Urology

Question 1

What are storage urinary symptoms

Answer 1

FUND

Frequency
Urgency
Nocturia
Dysuria

Question 2

What are voiding/obstructive urinary symptoms

Answer 2

HIPS

Hesitancy
Incomplete emptying
Poor stream
Straining
Others: terminal dribbling, overflow incontinence

Question 3

Mx of BPH (medical 2 and surgical 2)

Answer 3

Medical
a-blockers to relax smooth muscle of internal urinary sphincter (e.g. tamsulosin)
5a-reductase inhibitors to prevent conversion of testosterone to dihydrotestosterone (more potent androgen) (e.g. finasteride)

Surgical
Transurethral resection of the prostate (TURP)
Open prostatectomy

Question 4

1st line Ix for suspected prostate cancer

Answer 4

MRI – FIRST LINE

Question 5

Ix for prostate cancer (4)

Answer 5

PSA – low specificity
MRI – FIRST LINE
Transrectal Ultrasound-guided Biopsy
LFTs/bone profile – check for metastatic effects

Question 6

What are most bladder cancers

Answer 6

Transitional cell carcinomas

Question 7

RF for bladder cancer (5)

Answer 7

Dye stuffs 
Pelvic irradiation
Smoking 
Chronic UTIs 
Schistosomiasis

Question 8

Symptoms of bladder cancer

Answer 8

Painless macroscopic haematuria
FUND (not HIPS)
FLAWS

Question 9

Ix for bladder cancer (2)

Answer 9

Cystoscopy with biopsy

CT/MRI for staging

Question 10

What is RF of stress related urinary incontinence

Answer 10

Childbirth

Question 11

What is stress related urinary incontinence down to

Answer 11

Poor closure of the bladder

Question 12

What is urge related urinary incontinence down to

Answer 12

Detrusor overactivity

Question 13

What are rare causes of urinary incontinence (2)

Answer 13

Normal pressure hydrocephalus

Cord compression

Question 14

What is functional incontinence

Answer 14

individual is aware of the need to urinate, but are unable to get to the bathroom in time due to physical/mental reasons

Question 15

What is overflow incontinence

Answer 15

involuntary release of urine from an overfull bladder, in the absence of any need to urinate

Question 16

What should you always consider as a DDx of nephrolithiasis

Answer 16

leaking AAA

Question 17

4 types of urinary stone

Answer 17

CALCIUM OXALATE – most common
Magnesium ammonium phosphate
Urate
Cysteine

Question 18

What is the most common type of kidney stone

Answer 18

CALCIUM OXALATE – most common

Question 19

RF of nephrolithiasis (2)

Answer 19

Low fluid intake

Structural urinary tract abnormalities

Question 20

Gold standard Ix for urinary tract calculi

Answer 20

Non-contrast CT-KUB

Question 21

Ix for urinary tract calculi (4)

Answer 21

Urine dipstick (microscopic haematuria)
Non-contrast CT-KUB – GOLD STANDARD
Ultrasound
U&Es – check renal function

Question 22

Mx of nephrolithiasis

Answer 22

ANALGESIA
< 5 mm diameter – allow to pass spontaneously
> 5 mm diameter – SURGERY
Ureteroscopic lithotripsy
Extracorporeal Shockwave Lithotripsy (ESWL)
Percutaneous Nephrolithotomy (PCNL)

Question 23

What is percutaneous nephrolithotomy and under what circumstances is it performed

Answer 23

Percutaneous Nephrolithotomy (PCNL) – performed for large, complex stones (e.g staghorm calculus). After making a nephrostomy tract, a nephroscope is inserted which allows the disintegration and removal of stones.

Question 24

Presentation of testicular torsion (3)

Answer 24

Sudden-onset severe hemiscrotal pain
Nausea and vomiting
Swollen and erythematous scrotum

Question 25

What is the first step in Mx of suspected testicular torsion

Answer 25

Exploratory surgery

Question 26

Epidemiology of hydrocoele

Answer 26

Very young boys (< 1 yr) | Older men

Question 27

Causes of hydrocoele (4)

Answer 27

Idiopathic Infection Trauma Tumour

Question 28

Can the swelling be seperated from testicle in a hydrocoele

Answer 28

No

Question 29

Ix for hydrocoele (3)

Answer 29

Ultrasound - exclude tumour Testicular tumour markers Urine dipstick/MSU – check for infection

Question 30

Varicocele is caused by which dilated veins

Answer 30

dilated veins of the pampiniform plexus forming a scrotal mass

Question 31

Why are varicoceles more common on the lef (3)t

Answer 31

Reasons for being more common on the left: Angle at which the left testicular vein meets the left renal vein Lack of effective valves between the left testicular vein and the left renal vein Increased reflux from compression of the left renal vein

Question 32

Causes of epididimitis/orchitis under 35

Answer 32

<35 yrs: Chlamydia and Gonococcus

Question 33

Causes of epididimitis/orchitis over 35

Answer 33

> 35 yrs: Coliforms (e.g. Enterobacter, Klebsiella)

Question 34

How to differentiate epididimitis/orchitis from torsion

Answer 34

NOTE: less acute onset than torsion

Question 35

Where do testicular tumours metastasise

Answer 35

Para-aortic nodes

Question 36

Which tumour marker is never raised in seminomatous testicular cancer

Answer 36

AFP

Question 37

Which type of testicular tumours and what % is AFP raised in

Answer 37

• AFP is a marker for 50-70% of nonseminomatous tumours

Question 38

Which type of testicular tumours and what % is BHCG raised in

Answer 38

• ΒHCG is raised in 40% of nonseminomatous tumours | and 10% of seminomatous tumours

Question 39

What is lactate dehydrogenase a marker of

Answer 39

Testicular tumour burden

Question 40

Which tumour markers are involved in testicular cancer (3)

Answer 40

a-fetoprotein b-hCG Lactate Dehydrogenase

Question 41

What is a scrotal mass separate from the testes that transilluminates likely to be

Answer 41

Epididymal cyst

Question 42

What is a scrotal mass not separate from the testes that transilluminates likely to be

Answer 42

Hydrocoele