Urology

Question 1

What is Cystinurua?

Answer 1

Autosomal recessive condition where someone is predisposed to renal stones composed of cystine. Features include recurrent kidney stones throughout childhood

Question 2

What is the treatment that helps with cystine kidney stones?

Answer 2

Penicillamine

Question 3

What is Priapism?

Answer 3

Persistent painful erections lasting longer than 4 hours.

Sickle cell disease is a risk factor

Question 4

What can falsely raise a PSA test?

Answer 4

An active UTI of previous in last 6 weeks
Ejaculation in last 48 hours
Vigorously exercise
Urological intervention in last 6 weeks

Question 5

What could a left sided varicocele indicate?

Answer 5

Renal cáncer

Question 6

What is the first line treatment for urge incontinence?

Answer 6

Bladder training

Question 7

What is a key investigation for diagnosis of bladder cancer?

Answer 7

Flexible cystoscopy

Can visualise bladder lining
Can take biopsies for histological diagnosis

Question 8

What is the first line analgesic in renal colic?

Answer 8

IM/PR Diclofenac

Question 9

Which infection predisposes to staghorn calculi?

Answer 9

Proteus Mirabilis

Question 10

Which antibiotic is recommended for pregnant women with UTIs who are close to term?

Answer 10

Cefalexin

Question 11

Who should Nitrofurantoin be avoided in?

Answer 11

Those with a renal function eGFR below 45

Decreased efficacy

Question 12

Where does prostate cancer usually occur?

Answer 12

Peripheral zone

Question 13

Where does BPH usually occur?

Answer 13

Transitional zone

Question 14

How does Goserelin work?

Answer 14

Gonodotrophin releasing hormone agonist

GnRH is secreted intermittently.

What this drug does is increase GnRH secretion leading to continual secretion and subsequently disrupts the hormonal axis.

The end result is reduced secretion of testosterone which reduces growth of the prostate tumour

Question 15

Which tumour marker is normally raised in non-seminoma germ cell tumours.

Answer 15

AFP

Question 16

What is the bell clapper deformity?

Answer 16

Bell clapper deformity occurs when the testes is not fixed to the tunica vaginalis and hangs freely leaving it free to rotate

Question 17

What is a Wilm’s Tumour?

Answer 17

Most common renal malignancy in children

Question 18

What are risk factors for TCC of bladder?

Answer 18

Smoking
Exposure to aromatic amines (employed in rubber, dyes, and chemical industry)
Use of Cyclophosphamide

Question 19

What are risk factors for SCC of Bladder?

Answer 19

Schistosomiasis infection
Long-term catheterisation (10+ years)

Question 20

What is Phimosis?

Answer 20

Phimosis is characterised by an inability to retract the foreskin over the glans, commonly seen in infants and young children, which often resolves over time, but can also occur in adults due to various pathological conditions

Question 21

What does a Clear Cell Renal Cell Carcinoma look like under the microscope?

Answer 21

Well circumscribed lesion, mostly golden with interspersed areas of hemorrhagic and fibrotic tissue. Microscopically: Well defined cell membranes with mostly transparent cytoplasm, interspersed with highly vascularised stroma

Question 22

WHAT ARE THE FIRST LINE INVESTIGATIONS IN A PATIENT WITH PAINLESS HAEMATURIA?

Answer 22

CT urogram and cystoscopy

Question 23

What is a CT Urogram?

Answer 23

A CT of the urinary system using contrast

Question 24

What is Detrusor overactivity?

Answer 24

A common cause of urge incontinence

Symptoms are often precipitated by a certain ‘trigger’, for e.g. sound of running water, coffee, tea, arriving home (‘latchkey incontinence’ - a conditioned reflex), leaving home

Question 25

What is the first line imaging investigation for Prostate Cancer?

Answer 25

Multi-Parametric MRI

Question 26

What can be used to prevent the formation of calcium renal stones?

Answer 26

Thiazide Diuretic This is because thiazide diuretics inhibit the sodium-chloride cotransporter in the distal convoluted tubule, which leads to increased calcium reabsorption into the blood via the calcium-sodium exchange, therefore lowering urinary calcium levels.

Question 27

What is the most common complication of a TURP?

Answer 27

Retrograde Ejacula tion

Question 27

How does the size of the kidney stone affect the treatment?

Answer 27

<5mm = Watch and wait , review in 4 weeks <20mm = Shockwave Lithotripsy >20mm = Percutaneous Nephrolithotomy Hydronephrosis = Urgent nephrotic decompression

Question 28

What is percutaneous nephrolithotomy?

Answer 28

Passing a nephroscope percutaneously into the renal system, fragmenting the stone then extracting it.

Question 30

Why must you prescribe an anti-androgen with a GnRH agonist in prostate cancer?

Answer 30

Prevent paradoxical increase in symptoms with GnRH agonists is correct. Initially, treatment of prostate cancer with GnRH agonists can cause a paradoxical increase in symptoms such as bone pain, bladder obstruction and other symptoms, this is referred to as a 'tumour flare'. This occurs because GnRH temporarily causes the pituitary to increase luteinizing hormone (LH) secretion before it begins to inhibit LH release. The increase in LH causes increased stimulation of Leydig cells in the testicles which in turn produce more testosterone. Testosterone stimulates the survival and growth of prostate cancer. Therefore the initial increase in production of testosterone caused by GnRH agonists can cause paradoxical survival, growth and resultant symptoms of prostate cancer. Anti-androgens act by blocking androgen receptors which prevent androgens such as testosterone from binding their receptors and suppressing luteinizing hormone, which in turn reduces testosterone levels.

Question 31

What is decompression haematuria?

Answer 31

Occurs commonly after catheterisation of a patient with long term urinary retention, due to rapid decrease in pressure

Question 32

What are the differentials of frank haematuria?

Answer 32

LUTI Urolithiasis BPH Bladder Cancer Prostate Cancer Renal Cell Carcinoma

Question 33

What is a good way to remember the who is more likely to get which type of testicular cancers?

Answer 33

Teratomas - troops (age 20-30) Teratomas have a worse prognosis -TERRORtoma Seminomas - sergeants (age 30-40)

Question 34

Which bacteria commonly causes epididymi-orchitis in younger males?

Answer 34

Chlamydia Trachomatis

Question 35

Which medication is first line following failure of conservative measures in stress incontinence?

Answer 35

Duloxetine

Question 36

Which medication is first line following failure of conservative measures in urge incontinence?

Answer 36

Oxybutynin