Genitourinary #3

Question 1

Paraphimosis is

Answer 1

Retracted foreskin that cannot be returned to the normal position
-A urological emergency

Question 2

Treatment for paraphimosis

Answer 2

• Manual reduction
• Pharm therapy: granulated sugar, injection of hyaluronidase
• Definitive management: incision or circumcision

Question 3

Phimosis is

Answer 3

inability to retract foreskin over the glans

Question 4

MC type of prostate cancer

Answer 4

Adenocarcinoma

Question 5

Risk factors for prostate cancer

Answer 5

• Increasing age (HIGHEST RISK FACTOR)
• Genetics
• AA
• Diet

Question 6

Symptoms of prostate cancer

Answer 6

• Most are asymptomatic

- Back or bone pain: increased incidence of METS to bone, weight loss

Question 7

Diagnostics for prostate cancer

Answer 7

• DRE: hard, indurated, nodular, enlarged asymmetrical prostate
• PSA: > 4 is abnormal
• TURP: most accurate test

Question 8

What grading system determines aggressiveness or malignant potential of prostate cancer?

Answer 8

Gleason Grading System

Question 9

Adverse effects of prostatectomy

Answer 9

Incontinence and erectile dysfunction

Question 10

For advanced disease in prostate cancer, what is the treatment?

Answer 10

Androgen deprivation

-External beam radiation therapy

Question 11

MCC of microscopic hematuria in men

Answer 11

BPH

Question 12

MC type of nephrolithiasis

Answer 12

-Calcium oxalate

Question 13

Struvite nephrolithiasis is composed of

Answer 13

Magnesium ammonium phosphate

Question 14

Symptoms of nephrolithiasis

Answer 14

• Renal colic: sudden, constant upper lateral back or flank pain radiating to groin
• CVA tenderness
• Afebrile
• Hematuria
• N/V

Question 15

Diagnostics for nephrolithiasis

Answer 15

• UA: hematuria.
• -Acidic urine (pH < 5) = Uric acid and cystine
• -Alkaline urine (pH > 7.2) = Struvite stones
• Noncontrast CT of abdomen and pelvis (Imaging of choice)
• KUB

Question 16

On KUB radiographs, which stones are radiopaque?

Answer 16

Calcium and Struvite

-This means that they are visible on radiographs

Question 17

Management for Nephrolithiasis < 5-mm in diameter

Answer 17

• 80% chance of passage
• IVF and analgesics
• Tamsulosin may facilitate passage

Question 18

If the stone is ______ it may make passage of smaller stones more difficult

Answer 18

At ureterovesicular junction

Question 19

stones 5-10 mm in diameter, what is the treatment?

Answer 19

• 20% chance of passage
• Shock wave lithotripsy
• Ureteroscopy with or without stent: obstructed stone
• Percutaneous nephrolithotomy: large stones > 10 mm, struvite

Question 20

Risk factors for Calcium Nephrolithiasis

Answer 20

• Decreased fluid intake (MC)
• Males
• High animal protein intake
• PKD
• Increased Vitamin C intake in men

Question 21

MC type of penile cancer

Answer 21

Squamous cell carcinoma

Question 22

Penile cancer is associated with

Answer 22

• HPV 16, 6, 18
• Lack of circumcision
• Smoking
• HIV

Question 23

Treatment for erectile dysfunction

Answer 23

• Phosphodiesterase 5- inhibitors

- -Sildenafil, Tadalafil, Vardenafil

Question 24

How do PD-5 inhibitors work? MOA

Answer 24

-Nitric oxide mediated penile smooth muscle relaxation, leading to ability to generate and maintain an erection

Question 25

True or False: PD5 inhibitors should not be used in patients with CV disease?

Answer 25

True; may cause severe hypotension

Question 26

What is hypospadias?

Answer 26

Abnormal ventral placement of urethral opening

Question 27

Pathophysiology of hypospadias

Answer 27

-Failure of urogenital folds to fuse during development

Question 28

Treatment for hypospadias

Answer 28

- DO NOT CIRCUMCISE during neonatal period because foreskin can be used to repair the defect - Elective arthroplasty correction: between 6 months and 1 year old

Question 29

What is epispadias?

Answer 29

Abnormal dorsal placement of urethral opening

Question 30

Epispadias is often associated with

Answer 30

Bladder exstrophy (protrusion of bladder wall through defect in abdominal wall)

Question 31

pathophysiology of epispadias

Answer 31

-Failure of midline penile fusion

Question 32

Diagnostic of choice for urethral injuries

Answer 32

-Retrograde urethrogram (done prior to transurethral catheterization)

Question 33

Hallmark triad of symptoms for urethral injuries

Answer 33

-Blood at urethral meatus, inability to void, distended bladder

Question 34

How do urethral injuries most commonly occur?

Answer 34

Blunt trauma: straddle-type falls

Question 35

Symptoms of urethral injuries

Answer 35

- Gross hematuria - Blood at urethral meatus - Swelling, ecchymosis - High-riding prostate

Question 36

Peyronie Disease is associated with

Answer 36

- Vitamin E deficiency - Beta Blockers - Increased serotonin levels - Dupuytren's Contracture - HLA-B7 - Obesity, Smoking, DM, dyslipidemia

Question 37

What is another clinical intervention for Peyronie Disease?

Answer 37

- Vitamin E and potassium amino benzoate (PABA) - Colchicine - Injection of collagenase clostridium histolyticum - Surgery

Question 38

Treatment for premature ejaculation

Answer 38

- Topical desensitizing agents (Lidocaine, Benzocaine, Prilocaine) - SSRI's - PDE-5 Inhibitors - Others: Pindolol, Tramadol