Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Finals > Urology > Flashcards

Urology Flashcards

1
Q

Common locations of urinary tract stone deposition

A
  1. Pelviureteric junction
  2. Pelvic brim
  3. Vesicoureteric junction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Composition of renal stones

A

Calcium oxalate (75%)
Magnesium ammonium phosphate (15%)
Also: urate (5%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Presentation of urinary tract stones

A

Asymptomatic, or:

  1. Pain - spasms of renal colic ‘loin to groin’, with nausea/vomiting
  2. Infection - can coexist (inc risk if voiding impaired), eg UTI, pyelonephritis, pyonephrosis
  3. Haematuria
  4. Proteinuria
  5. Sterile pyuria
  6. Anuria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Investigations for renal calculi

A

Bedside - urine dip (usually +ve for blood)
Bloods - FBC, UE, phosphate, glucose, bicarb, urate
Imaging - non-contrast CT (99% visible), KUB XR (80% visible)
Others - urine Ca, oxalate, urate, citrate, Na, creatinine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Initial management of renal calculi

A

Analgesia -> diclofenac 75mg IV/IM, or 100mg PR
Fluids if unable to tolerate PO
ABx if infection (e.g taz)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Management of renal calculi

A

<5mm in lower ureter = 95% pass spontaneously, inc fluids

> 5mm/pain not resolving:

  • medical = nifedipine or a-blockers (tamsulosin) promote expulsion
  • extracorporeal shockwave lithotripsy (US waves shatter stone), or ureteroscopy
  • percutaneous nephrolithotomy -> when large, multiple, or complex
  • open surgery is rare
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Indications for urgent intervention for renal calculus and why

A

Delay kills glomeruli

When there’s infection AND obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Prevention of renal calculi

A

General = plenty of fluids, normal dietary Ca intake
Ca stone = thiazide diuretic
Oxalate stone = dec oxalate intake, pyridoxine
Urate = allopurinol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Predisposing factors that make renal calculi more likely

A

Recurrent UTIs
Metabolic = hypercalciuria/hypercalcaemia, hyperPTH, neoplasia, renal tubular acidosis
Urinary tract abnormalities (hydronephrosis, horseshoe kidney, ureterocele)
Foreign bodies (stents, catheters)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe the common causes of urinary tract obstruction

A

Luminal (stones, blood clot, sloughed papilla, tumour)
Mural (congenital/acquired stricture, NM dysfunction)
Extra-mural (abdo or pelvic mass/tumour)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Clinical features of upper urinary tract obstruction

A

Acute = loin pain radiating to groin. May be superinfosed infection ± loin tenderness, or enlarged kidney

Chronic = flank pain, renal failure, superimposed infection, polyuria (impaired urinary concentration)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Clinical features of lower urinary tract obstruction

A

Acute = acute urinary retention with severe suprapubic pain ± acute confusion

Chronic = urinary freq, hesitancy, poor stream, terminal dribbling, overflow incontinence, distended + palpable bladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Causes of acute lower urinary tract obstruction

A 
Prostatic obstruction
Urethral strictures
Anticholinergics
Blood clots
Alcohol
Constipation
Post-op
Infection
Neuro (Cauda Equina)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Causes of chronic lower tract obstruction

A 
Prostatic enlargement (common)
Pelvic malignancy
Rectal surgery
DM
CNS (transverse myelitis/MS)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Management of upper urinary tract obstruction

A

Nephrostomy or ureteric stent
A-blockers help reduce stent-related pain (dec ureteric spasm)
Pyeloplasty (to widen the PUJ)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Problems associated with ureteric stenting

A 
Stent-related pain
Trigonal irritation
Haematuria
Fever
Infection
Tissue inflammation
Encrustation
Biofilm formation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Management of lower urinary tract obstruction

A

Urethral or suprapubic catheter to relieve acute retention.
In chronic, only catheterise if there’s pain, infection, or renal impairment (intermittent self-catheterisation may be required)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Describe the underlying pathology and clinical features of benign prostatic hyperplasia

A

Benign nodular or diffuse proliferation of musculofibrous and glandular layers of the prostate

Features = LUT symptoms (nocturia, freq, urgency, dribbling, poor stream/flow, hesitancy, haematuria)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Investigations in benign prostatic hyperplasia

A 
Bedside = urine dip
Bloods = PSA, UE
Imaging = US, transrectal US ± biopsy
Others = MSU
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Management of benign prostatic hyperplasia

A 
Lifestyle = avoid caffeine and alcohol
Drugs = 
- a-blockers (tamsulosin) dec SM tone
- 5a-reductase inhibitors (finasteride)
Surgery = transurethral resection of prostate, transurethral incision of the prostate, retropubic prostatectomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Features of renal cell carcinoma

A

50% found incidentally
Haematuria, loin pain, abdo mass, anorexia, malaise, w/l
May cause a varicocele if invasion of L renal v compresses L testicular v

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Management of renal cell carcinoma

A

Radical nephrectomy
Cryotherapy and radio ablation if unfit/unwilling
Usually radio+chemo resistant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Prognosis of RCC

A

Mayo prognostic risk score:
0-1 = 96.5% 10yr survival
>10 = 19.2%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Presentation of TCC

A 
Painless haematuria
Frequency
Urgency
Dysuria
UT obstruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Prognosis of TCC

A

Varies with clinical stage/histological grade: 10-80% 5yr survival

26
Q

What is a Wilms’ tumour

A

Nephroblastoma

Childhood tumour of primitive renal tubules and mesenchymal cells

27
Q

Symptoms of prostate cancer

A 
May be asymptomatic
Nocturia
Hesitancy
Poor stream
Terminal dribbling
Obstruction
(w/l ± bone pain indicates mets)
28
Q

Management of prostate cancer

A 
Radical prostatectomy if <70
Radical radio (alt curative option)
Hormone therapy alone delays progression (so if elderly, unfit)
Active surveillance (esp if >70)
29
Q

Prognosis of prostate cancer

A

10% die in 6m

10% live >10yrs

30
Q

Describe balanitis and how you’d treat it

A

Acute inflammation of the foreskin and glans
Associated with strep and staph
More common in DM

Treat = abx, circumcision, hygiene advice

31
Q

Describe phimosis and paraphimosis and how you’d treat them

A

Phimosis = foreskin occludes meatus (causes recurrent balanitis and ballooning)

Paraphimosis = what tight foreskin is retracted and becomes irreplaceable (leads to oedema and even ischaemia of glans)

Treat = pt squeezes glans, ice packs and lidocaine gel.
May require dorsal slit/circumcision

32
Q

Describe prostatitis and how you’d treat it

A

May be acute or chronic
Causes = S faecalis, E. coli, chlamydia
Features = UTI, retention, pain

Treat = analgesia, levofloxacin

33
Q

Presentation of TCC

A

Painless haematuria
Recurrent UTIs
Voiding irritability

34
Q

How would you distinguish between different scrotal masses on examination?

A

Can’t get above = inguinoscrotal hernia
Separate and cystic = epididymal cyst
Separate and solid = epididymitis/varicocele
Testicular and cystic = hydrocele
Testicular and solid = tumour, haematocele, granuloma, orchitis

35
Q

Describe hydroceles

A

Fluid within tinica vaginalis
1’ = associated with patent processus vaginalis
2’ = testis tumour/trauma/infection

36
Q

Management of hydroceles

A

Aspiration

Surgery

37
Q

Causes and features of epididymo-orchitis

A

Chlamydia
E coli
N gonorrhoae
TB

Features = sudden-onset tender swelling, dysuria, sweats/fever

38
Q

Investigations in epididymo-orchitis

A

Bedside - 1st catch urine, STI screen
Bloods - ?STI bloods
Imaging - N/A
Other - urethral discharge

39
Q

Management of epididymo-orchitis

A

If <35yo: doxycycline
If gonorrhoea suspected: add ceftriaxone IM STAT

If >35yo (mostly non-STI): associated UTI, give ciprofloxacin

ABx should be used for 2-4wks
Warn of possible infertility and symptoms worsening before improving

40
Q

Describe varicoceles

A

Dilated veins of pampiniform plexus.
Usually L side
Often visible as distended scrotal blood vessels (‘bag of worms’)
Pts complain of a dull ache
Associated with subfertility (repair has little impact)

41
Q

Describe haematoceles

A

Blood in tunica vaginalis
Follows trauma
May need drainage/excision

42
Q

Outline the different types of testicular malignancy

A

Seminoma (55%) => 30-65yo
Non-seminomatous germ cell tumour (33%) - prev teratoma => 20-30yo
Mixed germ cell tumour (12%)
Lymphoma

43
Q

Signs of testicular malignancy

A

Typically painless testis lump found after trauma. There may also be:

  • haematospermia
  • secondary hydrocele
  • pain
  • SOB (lung met)
  • abdo mass (enlarged nodes)
  • effects of secreted hormones
  • mets
44
Q

Risk factors for testicular cancer

A

Undescended testis
Infant hernia
Infertility

45
Q

Symptoms and signs of testicular torsion

A

Sudden onset of pain in one of the testis, makes walking uncomfortable
Pain in abdo, N+V are common

Signs = inflammation of one testis (v tender, hot, and swollen)

46
Q

Differentials for testicular torsion

A

Epididymo-orchitis - but pts tend to be older, have symptoms of UTI, more gradual onset

Also consider - tumour, trauma, acute hydrocele

47
Q

Investigations in testicular torsion

A

Only if diagnosis is equivocal -> if likely torsion, get to surgery

Doppler US may show lack of blood flow to testis

48
Q

Management of testicular torsion

A

Surgery -> consent for possible orchidectomy + bilateral fixation
Expose and untwist the testis.
If colour looks good, return to scrotum
Fix both testes to the scrotum

49
Q

Describe the incidence of undescended testes

A

About 3% boys are born with at least 1 undescended testis (30% of premature)
<1% after 1st yr of life

50
Q

Causes of undescended testes

A

Complete absence of testis from scrotum - may be anorchism
Retractile testis - excessive cremasteric reflex (reassure)
Maldescended - may be found anywhere from abdo to groin
Ectopic testis - usually found in sup inguinal pouch, but may be abdo, perineal, penile, or femoral triangle

51
Q

Complications and management of maldescended/ectopic testes

A

Complications = infertility, x40 inc risk test Ca, inc risk test trauma, inc risk torsion

Manage = restores potential for spermatogenesis, inc risk of malignancy remains, but becomes easier to diagnose

  • surgery = orchidopexy
  • hormonal = most commonly hCG if in inguinal canal
52
Q

How long does it take for results to be seen with finasteride treatment of BPH?

A

Up to 6m

53
Q

Management of ureteric stone with hydronephrosis

A

Nephrostomy

54
Q

Pelvis fracture + highly displaced prostate

A

Membraneous urethral rupture

55
Q

Cause of fall after management of urinary retention

A

Physiological diuresis may be followed by pathological diuresis
May lead to hypovolaemia, dehydration, and electrolyte imbalance
-> do daily U+Es

56
Q

Non-malignant causes of a raised PSA

A

BPH
Prostatitis and UTI (wait 1m before doing PSA)
Ejaculation (avoid for 48hr before PSA)
Vigorous exercise (avoid for 48hr before PSA)
Urinary retention
Instrumentation of urinary tract

57
Q

Risk factors for bladder TCC

A

Smoking
Aniline dyes
Rubber manufacture
Cyclophosphamide

58
Q

Risk factors for bladder squamous cell cancer

A

Schistosomiasis
BCG treatment
Smoking

59
Q

What is TURP syndrome? What are the RFs?

A

Rare + life-threatening complication of transurethral resection of prostate surgery due to venous disruption and absorption of irrigation fluid.

RFs:

  • surgery >1h
  • height of bag >70cm
  • resented >60g
  • large blood loss
  • perforation
  • large amount of fluid used
  • poorly controlled CHF
60
Q

Infection associated with stag-horn calculi

A

Proteus (mirabilis)

61
Q

Mechanism of action of goserelin in prostate Ca

A

GnRH agonist - provides -ve FB to ant pit

62
Q

Removal of renal stones in pregnancy women

A

Ureteroscopy

Finals (25 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions