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Finals Revision > Urology > Flashcards

Urology Flashcards

(113 cards)

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1
Q

What is a staghorn calculus?

A

A stone in the renal pelvis and at least 2 of the calices

Usually a struvite stone

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2
Q

What is the risk of a second stone after the initial one?

A

50% chance

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3
Q

Risk factors for renal stones

A

High protein + salt diet, dehydration, age 20-50, gout, hyperparathyroidism, sarcoidosis, myeloproliferative disease, steroids, FH
Anatomy: horseshoe kidney, PUJO

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4
Q

What are the types of renal stones?

A 
75% Calcium
10-15% Struvite
5-10% Uric acid
1% Cystine
(Endevamir stones)
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5
Q

What type of stones do chemo patients mostly get?

A

Uric acid- tumour lysis syndrome

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6
Q

What is the most important differential of a renal stone presentation?

A

Ruptured AAA

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7
Q

What investigation is used to diagnose renal stones?

A

CTKUB

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8
Q

Management of renal stones

A

Conservative- analgesia, if <6mm 60% will pass spontaneously
Medical: urinary alkalination prevents formation of stones
Surgical: Stenting, lithotripsy, PCNL, ureteroscopy, radical nephrectomy

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9
Q

Indications for surgery in renal stones

A

AKI, unmanageable pain, UTI or other infection in tract, unlikely to pass

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10
Q

What is the best analgesia for ureteric colic?

A

PR Diclofenac

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11
Q

What are lower urinary tract syptoms?

A
  1. Storage Sx- frequency, urgency, nocturia

2. Voiding Sx- hesitancy, poor stream, intermittent stream, straining

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12
Q

Which of sympathetic and parasympathetic stimulation causes weeing and not weeing?

A 
Parasympathetic = Peeing (detrusor contraction)
Sympathetic = Stop peeing (detrusor relaxation)
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13
Q

What is Benign Prostatic Hyperplasia?

A

Hyperplasia of cells in transitional zone of prostate

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14
Q

Which nerve root does the parasympathetic supply to the bladder come from?

A

Pelvic nerve

S2-S4

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15
Q

Which receptors and neurotransmitters are involved in parasympathetic response of the bladder?

A

Acetylcholine release - works on M3 muscarinic Ach receptors

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16
Q

What is normal urine output?

A

> 0.5ml/kg/hr

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17
Q

Causes of urinary retention

A

BPH, Nerve dysfunction, Infection, Constipation, Drugs (anticholergics, antidepressants, opioids), Prolapse, Prostate/Bladder Ca, Meatal stenosis

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18
Q

Management of Urge incontinence

A 
Lifestyle- reduce caffeine, weight loss
Bladder training- 1st line
Anticholinergics- Oxybutinin, Tolterodine
Botulinum Toxin A
Surgery- augmentation cystoplasty
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19
Q

Which nerves does the Cauda Equina include?

A

L2-L5 + coccylgeal nerve

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20
Q

Red Flags for Cauda Equina syndrome?

A

Saddle/perineal anaesthesia
Incontinence/retention of urine/faeces
Reduced anal tone
Paralysis/loss of sensation lower limbs

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21
Q

Investigation of Cauda Equina syndrome

A

Urgent MRI

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22
Q

Name the 4 sections of the male urethra

A
  1. Prostatic
  2. Membranous
  3. Bulbar
  4. Penile
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23
Q

What are Lower Urinary Tract Symptoms?

A

Storage: urgency, daytime urinary frequency, nocturia, urinary incontinence, sensation of incomplete emptying
Voiding: hesitancy, weak or intermittent urinary stream, straining, incomplete emptying, terminal dribbling

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24
Q

What is found on PR examination in BPH?

A

Smooth enlarged prostate

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25
Which parts of a urine dip are raised in a UTI?
Leukocytes, Nitrites, high pH, Blood
26
Management of BPH
Conservative: limit caffeine, pads for incontinence Medical: Alpha blockers eg Tamsulosin/Doxazocin (relax prostate smooth muscle), 5-alpha reductase inhibitors- Finasteride (stop conversion of testosterone to stop hyperplasia of prostate) Surgical: TURP- Transurethral resection of prostate
27
Risks of Transurethral resection of prostate (TURP)?
Bleeding, UTI, urinary incontinence, ED, injury to rectum, urethral strictures, lymphocele (cysts) TURP syndrome
28
What is TURP syndrome?
Fluid overload and hyponatraemia from irrigation fluid absorbed through venous sinuses
29
Presentation of TURP syndrome
Respiratory distress, N&V, confusion, haemolysis, acute renal failure, reflex bradycardia
30
Management of TURP syndrome
Furosemide + Hypertonic saline
31
Where is ADH produced and stored?
Produced in hypothalamus | Stored in pituitary gland
32
Action of ADH
Increases water permeability in some places, allowing water reabsorption and concentration of urine Increases urea permeability in inner medullary collecting duct Increase of sodium absorption in ascending loop
33
Functions of the kidney
1. Producing + concentrating urine 2. Electrolyte regulation 3. Renin production/BP regulation 4. Erythropoeitin production 5. Conversion of vitamin D to active hydroxylated form 6. Acid-base regulation
34
What is normal plasma osmolality?
285-295
35
Equation for serum osmality
2 x (Na + K) + BUN/2.8 + Glucose/18
36
Functions of Angiotensin II
Arterioles- vasoconstriction Kidney- stimulates Na+ reabsorption Sympathetic nervous system: increased release of noradrenaline Adrenal cortex: release of aldosterone Hypothalamus: increased thirst + stimulates ADH release
37
Examples of ACE inhibitors
Ramipril Lisinopril Enalapril
38
Mechanism of action of ACE inhibitors
Inhibit ACE --> reduce Angiotensin II - Reduced alveolar resistance - Reduced arteriolar vasoconstriction - Reduced cardiac output - Increased sodium excretion in kidneys
39
Side effects of ACE inhibitors
Dry cough, hyperkalaemia, headache, dizziness, fatigue, renal impairment, angioedema
40
Causes of Urinary tract obstruction
Pregnancy, stones, BPH, prostate cancer, other tumours, polyps in ureter, anticholinergic drugs, spinal cord injury, strictures due to surgery, radiotherapy or drugs, ureterocele, abscesses, rectal impaction
41
What is a 'Page Kidney'?
Systemic hypertension secondary to extrinsic compression of the kidney by a subcapsular collection eg haematoma, seroma, urinoma - -> reduced blood flow to renal parenchymal tissue and induction of renin secretion - -> RAAS activated - -> Hypertension
42
Main sign of Page Kidney
Hypertension
43
What is the nervous supply to the ureters?
Sympathetic- T10-L1 | Parasympathetic- S2-S4
44
What is the most likely location of a ureteric stone?
Narrowest locations: 1. Ureteropelvic junction 2. Where ureter passes over pelvic brim 3. Vesicoureteric junction
45
Complications of ureteric obstruction
Hydronephrosis- obstructed kidney Pyonephrosis- infected obstructed kidney Stones due to urinary stasis
46
Presentation of ureteric colic
Pain in loin/flank, radiates to testicles/labia due to T12-L1 innervation N&V, haematuria, fever, sweats, dysuria, urinary frequency, straining
47
What is the most common type and location of prostate cancer?
Adenocarcinoma in peripheral zone (transitional)
48
Findings on DRE in prostate cancer
Prostate feels hard and craggy
49
Investigations of prostate cancer
Raised PSA Needle biopsy CT/MRI
50
What score is used for classifying prostate cancer?
Gleason score: histology of prostate cancer 1-5
51
What are urinary stones made from?
1. Calcium 2. Uric acid 3. Struvite 4. Cysteine
52
Management of Prostate cancer
T1-2: Active surveillance, radical prostatectomy, radical radiotherapy T3-4: Androgen deprivation therapy, external beam radiotherapy
53
What is Brachytherapy?
Places radioactive sources inside the patient to damage cancer cells DNA and their ability to grow and divide
54
What is Androgen deprivation therapy?
Reduces testosterone Surgical: bilateral orchidectomy Medical: LHRH analogue eg Goserelin- down-regulation of LH receptors on testes --> stop producing testosterone
55
How do you manage the initial surge in testosterone upon starting androgen deprivation therapy?
Give anti-androgen- Cyproterone citrate
56
What is Pyelonephritis?
Infection of the renal cortex and medulla
57
Aetiology of pyelonephritis
Ascending (from UTI) or Haematogenous (IVDU, endocarditis)
58
What are the most common causative organisms of pyelonephritis?
E coli, Klebsiella, Proteus miribalis
59
Presentation of Pyelonephritis
Loin pain, fever, rigors, N&V | Tenderness in renal angle
60
What is found on urinalysis in Pyelonephritis?
Blood, protein, leukocytes
61
Investigation of Pyelonephritis
Ultrasound KUB
62
Management of Pylonephritis
Gentamicin IV (but nephrotoxic)
63
Risk factors for Pyelonephritis
Vesicoureteric reflux, calculi, catheter, pregnancy, diabetes, primary biliary cirrhosis, immunocompromise, BPH
64
Complications of Pyelonephritis
Sepsis, parenchyma renal scarring, recurrent UTIs, preterm labour in pregnancy
65
What is pyonephrosis?
Pus in upper collection system of kidney
66
Presentation of Pyonephrosis
Fever, flank pain
67
Findings on USS of Pyonephrosis
Urinary tract obstruction Dilatation of pelvicalyceal system Echogenic debris in collecting system
68
Management of Pyonephrosis
Emergency insertion of percutaneous nephrostomy
69
Causes of raised PSA
``` Prostate cancer BPH Prostatitis UTI Old age TURP Urinary catheterisation Acute urinary retention ```
70
Investigation in suspected Pyonephrosis
Ultrasound KUB
71
Which 4 substances can urolithiasis be caused by?
1. Calcium oxalate 2. Calcium phosphate 3. Urate 4. Struvite
72
Where do urinary stones tend to lodge?
Narrowings: 1. PUJ 2. Pelvic brim 3. VUJ
73
Presentation of Urolithiasis
Intense loin to groin pain, loin tenderness | Microscopic haematuria
74
Investigations in Urolithiasis
Urine dipstick: microscopic haematuria Blood calcium + urate levels Abdo x-ray- 50% radio-opaque CTKUB
75
What % of stones can be seen on x-ray?
50% of stones radio-opaque
76
Management of Urolithiasis
Stones < 7mm left to pass naturally | Surgery: Lithotripsy, Lithaloplaxy, Percutaneous nephrolithotomy
77
Management of recurrent urate stones
Allopurinol
78
Most common type of bladder cancer in UK
Transitional cell carcinoma
79
Types of bladder cancer
1. Transitional cell carcinoma 2. Squamous cell carcinoma 3. Adenocarcinoma
80
Risk factors for bladder cancer
Age, smoking, male TCC: exposure to aromatic amines SCC: Schistosomiasis, long-term indwelling catheter, hx recurrent bladder stones
81
Presentation of bladder cancer
Painless haematuria, acute urinary retention (clots stuck), urinary frequency, dysuria, suprapubic pain Anaemia, palpable pelvic mass
82
Investigations of bladder cancer
FBC for anaemia | Cystoscopy, CT/MRI
83
Management of bladder cancer
Low-grade non-invasive: TURBT, intravesical mitomycin C chemo High-grade invasive: radical cystectomy, lymphadenectomy, radical radiotherapy, chemotherapy
84
Presentation of testicular torsion
Typically teenage boys Acute, sudden onset testicular pain, hot swollen testicle, high-lying transverse testis Absent cremasteric reflex
85
Which reflex can be tested in suspected testicular torsion?
Cremasteric reflex- absent | Testicle retracted on stroking of the inner thigh
86
Risk factors for testicular torsion
Often triggered by activity | 'Bell-Clapper' deformity- testicle normally fixed by tunica vaginalis- fixation is absent
87
Management of testicular torsion
Medical emergency- 6hr window after onset before ischaemia is irreversible Urgent urological assessment Immediate scrotal exploration, bilateral orchidopexy, orchidectomy
88
Complications of testicular torsion
Subfertility | Psychological
89
Presentation of testicular cancer
Non-tender irregular lump arising from testicle, hard without fluctuance/transillumination
90
Typically age group for testicular cancer
Age 15-40
91
How is testicular cancer diagnosed?
USS
92
Tumour markers for testicular cancer
AFP- seminoma BhCG- more in teratomas Lactate dehydrogenase
93
Management of testicular cancer
Orchidectomy/chemo/radiotherapy
94
Types of testicular cancer
50% Teratoma | 50% Seminoma
95
What is an Epididymal cyst?
Smooth extratesticular spherical cysts in the head of the epididymus Benign
96
Average age for presentation with Epididymal cyst?
Age 40
97
Presentation of Epididymal cyst
Well-defined, fluctuant lump which will transilluminate | Testis is palpable separate from cyst
98
Investigation of Epididymal cyst
Scrotal USS
99
Management of Epididymal cyst
Surgery if painful/big
100
What is a Hydrocele?
Abnormal collection of fluid within the remnants of the processus vaginalis
101
Types of Hydrocele
Simple Communicating Non-communicating
102
Causes of a simple Hydrocele in older people
Trauma, testicular torsion, varicocele, testicular tumour
103
Prognosis of simple Hydrocele
Usually disappears within 1-2yrs if neonatal
104
What is a communicating Hydrocele?
Persistence of the processus vaginalis --> free flow of peritoneal fluid
105
What is a non-communicating Hydrocele?
Excessive production of fluid within processus vaginalis
106
Presentation of Hydrocele
Scrotal enlargement with non-tender smooth cystic swelling | Lies anterior + below testis, will transilluminate
107
Investigation of Hydrocele
USS if unsure
108
Management of Hydrocele
Observation if < 2yrs old Therapeutic aspiration if large Surgical removal
109
What is a Varicocele?
Abnormal dilatation of testicular veins in panpiniform plexus
110
On which side is Varicocele more common?
Left
111
Presentation of Varicocele
Usually asymptomatic Testis feels like a 'bag of worms' Poor sperm production + reduced semen quality --> infertility
112
Investigation of Varicocele
Colour doppler studies | Sperm count
113
Management of Varicocele
Surgery if pain/infertility

Finals Revision (13 decks)

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