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Lottie's DPD 2 > Urology > Flashcards

Urology Flashcards

1
Q

What are the LUTS?

A

Storage and voiding Sx due to LUT dysfunction

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2
Q

What is benign prostatic enlargement?

A

Enlarged prostate due to histological process of BPH

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3
Q

What is BPH?

A

Benign prostatic hyperplasia - histological diagnosis of BPE

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4
Q

What is bladder outflow obstruction?

A

Bladder outlet obstruction caused by BPE

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5
Q

Name the parts of the prostate

A

Transition zone
Peripheral zone
Central zone
Anterior firbomuscular zone

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6
Q

Where do cancers occur?

A

Peripheral zone

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7
Q

Where does BPH occur?

A

Transition zone

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8
Q

Why does BPH cause Sx before cancer?

A

Cancer is in peripheral zone which is further from urethra than transition zone - obstructs later on

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9
Q

Does prostate size correlate to cancer risk?

A

No

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10
Q

Are LUTS signs of prostate cancer?

A

No - occasionally they can be but rare

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11
Q

List the 7 components of International Prostate Scoring System

A

Freq, intermittency, urgency, weak stream, straining, nocturia, incomplete emptying

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12
Q

What else do you ask in urology Hx except IPSS?

A

How much do the LUTS affect your QoL?

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13
Q

List the voiding Sx

A

Hesitancy, weak stream, intermittency, incomplete emptying

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14
Q

List the storage Sx

A

Frequency, urgency, nocturia

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15
Q

What causes voiding problems?

A

Urethral stricture, BPH, bladder outflow obstruction

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16
Q

What causes storage Sx?

A

Detrusor overactivity

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17
Q

List risks of BPH

A

Older age, Afro Carribean

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18
Q

What exams must be done for someone with urology probelms?

A

Abdo and DRE

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19
Q

What Ix are done for pt with urology problems?

A 
Urine dip 
Flow rate & postvoid residual bladder scan 
Blood tests (U&Es, PSA)
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20
Q

Conservative Mx for BPH/voiding Sx?

A

reassure, advice on reducing fluid intake in evening

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21
Q

Medical Mx for BPH/voiding Sx?

A

Alpha blocker - tamsulosin / alfuzosin

5 alpha reducatse inhibitor - finasteride

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22
Q

What health food supplement can help BPH?

A

Saw palmetto

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23
Q

Surgical Mx for BPH?

A

TURP - transurethral resection of prostate (cutting out channel in prostate for urine passage)

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24
Q

What is the alternative to surgical Mx of BPH?

A

Long term catheters

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25
Conservative Mx for storage Sx?
Reassure, dietary advice (no coffee/acidy thing/spicy) | Bladder training exercises
26
Medical Mx for storage Sx?
Anticholinergics - oxybutinin, tolterodine, solifenacin | Beta agonists - betmiga
27
Surgical Mx for storage Sx?
Botox injections
28
Side effects of anticholengerics?
Dry mouth and eyes
29
What should you do in the event of urinary retention?
``` Catheterise & measure residual volume DRE Urine culture (+/- treat UTI) FBC, U&Es Neuro exam if ?cord compression ```
30
When would you admit someone with urinary retention?
If obstructive nephropathy suspected - need to monitor urine output & replace fluids
31
Where does prostate cancer rank in terms of most common male cancer?
1st
32
PC of prostate cancer?
Asymptomatic usually LUTS, urinary retention, haematuria Metastases - bone pain, FLAWS, spinal cord compression
33
How are most prostate cancers found?
PSA
34
Risk factors of prostate cancer
Age, afro Caribbean, FH, BRAC2 gene
35
Does PSA increase with age?
Yes
36
What is normal PSA for 70y/o?
7.2
37
What else increases PSA?
UTI, BPH, new catheterisation, urinary retention
38
Does a DRE raise PSA?
NO - raises it by 0.1 so not relevant
39
Are MRIs useful for prostate cancer?
Yes - good at differentiating between high and low risk (high risk shows, but low doesnt)
40
How do you diagnose prostate cancer?
TRUS biopsy - transrectal biopsy
41
What scoring system is used to rate how aggressive the cancer is?
Gleason
42
Which staging is invasive?
T3/4 as its invading outside the prostate capsule
43
How do you initially manage prostate cancer?
Stage with MRI | MDT discussion
44
What are the options for Mx of prostate cancer?
``` Active surveillance Surgery Radiotherapy Watchful waiting Hormone Chemo ```
45
What are the surgical options for prostate cancer?
Radical prostatectomy
46
What are side effects of surgical Mx of cancer?
ED or incontinence
47
In whom would you do watchful waiting?
Elderly or co-morbid
48
In whom would you do active surveillance?
Low risk & volume disease
49
What is Ix & Mx of cord compression?
Urgent MRI IV dexamethasone Neuro referral
50
What should be done post radio/surgery for prostate cancer?
Repeated PSA to show recurrence
51
What is the cause of hydrocele in kids?
Patent processus vaginalis (connects to abdo)
52
What is the cause of hydrocele in adults?
Fluid collection in tunica vaginalis
53
What is the risk of hydrocele repair?
Recurrence (10%)
54
Why don't you do an aspiration in hydrocele?
Tunica tissue will stay baggy and the recurrence occurs straight away
55
What does a varicocele feel like?
Bag of worms
56
What is Mx of varicocele?
No Sx = reassure | Sx = surgical repair
57
Why should varicocele pts have an USS?
Can be caused by kidney cancer
58
What does testicular cancer feel like?
Non mobile, hard lump, joined to testicle
59
List causes of epididymitis and orchitis
STI, UTI, post op
60
Does testicular cancer affect old or young men?
YOUNG | 35-45 y/o
61
Name common type of testicular cancer
Seminomas
62
Ix of testicular cancer
USS Tumour markers CXR CT
63
List tumour markers of testicular cancer
AFP, HCG, LDH
64
Mx of testicular cancer
Radical inguinal orchidectomy +/- prosthesis
65
What can be given post op in testicular cancer
Chemo / radio
66
What is the working Dx of haematuria?
Cancer until proven otherwise
67
List causes of haematuria
``` Infection Cancer Medical - eg nephritic syndrome Trauma Kidney stones ```
68
Mx of haematuria?
``` Resuscitate 3 way catheter - wash out clots Hx and O/E Bloods - inc clotting MSU ```
69
What is a big risk factor for bladder cancer?
Smoking
70
What is the criteria for admission with haematuria?
Frank haematuria with clots Drop in Hb Social circumstances
71
WHat are Ix for haematuria?
FBC, clotting, U&E MSU cytology CT urogram with contrast OR USS KUB Flexible cystoscopy
72
What is gold standard for haematuria?
CT urogram with contrast
73
What is contradiction for cystoscopy?
Heavy bleeding
74
What do bladder cancer tumours look like?
Seaweed
75
Mx of bladder cancer?
Surgical resection of cancer
76
In whom are kidney stones more common?
White men
77
Why are kidney stones important?
``` Pain Infection Renal damage Suggest other pathology - eg hyperPTH Underlying pathology eg horse shoe kidney ```
78
What is infection of ureter called?
Pyelonephrosis / gram negative sepsis
79
How do you classify stones?
SIZE - <5mm / 5-20mm / >20mm
80
What % of stones visible on XRay?
70% - calcium oxolate stones
81
Which stones are not visible on XR?
Uric acid stones
82
What is best Ix for stones?
CT - can see all stones
83
Which stones can be treated medically and how?
Uric acid stones - K citrate
84
Can you feel a mass in kidney stones?
NO
85
When would you order immediate imaging for stones?
Fever, only 1 kidney, diagnosis unclear
86
Loin pain, soft abdo, non visible haematuria (85%). Dx?
Ureteric colic
87
What can cause utertic colic?
Stones, TCC, blood clot, RPF
88
What is the main thing to remember in ureteric colic in A&E?
ANALGESIA
89
What medicine can be used for renal stones?
Tamsulosin - relaxed ureter to encourage passage
90
What is the ideal urine colour?
Champagne colour
91
Tx of stones?
Spontaneous passage if small K citrate if uric acid stones Shock wave Tx (ESWL) Laser ureteroscopy
92
When would percutaneous nephrolithotomy be done?
>2cm stone
93
What advice is given to patients post kidney stone removal?
Keep fluid intake up
94
What is obstructive pylonephrosis ?
Obstruction + infection
95
Mx of obstructive pylonephrosis ?
Nephrostomy - to drain pus out
96
Testicular pain. Most important Dx?
Testicular torsion
97
How does testicular torsion vary from cancer PC?
Cancer = painless
98
Why is early diagnosis of testicular torsion important?
Testes start to die after 6 hours
99
What is very similar Dx to testicular torsion?
Torted appendix testis
100
What sign is present in torted appendix testis?
Blue dot sign
101
Who gets torted appendix testis?
Young boys
102
What is age range of testicular torsion?
Rare over 35 unless underlying deformity
103
PC of testicular torsion?
Tender, high riding testicle. Loss of cremateric reflex in children
104
DDx of testicular torsion?
Torted appendix testis | Epididymorchitis
105
What else needs to be done when fixing the testicular torsion?
Fix the other side to prevent the 2nd testes torting
106
At what time does ischaemic damage happen?
>6hrs
107
Can torsions happen more than once?
YES
108
Follow up issues of testicular torsion?
Recurrent pain | Prosthesis
109
Is fertility lost after losing 1 testicle?
NO

Lottie's DPD 2 (10 decks)

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