Which lower urinary tract symptoms fit under the following categories:
- Storage/ irritative
- Voiding/ Obstructive
FUND HIPS Storage/ irritative - Frequency - Urgency - Nocturia - Dysuria
Voiding/ obstructive
- Hesitancy
- Incomplete empyting
- Poor stream
- Straining
When does Benign prostatic hyperplasia cause pain?
What is found on DRE in BPH?
Which imaging technique is used for BPH?
- Pain caused in acute retention.
- DRE: smooth enlarged prostate with a palpable midline groove.
- USS urinary tact
What is the emergency treatment of BPH?
Give two medications used to treat BPH.
Give two surgical treatments for BPH:
- Emergency: catheterise
Medicines: - Alpha blocker: tamuslosin: relax smooth muscle of internal urinary sphincter.
- 5alpha- reductase inhibitor- finasteride: inhibits conversion of testosterone to dihydrotestosterone (more potent than testosterone)- decrease in prostate size.
Surgery - Transurethral resection of prostate (TURP). Open prostatectomy.
Give 3 symptoms of malignancy in prostate cancer
- Bone pain
- FLAWS
- Cord compression
- Paraneoplastic syndrome- e.g. hypercalcaemia.
What is found on DRE in prostate cancer?
What is the first line investigation for prostate cancer?
Give another investigation for prostate cancer.
- DRE: asymmetrical hard nodular prostate.
- MRI is first line investigation
- Transrectal Ultrasound-guided biopsy.
What type are most bladder cancers? What type are they rarely?
- Most bladder cancers are transitional cell carcinomas. Rarely squamous cell carcinoma
Give 5 risk factors for bladder cancer
- Chemical Industry: rubber/ textiles
- Pelvic irradiation
- Smoking
- Chronic UTIs
- Schistosomiasis.
What type of symptoms are experienced in bladder cancer?
- What urinary sign is indicative of bladder cancer
- Storage signs: FUND not HIPS
- Urinary sign: Painless Macroscopic Haematuria.
Give two appropriate investigations for bladder cancer.
- Cytoscopy with biopsy
- CT/ MRI for staging.
What is stress incontinence? Give 1 risk factor.
What is urge incontinence? What is it due to?
- Stress: physical movement/ activity (coughing/ laughing). Due to poor closure of bladder. Childbirth is a risk factor.
- Urge: urine leaks after sudden intense urge to urinate. Due to detrusor overactivity.
What is functional incontinence?
What is overflow incontinence?
- Functional: individual aware of need to urinate, unable to get to bathroom in time due to physical/ mental reasons.
- Overflow: Involuntary release of urine from overfull bladder, in absence of need to urinate.
Give 3 symptoms of nephrolithiasis (urinary tract stone)
What is the male to female ratio?
What is the most common type of stone.
- Severe loin to groin pain- patient writhing around in pain.
- Nausea
- Vomiting
3x more common in men. - Most common is calcium oxalate.
Give two metabolic causes of urinary tract stones
Give two risk factors for nephrolithiasis.
Metabolic: hypercalcaemia, hyperuricaemia.
Risk factors: low fluid intake, structural abnormalities in urinary tract.
What is the gold standard investigation for urinary tract stones?
- What can be seen on urine dipstick?
- Gold standard is CT-KUB.
- Urine: microscopic haematuria
What is the management of nephrolithiasis?
What defines an emergency in nephrolithiasis?
Management: Analgesia +
- <5mm: allow to pass spontaneously.
- > 5mm: surgery;
- Utereoscopic lithotripsy
- Extracorporeal shockwave lithotripsy
- Percutaneous nephrolithotomy: large complex stones.
Emergency: Signs of obstructed and infected kidney. Requires nephrostomy to relieve obstruction.
Give 3 signs/ symptoms of testicular torsion
- Sudden-onset sever hemiscrotal pain.
- Nausea and vomiting
- Swollen and erythematous scrotum
Differentials are strangulated hernia or epididymis-orchitis.
What is the management of testicular torsion
- Exploratory surgery within 6 hours.
- Both testicles are fixed in place
- Nephrotic tissue may need removal
- Duplex ultrasound
What is the definition of hydrocoele?
Which groups of men does it affect?
Give 3 causes other than idiopathic?
- Definition: collection of serous fluid in tunica vaginalis.
- Boys <1, older men
- Trauma, tumour, infection
Give 4 signs/ symptoms of hydrocoele
- Asymptomatic swelling
- Can get above swelling
- Transilluminates- unlike varicocoele
- Swelling cannot be separated from testicle.
Give 3 investigations for hydrocoele
- Ultrasound to exclude tumour
- Testicular tumour markers
- Urine dipstick/ MSU- check for infection
What is the definition of varicocoele? Which side is it more common on?
- Defintion: dilated veins of pampiniform plexus- forms scrotal mass. Associated with infertility.
- More common on left (80-90%)
Give 3 symptoms/ signs of varicocoele.
- Usually asymptomatic
- Scrotum feels like a bag of worms
- Swelling may reduce when lying down.
not transluminable
What age range is epidiydmitis and orchitis most common in?
What two pathogens are the cause for <35s.
Which group of pathogens are cause for >35s.
- 20-30
- <35: chlamydia and gonorrhoea
- > 35: Coliforms e.g. enterobacter, Klebsiella.
Others are mumps and candida.
Give 3 symptoms/ signs of epididymitis and orchitis
Give 2 clinical signs for epididymitis and orchitis
- Painful, swollen and tender testis/ epididymitis- less acute than testicular torsion.
- Penile discharge (if STI)
- Fever
Cremaster reflex
Phren sign
-
Upper GI61
-
Lower GI32
-
Cardiac causes of SOB43
-
Acute Resp18
-
Acute abdomen41
-
Breast25
-
Cranial Nerves and Ophthalmology47
-
Renal45
-
Urology28
-
Endo 145
-
Arthritides30
-
Resp 2: Chronic SOB36
-
Causes of clubbing4
-
Dermatology29
-
Chest pain23
-
Acute medicine19
-
Infectious diseases 124
-
Adrenals36
-
Infectious diseases 228
-
Anaemia29
-
Valvular and HTN20
-
Headaches23
-
Autoimmune21
-
Chronic Neuro29
-
Biliary and liver disease21
-
Haematology and Oncology25
-
Calcium metabolism15
-
Acute Neurology31
-
Vascular25
-
Cough (Resp. 3)19
-
A. Sam 1-423
