Urology / GU

Question 1

epididymitis vs orchitis

Answer 1

epididymitis usually bacterial

orchitis usually viral

Question 2

MC cause epididymitis-orchitis by age

Answer 2

men <35 - chlamydia (2nd gonorrhea)
men >35 + children - enteric organisms e.coli, klebsiella
viral in children - mumps mc

Question 3

testicular torsion

Answer 3

spermatic cord twists and cuts off testicular blood supply

-65% in teenagers 10-20yo

Question 4

cryptorchidism

Answer 4

undescended testicle

• mc in premature infants (70% descend spontaneously)
• MC right side

Question 5

complications of cryptorchidism

Answer 5

TESTICULAR CANCER (both in affected and unaffected side), subfertility, torsion and hernia

Question 6

mc type of testicular cancer

Answer 6

germinal cell tumors (seminoma or nonseminomatous) - usually malignant

Question 7

testicular cancer - germinal cell (MC) tumor types

Answer 7

seminoma (mc men 30-40s):
simple (lack tumor markers)
sensitive (to radiation)
slower growing
step-wise spread

non-seminomatous (mc <10 yo): embryonal cell, teratoma, yolk sac
-increased serum a-fetoprotein, inc B-hCG and radiorestistance

Question 8

communicating hydrocele

Answer 8

peritoneal/abdominal fluid enters via patent processus vaginalis (swelling worse w/ valsalva)

Question 9

varicocele

Answer 9

varicose veins in testes
MC left side; primary usually idiopathic; secondary can occur in abdominal mass compression of renal veins (mc w/ right side) or superior mesenteric artery compression of left renal vein (nutcracker syndrome)
-sudden onset on left side in older men –> possible renal cell carcinoma
-right-sided in children <10 –> possible retroperitoneal malignancy

Question 10

spermatocele (epididymal cyst)

Answer 10

• scrotal mass that contains sperm
• painless, superior, posterior and separate from teste
• transilluminates and no tx necessary

Question 11

paraphimosis

Answer 11

foreskin trapped behind corona of glans, constricting –> urologic emergency (tx by reduction of edema w/ cool compress and push OR granulated sugar, injection of hyaluronidase OR incision on dorsal)

Question 12

phimosis

Answer 12

inability to retract foreskin over the glans (tx by circumcision)

• normal until adolescence (13-22 yo)
• pathologic can be caused by DM - chronic glycosuria can lead to infx

Question 13

prostatitis

Answer 13

prostate gland inflammation 2ndary to ascending infection

Question 14

acute prostatitis differential by age

Answer 14

> 35 yo - e.coli MC, pseudomonas, klebsiella, proteus
<35 yo - chlamydia + gonorrhea (other e.coli, treponema, trichomonas, Gardnerella)
-viral may be seen in children (mumps mc)

Question 15

chronic prostatitis causes

Answer 15

e.coli 75-80%, enterococci

trich, HIV, stx or fx abnormality, recurrent UTIs

Question 16

risk factors for prostate cancer

Answer 16

genetics, high fat intake, obesity, AA
adenocarcinoma (95%)
-hormonally dependent on inc dihydrotestosterone production

Question 17

prostate cancer clinical sx

Answer 17

asymptomatic until invasion of bladder
urethral obstruction (freq, urg, retention, dec stream)
back pain/ bone pain (inc incidence mets to bone)

Question 18

when to do DRE + PSA

Answer 18

@ 50 yo

AA or family history @ 40

Question 19

bladder cancer MC type

Answer 19

transitional cell (TCC)
-other, squamous, adeno, sarcoma, small cell

Question 20

bladder cancer RF

Answer 20

smoking MC
exposure to dyes, rubber, leather, age >40, cauc M 3x mc
*highest rate of recurrence of all cancers

Question 21

renal cell carcinoma

Answer 21

• tumor of proximal convoluted tubule (v metabolically active so most prone to dysplasia)
• RF: smoking, dialysis, HTN, obesity, men

Question 22

erection physiology

Answer 22

parasympathetic –> artery dilation and muscle relaxation

flaccid state via sympathetic –> norepi –> arterial vasoconstric and venous dilation (reduce inflow and increase outflow)

Question 23

pathophysiology of ED

Answer 23

• abrupt usually psychological, gradual worsening more likely systemic causes
• neurologic (DM), psychogenic, vascular (atherosclerosis), prolactinoma, trauma, sx
• meds: BB, HCTZ, CCB, SSRIs, TCAs

Question 24

priapism

Answer 24

prologned erections w/out sex stimulation

• ischemic MC - decreased venous outflow may lead to compartment syndrome
• nonischemic - due to increased arterial inflow (related to trauma)

Question 25

differential for hematuria

Answer 25

<40 mc GU infx, nephrolithiasis >40 mc urinary tract cancer, prostatic dz upper GU: nephrolithiasis, kidney dz, renal cell CA, trauma, DM, sickle cell lower GU: BPH, urothelial cell cancer pseudo hematuria: rhabdo, beets, rhubarb, myoglobinuria, hemoglobinuria meds: ibuprofen, phenazopyridine, rifampin

Question 26

urethritis

Answer 26

gonoccocal urethritis - acute onset of sx (3-4 days), opaque, yellow, white or clear discharge, pruritus non-gonococcal - clamydia MC, 5-8 days --> purulent or mucopurulent discharge, pruritus. - hematuria, pain with intercourse - other types: ureaplasma urealyticum, trichamonas

Question 27

enuresis

Answer 27

primary monosymptomatic bedwetting - in children >5 in the absence of sx of infx

Question 28

bladder control (parasympathetic/sympathetic)

Answer 28

sympathetic tone closes bladder neck and increased pelvic floor tone parasympathetic tone increases in micturation, allowing relaxation

Question 29

functional incontinence

Answer 29

problem that keeps the patient from quickly getting up to the bathroom

Question 30

mixed incontinence

Answer 30

combo of stress + urge in 40-60%

Question 31

stress incontinence

Answer 31

urnie leakage due to increased intraabdominal pressure - laxity of pelvic floor muscles (childbirth, sx, postmenopause or post-prostatectomy) - sneeze, cough, laugh

Question 32

urge incontinence

Answer 32

leakage accompanied by or preceded by urge - detrusor muscle overactivity "overactive bladder" - detrusor stim by muscarinic acetylcholine receptors

Question 33

overflow incontinence

Answer 33

urinary retention (incomplete emptying) - decreased detrusor muscle "underactive bladder" atony - bladder outlet obstruction in BPH

Question 34

gleason score

Answer 34

for prostate cancer --> 1-10 (1 well-differentiated, not as bad; 10 is not well-formed and worse prognosis) staged into 1-5 (after score)

Question 35

MC STDs

Answer 35

HPV, chlamydia, gonorrhea (in order)

Question 36

MC UTI in infants

Answer 36

group B strep | >1yo - e.coli

Question 37

Struvite stone

Answer 37

staghorn calculi, urease producing bacteria

Question 38

stone size for passage

Answer 38

<5 mm likely to pass on own

Question 39

bladder calculi

Answer 39

elderly men | -associated w/ urinary stasis --> mc cause is infection of residual bladder urine w/ urea-splitting organisms

Question 40

name 5 urea-splitting bacteria (contribute to stones)

Answer 40

``` proteus pseudomonas klebsiella staphylococcus mycoplasma ```