Urology from AMK teach - 21/05/2022 Flashcards
67yr old women several episodes of seeing blood in ruine, vague ache in flank left side. mass in kidney. blood in urine, normal bladder. ct scan mass on kidney.
given most likely diagnosis what factor has contributed to this diagnosis
smoking - renal cell carcinoma - adenocarcinoma, silent cancer only picked up imaging , haematuria and vague loin pain with secondary problems like weight loss
dye factory workers - aromatic amines and schistosomiasis - bladder cancer
asbestos - mesothelioma - what does this present on lungs
alcohol - head and neck, HCC cancer
bladder cancer if found what should happen
2ww - 45 yr with unexplained haemutria , either without UTI or persisting after treatment for UTI
renal cancer appears like what in the lungs
renal cell carcinoma
CT for staging
investigations - USS,CT and IVU
nephrectomy - 1st line
4yr old oy painless abdomen mass , large firm and smooth mass in right flank
wilms tumour
PKD sx
pain, HTN , irregular kidneys and adults
are umbilical hernias present from birth
yes
nephroblastoma, wilms tumour common cancer under 5
metanephric blasternal cells
sx
painless enlarged mass, abdo pain, haemautria, lethargy, fever, weight loss, HTN
need a biopsy to diagnose but also USS abdomen and CT for staging
mangemtn includes nephrectomy with either chemo or radio
46yr lady fluctuating loin to groin pain, similar to previous episodes, stones in kidneys, penicillin allergy, most appropriate analgesia considering severity of her pain
intramuscular diclofenac
in renal colic avoid opiates
tamulosin - ading spontaneous
renal colic Is pain associated with renal stones. stuck in PUJ, plea trim and VUJ , risk factors include diet, dehydration, medications, caucasian , horseshoe kidney
causes what
inadequate drainage- hydronephrosis, diverticulum of bladder
excess of stones
lack oh inhibitors of stone formation like magnesium
abnormal constituents - infection of foreign body, vit a deficiency
renal colic sx and mx
intermittent severe loin to groin pain , N+V hameturia reduced urien output and symptoms of sepsis
MSU , FBC< renal , CRP, AXR , UD
non contrast CT KUB
NSAID and fluids and antiemetics and tamsulosin ( to make stone pass)
less than 5mm watch and wait
over 10mm surgical intervention
dark red blood, painless, HTN and dyes
transitional cell carcinoma
clear cells - renal cancer
SCC - flat mucosal lesions associated with schistosomiasis
RF for bladder cancer
smoking, chemical exposure, schistosomiasis, male, long term cathertisation
sx bladder cancer
painless haematuria, renal colic, urianry retention, dysuria, freeuncey, urgency, fever, weight loss, night sweats
IX- cystoscopy and biopsy
non muscle invasive for bladder cancer
Tis, Ta, T1
muscle invasive is T2-4
management is TURBT - trans urethral resection of bladder tumour- for what when what stage ????????
, intravesical chemo, intravesical BCG , radical cystectomy, chemo and radio
87yr man, hernia surgery der régional spinal anaesthesia. most likely post op complication of this patient
UR, headache, hypertension, meningitis or epidural haematoma
Urinary retention
define UR
bladder volume of over 150ml after attempted voiding
caused by BPH , UTI, tumour, medications , post-op
dull achy abdo pain radiated to penile tip , difficult to pass , maybe blood
suprapubic tenderness
Ix UR
MSU - bladder scan not diagnostic
Mx
urianry catheter
tamulosin
UTI treatment
nitrofurantoin for 7 days
antibiotics for U~TI
3day for simple women
5-10 days for immunosupressed women or abnormal anatomy
7 days for men , pregnant women or catheter related
nitrofurantoin avoid if eGFR is under 45 - cefalexin if pregnant
3month h of increased frequency, nocturia( night) , limited intake and no benefit. no family history, no masses, normal tone, enlarged prostate. most likely
BPH
overactive bladder - frequent, uriante posible icnotnence and nocturia
prostates, fever suprapubic and low back pain, clanged on DRE
prostate Ca - abnormal DRE - nodules
tamulosin - alpha blocker and finasteride and TURP used in
BPH
65 yr old wants screening for prostate cancer - prostate hard and asymmetrical and large on left , PSA high referred on 2ww and has transracial ultrasound guided biopsy what scoring symptoms will be used to evaluate diagnosis
Gleason grading system
glasgow score - acute pancreatic
prostate cancers are adenocarcinoma in peripheral zone
PSA raised in
prostate cancer BPH prostatis UTI vigrourosu exercise - cycling recent ejaculation
Gleason grading
6 low risk
7 intermediate e
8 or above high risk
staging TMN
37 man 2 week history of pelvic pain and dysuria, pain perineum and lower back,pain flares when opens bowls, run down and achy , no URTI , no PMH , no meds , abdomen is tender, nom assess, enlarged tender prostate . systemically well and has low grade fever, has leukocytes and nitrite an blood wha treatment fro likely diagnosis
prostitis
ciproflaxacin for 2 weeks - ofloxacin is alternative but requires 2 week course
chronic prostitis - trimethoprim for 4 weeks
acute bacterial prostitis
acute infection and rapid onset of sx , under 3 months, need to investigate fro STI
mx include laxatives,PO abx , ( IV if septic ) , analgesia
most common cause I e-coli
testis
30ry sexually aactive man, scortla pain, and discharge and malaise. inflammation , prehns sign is positive, palpable cord like trajectory
chlamydia trachoamtis
over 35 eocli can cause epididymis orchitis
parotid swelling
mumps
prehns sign
lift testicle releives pain in epididymis orchitis
Mx of epididymo orchitis
IV abx , high risk sti refer to GUM, low risk STI - ofloxacin 14 days
17yr old girl presents to her general practitioner with primary amenorrhea. small pbuic hair under arms , normal breast, bilateral groin swelling
complete androgen insensitivity syndrome XY - phenotypical female due to testosterone resistance , internally have testes
ansonia - kallmans syndrome
patients with complete androgen insensitivity syndrome do not have ovaries
testicualr cancer markers
AFPteratoma
beta HCG fro LDH
scrotal USS
whirlpool sign
testicular torsion
