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give some causes of a sterile pyuria?
- TB
- prostatitis
- calculi
- bladder tumour
- treated UTI
- UTI with fastidious culture requirement
- PKD
- cyclophosphamide induced cystitis
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which part of the gland does BPH affect more and why?
central, periurethral part as this is more sensitive to oestrogen
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what are the complications of BOO e.g. in BPH? think anatomically
- obstruction of urethra
- bladder destrusor muscle hypertrophies
- trabeculation
- diverticula in bladder wall (so get urine stasis so infection, stomas, tumour more likely)
- hydroureter
- hydronephrosis
- renal failure
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what are the 2 categories of symptoms in BPH? and examples of each
- Voiding problems (obstructive symptoms) and Storage problems (irritative symptoms)
- voiding: poor stream, hesitancy, terminal dribbling, incomplete emptying (pis en deux) leads to stasis of urine so get stones and UTI
- storage: frequency, urgency, nocturia, urge incontinence
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why may you get acute urinary retention in BPH?
- 1. anticholinergic drugs to treat symptoms of frequency (they block bladder contractions)
- 2. diuretics - even alcohol
- 3. prolonged voluntary suppression of micturition
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what is the medical management of BPH?
- 1. alpha 1 blockers eg tamsulosin, prazosin. relax SM. SE: postural hypotension
- 2. 5alpha reductase inhibitors eg finasteride. SE: loss libido, erectile dysfunction
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what is surgical management of BPH?
TURP
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what are RF for prostate cancer?
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how does prostate cancer spread to bones?
retrograde spread via the vertebral venous plexus
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how may symptoms of prostate cancer be different to BPH?
- as well as BOO, get symptoms of mets
- bone pain, hypercalcaemia, pathological fractures, leg swelling, renal failure
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what is the difference between treating early and late (advanced) prostate cancer?
- early: radical prostatectomy or watch and wait
- late: incurable, do palliative: LHRH analogue - gosrelin or anti-androgen eg flutamide or cyproterone
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when thinking about PKD, which 4 organs need to be asked about?
- brain: SAH, visual disturbance and headache (also due to high BP)
- liver: liver failure (cysts in liver and pancreas too)
- kidney: pyelonephritis: fever, N&V, rigors, loin pain
- heart: mitral valve prolapse: chest pain, SOB, palps
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what are the signs of hypercalcaemia on ECG?
short QT and wide T waves
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if you get a K+ of 7.2 in an ASYMPTOMATIC patient, what is the next best thing to do?
- ECG
- and repeat U&Es
- don't just go and give calcium gluconate, insulin, dextrose as risk hypoK+. the high K may just be artefact
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which type of testicular tumour is commonest in 20-30years?
teratoma
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what type of testicular tumour is commonest in 30-40 years?
seminoma
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how do you differentiate prostate cancer from chronic bacterial prostatits?
in chronic bacterial prostates: get perineal pain
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which drugs can cause acute urinary retention?
anticholinergics: TCA, antipsychotics eg chlorpromazine, opiates
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which drugs are used in BPH and assist urinary flow?
alpha 1 blockers eg doxazosin
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if a patient had painless haematuria and a DVT 3/12 ago and is now on warfarin, what is the cause of his haematuria?
- bladder cancer - this may have caused the DVT
- don't just put it down to warfarin therapy!
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which age group get Torsion of hydatid of Morgagni and is it an emergency? where is pain?
- children
- testicle twists around its appendix
- not an emergency
- see blue dot on scrotum
- pain in upper pole of testis
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who is sildenafil CI in and why?
people on NITRATES as it may produce hypotension
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13 year old girl has been drinking lots of fluids, wetting her bed, difficulty breathing and loses consciousness, whats diagnosis?
DM1
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how can you tell the difference between hydrocele and epididymal cyst?
- they both transilluminate
- but hydrocele is not separate from testis
- whereas epididymal cyst is separate
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