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Urology Flashcards

1
Q

Narrowest 3 points of ureters

A

Uteropelvic junction

Pelvic brim

Vesicoureteric junction

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2
Q

Types of renal stones

A

Mainly Calcium oxalate

Uric Acid

magnesium ammonium phosphate

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3
Q

Presentation of renal stones

A

Loin to groin renal colic pain

N&V

haematuria

fever

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4
Q

Investigation of renal stones

A

urinarysis (normal)

AXR (uric acid dont show)

CT

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5
Q

Management of renal stones

A

Conservative <5mm
analgesic: diclofenac, coedine
SM relaxants; alpha receptor blockers (tamsulosin)
CCB - nifedipine

>5mm or conservate doesnt work

  • extracorporeal shock wave lithotripsy
  • percuteaneous nephrolithomy (>2cm, stag horn: Mg ammonium phos)
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6
Q

Causes of urinary tract obstruction

A

Luminal - stones, blood clots, tumour Mural - stricture, neuromuscular problem Extramural - abdominal/pelvic mass/tumour, peritoneal fibrosis

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7
Q

Causes of acute urinary retention

A

Prostatic, urethral strictures, anticholinergics, alcohol, constipation, neurological

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8
Q

What is BPH?

A

Hyperplasia of connective and glandular tissue

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9
Q

Presentation of BPH

A

Storage symptoms - frequency, urgency, nocturia

Voiding symptoms - Hesitancy, Intermittent/incomplete emptying, post void dribbling, poor flow

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10
Q

Investigations for BPH

A

Symptoms score questionnaire

DRE (smooth symmetrical enlargement)

Abdo exam (palpable bladder - urinary retension)

PSA

Urine flow analysis

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11
Q

Treatment of BPH

A

lifestyle: avoid alcohol, caffeine
1st: alpha blockers - tamsulosin (decrease smooth muscle tone, s/e - drowsy, dizzy, dry)

5a-reductase inhibitors - finasteride

Surgical - TURP (transurethral resection of prostate)

  • TUIP (transurethral incision of prostate) removes less than TURP
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12
Q

Symptoms of RCC

A

1) haematuria
2) loin pain
3) abdo mass

anorexia, malaise, weight loss

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13
Q

Investigations of RCC

A

BP : HTN bc renin secreted by tumour

FBC: Erythrocytosis from XS EPO production. Anaemia of chronic disease

LDH and corrected Calcium: if high poor prognostic marker

LFT: elevated AST/ALT show mets

urine: haematuria and/or proteinuria

Imaging:US, *CT, MRI, CXR (cannonball metastases)

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14
Q

Management of RCC

A

1st line: if fit for surgery - partial or radical nephrectomy

1st line: if not fit for surgery - suveillance -> ablation

If RCC stage 4 (metastatic)

  • targeted molecular therapy: pazopanib
  • consider surgery, chemo and palliative radio
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15
Q

Most common prostate cancer

A

Adenocarcinoma arising from peripheral prostate

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16
Q

Innervation of ureters

A

T12-L2 (back and sides of abdo, top inner thigh & genitals

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17
Q

Parasympathetic nervous system function on detrusor

A

Causes detrusor contraction, from sacral spinal cord

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18
Q

Sympathetic nervous system function on detrusor

A

Causes detrusor relaxation, from lumbar spinal cord

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19
Q

Pathology of BPH

A

Inner transitional zone hyperplasia

Static component - increased bulk narrows lumen

Dynamic component - increased smooth muscle tone mediated by alpha adrenergic receptors

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20
Q

4 complications of BPH

A

Progression, sexual dysfunction, acute urinary retention, TURP syndrome

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21
Q

What is TURP syndrome?

A

Absorption of irrigation fluids into prostatic venous sinus

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22
Q

Presentation of Prostate Cancer

A
  • haematuria
  • haematospermia
  • LUTS
  • Incontinence
  • Impotence
  • Rectal Pain
  • weight loss, bone pain
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23
Q

factors that increase PSA

A

BPH, prostate cancer, bicyling, sex, prostatitis

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24
Q

Investigations for ?Prostate cancer

A

PSA

DRE

Urinalysis

Transurethral ultrasound of prostate (TRUS) ± biopsy

MRI

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25
Possible findings on DRE
1. normal- walnut sized, smooth, palpable, central sulcus 2. cancer- hard craggy 3. BPH - smooth, symmetrical enlargement 4. Prostatitis - soft, boggy, tender
26
Where does prostate cancer commonly met to
1. bone 2. lymph nodes 3. bladder 4. rectum 5. seminal vesicles
27
Scoring system for prostate cancer and how does it work
Gleason Score, 2 numbers, first and second most common type of growth X+Y=Z 1= small uniform glands 5= only occasional gland formation
28
Management of prostate cancer
Watchful waiting- no active management, repaeting PSA/DRE at intervals Active surveillance - specific regime of tests view to treat radically **_Radical prostatectomy_** - no mets, symptomatic/progressive disease. Remove prostate, seminal vesicels and surrounding connective tissue. SE= incontinence, sexual dysfunction, DVT **_Radiotherapy_** - elderly, radical RT given everyday for several weeks, palliative given once to relieve symtoms **_Androgen suppression_** - non localised disease. Bicalutaminde. LHRH antagonists (gosereline)
29
Stag horn canniculi
magnesium ammonium phosphate
30
How does finasteride work?
5 alpha reductase inhibs block conversion of testosterone -\> dihydrotestosterone high dihydrotestosterone associated with larger prostate
31
most common bladder cancer?
Transitional cell carcinoma
32
presentation of bladder cancer
- painless haematuria - UTI symptoms (dysuria) but -ve MC+S - flank pain: obstruction
33
Bladder cancer investigations
Urinalysis: haematuria, RBC casts if glomerular bleeding Urine cytology: +ve Imaging: USS, CT, cystoscopy
34
Management of bladder cancer
_Non muscle invasive_ TURBT + post op chemo ±BCG _Locally invasive_ 1st: radical/partial cystectomy + pre/post op chemo 2nd: immunotherapy - atezolizumab _Metastalic_ 1st: chemo + surgery/radio 2nd: immunotherapy -atezolizumab
35
What does the spermatic cord contain?
Pampiniform plexus (veins) tesicular nerves testicular artery Cremasteric artery Nerve to cremasteric artery Lymphatic vessesl vas deferens
36
What happens in testicular torsion and how does it present?
Spermatic cord twists cutting off blood supply to testicle -\> testicular death * painful, swollen, tender testis * fever, nausea vomiting
37
investigations for ? test torsion
USS doppler cremasteric reflex (not super sensitive) surgical exploration
38
management of testicular torsion?
surgery
39
When you would you diagnose AKI?
\<48 hour increase in 1) serum creatinine \>=26.4 above baseline 2) serum creatinine increase \>50% 3) Oligouria \<0.5mL/kg/hour for \>6 hours \*average pt weight 70kg so \<35mls/hour would be AKI
40
How do you break down the causes of AKI?
Pre renal Renal Post renal
41
What are the pre-renal causes of AKI?
dehydration sepsis
42
What are the renal causes of AKI?
Nephrotoxic meds vasculitis glomerulonephritis
43
What are the post renal causes of AKI?
stones strictures tumours prostate: BPH
44
which drugs are nephrotoxic?
NSAIDs gentamicin antifungals antivirals
45
How does AKI present?
Altered UP N&V, dehydration confusion
46
What would you find OE in a patient with AKI?
Increased JVP if fluid overloaded BP low
47
How do you manage a patient with AKI?
ABC haemodynamic restoration: fluids and inotropes Med review Treat hyperkalaemia, infection Urinalysis Immunology: Bence Jones, ANA and anti-dsDNA
48
which patients are at higher risk of developing AKI
* CKD: decreased function * Db: metformin causes lactic acidosis, prescribed ACE I * Atherosclerotic disease: poor inflow, ACEI * CCF: poor inflow ACE * Elderly: have above
49
How to prevent AKI
* avoid nephrotoxins * monitor at risk pt * give IV sodium bicarb or 0.9% sodium chloride if at risk
50
What causes erectile dysfunction
Physical: Age, meds, HTN, endocrine, trauma, MS Psychological: Depression, relationship issues, unsure of sexual orientation
51
Which meds are linked to ED?
HTN meds, chemo, anti D
52
Which investigations would you carry out for ED?
random plasma gluoce: DM serum testosterone, prolactin, LH, SHBG TFT FBC LFT
53
Medical management of ED?
* sildenafil 30/60m before sex * tadalfil daily * alprostadil, TU injection
54
Non medical management of ED?
* vacuum device * penile/scrotal rings * kegal exercises * relationship/individual therapy
55
Describe the anatomy of the penis
2 corpora cavernosa and 1 corpus spongiosum (surrounds urethra) which extends to form glans (tip) of penis all 3 sponge like and contain large spaces between and loose networks of tissue
56
Describe the physiology of an erection
* blood flows into spaces causing distension and elevation of penis * Arteries dilate and veins contain valves which restrict outflow of blood. * Corpus spongiosum doesnt become erect so semen can leave urethra
57
innervation of the penis
Erection: parasympathetic reflex S2 and S3 Ejaculation: sympathetic, L1 root
58
what is nephritic syndrome?
inflammatory response to immune cells causes damage to basement membrane allowing proteins, WBC and RBC into urine
59
What causes nephritic syndrome?
Bergers, post infectious, SLE
60
How does nephritic syndrome present?
Haematuria Oliguria HTN Odema/fluid retension
61
Nephritic syndrome diagnosis and management
Dipstick Diuretics, IVIG
62
What is nephrotic syndrome?
Damage to basement membrane increases permeability of serum protein proteinuria \>3.5g/day serum hypoalbuminaemia \<30g/L
63
What causes nephrotic disease?
minimal change disease focal segmental glomerulosclerosis SLE
64
nephrotic syndrome presentation
Periorbital oedema (scrotal, vulval, ankle) frothy urine (proteinuria) Ascites SOB fatigue
65
Investifations of nephrotic syndrome
Dipstick MC+S clotting: decreased AF-III Hyperlipidaemia
66
types of nephrotic syndrome
Steroid sensitive: minimal change Steroid sensitive: focal segmental glomerulosclerosis
67
Features of steroid sensitive nephrotic syndrome
reponds to steroids doesnt lead to renal failure diagnosed with microscopy and biopsy
68
features of steroid resistant nephrotic syndrome
* diagnosed with biopsy showing scarring * 1/3rd lead to renal failure * Mangement: ACEi, ARB, BP control
69
ADPKD presentation
_loin pain_ nocturia HTN Kidney enlargement gross haematuria post traums
70
extra-renal presentation of ADPKD
-due to mass effect dyspnoea GORD back pain -due to cyst complications haemorrage infection torsion rupture
71
Investigations for ADPKD
Urinalysis: infection, protein MC+S: coliforms FBC: high RBC (XS erythropoietin) U&E: creatinine, eGFR Imaging: USS, CT Genetic testing
72
Management of ADPKD
_Lifestyle:_ Patient education, Screening, No contact sport (rupture), CVD lifestyle _Monitoring:_ BP, annual blods and USS _Medical_ HTN: ACEI UTI Pregnancy: increased risk of severe HTN and pre-eclampsia
73
What are the pros and cons for screening for ADPKD in utero?
+ family planning +early detection and treatment of complications - insurance/employment discrimination - psychological effects of having incurable disease

phase 3b (15 decks)

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