Urology

Question 1

Management of urinary retention due to BPH?

Answer 1

2 way Foley catheter

Prescribe Doxazosin (alpha blocker) to relax prostate.

Question 2

What term describes a blockage to urine flow along the urinary tract?

Answer 2

Obstructive uropathy

Question 3

What term describes swelling of the kidneys secondary to obstruction to the outflow of urine?

Answer 3

Hydronephrosis

Question 4

What is the name for when urine is able to reflux from the bladder back into the ureters?

Answer 4

Vesicoureteral reflux

Question 5

What are the broad categories of causes of an acute kidney injury?

Answer 5

Pre-renal, renal and post-renal

Question 6

What term describes over or under activity of the detrusor muscle of the bladder that may occur in multiple sclerosis?

Answer 6

Neurogenic bladder

Question 7

What intervention can be used to bypass an upper urinary tract obstruction?

Answer 7

Nephrostomy

Question 8

What options can be used to bypass a lower urinary tract obstruction, such as a urethral stricture?

Answer 8

Urethral catheter or suprapubic catheter

Question 9

What is a notable side effect of tamsulosin?

Answer 9

Postural hypotension

Question 10

What is the name of the standard two-way urinary catheter?

Answer 10

Foley catheter

Question 11

What type of urinary catheter has a curved and slightly rigid tip to help navigate past an obstruction?

Answer 11

Coudé tip catheter

Question 12

What is the risk of not replacing the foreskin after inserting a urinary catheter in a man?

Answer 12

Paraphimosis

Question 13

What standard duration of antibiotics is used in patients with catheter-associated urinary tract infections?

Answer 13

7 days

Question 14

What scoring system can be used to assess the severity of lower urinary tract symptoms in benign prostatic hyperplasia?

Answer 14

International Prostate Symptom Score (IPSS)

Question 15

What two classes of medication can be used to treat benign prostatic hyperplasia? Give one example of each.

Answer 15

Alpha-blockers (e.g., tamsulosin) and 5-alpha reductase inhibitors (e.g., finasteride)

Question 16

What is the most common surgical treatment for benign prostatic hyperplasia?

Answer 16

Transurethral resection of the prostate (TURP)

Question 17

What term refers to when blood is present in the semen?

Answer 17

Haematospermia

Question 18

How long do symptoms need to be present to diagnose chronic prostatitis?

Answer 18

At least 3 months

Question 19

What is the National Institute of Health Chronic Prostatitis Symptom Index used to assess?

Answer 19

The severity of the symptoms (1) and their impact on quality of life (1) in chronic prostatitis

Question 20

What investigation can be used to establish the causative organism in acute bacterial prostatitis?

Answer 20

Urine microscopy, culture and sensitivities (MC&S)

Question 21

What would a fluctuant mass on examination of the prostate indicate?

Answer 21

Prostate abscess

Question 22

What medication can be used to relax smooth muscle and improve symptoms in patients with chronic prostatitis?

Answer 22

Alpha-blockers / tamsulosin

Question 23

What is the main hormone that plays a role in the growth of prostate cancer?

Answer 23

Testosterone

Question 24

What is the most common site of prostate cancer metastasis?

Answer 24

Bones

Question 25

What class of drug increases the risk of prostate cancer?

Answer 25

Anabolic steroids

Question 26

What does PSA stand for?

Answer 26

Prostate-specific antigen

Question 27

Where in the prostate is PSA produced?

Answer 27

Epithelial cells

Question 28

What makes the PSA an unreliable screening test for prostate cancer?

Answer 28

High rate of false positives and false negatives

Question 29

What is now the usual first-line investigation for suspected localised prostate cancer?

Answer 29

Multiparametric MRI of the prostate

Question 30

What is the definitive investigation for establishing the diagnosis of prostate cancer?

Answer 30

Prostate biopsy

Question 31

What scoring system is specific to prostate cancer and helps to determine what treatment is most appropriate?

Answer 31

Gleason grading system

Question 32

What treatment involves implanting radioactive metal “seeds” into the prostate?

Answer 32

Brachytherapy

Question 33

Name an androgen receptor blocker used in the treatment of prostate cancer.

Answer 33

Bicalutamide

Question 34

What type of medication are goserelin and leuprorelin examples of?

Answer 34

GnRH agonists

Question 35

Give two key complications of a radical prostatectomy.

Answer 35

Erectile dysfunction and urinary incontinence

Question 36

What cause of orchitis might be associated with pancreatitis and parotid gland swelling?

Answer 36

Mumps

Question 37

How do you test for mumps?

Answer 37

Saliva swap for PCR testing

Question 38

What is the typical first line treatment for epididymo-orchitis in patients that are low risk for STIs?

Answer 38

Ofloxacin

Question 39

Give three examples of quinolone antibiotics.

Answer 39

Ofloxacin Levofloxacin Ciprofloxacin

Question 40

What existing medical condition would prevent you prescribing a quinolone antibiotic? Why is this?

Answer 40

Epilepsy | Quinolone antibiotics lower the seizure threshold

Question 41

What significant adverse effect should you warn an otherwise healthy patient about when prescribing quinolone antibiotics?

Answer 41

Tendon damage / tendon rupture

Question 42

What is the risk and consequence of a delay in diagnosing and treating testicular torsion?

Answer 42

Ischaemia and necrosis of the testicle, leading to sub-fertility or infertility

Question 43

What abnormality in the scrotum increases the risk of testicular torsion?

Answer 43

Bell-clapper deformity

Question 44

What sign may be seen on an ultrasound scan in testicular torsion?

Answer 44

Whirlpool sign

Question 45

What procedure involves correcting the position of a testicle and fixing it in place?

Answer 45

Orchiopexy

Question 46

Where does fluid collect when a patient has a hydrocele?

Answer 46

Within the tunica vaginalis

Question 47

What can be done to distinguish a fluid-filled mass in the scrotum from a gas-filled or solid mass?

Answer 47

A fluid-filled mass will transilluminate by shining a torch through the skin

Question 48

What venous plexus swells in patients with a varicocele and where does this drain into?

Answer 48

Pampiniform plexus which drains into the testicular vein

Question 49

Which side are most varicoceles on? Why?

Answer 49

Left. Increased resistance in the left testicular vein is it drains into the renal vein, whereas the right testicular vein drains directly into the vena cava

Question 50

What examination finding should raise suspicion of a retroperitoneal tumour in a patient with a varicocele?

Answer 50

Does not disappear when lying down

Question 51

What is the most common cause of a soft, round lump at the top but separate from the testicle?

Answer 51

Epididymal cysts

Question 52

What cells give rise to most testicular cancers?

Answer 52

Germ cells

Question 53

What two groups can testicular tumours be broadly categorised into?

Answer 53

Seminomas and non-seminomas (mostly teratomas)

Question 54

What type of testicular tumour can cause gynaecomastia?

Answer 54

Leydig cell tumour

Question 55

What are the main tumour markers for testicular tumours?

Answer 55

Alpha-fetoprotein and beta-hCG

Question 56

What staging system is used for testicular cancer?

Answer 56

Royal Marsden staging system

Question 57

What are the four most common areas where testicular cancer metastasise?

Answer 57

Lymphatics Lungs Liver Brain

Question 58

What features would make you suspect pyelonephritis more than a lower urinary tract infection?

Answer 58

Fever Loin/back pain Nausea/vomiting Renal angle tenderness on examination

Question 59

What finding on a urine dipstick test is most suggestive of infection? What other findings might indicate infection?

Answer 59

Nitrites Leukocytes and red blood cells

Question 60

What is the most common causative organism in urinary tract infections?

Answer 60

Escherichia coli (E. coli)

Question 61

What is the most common reason for avoiding nitrofurantoin?

Answer 61

Renal impairment / eGFR < 45

Question 62

What is the typical duration of antibiotics in an uncomplicated lower urinary tract infection in an otherwise healthy woman?

Answer 62

3 days

Question 63

When should nitrofurantoin be avoided in pregnancy and why?

Answer 63

Third trimester due to neonatal haemolysis

Question 64

What duration of antibiotics is used in pyelonephritis for patients suitable for management in the community?

Answer 64

7-10 days

Question 65

What findings might be seen on cystoscopy in patients with interstitial cystitis?

Answer 65

Hunner lesions and granulations

Question 66

What treatment for interstitial cystitis involves filling the bladder with water, to high pressure, during a cystoscopy?

Answer 66

Hydrodistention

Question 67

What is the most common histological type of bladder cancer?

Answer 67

Transitional cell carcinoma

Question 68

What chemicals previously used in the dye and rubber industries are a key risk factor for bladder cancer?

Answer 68

Aromatic amines

Question 69

What infection is a risk factor for bladder cancer?

Answer 69

Schistosomiasis

Question 70

What is the typical primary presenting complaint in patients with bladder cancer?

Answer 70

Painless haematuria

Question 71

What is the investigation of choice in suspected bladder cancer?

Answer 71

Cystoscopy

Question 72

What procedure may be performed during a cystoscopy to remove a non-muscle-invasive bladder cancer?

Answer 72

Transurethral resection of bladder tumour (TURBT)

Question 73

What is the term used to describe medication injected given directly into the bladder through a catheter?

Answer 73

Intravesical

Question 74

What medication can be given directly into the bladder as a form of immunotherapy as part of the treatment of non-muscle-invasive bladder cancer?

Answer 74

Bacillus Calmette-Guérin (BCG)

Question 75

What is the most common solution for draining urine after a radical cystectomy?

Answer 75

Urostomy

Question 76

What are the two main risk factors for calcium-based kidney stones?

Answer 76

Hypercalcaemia Low urine output

Question 77

What type of kidney stones cannot be seen on an x-ray?

Answer 77

Uric acid

Question 78

What are staghorn calculi most often made of?

Answer 78

Struvite

Question 79

What is the characteristic symptom of kidney stones?

Answer 79

Renal colic

Question 80

What are the three big main of hypercalcaemia?

Answer 80

Calcium supplements Hyperparathyroidism Cancer

Question 81

What is the most effective form of analgesia for treating pain associated with kidney stones?

Answer 81

NSAIDs

Question 82

What medication can be used to help aid the spontaneous passage of stones?

Answer 82

Tamsulosin / alpha blockers

Question 83

What treatment for kidney stones involves a machine that generates shock waves and directs them at the stone under x-ray guidance?

Answer 83

Extracorporeal shock wave lithotripsy

Question 84

What treatment for kidney stones involves a camera inserted via an incision in the back, through the kidney and into the ureter, allowing the stones to be broken into small pieces and removed?

Answer 84

Percutaneous nephrolithotomy

Question 85

What chemical in carbonated drinks promotes calcium oxalate formation in the kidneys?

Answer 85

Phosphoric acid

Question 86

What may be added to water to reduce the risk of kidney stones?

Answer 86

Lemon juice

Question 87

What dietary advice regarding calcium should be given to patients with a history of kidney stones?

Answer 87

Maintain a normal calcium intake (low dietary calcium might increase the risk of kidney stones)

Question 88

Foods rich in what compound increase the risk of calcium kidney stones?

Answer 88

Oxalate

Question 89

Foods rich in what compound increase the risk of uric acid kidney stones?

Answer 89

Purine

Question 90

What is the classic triad of presenting features in renal cell carcinoma?

Answer 90

Haematuria Flank pain Palpable mass

Question 91

What finding on a chest x-ray is suggestive of metastatic renal cell carcinoma?

Answer 91

Cannonball metastases

Question 92

What paraneoplastic syndrome is associated with excessive unregulated erythropoietin production?

Answer 92

Polycythaemia

Question 93

What operation typically requires a “hockey-stick” incision?

Answer 93

Renal transplant

Question 94

What common skin lesions might suggest a patient is taking long-term immunosuppressants?

Answer 94

Seborrhoeic warts

Question 95

What characteristic examination finding can suggest a patient takes tacrolimus?

Answer 95

Tremor

Question 96

What characteristic examination finding can suggest a patient takes cyclosporine?

Answer 96

Gum hypertrophy

Question 97

What unusual opportunistic infections can occur secondary to immunosuppressant medications?

Answer 97

Pneumocystis jiroveci pneumonia, cytomegalovirus and tuberculosis