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MedEd > Urology > Flashcards

Urology Flashcards

1
Q

Prostate and bladder conditions?

A

BPH, prostate cancer, bladder cancer

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2
Q

Scrotal masses conditions?

A

Varicocele, hydrocele, epididymitis and orchitis, testicular cancer

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3
Q

Acute urology conditions?

A

Testicular torsion and urinary tract calculi

Urinary catherterisation

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4
Q

Causes of post renal obstruction?

A

Luminal = stones and clots
Mural = malignancy e.g. ureteric, prostae, blader, BPH and strictures
Extrinsic compression = retroperitoneal fibrosis

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5
Q

Post renal obstruction IX and management?

A

Urine dipstick and MC&S, drug chart review
Bloods = urea, creatnint, serum urea ratio, WCC< RP, cultures

Renal USS< bladder scan and CT KUB if considering stones

Mx: 1) flush catheter or replace and stop medications that could cause
Specific = ureteric stones or malignancy = surgery /chemo

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6
Q

Which bacteria most commonly forms staghorn calculi?

A

Proteus Miribalis

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7
Q

What are urinary tract calculi and symptoms?

A

Crystal deposition in the urinary tract AKA nephrolithiasis

Often asymptomatic, ureteric colic, SEVERE loin to groin pain, N+V, might be unable to sit still

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8
Q

Causes of urinary tract calculi?

A

Idiopathic, metabolic e.g. hypercalcaemia, hyperuircaemi - high cell turnover

RFs = low fluid intake, high salt meat diet and structural urinary tract abnormalities

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9
Q

Types of calculi?

A

Calcoim oxalate (80%)
Magnesium ammonium phosphate (staghonr/struvite stones) from proteus
Uric acid e.g. tumour lysis syndrome
Cysteine

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10
Q

red flags for urinary tract calculi?

A

Fever/signs of sepsis, persistent pain, renal impairment, dont forget AAA (CT with contrast)

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11
Q

Ix UTC?

A

Urine dipstick adn MSU, U&Es
Gold = non-contrast CT-KUB

?USS KUB
24hr urine collection for uric acid stones

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12
Q

Common sites of UTC blockage?

A

PUJ, ureter at pelvic brim, VUJ

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13
Q

Mx of ureteric colic?

A

Modify rfs, patient education, stop recurrence <5mm

Med: suppository diclofenac, antiemetics, medical explusion therapy (tamsulosin)

Surg: Indications (renal dysfunction, previous renal disease, infection, sever pain >48hours, bilateral stones)

  • Uretoscoy lithotripsy (10-20mm)
  • Extracoporeal shockwave lithotripsy
  • Percutaenous nephrolithotomy >20mm
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14
Q

Management of infected obstructed system?

A

ABCDE, sepsis 6
Decompression via stent or nephrostomy +-ITU
Percutaenous nephrostomy

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15
Q

Exam of scrotum?

A

If you cant get above lump = inguinal hernia

Attached to testicle = hydrocele
Cough for hernia
Transillumination = hydrocele

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16
Q

DDx for scrotal pain and sudden onset?

A

testicular torsion , torsion of testicular appendix, trauma, incarcerated hernia

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17
Q

DDx for painful gradual onset scrotal?

A

Acute epididymis, epididymo-orchitis

Haematocele

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18
Q

DDx for painless transilluminates scrotal?

A

Hydrocele (either communicating or non and reactive or trauma), communicating hydrocele for spermatic cord, indirect hernia (cannot get above), epidydmal cyst (can seperate from testis), spermatocele

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19
Q

DDx for painless, no transillumination scrotal lump?

A

Varicocele (bag of worms)

Tumour = germ cell seminoma (older), teratoma (younger), or non-germ cell

20
Q

What is a hydrocoele?

A

Presence of serous fluid in tunica vaginalis
Primary = patent processus vaginalis (infants)
Secondary = infection/inflammation, trauma or malignancy

21
Q

Signs and symptoms of hydrocoele and Ix?

A

Usually asymptomatic swelling, can get above swelling, non-seperate from testis, transilluminates

IX = USS to exclude tumour, testicular tumour markers and dipstick/MSU for infection

22
Q

What is varicocoele?

A

Dilated veins of the pampiniform plexus caused by venous reflux from valvular insufficiency

23
Q

Varicocoele sign/symptoms and Ix?

A

usually asymptomatic,
Bag of worms
Swelling may reduce lying down
Dragging sensation

Scrotal USS
Colour doppler CT, consider semen analysis

Provide scrotal support nd ligation or radiological embolisation

24
Q

Causes of epidymitis-orchitis?

A

Common in 20-30 YO
Sexually active: chlamydia and Gonoccocus
>35YO: colifroms e.g. enterobacter, klebsiella
Mumps orhitis in young

25
Q

Signs and symptoms of EO?

A

Acute onset severe pain over days, mild fever +- penile discharge
UTI symptoms
Painful, swollen and tender
Less acute onset that torsion

26
Q

How to differentiate between epididymitis and orchitis?

A

Prehns sign +ve = elevation eases epididymitis

27
Q

Rfs for testicular tumours?

A

20-40YO, cryptorchidism, klinefelter, hypospadias

28
Q

Symptoms/signs of testicular tumours?

A

painless swelling, dull ache, backache (mets to para-aortic nodes)
O/E = painless, hard, irregular mass, LNs

29
Q

types of testicular tumour?

A

Germ cell = seminoma (50% fried egg appearance, radiosensitive and 3rd decade)
teratoma (non rad sensitive) chorciocarcinoma (Hcg and blood spread), yolk sac = high AFP, embryonal arcinoma = haem spread

Sex cord tumour = sertoli adn lydig cell tumours

30
Q

Signs and symptoms of testicular torsion?

A

Sudden onset severe pain hemiscrotally, N+V, swollen and erythermatous scrotum, high lying testicule, horizontal lie, absent cremasteric reflex

31
Q

DDx for testicular torsion?

A

Epididymo-orchtiis
Torsion of appendix testis
strangulated hernia

32
Q

Mx for testicular torsion?

A

Clinical diagnosis (maybe doppler)
Urgent urology referral
Analgesia + anti-emetics
Exploratory suregry + contralateral fixation (orchodpexy)

33
Q

What are the storage LUTS?

A

Frequency, urgency, nocturia, dysuria

FUND

34
Q

What are the voiding/obstructive LUTS?

A

Hesitancy, incomplete emptying, poor stream, straining

HIPS

35
Q

What are post-micturation LUTS?

A

Incomplete emptying and terminal dribbling

36
Q

Symptoms of BPH?

A

LUTS, severe pain if urinary retention and DRE sows smoothly enlarged prostate with palpable midlien groove

37
Q

IX for BPH?

A

Bedisde and bloods

U&Es, bone profile and PSA and USS of urinary tract

38
Q

Mx for BPH?

A

Voiding training and limit caffeine and alcohol

Medical = alpha blockers (tamsulosin, doxasozin), 5alphareductase inhibitors e.g. finasteride
Anticholinergics e.g. oxybutynin
oral desmopressin for nocturia

Surg:
Transurethral resection of prostate (TURP)

39
Q

Symptoms of prostate cancer?

A

LUTS, malignancy symptoms, bone pain, cord compression flaws, paraneoplastic e.g. hypercalcaemia, DRE = asymettrical hard nodular craggy prostate

40
Q

Ix for prostate cancer?

A

Transrectal USS biopsy For gleason score

CXR for mets adn CT abdo and MRI pelvis

Lfts and bone profile

41
Q

What is bladder cancer and RFS?

A

Transitional cell carcinomas mainly

RFS: smoking, amine exposure (rbber/airport), chronic cystitis, previosu renal TCC, pelvic irradiation, schistosomiais

42
Q

Symptoms of bladder cancer?

A

Painless macroscopic haematuria, voiding symptoms, recurrent UTIs and FLAWS

43
Q

Ix for bladder cancer?

A

Cytoscopy with biopsy is diagnostic

CTMRI for staging

44
Q

Management for bladder cancer?

A

TURBT

Immunotherapy, radical cystectomy with ileal conduit

45
Q

What drug can predispose to urinary retention?

A

Amitriptylline

MedEd (32 decks)

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