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Things I don't know, but need to know, for fourth year > Urology > Flashcards

Urology Flashcards

(61 cards)

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1
Q

How would you manage a >60 year old male with unexplained non visible haematuria?

A

Urgent Referral to Urology via the cancer route

Raised WCC and or Dysuria also raise need for urgency.

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2
Q

Signs of Epididimo-Orchitis

A

Acute Pain and swelling

Pyrexia and Positive dipstick differentiates from torsion

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3
Q

What is orchitis often linked to?

A

Preceding viral infection

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4
Q

Antibiotic of choice used in a catheterised patient presenting with a UTI.

A

Usual organism is Pseudomonas. Gentamicin is first line.

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5
Q

Periureteric fat stranding is a sign of what?

A

Recent stone passage.

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6
Q

If symptoms of an enlarged prostate alongside an overactive bladder arent controlled by Alpha blocker and 5 Alpha Reductase Inhibitors. What can be done?

A

Add an Anticholinergic
Oxybutinin
Tolterodine

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7
Q

What are the two types of urethral trauma and what is the commonest?

A

Bulbar #

Membranous

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8
Q

Urinary retention + perineal haematoma +Blood at meatus

A

Bulbar rupture

Usually located to trauma to that area i.e straddle injuries

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9
Q

Prostate displaced upwards
Penile or perineal oedema
History of pelvic fracture

A

Membranous rupture

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10
Q

How are urethral injuries investigated and managed?

A

In a suspected urethral injury with urinary retention a suprapubic catheter is used.
An ascending urethrogram is used to check patency.

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11
Q

Painless smooth lump indistinguishable testicle
Transilluminates
Can cause discomfort but not pain

A

Hydrocoele

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12
Q

Single or multiple cysts
Painless
>40 years
Can get above and behind the lump

A

Ependidymal cyst

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13
Q

First line in prostate cancer treatment

A

Goserelin - synthetic GnRH agonist
initial worsening of symptoms
Overstimulates causing suppression of LH and FSH after a few weeks

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14
Q

What can be used to help reduce the flare up of symptoms post Goserelin induction?

A

Flutamide

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15
Q

A non steroidal anti androgen

A

Bicalutamide

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16
Q

A patient undergoing a Trans Urethral Resection of the Prostate suddenly develops Hyponatrameia hyper ammonia headaches and visual disturbances.

A

TURP syndrome
Glycine is hypotonic. It is used in irrigation. This draws out Na+ from the venous plexus during resection. It is also absorbed and broken down in the liver to form ammonia.
Hyponatraemia and Hyperammonia are caused.

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17
Q

Urothelial Cancers

A

Transitional cell - 90% cancers - strong smoking link
Squamous Cell - 8% - increased in areas with endemic schistosomiasis
Adenocarcinoma

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18
Q

Management of epidiymoorchitis of unknown cause.

A

IM ceftriaxone + Oral doxycycline for 10 days

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19
Q

30 % of children presenting with a UTI will have what?

A

Vesicoureteric reflex due to laterally displaced ureters

Recurrent UTIs and reflux nephropathy

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20
Q

How should recurrent UTIs in children be investigated?

A

Micturating Cystourethrogram

Dilated ureter, pelvic and calyces, ureteric tortuousity

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21
Q

What is the commonest line of testicular cancers?

A

Germ Cell tumours

Seminoma and Non seminoma

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22
Q

List some Non-Seminoma germ cell tumours

A

Embryonic
Yolk sac
Teratome
Choriocarcinoma

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23
Q

What are the other type of rarer testicular tumours

A

Leydig cell

Sarcoma

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24
Q

Commonest testicular tumour before the age of 25

A

Teratoma

Non Seminoma - bHCG and AFP

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25
Commonest testicular tumour over 35 years old
Seminoma
26
What are some generic symptoms of a testicular tumour
Painless lump, indiscernible from the testicle, Hydroceole, gynaecomastia Increased oestrogen : androgen ratio
27
increased hCG in 20% of testicular tumours
Seminoma
28
Increased AFP bhCG in 80% of these testicular tumours
Non seminoma
29
Increased LDH in 40% of these testicular tumours
Germ cell
30
How are testicular cancers diagnosed and managed?
USS is first line - if suspicious testicle is removed surgically. Then specific type of cancer can be diagnosed.
31
Testicular Appendage Torsion
Cremasteric reflex still present | Severe pain
32
Torsion of the spermatic chord
Cremasteric reflex is absent
33
How do you differentiate high from low pressure chronic urinary hypertension?
High pressure - Impaired renal function + bilateral hydronephrosis Low-pressure - no impaired renal function or hydronephrosis
34
Frank haematuria post catheterisation in a patient with chronic urinary retention.
Decompression haematuria | No intervention is required.
35
What is used to treat schistosomiasis and when?
Praziquantel | Even asymptomatic
36
List three of the drugs that should be used ( individually) alongside goserelin for the first three weeks of treatment to help reduce the tumour flair.
Bicalutamide Cyproterone Acetata Abirateron
37
What should you be wary of post catheterisation in someone who had urinary retention?
Physiological Diuresis - up to 24 hours Pathological Diuresis - over 48 hours Loss of large volumes of salt and water - may require fluid replacement
38
What is diagnostic of acute urinary retention?
300ml on USS | Can be less than this is signs and symptoms suggest
39
What can the volume of urine removed within the first 15 minutes of catheterisation tell us?
``` <200ml = no urinary retention >400ml = catheter should stay in place ```
40
What is the physiological post voiding volume remaining in the bladder?
``` <65 = <50ml is normal >65 = <100ml is normal ```
41
How is prostate confined adenocarcinoma managed? | T1/2
Active watch and wait Radical prostatectomy Radiotherapy
42
Post radiotherapy for prostate cancer what other cancers are they now at risk of?
Bladder Colon Rectal
43
Antibiotic management of Pyelonephritis
IV Amoxicillin + Gentamicin 7 or 10 days Co-Trimoxazole + Gentamicin in pen allergic Step down - Co Trimoxazole or sensitivities
44
Diagnosis of prostate cancer
PSA + Prostate exam -> multi parametric MRI If >3 points on linkert scale -> TRUS biopsy If <3 points on linkert scale -> patient given choice of having TRUS biopsy
45
Priapism key investigation
Cavernous Blood gas - determine in ischaemic or not
46
How is an ischaemic priapism managed?
Aspirate + Irrigate with saline Phenylephrine repeated every 5 mins Surgery
47
How is non ischaemic priapism managed?
Observe
48
Pain on intercourse A hard lump on the penis Penis is developing a bend
Peyronies disease Inflammatory scar tissue causes bending Surgery
49
Management of erectile dysfunction
Check BMI BP, lipid profile and glucose/Hb1AC | 9am testosterone levels -> if low test free unbound testosterone FSH and LH
50
Varicocele affect on fertility?
Reduces it | Research whether surgery increases fertility
51
Vesicoureteric reflux - diagnosis
Micturating cystourethrogram is diagnostic | DMSA scan to look for renal scarring
52
Vesicoureteric reflex can cause
Recurrent UTI Hydronephrosis Reflux Nephropathy ( chronic pyelonephritis) Renal scar can cause increased renin release and hypertension
53
Grading vesicoureteric reflux
Grade I = reflux into ureter only Grade II = reflux up to renal pelvises + no dilatation Grade III = Reflux up to calyces + mild dilatation Grade IV = Dilated up to calyces + moderate ureteral tortuosity Grade V = Gross dilation and severe ureteral tortuosity
54
Management of resolved testicular torsion?
Emergency surgery as very likely to reoccur
55
Whats the strongest risk factor for testicular cancer?
infertility
56
Timescale of PSA studies
>6 weeks post biopsy >4 weeks post UTI 48 hours post ejaculation or vigorous exercise
57
When is TURP used?
If someone presents with acute urinary retention despite being on both Alpha blocker a 5 Alpha Reductase inhibitors.
58
How can regular UTIs post sexual intercourse be managed?
Post coital antibiotic prophylaxis
59
Management of testicular torsion - surgery
Even if only unilateral symptoms both sides are fixed
60
Management of vescioureteric reflux
All require prophylactic antibiotics. Grade 1-3 will usually self-resolve Grade 3-5 will require surgery
61
Management of Bladder cancer
Superficial - transurethral resection = T1 | T2 and over = Radical cystectomy

Things I don't know, but need to know, for fourth year (31 decks)

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