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Phase 2a Medicine > Urogenital > Flashcards

Urogenital Flashcards

1
Q

what scrotal masses can you not get above

A

inguinoscrotal hernia or hydrocele extending proximally

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2
Q

Separate and cystic scrotal mass

A

epididymal cyst

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3
Q

separate and solid scrotal mass

A

epididymitis/ varicocele

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4
Q

testicular and cystic scrotal mass

A

hydrocele

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5
Q

5 testicular and solid masses

A

tumour, haematocele, granuloma, orchitis, gumma.

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6
Q

epididymal cyst

A

Benign cyst lesion of the epididymis.

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7
Q

pathology of epididymal cyst

A

Possibly due to obstruction of the epididymis.

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8
Q

2 clinical maifestations of epididymal cysts

A

Usually presents as a small paratesticular swelling which may be tender
Grossly appears as a thin-walled, translucent cystic lesion

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9
Q

management of epididymal cyst

A

Remove if symptomatic

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10
Q

hydrocele

A

An abnormal accumulation of fluid in the space between the two layers of the tunica vaginalis.

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11
Q

2 causes of hydocele

A

Usually caused by trauma (primary), or
A reaction to an underlying pathology such as epididymitis, orchitis or a tumour (secondary cause)

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12
Q

clinical manifestation of hydrocele

A

Scrotal swelling

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13
Q

3 management options for hydrocele

A

Can resolve spontaneously
Aspiration
Surgery: placating the tunica vaginalis/ inverting the sac

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14
Q

varicocele

A

A persistent abnormal dilation of the pampiniform venous plexus in the spermatic cord.

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15
Q

4 clinical manifestations of varicocele

A

Usually presents with nodularity on the lateral side of the scrotum
Some cause a dull ache, especially after prolonged standing or towards the end of the day
May contribute to male subfertility, as the increased flow raises the scrotal temperature and impairs spermatogenesis
Often visible as distended scrotal blood vessels.

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16
Q

management of varicocele

A

Surgery to remove if symptomatic
If left untreated can lead to infertility

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17
Q

what is Adenomatoid tumour

A

The most common benign paratesticular neoplasm.

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18
Q

possible locations for adenomatiod tumour

A

Can occur in epididymis, spermatic cord, and tunica albuginea

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19
Q

appearance of Adenomatoid tumour

A

Grossly, they are small solid, firm, grey/ white tumours which are usually <3cm

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20
Q

6 causes of UT obstruction

A

Urinary stones
Urothelial tumours
Extrinsic compression by abdominal/ pelvic masses
Prostatic hyperplasia
Urinary tract malformations
Strictures

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21
Q

3 common clinical manifestations of UT obstruction

A

Symptoms directly suggestive of obstruction (e.g. ureteric colic)
Impaired renal function
Recurrent UTIs

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22
Q

specific symptoms of Acute upper tract obstruction

A

Loin pain radiating to the groin. There may be superimposed infection, loin tenderness, enlarged kidney.

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23
Q

specific symptoms of chronic upper tract obstruction

A

Flank pain, renal failure, superimposed infection.

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24
Q

specific manifestations of Acute lower tract obstruction

A

Acute urinary retention, severe suprapubic pain, acute confusion.

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25
Q

specific manifestations of Chronic lower tract obstruction

A

Urinary frequency, hesitancy, poor stream, terminal dribbling, overflow incontinence

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26
Q

4 investigations for UT obstructions

A

Blood: U&E, creatinine, FBC and prostate-specific antigen
Urine: dipstick and MC&S
Ultrasound: hydronephrosis (swelling of the kidney due to a build-up of urine) or hydroureter = CT scan
CT scan: determines level of obstruction

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27
Q

treatment of Upper tract obstruction

A

nephrostomy or ureteric stent.

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28
Q

treatment of lower tract obstruction

A

urethral or suprapubic catheter.

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29
Q

complications of UT obstructions

A

Obstruction increases the risk of infection, stone formation, and renal damage

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30
Q

classification of haematuria

A

Visible: previously known as macroscopic, frank
Non-visible: found on dipstick/ microscopy, previously known as microscopic.

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31
Q

4 causes of haematuria

A

Malignancy (kidney, ureter, bladder)
Calculi
IgA nephropathy
Polycystic kidney disease

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32
Q

what causes a false haematuria positive

A

myoglobin triggers same dipstick reaction

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33
Q

investigations into cause of haematuria

A

Undergo urological assessment, imaging, and cystoscopy to exclude renal tract malignancy and calculi.

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34
Q

symptoms of testicular torsion

A

Sudden onset of pain in one testis, which makes walking uncomfortable
Pain in the abdomen, nausea, and vomiting are common

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35
Q

signs of testicular torsion

A

Inflammation of one testis – very tender, hot and swollen.
Testis may lie high and transversely

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36
Q

differential diagnoses for testicular torsion

A

The main one is epididymo-orchitis, and there will be symptoms of urinary infection, and more gradual onset of pain.

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37
Q

investigations for testicular torsion

A

Doppler US may demonstrate lack of blood flow to testis.
Do not delay surgical exploration

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38
Q

management of testicular torsion

A

Ask consent for possible orchidectomy + bilateral fixation
At surgery expose and untwist the testis

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39
Q

Benign prostatic hyperplasia

A

Enlargement of the prostate gland due to an increase in cell number.

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40
Q

pathology of Benign prostatic hyperplasia

A

Androgens are critical in the development of BPH, more specifically increased levels of dihydrotestosterone locally in the prostate.
Current evidence suggests that increased oestrogen levels in blood induce androgen receptors in prostate tissue and stimulate hyperplasia

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41
Q

6 symptoms of Benign prostatic hyperplasia

A

Frequency
Urgency
Nocturia
Hesitancy
Poor flow
Terminal dribbling

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42
Q

4 differential diagnoses for BPH

A

Overactive bladder
Prostatitis
Prostate cancer
UTI

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43
Q

4 investigations for BPH

A

GS+ FL= digital rectal exam
PSA test
Frequency chart
Urine dipstick

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44
Q

lifestyle changes for BPH

A

Avoid caffeine, alcohol, to reduce urgency.
Void twice in a row to aid emptying

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45
Q

drugs for BPH

A

useful in mild disease, and while awaiting surgery
α-blockers are 1st line e.g. Tamsulosin

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46
Q

surgery for BPH

A

Transurethral resection of prostate
Transurethral incision of the prostate
Retropubic prostatectomy

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47
Q

4 complications of BPH

A

Urinary retention
Recurrent UTIs
Bladder stones
Obstructive nephropathy

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48
Q

renal carcinoma

A

A malignant epithelial tumour arising in the kidney.

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49
Q

5 symptoms of renal carcinoma

A

Loin pain
Abdominal mass
Anorexia
Malaise
Weight loss

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50
Q

how are renal carcinoma cases usually picked up

A

About half of all cases present with painless haematuria
Most of the remained is picked up incidentally on imaging
A small proportion presents with metastatic disease

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51
Q

investigations for renal carcinoma

A

FL=
Abdominal/pelvis ultrasound, bloods: raised RBC, raised calcium, raised LDH
GS=
CT chest/abdo/pelvis

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52
Q

management of renal carcinoma

A

Radical nephrectomy.
Cryotherapy and radiofrequency ablation is an option for patients unfit or willing to undergo surgery

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53
Q

what is Nephroblastoma

A

AKA Wilm’s tumour
A malignant childhood renal neoplasm

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54
Q

presentation and prognosis of nephroblastoma

A

Presents with abdominal mass and haematuria
Most tumours are of low stage with an excellent prognosis with treatment

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55
Q

what are urothelial carcinomas

A

A group of urothelial neoplasms arising in the urothelial tract.

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56
Q

clinical manifestations of bladder cancer

A

Haematuria – painless
LUTS
Recurrent UTIs
Voiding irritability

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57
Q

4 investigations for bladder cancer

A

FL=
urinalysis for microscopy and culture (haematuria), bladder USS
GS=
Flexible cystoscopy and biopsy

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58
Q

management of T1 bladder cancer

A

Diathermy via transurethral cystoscopy/ transurethral resection of bladder tumour

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59
Q

management of T2-3 bladder cancer

A

Radical cystectomy is the gold standard.
Radiotherapy gives worse survival rates than surgery but preserves the bladder.

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60
Q

management for T4 bladder cancer

A

Palliative chemo/radiotherapy.
Chronic catheterisation and urinary diversions may help to relieve pain

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61
Q

pathology of prostate cancer

A

Arise from a precursor lesion known as prostatic intraepithelial neoplasia, characterised by neoplastic transformation of the epithelium lining of the prostatic ducts and acini.
Harbour mutations in a number of genes.

62
Q

3 clinical manifestations of prostate cancer

A

The vast majority of prostate cancers are asymptomatic.
LUTS may be present
Patients may present with symptoms of metastatic disease

63
Q

differential diagnoses for prostate cancer

A

Benign prostatic hyperplasia
Prostatitis

64
Q

investigations for prostate cancer

A

FL= Prostate exam and digital rectal exam (firm, hard, asymmetrical, rough), prostate specific antigen (raised), multiparametric MRI
GS=
Transrectal USS and biopsy

65
Q

4 management options for prostate cancer

A

Prostatectomy
Radiotherapy
Analgesia
Treat hypercalcaemia

66
Q

seminoma

A

germ cell tumour of the testicle.

67
Q

teratoma

A

non-germ cell tumour of the testicle.

68
Q

5 clinical manifestations of testicular tumours

A

Typically, painless testis lump, found after trauma/infection
Secondary hydrocele
Pain
Dyspnoea
Abdominal mass

69
Q

3 differential diagnoses for testicular tumours

A

Hydrocele
Abdominal hernias
Orchitis

70
Q

investigations for testicular tumours

A

GS= urgent doppler USS of testes
FL= α-FP and β-hcg and lactacte dehydrogenase raised tumour markers
urgent doppler USS of testes

71
Q

staging of testicular tumours

A

1 – no evidence of metastasis
2 – infradiaphragmatic node involvement
3 – supradiaphragmatic node involvement
4 – lung involvement (haematogenous)

72
Q

management of testicular tumours

A

Radical orchidectomy
Seminomas are exquisitely radiosensitive
Chemotherapy - teratoma
Radiotherapy - seminoma

73
Q

what is urolithiasis

A

The formation of stony concretions in the bladder or urinary tract.

74
Q

pathology of urolithiasis

A

Calculi form that cause symptoms by blocking and abrasing structures. Renal stones consist of crystal aggregates, stones form in collecting ducts and may be deposited anywhere from the renal pelvis to the urethra.

75
Q

3 classical narrowings where UT calculi are found

A

Pelviureteric junction, pelvic brim, vesicoureteric junction.

76
Q

6 risk factors for urolithiasis

A

High protein/ high salt intake
Male, white
Obesity
Dehydration
Medications – antacids, carbonic anhydrase inhibitor
Crystal urea

77
Q

what can UT calculi be formed from

A

Calcium oxalate/ calcium phosphate
Magnesium ammonium phosphate
Uric acid
Struvite – common in chronic UTI
Cystine stones

78
Q

what are urinary calculi

A

crystal aggregates which form in the renal collecting ducts but may become deposited anywhere in the urinary tract.

79
Q

anatomical factors causing urinary calculi

A

Congenital (horseshoe, duplex, PUJO spina bifida)
Acquired (obstruction, trauma, reflux)

80
Q

urinary factors causing U calculi

A

Metastable urine, promoters and inhibitors
Calcium, oxalate, urate, cystine
Dehydration

81
Q

traditional triad of presentations for U calculi

A

fever, vomiting, flank pain

82
Q

behaviour of large U calculi

A

Large stones tend to remain confined to the kidney – asymptomatic or recurrent UTIs

83
Q

behaviour of smaller U calculi

A

Smaller stones may pass into the ureter and become impacted, causing ureteric colic

84
Q

what is hydronephrosis

A

a combination of obstruction and dilation of renal pelvis that often causes lasting damage to the kidney

85
Q

typical pain of U calculi

A

spasms of renal colic ‘loin to groin’, with nausea/ vomiting

86
Q

pain for Obstruction of the kidney

A

felt in the loin

87
Q

pain for obsruction of mid-ureter

A

may mimic appendicitis

88
Q

pain for Obstruction lower ureter

A

may lead to symptoms of bladder irritability and pain in scrotum, penile tip or labia majora

89
Q

pain for obstuction in bladder or urethra

A

causes pelvic pain, dysuria

90
Q

3 possible presentations in the urine of a patient with U caliculi

A

Haematuria
Proteinuria
Sterile pyuria

91
Q

5 investigations for U caliculi

A

GS= CT – helps exclude differential causes
FL= Urine dipstick: haematuria, leukocytes, nitrates. FBC, CRP (infection), U&Es (hypercalcaemia). Abdominal x-ray (will show calcium stones but not uric acid stones as they are radiolucent)

92
Q

management of acute urolithiasis

A

NSAIDs for pain, antiemetics for vomiting and nausea
Allow stones to pass spontaneously (<5mm)
IV fluids
surgical intervention

93
Q

what is percutaneous nephrostomy

A

catheter placed through the skin and into the kidney to drain urine directly from the kidney

94
Q

surgical intervention for stone in the ureter

A

Ureteric stent insertion – stent passed through bladder through ureter into kidney, bypassing the blockage and draining the urine into the bladder

95
Q

surgical intervention for stone in the kidney

A

percutaneous nephrolithotomy – remove the stone from the kidney by a small puncture wound in the skin

96
Q

what is extracorporeal shock wave lithotripsy

A

uses shock waves to break down stones that form in the kidneys to unable easy passage of these fragments out of the body within urine

97
Q

6 prevention methods against urolithiasis

A

Overhydration
Low salt diet
Normal dairy intake
Healthy protein intake
Reduce BMI
Active lifestyles

98
Q

cause of UTIs

A

Caused by the presence and multiplication of microorganisms in the urinary tract.

99
Q

clinical syndromes of lower tract UTIs

A

Cystitis
Prostatitis
Epididymitis/ orchitis
Urethritis

100
Q

clinical syndrome of upper tract UTIs

A

pyelonephritis

101
Q

3 classifications for UTIs

A

Asymptomatic bacteriuria
Uncomplicated (normal renal tract structure and function)
Complicated (structural/ functional abnormality of genitourinary tract e.g. obstruction

102
Q

main causitive organism for UTIs

A

Escherichia coli

103
Q

transmission of UTIs

A

Ascending spread of endogenous gut bacteria into the urethra
The shorter urethra of women and its closer proximity to the anus are thought to be the main reason why females are more susceptible.

104
Q

5 risk factors for UTIs

A

Bacterial inoculation: sexual activity, urinary incontinence, faecal incontinence
Binding of uropathogenic bacteria: spermicide use, menopause
Decreased urine flow: dehydration, obstructed urinary tract
Bacterial growth: diabetes mellitus, immunosuppression, obstruction, stones, catheter, pregnancy
Female

105
Q

presentations of UTIs caused by bladder infection

A

frequency, urgency, dysuria, haematuria and suprapubic pain

106
Q

presentation of UTIs caused by acute pyelonephritis

A

acute pyelonephritis (Ascending spread into the kidneys)
causes a more severe illness with fever, rigors, vomiting and loin pain

107
Q

investigations for UTIs

A

Urinalysis showing leucocytes or nitrites is a useful quick screening test
Look for blood, protein, pH, ketones, glucose, leucocytes, nitrates
Microscopy: WBCs, RBCs, casts (can be indicative of infection), bacteria
Microbiological culture is gold standard
Should be a midstream urine specimen
A pure growth of >105 organisms/mL of urine is diagnostic

108
Q

management of uncomplicated UTIs

A

treat empirically with antibiotics 3 days

109
Q

management of non-pregnant women with UTIs

A

If 3+ symptoms of cystitis and no vaginal discharge, treat empirically with 3-day course of antibiotics
If first-line empirical treatment fails, culture urine and treat according to antibiotic sensitivity

110
Q

management of men with UTIs

A

Treat lower UTI with a 7-day course of antibiotics
If symptoms suggest prostatitis, consider a course of ciprofloxacin due to ability to penetrate prostatic fluid.

111
Q

management of complicated UTIs

A

Longer antibiotic course required – 7 days

112
Q

treatment of pregnant women with UTIs

A

Asymptomatic bacteriuria should be confirmed on a second sample. Treat with antibiotics.

113
Q

Prostatitis

A

Inflammation/ swelling of the prostate gland.

114
Q

pathology of prostatitis

A

ascending infection from the urinary tract, haematogenous spread.

115
Q

5 clinical presentations of prostatitis

A

Pain: perineum, rectum, scrotum, penis, bladder, lower back.
Fever
Malaise
Nausea
Urinary symptoms

116
Q

treatment of acute prostatitis

A

Start antibiotic treatment immediately for 28 days
Treat the pain

117
Q

treatment of chronic prostatitis

A

Pain relief
Stool softener
Antibiotics 4-6 weeks

118
Q

cystitis

A

Inflammation of the bladder caused by a bladder infection.

119
Q

6 symptoms of Cystitis

A

Frequency
Dysuria
Urgency
Suprapubic pain
Polyuria
Haematuria

120
Q

what is pyelonenephritis

A

Infection of the renal parenchyma and soft tissues of renal pelvis/ upper ureter

121
Q

symptoms of pyelonephritis

A

Loin pain
Fever
Pyuria (pus in the urine)
Vomiting
Associated cystitis symptoms
Septic shock

122
Q

investigations for pyelonephritis

A

FL=Urine dipstick (leucocytes, nitrites, maybe haematuria), FBC (raised WCC, CRP)
GS= Mid-stream urine microscopy and cultures (confirm UTI and identify pathogen)

123
Q

4 treatment options for pyelonephritis

A

Fluid replacement – increased losses
Broad spectrum IV antibiotics e.g. c-amoxiclav
Drain obstructed kidney
Analgesia

124
Q

pathology of urethritis

A

predominantly sexually transmitted
Gonococcal vs non gonococcal (gonorrhoea)
Chlamydia trachomatis
Requires sexual health referral

125
Q

presentation of urethritis

A

painful/difficult urination

126
Q

treatment of urethritis

A

Dependent on what has caused it
Ceftriaxone – gonorrhoea
Oflaxacin - bacteria
Doxycycline – chlamydia

127
Q

what is Epididymo-orchitis

A

Inflammation of the epididymis +/- testes.

128
Q

4 causes of Epididymo-orchitis

A

Chlamydia
E.coli
Mumps
N. gonorrhoea

129
Q

pathology of Epididymo-orchitis

A

sexually transmitted pathogens ascending from the urethra or non-sexually transmitted uropathogens spreading from the urinary tract.

130
Q

signs and symptoms of Epididymo-orchitis

A

Sudden-onset tender swelling, dysuria, sweats/ fever.
UTI symptoms
Unilateral swelling and tenderness of epididymis +/- testes
Urethral discharge

131
Q

4 treatment points for Epididymo-orchitis

A

Doxycycline
If gonorrhoea is suspected, doxycycline and ceftriaxone.
Analgesia, scrotal support, drainage of any abscess
Sexual abstinence and contact tracing

132
Q

male symptoms of STIs

A

Urethral discharge, dysuria, genital skin problems, testicular pain/ swelling, peri-anal or anal symptoms.

133
Q

female symptoms of STIs

A

unusual vaginal discharge, vulval skin problems, abdominal pain, unusual vaginal bleeding.

134
Q

exposure factors of STIs

A

Sexual contacts within last 3 months incl. sex of partners, type of contact (oral/vaginal/anal), contraceptive method, type and duration of relationship, symptoms in partner.

135
Q

male STI examination

A

retract foreskin, inspect urethral meatus for discharge, scrotal contents/tenderness/swelling.

136
Q

female examination for STIs

A

vulval examination, speculum of vagina/ cervix, bimanual examination for adnexal tenderness

137
Q

presentation of HSV

A

flu-like prodrome, vesicles/papules around genitals, anus, throat. These burst, forming painful shallow ulcers. Urethral discharge, dysuria, urinary retention, proctitis.

138
Q

Investigation for HSV

A

PCR.

139
Q

treatment of HSV

A

analgesia, topical lidocaine.

140
Q

primary presentation of syphilis

A

Primary chancre – genital skin, nipples, mouth
Incubation 9-90 days, usually 21-35 days
Dusky macule – papule – indurated clean based non-tender ulcer

141
Q

secondary presentation of syphilis

A

Onset after infection
May present with skin rash
Other manifestations e.g. mucous membrane lesions, generalised lymphadenopathy, alopecia, hoarseness, bone pain, hepatitis

142
Q

investigations for syphilis

A

Antibody testing for T. pallidum: dark field microscopy, serum treponema assay/agglutination, or PCR

143
Q

treatment of syphilis

A

Penicillin by injection
Efficient follow up and partner notification essential

144
Q

male presentation of chlamydia and gonorrhoea

A

Asymptomatic
Dysuria
Urethral discharge

145
Q

female presentation of chlamydia and gonorhoea

A

Asymptomatic
Discharge
Menstrual irregularity
Dysuria

146
Q

investigations for chlamydia

A

GS= Nucleic acid amplification tests (NAAT)
High specificity and sensitivity
Negative test does not mean not infected
Male – first void urine
Female;
Self-collected vaginal swab
Endocervical swab

147
Q

chlamydia treatment

A

Partner management
Azithromycin or doxycycline for 7 days

148
Q

community screening for chlamydia

A

Asymptomatic carriage of chlamydia for a number of years is well described
Community screening aims to reduce complications by reducing the prevalence of asymptomatic infection

149
Q

patient test for gonorrhoea

A

Microscopy of gram stained smears of genital secretions look for gram negative diplococci within cytoplasm
Male urethra
Female endocervix
Rectum
Culture on selective medium to confirm diagnosis

150
Q

investigations for gonorrhoea

A

Patient test
Sensitivity testing
NAAT

151
Q

treatment for gonorrhoea

A

Partner notification
Continuous surveillance of antibiotic sensitivity
Single dose treatment preferred
Ceftriaxone with azithromycin

Phase 2a Medicine (10 decks)

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