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T year LOBS surgery > Urology > Flashcards

Urology Flashcards

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1
Q

what are symptoms and signs of a UTI?

A
  • dysuria
  • urinary frequency
  • haematuria
  • back/flank pain
  • fever
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2
Q

why do UTI have nitrites in dipstick?

A

produced by gram negative bacteria

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3
Q

what is the first line treatment for standard UTI?

A
  • trimethoprim or nitrofurantoin 3-7 days
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4
Q

what antibiotics are good for antibiotic resistance UTI?

A
  • ciprofloxacin
  • levofloxacin
  • amoxicillin
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5
Q

what should be given for men with UTI?

A
  • 7 days of nitrofurantoin or trimethoprim
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6
Q

how does standard treatment of UTI change in men with signs of prostatitis?

A

A 4 week course of fluoroquinolone as the bacteria may penetrate the prostatic fluid

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7
Q

what are symptoms ad signs of testicular torsion?

A
  • sudden onset of pain in one testicle
  • uncomfortable to walk
  • abdominal pain
  • N and V
  • abnormal positioning of the testicle
  • negative prehn sign
  • ascent cremasteric reflex
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8
Q

what are differentials of testicular torsion?

A

-epididymitis

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9
Q

how is epididymitis presentation different to testicular torsion?

A
  • epididymitis is:
    more gradual in onset
    positive prehn sign
    positive cremasteric reflex
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10
Q

what are causes of epididymitis?

A

young: chlamydia
old: UTI

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11
Q

what are signs of urinary tract stone disease?

A
  • colicky pain
  • haematuria
  • dysuria
  • frequency
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12
Q

what is the emergency management of an infected obstructed kidney?

A
  • decompression using nephrostomy to remove the urine.
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13
Q

what is lithotripsy?

A

A treatment for kidney stones

Shock waves pass through and breaks the stones up.

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14
Q

who cant have lithiotripsy?

A
  • pregnancy
  • obese
  • bleeding disorders
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15
Q

what is ureteronoscopy?

A
  • helps large stones pass through with a laser.

- useful when lithiotripsy fails

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16
Q

what stones are ureteronoscopy used for?

A
  • under 3 cm

- after lithiotripsy hasn’t worked

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17
Q

what stones is percutaneous nephrolithotomy used for?

A
  • large or irregular shaped stones
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18
Q

what is percutaneous nephrolithotomy?

A

a sham incision is made in the back to enter the kidney and a nephroscope threaded in.

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19
Q

what is stone dissolution?

A
  • irrigation with saline, heparin or citrate via a nephrostomy tube
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20
Q

what is stress incontinence?

A

involuntary urine leakage on effort/exertion such as sneezing/ coughing. common after childbirth

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21
Q

what is urge incontinence?

A

involuntary urine leakage accompanied or immediately preceeded by urgency. due to detrusor muscle over activity.

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22
Q

what are differentials of urgency?

A 
UTI
MS
parkinsons
bladder stones
malignancy
BPH
urethritis
overactive bladder
cystitis
neurogenic bladder
prostatitis
urethral stricture
ovarian cancer
acetone poisoning
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23
Q

what are voiding symptoms?

A

weak or intermittent urinary stream, straining, hesitancy, terminal dribbling
incomplete emptying

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24
Q

what are storage symptoms?

A

urgency
frequency
incontinence
nocturia

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25
what is the medical management of BPH?
alpha blockers | - 5 alpha reductase inhibitors
26
what are examples of alpha blockers used for BPH?
- tamsulosin doxazosin alfuzosin
27
what is first line for BPH after lifestyle changes?
- alpha blocker
28
what are examples of 5 alpha reductase inhibitors used for BPH?
finasteride
29
how do 5 alpha reductase inhibitors work for BPH?
block conversion of testosterone to DHT which is responsible for prostate growth
30
when are 5 alpha reductase inhibitors used for BPH?
After lifestyle changes and alpha blockers have failed
31
what are adverse effects of 5 alpha reductase inhibitors?
``` - impotence reduced libido breast tenderness gynaecomastia inhibit hair growth ```
32
what are surgical options for BPH?
- laser therapy - trans-urethral needle ablaton - transurethral resection - open prostatectomy - holmium laser enucleation of the prostate
33
what is transurethral resection of the prostate?
- removing the periurethral and transitional zones of the prostate to relieve obstruction
34
what are complications of transurethral resection of the prostate?
- retrograde ejaculation - impotence - blood transfusion - failure to void
35
what is holmium laser enucleation of the prostate?
- removes the prostate from it's capsule in larger pieces and then these are removed endoscopically from the bladder
36
what are two catheter options for urinary retention?
- urethral catheter | - suprapubic catheter
37
what is a suprapubic catheter?
- the catheter is inserted into the abdomen via a cut in the abdomen.
38
when are suprapubic catheters used?
- urethral catheters are contraindicated - urethral injury - complete obstruction - bladder neck mass - BP prostate cancer
39
when are suprapubic catheters contraindicated?
no palpable distended urinary bladder - coagulopathy - prior abdominal or pelvic surgery - pelvic cancer - pregnancy - morbid obese
40
other than catheterisation what else can be offered for urinary retention?
- urethral dilation by inserting a wider tube to remove a stricture - urethral stents - alpha blockers - bethanechhol chloride (increases detrusor muscle activity) - prostate resection
41
what are complications of bladder outlet obstruction and urinary retention?
- UTI - high pressure chronic retention - low pressure chronic retention - recurrent epididymitis - bladder calculi - recurrent haematuria from the prostate - weakening of the bladder muscles - detrusor hypertrophy
42
what is obstructive uropathy?
when urine can't drain through a ureter so backs up causing hydronephrosis
43
what is high pressure chronic urine retention?
when the bladder is poorly complient and the intravesical pressure is >25 by the end of voiding. can result in chronic renal failure
44
what is low pressure chronic urine retention?
- the bladder is complient and the pressure remains low during filling. However complete detrusor muscle failure causes large residual volumes
45
what are signs of renal cell carcinoma?
- often asymptomatic - haematuria - loin pain - mass in the flank region - malaise, anorexia, weight loss - can have polycythaemia - hypertension (renin secretion) - anaemia - pyrexia - paraneoplastic syndromes - lower limb oedema
46
what is a paraneoplastic syndrome?
Clinical featurs due to an altered immune response to a malignancy or due to substances produced by the tumour
47
what cancers are paraneoplastic syndromes most commonly associated with?
lung, ovarian, lymphatic, breast
48
what cancer is the worst for causing paraneoplastic syndrome?
small cell lung cancer
49
what type of cancer is often in the prostate?
Adenocarcinoma
50
where do most prostate cancers arise?
the peripheral zone
51
what are signs of prostatic carcinoma?
often very few symptoms - lower urinary tract signs - back and skeletal pain - weight loss - anaemia - haematuria
52
what are signs of bladder cancer?
- frank macroscopic haematuria - bleeding in urine stream - suprapubic, urethral and penile tip pain
53
what are risk factors of prostate cancer?
- age - black population - family history - presence of PIN
54
what genes are involved with prostate cancer?
- sporadic; chromosome 8 inherited; chromosome one BRCA 2 carriers
55
what grading is used for prostate adenocarcinoma?
gleason system
56
what is PIN?
prostatic intraepithelial neoplasia | the cellular appearance of cancer but the basement membrane is still intact
57
what are risk factors for renal cell carcinoma?
- male - von hippel landau disease - smoking - obesity - end stage renal disease - polycystic kidneys - hypertension
58
what is hippel landau disease?
- autosomal dominant on chromosome 3 - defect in VHL suppressor gene - high risk of renal cell carcinoma
59
what are symptoms of von hippel lindau disease?
- hypervascular tumours of the CNS and retina - phaeochromocytomas - pancreatic cystis - islet cell tumours - endolympahtic sac tumours
60
what is the pathology behind hereditary papillary renal cell cancer?
autosomal dominant development of multiples RCC's mutation in MET protooncogenes that regulates tyrosine kinase growth factors
61
what are risk factors for testicular cancer?
- family history - cryptochordism - previous testicular tumour - klinefelters syndrome - testicular atrophy
62
what are the sex chromosomes in klinefleters syndrome?
XXY
63
what lymph nodes does testicular cancer spread to?
0 para aortic
64
what is the most common type of cancer in the bladder?
transitional cell carcinoma
65
what are environmental causes of bladder cancer?
- 2 naphthlamine, 4 aminobipphenyl, benzidine, NNBIS, 4 chlorotoluidine, phenacetin, cyclophosphamide
66
what do different PSA levels mean?
>4= can be BPH or cancer | >10- over half of cases cancer
67
what is PSA?
a serine protease that liquefies semen
68
where s PSA produced?
acini in the prostate
69
what is AFP used to monitor?
- liver cancer - testicular cancer - ovarian cancer
70
what is first line imaging for patients with frank haematuria?
CT
71
what testicle is more often affected by a varicocoele?
the left side because it drains into the renal vein
72
what is cryptorchidism?
failure of the testes to descend into the scrotum
73
what is the management of cryptochidism?
ochiopexy at 6-18 months
74
what are causes of Epididymo-orchitis
chlamydia Ecoli mumps gonorrhoea
75
what are clinical featurse of Epididymo-orchitis?
- pain - swelling - dysuria - fever
76
how does pregnancy change UTI treatment?
nitrofurantoin not in the 3rd trimester | trimethoprim not in the first trimester.

T year LOBS surgery (2 decks)

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