Finals revision > Urology > Flashcards

Urology Flashcards

(106 cards)

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1
Q

What is nephrolithiasis?

A

Kidney stones

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2
Q

Presentation of acute nephrolithiasis?

A

Loin to groin pain
Flank tenderness (renal angle)
Haematuria

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3
Q

Risk factors for kidney stones?

A

Dehydration
Diet (↑protein, ↑salt)
FHx/PHx
Repeated UTIs
Drugs - steroids, chemo, loop diuretics
Anatomical abnormalities
Endocrine disorders

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4
Q

Which drugs can increase the risk of kidney stones (3)?

A

Loop diuretics
Chemotherapy
Steroids

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5
Q

What are the most common sites of kidney stone obstruction?

A

Renal pelvis
Pelvic brim
Vesico-ureteric junction

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6
Q

Which are the most common type of kidney stones?

A

Calcium:
Calcium oxalate
Calcium phosphate
Mixture of the two

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7
Q

What are the different types of kidney stones?

A

Calcium
Struvite (ammonia, magnesium, phosphate)
Uric acid
Cystine

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8
Q

What is the characteristic look of struvite kidney stones?

A

‘Staghorn calculi’

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9
Q

Which kidney stones are radio-opaque/radio-lucent (4)?

A

Calcium (oxalate/phosphate) - opaque
Struvite - opaque
Urate - radio-lucent
Cystine - semi-opaque

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10
Q

Investigations for suspected kidney stones?

A

Urine dip/MCS
Bloods
CT KUB
CT Urogram (if urology requets)

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11
Q

What is are preferred analagesia in kidney stones?

A

NSAIDs - Diclofenac
IV Paracetamol

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12
Q

When is watchful waiting 1st line in kidney stones?

A

If <5mm and asymptomatic

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13
Q

How are renal stones bigger than 5mm managed?

A

5-10mm shockwave lithotripsy
10-20 mm shockwave lithotripsy OR ureteroscopy
> 20 mm percutaneous nephrolithotomy

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14
Q

How are ureteric stones managed?

A

< 10mm shockwave lithotripsy +/- alpha blockers
10-20 mm ureteroscopy

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15
Q

Why are alpha blockers sometimes used in kidney stones?

A

↑ smooth muscle relaxation and dilation of the ureter
Easier passing of stones

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16
Q

Which kidney stones are most associated with chemotherapy?

A

Urate stones - due to breakdown of tumour releasing uric acid

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17
Q

Which kidney stones are linked to inherited disorders?

A

Cystine stones linked to inherited metabolic disorders

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18
Q

What are some of the risk factors for bladder cancer (9)?

A

Smoking
Dyes/chemicals (aromatic amines)
Schistosomiasis
Age
Obesity
Male gender
Fhx
Bladder calculi
Long-term catheter

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19
Q

What is the most common type of bladder cancer?

A

Transitional cell carcinoma

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20
Q

Which type of bladder cancer does schistosomiasis cause?

A

Squamous cell carcinoma

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21
Q

What is the presentation of bladder cancer?

A

Painless haematuria
Recurrent UTIs
LUTS (voiding/obstructive sx)

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22
Q

What is gold stander for diagnosis of bladder cancer?

A

Cystoscopy + biopsy

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23
Q

What are the T staging for bladder cancer (broadly)?

A

T1 = mucosa only (in situ)
T2/3 = muscle invasion (high grade)
T4 = invades past bladder

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24
Q

What are treatment options for bladder cancer?

A

Transurethral resection of bladder tumour (TURBT)
Intravesical chemotherapy
Intravesical BCG
Radical cystectomy

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25
What are some presenting features of a UTI?
Dysuria Frequency Urgency Incontinence Cloudy/foul smelling urine Confusion
26
Which features differentiate lower UTI from upper UTI?
Cystitis = suprapubic pain Pyelonephritis = loin pain, fever, N+V
27
Risk factors for UTI?
Female Sexual intercourse Pregnancy Diabetes Dehydration Incomplete emptying Structural abnormality Catheter
28
Investigations for UTI?
Urine dip Urine MC&S Bloods - FBC, CRP, U&Es USS KUB
29
What is the most specific indication of a UTI on urine dip?
Nitrites
30
When should urine dip **NOT** be used?
In patients >65yrs = straight for MCS
31
When should urine be sent for MCS (5)?
Women aged >65 Recurrent UTI Pregnant women Men Visible/non-visible haematuria
32
Abx choice for LUTI in non-pregnant women?
Nitrofurantoin or Trimethoprim 3 days
33
Abx choice for LUTI in pregnant women?
1st = Nitrofurantoin 7d (NOT DURING 3RD TRI) 2nd = amoxicillin or cefalexin 7d
34
Abx choice for LUTI in men?
Nitrofurantoin or trimethoprim 7 days
35
What are the most common causative organisms in UTIs?
E. coli
36
Which antibiotic should be avoided in UTIs if the patient has eGFR <45?
Nitrofurantoin
37
Which antibiotic should be avoided in UTIs in pregnant women?
Trimethoprim = teratogenic
38
How is pyelonephritis managed?
Consider for admission Analgesia Broad spec cephalosporin or quinolone
39
Risk factors for prostate cancer?
Age Fhx Black ethnicity Anabolic steroids
40
Possible presenting features of prostate cancer?
May be asymptomatic LUTS Haematuria Erectile dysfunction Bone pain if metastatic
41
Investigations for prostate cancer (4)?
DRE Trans rectal USS +/- biopsy MRI/CT for staging PSA (limited usefulness)
42
What are some possible causes of raised PSA aside from prostate cancer (6)?
BPH Prostatitis UTI Ejaculation (within 48hr) Vigorous exercise (within 48 hours) Urinary retention
43
When is prostate biopsy indicated?
When MRI findings are Likert 3 or above
44
Management options for prostate cancer (5)?
Surveillance/watchful waiting Radiotherapy Hormone therapy Surgery Brachytherapy
45
What is urge incontinence caused by?
Overactivity of detrusor muscle (AKA overactive bladder)
46
What are the symptoms of urge incontinence?
Urgency - followed by uncontrollable drops Frequency Nocturia
47
Risk factors for urge incontinence (7)?
Diuretics UTIs Caffeine Alcohol ↑Fluid intake Constipation Neurogenic - MS, PD, stroke
48
Management of urge incontinence?
Bladder retraining for 6w Meds Botilinum toxin A
49
Pharmacological management of urge incontinence?
Antimuscarinics e.g. Oxybutynin Tolterodine Solifenacin Mirabegron (beta-3-agonist)
50
What is stress incontinence caused by?
Weak pelvic floor
51
Symptoms of stress incontinence?
Leakage on ↑intra abdominal pressure e.g. Sneezing Coughing Laughing Straining
52
Risk factors for stress incontinence?
Pregnancy (+ long deliveries) Obesity Age Vaginal prolapse Hysterectomy
53
Management of stress incontinence?
Weight loss Pelvic floor exercises Meds Surgery
54
Pharmacological management of stress incontinence?
Duloxetine (↑sphincter activity)
55
What is the cause of overflow incontinence (bladder)?
Bladder outlet obstruction e.g. prostate enlargement, constipation Or detrusor muscle failure e.g. neurological
56
Overflow urinary incontinence symptoms?
Leakage without urgency
57
Management of overflow incontinence?
Treat underlying cause Lifestyle Intermittent self-catheterisation
58
Testicular cancer age demographic?
20-30s
59
Types of testicular cancer?
Seminomas Non-seminomas
60
Risk factors for testicular cancer (5)?
Undescended testes Male infertility Fhx Increased height Mumps orchitis
61
Classic presenting features of testicular cancer?
Painless lump: Hard Irregular Non fluctuant No transillumination Rarely presents with pain Gynaecomastia
62
Investigations for suspected testicular cancer?
Scrotal ultrasound Tumour markers
63
Which tumour markers tested in suspected testicular cancer (3)?
AFP Beta-hCG LDH
64
Management of testicular cancer?
Orchidectomy Chemo/radio depending on type Sperm banking
65
Possible side effects of testicular cancer treatment?
Infertility Hypogonadism Peripheral neuropathy
66
Symptoms of BPH?
LUTS: Hesitancy Weak flow Urgency Frequency Intermittency Straining Terminal dribbling Nocturia Incomplete emptying
67
Investigations for suspected BPH?
Urine dip DRE Abdo exam PSA
68
Medical management of BPH?
Alpha-blockers e.g. tamsulosin (relax smooth muscle) 5-alpha reductase inhibitors e.g. finasteride (reduce size)
69
Surgical management options for BPH?
Transurethral resection (TURP) Open prostatectomy
70
Common side effects of tamsulosin (4)?
Postural hypotension Dizziness Dry mouth Depression
71
Common side effect of finasteride?
Erectile dysfunction Reduced libido Gynaecomastia
72
Presentation of epididymo-orchitis?
Unilateral testicular pain Swelling Dragging or heavy sensation Tenderness on palpation Pain relief on elevation +/- systemic sx of infection
73
What are some possible bacterial causes of epididymo-orchitis (5)?
E coli Chlamydia Gonorrhoea Mumps TB
74
Management of epididymo-orchitis?
Analgesia Antibiotics Scrotal support Abstain from intercourse
75
What is twisted in testicular torsion?
Spermatic cord
76
Presentation of testicular torsion?
Acute rapid onset Unilateral testicular pain Abdominal pain +/- vomiting
77
What is found on examination in testicular torsion?
Swollen, tender, elevated testicle Absent cremasteric reflex Elevation does not ease pain (Prehn's sign)
78
Management of testicular torsion?
Urgent surgical exploration Detorsion Both testis fixed (orchiopexy)
79
What is seen on scrotal USS in testicular torsion?
Whirlpool sign
80
What are some possible causes of hydonephrosis?
Ureteric stones Tumours Stenosis of urethra Prostate enlargement Bladder tumour Retroperitoneal fibrosis
81
Investigation in suspected hydronephrosis?
USS CTKUB
82
Management of hydronephrosis?
Relieve obstruction and drain urine Stent or nephrostomy
83
Symptoms of urethritis?
Dysuria +/- urethral discharge
84
Common causes of urethritis?
Chlamydia Mycoplasma genitalium
85
Management of urethritis?
PO doxycycline for 7d OR STAT PO azithromycin
86
What is a hydrocele?
Collection of fluid within the tunica vaginalis
87
Clinical features of a hydrocele?
Soft, non-tender swelling (around one of testes) Transilluminates +ve Confined to scrotum (can get above it)
88
Management of a hydrocele?
Usually resolve spontaneously in 1-2yrs In adults - USS to exclude underlying cause
89
What is a varicocele?
Abnormal enlargement of testicular veins
90
Clinical features of a varicocele?
Throbbing/dull pain Dragging sensation 'Bag of worms'
91
Management of varicocele?
Usually conservative Surgery if pt troubled by pain
92
Most common causative organism in acute bacterial prostatitis?
E. coli
93
Clinical presenting features of prostatitis (5)?
Pelvic pain LUTs Sexual dysfunction Pain w/ bowel movements Tender/enlarged prostate
94
Risk factors for bacterial prostatitis (4)?
Recent UTI Urogenital instrumentation Catheterisation Recent prostate biopsy
95
Investigations in suspected prostatitis?
Urine dip Urine MC&S STI testing
96
Management of bacterial prostatitis?
PO abx (quinolone) Analgesia
97
Features of an epididymal cyst?
Soft, round lump Separate to body of testicle Top of testicle May be able to transilluminate
98
How can epididymal cysts be diagnosed?
USS
99
Features of renal colic?
Loin to groin pain Flank pain Severe In waves
100
Risk factors for renal cell cancer (5)?
Middle-aged men Smoking HTN Obesity Tuberous sclerosis
101
Classic triad of renal cell cancer (+ other features)?
Haematuria Loin pain Abdo mass PUO Varicocele Paraneoplastic syndrome sx
102
Management of renal cell cancer?
Partial or total nephrectomy
103
Which zone of the prostate is primarily affected in prostate cancer?
Peripheral zone
104
First-line investigation in suspected prostate cancer?
Multiparametric MRI
105
What score is used in porstate cancer?
Gleason score
106
How is gleason score calculated?
The two most common tumour patterns across all samples are graded based on their differentiation
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