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Phase 3b > Urology > Flashcards

Urology Flashcards

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1
Q

How might prostate cancer present itself?

A 
2 week wait referral 
Abnormal DRE
Bone pain
Renal failure 
Weight loss
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2
Q

What do you give with an LHRH agonist to prevent tumour flares?

A

Anti-androgen

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3
Q

Most common site of prostate mets

A

Bone

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4
Q

Most common site of prostate mets

A

Bone

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5
Q

Bladder cancer investigation

A

Flexible cystoscopy

+ dip/MSU, urine cytology

+ pelvic MRI for local spread and CT for distant mets

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6
Q

Haematuria imaging?

A

U&E (to check if renal function is okay for contrast)
CTIVU (ureteric cancer)
Flexible cystoscopy

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7
Q

2 week wait referral indications for haematuria

A

> 45 and:

Unexplained visible haematuria in absence of UTI

Persistant visible haematuria following successful UTI treatment

> 60 and non-visible haematuria with dysuria or raised WCC

Consider non-urgent referral if >60 and recurrent UTIs

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8
Q

Prostate cancer DRE findings

A

Enlarged, hard, nodular, asymmetrical

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9
Q

When would you carry out a DRE on a patient

A 
LUTS
Haematuria
Raised PSA
ED
Unexplained symptoms (e.g. weight loss, back pain, bone pain)
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10
Q

What must be avoided before a PSA test

A

Ejaculation or vigorous exercise in last 48 hours
Urological intervention in last 6 weeks
UTI in last 6 weeks

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11
Q

First line investigation of prostate cancer and what scoring system is used for this imaging of prostate cancer

A

Multiparametric MRI

Likert scoring (5 point)

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12
Q

When to do a prostate biopsy?

A

Likert score 3 and over

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13
Q

Low risk prostate cancer criteria

A

PSA <10NG/ML AND <6 Gleason AND T1-T2A

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14
Q

High risk prostate cancer criteria

A

PSA >20NG/ML or 8-2 Gleason or >T2c

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15
Q

Management of localised prostate cancer

A

Active surveillance (only in low or intermediate risk), radical prostatectomy or radical radiotherapy

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16
Q

Management of metastatic prostate cancer

A

Docetaxel chemotherapy and androgen deprivation therapy

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17
Q

Most common cause of scrotal swelling, diagnosis and management

A

Epididymal cyst
Ultrasound
Usually supportive, or sclerotherapy or surgical removal if large

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18
Q

Characteristics of acute urinary retention

A

Painful
600ml-L
normal U&Es
Relieved by catheter

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19
Q

Management of acute urinary retention

A 
Catheter
Alpha blocker (tamsulosin) for TWOC)
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20
Q

Chronic urinary retention characteristics

A

Impaired renal function and hydronephrosis (if high pressure)
Painless
Risk of stones and infection

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21
Q

Management of non-muscle-invasive bladder cancer

A

TURBT (trans urethra removal of bladder tumour)

Intermediate risk: + intravesical mitomysin C

High risk: + repeat TURBT after 6 weeks + intravesical BCG or radical cystectomy

Radical cystectomy given with cisplatin

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22
Q

Management of muscle-invasive bladder cancer

A

Radical cystectomy or radiotherapy

Neoadjuvant cisplatin given before cystectomy

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23
Q

Management of epididymo-orchitis

A

IM ceftriaxone + ora doxycycline

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24
Q

What is Prehn’s sign and what is it suggestive of

A

Testicular pain that eases on elevation of the teste

Suggests epidiymo-orchitis as relieves the pressure on epididymis

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25
Presentation and management of testicular torsion
Sudden severe pain in testicle often referred to lower abdomen Nausea and vomiting Swollen, red and elevated teste Prehn's sign absent Loss of cremasteric reflex Mx: surgical fixation of both testes
26
Causes and symptoms of urethral stricture
STIs Hypospadias Lichen sclerosis Traumatic placement of catheter Sx: painful/difficulty urinating, dribbling, incomplete emptying
27
Why can chemotherapy increase risk of renal stones?
Increases uric acid
28
Most common type of renal stones?
Calcium oxalate
29
What renal stones are associated with chronic infection?
Struvite - staghorn stones Result of urease producing bacteria (proteus mirabilis)
30
Characteristics of testicular cancer
Painless lump Raised LDH, AFP and hCG (in non-seminomas) can be seen Gynaecomastia
31
Types of testicular cancer
Seminomas | Non-seminomas (teratoma, embryonal, yolk sac)
32
Risk factors associated with testicular cancer
Cryptorchidism Infertility Kleinfelters Fhx
33
Diagnosis and management of testicular cancer
Ultrasound Orchidectomy Chemo/radio
34
Renal cell carcinoma triad and other features
Flank pain Haematuria Renal mass Left varicocele (occlusion of left testicular vein) Eryhtropoeitin production (polycythaemia) PTH (hypercalcaemia), renin, ACTH Paraneoplastic hepatic dysfunction syndrome (Stauffer) with hepatosplenomegaly and cholestasis
35
Management of renal cell carcinoma
Partial/total nephrectomy Alpha-interferon and IL-2 (if mets or to reduce tumour size) Sunitinib (receptor tyrosine kinase inhibitor)
36
Infection associated with squamous cell carcinoma of the bladder
Schistostomiasis (African)
37
Management of metastatic prostate cancer
``` HORMONAL THERAPY GnRH agonists (goserelin) ``` + anti-androgen (cyproterone acetate or flutamide) to prevent rise in testosterone Orchidectomy
38
Main complication of prostatectomy
Erectile dysfunction
39
Main risk associated with radiotherapy for prostate cancer
Bladder, colon and rectal cancer
40
Definition of chronic urinary retention
>500ml post-voiding
41
Normal post-void volumes in < and >65s
<50mls in <65s | <100mls in >65s
42
Inguinal hernia characteristics
Can't get above the swelling Cough impulse Reducible
43
Hydrocele characteristics
``` Non-painful Can transilluminate Can get above it Often presenting feature of testicular cancer in young men Filled with clear fluid ```
44
Characteristics of varicocele
Often left side (testicular vein drains into renal vein) Can be presenting feature of renal cell carcinoma Affected testis may be smaller Bilateral varicoceles can affect fertility
45
Causes of acute epididymo-orchitis
Chlamydia | Assoc with dysuria and urethral discharge
46
Investigation of testicular cancer
USS | Serum AFP and bHCG
47
Features of epidiymal cysts
``` Possible to get above the swelling Filled with clear or opalescent fluid Painless 40s Lie above and behind testes ```
48
Most common cause of cancer in an ileal neobladder
Adenocarcinoma (most common cancer in bowel)
49
Most common causative organism of epidymitis in >35s? <35s?
>35s/MSM: E.coli <35s: Chlamydia
50
Chronic high pressure urinary retention characteristics
Renal function impairment or hydronephrosis
51
Renal stone first-line investigation
Non-contrast CT KUB
52
Management of acute upper urinary tract obstruction
Nephrostomy tube (depressurise kidneys) followed by removal of obstruction E.g. ESWL (extra-corporeal shockwave lithotripsy) or cystoscopy
53
Diagnosis of hydronephrosis
Ultrasound IV urogram to detect position CT if suspect renal colic
54
Balanitis xerotica obliterans (BXO) associations?
Phimosis Squamous cell carcinoma Risk of infection
55
Most common causes of acute prostatitis
E. coli Young men: STI (Gonorrhoea and chlamydia)
56
Management of acute prostatitis
14 days of quinolone
57
Congenital contraindication for circumcision
Hypospadias (foreskin used in repair)
58
Initial management of renal stone
IM diclofenac
59
Definitive management of renal stones
<5mm: pass spontaneously <2cm: lithotripsy <2cm in pregnant females: ureteroscopy (stent) Complex or staghorn: percutaneous nephrolithotomy
60
Initial erectile dysfunction screen
cardiovascular system (BP) HbA1c and lipids Testosterone (for hypogonadism) - 6 month trial of testosterone if consistently less than 12nmol/l
61
TURP syndrome characteristics
Hyponatraemia Hyperammonia CNS disturbances Respiratory symptoms Caused by prolonged irrigation by glycine
62
Management of hydrocele in babies?
Should self-resolve by 18 months to 2 years of age
63
Common causes of urinary retention
``` BPH Ureteric strictures Post-operative/post-partum Uterine fibroids Constipation UTI Medications ```
64
What medications can cause urinary retention?
``` Anti-cholinergics TCAs Anti-histamines Benzos Anti-histamines Opioids ```
65
Management of overractive bladder
Antimuscarinics (oxybutinin) Moderate fluid intake Bladder retraining
66
Management of nocturia
Moderate fluid intake in evening Furosemide late afternoon Desmopressin
67
Management of voiding symptoms in men
Conservative pelvic floor muscle exercises and bladder training Moderate-severe: alpha blocker Enlarged prostate: 5-alpha reductase inhibitor (finasteride)
68
Alpha blocker examples
Doxazosin | Tamsulosin
69
5-alpha reductase inhibitor example
Finasteride
70
Pelvic fracture with perineal oedema and non-palpable prostate
Membranous urethral rupture
71
Prophylaxis against calcium renal stones
Thiazide diuretic
72
Irregular non-calcified mass in kidney/adrenal gland in a child with hypertension
Nephroblastoma (Wilms) If was calcified and normotensive - neuroblastoma
73
Treatment of balanitis
STI: appropriate treatment Dermatitis: topical hydrocortisone Candida: clotrimazole or nystatin cream Bacterial: fluclox or erythromycin Recurrent: circumcision
74
Most common cause of renal cancer and how does it affect the lung?
Renal adenocarcinoma Cannon ball mets in lung --> haemoptysis
75
Most effective treatment of renal cell carcinoma
Radical nephrectomy (resistant to chemo and radio)
76
A 31-year-old man presents as he and his partner have been having problems conceiving. On examination there is a diffuse lumpy swelling on the left side of his scrotum. This is not painful and the testicle, which can be felt separately, is normal.
Varicocele
77
Management of hydrocele in adults
Refer for urgent testicular ultrasound (associated with cancer)
78
What needs to be monitored following relief of acute urinary retention?
Diuresis - risk of hypovolaemia and hyponatraemia Monitor U&Es
79
Tamsulosin side effects
Dizziness and postural hypotension
80
Causes of priapism
Sickle cell and other haemoglobinopathies Drugs for ED (sildenafil) Medications (antihypertensives, anticoagulants, cocaine, marijuana) Trauma
81
Investigations for priapism
Cavernous blood gas (raised CO2 and low O2 if ischaemic) Doppler as alternative to assess blood flow FBC Toxicology
82
Management of ischaemic priapism
1. Aspiration of blood in cavernosa and injection of saline to clear the viscous blood 2. Intracavernosal injection of phenylephrine every 5 mins 3. surgery
83
Management of non-ischaemic priapism
Observation
84
Medication used to aid spontaneous passage of ureteric stone
Alpha blocker (sometimes CCB)
85
What kinds of testicular cancer would have a raised hcg and afp?
Teratomas or yolk sac tumours
86
Management of asymptomatic varicocele with normal semen parameters?
Semen analysis every 1-2 years
87
Complications of TURP?
TURP syndrome Urethral stricture Retrograde ejaculation Perforation of prostate
88
When can vasectomy be confirmed to be contraceptive
Clear sperm analysis
89
How long does finasteride take to be effective in BPH?
up to 6 months
90
Young man with history of urinary incontinence and previous gonorrhoea - likely dx?
Urethral stricture
91
Woman admitted with loin pain, fever and dysuria. Treatment?
Pyelonephritis - IV gentamicin
92
Investigations for high PSA
MRI prostate Prostate biopsy Bone scan
93
Androgen deprivation therapy main side effects patients complain of
Hot flushes, fatigue, erectile dysfunction
94
Older man with history of nocturnal enuresis presents with inability to void. Catheter shows residual of 2.4L. Management?
Admit, U&Es, monitor diuresis High pressure chronic retention, could lead to renal dysfunction and hydronephrosis and can cause dehydration

Phase 3b (18 decks)

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