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159 Cards in this Set
- Front
- Back
Briefly describe motor nerve supply of the bladder. Also name the neurotransmitters which are involved and their effect on normal bladder function. |
Parasympathetic: S2-4 supplies detrusor via pelvic nerves, acetylcholine is the neurotransmitter and it causes contraction of the detrusor
Sympathetic: T10-L2 supplies detrusor via hypogastric and pelvic plexuses, noradrenaline acts on the beta receptors causing relaxation of detrusor T10-L2 supplies smooth muscle in bladder neck and proximal sphincter, noradrenaline acts on alpha adrenergic receptors causing contraction of the sphincter
Somatic: S2-3 supplies distal sphincter via nervi ergentes, it also supplies peri-urethral striated loop via pedundal nerve |
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Name the types of medication that has an effect on the bladder |
1. Anti-cholinergics - Inhibits Detrusor contraction 2. Alpha receptor agonists - Causes bladder neck and proximal sphincter contraction |
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Briefly describe the sensory nerve supply to the bladder |
Run in spinal column through sympathetic and parasympathetic fibres to the cerebral cortex and micturition centre in pons |
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Name the commonest underlying causes of urinary retention |
1. BPH 2. Prostatic carcinoma 3. Urethral stricture 4. Severe haematuria 5. Bladder stone |
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Name the possible causes which precipitate acute urinary retention in a patient who already ahs some benign prostatic hyperplasia. Also describe briefly the mechanism by which these conditions can precipitate retention |
Prostatitis - Swelling of prostate Drugs - Alpha receptor agonists/anticholinergics Alcohol - Diuresis = overextended bladder Constipation - Share same nerve supply as bladder Cardiac failure - Congestion of pelvic veins Post-operatively - Anaesthetics, IV fluid |
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Describe the differences in the clinical picture of a cute and chronic urinary retention. |
Acute: Painful, tender bladder accompanied by urgent need to urinate
Chronic: No urgency, pain or tenderness felt. |
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What is overflow incontinence ? |
constant dribbling incontinence in the presence of a full bladder
OR
Bladder is full due to retention, therefore any small amount of urine entering the bladder causes overflow leading to excretion of that small amount of urine |
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Name the obstructive and irritative LUTS. |
Obstructive: W - Waiting to micturate H - Hesitancy I - Intermittency T - Terminal incontinence E - Emptying incompletely S - Straining and weak Stream
Irritative: F - Frequency U - Urgency N - Nocturia D - Dysuria S - Straining |
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What are the specific or unique complications of catheterisation in a patient with chronic urinary retention ? |
Post-obstructive diuresis, which results in severe dehydration causing hypovolaemic shock and ultimately death |
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What are the indications for a patient with chronic retention to be catheterized ? |
UTI's Incontinence Renal failure |
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What is a suprapubic cystostomy ? |
An opening or outlet is made in the bladder using a suprapubic stab catheter or with open surgical insertion |
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What are the contraindications to insert a suprapubic catheter ? |
Small bladder Empty bladder Previous lower abdominal surgery Macroscopic haematuria |
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What is the most important, absolute requirement which must be met before a suprapubic stab catheter is inserted ? |
A palpable percussable full bladder |
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What are the complications of a suprapubic stab catheter ? |
Bowel injury Bleeding from skin Haematuria Recurrence of retention |
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How often does a transurethral silicone catheter have to be replaced ? |
every 3 months |
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Name three important practical points about the technique for the insertion of a transurethral catheter in a man. |
Sterile technique Adequate lubricant Make sure catheter is in bladder before inflating the balloon |
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Name 4 complications of BPH |
Chronic retention Overflow incontinence Infection Kidney failure Hydronephrosis Haematuria |
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Name the possible options in the treatment of a patient with BPH and give an example of each. |
Medical treatment - Alpha-adrenergic blockers 5-Alpha-reductase inhibitors
Surgical treatment- Transurethral resection of the prostate (TURP) Prostatectomy |
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Name the indications of surgical treatment for BPH |
Chronic or recurrent urinary retention UTI Epididymo-orchitis Overflow incontinence Bladder calculi Bladder wall changes Recurrent haematuria Failed medical treatment |
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Name the possible complications of trans-urehtral resection of the prostate (TURS) |
TUR-syndrome Blood loss Septicaemia Epididymo-orchitis Retention Incontinence Urethral stricture Retrograde ejaculation Impotence |
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Name 2 factors that are important in the development of BPH |
Age Androgens |
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Name the enzyme which is therapeutically blocked during treatment of BPH |
5-alpha-reductase |
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Briefly describe what TURP is |
Tranurethral resection of the prostate - With a resectoscope and electrodiatherapy, the peri-urethiral part of the prostate is cut away in small pieces, chips are washed into the bladder by irrigation fluid, then out of the bladder with an Elik evacuator |
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From which part of the prostate does BPH rise |
The transitional zone |
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Name the different causes of urethral strictures in men |
Infection Iatrogenic Trauma Congenital Malignancies |
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Name the complications of urethral strictures in males |
bladder wall changes Fistula formation Peri-urethral abscess formation Bladder stones Urinary retention Infection Hydro-ureteronephrosis Infertility Haematuria Squamous cell carcinoma of the bladder |
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Name the infective complications that can arise in men with a urethral stricture |
Cystitis Prostatitis Epididymitis Epididymorchitis Necrotizing Fascitis |
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How can the diagnosis of a urehtral stricture be confirmed ? |
Catheterisation Antegrade urethrogram retrograde urethrogram Urethroscopy |
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What are the options of urethral stricture treatment ? |
They are surgical: Urethroplasty Internal urethrotomy (Sachse's Procedure) Dilatation |
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Name the possible complications of dilatation or optical internal urethrotomy (Sachse's procedure) |
Urethral bleeding False passage Septicaemia recurrence of stricture Rectal perforation |
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Name 5 types of incontinence |
1. Stress urinary incontinence 2. Urge incontinence 3. Overflow incontinence 4. Paradoxical incontinence 5. Total urinary incontinence |
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Define primary nocturnal enuresis |
No daytime symptoms of bed-wetting and has never had a dry period for longer than 6 months |
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Which child with enuresis does not need any special investigations ? |
A child with primary nocturnal enuresis with normal special investigations and a normal examination |
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How can a child with monosymptomatic, primary enuresis be treated ? |
General measures (such as education) Enuresis alarm (most effective) Pharmacotherapy- Imipramine Desmopressing Anti-cholinergics |
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Name the possible causes of enuresis in children or adults |
Developmental delay Inadequate ADH release Reduced bladder capacity Psychological problems Sleep disorders |
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What is the so called overactive bladder ? |
This is where normal nocturnal surge of ADH secretion does not occur leading to increased urine production at night |
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Name common conditions that may cause a neurogenic bladder |
Cardiovascular Acident Brain tumour Concussion Dementia Spinal cord injury Diabetes Mellitus Hepres infection |
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Which imaging investigations should be performed after an acute UTI in children ? |
Ultrasond IVP |
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Name the clinical signs and symtpoms of acute pyelonephritis |
Fever Rigors Pain Vomiting Tachycardia |
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Name the 2 route of infection which can lead to pyelonephritis and name the most common causative organism |
Haematogenous - Staphylococcus aureus Ascending - E. coli |
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Which organism causing UTI's may be associated with alkaline urine and formation of bladder or renal calculi ? |
Proteus |
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Which urinary tract factors will predispose a patient to urinary tract infections ? |
Obstrucion of upper tracts Dilated blood vessels Bladder outflow obstruction Foreign bodies Instrumentation Trauma to urinary tract |
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Name 4 clinical observations that can help you to differentiate between a upper and lower UTI |
A lower UTI would present in the following manner: Not systemically unwell Low grade fever Haematuira Irritative LUTS |
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What is the typical finding on examination of the urine in a patient with tuberculosis of the urinary tract ? |
Acid and sterile pyuria |
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Name the possible causes of a sterile pyuria |
TB UTI which has already been treated with AB Stones in urinary tract Papillary necrosis Bladder cancer |
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Name the features of urinary tract TB on an IVP. |
Papillary necrosis Cavities in renal medulla Moth eaten calyces Infundibular stenosis Blunting of calyces Distended calyces Ureter strictures |
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Briefly describe the life cycle of the bilharzia parasite which involves the urinary tract in the humans |
Worm - Ova - Meracidia - Sporocysts - Cercariae |
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What is the treatment for active Bilharzia of the urinary tract ? |
Praziquantel |
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Name the complications of bilharzia with regards to the urogenital system |
Squamous cell carcinoma of the bladder Ureteric strictures Vesico-ureteric reflux Fibrosis and calcification of bladder and genital tract |
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List 2 hormones that are secreted by the foetal testes |
Testosterone MIF |
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When does the testis normally descend into the scrotum |
28-32 weeks gestation |
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What does the term cryptorchidism mean ? |
Undescended testes |
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What is the difference between undescended, absent, ectopic and retractile testes ? |
Undescended - Stuck somewhere in path of normal decent Absent - There are no testes Ectopic - Testes are in a place that is not in the normal path of decent Retractile - Testes are pulled up out of the scrotum do to overactive cremasteric muscle |
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What are the complications of undescended testes ? |
Infertility Malignancy Inguinal hernia Psychological problems |
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What are the treatment options in undescended testes ? |
Orchidopexy Hormonal treatment |
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What is the difference between hypospadias and epispadia ? |
Hypo - Opening of meatus of urethra is on the ventral side of penis Epi - Opening of meatus of urethra is on the dorsal side of the penis |
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List the characteristics of hypospadias |
Chordee of the penis Dorsal hood of skin Ventral opening of urehtral meatus |
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What is chordee |
Ventral curvature of penile shaft |
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Why should circumcision not be performed on a patient with hypospadias ? |
The dorsal hood is necessary for surgical repair thereof |
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What is the defining characteristic of true hermaphroditism ? |
Baby has both testicular and ovarian tissue |
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What is the underlying abnormality or cause of female pseudohermaphroditism ? Why may babies with this condition die shortly after birth ? |
Due to Congenital Adrenal Hyperplasia, death due to deficiency of cortisol |
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What are the possible causes of male pseudohermaphroditism ? |
Decrease in testosterone synthesis Deceased androgen receptor sensitivity Deficiency of 5-alpha-reductase enzyme |
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Define phimosis |
Inability of the foreskin to retract over the glans of the penis |
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List the causes of phimosis |
Recurrent balantitis Recurrent dermatitis Repeated forcible retraction of baby's foreskin Foreskin is too tight to be pulled back over the glans |
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List the indications of circumcision |
True phimosis Paraphimosis Recurrent balantitis Genital warts affecting the foreskin Carcinoma of the foreskin Religous reasons Cultural reasons |
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Define paraphimosis |
Tight foreskin is retracted behind the glans and then cannot be reduced
|
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Define balanitis |
Infection or inflammation of the glans of the penis |
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Define Balano-posthitis |
Infection of the glans and the foreskin of the penis
|
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Define circumcision |
Surgical removal of the foreskin |
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What are the advantages of circumcision ? |
Lower incidence of UTI's Lower incidence of malignancy Lower incidence of STD transmission Easier hygiene |
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What are the complications of circumcision ? |
Injury to the glans Removal of too much skin Injury to the urethra Bleeding Decreased sensation of the glans Infection |
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Name the most common causes of painless scrotal swelling |
Hudrovoele Spermatocoele Varicocoele Inguinal hernia Testicular tumour Chronic epididymitis |
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What is the underlying abnormality in a congenital hydrocoele ? |
A patent processus vaginalis |
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Tabulate the differences in a hydrocoele and an inguinal hernia |
Hydrocoele: Cannot be reduced No cough impulse Dull to percussion No bowel sounds over it Swelling stops at superficial inguinal ring
Hernia: Can be reduced Cough impulse Resonant on percussion Bowel sounds heard Swelling extends through inguinal canal |
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Name the possible reasons why a hydrocoele is sometimes not transilluminable |
1. Turbid fluid 2. Thickened wall 3. Scrotal skin too pigmented 4. Loculated 5. Light source not bright enough 6. Room not dark enough |
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Name the options in the management of an idiopathic hydrocele |
Reassurance Sclerotherapy and aspiration Hydrocoelectomy |
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What are the possible complications of hydrocoele treatment ? |
Pain Bleeding Infection Recurrence |
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Which organism causes a chronic epididymitis with a draining scrotal sinus ? |
Mycobacterium tuberculosis |
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What is a varicocele ? |
Varices of the pampiniform plexus |
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What are the causes of a varicocele ? |
Absence of valves in the testicular veins The angle with which the left vein joins the renal vein predisposes formation thereof The nutcracker effect caused by the aorta and the superior mesenteric artery predisposes formation thereof |
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Name the commonest cause of acute pain and swelling of the scrotum |
Epididymitis/epididymo-orchitis Torsion Inguinal hernia Trauma Necrotizing fascitis |
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Describe the typical clinical picture of torsion of the testis |
Acute onset Severe pain from time of onset Onset with activity/trauma Swelling begins hour or more after pain Abdominal pain Nausea and vomiting Testis situated high in scrotum Elevation of testis worsens pain Thick short spermatic cord Anteriorly situated epididymis Testis lies horizontally |
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Describe the typical clinical picture of epididymo orchitis |
Gradual onset Pain gradually worsens No relationship with activity/trauma Swelling begins before or together with pain No abdominal pain No nausea and vomiting Testis in normal position Elevation of scrotum relieves pain Normal spermatic cord Posteriorly situated epididymis Testis lies longitudinally |
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What is the optimal option for the management of testicular torsion ? |
Manual detorsion, followed by orchidopexy of both testes |
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What are the most common cause of epididymo-orchitis in men (i) under 35 and (ii) over 35 |
(i) - Neisseria gonorrhoeae; Chlamydia trachomatis
(ii) - Gram negative coliforms |
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Which organism is most commonly the cause of acute orchitis ? |
Mumps virus |
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Which organisms usually cause necrotizing fascitis ? |
Gram negative aerobes and anaerobes and streptococci |
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Describe the typical clinical picture of necrotizing fascitis |
Pain and swelling of scrotum Oedema Crepitus Gangrene Fever and systemic toxicity
|
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What is the best screening investigation for imaging of the urinary tract in a trauma patient with macroscopic haematuria ? |
IVP |
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What are the contra-indications of performing a IVP ? |
Haemorrhagic shock Pregnancy Allergy Renal failure |
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List the complications of renal injuries |
haemorrhagic shock Ileus Secondary bleeding Necrosis Perinephric urinoma Hypertension |
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What are the common causes of secondary haemorrhage in renal injuries ? |
A-V fistula formation Pseudoaneurysm |
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What is the possible mechanism by which renal injury can cause hypertension ? |
Secretion of renin due to ischaemic part of kidney |
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Name 3 common causes of macroscopic haematuria with blunt trauma over the lower abdomen |
Interstitial rupture Intraperitoneal rupture Extraperitoneal rupture |
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Name 4 possible complications of injury of the posterior urethra after a pelvic fracture |
Urethral stricture Impotence Incontinence Para-urethral abscesses Necrotizing fascitis Fistula formation |
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What is the best imaging investigation to demonstrate bladder rupture ? |
Abdominal x-ray with high pressure cystogram |
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How is a high pressure cystogram done ? |
Infusion of approximately 300 ml water soluble x-ray contrast agent at a pressure of about 50-100cm water, until inflow of contrast stops spontaneously |
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Which investigation is used to demonstrate a urethral injury, and how is this done ? |
A retrograde urethrogram, contrast is infused through the meatus, and an x-ray is performed in order to detect and limit extravasation of contrast |
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Name the clinical signs of a urethral injury in a male with a pelvic fracture |
Passing of blood at the external meatus Acute urinary retention Genital swelling High-riding prostate |
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What is the difference between a retrograde and a prograde urethrogram ? |
Retrograde - Contrast injected through the external meatus of urethra Prograde - Contrast injected into bladder |
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What are the complications of a urethral injury in males ? |
Urethral stricture formation Impotence Peri-urethral abscess formation Fistula formation Necrotizing fasciitis Cystitis Epididymo-orchitis |
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Name 4 organisms that commonly cause urethritis in males |
Neisseria gonorhoea Chlamydia trachomatis Ureaplasma urealyticum |
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What antibiotics would you use in the treatment of a 20 year old male with a urethral discharge |
Ofloxacin Doxycycline |
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What organism is the commonest cause of acute epididymitis in a heterosexual man younger than 35 years ? |
Chlamydia trachomatis |
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Name the infective conditions which cause ulcerative lesions of the penis, and name the organism involved in each |
Syphilis - Treponema pallidum Chancroid - Haemophilus ducreyi Lymphogranuloma venereum - Chlamydia trachomatis Granuloma inguinale - Calymmatobacterium granulomatis Hepres simplex - HSV T 2 Condylomata acuminata - HPV |
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List the differences in the primary lesions and lymph nodes in (i) syphilis and (ii) chancroid |
(i) Chancre is painless, deeply puncehd out, clear base, not purulent with bilaterally enlarged rubbery non-tender lymph nodes
(ii) Chancroid is painful, with purulent and bleeding ulcer with a unilaterally enlarged lymph node that is soft and very tender |
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Name the different types of prostitis |
Bacterial Non-bacterial Prostatodynia |
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List 5 conidtions which can be confused with the clinical pciture of prostitits |
BPH Urethral stricture Cystitis Bladder stone Prostate cancer Bladder cancer |
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Name 5 serious conditions that should be excluded in a woman with a long history of urinary symptoms and sever pelvic pain before interstitial cystitis is amde |
Bacterial cystitis Endometriosis Bladder cancer Bladder stone Pelvic infection |
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Name the classical presenting symptoms and signs in a patient with renal cell carcinoma |
Haematuria Palpable kidney mass Loin pain |
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What is the curative treatment for localized RCC ? |
radical nephrectomy |
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Name 3 contraindications for doing an IVP |
Renal failure Allergy Pregnancy |
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Name the 2 most common types of genetic cysric renal conditions and the way of inheritance of each` |
Adults: Autosomal dominant polycystic kidney disease
Infantile: Autosomal recessive polycystic kidney disease |
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What are the causes of a filling defect on IVP ? |
Renal TB Carcinoma Renal stones Ureteric stones Pelvi-ureteric junction obstruction |
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Name 5 paraneoplastic syndromes which can be associated with renal cell carcinoma |
Hypertension Aneamia Polycythaemia Weight loss Fever |
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List 3 associated abnormalities of adult polycystic kidney disease |
Diverticuli of the colon Mitral valve prolapse Berry aneurysm |
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What are the sonographic differences between a simple renal cyst and a solid renal mass ? |
Simple Renal Cyst- Uniform round border No internal echoes Clear signal enhancement of distal wall
Solid Renal mass- Irregular, poorly circumscribed border Internal echoes No signal enhancement of distal wall |
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What is the differential diagnosis of a palpable kidney mass in children? |
Autosomal recessive polycystic kidney disease Multicystic dysplastic kidney disease Hydronephrosis Lymphoma Neuroblastoma Nephroblastoma |
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How can renal cell carcinoma present clinically ? |
Haematuria Palpable kidney mass Loin pain
Metastatic symptoms: Dyspnea Bone pain Fractures Neurological symtpoms Varicocele Oedema
Paraneoplastic symptoms: Anaemia Fever Weight loss Polycythaemia Hypertension |
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In which age group does Nephroblastoma (Wilm's tumour) usually occur ? |
ages 2-3 |
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How is Wilms tumour treated ? |
Surgical nephrectomy, radiotherapy and chemotherapy |
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What is an angiomyolipoma of the kidney ? |
A benign hamartoma that consist of muscle, fat and blood vessels |
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Name the ways in which autosomal recessive polycystic kidney disease can present clinically |
Oligohydramnios Palpable kidney mass Renal failure Respiratory distress (due to oligohydramnios) |
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Name the types of cysts or cystic kidney diseases which may occur in the kidneys |
Simple renal cyst Hydatid disease Autosomal dominant polycystic kidney disease Autosomal recessive polycystic kidney disease Multicystic dysplastic kidney |
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What drug can be used to treat an echinococcus cyst of the kidney ? |
Albendazole |
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In what part of the prostate does prostate cancer usually start |
The peripheral zone |
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Which conditions can elevate serum PSA ? |
BPH Prostate cancer Prostatic biopsy Prostatic infarction |
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What are the possible complications of a transrectal prostatic biopsy ? |
Bacteraemia Speticaemia Prostatitis Haematuria Rectal bleeding Cystitis |
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Discuss the methods of (hormonal) treatment of metastatic prostate cancer |
Bilateral orchidectomy Estrogen therapy Anri-androgens LHRH Agonists |
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Name the most common symtpom of metastatic prostate carcinoma |
LUTS (Both obstructive and irritative) |
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How is a prostate biopsy usually performed |
transrectally |
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What are the complications of a transrectal biopsy of the prostate ? |
Bleeding Bacteraemia Prostatitis Septicaemia Cystitis Haematuria |
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In what age group does prostate cancer usually apear |
>45-50 years |
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What is the most common histological type of bladder cancer ? |
Transitional cell carcinoma |
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What is the classic presenting sign of bladder cancer ? |
Painless macroscopic haematuria |
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Name 3 histologically different types of bladder cancer |
Transitional cell carcinoma Squamous cell carcinoma Adenocarcinoma |
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What is usually the treatment for superficial transitional cell carcinoma of the bladder ? |
Trans Urethral Resection of Bladder Tumour (TURBT) |
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List 5 causes of a filling defect in the bladder on an IVP |
Bladder cancer Bladder stone Catheter Fungal ball Bowel gas BPH |
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What type of urinary diversion is usually done on a patient with a radical cystectomy ? |
Bricker's diversion |
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Name the aetiological factors of squamous cell carcinoma of the bladder |
Bilharzia Bladder stones Recurrent cystitis Longterm indwelling catheter |
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What operation is done to cure TCC of the upper urinary tract ? |
Nephro-ureterectomy |
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What are the possible causes of a filling defect in the renal pelvis on a IVP ? |
TCC Uriac acid stone Blood clot Air bubble Fungus ball Necrotising papilla Cystic ureteritis |
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What type of kidney stone will usually be visible on an X-ray ? |
Calcium containing stones |
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What is the usual finding on examination of the urine in a patient with a stone in the ureter ? |
Microscopic haematuria |
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Which kidney stone is not visible on X-ray film, and what is the medical treatment thereof ? |
Uric acid stone, it is treated medically with Citro Soda |
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Which organisms play a common role in the formation of infection stones ? |
Klebsielle and proteus |
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How does Klebsiella and proteus organisms cause the formation of infection stones ? |
They produce the enzyme urease, which breaks up urea in the urine causing the urine to become more alkaline. Therefore calcium and phosphate precipitates more easily, leading to stone formation |
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What is the typical appearance of an infection stone ? |
Staghorn appearance |
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What are the treatment options for a ureteric stone than will not pass spontaneously ? |
ESWL (lithotripsy) Urethroscopic urethrolithotripsy Dormia extraction Urethrolitotomy |
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What is the treatment option for a large infection stone in a well functioning kidney ? |
Percutaneous nephrolithotomy |
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Name the 4 chemical elements usually found in struvite stones |
Phosphate Calcium Magnesium Ammonium |
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Name the 4 common types of urinary tract stones |
1. Caclium oxalate 2. Struvite 3. Uric acid 4. Cystine |
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Which enzyme can be inhibited to decrease the formation of uric acid stones ? |
Xanthine oxidase inhibitors |
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List the biochemical risk factors for the formation of urinary tract calculi |
Stasis Concentration Ph Nidus
|
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List the indications for referral with regards to urinary tract stones |
Renal failure Worsening pain Not resolving Bilateral stones Multiple stones Very large stone |
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Name the causes of bladder stone formation |
Anything that will cause bladder outflow obstruction:
BPH Urehtral stricute Posterior urethral valve Porostate cancer Hameaturia Foreign object in the bladder |
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Name the factors that promote calcium stone formation in the urinary tract |
Hypercalciuria Hyperoxaluria Hyperuricosuria Hypomagnesuria Hypocytraturia |
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Name the 2 inhibitors of calcium stone formation |
Citrate Magnesium |
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Which drug is an inhibitor of xanthine oxidase |
Allopurinol |