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Finals > Urology > Flashcards

Urology Flashcards

1
Q

What are the causes of haematuria?

A 
V: coagulopathy
I: UTI, prostatitis, pyelonephritis, TB
T: STONES, post cystoscopy
A: IgA nephropathy, glomerulonephritis
M: 
I: catheter 
N: bladder, prostate, renal, endometrial CANCERS
D: NSAIDs, sulphonamides, aminoglycosides

Other:
BPH, vigorous exercise, sex

False:
beetroot, menstruation, rifampicin

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2
Q

What are the haematuria related red flags requiring urgent urology referral?

A

<45 with VH that remains despite UTI treatment (if +ve for UTI)

> 60 with NVH + dysuria or raised WCC

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3
Q

How would you examine a testicular lump?

A

LOOK:
site, symmetry, size, skin changes

FEEL:
tender? attached? can you get above it? temperature? pulse? reducible?

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4
Q

How would you investigate a testicular lump?

A

USS

Do not biopsy as if cancer there is risk of seeding

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5
Q

What are your differentials for a testicular lump?

A 
hydrocele
varicocele
spermatocele
haematocele 
epididimo-orchitis 
inguinal hernia 
testicular cancer
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6
Q

What is an epididymal cyst/spermatocele? What would be your examination findings?

A

sits above and behind the testes
fluctuant
sits separate to the testes
transluminates

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7
Q

What is a hydrocele? What would be your examination findings?

A

fluid within the tunica vaginalis

painless
fluctuant
attached to the testes
transluminates

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8
Q

What is orchitis? What would be your examination findings?

A

Very rarely occurs alone without epididymitis

Infection due to chlamydia, gonorrhoea, e.coli and TB, mumps

sudden onset swelling with LUTS
check the parotid gland for swelling (mumps)

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9
Q

What is a varicocele? What would be your examination findings?

A

dilated veins of the paniform plexus

“bag of worms”
sits separate to the testes
doesn’t transluminate
disappears on lying down

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10
Q

What is a haematocele?

A

blood within the tunica vaginalis following trauma

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11
Q

What is worrying about a varicocele?

A

can indicate a renal tumour

can lead to infertility as it raises the temperature of the testes

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12
Q

What would be your examination findings for epididymitis?

A

acute unilateral pain
swollen and erythematous
fever
Phrens sign: reduced pain on elevation of the testes

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13
Q

Which testicular lumps transluminate?

A

hydrocele

spermatocele/epidydimal cyst

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14
Q

What are the types of urinary stones?

A

80% are either calcium oxalate, calcium phosphate or mixed
struvite
urate

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15
Q

What are the causes/risk factors for urinary stones?

A

Dehydration
Increased mineral content:
CALCIUM: high PTH, bone destruction, thiazide
OXALATE: IBD, nuts and rhubarb
URIC ACID: gout, chemotherapy, red meat, myeloproliferative disease

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16
Q

How do urinary stones present?

A

Dehydrated (drinking makes pain worse)
Colic from loin to groin with dull ache in between waves
tenderness over the loin
non-visible haematuria

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17
Q

What is the gold standard investigation for urinary stones?

A

Non-contrast CT KUB

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18
Q

What is the immediate management for someone with renal stones?

A

Diclofenac IM
Fluids
+/- antiemetics

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19
Q

What would suggest someone with renal stones needed treating in hospital?

A

> 5mm
known renal problems
unable to cope with symptoms

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20
Q

What is the medical management option for renal stones? When would this be indicated?

A

alpha blockers can be used if the stone is in a distal location

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21
Q

What are the surgical options for a renal stone? When are these indicated?

A

ureteroscopy: stone <2cm and can be pregnant
ESWL: stone <2cm and not pregnant
Percutaneous nephrolithotomy: >2cm or staghorn
Nephrostomy: severe obstruction

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22
Q

What are the contraindication to ESWL?

A

pregnant

stone located over bony prominence

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23
Q

Where is a stone likely to become stuck?

A

VUJ
PUJ
crossing the pelvic brim under the iliac vessels

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24
Q

What is the x-ray appearance of renal stones?

A

calcium phosphate and oxalate: radio-opaque

urate: radio-lucent
cystine: semi-opaque ground glass appearance

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25
Q

What are the risk factors for developing bladder stones?
How do they present?
What do they predispose to?

A

retention and schistosomiasis
LUTS
bladder SSC

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26
Q

What are the complications of renal stones?

A

hydronephrosis
AKI
become infected

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27
Q

What are your differentials for urinary obstruction?

A

LUMEN: stone, blood clot, tumour
WALL: stricture, NM dysfunction
OUTSIDE: BPH, large fibroid, tumour

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28
Q

Compare the presentation of acute urinary obstruction to chronic urinary obstruction

A

acute: retention so suprapubic tenderness and confusion
chronic: LUTS

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29
Q

What organism is most commonly responsible for pyelonephritis?

A

E.coli

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30
Q

What are the causes of pyelonephritis? i.e. how does infection get to the kidney?

A

UTI
systemic from sepsis
via lymphatics i.e. if someone has a retroperitoneal abscess

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31
Q

What are the risk factors for pyelonephritis?

A

relating to flow:
BPH, VUR, catheter, neuropathic bladder, stones

immunocompromised: diabetics, steroids

sexually active

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32
Q

How does pyelonephritis present?

A

fever + loin pain + N&V

costo-vertebral angle tenderness

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33
Q

How is pyelonephritis managed?

A

emperical abx and fluids

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34
Q

Who does emphysematous pyelonephritis commonly effect? How is it diagnosed?

A

diabetics

if someone doesn’t respond to abx you can do a CT and see the gas surrounding the kidney

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35
Q

What are the risk factors for developing renal cysts?

A

smoking and HTN

APKD

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36
Q

How do renal cysts present?

A

flank pain
haematuria
+/- uncontrolled HTN

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37
Q

What investigations would you do for someone with renal cysts?

A

CT with contrast to rule out renal cell carcinoma

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38
Q

What scoring system determines the management of renal cysts? What are the management options?

A

Bosniak scoring system

Aspirate or de-roofing

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39
Q

What does BPH stand for?

A

benign prostate hyperplasia

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40
Q

What does BPH feel like on examination?

A

firm
smooth
symmetrical

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41
Q

How do you evaluate LUTS in someone with suspected BPH?

A

IPSS

42
Q

What are the management options for BPH?

A
  1. reassure and lifestyle
  2. alpha blockers (tamsulosin)
  3. 5a-reductase inhibitor (fenasteride)
  4. TURP
43
Q

Name an a-blocker?

What are the side effects of a-blockers?

A

Tamsulosin

  • postural hypotension
  • retrograde ejaculation
44
Q

How do 5a-reductase inhibitors work?
Name one?
What is a disadvantage of them?

A

stop the enzyme 5a-reductase which converts testosterone to the more potent DHT

e.g. fenasteride

Disadvantage: They take a long time before any benefit seen

45
Q

What is TURP?

What are the risks associated?

A 
trans-urethral resection of the prostate (removal uses diathermy)
ADRS:
sexual dysfunction
retrograde ejaculation
strictures 
TURP syndrome
46
Q

What is TURP syndrome?

A

Occurs due to the hypoosmolar fluid used in the process of TURP. Leads to fluid overload and hyponatraemia

47
Q

What are the causes of prostatitis?

A

spread from UTI or STI

lymph spread from a rectal abscess

48
Q

What are the risk factors for prostatitis?

A

catheter
strictures
recent cystoscopy

49
Q

How does prostatitis present?

A 
perianal or suprapubic pain
fever
LUTS
\+ejaculatory pain
\+bloody discharge
50
Q

What is felt/seen on examination of prostatitis?

A

tender
boggy
inguinal lymphadenopathy

51
Q

How do you investigate prostatitis?

A

Urine culture for sensitivities

52
Q

How do you manage prostatitis?

A

Quinolone eg ciprofloxacin

53
Q

What is the definition of priapism?

A

erection lasting >4 hours that is not associated with sexual arousal
+ pain

54
Q

What is the pathophysiology of priapism?

A

Ischaemic:
impaired vasorelaxation means de-oxygenated blood is left within the corpus cavernosum

non-ischaemic:
high arterial inflow due to trauma or fistula

55
Q

What is the results of a cavernosal blood gas analysis in ischaemic priapism?

A

acidotic
low O2
high CO2

56
Q

What are the drug causes of priapsim?

A

anti-hypertensives
anti-depressants
anti-coagulants
cocaine, ectasy

57
Q

How is ischaemic priapism managed?

A

aspirate the blood from the corpus cavernosa
inject a saline flush
inject intercavernosal phenylephrine

58
Q

What are the histological subtypes of renal cancer? Which is the most common?

A

They are adenocarcinomas:

  • clear cell (most common)
  • papillary
  • chromophobe
59
Q

How does renal cancer present?

A 
haematuria 
loin pain
abdominal mass
ongoing fever of unknown origin
left testicular varicocele
60
Q

What are some paraneoplastic hormone changes associated with renal cancer?

A

ACTH
PTH
Erythropoietin

61
Q

What are the risk factors for developing renal cancer?

A

smoking

tuberous sclerosis

62
Q

How is renal cancer managed?

A

nephrectomy

Chemo and radio DO NOT work

63
Q

Describe the cause of a membranous vs bulbar urethral rupture

A

membranous: pelvic fractures
bulbar: straddle injury e.g. on a bike

64
Q

Describe the presentation of a bulbar vs membranous urethral rupture

A

membranous: blood at meatus, penile and perineal oedema, prostate is elevated
bulbar: blood at meatus, perineal haematoma, retention

65
Q

How is urethral rupture managed?

A

suprapubic catheter

66
Q

How would a bladder injury present?

A

Often history of pelvic fracture
haematuria
retention
suprapubic pain

67
Q

What in the history would help differentiate organic vs psychogenic erectile dysfunction

A

organic: slow onset, libido present
psychogenic: reduced libido, able to self stimulate

68
Q

What are some causes/risk factors of erectile dysfunction?

A

B-blockers and SSRIs
Alcohol
CVS disease or risk factors for CVS disease

69
Q

How do you investigate erectile dysfunction?

A

measure free testosterone at 9am

Calculate CVS risk factor score

70
Q

How is erectile dysfunction managed?

A

Viagra

71
Q

Epididymitis has a bi-modal age distribution. Compare the causes and therefore risk factors for these 2 groups.

A

20-30

  • often STI so gonorrhoea and chlamydia
  • MSM, multiple partners, new partner

> 60

  • often UTI so e.coli
  • catheter, BPH, stricture
72
Q

How is epididymitis investigated?

A

20-30 y/o need first void urine for NAAT

>60 need mid stream urine for dip

73
Q

How is epididymitis managed?

A

If STI causes: ceftriaxone and doxycycline

If UTI causes: ofloxacin

74
Q

How does epididymitis present?

A

unilateral scrotal pain, swelling, erythematous, tender
Fever
Pain reduces on elevation of the testes (Phrens sign)

75
Q

What organisms commonly cause urethritis? Therefore what is the management?

A

Gonorrhoea: ceftriaxone and azithromycin
Chlamydia: doxycycline

76
Q

How does urethritis in men present?

A

dysuria
penile discharge
penile irritation

77
Q

Name a complication of urethritis and state how this would present

A

reactive arthritis

  • oligoarthritis of the lower limbs
  • conjunctivitis and uveitis
  • oral ulcers
  • malaise
78
Q

What is fournier’s gangrene?

A

necrotising fasciitis of the perineum

79
Q

How does fournier’s gangrene present?

A 
pain out of proportion
fever
crepitus 
haemorrhagic bullae 
sensation loss
80
Q

What is balanitis?

A

inflammation of the glans penis

81
Q

How is balanitis managed?

A

saline bath
+/- STI/UTI treatment
+/- clitrimazole for candida
+/- hydrocortisone for dermatitis

82
Q

How is recurrent balanitis managed?

A

circumcision

83
Q

What can cause LUTS? Of these what are the most common in men and women?

A

Women: UTI or menopause
Men: UTI or BPH

malignancy
detrusor weakness
strictures
multiple sclerosis

84
Q

Compare the symptoms of storage vs voiding LUTS

A

storage:

  • nocturia
  • urge incontinence
  • increase frequency

voiding:

  • hesitancy
  • poor stream
  • feeling of incomplete emptying
  • terminal dribble
85
Q

How are predominantly voiding LUTS managed?

A

pelvic floor exercises
alpha blockers
5a-reductase inhibitors

86
Q

How is nocturia managed?

A

furosemide taken late afternoon

87
Q

How is overactive bladder managed?

A

antimuscarinics: oxybutynin or tolterodine

88
Q

What would be your first line investigation for LUTS?

A

Frequency and volume chart

89
Q

What do urodynamic studies assess?

A

detrusor pressures
storage capacity
flow

90
Q

How does acute retention present?

A

suprapubic pain

increased residual volume

91
Q

What are the risk factors for urinary retention?

A 
BPH
Strictures 
Prostate cancer 
anti-muscarinics 
MS and parkinsons 
constipation
92
Q

How is acute retention managed?

A

Catheterise for 24-48 hours
TWOC
if re-retention then consider long term catheter

93
Q

How does chronic retention present?

A

increased residual volume
Painless
Overflow incontinence (worse at night)

94
Q

What are some complications of chronic retention?

A

Infections and stones because of stasis

95
Q

How is chronic retention managed?

A

If residual volume >1L then catheterise

96
Q

How does acute on chronic retention present?

A

often still painless or minimal pain

97
Q

patients with acute on chronic retention are at particular risk of what complication of retention?

A

post-obstructive diuresis

98
Q

What is the pathophysiology of post-obstructive diuresis?

A

occurs in patients in retention who are catheterised.
There is a loss of the medullary concentration gradient.
On catheterisation the kidneys over diuresis leading to large volumes of urine and AKI

99
Q

How is post-obstructive diuresis managed?

A

IV fluids

100
Q

What is the result of high pressure retention? Why does this happen?

A

with high bladder pressures there is a loss of the normal anti-reflux mechanism meaning urine backs up leading to hydroureter and hydronephrosis

Finals (16 decks)

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