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SAQ for finals > Urology > Flashcards

Urology Flashcards

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1
Q

List 4 causes of acute urinary retention

A

Men: most commonly BPH
UTI
Constipation
Medications (anticholinergics, opiates, antidepressants)

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2
Q

In acute urinary retention, other than abdo exam, name the other examination which should be performed and why?

A

peripheral nervous system (assess lower limbs for cauda equina compression)

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3
Q

list two important things to undertake with regards to post-catheterisation care

A

document residual volume
take specimen for CSU
retract foreskin over glans penis

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4
Q

list 3 investigations to perform in acute urinary retention

A

U&E and creatinine for AKI
renal USS (if U&E elevated)
FBC, CRP, MSU for infection

(note: PSA will be elevated in urinary retention anyway)

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5
Q

List 4 treatments for hyperkalaemia

A

Calcium gluconate
Insulin and dextrose
Salbutamol nebulisers
Calcium resonium

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6
Q

painful retention + 700ml from urinary catheter. Acute or chronic retention?

A

acute

chronic will hold higher volumes e.g. 1.5L and be PAINLESS

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7
Q

condition at risk of after urinary retention and precautions

A

post-obstructive diuresis

hourly urine output monitoring with replacement of losses with IV fluids

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8
Q

name 2 medications that a pt with acute urinary retention may have been started on after treatment, and how they exert their effects

A

tamsulosin (alpha-1 receptor adrenergic antagonist) - relaxes prostatic smooth muscle

finasteride (anti-androgen 5-alpha-reducatase inhibitor) - inhibits conversion of testosterone to dihydrotestosterone (more potent androgen in prostatic tissue)

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9
Q

List 4 causes of macroscopic haematuria

A

IgA nephropathy
renal tract tumour
renal tract stone
renal tract trauma
schistosomiasis
nephritic syndrome

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10
Q

2 investigations to establish cause of haematuria

A

renal tract USS
KUB-x ray
flexible cystoscopy
urinary cytology

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11
Q

list 3 factors a/w bladder tumours

A

smoking
aromatic amines (paint and dye workers)
chronic cystitis
shistosomiasis

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12
Q

most likely malignant cell in bladder cancer

A

transitional cell carcinoma

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13
Q

bladder cancer T1 TCC - 2 treatments indicated?

A

TURBT
intravesicle agents (BCG)

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14
Q

list 3 places a bladder tumour may metastasise

A

liver, lungs, bone
pelvic structures: uterus, rectum
lymph nodes e.g. iliac

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15
Q

list 4 non-malignant causes of raised PSA

A

UTI
BPH
prostatitis
prostate biopsy
DRE
urinary retention
catheterisation

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16
Q

explain the following terms: sensitivity, PPV

A

sensitivity: number of people who are positive who test positive (pick up rate)
true positives/(true positives + false negatives)

PPV: number of positive tests which are positive people
true positives/(true positives + false positives)

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17
Q

what effect would a low positive predictive value have on patients

A

more patients would have to undergo unnecessary secondary investigations for a disease they don’t have

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18
Q

list 4 criteria for a screening programme to be deemed suitable for a population

A
  1. known disease course
  2. acceptable screening test
  3. early symptoms should be present
  4. treatment available
  5. cost effective
  6. prompt treatment has more benefit than delayed
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19
Q

why is antibiotic cover important for a prostate biopsy

A

transrectal biopsy risk of bowel flora

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20
Q

score used to evaluate prognosis in prostate cancer

A

Gleason score

The two most common tumour patterns across all samples are graded based on their
differentiation

The sum of the two grades is the Gleason score

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21
Q

explain the term active surveillance

A

keeping check on PSA levels to see if disease has progressed

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22
Q

list 2 treatments for more aggressive prostate cancer

A

radial prostatectomy
chemo/radio

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23
Q

Other than testicular torsion, list 4 other causes of testicular pain

A

hydrocele
varicocele
testicular cancer
epidiymal cyst
epididymo-orchitis

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24
Q

What are the clinical features of tescticular torsion

A

sudden-onset (usually unilateral) testicular pain
swollen and hot testis
high-lying transverse testis

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25
What investigation is most likely is testicular torsion is a possibility
urgent surgical exploration scrotal ischaemia and necrosis is a time-dependent process
26
Name 3 layers of the testis
Skin Cremaster muscle Tunica vaginalis
27
why does a left orchidectomy and right orchidopexy take place at the same time?
to ensure that the right testis is protected from a later episode of torsion
28
list 2 long-term sequelae of orchidectomy for testicular torsion
psychological problems a/w operation emasculation reduction in fertility cosmetic deformity
29
what characteristics of a mass would make you think it was renal in origin?
moves up and down with respiration palpable on bimanual palpation able to get above the mass
30
Malignant renal mass Likely histology in a) 55 year old b) 4 year old
a) RCC b) Wilm's tumour (nephroblastoma)
31
painless testicular mass feels like a bag of worms when he stands up - likely diagnosis
varicocele
32
Abnormally high Hb in RCC
some renal tumours are a/w increased erythropoeitin release
33
List 4 risk factors for RCC
smoking increasing age male obesity long-term dialysis
34
what factors would affect a patient's suitability for major surgery in malignancy
stage of tumour comorbidities: IHD, COPD, obesity
35
2 a) advantages and b) disadvantages of laparoscopic surgery over open surgery
a) reduced post-op pain, reduced hospital stay, smaller incisions, reduced bleeding b) increased length of op, poorer operative views
36
bedside test useful in renal colic
urinalysis
37
imaging test in renal colic
KUB-CT
38
why is pain referred to the groin in renal calculi
visceral nerve supply to the ureter and kidneys follows a similar course to somatic nerve supply to the gonads and flank so it is referred to these regions
39
where are 3 places the ureter is narrowed and more prone to obstruction with a stone?
pelvi-ureteric junction (renal pelvis to ureter) crossing the pelvic brim vesico-ureteric junction (ureter enters bladder)
40
source of fever in renal colic
pyelonephritis
41
renal calculi + fever ABC, fluids, ABx - what now?
percutaneous nephrostomy to relieve infected obstruction of urine
42
name 1 lifestyle measure for the prevention of renal stones forming
increase water intake to keep hydrated maintain calcium intake to 1-1.2g reduce oxalate-rich foods
43
how to distinguish cause of testicular swelling
transillumination with a torch if light is transmitted it suggests fluid e.g. hydrocele
44
radiological investigation in testicular swelling
ultrasound testis/scrotum
45
anatomical basis of hydrocele
arises in the tunica vaginalis, derived from the processus vaginalis
46
list secondary causes of hydrocele
trauma, infection, tumour
47
what is a 'triple diagnossis'
physical psychological social
48
excision and plication of hydrocele - why is it plicated?
to prevent the fluid reaccumulating
49
hydrocele in infancy is indicative of what anatomical anomoly?
a patent processus vaginalis
50
management of hydrocele is pt < 1 year old and why
conservative as most resolve spontaneously by 1
51
name 2 general risks of an operation found on a consent form
infection bleeding failure of procedure VTE
52
what two specific functions may a pt lose in a TURP
urinary continence ability to gain an erection
53
2 risks specific to TURP
clot retention bladder neck stenosis bladder wall injury retrograde ejaculation TURP syndrome
54
2 advantages of spinal anaesthetic compared to general
less chance of respiratory complications quicker time to discharge costs less decreased bleeding
55
how does TURP syndrome arise?
irrigation fluid from operation enters intravascular space, causing fluid overload and hyponatraemia
56
Explain: a) stress incontinence b) urge incontinence
stress = raised intra-abdominal pressure as pelvic floor and fascia fail to support urethra urge = involuntary urine leak preceded by a sudden urge to micturate (overactive nerves)
57
2 things that predispose to stress incontinence
previous childbirth surgery to pelvic floor chronic cough obesity
58
List 4 lifestyle methods that may help stress incontinence
pelvic floor exercises weight loss smoking cessation avoid caffeine/alcohol avoid drinks at bed time
59
How does oxybutynin exert its effect? List 3 side effects
anti-cholinergic dry eyes, mouth, constipation, drowsiness
60
Name 2 causes of recurrent UTI in men
bladder outflow obstruction (prostatic enlargement, urethral stricture) neuropathic bladder urinary tract surgery immunosuppression
61
name 3 common organisms found in UTI
e.coli klebsiella enterococcus
62
2 causes of a urethral stricture
pelvic trauma perineal trauma insertion of foreign bodies gonorrhoea or chlamydia
63
3 investigations for urethral stricture
cystoscopy urinalysis (MC&S and cytology) renal function (U&E)
64
2 complications of urethral stricture
calculus formation in urinary tract chronic infection (can spread to prostatitis) epididymitis or Fournier's gangrene renal impairment due to obstruction
65
stricture in the anterior urethra and large out-pouting of bladder mucosa - what is this?
bladder diverticulum
66
name a treatment for urethral stricture
internal urethrotomy
67
Name 2: a) voiding LUTS b) storage LUTS
Voiding: hesitancy / weak or intermittent urinary stream / splitting / spraying / straining / incomplete emptying / terminal dribbling Storage: urgency / frequency / nocturia / urinary incontinence / feeling the need to urinate again immediately after
68
Which validated screening tool is used to evaluate LUTS and give a symptom score?
International Prostate Symptom Score
69
Which zone of the prostate is primarily affected in prostate cancer?
Peripheral zone
70
Imaging used 1st line for suspected prostate cancer
Multiparametric MRI
71
Most common composition of a renal tract stone
Calcium oxalate
72
Preferred management option of large staghorn calculi which fills the renal pelvis?
Percutaneous nephrolithotomy
73
Pyelonephritis triad
Flank pain Fever Nausea and vomiting

SAQ for finals (20 decks)

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