Genitourinary Conditions A

Question 1

Nephrolithiasis - Description

Answer 1

formation of kidney stones (renal calculi) in urinary tract

Question 2

Nephrolithiasis - Risk Factors (General) (5)

Answer 2

1) male
2) 20-40 years old
3) obesity
4) dehydration
5) precipitant drugs (e.g. diuretics, antacids, Na+/Ca2+ containing drugs, vitamin C/D)

Question 3

Nephrolithiasis - Types (5)

Answer 3

1) calcium oxalate (64%)
2) calcium phosphate (16%)
3) uric acid (10-20%)
4) cysteine (1%)
5) struvite (1-5%)

Question 4

Nephrolithiasis - Risk Factors (Calcium) (4)

Answer 4

1) hyperparathyroidism
2) hypercalcaemia
3) high dietary calcium
4) high dietary oxalate (e.g. chocolate, spinach)

Question 5

Nephrolithiasis - Risk Factors (Uric Acid) (2)

Answer 5

1) hyperuricaemia (±gout)

2) ileostomy

Question 6

Nephrolithiasis - Risk Factors (Cysteine) (1)

Answer 6

1) genetic (cystinuria)

Question 7

Nephrolithiasis - Risk Factors (Struvite) (1)

Answer 7

1) urea splitting bacteria (e.g. Klebsiella, Proteus, Pseudomonas)

Question 8

Nephrolithiasis - Symptoms (6)

Answer 8

1) sudden onset severe writhing colicky loin to groin pain (can’t lie still)
2) testicular/labial pain
3) nausea
4) vomiting
5) stranguria (burning dysuria in frequent small volumes despite urgency) (i.e. inc. dysuria, oliguria, urgency)
6) haematuria

Question 9

Nephrolithiasis - Complications (3)

Answer 9

1) recurrent renal calculi
2) recurrent urinary tract infection
3) pyelonephritis

Question 10

Nephrolithiasis - Investigations (3/2)

Answer 10

initial
1) kidney, ureter, bladder x-ray (KUBXR) (80%)
2) urine dipstick (blood)
3) UnE (cause)
consider
1) non-contrast CT kidney, ureter, bladder* (NCC-KUB) (99%) (18 months radiation dose)
2) abdominal ultrasound (rare acutely)

Question 11

Nephrolithiasis - Management (4/7/3)

Answer 11

conservative
1) leave to pass naturally (<5mm)
2) hydration
3) weight loss
4) low dietary sodium, calcium
medical
1) analgesia (NSAIDs, aspirin —> diclofenac)
2) antiemetic
3) antibiotics (if infected)
4) αB (e.g. tamulosin) (>5mm)
5) thiazide diuretic (calcium recurrence)
6) sodium bicarbonate (uric acid recurrence)
7) cysteine chelator (cysteine recurrence)
surgery
1) extracorpeal shockwave lithotripsy (>10mm or refractory)
2) uretoscopy + YAG laser lithotripsy (>10mm or refractory)
3) percutaneous nephrolithotomy (>15mm or complex)

Question 12

Acute Kidney Injury - Description

Answer 12

acute increased serum urea and creatinine and decreased urine output due to acute kidney function decline

Question 13

Acute Kidney Injury - Risk Factors (10)

Answer 13

1) >75 years old
2) male
3) shock (cardiogenic, hypovolaemic, septic)
4) malignancy
5) diabetes mellitus
6) cardiovascular disease
7) chronic liver disease
8) chronic kidney disease (esp. >stage 3a)
9) past acute kidney failure
10) nephrotoxic drugs (e.g. NSAID, ACEi, gentamicin)

Question 14

Acute Kidney Injury - Causes (Pre-Renal) (5)

Answer 14

1) decreased cardiac output (cardiogenic shock)
2) decreased blood volume (haemorrhage, burns, diarrhoea, vomiting, diuretics)
3) systemic vasodilation (septic shock)
4) renal vasoconstriction (NSAID, ACEi, ARB, hepatorenal syndrome)
5) ischaemia (renal artery stenosis)

Question 15

Acute Kidney Injury - Causes (Intra-Renal) (4)

Answer 15

1) acute glomerulonephritis (nephrotoxic drugs, infection, SLE)
2) acute interstitial nephritis (nephrotoxic drugs, infection)
3) acute tubular necrosis (nephrotoxic drugs, myeloma)
4) vascular (vasculitis, thrombus)

Question 16

Acute Kidney Injury - Causes (Post-Renal) (2)

Answer 16

1) internal obstruction (renal calculi, urinary tract tumour, stricture)
2) external compression (benign prostatic hyperplasia, pelvic tumour)

Question 17

Acute Kidney Injury - Symptoms (6)

Answer 17

1) oliguria —> anuria
2) nausea
3) vomiting
4) dizziness
5) orthopnoea
6) paroxysmal nocturnal dyspnoea

Question 18

Acute Kidney Injury - Signs (6)

Answer 18

1) hypertension
2) hypotension
3) postural hypotension
4) tachycardia
5) peripheral oedema
6) high JVP

Question 19

Acute Kidney Injury - Complications (6)

Answer 19

1) hyperphosphataemia
2) hyperkalaemia —> arrhythmia
3) uraemia
4) metabolic acidosis
5) chronic kidney disease
6) pulmonary oedema

Question 20

Acute Kidney Injury - Investigations (6/0)

Answer 20

initial

1) UnE (high urea, creatinine, K+, metabolic acidosis)
2) LFT (hepatorenal syndrome)
3) blood/urine MSnC (infection)
4) urine dipstick (blood+proteins—>glomerular, leucocytes+nitrates—>infection)
5) kidney ultrasound (CKD—>small kidneys, obstruction)
6) ECG (hyperkalaemia)

Question 21

Acute Kidney Injury - Management (0/7/2)

Answer 21

medical
1) treat underlying cause
2) stop nephrotoxic drugs (NSAID, ACEi, gentamicin)
3) loop diuretic (hypervolaemia)
4) IV fluids (hypovolaemia)
5) vassopressor (e.g. catecholamines) (hypotensive)
6) calcium gluconate or insulin (hyperkalaemia)
7) sodium bicarbonate (metabolic acidosis)
surgery
1) urinary catheter (obstruction)
2) renal replacement therapy (esp. haemofiltration) (refractory)

Question 22

Chronic Kidney Disease - Description

Answer 22

GFR<60ml/min/1.73m2 for >3 months due to chronic progressive kidney function decline

Question 23

Chronic Kidney Disease - Causes (6)

Answer 23

1) diabetes mellitus
2) hypertension
3) acute kidney injury
4) polycystic kidney disease
5) glomerular nephritic/nephrotic syndrome
6) autoimmune (e.g. SLE, RA)

Question 24

Chronic Kidney Disease - Risk Factors (7)

Answer 24

1) >50 years old
2) male
3) family history
4) Afro-Caribbean or Hispanic
5) obesity
6) smoking
7) nephrotoxic drugs (e.g. NSAIDs, ACEi, gentamicin)

Question 25

Chronic Kidney Disease - Stages (6)

Answer 25

1) GFR≥90 2) 60≤GFR<90 3a) 45≤GFR<60 3b) 30≤GFR<45 4) 15≤GFR<30 5) GFR<15 (end-stage kidney failure)

Question 26

Chronic Kidney Disease - Pathophysiology (Diabetes Mellitus) (8)

Answer 26

1) high blood glucose 2) increased reactive oxygen species, proinflammatory cytokines, growth factors 3) glomerulosclerosis of nephrons 4) irreversible nephron failure 5) glomerular hyperfiltration in remnant nephrons 6) initial GFR increase in remnant nephrons 7) eventual glomerulosclerosis of remnant nephrons 8) irreversible nephron failure

Question 27

Chronic Kidney Disease - Pathophysiology (Hypertension) (12)

Answer 27

1) increased blood pressure 2) blood vessel lumen narrowing due to wall thickening 3) decreased kidney blood flow 4) decreased GFR 5) increased renin secretion 6) further increased blood pressure 7) glomerulosclerosis of nephrons 8) irreversible nephron failure 9) glomerular hyperfiltration in remnant nephrons 10) initial GFR increase in remnant nephrons 11) eventual glomerulosclerosis in remnant nephrons 12) irreversible nephron failure

Question 28

Chronic Kidney Disease - Symptoms (4)

Answer 28

1) asymptomatic 2) polyuria/oliguria/anuria 3) fatigue (anaemia) 4) dyspnoea (pulmonary oedema)

Question 29

Chronic Kidney Disease - Symptoms (Uraemia) (8)

Answer 29

1) malaise 2) nausea 3) vomiting 4) anorexia 5) weight loss 6) pruritus (itchy skin) 7) amenorrhoea 8) erectile dysfunction

Question 30

Chronic Kidney Disease - Signs (6)

Answer 30

1) periorbital oedema 2) peripheral oedema 3) ecchymosis/purpura/petechia (uraemia) 4) Kussmaul’s breathing (deep laboured breathing) (metabolic acidosis)

Question 31

Chronic Kidney Disease - Complications (7)

Answer 31

1) compensatory hypertension 2) anaemia 3) uraemia —> encephalopathy/pericarditis/coagulopathies 4) hyperkalaemia —> arrhythmia 5) hypocalcaemia/hyperphosphataemia —> secondary parahyperthyroidism —> renal oestodystrophy —> osteomalacia/osteoporosis 6) metabolic acidosis 7) pulmonary oedema

Question 32

Chronic Kidney Disease - Investigations (8/1)

Answer 32

1) U&E (high urea, creatinine, K+, metabolic acidosis) 2) serum Ca2+ (low) 3) serum PO43-(high) 4) serum PTH (high) 5) FBC (normocytic anaemia) 6) urine dipstick (haematuria, proteinuria) 7) eGFR (<60ml/min/1.73m2) 8) kidney ultrasound (small) consider 1) kidney biopsy (underlying cause)

Question 33

Chronic Kidney Disease - Management (4/2/1)

Answer 33

``` conservative 1) glucose control 2) smoking cessation 3) weight loss 4) renal replacement therapy education medical 1) treat underlying cause 2) stop nephrotoxic drugs (e.g. NSAIDs, gentamicin) surgery 1) renal replacement therapy (peritoneal dialysis, haemodialysis, haemodiafiltration, haemofiltration, kidney transplant) ```

Question 34

Chronic Kidney Disease - Management (Complications) (10)

Answer 34

``` hypertension 1) ACEi or ARB (or CCB) 2) βB or thiazide diuretic (adjunct) cardiovascular disease 3) aspirin 4) statin anaemia 5) EPO stimulating agent 6) ferrous sulphate secondary hyperparathyroidism 7) phosphate binder 8) ergocalciferol metabolic acidosis 9) sodium bicarbonate oedema 10) loop diuretic (e.g. furosemide) ```

Question 35

Kidney Cancer - Description (Renal Cell Carcinoma)

Answer 35

malignant proliferation of PCT epithelium

Question 36

Kidney Cancer - Risk Factors (Renal Cell Carcinoma) (10)

Answer 36

1) >50 years old 2) male 3) family history (4x) 4) Czech 5) Von Hippel Landau syndrome (50%) 6) smoking (20%) 7) obesity 8) hypertension 9) chronic kidney disease (15%) 10) polycystic kidney disease

Question 37

Kidney Cancer - Types (4)

Answer 37

1) renal cell carcinoma (85%) 2) transitional cell carcinoma (10%) 3) sarcoma 4) Wilms’ tumour

Question 38

Kidney Cancer - Symptoms (Renal Cell Carcinoma) (7)

Answer 38

1) asymptomatic (50% incidental diagnosis) 2) flank/loin pain 3) haematuria systemic 4) fever 5) malaise 6) anorexia 7) weight loss

Question 39

Kidney Cancer - Signs (Renal Cell Carcinoma) (1)

Answer 39

1) abdominal mass

Question 40

Kidney Cancer - Complications (Renal Cell Carcinoma) (6)

Answer 40

1) anaemia 2) polycythaemia 3) hypertension 4) hypercalcaemia 5) SIADH 6) varicocele

Question 41

Kidney Cancer - Investigations (Renal Cell Carcinoma) (6/1)

Answer 41

``` initial 1) FBC (anaemia or polycythaemia) 2) LFT (abnormal) 3) high CRP + ESR 4) urine dipstick (haematuria, proteinuria) 5) kidney ultrasound (exclude simple cysts) 6) abdomen, pelvis enhanced contrast CT* consider 1) kidney biopsy (confirmation) ```

Question 42

Kidney Cancer - Management (Renal Cell Carcinoma) (0/4/2)

Answer 42

medical 1) local ablation (radiofrequency or cryo-) (non-surgical candidate) 2) chemotherapy (IL-2, TNF-α) (stage 3-4) 3) angiogenesis inhibitor (e.g. sunitinib) (refractory stage 3-4) 4) mTOR inhibitor (e.g. temsirolmus) (refractory stage 3-4) surgery 1) radical nephrectomy* (unilateral) 2) partial nephrectomy (bilateral)

Question 43

Bladder Cancer - Description (Transitional Cell Carcinoma)

Answer 43

malignant proliferation of transitional epithelium

Question 44

Bladder Cancer - Risk Factors (6)

Answer 44

1) >40 years old 2) male 3) family history 4) schistomiasis (squamous cell carcinoma) 5) smoking 6) occupation (petroleum, rubber)

Question 45

Bladder Cancer - Types (4)

Answer 45

1) transitional cell carcinoma (90%) 2) squamous cell carcinoma (5%) 3) adenocarcinoma 4) sarcoma

Question 46

Bladder Cancer - Metastasis (Transitional Cell Carcinoma) (3)

Answer 46

1) local —> pelvic structures 2) lymphatic —> iliac node, para-aortic node 3) haematogenous —> liver, lungs

Question 47

Bladder Cancer - Symptoms (Transitional Cell Carcinoma) (2)

Answer 47

1) painless haematuria (dysuria rare) | 2) urge incontinence

Question 48

Bladder Cancer - Complications (Transitional Cell Carcinoma) (3)

Answer 48

1) recurrent urinary tract infection 2) hydronephrosis 3) metastasis (e.g. lungs)

Question 49

Bladder Cancer - Investigations (Transitional Cell Carcinoma) (1/3)

Answer 49

``` initial 1) urine dipstick (haematuria) consider 1) cystoscopy + tissue biopsy* 2) urine cytology 3) CT/MRI urogram (stage) ```

Question 50

Bladder Cancer - Management (3/2)

Answer 50

medical 1) post-op chemotherapy (T1-T3) 2) radiotherapy (T2-T3) (non-surgical candidate) 3) palliative chemotherapy + radiotherapy (T4) surgery 1) transurethral resection (T1) 2) radical cystectomy* (T2-T3)

Question 51

Testicular Cancer - Description

Answer 51

malignant proliferation of testicular germ cells

Question 52

Testicular Cancer - Risk Factors (6)

Answer 52

1) 20-35 years old 2) family history 3) Caucasian 4) undescended testis 5) infant hernia 6) infertility

Question 53

Testicular Cancer - Types (3)

Answer 53

1) seminoma (55%) 2) non-seminomatous germ cell tumour (33%) 3) mixed germ cell tumour (teratoma) (12%)

Question 54

Testicular Cancer - Symptoms (4)

Answer 54

1) testicular pain 2) abdominal pain 3) back pain (para-aortic node metastasis) 4) dyspnoea (lung metastasis)

Question 55

Testicular Cancer - Signs (2)

Answer 55

1) testicular mass | 2) abdominal mass

Question 56

Testicular Cancer - Complications (3)

Answer 56

1) hydrocele 2) infertility 3) metastasis (e.g. lung)

Question 57

Testicular Cancer - Investigations (3/2)

Answer 57

``` initial 1) testicle colour Doppler ultrasound 2) serum α-fetoprotein (positive) 3) serum β-human chorionic gonadotrophin (positive) consider 1) testicular biopsy (confirmation) 2) abdomen, pelvis CT (staging) ```

Question 58

Testicular Cancer - Management (2/2/1)

Answer 58

``` conservative 1) sperm storage 2) regular self-examination medical 1) chemotherapy (metastasis above diaphragm) 2) radiotherapy (metastasis below diaphragm) surgery 1) radical orchidectomy* ```

Question 59

Prostate Cancer - Description

Answer 59

malignant proliferation of prostate glandular epithelium

Question 60

Prostate Cancer - Risk Factors (6)

Answer 60

1) >50 years old (increases with age, 80% of >80 years old) 2) family history (2-3x) 3) Afro-Caribbean (high testosterone) 4) BRCA-2 (5-7x) 5) HOXB-13 6) fatty diet

Question 61

Prostate Cancer - Types (4)

Answer 61

1) acinar adenocarcinoma (90%) 2) ductal adenocarcinoma (9%) 3) transitional cell carcinoma 4) squamous cell carcinoma

Question 62

Prostate Cancer - Metastasis (3)

Answer 62

1) local —> pelvic structure 2) lymphatic —> iliac node, para-aortic node 3) haematogenous —> bone*, brain, liver, lungs

Question 63

Prostate Cancer - Symptoms (6)

Answer 63

``` 1) asymptomatic lower urinary tract symptoms 2) nocturia 3) frequency 4) hesitancy 5) haematuria 6) dysuria ```

Question 64

Prostate Cancer - Symptoms (Metastasis) (4)

Answer 64

1) anorexia 2) weight loss 3) fatigue 4) bone pain

Question 65

Prostate Cancer - Signs (2)

Answer 65

1) hard irregular prostate (digital rectal examination) | 2) palpable lymph nodes (metastasis)

Question 66

Prostate Cancer - Complications (1)

Answer 66

1) metastasis (esp. bone)

Question 67

Prostate Cancer - Investigations (1/2)

Answer 67

initial 1) serum PSA (>4μg/L, 16μg/L if metastatic) consider 1) transrectal ultrasound guided prostate biopsy* 2) abdomen, pelvis MRI (staging

Question 68

Prostate Cancer - Management (1/3/1)

Answer 68

conservative 1) surveillance (>70 years old + low risk) medical 1) androgen deprivation therapy (LHRH agonists, androgen receptor blockers) (delays progression) 2) bisphosphonates (bone metastasis—>hypercalcaemia) 3) radiotherapy (external beam or brachytherapy) (>70 years old or non-surgical candidate) surgery 1) radical prostatectomy* (<70 years old)

Question 69

Benign Prostatic Hyperplasia - Description

Answer 69

benign nodular or diffuse proliferation of prostate glandular epithelium and stromal cell

Question 70

Benign Prostatic Hyperplasia - Risk Factors (4)

Answer 70

1) >50 years old (increases with age) 2) family history 3) Afro-Caribbean (high testosterone) 4) smoking

Question 71

Benign Prostatic Hyperplasia - Pathophysiology (3)

Answer 71

1) benign nodular or diffuse proliferation of prostate glandular epithelium and stromal cells 2) prostate enlarges 3) prostate narrows urethra (compression or obstruction)

Question 72

Benign Prostatic Hyperplasia - Symptoms (10)

Answer 72

``` storage lower urinary tract symptoms 1) nocturia 2) frequency 3) urgency 4) incontinence voiding lower urinary tract symptoms 5) hesitancy 6) haematuria 7) dysuria (infection) 8) poor intermittent stream 9) straining 10) after dribble (post-micturition or terminal) ```

Question 73

Benign Prostatic Hyperplasia - Signs (2)

Answer 73

1) smooth enlarged prostate (digital rectal examination) | 2) palpable bladder

Question 74

Benign Prostatic Hyperplasia - Complications (3)

Answer 74

1) bladder calculi 2) urinary tract infections 3) urinary retention

Question 75

Benign Prostatic Hyperplasia - Investigations (3/3)

Answer 75

initial 1) serum PSA (high) 2) urine dipstick (pyruria) 3) International Prostate Symptoms Score (7Qs, 0-35) consider 1) abdomen, pelvis ultrasound (mass, stone, hydronephrosis) 2) transrectal ultrasound (mass, stone, hydronephrosis) 3) cystoscopy (mass, stone, stricture)

Question 76

Benign Prostatic Hyperplasia - Management (3/2/2)

Answer 76

conservative 1) avoid coffee, alcohol 2) relax when voiding 3) void twice in a row medical 1) α1B (e.g. tamulosin) (voiding symptoms) 2) 5α reductase inhibitor (e.g. finasteride) surgery 1) transurethral incision of prostate (TIRP) 2) transurethral resection of prostate* (TURP)

Question 77

Pyelonephritis - Description

Answer 77

inflammation of kidney and upper ureter, urinary tract infection

Question 78

Pyelonephritis - Causes (5)

Answer 78

KEEPS 1) Klebsiella 2) Enterocci 3) Escherichia coli* 4) Proteus 5) Staphylococci

Question 79

Pyelonephritis - Risk Factors (10)

Answer 79

1) <35 years old 2) female 3) sex 4) pregnancy 5) menopause 6) urinary tract obstruction (e.g. renal calculi) 7) catheter 8) diabetes mellitus 9) immunocompromised (e.g. HIV, chemo, steroids) 10) congenital abnormalities

Question 80

Pyelonephritis - Pathophysiology (3)

Answer 80

1) bowel flora Escherichia coli 2) females have a shorter urethra which is closer to anus 3) ascending transurethral transmission of bacteria to urinary tract

Question 81

Pyelonephritis - Symptoms (9)

Answer 81

1) loin pain 2) costovertebral back pain 3) fever cystitis/urethritis associated 4) frequency 5) urgency 6) dysuria systemic 7) malaise 8) nausea 9) vomiting

Question 82

Pyelonephritis - Signs (4)

Answer 82

1) loin tenderness 2) costovertebral back tenderness 3) pyuria 4) fell smelling urine

Question 83

Pyelonephritis - Complications (4)

Answer 83

1) acute kidney injury 2) renal abscess 3) recurrent urinary tract infection 4) sepsis

Question 84

Pyelonephritis - Investigations (4/0)

Answer 84

initial 1) urine dipstick (nitrites, leucocytes, proteins) 2) midstream urine MS+C* (>10^5 colony forming units) 3) FBC (leucocytosis) 4) high CRP + ESR

Question 85

Pyelonephritis - Management (3/3/0)

Answer 85

``` conservative 1) rest 2) cranberry juice 3) rehydration medical 1) analgesia 2) PO antibiotics (ciprofloxacillin or co-amoxiclav) 3) IV antibiotics (gentamicin or co-amoxiclav) ```

Question 86

Cystitis - Description

Answer 86

inflammation of bladder, urinary tract infection

Question 87

Cystitis - Causes (5)

Answer 87

KEEPS 1) Klebsiella 2) Enterococci 3) Escherichia coli* 4) Proteus 5) Staphylococci

Question 88

Cystitis - Risk Factors (10)

Answer 88

1) >60 years old 2) female 3) sex 4) pregnancy 5) menopause 6) urinary tract obstruction (e.g. renal calculi) 7) catheter 8) diabetes mellitus 9) immunocompromised (e.g. HIV, chemo, steroids) 10) congenital abnormalities

Question 89

Cystitis - Pathophysiology (3)

Answer 89

1) bowel flora Escherichia coli 2) females have shorter urethra which is closer to anus 3) ascending transurethral transmission of bacteria

Question 90

Cystitis - Symptoms (6)

Answer 90

1) suprapubic pain 2) fever 3) frequency 4) urgency 5) dysuria 6) haematuria

Question 91

Cystitis - Signs (2)

Answer 91

1) pyuria | 2) foul smelling urine

Question 92

Cystitis - Complications (2)

Answer 92

1) pyelonephritis | 2) recurrent urinary tract infection

Question 93

Cystitis - Investigations (4/0)

Answer 93

initial 1) urine dipstick (nitrites, leucocytes, proteins) 2) mid-stream urine MS+C* (>10^5 colony forming units) 3) FBC (leucocytosis) 4) high CRP + ESR

Question 94

Cystitis - Management (3/3/0)

Answer 94

``` conservative 1) rest 2) cranberry juice 3) rehydration medical 1) analgesia 2) PO antibiotics (trimethoprim or cefalexin) 3) IV antibiotics (ciprofloxacin or co-amoxiclav) (severe) ```

Question 95

Prostatitis - Description

Answer 95

inflammation of prostate, urinary tract infection

Question 96

Prostatitis - Causes (5)

Answer 96

1) Escherichia coli (80%) 2) Enterococci 3) Pseudomonas 4) Chlamydia 5) Streptococci faecaelis

Question 97

Prostatitis - Risk Factors (7)

Answer 97

1) 35-50 year olds 2) male 3) sexually transmitted infection 4) urinary tract infection 5) benign prostatic hyperplasia 6) post biopsy 7) catheter

Question 98

Prostatitis - Symptoms (13)

Answer 98

1) perianal pain 2) fever (inc. rigors) 3) malaise storage lower urinary tract symptoms 4) nocturia 5) frequency 6) urgency 7) incontinence voiding lower urinary tract symptoms 8) hesitancy 9) poor intermittent stream 10) straining 11) dysuria 12) haematuria 13) after dribble (post micturition or terminal)

Question 99

Prostatitis - Signs (1)

Answer 99

1) hot soft tender prostate (digital rectal examination)

Question 100

Prostatitis - Complications (3)

Answer 100

1) urinary retention 2) sepsis 3) recurrent urinary tract infection

Question 101

Prostatitis - Investigations (5/2)

Answer 101

``` initial 1) serum PSA (high) 2) urine dipstick (nitrites, leucocytes, proteins) 3) mid-stream urine MS+C* (>10^5 colony forming units) 4) FBC (leucocytosis) 5) high CRP + ESR consider 1) STI screening 2) transurethral ultrasound ```

Question 102

Prostatitis - Management (0/2/0)

Answer 102

medical 1) analgesia (NSAID) 2) PO antibiotics (ciprofloxacin)

Question 103

Urethritis - Description

Answer 103

inflammation of urethra (sexually transmitted infection or trauma)

Question 104

Urethritis - Causes (7)

Answer 104

``` sexually transmitted infection 1) Chlamydia trachomatis* 2) Neisseria gonorrhoea 3) Ureaplasma urealyticum 4) Mycoplasma genitalum trauma 5) catheter 6) urethral stricture 7) urinary calculi ```

Question 105

Urethritis - Risk Factors (4)

Answer 105

1) 15-24 years old 2) female 3) homosexual male 4) unprotected sex

Question 106

Urethritis - Symptoms (5)

Answer 106

1) asymptomatic (10% gonorrhoea, 50% chlamydia0 2) dysuria 3) urethral pain 4) urethral discharge 5) urethral itching

Question 107

Urethritis - Investigations (3/0)

Answer 107

initial 1) nucleic acid amplification test (swab - female, first void volume - male) 2) urethral discharge MS+C (PMN leucocytes) 3) urine dipstick (exclude UTI)

Question 108

Urethritis - Management (3/3/0)

Answer 108

``` conservative 1) patient education 2) partner notification 3) contact tracking medical 1) analgesia 2) PO azithromycin (chlamydia) 3) PO azithromycin + IM ceftriaxone (gonorrhoea) ```

Question 109

Erectile Dysfunction - Description

Answer 109

inability to achieve or maintain an erection

Question 110

Erectile Dysfunction - Causes (Organic) (6)

Answer 110

1) vascular (e.g. atherosclerosis) (40%) 2) diabetes mellitus (30%) 3) iatrogenic (15%) 4) trauma (e.g. radical prostatectomy) 5) neurogenic 6) endocrine

Question 111

Erectile Dysfunction - Causes (Psychogenic) (5)

Answer 111

1) age related libido decline 2) partner related 3) fear of failure 4) depression 5) major life stress (e.g. death of partner)

Question 112

Erectile Dysfunction - Risk Factors (12)

Answer 112

1) ischaemic heart disease 2) peripheral vascular disease 3) hypertension 4) hypogonadism 5) diabetes mellitus 6) smoking 7) alcohol 8) neurological disease 9) psychosexual/relationship problems 10) antihypertensive 11) antidepressant 12) antiandrogenic

Question 113

Erectile Dysfunction - Symptoms (1)

Answer 113

1) premature ejaculation

Question 114

Erectile Dysfunction - Signs (6)

Answer 114

1) penile plaques 2) penile deformities 3) penile angulation 4) small testes (hypogonadism) 5) abnormal hair pattern 6) gynecomastia

Question 115

Erectile Dysfunction - Investigations (5/2)

Answer 115

``` initial 1) Internal Index of Erectile Dysfunction questionnaire 2) fasting blood glucose (>11mM) 3) fasting lipid profile 4) BP 5) HR consider 1) 9:00am testosterone (low - hypogonadism) 2) PRL/FSH/TSH (if testosterone low) ```

Question 116

Erectile Dysfunction - Management (2/5/1)

Answer 116

``` conservative 1) psychosexual therapy 2) risk factor modification medical 1) Viagra 2) treat underlying cause (1st) 3) phosphodiesterase-5-inhibitors (2nd) 4) intracarvenous prostaglandin injections (3rd) 5) vacuum erection device (4th) surgery 1) penile prosthesis (5th) ```