Urology

Question 1

True or false; prostate cancer always presents with a raised PSA

Answer 1

False - can be normal

Question 2

State whether the following renal stones are opaque or radiolucent

1 Calcium oxalate
2 Mixed oxalate/phosphate
3 Triple phosphate
4 Urate
5 Cysteine
6 Xanthine

Answer 2

1 Opaque
2 Opaque
3 Opaque
4 Radiolucent
5 Semiopaque
6 Radiolucent

Question 3

What is the cremasteric reflex and when is it lost?

Answer 3

Stroking the inner thigh causes ipsilateral testicular retraction.

Absent in torsion

Question 4

Which drugs commonly cause erectile dysfunction?

Answer 4

SSRIs

Beta blockers

Question 5

What is the best investigation for hydronephrosis?

Answer 5

Ultrasound of the renal tract

Question 6

What is the first line management of hydronephrosis?

Answer 6

Nephrostomy

Question 7

What are the causes of hydronephrosis?

Answer 7

Unilateral - PACT
Pelvic ureteric obstruction
Aberrant vessels
Calculi
Tumour

Bilateral - SUPER
Stenosis of urethra
Urethral valve
Prostate
Extensive bladder tumour
Retroperitoneal fibrosis

Question 8

WHat are staghorn calculi typically composed of?

Answer 8

Mangeium ammonium phosphate (triple phosphate Struvite) stones

Question 9

Which infection is most commonly associated with staghorn calculi?

Answer 9

Proteus mirabilis

Question 10

Renal cancer with exposure to textiles industry?

Answer 10

TCC

Question 11

What type of renal cancer is associated with Tuberous Sclerosis?

Answer 11

Angiomyolipoma

Question 12

How might a lower UTI precipitate urinary retention?

Answer 12

Urethritis _> oedema -> retention

Question 13

What is the use of a PSA in urinary retention?

Answer 13

None - it is generally raised due to compression

Question 14

How do you diagnose acute retention?

Answer 14

Bladder scan with >300ml volume

Question 15

What is the first line investigation in suspected prostate cancer?

Answer 15

Multiparametric MRI (NOT TRUS guided biopsy)

Question 16

What is the most common type of prostate cancer?

Answer 16

Adenocarcinoma

Question 17

What is the first line investigation for any testicular lump?

Answer 17

Ultrasound

Question 18

What complication may occur after acute urinary retention, and how should it be monitored for?

Answer 18

AKI

Cr

Question 19

What should be done for a patient with an unresolved varicocele?

Answer 19

Renal tract USS

Question 20

What is the commonest infective agent of epididimo orchitis in a patient with a low vs. high STI risk?

Answer 20

E coli in low risk

Chlamydia in high risk

Question 21

What is the commonest cause of scrotal swelling seen in primary care, and what are its features?

Answer 21

Epididymal cysts

Separate from body of testicle on the posterior aspect

Question 22

What are the features of a hydrocele?

Answer 22

Soft non tender swelling antero-inferior to the testicle
You can get above the mass
Transluminates

Question 23

What are the side effects of tamsulosin?

Answer 23

Dizziness
Postural hypotension
Dry mouth
Depression

Question 24

What are the side effects of finestaride?

Answer 24

ED
Reduced libido
Ejaculation problems
Gynaecomastia

Question 25

What is the first step in the management of patients with chronic urinary retention and hydronephrosis?

Answer 25

Intermittent self catheterisation

Question 26

WHich has the better prognosis, seminoma or teratoma?

Answer 26

Seminoma

Question 27

What investigation should be done in the event of priapism and why?

Answer 27

Cavernosal blood gas analysis to distinguish between ischaemic and non ischaemic priapism

Question 28

Which type of renal calculus is associated with an inherited metabolic disorder?

Answer 28

Cystine

Question 29

What type of renal stone would you see in a patient undergoing chemo?

Answer 29

Urate (radiolucent)

Question 30

What are the features of a nephroblastoma (WIlm's tumour)

Answer 30

Early (first 4 years) Haematuria with mass 50% have pyrexia Lung mets

Question 31

What does periureteric fat stranding indicate?

Answer 31

Recent stone passage

Question 32

What testicular pathology may occur after a urological intervention?

Answer 32

Epidydimo orchitis

Question 33

WHat are some common complications following radical prostatectomy?

Answer 33

Incontinence ED Urethral stenosis

Question 34

What might occur in the early stages of treatment with 5alha reducatas inhibitors, and how can this be prevented?

Answer 34

A transient rise of prostate symptoms known as the 'flare effect' due to increase in LH production prior to receptor down regulation Flutamide is a synthetic antiandrogen which can be used to attenuate this flare

Question 35

Measurement of PSA should be deferred for how long after prostatitis?

Answer 35

1 month

Question 36

True or false, the cremasteric reflex is present in torsion of the testicular appendage

Answer 36

True

Question 37

What is the commonest type of renal carcinoma?

Answer 37

Adenocarcinoma

Question 38

Which urological malignancy (other than RCC) metastasises to the lungs?

Answer 38

Teratoma - common in younger males

Question 39

What are the prophylactic benefits of circumcision?

Answer 39

Reduced risk of penile cancer Reduced risk of UTI Reduced risk of STIs including HIV

Question 40

What is the strongest risk factor for testicular cancer?

Answer 40

Infertility (3x higher)

Question 41

Manageme4nt of renal calculi with signs of infection?

Answer 41

Surgical decompression

Question 42

What is a contraindication to circumcision?

Answer 42

Hypospadias

Question 43

A 75-year-old man presents with a swelling in his right scrotum. On examination a large, non-tender swelling is found in the scrotum. You cannot palpate above the swelling during the examination.

Answer 43

Inguinal hernia, as you cannot palpate above the swelling

Question 44

WHat are the commonest causes of organic erectile dysfunction?

Answer 44

Vascular - e.g. CVD, HTN, DM etc

Question 45

What cancer are patients with schistosomiasis at risk of?

Answer 45

Squamous cell carcinoma of the bladder

Question 46

What is the preferred management of urolithiasis in pregnant women?

Answer 46

Ureteroscopy

Question 47

What is the management of a stone burden <2cm?

Answer 47

Shock wave lithotripsy with urinary alkalinization

Question 48

Prostate cancer radiotherapy puts patients at increased risk of which cancers?

Answer 48

Bladder Colon Rectal

Question 49

How long does finestaride take to work?

Answer 49

6 months

Question 50

AFP and HCG are typically normal and raised in whicy types of t esticular cancer?

Answer 50

Normal in seminomas | Raised in teratomas and yolk sac tumours

Question 51

WHich type of testicular lump is associated with infertility?

Answer 51

Varicoceles

Question 52

What is recommended as pain management in renal colic?

Answer 52

75 IM diclofenac

Question 53

What should be prescribed in the first 3 weeks of goserelin treatment?

Answer 53

Cyproterone acetate (anti-androgen)

Question 54

Balanitis xerotica obliterans may cause...?

Answer 54

Phimosis

Question 55

Schistosomiasis is a risk factor for which type of renal cancer?

Answer 55

Squamous cell carcinoma of the bladder

Question 56

What are the complciations of TURP?

Answer 56

TURP ``` Turp syndrome: Dilutional hyponatraemia Fluid overload Glycine toxicity Occurs due to irrigation fluid entering the systemic circulation ``` Urethral stricture/UTI Retrograde ejaculation Perforation of the prostate

Question 57

What is a normal post void bladder volume in under and over 65 year olds?

Answer 57

<65 - <50ml | >65 - <100ml

Question 58

What is the mechanism of Goserelin?

Answer 58

GnRH agonist