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Julia PCP2 > Genitourinary > Flashcards

Flashcards in Genitourinary Deck (50):
1

Name 3 types of stones. Which is the most common?

1. Calcium oxalate (70%)
2. Uric acid
3. Magnesium ammonium phosphate

2

What are some risk factors for ureteric stone development?

Dehydration
Diet high in animal protein &salt

3

What are the initial investigations for a suspected stone?

-FBE, UEC
-Serum calcium & uric acid
-MSU
-CT-KUB and plain KUB

4

What are some indications for intervention for a ureteric stone?

-Infection/sepsis
-Renal impairment
-Bilateral obstructions
-Solitary kidney
-Inability to control symptoms
-Prolonged obstruction
-Unlikely to pass spontaneously

5

What organism usually causes obstructive pylonephrosis?

E. coli

6

What is the management of obstructive pylonephrosis?

-IV Abs (gentamicin?)
-Urgent decompression
-Supportive care (fluids, monitoring)

7

What are some medical treatments for ureteric stones?

-a-blockers, eg. Tamsulosin 0.4mg OD for 2 weeks

-calcium channel blockers & steroids not as effective

8

What are the surgical options for a ureteric stone?

-JJ stent & delayed management
-Ureteroscopy & lithotrospsy
-Shock wave lithotripsy

9

What is the likely make-up of a radiolucent stone?

-Uric acid (or cystine)
-Form in acidic urine

10

What are some strategies to prevent stone recurrence?

-Adequate fluid intake
-Dietary modification
-Urinary alkalinization
-Medical therapy - allopurinol, thiazide diuretics
-Cystinuria

11

What are 5 causes of urological haematuria?

-Obstructive uropathy
-Carcinoma of the prostate
-Nephritis
-Trauma
-Tumour
-TB
-Thrombosis
-Haematological
-Infection/inflammation
-Stones

12

Which common drugs can make the urine beetroot red?

-Pyridium
-Nitrofurantoin
-Rifampin
-Ibuprofen
-Phenytoin
-L-DOPA
-Chloroquine

13

What is the acute work-up for haematuria?

-Bloods: Hb, clotting, creatinine
-MSU -> M/C/S
-Upper tract imaging: CT-IVP, U/S
-Cystoscopy
-Others: urine cytology, PSA, urinalysis

14

What are the obstructive urinary symptoms?

Poor flow, hesitancy, intermittency, terminal dribbling

15

What are the irritative urinary symptoms?

Frequency, urgency, nocturia, incontinence

16

What are the 3 most common causes of obstructive urinary symptoms?

-BPH
-Prostate cancer
-Stricture

17

What are 5 causes of irritative urinary symptoms?

-UTI
-Secondary to obstruction
-Bladder cancer
-Stone
-Diabetes
-TB

18

What is your work-up for lower urinary tract symptoms?

-MSU
-UEC
-PSA
-Bladder diary
-Voiding flow rate
-US - residual urine, hydronephrosis

19

Which drugs can be used in lower urinary tract symptoms?

-Alpha blockers
-5-alpha reductase inhibitors

20

What are the surgical options for treatment of lower urinary tract symptoms?

-TURP
-BNI (bladder neck incision)
-Open prostatectomy

21

What is acute urinary retention?

Sudden and PAINFUL inability to pass urine

22

What are some painless causes of urinary retention?

-Neurogenic
-Longterm voiding detrusor dysfunction
-Ageing

23

What can precipitate acute urinary retention?

-Medication (anticholinergics)
-UTI
-Diuresis (esp. ALCOHOL)
-Postoperative

24

What are common causes of acute urinary retention in females?

-Urethritis/UTI
-Meatal stenosis/stricture
-Tumour
-Urethral diverticulum
-Urethral stone
-Extrinsic compression - prolapsed uterus or pelvic mass

25

What are the appropriate size catheters for: men, women & haematuria?

Men: 12-14F
Women: 14-16F
Haematuria: 22-24F

26

What is the management of obstructive nephropathy?

-Admit
-Monitor urine hourly
-Replace urine volume with 1/2 volume 0.9% NaCl
-Monitor UECs regularly
-Replace magnesium & phosphate as required

27

What are the treatment options for AUR?

-Alpha-blocker & TOV
-Surgery: TURP, laser, open
-Long-term IDC

28

Differential diagnosis of a painless scrotal lump?

Hydrocoele, epididymal cyst, varicoele, benign tumour, idiopathic scrotal oedema, testicular cancer, lymphoma, inguinal hernia, ascites

29

What 3 serum markers might be elevated in testicular cancer?

-alpha-fetoprotein
-beta-HCG
-LDH

30

Which lymph nodes do the testicles drain to first?

Retroperitoneal lymph nodes (require CT abdomen & pelvis for staging)

31

What are the treatment options for testicular cancer?

-Inguinal orchidectomy
-Chemotherapy (BEP)
-Retroperitoneal lymph node dissection

32

What are the main investigations for suspected testicular cancer?

-Serum tumour markers
-Urgent scrotal U/S

33

What 2 places does testicular cancer commonly metastasize to first?

-Retroperitoneal lymph nodes
-Chest

34

What are the differentials for an acute scrotum?

-Testicular torsion
-Trauma
-Epididymo-orchitis
-Testicular appendage torsion
-Acute indirect inguinal hernia

35

What conditions can predispose to testicular torsion?

-Cryptorchidism
-Bell clapper deformity

36

What are the physical findings in testicular torsion?

-Tender, firm, high-riding testicle with a horizontal lie
-Absent cremasteric reflex
-Epididymis not posterior to testis

37

What are the common causative bacteria in epididymo-orchitis?

Men 35: E. coli & other GNBs

38

What are the risk factors for epididymo-orchitis?

-IDC
-Chronic retention
-Structural abnormality
-Instrumentation

39

What are the physical examination findings in epididymo-orchitis?

-Swollen, tender testis
-Fever
-Hydrocoele

40

What investigations should be ordered in suspected epididymo-orchitis?

-U/S - to rule out torsion
-Urinalysis & MSU
-Urine/urethral swab for PCR

41

Which antibiotics should be used in epididymo-orchitis?

GNB coverage: trimethoprim, cephalexin, augmentin or norfloxacin for 2 weeks
-give ampicillin & gentamicin via IV until afebrile

STI coverage: ceftriaxone & azithromycin & doxycycline

42

What are the macroscopic & microscopic features of papillary bladder cancer in situ?

-Cytologically malignant cells
-Lack of cohesiveness
-Mucosal reddening, granularity or thickening

43

What conditions predispose to carcinoma of the bladder?

-Smoking
-Industrial exposure to arylamines
-Schistosomiasis
-Long-term use of analgesics
-Long-term exposure to cyclophosphamide

44

What are the histological features of a testicular seminoma?

Large cells with distinct borders, pale nuclei, prominent nucleoli & sparse lymphocytic infiltrate

45

What are the 3 broad classifications of testicular neoplasms?

-germ cell tumours
-sex cord stromal tumours
-lymphoma

46

What are common germ cell tumours of the testicles?

-Seminoma
-Embryonal carcinoma
-Yolk sac tumour
-Choriocarcinoma
-Teratoma
-Mixed tumours

47

In which region of the prostate does hyperplasia typically arise?

Transitional zone

48

In which region of the prostate does carcinoma typically arise?

Peripheral zone

49

What does a Gleason score confer?

Degree of differentiation of cells (GRADE)

50

What are first-line antibiotics in uncomplicated UTI?

Trimethoprim (but NOT in pregnancy)