GU

Question 1

what is the comonest male malignancy in 15-44yos

Answer 1

testicular cancer

Question 2

what is most common type of testic cancer

Answer 2

germ cell tumours of whihc 50% = seminoma (sperm producing tissue)

Question 3

RF of testicular cancer

Answer 3

fam Hx
undescended tester
klinefelters syndrome

Question 4

Cfs of testicular cancer

Answer 4

painless lump
haematospermia
secondary hydrocele
mets? - abdo mass (enlarged nodes)
back pain (bones)
dyspnoea (lungs)
"dragging sensation"

Question 5

Ix of testic cacner

Answer 5

bloods -alpha fetoprotein (made by yolk sac tumurs and others)
beta - hCG (= beta humanchorionic gonadotropin) NEVER IN NORM MEN
lactate dehydrogenase
biopsy = inguinal orchiectomy
CT to assess metastasis

Question 6

Management of Testicular tumours

Answer 6

Radical orchiectomy plus Radiotherapy

chemo

Question 7

5yr survival rate for testic cancer

Answer 7

90%

Question 8

Staging system for Testicular tumour

Answer 8

Stage 1 no metastasize
2 spread to infradiaphragmatic
3 supradiaphragmatic
4 involvement into the lungs

Question 9

where does prostate cancer most often spread to

Answer 9

metastasis to bone and lymph nodes

or spread locally to bladder, seminal vesicles, rectum

Question 10

Presentation of prostate cancer

Answer 10

LUTS, voiding and storing,
+ haematuria, dysuria
Back pain ( also found in prostatitis)
weight loss and anemia

Question 11

Epidimeology assosiations and risk factors of prostate cancer

Answer 11

+ve family history, Age
increased testosterone (Black people)
BRCA2 gene

Question 12

What type of cancer is prostate cancer and which cells does it originate from

Answer 12

adenocarcinoma, originating from epithelium in the TRANSITIONAL ZONE of prostate

Question 13

Physical examinations for prostate cancer

Answer 13

DRE shows hard irregular prostate

examination could show enlarged lymph nodes (late stage)

Question 14

Investigations for Prostate cancer

Answer 14

PSA- Elevated
Transrectal ultrasound and biopsy - diagnostic and graded

CT/MRI used to identify spread.
Bone scan

Question 15

why does PSA elevation not necces mean prostate cancer

Answer 15

PSA increases in BPH (more cells)
after ejaculation
infection
catheters

Question 16

what scoring system used for Prostate cancer

Answer 16

gleason scoring (/10) 
6 or less = low grade
7=intermed
8-10 = high

Question 17

DDx of prostate cancer

Answer 17

BPH
prostatitis
bladder tumours

Question 18

complication of prostate cancer

Answer 18

spinal cord compression

Question 19

Mx of prostate cancer (metasised)

Answer 19

hormone therapy -
STIM INHIB SHRINKS
antiandrogen FIRST - increases testosterone production
high GNRH (Goserelin) therefore pit gland resistent
give LH anatgonist (flutamide ) = no testosterone
+radiotherapy

Question 20

Mx - localised

Answer 20

active surveillence
if progressing =
radical Prostatectomy + supplementary chemo and radiotherapy

Question 21

SE of hormone therapy in prostate cancer

Answer 21

loss of libido

osteroporosis

Question 22

what is the biomarker in prostate cancer and where found

Answer 22

PCA3 - in urine

Question 23

what converts testosterone to dihydrotestosterone

Answer 23

5-alpha reductase

Question 24

what does testosterione get converted to

Answer 24

dihydrotestosterone (DHT)

Question 25

why is dihydrotestosterone assos w BPH

Answer 25

more potent than testosterone and can cross cell membrane and bind to recepotors and inib apoptosis= HYPERPLASIA

Question 26

what is BPH

Answer 26

increased size of prostate without malignancy | prolif og musculofibrous/glandular tissue

Question 27

Rf of BPH

Answer 27

age obesity fam hx

Question 28

what does digital rectal exam show in BPH

Answer 28

smooth and enlarged

Question 29

CFs of BPH

Answer 29

LUTS storage - freq, urgency, nocturia voiding - hesitancy, dysuria, incomplete voiding, post micturation dribbling, poor stream haematuria, dysuria - Cancer??

Question 30

Dx of BPH

Answer 30

``` DRE - smooth enlarged PSA - excl malignancy Transrectal ultrasound - size palp bladder? Urinalysis: MSU MS and C. all comes back clear, eliminates UTI dipstick ```

Question 31

what does α1-adrenergic receptors do

Answer 31

vasoconstiction, induces contraction of the urinary bladder

Question 32

lifestyle changes to someone with BPH = mild

Answer 32

less caffiene less alcohol bladder training

Question 33

complications of BPH

Answer 33

``` stones haematuria infections retention renal disease ```

Question 34

Differential for LUTS voiding and storing

Answer 34

``` BPH UTI Prostatic carcinoma Bladder cancer Overactive bladder prostatitis ```

Question 35

Management of BPH | pharamacological

Answer 35

5 alpha reductase inhibitor - finasteride (SE = reduced libido) = decrease in testosterone conversion to dihydrotestosterone alpha 1 anatagonist - TAMSULOSIN SE-dry mouth dizzy or orchiectomy as testosterone linked

Question 36

5-alpha reductase inhib used in BPH

Answer 36

finasteride

Question 37

alpha blocker used in BPH

Answer 37

tamsulosin (alpha 1 anatagonist)

Question 38

indications for surgey in BPH

Answer 38

``` RUSHES retention UTI recurrent Stones Haematuria elevated creatinine symptoms deterioration (uncontrolled) ```

Question 39

what is treatment for overactive bladder syndrome

Answer 39

Anticholinergics- tolterodine

Question 40

Surgery options for BPH

Answer 40

Transurethral resection of prostate (TURP) Transurethral Incision of Prostate (TUIP) Prostatectomy

Question 41

what are symptoms of urinary retention

Answer 41

``` Painful confusion fever flank pain LUTS ```

Question 42

what can cause urinary retention

Answer 42

``` any urethral obstruction BPH malignancy from outside stones, Anticholinergics Iatrogenic ```

Question 43

treatment of urinary retention

Answer 43

Urethral catheter and treat underlying causes