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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
Q

Conservative Mx for storage Sx?

A

Reassure, dietary advice (no coffee/acidy thing/spicy)

Bladder training exercises

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26
Q

Medical Mx for storage Sx?

A

Anticholinergics - oxybutinin, tolterodine, solifenacin

Beta agonists - betmiga

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27
Q

Surgical Mx for storage Sx?

A

Botox injections

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28
Q

Side effects of anticholengerics?

A

Dry mouth and eyes

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29
Q

What should you do in the event of urinary retention?

A 
Catheterise & measure residual volume 
DRE 
Urine culture (+/- treat UTI)
FBC, U&Es
Neuro exam if ?cord compression
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30
Q

When would you admit someone with urinary retention?

A

If obstructive nephropathy suspected - need to monitor urine output & replace fluids

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31
Q

Where does prostate cancer rank in terms of most common male cancer?

A

1st

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32
Q

PC of prostate cancer?

A

Asymptomatic usually
LUTS, urinary retention, haematuria
Metastases - bone pain, FLAWS, spinal cord compression

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33
Q

How are most prostate cancers found?

A

PSA

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34
Q

Risk factors of prostate cancer

A

Age, afro Caribbean, FH, BRAC2 gene

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35
Q

Does PSA increase with age?

A

Yes

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36
Q

What is normal PSA for 70y/o?

A

7.2

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37
Q

What else increases PSA?

A

UTI, BPH, new catheterisation, urinary retention

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38
Q

Does a DRE raise PSA?

A

NO - raises it by 0.1 so not relevant

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39
Q

Are MRIs useful for prostate cancer?

A

Yes - good at differentiating between high and low risk (high risk shows, but low doesnt)

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40
Q

How do you diagnose prostate cancer?

A

TRUS biopsy - transrectal biopsy

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41
Q

What scoring system is used to rate how aggressive the cancer is?

A

Gleason

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42
Q

Which staging is invasive?

A

T3/4 as its invading outside the prostate capsule

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43
Q

How do you initially manage prostate cancer?

A

Stage with MRI

MDT discussion

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44
Q

What are the options for Mx of prostate cancer?

A 
Active surveillance 
Surgery 
Radiotherapy 
Watchful waiting 
Hormone 
Chemo
45
Q

What are the surgical options for prostate cancer?

A

Radical prostatectomy

46
Q

What are side effects of surgical Mx of cancer?

A

ED or incontinence

47
Q

In whom would you do watchful waiting?

A

Elderly or co-morbid

48
Q

In whom would you do active surveillance?

A

Low risk & volume disease

49
Q

What is Ix & Mx of cord compression?

A

Urgent MRI
IV dexamethasone
Neuro referral

50
Q

What should be done post radio/surgery for prostate cancer?

A

Repeated PSA to show recurrence

51
Q

What is the cause of hydrocele in kids?

A

Patent processus vaginalis (connects to abdo)

52
Q

What is the cause of hydrocele in adults?

A

Fluid collection in tunica vaginalis

53
Q

What is the risk of hydrocele repair?

A

Recurrence (10%)

54
Q

Why don’t you do an aspiration in hydrocele?

A

Tunica tissue will stay baggy and the recurrence occurs straight away

55
Q

What does a varicocele feel like?

A

Bag of worms

56
Q

What is Mx of varicocele?

A

No Sx = reassure

Sx = surgical repair

57
Q

Why should varicocele pts have an USS?

A

Can be caused by kidney cancer

58
Q

What does testicular cancer feel like?

A

Non mobile, hard lump, joined to testicle

59
Q

List causes of epididymitis and orchitis

A

STI, UTI, post op

60
Q

Does testicular cancer affect old or young men?

A

YOUNG

35-45 y/o

61
Q

Name common type of testicular cancer

A

Seminomas

62
Q

Ix of testicular cancer

A

USS
Tumour markers
CXR
CT

63
Q

List tumour markers of testicular cancer

A

AFP, HCG, LDH

64
Q

Mx of testicular cancer

A

Radical inguinal orchidectomy +/- prosthesis

65
Q

What can be given post op in testicular cancer

A

Chemo / radio

66
Q

What is the working Dx of haematuria?

A

Cancer until proven otherwise

67
Q

List causes of haematuria

A 
Infection 
Cancer 
Medical - eg nephritic syndrome
Trauma 
Kidney stones
68
Q

Mx of haematuria?

A 
Resuscitate 
3 way catheter - wash out clots 
Hx and O/E 
Bloods - inc clotting 
MSU
69
Q

What is a big risk factor for bladder cancer?

A

Smoking

70
Q

What is the criteria for admission with haematuria?

A

Frank haematuria with clots
Drop in Hb
Social circumstances

71
Q

WHat are Ix for haematuria?

A

FBC, clotting, U&E
MSU cytology
CT urogram with contrast OR USS KUB
Flexible cystoscopy

72
Q

What is gold standard for haematuria?

A

CT urogram with contrast

73
Q

What is contradiction for cystoscopy?

A

Heavy bleeding

74
Q

What do bladder cancer tumours look like?

A

Seaweed

75
Q

Mx of bladder cancer?

A

Surgical resection of cancer

76
Q

In whom are kidney stones more common?

A

White men

77
Q

Why are kidney stones important?

A 
Pain 
Infection 
Renal damage 
Suggest other pathology - eg hyperPTH 
Underlying pathology eg horse shoe kidney
78
Q

What is infection of ureter called?

A

Pyelonephrosis / gram negative sepsis

79
Q

How do you classify stones?

A

SIZE - <5mm / 5-20mm / >20mm

80
Q

What % of stones visible on XRay?

A

70% - calcium oxolate stones

81
Q

Which stones are not visible on XR?

A

Uric acid stones

82
Q

What is best Ix for stones?

A

CT - can see all stones

83
Q

Which stones can be treated medically and how?

A

Uric acid stones - K citrate

84
Q

Can you feel a mass in kidney stones?

A

NO

85
Q

When would you order immediate imaging for stones?

A

Fever, only 1 kidney, diagnosis unclear

86
Q

Loin pain, soft abdo, non visible haematuria (85%). Dx?

A

Ureteric colic

87
Q

What can cause utertic colic?

A

Stones, TCC, blood clot, RPF

88
Q

What is the main thing to remember in ureteric colic in A&E?

A

ANALGESIA

89
Q

What medicine can be used for renal stones?

A

Tamsulosin - relaxed ureter to encourage passage

90
Q

What is the ideal urine colour?

A

Champagne colour

91
Q

Tx of stones?

A

Spontaneous passage if small
K citrate if uric acid stones
Shock wave Tx (ESWL)
Laser ureteroscopy

92
Q

When would percutaneous nephrolithotomy be done?

A

> 2cm stone

93
Q

What advice is given to patients post kidney stone removal?

A

Keep fluid intake up

94
Q

What is obstructive pylonephrosis ?

A

Obstruction + infection

95
Q

Mx of obstructive pylonephrosis ?

A

Nephrostomy - to drain pus out

96
Q

Testicular pain. Most important Dx?

A

Testicular torsion

97
Q

How does testicular torsion vary from cancer PC?

A

Cancer = painless

98
Q

Why is early diagnosis of testicular torsion important?

A

Testes start to die after 6 hours

99
Q

What is very similar Dx to testicular torsion?

A

Torted appendix testis

100
Q

What sign is present in torted appendix testis?

A

Blue dot sign

101
Q

Who gets torted appendix testis?

A

Young boys

102
Q

What is age range of testicular torsion?

A

Rare over 35 unless underlying deformity

103
Q

PC of testicular torsion?

A

Tender, high riding testicle. Loss of cremateric reflex in children

104
Q

DDx of testicular torsion?

A

Torted appendix testis

Epididymorchitis

105
Q

What else needs to be done when fixing the testicular torsion?

A

Fix the other side to prevent the 2nd testes torting

106
Q

At what time does ischaemic damage happen?

A

> 6hrs

107
Q

Can torsions happen more than once?

A

YES

108
Q

Follow up issues of testicular torsion?

A

Recurrent pain

Prosthesis

109
Q

Is fertility lost after losing 1 testicle?

A

NO

Lottie's DPD 2 (10 decks)

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