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Urology Flashcards

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1
Q

What are the causes of haematuria?

A 
V: coagulopathy
I: UTI, prostatitis, pyelonephritis, TB
T: STONES, post cystoscopy
A: IgA nephropathy, glomerulonephritis
M: 
I: catheter 
N: bladder, prostate, renal, endometrial CANCERS
D: NSAIDs, sulphonamides, aminoglycosides

Other:
BPH, vigorous exercise, sex

False:
beetroot, menstruation, rifampicin

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2
Q

What are the haematuria related red flags requiring urgent urology referral?

A

<45 with VH that remains despite UTI treatment (if +ve for UTI)

> 60 with NVH + dysuria or raised WCC

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3
Q

How would you examine a testicular lump?

A

LOOK:
site, symmetry, size, skin changes

FEEL:
tender? attached? can you get above it? temperature? pulse? reducible?

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4
Q

How would you investigate a testicular lump?

A

USS

Do not biopsy as if cancer there is risk of seeding

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5
Q

What are your differentials for a testicular lump?

A 
hydrocele
varicocele
spermatocele
haematocele 
epididimo-orchitis 
inguinal hernia 
testicular cancer
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6
Q

What is an epididymal cyst/spermatocele? What would be your examination findings?

A

sits above and behind the testes
fluctuant
sits separate to the testes
transluminates

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7
Q

What is a hydrocele? What would be your examination findings?

A

fluid within the tunica vaginalis

painless
fluctuant
attached to the testes
transluminates

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8
Q

What is orchitis? What would be your examination findings?

A

Very rarely occurs alone without epididymitis

Infection due to chlamydia, gonorrhoea, e.coli and TB, mumps

sudden onset swelling with LUTS
check the parotid gland for swelling (mumps)

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9
Q

What is a varicocele? What would be your examination findings?

A

dilated veins of the paniform plexus

“bag of worms”
sits separate to the testes
doesn’t transluminate
disappears on lying down

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10
Q

What is a haematocele?

A

blood within the tunica vaginalis following trauma

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11
Q

What is worrying about a varicocele?

A

can indicate a renal tumour

can lead to infertility as it raises the temperature of the testes

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12
Q

What would be your examination findings for epididymitis?

A

acute unilateral pain
swollen and erythematous
fever
Phrens sign: reduced pain on elevation of the testes

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13
Q

Which testicular lumps transluminate?

A

hydrocele

spermatocele/epidydimal cyst

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14
Q

What are the types of urinary stones?

A

80% are either calcium oxalate, calcium phosphate or mixed
struvite
urate

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15
Q

What are the causes/risk factors for urinary stones?

A

Dehydration
Increased mineral content:
CALCIUM: high PTH, bone destruction, thiazide
OXALATE: IBD, nuts and rhubarb
URIC ACID: gout, chemotherapy, red meat, myeloproliferative disease

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16
Q

How do urinary stones present?

A

Dehydrated (drinking makes pain worse)
Colic from loin to groin with dull ache in between waves
tenderness over the loin
non-visible haematuria

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17
Q

What is the gold standard investigation for urinary stones?

A

Non-contrast CT KUB

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18
Q

What is the immediate management for someone with renal stones?

A

Diclofenac IM
Fluids
+/- antiemetics

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19
Q

What would suggest someone with renal stones needed treating in hospital?

A

> 5mm
known renal problems
unable to cope with symptoms

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20
Q

What is the medical management option for renal stones? When would this be indicated?

A

alpha blockers can be used if the stone is in a distal location

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21
Q

What are the surgical options for a renal stone? When are these indicated?

A

ureteroscopy: stone <2cm and can be pregnant
ESWL: stone <2cm and not pregnant
Percutaneous nephrolithotomy: >2cm or staghorn
Nephrostomy: severe obstruction

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22
Q

What are the contraindication to ESWL?

A

pregnant

stone located over bony prominence

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23
Q

Where is a stone likely to become stuck?

A

VUJ
PUJ
crossing the pelvic brim under the iliac vessels

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24
Q

What is the x-ray appearance of renal stones?

A

calcium phosphate and oxalate: radio-opaque

urate: radio-lucent
cystine: semi-opaque ground glass appearance

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25
What are the risk factors for developing bladder stones? How do they present? What do they predispose to?
retention and schistosomiasis LUTS bladder SSC
26
What are the complications of renal stones?
hydronephrosis AKI become infected
27
What are your differentials for urinary obstruction?
LUMEN: stone, blood clot, tumour WALL: stricture, NM dysfunction OUTSIDE: BPH, large fibroid, tumour
28
Compare the presentation of acute urinary obstruction to chronic urinary obstruction
acute: retention so suprapubic tenderness and confusion chronic: LUTS
29
What organism is most commonly responsible for pyelonephritis?
E.coli
30
What are the causes of pyelonephritis? i.e. how does infection get to the kidney?
UTI systemic from sepsis via lymphatics i.e. if someone has a retroperitoneal abscess
31
What are the risk factors for pyelonephritis?
relating to flow: BPH, VUR, catheter, neuropathic bladder, stones immunocompromised: diabetics, steroids sexually active
32
How does pyelonephritis present?
fever + loin pain + N&V | costo-vertebral angle tenderness
33
How is pyelonephritis managed?
emperical abx and fluids
34
Who does emphysematous pyelonephritis commonly effect? How is it diagnosed?
diabetics | if someone doesn't respond to abx you can do a CT and see the gas surrounding the kidney
35
What are the risk factors for developing renal cysts?
smoking and HTN | APKD
36
How do renal cysts present?
flank pain haematuria +/- uncontrolled HTN
37
What investigations would you do for someone with renal cysts?
CT with contrast to rule out renal cell carcinoma
38
What scoring system determines the management of renal cysts? What are the management options?
Bosniak scoring system | Aspirate or de-roofing
39
What does BPH stand for?
benign prostate hyperplasia
40
What does BPH feel like on examination?
firm smooth symmetrical
41
How do you evaluate LUTS in someone with suspected BPH?
IPSS
42
What are the management options for BPH?
1. reassure and lifestyle 2. alpha blockers (tamsulosin) 3. 5a-reductase inhibitor (fenasteride) 4. TURP
43
Name an a-blocker? | What are the side effects of a-blockers?
Tamsulosin - postural hypotension - retrograde ejaculation
44
How do 5a-reductase inhibitors work? Name one? What is a disadvantage of them?
stop the enzyme 5a-reductase which converts testosterone to the more potent DHT e.g. fenasteride Disadvantage: They take a long time before any benefit seen
45
What is TURP? | What are the risks associated?
``` trans-urethral resection of the prostate (removal uses diathermy) ADRS: sexual dysfunction retrograde ejaculation strictures TURP syndrome ```
46
What is TURP syndrome?
Occurs due to the hypoosmolar fluid used in the process of TURP. Leads to fluid overload and hyponatraemia
47
What are the causes of prostatitis?
spread from UTI or STI | lymph spread from a rectal abscess
48
What are the risk factors for prostatitis?
catheter strictures recent cystoscopy
49
How does prostatitis present?
``` perianal or suprapubic pain fever LUTS +ejaculatory pain +bloody discharge ```
50
What is felt/seen on examination of prostatitis?
tender boggy inguinal lymphadenopathy
51
How do you investigate prostatitis?
Urine culture for sensitivities
52
How do you manage prostatitis?
Quinolone eg ciprofloxacin
53
What is the definition of priapism?
erection lasting >4 hours that is not associated with sexual arousal + pain
54
What is the pathophysiology of priapism?
Ischaemic: impaired vasorelaxation means de-oxygenated blood is left within the corpus cavernosum non-ischaemic: high arterial inflow due to trauma or fistula
55
What is the results of a cavernosal blood gas analysis in ischaemic priapism?
acidotic low O2 high CO2
56
What are the drug causes of priapsim?
anti-hypertensives anti-depressants anti-coagulants cocaine, ectasy
57
How is ischaemic priapism managed?
aspirate the blood from the corpus cavernosa inject a saline flush inject intercavernosal phenylephrine
58
What are the histological subtypes of renal cancer? Which is the most common?
They are adenocarcinomas: - clear cell (most common) - papillary - chromophobe
59
How does renal cancer present?
``` haematuria loin pain abdominal mass ongoing fever of unknown origin left testicular varicocele ```
60
What are some paraneoplastic hormone changes associated with renal cancer?
ACTH PTH Erythropoietin
61
What are the risk factors for developing renal cancer?
smoking | tuberous sclerosis
62
How is renal cancer managed?
nephrectomy | Chemo and radio DO NOT work
63
Describe the cause of a membranous vs bulbar urethral rupture
membranous: pelvic fractures bulbar: straddle injury e.g. on a bike
64
Describe the presentation of a bulbar vs membranous urethral rupture
membranous: blood at meatus, penile and perineal oedema, prostate is elevated bulbar: blood at meatus, perineal haematoma, retention
65
How is urethral rupture managed?
suprapubic catheter
66
How would a bladder injury present?
Often history of pelvic fracture haematuria retention suprapubic pain
67
What in the history would help differentiate organic vs psychogenic erectile dysfunction
organic: slow onset, libido present psychogenic: reduced libido, able to self stimulate
68
What are some causes/risk factors of erectile dysfunction?
B-blockers and SSRIs Alcohol CVS disease or risk factors for CVS disease
69
How do you investigate erectile dysfunction?
measure free testosterone at 9am | Calculate CVS risk factor score
70
How is erectile dysfunction managed?
Viagra
71
Epididymitis has a bi-modal age distribution. Compare the causes and therefore risk factors for these 2 groups.
20-30 - often STI so gonorrhoea and chlamydia - MSM, multiple partners, new partner >60 - often UTI so e.coli - catheter, BPH, stricture
72
How is epididymitis investigated?
20-30 y/o need first void urine for NAAT | >60 need mid stream urine for dip
73
How is epididymitis managed?
If STI causes: ceftriaxone and doxycycline | If UTI causes: ofloxacin
74
How does epididymitis present?
unilateral scrotal pain, swelling, erythematous, tender Fever Pain reduces on elevation of the testes (Phrens sign)
75
What organisms commonly cause urethritis? Therefore what is the management?
Gonorrhoea: ceftriaxone and azithromycin Chlamydia: doxycycline
76
How does urethritis in men present?
dysuria penile discharge penile irritation
77
Name a complication of urethritis and state how this would present
reactive arthritis - oligoarthritis of the lower limbs - conjunctivitis and uveitis - oral ulcers - malaise
78
What is fournier's gangrene?
necrotising fasciitis of the perineum
79
How does fournier's gangrene present?
``` pain out of proportion fever crepitus haemorrhagic bullae sensation loss ```
80
What is balanitis?
inflammation of the glans penis
81
How is balanitis managed?
saline bath +/- STI/UTI treatment +/- clitrimazole for candida +/- hydrocortisone for dermatitis
82
How is recurrent balanitis managed?
circumcision
83
What can cause LUTS? Of these what are the most common in men and women?
Women: UTI or menopause Men: UTI or BPH malignancy detrusor weakness strictures multiple sclerosis
84
Compare the symptoms of storage vs voiding LUTS
storage: - nocturia - urge incontinence - increase frequency voiding: - hesitancy - poor stream - feeling of incomplete emptying - terminal dribble
85
How are predominantly voiding LUTS managed?
pelvic floor exercises alpha blockers 5a-reductase inhibitors
86
How is nocturia managed?
furosemide taken late afternoon
87
How is overactive bladder managed?
antimuscarinics: oxybutynin or tolterodine
88
What would be your first line investigation for LUTS?
Frequency and volume chart
89
What do urodynamic studies assess?
detrusor pressures storage capacity flow
90
How does acute retention present?
suprapubic pain | increased residual volume
91
What are the risk factors for urinary retention?
``` BPH Strictures Prostate cancer anti-muscarinics MS and parkinsons constipation ```
92
How is acute retention managed?
Catheterise for 24-48 hours TWOC if re-retention then consider long term catheter
93
How does chronic retention present?
increased residual volume Painless Overflow incontinence (worse at night)
94
What are some complications of chronic retention?
Infections and stones because of stasis
95
How is chronic retention managed?
If residual volume >1L then catheterise
96
How does acute on chronic retention present?
often still painless or minimal pain
97
patients with acute on chronic retention are at particular risk of what complication of retention?
post-obstructive diuresis
98
What is the pathophysiology of post-obstructive diuresis?
occurs in patients in retention who are catheterised. There is a loss of the medullary concentration gradient. On catheterisation the kidneys over diuresis leading to large volumes of urine and AKI
99
How is post-obstructive diuresis managed?
IV fluids
100
What is the result of high pressure retention? Why does this happen?
with high bladder pressures there is a loss of the normal anti-reflux mechanism meaning urine backs up leading to hydroureter and hydronephrosis

Finals (16 decks)

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