Integrative

Question 1

5 List 3 markers of testicular tumours

Answer 1

aFP
hCG
LDH

Question 2

5 What 2 types of drugs would you use to manage male lower urinary tract symptoms ?

Answer 2

Alpha blockers (rapid relief)
5α-Reductase Inhibitors (slower symptom relief but slows progressio reduces risk of retention)

Question 3

5 What examination/s would you do for a male patient with LUTS (lower urinary tract symptoms)?

Answer 3

Examine penis

DRE

Question 4

5 What is the incidence of phimosis?

Answer 4

1% in adult non-circumcised population

More so in childhood & adolescence (physiological)

Question 5

5 List 8 sequelae of phimosis

Answer 5

Hygiene issues incl inc risk STIs
Pain on intercourse, splitting / bleeding 
Balanitis 
Posthitis (inflamed foreskin / prepuce)
Balanitis Xerotica Obliterans
Paraphimosis
Urinary retention
Penile cancer

Question 6

5 What are the 3 commonest causes of paraphimosis?

Answer 6

Phimosis
Catheterisation
Penile cancer

Question 7

5 What are the 2 main risk factors for squamous cell carcinoma of the penis?

Answer 7

Phimosis (due to poor hygiene and smegma build up)

HPV 16 and 18

Question 8

5 Besides religious choice what are the main indications for pediatric circumcision ?

Answer 8

Recurrent balanitis and UTIs

Question 9

5 List 5 key indications for circumcision in adults

Answer 9

– Recurrent balanitis
– Phimosis
– Recurrent paraphimosis
– Balanitis xerotica obliterans
– Penile Cancer

Question 10

5 What cause should you always consider in acute scrotal pain?

Answer 10

Testicular torsion

Question 11

5 What is the typical history in testicular torsion?

Answer 11

Young man, under 30

Sudden onset of unilateral scrotal pain with nausea but no associated lower urinary tract symptoms.

Question 12

5 How would you manage a patient with suspected testicular torsion?

Answer 12

Examination and refer to urology for emergency scrotal exploration

Question 13

5 What findings on examination would help confirm a diagnosis of testicular torsion?

Answer 13

Very tender testis, lying high in scrotum with horizontal lie

Question 14

5 What’s the most common cause of epididymo-orchitis in middle aged men?

Answer 14

UTI (esp E.coli)

Question 15

5 Why is it important to examine the skin of the whole scrotal and perineal area in cases of epididymo-orchitis?

Answer 15

In case of Fournier’s Gangrene - necrotic area of scrotal skin.
Although rare has a high mortality rate

Question 16

5 Why is it more worrying if a palpable scrotal lump is within the body of the testis?

Answer 16

May be a testicular tumour

Question 17

5 What is the differential diagnosis for a painful and tender scrotal lump?

Answer 17

Epididymitis
Epididymo-orchitis
Strangulated inguino-scrotal hernia (this is an emergency)

Question 18

5 In what age range are germ cell testicular tumours most common?

Answer 18

<45 year olds (in older men tumour may be lymphoma)

Question 19

5 How does a hydrocele form?

Answer 19

imbalance of fluid production and

resorption between tunica albuginea and tunica vaginalis

Question 20

5 What would be the typical history of a varicocele?

Answer 20

History of dull ache in scrotal area in evenings. On examination L sided non-tender scrotal swelling with “bag of worms” texture above testis.

Question 21

5 What is the treatment for a testicular tumour?

Answer 21

Inguinal orchidectomy

Question 22

5 When would a radiological embolisation be indicated for a varicocele?

Answer 22

If pt symptomatic, infertile, or if adolescent and growth of testis affected
(otherwise reassurance)

Question 23

5 What range of residual volume of urine would suggest that a case of urinary retention has an acute cause?

Answer 23

<1000ml

acute on chronic >1000ml

Question 24

5 What are the 2 main treatments for acute-on-chronic urinary retention

Answer 24

Long term catheter
Surgery
(NB trial w/o catheter usually unsuccessful and no point if associated kidney damage)

Question 25

5 What is the main cause of nocturnal enuresis in older men?

Answer 25

Chronic retention w/ overflow incontinence

Question 26

5 What are the main type of receptors that mediate sympathetic smooth muscle tone of the bladder?

Answer 26

Alpha 1 adrenoreceptors

Question 27

5 What are the 3 main lifestyle interventions for managment of BPH?

Answer 27

* Reduce caffeine intake * Avoid fizzy drinks * Avoid drinking more than 2.5L day

Question 28

5 How do 5α-Reductase Inhibitors work?

Answer 28

Shrink prostate by depriving it of androgens

Question 29

5 What is the standard surgical treatment for BPH?

Answer 29

Transurethral resection of prostate (TURP)

Question 30

5 If there is a scrotal lump in the body of the testis, what cause is it vital to investigate for?

Answer 30

Testicular cancer

Question 31

5 What are the 6 main physical causes of erectile dysfunction?

Answer 31

``` Diabetes Atherosclerosis incl smoking Regular heavy drinking Side effects of prescribed drugs (esp those for high blood pressure, heart disease, depression, peptic ulcers and cancer) Prostate gland surgery Spinal cord injury ```