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Surgery II > Urology: Diagnostic Tests in Urology > Flashcards

Urology: Diagnostic Tests in Urology Flashcards

1
Q

what are the 3 key things to do to get a diagnosis?

A
  • history
  • physical examination
  • investigations
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2
Q

what do urine cultures do?

A
  • incubation to grow the offending microbe

- testing for sensitivity to antibiotics, if bacterial

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3
Q

which tests are included in a urine dipstick?

A
  • RBC
  • WBC
  • protein
  • glucose
  • pH
  • nitrites
  • specific gravity
  • ketones
  • bilirubin
  • urobilinogen
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4
Q

what is a 24-hr urine collection used for?

A

check for hormone levels in the urine, apart from levels of electrolytes

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5
Q

what type of investigations are used in urology?

A
  • urinalysis/blood tests
  • radiological imaging
  • endoscopy
  • biopsy
  • urodynamic studies
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6
Q

what should you delve into in the history?

A
  • duration, severity, chronicity, periodicity and degree of disability of the presenting complaint
  • past medical history (surgery, conditions, drugs, allergies, anaesthesia)
  • family history (familial prostate cancer, cystine stones, polycystic kidneys, smoking, alcohol, occupation)
  • drug history
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7
Q

what does pain signify in urology?

A
  • inflammatory pain is constant
  • obstructive pain fluctuates in intensity
  • in renal colic, the patient cannot get comfortable and thus, they roll around in agony
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8
Q

what should you ask in haematuria?

A
  • is it frank or microscopic?
  • when does it occur in the urinary stream - initial, total, terminal
  • is it associated with pain
  • are there any clots passed in the urine
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9
Q

what are the lower urinary tract symptoms?

A
  • obstructive: hesistancy, poor flow, terminal dribbling
  • irritative: frequency, urgency, urge incontinence
  • noctural
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10
Q

other symptoms which are important to ask about

A
  • haematospermia
  • pneumaturia
  • urethral discharge
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11
Q

what does urethral discharge signify?

A
  • venereal disease

- urethral carcinoma

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12
Q

what is JACCOL?

A

jaundice, anaemia, clubbing, cyanosis, oedema, lymphadenopathy

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13
Q

physical examination in urology

A
  • JACCOL
  • cachexia
  • kidney, bladder, genitalia, rectal and vaginal exam
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14
Q

blood investigations for calculous disease

A

serum Ca, uric acid etc

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15
Q

blood investigations for prostate conditions

A

PSA level

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16
Q

blood investigations for testicular disease

A

AFP, bHCG, LDH

17
Q

what is PSA?

A
  • prostate specific antigen
  • single chain glycoprotein
  • only produced by prostatic epithelial cells
  • can be elevated in both benign and malignant conditions
18
Q

PSA assays

A
  • age-specific reference ranges
  • PSA density
  • PSA velocity
  • free and bound PSA (in cancer cases, there is a higher proportion of bound PSA whilst in benign disease, there is a higher proportion of free PSA)
19
Q

what do they take into consideration for prostatic cancer diagnosis?

A
  • PSA
  • tumour volume
  • radiological investigations
20
Q

pros of ultrasound examinations

A
  • non-invasive, quick, cost-effective
  • good assessmnet of kidneys, bladder residuals, testes and prostate
  • differentiates solid from cystic lesions
21
Q

type of endoscopy done in urology

A
  • rigid, flexible cystoscopy
  • retrograde pyelography
  • antagrade pyelography
  • rigid, flexible ureterorenoscopy
22
Q

how is a retrograde pyelogram done?

A

dye is injected into the urethra which then, goes up. xrays are taken to monitor the flow of the dye

23
Q

which radionuclear studies are done in urology?

A

renography

  • DTPA (dynamic scanning) - functional, obstruction and reflux
  • DMSA (static scanning) gives information about scarring and anatomy of the kidneys
  • PET/CT scanning
24
Q

everything about prostate biopsies

A
  • done to confirm the diagnosis of prostate cancer
  • can be approached transrectally
  • the affected part of the prostate can be identified using a MRI
25
Q

what are urodynamic studies?

A

investigates the function and the dysfunction of the lower urinary tract during the storage and voiding phases of the micturition cycle

26
Q

what does a uroflowmetry measure?

A

the amount of urine passed

27
Q

symptoms of sexual dysfunction

A
  • loss of desire/arousal
  • erectile problems - absent, weak or short-lasting
  • ejaculation problems - premature, absent, delayed
  • psychological factors
28
Q

how can prostatic pain manifest?

A
  • can be referred to the perineum, testes, groin, pain sitting down
29
Q

how can testicular pain manifest?

A
  • can be primary or referred
  • primary: trauma, torsion, hydrocoele, varicocoele infection
  • referred: kidney, ureter, retroperitoneum, indirect inguinal hernia
30
Q

causes of bladder pain

A
  • bladder distension
  • inflammation
  • chronic retention is usually painless
31
Q

causes of urinary incontinence

A
  • fistula: ureterovaginal/vesicovaginal/ectopic ureter
  • sphincter weakness (genuine stress incontinence)
  • detrusor instability
  • bladder outflow obstruction
  • atonic bladder (last 2 due to overflow incontinence)
32
Q

how is ultrasound frequency related to image quality

A
  • image quality is higher in higher frequency scans

- greater penetrance of waves in lower frequenecy scans

33
Q

what type of situation is an obstruction and infected kidney

A

EMERGENCY

34
Q

what do you when there is a case of obstructed/infected kidney?

A
  • early relief of obstruction
  • antegrade nephrostomy
  • cystoscopic placement of stent
35
Q

why are urethral catheters used?

A
  • collect urine specimens
  • assess a degree of retention
  • exclude a urethral stricture
  • as permanent indwelling damage
  • as intermittent self-catheterisation

Surgery II (19 decks)

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