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Hayders Phase 2A > GU > Flashcards

GU Flashcards

1
Q

what can predispose somone to testicular torsion,

epidemiology

A

Bell clapper deformity
boys 11-3 is peak age
5-30 is range

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2
Q

what is the presentation for testicular torsion

A

Sudden onset of unilateral testicular pain
nausea and vomiting
fever
suprapubic abdominal pain

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3
Q

Management of testicular torsion

what’s the optimum operation time

A

emergency, surgically operate, ask consent for potential orchidectomy
operate and untwist testicle and fixate testicle to back of scrotum
optimum operation time within 6 hours
only do investigation if unsure, Scrotal doppler ultrasound

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4
Q

signs of testicular torsion

A

inflammation, tender hot and swollen enlargement
High riding testicle
horizontal laying testicle
pain doesn’t go away

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5
Q

in what region does prostatic hyperplasia or carcinoma occur

A

in the intermittent transitional region of the prostate

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6
Q

symptoms of prostatic hyperplasia

A

Storing and voiding symptoms
frequency, urgency, bocturia, urgency incontinence
voiding
post void dribble, poor stream, hesitation (Haematuria and dysuria potential symptoms for carcinoma)

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7
Q

what are complications of prostatic hyperplasia

A

retention, stone or renal disease

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8
Q

what would fever with dysuria indicate

A

UTI Indicating Pyelonephritis

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9
Q

signs of BPH

A

prostatic enlargement on DRE
Hard and irregular suggest Carcinoma
smooth and enlarged suggests BPH

abd exam shows palpable bladder
inspect External meatus for signs of STI or UTI

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10
Q

Differential for LUTS voiding and storing

A 
BPH
UTI 
Prostatic carcinoma 
Bladder cancer 
Overactive bladder 
prostatitis
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11
Q

Investigations for BPH

A

Urinalysis: MSU MS and C. all comes back clear, eliminates UTI
dipstick
DRE
PSA - elevation can suggest carcinoma or BPH
volume chart-
international prostate symptom score questionnaire

Other Ultrasound
CT

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12
Q

Management of BPH

Conservative or in mild symptoms

A

Mild symptoms- watchful waiting, avoid Alcohol and caffeine. bladder training

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13
Q

Management of BPH

pharamacological

A

Orchidectomy is ideal however tends to be unwanted. since testosterone is linked to BPH. other cause is prostatic smooth muscle constriction

5 alpha reductase inhibitor - finasteride
Alpha Blockers- Tamsulosin
combination therapy

potentially anticholinergics or phosphodiesterase (PDE) 5 inhibitors

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14
Q

what is treatment for overactive bladder syndrome

A

Anticholinergics- tolterodine

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15
Q

Indications for surgery in BPH

A 
RUSHES
retention 
UTI recurrent
Stones
Haematuria 
elevated creatinine 
symptoms deterioration (uncontrolled)
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16
Q

Surgery options for BPH

A

Transurethral resection of prostate (TURP)
Transurethral Incision of Prostate (TUIP)
Prostatectomy

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17
Q

what is 5 alpha reductase inhibitors method of action

A

Inhibits conversion of testosterone to DHT DiHydrotestosterone (a more potent form of testosterone which can be linked to BPH)

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18
Q

what investigation would you carry out if patient presents with LUTS and haematuria

A

same as the other: PSA, DRE, Urinalysis, fluid volume

Cystoscopy for all haematuria patients

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19
Q

what are symptoms of urinary retention

A 
Painful
confusion 
fever
flank pain 
LUTS
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20
Q

what can cause urinary retention

A 
any urethral obstruction 
BPH 
malignancy from outside
stones, urolithiasis
Anticholinergics 
Iatrogenic
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21
Q

treatment of urinary retention

A

Urethral catheter and treat underlying causes

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22
Q

what is commonest renal tumour in adults

A

Renal cell carcinoma

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23
Q

what is the renal cell carconoma from

A

Proximal tubular epithelium

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24
Q

epidemiology risk factors age of onset of RCC

A 
55 y o 
Smoking obesity hypertension 
pre existing renal disease 
renal failure PCKD
Von Hippel lindau disease
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25
Q

Clinical features of RCC

presentations and symptoms, cardinal signs

A

Malaise anorexia weight loss, pyrexia

haematuria and loin pain and palpable mass in flank

patients commonly present with metastasis
decreased EPO causes anemia and polycythemia
tumour secreting renin = hypertension

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26
Q

Investigations and diagnosis of RCC

A

Ultrasound - shows mass
CT MRI- can be used to stage
Biopsy, use to confirm malignancy

Other investigations:
FBC - anemia , Polycythemia
LFT- can be increased aminotransferases
Creatinine- can be increased
urinalysis - dipstick shocks proteinuria and haematuria

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27
Q

What is Von Hippel lindau disease

A

autosomal dominant disease where multiple cysts form around the body and predisposes to multiple tumours

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28
Q

Management of RCC

A

Stage 1 0r 2 - nephrectomy or partial nephrectomy

stage 3 or 4 = temsirolimus, chemo

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29
Q

what are different urethral tumours

state which one is most common

A

Bladder, commones 50%
urethra
renal pelvis
ureter

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30
Q

what cells do urethral tumors originate from

A

Transitional epithelium cells lining the Gutract

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31
Q

RFs for urethral tumours

A

Smoking, exposure to industrial carcinogens, chronic inflammation

32
Q

Presentation of bladder tumours

A

Painless haematuria

Other include Dysuria or frequency

33
Q

presentation of renal pelvis or ureter tumour

A

Haematuria + loin pain

34
Q

Investigations for Urothelial tumours

A

Cystoscopy ( any haematuria presentation do cystoscopy). this can identify presence of mass
then CT/MRI to stage

35
Q

Management of tumour in renal pelvis or ureter

A

nephroureterectomy

36
Q

Management of bladder cancer

A

if superficial: Transurethral resection + chemo to slow down

if invasive: cystectomy or radical radiotherapy if over 70

37
Q

What type of cancer is prostate cancer and which cells does it originate from

A

adenocarcinoma, originating from epithelium of a gland

originates from epithelium in the transitional zone of prostate

38
Q

prevalence of prostate cancer

A

Commonest male cancer 80% of those over 80%

39
Q

where does prostate cancer most often spread to

A

metastasis to bone and lymph nodes

or spread locally to bladder, seminal vesicles, rectum

40
Q

Epidimeology assosiations and risk factors of prostate cancer

A

+ve family history, Age
increased testosterone (Black people)
BRCA2 gene

41
Q

Presentation of prostate cancer

A

LUTS, voiding and storing,
+ haematuria, dysuria
Back pain ( also found in prostatitis)
weight loss and anemia

42
Q

Physical examinations for prostate cancer

A

DRE shows hard irregular prostate

examination could show enlarged lymph nodes (late stage)

43
Q

Investigations for Prostate cancer

A

PSA- Elevated
Transrectal ultrasound and biopsy - diagnostic and graded

CT/MRI used to identify spread.
Bone scan

44
Q

what is the scoring system for prostate cancer

A

Gleason scoring system
out of 10
up to 6 is low grade tumour
7 is fast is intermediate grade ( Grade 2 and 3)
8,9,10 is high grade (8 is grade 4 and 9,10 is grade 5)

45
Q

what can causes Elevated PSA

A

BPH
adenocarcinoma is PSA is very high
prostatitis

can be falsely elevated by cycling, catheters, ejaculations

46
Q

Prostate cancer treatment

contained within prostate

A

radical Prostatectomy + supplementary chemo and radiotherapy

47
Q

Prostate cancer treatment metastasized

A

hormone therapy, since prostate cancer very sensitive to hormones

androgen deprivation or orchidectomy
or GNRH Goserelin or LH agonist flutamide , stimulate then inhibits. shrinks tumors
+radiotherapy

48
Q

lumps in the testicle: after examination, cannot get above the mass

A

Inguinoscrotal hernia

hydroceles

49
Q

lumps in the testicle: after examination, feels cystic and is attached to testicle

A

hydroceles

50
Q

lumps in the testicle: after examination, feels cystic and is not attached to testicle

A

epididymal cyst

51
Q

lumps in the testicle: after examination, feels solid and is not attached to testicle

A

epididymitis

varicoceles

52
Q

lumps in the testicle: after examination, feels solid and is attached to testicle

A

Tumour
orchitis
haematocele

53
Q

what is a hydroceles

A

fluid in tunica vaginalis
can be primary due to congenital abnormality or secondary to trauma
aspirate or surgery lords repair

54
Q

what is an epididymal cyst

A

cyst, usually asymptomatic but can be if gets large enough and needs removal

55
Q

what is a varicoceles

A

dilation of veins in paniform plexus, feels like bag of worms, can cause dull pain, surgically repair

56
Q

what is a haematocele

A

collection of blood in Tv, occurs after trauma, may need drainage

57
Q

what is epididymo-orchitis

A

inflammation of epididymis, causes by STI, first catch MC and S , chlamydia, mumps, n. gonorrhoea
sudden onset tender swelling dysuria, fever sweats, NO PAIN
Treat with antibiotics plus sexual partners

58
Q

Testicular cancer prevalence

A

Commonest malignancy in males age 14-44

59
Q

RF for testicular cancer

A

Family History plus undescended testicle

60
Q

presentation for testicular tumour

A 
painless lump in testicle, often found after trauma or infection 
Hemospermia 
effect on hormone 
If metastasized 
cough and dyspnea 
back pain 
abdominal mass
61
Q

Investigations and diagnosis for testicular tumour

A

Ultrasound, Biopsy
CT to assess metastasis
markers and alpha fetoprotein and Beta HCG

62
Q

Management of Testicular tumours

A

Radical orchiectomy plus Radiotherapy

63
Q

Staging system for Testicular tumour

A

Stage 1 no metastasize
2 spread to infradiaphragmatic
3 supradiaphragmatic
4 involvement into the lungs

64
Q

what is a complicated and uncomplicated UTI

A 
complicated = men, pregnancy, immunocompromised 
uncomplicated = non pregnant women
65
Q

Presentation of UTI

A 
dysuria 
frequency and urgency 
Haematuria 
smelly urine 
Suprapubic pain and tenderness 
back and flank pain 
elderly confusion 
Fever (indicates pyelonephritis)
66
Q

causative agent of UTI

and their effects

A

E Coli, commonest 50%
kelbestia - more likely to occur during hospital stay
proteus- stones
S. Aureus - risk of infective endocarditis
Pseudomonas chlamydia - immunocompromised

67
Q

Investigations for a UTI

A

Urinalysis
dipstick - proteinuria, nitrites, pyuria
MSU MC and S increased wcc and bacteria

68
Q

what is a lower and upper UTI

A

Lower, cystic (Bladder or urethra) or prostate

Upper, pyelonephritis, urter

69
Q

what is pyelonephritis

A

Infection of the renal pelvis by UTI

70
Q

presentation of pyelonephritis

A

Same as lower UTI ( dysuria, haematuria, Frequency, suprapubic pain and tenderness)
+ nausea and vomiting , back and flank pain, Loin Pain and tenderness fever and systemic illness
plus sign of costovertebral tenderness

main distingushing differences really is fever, nausea and vomiting. since all other signs also occur in UTI but less frequently

71
Q

Investigations for pyelonephritis

A

same as LUTI but also bloods, WCC ESR and CRP
Gram Stain will show e coli or any bacteria
Urinalysis
FBC
ESR CRP
Blood culture

72
Q

Treatment of UTI: cystic UTI complicated or uncomplicated

A

Oral Trimethoprim

or IV gentamicin if in patient care

73
Q

Treatment of UTI: pyelonephritis uncomplicated

A

Trimethoprim

74
Q

Treatment of UTI: pyelonephritis complicated

A

IV Gentamicin

75
Q

Investigations for Testicular torsion

A

Scrotal doppler ultrasound

76
Q

Questionnaire used for BPH investigations

A

International prostate symptom questionnaire form

Hayders Phase 2A (10 decks)

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