UROLOGY 2 Flashcards by Eira Hegarty

List 5 types of renal stones:

Calcium oxalate
Calcium phosphate
Uric acid / urate
Cystine
Struvite

How well did you know this?

Not at all

Perfectly

85% of renal stones are ? type:

Calcium oxalate

How well did you know this?

Not at all

Perfectly

Which types of renal stones are radiolucent?

Uric acid

Xanthine

How well did you know this?

Not at all

Perfectly

Pathophysiology of formation of a struvite stone:

Formed from magnesium, ammonia and phosphate - therefore associated with chronic infection and urease producing bacteria.

Crystals precipitate in the alkaline urine.

How well did you know this?

Not at all

Perfectly

Major risk factor for formation of calcium oxalate stones:

Hypercalciuria

How well did you know this?

Not at all

Perfectly

Which type of stone is more common in children with inborn errors of metabolism?

Uric acid

Precipitated when the pH is too low

How well did you know this?

Not at all

Perfectly

Which type of stone may occur in RTA due to high urinary pH increasing supersaturation of urine with 2 electrolytes?

Calcium phosphate = RTA stone

How well did you know this?

Not at all

Perfectly

When a stone is not available for analysis, the urine pH can help guide which type of stone was present:

> 7.2 = struvite
6.5 = cystine
6 = calcium oxalate
5.5 = calcium phosphate
5.5 = uric acid

How well did you know this?

Not at all

Perfectly

What type of stone is a staghorn made from, and which 2 infections predispose their formation?

Struvite = Staghorn

Ureaplasma urealyticum

Proteus

How well did you know this?

Not at all

Perfectly

Risk factors for renal stones:

Hypercalciuria
Dehydration
RTA
PKD
Hyperparathyroidism, hypercalcaemia

How well did you know this?

Not at all

Perfectly

Drugs can both cause and prevent calcium stones, which drugs are these?

Cause: loop diuretics, steroids, acetazolamide and theophylline

Prevent: thiazide diuretics due to increased resorption at the distal tubule

How well did you know this?

Not at all

Perfectly

Risk factors for urate stones specifically (2):

gout

ileostomy = loss of bicarbonate and fluid precipitates uric acid

How well did you know this?

Not at all

Perfectly

What is the analgesia of choice for renal colic, + further options if not controlled / contraindicated?

NSAIDs first line

IV paracetamol

IM diclofenac inpatient

How well did you know this?

Not at all

Perfectly

How do alpha blockers work and when are they indicated in renal colic?

Relax smooth muscle of the ureters, allowing stone to pass.

<10mm stones

How well did you know this?

Not at all

Perfectly

Initial non-imaging investigations in suspected renal stones:

Urine dip and culture

U+Es, creatinine, renal function

FBC, CRP for associated infection

Calcium and urate levels

How well did you know this?

Not at all

Perfectly

Imaging of renal stones, including time frames and when these differ:

NON-CONTRAST CTKUB within 24 hours.

IMMEDIATE if single kidney, fever, or uncertain about diagnosis e.g. Triple A within differential

How well did you know this?

Not at all

Perfectly

What is the imaging of choice for renal stones in pregnancy and childhood?

How well did you know this?

Not at all

Perfectly

All ureteric stones require input; what is the definitive management for ureteric stones of <10mm and 10-20mm?

<10mm = ESWL +/- alpha-blocker

10-20mm = Ureteroscopy , with stent left in place for 4 weeks

How well did you know this?

Not at all

Perfectly

Renal stones are managed based on their size. Discuss the management for <5mm, 5-10mm, 10-20mm and >20mm

<5mm = watchful waiting

5-10mm = ESWL

10-20 = ESWL or ureteroscopy

> 20mm = percutaneous nephrolithotomy (intracorporeal SWL)

How well did you know this?

Not at all

Perfectly

Calcium stones may be due to hypercalciuria, which is found in 5-10% of the general population. Give some preventative measures of hypercalciuria.

Hydration
Lemon in drinking water
Reduced carbonated drinks
Reduced salt
Potassium citrate may help
Thiazide diuretics

How well did you know this?

Not at all

Perfectly

2 drugs that reduce urinary oxalate secretion:

Cholestyramine
Pyridoxine

How well did you know this?

Not at all

Perfectly

Prevention of uric acid stones:

Study These Flashcards

Allopurinol

Oral bicarb causing urinary alkalisation

When should ‘combination therapy’ be used in BPH, and what does it consist of?

Study These Flashcards

Mod-severe symptoms on IPSS and large prostate

Alpha-1 antagonist tamsulosin

5 alpha reductase inhibitor finasteride (effects may take 6m)

Surgical management of BPH;

Study These Flashcards

TURP

Action and adverse effects of finasteride:

Finasteride; reduces conversion of testosterone to DHT which has been shown to induce BPH. Adverse: Impotence Decreased libido Ejaculation disorders Gynaecomastia and breast tenderness

What IPSS score is considered moderate-severe?

>=8

Cause of TURP syndrome, and electrolyte abnormalities observed:

TURP syndrome is caused by excess glycine used during TURP surgery. Glycine is hypotonic, and it gets into the systemic system via the open prostatic venous sinuses, causing severe symptoms. Hyponatraemia Hyperammonia after glycine has been broken down in the liver

Risk factors for developing TURP syndrome.

Surgery >1 hour Height of bag >70cm Weight removed 60g Large blood loss Perforation Large amount of fluid used Poorly controlled congestive heart failure

IPSS scoring system cut offs:

0-7 = mild 8-19 = mod 20-35 = severe

ED can be broadly split into organic, psychogenic and mixed causes. Give 3 factors that favour an organic cause;

Normal libido Lack of tumescence Gradual onset

ED can be broadly split into organic, psychogenic and mixed causes. Give 3 factors that favour a psychogenic cause:

Acute onset Relationship change or difficulty Spontaneous / self stimulated erections are achieved Reduced libido Hx of psychological problems Hx of premature ejaculation

Cardiovascular risk factors for ED:

Dyslipidaemia Obesity Metabolic syndrome Hypertension Diabetes Alcohol Smoking

2 classes of drugs that are risk factors for ED:

SSRI BB

Initial investigations for ED:

10 year CV risk, including lipids and fasting glucose level Free testosterone, taken between 9 and 11 am

Free testosterone was measured in a man who had presented with ED. What tests are recommended next, and what is the further management if these ones are abnormal?

Repeat the free Testosterone Add FSH, LH and prolactin If abnormal, refer to endocrinology

What class of drug is sildafenil? 2nd line option for ED?

PDE-5 inhibitor Vacuum erection device

4 potential departments you could need to refer someone presenting with ED to;

Cardiology - high cardiac risk where sex may be unsafe or PDE-5i is contraindicated. Mental health services Endocrinology - low serum testosterone, or abnoramlities of fsh, lh and prolactin Urology - young man always had problems, penile structural abnormality or abnormal testicular examination

Where does renal cell cancer arise from?

Proximal renal tubular epithelium

Most common histological subtype of renal cell cancer, + 2nd and 3rd:

Clear cell Papillary Chromophobe

Classical triad of RCC:

Haematuria Loin pain Abdominal mass

Endocrine effects of RCC (3)

EPO secretion causing polycythaemia PTHrP secretion cause hypercalcaemia (could also be due to bony mets) ACTH

What is Stauffer syndrome?

LFT derangement without renal mets Cholestasis, hepatosplenomegaly. IL-6 increased

A RCC is compressing veins due to mass effect. What is a likely outcome of this?

Varicocele

A RCC has invaded into Gerota's fascia, what T stage is it?

T1 vs T2 stage RCC:

<=7 confined to kidney =T1 >7 = confined to kidney = T2

2 structures a T3 RCC would invade into, and 2 that it would not at this stage:

Major veins e.g. renal vein, then IVC, perinephric tissue NOT into gerota's fascia or the ipsilateral adrenal gland

Which type of immunotherapy is superior in RCC?

TKI e.g. sorafenib

Risk factors for RCC:

Obesity Smoking Von Hippel Lindau Tuberous sclerosis Hypertension End stage renal failure

RCC is the common primary of cannonball mets in the lungs. Give the next most common type of cancer associated with them:

choriocarcinoma (placenta)

Staging scan in RCC:

CT thorax abdo pelvis

Most common bacterial cause of epididymo-orchitis in elderly patients:

E.coli

Epididymo-orchitis is most commonly caused by local spread of sexual infection in young men. 2 organisms, investigations and management:

Chlamydia Neisseria gonorrhoea STI screen NAAT swabs Unknown organism IM CEFTRIAXONE SINGLE DOSE, + ORAL DOXY 14 DAYS

Empirical treatment of elderly patients with epididymo-orchitis:

Send MSU Oral quinolone for 2 weeks e.g. ofloxacin

UROLOGY 2 Flashcards

(53 cards)