Urology

Question 1

How might the position of patient differ in someone with renal colic versus abdominal pain?

Answer 1

renal colic- cannot find comfortable position therefore rolling around

abdo pain- staying still in one position

Question 2

List two sites of stone impaction

Answer 2

PUJ
Pelvic brim
VUJ

Question 3

How can struvite stone present?

Answer 3

recurrent UTIs
malaise
weakness
loss of appetite

Question 4

List three differential diagnoses for renal colic

Answer 4

Acute abdo- gallstones, pancreatitis, AAA
Pyelonephritis
Bacterial cystitis
Gynae
Referred pain- orchitis
Chest- lobar pneumoni, rib fractures

Question 5

Which imaging do you do for renal colic? (the most sensitive investigation)

Answer 5

Non-contrast CT KUB

Question 6

What does radio-opaque mean?

Answer 6

presence of calcium within the stone

Question 7

List one radioopaque stone

Answer 7

ca phosphate
ca oxalate

Question 8

List one radiolucent stone= transparent

Answer 8

uric acid
(struvite stone= infection, cystine are relatively radiolucent)

Question 9

Which co-infection is indinavir stones associated with?

Answer 9

HIV

Question 10

What is the treatment for renal stones?

Answer 10

Analgesia- NSAIDs, opiates
Alpha blockers
Stent or percutaneous nephrostomy tube
surgery

Question 11

List two indications for intervention to remove stone?

Answer 11

pain unresponsive for analgesia
related fever
renal function impairment
obstruction unrelieved >4 weeks

Question 12

What is the first intervention for kidney stone?

Answer 12

shock wave therapy- ESWL

Question 13

If ESWL fails, what is the next option?

Answer 13

PCNL- percutaneous nephrolithonomy

Question 14

What is one indication for ESWL?

Answer 14

pregnancy
pacemaker
distal obstruction
uncorrected coagulopathy

Question 15

Name one indication for PCNL

Answer 15

staghorn calculi
stone >2cm
multiple stones

Question 16

Which surgical treatment for kidney stones is safe in pregnant women?

Answer 16

ureterenoscopy

Question 17

Which treatment is safe for coagulopathies?

Answer 17

ureterenoscopy

Question 18

List three surgical treatments for stones

Answer 18

cystoscopy
open surgery
ureterenoscopy
nephrectomy!!

Question 19

List two complications of urinary retention

Answer 19

infection, AKI, haematuria

Question 20

List two complications of chronic urinary retention

Answer 20

hydronephrosis
CKD
bladder detrusor hypertrophy

Question 21

List three risk factors for acute urinary retention

Answer 21

BPH
Constipation
Cancer- prostate, pelvic
Infection- cystitis
Trauma
Medications

Question 22

List one medication that can lead to urinary retention

Answer 22

antimuscarinics (decreased bladder sensation and detrusor contractility)
sympathomimetics
opioids (decreased bladder sensation)

Question 23

Signs of acute urinary retention when palpating and percussing bladder?

Answer 23

dull to percussion
enlarged palpable bladder

Question 24

List two aspects of examination in acute urinary retention

Answer 24

abdo exam- suprpubic tenderness and palpate/percuss bladder
PR exam
vaginal exam
neuro exam- neuro impairment

Question 25

List three investigations for acute urinary retention

Answer 25

bladder USS urinary catheterisation urinalysis U+Es FBC- infection, haematuria

Question 26

What is the treatment for acute urinary retention?

Answer 26

urethral catheterisation suprapubic catheter treat underlying cause

Question 27

Red flags for malignancy with haematuria

Answer 27

old age male cigarette smoking chemical exposure- benzenes history of pelvic radiation

Question 28

List two differentials for glomerular haematuria

Answer 28

IgA nephropathy- Berger's disease Thin glomerular basement disease hereditary nephritis- Alport syndrome

Question 29

List two causes for non-glomerular haematuria

Answer 29

urinary obstruction transitional cell carcinoma pyelonephritis renal cell cancer UTI BPH Strenuous exercise

Question 30

List two causes for pseudo haematuria

Answer 30

food- beetroot, blackberries menses drug related

Question 31

Painless haematuria. What MUST you rule out

Answer 31

transitional cell carcinoma

Question 32

List three differentials for the acute scrotum

Answer 32

testicular torsion acute epididymitis acute orchitis abscess hernia hydrocele