urology Flashcards
(128 cards)
1
Q
modifiable risk factors in incontinence
A
weight loss caffeine consumption alcohol medication review e.g. diuretics carbonated drinks amount being drunk also discuss incontinence pads
2
Q
investigations in incontinecne
A
vaginal exam / PR exam in males bladder diary (3 days) urine dip + culture bladder scan urodynamic testing
3
Q
management of stress incontinence 1st line
A
lifestyle
supervised pelvic floor exercises for 3 months
4
Q
management of stress incontinence
A
surgery
duloxetine - last line
5
Q
tx urge incontinence 1st line
A
bladder retraining 6 weeks
6
Q
2nd line tx urge incontinence
A
anticholinergics
oxybutynin, tolterodine, darifenacin, solifenacin
7
Q
SEs of anticholinergics
A
dry mouth, dry eyes, urinary retention, constipation and postural hypotension
8
Q
alternative to anticholinergics in tx of urge incontinence
A
mirabegron - beta 3 agonist
9
Q
what is a CI to the use of mirabegron and what should be monitored while taking it
A
contraindicated in uncontrolled hypertension
measure BP before treatment and 1 month after
10
Q
invasive treatments of urge incontinence
A
botox
surgery
11
Q
some drugs that cause acute urinary retention
A
- Anticholinergics e.g. antipsychotics or antihistamines
- tricyclic antidepressants e.g. amitriptyline
- opioids
- benzodiazepines
- NSAIDs
- Disopyramide
- alcohol
12
Q
treatment acute urinary retention
A
catheter - monitor fluid balance and beware if urine output > 200ml/hr - post obstructive diuresis
13
Q
dx investigation of urinary retention
A
bladder ultrasound scan, volume > 300 confirms (but dont always need to meet this)
if > 400 leave catheter in place
14
Q
ix done in acute urinary retention
A
urine dup and culture
U+E, creatinine
FBC CRP
PSA - NOT DONE as is typically elevated in acute scenario
PV, PR and neuro exam
15
Q
tx post-obstructive diuresis
A
IV fluids and sodium replacement
16
Q
what can occur after catheterisation for chronic retention due to the rapid decrease in pressure in the bladder
A
decompression haematuria
17
Q
where is hypospadias found
A
inferior (ventral) surface of penis
18
Q
when is hypospadias corrected
A
1 year
19
Q
tx penile candidiasis
A
topical clotrimazole 2 weeks
20
Q
tx penile dermatitis - allergic, contact, eczema or psoriasis
A
mild topical steroid
21
Q
tx bacterial balanitis
A
oral fluclox or clarith
22
Q
tx anaerobic balanitis
A
saline washing +/- topical or oral metronidazole if not settling
23
Q
tx penile lichen sclerosis (balanitis xerotica obliterans)
A
high potency topical steroid (clobetasol)
circumcision
24
Q
what kind of balanitis is seen with reactive arthritis
A
circinate balanitis
25
circinate balanitis tx
mild topical steroid
26
general treatment balanitis
saline washing
wash under foreskin properly
mild topical steroid ST
27
main risk factors for SCC of penis
hrHPV
| non-circumcised
28
ix SCC of penis
biopsy
| US and MRI for invasion
29
name 3 precursor lesions of penile SCC
bowens - leukoplakia
erythroplasia of queryat - erythroplakia
bowenoid papulosis - multiple reddish papules
30
tx penile SCC in situ
circumcision or topical 5FU
31
sentinel nodes of penile cancer
inguinal
32
2 main causes of priapism
haemoglobinopathy - sickle cell
| use of drugs e.g. sildenafil, cocaine
33
ix to differentiate ischaemic and non-ischaemic priapism
cavernoal blood gas analysis
USS
FBC and toxicology
34
1st line tx ischaemic priapism > 4 hours
aspiration of blood from cavernosa
| often + injection of saline flush
35
tx ischaemic priapism if aspiration and injection of saline fails
injection of vasoconstrictor e.g. phenylephrine
36
1st line tx non-ischaemic priapism
observation
37
factors indicating organic cause of ED
gradual onset symptoms
lack of tumescence
normal libido
38
drugs causing ED (2)
SSRI
| BB
39
main RF for ED
CVD
40
ix for ED
lipid and fasting glucose
free morning testosterone
- if low do FSH, LH and prolactin
41
tx ED
PDE-5 inhibitors- sildenafil (viagra)
| - prescribe regardless of cause / can be purchased
42
what is phimosis
cant retract foreskin
43
what is paraphimosis
cant replace foreskin
44
what part of the prostate is palpable on DRE
posterior aspect - peripheral zone
45
list the main obstructive urinary symptoms "prostatism"
```
poor stream
straining
hesitancy - difficulty starting
terminal dribbling
incomplete emptying
overflow incontinence
nocturia
```
46
ix for BPH
```
urine dip and culture
PSA
uroflowmetry
urinary frequency-volume chart for 3 days
IPSS
```
47
1st line tx BPH
uroselective a-blocker
| tamsulosin, terazosin, alfuzosin
48
SE of alpha blocker
dizziness
postural hypotension
dry mouth
depression
49
2nd line treatment BPH
5-a reductase inhibitor
finasteride
dutasteride
50
SE of 5-a reductase inhibitor
ED
reduced libido
ejaculation problems
gynaecomastia
51
how long do 5-a reductase inhibitors take to work and what do they do
shrink prostate
| 6 months
52
what do alpha blockers do in BPH
relax bladder and prostate smooth muscle
53
what drug could be used if there are storage and voiding problems despite use of alpha blocker
antimuscarinic - tolterodine, darifenacin
54
surgery for BPH
TURP
55
SE of TURP
ED
| retrograde ejaculation
56
is there prostate cancer screening
no - but if a man asks for PSA / risk factors then do PSA
57
how many prostate cancer present
usually clinically silent
may present as bone pain (mets)
hard craggy mass on PR
locally advanced - urinary symptoms
58
what are the upper limits of PSA
50 - 69 = 3
| > 70 = 5
59
1st line ix in prostate cancer
multiparametric MRI
60
investigation of prostate cancer if likert scale >= 3
prostatic biopsy - 6 on each side
61
most common spread of prostate cancer
haematogenous
| - bone, lungs, liver
62
presentation of prostate bone mets
osteosclerotic lesions usually in lumbosacral region
low back pain
raised ALP, PSA and prostatic acid phosphatase
63
grading of prostate cancer
gleason
64
treatment prostate cancer if elderly, low gleason score, multiple comorbidity
watchful waiting/active surveillance
| - candidates for this should have at least 10 core biopsies and at least 1 rebiopsy
65
tx prostate cancer localised disease
radical prostatectomy and removal of obturator nodes
66
tx prostate cancer other than radical prostatectomy
radical radiotherapy
hormonal therapy
chemotherapy
bilateral orchidectomy (form of hormonal)
67
SE radical radiotherapy of prostate
increased risk of bladder, colon and rectal cancer
68
tx metastatic prostate cancer
androgen deprivation therapy - hormonal, steroids, chemo
| radiotherapy - bone mets
69
what chemotherapy drug is used in prostate cancer
docetaxel
70
hormonal therapies are used in prostate cancer: synthetic GnRH agonists
goserelin
71
hormonal therapies are used in prostate cancer: anti-androgen
cyproterone acetate
72
hormonal therapies are used in prostate cancer: non-steroidal antiandrogen
bicalutamide
73
hormonal therapies are used in prostate cancer: androgen synthesis inhibitor
abiraterone
74
what is important to prescribe with synthetic GnRH agonists and why
testosterone rises initially for 2-3 weeks before falling so cover with anti-androgen to prevent tumour flare
75
how would a tumour flare present
bone pain, bladder obstruction
76
are non-steroidal or steroidal antiandrogens used more
non-steroidal (bicalutamide)
77
when might an androgen synthesis inhibitor (abiraterone) be used in prostate cancer
metastatic prostate cancer in patients with no/mild symptoms after androgen deprivation therapy has failed, before chemo
78
what is prehn's sign
testicular torsion - elevation of the testis doesnt ease the pain
79
tx communicating hydrocele in new born males
nothing - usually resolves in a few months
transinguinal ligation of PPV if not healed by 1-2 years old
80
describe the mass of a hydrocele
transilluminates
can 'get above'
confined to scrotum
soft, non-tender
81
ix hydrocele to exclude tumour
ultrasound
82
"bag of worms"
variocele
83
variocele can be a presenting feature of what
renal cell carcinoma
84
dx variocele
ultrasound + doppler studies
85
scrotal swelling separate from body of testicle, found posteriorly
epididymal cyst
86
describe a testicular tumour mass
firm, painless testicular mass that cannot be transiluminated
heaviness in scrotum
87
common presenting feature of testicular cancer
gynaecomastia
88
tx all testicular tumours
dont biopsy
| radical orchidectomy via inguinal approach
89
tumour marker: bHCG
highly malignant testicular teratoma
| sometimes seminoma
90
tumour marker: AFP
non-seminoma
| yolk sac component of teratoma
91
tumour marker: PLAP
seminoma
92
main RF for germ cell testicular tumour
undescended testis
93
ix testicular tumour
ultrasound - first line
94
AFP is never raised in a ______ testicular tumour
pure seminoma
95
tumour marker: LDH
tumour burden - raised in 40% germ cell tumours
96
what lymph nodes do testicular tumours spread to
para-aortic
97
age group of seminoma
30-50
98
"potato tumour"
seminoma
| semolina used in rice pudding - rice is a carb - potato tumour
99
seminomas are highly responsive to chemo/radio
radio
100
what testicular tumours occur in younger males
non-seminoma
| - teratoma, embryonal, yolk sac, choriocarcinoma
101
age group of teratoma
20-30
| can occur in childhood
102
tumour marker of trophoblastic teratoma
bHCG
103
tumour marker of teratoma with yolk sac elements
AFP
104
can you "get above" an inguinal hernia
no
105
variocele typically occurs on what side
left
106
tender boggy prostate
acute bacterial prostatitis
107
most common cause of acute bacterial prostatitis
E coli
108
tx acute bacterial prostatitis
ofloxacin 14 days
109
unilateral testicular pain and swelling, pain relieved when elevate testis
epididymo-orchitis
110
ix epididymo-orchitis
urine culture and CT PCR
111
most common cause of epididymo-orchitis
chlamydia
112
tx epididymo-orchitis
passmed - ceftriaxone 500mg IM single dose + doxycycline 100mg oral BD 10-14 days
lecture for epididymitis
113
ix bladder injury
CT cystogram
114
urinary retention, perinal haematoma and blood at meatus is the typical triad of
bulbar urethral injury
115
ix urethral injury
ascending/retrograde urethrogram
116
causes of haematuria
```
cancer - bladder, renal, prostate
stones
BPH
prostatitis
urethritis
nephritic syndrome
```
117
drugs causing red/orange urine (2)
rifampicin
| doxorubicin
118
ix haematuria (primary care, bloods etc)
urine dip and culture
U+E, ACR
BP
urine microscopy
119
ix haematuria suspecting bladder cancer
cystoscopy
120
treatment acute loin pain
NSAID +/- opioid
121
tx small stone expected to pass <5mm
tamsulosin (alpha blocker)
122
treatment renal stone not expected to pass if no infection and <2cm total
ureteric stent/ureteroscopy
| ECSL - stone fragmentation (CI in pregnancy)
123
treatment renal stone if infected or hydronephrosis
percutaneous nephrostomy
124
tx clot retention post frank haematuria
3 way irrigating catheter
125
ix frank haematuria
CT urogram / USS + cystoscopy
126
blue dot sign, cremasteric reflex present
torsion of appendage
127
ix perinephric abscess
CT
128
ix renal trauma
CT with contrast
