Urology

Question 1

What type of cancer is prostate cancer?

Answer 1

Adenocarcinoma

Question 2

What are some risk factors for prostate cancer?

Answer 2

Age
Family history
Afro-Caribbean descent

Question 3

What is the tumour level for prostate cancer?

Answer 3

PSA

Levels depend on age

Question 4

How would an abnormal prostate feel on DRE?

Answer 4

Enlarged, hard, irregular

Question 5

What are some symptoms of local prostate cancer?

Answer 5

Urinary symptoms e.g. hesitant starting, increased frequency, urgency, UTI, incomplete emptying

Question 6

How could symptoms of locally invasive prostate cancer present?

Answer 6

Haematuria
Dysuria
Ureteric obstruction (causing loin pain/ anuria/ signs of AKI/ CKD)
Tenesmus
Suprapubic pain

Question 7

Other than prostate cancer, what else can PSA be raised in?

Answer 7

BPH
Exercise
UTI
Ejaculation 
Instrumentation of urinary tract eg catheter

Question 8

What scoring system is used to grade prostate cancer?

Answer 8

Gleason scoring (6 to 10 cancer, 10 being worst differentiated)

Question 9

A painless lump is felt in a 28 year old males testicle, what is the most likely to be?

Answer 9

Testicular cancer

Question 10

Which prostatic zones enlarge in prostate Ca and in BPH?

Answer 10

In prostate Ca the peripheral zone is affected

In BPH the inner transitional zone enlarges

Question 11

What is tamsulosin and when may it be indicated?

Answer 11

It is an alpha blocker
So causes smooth muscle relaxation in the bladder neck and the prostate
Can be used in urinary retention, BPH, to help with passage of renal stones

Question 12

What drugs are first line in BPH?

Answer 12

Alpha blocker e.g. tamsulosin

Question 13

If there is a scrotal mass, and on palpating you cannot get above it, what diagnosis does this suggest?

Answer 13

Inguinalscrotal hernia

Question 14

What is epididymo-orchitis?

Answer 14

Acute inflammation of the epididymis often caused by a bacterial infection
(Chlamydia/ gonorrhoea if <35)

Question 15

What are epididymal cysts?

Answer 15

Cyst containing clear or milky fluid that lies above and behind the testis, can be removed in symptomatic

Question 16

What is a varicocele?

Answer 16

Dilated veins of the pampiniform venous plexus that feels like a bag of worms
Associated with infertility

Question 17

Which side are varicoceles more common in?

Answer 17

Left

Question 18

Severe and sudden onset of pain in one testis indicates what?

Answer 18

Testicular torsion

Question 19

When in testicular torsion most common?

Answer 19

Ages 10 to 30

Question 20

What is a hydrocele?

Answer 20

Accumulation of fluid within the tunica vaginalis
Presents as a mass that transluminates
Soft, non tender swelling that is anterior to and below the testis
May occur in children due to patent processus vaginalis

Question 21

What are some causes of haematuria?

Answer 21

Infection
Trauma
Tumours
Stones
Nephropathies

Question 22

What are the 3 most common locations where renal stones are deposited?

Answer 22

PUJ
Pelvic brim
Vesicoureteric junction

Question 23

What are most renal stones formed from?

Answer 23

Calcium oxalate

Question 24

What type of renal stones form staghorn calculus?

Answer 24

Struvite (triple phosphate) stone that form in alkaline urine

Question 25

Which renal stones are radiolucent?

Answer 25

Urate stones

Question 26

What is Renal colic?

Answer 26

Excruciating ureteric spasms eliciting pain from loin to groin Associated with nausea and vomiting Often cannot lie still

Question 27

What investigations would you want for a px with ?renal stones?

Answer 27

``` FBC U&Es (may have raised calcium/ phosphate/ bicarbonate/ urate) Urine dip (usually +ve for blood) MSU (culture) USS non-contrast CT KUB to confirm diagnosis ```

Question 28

How would you initially managed a px with renal colic?

Answer 28

- NSAID diclofenac IM - Hydration! (IV fluids if not P.O.) - Antiemetics - Alpha blocker e.g. tamsulosin to aid stone passage - Abx e.g. gentamycin if infection - Then can try ECSWL/ ureteroscopy/ nephrolithotomy etc

Question 29

What is ECSWL?

Answer 29

Extracorpeal shockwave lithotripsy Use if stone <1cm Uses laser to break up the stones

Question 30

What is percutaneous nephrolithotripsy and when would it be indicated?

Answer 30

Keyhole surgery to gain access to Renal collecting system | Used to remove large/ multiple/ complex stones e.g. staghorn calculus

Question 31

When will urgent surgery be indicated for a px with renal stones?

Answer 31

If infection + obstruction present Can lead to urosepsis Urgent percutanoues nephrolithotripsy or stent, and IV Abx

Question 32

Why may a thiazide be used for patients with calcium renal stones?

Answer 32

To reduce calcium excretion and prevent further stones

Question 33

What advice would you give to prevent further renal stones?

Answer 33

- drink plenty of fluids | - avoid foods high in oxalate e.g. coffee, beetroot, spinach, chocolate

Question 34

When would antimuscarinics be contraindicated?

Answer 34

Glaucoma (Can cause dry eyes) | Myasthenia gravis

Question 35

How would stress incontinence be managed?

Answer 35

1st line: pelvis floor exercises (8 contractions 3xday for 3/12), also conservative management eg reduce caffeine, modify fluid intake Surgery: vaginal tape or urethral fascial sling or intramural bulkin injections If surgery CI, try Duloxetine

Question 36

How would urge urinary incontinence be managed?

Answer 36

1st line bladder training programme 2nd line: antimuscarinics e.g. oxybutynin Can also try intravesical Botox, Beta 3 agonist, tropical Oestrogens if lost menopausal

Question 37

What is oxybutynin?

Answer 37

Antimuscarinic often used in urge incontinence

Question 38

What is a likely diagnosis for a px presenting with haematuria, loin pains and an abdominal mass?

Answer 38

Renal cell carcinoma

Question 39

Which cancer can a left varicocele be a symptom for and why?

Answer 39

Renal cell carcinoma | If it invades the left Renal vein it can compress the left testicular vein

Question 40

Why does RCC cause hypertension?

Answer 40

Due to increased renin secretion

Question 41

Why can RCC present with polycythaemia?

Answer 41

Increased EPO production

Question 42

What is polycythaemia?

Answer 42

Elevated haematocrit (volume % of RBCs in the blood)

Question 43

Which cancer often presents with lots of paraneoplastic syndromes?

Answer 43

RCC

Question 44

Why can RCC present with hypercalcaemia?

Answer 44

More activated vitamin D

Question 45

Why are renal cell carcinomas not managed with radio and chemo therapy?

Answer 45

Radio and chemo resistant | So tyrosine kinase inhibitor biological therapies are given to inhibit angiogenesis

Question 46

How is renal cell carcinoma managed?

Answer 46

T1 can have partial nephrectomy | T2-4 radial nephrectomy

Question 47

What is Wilms tumour?

Answer 47

Childhood nephroblastoma | Presents with abdominal mass and haematuria

Question 48

What type of cancers are most bladder cancers?

Answer 48

Transitional cell carcinomas

Question 49

What are some risk factors for bladder Ca?

Answer 49

Male Smoking Aromatic amine exposure (rubber industry) Schistosomiasis (risk of SCC not TCC)

Question 50

How does bladder cancer present?

Answer 50

Painless haematuria Recurrent UTIs Voiding irritation

Question 51

How is bladder cancer diagnosed?

Answer 51

Flexible cystoscopy with biopsy | CT urogram

Question 52

How is bladder Ca managed?

Answer 52

``` Transurethral resection of bladder tumour BCG regimen (stimulates immune response) ``` If superficial eg Ta/T1 can have intravesical mitomycin For T2-3 radical cystectomy, with chemo T4 usually palliative chemo and radiotherapy

Question 53

What ethnic group is prostate Ca more common in?

Answer 53

Afro Caribbean