Urology Flashcards

1
Q

Principles of prostate cancer management

A

Young- radial prostectomy

Old- no symp- watch and wait
Symptoms i.e blockage- no pain- hormonal

Pain from mets- pain ladder then radiotherapy

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1
Q

Management of BPH

A

Tamsulosin- a blocker for SM relaxation- work at neck of bladder
Finasteride- 5a reductase inhibitor- blocks DHT

If severe symptoms not responding to medical therapy
TURP
If small prostate- bladder neck incision procedures

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2
Q

Torsion of testes vs appendage

A

Teste- no cremastatic reflex present
Elevation of teste does not ease pain
Twisting of testicular cord
10-30 age
Red scrotum

Appendage- present
May be a blue dot

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3
Q

Pain of tests aided by elevation

A

Varicocele

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4
Q

Tx of testicular torsion

A

Surgical exploration
Bilateral fixation
Since Bell Clapper testes are usually bilateral

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5
Q

Types and presentation of urethra rupture

A

Blood in urethra- most common

Bulbar
Most common
Cyclist
Perineal Haematoma
Urinary retention

Membranous
Pelvic fracture
High riding prostate

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6
Q

Mx of ?membranous urethra rupture

A

Ascending Urethrogram
Suprapubic catheter
Urethroplasty definitive

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7
Q

Tense, tender non-transuluminating mass in scrotum , dx and mx

A

Haematocele - require surgical exploration
Hx of trauma

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8
Q

Haematocele vs hydrocele

A

Haematocele- painful, ischaemic, non transilluminating

Hydrocele- non painful, fluctuating, can get above, transilluminating

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9
Q

Perineal injury and butterfly haematoma

A

Penile urethral and Bucks fascia injury (Depp fascia of penis)

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10
Q

Varicocele veins and ix

A

Pampiniform plexus

US to ix for RCC

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11
Q

Teste malignacy surgery

A

Orchidectomy vie inguinal approach
Allows high ligation of artery and avoid exposure of lymphatics

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12
Q

Dribbling incontinence

A

Vaginal vesicle fistula

Post labour

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13
Q

Renal and ureteric stone management

A

Renal-<5mm asymptomatic- watch and wait- most will pass within 4w

<10mm- ESWL

10-20mm- ESWL or ureteroscopy- ( or if pregnant)
Lower pole calyx- PCNL if >1cm
Upper pole ESWL if <2cm

> 20mm or staghorn- PCNL

Ureteric - if upper or middle 1/3- push bang technique
Lower 1/3- JJ stent
<5mm WW

5-10- ESWL

10-20 ureteroscopy

Obstructive features- RF/ Sepsis/ Solitary Kidney/ Continuing obstruction) present then
Nephrostomy. If no Nephrostomy option in answer key ,then give Ureteric stent opt

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14
Q

Organisms with renal tract

A

E coli
Prophylactic gent

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15
Q

When is lithotripsy CI

A

Pregnancy
Impending AAA rupture
Significant vascular calcification
Urosepsis
Uncorrected coagulopathy

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16
Q

Which stones are more likely to pass spontaneously

A

Distally sited

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17
Q

Primary vs secondary hydrocele

A

Primary- congenial- incomplete fusing of tunica vaginalis

Seconday- develops over longer period- not tense swelling

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18
Q

Features of hydrocele

A

Difficulty palpating test
Can get above it
Transilluminates
Fluctuant

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19
Q

Features of each type of renal stone

A

Calcium oxalate- high calcium
Radio-opaque
Hyperuricosuria

Cystine -multiple stone
Inherited disorder- familial
Inherited recessive
Sulphur
Acidic

Uric acid- occur in malignancy
Radiolucent
Most acidic

Calcium phosphate- renal tubular acidosis 1 and 3
Alkaline pH
Most radio-opaque

Struvate- Associated with chronic infections
Only Slightly radio-opaque
Alkaline pH
Mg, Ammonium, P

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20
Q

Which stones with most acidic vs alkaline pH

A

Acidic- Uric acid - 5.5
Cysteine

Alkalinic- strivate >7.2
calcium phosphate >5.5

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21
Q

Cause of SCC of kidney to arise

A

From chronic inflammation of kidney

Such as staghorn calculi

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22
Q

Part of nephron that RCC arises from

A

PCT

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23
Q

Testicular cancer by age and tumour markers

A

> 30- Seminoma
bHCG- elevated in 10%
Lactate DH- 10-20%
Sheet like fribous, lymphatic and granuloma

<30- Non seminoma
AFP high in 70%
bHCG in 40%

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24
Q

Testicular caner pathology

A

Seminoma
Sheet like lobular patterns of cells with substantial fibrous component. Fibrous septa contain lymphocytic inclusions and granulomas may be seen.

Non seminoma
Heterogenous texture with occasional ectopic tissue such as hair

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25
Q

Non infective cause of epipidymo orchitis

A

Amiodarone

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26
Q

Scan for renal scarring

A

DMSA

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27
Q

Tx of non muscle invasive/ CIS/T1 TCC

A

Low risk (G1/2 <3cm)- TURBT and 1 shot of mycomycin

Intermediate risk (G1/2 >3cm)- TURBT and 6x shtos of IC mycomycin

High risk (G3)- TURBT, then another TURBT within 6w and then IC BCG or radical cystectomy

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28
Q

Tx of T2-3 bladder cancer

A

Radical Cystectomy + chemo

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29
Q

Staging of bladder cancer

A

T1- subepithelial connective tissue (thru’ lamina propria)

T2- muscle layer

T3- through wall into pre vesicle/fatty layer around it

T4- nearby organs
a- prostate, uterus, vagina

T4b- pelvic wall or abdominal wall

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30
Q

Treatment of T4b bladder cancer

A

Inoperable pallitaiton

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31
Q

Treatment of N1 bladder cancer

A

Palliation

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32
Q

Management of incontinence

A

Stress- pelvic floor exercises 3m
Consider surgery - colposuspension or rectus fascial sling

Urge- training 6w
then oxybutinin
Then botulism to detrusor overreactive
Then sacral nerve stimulation

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33
Q

RCC paraneoplastic

A

Hypercalcaemia
Hypertension
Polycythaemia
Cushing
Non mets liver dysfunction - Stauffer’s syndrome
Galactorrhoea

CHARGE

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34
Q

Cannon ball mets in lung

A

Mets from RCC

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35
Q

Non endocrine paraneoplastic RCC

A

Anaemia
Amyloidosis
Neuropathy
Coagulopathy

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36
Q

Pathophysiology of paraneoplastic syndrome

A

Triggered by an altered immune system response to a neoplasm. They are defined as clinical syndromes involving nonmetastatic systemic effects that accompany malignant disease

Or it secretes a hormone

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37
Q

Pseudo haematuria

A

Myoglobinuria
Haemaglobinuria
Rifampicin, methyldopa, phenytoin, quinine
Porphyria
Bilirubinuria

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38
Q

What should you give initially when treating prostate cancer medically

A

LHRH agonist- goserelin

Anti-androgen- to counter flare in first 3w - flutamide

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39
Q

Which cancers do you not biopsy

A

Hepatic
Renal
Testicular

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40
Q

Mx of hydrocele in paeds

A

Non communicating usually disappear by 1st bday

If still present
Likely Communicating hydrocele

Require trans inguinal ligation of the PPV

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41
Q

Gleason scoring

A

The Gleason score is calculated by adding together the two grades of cancer cells that make up the largest areas of the biopsied tissue sample

On a scale of 1-5 each

The two added together give the Gleason score. Where 2 is best prognosis and 10 the worst.

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42
Q

Where does lymphatic spread of prostate cancer spread to first

A

Obturator

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43
Q

What gives a higher cancer of distant spread in prostate cancer

A

Local spread to seminal vesicles

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44
Q

Mx of RCC

A

T1- partial nephrectomy

For T2 lesions and above a radical nephrectomy

Patients with completely resected disease do not benefit from adjuvant therapy

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45
Q

Transitional cell cancer of kidney/ureter tx

A

Nephroureterectomy with disconnection of the ureter at the bladder.

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46
Q

Tx for bone mets from prostatic cancer

A

Androgen
Bisphosphonate
Radiotherapy

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47
Q

Man with malignancy on chemo, colicky pain, with nothing showing on x ray

A

Uric acid stone
Will not show on X ray
Will show on USS

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48
Q

Penile fracture features and mx

A

Intercourse
Snap
Proximal shaft
Tense haematoma and blood may be seen at the meatus if the urethra is injured.

Surgical and a circumferential incision made immediately inferior to the glans. The skin and superficial tissues are stripped back and the penile shaft inspected. Injuries are usually sutured and the urethra repaired over a catheter.

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49
Q

Features of tuberous sclerosis

A

depigmented ‘ash-leaf’ spots which fluoresce under UV light
roughened patches of skin over lumbar spine (Shagreen patches)
adenoma sebaceum: butterfly distribution over nose
fibromata beneath nails (subungual fibromata)
café-au-lait spots* may be seen

Epilepsy
Learning difficulties

polycystic kidneys, renal angiomyolipomata

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50
Q

Effects of a blockers vs 5a reductase

A

5a - better SE profile
a- faster onset

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51
Q

Innervation of male gentialia

A

Scortum- anterior- ilioinguinal and gentiofemoral

Posterior- posterior scrotal nerves from perineal

Penis- dorsal nerve of penis
Parasympathetic innervation is carried by cavernous nerves from the peri-prostatic nerve plexus,

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52
Q

Innervation of female genetalia

A

Anterior – ilioinguinal nerve, genital branch of the genitofemoral nerve

Posterior – pudendal nerve, posterior cutaneous nerve of the thigh.

Clitoris- dorsal nerve of clitoris

The clitoris and the vestibule also receive parasympathetic innervation from the cavernous nerves – derived from the uterovaginal plexus

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53
Q

Man kicked in testes, very swollen and tender what mx?

A

Scrotal exploration for Acute haematocele
Repair damage

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54
Q

Mx of adult hydrocele

A

Jaboulay procedure via scrotal approach

subtotal excision of the tunica vaginalis and everting the sac behind the testes followed by placing the testes in a newly created pocket between the fascial layers of the scrotum

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55
Q

Likely organism cause of staghorn calculus

A

Proteus

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56
Q

Symp vs para innervation of penis

A

Symp- ejaculation -T11-L1- from pelvis plexus to cavernous nerve
Para- erection- S1-4- splanchnic nerve (nervi erigentes) to cavernous nerve

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57
Q

Which lobe is most likely enlarged in prostate in BPH and which is most likely affected by carcinoma

A

Median- BPH

Post- carcinoma

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58
Q

What has been damaged when someone post colon surgery has impotence

A

nervi erigentes
Splachnic nerves- in abdo contain symp- pelvic para

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59
Q

Which stone is most radio dense

A

Calcium Phosphate

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60
Q

An 18 month old boy presents with recurrent urinary tract infections. An ultrasound scan is performed and shows bilateral hydronephrosis and hydroureter.

A

Posterior urethral valves

Diagnostic features include bladder wall hypertrophy, hydronephrosis and bladder diverticula.

61
Q

Mx of posterior urethral valves

A

Treatment is with bladder catheterisation. Endoscopic valvotomy is the definitive treatment of choice with cystoscopic and renal follow up.

62
Q

Renal imaging

A

DMSA- useful for cortical defects, ectopic or aberrant kidneys, no info of ureters

MAG3- secreted by tubulars- useful if GFR is impaired - often used in investigating failing transplant
PREFERRED in neonates, impaired function, obstruction

DTPA- filtered at the level of the glomerulus -GFR and renal fucntion

63
Q

What cells on mets suggest renal cell carcinoma

A

Clear cell tumours

64
Q

By what age should 95% of foreskins be retractable

A

16

65
Q

Pelvic frature and peritonism

A

Bladder rupture

66
Q

Firm mass felt in distal spermatic cord of 3m old boy

A

Rhabdomyosarcoma

67
Q

TCC of kidney features

A

Exposure to chemicals in textile, plastic and rubber

68
Q

Angiomyolipoma features

A

Tuberous sclerosis

Tumour is composed of blood vessels, smooth muscle and fat
Massive bleeding may occur in 10% of cases

69
Q

Mx of angiomyolipoma

A

50% of patients with lesions >4cm will have symptoms and will require surgical resection

70
Q

Child with flank mass, hypertensive dx ix and mx

A

Nephroblastoma

US and CT

Surgical resection combined with chemotherapy

71
Q

Child with calcified tumour of adrenal gland, dx, ix and mx

A

Neuroblastoma

Neural crest origin

MIBG scan, CT to stage

Resection, radio and chemo

72
Q

Child has urine that is difficult to control

A

Hypospadias
No hesitancy

73
Q

Male with testicular mass and gynaecomastia

A

Leydig cell tumour-produce testosterone and oestrogen

74
Q

Which drug causes haemorrhage cystitis

A

Cyclophosphamide

75
Q

Epopnymou name for Renal AC

A

Grawitz tumour

76
Q

A 58 year old man has an episode of painless frank haematuria whilst undergoing a 24 urine collection for investigation of hypertension.

A

Renal adenocarcinoma

77
Q

A 20 year old male notices a mild painful swelling of his right scrotum. He also complains of abdominal pain. Clinically, the patient is found to have a swollen right testicle. Supraclavicular node lymphandenopathy

A

Teratoma
Thats mets
Will need orchidectomy via inguinal approach

78
Q

Classification of priapism

A

Low flow
Due to veno-occlusion (high intracavernosal pressures).
Most common type
Often painful
Often low cavernosal flow
If present for >4 hours requires emergency treatment

High flow
Due to unregulated arterial blood flow.
Usually presents as semi rigid painless erection

Recurrent
Typically seen in sickle cell disease, most commonly of high flow type.

79
Q

Aspiration of priapism

A

Bright red- high flow
Dark red- low flow

80
Q

Mx of low flow priapism

A

Aspiration from corpus cavernosa ini attempt to decompress

81
Q

Pink renal tumour

A

TCC

Most others are yellow or brown

82
Q

Preg with brisk frank Haematuria, prev c section

A

Placenta percreta

83
Q

Which meds are associated with less risk of urinary retention

A

FInasteride

84
Q

Ix of prostate cancer

A

PSA
MRI for staging
Biopsy

85
Q

Incidental adrenal lesions ix

A

Morning and midnight plasma cortisol measurements
Dexamethasone suppression test
24 hour urinary cortisol excretion
24 hour urinary excretion of catecholamines
Serum potassium, aldosterone and renin levels

86
Q

When should you be suspicious of malignancy in adrenal mass

A

25% of all adrenal lesions >4cm in diameter are malignant

87
Q

Tx of TCC blocking ureteric orifice

A

Antegrade ureteric stent

88
Q

Ureteric filling defects and irregular renal pelvis

A

TCC- as can do down ureter

89
Q

Differentiating between neuro vs nephrology in child on examination

A

Nephroblastoma – if midline not crossed Neuroblastoma – if midline crossed

90
Q

Which artery if ligated would affect supply to seminal vesicles the most

A

middle rectal artery,also supplied by inferior vesicle

91
Q

What can happen as a consequence of TURP

A

HypoNa
Hypertension
Bradycardia reflex

92
Q

Most common area for renal stones

A

Uterovesical junction

93
Q

Which urinary stones are acidic

A

Uric and cystein

94
Q

What is the patient at risk of if had testicular torsion

A

Cancer in ispilateral and contralateral teste

95
Q

Risks with TURP

A

Retrograde ejactulation

96
Q

Important measurements in teratoma management

A

Tumour markers
To monitor if orchidectomy is effective

97
Q

Increased vascularity of DTPA scan

A

Tumour -SOL

98
Q

First line Ix for LUTS

A

DRE, PSA, creatinine, post void volume, Flow rate, renal US

99
Q

Most common cancer to be multi centric

A

TCC

More than 1 at once

100
Q

Young patient has proteinuria - next ix and mx

A

ACR- more sensitive
Fasting blood glucose
urine protein electrophoresis
Nephrology referral

Myeloma or renal disease

101
Q

Other tx patients with prostate cancer undergoing radio with sig LUTS

A

TURP - otherwise risk of retention

102
Q

Colour of hydrocele when pen torch used

A

Red

103
Q

Types of undescended teste

A

Retractile
Ectopic
Incomplete descent
Atrophic
Acquired UDT - ascended

104
Q

Risk fo cryptochordism

A

Cancer 8x and infertility

Other processus vaginalis likely patent

105
Q

White blood cell casts on urine

A

Glomerulonephritis and TI nephritis
Pyelonephritis

106
Q

What is used to estimate GFR

A

Serum creatinine

107
Q

Anomalies assorted With hyposadius

A

Undescended testes, inguinal hernia, disorder of sexual development and hydrocele

108
Q

When is hhyospadius repair done

A

Indicated if deformity severe, intervenes with voiding or predicted sexual function

6-18m age

109
Q

Appendage commonly affected by torsion

A

Hydatid of Morgagni

110
Q

Tx of Wilms tumour

A

Resection and chemo

111
Q

Where Wilms tumour spread to

A

Lung

112
Q

Kidney transplant anastomosis

A

To external iliac artery and vein

113
Q

When are anticholinergics CI

A

MG
Bowel disorders
Glaucoma
Bladder Outflow obstruction

114
Q

CI of PCNL

A

Clotting abnormalities

115
Q

What does urine specific gravity measure

A

Renal concentrating ability

116
Q

Examples of benign renal tumours

A

Oncocytoma and angiomyolipoma

117
Q

Tumour to develop in maldescended teste

A

Seminoma

118
Q

TNM of renal tumour

A

T1 <7cm a <4cm b4-7
2- >7cm limited to kidney
3a- into renal veins but not Gerotas
b- in IVC below diaphragm
c- above diaphragm
T4- gerotas even adrenals

N1- single
N2- mutliple

119
Q

Tx of muscle invasive bladder cancer

A

Cystectomy

120
Q

Tx of non muscle invasive bladder cancer

A

Low risk - TURBT and Intravesicle mitomycin C

Intermediate-TURBT anf 6x Intravesicle mitomycin C

High- TURBT and again within 6w then BCG or radical cystectomy

121
Q

Renal replacement therapy indication and options

A

Indicated in fluid overload, hyperkalaremia, acidosis and uraemia

Haemofilatration or peritoneal

122
Q

Urinary sodium in ATN vs pre renal

A

Low <20 in pre rnal
High in ATN

As tubules non functioning and unable to absorb

123
Q

C diff diagnosis

A

Toxin in faeces

124
Q

Examples of urease producing bacteraemia

A

Proteus
Klebsiella
Pseudomonas

125
Q

Appearance of squamous cell carcinoma

A

Solid
Trigone or lateral walls
Invasive

126
Q

Most common organic cause of impotence

A

Diabetes

127
Q

HIV patient with loin pain but no stone on imaging

A

Indinavir stone - radiolucent

128
Q

Gout renal stones

A

Uric acid

129
Q

TNM of teste cancer

A

T1- teste
2- tunica albuginea or vaginalis with vascular/lymph
3- spermatic cord
4- scortum

N1- node <2cm, less than 5
2- 2-5 all <5 or
3- lymph node >5cm

M1 distant mets

130
Q

UTI pathogen with recent surgery

A

Staph aureus

131
Q

Mx of priapism

A

Low flow- urgent decompression with aspiration of blood from corpora

High flow- conservative

132
Q

Condition causing priapism

A

Sickle cell

133
Q

Define priapism

A

Prolonged unwanted erection in absence of sexual desire for >4hrs

134
Q

RF of SCC of bladder

A

Long term indwelling
Schisto

135
Q

Best scan for obstruction

A

MAG3

136
Q

Abx for preg UTI at term allergic to amox

A

Cephalexin

137
Q

Drug causing epipid-orchitis

A

Amiodarone

138
Q

Epididymo-orchitis abx course

A

2w doxy or cipro

139
Q

Microscopic haematura ix

A

Flexible cystocopy

140
Q

When should urethral repair surgery happen after injury

A

6-12w

141
Q

Pt mass in abdo, unsure if started period

A

Imperforate hymen

Haematocolpos

142
Q

?renal stones and preg ix

A

USS first line

143
Q

Gleason score meaning

A

8-10 poorly differentiated
7 mod
<7 well

144
Q

Pre orhcidetomy work up

A

AFP, bhcg, LDH

CT chest abdo pelvis

Fertility counselling

145
Q

Fixing method of testes in torsion

A

Both testes invaginated in the tunica vaginalis and sutured to the midline septum with non absorbable sutures

146
Q

Ureters on X ray location

A

Medial to transverse processes of lumbar
Start at L1

147
Q

What is posterior to ureters at pelvic brim

A

Bifurication of common lilac artery

148
Q

Mx of undescended teste

A

After 6m should be corrected by 12m

If >2cm from deep- Fowler Stephen method
<2cm- 1 stage orchidoplexy

149
Q

Sudden flank pain, anuria, elevation in creatinine

A

Renal vein thrombosis