urology and genitourinary Flashcards
1
Q
Common urological sx
A
loin pain
infections
uro-sepsis
LUTS/retention or incontinence
haematuria
UTI
scrotal swelling and pain
erectile dysfunction
AKI
2
Q
common presentation prostate cancer
A
raised PSA - 2ww
abnormal DRE
wt loss
bone pain
renail failure
LUTS
3
Q
mx prostate cancer
A
prostatectomy
ERBT/ADT
brachytherapy
surveillance
4
Q
serious complication metastatic prostate cancer
A
cord compression - need MRI and steroids
5
Q
kidney stones
A
severe loin to groin pain
need pain relief NCCT, U+Es, Ca, uric acid
exclude sepsis
6
Q
urological emergencies
A
testicular torsion
uro sepsis (epididymo-orchitis, pyelonephritis, fourniers gangrene)
ureteric colic
acute retention
haematuria
trauma
paraphimosis
7
Q
2WW criteria for haematuria
A
aged over 45 and:
unexplained visible haematuria without UTI
visible haematuria that persists after UTI tx
aged 60 and over and unexplained non visible haematuria and either dysuria or a raised WCC
8
Q
common causes haematuria
A
kidneys: transitional cell carcinoma, stones, clotting disorders, glomerulonephritis, acute tubular necrosis, HSP, cancer, trauma
ureters: transitional cell carcinoma, stones
bladder: transitional cell carcinoma, stones, cystitis, UTI
prostate: malignanct, BPH, prostatisi
urethra: cancer, trauma
vagina- need to rule out
pseudo: beetroot, rifampicin
9
Q
mx signifiant haematuria
A
A_E
oxygen
IV access and bloods +/- fluids
3 way catheter
mid stream sample
10
Q
ix haematuria
A
bloods
urine sample
imaging: USS, contrast CT
flexible cystoscopy
11
Q
acute vs chronic urinary retention
A
acute painful, chronic not
chronic v large vol
chronic insidious onset and hx luts
12
Q
features urinary retention
A
difficult passing urine
abdo/suprapubic pain
restless
preceding luts
dysuria or haematuria before this
examination: tenderness suprapubically, palpable bladder, enlarged prostate
13
Q
causes urianry retention
A
uroloical: BPH, blocked catheter, failed TWOC, clot retention, cancer, urethral stricture
GI: constipation, infection, malignancy, IBD, surgery
systemic: infection, pain
medicationL phenylephrine, anticholinergics
neruo: MS, guillain barre, spinal cord injury, cauda equina
14
Q
mx acute urinary retention
A
2 way catheter and record residual vol drained
urine sample
15
Q
indications high pressure urinary retention
A
large residual vol urine (>1l)
deranged renal function (high creatinine)
16
Q
features testicular torsion
A
sudden onset testicualr pain, may radiate to back/loin
common 10-30y
can be associated with local trauma
nausea and vomiting
examination: tender, fixed and high riding testicle, swelling, absent cremasteric reflex
17
Q
mx testicualr torsion
A
surgical exploration
dont USS as wastes time
18
Q
most common cause obstructed infected kidney
A
stone - gets stuck comonly at pelvi-ureteric junction, where ureter crosses iliac vessels, vesico-ureteric junction
19
Q
features infected obstructed kidney
A
fever
rigors
loin-groin/back/abdo pain
haematuria
tachycardia
tachypnoea
high news
other features sepsis
20
Q
mx infected obstructed kidney
A
bloods and fluid resus
urine sample for culture, pregnancy test
assess urine output
abx
CTKUB
drain: ureteric (JJ) stent, nephrostomy
21
Q
features of renal trauma
A
suspicious mechanism of injury
possible haematuria
loin or back pain
haemodynamic instability
damage to surrounding structures - ribs, vertebrae, spleen, bowel
22
Q
features ureteric trauma
A
suspicious mechanism of injury
insidious onset of generalised sx includin peritonitis, abdo pain, ileus, uronoma, urine leaking from a wound/fistula
23
Q
features of bladder trauma
A
suspicious mechanism of injury
pelvic fracture
peritonism
abdo distension
ileus
oliguric/anuric
haematuria
blood at urethral meatus
perineal/scrotal bruising
high riding prostate
24
Q
mx bladder injury
A
CT used to diagnise
if extraperitoneal: urethral catheter to allow healing
if intraperitoneal: surgical repair
25
features penile fracture
feeling of a snap or pop while the penis is erect followed by immediate detumescence
eggplant appearance: swelling, discolouration deformity
26
mx penile fracture
surgical repair
27
what is paraphimosis
foreskin retracted behind the glans and cannot be replaced
28
features paraphimosis
foreskin retracted behind corona of glans penis
penile oedema
discolouration and necrosis
cracks in the skin
may be pain
often in catheterised patients
29
mx paraphimosis
REDUCTION
methods:
ice: topical lidocaine 5 misn then ice wrapped in gauze
sugar: apply 50% dextrose then ice - not that good
surgical
30
what is fourniers gangrene
necrotising fascitis of the genitalia and perineum
31
common causes fourniers gangrene
e.coli, klebsiella, enterococci
clostridium, bacteroids
32
features fourniers gangrene
acutely unwell
sepsis
erythematous area around external genitalia or perineum
blistering of skin
crepitus
discolourisation as necrosis occurs
33
RF fourniers gangrene
DM
catheterisation
immunocompromise
post surgery
perineal and peri-anal infections
steroid therapy
34
mx fourniers gangrene
abx
make ITU aware
debridement necrotic tissue in theatre
35
what is priapism
persistance of an unwanted erection for more than 4 hrs in the abscense of sexual stimulation
36
types of priapism
low flow: caused by venous occlusion. rigid and painful
high flow: caused by dysfunction arterial flow. semi rigid and painless
recurrent: stuttering. oftne in sickle cell disease
37
mx low flow priapism
exercise and cooling
if fails: aspiration
if fails: intracavernosal injection of an alpha q adrenergic agonist (phenylephrine)
if fails: theatre
38
mx high flow priapism
conservativelt
selective embolisation of arterires
39
mx recurrent priapism
mx sickle cell disease
analgesia
40
features pelvic ureteric junction obstruction
narrowing of ureter as it joins renal pelvis
obstructs urine flow from kidney
congenital
increased risk infections and stones
may present with hydronephrosis, loin pain, discomfort
41
features horseshoe kidney
congenital
kindeys join so 1 big kidney - join=isthmus
risk kidney stones, pyelonephritis, PUJ obstruction
42
features renal agenesis and dysplasia
unilateral
kidney absent or underdeveopled
43
features renal cysts
increase with age
rarely affect renal function
if complex need to rule out malignanc
44
features adult polycystic kidneys
commonly causes CKD
increased risk hepatic and pancreatic cysts, HTN, intracranial aneurisms, valve abnormalitiies
45
features ectopic kidney
ascends insufficientky
increased risk PUJO
often foudn in pelvis
some are non functioning
46
common types of renal cancer
renal cell carcinoma: adenocarcinoma
transitional cell carcinoma: originates from urothelial cells
wilms tumour: nephroblastoma, children
47
RF renal cancer
smoking
CKS and dialysis
HTN
male
obesity
age
genetics: von-hippel lindaue, HNPCC, tuberous sclerosis
48
features renal cancer
mass
haematuria
loin pain
htn
signs metastatic spread
left sided variocele
paraneoplastic syndromes e.g. polycythaemia, anaemia, hypercalcaemia
49
classic triad renal cancer
mass, haematuria, pain
however less than 10% present with this
50
mx renal cancer
support
medical: surveillance, radiotherapy, chemo
surgical: nephrectomy, nephroereterectomy, renal artery embolisation
51
gold standard ix kidney stones
non contrast CT KUB
52
features renal colic
loin or loin to groin pain 0 very severe
cannto sit still
nausea, clammy
tachycardia
haematuria
sx infection
53
kidney stone composition
calcium oxalate - most common, radio-opaque, cause=acidic urine
uric acid: radio-lucent, cause = acidic urine
struvite: radio-opaque, cause=infection
cystine: slightly radio-opaque, cause=genetic
calcium phosphate: radio-opaque, cause=alkaline urine hyperparathyroidism
54
intrinsic RF for kindey stones
20-50y
males
genetics: caucasiana nd asian, fhx, cystinuria, hypercalcuira, hyperuricaemia
anatomy: horseshoe/duplex kindey, PUJO
UTIs
medication: loop diuretics, steroids, chemo, anti-epileptics
55
extrinsic RF kidney stones
western lifestyle
hot climae
fluid intake <1.2L/
sednetary lifetyle
working in a hot emvironment
deit: high protein, high salt, low ca, malabsorption
56
when do renal stones need emergency intervention
signs infection
single funtioning kidney
renal impairment
obstructed kidney
57
mx renal stones
active surveillance
extracorporeal shockwave lithotripsy
percutaneous nephrolithotomy
flexible uteroscopy
58
mx proximal ureteric stones
ESWL
rigif uteroscomy
conservative
59
mx distal ureteric stones
conservative
ESWL
rigid ureteroscopy
60
causes bladder calculi (stones)
urinary stasis - ibstructing prostate
61
common composition bladder calculi
calcium based
62
ix for bladder calculi
USS, XR, flexible cystoscopy
63
features bladder calculi
pain
luts
haematuria
utis
incidental finding
64
mx bladder calculi
endoscopic: cystolitholapaxy, laser fragmentation, pneumatic lithotripsy
open: cystolithotomy
65
bladder cancer types
most common= transitional cell carcinoma
others=squamous cell carcinoma, adenocarcinoma
66
RF bladder cancer
50-80y
male
caucasian
exposure to aromatic amines (dyes, rubber, leather, paint, textiles)
medications: cyclophosphamide
smoking
fhx
hnpcc
67
RF bladder squamous cell carcinoma
smoking
schistosomiasis
chronic cystitis
long term catheter
intermittent self catherisation
68
features bladder cancer
haematuria-often painless and visble
urgency
suprapubic/pelvic mass
suprapubic pain
recurrent uti
sx systemic spread
69
mx bladder cancer
support
medicalL radiotherpay, chemotherapy
surgical: TURBT most common, cystodiathermy, cystectomy
70
LUTS
storage: freq, urgency, urge incontience, nocturia, bedwetting
voiding: haematuria, dysuria, hesitancy, poor flow, terminal dribbling, incomplete voiding
71
ix for cause of luts
uroflowometry
post voidal residual vol
psa and renal function
urine dipstick and culture
freq vol chart
USS
urodynamic testing
72
causes voiding luts
BPH
prostate cancer
uretheral stricture
meatal stenosis
phimosis
73
causes storage luts
overactive bladder
cystitis
intravesical pathology - tumour or bladder calculi
74
what is BPH
increase in number of epithelial and stromal cells
often in transitional zone
75
presnetation BPH
luts
76
mx BPH
alpha blockers: tamsulosin
5alpha reductase inhibitors finasteride
TURP, laser prostatecomy
77
SE tamsulosin
retrogreade ejaculation, dizzy, hypotension
78
SE finasteride
erectile dysfunction, reduced libido and ejaculation
79
most common type of prostate cancer
adenocarcinoma - usually originates in the peripheral zone
80
features prostate canceerq
luts
haematospermia
rasied psa
abnormal dre - hard, nodular, craggy
bone or back pain due to metastases
81
what is gleason grading
grading of prostate cancer using histology
guides tx
82
mx prostate cancer
active surveillance: if low risk
radiotherapy: local and locally advanced cancer and bone metastases
hormone therapy
chemo: metastases
surgical - prostatectomy
83
features testicular cancer
palpable lump
non transilluminable
may be painful
often found on self examination
84
RF testicular cancer
20-45y
caucasian
cryptorchidism
prev testicular cancer
HIV
fhx
85
types of testicular cancer
germ cell tumours (90%): seminomas, teratoma, chordiocarcinoma, yolk sac tumour
non germ cell tumours: sertoli, leydig, lymphoma, mesenchymal
86
ix testicular cancer
USS
CXR if sx for metastases
tumour markers: AFP, hCG, LDH
87
mx testicular cancer
semen cropreservation
urgent radical inguinal orcidectomy
+/- testicular prosthesis
metastases: resect lymoh nodes, chemo, radiotherapy
88
what is cryptorchidism
undescended testes
89
what does untx undescended testes increase risk of
infertility
testicular torsion
testicular cancer as present late as cant examine testes
90
retractile crptorchidism
can easily be brough into scrotum
variant of normal
does not require surgery
91
maldescended testes
on normal path of descent
92
ectopic crptorchidism
often in thigh, perineum, opposite side of scrotum
93
mx palpable maldescended testes
orchidoplexy
94
mx impalpabe testes
laparoscopy to find and bring down if viable
sometiems done as a 2 stage procedure
95
describing a lump
6S: site, size, shape, surface, skin, scar
5C: consistency, contour, colour, can you mobilise it, can you palpate any lymoh nodes
4T: tender, temp, tethering, transillumination
96
what is hydrocele
accumulation of fluid within tunica vaginalis
97
causes secondary hydrocele
malignancy, trauma, infectio,n torsion
98
features of hydrocele
fluctuant scrotal swelling
transilluminable
unable to palpate the testis separate to the swelling
can get above the swelling
99
mx hydrocele
conservative
surgical
aspiration if not suitbale for anaesthetic
100
what is variocele
dilatation testicualr veins
101
features variocele
feels like a bag of worms
dragging sensation
aching
identified on USS
102
mx variocele
conservative
surgical ligation
embolisation
103
features epididymal cyst
palpable lumps within epididymis
difficult to transilluminate
may be pain
USS
104
mx epididymal cyst
conservative
surgical excision if large or sx
105
features sebaceous cyst of scrotum
hard containing a white/yellow substance
palpable lump within scrotal skin
lumos tethered to skin
rubbery feel
non transilluminable
multiple cysts
usually painless
106
mx scrotal sebaceous cyst
conservative
surgical excision
107
what is epididymo-orchitis
infection epididymis/testicle
108
common causes epididymo-orchitis
e.coli
chlamydia, gonorrhea
mumps if unvaccinated
109
features epididymo-orchitis
preceding sx uti
luts
penile discharge
painful hemiscrotum - hot and swollen
fever
epididymis tender and cord may feel thickened
110
mx epididymo-orchitis
rule out torsion
abx depending on cause
111
what is erectile dysfunction
the recurrent inability to achieve or maintain an erection inhibiting sexual intercourse
112
ix in erectile dysfunction
examination: CV, neuro, abdo, external genitalia, dre
bloods: testosterone, lh, fsh, prolactin, sex-hormone binding globulin, tfts, glucose
nocturnal penile tumescence testing
MRI - peyonries plaques. doppler USS-vasculature
113
organic causes erectile dysfunction
endo: DM, thryoid, hyperprolactinaemia, hypogonadism
neuro: spinal cord pathology e.g. compression, MS, parkinsons
vascular: hyperlipidaemia, peripheral vascular disease, htn
medication: antidepresants, parkinsons, anti androgens, anti htn
other: alcohol, smoking, pelvic surgery/radiotherapy, peyronies disease, substance abuse
114
mx psychogenic erectile dysfunction
therapy
115
mx organic erectile dysfunction
phosphodiesterase type 5 i: cause vasodilation
intrauretheral prostaglandins: vasodilation
intracavernosal injections
vacuum erection device
testosterone replacement of hypogonadism
penile prothsesis
116
what is peyronies disease
curvature of the penis caused by the development of fibrotic tissue on the tunica albuginea
117
cause peyronies disease
repeated minor trauma causes microvascular damage resulting in inflammation and fibrosis
associated with DM, HTN, high cholesterol, dupuytrens contracture, plantar fascitis
118
features peyronies disease
significant curvature of penis usually only notabel when erect
penile shortening
penile pain
erectily dysfunction
difficulty having penetrative intercourse
palpable fibrous plaque along shaft of penis at site of angular deviation
altered shape- hourglass
119
mx peyronies disease
medical: oral pentoxiifyline, verapamil injection, extra-corporeal shockwave therapy
surgical: only on stable plaques - nesbits procedure
120
what is phimosis
tight foreskin unable to retract over the glans
121
features phimosis
usually asx
ballooning of foreskin on micturition
pain and irritation during intercourse
balanoposthisis - infection
122
what is balanitis xerotica obliterans
chronic inflammatory condition that can cause phimosis
often with grey/whote discolouration
123
mx balanitis xerotica obliterans
topical steroids
circumcision
124
mx phimosis
normal in childhood
circumcision
125
what is urethral stricture disease
subepithelial fibross within the corpus spongiosum causeing a narrowing of the urethra
126
cause urethral stricture disease
trauma
inflammation-urethritis
127
features urethral stricture disease
voiding luts
urinary retention
utis
difficult to pass a catherter
128
mx urethral stricture disease
surgery-dilatation or urethrotomy
129
RF incontinence
age
gender
oestrogen deficiency
anatomical disorders - fistulae
childbirth and pregnancy
abdominal, pelvic, perineal and prostate surgery
DM
smoking
obesity
uti
poor mobility
neuro: MS, parkinsons, spinal cord injury
130
what is stress urinary incontinence
involuntary leakage of urine on effort, exertion, sneezing or coughing
131
cause of stress urinary incontinence
hypermobility of bladder base, pelvic floor and urethral sphincter deficiency
132
tx stress urinary incontinenc
conservative: wt loss, exercise
pelvic floor training
surgical: tape, slings
artificial urinary sphincter implamentation-men post prostatectomy
133
what is urge urinary incontience
involuntary leakage of urine accompanied by or immediatelt proceeded by urgency
134
cause of urge urinary incontience
over active detrusor muscle
135
what is overactive bladder syndrome
urgency with or witjout urge incontinence, often with frequency and nocturia
136
mx urge urinary incontience
conservative: reduce caffeien, alcohol
anti-muscarinics: oxybutynin
b3 adrenoreceptor agonist: mirabegron
neuromodulation
botox
clam cytoplasty or urinary diversion
137
what is mixed urinary incontience
the involuntary leakage of urine associated with effort, exertion, coughing or sneezing accompanied by or immediately proceeded by irgency
138
cause mixed urinary incontience
hypermobility of bladder base, pelvic floor and urethral sphincter deficiency and over active detrusor muscle
139
what is overflow incontinence
involuntarty leakage of urine when the bladder is abnormally distened with large volumes of urine
140
cause overflow urinary invontinence
often due to bladder outflow obstruction and a degree of detrusor failure
141
mx overflow urinary incontience
tx bladder outflow obstruction
long term catheter
intermittent self catheterisation
142
uncomplicated UTI
in an otherwise normal urinary tract
143
complicated uti
in an abnoral (structure or cancer/stones) or male urinary tract
144
symptoms uti
suprapubic pain or discomfort
freq
urgency
strangury
dysuria
haematuria
malodorous urine
delirium
fever
loin pain or rigors in pyelonephritis
145
signs of utis
suprapubic tenderness
renal angle tenderness in pyelonephritis
positive urinary dipstick testing for leucocytes
haematuria
delirium
sepsis
146
common causes uti
e.coli
proteus mirabilis - can be associated with stones
klebsiella
147
mx uti
uncomplicated: 3d abx
complicated : 7d abx, mayneed iv
148
RF uti
female
prev utis
post-menopausal
age
DM
pregancy
anatomcal abnormalities urinary tract
catheters
149
definition recurrent utis
2 infections in 6m or 3 in 1 y
150
ix recurrent uti
for cause e.g, stones or malignancy
CT/USS and cystoscopy
151
mx recurrent utis
conservative: increase fluid, vaginal oestrogen in post menopausal, avoid constipation, good hygiee, void before and after sex
self start abx
post coital prophylactic abx if trigger
long term low dose prophylacttic abx
152
common reasons for failing to catheterise m
enlarged prostate
urethral stricture
153
when to provide prophylactic abx if catheterised
prev infections from catheter
high risk infection
difficult insertion
at risk endocarditis
154
common reasons for failing to catheterise a f
meatal stenosis
cystocele
position urethral meatus
155
acute risks catheterisation
pain
bleeding
false passage
failure
urethral damage
paraphimosis
infection
156
chronic rissk catheterisation
stricture formation
failed TWOC
stones
cancer
157
symptoms gonorrhoea
penile/vaginal discharge
dysuria
conjunctivitis
pelvic pain/deep dyspareunia/pot coital and intermenstrual bleeding
158
cause gonorrhoea
neisseria gonorrhoea
159
complications gonorrhoea
PID
epididymo-orrchitits
tubo-ovarian abscess
ectopic pregnancy
infertility
systemic - disseminated gonococcal infection (rash, septic arthritis)
160
mx gonorrhoea
IM ceftriaxone
161
cause of chllamydia
chlamydia trachomatis
162
sx chlamydia
penile/vaginal discharge
dysuria
conjunctivitis
pelvic pain/deep dyspareunia/pot coital and intermenstrual bleeding
163
complications chlamydia
PID
epididymo-orrchitits
tubo-ovarian abscess
ectopic pregnancy
infertility
systemic - disseminated gonococcal infection (rash, septic arthritis)
systemic: sexually acquired reactive arthritis, peri hepatitis
164
mx chlamydia
doxycycline 1wk
165
cause of lymphogranulom a venerum
chlamydia trachomatis serova l1-3
166
sx lymphogranulom a venerum
proctitis- bleeding, tenesmus, change in bowel habit, inguinal ymphadenopathy
167
complications lymphogranulom a venerum
fistula
168
mx lymphogranulom a venerum
doxycycline 3w
169
cause of syphilis
treponema pallidum
170
mx syphilis
penicllin
171
sx trichomonas vaginalis
vaginal discahrge, vulval itch
172
mx trichomonas vaginalis
metronidazole
173
cause of genital herpes
herpes simplex type 1 and 2
174
sx herpes
uclers, dysuria, occassionalyy dischagre
175
complications herpes
disseminated encephalitis
176
mx herpes
aciclovir
177
cause genital warts
hpv 6 and 11
178
mx genital wart
imiquimod/podophyllotoxin, cryotherapy
179
ix for stis - heterosexual
CT/GC DNA NAAT and 2w after LSI
men=urine, women = vulvovaginal swab
serology baseline plus
syphilis 4-6w post lsi, hiv 4-6w using 4th gen test but need to finalise at 12w, hep b at 12w
ulcers/dishcarge/pain: refer
180
when to consider PEP HIV
all who present u to 72h
type of activity, where, sexual orientation
181
what is PEP
truvada (tenofovir/emtracitabine) plus raltegravir
182
presentation HIV
2-6w after exposure
glandular fever/flu like sx: fever, sore throat, rash, lymphadenopathy, muscle and joint pain, mouth ulcers/candida
pneumonia
viral meningitis
183
presentation primary syphilis
single painless genital ulcer 9-90d after exposure
184
presentation secondary syphilis
6-12w after exposure
generalised rash: palms and soles of feet, warts on genitals, snail track ulcers of mouth
hair loss
flu, lymoh nodes enlarged
bone pain, joint pain
liver and kidney problems
viral meningitis, iritis
185
tropical stis
chancroid
donovanosis
186
presntation tropical stis
pustule
painful or painless ulcers
lymphadenopathy
187
asx sti screening female
vulvovaginal swab for gonorrhoea/chlamydia naat
bloods for sts and hiv
188
x st screening heterosexual male
First void urine for Chlamydia/Gonorrhoea
NAAT
Bld test for STS + HIV
189
asx screening men who have sex with men
First void urine for Chlamydia/Gonorrhoea
NAAT
Pharyngeal swab for Chlamydia/Gonorrhoea
NAAT (may be self taken)
Rectal swab for Chlamydia/Gonorrhoea NAAT
(may be self taken)
Bld for STS, HIV, Hep B (& Hep C if indicated)
190
sx screening stis female
Vulvo-vaginal swab for Gonorrhoea + chlamydia NAAT
High vaginal swab (wet & dry slides) for Bacterial Vaginosis (BV), Trichomonas Vaginalis (TV), Candida
Cervical swab for slide + Gonorrhoea culture
Dipstick urinalysis (If has dysuria)
Bld for STS + HIV
191
symtpomatic screening heterosexual male
Urethral swab for slide + Gonorrhoea culture
First void urine for Gonorrhoea + Chlamydia NAAT
Dipstick urinalysis (If has dysuria)
Bld for STS + HIV
192
symptomatic screening men who have sex with men
First void urine for Chlamydia/Gonorrhoea
NAAT
Pharyngeal swab for Chlamydia/Gonorrhoea
NAAT (may be self taken)
Rectal swab for Chlamydia/Gonorrhoea NAAT
(may be self taken)
Bld for STS, HIV, Hep B (& Hep C if indicated)
urethral and rectal slides
urethral, rectal, pharyngeal culture plates
193
who to screen for hep b
Men who have Sex with Men (MSM)
Commercial Sex Workers (CSW) and their sexual
partners
IVDUs (current or past), and their sexual partners
People from high risk areas and their sexual
partners: Africa, Asia, Eastern Europe
194
primary prevention strategeis to reduce stis
awareness compaigns
discussion
vaccination - hep b, hpv
pre and post exposure prophylaxis
195
secondary prevention stis
easy access to tests and treatments
partner notification
targeted screening
196
markers to monitor HIV infection
CD4+ t cell count
HIV viral load
197
AIDS defining conditions
infections: candidiasis, extra-pulmonary crptococcosis, CMV, mycobacterium TB, toxoplasmosis, HSV, pneumocystis jiroveci pneumonia
neoplasms: kaposis sarcoma, primary cns lymphoma, non hodgkins lymphoma
direct hiv effect: dementia/encephalopathy, wasting
198
features clinically latent phase HIV
no findings other than persistent generalised lymphadenopathy
199
features early symptomatic HIV
oral/vaginal candida
oral hairy leukolakia
VZV
cervical dysplasia
peripheral neuropathy
bacillary angiomatosis
immune mediated ITP
PID
listeriosis
200
Types androgen deprivation therapy for prostate ca
LHRH agonists - buserelin
LHRH antagonist - degarellix
Anti androgenic- flutamide, bicalutamide
Bilateral orchidectomy
201
LHRH agonists for prostate ca
E.g. buserelin, goserelin
Take a while to work
Reduce LH so less testosterone
When LHRH agonists are first given, testosterone levels go up briefly before falling to very low levels. This effect, called tumor flare, give antiandrogenz to counteract
202
LHRH antagonist for prostate ca
Degarelix
Works quickly
Increases LH so testosterone reduces due to negative feedback
GnRH blocker
When LHRH agonists are first given, testosterone levels go up briefly before falling to very low levels
