MSRA > Uro > Flashcards

Uro Flashcards

(101 cards)

Study These Flashcards
1
Q

Acute Prostatitis
Common pathogens:

A

E. coli (most common)
Pseudomonas
Klebsiella
Enterococcus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Investigations Acute Prostatitis

A

Urine dipstick and midstream sample for MCS
If acutely unwell: FBC, CRP, blood cultures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Management Acute Prostatitis

A

Admit if severely unwell/septic/abscess etc.
Consider urgent referral if immunocompromised/diabetic/urological condition
Antibiotics (14-day course):
1st line: Ciprofloxacin 500 mg BD
Alternative: Ofloxacin 200 mg BD
If contraindicated: Trimethoprim 200 mg BD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Man with fever, dysuria, perineal pain, tender boggy prostate on DRE
1st line treatment

A

Ciprofloxacin 500 mg BD for 14 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

(BPH) Investigations

A

PSA (can be mildly raised in BPH)
IPSS score:
0–7: mild
8–19: moderate
20–35: severe
Imaging (e.g. MRI) if diagnostic uncertainty or haematuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

IPSS score:

A

(BPH)
0–7: mild
8–19: moderate
20–35: severe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Management (BPH)

A

Voiding symptoms → 1st line: alpha-blocker (tamsulosin, alfuzosin)
Persistent symptoms despite alpha-blocker → Consider anticholinergic (e.g. oxybutynin)
Enlarged prostate → 1st line: 5-alpha-reductase inhibitor (finasteride, dutasteride)
Inhibit conversion of testosterone to DHT - reduces prostate volume
Surgical: TURP if refractory to medical therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Enlarged prostate →

A

NICE defines ‘enlarged’ referencing - estimated prostate > 30g / PSA > 1.4ng/ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Most common cancer in men

A

Prostate Cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

most common subtype Prostate Cancer

A

Acinar adenocarcinoma = most common subtype (peripheral zone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Risk Factors Prostate Cancer

A

age, African-Caribbean ethnicity, FHx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Erectile dysfunction - always check

A

Psa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Investigations Prostate Cancer

A

PSA
1st line imaging: MRI prostate
Biopsy: TRUS or transperineal
Staging: CT TAP ± PET

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Age (years) PSA Threshold (ng/mL)

A

< 40 Use clinical judgement
40–49 > 2.5
50–59 > 3.5
60–69 > 4.5
70–79 > 6.5
> 79 > 20, or > 7.5 with symptoms of metastatic disease (e.g. bone pain, fatigue, weight loss)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Management
Local disease
Prostate Cancer

A

Low-risk: active surveillance (PSA, MRI, biopsy)
Intermediate/high-risk:
Radical prostatectomy
Radiotherapy ± brachytherapy
SEs: ED, incontinence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Metastatic disease mx
Prostate Cancer

A

Androgen deprivation therapy (ADT)
Bicalutamide (anti-androgen)
Goserelin (GnRH analogue)
Chemotherapy if hormone refractory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Smooth prostate + LUTS + mild PSA rise →

A

Bph

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Nodular prostate + LUTS + PSA significantly raised →

A

cancer until proven otherwise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Back pain + LUTS + high PSA

A

Mets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Most common causes: Epididymo-orchitis

A

<35 years: STI (Chlamydia trachomatis, Neisseria gonorrhoeae)
Ceftriaxone + Doxycycline
>35 years: UTI pathogens (E. coli, Proteus, Klebsiella)
Ofloxacin or levofloxacin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

sudden pain, N&V, absent cremasteric reflex

A

Must exclude torsion:

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Investigations Epididymo-orchitis

A

First-pass urine NAAT for CT/NG
Urine dipstick ± MSU for culture
Consider STI screen and sexual health referral in <35 or at-risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Management Likely STI-related (age <35 or STI risk factors)
Epididymo-orchitis

A

Ceftriaxone 1g IM stat
Plus Doxycycline 100mg BD for 14 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

ManagementEpididymo-orchitis
Likely UTI/enteric cause (age >35 or recent catheter)

A

Ofloxacin 200mg BD for 14 days
or
Levofloxacin 500mg OD for 10 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Mixed risk (e.g. MSM, anal sex) ManagementEpididymo-orchitis
Ceftriaxone 1g IM stat Plus Ofloxacin 200mg BD for 10 days
26
Peyronie’s Disease pathophysiology
Fibrosis of the tunica albuginea → acquired penile curvature
27
Management Peyronie’s Disease
Sildenafil for ED Surgery to reduce curvature in persistent cases
28
Priapism pathophysiology
High-flow (non-ischaemic) – unregulated arterial inflow (e.g. trauma) Low-flow (ischaemic) – venous outflow obstruction (e.g. sickle cell)
29
Partial Rigidity
High-flow Trauma, spinal injury
30
Investigationsv Priapism
Corporal blood gas: High-flow: PO₂ > 9, CO₂ < 4.5 Low-flow: PO₂ < 3, CO₂ > 6, ↑ lactate
31
Management Priapism
Initial: Corporal aspiration, analgesia Phenylephrine intracavernosal injection Surgery: shunt formation if refractory
32
Paraphimosis
inability to pull forward a foreskin, that has already been retracted over the glans Once occurred, the paraphimosis reduces venous return from the distal penis and glans, resulting in progressive oedema - eventually can result in penile ischaemia and necrosis
33
Management Paraphimosis
Manual reduction after analgesia Surgical (dorsal slit or circumcision) if manual fails
34
Phimosis
Inability to retract foreskin Normal in young boys – usually resolves with age
35
Phimosis clinical Features
Ballooning of foreskin on micturition Spraying urine stream Pain during intercourse (adults)
36
PhimosisManagement
If persistent, trial topical steroids Circumcision if persistent/symptomatic
37
Soft, smooth mass separate from testis
Epididymal Cysts
38
Investigation Epididymal Cysts
USS
39
Hydrocele pathophysiology
Fluid accumulation within tunica vaginalis
40
Varicocele pathophysiology
Dilated pampiniform plexus → scrotal venous congestion 90% are left-sided
41
right-sided varicocele
RCC
42
Management Varicocele
Conservative unless symptomatic Surgical referral if painful or persistent Majority occur on the left. Therefore right-sided varicocele → suspect RCC Sudden onset or tense lying down → urgent referral
43
Painful sustained errection + sickle cell
low flow priapism = urological emergency
44
most common stone type (~85%).
Calcium oxalate
45
gold standard investigation. Renal Stones (Urolithiasis)
CT KUB (non-contrast)
46
Infected + obstructed kidney =
urological emergency → nephrostomy/stent.
47
Mg/NH₃/PO₄ – associated with Proteus
Struvite
48
Radiolucent stones
Uric acid Radiolucent – needs CT or US for detection
49
Risk Factors Drugs: Renal Stones (Urolithiasis)
Loop diuretics, acetazolamide, steroids, theophylline
50
Other Risk Factors Renal Stones (Urolithiasis)
Hypercalcaemia (e.g. hyperparathyroidism) Type 1 RTA, Cystinuria
51
Which drug is protective Renal Stones (Urolithiasis)
Thiazides are protective (↑ calcium reabsorption)
52
Management 🔹 Analgesia Renal Stones (Urolithiasis)
1st Line: NSAID (PR diclofenac often in exams)
53
Renal Stones (Urolithiasis) mx Medical Expulsive Therapy
Distal ureteric stones <10 mm → consider alpha blockers (e.g. tamsulosin)
54
Interventional Options 🧊 Renal Stones
<5 mm Watchful waiting <10 mm SWL 1st line 10–20 mm SWL or ureteroscopy >20 mm Percutaneous nephrolithotomy (PCNL)
55
Ureteric Stones Interventional Options
<10 mm SWL 1st line >10 mm Ureteroscopy
56
Contraindications to SWL
Pregnancy Coagulopathy or anticoagulant use
57
Infected + Obstructed Kidney
Urological emergency Urgent nephrostomy or stent insertion required
58
Renal Stones (Urolithiasis) prevention
If >50% calcium oxalate: Potassium citrate Thiazide diuretics
59
Radiolucent stone on AXR
uric acid → confirm with CT
60
<5 mm stone =
likely to pass on its own
61
recurrent Proteus UTI
Struvite stone =
62
Sudden pain + known single kidney
urgent CT KUB
63
Testicular salvage is possible within
4–6 hours;
64
bell-clapper deformity.
High risk for torsion horizontal lie, increased testicular mobility
65
Risk Factors torsion
Age: Neonates Adolescents (peak 12–24 years) Bell-clapper deformity – horizontal lie, increased testicular mobility Undescended testes
66
Negative Prehn’s sign (no relief with elevation)
Torsion
67
USS may be used if torsion is unlikely or equivocal:
Reduced/absent testicular blood flow Twisting of spermatic cord Reactive hydrocele
68
Management torsion
Emergency scrotal exploration in all suspected cases If testis is viable → Bilateral orchidopexy If non-viable → Orchidectomy (removal)
69
High-riding, horizontal testis + absent cremasteric reflex →
Torsion
70
RCC often presents with a classic triad
haematuria, flank pain, abdominal mass (but rarely all together).
71
diagnosis is clinical + USS, never biopsy.
Testicular cancer
72
high recurrence rate –
Bladder cancer has a high recurrence rate – follow-up is crucial.
73
strongly with HPV infection.
Penile cancer is rare but linked strongly with HPV infection.
74
Most common renal malignancy
(RCC) esp. clear cell subtype Origin: Proximal tubule
75
In rcc Left varicocele (due to
gonadal vein compression)
76
Rcc Paraneoplastic
Excess production of EPO – polycythaemia Parathyroid hormone excess – Hypercalcaemia Excess renin – Hypertension
77
Stauffer syndrome
hepatic dysfunction without metastasis - Hepatosplenomegaly and cholestasis Rcc
78
Investigations rcc
CT abdomen-pelvis (with contrast) – gold standard
79
Management rcc
Nephrectomy (partial or radical) Poor response to chemo; immunotherapy (IL-2, IFN-α) used in some cases
80
90%Bladder Cancer
Transitional cell carcinoma
81
RFs Bladder Cancer
Smoking, age, aromatic hydrocarbons (aniline dyes, rubbers), schistosomiasis
82
Investigations Bladder Cancer
Flexible cystoscopy 1st line TURBT (therapeutic + diagnostic)
83
Management Bladder Cancer
TURBT ± intravesical BCG/mitomycin Radical cystectomy for muscle-invasive disease
84
Testicular Cancer 95%
Germ cell tumours = 95% (seminomas & NSGCTs)
85
Investigations Testicular Cancer
Tumour markers: Seminomas: ↑ βHCG (20%), normal AFP NSGCTs: ↑ βHCG and/or AFP 1st line: USS testis CT-TAP No biopsy – risk of seeding
86
🧪 Penile Cancer most are
squamous cell carcinomas
87
🧪 Penile Cancer RFs: HPV (types
6, 16, 18
88
Investigations 🧪 Penile Cancer
Biopsy, PET, CT TAP
89
Management 🧪 Penile Cancer
Topical chemo (e.g. 5-FU) if superficial Surgical excision required in most cases
90
Referral Criteria Bladder Cancer
≥45 Unexplained visible haematuria, without urinary tract infection (UTI) ≥45 Visible haematuria that persists after treatment of UTI ≥60 Unexplained non-visible haematuria and either: ↑ white cell count or dysuria
91
Renal Cancer Referral Criteria
≥45 Unexplained visible haematuria, without UTI ≥45 Visible haematuria that persists after treatment of UTI
92
Prostate Cancer Referral Criteria
Any age PSA above age-specific threshold Any age Abnormal digital rectal examination (DRE) (e.g. craggy, hard, irregular prostate)
93
Testicular Cancer Referral Criteria
Any age Non-painful enlargement or change in shape/texture of testicle 2WW referral Any age Unexplained or persistent testicular symptoms Consider direct access USS
94
Penile Cancer Referral Criteria
Any age Penile mass or ulcer, STI excluded or persists after STI treatment Any age Unexplained symptoms affecting foreskin or glans
95
Cannonball mets on CXR = think
Rcc
96
βHCG + AFP raised =
NSGCT
97
Penile ulcer + HPV history =
SCC of the penis
98
Testicular cancer CFs: Age
20-40yrs
99
The first-line investigation following an abnormal PSA or suspicious DRE is
a multiparametric MRI of the prostate,
100
blue dot” sign on the scrotum
Torsion of the hydatid of Morgagni –
101
Haematuria 2WW guidelines
(1) Age 45+ with unexplained visible haematuria, without UTI (2) Age 45+ with visible haematuria which persists after treatment of UTI (3) Age 60+ with unexplained non-visible haematuria and either (a) elevated WCC or (b) dysuria
MSRA
flashcards
Decks in class (27)
# Cards
Brainscape helps you reach your goals faster, through stronger study habits.
© 2026 Bold Learning Solutions. Terms and Conditions