Urology Flashcards
(150 cards)
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
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
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
3
Q
Pain of tests aided by elevation
A
Varicocele
4
Q
Tx of testicular torsion
A
Surgical exploration
Bilateral fixation
Since Bell Clapper testes are usually bilateral
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
6
Q
Mx of ?membranous urethra rupture
A
Ascending Urethrogram
Suprapubic catheter
Urethroplasty definitive
7
Q
Tense, tender non-transuluminating mass in scrotum , dx and mx
A
Haematocele - require surgical exploration
Hx of trauma
8
Q
Haematocele vs hydrocele
A
Haematocele- painful, ischaemic, non transilluminating
Hydrocele- non painful, fluctuating, can get above, transilluminating
9
Q
Perineal injury and butterfly haematoma
A
Penile urethral and Bucks fascia injury (Depp fascia of penis)
10
Q
Varicocele veins and ix
A
Pampiniform plexus
US to ix for RCC
11
Q
Teste malignacy surgery
A
Orchidectomy vie inguinal approach
Allows high ligation of artery and avoid exposure of lymphatics
12
Q
Dribbling incontinence
A
Vaginal vesicle fistula
Post labour
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
14
Q
Organisms with renal tract
A
E coli
Prophylactic gent
15
Q
When is lithotripsy CI
A
Pregnancy
Impending AAA rupture
Significant vascular calcification
Urosepsis
Uncorrected coagulopathy
16
Q
Which stones are more likely to pass spontaneously
A
Distally sited
17
Q
Primary vs secondary hydrocele
A
Primary- congenial- incomplete fusing of tunica vaginalis
Seconday- develops over longer period- not tense swelling
18
Q
Features of hydrocele
A
Difficulty palpating test
Can get above it
Transilluminates
Fluctuant
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
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
21
Q
Cause of SCC of kidney to arise
A
From chronic inflammation of kidney
Such as staghorn calculi
22
Q
Part of nephron that RCC arises from
A
PCT
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%
24
Testicular caner pathology
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
25
Non infective cause of epipidymo orchitis
Amiodarone
26
Scan for renal scarring
DMSA
27
Tx of non muscle invasive/ CIS/T1 TCC
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
28
Tx of T2-3 bladder cancer
Radical Cystectomy + chemo
29
Staging of bladder cancer
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
30
Treatment of T4b bladder cancer
Inoperable pallitaiton
31
Treatment of N1 bladder cancer
Palliation
32
Management of incontinence
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
33
RCC paraneoplastic
Hypercalcaemia
Hypertension
Polycythaemia
Cushing
Non mets liver dysfunction - Stauffer's syndrome
Galactorrhoea
CHARGE
34
Cannon ball mets in lung
Mets from RCC
35
Non endocrine paraneoplastic RCC
Anaemia
Amyloidosis
Neuropathy
Coagulopathy
36
Pathophysiology of paraneoplastic syndrome
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
37
Pseudo haematuria
Myoglobinuria
Haemaglobinuria
Rifampicin, methyldopa, phenytoin, quinine
Porphyria
Bilirubinuria
38
What should you give initially when treating prostate cancer medically
LHRH agonist- goserelin
Anti-androgen- to counter flare in first 3w - flutamide
39
Which cancers do you not biopsy
Hepatic
Renal
Testicular
40
Mx of hydrocele in paeds
Non communicating usually disappear by 1st bday
If still present
Likely Communicating hydrocele
Require trans inguinal ligation of the PPV
41
Gleason scoring
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.
42
Where does lymphatic spread of prostate cancer spread to first
Obturator
43
What gives a higher cancer of distant spread in prostate cancer
Local spread to seminal vesicles
44
Mx of RCC
T1- partial nephrectomy
For T2 lesions and above a radical nephrectomy
Patients with completely resected disease do not benefit from adjuvant therapy
45
Transitional cell cancer of kidney/ureter tx
Nephroureterectomy with disconnection of the ureter at the bladder.
46
Tx for bone mets from prostatic cancer
Androgen
Bisphosphonate
Radiotherapy
47
Man with malignancy on chemo, colicky pain, with nothing showing on x ray
Uric acid stone
Will not show on X ray
Will show on USS
48
Penile fracture features and mx
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.
49
Features of tuberous sclerosis
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
50
Effects of a blockers vs 5a reductase
5a - better SE profile
a- faster onset
51
Innervation of male gentialia
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,
52
Innervation of female genetalia
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
53
Man kicked in testes, very swollen and tender what mx?
Scrotal exploration for Acute haematocele
Repair damage
54
Mx of adult hydrocele
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
55
Likely organism cause of staghorn calculus
Proteus
56
Symp vs para innervation of penis
Symp- ejaculation -T11-L1- from pelvis plexus to cavernous nerve
Para- erection- S1-4- splanchnic nerve (nervi erigentes) to cavernous nerve
57
Which lobe is most likely enlarged in prostate in BPH and which is most likely affected by carcinoma
Median- BPH
Post- carcinoma
58
What has been damaged when someone post colon surgery has impotence
nervi erigentes
Splachnic nerves- in abdo contain symp- pelvic para
59
Which stone is most radio dense
Calcium Phosphate
60
An 18 month old boy presents with recurrent urinary tract infections. An ultrasound scan is performed and shows bilateral hydronephrosis and hydroureter.
Posterior urethral valves
Diagnostic features include bladder wall hypertrophy, hydronephrosis and bladder diverticula.
61
Mx of posterior urethral valves
Treatment is with bladder catheterisation. Endoscopic valvotomy is the definitive treatment of choice with cystoscopic and renal follow up.
62
Renal imaging
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
What cells on mets suggest renal cell carcinoma
Clear cell tumours
64
By what age should 95% of foreskins be retractable
16
65
Pelvic frature and peritonism
Bladder rupture
66
Firm mass felt in distal spermatic cord of 3m old boy
Rhabdomyosarcoma
67
TCC of kidney features
Exposure to chemicals in textile, plastic and rubber
68
Angiomyolipoma features
Tuberous sclerosis
Tumour is composed of blood vessels, smooth muscle and fat
Massive bleeding may occur in 10% of cases
69
Mx of angiomyolipoma
50% of patients with lesions >4cm will have symptoms and will require surgical resection
70
Child with flank mass, hypertensive dx ix and mx
Nephroblastoma
US and CT
Surgical resection combined with chemotherapy
71
Child with calcified tumour of adrenal gland, dx, ix and mx
Neuroblastoma
Neural crest origin
MIBG scan, CT to stage
Resection, radio and chemo
72
Child has urine that is difficult to control
Hypospadias
No hesitancy
73
Male with testicular mass and gynaecomastia
Leydig cell tumour-produce testosterone and oestrogen
74
Which drug causes haemorrhage cystitis
Cyclophosphamide
75
Epopnymou name for Renal AC
Grawitz tumour
76
A 58 year old man has an episode of painless frank haematuria whilst undergoing a 24 urine collection for investigation of hypertension.
Renal adenocarcinoma
77
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
Teratoma
Thats mets
Will need orchidectomy via inguinal approach
78
Classification of priapism
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
Aspiration of priapism
Bright red- high flow
Dark red- low flow
80
Mx of low flow priapism
Aspiration from corpus cavernosa ini attempt to decompress
81
Pink renal tumour
TCC
Most others are yellow or brown
82
Preg with brisk frank Haematuria, prev c section
Placenta percreta
83
Which meds are associated with less risk of urinary retention
FInasteride
84
Ix of prostate cancer
PSA
MRI for staging
Biopsy
85
Incidental adrenal lesions ix
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
When should you be suspicious of malignancy in adrenal mass
25% of all adrenal lesions >4cm in diameter are malignant
87
Tx of TCC blocking ureteric orifice
Antegrade ureteric stent
88
Ureteric filling defects and irregular renal pelvis
TCC- as can do down ureter
89
Differentiating between neuro vs nephrology in child on examination
Nephroblastoma – if midline not crossed Neuroblastoma – if midline crossed
90
Which artery if ligated would affect supply to seminal vesicles the most
middle rectal artery,also supplied by inferior vesicle
91
What can happen as a consequence of TURP
HypoNa
Hypertension
Bradycardia reflex
92
Most common area for renal stones
Uterovesical junction
93
Which urinary stones are acidic
Uric and cystein
94
What is the patient at risk of if had testicular torsion
Cancer in ispilateral and contralateral teste
95
Risks with TURP
Retrograde ejactulation
96
Important measurements in teratoma management
Tumour markers
To monitor if orchidectomy is effective
97
Increased vascularity of DTPA scan
Tumour -SOL
98
First line Ix for LUTS
DRE, PSA, creatinine, post void volume, Flow rate, renal US
99
Most common cancer to be multi centric
TCC
More than 1 at once
100
Young patient has proteinuria - next ix and mx
ACR- more sensitive
Fasting blood glucose
urine protein electrophoresis
Nephrology referral
Myeloma or renal disease
101
Other tx patients with prostate cancer undergoing radio with sig LUTS
TURP - otherwise risk of retention
102
Colour of hydrocele when pen torch used
Red
103
Types of undescended teste
Retractile
Ectopic
Incomplete descent
Atrophic
Acquired UDT - ascended
104
Risk fo cryptochordism
Cancer 8x and infertility
Other processus vaginalis likely patent
105
White blood cell casts on urine
Glomerulonephritis and TI nephritis
Pyelonephritis
106
What is used to estimate GFR
Serum creatinine
107
Anomalies assorted With hyposadius
Undescended testes, inguinal hernia, disorder of sexual development and hydrocele
108
When is hhyospadius repair done
Indicated if deformity severe, intervenes with voiding or predicted sexual function
6-18m age
109
Appendage commonly affected by torsion
Hydatid of Morgagni
110
Tx of Wilms tumour
Resection and chemo
111
Where Wilms tumour spread to
Lung
112
Kidney transplant anastomosis
To external iliac artery and vein
113
When are anticholinergics CI
MG
Bowel disorders
Glaucoma
Bladder Outflow obstruction
114
CI of PCNL
Clotting abnormalities
115
What does urine specific gravity measure
Renal concentrating ability
116
Examples of benign renal tumours
Oncocytoma and angiomyolipoma
117
Tumour to develop in maldescended teste
Seminoma
118
TNM of renal tumour
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
Tx of muscle invasive bladder cancer
Cystectomy
120
Tx of non muscle invasive bladder cancer
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
Renal replacement therapy indication and options
Indicated in fluid overload, hyperkalaremia, acidosis and uraemia
Haemofilatration or peritoneal
122
Urinary sodium in ATN vs pre renal
Low <20 in pre rnal
High in ATN
As tubules non functioning and unable to absorb
123
C diff diagnosis
Toxin in faeces
124
Examples of urease producing bacteraemia
Proteus
Klebsiella
Pseudomonas
125
Appearance of squamous cell carcinoma
Solid
Trigone or lateral walls
Invasive
126
Most common organic cause of impotence
Diabetes
127
HIV patient with loin pain but no stone on imaging
Indinavir stone - radiolucent
128
Gout renal stones
Uric acid
129
TNM of teste cancer
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
UTI pathogen with recent surgery
Staph aureus
131
Mx of priapism
Low flow- urgent decompression with aspiration of blood from corpora
High flow- conservative
132
Condition causing priapism
Sickle cell
133
Define priapism
Prolonged unwanted erection in absence of sexual desire for >4hrs
134
RF of SCC of bladder
Long term indwelling
Schisto
135
Best scan for obstruction
MAG3
136
Abx for preg UTI at term allergic to amox
Cephalexin
137
Drug causing epipid-orchitis
Amiodarone
138
Epididymo-orchitis abx course
2w doxy or cipro
139
Microscopic haematura ix
Flexible cystocopy
140
When should urethral repair surgery happen after injury
6-12w
141
Pt mass in abdo, unsure if started period
Imperforate hymen
Haematocolpos
142
?renal stones and preg ix
USS first line
143
Gleason score meaning
8-10 poorly differentiated
7 mod
<7 well
144
Pre orhcidetomy work up
AFP, bhcg, LDH
CT chest abdo pelvis
Fertility counselling
145
Fixing method of testes in torsion
Both testes invaginated in the tunica vaginalis and sutured to the midline septum with non absorbable sutures
146
Ureters on X ray location
Medial to transverse processes of lumbar
Start at L1
147
What is posterior to ureters at pelvic brim
Bifurication of common lilac artery
148
Mx of undescended teste
After 6m should be corrected by 12m
If >2cm from deep- Fowler Stephen method
<2cm- 1 stage orchidoplexy
149
Sudden flank pain, anuria, elevation in creatinine
Renal vein thrombosis
