Genitourinary: Part 6 Flashcards
1
Q
What aged men are effected by testicular tumours
A
15-44
2
Q
What percentage of testicular tumours arise from germ cells
A
96%
3
Q
Name two germ cell tetsicular tumours
A
Seminomas
Teratomas
4
Q
What age people does teratomas effect
A
Infants
5
Q
What age people do seminomas effect
A
25-40 years
6
Q
Name three non-germ cell tumours
A
- Leydig cells
- Sertoli cell tumours
- Sarcomas
7
Q
Risk factors for testicular tumours
A
- FAMILY HISTORY
- Infant hernia
- Undescended testis
- Infertility
8
Q
Clinical presentation of testicular tumours
A
- Painless lump in testicles
- Tetsicular or abdo pain
- Cough and dyspnoea (due to lung metastases)
- Back pain - para-aortic lymph node metastasis)
- Abdo mass
9
Q
Differential diagnosis of testicular tumours
A
- Testicular torsion
- Lymphoma
- Hydrocele
- Epididymal cyst
10
Q
Diagnostics for testicular tumours
A
- ULTRASOUND
- BIOPSY + HISTOLOGY
- SERM tumour markers
- CXR + CT - assess tumour staging
11
Q
Why is an ultrasound used in testicular tumours
A
- Differentiate between masses in the body of the testes and intrascrotal swellings
12
Q
Name some serum tumour markers
A
- Alpha-fetoprotein
2. Beta subunit of hCG (B-hCG)
13
Q
Level of AFP and B-hCG in teratomas
A
RAISED
14
Q
Level of AFP and B-hCG in seminomas
A
Normal AFP and raised B-hCG in some
15
Q
Treatment of testicular tumours
A
- RADICAL ORCHIDECTOMY via inguinal approach
2. Sperm storage offered
16
Q
Treatment of seminomas with metastases below diaphragm
A
RADIOTHERAPY only
17
Q
What are widespread testicular tumours treated
A
CHEMOTHERAPY
18
Q
What are teratomas treated with
A
CHEMOTHERAPY
19
Q
Define UTI
A
- Inflammatory response of the urothelium to bacterial invasion, usually associated with bacteria and pyuria
20
Q
What boundaries define UTI
A
- > 10^5 organisms/ml in fresh mid-stream urine
21
Q
What 5 pathogens account for UTI
A
KEEPS K = Klebsiella spp. E = E.coli (MOST COMMON) E = Enterococci P = Proteus spp. S = Staphylococcus spp (coagulase negative)
22
Q
Three ways we classify UTIs
A
- LOCATION: Lower UTI vs Upper
- CLINICAL RISK: Uncomplicated vs complicated
- TIMING: Single/isolated vs Unresolved
Acute vs Chronic
23
Q
What strain of e.coli causes UTI
A
UPEC - uropathogenic strains of E.coli
24
Q
What structures are found on the surface of E.coli
A
- FIMBRIAE/PILLI
- Glcocalix
- Acid polysaccharide coat that resists phagocytosis
25
What structures do bacteria adhere to
1. UROTHELIUM
2. VAGINAL EPITHELIUM
3. VAGINAL MUCUS
26
Under what circumstance is rate of adhesion highest
1. Oestrogen depletion due to the loss of lactobacilli and pH rises causing increases colonisation by colonic flora and reduction in vaginal mucus secretion
27
In what people is oestrogen-depleted UTI common in
Post-menopausal women
28
What antigen increases susceptibility to RECURRENT UTIs if you have it
HLA-A3
29
3 ways UTI causing bacteria defends itself against the host
1. CAPSULE - resists phagocytosis
2. TOXIC cytokines
3. ENZYME PRODUCTION
30
What enzyme secrete urease against the host
GRAM NEGATIVE: Proteus, Klebsiella and pseudomonas
GRAM POSITIVE: Staphylococci + Mycoplasma
31
Host defence mechanisms against UTI causing bacteria
1. ANTEGRADE flushing of urine
2. Tamm-Horsfall protein - antimicrobial
3. Low urine pH and high osmolarity
4. Urinary IgA
32
Name the UTI in the upper tract
1. PYELONEPHRITIS
33
Name the UTI in the lower tract
1. Cystitis
2. Prostatitis
3. Epididymo-orchitis
4. Urethritis
34
What is an uncomplicated UTI I
UTI in healthy non-pregnant women with normally functioning urinary tract
35
What is a complicated UTI
1. Infection in patients with abnormal urinary tract (stones, obstruction, systemic diseases involving the kidney like diabetes)
36
Problems with complicated UTIs
treatment failure
37
What complications can reuaslt from complicated UTIs
Renal papillary necrosis and renal abscess
38
In what gender are complicated UTIs found
MEN - associated with urological abnormalities like bladder outlet obstruction
39
Risk factors for UTIs
1. FEMALES
2. Sex
3. Pregnancy
4. Menopause
5. Decrease in host defence
6. Urinary tract obstruction resulting in urine stasis
7. Catheter
40
What route does UTI transmission occur in
Ascending transurethral route - sex and urethral catheter
41
Why are women more susceptible to UTIs
Shorter urethra and more proximal to anus
42
What is pyelonephritis
Infection of the renal parenchyma and soft tissues of the renal pelvis and upper ureter
43
What causes pyelonephritis
```
KEEPS:
Klebsiella spp.
E.coli (MAJORLY)
ENTEROCOCCUS spp.
Proteus spp.
Staphylococcus app - coagulase negative
```
44
Risk factors for pyelonephritis
1. Structural renal abnormalities
2. Stones
3. Catheterisation
4. Pregnancy
5. Diabetes
6. Immunocompromised patients
45
Where does UPEC come from
Patient's own flora
46
What three ways can you get pyelonephritis
1. Ascending transurethral route
2. Bloodstream
3. Lymphatics
47
Three adhesive features of UP e.coli
1. P pilli to allow ureteral ascent
2. Aerobactin - Fe acquisition
3. Haemolysin - pore formation
48
Clinical presentation of pyelonephritis
1. Triad of: Loin pain, fever and pyuria
2. Rigors
3. Headaches
4. Haematuria
5. Bacteruria
6. Malaise, nausea and vomiting
7. Oliguria if AKI
49
Differential diagnosis of pyelonephritis
1. Diverticulitis
2. Abdo aortic aneurysm
3. Kidney stones
4. Cystitis
5. Prostatitis
50
Diagnostics of pyelonephritis
1. Tender loin on examination
2. Urine dipstick
3. Midstream urine microscopy, culture and sensitivity - GOLD
4. FBC
5. URGENT ULTRASOUND
51
What features of urine dipstick indicate pyelonephritis
1. Detects nitrites - bacteria break down nitrates to release nitrites
2. Detect leucocyte elastase
3. Foul-smelling urine
4. Dipstick positive for proteins
52
FBC results for pyelonephritis
1. Elevated WCC
| 2. CRP and ESR raised in acute infection
53
Why is ultrasound done for pyelonephritis
1. calculi
2. Obstruction
3. Abnormal urinary anatomy
4. Incomplete bladder emptying
54
How is pyelonephritis treated
1. rest
2. Cranberry juice
3. WATER
4. ANALGESIA
5. Antibiotics
6. Surgery to drain abscess and stones
55
Antibiotics for pyelonephritis
1. ORAL CO-AMOXICLAV or CIPROFLOXACILLIN
IV GENTAMICIN/CO-AMOXICLAV if severe
56
What is cystitis
Urinary infection of the bladder
57
What gender is cystitis common in
WOMEN
58
Common cause of cystitis
E.coli
59
Risk factors of cystitis
1. Urinary obstruction
2. Previous damage to bladder epithelium
3. Stones
4. Poor bladder emptying
60
Clinical presentation of cystitis
1. Dysuria
2. Frequency
3. Urgency
4. Suprapubic pain
5. Haematuria
6. Offensive urine
7. Abdominal/loin tenderness
61
Diagnostics of cystitis
1. Urine microscopy and sensitivity of sterile mid-stream urine
2. Urine dipstick: Positive for leucocytes, blood and nitrites
62
treatment of cystitis
1. ANTIBIOTICS: TRIMETHOPRIM or CEFALEXIN
2nd line:
CIPROFLOXACIN or CO-AMOXICLAV
63
What is prostatitis
Inflammation of prostate gland
64
What condition is prostatitis associated with
LUTS
65
What causes acute prostatitis
1. Strep faecalis
2. E.coli
3. Chlamydia
66
What causes chronic prostatitis
1. Bacterial: Strep faecalis, E.coli or chlamydia
| 2. Non-bacterial; elevated prostatic pressure, pelvic floor myalgia
67
Risk factors for prostatitis
1. STI
2. UTI
3. Indwelling catheter
4. Post-biopsy
5. Increasing age
68
Clinical presentation of acute prostatitis
1. Systemically unwell
2. Fever, riggers and malaise
3. Pain ejaculation
4. LUTS symptoms
5. Pelvic pain
69
Clinical presentation of chronic prostatitis
1. Acute symptoms over 3 months
2. Recurrent UTIs
3. Pelvic pain
70
Differential diagnosis of prostatitis
1. Cystitis
2. BPH
3. Calculi
4. Bladder neoplasia
5. Prostatic abscess
71
Diagnostics for prostatitis
1. DRE
2. Urine dipstick
3. Mid-stream urine microscopy and sensitivity
4. Blood culture
5. STI screen
6. Trans-urethral ultrasound scan
72
Treatment for acute prostatitis
1. ANTIBIOTICS: IV GENTAMICIN + IV CO-AMOXICLAV/ IV TAZOCIN or CARBAPENEM
2. 2-4 weeks on CIPROFLOXACIN once well
3. TRUSS abscess drainage
73
Second line treatment for acute prostatitis
TRIMETHPRIM
74
Treatment for chronic prostatitis
1. 4-6 week course of CIPROFLOXACIN (usually doesn't work)
2. TAMSULOSIN
3. IBUPROFEN
75
Complications of prostatisti s
LUTS
76
What is urethritis
Inflammation of urethra
77
What usually causes urethritis
STD
78
What gender is effected by urethritis
Men
79
Most common cause of urethritis
Chlamydia
80
Main causes of urethritis
Gonococcal: Neisseria gonorrhoea
Non-gonococcal: Chlamydia trahcmoatis
Mycoplasma genitalium
Ureaplasma urealyticum
Trichomonad vaginalis
81
Non-infective causes of urtrhitis
1. Trauma
2. Urethral stricture
3. Irritation
4. Stone
82
Risk factors for Urethritis
1. Sex
2. Unprotected sex
3/ Male to male sex
4. Male
83
Clinical presentation of urethritis
1. Asymptomatic
2. Dysuria + discharge (blood + pus)
3. Urethral pain
4. Penile discomfort
5. Skin lesions
6. Systemic symptoms
84
Differential diagnosis of urethritis
1. Candida balantis
2. Epididyimitis
3. Cystitis
4. Acute prostitis
5. Urethral malignancy
85
Diagnostics of urethritis
1. Nucleic acid amplification test
2. Microscopy of gram-stained smears of genital secretions
3. Blood culture
4. Urine dipstick
5. Urethral smear
86
Describe NAAT in females
1. Self collected vaginal swab (endocervical swab, first void urine)
87
NAAT in males
First void urine
88
Pro of NAAT
High specificity and sensitivity
89
Why is urine dipstick used in urethritis
Excludes UTI
90
treatment of chlamidya
1. AZITHROMYCIN or 1 week oral DOXYCYCLINE
91
Treatment for chlamydia in pregnant women
1. ORAL ERYTHROMYCIN for 14 days or ORAL AZITHROMYCIN stat
92
How is Gonorrhoea treated
1. IM CEFTRIAXONE with ORAL AZITHROMYCIN
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