Urology Flashcards
(85 cards)
1
Q
what spinal level do the kidneys sit at
A
T12 to L3
2
Q
which kidney is lower and why?
A
right
liver above
3
Q
what hormone is responsible for concentrating urine
A
ADH
4
Q
what is an end artery? and an e.g.
A
the only artery that supplies oxygenated blood to a portion of tissue. e.g. Renal/ splenic artery
5
Q
where is adh made?
A
hypothalamus, stored in and released from the pituitary
6
Q
where in the kidneys do renal stones form?
A
collecting ducts
7
Q
classic places where renal stones obstruct?
A
- pelviureteric junction [betw renal pelvis +ureter]
- pelvic brim
- vesicoureteric junction
8
Q
most common age + sex for renal calculi
A
20-40
male
9
Q
describe characteristic pain of renal colic
A
v severe
loin to groin
w/ N+V
10
Q
what can differentiate the pain of peritonitis & renal colic- viewing patient from the end of the bed
A
renal colic - can’t lie still
peritonitis - lie still
11
Q
sx of pyelonephritis
A
loin pain
fever, rigors
N+V
12
Q
presentation of renal caluli
A
loin to groin pain N+V infection [fever] haematuria, proteinuria anuria
13
Q
Ix in renal calculi
A
U+E, FBC, Ca2+, PO43-, glucose, bicarb, urate
dipstick and MC+S
CT [non-contrast]
KUB XR
14
Q
Mx of renal calculi
A
analgesia fluids antibiotics if infection pass spontaneously OR nifedipine/tamsulosin US waves Surgery
15
Q
Indications for urgent intervention (delay kills glomeruli) in renal calculi
A
Infection AND obstruction Sepsis Impending AKI Solitary kidney Bi-lateral stones
16
Q
Risk Factors of renal calculi
A
Dehydration Drugs (steroids, aspirin) Recurrent UTIs Urinary tract abnormalities Family history
17
Q
Types of luminal urinary tract obstruction
A
Stones
Blood clot
Sloughed papilla
Tumour (renal, uriteric, bladder)
18
Q
Types of mural urinary tract obstruction
A
Stricture (congenital/acquired)
Schistosomiasis
Neuromuscular disfunction (bladder)
19
Q
Causes of extra-mural urinary tract obstruction
A
Abdo/pelvic mass/tumour
Retroperitoneal fibrosis
Post surgery
20
Q
Causes of lower tract obstruction (urinary retention) - name 4
A
BPH Prostate CA other pelvic malignancy Urethral stricture Anti cholinergics Blood Clot (from bladder lesion) Constipation Post-op Alcohol Infection Neuro (cauda equina, MS) DM
21
Q
surgical sieve for differentials
A
VITAMIN C+D Vascular Infective/Inflammatory Trauma Autoimmune Metabolic Iatrogenic Neoplasia Congenital Degenerative
22
Q
what are the 2 types of kidney CA + which is the most common
A
RCC [parenchyma] - 90%
transitional cell carcinoma/ urothelial
23
Q
name 5 differentials for haematuria
A
renal calculi bladder CA [squamous/TCC] kidney RCC/TCC cystitis pyelonephritis prostate CA/ BPH/ prostatitis
24
Q
name the 3 causes of rigors
A
pyelonephritis
cholecystitis
abscess
25
important aspects of the social Hx in urology/ haematuria Hx
smoking
occupations [dye]
travel Hx - schisto
26
Ix in haematuria
```
dipstick
FBC, U+E, clotting, CRP, PSA
US kidney
cystoscopy
CT urogram
diffusion weighted MRI [prostate CA]
```
27
2 types of drugs used for BPH
Tamsulosin - alpha 1 blocker [relaxes smooth muscle]
| Finasteride - 5a-reductase inhibitor [blocks testosterone]
28
what aspect of a cancer do diffusion weighted MRI and contrast CT pick up
^vascularity compared to normal tissue
29
how do you differentiate a hydrocoele from a hernia?
can get above hydrocoele
| hydrocoele transluminates
30
Ix in recurrent UTI
cystoscopy
| US kidney [scarring]
31
Sx of chronic lower urinary tract obstruction
frequency
poor stream
terminal dribbling
hesitancy
32
possible examination findings in chronic lower urinary tract obstruction e.g. Pt with hesitancy, poor stream, terminal dribbling etc.
enlarged prostate on PR
| large palpable full bladder
33
complications of chronic lower urinary tract obstruction e.g. BPH
renal failure
| UTI
34
Ix in urinary tract obstruction
FBC, U+E, PSA
dipstick, MC+S
US [hydronephrosis]
CT
35
upper urinary tract obstruction Mx
nephrostomy
ureteric stent
+ alpha blocker for stent pain
pyeloplasty to widen PUJ
36
lower urinary tract obstruction Mx
catheter - urethral or suprapubic
clot retention - 3 way catheter and bladder washout
alpha blocker for BPH
37
what picture might an ABG show in acute urinary retention
metabolic acidosis
| [resp compensated]
38
sx of BPH
```
hesitancy
frequency
urgency
terminal dribbling
nocturia
overflow incontinence
poor flow
haematuria
```
39
which areas of the prostate enlarge in BPH and carcinoma
inner transitional zone in BPH
| peripheral layer in CA
40
Ix in BPH
```
MSU
PSA, U+E
PR exam
US bladder [residual]
US kidney [hydroneph]
transrectal US
+/- biopsy
```
[MRI prostate]
[cystoscopy]
41
what order should you to PSA venepuncture + PR exam?
venepuncture 1st as PR can increase PSA
42
tamsulosin / alpha blocker side effects
dizzy
| sexual dysfunction
43
main side effect of finasteride
sexual dysfunction
44
risks of TURP [transurethral resection of prostate]
```
impotence
incontinence
retrograde ejaculation
bleeding
infection
clot retention
TURP syndrome [absorption of washout - CNS/CVS/hyponatraemia Sx]
```
45
Mx of retroperitoneal fibrosis
surgery/stent
| steroids
46
sx of renal cell carcinoma
loin pain
haematuria
abdo mass
malaise
weight loss
anorexia
pyrexia
[rarely - varicocoele]
47
Ix in RCC
BP
FBC, ESR, U+E, ALP [mets]
urine dipstick + cytology
US, CT, MRI, CXR
48
what change might you see in BP of RCC patient + why
^ from renin secretion
49
FBC findings in RCC
polycythaemia from erythropoetin secretion
50
RCC lung mets - appearance on CXR
cannon ball mets
51
Mx of RCC
nephrectomy
[cryotherapy, ablation if unfit for surgery]
metastatic: IL2, temsirolimus
[radio and chemo resistant]
52
tcc of the bladder presentation
```
painless haematuria
frequency
urgency
dysuria
obstruction
recurrent UTIs
```
53
Ix in suspected bladder TCC
```
urine microscopy /cytology
cystoscopy + biopsy
contrast XR
CT urogram
MRI [nodes]
```
54
sx of prostate CA
asymptomatic
frequency, urgency, hesitancy, nocturia, poor stream etc
obstruction
weight loss
bone pain
55
Ix in Prostate CA [/exam]
```
DRE
PSA
transrectal US + biopsy
bone scan
CT/MRI
```
56
Mx options for prosate Ca
Pt choice,
active surveillance
prostatectomy
radiotherapy [ext/brachy]
hormone therapy
LHRH agonist Goserelin
analgesia
bisphos for ^calc
57
presentation and examination findings in prostatitis
```
UTIs
retention
pain
haematospermia
boggy prostate of DRE
```
58
mx of acute prostatitis
analgesia
| levofloxacin for 28 days
59
risk factors for bladder CA
```
smoking
schisto
cysitis
rubber industry
pelvic irradiation
```
60
TCC of bladder Mx
```
TURBT
radical cystectomy in more advanced
BCG
chemo
radio
reconstruction or urostomy
palliative care
```
61
causes of incontinence in men
BPH
| pelvic surgery/ TURP
62
describe the 2 categories of incontinence in women
stress & urge
stress = weak pelvic floor
urge = detrusor overactivity
63
give 5 risk factors for female incontinence
```
age
obesity
prolapse
weak pelvic floor muscles
pregnancy
following childbirth
stroke
parkinsons
dementia
```
64
ix in female incontinence
urodynamic studies
65
Mx of urinary incontinence
```
rule out UTI + faecal impaction
consider diuretic use
consider retention overflow [palpable bladder]
weight loss
pelvic floor exercises
```
STRESS:
pessary for prolapse
surgery to stabilise urethra
duloxetine
```
URGE:
rule out neuro cause
vaginitis > topical oestrogen
antimuscarinics [tolterodine]
mirbegron
botox
nerve stimulation
surgery - clam ileocystoplasty
```
66
side effects of antimuscarinics for incontinence
```
dry mouth
dry eyes/skin
constipation
drowsy
retention
^HR
abdo pain
sinusitis
oedema
weight gain
```
67
important testicular examination findings:
1. testicular lump = what, until proven otherwise?
2. acute tender enlarged testis = what, until proven otherwise?
1. CA
| 2. torsion
68
if you cannot feel above a scrotal mass, what is it likely to be
inguinoscrotal hernia
69
a scrotal mass that is separate from the testis and feels cystic
epididymal cyst
70
secondary hydrocoeles occur following....
infection
trauma
tumour
71
Mx of hydrocoele
resolve on their own
OR
aspiration
surgery
72
differentials for a solid testicular mass
```
tumour
orchitis
haematocoele
gumma [syphilis]
granuloma
```
73
solid scrotal mass, separate from testis, differentials?
epididymitis
| varicocoele
74
causes of epididymo-orchitis
```
chlamydia
e.coli
mumps
gonorrhoea
TB
```
75
Sx of epididymo-orchitis
tender swelling of testis
sudden onset
fever
dysuria
76
Mx of epididymo-orchitis
```
Abx
analgesia
STI screen/ treat partners
scrotal support
drainage of abscess
```
77
visible distended scrota blood vessels that feel like 'a bag of worms'. diagnosis?
varicocoele [dilated veins of the pampiniform plexus]
78
presentation of testicular tumour
```
typically painless testis lump
haematospermia
hydrocoele
can have pain
SOB [lung mets]
abdo mass [nodes]
```
79
Ix in testicular CA
CXR
CT
biopsy
tumour markers [AFP, BHCG]
80
Mx of testicular CA
orchidectomy
| radio, chemo
81
in testicular torsion how long do you have to save the testis?
6 hours
82
presentation of testicular torsion
sudden onset of pain in one testis
abdo pain
N+V
83
differentials of testicular torsion
```
epidiymo-orchitis
tumour
trauma
hydatid torsion
idiopathic scrotal oedema
acute hydrocoele
```
84
complications of maldescended or ectopic testes
```
infertility
^risk of testicular CA
^risk of torsion
^risk of hernias
and other urinary tract abnormalities
```
85
name the only type of renal stone that is genetic/ inherited
cystine
