Urology 2

Question 1

Presentation of obstructive uropathy?

Answer 1

upper:
loin to groin pain
oliguria
vomiting
impaired renal function

lower:
urine retention
difficulty passing urine
impaired renal function

Question 2

Causes of obstructive uropathy?

Answer 2

upper:
stones
tumour
strictures
retroperitoneal fibrosis
bladder cancer
ureterocoele

lower:
BPH
prostate cancer
bladder cancer
urethral strictures
neurogenic bladder

Question 3

Causes of neurogenic bladder?

Answer 3

MS
DM
stroke
Parkinson’s
spinal cord injury
spina bifida

Question 4

Mx of obstructive uropathy?

Answer 4

bypassing the obstruction

nephrostomy in upper
urethral or suprapubic catheter in lower

Question 5

Complications of obstructive uropathy?

Answer 5

pain
AKI
CKD
infection
hydronephrosis
urinary retention
overflow incontinence

Question 6

Indications for urinary catheter?

Answer 6

urinary retention
neurogenic bladder
surgery
output monitoring
bladder irrigation
delivery of meds

Question 7

Prostate exam results?

Answer 7

BPH -> smooth, symmetrical and slightly soft, with maintained central sulcus

prostate cancer -> firm/hard, asymmetrical, irregular, craggy and loss of central sulcus

Question 8

Mx of BPH?

Answer 8

medical:
alpha blockers (tamsulosin- immediate relief of symptoms)
5-alpha-reductase inhibitors (finasteride- decrease size of prostate over 6 months)

surgical:
TURP

Question 9

Complications of TURP?

Answer 9

urinary incontinence
erectile dysfunction
retrograde ejaculation
urethral strictures
failure to resolve symptoms
TURP syndrome

Question 10

RFs for prostate cancer?

Answer 10

age
FHx
Black
tall stature
anabolic steroids

Question 11

Presentation of prostate cancer?

Answer 11

asymptomatic
LUTS
haematuria
erectile dysfunction
mets

Question 12

Causes of raised PSA?

Answer 12

prostate cancer
BPH
prostatitis
UTI
vigorous exercise (cycling)
recent ejaculation
prostate biopsy
DRE

Question 13

Investigations for prostate cancer?

Answer 13

multiparametric MRI
TRUS biopsy
trans-perineal biopsy
isotope bone scan

Question 14

Gleason scoring of prostate cancer?

Answer 14

grading based on histology
out of 10

the grade of the most prevalent pattern in the biopsy + the grade of the second most prevalent pattern in the biopsy

6 low risk
7 intermediate
8-10 high risk

Question 15

Grading of prostate cancer?

Answer 15

Gleason score
TNM

Question 16

Mx of prostate cancer?

Answer 16

watch and wait
TURP
external beam radiotherapy/brachytherapy
radical prostatectomy
hormone therapy (GnRH agonists, androgen receptor antagonists)

Question 17

Most common organisms causing epididymo-orchitis?

Answer 17

E coli
Neisseria gonorrhoea
Chlamydia
mumps

Question 18

Diagnosing epididymo-orchitis?

Answer 18

differentiate if caused by STI or enteric organism

urine C&S
NAAT
charcoal swab
saliva swab
serum antibodies for mumps
US

Question 19

Mx for epididymo-orchitis?

Answer 19

Enteric:
ofloxacin
levofloxacin
co-amoxiclav

STI:
IM ceftriaxone (gonorrhoea)
doxycycline (chlamydia)

Question 20

Complications of epididymo-orchitis?

Answer 20

chronic pain
chronic epididymitis
testicular atrophy
subfertility
scrotal abscess

Question 21

Presentation of testicular torsion?

Answer 21

firm swollen testes
retracted testes
absent cremasteric reflex
abnormal testicular lie
rotation

Question 22

Mx of testicular torsion?

Answer 22

surgical emergency

surgical exploration
bilateral orchidopexy

Question 23

DDx for scrotal/testicular lump?

Answer 23

hydrocele
varicocele
epididymal cyst
testicular cancer
epididymo-orchitis
inguinal hernia
testicular torsion

Question 24

Presentation of hydrocele?

Answer 24

testicle palpable within hydrocele
soft, fluctuant, may be large
irreducible
no bowel sounds
transilluminated
can ‘get above’ it

Question 25

Presentation of varicocele?

Answer 25

throbbing/dull pain dragging sensation subfertility 'bag of worms' more prominent on standing

Question 26

Left varicocele may indicate?

Answer 26

RCC

Question 27

Presentation of epididymal cyst?

Answer 27

soft, round lump typically at top of testicle separate from the testicle may be able to transilluminate

Question 28

RFs for testicular cancer?

Answer 28

undescended testes infertility FHx incr. height

Question 29

Investigations for testicular cancer?

Answer 29

scrotal US AFP (teratomas) LDH (both) bhCG (both)

Question 30

Mx of testicular cancer?

Answer 30

surgery chemorads sperm banking

Question 31

RFs for bladder cancer?

Answer 31

smoking incr. age aromatic amines schistosomiasis (SCC)

Question 32

Types of bladder cancer?

Answer 32

transitional cell carcinoma (90%) SCC (5%)

Question 33

Presentation of bladder cancer?

Answer 33

painless haematuria (bladder cancer until proven otherwise)

Question 34

Investigations for bladder cancer?

Answer 34

cystoscopy + biopsy

Question 35

Staging of bladder cancer?

Answer 35

TNM non-muscle infiltrative muscle infiltrative (T2-T4)

Question 36

Mx of bladder cancer?

Answer 36

MDT TURBT intravesical chemotherapy post-surgery intravesical BCG radical cystectomy urostomy with ileal conduit chemorads

Question 37

Complications of renal stones?

Answer 37

obstruction leading to AKI infection leading to sepsis

Question 38

Investigations for renal stones?

Answer 38

urine dipstick bloods calcium non-contrast CT KUB US in pregnant women

Question 39

Mx of renal stones?

Answer 39

IM diclofenac antiemetics antibiotics tamsulosin can help <5mm -> watchful waiting <2cm -> lithotripsy pregnant women ->ureteroscopy complex -> percutaneous nephrolithotomy upper obstruction -> nephrostomy

Question 40

Prevention of renal stones?

Answer 40

2.5-3 litres a day normal calcium intake lemon juice thiazides potassium citrate

Question 41

Types of RCC?

Answer 41

adenocarcinomas: clear cell papillary chromophobe

Question 42

RFs for RCC?

Answer 42

smoking obesity HTN von-Hippel-Lindau disease end-stage renal failure tuberous sclerosis

Question 43

Presentation of RCC?

Answer 43

asymptomatic flank pain, abdo mass, haematuria paraneoplastic syndromes mets

Question 44

Paraneoplastic syndromes associated with RCC?

Answer 44

polycythaemia hypercalcaemia HTN Stauffer's syndrome Cushing's

Question 45

Staging of RCC?

Answer 45

TNM Stage 1 - <7cm Stage 2 - >7cm Stage 3 - not beyond Gerota's fascia Stage 4 - beyond Gerota's fascia

Question 46

Mx of RCC?

Answer 46

partial or radical nephrectomy arterial embolisation percutaneous cryotherapy radiofrequency ablation

Question 47

Benefits of renal transplant?

Answer 47

add 10 years to life compared to dialysis

Question 48

Scar associated with renal transplant?

Answer 48

hockey-stick scar

Question 49

Complications of renal transplant?

Answer 49

rejection, failure, electrolyte imbalances infections, SCC, NHL PCP, CMV, TB