1
Q
What is the most common histological type of bladder cancer?
A
Transitional-cell carcinoma (90-95%)
Transitional-cell carcinoma is the predominant type of bladder cancer.
2
Q
What percentage of bladder cancers are squamous-cell carcinoma?
A
~ 3%
Squamous-cell carcinoma has a wide geographic presentation, particularly in areas with high rates of schistosomiasis.
3
Q
What is the treatment for adenocarcinoma of the bladder?
A
Surgical – radical cystectomy
Adenocarcinoma accounts for about 2% of bladder cancers and is not chemosensitive or radiosensitive.
4
Q
What is the characteristic feature of urachal carcinoma?
A
Massive mucous secretion
Urachal carcinoma is most commonly associated with the bladder dome.
5
Q
What is the typical treatment for squamous cell carcinoma (SCC) of the bladder?
A
Surgical – radical cystectomy
SCC accounts for about 5% of bladder cancers and is not chemosensitive or radiosensitive.
6
Q
What type of bladder cancer is characterized as aggressive and has a 20% five-year survival rate?
A
Carcinosarcoma
Carcinosarcoma is not chemosensitive or radiosensitive.
7
Q
True or False: Small cell, neuroendocrine bladder cancer is chemosensitive.
A
True
It is treated with neo-adjuvant chemotherapy and cystectomy if it responds.
8
Q
What is the most common site for partial cystectomy?
A
Dome of the bladder
Partial cystectomy is done when invasive tumors can be removed with a margin of normal mucosa.
9
Q
What is field cancerization?
A
Whole urothelium exposed to carcinogen
This leads to multiple genetically unrelated tumors.
10
Q
Which investigation is 100% positive for CIS?
A
Urine cytology
Urine cytology is most useful in cases where CIS is suspected and cystoscopy may appear normal.
11
Q
What are the treatment options for bladder cancer?
A
- TURBT
- Radical cystectomy
- Partial cystectomy
- Neo-adjuvant/Adjuvant Chemotherapy
- Definitive Chemo-Radiotherapy
These options depend on the type and stage of bladder cancer.
12
Q
What does TURBT stand for?
A
Transurethral Resection of Bladder Tumors
This procedure involves examining the bladder under anesthesia and removing tumors.
13
Q
What is the purpose of neo-adjuvant chemotherapy?
A
- In-vivo drug sensitivity testing
- Shrinks down tumor for easier surgery
- Addresses micro-metastatic disease early
Neo-adjuvant chemotherapy is given before surgery to improve outcomes.
14
Q
Fill in the blank: The chemotherapy regimen MVAC includes Methotrexate, Vinblastine, Doxorubicin, and _______.
A
Cisplatin
MVAC is a common chemotherapy regimen used in bladder cancer.
15
Q
What is a common complication following radical cystectomy?
A
- Urinary Leakage
- Lymphatic Leakage
- Recurrent UTI
- Ureteric stricture
- Bladder neck stenosis
These complications can occur early or late after surgery.
16
Q
What are the clinical features of bladder cancer?
A
- Hematuria (80-90%)
- Urinary symptoms (frequency, urgency, nocturia)
- Pain (less common)
Hematuria is often the most significant symptom, but can vary in presentation.
17
Q
What risk factors are associated with bladder cancer?
A
- Age
- Gender
- Race
- Cigarette smoking
- Environmental carcinogens
- Chronic UTIs
These factors significantly increase the risk of developing bladder cancer.
18
Q
What is the male to female ratio for bladder cancer incidence?
A
3:1
Bladder cancer is more common in men than women.
19
Q
What percentage of bladder cancers are small-cell carcinoma?
A
<1%
Small-cell carcinoma is rare compared to other types of bladder cancer.
20
Q
What is the recommended follow-up for patients after TURBT?
A
Lifelong cystoscopy
Follow-up frequency typically starts at every three months.
21
Q
What is a common clinical presentation of localized prostate cancer?
A
Asymptomatic with elevated PSA, abnormal DRE findings, lower urinary tract symptoms, hematuria, voiding discomfort, and hematospermia
DRE: Digital Rectal Examination
22
Q
What symptoms may indicate locally advanced prostate cancer?
A
Asymptomatic features of localized PC, symptoms of renal failure from urinary obstruction, malignant priapism, and rectal obstruction
23
Q
What are common symptoms of metastatic prostate cancer?
A
Lower limb swelling from lymphatic obstruction, anorexia, weight loss, bone pain, pathological fracture, anemia, jaundice, coagulopathy
24
Q
What abnormal findings can be noted during a DRE?
A
Nodule, asymmetry, hard consistency, fixed craggy mass
25
What percentage of abnormal DRE findings are associated with prostate cancer?
Approximately 50%
26
What is the chance of predicting prostate cancer with an abnormal DRE in the presence of a normal PSA?
30%
27
What is PSA and what does it do?
A 34KD glycoprotein enzyme produced by prostate epithelial cells that liquefies ejaculate and is present in both benign and malignant disease
28
What is the percentage of complexed or bound PSA compared to free PSA?
Complexed PSA: 75%, Free PSA: 25%
29
What are age-specific PSA levels for men aged 40-49?
<2.5 ng/ml
30
What is the normal PSA velocity rate of rise per year?
<0.75 ng/ml
31
What are some causes of elevated PSA levels?
* BPH
* Urethral instrumentation
* DRE
* Prostatic infarct
* Prostatitis
* Prostate biopsy
32
What imaging techniques are used for prostate cancer diagnosis?
* Abdominopelvic USS
* KUB+P+PVR
* Transrectal Ultrasound
* TRUSS guided biopsy
* Multiparametric MRI
* Radionucleotide Bone Scan
33
What are common complications of prostate cancer?
* Anemia
* Spinal cord metastasis
* Visceral metastasis
* Urinary retention
* UTI
* Renal failure
* Lymphoedema
* Constipation
* Mortality
34
What are the management options for localized prostate cancer?
* Watchful waiting
* Active surveillance
* Radical prostatectomy
* Radical external beam radiotherapy
* Brachytherapy
35
What is the Gleason grading system used for?
To grade adenocarcinoma based on gland forming differentiation
36
What does a Gleason score of 2-4 indicate?
Well-differentiated
37
What does a Gleason score of 8-10 indicate?
Poorly differentiated
38
What are the main sites of local spread for prostate cancer?
* Urethral sphincter
* Corpora of the penis
* Seminal vesicles
* Bladder trigone
* Distal ureters
39
What are the most frequent sites of metastasis for prostate cancer?
* Internal iliac lymph nodes
* Bones
40
What percentage of bone metastases from prostate cancer are sclerotic?
85%
41
What is the most commonly affected area by prostate cancer metastasis?
Axial skeleton: spine, ribs, pelvis
42
What are the characteristics of prostate cancer primarily seen in pathology?
Greater than 95% are adenocarcinomas; basal cells are absent and the basement membrane is breached by malignant cells
43
What hormonal factors influence the risk of prostate cancer?
Testosterone and dihydrotestosterone
44
What age group shows a rising prevalence of prostate cancer?
From 29% in the 5th decade to 67% in the 9th decade
45
What is a rare cause of prostate cancer before age 50?
Rare before age 50
46
What is the role of family history in prostate cancer risk?
5% inherited with genetic abnormalities on specific chromosomes
47
What is chronic dialysis?
A long-term treatment for kidney failure.
48
List three risk factors associated with kidney cancer.
* Obesity
* Hypertension
* Tobacco use
49
What type of exposure is linked to kidney cancer?
* Trichloroethylene
* Cadmium
* Asbestos
* Arsenic
* Phenacetin
50
Which genetic condition is associated with clear cell RCC?
VHL gene
51
What gene is linked to type 1 papillary RCC?
c-Met gene
52
Which gene is associated with type 2 papillary RCC?
Fumarate hydratase gene
53
What genetic condition is linked to chromophobe RCC?
Birt-Hogg-Dube (BHD) gene
54
What is the classic triad of kidney cancer symptoms?
* Flank pain
* Gross hematuria
* Abdominal mass
55
What percentage of patients with kidney cancer experience paraneoplastic syndrome?
20%
56
What is the incidence of kidney cancer in the western world?
3% of all adult malignancies
57
What is the term for the observation of small localized tumors in elderly patients?
Active surveillance
58
What are the types of nephrectomy used in kidney cancer treatment?
* Partial nephrectomy
* Radical nephrectomy
* Palliative/cytoreductive tumor nephrectomy
59
What types of therapy are used for kidney cancer treatment?
* Immunotherapy
* Anti-angiogenesis agents
* Chemotherapy
* Radiotherapy
60
What is the Robson TNM classification used for?
Staging kidney cancer
61
List one type of benign renal neoplasm.
* Benign renal cyst
62
What is the medical term for renal cell carcinoma?
RCC
63
True or False: Chemotherapy and radiotherapy have a very poor response in kidney cancer treatment.
True
64
What is the significance of the multi-drug resistance gene in kidney cancer?
It contributes to treatment resistance.
65
Fill in the blank: The __________ is a benign renal neoplasm characterized by the proliferation of blood vessels and smooth muscle.
Angiomyolipoma
66
What is the role of gene therapy in kidney cancer?
It is a potential future treatment option.
67
What is the typical follow-up procedure for kidney cancer patients?
Regular monitoring for recurrence or progression.
68
What is male infertility defined as?
Failure to conceive after 12 months of adequate cohabitation
69
What percentage of barren marriages are attributed to male infertility?
40%
70
What are the common causes of male infertility?
* Disorders of testes
* Endocrine abnormalities
* Genetic factors
* Anatomical abnormalities
* Systemic illnesses
* Environmental factors
* Social habits
71
What is the commonest cause of surgically correctable male infertility?
Varicocele
72
What are some examples of congenital abnormalities that can cause male infertility?
* Kallman’s syndrome
* Cystic fibrosis
* Cryptorchidism
73
What is the lower reference limit for semen volume?
1.4 ml
74
What is the minimum sperm concentration considered normal?
16 million per ml
75
What are the parameters included in seminal fluid analysis?
* Semen volume
* Total sperm number
* Sperm concentration
* Progressive motility
* Sperm morphology
* Vitality
76
What hormonal evaluations are important in the investigation of male infertility?
* FSH
* LH
* Testosterone
* Prolactin
* Oestrogen
77
Fill in the blank: Azoospermia can be _______ or non-obstructive.
obstructive
78
What imaging studies may be performed in the investigation of male infertility?
* Doppler USS of the scrotum
* MRI for pituitary pathology
79
What is the purpose of a post-coital test?
To assess sperm function and interaction with cervical mucus
80
What are some management options for male infertility?
* Counseling
* Surgical intervention
* Assisted reproductive techniques (ARTs)
81
What is vaso-vasotomy?
A surgical procedure to reconnect the vas deferens
82
What are common risk factors associated with male infertility?
* Cigarette smoking
* Alcohol intake
* Occupational exposure to hazardous chemicals
83
What is the significance of the 5th percentile in semen analysis?
It helps establish lower reference limits for various semen parameters
84
True or False: Gynecomastia can be a clinical feature of male infertility.
True
85
What is the recommended abstinence period before seminal fluid analysis?
3 days
86
What are the potential effects of systemic illnesses like sickle cell disease on male fertility?
They can cause infertility due to complications affecting testicular function
87
Fill in the blank: The presence/absence of the _______ is examined during a physical examination for male infertility.
testes
88
What types of sperm abnormalities can lead to infertility?
* Azoospermia
* Oligospermia
* Asthenozoospermia
* Teratozoospermia
89
What are some psychological considerations in the management of male infertility?
* Counseling for emotional support
* Discussing the impact on relationships
90
What is the potential role of immunological disorders in male infertility?
Autoantibodies can affect sperm function and viability
91
What are the common surgical procedures for addressing male infertility?
* Vaso-vasotomy
* Epididimo-vasotomy
* Microsurgical anastomosis
92
What are the two corporeal bodies of the penis involved in erection?
Corpora cavernosa and corpus spongiosum
93
What physiological process causes erection?
Smooth muscle relaxation and increased arterial flow into the corpora cavernosa causing engorgement
94
In priapism, what happens to venous outflow tracts?
Engorgement of the corpora cavernosa compresses the venous outflow tracts, trapping blood
95
What characterizes low flow or ischaemic priapism?
Blockage of draining venules and paralysis of the intrinsic detumescence mechanism
96
What is the cause of high flow or arterial priapism?
Uncontrolled arterial inflow from a fistula between the cavernosal artery and the corpus cavernosum
97
True or False: Penile pain is present in ischaemic priapism.
True
98
What are the clinical features of non-ischaemic priapism?
No full rigidity, no penile pain, sometimes haemotological abnormalities
99
What should be assessed during the history taking for priapism?
Duration of erection, events surrounding onset, duration of pain, similar prior episodes, medical history
100
What medical history is relevant for priapism?
Sickle cell disease, medication use, history of malignancy, recent urologic surgery
101
What physical examination findings are consistent with low flow priapism?
Rigid erection, ischaemic corpora, dark blood upon corporeal aspiration, no evidence of trauma
102
What investigations are performed in cases of priapism?
Full blood count, penile blood gas, urine toxicology, penile duplex doppler ultrasonography, pelvic angiography
103
What is a pre-hospital treatment for priapism?
Ice packs to the perineum and penis, external perineal compression, walking upstairs
104
What is the first-line treatment for low-flow priapism in the hospital?
Intracavernosal phenylephrine
105
What should be done if initial aspiration of the corpus cavernosum reveals bright red blood?
Consider an arterial cause for priapism and treat as high-flow cases
106
What are potential treatments for high-flow priapism?
Observation, compression therapy, selective angiography with embolization, surgical ligation
107
What complications can arise from priapism?
Erectile dysfunction, penile gangrene
108
What is the definition of priapism?
An involuntary, prolonged erection often unrelated to sexual stimulation, lasting more than 4 hours
109
List the types of priapism.
* Ischaemic (low flow, venous)
* Non-ischaemic (high flow, arterial)
* Stuttering priapism
110
What are some causes of ischaemic priapism?
* Haemoglobinopathies (e.g. sickle cell anaemia)
* Hypercoagulable states
* Vasoactive medications
* Neoplastic processes
* Illicit drug use
111
What causes non-ischaemic priapism?
* Direct trauma or injury
* Iatrogenic injury during surgical interventions
* Congenital arterial malformations
112
What is the most common type of trauma associated with ureteral injury?
External trauma
## Footnote
Rarely occurs compared to other types of trauma
113
What classification system is used for ureteral injuries?
American Association for the Surgery of Trauma classification
## Footnote
Grades I to V
114
What does Grade I ureteral injury indicate?
Haematoma only
115
What does Grade II ureteral injury indicate?
Laceration < 50% of circumference
116
What does Grade III ureteral injury indicate?
Laceration > 50% of circumference
117
What does Grade IV ureteral injury indicate?
Complete tear < 2 cm of devascularization
118
What does Grade V ureteral injury indicate?
Complete tear > 2 cm of devascularization
119
What percentage of blunt trauma cases show haematuria?
55 – 75%
120
What is a common diagnostic method for ureteral injury?
IVU, CT scan, Retrograde Ureterography, antegrade ureterography
121
What percentage of bladder injuries are associated with pelvic fractures?
83 – 100%
122
What imaging technique is used for bladder injuries?
Retrograde cystography
123
What grade indicates a bladder contusion?
Grade 1
124
What grade indicates an extraperitoneal rupture of <2cm?
Grade 2
125
What grade indicates an intraperitoneal rupture >2cm?
Grade 4
126
What is the treatment for an extraperitoneal rupture?
Catheter drainage alone
127
What is a potential complication of bladder neck involvement?
Open surgical repair
128
What is the most common cause of anterior urethral injuries?
Fall astride
129
What type of trauma is associated with posterior urethral injuries?
RTA, pelvic fracture
130
What is the AAST classification of urethral injuries?
Grades I to V
131
What does a Grade I urethral injury indicate?
Contusion with blood at the urethral meatus
132
What does a Grade IV urethral injury indicate?
Complete disruption with < 2 cm of urethral separation
133
What is a common sign of urethral injury?
Blood at the external urethral meatus
134
What is the preferred management for urethral injuries?
Avoid passing a urethral catheter
135
What is the most common type of renal injury?
Blunt trauma
136
What percentage of renal injuries are classified as Grade I & II?
85%
137
What is the diagnosis method for renal injury?
CT abdomen with contrast
138
What is the treatment approach for renal injuries?
Non-operative in 95% of cases
139
What are potential complications of renal injury?
Haemorrhage, urinoma, perinephric abscess, renal loss
140
What is a non-contrast CT scan used for?
Imaging to detect urinary stones and other abnormalities
## Footnote
Non-contrast CT scans are particularly useful in urology for diagnosing stones due to their high sensitivity.
141
What does IVU stand for?
Intravenous Urogram
## Footnote
An imaging technique used to visualize the urinary tract.
142
What does KUB stand for in medical imaging?
Kidneys, Ureters, and Bladder plain x-ray
## Footnote
A basic x-ray used to assess the urinary system.
143
What does USS stand for?
Ultrasound Scan
## Footnote
A non-invasive imaging technique often used for assessing kidneys and urinary tract.
144
What is a retrograde ureteropyelogram?
An imaging technique where contrast is injected into the ureters to visualize the urinary tract
## Footnote
Useful for identifying obstructions or abnormalities.
145
What is nuclear scintigraphy?
A diagnostic imaging technique that uses radioactive materials to visualize organ function
## Footnote
Often used to assess kidney function.
146
What components are measured in a 24-hour urinary excretion test?
* Calcium
* Uric acid
* Oxalate
* Citrate
* Sodium
* Volume
* pH
* Clearance
## Footnote
This test helps in evaluating metabolic causes of stone formation.
147
What are common clinical presentations of urinary stone disease?
* Pain
* Haematuria
* Recurrent infection
* UTI
* Pyonephrosis
* Fever
* Nausea, vomiting
## Footnote
These symptoms can indicate the presence of stones or complications.
148
At what cystine concentration does super saturation occur?
> 250 mg/L
## Footnote
Cystine solubility increases as pH rises from 6.5 to 7.5.
149
What is the hallmark of treatment for cystine stones?
Water, water, and more water
## Footnote
Hydration is crucial for managing cystine stones.
150
Cystine stones only develop in patients with _______.
[cystinuria]
## Footnote
Cystinuria is an autosomal recessive disorder that leads to increased cystine in urine.
151
What are the treatment options for urinary stones?
* Spontaneous passage
* ESWL
* Ureteroscopy + lithotripsy
* Percutaneous nephrolithotomy
* Open stone surgery
## Footnote
Treatment choice depends on stone size, location, and patient condition.
152
What are indications for ESWL?
* Renal and ureteric calculi < 2cm
* Certain professional situations (e.g., pilots, military)
* Solitary kidneys at risk of anuria
* Patients with renal insufficiency
## Footnote
ESWL is a non-invasive procedure to break stones using shock waves.
153
What are common complications of urinary stones?
* Recurrent UTI
* Hematuria
* Bladder tumors (squamous type)
* Colic
* Steinstrasse
* Skin bruising
* Urosepsis
## Footnote
Complications can arise from both the stones and their treatment.
154
What is a staghorn calculus?
A stone that occupies most of the renal pelvis and extends to at least 2 primary calyces
## Footnote
Typically associated with struvite stones.
155
Struvite stones form due to _______.
[chronic upper urinary tract infection]
## Footnote
They are often caused by urease-producing organisms.
156
What is the optimal 24-hour urine uric acid level?
600 mg/d or less
## Footnote
Levels above this can predispose to uric acid stone formation.
157
What dietary factor increases the risk of oxalate stones?
Ingestion of large amounts of Vitamin C (> 2 gram/day)
## Footnote
High vitamin C intake can lead to increased oxalate absorption.
158
What is hypocitraturia?
A common metabolic defect that predisposes to stone formation
## Footnote
Citrate is an important inhibitor of stone formation.
159
What does Randall plaque refer to?
Deposition of stone material on a renal papillary calcium phosphate nidus
## Footnote
It is a precursor to stone formation.
160
What are the components of stones?
* Crystals
* Matrix (protein component)
* Urinary ions (Ca, oxalate, phosphate, uric acid, sodium, citrate, magnesium, sulphate)
## Footnote
Understanding stone composition is crucial for treatment and prevention.
161
What is the most common metabolic abnormality associated with stone disease?
Hypercalciuria
## Footnote
It can be classified into absorptive, resorptive, and renal-leak categories.
162
What is the role of magnesium in stone formation?
Magnesium is a recognized inhibitor of stone formation
## Footnote
Its clinical role in therapy is still under investigation.
163
What is a common prenatal diagnosis tool for PUJ obstruction?
Ultrasound scan
## Footnote
Other diagnostic tools include IVU, MRI, and radionuclear renography.
164
List the clinical features of Pelvi-ureteric junction obstruction.
* Asymptomatic
* Flank mass
* Failure to thrive
* Sepsis from recurrent UTI
* Flank pain
* Haematuria
* Calculus formation
* Nausea / vomiting
165
What is the surgical treatment for PUJ obstruction?
Pyeloplasty
166
What are anomalies of the ureters?
* Lateral ectopia
* Ectopic ureters
* Duplication
* Ureterocele
* Megaureter
* Vesicoureteric reflux
167
What characterizes Prune-belly syndrome?
* Absence or hypoplasia of abdominal musculature
* Large hypotonic bladder
* Dilated tortuous ureters
* Bilateral cryptorchidism
168
What are the anomalies of number in kidneys?
* Agenesis (Bilateral and Unilateral)
* Supernumerary kidney
169
What are the anomalies of ascent in kidneys?
* Simple ectopia
* Cephalad ectopia
* Thoracic kidney
170
What are the anomalies of volume and structure in kidneys?
* Hypoplasia
* Multicystic kidney
* Polycystic kidney (Infantile and Adult)
* Other cystic disease
* Medullary cystic disease
171
What are the anomalies of rotation in kidneys?
* Incomplete
* Excessive
* Reverse
172
What are the clinical features of Posterior Urethral Valves?
* Prenatal diagnosis
* Postnatal diagnosis
* Other problems: Glomerular filtration, Renal tubular function, Hydronephrosis, VUR, Vesical dysfunction
173
True or False: Surgery is the only treatment for hypospadia.
True
174
What are the classifications of hypospadia based on urethral opening?
* Glanular
* Coronal
* Subcoronal
* Penile (Distal, mid, and proximal penile)
* Peno-scrotal
* Scrotal
* Perineal
175
What are common factors in mothers that increase the risk of hypospadia in the baby?
* Obesity
* Age over 35 years
* Use of fertility treatment
* Exposure to pesticides
* Smoking
176
Fill in the blank: The constant feature of hypospadia is __________.
ventral urethral opening
177
What are potential complications of hypospadia surgery?
* Fistula
* Stricture
* Meatal stenosis
* Breakdown of repair
178
What are anomalies of renal vasculature?
* Aberrant, accessory, or multiple vessels
* Renal artery aneurysm
* Arteriovenous fistula
179
What are anomalies of the collecting system?
* Calyx and infundibulum anomalies
* Hydrocalyx
* Megacalycosis
* Unipapillary kidney
* Extrarenal calyces
* Anomalous calyx
180
What is the characteristic of a horseshoe kidney?
Fusion of the kidneys at the lower poles
181
What is a common hereditary kidney disease associated with epilepsy and mental retardation?
Tuberous sclerosis
182
What is the aetiology of Pelvi-ureteric junction obstruction?
* Intrinsic factors (e.g., valvular mucosal folds)
* Extrinsic factors (e.g., aberrant vessels, tumors)
183
What is the significance of Young's Classification?
It classifies the severity and types of Posterior Urethral Valves
184
What are common urologic disorders?
Urinary tract infections, Urolithiasis, Benign Prostatic Hyperplasia, Cancer of the prostate, Urethral Stricture
## Footnote
These conditions are frequently encountered in urology.
185
What are the signs and symptoms of urethritis?
Urethral discharge, burning on urination, asymptomatic
## Footnote
Distinction between gonococcal and nongonococcal urethritis.
186
How is urethritis diagnosed?
Incubation period, urethral swab, serum: Chlamydia-specific ribosomal RNA
## Footnote
Incubation periods vary: 3-10 days for gonococcal vs. 1-5 weeks for nongonococcal.
187
What are the acute and chronic presentations of epididymitis?
Acute: pain, swelling of the epididymis <6 weeks; Chronic: long-standing pain, usually no swelling
## Footnote
Diagnosis differentiates between epididymitis and torsion using ultrasound.
188
What symptoms are associated with prostatitis?
Dysuria, frequency, dysfunctional voiding, perineal pain, painful ejaculation
## Footnote
Prostatitis can be acute bacterial or chronic.
189
What are the signs and symptoms of cystitis?
Dysuria, frequency, urgency, voiding of small urine volumes, suprapubic/lower abdominal pain, ± hematuria
## Footnote
Diagnosis includes dip-stick urinalysis and urine culture.
190
What is pyelonephritis?
Inflammation of the kidney and renal pelvis
## Footnote
Symptoms include chills, fever, flank pain, GI symptoms, and dysuria.
191
What are common causes of pyelonephritis?
Gram-negative sepsis, Enterobacteriaceae (E. coli), Enterococcus
## Footnote
Urine culture is positive in 80% of cases.
192
What are risk factors for urolithiasis?
Genetics, age (20s-40s), sex (male > female), geography, climate, water intake, diet, occupation
## Footnote
Recurrence rate for urolithiasis is 50% at 10 years.
193
What is the most common type of kidney stone?
Calcium stones (75%)
## Footnote
Other types include uric acid stones, cystine stones, and struvite stones.
194
What are the signs and symptoms of urolithiasis?
Renal or ureteric colic, frequency, dysuria, hematuria, GI symptoms (N/V, ileus, diarrhea)
## Footnote
Differential diagnoses include gastroenteritis, acute appendicitis, and colitis.
195
What is the management of urolithiasis?
Conservative: hydration, analgesia, antiemetic; stones <5mm have >90% spontaneous passage
## Footnote
Indications for admission include renal impairment and refractory pain.
196
What are the treatment options for benign prostatic hyperplasia (BPH)?
Medical therapy (α-Adrenergic blockers, androgen suppression), surgical options (TURP, laser ablation, open prostatectomy)
## Footnote
Common medications include Tamsulosin, Finasteride, and Doxazosin.
197
What is prostate cancer?
Carcinoma of the prostate gland that may spread to bones and lymph nodes
## Footnote
Risk factors include obesity, age, family history, and elevated testosterone levels.
198
What are the symptoms of prostate cancer?
LUTS, blood in urine, dysuria, pelvic pain, lymphedema, renal insufficiency
## Footnote
Evaluation includes DRE, PSA, biopsy, MRI, and CT scans.
199
What are the treatment options for prostate cancer?
Radical prostatectomy, radiotherapy (external beam, brachytherapy), hormone therapy, chemotherapy
## Footnote
Hormone therapy includes LH-RH antagonists and agonists.
200
What is a urethral stricture?
A scar in or around the urethra that blocks urine flow, resulting from inflammation, injury, or infection
## Footnote
More common in men due to longer urethras.
201
What are the common causes of urethral stricture?
Trauma to the urethra, infections, instrumentation damage
## Footnote
Includes straddle injuries and trauma from catheterization.
202
What are the symptoms of urethral stricture?
LUTS, painful urination, slow urine stream, decreased urine output, urinary tract infections
## Footnote
Symptoms can lead to serious complications if untreated.
203
What diagnostic tests are used for urethral stricture?
Detailed history, physical examination, urethral imaging, retrograde urethrogram (RUG)
## Footnote
RUG combined with antegrade urethrogram (MCUG) helps determine stricture length.
204
What are the treatment options for urethral stricture disease?
Urethral dilatation, urethrotomy, urethroplasty
## Footnote
Treatment choice depends on stricture length, location, and scar tissue.
205
What are potential complications of urethral stricture?
Renal failure, urinary tract infections, hernia, epididymitis/orchitis
## Footnote
Complications can arise from untreated strictures.
206
What is the definition of varicose veins according to the Oxford Medical Dictionary?
Distended, lengthened, and tortuous veins
## Footnote
No universally accepted standard definition exists for varicose veins.
207
What percentage of the adult population has minor manifestations of varicose veins according to the CALLAM review?
50% of the adult population
## Footnote
This includes 50-55% women and 40-50% men.
208
What are the main risk factors for developing varicose veins?
* Age
* Sex
* Family history (FOXC2 gene)
* Pregnancy
* Obesity
* Menopause
* Pelvic vein reflux
* Chronic alcohol consumption
* Hyperhomocysteinemia
209
What is the 'vicious cycle' concept in the pathophysiology of varicose veins?
Pooled blood → venous hypertension → venous dilatation → valvular insufficiency
210
What does CEAP classification stand for in varicose veins classification?
* C0 = no visible/palpable signs of venous disease
* C1 = telangiectasia or reticular veins
* C2 = varicose veins
* C3 = C2 + edema
* C4a = C2 + pigmentation/eczema
* C4b = C2 + lipodermatosclerosis
* C5 = healed venous ulcer
* C6 = active venous ulcer
211
What are common clinical presentations of varicose veins?
* Pain/tenderness along the course of a vein
* Bursting pain worsened by standing
* Improved by ambulation or limb elevation
* Pruritus
* Burning sensation
* Leg heaviness/restless legs
* Night cramps
* Paraesthesia
212
What is the Tredelenburg test used for in the examination of varicose veins?
To assess for superficial vein incompetence
213
Fill in the blank: The principal problem in varicose veins pathophysiology is vein wall _______.
weakness
214
What are the indications for conservative treatment of varicose veins?
* Pregnancy
* Elderly
* Very ill patients
* Rejection of other modalities
215
What are some medical treatments for varicose veins?
* Chemical sclerosants
* Laser therapy
* Intense pulsed light therapy
* Radio-frequency ablation
216
What complications can arise from venous stripping?
* Hematoma
* Damage to adjacent tissue
* Pain
* Revascularisation
217
True or False: The 'Converse Hypothesis' suggests that the principal problem in varicose veins is incompetence in the valves.
False
218
What is the purpose of the Perthes test in the context of varicose veins?
To evaluate the deep venous system for incompetence
219
What is the primary goal of surgical treatment for varicose veins?
To remove or occlude the affected veins
220
What is the role of Doppler/duplex scan in the investigation of varicose veins?
To assess blood flow and venous structure
221
Fill in the blank: The 'multiple tourniquet test' helps to observe venous filling and site of filling in the _______ system.
venous
222
What are the two techniques used in venous stripping?
* Extraluminal collision technique (Myer's)
* Invagination technique (Codman's)
223
What is a common treatment for varicose veins that utilizes radiofrequency waves?
Radiofrequency ablation
224
What type of veins are primarily treated with endovenous laser therapy?
Superficial veins, particularly the great saphenous vein (GSV) with superficial incompetence
225
What is one of the complications associated with subfascial ligation?
Identification of incompetent supramalleolar perforators
226
What is the significance of the 5th century B.C. in the context of varicose veins?
Galen and Hippocrates described the diagnosis and treatment modalities still used today
227
What are some potential complications of varicose veins?
* Variceal bleeding
* New-onset dermatitis
* Thrombophlebitis
* Cellulitis
* Ulceration
228
What is manual detorsion?
A technique involving elevating the testis toward the ipsilateral inguinal ring, stabilizing the cranial portion of the spermatic cord, and rotating the testis laterally.
229
What indicates a successful manual detorsion?
Lengthening of the spermatic cord and immediate relief of pain.
230
What should be performed prior to discharging a patient after manual detorsion?
Surgical exploration and testicular fixation.
231
How can the success of manual detorsion be assessed?
With Doppler sonography and resolution of symptoms.
232
What is extravaginal torsion?
A type of testicular torsion that occurs exclusively in perinatal life, where the entire cord including the tunica vaginalis becomes twisted.
233
What are the symptoms of extravaginal torsion?
Painless scrotal swelling and a firm mass in the scrotum.
234
What is intravaginal torsion?
Occurs when there is an abnormally high fixation of the tunica vaginalis to the spermatic cord, allowing for twisting within the tunica vaginalis.
235
What is mesorchial torsion?
A rare type of testicular torsion that occurs when the tissue around the spermatic cord twists.
236
What are the signs of testicular torsion?
* Affected testis is at a higher level (Demings sign) * Normal testis lying horizontally (Angel's sign) * Pain not relieved on elevation of scrotum (Prehn's sign) * Absent cremasteric reflex on the affected side.
237
What are common clinical features of testicular torsion?
* Sudden severe pain in hemi-scrotum * Swelling * Nausea and vomiting * Abdominal pain * Testicle position changes * Discoloration * Fever * Testicular tenderness.
238
What methods are used for diagnosing testicular torsion?
* Clinical evaluation * Color Doppler ultrasonography * Urinalysis.
239
What is the TWIST score?
A scoring system designed to assess the likelihood of testicular torsion based on five criteria: testicular swelling, hard testis, absent cremasteric reflex, nausea or vomiting, and high-riding testis.
240
What is the risk categorization based on the TWIST score?
* Low risk: 0-2 * Intermediate risk: 3-4 * High risk: 5-7.
241
What is the definitive management of testicular torsion?
Surgical detorsion followed by orchiopexy or orchiectomy.
242
What should be advised to patients after surgery for testicular torsion?
Avoid strenuous activity or exercise for some time.
243
What is compensatory hypertrophy?
When the remaining testicle grows larger than normal after one is removed.
244
What is bell clapper deformity?
A congenital condition causing the testicles to hang loosely in the scrotum, increasing the likelihood of torsion.
245
What causes bell clapper deformity?
Failure of normal posterior anchoring of the gubernaculum, epididymis, and testis to the scrotum.
246
What are the risk factors for testicular torsion?
* Underlying bell clapper deformity * Undescended testicle * Long spermatic cord * Trauma * Prior intermittent torsion.
247
What is the average yearly incidence of testicular torsion in 'at risk' men?
2.7 cases per 100,000.
248
Which age group is most commonly affected by testicular torsion?
Young adults, particularly below 25 years.
249
What is the surgical approach for detorsion in testicular torsion?
Through a midline longitudinal or bilateral transverse scrotal incision.
250
What is the testicular salvage rate if surgery is performed within 6 hours?
100%.
251
What is the testicular salvage rate if surgery is delayed beyond 24 hours?
20%.
MBBS Revision
flashcards
Decks in class (13)
# Cards
-
SURGERY - General900
-
SURGERY - Pediatrics140
-
SURGERY - Urology251
-
SURGERY - NEURO177
-
SURGERY - Trauma149
-
SURGERY - Cardiothoracic298
-
COBES - Epidemiology & Biostatistics129
-
COBES - Communicable & Non-Communicable Dx210
-
MEDICINE - Cardiology407
-
MEDICINE - Nephrology643
-
MEDICINE - Gastroenterology16
-
MEDICINE - Rheumatology403
-
MEDICINE - Neurology706
