The GP can get above the swelling and distinguish it from the testicle. What is the most likely diagnosis?
A Indirect inguinal hernia B Direct inguinal hernia C Hydrocoele D Varicocoele E Epididymal cyst
D Varicocoele
A 21-year-old man visits his GP complaining that his scrotum feels ‘heavier than usual’. On examination, a firm, non-tender lump can be palpated at the base of the right testicle. The patient had an undescended testicle as a child, which was corrected with orchidopexy. Testicular cancer is suspected and a CT scan is requested to assess for spread. Which group of lymph nodes does testicular cancer spread to?
A Inguinal B Femoral C Para-aortic D Iliac E Mesenteric
C Para-aortic
A 32-year-old man presents with a 2-week history of frequent urination and excessive thirst. He has also noticed that he feels much weaker than usual, and is struggling to complete his usual gym routine. He has been to see his GP once before because his blood pressure was high on multiple occasions, however, he did not return to receive treatment. His blood pressure is measured again and it is 184/94 mm Hg. What would you expect to see on the ECG of this patient?
A Tented T waves B Absent P waves C ST elevation D J waves E U waves
E U waves
Pt has Conn’s syndrome => hypokalaemia, which induces nephrogenic diabetes insipidus, which, consequently, leads to polyuria and polydipsia. Furthermore, muscle weakness is another feature of hypokalaemia. The main ECG features of hypokalaemia are U waves, ST depression, flattened T waves and prolonged PR interval.
