Urology

Question 1

What is Hydronephrosis?

Answer 1

Swollen kidney

Question 2

What causes Hydronephrosis?

Answer 2

Obstruction of urine flow from the kidney at the ureteropelvic junction

Question 3

What are common causes of obstruction in Hydronephrosis?

Answer 3

Kidney stones
Prostate Hyperpasia
Cervical cancer
Retroperitoneal Fibrosis
Congenital Malformation: bladder obstruction
Ureter injury during surgery

Question 4

What is the best test for Hydronephrosis?

Answer 4

US: showing dilation of the renal pelvis and upper ureter

Question 5

How do you treat Hydronephrosis?

Answer 5

relief of obstruction
Percutaneous Nephrostomy tube
Observe for post-obstructive diuresis and correct electrolytes PRN

Question 6

What is Urge Incontinence?

Answer 6

Involuntary leakage of urine with significant urgency: sudden and compelling desire to pass urine immediately

Question 7

What is stress incontinence?

Answer 7

Involuntary leakage with exertion, sneezing and/or coughing

Question 8

What is mixed incontinence?

Answer 8

Involuntary leakage associated with both urgency and stress

Question 9

What is postvoid dribbling?

Answer 9

Slow escape of urine retained in the urethra after the bladder has emptied

Question 10

What is the best initial therapy for incontinence?

Answer 10

Lifestyle modification
-Weight loss, dietary changes
-bladder training
-pelvic floor muscle exercises

Question 11

What drug classes are commonly used for Urge incontinence?

Answer 11

Antimuscarinic drugs and beta-adrenergic agonists

Question 12

What drug class is used for urge incontinence with BPH?

Answer 12

alpha-blockers

Question 13

What drug is used for non-responsive stress incontinence?

Answer 13

Duloxetine

Question 14

What is BPH?

Answer 14

noncancerous increase in prostate size

Question 15

What common symptoms are associated with BPH?

Answer 15

Storage: increased daytime frequency, nocturia, urgency

Voiding: slow stream, splitting or spraying, intermittent stream, hesitancy, straining, terminal dribbling

Question 16

What is the best initial treatment for BPH?

Answer 16

Alpha-1 antagonists

Question 17

What are common alpha-1 antagonist drugs?

Answer 17

Tamsulosin, Terazosin, Dozazosin

Question 18

What is the most common side effect of alpha-1 antagonists?

Answer 18

Hypotension

Question 19

What other drug class is used for BPH?

Answer 19

5-alpha-reductase inhibitors: reduce the size of the prostate over 6-12 months

Question 20

What are common 5-alpha-reductase inhibitor drugs?

Answer 20

Finasteride and Dutasteride

Question 21

What are common risk factors for Erectile Dysfunction?

Answer 21

Obesity, diabetes and depression

Question 22

What is the first class of drugs used for Erectile Dyfunction?

Answer 22

PDE-5 inhibitors

Question 23

What are common PDE-5 Inhibitors?

Answer 23

Sildenafil, Vardenafil, Tadalafil, Avanafil

Question 24

What patients are PDE-5 inhibitors contraindicated in?

Answer 24

Patients taking Nitrates
Caution in alpha-blockers

Question 25

What is the 2nd line therapy for erectile dysfunction?

Answer 25

penile injections of vasodilators like Alprostadil

Question 26

What is Hypospadias?

Answer 26

Urethral opening on the ventral side of the penis, proximal to the tip of the glands

Question 27

How do you treat Hypospadias?

Answer 27

Surgical correction

Question 28

What should you avoid in Hypospadias?

Answer 28

CircumcisionWhat

Question 29

is Epispadias?

Answer 29

Urethral opening on the dorsal surface of the penis

Question 30

What is Epispadias associated with?

Answer 30

Urinary incontinence and bladder exstrophy

Question 31

How do you manage Epispadias?

Answer 31

surgical correction

Question 32

What is Priapism?

Answer 32

Prolonged penile erection >4-6 hours in the absence of sexual stimulation

Question 33

What is Ischemic (low-Flow) Priapism?

Answer 33

Decreased venous flow

Question 34

What is Nonischemic (high-flow)Priapism?

Answer 34

fistula between cavernosal artery and corporal tissue often associated with trauma to the perineum

Question 35

Which type of Priapism is more common?

Answer 35

Ischemic

Question 36

How to differentiate ischemic vs non-ischemic priapism?

Answer 36

Blood sample from corpora cavernosum for blood gas analysis

Question 37

How do you treat Ischemic Priapism?

Answer 37

Intracavernosal Injection of a vasoconstrictor: phenylephrine and cavernosal blood aspiration

Question 38

How do you treat nonischemic priapism?

Answer 38

monitor conservatively

Question 39

What is Peyronie Disease?

Answer 39

Abnormal curvature of the penis due to repetitive trauma during sex

Question 40

What causes Peyronie Disease?

Answer 40

Fibrosis in the tunica albuginea leading to pain with erections, palpable nodules and curvature

Question 41

What is the most accurate test for Peyronie Disease?

Answer 41

US looking for abnormal blood flow

Question 42

what is the best initial theapy for Peyronia disease?

Answer 42

Pentoxifylline: within 3 months of onset

Question 43

How do you manage Peyronie disease beyond 3 months?

Answer 43

Collagenase injections

Question 44

What is a hydrocele?

Answer 44

painless, swollen fluid-filled sac along the spermatic cords within the scrotum that transilluminates with inspection

Question 45

What causes a Hydrocele?

Answer 45

Remnant of the tunica vaginalis

Question 46

How to you manage Hydrocele?

Answer 46

Watchful waiting for the first year: then surgery to decrease risk of future inguinal hernias

Question 47

What is a varicocele?

Answer 47

Varicose vein in the scrotal veins causing swelling and increased pressure of the pampiniform plexus

Question 48

What is the #1 complaint in varicocele?

Answer 48

Dull ache and heaviness in the scrotum

Question 49

What is the best initial test for a varicocele?

Answer 49

Physical exam with a bag of worm sensation to the scrotum

Question 50

What is the most accurate test for a varicocele?

Answer 50

US showing dilated vessels of the pampiniform plexus >2mm US both sides as it is usually bilateral

Question 51

How do you manage symptomatic Varicocele?

Answer 51

Surgical ligation or embolization

Question 52

What is Cryptorchidism?

Answer 52

Congenital absence of one testicle in the scrotal sac: usually found within the inguinal canal

Question 53

How do you manage Cryptorchidism after 4 months of age?

Answer 53

Orchipexy as soon as possible; definitely by age 2

Question 54

What is a testicular torsion?

Answer 54

twisting of the spermatic cord cutting off the testicles blood supply

Question 55

What is the most common symptom of testicular torsion?

Answer 55

Rapid onset severe pain and tenderness in the testicles, groin and lower abdomen

Question 56

What is seen on physical exam with a testicular torsion?

Answer 56

Asymmetrically high-riding testis with long axis transversely instead of longitudinally Absent cremasteric reflex

Question 57

What is the best initial test for Testicular Torsion?

Answer 57

Physical exam

Question 58

What is the most accurate test for testicular torsion?

Answer 58

US to confirm absence of blood flow and twisting testicle

Question 59

How do you treat a testicular torsion?

Answer 59

Manual detorsion and surgical intervention

Question 60

What is Fournier Gangrene?

Answer 60

Necrotizing Fasciitis of the perineum and scrotum from mixed aerobic/anaerobic infection

Question 61

What are common symptoms of Fournier Gangrene?

Answer 61

severe pain on the anterior abdominal wall migrates into the gluteal muscles, scrotum and penis

Question 62

What is seen on Physical exam in Fournier Gangrene?

Answer 62

Blisters/bullae, crepitus, subcutaneous gas, fever, tachycardia, hypotension

Question 63

What is the most accurate test for Fournier Gangrene?

Answer 63

CT: air along the fascial planes or deeper tissue involvment

Question 64

How do you treat Fournier Gangrene?

Answer 64

Surgical exploration, debridement and abx