Urology Flashcards by Winnie Win

When during urination does blood appear, indicates what?

Initial - diseased urethra, distal to UG diaphragm

Terminal - disease near bladder neck, prostatic urethra

Throughout - disease in bladder or upper urinary tract

How well did you know this?

Not at all

Perfectly

What are lower urinary tract symptoms? [FUN DISSH]

storage: frequency, urgency, nocturia

voiding: terminal dribbling, intermittency, poor stream, straining, hesitancy

others: polyuria, oliguria, urethral discharge

How well did you know this?

Not at all

Perfectly

What causes storage problems?

UTI, stones, bladder tumour

How well did you know this?

Not at all

Perfectly

What causes voiding problems?

BPH, prostate cancer, urethral stricture

How well did you know this?

Not at all

Perfectly

Upper urinary tract symptoms

Loin pain/tenderness

Severe loin pain w radiation to iliac fossa, groin, genitalia

How well did you know this?

Not at all

Perfectly

What causes upper urinary tract symptoms?

Renal infection, infarction, obstruction, glomerulonephritis

radiating pain caused by acute obstruction of renal pelvis/ureter by calculus/blood clots

How well did you know this?

Not at all

Perfectly

Hallmark of malignancy in urology

Painless gross haematuria in patient >35 years old

How well did you know this?

Not at all

Perfectly

Urine characteristics of glomerular bleeding

Frothy - proteinuria
Blood - smoky brown, “coca-cola”
no clots
some RBCs are dysmorphic
RBC cast may be present

How well did you know this?

Not at all

Perfectly

Urine characteristics of extraglomerular bleeding

Red or pink blood
Blood clots may be present
Non frothy - no proteinuria
Normal RBC
RBC casts absent

How well did you know this?

Not at all

Perfectly

Presence of RBC casts diagnostic of?

Glomerulonephritis / vasculitis

How well did you know this?

Not at all

Perfectly

Different aetiologies for post-renal haematuria

Trauma
Infection
Stones
Tumours
BPH

How well did you know this?

Not at all

Perfectly

Renal causes of haematuria usually present

microscopically

How well did you know this?

Not at all

Perfectly

Risk factors for RCC

Smoking

Industrial exposure

Prior kidney irradiation

Family history - VHL, tuberous sclerosis

Acquired polycystic kidney disease - secondary to chronic dialysis

How well did you know this?

Not at all

Perfectly

Types of RCC and which part of collecting duct system they arise from (3)

clear cell RCC - proximal tubule epithelium

Papillary RCC - distal tubule

Chromophobe RCC - collecting ducts

How well did you know this?

Not at all

Perfectly

Prognosis of each type of RCC

clear cell - resistent to chemo & radio

papillary - type 1 good, type 2 poor

chromophobe - excellent

How well did you know this?

Not at all

Perfectly

Ddx for renal masses
(split benign and malignant)

Benign:
- angiomyolipoma (most common benign)
- renal cysts
- renal abscess
- pyelonephritis
- renal oncocytoma

Malignant:
- RCC
- Wilm’s tumour (nephroblastoma) more common in kids
- Metastases
- Sarcoma

How well did you know this?

Not at all

Perfectly

Triad of presenting symptoms for advanced renal tumours

Painless haematuria, flank pain, palpable flank mass

How well did you know this?

Not at all

Perfectly

Common regional symptom of RCC

Left testicular varicocele

Tumour invades into left renal vein, blocks drainage of left testicular vein that empties

How well did you know this?

Not at all

Perfectly

Paraneoplastic syndromes of RCC

Hypertension - renin overproduction

Hypercalcaemia - production of PTH-related peptide, acts like PTH, bone resorption

Polycythaemia - EPO production

Cushing’s, feminisation/masculinisation

How well did you know this?

Not at all

Perfectly

Kidney tumour limited to kidney is stage ___, progression to stage ___ occurs when ___

2
3 - when tumour invades major vessels/adrenal gland

How well did you know this?

Not at all

Perfectly

Difference between total and radical nephrectomy

Total: remove kidney

Radical: ligate renal artery/vein + remove kidney + Gerota’s fascia +/- adrenal gland

How well did you know this?

Not at all

Perfectly

What is milk-alkali syndrome?

Repeated calcium & alkali ingestion leading to

hypercalcaemia + metabolic alkalosis + AKI

predisposes to stone formation

How well did you know this?

Not at all

Perfectly

Non-modifiable risk factors for urolithiasis

Age
Gender (M)
Cystinuria
Inborn error of purine metab
Crohn’s - hyperoxaluria
HyperPTH - hypercalciuria
Gout - hyperuricosuria

How well did you know this?

Not at all

Perfectly

Points of constriction of the ureter

Pelvic-ureteric junction (where pelvis of kidney meets ureter)

Pelvic brim (near common iliac artery bifurcation)

Vesico-ureteric junction (entry to bladder)

How well did you know this?

Not at all

Perfectly

What stones are radiopaque on X ray?

Calcium oxolate Calcium phosphate Struvite (magnesium, ammonium, phosphate)

What stones are radiolucent on X ray?

Urate Cystine

Struvite stones are formed due to?

Infection with urease positive bacteria (Proteus, Staph. sapro, kleb) Hydrolyse urea to ammonia, make urine alkali -> Staghorn calculi form

Causes of stone formation (3)

Supersaturation Infection Drugs

Ureteric stone presentation

Ureteric colic pain - severe, intermittent loin to groin (+- ipsilateral testis/labia) Haematuria Upper UT infection - fever Stone at VUJ - frequency, urgency, dysuria

Renal stones presentation

Asymptomatic unless block PUJ -> hydronephrosis -> infection -> pyonephrosis Vague flank pain Large staghorn calculi can completely fill kidney pelvis + calyces -> chronic renal failure

Bladder stone symptoms

Storage LUTS - frequency, urgency Dysuria Haematuria

Drugs that increase risk of stone formation

Acyclovir Antacids Salicylic acid

When is a stone unlikely to pass with conservative management?

>1 month, probably too large to pass on its own

Complications of stone

Blocks urine flow -> UTI Damage renal tissue Bleeding Increase in size

Types of bladder cancer

Transitional cell carcinoma (most common) Squamous cell carcinoma Rhabdomyosarcoma (children)

Risk factors for bladder cancer

Industrial exposure: rubber workers, textile/printing industries Non-industrial: smoking analgesia abuse chronic parasite infection - schistosoma (causes SCC) chemo, chronic cystitis from radiation

LUTS in relation to bladder cancer

Storage problems - carcinoma in situ Voiding problems - cancer at neck of bladder/prostatic urethra Dysuria, pyuria

Where can bladder tumour invade and what does it cause?

Colon (vesico-colic fistula) - pneumaturia Vagina (vesico-vaginal fistula) - incontinence

Aetiologies of acute urinary retention

Mechanical: - BPH - Stricture - STD, instrumentation - Stones Functional: - Drugs - anticholinergics - UTI - Spinal cord compression - Neurogenic bladder

Bladder is percussible when containing ___ of urine, palpable when more than ___

150mL 200mLs

DDx classification for ARU

Mechanical - extraluminal, mural, luminal Functional - infection, neurologic impairment, drugs, others

Extraluminal causes of ARU

BPH prostate cancer constipation pelvic masses pelvic organ prolapse

Mural causes of ARU

TCC of bladder neck Strictures Urethritis

Luminal causes of ARU

Stones Strictures Foreign body Blood clot

Functional causes of ARU

neuro - cord compression (Cauda equina syndrome) infection drugs - anticholinergic, sympathomimetic, cardiac meds, pain meds, psychiatric meds others - post anaesthesia, pain

AdenoCA of prostate commonly occurs in ___ zone

peripheral zone *palpable on DRE

Symptoms of prostate cancer

symptoms of BPH (DISH) + haematuria + dysuria

BPH commonly occurs in ___ zone

central

Major stimulus of prostate hyperplasia

dihydrotestosterone produced by testosterone via 5-alpha reductase

BPH cardinal features

- voiding LUTS - storage LUTS (complication of urine retention - UTI, stones) - haematuria - ARU - overflow incontinence

Complications of BPH

- hydroureter - hydronephrosis - pyonephrosis - pyelonephritis - hernia

Enlarged prostate: ___ on DRE

>3 finger breadth intact median sulcus no nodule firm smooth rectal mucosa, not attached to prostate

Questions to differentiate testicular swellings (4)

1) Whether can get over testis 2) Whether can differentiate testis from epididymis 3) Whether transilluminable 4) Whether tender

Testicular torsion happens in ___

peri-pubertal age group (12-18 yrs)

How to differentiate torsion from epididymitis

Prehn sign -ve in torsion: lifting testis does not relief pain +ve in epididymitis

What is Fournier gangrene

Necrotising fasciitis of the perineum & genital region frequently due to synergistic polymicrobial infection

Risk factors of fournier gangrene

Diabetes, alcoholics, immunocompromised

Scrotal varicocele commonly occurs on the ___. Why?

Left hemi-scrotum Left spermatic vein enters left renal vein at perpendicular angle. Intravascular pressure in left renal vein higher than right (compressed between aorta and SMA). Higher backpressure -> varicocele.

Risk factors for testicular tumour

Cryptorchidism - failure of testicle to descend HIV gonadal dysgenesis

Most common type of testicular tumour

Germ cell tumours - especially seminomatous

Seminoma prognosis

Excellent prognosis Highly responsive to radiotherapy Metastasize late

Non-seminomatous germ cell tumour prognosis

Variable response sensitive to chemo metastasize early

Testicular torsion causes irreversible damage after ___

12 hours

Clinical presentation of testicular torsion

Acute abdomen (T10 innervation) Nausea + vomiting No voiding complaints, dysuria, fever, STD exposure

Urology Flashcards

(64 cards)