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Julia PCP2 > Genitourinary > Flashcards

Genitourinary Flashcards

(50 cards)

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1
Q

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

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

What are some risk factors for ureteric stone development?

A

Dehydration

Diet high in animal protein &salt

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3
Q

What are the initial investigations for a suspected stone?

A
  • FBE, UEC
  • Serum calcium & uric acid
  • MSU
  • CT-KUB and plain KUB
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4
Q

What are some indications for intervention for a ureteric stone?

A
  • Infection/sepsis
  • Renal impairment
  • Bilateral obstructions
  • Solitary kidney
  • Inability to control symptoms
  • Prolonged obstruction
  • Unlikely to pass spontaneously
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5
Q

What organism usually causes obstructive pylonephrosis?

A

E. coli

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6
Q

What is the management of obstructive pylonephrosis?

A
  • IV Abs (gentamicin?)
  • Urgent decompression
  • Supportive care (fluids, monitoring)
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7
Q

What are some medical treatments for ureteric stones?

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

- calcium channel blockers & steroids not as effective

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8
Q

What are the surgical options for a ureteric stone?

A
  • JJ stent & delayed management
  • Ureteroscopy & lithotrospsy
  • Shock wave lithotripsy
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9
Q

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

A
  • Uric acid (or cystine)

- Form in acidic urine

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10
Q

What are some strategies to prevent stone recurrence?

A
  • Adequate fluid intake
  • Dietary modification
  • Urinary alkalinization
  • Medical therapy - allopurinol, thiazide diuretics
  • Cystinuria
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11
Q

What are 5 causes of urological haematuria?

A
  • Obstructive uropathy
  • Carcinoma of the prostate
  • Nephritis
  • Trauma
  • Tumour
  • TB
  • Thrombosis
  • Haematological
  • Infection/inflammation
  • Stones
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12
Q

Which common drugs can make the urine beetroot red?

A
  • Pyridium
  • Nitrofurantoin
  • Rifampin
  • Ibuprofen
  • Phenytoin
  • L-DOPA
  • Chloroquine
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13
Q

What is the acute work-up for haematuria?

A
  • Bloods: Hb, clotting, creatinine
  • MSU -> M/C/S
  • Upper tract imaging: CT-IVP, U/S
  • Cystoscopy
  • Others: urine cytology, PSA, urinalysis
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14
Q

What are the obstructive urinary symptoms?

A

Poor flow, hesitancy, intermittency, terminal dribbling

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15
Q

What are the irritative urinary symptoms?

A

Frequency, urgency, nocturia, incontinence

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16
Q

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

A
  • BPH
  • Prostate cancer
  • Stricture
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17
Q

What are 5 causes of irritative urinary symptoms?

A
  • UTI
  • Secondary to obstruction
  • Bladder cancer
  • Stone
  • Diabetes
  • TB
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18
Q

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

A
  • MSU
  • UEC
  • PSA
  • Bladder diary
  • Voiding flow rate
  • US - residual urine, hydronephrosis
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19
Q

Which drugs can be used in lower urinary tract symptoms?

A
  • Alpha blockers

- 5-alpha reductase inhibitors

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20
Q

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

A
  • TURP
  • BNI (bladder neck incision)
  • Open prostatectomy
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21
Q

What is acute urinary retention?

Study These Flashcards
A

Sudden and PAINFUL inability to pass urine

22
Q

What are some painless causes of urinary retention?

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A
  • Neurogenic
  • Longterm voiding detrusor dysfunction
  • Ageing
23
Q

What can precipitate acute urinary retention?

Study These Flashcards
A
  • Medication (anticholinergics)
  • UTI
  • Diuresis (esp. ALCOHOL)
  • Postoperative
24
Q

What are common causes of acute urinary retention in females?

Study These Flashcards
A
  • 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)

Julia PCP2 (21 decks)

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