urology Flashcards
(185 cards)
1
Q
what is the normal function of the LUT?
A
- to convert a continuous process of excretion (urine prod) to an intermittent process of elimination
- store urine insensibly
- void urine when convenient
2
Q
what does the detrusor muscle do?
A
relaxes during storage
contracts during voiding
3
Q
what does the distal sphincter in LUT do?
A
contracts during storage
relaxes during voiding
4
Q
what is PS control of LUT?
A
cholinergic
s2-4
5
Q
what is S control of LUT?
A
noradrenergic
t10-l2
6
Q
what are 2 types of LUT symptoms?
A
storage and voiding
7
Q
what are some storage symptoms of LUT?
A
frequency
nocturia
urgency
urgency incontinence
8
Q
what are some voiding symptoms of LUT?
A
hesitancy straining poor/intermittent stream incomplete emptying post micturition dribbling haematuria dysuria
9
Q
what is BPH
A
benign prostatic hyperplasia
histological, increase in cell number
10
Q
what is BPE
A
benign prostatic enlargement
11
Q
why might BPH happen
A
bc of cell number increase
decrease in apoptosis
combo of 2
12
Q
how are androgens liked to BPE/BPH?
A
don’t cause BPE
are a requirement for BPH
13
Q
what do u look for in LUT history
A
what symptoms - storage/voiding/mix? duration PMH PSH DHx allergies symptom scoring
14
Q
what do u do in a gen exam?
A
abdo exam external genitalia DRE focused near exam urinalysis
15
Q
what investigations are there for LUT?
A
flow rates/residual vol
freq vol chart
imaging
PSA
16
Q
what is acute retention of urine like
A
painful
upo 1L residual urine
normal u&e’s
pain relieved by catheterisation
17
Q
what is chronic retention of urine
A
difficult to define
increased risk of infections/stones
18
Q
what are LUT treatment aims?
A
improve urinary symptoms
improve QOL
reduce complications of bladder outflow obstruction
19
Q
what are 3 drug treatments for LUT?
A
alpha-adrenergic antagonists: improves flow average
5-alpha-reductase inhibitors - inhibits conversion of testosterone to more active DHT: reduces size by 20-30%
anti-cholinergic - for overactivity
20
Q
what are some indicates for surgery for LUT symptoms? (RUSHES)
A
Retention UTIs Stones Haematuria Elevated creatinine Symptom deterioration
21
Q
what is TURP
A
trans-urethral resection of prostate
22
Q
how do u diagnose AKI?
A
creatinine rise
urine output low
23
Q
what is rhabdomyolysis?
A
serios syndrome due to muscle injury
results from death of muscle fibres - release of their contents into bloodstream
can lead to serious complications such as renal failure
24
Q
what are 3 main causes of AKI?
A
pre-renal
intrarenal
post-renal
25
what are pre-renal AKI causes?
TRAUMA
1. due to sudden/severe BP decrease
2 .flow obstruction to kidneys
3. D&V fluid loss
26
what are intrarenal AKI causes?
direct kidney damage
inflammation/infection
drugs
trauma
27
what are post-renal AKI causes
obstruction of urine flow (BPH, kidney stones, bladder injury, blood clots)
28
what is the most common AKI cause?
intrarenal
29
what is a medical emergency associated with AKI and what is its ECG finding?
hyperkalaemia
peaked t waves?
30
how do u manage hyperkalaemia
insulin/dextrose
IV fluid
salutamol
31
how do u manage AKI
identify risk factors
think abt common causes
dialysis indicators
32
what are some AKI risk factors?
age
comorbidities
reasons for admission
drugs
33
what are some indications for dialysis in AKI
pul oedema
persistent hyperkalemia
drug overdose
metabolic acidosis
34
what does prognosis of AKI depend on
early recognition/intervention
35
describe the kidneys in simple anatomical terms !
retroperitoneal organs
lie btwn t11-l3
blood supply from renal artery direct from aorta at L1
36
where do the ureters run?
over PSOAS muscle, cross iliac vessels at pelvic brim and insert into bladder trigone
37
how is urine transported down the ureter?
via peristalsis
38
where is pontine micturition centre n what does it do?
periaqueductal grey
coordination of voiding
39
where is the micturition reflex coordinated?
sacral micturition centre
40
what is the 2 diff reflexes after storage phase?
guarding reflex - inappropriate to void
| micturition reflex - appropriate to void
41
where is the guarding reflex coordinated?
onus's nucleus
42
what is normal adult bladder capacity
4-500ml
43
why does pressure remain low in the bladder?
as vol increases
| pressure remains low due to "receptive relaxation" and detrusor muscle cmpliance
44
what happens during filling phase?
afferent pelvic nerves - slow firing signals to pons via spinal cord
S stimulation maintains detrusor muscle relaxation
somatic nerve stimulation
maintains urethral contraction
45
what kind of a reflex is micturition reflex?
autonomical spinal reflex
46
what happens for bladder emptying?
coordinated detrusor contraction with external sphincter relaxation to expel urine from bladder
positive feedback loop until all urine expelled
47
summarise storage
1. receptive relaxation
2. detrusor relaxation (sympathetic stimulation t11-l2)
3. external urethral sphincter contracted (pudendal stimulation s2-4)
48
summarise micturition
1. voluntary control from cortex and PMC
2. detrusor contraction (PS stimulation s2-4)
3. external urethral sphincter relaxation (pudendal inhibition s2-4)
49
what is the diff btwn m/f LUT symptoms?
women - incontinence
| men - difficulty voiding, poor stream etc
50
what are some storage LUTS
frequency
urgency
nocturia
incontinence
51
what are some voiding LUTS
```
slow stream
spraying
intermittency
hesitancy
straining
terminal dribble
```
52
what are some post-micturition LUTS
post-micturition dribble
| feeling of incomplete emptying
53
what is OAB
overactive bladder
54
what is the diff btwn terminal and post-micturition dribble?
terminal - at end of stream
| post-micturition - finish, trousers up, THEN
55
how many times a day is normal for urinating?
2-8x a day
56
how many times is it normal to go to the toilet during the night
once
57
define incontinence
involuntary loss of urine (failure of storage)
58
define urgency incontinence
associated with urgent desire to void which is difficult to defer
59
what is stress incontinence?
associated with coughing/straining
60
what is OAB? (overactive bladder)
urgency w/ frequency, w/ or w/o nocturne
61
how do u manage an OAB?
behavioural therapy (freq vol chart, caffeine etc)
anti-muscarinic agents
b3 agonists
botox
surgery
62
how do anti-muscarinics work for OAB?
why can they be bad?
decrease PS activity by blocking m2/3 receptors
BUT side effects: dry mouth
63
what is the main side effect associated with anti-muscarinics?
dry mouth
64
how do b3 agonists work for OAB?
increase sympathetic activity at b3 receptor in bladder
65
how does botox work for OAB?
blocks neuromuscular junction for Each release
66
what is stress incontinence usually secondary to in females?
birth trauma (denervation of pelvic floor, weakening of fascial support of bladder/urethra)
67
what is an obstructive cause for voiding problems in men?
and what is a treatment ?
BPE
| give alpha blockers ± 5alpha reductase inhibitors
68
what does neurogenic incontinence need an understanding of?
the neurological condition and its implications
69
how does the prostate surround the urethra?
like a donut
70
what is the main function of the prostate?
to produce PSA which liquefies semen
71
what does PSA do
liquefies semen
72
what is the main biomarker for prostate cancer
PSA
73
what type of cancer is usually prostate cancer?
adenocarcinoma
74
what is PSA?
detected in small quantities in blood
prostate specific not cancer specific
elevated in BPE, prostatitis etc
75
what is grading in prostate cancer like ?
Gleason grading
higher score = more aggressive
76
how do u treat prostate cancer?
surgery - prostatectomy
radiotherapy
observation - watchful waiting
77
what is androgen deprivation therapy?
also called androgen suppression therapy
an antihormone therapy whose main use is in treating prostate cancer
prostate cancer cells usually require androgen hormones, such as testosterone, to grow
78
what is the commonest site of metastasis for prostate cancer?
bone
79
what are the 2 types of haematuria?
visible vs non-visible
80
what investigations do u do if someone has haematuria?
bloods - FBC, U&E, PSA
MSU/dipstick
cytology
81
how does bladder cancer often present?
85% painless VH
recurrent UTIs
90%+ transition cell carcinoma
82
what are some bladder cancer risk factors?
smoking
occupational
drugs
bladder stones
83
how are most renal cancers picked up ?
incidentally
84
what is epididymitis
inflamed epididymis
causes pain n swelling in testicles
85
what are the most common causes of epididymitis n who does it usually affect?/
E. coli and chlamydia
young males!
86
what is hydrocele?
excessive fluid in tunics vaginalis (serous space surrounding testis)
87
what are the 2 main types of causes of hydrocele?
primary: absence of testis disease, large/tense, young boys
secondary: reaction to testicular pathology eg testicular tumours, painless
88
how do testicular tumours present
80% painless testis lump - hard, lies within testis, can be felt above, doesn't transiluminate
usually painless, short history
found incidentally
other presenting symptoms include hydrocele, pain, metastases
89
what is orchidectomy/
surgical removal of testicle(s)
90
more than 90% of testicular cancers develop in what?
germ cells (that prod sperm)
91
what determines fluid movement?
hydrostatic pressure
osmotic pressure (salt n electrolytes)
oncotic pressure (protein)
92
where are baroreceptors located
aortic arch
| carotid sinus
93
what are signs of hypovolaemia
```
tacky
hypotension
low
reduced tissue turgor/urine output/weight
dry
```
94
what are signs of hypervolaemia
normal pulse
high/normal BP
normal tissue turgor, urine output
increased weight
95
what are some symptoms of hypovolaemia
thirst
| dizziness
96
what are some symptoms of hypervolaemia
breathlessness
| leg oedema
97
what is hypervolaemia
fluid overload
98
how can fluid status be clinically assessed
BP/pulse
decreased turgor: skin remains elevated after being pulled up n released
99
what are some sites of fluid accumulation?
pul oedema
ascites
bowel obstruction
100
what is the aim of fluid management?
euvolaemia - no signs/symptoms of hypo/hypervolaemia
101
which patients are at risk of hypovolaemia
elderly
short bowel syndrome
bowel obstruction
diuretics
102
which patients are at risk of hypervolaemia
acute kidney injury
chronic kidney disease
heart/liver failure
103
how do u manage hypovolaemia
oral fluid
IV fluid
treat reversible cause
104
how do the stages of chronic kidney disease differ?
s1 - normal/raised GFR
s4 - severe decrease GFR
s5 - kidney failure - dialysis
105
what is oligouria?
less than 400 mL/500 mL per 24h in adults
106
what is anuria?
failure of kidneys to produce urine
107
what do hypovolaemic patients need?
fluid replacement
108
what do hypervolaemic patients need?
diuretics and fluid restriction
109
why do advanced CKD patients need regular fluid status assessments?
they may be oligouric/anuric
110
what are clinical features of glomerulonephritis
systemic inflammatory features
| features of other organ system involvement
111
lupus/lupus nephritis is more common in which ethnic backgrounds?
africans
hispanics
asians
112
what is the most important thing to do in glomerulonephritis????
urine DIPSTICKKKK
113
what is the arterial supply for the penis?
internal iliac
114
what is PS nerve supply for the penis?
erectile s2-4
115
what is S nerve supply for the penis?
T11-L2
point n shoot
116
what happens in the erect state?
PS stimulation
arteriolar dilatation
trabecular smooth muscle relaxation
117
when is the best time to take a blood test for testosterone?
morning bc it peaks then
118
define erectile dysfunction
persistent inability to attain/maintain an erection sufficient to permit satisfactory sexual performance
119
what is important abt the peripheral control of erections?
smooth muscle mediated
| NO release important
120
what is sig about erectile dysfunction?
can be the first presentation of HD... used as a screening tool
arteries that supply penis are slightly smaller than cardiac arteries - if atherosclerosis here, then most likely will be in heart
121
what are risk factors for erectile dysfunction?
similar to CVS symptoms
122
what do u physically examine on a patient with erectile dysfunction?
BP/HR
genitalia
prostatic enlargement
hypogonadism (small testes etc)
123
how do u treat erectile dysfunction
lifestyle/risk factor modification
identify and treat reversible causes
124
what are some curable causes of erectile dysfunction
hormonal - testosterone deficiency
testosterone replacement
psychosexual counselling
125
how do u give testosterone
doesn't have 1st pass metabolism in liver so can't swallow
can have it IM, or as a gel
126
what is 1st line treatment for erectile dysfunction
phosphodiesterase (PDE5) inhibitors
127
what is the average age of onset for eating disorders
15-18
128
what is the average age of seeing an eating disorder patient from time of development to seeing a specialist?
≈7 years
129
what are the 2 types of eating disorders?
restricting
binge eating/purging
130
what is bulimia nervosa?
recurrent episodes of binge eating characterised by:
eating in a discrete amt of time large amts of food AND/OR sense of lack of control over eating during an episode
recurrent inappropriate compensatory behaviour to prevent weight gain
131
what is binge eating disorder
recurrent episodes of binge eating
132
where do u often see bingers?
obesity clinics
133
what are important issues to look out for in eating disorder patients?
- severe restriction of food/fluid
- electrolyte imbalance (ask pt if their fingers tingle, do they get cramps? K)
- bone deterioration
- physical damage eg tears to oesophagus
- alcohol/drug intake
134
what are some urgent signs to look for in an eating disorder patient?
```
muscular weakness
breathing problems
deterioration of consciousness
cardiac signs
rapid weight loss
```
135
what are the NICE guidelines for treating eating disorders?
CBT
family therapy
no evidence-based medications
136
what is the full name for chlamydia?
chlamydia trachomatis
137
what is the full name for gonorrhoea?
neisseria gonorrhoeae
138
what is the diff btwn gonorrhoea and chlamydia?
gonorrhoea is "more vigorous" infection - onset is quicker n more noticeable.
also numerically less common
139
what happens in chlamydia/gonorrhoea in males
dysuria, urethral discharge
| complications mostly w chlamydia
140
what happens in chlamydia/gonorrhoea in females
non-specific
discharge, menstrual irregularity, dysuria
female complications: pelvic inflammatory disease etc
141
how do u treat chlamydia?
partner management
test for other STIs
1st line treatment - doxycycline
142
how do u diagnose gonorrhoea
microscopy of gram stained smears of genital secretions
143
how do u diagnose chlamydia
cell culture/Nucleic Acid Amplification Tests
144
how do u treat gonorrhoea?
partner notification
test for other STIs
v bad for AB resistance
145
syphilis is highly transmissible how?
through oral sex
146
what happens in primary syphilis?
primary chancre - 95% genitals
incubation usually 3-5w
"chunky" lymph nodes
147
what happens in secondary syphilis?
a rash
148
what is the most common STI
chlamydia
149
what are the primary/secondary/tertiary control strategies for STIs?
1 - reducing risk of acquiring STI
2 - case finding
3 - reducing morbidity/mortality
150
why trace partners of STI sufferers?
break chain of transmission
prevent re-infection of index patient
prevent complications of untreated infection
151
what are UTIs caused by
presence n multiplication of microorganisms in urinary tract
152
what are some lower tract UTI symptoms
cystitis
prostatitis
epididymitits/orchitis
urethritis
153
what are some upper tract UTI symptoms
pyelonephritis
154
what is pyelonephritis
kidney inflammation
155
what is cystitis
bladder inflammation
156
what is orchitis
testicular inflammation
157
what is bacteriuria
presence of bacteria in urine
can be symptomatic or asymptomatic
158
what is pyuria
presence of leucocytes in the urine
associated w infection
159
what is the most common pathogen for UTIs
E. coli (50%+)
160
what is path of colonic flora to UTI?
```
colonic flora
colonisation of vagina
colonisation of urethral meatus
ascent of bacteria - bacteriuria
UTI
```
161
what are symptoms of UTI
frequency
dysuria
may have haematuria
may have pyrexia if upper tract
162
how do u diagnose a UTI
urine dipstick sample
| in urinalysis: blood, protein, pH, glucose (diabetic POV), ketones (sign of SKA), nitrates (highly predictive of UTI)
163
WBC count above 10^4 indicates what?
infection present
164
how do u treat an uncomplicated UTI
short 3day course
165
what are 1st line AB?
nitrofurantoin
166
where can u get stones?
anywhere from collecting duct to external urethral meatus
167
what are some upper urinary tract stones?
renal stones
| ureteric stones
168
what are some lower urinary tract stones?
bladder stones
prostatic stones
urethral stones
169
how can stones be prevented?
```
overhydration
low salt (Na) diet
normal dairy intake
healthy protein intake
reduce BMI
active lifestyle
```
170
which symptoms can stones cause?
```
can be asymptomatic
loin pain
"renal" colic
UTI symptoms (dysuria, urgency, freq)
recurrent UTIs
haematuria
```
171
what does SOCRATES stand for (history taking)
```
Site
Onset
Character
Radiation
Associated features
Timing
Exacerbating/relieving factors
Severity
```
172
what is renal colic?
pain results from UT obstruction
unilateral loin pain
rapid onset
unable to get comfy
radiates to groin and ipsilateral testis/labia
associated nausea/vomiting
spasmodic/colicky
classically severe 12/10, worse than labour
173
how do u investigate ureteric colic
ABC and give analgesia/antiemetic
focused history n exam
urinalysis, blood count
174
what is KUBXR
kidney, ureter and bladder xray - abdo
175
what is pyonephrosis?
infection of kidneys' collecting system
pus collects in renal pelvis - causes distension of kidney --> kidney failure
176
what is the gold standard for diagnosis?
NCCT KUB
Non-contrast (computerised tomography)
177
what is the govt's alcohol strategy (2012)
minimum pricing
licensing
law
178
what is max no. of alcohol units a week?
no more than 14
179
what is substance misuse?
recurrent substance use resulting in a failure to fulfil major role obligations such as work/school/home life
180
what is SADQ?
severity of alcohol dependence questionnnaire
20 questions - physical/affective withdrawals, relief drinking, freq, speed of onset
181
what is dependance?
a state in which an organism functions only in the presence of a drug
manifests as a physical disturbance when the drug is withdrawn
182
what is assisted withdrawal (detox)?
alcohol potentiates GABA - major inhibitory neurotransmitter in CNS
so GABA mediated meds!
183
what is tolerance?
aa state in which an organism no longer responds to a drug
higher dose required to achieve same effect
184
what is distribution/metabolism of alcohol like
extensively metabolised by liver
crosses BBB
particularly active in CNS grey matter ((high blood flow)
185
what are withdrawal symptoms of alcohol?
headache
muscular pain
anxiety
hallucinations
