Genitourinary Flashcards by julia hart

Name 3 types of stones. Which is the most common?

Calcium oxalate (70%)
Uric acid
Magnesium ammonium phosphate

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What are some risk factors for ureteric stone development?

Dehydration

Diet high in animal protein &salt

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What are the initial investigations for a suspected stone?

FBE, UEC
Serum calcium & uric acid
MSU
CT-KUB and plain KUB

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What are some indications for intervention for a ureteric stone?

Infection/sepsis
Renal impairment
Bilateral obstructions
Solitary kidney
Inability to control symptoms
Prolonged obstruction
Unlikely to pass spontaneously

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What organism usually causes obstructive pylonephrosis?

E. coli

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What is the management of obstructive pylonephrosis?

IV Abs (gentamicin?)
Urgent decompression
Supportive care (fluids, monitoring)

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What are some medical treatments for ureteric stones?

a-blockers, eg. Tamsulosin 0.4mg OD for 2 weeks

- calcium channel blockers & steroids not as effective

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What are the surgical options for a ureteric stone?

JJ stent & delayed management
Ureteroscopy & lithotrospsy
Shock wave lithotripsy

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What is the likely make-up of a radiolucent stone?

Uric acid (or cystine)

- Form in acidic urine

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What are some strategies to prevent stone recurrence?

Adequate fluid intake
Dietary modification
Urinary alkalinization
Medical therapy - allopurinol, thiazide diuretics
Cystinuria

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What are 5 causes of urological haematuria?

Obstructive uropathy
Carcinoma of the prostate
Nephritis
Trauma
Tumour
TB
Thrombosis
Haematological
Infection/inflammation
Stones

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Which common drugs can make the urine beetroot red?

Pyridium
Nitrofurantoin
Rifampin
Ibuprofen
Phenytoin
L-DOPA
Chloroquine

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What is the acute work-up for haematuria?

Bloods: Hb, clotting, creatinine
MSU -> M/C/S
Upper tract imaging: CT-IVP, U/S
Cystoscopy
Others: urine cytology, PSA, urinalysis

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What are the obstructive urinary symptoms?

Poor flow, hesitancy, intermittency, terminal dribbling

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What are the irritative urinary symptoms?

Frequency, urgency, nocturia, incontinence

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What are the 3 most common causes of obstructive urinary symptoms?

BPH
Prostate cancer
Stricture

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What are 5 causes of irritative urinary symptoms?

UTI
Secondary to obstruction
Bladder cancer
Stone
Diabetes
TB

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What is your work-up for lower urinary tract symptoms?

MSU
UEC
PSA
Bladder diary
Voiding flow rate
US - residual urine, hydronephrosis

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Which drugs can be used in lower urinary tract symptoms?

Alpha blockers

- 5-alpha reductase inhibitors

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What are the surgical options for treatment of lower urinary tract symptoms?

TURP
BNI (bladder neck incision)
Open prostatectomy

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What is acute urinary retention?

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Sudden and PAINFUL inability to pass urine

What are some painless causes of urinary retention?

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Neurogenic
Longterm voiding detrusor dysfunction
Ageing

What can precipitate acute urinary retention?

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Medication (anticholinergics)
UTI
Diuresis (esp. ALCOHOL)
Postoperative

What are common causes of acute urinary retention in females?

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Urethritis/UTI
Meatal stenosis/stricture
Tumour
Urethral diverticulum
Urethral stone
Extrinsic compression - prolapsed uterus or pelvic mass

What are the appropriate size catheters for: men, women & haematuria?

Men: 12-14F Women: 14-16F Haematuria: 22-24F

What is the management of obstructive nephropathy?

- Admit - Monitor urine hourly - Replace urine volume with 1/2 volume 0.9% NaCl - Monitor UECs regularly - Replace magnesium & phosphate as required

What are the treatment options for AUR?

- Alpha-blocker & TOV - Surgery: TURP, laser, open - Long-term IDC

Differential diagnosis of a painless scrotal lump?

Hydrocoele, epididymal cyst, varicoele, benign tumour, idiopathic scrotal oedema, testicular cancer, lymphoma, inguinal hernia, ascites

What 3 serum markers might be elevated in testicular cancer?

- alpha-fetoprotein - beta-HCG - LDH

Which lymph nodes do the testicles drain to first?

Retroperitoneal lymph nodes (require CT abdomen & pelvis for staging)

What are the treatment options for testicular cancer?

- Inguinal orchidectomy - Chemotherapy (BEP) - Retroperitoneal lymph node dissection

What are the main investigations for suspected testicular cancer?

- Serum tumour markers | - Urgent scrotal U/S

What 2 places does testicular cancer commonly metastasize to first?

- Retroperitoneal lymph nodes | - Chest

What are the differentials for an acute scrotum?

- Testicular torsion - Trauma - Epididymo-orchitis - Testicular appendage torsion - Acute indirect inguinal hernia

What conditions can predispose to testicular torsion?

- Cryptorchidism | - Bell clapper deformity

What are the physical findings in testicular torsion?

- Tender, firm, high-riding testicle with a horizontal lie - Absent cremasteric reflex - Epididymis not posterior to testis

What are the common causative bacteria in epididymo-orchitis?

Men 35: E. coli & other GNBs

What are the risk factors for epididymo-orchitis?

- IDC - Chronic retention - Structural abnormality - Instrumentation

What are the physical examination findings in epididymo-orchitis?

- Swollen, tender testis - Fever - Hydrocoele

What investigations should be ordered in suspected epididymo-orchitis?

- U/S - to rule out torsion - Urinalysis & MSU - Urine/urethral swab for PCR

Which antibiotics should be used in epididymo-orchitis?

GNB coverage: trimethoprim, cephalexin, augmentin or norfloxacin for 2 weeks -give ampicillin & gentamicin via IV until afebrile STI coverage: ceftriaxone & azithromycin & doxycycline

What are the macroscopic & microscopic features of papillary bladder cancer in situ?

- Cytologically malignant cells - Lack of cohesiveness - Mucosal reddening, granularity or thickening

What conditions predispose to carcinoma of the bladder?

- Smoking - Industrial exposure to arylamines - Schistosomiasis - Long-term use of analgesics - Long-term exposure to cyclophosphamide

What are the histological features of a testicular seminoma?

Large cells with distinct borders, pale nuclei, prominent nucleoli & sparse lymphocytic infiltrate

What are the 3 broad classifications of testicular neoplasms?

- germ cell tumours - sex cord stromal tumours - lymphoma

What are common germ cell tumours of the testicles?

- Seminoma - Embryonal carcinoma - Yolk sac tumour - Choriocarcinoma - Teratoma - Mixed tumours

In which region of the prostate does hyperplasia typically arise?

Transitional zone

In which region of the prostate does carcinoma typically arise?

Peripheral zone

What does a Gleason score confer?

Degree of differentiation of cells (GRADE)

What are first-line antibiotics in uncomplicated UTI?

Trimethoprim (but NOT in pregnancy)

Genitourinary Flashcards

(50 cards)