Urology/renal Flashcards
hydrocele vs epidermal cyst?
epidermal cyst - SEPARATE from the body of the testicle + found posterior to the testicle
hydrocele - in tunica vaginalis IN TESTICLE - soft, non-tender swelling of the hemi-scrotum. Usually anterior to and below the testicle. Can get above it unlike a hernia
both can transilluminate
What cancer is a varicocele associated with?
RCC
How long can it take finasteride to work?
5 alpha-reductase inhibitors
Reduce testosterone conversion –> reduce prostate size
take up to 6m to work
What bloods results would you see with rhabdomyolysis?
raised - K, PO4, uric acid, CK
low - Ca
What medical mx can be given for renal stones (not pain relief)?
Alpha-adrenergic blockers eg tamsulosin can help facilitate stone passage. They work by relaxing the smooth muscle in the walls of the ureter, thereby allowing the stone to pass more easily, used if 5-10mm size
most common causitive agent in <20 yrs for epeidiy-morchitis vs >35?
chlamydia <20
e.coli >35
How do you diagnose post-strep glomerulonephritis?
Anti-streptolysin O titres
How is stress incontinence mx?
Lifestyle - wt loss, no caffeine, no excess fluids
pelvic floor exercises
surgery
duloxetine/ SNRI
What diet do u follow in renal failure
Low protein
Low phosphate
Low sodium
Low potassium
High calcium
High Vit D (may use calci-D supp)
Different stages of CKD?
stage 1 - egfr >90 + markers of kidney damage (proteinuria or raised cr/ urea)
stage 2 - ecgfr 60-90 + markers of kidney damage
stage 3a- eGFR 45-59 with or without kidney damage
stage 3b- eGFR 30-44
Overflow incontinence vs urge vs overactive bladder vs stress?
over flow incontinence LUTS + bladder palpable- can be caused by prostate, foecal impaction or nerve damage (treat underlying cause and cathterise)
Urge incontinence would be preceded by a sudden need to urinate.
An overactive bladder syndrome is a form of urge incontinence caused by an overactive bladder, it too would be associated with incontinence, polyuria and nocturia. Detrusor overactivity is the cause. (treat with bladder trining, antimuscarinics etc)
Stress incontinence would be likely associated with raised intraabdominal pressure, such as a sneeze or a cough. (pelvic floor training, then try duloxetine/ srgery)
What is schistosoma infection linked to?
developing squamous cell carcinoma of the bladder.
How do the results for urine osmalility and sodium look for pre-renal vs renal AKI?
pre-renal ie poor perfusion of kidney –> Kidneys act to concentrate urine and retain sodium - urine osmolality high, urine sodium low
Renal ie acute tubular necrosis / nephritis —> Kidneys can no longer concentrate urine or retain sodium - urine osmolality low, urine sodium high
In a patient with recurrent renal stones due to hypercalcuira how may risk be reduced?
thiazide diuretics
Mx of epidimyo-orchitis?
If unknown organism: ceftriaxone 500mg intramuscularly single dose, plus oral doxycycline 100mg twice daily for 10-14 days if younger man where STI more likely cause
cipro used if older man
What is the surgical mx of testicular torison in presence of a bell clapper deformiity?
should involve fixation of both testes to prevent torsion of the other testes
Mx of hydrocele?
Adult patients with a hydrocele require an ultrasound to exclude underlying causes such as a tumour
Summarise renal artery stenosis - pathophysiology, ix and mx
Renal artery is narrowed due to atherosclerosis/ connective tissue issue (eg takayasus arteritis in young asian women)–> lower BP in kidney arterioles —> release of renin and kidney atrophues —> high BP in body
Will present with raised BP, potential CKD, CT will show one kidney smaller than other, best imaging is digital subtration angiography
mx may be conservative, may need ballooon angioplasty
Post strep glomerulonephritis Vs iga nephropathy
Post strep:
-1-2 week post URTI
-protreinuria and haematuria
- low complement levels
IGa A aka Berger’s disease:
-1-2 days post URTI
-young males
-haematuria only
-associsted with HSP, alcohol and coeliac
|Presentation of renal vein thrombosis?
loin pain, haematuria, declined renal function, on USS that kidney is enlarged
secondary to nephrotic syndrome
What do the presence of red cell casts in urine indicate?
glomerulonephritis
gold standard ix for urinary reflux?
micturating cystogram
What is the most appropriate 1st line abx for pyelonephritis (if no cultures back)?
cefalexin 500mg BD for 7-10 days
mx of overactive bladder?
1st line - bladder training
2nd line - oxybutynin, solifenacin, tolteridine, trospium
3rd line - botulinum toxin A, sacral nerve stimulation, augmentation cystoplasty, urinary diversion
phimosis vs paraphimosis?
Phimosis - foreskin is tight and can’t be fully retracted, painless, difficulty urinating, may bulge during urinating.
Can be caused by scarring to foreskin, infection, forcing foreskin before its ready to retract
treat with steroid cream, if over 10 circumcision
paraphimosis - foreskin is retracted and can’t be returned to its original position, painful, swollen, may be colour change
can be caused by phimosis, infection, not replacing foreskin after retration
treat with circumcision and abx if needed
most common type of testicular ca?
germ cell tumour - of these 40% seminoma (treat RT), 60% non-seminoma germ cell tumour (treat chemo)
most common composition renal stones?
Calcium oxalate = most common type renal stone
Do you get hyper or hypotension post dialysis?
HYPOtension
What does increased vs decreased specific gravity on urine sample mean
Increased specific gravity on urine tests means dehydration/ HF/ glycosuria/ SIADH/ proteinuria. Decreased specific gravity means excess fluid, pyelonephritis, renal failure, diabetes insipidus
What is phimosis?
Phimosis = cannot retract foreskin, if physiological manage with steroids top and wait as will resolve, if secondary to eg trauma, recurrent balanitis, manage with circumcision
What is the 1st line abx for pyelonephritis, if no cultures available?
cefalexin
WHat diet can you adopt to reduce risk renal stones
Reduce oxalate in diet for recurrent stones - oxalate in chocolate, strawberries, rhubarb, tea, nuts, spinach, beetroot, beans
What is the most common cause of painless frank haematuria in male >60s?
Bladder cancer, TCC
What is sterile pyruia?
WCC in urine but -ve culture
How long after a vasectomy does it take for patients to be safe from pregnancy?
Vasectomy - About 12 weeks after the procedure, the patient will need to produce a sample for analysis and only when tests have confirmed azoospermia, the patient can stop using additional contraception. This is usually around 16 and 20 weeks.
