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General Medicine > Urology > Flashcards

Urology Flashcards

1
Q

Most common cause of epididymo-orchitis

A

If >35yo - gram -ve enteric organisms - E. Coli, pseudomonas

If <35yo - STIs - chalmydia, gonorrhoea

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2
Q

Causes of acute orchitis

A

Viral : mumps, coxsackie A, varicella, echovirus
Bacterial : E. Coli, Klebsiella, Pseudomonas, Staphylococcus, Streptococcus
Granulomatous : Syphillis, TB, Leprosy, Actinomyces,
Fungal - rare
Trauma
Idiopathic

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3
Q

Syx of epididymo-orchitis

A

Unilateral scrotal pain + swelling - acute onset
Bilateral in 10%
If STI - discharge, urethritis
Syx suggesting UTI
Systemic syx of mumps (headache, fever, parotid swelling)

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4
Q

Signs of epididymo-orchitis

A 
Tenderness on plantation
Palpable swelling of epididymis 
\+/- Urethral discharge 
\+/- secondary hydrocele 
Erythema of scrotum
Pyrexia
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5
Q

What is the time limit for testicular salvage in testicular torsion

A

6 hours

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6
Q

What age is testicular torsion most common

A

<20 years

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7
Q

Differential diagnosis of epididymo-orchitis

A 
testicular torsion 
Trauma
Abscess formation
Testicular tumour
Epididymal tumour
Hydrocele
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8
Q

Painless haematuria suggests what?

A

Bladder cancer

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9
Q

Presentation of acute bacterial prostatitis

A 
Systemically unwell
Lethargy 
Fever
Perineal pain
Lower back pain
(if severe-Urinary retention, urethral discharge, anal discharge)
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10
Q

What might suggest acute prostatitis on digital rectal examination

A

Inflamed and painful prostate

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11
Q

Common pathogens in acute bacterial prostatitis

A

E. coli

Strep faecalis

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12
Q

What conditions predispose to pyelonephritis

A

Urinary reflux
Anatomical abnormality
Urinary stasis

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13
Q

Presentation of acute pyelonephritis

A 
Malaise
Fever
Rigors
Vomiting
Dysuria
Haematuria
Loin pain
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14
Q

Treatment of pyelonephritis

A

Cefuroxime
+/- gentamicin
Up to 14d

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15
Q

Presentation of epididymo-orchitis

A

Acutely painful and swollen testicle
Scrotal discolouration

+/- urethral discharge + hx of unprotected sex

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16
Q

Causes of bladder stones

A

Usually due to another urinary System problem

  • Bladder diverticulum
  • Enlarged prostate
  • Neurogenic bladder
  • Urinary tract infection

Almost all bladder stones occur in men.

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17
Q

Symptoms of bladder stones

A 
Abdominal pain / pressure
Abnormally coloured / dark-colored urine
Haematuria
Difficulty urinating
Frequency
Inability to urinate except in certain positions
Interruption of the urine stream
Dysuria
discomfort in the penis
Urinary tract infection
Fever
urgency
Loss of control over urine.
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18
Q

Management of bladder stones

A

Drinking more water to help pass small stones
cystoscopy to remove stones

Open surgery to remove large stones

Tx cause of bladder stones.

19
Q

Indications the short term catheterisation

A
  • Treatment of acute urinary retention.
  • Preoperative prophylactic emptying of the bladder prior to urological or pelvic surgery
  • Monitoring urine output in critically ill patients.
  • Checking urinary residual volumes.
20
Q

Features of a hydrocele

A

Tense, smooth, fluctuant, trans-illuminating swelling around the testicle

21
Q

Management of Testicular torsion

A

Surgical emergency
Surgery within six hours
Reduce and Fix the testis

22
Q

What is an irregular testicular lump likely to be?

A

Testicular cancer

  • seminoma (60%)
  • teratoma (40%)
23
Q

What patients typically get testicular seminomas

A

30-40yo M

Arise from seminiferous tubules

24
Q

What patients typically get testicular teratomas

A

20-30yo M

arise from germ cells

25
Q

Management of testicular tumour

A

Radical inguinal orchidectomy
+ radiotherapy for LN involvement (not teratomas)
+ chemotherapy for extensive node involvement

26
Q

Indications for long-term catheterisation

A

Treatment of chronic urinary retention due to bladder outlet obstruction
Neuropathic bladder.
Intractable skin breakdown exacerbated by incontinence.
Terminally ill or very frail incontinent patients where repeated bedding changes would be distressing.
Patient preference after failure of continence interventions.

27
Q

Management of epididymo-orchitis

A

Bed rest
Scrotal support
Antibiotics (e.g. Ciprofloxacin+doxycycline)

28
Q

Most common type of bladder cancer

A

Transitional cell carcinoma

Squamous cell due to schistosomiasis

29
Q

Presentation of a varicocele

A 
Scrotal swelling
Does not transilluminate 
No cough impulse
Usually L sided
'Bag of worms'
30
Q

What is a hydrocele

A

Collection of fluid in the tunica vaginalis

31
Q

Tumour markers of testicular cancer

A

Alpha fetoprotein
Beta-HCG

Both suggest teratoma

32
Q

Management of testicular teratoma

A

Orchidectomy

Chemotherapy

33
Q

Management of testicular seminoma

A

Orchidectomy

Radiotherapy

34
Q

Presentation of testicular cancer

A 
Painless lump
Testicular pain +/- abdominal pain.
Dragging sensation.
Recent trauma
Hydrocele
Gynaecomastia
Metastasis--> back pain / liver, lung, brain.
35
Q

What may haematuria after trauma suggest

A

Renal injury

Needs CT scan

36
Q

What does blood at the urinary meatus following trauma suggest

A

Urethral injury

If suspected do anterograde urethrogram

37
Q

Normal prostate specific antigen levels

A

<4

38
Q

What increases prostate specific antigen

A 
Increasing age
Prostate cancer
Benign prostatic hypertrophy 
Urinary tract infection
Urethral instrumentation
Recent ejaculation
39
Q

What is brachytherapy

A

Implantation of radioactive seeds in the prostate gland.

For localised prostate cancer

40
Q

2 drugs used to manage benign prostatic hypertrophy

A

Doxazosin (or alfuzosin)

Finasteride

41
Q

Symptoms of phimosis

A

Non-retraction of the foreskin
E.g. Congenital / scaring / lichen sclerosis / fibrosis
Foreskin becomes white and fixed to glans
The prepuce may balloon on micturation - circumscion not needed.
If urinary obstruction - circumcise

42
Q

What is Peyronie’s disease + symptoms

A

Progressive fibrosis of tunica albuginea covering corpus cavernosum.
Pain on erection
Deviation of erection / ventral curvature
Pain on intercourse / becomes impossible

43
Q

When does priapism become painful

What are possible complications

A

Pain after 3/4 hrs
Ischaemia + interstitial oedema after 12 hrs
Smooth muscle necrosis after 24 hrs
Can cause long term ED - risk relative to duration

44
Q

Managment of priapism

A

Exercise + ice
Oral terbutaline
Intracavernosal phenylephrine

General Medicine (25 decks)

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