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Urology Flashcards

1
Q

Discuss the management of patient with signs of infection and a stone causing obstruction

A

Ureteric obstruction due to a stone with infection is a surgical emergency
- sepsis 6
- decompression via nephrostomy tube placement in IR/ ureteric stent placement
Then definitive treatment e.g. stone removal if needed at later date

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2
Q

Management of renal colic with stone of 3.5mm on US

A

A&A Analgesia and advice on stone prevention

Stones <5mm usually pass spontaneously within 4 wks

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3
Q

When would you consider open surgery for renal stones?

A

If other treatment failed, if there is complex stone burden or an endoscopic surgery is not an option.

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4
Q

What advice would you give on stone prevention?

A

High fluid intake

Diet low in animal proteins and low in salt

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5
Q

What are the options without doing open surgery?

A

Shockwave lithotripsy
Ureteroscopy ± stent placement - good option in pregnant women with stone burden <2cm
Percutaneous nephrolithotomy - complex renal calculi and stag horn calculi

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6
Q

How could you classify renal stones?

A 
By composition 
- Calcium oxalate 80%
- uric acid 5-10%
Calcium  phosphate + oxalate 10%
Struvite 2%
Cystine 1%
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7
Q

Someone with Crohn’s disease has a higher risk of forming what type of stone?

A

Calcium oxalate

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8
Q

What type of stone is classically associated with infection?

A

Struvite

- proteus? infection

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9
Q

What are the risk factors for renal calculi?

A

Intrinsic - age 20-50 , male 1.3x, History ( 10% annual recurrence rate), genetic ( 25% have fam hx, caucausion and asian more common, genetic disorders e.g. familial renal tubular acidosis

Extrinsic - low fluid intake, hot climates, diet.

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10
Q

What is the imaging of choice for renal colic?

A

CT KUB

Pelvic X ray

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11
Q

What is the association between a diet high in Ca and the formation of renal stones?

A

None

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12
Q

Causes of urethral stricture

A

Trauma - instrumentation or pelvic #
Infection
Chemo, radiation
Balantitis xerotica obliterans

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13
Q

What are the symptoms of a urethral stricture?

A 
Hesitancy 
Strangury 
Poor stream 
Terminal dribbling 
Incomplete voiding
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14
Q

Causes of urinary retention

A

Obstructive
Neurological
Myogenic

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15
Q

Obstructive causes of urinary retention

A
  • mechanical ( BPH, urethral stricture, stones, constipation)
  • dynamic ( post op pain, drugs, = increased smooth muscle tone)
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16
Q

Neurological causes of urinary retention

A

Due to either sensory or motor disruption

  • pelvic surgery
  • MS
  • DM
  • Spinal injury / compression
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17
Q

Myogenic causes of urinary retention

A

Over distension of bladder due to

high alcohol intake or post anaesthesia

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18
Q

Clinical presentation of acute urinary retention

A

Suprapubic tenderness
Palpable bladder dull to percussion
Large prostate on PR
less then 1L drained on catheterisation

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19
Q

What would be seen on imaginary of patient with urinary retention?

A

US bladder volume, hydronephrosis, dilate ureters

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20
Q

What are the management options for a patient with urinary retention?

A
  1. Conservative ( analgesia, walking, running water or hot bath)
  2. Catheterise ( + monitor urine output with fluid replacement to manage post-obstructive diuresis. Then try to void without catheter after 24-72hrs.
  3. TURP indicated if TWOC fails or there is impaired renal fan.
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21
Q

When is a suprapubic catheter contraindicated?

A

Known or suspected bladder cancer
undiagnosed haematuria
Prep lower abdomen surgery.

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22
Q

Most common type of bladder cancer?

A

Transitional 90%

SCC 10%

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23
Q

What is a risk factor for SCC?

A

Schistosomiasis

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24
Q

Large soft mass in the scrotum that can be separated from the testicle. Most prominent with the patient standing

A

Inguinal Hernia

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25
Non tender, soft, fluctuant lump at the superior pole of the testicle that is separate from the testicle itself. Transilluminated with light
Epididymal cyst
26
Non tender soft fluctuant lump around the testicle that transilluminates with light
Hydrocele
27
Mildly tender, soft, irregular lump separate from the testicle
Varicocele
28
Scrotal exam finds hard, irregular lump, non tender
Testicular cancer
29
Very tender, hot swollen testicular swelling most prominent at the superior pole and back of the testicle
Epididymo-orchitis
30
How does LHRH agonist work?
LHRH stimulates release of LH from pituitary. LH then stimulates release of testosterone. The LHRH agonists bind to the pituitary and initially stimulate LH release but the constantly high levels of LH eventually result in a down regulation and absence of testosterone.
31
Most common type of testicular cancer
Germ cell tumors 90% ( seminoma most common 50%)
32
Examples of non germ cell testicular cancers
Epidermoid, adneomatoid, carcinoid
33
Leydig cell and Sertoli cell tumors are examples of
Mixed germ cell tumors
34
Most common type of non-seminomatous tumor
Teratoma
35
Most common type of renal stone
Calcium oxalate
36
Anabolic steroid use is linked to what type of cancer
Prostate cancer
37
Exposure to aromatic amines is linked to what
Bladder cancer
38
Long term dialysis increases risk of what type of cancer
Renal cancer
39
Best image to use in renal colic
CT KUB
40
Bell clapper deformity predisposes to what?
Testicular torsion
41
Why does bell clapper deformity predispose to testicular torsion?
Absence of the normal posterior attachment of the testicle to the tunica vaginalis
42
21 y/o man with painless, hard, irregular left testicular lump where AFP v elevated, beta hCG elevated, lactate dehydrogenase v elevated? Dgx?
Teratoma
43
Management of epididymis-orchitis
Ciprofloxacin or doxycycline if STI
44
Initial management of BPH
Tamsulosin [alpha blocker - relax smooth muscle] | Finasteride [5-a reductase inhibitors = Block testosterone +reduce prostate size]
45
Time window for testicular torsion
6hrs
46
Management of stone less than 2cm in aggregate
Lithotripsy
47
Mgmt stone burden less than 2cm in pregnant female
Ureteroscopy
48
Complex renal calculi ans staghorn calculi management
Percutaneous nephrolithotomy
49
Ureteric calculi less then 5mm mgmt
expectantly?
50
Complications of shockwave lithotripsy
Solid organ injury | Stone fragmentation causing ureteric obstruction
51
Risk factors for TCC
Smoking exposure to aniline dyes in printing and textiles Rubber manufacture Cyclophosphamide
52
T/F smoking is a risk factor for SCC of bladder?
true
53
indications for circumcision
Phimosis Recurrent balantitis Balantitis xerotica obliterans Paraphimosis
54
Lump not separated from testes that transilluminates
Hydrocoele
55
Most cases of acute epididymis-orchitis are due to?
Chlamydia
56
Why doe varicoceles typically occur on the left? | What are possible associations with varicoceles?
Left because testicular vein drains into the renal vein May be the presenting feature of a renal cell carcinoma Bilateral varicoceles may affect fertility
57
What type of drug is tamsulosin and how does it work?
Alpha 1 antagonist | Decreases smooth muscle tone of bladder and prostate
58
S/Es of tamsulosin
Dixxiness, dry mouth, depression | Risk of orthostatic hypotension
59
How long for 5 alpha reductase inhibitors to work? Give Eg | MOA
Finasteride 6 moths to reduce prostate volume and slow dx progression block conversion of testosterone to dihydrotestosterone which induces BPH
60
Erectile dysfunction, reduced libido, ejaculation problems and gynaecomastia are possible side effects of what drug used for BPH?
5 alpha reductase inhibitor finasteride
61
Hyponatremia+ Fluid overload + glycine toxicity are part of what?
TURP syndrome
62
Elevated AFP is associated with what type of cancer?
Testicular non seminoma ENDODERMAL
63
Difference between a renal cell carcinoma and a renal cyst on CT scan?
RCC is a separated mass containing solid and liquid components Cysts are not separated.
64
Cause of epididymitis by age group
less than 35 - STI chlamydia or gonorrhea | over 60 E coli
65
Tx of erectile dysfunction
Phosphodiesterase inhibitors e.g. sildenafil | Do not give nitrates at same time
66
tx of kidney stones
If < 0.5cm → Pain control If > 0.5cm → medical expulsion therapy [e.g. CCB] If 1.5cm → Stenting or Lithotripsy If >3cm → Surgery If septic / acute upper UT obstruction → Nephrostomy tube and figure out after
67
Causes of haematuria
``` start from top -> down Medications Drug induced → ketamine + cyclophosphamide Chemical Radiation cystitis Renal Glomerulonephritis PKD Renal cell carcinoma Renal calculi Ureter Urothelial cancer Outside malignancy Cervical ca Calculi Strictures Bladder UTI Most common Cystitis Bladder stones Bladder ca and pelvic ca Prostate Prostate ca BPH Urethra Structures Urethritis ```
68
Undescended testes after 3 months
Refer to surgery
69
Radiouscent gallstones
Urate
70
Past paper q on bladder cancer
Intrathecal Chemo may be used
71
what is the link between gynaecomastia and testicular cancer
Gynaecomastia in testicular cancer occurs due to an increased oestrogen:androgen ratio
72
Typical age for testicular cancer
20-30yrs
73
small fluid-filled lump. smooth regular character, and that it feels separate from the body of the testicle.
An epididymal cyst
74
what type of drug is goserelin
GnRH agonist
75
What is the first-line in patients with benign prostatic hyperplasia
Alpha 1 antagonist
76
classic age for testicular teratomas and seminomas
Teratomas for the troops (20-30), Seminomas for the Sergeants (30s/40s onwards)
77
HCG and AFP may be raised in what type of cancers
teratoma and yolk sac | not seminomas

Clinical (45 decks)

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