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finals > urology and genitourinary > Flashcards

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

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2
Q

common presentation prostate cancer

A

raised PSA - 2ww
abnormal DRE
wt loss
bone pain
renail failure
LUTS

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3
Q

mx prostate cancer

A

prostatectomy
ERBT/ADT
brachytherapy
surveillance

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4
Q

serious complication metastatic prostate cancer

A

cord compression - need MRI and steroids

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5
Q

kidney stones

A

severe loin to groin pain
need pain relief NCCT, U+Es, Ca, uric acid
exclude sepsis

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6
Q

urological emergencies

A

testicular torsion
uro sepsis (epididymo-orchitis, pyelonephritis, fourniers gangrene)
ureteric colic
acute retention
haematuria
trauma
paraphimosis

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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

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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

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9
Q

mx signifiant haematuria

A

A_E
oxygen
IV access and bloods +/- fluids
3 way catheter
mid stream sample

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10
Q

ix haematuria

A

bloods
urine sample
imaging: USS, contrast CT
flexible cystoscopy

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11
Q

acute vs chronic urinary retention

A

acute painful, chronic not
chronic v large vol
chronic insidious onset and hx luts

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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

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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

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14
Q

mx acute urinary retention

A

2 way catheter and record residual vol drained
urine sample

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15
Q

indications high pressure urinary retention

A

large residual vol urine (>1l)
deranged renal function (high creatinine)

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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

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17
Q

mx testicualr torsion

A

surgical exploration
dont USS as wastes time

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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

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19
Q

features infected obstructed kidney

A

fever
rigors
loin-groin/back/abdo pain
haematuria
tachycardia
tachypnoea
high news
other features sepsis

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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

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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

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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

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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

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24
Q

mx bladder injury

A

CT used to diagnise
if extraperitoneal: urethral catheter to allow healing
if intraperitoneal: surgical repair

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25
Q

features penile fracture

A

feeling of a snap or pop while the penis is erect followed by immediate detumescence
eggplant appearance: swelling, discolouration deformity

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26
Q

mx penile fracture

A

surgical repair

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27
Q

what is paraphimosis

A

foreskin retracted behind the glans and cannot be replaced

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28
Q

features paraphimosis

A

foreskin retracted behind corona of glans penis
penile oedema
discolouration and necrosis
cracks in the skin
may be pain
often in catheterised patients

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29
Q

mx paraphimosis

A

REDUCTION
methods:
ice: topical lidocaine 5 misn then ice wrapped in gauze
sugar: apply 50% dextrose then ice - not that good
surgical

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30
Q

what is fourniers gangrene

A

necrotising fascitis of the genitalia and perineum

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31
Q

common causes fourniers gangrene

A

e.coli, klebsiella, enterococci
clostridium, bacteroids

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32
Q

features fourniers gangrene

A

acutely unwell
sepsis
erythematous area around external genitalia or perineum
blistering of skin
crepitus
discolourisation as necrosis occurs

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33
Q

RF fourniers gangrene

A

DM
catheterisation
immunocompromise
post surgery
perineal and peri-anal infections
steroid therapy

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34
Q

mx fourniers gangrene

A

abx
make ITU aware
debridement necrotic tissue in theatre

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35
Q

what is priapism

A

persistance of an unwanted erection for more than 4 hrs in the abscense of sexual stimulation

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36
Q

types of priapism

A

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

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37
Q

mx low flow priapism

A

exercise and cooling
if fails: aspiration
if fails: intracavernosal injection of an alpha q adrenergic agonist (phenylephrine)
if fails: theatre

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38
Q

mx high flow priapism

A

conservativelt
selective embolisation of arterires

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39
Q

mx recurrent priapism

A

mx sickle cell disease
analgesia

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40
Q

features pelvic ureteric junction obstruction

A

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

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41
Q

features horseshoe kidney

A

congenital
kindeys join so 1 big kidney - join=isthmus
risk kidney stones, pyelonephritis, PUJ obstruction

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42
Q

features renal agenesis and dysplasia

A

unilateral
kidney absent or underdeveopled

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43
Q

features renal cysts

A

increase with age
rarely affect renal function
if complex need to rule out malignanc

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44
Q

features adult polycystic kidneys

A

commonly causes CKD
increased risk hepatic and pancreatic cysts, HTN, intracranial aneurisms, valve abnormalitiies

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45
Q

features ectopic kidney

A

ascends insufficientky
increased risk PUJO
often foudn in pelvis
some are non functioning

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46
Q

common types of renal cancer

A

renal cell carcinoma: adenocarcinoma
transitional cell carcinoma: originates from urothelial cells
wilms tumour: nephroblastoma, children

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47
Q

RF renal cancer

A

smoking
CKS and dialysis
HTN
male
obesity
age
genetics: von-hippel lindaue, HNPCC, tuberous sclerosis

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48
Q

features renal cancer

A

mass
haematuria
loin pain
htn
signs metastatic spread
left sided variocele
paraneoplastic syndromes e.g. polycythaemia, anaemia, hypercalcaemia

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49
Q

classic triad renal cancer

A

mass, haematuria, pain
however less than 10% present with this

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50
Q

mx renal cancer

A

support
medical: surveillance, radiotherapy, chemo
surgical: nephrectomy, nephroereterectomy, renal artery embolisation

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51
Q

gold standard ix kidney stones

A

non contrast CT KUB

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52
Q

features renal colic

A

loin or loin to groin pain 0 very severe
cannto sit still
nausea, clammy
tachycardia
haematuria
sx infection

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53
Q

kidney stone composition

A

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

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54
Q

intrinsic RF for kindey stones

A

20-50y
males
genetics: caucasiana nd asian, fhx, cystinuria, hypercalcuira, hyperuricaemia
anatomy: horseshoe/duplex kindey, PUJO
UTIs
medication: loop diuretics, steroids, chemo, anti-epileptics

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55
Q

extrinsic RF kidney stones

A

western lifestyle
hot climae
fluid intake <1.2L/
sednetary lifetyle
working in a hot emvironment
deit: high protein, high salt, low ca, malabsorption

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56
Q

when do renal stones need emergency intervention

A

signs infection
single funtioning kidney
renal impairment
obstructed kidney

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57
Q

mx renal stones

A

active surveillance
extracorporeal shockwave lithotripsy
percutaneous nephrolithotomy
flexible uteroscopy

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58
Q

mx proximal ureteric stones

A

ESWL
rigif uteroscomy
conservative

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59
Q

mx distal ureteric stones

A

conservative
ESWL
rigid ureteroscopy

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60
Q

causes bladder calculi (stones)

A

urinary stasis - ibstructing prostate

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61
Q

common composition bladder calculi

A

calcium based

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62
Q

ix for bladder calculi

A

USS, XR, flexible cystoscopy

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63
Q

features bladder calculi

A

pain
luts
haematuria
utis
incidental finding

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64
Q

mx bladder calculi

A

endoscopic: cystolitholapaxy, laser fragmentation, pneumatic lithotripsy
open: cystolithotomy

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65
Q

bladder cancer types

A

most common= transitional cell carcinoma
others=squamous cell carcinoma, adenocarcinoma

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66
Q

RF bladder cancer

A

50-80y
male
caucasian
exposure to aromatic amines (dyes, rubber, leather, paint, textiles)
medications: cyclophosphamide
smoking
fhx
hnpcc

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67
Q

RF bladder squamous cell carcinoma

A

smoking
schistosomiasis
chronic cystitis
long term catheter
intermittent self catherisation

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68
Q

features bladder cancer

A

haematuria-often painless and visble
urgency
suprapubic/pelvic mass
suprapubic pain
recurrent uti
sx systemic spread

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69
Q

mx bladder cancer

A

support
medicalL radiotherpay, chemotherapy
surgical: TURBT most common, cystodiathermy, cystectomy

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70
Q

LUTS

A

storage: freq, urgency, urge incontience, nocturia, bedwetting
voiding: haematuria, dysuria, hesitancy, poor flow, terminal dribbling, incomplete voiding

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71
Q

ix for cause of luts

A

uroflowometry
post voidal residual vol
psa and renal function
urine dipstick and culture
freq vol chart
USS
urodynamic testing

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72
Q

causes voiding luts

A

BPH
prostate cancer
uretheral stricture
meatal stenosis
phimosis

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73
Q

causes storage luts

A

overactive bladder
cystitis
intravesical pathology - tumour or bladder calculi

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74
Q

what is BPH

A

increase in number of epithelial and stromal cells
often in transitional zone

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75
Q

presnetation BPH

A

luts

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76
Q

mx BPH

A

alpha blockers: tamsulosin
5alpha reductase inhibitors finasteride
TURP, laser prostatecomy

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77
Q

SE tamsulosin

A

retrogreade ejaculation, dizzy, hypotension

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78
Q

SE finasteride

A

erectile dysfunction, reduced libido and ejaculation

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79
Q

most common type of prostate cancer

A

adenocarcinoma - usually originates in the peripheral zone

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80
Q

features prostate canceerq

A

luts
haematospermia
rasied psa
abnormal dre - hard, nodular, craggy
bone or back pain due to metastases

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81
Q

what is gleason grading

A

grading of prostate cancer using histology
guides tx

82
Q

mx prostate cancer

A

active surveillance: if low risk
radiotherapy: local and locally advanced cancer and bone metastases
hormone therapy
chemo: metastases
surgical - prostatectomy

83
Q

features testicular cancer

A

palpable lump
non transilluminable
may be painful
often found on self examination

84
Q

RF testicular cancer

A

20-45y
caucasian
cryptorchidism
prev testicular cancer
HIV
fhx

85
Q

types of testicular cancer

A

germ cell tumours (90%): seminomas, teratoma, chordiocarcinoma, yolk sac tumour
non germ cell tumours: sertoli, leydig, lymphoma, mesenchymal

86
Q

ix testicular cancer

A

USS
CXR if sx for metastases
tumour markers: AFP, hCG, LDH

87
Q

mx testicular cancer

A

semen cropreservation
urgent radical inguinal orcidectomy
+/- testicular prosthesis
metastases: resect lymoh nodes, chemo, radiotherapy

88
Q

what is cryptorchidism

A

undescended testes

89
Q

what does untx undescended testes increase risk of

A

infertility
testicular torsion
testicular cancer as present late as cant examine testes

90
Q

retractile crptorchidism

A

can easily be brough into scrotum
variant of normal
does not require surgery

91
Q

maldescended testes

A

on normal path of descent

92
Q

ectopic crptorchidism

A

often in thigh, perineum, opposite side of scrotum

93
Q

mx palpable maldescended testes

A

orchidoplexy

94
Q

mx impalpabe testes

A

laparoscopy to find and bring down if viable
sometiems done as a 2 stage procedure

95
Q

describing a lump

A

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
Q

what is hydrocele

A

accumulation of fluid within tunica vaginalis

97
Q

causes secondary hydrocele

A

malignancy, trauma, infectio,n torsion

98
Q

features of hydrocele

A

fluctuant scrotal swelling
transilluminable
unable to palpate the testis separate to the swelling
can get above the swelling

99
Q

mx hydrocele

A

conservative
surgical
aspiration if not suitbale for anaesthetic

100
Q

what is variocele

A

dilatation testicualr veins

101
Q

features variocele

A

feels like a bag of worms
dragging sensation
aching
identified on USS

102
Q

mx variocele

A

conservative
surgical ligation
embolisation

103
Q

features epididymal cyst

A

palpable lumps within epididymis
difficult to transilluminate
may be pain
USS

104
Q

mx epididymal cyst

A

conservative
surgical excision if large or sx

105
Q

features sebaceous cyst of scrotum

A

hard containing a white/yellow substance
palpable lump within scrotal skin
lumos tethered to skin
rubbery feel
non transilluminable
multiple cysts
usually painless

106
Q

mx scrotal sebaceous cyst

A

conservative
surgical excision

107
Q

what is epididymo-orchitis

A

infection epididymis/testicle

108
Q

common causes epididymo-orchitis

A

e.coli
chlamydia, gonorrhea
mumps if unvaccinated

109
Q

features epididymo-orchitis

A

preceding sx uti
luts
penile discharge
painful hemiscrotum - hot and swollen
fever
epididymis tender and cord may feel thickened

110
Q

mx epididymo-orchitis

A

rule out torsion
abx depending on cause

111
Q

what is erectile dysfunction

A

the recurrent inability to achieve or maintain an erection inhibiting sexual intercourse

112
Q

ix in erectile dysfunction

A

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
Q

organic causes erectile dysfunction

A

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
Q

mx psychogenic erectile dysfunction

A

therapy

115
Q

mx organic erectile dysfunction

A

phosphodiesterase type 5 i: cause vasodilation
intrauretheral prostaglandins: vasodilation
intracavernosal injections
vacuum erection device
testosterone replacement of hypogonadism
penile prothsesis

116
Q

what is peyronies disease

A

curvature of the penis caused by the development of fibrotic tissue on the tunica albuginea

117
Q

cause peyronies disease

A

repeated minor trauma causes microvascular damage resulting in inflammation and fibrosis
associated with DM, HTN, high cholesterol, dupuytrens contracture, plantar fascitis

118
Q

features peyronies disease

A

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
Q

mx peyronies disease

A

medical: oral pentoxiifyline, verapamil injection, extra-corporeal shockwave therapy
surgical: only on stable plaques - nesbits procedure

120
Q

what is phimosis

A

tight foreskin unable to retract over the glans

121
Q

features phimosis

A

usually asx
ballooning of foreskin on micturition
pain and irritation during intercourse
balanoposthisis - infection

122
Q

what is balanitis xerotica obliterans

A

chronic inflammatory condition that can cause phimosis
often with grey/whote discolouration

123
Q

mx balanitis xerotica obliterans

A

topical steroids
circumcision

124
Q

mx phimosis

A

normal in childhood
circumcision

125
Q

what is urethral stricture disease

A

subepithelial fibross within the corpus spongiosum causeing a narrowing of the urethra

126
Q

cause urethral stricture disease

A

trauma
inflammation-urethritis

127
Q

features urethral stricture disease

A

voiding luts
urinary retention
utis
difficult to pass a catherter

128
Q

mx urethral stricture disease

A

surgery-dilatation or urethrotomy

129
Q

RF incontinence

A

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
Q

what is stress urinary incontinence

A

involuntary leakage of urine on effort, exertion, sneezing or coughing

131
Q

cause of stress urinary incontinence

A

hypermobility of bladder base, pelvic floor and urethral sphincter deficiency

132
Q

tx stress urinary incontinenc

A

conservative: wt loss, exercise
pelvic floor training
surgical: tape, slings
artificial urinary sphincter implamentation-men post prostatectomy

133
Q

what is urge urinary incontience

A

involuntary leakage of urine accompanied by or immediatelt proceeded by urgency

134
Q

cause of urge urinary incontience

A

over active detrusor muscle

135
Q

what is overactive bladder syndrome

A

urgency with or witjout urge incontinence, often with frequency and nocturia

136
Q

mx urge urinary incontience

A

conservative: reduce caffeien, alcohol
anti-muscarinics: oxybutynin
b3 adrenoreceptor agonist: mirabegron
neuromodulation
botox
clam cytoplasty or urinary diversion

137
Q

what is mixed urinary incontience

A

the involuntary leakage of urine associated with effort, exertion, coughing or sneezing accompanied by or immediately proceeded by irgency

138
Q

cause mixed urinary incontience

A

hypermobility of bladder base, pelvic floor and urethral sphincter deficiency and over active detrusor muscle

139
Q

what is overflow incontinence

A

involuntarty leakage of urine when the bladder is abnormally distened with large volumes of urine

140
Q

cause overflow urinary invontinence

A

often due to bladder outflow obstruction and a degree of detrusor failure

141
Q

mx overflow urinary incontience

A

tx bladder outflow obstruction
long term catheter
intermittent self catheterisation

142
Q

uncomplicated UTI

A

in an otherwise normal urinary tract

143
Q

complicated uti

A

in an abnoral (structure or cancer/stones) or male urinary tract

144
Q

symptoms uti

A

suprapubic pain or discomfort
freq
urgency
strangury
dysuria
haematuria
malodorous urine
delirium
fever
loin pain or rigors in pyelonephritis

145
Q

signs of utis

A

suprapubic tenderness
renal angle tenderness in pyelonephritis
positive urinary dipstick testing for leucocytes
haematuria
delirium
sepsis

146
Q

common causes uti

A

e.coli
proteus mirabilis - can be associated with stones
klebsiella

147
Q

mx uti

A

uncomplicated: 3d abx
complicated : 7d abx, mayneed iv

148
Q

RF uti

A

female
prev utis
post-menopausal
age
DM
pregancy
anatomcal abnormalities urinary tract
catheters

149
Q

definition recurrent utis

A

2 infections in 6m or 3 in 1 y

150
Q

ix recurrent uti

A

for cause e.g, stones or malignancy
CT/USS and cystoscopy

151
Q

mx recurrent utis

A

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
Q

common reasons for failing to catheterise m

A

enlarged prostate
urethral stricture

153
Q

when to provide prophylactic abx if catheterised

A

prev infections from catheter
high risk infection
difficult insertion
at risk endocarditis

154
Q

common reasons for failing to catheterise a f

A

meatal stenosis
cystocele
position urethral meatus

155
Q

acute risks catheterisation

A

pain
bleeding
false passage
failure
urethral damage
paraphimosis
infection

156
Q

chronic rissk catheterisation

A

stricture formation
failed TWOC
stones
cancer

157
Q

symptoms gonorrhoea

A

penile/vaginal discharge
dysuria
conjunctivitis
pelvic pain/deep dyspareunia/pot coital and intermenstrual bleeding

158
Q

cause gonorrhoea

A

neisseria gonorrhoea

159
Q

complications gonorrhoea

A

PID
epididymo-orrchitits
tubo-ovarian abscess
ectopic pregnancy
infertility
systemic - disseminated gonococcal infection (rash, septic arthritis)

160
Q

mx gonorrhoea

A

IM ceftriaxone

161
Q

cause of chllamydia

A

chlamydia trachomatis

162
Q

sx chlamydia

A

penile/vaginal discharge
dysuria
conjunctivitis
pelvic pain/deep dyspareunia/pot coital and intermenstrual bleeding

163
Q

complications chlamydia

A

PID
epididymo-orrchitits
tubo-ovarian abscess
ectopic pregnancy
infertility
systemic - disseminated gonococcal infection (rash, septic arthritis)
systemic: sexually acquired reactive arthritis, peri hepatitis

164
Q

mx chlamydia

A

doxycycline 1wk

165
Q

cause of lymphogranulom a venerum

A

chlamydia trachomatis serova l1-3

166
Q

sx lymphogranulom a venerum

A

proctitis- bleeding, tenesmus, change in bowel habit, inguinal ymphadenopathy

167
Q

complications lymphogranulom a venerum

A

fistula

168
Q

mx lymphogranulom a venerum

A

doxycycline 3w

169
Q

cause of syphilis

A

treponema pallidum

170
Q

mx syphilis

A

penicllin

171
Q

sx trichomonas vaginalis

A

vaginal discahrge, vulval itch

172
Q

mx trichomonas vaginalis

A

metronidazole

173
Q

cause of genital herpes

A

herpes simplex type 1 and 2

174
Q

sx herpes

A

uclers, dysuria, occassionalyy dischagre

175
Q

complications herpes

A

disseminated encephalitis

176
Q

mx herpes

A

aciclovir

177
Q

cause genital warts

A

hpv 6 and 11

178
Q

mx genital wart

A

imiquimod/podophyllotoxin, cryotherapy

179
Q

ix for stis - heterosexual

A

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
Q

when to consider PEP HIV

A

all who present u to 72h
type of activity, where, sexual orientation

181
Q

what is PEP

A

truvada (tenofovir/emtracitabine) plus raltegravir

182
Q

presentation HIV

A

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
Q

presentation primary syphilis

A

single painless genital ulcer 9-90d after exposure

184
Q

presentation secondary syphilis

A

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
Q

tropical stis

A

chancroid
donovanosis

186
Q

presntation tropical stis

A

pustule
painful or painless ulcers
lymphadenopathy

187
Q

asx sti screening female

A

vulvovaginal swab for gonorrhoea/chlamydia naat
bloods for sts and hiv

188
Q

x st screening heterosexual male

A

First void urine for Chlamydia/Gonorrhoea
NAAT

Bld test for STS + HIV

189
Q

asx screening men who have sex with men

A

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
Q

sx screening stis female

A

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
Q

symtpomatic screening heterosexual male

A

Urethral swab for slide + Gonorrhoea culture

First void urine for Gonorrhoea + Chlamydia NAAT

Dipstick urinalysis (If has dysuria)

Bld for STS + HIV

192
Q

symptomatic screening men who have sex with men

A

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
Q

who to screen for hep b

A

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
Q

primary prevention strategeis to reduce stis

A

awareness compaigns
discussion
vaccination - hep b, hpv
pre and post exposure prophylaxis

195
Q

secondary prevention stis

A

easy access to tests and treatments
partner notification
targeted screening

196
Q

markers to monitor HIV infection

A

CD4+ t cell count
HIV viral load

197
Q

AIDS defining conditions

A

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
Q

features clinically latent phase HIV

A

no findings other than persistent generalised lymphadenopathy

199
Q

features early symptomatic HIV

A

oral/vaginal candida
oral hairy leukolakia
VZV
cervical dysplasia
peripheral neuropathy
bacillary angiomatosis
immune mediated ITP
PID
listeriosis

200
Q

Types androgen deprivation therapy for prostate ca

A

LHRH agonists - buserelin
LHRH antagonist - degarellix
Anti androgenic- flutamide, bicalutamide
Bilateral orchidectomy

201
Q

LHRH agonists for prostate ca

A

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
Q

LHRH antagonist for prostate ca

A

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

finals (31 decks)

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