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Year 6 - Surgery > Passmed: Uro > Flashcards

Passmed: Uro Flashcards

1
Q

What can germ cell tumours be divided up into?

A

Seminomas

Non-Seminomas: embryonal, yolk sac, teratoma, choriocarcinoma

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2
Q

What can non-germ cell tumours be divided up into?

A

Leydig + Sarcomas

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3
Q

Late comps of radical prostatectomy

A

Incontinence, ED, urethral stenosis

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4
Q

What is retrograde ejaculation a common comp of?

A

Alpha blockers and TURP

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5
Q

What post void volumes are considered physiological in pts aged above/below 65yrs?

A

<50ml if <65y

<100ml if >65y

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6
Q

What is chronic urinary retention defined as?

A

Presence of >500ml within the bladder after voiding

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7
Q

What does a post catheterisation urine volume of >800ml suggest?

A

Acute on chronic urinary retention

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8
Q

What meds can cause acute urinary retention?

A 
Anticholinergics
Benzodiazepines
Antihistamines
Opioids
TCAs
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9
Q

Ddx for urinary retention

A

Urethral obstrc: BPH, stricture, calculi, cystocele, constipation

Plus meds, neuro, UTI, postop, postpartum

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10
Q

Why do adult pts w a hydrocele require an urgent ultrasound?

A

To exclude any underlying causes such as a tumour

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11
Q

Aside from tumours what else can hydroceles develop secondary to?

A

Epididymo-orchitis and testicular torsion

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12
Q

How does epididymo-orchitis present?

A

Acute pain and swelling following urological intervention, pyrexia, pos urine dip

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13
Q

What is a/w mumps?

A

Orchitis

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14
Q

Which side are varicoceles typically?

A

The left because the testicular vein drains into the renal vein as opposed to directly into the IVC

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15
Q

What should your work up inc for a left varicocele?

A

Must exclude RCC

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16
Q

Screen for LUTS

A

Storage: FUND + Voiding: HIPS

Frequency
Urgency
Nocturia
Dysuria

Hesitancy
Incomplete
Poor Stream
Straining

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17
Q

Mx of nocturia

A

Advise moderating fluid intake at night, furosemide 40mg late afternoon, consider desmopressin

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18
Q

Mx of predominantly overactive bladder

A

Conservative: moderating fluid intake + bladder retraining

Pharmaco: antimuscarinic -> mirabegron

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19
Q

Mx of predominantly voiding sx

A

Conservative: prudent fluid intake + pelvic floor training

Pharmaco: alpha blocker, use 5α reductase inhibitor if prostate, use antimuscarinic if mixed sx

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20
Q

SEs of alpha blockers e.g. tamsulosin and alfuzosin

A

Dizziness, postural hypotension, dry mouth

Tamsulosin doesn’t help w posture, no wonder dizziness can foster!

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21
Q

SEs of 5 α reductase inhibitor e.g. finasteride

A

Sexual dysfunction, ED, reduced libido, ejaculation problems, gynaecomastia

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22
Q

Give examples of antimuscarinic drugs

A

Oxybutynin
Tolterodine
Darifenacin

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23
Q

What can be used as immediate pain relief for renal colic?

A

IM Diclofenac

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24
Q

Mx of stones

A

<5mm: watch + wait

<10mm: alpha blocker, oral nifedipine, SWL

10-20mm: URS

> 20mm: PCNL

SWL = Shockwave Lithotripsy
URS = Ureteroscopy
PCNL = Percutaneous Nephrolithotomy
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25
Q

Aetiology of hydronephrosis

A

Unilateral: PACT + Bilateral: SUPER

Pelvic-Ureteric Obstrc
Aberrant Renal Vessels
Calculi
Tumours of Renal Pelvis

Stenosis of Urethra
Urethral Valve
Prostatic Enlargement
Extensive Bladder Tumour
Retro-Peritoneal Fibrosis
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26
Q

What should be performed on all pts w renal colic within 14hrs of admission?

A

Non contrast CT KUB

NB: if pyrexic, solitary kidney, uncertain dx perform immediately

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27
Q

What are the medical indications for circumcision?

A

Phimosis
Paraphimosis
Recurrent Balanitis
Balanitis Xerotica Obliterans

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28
Q

What is important to exclude prior to circumcision?

A

Hypospadias

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29
Q

Tx of acute balanitis

A

Dependent on underlying cause: STI - abx, candida - antifungal, dermatitis - topical hydrocortisone

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30
Q

What should men presenting w ED be screened for?

A

Underlying diabetes, CVD and hypogonadism therefore test glucose, lipid profile, testosterone

31
Q

What is generally considered to be a normal age-adjusted serum PSA?

A

50-59yrs: <3ng/ml
60-69yrs: <4ng/ml
>70yrs: <5ng/ml

32
Q

Urethral injury: bulbar vs membranous rupture

A

Bulbar: most common, straddle type injury, triad of 1) urinary retention 2) perineal haematoma 3) blood at the meatus

Membranous: either extra or intra peritoneal, pelvic #, penile/perineal oedema/haematoma and upwards displacing prostate on PR

33
Q

Ix + Mx of urethral injury

A

Ascending urethrogram + surgically placed suprapubic catheter

34
Q

Ix + Mx of bladder injury

A

IVU/Cystogram + extra: conservative or intra: laparotomy

35
Q

What is a TURP syndrome?

A

Presents w CNS, resp and systemic sx caused by irrigation w glycine resulting in hypoNa and hyperammonia

36
Q

How is bladder voiding measured?

A

By urodynamic studies

37
Q

RFs for testicular ca

A 
FHx
Infertility
Klinefelter’s
Cryptorchidism
Mumps Orchitis
38
Q

When should PSA testing not be done within?

A

At least: 48hrs of ejaculation or vigorous exercise, 1w DRE, 4w proven urinary infection, 6w prostate biopsy

39
Q

Which drug is a recognised non infective cause of epididymitis?

A

Amiodarone

40
Q

Which reflex is lost following testicular torsion?

A

Cremasteric

41
Q

What is a common cause of a hydrocele in children?

A

A patent processus vaginalis

42
Q

How can hydroceles be divided?

A

Communicating: PPV

Non-Communicating: XS fluid production within tunica vaginalis

43
Q

Tx of hydrocele

A

Children - trans inguinal ligation of PPV

Adults - Lords or Jabouley procedure

44
Q

Raised AFP and HCG: seminoma or non-seminoma?

A

Non-Seminoma

45
Q

Classical triad of RCC

A

Loin Pain
Haematuria
Abdo Mass

46
Q

Most effective mx option in RCC

A

Partial/total radical nephrectomy

47
Q

Which ca classically results in cannonball mets in the lungs?

A

RCC + Choriocarcinoma

49
Q

RFs for prostate ca

A

Age
FHx
Obesity
Afro-Caribbean

50
Q

RFs for bladder ca

A

Transitional cell carcinoma: smoking, aniline dyes, rubber manufacture, cyclophosphamide

Squamous cell carcinoma: smoking + schistosomiasis

51
Q

What medical benefits does circumcision reduce the risk of?

A

UTI, HIV, penile cancer

52
Q

Tx of Infantile Hydrocele

A

Reassurance and surgical repair ie Lord’s or Jaboulay’s if it does not resolve within 1-2yrs

53
Q

Urethral Injury: Bulbar vs Membranous

A

Bulbar: more common; straddle type injury; triad of urinary retention, perineal haematoma and blood at the meatus

Membranous: extra or intraperitoneal; usually due to pelvic fracture; penile/perineal oedema/haematoma and high riding prostate

54
Q

Ix for Urethral Injury

A

Ascending Urethrogram

55
Q

Mx of Urethral Injury

A

Suprapubic Catheter

56
Q

How does rhabdomyolysis cause AKI?

A

ATN

57
Q

What causes acute interstitial nephritis?

A

Drugs, Autoimmune, Infection

58
Q

Comps of TURP

A

Turp Syndrome
Urethral Stricture/UTI
Retrograde Ejaculation
Perforation of Prostate

59
Q

Why does TURP syndrome occur?

A

When irrigation fluid enters the systemic circulation leading to: dilutional hyponatraemia, fluid overload, glycine toxicity

60
Q

ED: Organic vs Psychogenic

A

Organic: gradual onset, normal libido, lack of tumescence, recent op/trauma, DHx, SHx

Psychogenic: sudden onset, dec libido, good quality spontaneous or self stimulated erections, major life event, problems or changes in a relationship, prev psychological problems, hx of premature ejaculation

61
Q

Ix for ED

A

Calculate CVD risk by measuring lipid and fasting glucose

Measure free testosterone b/w 9-11am and if low repeat along with FSH, LH and prolactin

62
Q

Mx of ED

A
  1. PDE-5 Inhibitor 2. Vacuum Device

Any hormone abnormalities refer to endo and if a young male who has always had difficulty refer to urology

63
Q

Which type of renal stones are radiolucent?

A

Urate + Xanthine

64
Q

What are stag horn calculi composed of?

A

Struvite: Magnesium Ammonium Phosphate or Triple Phosphate

65
Q

What pH of urine do struvite stones form in?

A

Alkaline

66
Q

Which renal stones are inherited?

A

Cystine

67
Q

How long after ejaculation, vigorous exercise and prostatitis/UTI should you wait before measuring PSA?

A

Ejaculation/Exercise: 48hrs

Prostatitis/UTI: 1mnth

68
Q

How does torsion of the testicular appendage present?

A

Hx: sudden onset pain in one hemiscrotum w no other urinary sx

O/e: the superior pole will be tender with a blue discolouration and the cremasteric reflex is usually preserved

69
Q

Which pathogen most commonly causes acute bacterial prostatis?

A

E Coli

70
Q

Mx of Acute Bacterial Prostatitis

A

14d Quinolone + STI Screen

71
Q

Acute Bacterial Prostatitis RFs

A

Recent UTI; urogenital instrumentation; intermittent bladder catheterisation; recent prostate biopsy

72
Q

How does your age group match with the most likely organism responsible for epididymo-orchitis?

A

<35: Chlamydia

>35: E. Coli

73
Q

Does a vasectomy work immediately?

A

No

74
Q

When can UPSI begin following a vasectomy?

A

After semen analysis x2 usually done at 16 and 20wks

Year 6 - Surgery (27 decks)

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