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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
what is seen on imaging for early stages diabetic nephropathy
enlarged kidneys
26
when to suspect vesicovaginal fistula?
patients with continuous dribbling incontinence after prolonged labour and from an area with limited obstetric services.
27
prostate cancer type
adenocarcinoma, obviously
28
new first line for prostate cancer investigation + staging PSA levels?
Multiparametric MRI (rather than transrectal US biopsy) Gleason staging (6 is low risk, 7 is intermediate, 8+ high) 4+ PSA is likely for cancer
29
1st line Ix testicular cancer
USS colour doppler of testes
30
Which tumour markers in testicular cancer?
Alpha fetoprotein = non - seminoma Beta HCG = seminoma + non-seminoma LDH = seminoma
31
testicular cancer staging?
Stage 1 - just testicle Stage 2 - retroperitoneal lymph nodes Stage 3 - lymph nodes above diaphragm Stage 4 - mets
32
When should PSA not be done? (timings)
6 weeks of a prostate biopsy 4 weeks following UTI 1 week DRE 48 hrs vigorous exercise 48 hrs ejaculation
33
When would u choose 5 alpha reductase i over Alpha 1 antagonists for BPH?
IF the hyperplasia is significant
34
key findings multiple myeloma?
monoclonal band on electropheresis Bence jones proteins in urine roulex formation on film
35
tumour lysis syndrome aka during chemo kidney stones type?
uric acid
36
Familial kidney stones?
Cysteine
37
kidney stores and if they are seen on imaging?
Calcium oxalate - Opaque calcium phosphate stones - Opaque Cystine stones - Semi-opaque, 'ground-glass' appearance Urate stones - radio-lucent Xanthine stones - Radio-lucent
38
AKI pre-renal causes and distinctive feature?
Low urine Na (reduced blood supply to kidneys) - hypovolaemia (diarrhoea, vomiting, bleed) - hypotension (shock, sepsis, anaphylaxis) - heart failure - renal artery stenosis
39
AKI renal causes + distinctive feature
High urinary Na intrinsic renal disease leading to less filtration - glomerulonephritis - interstital nephritis - Acute tubular necrosis! - vascular issues
40
Post renal AKI causes?
obstruction of urine outflow = pressure - kidney stones - masses - ureter strictures - enlarged prostate / cancer
41
NICe criteria for AKI?
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
Tubular necrosis (AKI) summary
ischaemia/nephrotoxins = damage to tubular cells Muddy brown granular casts in urine on microscopy High urinary Na and low osmolality
43
Acute interstitial nephritis (AKI) summary
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
Thrombotic Thrombocytopenia Purpura and AKI
can affect small vessels - renal cause of AKI mx with plasmapharesis + rituximab
45
Urine dipstick results for AKI
Protein = intrinsic renal cause +++ leukocytes = acute interstitial nephritis Blood = glomerulonephritis
46
Hyperkalaemia treatment is 6.5+ or ECG changes?
IV Calcium gluconate 10% 30mL Insulin to drive potassium into cells along with dextrose to prevent hypoglycaemia
47
(nephrotic syndrome) Minimal change disease summary
Children with periorbital oedema Linked to URTI + non-hodgkins lymphoma damage to podocytes, fusion seen on electron microscope Treat with prednisolone
48
(nephrotic syndrome) Membranous gomerulonephritis summary
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
(nephrotic syndrome) focal segmental glomerulosclerosis summary
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
(secondary nephrotic syndrome) Diabetic nephropathy summary
key info in hx e.g other pathys microalbuminuria microscope = mesangial expansion, GBM thick, kimmelstiel-wilson nodules Mx ACEi/ARB + diabetic mx
51
(secondary nephrotic syndrome) Amyloidi nephropathy summary
Elderly px links to Multiple Myeloma + chronic inflammatory disease e.g. RA /TB amyloid deposits in kidney congo red staining = apple green birefringence
52
why fatty casts in urine sediment micrscopy?
Seen due to hyperlipidaemia in nephrotic syndrome
53
Nephrotic oedema mx Proteinuria mx
conservative + furosemide RAAS i = ACEi / ARBs
54
(Nephritic syndrome) membranoproliferative glomerulonephritis summary?
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
(Nephritic syndrome) rapidly proliferative glomerulonephritis summary? 3 types Type 1 - goodpasture syndrome type 2 - immune complex mediated type 3 - pauci immune
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
What is normal plasma osmolality? What is the plasma osmolality in CDI/NDI ?
275 - 290 290+ (high) * if psychogenic polydipsia = low plasma osmolality
57
patient referred to 2 week urology will have what checked?
Cystoscopy + CT Urogram
58
dehydrated patient with hypernatraemia is given fluids, what may happen?
If you give fluids too much and correct hyperNa too fast = cerebral oedema
59
what is nephrotic syndrome defined as?
proteinuria 3.5+ periorbital oedema hypoalbumin <25
60
(nephrotic syndrome) child with oedema?
Minimal change disease
61
bladder outflow obstruction ix?
urodynamics
62
acute urinary retention ix?
bladder US + post voidal volume
63
CKD defined as?
GFR <60 or 60-90 but with sx / proteinuria
64
A score in CKD?
A1 = <3 A2 = 3-30 A3 = 30+
65
Medications to give if CKD G1-G2 CKD G3-G4 ACR 30<
- ACEi - ACEi + dapagliflozin + statin - lisinopril specifically as the ACEi
66
if prostate cancer stage T4/T5 mx?
radical prostectomy side effect = erectile dysf
67
two week referral for ?
65+ with microscopic haem + dysuria / WCC
68
bladder cancer mx?
for non musle invasive = TURBT for muscle invasive = radical cystectomy
69
ischaemic damage + muddy brown casts?
AKI = acute tubular necrosis
70
penicillin cause + white cell casts + systemic upset?
acute interstitial nephritis
71
manage hyperK?
IV calcium gluconate 10% 30ml, Insulin + dextrose
72
what prevents osteoporosis fractures, give in px with multiple myeloma?
Zolendronic acid
73
overactive bladder / urge incontinence tx?
1 = retraining 2 = oxybutin
74
hydronephrosis IX + MX?
US neprhtostomy
75
white cell casts in urine and E coli culture pink on Mc Conkey ?
Pyelonephritis
76
BPH mx summary?
Tamsulosin - dizzy, hypoT Finasteride - x libido, gynaecomastia , erectile dysf
77
orchitis mx summary?
35 - : NAAT ix and give doxycycline if gonorrhoea give ceftriaxone 35+ : MSSU ix and give ciprofloxacin

Year 3 (14 decks)

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