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Year 3 > Urology Qs > Flashcards

Urology Qs Flashcards

1
Q

Usually 1st line investigation for UTI is urine dip in which ++ leukocytes and ++ nitrates are seen, in which patients is this not 1st line?

A

65+
and
catheterised px

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2
Q

A person with UTI can present with
- dysuria
- frequency + urgency
- haematuria
- malodour
and what sign on examination??

A

Suprapubic tenderness = cystitis (bladder infection which is uti)

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3
Q

If UTI travels up and becomes upper uti and then pyelonephritis what is seen?

A

Fever above 38
Rigours
Haemodynamically unstable
Loin pain (back pain)
renal angle tenderness

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4
Q

Which two abx are given to manage uncomplicated UTI?

A

Trimethoprim
Nitrofurantoin

2nd line - amoxicillin

  • need to know usage in pregnancy for both
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5
Q

How to manage pyelonephritis?

A

10-14 days abx Quinolone or cephalosporin

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6
Q

UTI in a pregnant women in 3rd trimester? asymptomatic or otherwise doesn’t matter still treat if positive culture

A

Amoxicillin or cefalexin

do not use the 1st line UTI tx in 3rd trimester if you can help it

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7
Q

What about this question indicates the need for a urine culture to be done?

A 25-year-old woman presents to the GP with a 3-day history of burning pain when passing urine. During the day, she finds she has to pass urine every 30 minutes. She is not sexually active and has no past medical history except for an allergy to penicillin.

Her temperature is 36.8ºC, her heart rate is 72 bpm, and her blood pressure is 126/74 mmHg. An abdominal examination is unremarkable and there is no costovertebral angle tenderness. A dipstick is positive for leukocytes, nitrites, and blood.

A

the blood at the very end oh my days

any type of haematuria requires a urine culture

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8
Q

Which drug hx mean a patient cannot be given trimethoprim and instead give nitrofurantoin?

A

Methotraxate (both alter folate metabolism - ‘never tri METH twice’

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9
Q

If a man presents with hx of UTI and needs 3 days abx, what else should be done?

A

All men with UTIs must have a culture done not just dipstick

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10
Q

risk factors for testicular cancer

A

cryptochordichism
under 45
infertility

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11
Q

signs on examination testicular cancer

A

hydrocele
non transilluminating
gyncaecomastia - bHcG germ line tumour
lymphadenopathy

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12
Q

What is finasteride?

A

5 alpha reductase inhibitor

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13
Q

Side effects of finasteride?

A

diminished libido
erectile dysfunction
gynaecomastia

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14
Q

what is TURP
what is TURP syndrome

A

transurethral resection of the prostate
surgical therapy for BPH

TURP syndrome (hyponatraemia, fluid overload, glycine toxicity), urethral stricture/UTI, retrograde ejaculation, perforation of prostate

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15
Q

metastatic prostate cancer treated with hormone therapy, can be 3 types of drugs, such as?

A

GnRH agonist = goserelin
GnRH antagonist = degarelix
Androgen antagonist = bicalutamide / enzalutamide

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16
Q

what complication of GnRH agonist goserelin given for metastatic prostate cancer should you be aware of

A

‘tumour flare’ at the start, as testosterone first rises then falls, can cause bone pain, bladder obstruction etc. so need to give an anti-androgen e.g. cyproterone acetate / flutamide

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17
Q

What induction therapy is given to patients with multiple myeloma before they start stem cell therapy?

A

dexamethasone and thalidomide

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18
Q

what is seen on multiple myeloma
blood film?
urine?

A

blood film = roulex formation
urine = bence jones proteins

  • 1st line investigation is actually serum/urine electropheresis looking for monoclonal immunoglobulins
    and diagnostic test is aspirate biopsy of bone marrow
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19
Q

A patient with multiple myeloma has symptomatic hypercalcaemia, how to treat this?

A

IV fluids + biphosphonates

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20
Q

prophylaxis for nephrotic syndrome px and why?

A

prevent complication of venous thromboembolic disease

give prophylactic LMWH

due to hypercoagulable state due to loss of antithrombin iii. via kidneys

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21
Q

what cancer does long term catheter risk?

A

SCC of bladder

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22
Q

DAMN drugs that cause AKI

A

D - diuretic
A - aminoglycoside (gentamicin) + ACEi/ARB
M - metformin
N - NSAIDs

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23
Q

what is an indication for haemodialysis in a px with aki?

A

pulmonary oedema

uraemia - encephalopathy + pericarditis

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24
Q

This medication may have to be stopped in AKI as increased risk of toxicity (but doesn’t usually worsen AKI itself)

A

Metformin

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25
Q

what is seen on imaging for early stages diabetic nephropathy

A

enlarged kidneys

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26
Q

when to suspect vesicovaginal fistula?

A

patients with continuous dribbling incontinence after prolonged labour and from an area with limited obstetric services.

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27
Q

prostate cancer type

A

adenocarcinoma, obviously

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28
Q

new first line for prostate cancer investigation + staging

PSA levels?

A

Multiparametric MRI (rather than transrectal US biopsy)

Gleason staging (6 is low risk, 7 is intermediate, 8+ high)

4+ PSA is likely for cancer

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29
Q

1st line Ix testicular cancer

A

USS colour doppler of testes

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30
Q

Which tumour markers in testicular cancer?

A

Alpha fetoprotein = non - seminoma
Beta HCG = seminoma + non-seminoma
LDH = seminoma

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31
Q

testicular cancer staging?

A

Stage 1 - just testicle
Stage 2 - retroperitoneal lymph nodes
Stage 3 - lymph nodes above diaphragm
Stage 4 - mets

32
Q

When should PSA not be done? (timings)

A

6 weeks of a prostate biopsy

4 weeks following UTI

1 week DRE

48 hrs vigorous exercise

48 hrs ejaculation

33
Q

When would u choose 5 alpha reductase i over Alpha 1 antagonists for BPH?

A

IF the hyperplasia is significant

34
Q

key findings multiple myeloma?

A

monoclonal band on electropheresis

Bence jones proteins in urine

roulex formation on film

35
Q

tumour lysis syndrome aka during chemo kidney stones type?

A

uric acid

36
Q

Familial kidney stones?

A

Cysteine

37
Q

kidney stores and if they are seen on imaging?

A

Calcium oxalate - Opaque

calcium phosphate stones - Opaque

Cystine stones - Semi-opaque, ‘ground-glass’ appearance

Urate stones - radio-lucent

Xanthine stones - Radio-lucent

38
Q

AKI pre-renal causes and distinctive feature?

A

Low urine Na

(reduced blood supply to kidneys)
- hypovolaemia (diarrhoea, vomiting, bleed)
- hypotension (shock, sepsis, anaphylaxis)
- heart failure
- renal artery stenosis

39
Q

AKI renal causes + distinctive feature

A

High urinary Na

intrinsic renal disease leading to less filtration
- glomerulonephritis
- interstital nephritis
- Acute tubular necrosis!
- vascular issues

40
Q

Post renal AKI causes?

A

obstruction of urine outflow = pressure

  • kidney stones
  • masses
  • ureter strictures
  • enlarged prostate / cancer
41
Q

NICe criteria for AKI?

A

Rise in creatinine 25+ in 48 hours
Rise in creatinine of 50%+ in 7 days

Urine output of <0.5ml/kg/hr for 6 hours

42
Q

Tubular necrosis (AKI) summary

A

ischaemia/nephrotoxins = damage to tubular cells

Muddy brown granular casts in urine on microscopy

High urinary Na and low osmolality

43
Q

Acute interstitial nephritis (AKI) summary

A

Drug caused - penicillin/abx/NSAIDs

Systemic symptoms - fever, rash, allergic reaction

White cell casts on urinalysis
Leukocytes +++
Bloods may show raised IgE and eosinophilia

44
Q

Thrombotic Thrombocytopenia Purpura and AKI

A

can affect small vessels - renal cause of AKI

mx with plasmapharesis + rituximab

45
Q

Urine dipstick results for AKI

A

Protein = intrinsic renal cause

+++ leukocytes = acute interstitial nephritis

Blood = glomerulonephritis

46
Q

Hyperkalaemia treatment is 6.5+ or ECG changes?

A

IV Calcium gluconate 10% 30mL

Insulin to drive potassium into cells

along with dextrose to prevent hypoglycaemia

47
Q

(nephrotic syndrome) Minimal change disease summary

A

Children with periorbital oedema
Linked to URTI + non-hodgkins lymphoma

damage to podocytes, fusion seen on electron microscope

Treat with prednisolone

48
Q

(nephrotic syndrome) Membranous gomerulonephritis summary

A

Most common primary type in adults

Connective tissues + malignancy links

Thicker basement membrane with spike and dome apperance

Anti phospholipase A2 receptor antibodies seen

Steroids do not really work

49
Q

(nephrotic syndrome) focal segmental glomerulosclerosis summary

A

afro-carrib

damage and loss of podocytes due to sclerosis with mesangial collapse (biopsy)

Electron microscope = effacement of foot processes

HIV and obesity and sickle cell link

corticosteroid tx

50
Q

(secondary nephrotic syndrome) Diabetic nephropathy summary

A

key info in hx e.g other pathys

microalbuminuria

microscope = mesangial expansion, GBM thick, kimmelstiel-wilson nodules

Mx ACEi/ARB + diabetic mx

51
Q

(secondary nephrotic syndrome) Amyloidi nephropathy summary

A

Elderly px

links to Multiple Myeloma + chronic inflammatory disease e.g. RA /TB

amyloid deposits in kidney

congo red staining = apple green birefringence

52
Q

why fatty casts in urine sediment micrscopy?

A

Seen due to hyperlipidaemia in nephrotic syndrome

53
Q

Nephrotic oedema mx
Proteinuria mx

A

conservative + furosemide

RAAS i = ACEi / ARBs

54
Q

(Nephritic syndrome) membranoproliferative glomerulonephritis summary?

A

90% is type 1
- immune complex deposits due to chronic infection
- tram track apperance on electron microscope

type 2
- complement deposits e.g. SLE (Low C3 in serum)

mx with steroid

55
Q

(Nephritic syndrome) rapidly proliferative glomerulonephritis summary?

3 types
Type 1 - goodpasture syndrome
type 2 - immune complex mediated
type 3 - pauci immune

A

1 = anti GBM antibodies -> pulmonary sx + nephritic sx

2 =
- poststreptococcal infection -> smoky urine, stary sky on immunoflourescence
- IgA nephropathy -> post infection, macroscopic haematuria recurrently
- IgA vasculitis -> purpuric rash, abdo pain, joint pain, IgA in blood
- SLE deposits causing type 3 hypersensitivity

3 =
- cANCA -> polyangiitis, saddle nose shape, epistaxis, sinusitis
- pANA -> miscroscopic polyangiitis (rash, pain, numbness in extremeties, eosinophilic granulmatosis)

56
Q

What is normal plasma osmolality?

What is the plasma osmolality in CDI/NDI ?

A

275 - 290

290+ (high)

  • if psychogenic polydipsia = low plasma osmolality
57
Q

patient referred to 2 week urology will have what checked?

A

Cystoscopy + CT Urogram

58
Q

dehydrated patient with hypernatraemia is given fluids, what may happen?

A

If you give fluids too much and correct hyperNa too fast = cerebral oedema

59
Q

what is nephrotic syndrome defined as?

A

proteinuria 3.5+
periorbital oedema
hypoalbumin <25

60
Q

(nephrotic syndrome) child with oedema?

A

Minimal change disease

61
Q

bladder outflow obstruction ix?

A

urodynamics

62
Q

acute urinary retention ix?

A

bladder US + post voidal volume

63
Q

CKD defined as?

A

GFR <60
or
60-90 but with sx / proteinuria

64
Q

A score in CKD?

A

A1 = <3
A2 = 3-30
A3 = 30+

65
Q

Medications to give if

CKD G1-G2
CKD G3-G4
ACR 30<

A
  • ACEi
  • ACEi + dapagliflozin + statin
  • lisinopril specifically as the ACEi
66
Q

if prostate cancer stage T4/T5 mx?

A

radical prostectomy

side effect = erectile dysf

67
Q

two week referral for ?

A

65+ with microscopic haem + dysuria / WCC

68
Q

bladder cancer mx?

A

for non musle invasive = TURBT

for muscle invasive = radical cystectomy

69
Q

ischaemic damage + muddy brown casts?

A

AKI = acute tubular necrosis

70
Q

penicillin cause + white cell casts + systemic upset?

A

acute interstitial nephritis

71
Q

manage hyperK?

A

IV calcium gluconate 10% 30ml, Insulin + dextrose

72
Q

what prevents osteoporosis fractures, give in px with multiple myeloma?

A

Zolendronic acid

73
Q

overactive bladder / urge incontinence tx?

A

1 = retraining

2 = oxybutin

74
Q

hydronephrosis IX + MX?

A

US

neprhtostomy

75
Q

white cell casts in urine and E coli culture pink on Mc Conkey ?

A

Pyelonephritis

76
Q

BPH mx summary?

A

Tamsulosin - dizzy, hypoT
Finasteride - x libido, gynaecomastia , erectile dysf

77
Q

orchitis mx summary?

A

35 - :
NAAT ix and give doxycycline

if gonorrhoea give ceftriaxone

35+ :
MSSU ix and give ciprofloxacin

Year 3 (14 decks)

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