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Phase 3b > Urology > Flashcards

Urology Flashcards

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
Q

Presentation and management of testicular torsion

A

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

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26
Q

Causes and symptoms of urethral stricture

A

STIs
Hypospadias
Lichen sclerosis
Traumatic placement of catheter

Sx: painful/difficulty urinating, dribbling, incomplete emptying

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27
Q

Why can chemotherapy increase risk of renal stones?

A

Increases uric acid

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28
Q

Most common type of renal stones?

A

Calcium oxalate

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29
Q

What renal stones are associated with chronic infection?

A

Struvite - staghorn stones

Result of urease producing bacteria (proteus mirabilis)

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30
Q

Characteristics of testicular cancer

A

Painless lump
Raised LDH, AFP and hCG (in non-seminomas) can be seen
Gynaecomastia

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31
Q

Types of testicular cancer

A

Seminomas

Non-seminomas (teratoma, embryonal, yolk sac)

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32
Q

Risk factors associated with testicular cancer

A

Cryptorchidism
Infertility
Kleinfelters
Fhx

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33
Q

Diagnosis and management of testicular cancer

A

Ultrasound

Orchidectomy
Chemo/radio

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34
Q

Renal cell carcinoma triad and other features

A

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

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35
Q

Management of renal cell carcinoma

A

Partial/total nephrectomy

Alpha-interferon and IL-2 (if mets or to reduce tumour size)

Sunitinib (receptor tyrosine kinase inhibitor)

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36
Q

Infection associated with squamous cell carcinoma of the bladder

A

Schistostomiasis (African)

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37
Q

Management of metastatic prostate cancer

A 
HORMONAL THERAPY
GnRH agonists (goserelin)

+ anti-androgen (cyproterone acetate or flutamide) to prevent rise in testosterone

Orchidectomy

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38
Q

Main complication of prostatectomy

A

Erectile dysfunction

39
Q

Main risk associated with radiotherapy for prostate cancer

A

Bladder, colon and rectal cancer

40
Q

Definition of chronic urinary retention

A

> 500ml post-voiding

41
Q

Normal post-void volumes in < and >65s

A

<50mls in <65s

<100mls in >65s

42
Q

Inguinal hernia characteristics

A

Can’t get above the swelling
Cough impulse
Reducible

43
Q

Hydrocele characteristics

A 
Non-painful
Can transilluminate
Can get above it 
Often presenting feature of testicular cancer in young men 
Filled with clear fluid
44
Q

Characteristics of varicocele

A

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
Q

Causes of acute epididymo-orchitis

A

Chlamydia

Assoc with dysuria and urethral discharge

46
Q

Investigation of testicular cancer

A

USS

Serum AFP and bHCG

47
Q

Features of epidiymal cysts

A 
Possible to get above the swelling 
Filled with clear or opalescent fluid
Painless
40s
Lie above and behind testes
48
Q

Most common cause of cancer in an ileal neobladder

A

Adenocarcinoma (most common cancer in bowel)

49
Q

Most common causative organism of epidymitis in >35s?

<35s?

A

> 35s/MSM: E.coli

<35s: Chlamydia

50
Q

Chronic high pressure urinary retention characteristics

A

Renal function impairment or hydronephrosis

51
Q

Renal stone first-line investigation

A

Non-contrast CT KUB

52
Q

Management of acute upper urinary tract obstruction

A

Nephrostomy tube (depressurise kidneys) followed by removal of obstruction

E.g. ESWL (extra-corporeal shockwave lithotripsy) or cystoscopy

53
Q

Diagnosis of hydronephrosis

A

Ultrasound

IV urogram to detect position

CT if suspect renal colic

54
Q

Balanitis xerotica obliterans (BXO) associations?

A

Phimosis
Squamous cell carcinoma
Risk of infection

55
Q

Most common causes of acute prostatitis

A

E. coli

Young men: STI (Gonorrhoea and chlamydia)

56
Q

Management of acute prostatitis

A

14 days of quinolone

57
Q

Congenital contraindication for circumcision

A

Hypospadias (foreskin used in repair)

58
Q

Initial management of renal stone

A

IM diclofenac

59
Q

Definitive management of renal stones

A

<5mm: pass spontaneously

<2cm: lithotripsy

<2cm in pregnant females: ureteroscopy (stent)

Complex or staghorn: percutaneous nephrolithotomy

60
Q

Initial erectile dysfunction screen

A

cardiovascular system (BP)
HbA1c and lipids
Testosterone (for hypogonadism) - 6 month trial of testosterone if consistently less than 12nmol/l

61
Q

TURP syndrome characteristics

A

Hyponatraemia
Hyperammonia
CNS disturbances
Respiratory symptoms

Caused by prolonged irrigation by glycine

62
Q

Management of hydrocele in babies?

A

Should self-resolve by 18 months to 2 years of age

63
Q

Common causes of urinary retention

A 
BPH
Ureteric strictures 
Post-operative/post-partum
Uterine fibroids 
Constipation 
UTI 
Medications
64
Q

What medications can cause urinary retention?

A 
Anti-cholinergics
TCAs
Anti-histamines
Benzos 
Anti-histamines
Opioids
65
Q

Management of overractive bladder

A

Antimuscarinics (oxybutinin)
Moderate fluid intake
Bladder retraining

66
Q

Management of nocturia

A

Moderate fluid intake in evening
Furosemide late afternoon
Desmopressin

67
Q

Management of voiding symptoms in men

A

Conservative pelvic floor muscle exercises and bladder training

Moderate-severe: alpha blocker

Enlarged prostate: 5-alpha reductase inhibitor (finasteride)

68
Q

Alpha blocker examples

A

Doxazosin

Tamsulosin

69
Q

5-alpha reductase inhibitor example

A

Finasteride

70
Q

Pelvic fracture with perineal oedema and non-palpable prostate

A

Membranous urethral rupture

71
Q

Prophylaxis against calcium renal stones

A

Thiazide diuretic

72
Q

Irregular non-calcified mass in kidney/adrenal gland in a child with hypertension

A

Nephroblastoma (Wilms)

If was calcified and normotensive - neuroblastoma

73
Q

Treatment of balanitis

A

STI: appropriate treatment
Dermatitis: topical hydrocortisone
Candida: clotrimazole or nystatin cream
Bacterial: fluclox or erythromycin

Recurrent: circumcision

74
Q

Most common cause of renal cancer and how does it affect the lung?

A

Renal adenocarcinoma

Cannon ball mets in lung –> haemoptysis

75
Q

Most effective treatment of renal cell carcinoma

A

Radical nephrectomy (resistant to chemo and radio)

76
Q

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.

A

Varicocele

77
Q

Management of hydrocele in adults

A

Refer for urgent testicular ultrasound (associated with cancer)

78
Q

What needs to be monitored following relief of acute urinary retention?

A

Diuresis - risk of hypovolaemia and hyponatraemia

Monitor U&Es

79
Q

Tamsulosin side effects

A

Dizziness and postural hypotension

80
Q

Causes of priapism

A

Sickle cell and other haemoglobinopathies
Drugs for ED (sildenafil)
Medications (antihypertensives, anticoagulants, cocaine, marijuana)
Trauma

81
Q

Investigations for priapism

A

Cavernous blood gas (raised CO2 and low O2 if ischaemic)

Doppler as alternative to assess blood flow

FBC
Toxicology

82
Q

Management of ischaemic priapism

A
  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
Q

Management of non-ischaemic priapism

A

Observation

84
Q

Medication used to aid spontaneous passage of ureteric stone

A

Alpha blocker (sometimes CCB)

85
Q

What kinds of testicular cancer would have a raised hcg and afp?

A

Teratomas or yolk sac tumours

86
Q

Management of asymptomatic varicocele with normal semen parameters?

A

Semen analysis every 1-2 years

87
Q

Complications of TURP?

A

TURP syndrome
Urethral stricture
Retrograde ejaculation
Perforation of prostate

88
Q

When can vasectomy be confirmed to be contraceptive

A

Clear sperm analysis

89
Q

How long does finasteride take to be effective in BPH?

A

up to 6 months

90
Q

Young man with history of urinary incontinence and previous gonorrhoea - likely dx?

A

Urethral stricture

91
Q

Woman admitted with loin pain, fever and dysuria. Treatment?

A

Pyelonephritis - IV gentamicin

92
Q

Investigations for high PSA

A

MRI prostate
Prostate biopsy
Bone scan

93
Q

Androgen deprivation therapy main side effects patients complain of

A

Hot flushes, fatigue, erectile dysfunction

94
Q

Older man with history of nocturnal enuresis presents with inability to void. Catheter shows residual of 2.4L. Management?

A

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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