Phase 2a NEW > Genitourinal > Flashcards

Genitourinal Flashcards

(67 cards)

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1
Q

LUTS

A

Lower urinary tract symptoms

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2
Q

Why males have a stronger bladder neck mechanism than females

A

Strong bladder neck mechanism in order to prevent reflux of ejaculate into the bladder

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3
Q

LUTS - Types

A

Storage
Voiding
Post-micturition

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4
Q

LUTS - Storage

A

Frequency
Urgency
Nocturia
Incontinence

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5
Q

LUTS - Voiding

A 
Slow stream
Spitting/spraying
Intermittency
Hesitancy
Straining
Terminal dribble
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6
Q

LUTS - Post-micturition

A

Post-micturition dribble

Feeling of incomplete emptying

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7
Q

Bladder diary

A

For LUTS patients

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8
Q

Incontinence

A

Involuntary loss of urine - failure of storage
Urgency incontinence - urgent desire to void which is difficult to defer
Stress incontinence - coughing/straining
Mixed incontinence - stress and urgency
Continuous incontinence- fistula
Overflow incontinence - full bladder
Social incontinence - dementia

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9
Q

Urgency incontinence

A

OAB - Overactive bladder (urgency with frequency, with or without nocturia, wet or dry)

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10
Q

Urodynamics

A

Diagnostic - Detrusor overactivity on OAB

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11
Q

OAB - Management

A 
Behavioural - Frequency volume chart, caffeine, alcohol
Anti-muscarinics - M2/3 blockers
B3 agonists
Botox - Potent toxin
Surgery - cystoplasty
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12
Q

Stress incontinence

A

F>M
Females management - Pelvic floor physio, duloxetine, surgery (artificial sphincter)
Male management - Surgery (artificial sphincter)

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13
Q

Voiding problems - Obstructive

A

BPE - Treat with alpha blockers, phosphodiesterase 5 inhibitor (viagra), last resort is TURP (surgery)
Urethral stricture
Prolapse/mass

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14
Q

Voiding problems - Non-obstructive

A

Treat with catheter

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15
Q

Spastic spinal cord injury

A 
Supra-conal lesion
Lost coordination
lost completion of voiding
Reflex bladder contractions
Detrusor sphincter dyssynergia 
Diagnostic - urodynamics - raised pressures
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16
Q

Flaccid spinal cord injury

A 
Conus lesion
Lost bladder contraction
Lost guarding reflex 
Lost receptive relaxation 
Areflexic bladder
Stress incontinence
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17
Q

Neurogenic bladder - Management

A

Artificial sphincter

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18
Q

Autonomic dysreflexia

A 
Occurs lesions above T6
Overstimulation of sympathetic NS below level of lesion in response to a noxious stimulus 
Headache
Severe hptn
Flushing 
Management - Catheter drainage
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19
Q

Convene drainage

A

No indwelling catheter

Basically a condom connected to a bag which drains urine

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20
Q

Suprapubic catheter

A

Goes through abdo instead of urethra

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21
Q

Bladder problems in MS

A

OAB syndrome

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22
Q

Prostate cancer - Risks

A

Increasing age
Family history - 1st-degree relatives
Ethnicity - Afro-carib raised risk, uncommon in far east

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23
Q

Prostate cancer

A

Histology - majority are adenocarcinoma in peripheral zone

Gleason grading system is diagnostic following DRE

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24
Q

Routes of spread

A

Haematogenous - spread to bone, lung, lung, liber and kidneys
Lymphatics
Local tissues

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25
Prostate cancer staging
T1-T4 (spread of tumour) N1 (mets in regional lymph nodes) M1a,b,c (non-regional lymph nodes, bones, others)
26
Cancer - General symptoms
Wt loss Fatigue Night sweats Loss of appetite
27
Prostate cancer - symptoms
Wt loss Fatigue Urinary (Voiding and storage) - slow stream, poor stream, frequent, terminal dribbling Bone pain (indicative of advanced prostate cancer)
28
Prostate cancer - Examination
DRE - Nodule, asymmetry, the difference in texture, bogginess Overdistended bladder
29
Prostate cancer - Investigations - PSA
PSA (Prostate surface antigen) Glycoprotein produced only by prostate cells which is specific to the prostate but not to prostate cancer High sensitivity but low specificity Elevated level suggests prostate cancer
30
Prostate cancer - Investigations - MRI
MRI prostate Prior to biopsy Can identify lesions to target with biopsy Aids in local staging
31
Prostate cancer - Investigations - Biopsy
Indicated by a palpably suspicious DRE regardless of PSA Suspicious lesion on MRI TRUS or transperineal Gleason grading on results of biopsy
32
Prostate cancer - Investigations - Stagibg imaging
``` Bone scan (bone mets) CT abdo Look for lymph nodes (obturator region) and mets ```
33
Prostate cancer - Treatment
Active surveillance Radical prostatectomy (curative surgery) Radiotherapy Complications of surgery/radio - Urinary incontinence Hormone therapy - Orchiectomy (surgical removal of both testicles - the main source of testosterone) LHRH agonists - Goserelin, antiandrogens - Flutamide Chemo - Docetaxel Bisphosphonates
34
Prostate cancer
Androgen sensitive
35
Prostate cancer - Prognosis
Hormone resistance + mets = bad prognosis
36
Renal cancer - RFs
``` Smoking Environment - petroleum Occupational - Asbestos Hormonal - obesity Genetic - VHL, BHD ```
37
Renal cancer - Presentation
Triad - Mass, haematuria, pain Mets symptoms if present Varicocele (rare)
38
Renal cancer - Bosniak classification
``` 1-4 2F - Septation 4 - Malignant Simple renal cyst- US Complex - CT ```
39
Renal cancer - Spread
``` Local Nodal Renal vein Organs (Local, regional, distant - Host organ, lymph, distant organ(s) ) ```
40
Renal cell cancer - Genetic causes
VHL - Chromosome 3 mutation TSC BHD
41
Commonest renal cancer
Clear cell RCC
42
Renal cancer - Treatment
``` Surveillance Radical nephrectomy Partial nephrectomy Radiofrequency ablation TKIs ```
43
Bladder cancer - RFs
``` M>F Age increasing Occupation (industry) - dyes, rubber, aromatic amines Schistosomiasis endemic areas Smoking Long term catheterisation ```
44
Bladder cancer - Presentation
``` Painless haematuria (painless due to no stimulus for pain) Flank pain Lower limb oedema Pelvic mass Wt loss Bone pain ```
45
Bladder cancer - Staging indications
T2 = muscle-invasive
46
Bladder cancer - Histology
Transitional cell carcinoma
47
Bladder cancer - Investigations
CT bladder | Cystoscopy
48
Bladder cancer - Treatment
``` TURBT Chemo Cystectomy Radio Palliative ```
49
Testicular cancer
Adolescence One of the most curable cancers RFs - HIV, genetics (1st deg rel)
50
Testicular cancer - Pathology
Germ cell tumours divided into seminomatous and non-seminomatous
51
Testicular cancer - Presentation
Scrotal lump Painless mets symptoms if present CNS symptoms
52
Testicular cancer - Differential diagnosis
``` Hydrocele Epidydimal cyst Varicocele Tetsicular torsion Indirect inguinal hernia ```
53
Testicular cancer - Investigations
US testes CT brain Tumour markers (raised) - AFP, HCG, LDH
54
Testicular cancer - Treatment
Radical inguinal orchidectomy Radio Chemo
55
Stones locations
Anywhere from collecting duct to the external urethral meatus
56
Idiopathic kidney stone - Causes
Dehydrated, so concentrated urine consisting of calcium, oxalate, urate, cystine Infection Calcium oxalate is most common stone
57
Mechanism of stone formation
Stones form from crystals in supersaturated urine especially when it becomes static
58
Stones - Prevention
``` Overhydration Low salt diet Reduce BMI Active lifestyle Normal dairy intake Moderate protein intake ```
59
Uric acid stones
Only form in acid urine
60
Kidney stones - Symptoms
``` Tend to be asymptomatic Loin pain/kidney pain Haematuria Urgency Frequency Recurrent UTIs N/V ```
61
Pain history
``` SOCRATES Site - Loin, unilateral Onset - Rapid Radiation - Loin to groin etc ```
62
Loin pain - Differential diagnosis
Ruptured AAA Bowel path - diverticulitis, appendicitis Gynae - ovarian cyst, ectopic preg Testicular torsion
63
Kidney stones - Investigation
KUBXR (Kidney, ureter, bladder XR) NCCT-KUB (CT) = Gold standard Hydronephrosis - inflammatory renal dilation on imaging USS - For preg/younger patients
64
Kidney stones - Management
``` NSAID Opiates IV fluids Surgical Lithotripsy - shock wave breaks up stones Ureteroscope - ureter stone Endoscope - bladder stone Laser ```
65
Pyonephrosis
Combination of infection and obstruction Basically hydronephrosis where water is replaced with pus Systemic sepsis leads to septic shock Treatment - Drainage (nephrostomy) - ureteric stents help dilate ureter
66
Urosepsis - Consequences
20 digit gangrene
67
Sepsis 6
ABCDE Abx Resus
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