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give some causes of a sterile pyuria?
- bladder tumour
- treated UTI
- UTI with fastidious culture requirement
- cyclophosphamide induced cystitis
which part of the gland does BPH affect more and why?
central, periurethral part as this is more sensitive to oestrogen
what are the complications of BOO e.g. in BPH? think anatomically
- obstruction of urethra
- bladder destrusor muscle hypertrophies
- diverticula in bladder wall (so get urine stasis so infection, stomas, tumour more likely)
- renal failure
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
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
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
what is surgical management of BPH?
what are RF for prostate cancer?
how does prostate cancer spread to bones?
retrograde spread via the vertebral venous plexus
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
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
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
what are the signs of hypercalcaemia on ECG?
short QT and wide T waves
if you get a K+ of 7.2 in an ASYMPTOMATIC patient, what is the next best thing to do?
- and repeat U&Es
- don't just go and give calcium gluconate, insulin, dextrose as risk hypoK+. the high K may just be artefact
which type of testicular tumour is commonest in 20-30years?
what type of testicular tumour is commonest in 30-40 years?
how do you differentiate prostate cancer from chronic bacterial prostatits?
in chronic bacterial prostates: get perineal pain
which drugs can cause acute urinary retention?
anticholinergics: TCA, antipsychotics eg chlorpromazine, opiates
which drugs are used in BPH and assist urinary flow?
alpha 1 blockers eg doxazosin
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!
which age group get Torsion of hydatid of Morgagni and is it an emergency? where is pain?
- testicle twists around its appendix
- not an emergency
- see blue dot on scrotum
- pain in upper pole of testis
who is sildenafil CI in and why?
people on NITRATES as it may produce hypotension
13 year old girl has been drinking lots of fluids, wetting her bed, difficulty breathing and loses consciousness, whats diagnosis?
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