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Year 2 MBChB > Urology > Flashcards

Urology Flashcards

1
Q

What does BPH present with?

A

LUTS: voiding symptoms, storage symptoms

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2
Q

What are voiding symptoms?

A

Weak or intermittent flow, straining, hesitancy, dribbling, incomplete emptying

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3
Q

What are storage symptoms?

A

Urgency, frequency, urgency incontinence and nocturia

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4
Q

What is the management of BPH?

A

Watch and wait, alpha blocker (tamsulosin), 5 AR inhibitor (finasteride)

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5
Q

What is the effect of alpha blockers in BPH?

A

Decreased smooth muscle tone

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6
Q

What are the side effects of alpha blockers?

A

Dizziness, postural hypotension, dry mouth, depression

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7
Q

What is the mode of action of 5-AR inhibitors?

A

Block conversion of testosterone to DHT - shrinks prostate

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8
Q

What are some key things with finasteride?

A

Takes around 6m, reduced PSA concentrations by 50%

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9
Q

What are side effects of finasteride?

A

Erectile dysfunction, reduced libido, ejaculation probs, gynaecomastia

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10
Q

What increases the risk of bladder cancer?

A

Smoking, exposure to hydrocarbons (dyes, rubber), schistosomiasis

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11
Q

What is the commonest bladder malignancy?

A

Transitional cell carcinoma

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12
Q

What is the growth pattern of transitional cell carcinomas?

A

Papillary

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13
Q

How are superficial bladder malignancies managed?

A

TURBT

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14
Q

What are the medical benefits for circumcision?

A

Reduced risk of penile cancer, UTIs and STIs

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15
Q

What are the features of epididymo-orchitis?

A

Unilateral testicular pain and swelling, urethral discharge

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16
Q

What is the most important differential of epididymo-orchitis?

A

Testicular torsion

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17
Q

What is the management of epididymo-orchitis?

A

Ceftriaxone 500mg IM + doxycycline 100mg PO BD 10-14 days

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18
Q

What is epididymo-orchitis commonly caused by?

A

Chlamydia, gonorrhoea, e coli

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19
Q

What does blood at the meatus indicate?

A

Urethral injury

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20
Q

What are the triad of signs for bulbar rupture?

A

Urinary retention, perineal haematoma, blood at meatus

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21
Q

What injury causes bulbar rupture?

A

Straddle type

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22
Q

What injury causes membranous rupture?

A

Pelvic fracture

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23
Q

What is found on PR in membranous rupture?

A

Prostate displace upwards

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24
Q

What investigation is done in urethral injury?

A

Ascending urogram

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25
What is the management of urethral injury?
Suprapubic catheter
26
What is the investigation for bladder injury?
IVU or cystogram
27
What is the management of bladder injury?
Laparotomy if intraperitoneal, conservative if extra
28
What examinations should be done in LUTS?
urinalysis, PR, PSA, frequency-volume chart
29
What are conservative measures for BPH?
Pelvic floor muscle training, bladder training, prudent fluid intake and containment products
30
What is urge incontinence?
Need to go and can't hold
31
What is the management of nocturne?
Furosemide 40mg in late afternoon may be helpful, desmopressin may also be helpful
32
What is the pathology of most prostate cancers?
Adenocarcinoma
33
What is the most common cause of scrotal swellings seen in primary care?
Epididymal cysts
34
What are the features of Epididymal cysts?
Separate from body of testicle, found posterior to testicle
35
What conditions are associated with Epididymal cysts?
PCKD, CF, von Hippel-Lindau syndrome
36
How are testicular things diagnosed?
USS
37
What is a hydrocele?
Accumulation of fluid within the tunica vaginalis
38
What are the two types of hydrocele?
Communicating and non-communicating
39
What is a communicating hydrocele?
Caused by potency of the processus vaginalis allowing peritoneal fluid to drain down
40
Who are communicating hydroceles common in?
Newborns - resolve in first few months of life
41
What is a non-communicating hydrocele?
Excessive fluid production within the tunica vaginalis
42
What are the features of a hydrocele?
Soft non-tender swelling of semi-scrotum; usually anterior to and below testicle. You can get above mass on exam and it transilluminates
43
What is a varicocele?
Varicosities of the pampiniform plexus
44
What are the features of a varicocele?
More common on left side, 'bag of worms', sub fertility
45
What may a varicocele be a presenting feature of?
Renal cell carcinoma because testicular vein drains into renal vein
46
What are the most common testicular cancers?
Germ cell tumours
47
How can germ cell tumours be divided?
Seminomas and non-seminomas
48
What is the peak age for teratomas?
25 years
49
What is the peak age for seminomas?
40 years
50
What are the tumour markers doing in seminomas?
AFP usually normal, HCG elevated in 10%, LDH elevated in 15%
51
What are the tumour markers doing in a teratoma/yolk sac tumour?
AFP elevated 70%, HCG elevated in 40%
52
What is the management of a hydrocele in adults?
Lords or Jabouley procedure
53
What is the management of a hydrocele in children?
Transinguinal ligation of PPV
54
What is testicular torsion?
Twist of spermatic cord resulting in testicular ischaemia and necrosis
55
What are the features of testicular torsion?
Severe sudden pain, N&V, swollen tender testis - skin may be red, cremasteric reflex is lost
56
What is the cremasteric reflex?
Elevation of the testes on stroking inner aspect of thigh
57
What is the success rate of vasectomy reversal?
up to 50% if done within 10 years
58
What is OAB/urge incontinence due to?
Detrusor overactivity
59
What is stress incontinence?
Leaking when laughing or coughing
60
What is the management of urge incontinence?
Bladder retaining --> oxybutynin
61
When should oxybutynin be avoided?
In frail older women
62
What is the management of stress incontinence?
Pelvic floor exercises --> surgery if severe and not improving
63
What is the investigation of choice to detect calculi?
CT
64
When is IVU indicated?
Visualisation of renal excretion and to assess course of ureters
65
What is the investigation of choice for bladder cancer?
Cystoscopy
66
What is the investigation of choice for prostate cancer?
TRUS biopsy

Year 2 MBChB (8 decks)

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