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year 3 conditions > urology and renal > Flashcards

urology and renal Flashcards

1
Q

what is the PIRADS score used for

A

used to rate the clinical significance of prostate cancer on MMRI (multi parametric MRI)
PIRADS 1- very low
PIRADS 2- low
PIRADS 3- intermediate/ equivocal
PIRADS 4- high
PIRADS 5- very high

carry out biopsy with MMRI Prostate result of PIRADS 3 and above

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2
Q

what is priapism, and what is the difference between ishcaemic and non ischaemic priapism

A

penis maintains a prolonged erection

ischaemic priapism
- rigid
- painful
- due to venous occlusion

non ischaemic priarism
- not fully rigid
- painless
- arterial flow isn’t working properly, often due to trauma

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3
Q

which cancer is aromatic amine exposure a risk factor for

A

bladder cancer

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4
Q

what dies transillumination a testicular swelling indicate

A

hydrocele

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5
Q

male
fever
chills
pain in perineal region
stinging sensation when passing urine
urinary frequency / hesitancy
cant tolerate rectal exam due to pain
likely diagnosis?

A

prostatitis

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6
Q

most common causative agent of prostatitis

A

E coli

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7
Q

sudden severe onset pain in left scrotum
no hx of trauma
left testicle is elevated and tender
absent cremasteric reflex
no pain relief on elevation of testicle
diagnosis

A

testicular torsion

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8
Q

what to do if suspect testicular torsion from examination and observation

A

immediate surgical exploration
if surgery cant redone, manual detorsion

(only do duplex ultrasound if it won’t delay the surgery), usually just do surgical exploration straight away

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9
Q

what does horizontal lie of testes indicate

A

bells clapper deformity

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10
Q

medication for prostatitis

A

oral ciprofloxacin 500mg twice daily

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11
Q

pt with prostate cancer presents with new onset leg weakness and incontinence
what investigation should be done and what are you looking for

A

MRI spine
to look for spinal cord compression due to metastases

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12
Q

what is balanitis

A

inflammation of the glans penis

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13
Q

what is phimosis

A

a congenital tightening of the opening of the foreskin so that it cannot be retracted

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14
Q

what is paraphimosis

A

inability to return a retracted foreskin over the glans, as opposed to inability to retract the foreskin over the glans
is a urological emergency because the prepuce becomes trapped behind the corona of the glans penis, causing vascular compromise to the glans
commonly occurs after cleaning or catheter insertion

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15
Q

what is lichen sclerosus

A

itchy white patches around the genitals or anus
increases chance of cancer
and can cause phimosis

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16
Q

some non cancer causes of raised PSA

A

BPH
UTI
older age
prostatitis
ejaculation
PTH
prostate injury
surgical procedures - insertion of catheter or surgical scope into the bladder
urinary retention

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17
Q

A 64-year-old man presents with urinary frequency, nocturia, and difficulty initiating urination. He denies dysuria, Haematuria, abdominal pain and lower back pain. His PSA result is elevated and a PR exam reveals a smooth, symmetrical prostate with a central sulcus
First line tx

A

alpha blocker eg tamsulosin

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18
Q

what is orchidopexy

A

surgery that moves the undescended testicle into the scrotum - corrects cryptorchidism

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19
Q

what is a varicocele and symptoms

A

a mass of varicose veins in the spermatic cord
dully achey feeling
testis feels like a ‘bag of worms’
does not transilluminate
not rlly painful
can be asymptomatic or present with a dragging sensation which disappears in the supine position.

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20
Q

where is epididymis felt

A

behind the testis

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21
Q

what effect can trazodone have on the penis

A

can cause priapism

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22
Q

what is interstitial cystitis

A

pain low down in your tummy, sudden urges to pee and needing to pee more often than normal.
The exact cause of interstitial cystitis is unknown. It’s not a bladder infection like other types of cystitis.

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23
Q

what are PDE5 inhibitors eg sildenafil taken for and what is an absolute C/I of taking them

A

treat erectile dysfunction (or pulmonary htn)
absolute contraindication: if the patient is taking organic nitrates. the two substances together can cause fatal hypotension

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24
Q

what medication can be given to pt with erectile dysfunction who takes isosorbide mononitrate

A

Intracavernosal prostaglandins

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25
Q

bluish appearance of scrotal skin
negative transillumination test
diagnosis

A

haematocele
Haematocele is a haemorrhage into the tunica vaginalis space, usually due to trauma, surgical injury or testis tumour

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26
Q

first line IX for suspected testicular cancer

A

ultrasound of scrotum
DONT BIOPSY TESTICULAR MASS as can seed cancer into rest of scrotum

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27
Q

woman leaks small volumes of urine when coughing, laughing, lifting
what is the most appropriate management

A

pelvic floor exercises

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28
Q

anterior painless swelling in his scrotum that has been gradually increasing in size over the past few months. The swelling transilluminates on examination.
diagnosis

A

hydrocele

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29
Q

if a pt is suffering from ischaemic priapism what is the first line management

A

aspiration
(to decompress the corpus cavernosa by aspiration and injection of a sympathomimetic to reduce the risk of tissue necrosis)

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30
Q

scrotal swelling that transilluminate in a baby under 1 years old
what is the course of action

A

observation
- Scrotal swelling which transilluminates suggest congenital communicating hydrocele, will usually resolve by 1 years

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31
Q

how to mange low risk localised prostate cancer in a pt with life expectancy of less than 10 years

A

active surveillance (the risks of treatment may outweigh the benefits)

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32
Q

advice for males before PSA test to avoid a false positive result

A

avoid ejaculation
(The serum PSA level rises immediately after ejaculation. If taken within 48 hours of ejaculation, it leads to a false positive result)

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33
Q

haematuria - and passing clothes in urine
urinary retention of 520 ml in bladder
PSA of 108
likely diagnosis

A

prostate cancer

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34
Q

which score is used for prostate cancer scoring

A

Gleason score

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35
Q

after catheter insertion
oedematous foreskin of glands with bluish discolouration
diagnosis?

A

paraphimosis

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36
Q

what is posthitis

A

inflammation of the foreskin caused by infection or irritation
presents with redness, swelling, and pain of the foreskin but does not cause difficulty in retracting the foreskin

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37
Q

what type of medication is sildenafil

A

PDE5 inhibitor

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38
Q

what is the most common symptom of metastatic prostatic cancer

A

lower back pain

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39
Q

signs of torsion of testicular appendage

A

a hard, tender nodule may be palpable on the upper pole of the testicle,
and a blue discoloration referred to as the “blue dot sign” may be visible in this area

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40
Q

3 main tumour marker sin testicular cancer

A

AFP
beta-hCG
LDH

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41
Q

How to manage unilateral undescended testis in a 4 month old

A

wait until 6 months of age - may descend by itself
if doesn’t descend by then refer to specialist who will perform orchidopexy

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42
Q

next step in management of BPH after pt is on tamsulosin, finasteride and is still symptomatic

A

TURP (transurethral resection of the prostate)

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43
Q

which Gleason score classifies a prostate cancer as low risk, so the tx is just active surveillance

A

6

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44
Q

which virus from the Paramyxoviridae family causes orchitis

A

mumps

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45
Q

what is nephrostomy

A

a procedure to drain urine from your kidney using a catheter

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46
Q

urgent management required for a pt with an obstructed left kidney (due to a stone) which has caused hydronephrosis? pt is febrile and urine is +ve for blood/leucocytes/nitrites

A

IV abx and surgical decompression or nephrostomy
(Extracorporeal shockwave lithotripsy (ESWL) should not be used for pts with active infection its only used for pts with uncomplicated stones)

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47
Q

what is hydronephrosis

A

kidneys swell due to build up of urine inside of them

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48
Q

cause of poor urinary stream/post micturition dribble in pt who had a radical prostatectomy

A

urethral stricture

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49
Q

how does prostatectomy affect PSA levels

A

PSA should fall, should remain low and stable

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50
Q

which electrolyte imbalance is present in TURP syndrome

A

hyponatraemia

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51
Q

what is the most common part of the prostate that BPH develops in

A

transitional zone

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52
Q

what is the most common part of the prostate that cancer develops in

A

peripheral zone

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53
Q

cause of bilateral hydronephrosis with no urinary symptoms other than incontinence in a 68 yr old man

A

BPH - causes bilateral obstruction, also is gradually growing not acute so causes the chronic retention the pt has (as they have no symptoms, acute presents with pain etc)

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54
Q

if you cannot ‘get on top’ of a swelling, what does this indicate

A

inguinal hernia
inability to delineate the superior margin is worrying for an inguinal hernia

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55
Q

main side effect of an orchietcomy

A

reduced fertility

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56
Q

what is the meatus of the penis

A

the opening where urine comes out

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57
Q

course of action for newborns with BILATERAL undescended testes

A

refer to a senior paediatrician for endocrine or genetic investigation (consider the possibility of an underlying pathology (commonly congenital adrenal hyperplasia (CAH))

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58
Q

what pathology can cause BILATERAL undescended testes in newborn

A

congenital adrenal hyperplasia

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59
Q

which medication is known to cause priapism

A

trazodone

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60
Q

what do bells clapper deformity and cryptorchidism increase the risk of

A

testicular torsion

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61
Q

first line tx for prostatitis

A

a quinolone eg ciprofloxacin

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62
Q

causes of bilateral hydronephrosis

A

Bilateral hydronephrosis = SUPER:
Stenosis of urethra,
Urethral valve,
Prostatic enlargement,
Extensive bladder tumour (i.e. obstructing both ureteral orifices),
Retroperitoneal fibrosis

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63
Q

symptoms of renal cancer

A

flank/loin mass
loin pain
flank pain
haematuria

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64
Q

what is the criteria for 2 ww referral for renal cancer

A

If they are aged 45 years and over and have:
Unexplained visible haematuria without urinary tract infection, or
Visible haematuria that persists or recurs after successful treatment of urinary tract infection.

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65
Q

Tx of RCC vs TCC in renal cancer

A

transitional cell carcinoma
- chemo and surgery (partial/radical nephroureterectomy)

renal cell carcinoma
- surgery is the primary treatment (partial or radical nephrectomy)

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66
Q

nephroureterectomy vs nephrectomy

A

nephroureterectomy = removal of kidney, ureter and small piece of bladder where ureter and bladder connect

nephrectomy = removal of kidney

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67
Q

initial imaging fo a mass felt in flank which you suspect to be renal cancer

A

renal ultrasound
can do CT with IV contrast after

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68
Q

what does E coli look like under microscope

A

pink rod shaped bacteria

69
Q

72 yr old with painless visible haematuria
next steps ?

A

2 ww referral to haemturia clinic - Visible haematuria is bladder cancer until proven otherwise

70
Q

immediate management for acute urinary retention

A

insertion of urinary catheter

71
Q

what is Robotically assisted laparoscopic prostatectomy used for

A

prostate cancer

72
Q

what is Transurethral resection of the prostate used for

A

BPH

73
Q

what lifestyle modifications can be taken to prevent recurrence of calcium oxalate stones

A

Reduce oral intake of rhubarb, spinach and tea (oxalate rich foods)
increasing dietary calcium intake.

74
Q

what medication can be taken to prevent recurrence of calcium phosphate stones

A

thiazide like diuretics

75
Q

3 substances in urine dipstick for UTI

A

leucocyte esterase and nitrites and blood

76
Q

2 substances in urine dipstick for nephritic syndrome

A

protein and blood

77
Q

pt with urine dipstick position for blood and renal US showing mild right sided hydronephrosis
alos lost 3kg in weight
likely diagnosis?

A

bladder cancer
(renal ultrasound would typically identify a mass)

78
Q

what is the cause of haematuira after someone has been lying in the same position for a long time after a fall and has a raised CK

A

myoglobuniuria due to rhabdomyolysis

78
Q

chronic fatigue, unilateral flank pain, secondary polycythaemia, microscopic haematuria and a left sided varicocele that fails to resolve on lying down
what is the like diagnosis

A

Renal cell carcinoma

79
Q

what is the management if a patient is septic secondary to renal calculi

A

nephrostomy - the patient requires urgent decompression of the are septic

80
Q

first line abx for a 10 week pregnant woman with UTI

A

nitrofuratonin
(Amoxicillin would be considered in this scenario as a second-line option if nitrofurantoin had been taken for at least 48 hours with no results, or when the first choice is not suitable due to possible organism resistance)

81
Q

which type of kidney stones in penicillin given to prevent/reduce the number of, it also run-in the family

A

cystine kidney stones

Cystinuria is an autosomal recessively inherited metabolic disorder which predisposes to recurrent renal stones composed of cystine and urinary tract infections in childhood. Preventative treatment includes the prescription of penicillamine to reduce the amount of cystine present in the urine.

82
Q

which medication can prevent struvite kidney stones

A

acetohydroxamic acid (AHA)

83
Q

definitive management if clot retention occurs as a complication after TURP procedure

A

emergency clot evacuation and diathermy to the bleeding point

84
Q

struvite kidney stones are associated with recurrent UTIs involving which bacteria?

A

Proteus bacteria

85
Q

management of long pt with asymptotic microscopic haematuria

A

repeat urinalysis in a few weeks

86
Q

first line and gold standard investigation for kidney stones

A

first line: urine dipstick
gold standard: non contrast CT KUB

87
Q

tx for T2 / 7cm and above renal tumour without metastases

A

radical nephrectomy
(partial nephrectomy is used for T1 or <4cm tumours)
(immunotherapy eg biological are used for metastatic cancer or unresectable tumours)

88
Q

what is a vaginal cystocele

A

wall between bladder and vagina weakness
causes the bladder to fall onto the vagina and compress it

89
Q

main side effect of long term use of nitrofuratonin

A

pulmonary effects eg pulmonary fibrosis, ILD, interstitial pneumonia

90
Q

what does urolithiasis means

A

kidney stones

91
Q

what imaging modality is used to investigate painless visible haemturia

A

cystoscopy

92
Q

balanopsthitis vs posthitis

A

balanopsthitis
= inflammation of penis and foreskin

posthitis
= inflammation of foreskin

93
Q

what is functional incontinence

A

patient cant get to the toilet despite wanting to
- eg may be due to sedating medications

94
Q

which recreational drug can cause cystitis

A

ketamine

95
Q

if a pt has display myopia, dislocation of the lens, osteoporosis, learning difficulties and abnormal blood clotting
and gets acidic kidney stones with ground glass appearance, which runs in family
what are the stones likely to be made of

A

cystine
- pt is suffering with homocystinuria
(autosomal recessive)

96
Q

which kidney stones run in family

A

cystine

97
Q

which kidney stones can have a ground glass appearance

A

cystine

98
Q

what is Haemorrhagic discolouration of the right flank called and what does it indicate

A

This describes Grey-Turner’s sign, which is indicative of bleeding into the peritoneum. (intraperitoneal or retroperitoneal hemorrhaging)
It is associated with acute pancreatitis ectopic pregnancy etc

99
Q

what is Haemorrhagic discolouration of the umbilical area called and what does it indicate

A

This describes Cullen’s sign, which is indicative of bleeding into the peritoneum.
(intraperitoneal or retroperitoneal hemorrhaging)
It is associated with acute pancreatitis, ectopic pregnancy etc

100
Q

what incontinence does episiotomy increase risk of

A

anal incontinence

101
Q

what incontinence does multiparty increase risk of

A

stress incontinence

102
Q

what is hydronephrosis and what tx is indicated for it

A

one or both kidneys stretch and swell due to ruin build up
insertion of urethral stent

103
Q

what is used for pregnant women with kidney stones over 10 mm

A

ureteroscopy
extra corporeal shock wave lithiotripsy and
percutaneous nephrolithotomy are contraindicated in pregnancy

104
Q

which incontinence can be triggered by sound of running water, tea and coffee, arriving/leaving home

A

urge incontinence (detrusor overactivity)

105
Q

what is the cause if bilateral lower limbs oedema in someone with renal caner

A

inferior vena cava occlusion

106
Q

Macroscopically: multifocal with flat to papillary lesions. Microscopically: foci of squamous differentiation or extensive keratinization and intercellular bridges
which renal cancer is this

A

transitional cell carcinoma

107
Q

Macroscopically: Well circumscribed lesion, mostly golden with interspersed areas of hemorrhagic and fibrotic tissue. Microscopically: Well defined cell membranes with mostly transparent cytoplasm, interspersed with highly vascularised stroma
which renal cell cancer is this

A

clear cell renal cell carcinoma

108
Q

how is balanoposthitis caused by lichen sclerosis in a young boy treated

A

circumcision

109
Q

which type of cancer is a left sided varicocele suggestive of and why

A

renal cell carcinoma
the cancer compresses the left renal vein, causing blockage of left variceal veins –> varicocele

110
Q

gold standard imaging modality for staging a renal cancer

A

CT abdomen/pelvis with IV contrast

111
Q

what should be done if a kidney stone is blocking the kidney, causing hydronephrosis and infection in the kidney

A

urgent surgical decompression

112
Q

is asymptomatic bacteriuria treated

A

no in men and non pregnant women
yes in pregnant women

113
Q

which antibiotic should be used and which should be avoided in a breastfeeding woman

A

use trimethoprim, second line is amoxicillin
avoid nitrofuratonin

114
Q

what is wills tumour

A

most common renal cancer in ages 2-5

115
Q

what type of kidney stone causes stag horn calculi (ie the calculus/stone moulds to the shoe of the renal pelvis)

A

struvite

116
Q

woman is constantly leaking urine. she has had a difficult and prolonged labour when having her last child
what is the diagnosis

A

vesicovaginal fistula

117
Q

which malignancy is most likely to cause painless haematuria in an older male with a significant smoking history

A

TCC ofd the bladder

118
Q

what causes abdominal mass with flank pain

A

renal cancer

119
Q

which bladder cancer is most common in people who have chronic inflammation of the bladder (e.g. long term catheter or history of schistosomiasis)

A

squamous cell carcinoma of bladder

120
Q

criteria for 2 ww referral for haematuria

A

If they are aged 45 years and over and have:
1) Unexplained visible haematuria without urinary tract infection
or 2) Visible haematuria that persists or recurs after successful treatment of urinary tract infection.

121
Q

first line scans for visible haemturia

A

ct urogram and cystoscopy

122
Q

tx for fungal balanoposthitis

A

counselling on genital hygiene and topical antifungal agents (eg. Co-trimazole)

123
Q

A 52 year old woman presents with recurrent left sided loin pain and fevers. She suffers from recurrent pyelonephritis. A CT scan of the Kidneys, Ureters and Bladders (CT KUB) shows a staghorn calculus
which infective organism is the most likely cause

A

proteus bacteria

124
Q

what antibiotic class is ciprofloxacin

A

quinolone - used to treat pyelonephritis in hospital

125
Q

what are vesicovaginal fistulas caused by

A

prolonged and obstructed vaginal childbirths

126
Q

what type of incontinence can lots of opiates and sedatives cause

A

functional incontinence

127
Q

most common type of renal stone

A

calcium oxalate

128
Q

what does terminal (ie at the end of voiding), painful haematuria indicate

A

bladder calculi

129
Q

what is neurogenic bladder

A

lack of control of bladder due to brain/nerve/spine issue
occurs in conditions such as MS, stroke, diabetes, Parkinson’s
bladder hyperactivity, bladder spasms, urinary urgency and frequency

130
Q

which antibiotic can be used for UTI in pt with G6PD deficiency

A

cefalexin
(trimethoprim and nitrofuratonin are contraindicated)

131
Q

why should a pt be kept in hospital after catheterisation of their acute urinary retention

A

to monitor for if they develop post obstructive diuresis
prolonged polyuria, excessive salt and water los –> dehydration
develops after rapid decompression of urinary retention
can cause AKI
is a major concern for pts with mention volumes > 1000ml

132
Q

what is the tx for pts with renal cancer of T2 and above

A

radical nephrectomy

133
Q

what is the likely cause of a week of difficulty passing urine and 3 days of vision loss
has had a similar episode before

A

MS

134
Q

what is a pessary ring used for

A

vaginal prolapse

135
Q

what is the tx for localised renal cell carcinoma of 3.5 cm

A

partial nephrectomy (Partial nephrectomy is the preferred treatment for localised renal cell carcinoma less than 4 cm in size)

136
Q

haemturia, flank pain, mass
diagnosis

A

renal cell carcinoma

137
Q

which hyperparathyroidism is a common complication of CKD

A

Secondary hyperparathyroidism

138
Q

ACEi and ARB in pts with CKD and hypertension should be stopped if the serum potassium concentration exceeds what number

A

6

139
Q

which investigation allows you to visualise the flow through the urinary system and is most useful when an obstruction is suspected

A

IV urogram

140
Q

sessile vs papillary tumours

A

Flat tumors (Sessile) are flat, superficial, spreading tumors. These tumors are often more difficult to treat. Papillary tumors have long, finger-like projections that stretch out from the bladder wall toward your bladder’s interior.

141
Q

contrast autosomal dominant and autosomal recessive polycystic kidney disease

A

autosomal dominant
caused by a mutation on chromosome 16
presents in adults

autosomal recessive
caused by a mutation on chromosome 9
presents in infants

142
Q

adult pt has a subarachnoid haemorrhage and has bilateral flank masses which do not move on respiration
diagnosis?

A

autosomal dominant polycystic kidney disease
(autosomal dominant in adults, autosomal recessive in children)

143
Q

what does periorbital oedema in a young child with no history of allergen exposure suggest

A

nephrotic syndrome

144
Q

what syndrome does ‘cant see, cant pee can’t hear a bee’ refer to

A

Alport’s sydnrome
- retinal flecks
- haematuria
- bilateral sensineural hearing loss

145
Q

which investigation provides a definitive diagnosis of nephrotic syndrome

A

renal biopsy

146
Q

first investigation when a patient presents with postoperative urinary retention

A

bladder scan or ultrasound

147
Q

what findings in urine indicate rhabdomyolysis

A

decreased urea:creatinine ratio
elevated CK

148
Q

likely cause of high urea in body builder’s urine

A

protein supplement use

149
Q

pt presents with significant periorbital oedema, frothy urine and swollen red painful leg
what is the likely cause of the painful leg

A

DVT
(nephrotic syndrome can cause hypercoagualibity)

150
Q

what type of anaemia does CKD cause

A

normocytic normochromic anaemia
This is because the kidneys are responsible for the production of erythropoietin which promotes erythropoiesis in the bone marrow

151
Q

what is the biggest risk factor for bladder cancer

A

smoking

152
Q

how is creatinine clearance for each pt calculated and which variables are taken into account

A

using the Cockcroft-Gault formula,
which requires the following variables:
age,
gender,
creatinine
weight

153
Q

what is another word for Berger’s disease

A

IgA nephropathy

154
Q

what do kidneys in CKD look like on US

A

Bilaterally shrunken

155
Q

Enlarged left kidney on ultrasound and raised serum urea and creatinine
what does this suggest

A

hydronephrosis

156
Q

how are bicarbonate levels affected on renal impairment

A

reduced
This is because the kidneys excrete hydrogen ions, which accumulate in renal impairment and reduce serum bicarbonate levels

157
Q

what is the most common viral cause of focal segmental glomerulosclerosis

A

HIV

158
Q

what type of acidosis can CKD cause

A

CKD can cause met acidosis due to decreased production of sodium bicarbonate

159
Q

how to correct/treat normocytic nomochromic anaemia in CKD pt

A

give EPO
BUT if there is iron deficiency, correct this first, as giving EPO can exacerbate it

160
Q

AA amyloid vs AL amyloid

A

AA amyloid (associated with inflammation) rather than AL amyloid (associated with autoimmune conditions)

161
Q

pt presents with a local muscle invasive tumour contained within the bladder. Further investigations show no evidence of metastases
management?

A

cystectomy
(not TURBT, that is for grade T1 or superficial tumours)

162
Q

what is the likely cause of acute onset new abdo pain, haematuria and oedema in a pt with nephrotic syndrome

A

renal vein thrombosis

163
Q

what is the most reliable indicator of rhabdomyolysis

A

raised CK

164
Q

muscles aches and pains and red-brown urine
diagnosis?

A

rhabdomyolysis

165
Q

which diabetic med should be stopped in AKI if eGFR is < 30

A

metformin

166
Q

how can you judge if a pts AKI will progress to CKD/ESRF or full recovery

A

if
pts baseline urea and creatinine indicate normal renal function before the KI
repeat U&Es after starting Tx indicate recovery
and pt asks pre existing risk factors
you expect full recovery

167
Q

what are the common drugs that need to be stopped in AKI

A

“Stop the DAMN drugs”:
Diuretics and digoxin
ACE inhibitor/ ARB
Metformin and methotrexate
NSAIDs

year 3 conditions (17 decks)

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