1
Q
What are normal Post-void volumes?
A
Post-void volumes of <50 ml are considered physiological in patients aged < 65 years old.
Post-void volumes of < 100ml are considered physiological in patients aged > 65 years old
2
Q
What is the difference between high pressure and low pressure urinary retention?
A
High pressure retention
* impaired renal function and bilateral hydronephrosis
* typically due to bladder outflow obstruction
Low pressure retention
* normal renal function and no hydronephrosis
3
Q
How to confirm the diagnosis of urinary retention?
A
Bladder USS, A volume of >300 cc confirms the diagnosis
4
Q
Mass felt on the back of the testicle that is seperate from the testicle
A
Epididymal cysts
5
Q
what is the most common Scrotal swelling in primary care?
A
Epididymal cysts
6
Q
What is the management of Epididymal cysts ?
A
Management is usually supportive but surgical removal or sclerotherapy may be attempted for larger or symptomatic cysts.
7
Q
Soft, non-tender swelling of the hemi-scrotum.
Usually anterior to and below the testicle, can get above it on palpation
A
Hydrocele
8
Q
How do you diagnose a Hydrocele?
A
may be clinical but ultrasound is required
9
Q
How do you manage a Hydrocele?
A
- infantile hydroceles are generally repaired if they do not resolve spontaneously by the age of 1-2 years
- in adults a conservative approach may be taken depending on the severity of the presentation. Further investigation to exclude malignancy
10
Q
Mass that feels like bag of worms?
A
Varicocelle it does not tranluminate
11
Q
Which side is Varicocelle most common in?
A
more common on the left side (> 80%)
12
Q
How do you investigate Varicocelle?
A
Dopple USS
13
Q
How do you manage Varicocelle?
A
- usually conservative
- occasionally surgery is required if the patient is troubled by pain or semen is affected
14
Q
How often to test semen after asymptomatic Varicocelle?
A
Semen analysis every 1-2yrs
15
Q
What is the surgical treatment of Hydrocelle in adults?
A
Lords or Jabouley procedure.
16
Q
What is the most common malignancy in men 20-30 yrs?
A
Testicular Cancer
17
Q
Give an example of a non-germ cell tumour
A
Leydig cell tumours and sarcomas
18
Q
How can we further divide germ cell tumours?
A
- seminomas
- non-seminomas: including embryonal, yolk sac, teratoma and choriocarcinoma
19
Q
What are the main symptoms of testicular cancer?
A
- a painless lump- most common presenting symptom
- hydrocele
- gynaecomastia (due to increased oestrogen: androgen ration, high hCG will prompt oestrogen production from Leydig cell tumpurs)
rf is
infertility
cryptorchidism
family history
Klinefelter’s syndrome
mumps orchitis
20
Q
Which tumour marker is linked with seminomas?
A
hCG
21
Q
Which tumour marker is linked with non-seminomas?
A
AFP
22
Q
Which tumour marker is linked with germ cell tumours?
A
LDH
23
Q
What is the best investigation for testicular cancer?
A
USS
24
Q
What is the most common cause of Epididymo-orchitis in men under 35yrs?
A
gonorrhoea or chlamydia
25
What medication can cause Epididymo-orchitis?
Amiodarine
26
What is the management of Epididymo-orchitis?
if STI is suspected:
ceftriaxone 500mg intramuscularly single dose, plus doxycycline 100mg by mouth twice daily for 10-14 days
if enteric organism is suspected:
treating empirically with an oral quinolone for 2 weeks (e.g. ofloxacin)
send MSU as above
27
Acute sudden pain and cremesteric reflex is lost?
Testicular Torsion
28
Patient that presents with testicular torsion but has preserved Cremasteric reflex
Torsion of testicular appendage
29
What are the Lower Urinary Tract Symptoms (LUTS) in Benign Prostatic Hyperplasia?
Voiding symptoms (obstructive):
* weak or intermittent urinary flow
* straining
* hesitancy
* terminal dribbling
* incomplete emptying
Storage symptoms (irritative)
* urgency
* frequency
* urgency incontinence
* nocturia
Post-micturition
* dribbling
30
What is the management of Benign Prostatic Hyperplasia?
Watchful waiting
1.Alpha-1 antagonists e.g. tamsulosin, alfuzosin
* decrease smooth muscle tone of the prostate and bladder
* if persist after that then use an antimuscarinic (anti-cholinergic) drug tolterodine or darifenacin
2. 5 alpha-reductase inhibitors e.g. finasteride
* block the conversion of testosterone to dihydrotestosterone (DHT), which is known to induce BPH
* takes time and symptoms may not improve for 6 months
Surgery
o transurethral resection of prostate (TURP)
31
What is the most common type of Prostate Cancer?
Adenocarcinoma
32
What is the first line investigation for Prostate cancer what scale should be used?
Multiparametric MRI is now the first-line investigation for people with suspected clinically localised prostate cancer.
the results are reported using a 5 point Likert scale
* If the Likert scale is >=3 a multiparametric MRI-influenced prostate biopsy is offered
* If the Likert scale is 1-2 then NICE recommend discussing with the patient the pros and cons of having a biopsy.
33
What other things can raise PSA levels?
* benign prostatic hyperplasia (BPH)
* prostatitis and urinary tract infection (NICE recommend to postpone the PSA test for at least 1 month after treatment)
* ejaculation (ideally not in the previous 48 hours)
* vigorous exercise (ideally not in the previous 48 hours)
34
What is the most common type of renal cancer?
is clear cell (75 to 85 percent of tumours)
35
What are the presenting symptoms of renal cancer?
o classical triad:
* haematuria
* loin pain
* abdominal mass
o pyrexia of unknown origin
36
What is Stauffer syndrome?
paraneoplastic disorder associated with renal cell cancer
typically presents as cholestasis/hepatosplenomegaly
37
What medication can be used to decreased the size of Renal Cell Carcinoma?
**Alpha-interferon** and interleukin-2 have been used to reduce tumour size and also treat patients with metatases
**Receptor tyrosine kinase inhibitors** (e.g. sorafenib, sunitinib) have been shown to have superior efficacy compared to interferon-alpha
38
What is the best imaging for renal stone?
Non-contrast CT KUB
39
What is the pain management for renal stone?
NSAID as the analgesia of choice for renal colic
* if NSAIDs are contraindicated or not giving sufficient pain relief --> **IV paracetamol**
o if CKD or recent upper GI bleed
* the CKS guidelines suggest for patients who require admission: 'Administer a parenteral analgesic (such as **intramuscular diclofenac**) for **rapid relief** of severe pain'
**Alpha blockers**:
* promote smooth muscle relaxation and dilation of the ureter. potentially easing stone passage- for distal ureteric stones less than 10mm in size
40
How to manage Stone burden of less than 2cm in aggregate
Lithotripsy
41
How to manage stone burden of less than 2cm in pregnant females
Ureteroscopy
42
How to manage complex renal calculi and staghorn calculi?
Percutaneous nephrolithotomy
43
How to manage Ureteric calculi less than 5mm?
Manage expectantly
44
How to prevent calcium renal stones?
High fluid intake
Low animal protein, low salt diet (a low calcium diet has not been shown to be superior to a normocalcaemic diet)
Thiazides diuretics (increase distal tubular calcium resorption)
45
How to prevent Oxalate stones?
* cholestyramine reduces urinary oxalate secretion
* pyridoxine reduces urinary oxalate secretion
46
How to prevent Uric Acid stones?
*allopurinol
* urinary alkalinization e.g. oral bicarbonate
47
Most common type of renal stone?
Calcium oxalate
48
radio-opaque on xray?
Calcium oxalate
Calcium phosphate
49
radiodense renal stones
Cystine
50
Renal stones associated with malignancy?
Uric acid
51
Radiolucent renal stones?
Uric Acid
52
Renal stones associated with urease producing bacteria
Struvite
53
With what bacteria is Struvite stones associated with?
Proteus mirabilis
54
What are unilateral causes of Hydronephrosis?
PACT:
* Pelvic-ureteric obstruction (congenital or acquired)
* Aberrant renal vessels
* Calculi
* Tumours of renal pelvis
55
What are the causes of bilateral of hydronephrosis?
SUPER
* Stenosis of the urethra
* Urethral valve
* Prostatic enlargement
* Extensive bladder tumour
* Retro-peritoneal fibrosis
55
What is the best investigation for Hydronephrosis?
Ultrasound - first-line: identifies presence of hydronephrosis and can assess the kidneys
56
What is the best management of hydronephrosis?
* Remove the obstruction and drainage of urine
* Acute upper urinary tract obstruction: nephrostomy tube
* Chronic upper urinary tract obstruction: ureteric stent or a pyeloplasty
57
What are factors favoring an organic cause of erectile dysfunction?
Gradual onset of symptoms
Lack of tumescence
Normal libido
58
What are factors favoring a psychogenic factor of erectile dysfuntion?
Sudden onset of symptoms
Decreased libido
Good quality spontaneous or self-stimulated erections
Major life events
Problems or changes in a relationship
Previous psychological problems
History of premature ejaculation
59
What are the best investigations for Erectile Dysfunction?
1. Calculate 10-year cardiovascular risk by measuring lipid and fasting glucose serum levels.
2. Free testosterone should also be measured in the morning between 9 and 11am.
a. If low or borderline, it should be repeated along with FSH, LH and prolactin and if low then refer to endocrinology.
60
What is the best management of Erectile Dysfunction?
1. PDE-5 inhibitors (such as sildenafil, 'Viagra') have revolutionised the management of ED
a. they should be prescribed (in the absence of contraindications) to all patients regardless of aetiology (but can also be over the counter)
2. Vacuum erection devices are recommended as first-line treatment in those who can't/won't take a PDE-5 inhibitor.
61
How should you manage Nocturia ?
* advise about moderating fluid intake at night
* furosemide 40mg in late afternoon may be considered
* desmopressin may also be helpful
62
What testing needs to be done after Vasectomy to make sure a man can have uncprotected sex?
Semen analysis needs to be performed twice following a vasectomy before a man can have unprotected sex (usually at 12 weeks)
63
What is the most common cause of Acute bacterial prostatitis?
E.COLI
64
What is the management of Acute Bacterial Prostatitis?
* Clinical Knowledge Summaries currently recommend a 14-day course of a quinolone
* consider screening for sexually transmitted infections
65
What is TURP syndrome?
It is caused by irrigation with large volumes of glycine, which is hypo-osmolar and is systemically absorbed when prostatic venous sinuses are opened up during prostate resection.
This results in **hyponatremia**, and when glycine is broken down by the liver into ammonia**, hyper-ammonia and visual disturbances.**
66
# **
What are RF's for TURP syndrome?
* surgical time > 1 hr
* height of bag > 70cm
* resected > 60g
67
What is the best investigation for Urethral Injury?
Ascending urethrogram
68
What is the best management for Urethral Injury?
* suprapubic catheter (surgical placement, not percutaneously)
69
urinary retention, perineal haematoma, blood at the meatus
Bulbar rupture (urethral injury)
70
Penile or perineal oedema/ hematoma
Membranous rupture
71
What is the best investigation for Bladder Injury?
IVU or cystogram
72
What is the management of an Overactive Bladder?
* conservative measures include moderating fluid intake
* bladder retraining should be offered
* antimuscarinic drugs oxybutynin (immediate release), tolterodine (immediate release), or darifenacin (once daily preparation)
* mirabegron may be considered if first-line drugs fail or Botox Injection
73
How to manage Voiding Symptoms?
* conservative: pelvic floor muscle training, bladder training
* if 'moderate' or 'severe' symptoms offer an alpha-blocker
* 5-alpha reductase inhibitor if prostate is enlarged or high risk
* if enlarged prostate and 'moderate' or 'severe' symptoms both an alpha-blocker and 5-alpha reductase inhibitor
* if there are mixed symptoms of voiding and storage not responding to an alpha blocker then a antimuscarinic (anticholinergic) Oxybutynin drug may be added
74
Which cancer is linked with Schistosomiasis and Smoking?
squamous cell carcinoma of the bladder
75
What are the best investigations for Bladder cancer?
cystoscopy and biopsies or TURBT
76
What is the best management of Bladder Cancer?
* if superficial lesions then TURBT in isolation
* if with higher grade can offer intravesical chemotherapy
77
What is the most common type of bladder cancer and what are its RF's?
urothelial (transitional cell)
RF; smoking, exposure to aniline dyes
78
What is the best investigation for urethral stricture?
* uroflowmetry
* ultrasound postvoid residual (PVR) measurement
79
Have not done management of metastatic pratate cancer
80
Renal stones above 20mm and beloow
Renal stones > 20 mm should be managed using percutaneous nephrolithotomy
Flexible ureteroscopy is not the correct choice. This modality would be more appropriate for stones measuring 10-20mm, particularly when there are contraindications to shockwave lithotripsy, if previous shockwave lithotripsy has failed, or if there are anatomical challenges that reduce its effectiveness.
Shockwave lithotripsy is also incorrect. It tends to be more suitable for smaller renal stones ranging from 10-20mm in diameter.
shockwave lithotripsy is used in adults in a non-emergency setting where hydronephrosis and features of infection are not present.
81
patient presents with hydronephrosis and infection
Patients with hydronephrosis require immediate renal decompression via a nephrostomy tube to reduce the risk of permanent renal damage, and the need for this is increased if they are febrile or have other signs of infection due to the risk of sepsis.
82
How do you manage Decompression haematuria?
conservatively
83
When do you perform a partial nephrectomy?
1. tumour less than 7cm that is
2. completely confined to the kidney and **not invading the caps**
84
85
When should you use alpha blocker for symptomatic relief of renal stone?
distal ureteric stones less than 10 mm in size
86
Renal stones
watchful waiting if < 5mm and asymptomatic
5-10mm shockwave lithotripsy
10-20 mm shockwave lithotripsy OR ureteroscopy
> 20 mm percutaneous nephrolithotomy
Uretic stones
shockwave lithotripsy +/- alpha blockers>< 10mm shockwave lithotripsy +/- alpha blockers
10-20 mm ureteroscopy
87
What is the most common casue of organic erectile dysfunction
vascular causes are the most common
88
What is the management of testicular torsion?
Urgent bilateral orchodopexy
89
What is the cause of Epididymo-orchitis in individuals with a low STI risk ?
e/coli
90
How should you manage Acute upper urinary tract obstruction?
nephrostomy
91
What drugs can cause erectile dysfunction?
SSRI beta blocker
92
What score is used for prostate cancer and what score indicated malignancy ?
Prostate cancer is histologically graded using the Gleason score (see below). A score of 10 is consistent with a histologically aggressive form of the disease.
93
What type of lymphadenopathy is in testicular cancer?
Retroperitoneal lymphanedopathy not inguinal (if inguinal then it is bad prognostic feature)
94
Outline the imaging sequence if suspecting a testicular cancer
USS--> CT--> ORCHIDECRTOMY (INGUINAL DUE TO THE LYMPHATIC DRAINAGE)
95
How do you manage urothelial cancer?
Depends if the cacner has gone throught the MUSLEC or NOT
if it has then removal of the bladder and ILEAL CONDUCT
96
What are the appropriate investigations for epididimorochitis?
Investigations for suspected epididymo-orchitis are guided by age:
sexually active younger adults: NAAT for STIs
older adults with a low-risk sexual history: MSSU
97
What can cause a Sharp rise in creatinine following ACE inhibitor initiation
Renal artery stenosis
Year-6
flashcards
Decks in class (34)
# Cards
-
Gastroenterology vol1115
-
Gastroenterology vol2119
-
Rheumatology 170
-
Rheumatology COPY66
-
Orthopaedics74
-
Respiratory 180
-
Respiratory 2101
-
Cardiovascular116
-
Cardiovascular II95
-
Vascular + ENT126
-
NEUROLOGY 1110
-
NEUROLOGY 2104
-
Renal66
-
Renal COPY66
-
Urology98
-
Infectious Diseases 1107
-
Infectious Diseases 2109
-
Endocrinology149
-
Haematology99
-
Psychiatry44
-
Dermatology64
-
Dermatology vol 239
-
Obstetrics85
-
Contraceptive26
-
Breast16
-
Opthalmoscopy72
-
Geriatrics18
-
Palliative Care8
-
Anaesthesia29
-
Oncology24
-
Felicia70
-
sHAkIrA58
-
PSA25
-
Fluids6
