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PLABABLE 2.0 > Urology > Flashcards

Urology Flashcards

1
Q

A man presents with Left Scrotal dull pain, dragging pain, after sports. PE: (+) cough impulse

A

Varicocele

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2
Q

Imaging of choice for varicocele

A

Scrotal Doppler

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3
Q

Why is varicocele more common in the left?

A

You have to remember that

  1. Left testicular vein drains into the left renal vein in a 90 degree manner
  2. Right testicular vein drains into the IVC in an oblique

The slanting of drainage has something to do with pressure and Left Testicular Vein has to drain blood at a much higher pressure

You have to remember that varicocele results from INCOMPETENT VALVES in the testicular vein leading to retrograde blood flow, vessel dilatation and tortuosity of the pampiniform plexus.

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4
Q

In which types of scrotal swelling will you be able to go above the swelling on physical examination?

A

Epididymal Cyst

Hydrocele

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5
Q

Acute, severe testicular pain
Common in adolescent and young
Pain does not reduce by elevation of testis

A

Testicular Torsion

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6
Q

Treatment for testicular torsion

A

Urgent explratory surgery with orchidopexy

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7
Q

Dysuria + urethral discharge + sexually active +M fever + red and tender scrotal skin + pain reduced on elevation of testis

A

Acute EO

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8
Q

Common causative agents of EO in a 35 year old sexually-active

A

Chlamydia

Gonorrhea

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9
Q

Common causative agents of EO in >35 y/o

A

E. coli

Pseudomonas

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10
Q

Investigation of choice for acute epididymo-orchitis

A

Urethral swab and smear

Microscopy and culture of mid-stream urine

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11
Q

Treatment of AEO in sexually-active <35 y/o

A

Cetriaxone 1g IM stat
PLUS
Doxycycline 100mg BD for 10=14 days

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12
Q

Acute EO in >35y/o

A

Ofloxacin 200mg BD x 14 days
OR
Levofloxacin 500mg BD for 10 days

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13
Q

Best management for stress incontinence

A

Pelvic floor exercises

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14
Q

Management of renal stones

A

For a healthy individual:
<0.5 cm - increase oral fluid intake
0.5-2cm - ESWL > Ureteroscopy with dormia basket
>2cm - PCNL

If patient has only ONE FUNCTIONING kidney:
Regardless of the size, Percutaneous nephrostomy

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15
Q

FEVER + AKI + STONE + HYDRONEPHROSIS
What does this suggest?
Management?

A

This suggests OBSTRUCTIVE UROPATHY
Regardless if patient presents with two or one kidney, management is PERCUTANEOUS NEPHROSTOMY to instantly decompress the renal collecting system regardless of the stone size.

***Remember that Percutaneous Nephrostomy is the BEST INITIAL STEP in an attempt to save the kidney. After draining the urine, you may proceed with the most appropriate management by applying the STONE SIZE RULE.

Also, if percutaneous nephrostomy is not available in the options, pick Uretering Stenting as this would function in decompressing the pelvicalyceal system.

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16
Q

When is STONE SIZE rule not applicable?

A

It is not applicable if patient presents with FEVER + ANURIA (AKI) + STONE + HYDRONEPHROSIS. Regardless if the patient has one or two healthy kidneys, patient is managed with percutaneous nephrostomy.

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17
Q

Unilateral loin pain + Positive HCG in urine

A

Suspect Ectopic pregnancy

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18
Q

Loin pain + negative HCG + pain radiates to groin
with or without elevated WBCs and CRP
with or without vomiting

A

Ureteric colic

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19
Q

Positive prehn’s signs

A

Pain relief by elevating the testis

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20
Q

Single or multiple cysts that develop slowly + contains clear or opalescent fluid + over 40 years of age + painless, non-tender scrotal swelling + lies above and behind the testis + on examination, usually possible to get above the lump
Diagnosis?
DIagnostic?

A

Epididymal Cyst

Ultrasound

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21
Q

Non-painful, soft, fluctuant scrotal swelling + on examination, possible to get above the lump + contains clear fluid + transilluminates

A

Hydrocele

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22
Q

Severe, sudden onset testicular pain + abnormal testicular lie + affects adolescents and young males + on examination: testicular pain and tenderness not eased by elevation

A

Testicular torsion

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23
Q

How does acute EO present?

A

Dysuria + urethral discharge + positive prehn’s sign + scrotal skin is red and tender + painful micturition

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24
Q

Scrotal swelling typically occurring in the left + dull-aching or dragging pain that is worse after exercise or at the end of the day + bag of worms + show impulse on cough
Management?

A

Varicocele
If painless - Reassure
If with concerns regarding fertility and if patient complains of persistently severe pain - Surgery

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25
Q

Management of testicular malignancy

A

Orchidectomy via an inguinal approach

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26
Q

Management of testicular torsion

A

URGENT surgical exploration and testicular fixation

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27
Q

Urinary urgency or frequency + Subrapubic pain worse on bladder filling and relieved after voiding
Diagnostics?
Management?

A 
Urine (midstream) for culture to rule out UTI
Bladder training (Avoid pelvic floor exercises as we need pelvic floor relaxation)
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28
Q

Leakage of small amount of clear fluid (usually with no distinct odor) into the vagina + history of gyne surgery or radiotherapy (for cervical cancer)
Diagnosis?
Diagnostic?

A

Vesicovaginal fistula
3 swab test (3 swabs on top of each other)

***In V-V fistula, you expect discoloration of the topmost or middle swab. Remember that bladder is filled with methylene blue. So if the topmost is wet but no discoloration, fistula must be coming above the bladder which is the ureter, thus, Ureterovaginal fistula should be entertained.

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29
Q

Leakage of urine during activity (sneezing, coughing or laughing)
Diagnosis?
Initial Management?

A

Stress incontinence
Pelvic floor exercises: 8PC TID x 3 mos.
If fails, vaginal tape. Duloxetine if not amenable for surgery

***Remember that in stress incontinence, you have weak pelvic floor muscles or bladder outlet that cannot counteract the increased abdominal pressure (during physical activity), hence, leakage of urine.

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30
Q

Leakage of urine when there is a sensation of need to void.
Diagnosis?
Management?

A 
Urge incontinence (Detrusor overactivity)
Bladder training (anti-M if bladder training fails)
31
Q

When I feel the desire to pee, I have to go and pee.

A 
Urge incontinence (Detrusor overactivity)
Bladder training (anti-M if bladder training fails)
32
Q

When I feel a desire to pee, sometimes I slightly wet myself before making it to the bathroom

A 
Urge incontinence (Detrusor overactivity)
Bladder training (anti-M if bladder training fails)
33
Q

DRE finding of BPH

A

Firm, enlarged, smooth, NOT NODULAR prostate

34
Q

First line treatment of BPH

A

(Watchful waiting)

Alpha1blocker - Tamsulosin

35
Q

Side effects of Alpha1 Blockers

A

Postural Hypotension and drowsiness, Cough & dyspnea

36
Q

Finasteride is first-line if patient presents with LUTS with prostate enlargement in addition to this PSA value

A

> 1.4

37
Q

There is urinary flow obstruction that has been relieved after inserting Foley catheter, what should you do next?

A

Before jumping into surgery, you must PRESCRIBE TAMSULOSIN and REFER FOR TWOC*

*Trial without catheter

***Tamsulosin then TWOC to check if voiding will happen

38
Q

Patient underwent TURP and presents with agitation and confusion.
Diagnosis?

A

TURP syndrome

***Think of dilutional hyponatremia as excessive irrigation might have triggered the dilutional hyponatremia. Excessive irrigation must be done for full visualization.

39
Q

DRE finding of prostate cancer

A

Hard, asymmetrical, nodular, irregular enlargement with loss of median sulcus

40
Q

HANI of prostate cancer

A

DRE findings: Hard, asymmetrical, nodular, irregular enlargement of the prostate with loss of median sulcus.

41
Q

First-line investigation if you are presented with a patient who presents with hesitancy, hematuria, weight loss, pain (suprapubic, back, perineal or testicular) with DRE finding of HANI.
Most appropriate follow-up investigation?

A

First-line: Multiparametric MRI

Follow-up: Serum PSA

42
Q

Basing on the PSA levels when do you suspect PSA?

A

40-49: >2.0
50-69: >3.0
>70: >5.0

43
Q

A known case of prostate cancer presents with LOIN PAIN and ANURIA. RFT is impaired. Diagnostics?

A

Suspect occluded ureter

Do US of KUB

44
Q

A known case of prostate cancer presents with groin/perianal numbness (saddle paresthesia) with back pain and no urge to void

A

Suspect cauda equina syndrome

URGENT MRI of the spine

***Remember SPINE is the most common site of bone metastasis

45
Q

After abdominal surgery, patient presents with unilateral flank pain, anuria post-op. Initial investigation?

A

Renal ultrasound

46
Q

Why is a patient with sarcoidosis prone in developing kidney stones?

A

Due to hypercalcemia

47
Q

Most common malignancy in men aged 20-35 years old

A

Testicular cancer

48
Q

Painless, non-tender lump within the testis + slowly growing + young man
Diagnosis?
INitial investigation?

A 
Testicular cancer (90% is germ cell tumor)
Ultrasound | LDH
49
Q

Greatest RF for bladder cancer

A

Smoking

50
Q

Commonest type of bladder cancer

A

Transitional cell CA

51
Q

Above 40 years old + Frank hematuria

Diagnostics?

A

Flexible cystoscopy + CT urogram

52
Q

Less than 40 years old with hematuria

Diagnostics?

A

CT KUB (less likely caused by malignancy

53
Q

After successful treatment of UTI, non-smoker patient aged >45 presents with persistent hematuria. Next step?

A

Suspect bladder CA even if patient is non-smoker, thus, you should REFER patient for a 2-WEEK WAIT appointment with Uro or Nephro

54
Q

Important disease associated with ADPKD

A

Intracranial aneurysm

55
Q

Gold standard for Reflux nephropathy

A

MCUG

56
Q

Diagnostic test of choice to check for renal scarring

A

Tc scan (DMSA)

57
Q

What is recurrent UTI

A

2 in 6
OR
3 in 12

58
Q

Description of varicocele with renal pain and hematuria

A

RCC

59
Q

If a patient is to be requested for PSA, what advice should you give?

A

Avoid ejaculation or exercise 48 hours before serum PSA test.

60
Q

Isolated frank hematuria in an elderly? Next step?

A

It is important to rule out bladder cancer, hence, CYSTOSCOPY

61
Q

Prolonged IFC + urine dipstick (+1 protein, 1+ RBC, - nitrates)
Best investigation?

A

Urine culture

62
Q

Investigation for scrotal swelling

A

Ultrasound

63
Q

A patient presents with LUTS. DRE: large, symmetrical, soft prostate. He was given finasteride. What may be the cause for him being given finasteride?
MOA of finasteride?

A

Elevated PSA > 1.4

5-alpha reductase inhibitor

64
Q

Initial investigation for UTI

A

Dipstick urinalysis

65
Q

DRE finding of acute bacterial prostatitis?

A

Tender and boggy PG

66
Q

Management for acute bacterial prostatitis?

A

Empiric antibiotic: Quinolones (ciprofloxacin, ofloxacin)

67
Q

A 55-year old man presents complaining of LBP on urination over the past week. There is also increased urinary frequency. O/E: there is suprapubic tenderness. Per rectal examination detects tender prostate. Midstream urine is sent for culture and sensitivity. What should be done next?

What is the likely diagnosis?
Next step in management?

A

Prostatitis

Start on empirical antibiotics - quinolones (No need to wait for culture and sensitivity results)

68
Q

Why do you do cystoscopy and CT urogram in a patient above 40 with hematuria while CT KUB in patients less than 40?

A

Above 40 with frank hematuria, you rule out bladder cancer through cystoscopy. You also look for ureteric and renal cancers through CT urogram. Since malignancy is not likely to be found in patients below 40, you request for CT-KUB as stone might be the plausible cause of hematuria.

69
Q

Recurrent UTI in postmenopausal women with no other abnormalities?

A

Vaginal oestrogen

***because of the risk of antibacterial resistance

70
Q

Recurrent UTI in premenopausal women with no other abnormalities

A

Long-term antibiotic prophylaxis

71
Q

Two conditions where you would pick percutaneous nephrostomy or ureteric stenting

A

Obstructive uropathy PLUS fever

Obstructive uropathy PLUS AKI

72
Q

Spina bifida with UTI

A

Urinary incontinence pad

73
Q

Spina bifida with incontinent, no UTI

A

Self-catheterization

74
Q

Spina bifida with advanced urinary disease

A

Augmentation cystoplasty and Mitrofanoff stoma

PLABABLE 2.0 (33 decks)

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